Male female Flashcards
why male labs
-cancers
-dysfunction
-infertility
-infections
prostate cancer: PSA
-prostate specific antigen- PSA
-predication of the course of ds
-prediction of stage of ds
-follow up after tx
-controversial in screening!!!
-Not recommended screening unless suspicion!
-only order if palpate nodule, urinary symptoms etc
-Correlation with size of prostate
-Elevation in Prostate Carcinoma and Benign Prostatic Hypertrophy (BPH)
-Increased after exam or biopsy
-If elevated after 2-3 months: concern for cancer
-excellent for post cancer screening and removal
PSA screening criteria
men aged 55-69 years - cat C (only ordere with clinical indication)
-1 test
-many pros and harms of testing
-based on family hx, race/ethnicity, cormorbid medical conditions, pt values ab benefits and harms of screening and tx specific outcomes
-dont screen men who do not express preference for screening
70+ men- dont screen (cat D)
-digital rectal exam elevates PSA -> send script
testicular cancer
Types:
- Germ cell tumors 90%:
- seminomas, non-seminomatous germ cell - sex cord/stromal tumors 10%- leydig, sertoli
Labs:
-hCG, AFP, LD (LD-1)
-if testes dont descend- stay in abdomen -> cancer
- enlarged testis, US confirm mass
-stage 1- in testes
-stage 2- in lymph nodes too
-stage 3- liver, lung spread
bladder cancer
-painless hematuria
-urine cytology for cancer cells
-darker urine
-trace blood in urine -> suspect this
-no pain receptors on bladder
-more growth into deeper tissue- greater stage
-smoking #1 cause: Endothelial irritation from deposits
gonadal dysfunction: what is it, incidence with age, sx
-Partial androgen deficiency
-Advanced age “andropause”
-Decreased testosterone with normal gonadrotropin levels***
-40’s: 7%, 50’s: 30%, 60’s: 50%, 80’s: 90%
Symptoms
-Mood Changes
-Sexual dysfunction
-muscle atrophy
-bone density
-poor memory
-hair loss
evaluation of low testosterone in males
Checks labs for LH levels, and serum testosterone
- If low testosterone and low LH → pituitary or hypothalamic problem (secondary hypogonadism)
- If low testosterone and high LH → secondary cause of low androgen/primary hypogonadism
- R/O cancer tx, alkylating agent or testicular radiation, trauma, mumps orchitis
-test low and LH and FSH not elevated -> secondary hypogonadism -> check T4, cortisol, prolactin, ferritin, transferrin saturation, MRI
-test, LH, FSH elevated -> primary hypogonadism -> genetic testing for klinefelter syndrome
partial androgen deficiency tx
Treatment = testosterone replacement therapy
-Replacement increases muscle mass, increase bone mass, protect against falls & reduces bone fractures
-Side Effects: pathogenesis of BPH & prostate cancer, decrease sperm count, dyslipidemia, increased CAD
infertility in males
-Failure to conceive after 1 year, 15% of couples, male infertility 50% cases (females also 50%)
-Production, blockage, morphology , motility
-tight clothes
-computer on lap
Semen Analysis
-2-5 days abstinence then collection
-Viscosity
-Completeness of liquefaction
-Appearance: curled tails?
-pH: vaginal canal and uterus needs a certain pH to combat
-Motility pattern- Beating flagella and Progressive motility
-Viability- is sperm dead?
-Sperm agglutination / antibodies: sperm cells killing themself?
estrogen effects
-cardioprotective
-breast growth
-memory function
-libido
-body temp regulation
-liver: cholesterol production regulation
-bone strength
-skin- antiaging effect
-pregnancy: monthly prep w/ menstrual cycle
cervical cancer screening: pap smear
-21-29- every 3 years with cytology alone
-30-65 years- every 3 years with cytology alone -> every 5 years with hrHPV testing alone or every 5 years with costesting
-younger than 21 and women >65 with prior screening, and women with hysterectomy -> do not screen
pregnancy test
Urine hCG- 14 days post conception -> implantation!
-first urine in the morning= most accurate with highest concentration
Beta hCG- 8-11 days post conception
-doubles every 1.5-2 days for the first 8 weeks
-order this to r/o preg in ER (more accurate test)
at 8 wks: heart beat!
maternal serum screening 1st vs 2nd trimester workup
Screen for fetal abnormalities:
-neural tube defects
-trisomy 21/down’s syndrome
-trisomy 18
1st trimester work up:
-AFP
-hCG
-PAPP: pregnancy associated plasma protein
-nucal US
2nd trimester work up “Quad”-
-AFP
- hCG
- inhibin A
-estriol
-trisomy 18: all low
-trisomy 21- AFP & estriol low, hCG & inhibin A elevated
AE: american eagle low (18)
HI: HIs are high (21)
fetal DNA
-testing maternal serum
-does not tell of neural tube defects
-gender
-tells you about chromosomal abnormalities***
recommended for:
-mother > 35 yo(higher chance of chromosome abnormalities
-US suggests abnormalities
-previous pregnancy
- abnormal labs
ectopic pregnancy
-1.3 – 2% of pregnancies
-Maternal death
-MC fallopian tubes -> rupture -> death
Risk factors/increased in:
-Tubal damage ( infections)
-Smoking
-Infertility
-Previous ectopic pregnancy
Symptoms:
-mostly asymptomatic (25% sx)
-lower abdominal pain
-vaginal bleeding
- adnexal mass (palpable)
Work up:
-hCG (abnormally high)
-US
-medical tx: oral methotrexate
-surgical intervention
- If a positive pregnancy but scan of the uterus does not show a fetus, assuming ectopic until proven otherwise**
spontaneous abortion
-miscarriage in 1 - 5 PREGNANCIES*******
-10-20% of all pregnancies < 20 weeks
-increased risk - maternal age, previous miscarriage, smoking, ETOH, drugs
-50% occur secondary to chromosomal abnormalities
- considered recurrent if 3 or more consecutive
-1-5% recurrent
-8 weeks should have heart beat
trophoblastic tissue
-Disease process of the placenta: Implantation of embryo -> produces abnormal tissue rather than fetus
-Can have malignancy
-Dx: No fetal heart beat, ELEVATED hCG, shortened hCG doubling time
-Dissection and excision: follow post surgical hCG to ensure its no longer elevated -> possible metastases to other location (ex: lungs)
TX IS SURGICAL EXCISION NOT METHOTREXATE
preeclampsia/eclampsia
-increased morbidity and mortality
-preeclampsia- HTN & proteinuria (2-8%)
-eclampsia- above plus seizures
Also occurring: HELLP syndrome
-coagulapathies (low platelets)
-elevated LFTs
-renal failure
-cerebral ischemia (HTN)
-symptom control till delivery
HELLP:
- hemolysis
- Elevated Liver enzymes
- Low Platelets
HELLP syndrome
-Hemolysis
-E&L- elevated liver enzymes
-L&P- low platelets (thrombocytopenia)
-27-36 wks
-can occur with preeclampsia
-bruising !!
fatty liver in pregnancy
-sx: Nausea & Vomiting, RUQ pain, lethargy
-@ 36 weeks
-DX Liver Biopsy
-AST>ALT, elevated bilirubin, hypoglycemia, hyperuricemia, elevated PTT, elevated PT, decreased fibrogen
female infertility causes
“HI UTOPIC infertility (no kids = utopia)”
-Hormonal
-Iatrogenic
-Uterine
-Tubal
-Ovarian
-Psychosocial
-Immunological
-Cervical
hystersalpingogram
-occlusions at isthmus of both fallopian tubes
-test for infertility blocks
breast screening criteria
-women 50-74- every other year screening
-women 40-49- high risk
->75 or older- no screening
-you can screen anyone with a hx or hx of cancer
breast cancer: incidence and risk factors
-1 in 8 women
-1% in males
-spiculated nodule on mammogram
Risk factors:
-Increased age
-Family history
-Hormonal Hx
-Clinical density -> US bc hard to see
-Obesity
-ETOH
management algorithm for pts with abnormal mammograms
abnormal screening mammogram = do a diagnostic mammogram +/- breast US
- normal/bengin result: return to annual screening
- probably benign: repeat 6 months
- high suggestion of malignancy: percutaneous bx
female infertility: indications and timing of infertility evaluations
when to initiate infertility eval:
- under 35 with no risk factors: after 12 months of attempting
- 35-40: after 6 months of attempting
initiate eval upon presentation:
- 40+ yrs
- no period (amenorrhea)/oligomenorrhea
- suspected tubal/uterine ds
- hx of chemo/radiation, endometriosis
- male parter w hx of surgery, mumps, impotence, chemo/radiation
tell pt to track cycle!!!!
menopause
suspect in females over 40 with:
- irregular periods
- negative hCG
- hot flashes
no period over 12 months + over 45 = clinical menopause
under 45 and no clear dx: workup for endocrine issues with TSH, FSH, prolactin -> normal = early menopause
breast cancer: tx
-Breast conserving surgery
-Radiation
-Mastectomy
-radical mastectomy- takes lymph nodes too and some of pec
-Chemotherapy
-Hormone Therapy
breast cancer prognosis
-Tumor size
-Axillary node involvement
-Histological type
-Histological grade- disorganization
-Lymphatic & vascular invasion
-Biomarkers
breast cancer labs: tumor markers
-not genetic -> we are testing the tumor
Estrogen Receptor:
-is tumor growing in response to estrogen
-Estrogen dependent
-70% of breast cancer (MC)
-Favorable prognosis
Progesterone Receptor
Endocrine treatments can include Selective ER modulators:
-Tamoxifen- blocks estrogen receptors
-Ovarian ablation: reduces estrogen production
labs: HER-2
-Chromosomal gene abnormality: Cell proliferation & survival gene
-10%- 15% have gene amplified
-More aggressive and poor outcome
-Focused therapy with trastuzumab (herceptin) -> Cardiotoxic (dilated)
-this drug stops cell proliferation while you do surgery/resection/chemo
- trastuzumab (herceptin): blocks HER2 receptors
breast cancer biomarkers
-none currently that are elevated in all pts
-other markers can be elevated in metastatic ds
-other markers can also rise during chemo
hereditary breast and ovarian cancer: BRCA 1 and BRCA 2
Hereditary mutation:
-60-80% occurrence of Breast & Ovarian Cancer
-Tumor suppressor genes / gene stability deleted
-BRCA gene typically suppresses cancer
-BRCA 1 lifetime ovarian cancer: 15-60%
-BRCA 2 lifetime ovarian cancer: 10-27%
-increased melanoma, prostate CA, and pancreatic CA risk
Indicators of BRCA 1 and 2 Mutation Risk:
-Early Breast Cancer onset < 50 yrs
-bilateral cancer
-concurrent Breast and Ovarian cancer
-Autosomal dominant inheritance pattern
-Breast Cancer in male relative
hereditary breast and ovarian cancer management
If BRCA 1 or 2 mutation present:
-Intensive Screening: MRI
-Chemoprevention
-Mastectomy: preventative measure
-Prophylactic oophorectomy after childbearing: Decrease risk of Breast and Ovarian cancer
