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Male female juju Flashcards

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1
Q

What is controversial in screening? what else would cause elevated PSA?

A

Prostate Specific Antigen
-Not recommended screening unless suspicion
- PSA elevated in other things like prostate CA, BPH, vigorous rectal exam/bx

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2
Q

PSA Correlation with ______. PSA allows for prediction of what?

A

correlates with: Size of prostate PSA •Prediction of the course of disease •Prediction of the stage of disease

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3
Q

Prostate Specific Antigen can also be elevated in

A

Prostate Carcinoma and Benign Prostatic Hypertrophy & any pelvic floor stimulation, exam or biopsy

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4
Q

If PSA elevated after 2-3 months what should you be concerned for

A

Cancer

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5
Q

PSA: USPTF Recommendations based on age: - 50 - 55 to 69 years - 70+

A

50: screen average risk men (age 45 with high risk) 55-69:
- class C recommendation
->only order PSA WITH clinical indication 70+:
- recommends against PSA-based screening for prostate cancer at this age

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6
Q

Testicular Cancer what is the most common tumor?

A

Germ Cell Tumors 90% (15-34 yrs old)
- Seminomas
- Non-Seminomatous Germ Cell
——— sex cord/stromal tumors (10%):
- leydig
- sertoli

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7
Q

stages of testicular cancer

A

stage 1:
- testicles stage 2:
- testicles
- lymph nodes stage 3:
- testicles
-lymph nodes
- liver
- lungs

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8
Q

What is the other 10% of testicular cancer?

A

Sex Cord / Stromal Tumors 10% •Leydig •Sertoli

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9
Q

What labs may be elevated in settings of testicular cancer?

A

•hCG, AFP, LD (LD-1)
-Tumor Markers

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10
Q

Bladder Cancer characterized by: ______. what tests to dx

A

Painless Hematuria dx:
- urine cytology for cancer cells

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11
Q

What is the most common cause of bladder cancer?

A

Smoking

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12
Q

Gonadal Dysfunction is a

A

•Partial androgen deficiency •Advanced age “andropause”
- low testosterone with normal gonadotrophin levels
- incidence increases with age: 40s = 7%, 80s = 90%

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13
Q

Incidence of gonadal dysfunction increases with

A

Age •40’s: 7%, 50’s: 30%, 60’s: 50%, 80’s: 90%

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14
Q

•Symptoms of gonadal dysfunction + tx

A

sx: •Mood Changes •Sexual dysfunction tx: Testosterone replacement
- increases Muscle mass, increase bone mass, protect against falls & reduces bone fractures

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15
Q

What does testosterone replacement increase? side effects?

A

Muscle mass, increase bone mass, protect against falls & reduces bone fractures side effects:
-pathogenesis of BPH & prostate cancer
- decrease sperm count
- dyslipidemia
- increased CAD

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16
Q

testosterone levels: If low LH then where is the problem? If high LH then where is the problem?

A

low LH: Pituitary or hypothalmic problem high LH: Secondary cause of low androgen level

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17
Q

What is testosterones influence on brain?

A

Increased sex drive, improved mood, confidence, memory function

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18
Q

What is testosterones influence on muscles?

A

Muscle growth Increased Strength Increased endurance

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19
Q

What is testosterones influence on bones?

A

Bone mass density maintenance

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20
Q

What is testosterones influence on bone marrow?

A

RBC production

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21
Q

What is testosterones influence on sex organs?

A

Sperm production Erectile function Prostate growth

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22
Q

What is testosterones influence on skin?

A

Hair + collagen growth

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23
Q

What is infertility classified as? Occurs in ___ of couples

A

•Failure to conceive after 1 year
- 15% of couples
- male infertility 50% cases

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24
Q

Semen Analysis for infertility requires abstinence for ____ days

A

2-5 days abstinence

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25
Semen analysis is observed for
•Viscosity •Completeness of liquefaction •Appearance •pH •Motility pattern: Beating flagella or Progressive motility •Viability: are they dead? •Sperm agglutination / antibodies
26
What is estrogen's influence on the brain?
Body temperature adjustment Memory function Libido Adjustment
27
What is estrogen's influence on the liver?
Cholesterol production regulation
28
What is estrogen's influence on the bones?
Bone strength Density increasing
29
What is estrogen's influence on the skin?
Anti- aging effect
30
What is estrogen's influence on the heart?
Protects from cholesterol
31
What is estrogen's influence on the Breast?
Breast growth and feeding function
32
What is estrogen's influence on the Ovaries
Maturation + Stimulation
33
What is estrogen's influence on the uterus?
Monthly prep for pregnancy or menstrual cycle
34
Cervical Cancer Screening: Pap Smear for Women aged 21-29
Screen for cervical cancer every 3 years with cytology alone. Grade A
35
Cervical Cancer Screening: Pap Smear for Women aged 30-65
Screen for cervical cancer every 3 years with cytology alone every 5 years with hrHPV testing alone or every 5 years with cotesting Grade A
36
Cervical Cancer Screening: Pap Smear for women younger than 21 years, women older than 65 years with adequate prior screening, and women who have had a hysterectomy
Do not screen for cervical cancer Grade D: not recommended
37
Urine hCG can detect _______ , _____ days post conception
Pregnancy, 14 days *most accurate: urine in the morning highest level*
38
Beta hCG measures______, can detect ________
hCG in the blood can detect pregnancy 8-11 days post conception
39
Beta hCG is used when
- used for more accurate test if a pt is undergoing surgery, etc - doubles every 1.5-2 days: can tell how far along a pt is or if they have miscarriage
40
Higher beta Hcg indicates
higher placenta area .. twins maybe
41
Maternal Serum Screening is done for
fetal abnormality •Neural Tube Defects •Trisomy 21 / Down's Syndrome •Trisomy 18
42
1st trimester of pregnancy work up includes
•AFP •hCG •PAPP : Pregnancy Associated Plasma Protein •Nuchal Ultrasound
43
•2nd trimester pregnancy work up includes
“Quad” •AFP •hCG •Estriol •Inhibin A trisomy 18: all 4 low trisomy 21: - low AFP and estriol - hCG and inhibin elevated
44
In Trisomy 18 what does the work up show?
•AFP •hCG •Estriol •Inhibin A ARE ALL LOW
45
In Trisomy 21 what does the work up show?
•AFP+ Estriol LOW •Inhibin A + hCG are elevated
46
Maternal serum screening: Fetal DNA testing is in mothers serum tells you what. does not tell you what
Gender and chromosomal abnormalities - does not tell you about neural tube defects
47
Maternal serum screening recommended for
•Mother >35 yo: geriatric pregnancy increases chance of chromosome abnormalities •US suggest •Previous pregnancy •Lab abnormal
48
Ectopic pregnancy can cause
fallopian tube rupture* - hemorrhage and maternal death - MC location: fallopian tube
49
Ectopic Pregnancy increased likelihood in
•Tubal damage (PID, Chylamdia, Gonnorhea) •Smoking •Infertility •Previous ectopic pregnancy
50
3 most common symptoms of ectopic pregnancy?
•Lower abdominal pain (fallopian tube expansion) •Vaginal bleeding •Adnexal mass (you can feel on bimanual exam) (75% no symptoms!)
51
Work Up for ectopic pregnancy
•HCG (increased) •Ultrasound - If a positive pregnancy but scan of the uterus does not show a fetus, assuming ectopic until proven otherwise** - tx: oral methotrexate or surgery
52
ectopic pregnancy: Surgical vs medical intervention
Based on size location or if theres already bleeding - if its bleeding= your going in and removing fallopian tube - medical tx: Methotrexate
53
Spontaneous Abortion (Miscarriage) occurs in
10-20% of all pregnancies < 20 weeks
54
Increased risk for miscarriage with
Maternal Age Previous miscarriage Smoking ETOH Drugs
55
50% of spontaneous abortions occur secondary to
chromosomal abnormalities
56
Spontaneous abortion (miscarriage) is considered recurrent if
3 + consecutive (1-5% are recurrent)
57
What is trophoblastic disease?
Disease process of the placenta -Can have malignancy
58
trophoblastic ds: dx and tx
dx: - No fetal heart beat - ELEVATED hCG - shortened hCG doubling tx: - Dilation & Excision - follow post surgical hCG to assure reduction
59
Signs of Preeclampsia vs eclampsia
HTN (>140/90) Proteinuria (>300 mg/L) + SEIZURES in eclampsia other signs: - coagulopathy - elevated liver enzymes - renal failure - cerebral ischemia
60
In preeclampsia/ eclampsia increased
morbidity and mortality sx control till delivery
61
What other sx can occur in preeclampsia/eclampsia?
•Coagulapathies •Elevated liver enzymes •Renal failure •Cerebral ischemia sx control till delivery ---- HTN proteinuria
62
HELLP Syndrome occurs at ____ weeks
27-36 weeks - can occur with preeclampsia
63
HELLP syndrome stands for
Hemolysis Elevated Liver enzymes Low Platelets Commonly present with bruising with low platelets -> do further workups CBC and LFTs
64
Fatty Liver in Pregnancy symptoms
Nausea & Vomiting, RUQ pain, lethargy
65
Fatty liver in pregnancy can be see in ____ weeks
36 weeks of pregnancy
66
Fatty Liver in Pregnancy: dx and labs
dx: Liver biopsy labs: - AST>ALT - Elevated bilirubin - Hypoglycemia - Hyperuricemia - Elevated PTT - Elevated PT - Decreased Fibrogen
67
Female Infertility causes
•Ovarian •Hormonal •Tubal •Cervical •Uterine •Psychosocial •Iatrogenic •Immunological
68
infertility evaluation indications
under 35: 12 months of attempting to conceive 35 -40: 6 months of attempting to conceive initiate evaluation upon presentation even under 6 months of attempting to conceive: - no period - over 40 yrs - hx of chemo/radiation, advanced stage endometriosis - male partner with hx of groin/testicular cancer, adult mumps, sexual dysfunction
69
Menopause: suspicion
over 40 with - irregular periods - negative hCG - hot flashes
70
Stages of Breast Cancer
Stage 1: just cancerous lesion Stage 2: advanced size, may cross vessel Stage 3: Local lymph node involvement Stage 4: Distal lymph node involvement
71
Breast Cancer Screening: age groups
Mammography 50-74: - screen every 2 years - grade B 40-49: - individual basis - grade C: net benefit is small to screen this early dense breasts or 75+: - dont screen positive/abnormal mammogram -> perform diagnostic mammogram +/- breast US
72
Breast cancer occurs in ______ of women, what percent of males
1/8 women 1% of males
73
Risks for breast cancer
•Increased age •Family history •Hormonal Hx •Clinical density •Obesity •ETOH
74
Breast Cancer Treatment
-Breast conserving surgery -Radiation -Mastectomy -Chemotherapy -Hormone Therapy
75
Labs for breast cancer include: tumor markers
Estrogen Receptor (70% of breast cancer): Favorable prognosis - The tumor is estrogen dependent (higher the estrogen, the higher ability to grow) Progesterone Receptor (30%) treated with selective ER modulators: - tamoxifen - ovarian ablation
76
Breast Cancer prognosis depends on
-Tumor size -Axillary node involvement -Histological type -Histological grade -Lymphatic & vascular invasion -Biomarkers: none currently elevated in all pts
77
breast cancer: Endocrine treatments
Selective ER modulators •Tamoxifen •Ovarian ablation
78
HER-2 chromosomal gene + tx
increased cell proliferation and survival chromosomal gene - 10-15% have gene amplified - More aggressive and poor outcome tx: - focused therapy w trastuzumab (cardiotoxic) - herceptin: blocks HER2 receptors
79
Focused therapy for HER-2 Cancer with
Trastuzumab - cardiotoxic
80
Is there a biomarker for breast cancer to routinely screen?
No •None currently that are elevated in all patients •Other markers can be elevated in metastatic disease •Other markers can also rise during chemotherapy
81
Hereditary Breast and Ovarian Cancer BRCA 1 & BRCA 2
autosomal dominant inheritance: hereditary mutation - BRCA1 and BRCA2 are two genes that play a critical role in the normal suppression of tumors - this gene mutation inhibits the body's ability to suppress tumor growth Less proofreading = higher likely hood of cancer - increases risk of breast and ovarian cancer - increases risk of melanoma, prostate, and pancreatic cancer
82
who do we suspect has BRCA 1 and BRCA 2 mutation
•Early Breast Cancer onset < 50 yo •Bilateral Cancer •Hx of Breast & Ovarian cancer •Autosomal dominant •Breast Cancer in male relative
83
BRCA 1 & BRCA 2 having both mutations...
If mutation present 60-80% occurrence of breast cancer
84
Lifetime ovarian cancer risk: Just BRCA 1 gene mutation.. Just BRCA 2 gene mutation..
1: 15-60% 2: 10- 27%
85
Having BRCA mutations increase risk for breast and ovarian cancer as well as
Increased Melanoma, Prostate CA, & Pancreatic CA
86
If BRCA gene present
-Intensive Screening: MRI* -Chemoprevention -Mastectomy -Prophylactic oophorectomy (remove ovary) •After childbearing •Decrease risk of Breast and Ovarian

Clinical Lab (17 decks)

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