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Urology > Urology Diagnostic Testing > Flashcards

Urology Diagnostic Testing Flashcards

1
Q

Gonadal Function tests? 3

A
  1. Testosterone
  2. FSH
  3. LH
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2
Q

Symptoms of testosterone deficiency in adult males
1. Decreased what? 4

  1. Other symptoms? 3
A
  1. Decreased:
    - energy,
    - libido,
    - muscle mass,
    - body hair
    • Hot flashes,
    • gynecomastia,
    • infertility
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3
Q

Testosterone

  1. Produced by what?
  2. Stimulates what?
  3. Negative feedback loop – testosterone inhibits the production of what?
  4. Single most important diagnostic test for what?
A
  1. Produced in the testes by the Leydig cells
  2. LH stimulates production
  3. Negative feedback loop – testosterone inhibits the production of LH and FSH
  4. male hypogonadism
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4
Q
  1. What to order to evaluate testosterone?

2. Whats the normal range?

A
  1. Measure serum total testosterone

2. Normal range 300-800 ng/dL

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5
Q

What combined to make serum total testosterone?

A

free testosterone + protein bound

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6
Q
  1. Abnormal testosterone binding to the sex hormone binding globulins: may need a what?
  2. If SHBG increased then what?
  3. What would cause an increase? 6
  4. If SHBG decreased then what?
  5. What would cause this decrease?
    8
A
  1. free testosterone test
  2. less free testosterone
    • Aging,
    • hyperthyroidism,
    • increased estrogen,
    • liver disease,
    • HIV,
    • antiseizure drugs
  4. more free testosterone
    • Obesity,
    • insulin resistance,
    • T2DM,
    • hypothyroidsm,
    • increased GH,
    • exogenous androgens,
    • glucocorticoids,
    • nephrotic syndrome
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7
Q

Testosterone:

  1. Collect sample when?
  2. If normal do what?
  3. If abnormal do what?
A
  1. Collect sample at 8AM when testosterone levels are the highest
  2. If normal – stop testing
  3. If abnormal – repeat 1-2 more times to confirm
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8
Q

If testosterone is low X 2

What tests should we do?

A
  1. Check LH and FSH
  2. Testosterone low and LH and FSH high = primary hypogonadism
  3. Testosterone low and LH and FSH not elevated = secondary hypogonadism
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9
Q
  1. Testosterone low and LH and FSH high = primary hypogonadism from what?
  2. Testosterone low and LH and FSH not elevated = secondary hypogonadism from what? 4
A
  1. Klinefelter
    • T2DM,
    • liver or
    • kidney disease
    • Aging
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10
Q
  1. What does PSA stand for?
  2. Secreted from where?
  3. Present where? 2
  4. Function?
A
  1. Prostate specific antigen
  2. Secreted by the epithelial cells of the prostate
    • Present in low levels in the serum
    • Present in the semen
  4. Function is to liquefy the semen in the seminal coagulum to allow sperm to swim freely
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11
Q

Causes of an elevated PSA

A
  1. BPH
  2. Prostate cancer
  3. Prostatic inflammation or infection
  4. Perineal trauma
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12
Q

Perineal trauma causes?

3

A
  1. Rarely DRE
  2. Bike riding
  3. Sexual activity (persists for 48-72 hrs post)
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13
Q

Causes of a decreased PSA?

2

A
  1. Obesity

2. Delayed early detection may partially explain worse outcomes in obese men with early prostate cancer

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14
Q

Elevated PSA values

  1. Indirect measurement of what?
  2. Normal values increased with what?
  3. Values can vary by what?
  4. What time of day should you draw blood?
A
  1. Indirect measurement of prostate glandular size in men without cancer
  2. Normal values increase with age
  3. Values can vary by race
    Blacks have higher PSA levels than whites
  4. Dosent matter. Any day
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15
Q

Low PSA levels
Elevated BMI levels may cause lower PSA levels
AND medications. Which meds can reduce PSA levels?
4

A
  1. 5-alpha-reductase inhibitors (50% or greater reductions)
  2. NSAIDs
  3. Statins 17.4%
  4. Thiazides 26%
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16
Q

Normal values are controversial as well

  1. Normal levels?
  2. However what is the problem with this?
  3. So what is the most important thing to follow?
A
  1. In the past a value less than 4.0 ng/mL was normal
    • Men with prostate cancer were found to have values less than 4
    • Men without prostate cancer were found to have values greater than 4
  3. Important to follow the trend – how much has the PSA increased over the last year
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17
Q

Ongoing research:

  1. ___ specific reference ranges
  2. Free vs. Total PSA
    - Lower portion of free PSA may be correlated with what?
  3. PSA velocity and PSA doubling time are what? 2
  4. Pro-PSA
    More strongly associated with what?
A
  1. Age
  2. more aggressive forms of cancer
    • Rate of change in PSA values over time
    • Time it takes to double the PSA
  4. prostate cancer than BPH
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18
Q

PSA parameters:

3

A
  1. PSA Density (serum PSA/ prostate volume)
  2. PSA Velocity (change in PSA over time)
  3. Free/Total PSA (PSAII)
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19
Q 
PSA Density (PSAD)
1. PSA levels are higher in men with what?
  1. The PSA density (PSAD) is sometimes used for men with _____ to try to adjust for this.
  2. What does it measure?
    - What does it use to measure this?
    - What equation do you get to find the PSAD?
  3. A higher PSA density (PSAD) indicates greater likelihood of what?
A
  1. BPH
  2. BPH
  3. It measures the volume (size) of the prostate
    - with a transrectal ultrasound (TRUS) and
    - divides the PSA number by the prostate volume
  4. cancer
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20
Q 
PSA Velocity (PSAV)
1. PSA velocity is what?
  1. A PSA that is changing how is more suspicious for cancer?
  2. However, a PSA that is already high or quickly rises to a concerning level will quickly lead to further evaluation
    Usually with a what?
A
  1. the rate of change in PSA over time
  2. rising quickly
  3. transrectal prostate bx
21
Q

Free/Total PSA(PSAII)
1. Percentage of Free PSA decreases as ________ increases in serum of men with prostate cancer

  1. Ratio of f/t PSA, especially in men w/ normal PSA values can be helpful in diagnosing those w/ possible ___?
  2. Free and total prostate-specific antigen:
    Only useful with PSA _________ ng/dl
A
  1. Total PSA
  2. CA
  3. 4.0-10.0
22
Q

Free/Total PSA(PSAII)
1. If the free PSA is elevated in respect to the bound PSA, then the PSA is probably being produced by what?

  1. If there is a high level of bound PSA, then it is likely to be manufactured by what?
A
  1. BPH

2. prostate cancer cells

23
Q

Semen analysis

  1. Remains the mainstay for what?
  2. Abstain from what?
  3. Collect how much?
  4. Analyze within what time?
  5. Obtained by?
  6. Turn around for results?
A
  1. Remains the mainstay in investigating male fertility potential
  2. Abstain from coitus 2 to 3 days
  3. Collect all the ejaculate
  4. Analyze within 1 hour
  5. Obtained by masturbation
  6. Provides immediate information
24
Q

Semen analysis
1. Macroscopic? 3

  1. Microscopic? 6
A
  1. Macroscopic
    - Viscosity
    - Volume
    - pH
  2. Microscopic
    - Sperm concentration/count
    - Motility
    - Morphology
    - Viability (supravital stain)
    - Leukocyte count
    - Search for immature germ cells
25
Q

Normal semen analysis

  1. Volume?
  2. Concentration?
  3. Initial Forward motility?
  4. Normal morphology?
A
  1. > 1 cc
  2. > 2x10^6 cc
  3. > 50%
  4. > 60%
26
Q

Semen analysis

  1. What is azospermia?
  2. What is oligospermia?
A
  1. Azospermia
    No measurable sperm in the semen
  2. Oligospermia
    Less than 15 million sperm/ml
27
Q

Abnormal Semen Analysis
1. Azospermia causes? 3

  1. Oligospermia causes? 4
  2. Abnormal volume? 4
A
  1. Azospermia
    - Klinefelter’s (1 in 500)
    - Hypogonadotropic-hypogonadism
    - Ductal obstruction (absence of the Vas deferens)
  2. Oligospermia
    - Anatomic defects
    - Endocrinopathies
    - Genetic factors
    - Exogenous (e.g. heat)
  3. Abnormal volume
    - Retrograde ejaculation
    - Infection
    - Ejaculatory failure
    - Medications
28
Q
  1. What is the four glass test used for?
  2. Describe it?
    4
  3. What is each glass tested for?
    4
A
  1. PROSTATIC SECRETIONS
    (chronic prostatitis)
    • This 4-glass test begins by asking the patient to provide the 10 mL of urine in one glass.
  • Then, 10 mL of midstream urine is provided in the next glass.
  • Next, prostatic massage is performed, and EPS is collected in a third glass.
  • Finally, postmassage urine is collected in the fourth (final) glass.[6]
    • The initially voided urine is tested for urethral infection,
  • while the midstream urine is tested for bladder infection.
  • The EPS fluid is examined for WBCs.
  • Finally, the postmassage urine is used to flush out bacteria in the prostate that may remain within the urethra.[8]
29
Q

Prostatic massage

  1. Avoid in who?
  2. Risk for what? 2
A
  1. Avoid in acute bacterial prostatitis

2. Risk for induction of bacteremia or sepsis

30
Q

Diagnosis of UTI
1. In adults and older children a mid stream urine sample usually reliably represents what?

  1. Samples collected from what should not be used to diagnose UTI as they invariably will be contaminated? 3
  2. The most reliable sample is obtained via what? 2
    (often less traumatic than catheterization)
A
  1. the urine in the bladder (Clean catch)
    • urinary bags,
    • pedi-bags or
    • bedpans
    • catheterization or
    • suprapubic aspiration in infants
31
Q

Urine Culture and Sensitivity
1. Gold standard for?

  1. Some argue criteria for bacteriuria is only ____ cfu/mL of a uropathogen in symptomatic females or_____ in symptomatic males.
  2. Bacterial identification from urine C&S, key in males and females with what?
A
  1. Traditional gold standard for significant bacteriuria >100,000 cfu/mL of urine
  2. 100, 1000
  3. complicated UTI’s.
32
Q

Sensitivity of Urine C&S:
Measurement of sensitivity of bacteria to antibiotics
Methods?
2

A
  1. Agar diffusion
    - Kirby-bauer - discs
    - Etest - strips
  2. Broth dilution
33
Q

Sensitivity tests

  1. Solid media looking at?
  2. Liquid media looking at?
A
  1. Solid media
    disc diffusion technique
  2. Liquid media
    minimum inhibitory concentration (MIC) test
34
Q

Bladder Cancer:
1. These patients usually present with what?

  1. You will end up getting what? 2
  2. The real diagnostic test of course will be the what?
A
  1. painless hematuria
  2. UA and some cytology
  3. cystoscopy
35
Q

Diagnosis of Bladder Cancer with cytology
1. Microscopic cytology of urinary sediment or saline bladder wash to detect what?
(which is more accurate?)

  1. Microscopic cytology is more sensitive in what but can be falsely negative in 20% of cases? 2
A
  1. malignant cells. (saline bladder washes more accurate)
    • high grade tumors or
    • carcinoma in situ
36
Q

Urodynamics (the function)

2

A
  1. Peak flow urine rates

2. Pressure flow study`

37
Q

What do the following measure:

  1. Peak flow urine rates?
  2. Pressure flow study?
A
  1. Peak flow urine rates
    - Measures how fast urine is passed
  2. Pressure flow study
    - Urodynamic catheter in bladder
    - Allows measurement of pressure and urine flow during voiding
38
Q

Urodynamic Assessment

  1. Used to assess what?
  2. Specifically? 2
A
  1. Used to assess how well the bladder and urethra are functioning
    • Sphincter control
    • Bladder filling/emptying
39
Q

Indications: To assess symptoms such as?

7

A
  1. Urinary incontinence
  2. Frequent urination
  3. Sudden, strong urges to urinate
  4. Painful urination
  5. Problems starting a urine stream
  6. Problems emptying the bladder
  7. Recurrent UTI
40
Q

Urodynamic Testing

5

A
  1. Uroflowmetry
  2. Post-void residual measurement
  3. Cystometry
  4. Electromyography
  5. Video dynamics
41
Q

What does Cystometry measure?

3

A
  1. Measurement of bladder pressure
  2. Measurement of leak point pressure
  3. Pressure flow studies
42
Q

Uroflowmetry

  1. Screening tool for what?
  2. Measure what?
  3. Reserved for which pts?
A
  1. Screening tool for patients with suspected bladder outlet obstruction
  2. Measures peak flow in mL/sec
  3. Reserved for patients with severe symptoms where invasive therapy is considered—done by urologist
43
Q
  1. What is PVR?

2. What are normal values? 2

A
  1. Post-void Residual (PVR)
    2.
    -Less than 50 ml
    -If patient is > 60 years old normal is 50-100 ml
44
Q
  1. Cystometrogram (CMG) is what?
  2. How is it done? 2
  3. Assesses? 4

Rarely done—invasive—urologist referral!!!!

A
  1. Graphic display of vesical pressure
    • Bladder is filled with water at a steady rate
    • Pressure flow study compared with uroflow can distinguish bladder outlet obstruction from impaired detrusor function
    • Detrusor activity
    • Sensation
    • Capacity
    • Compliance

Rarely done—invasive—urologist referral

45
Q

Urethral Pressure Profile

  1. Measures what?
  2. Indications for testing? 3
A
  1. Measures urethral pressures at multiple levels
  2. Indications for testing
    - Sphincter dysfunction
    - Urinary incontinence
    - Detrusor sphincter dyssynergia
46
Q

Video Urodynamics

  1. AKA?
  2. Combines what kind of measurements?
  3. Invasive or non-invasive?
A
  1. AKA Multichannel Fluoroscopic Urodynamics
  2. Combines measurement of pressures with uroflow and EMG measurements under radiographic guidance to evaluate interplay between all these functions
  3. INVASIVE
47
Q

Chlamydia

  1. Dx?
  2. Which collection method used in women?
  3. IN men? 2

Some available NAATs include the ability to detect Neisseria gonorrhea from the same specimen

A
  1. Nucleic acid amplification tests (NAATs) detect small amounts of chlamydial nucleic acid
  2. Vaginal swab preferred in women (Urine ok for women too but vaginal sample more sensitive)
    • Urine or urethral swab in men
    • Rectal swabs also may be obtained
48
Q

Gonorrhea
1. Males with suspected urethritis: Dx tests? 2

  1. Females with suspected cervicitis or urethritis dx tests? 1
A
  1. Males with suspected urethritis
    - Microscopy with Gram stain of a urethral swab performs well in men with suspected urethritis
    - Noninvasive method - nucleic acid amplification testing of urine
  2. Females with suspected cervicitis or urethritis
    - vaginal swab specimen has the best overall sensitivity and specificity

Urology (12 decks)

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