Test 1 Flashcards
FSH in males
- acts on seminiferous tubules to produce sperm
- acts on seminiferous tubules to release inhibin B
inhibin B
acts on anterior pituitary to inhibit production of FSH
LH in males
- acts on Leydig cells to produce testosterone
- testosterone has negative feedback on anterior pituitary to inhibit LH
hypogonadotropic hypogonadism pathophysiology
- secondary
- pituitary does not secrete enough LH and FSH
hypogonadotropic hypogonadism causes
- hyperprolactinemia (increased dopamine inhibits GnRH)
- Kallmann’s syndrome
- opiates
- diabetes
- GnRH agonist therapy (prostate cancer)
hypogonadotropic hypogonadism labs
- low or normal LH
- low FSH
- low testosterone
Kallmann’s Syndrome characteristics
- X linked recessive trait
- most common congenital gonadotropin deficiency
- micropenis and cryptorchidism
- cleft lip
- hearing loss
- abnormal tooth
- can’t distinguish odors
hypergonadotropic hypogonadism
- primary gonadal dysfunction
- failure in testosterone = increased LH
- sertoli cell dysfunction = increased FSH
hypergonadotropic hypogonadism labs
- low testosterone
- increased LH
- increased FSH
- usually low sperm count
Klinefelter’s Syndrome
- hypergonadotropic hypogonadism
- XXY (diagnose with chromosome analysis)
- infertile or reduced fertility
Klinefelter’s Syndrome physical characteristics
- breast development
- small testicular size
- female pubic hair pattern
- tall, thin, long arms
- azoospermia
cryptorchidism
- one or both testes fail to descend from abdomen
- most common defect of male genitals
- most descend within first year
cryptorchidism treatment
- orchioplexy
- untreated has higher risk of testicular cancer
anorchia
- both testes absent at birth
- fail to develop within 8 weeks = female genitalia develop
- develop but lose function 8-10 weeks = ambiguous genitalia
- function loss after 14 weeks = partial male genital with no testes
HCG stimulation/challenge
- collect basal and post HCG injection testosterone
- Increase = cryptorchidism
- Absence = anorchia
HCG causes leydig cells to secrete androgens
natural decline in testosterone
- decreased libido
- fatigue
- elevated LH
- low testosterone
- low sperm
defects in androgen action physiology
- testosterone normally binds to androgen receptors
- absence of receptors cause testicular feminization
defects in androgen action labs
- elevated testosterone
- elevated LH
defects in androgen action labs
- intersex
- 5 alpha reductase enzyme deficiency
intersex physiology
- born with primary sex characteristics of one sex
- develop secondary sex characteristics different than expected
- cryptorchid
androgen insensitivity
- partial resistance to testosterone
- hypogonadism
- cryptorchidism
- gynecomastia
- serum testosterone is normal
testosterone labs
- evaluate in morning with highest level at 0800
- excess production induces premature puberty in males
- assess hypogonadism, pituitary gonadotropin, impotency, cryptorchidism, and part of infertility
FSH in females
- stimulates development of follicles in ovaries
- acts on granulosa cells
LH in females
- stimulates development of corpus luteum in ovaries
- acts on theca interna cells
- surge causes ovulation
how is number of days in menstrual cycle determined
time required for development of follicles and corpus luteum after menstruation and feedback effect of estrogen and progesterone
estrogen
- estradiol, estrone, and estriol
- made by ovary
estrogen stimulate growth and development of
- uterus, fallopian tubes, vagina, external female sex organs
- endometrial proliferation
- breast development
- skeletal growth
- fat deposition
progesterone
- produced by corpus luteum
- best test to determine if ovulation has occurred
menses steps
- pituitary secretes LH and FSH
- estrogen inhibits secretion of LH and FSH
- pituitary secretes large amount of LH (despite inhibition) immediately before ovulation
- after ovulation corpus luteum secretes estrogen and progesterone to inhibit LH and FSH
- degradation of corpus luteum causes estrogen and progesterone levels to fall, allowing LH and FSH levels to rise
primary amenorrhea
-no menses by age 16
or
-no menses by 14, absence of breast development, and less than 3% height for age range
primary amenorrhea pearls
- if normal pubertal development think structural
- if delayed pubertal development thing genetic
turner syndrome
- primary amenorrhea cause (premature ovarian failure)
- most common chromosomal abnormality, XO
- short stature with webbing of neck
turner syndrome labs
- high LH
- high FSH
turner syndrome treatment
- growth hormone
- age <12 androgen therapy
- age >12 hormone replacement with estrogen/progesterone
secondary amenorrhea
-had menses but no menses for 3-6 months
causes of secondary amenorrhea
- pregnancy most common
- menopause second most common
- premature ovarian failure
menopause
- high FSH
- no menses for 12 months
premature ovarian failure
- menopause under the age of 40
- FSH and LH are elevated
secondary amenorrhea caused by hypothalamic pituitary issues
- low frequency of GnRH pulses
- hyperprolactinemia
- Low to normal FSH
- high prolactin
PCOS pathophysiology
- rapid GnRH pulses increase LH synthesis with excessive androgen secretion
- excess androgens cause hirsutism, development of male characteristics, and amenorrhea
- infertility varies
PCOS physical presentation
- history irregular menses
- androgenic features
- central obesity
- mood disturbance
PCOS labs
- insulin resistance
- LH exaggerated surge
- testosterone >20
- dyslipidemia
- pelvic ultrasound not required for diagnosis
asherman syndrome
- caused by infection of uterine lining (endometriosis) or vigorous curettage causing scarring
- causes secondary amenorrhea with normal FSH
- estrogen and progesterone given after scar tissue removed
- high risk for spontaneous abortion
progesterone withdraw test
- administer progesterone for 10 days
- therapeutic and diagnostic
- withdraw of medication should cause bleeding
- absence of bleeding indicates lack of estrogen or uterine abnormality
nonobstructive azoospermia
- failure of testes to produce sperm due to absence of germ cells and failure of spermatogenesis
- often have elevated FSH
obstructive azoospermia
- blockage of ducts
- cystic fibrosis
- STDs
semen analysis components
- sperm count
- semen examination
- seminal cytology
semen analysis indications
- evaluate sperm quality
- infertility
- document adequate vasectomy
causes of abnormal semen analysis
- heat/cold
- light
- inadequate abstinence
low or absent fructose in semen analysis
-associated with congenital absence of the vas deferens and seminal vesicles
or
-ejaculatory duct obstruction
fern test (cervical mucus) indications
- timing of ovulation
- determine ovarian function near menopause
- determine spontaneous rupture of membranes
post coital cervical mucus indications
measure ability of sperm to penetrate mucus and maintain motility
anti-Mullerian hormone
- in males, high levels inhibit the development of the female reproductive tract
- in females, low levels until puberty when produced by ovaries
- disappears from ovary when menopause starts
anti-Mullerian hormone clinical usage
- assess ovarian reserve (predict menopause timing)
- IVF
- predict ovarian loss after chemo
- biomarker for PCOS
- can be measured at any point during cycle
fetal nuchal translucency
- screens for pregnancies that need diagnostic testing
- increased could indicate trisomy 18, 21, or cardiac anomalies
chorionic villus sampling indications
- abnormal nuchal translucency
- advanced maternal age
- history genetic disorder
chorionic villus sampling risks
- miscarriage
- leakage of amniotic fluid
amniocentesis indications
- fetal maturity in respiratory distress
- genetic abnormalities
- Rh incompatibility
- neural tube defects
- high risk patients
cell free DNA
- prenatal screening for trisomy and other genetic abnormalities
- amniocentesis or CVS are the gold standard
triple marker
- AFP, estriol, HCG
- identifies down’s, neural tube defects, placental insufficiency, oligohydramnios
- is not diagnostic and needs follow up confirmation testing
alpha-fetoprotein indications
- neural tube defect
- body wall defect
- also used as tumor marker
estriol
- predominant estrogen in pregnancy
- decreased values can indicate fetal distress
serum HCG rule of 10’s
10 units at missed period
100,000 units at 10 week peak
10,000 units at term
HCG utility
- not used to determine week of pregnancy
- used in evaluation of triple marker
HCG and ectopic pregnancy
- serial HCG every 48 hours
- HCG can both rise and fall in ectopic
- the initial 48 hour rise can mimic intrauterine pregnancy
down syndrome triple marker
- low AFP
- low estradiol
- high HCG
trisomy 18 triple marker
- low AFP
- low estradiol
- low HCG
neural tube defect triple marker
- high AFP
- estradiol and HCG not applicable
fetal fibronectin
- used to detect rupture of membranes
- help to predict preterm delivery to initiate early intervention
- 24 to 34 week gestation
- <3 cm dilated and intact membrane
fetal fibronectin predictive value
- negative highly predictive that labor will not occur next 7 to 14 days
- positive indicates delivery likely next 7-14 days
group B strep
- common cause of neonatal pneumonia
- screen at 35-37 weeks
- positive gets ABX
- if positive once then positive for all subsequent pregnancies
TORCH
Toxoplasmosis Other agents (syphilis, HIV, varicella, fifth disease) Rubella CMV HSV
disease that can cause microcephaly, mental impairment, or death
toxoplasmosis
- immunosuppressed can have CNS lesions
- congenital microcephaly, chronic retinitis, convulsions
syphilis
- sores on infected infants are contagious
- most symptoms develop later after birth
CMV
- most common congenital viral infection with majority asymptomatic
- hearing loss is most common manifestation
CMV screening
- only screened if symptomatic or exposed
- be suspicious of mono like symptoms during pregnancy
HSV patterns
- localized to skin, eyes, mouth
- localized to CNS
- disseminated involving multiple organs
stool for occult blood pearls
- fecal DNA more sensitive for cancer screening
- fecal immunochemical test (FIT) more specific for lower GI bleeding
fecal immunochemical test
- positive needs colonoscopy
- detects hemoglobin with no lifestyle changes prior to test
- high temperature and delayed time to sample can alter results
APT test
- done on newborn
- differentiate if bloody stool source is maternal or newborn
- normal is no newborn blood detected
fecal fat
- gold standard for diagnosing steatorrhea
- deficiency of pancreatic digestive enzymes or bile
- falsely high: enema, laxative, mineral oil
- falsely low: Metamucil, barium
fecal leukocytes
- evaluate diarrhea due to infection/inflammation
- 10 to 15% of stools with invasive pathogen have absence of fecal leukocytes
- normal stool has no leukocytes
stool culture
- must be ordered separately from other stool tests
- one negative is not end point with patients showing infectious disease
- normal flora can become pathogenic after alterations by ABX
- after some Tx repeat culture for test of cure
C. Diff toxin assay
- patients with diarrhea who have recently taken ABX
- immunosuppressed patient with diarrhea without history of ABX use
- symptoms occur 4-10 days after ABX
- usually hospital acquired
LP contraindication
- increased ICP
- severe degenerative joint disease
- infection near LP site
CSF critical values
neutrophils >20
glucose <20
protein >45
traumatic blood in CSF
- blood decreases with subsequent vials
- clotting may be present
- centrifuge of sample has clear supernatant
glucose in CSF
- changes in blood sugar reflected in CSF 1 hour later
- decreases with bacterial infection
- CSF glucose <60% of BG = infection or neoplasm
protein in CSF
- normally very little protein due to difficulty crossing blood brain barrier
- reliable indication of CSF pathology
serum vs CSF protein electrophoresis in regards to multiple sclerosis
-abnormal result is finding 2 or more bands in the CSF not present in the serum
lactic acid in CSF
- used to differentiate between bacterial and nonbacterial meningitis
- increased in cerebral hypoxia or ischemia
lactate dehydrogenase in CSF
-can differentiate between bacterial and viral meningitis
syphilis serology in CSF
-ordered if serum RPR is positive
glutamine in CSF
- most prominent amino acid in CSF
- detect and evaluate hepatic encephalopathy/coma
CRP in CSF
- acute phase reactant
- non elevated levels = no bacterial meningitis
cloudy CSF
-potentially contagious until proven otherwise
most common causes of bacterial meningitis in children
- H influenzae type B
- Group B strep
most common causes of bacterial meningitis in adults
- meningococci
- pneumococci
peritoneal transudate appearance
- clear
- serous
- light yellow
peritoneal exudate appearance
- cloudy
- turbid
- milky
transudates
- extravascular fluid from increased fluid pressure or decreased colloid oncotic forces
- low protein
- low specific gravity
transudate causes
- CHF
- cirrhosis
- nephrotic syndrome
exudates
- extravascular fluid due to vessel alteration during inflammation
- increased protein
- increased specific gravity
exudates causes
- infection
- malignancy
- vascular disease
- trauma
CSF tubes and tests
- chemistry/serology
- microbiology
- hematology
- additional studies/repeat cell count
light’s criteria
fluid is exudate if one or more conditions met
- serum protein exceeds 0.5
- LDH pleural:serum exceeds 0.6
- pleural LDH exceeds 2/3 upper level of normal for serum
inflammatory versus non-inflammatory synovial fluid
- non inflammatory: high viscosity, clear, <2000 WBC
- inflammatory: low viscosity, cloudy, 5000-75000 WBC
gout crystal analysis
-negatively birefringent under polarized light (yellow)
pseudo gout crystal analysis
-positively birefringent (blue)
sweat chloride
gold standard to diagnosis cystic fibrosis
