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Clinical Lab > Male female juju > Flashcards

Male female juju Flashcards

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
Q

Semen analysis is observed for

A

•Viscosity •Completeness of liquefaction •Appearance •pH •Motility pattern: Beating flagella or Progressive motility •Viability: are they dead? •Sperm agglutination / antibodies

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26
Q

What is estrogen’s influence on the brain?

A

Body temperature adjustment Memory function Libido Adjustment

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27
Q

What is estrogen’s influence on the liver?

A

Cholesterol production regulation

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28
Q

What is estrogen’s influence on the bones?

A

Bone strength Density increasing

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29
Q

What is estrogen’s influence on the skin?

A

Anti- aging effect

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30
Q

What is estrogen’s influence on the heart?

A

Protects from cholesterol

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31
Q

What is estrogen’s influence on the Breast?

A

Breast growth and feeding function

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32
Q

What is estrogen’s influence on the Ovaries

A

Maturation + Stimulation

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33
Q

What is estrogen’s influence on the uterus?

A

Monthly prep for pregnancy or menstrual cycle

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34
Q

Cervical Cancer Screening: Pap Smear for Women aged 21-29

A

Screen for cervical cancer every 3 years with cytology alone. Grade A

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35
Q

Cervical Cancer Screening: Pap Smear for Women aged 30-65

A

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
Q

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

A

Do not screen for cervical cancer Grade D: not recommended

37
Q

Urine hCG can detect _______ , _____ days post conception

A

Pregnancy, 14 days most accurate: urine in the morning highest level

38
Q

Beta hCG measures______, can detect ________

A

hCG in the blood can detect pregnancy 8-11 days post conception

39
Q

Beta hCG is used when

A
  • 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
Q

Higher beta Hcg indicates

A

higher placenta area .. twins maybe

41
Q

Maternal Serum Screening is done for

A

fetal abnormality •Neural Tube Defects •Trisomy 21 / Down’s Syndrome •Trisomy 18

42
Q

1st trimester of pregnancy work up includes

A

•AFP •hCG •PAPP : Pregnancy Associated Plasma Protein •Nuchal Ultrasound

43
Q

•2nd trimester pregnancy work up includes

A

“Quad” •AFP •hCG •Estriol •Inhibin A trisomy 18: all 4 low trisomy 21:
- low AFP and estriol
- hCG and inhibin elevated

44
Q

In Trisomy 18 what does the work up show?

A

•AFP •hCG •Estriol •Inhibin A ARE ALL LOW

45
Q

In Trisomy 21 what does the work up show?

A

•AFP+ Estriol LOW •Inhibin A + hCG are elevated

46
Q

Maternal serum screening: Fetal DNA testing is in mothers serum tells you what. does not tell you what

A

Gender and chromosomal abnormalities
- does not tell you about neural tube defects

47
Q

Maternal serum screening recommended for

A

•Mother >35 yo: geriatric pregnancy increases chance of chromosome abnormalities •US suggest •Previous pregnancy •Lab abnormal

48
Q

Ectopic pregnancy can cause

A

fallopian tube rupture*
- hemorrhage and maternal death
- MC location: fallopian tube

49
Q

Ectopic Pregnancy increased likelihood in

A

•Tubal damage (PID, Chylamdia, Gonnorhea) •Smoking •Infertility •Previous ectopic pregnancy

50
Q

3 most common symptoms of ectopic pregnancy?

A

•Lower abdominal pain (fallopian tube expansion) •Vaginal bleeding •Adnexal mass (you can feel on bimanual exam) (75% no symptoms!)

51
Q

Work Up for ectopic pregnancy

A

•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
Q

ectopic pregnancy: Surgical vs medical intervention

A

Based on size location or if theres already bleeding
- if its bleeding= your going in and removing fallopian tube
- medical tx: Methotrexate

53
Q

Spontaneous Abortion (Miscarriage) occurs in

A

10-20% of all pregnancies < 20 weeks

54
Q

Increased risk for miscarriage with

A

Maternal Age Previous miscarriage Smoking ETOH Drugs

55
Q

50% of spontaneous abortions occur secondary to

A

chromosomal abnormalities

56
Q

Spontaneous abortion (miscarriage) is considered recurrent if

A

3 + consecutive (1-5% are recurrent)

57
Q

What is trophoblastic disease?

A

Disease process of the placenta
-Can have malignancy

58
Q

trophoblastic ds: dx and tx

A

dx:
- No fetal heart beat
- ELEVATED hCG
- shortened hCG doubling tx:
- Dilation & Excision
- follow post surgical hCG to assure reduction

59
Q

Signs of Preeclampsia vs eclampsia

A

HTN (>140/90) Proteinuria (>300 mg/L) + SEIZURES in eclampsia other signs:
- coagulopathy
- elevated liver enzymes
- renal failure
- cerebral ischemia

60
Q

In preeclampsia/ eclampsia increased

A

morbidity and mortality sx control till delivery

61
Q

What other sx can occur in preeclampsia/eclampsia?

A

•Coagulapathies •Elevated liver enzymes •Renal failure •Cerebral ischemia sx control till delivery
—- HTN proteinuria

62
Q

HELLP Syndrome occurs at ____ weeks

A

27-36 weeks
- can occur with preeclampsia

63
Q

HELLP syndrome stands for

A

Hemolysis Elevated Liver enzymes Low Platelets Commonly present with bruising with low platelets
-> do further workups CBC and LFTs

64
Q

Fatty Liver in Pregnancy symptoms

A

Nausea & Vomiting, RUQ pain, lethargy

65
Q

Fatty liver in pregnancy can be see in ____ weeks

A

36 weeks of pregnancy

66
Q

Fatty Liver in Pregnancy: dx and labs

A

dx: Liver biopsy labs:
- AST>ALT
- Elevated bilirubin
- Hypoglycemia
- Hyperuricemia
- Elevated PTT
- Elevated PT
- Decreased Fibrogen

67
Q

Female Infertility causes

A

•Ovarian •Hormonal •Tubal •Cervical •Uterine •Psychosocial •Iatrogenic •Immunological

68
Q

infertility evaluation indications

A

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
Q

Menopause: suspicion

A

over 40 with
- irregular periods
- negative hCG
- hot flashes

70
Q

Stages of Breast Cancer

A

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
Q

Breast Cancer Screening: age groups

A

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
Q

Breast cancer occurs in ______ of women, what percent of males

A

1/8 women 1% of males

73
Q

Risks for breast cancer

A

•Increased age •Family history •Hormonal Hx •Clinical density •Obesity •ETOH

74
Q

Breast Cancer Treatment

A

-Breast conserving surgery
-Radiation
-Mastectomy
-Chemotherapy
-Hormone Therapy

75
Q

Labs for breast cancer include: tumor markers

A

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
Q

Breast Cancer prognosis depends on

A

-Tumor size
-Axillary node involvement
-Histological type
-Histological grade
-Lymphatic & vascular invasion
-Biomarkers: none currently elevated in all pts

77
Q

breast cancer: Endocrine treatments

A

Selective ER modulators •Tamoxifen •Ovarian ablation

78
Q

HER-2 chromosomal gene + tx

A

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
Q

Focused therapy for HER-2 Cancer with

A

Trastuzumab
- cardiotoxic

80
Q

Is there a biomarker for breast cancer to routinely screen?

A

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
Q

Hereditary Breast and Ovarian Cancer BRCA 1 & BRCA 2

A

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
Q

who do we suspect has BRCA 1 and BRCA 2 mutation

A

•Early Breast Cancer onset < 50 yo •Bilateral Cancer •Hx of Breast & Ovarian cancer •Autosomal dominant •Breast Cancer in male relative

83
Q

BRCA 1 & BRCA 2 having both mutations…

A

If mutation present 60-80% occurrence of breast cancer

84
Q

Lifetime ovarian cancer risk: Just BRCA 1 gene mutation.. Just BRCA 2 gene mutation..

A

1: 15-60% 2: 10- 27%

85
Q

Having BRCA mutations increase risk for breast and ovarian cancer as well as

A

Increased Melanoma, Prostate CA, & Pancreatic CA

86
Q

If BRCA gene present

A

-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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