Male/Female labs Flashcards

1
Q

hormone flow chart

A
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2
Q

why male labs

A

-cancers
-dysfunction
-infertility
-infections

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3
Q

prostate cancer

A

-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
-excellent for post cancer screening and removal

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4
Q

PSA screening criteria

A

-men aged 55-69 years - cat C
-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

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5
Q

testicular cancer

A

-types:
-1. germ cell tumors 90%- seminomas, non-seminomatous germ cell
-2. sex cord/stromal tumors 10%- leydig, sertoli

-labs:
-hCG, AFP, LD (LD-1)

-if testes dont descend- stay in abdomen -> cancer

-stage 1- in testes
-stage 2- in lymph nodes too
-stage 3- in other others too

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6
Q

bladder cancer

A

-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

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7
Q

gonadal dysfunction

A

-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 growth

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8
Q

evaluation of low testosterone in males

A

-test low and LH and FSH not elevated -> secondary hypogonadism -> check T4, cortisol, prolactin, ferritin, transferrin saturation, MRI

-test low, LH, FSH elevated -> primary hypogonadism -> genetic testing for klinefelter syndrome
-R/O cancer tx, alkylating agent or testicular radiation, trauma, mumps orchitis

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9
Q

partial androgen deficiency

A

-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
-Testosterone Levels
-If low LH then pituitary or hypothalmic problem
-If high LH then secondary cause of low androgen level

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10
Q

causes of primary hypogonadism in males

A
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11
Q

causes of hypogonadotropic (secondary) hypogonadism

A
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12
Q

infertility in males

A

-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
-Viscosity
-Completeness of liquefaction
-Appearance
-pH
-Motility pattern- Beating flagella and Progressive motility
-Viability- is sperm dead
-Sperm agglutination / antibodies

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13
Q

estrogen effects

A

-cardioprotective
-breast growth
-memory function
-libido
-body temp regulation
-liver- cholesterol production
-bone strength
-skin- antiaging effect
-pregnancy

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14
Q

cervical cancer screening: pap smear

A

-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

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15
Q

pregnancy test

A

-Urine hCG- 14 days post conception -> implantation!
-first urine in the morning

-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

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16
Q

maternal serum screening

A

-fetal abnormalities:
-neural tube defects
-trisomy 21/down’s syndrome
-trisomy 18

-1st trimester work up:
-AFP
-hCG
-PAPP- pregnancy assoc plasma protein
-nucal US

-2nd trimester work up “Quad”-
-AFP
-hCG
-estriol
-inhibin A
-trisomy 18- all low
-trisomy 21- AFP & estriol low, hCG & inhibin A elevated

17
Q

fetal DNA

A

-maternal serum
-dose not tell of neural tube defects
-gender
-chromosomal abnormalities

-recommended for:
-mother > 35 yo
-US suggest neural tube defects
-previous pregnancy
-lab abnormal

18
Q

ectopic pregnancy

A

-1.3 – 2% of pregnancies
-Maternal death
-MC fallopian tubes
-Increased:
-Tubal damage ( infections)
-Smoking
-Infertility
-Previous

-symptoms:
-mostly asymptomatic
-lower abdominal pain
-vaginal bleeding
-adnexal mass

-work up:
-hCG
-US

-medical tx with methotrexate
-surgical intervention

19
Q

spontaneous abortion

A

-miscarriage
-10-20% of all pregnancies < 20 weeks
-increased risk - maternal age, previous, smoking, ETOH, drugs
-50% occur secondary to chromosomal abnormalities
-recurrent if 3 or more consecutive
-1-5% recurrent
-8 weeks should have heart beat

20
Q

trophoblastic tissue

A

-Disease process of the placenta
-Can have malignancy
-Dx: No fetal heart beat, ELEVATED hCG, shortened hCG doubling
-D & E, follow post surgical hCG to assure reduction

21
Q

preeclampsia/eclampsia

A

-increased morbidity and mortality
-preeclampsia- HTN & proteinuria (2-8%)
-eclampsia- above plus seizures
-also occurring:
-coagulapathies
-elevated LFTs
-renal failure
-cerebral ischemia

-symptom control till delivery

22
Q

HELLP syndrome

A

-Hemolysis
-E&L- elevated liver enzymes
-L&P- low platelets (thrombocytopenia)
-27-36
-can occur with preeclampsia
-bruising !!

23
Q

fatty liver in pregnancy

A

-Nausea & Vomiting, RUQ pain, lethargy
-36 weeks
-Liver Biopsy
-AST>ALT, elevated bilirubin, hypoglycemia, hyperuricemia, elevated PTT, elevated PT, decreased fibrogen

24
Q

female infertility

A

-causes:
-Ovarian
-Hormonal
-Tubal
-Cervical
-Uterine
-Psychosocial
-Iatrogenic
-Immunological

25
Q

indications and timing of infertility eval

A
26
Q

infertility eval: hx

A
27
Q

hystersalpingogram

A

-occlusions at isthmus of both fallopian tubes
-test for infertility blocks

28
Q

eval of suspected menopause in females >40

A
29
Q

breast screening criteria

A

-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

30
Q

breast cancer

A

-1 in 8 women
-1% in males
-spiculated
-Risk:
-Increased age
-Family history
-Hormonal Hx
-Clinical density -> US bc hard to see
-Obesity
-ETOH

31
Q

management for pts with abnormal mamo

A
32
Q

breast cancer: tx

A

-Breast conserving surgery
-Radiation
-Mastectomy
-radical mastectomy- takes lymph nodes too and some of pec
-Chemotherapy
-Hormone Therapy

33
Q

breast cancer prognosis

A

-Tumor size
-Axillary node involvement
-Histological type
-Histological grade- disorganization
-Lymphatic & vascular invasion
-Biomarkers

34
Q

breast cancer labs: tumor markers

A

-not genetic -> we are testing the tumor

-Estrogen Receptor:
-is tumor thriving in estrogen environment
-Estrogen dependent
-70% of breast cancer
-Favorable prognosis

-Progesterone Receptor

-Endocrine treatments Selective ER modulators:
-Tamoxifen- blocks estrogen
-Ovarian ablation

35
Q

labs: HER-2

A

-Chromosomal gene
-Cell proliferation & survival gene
-10%- 15% have gene amplified
-More aggressive and poor outcome
-Focused therapy with trastuzumab -> Cardiotoxic (dilated)
-this drug stops proliferation while you do surgery/resection/chemo

36
Q

breast cancer biomarkers

A

-none currently that are elevated in all pts
-other markers can be elevated in metastatic ds
-other markers can also rise during chemo

37
Q

hereditary breast and ovarian cancer: BRCA 1 and BRCA 2

A

-Hereditary mutation
-Breast & Ovarian Cancer
-Tumor suppressor genes / gene stability deleted
-BRCA typically suppresses cancer

-Risk for mutation:
-Early Breast Cancer onset < 50 yo
-Bilateral Cancer
-Breast & Ovarian
-Autosomal dominant
-Breast Cancer in male relative

-BRCA 1 and BRCA 2- if mutation present 60-80% occurrence of breast cancer
-BRCA 1- lifetime ovarian cancer 15-60%
-BRCA 2- lifetime ovarian cancer 10-27%
-increased melanoma, prostate CA, and pancreatic CA

38
Q

hereditary breast and ovarian cancer management

A

-Intensive Screening
-Chemoprevention
-Mastectomy

-Prophylactic oophorectomy:
-After childbearing
-Decrease risk of Breast and Ovarian