Genitourinary and Reproductive - Labs

Question 1

Imaging for nephrolithiasis?

Answer 1

Non-contrast spiral CT - all stones
X-ray - stippled calcification - uric acid stones radiolucent and not visible
Ultrasound - can see uric acid stones

Question 2

Abdominal ultrasound used for what conditions?

Answer 2

Nephrolithiasis
Pyelonephritis
Renal failure

Question 3

CT scan used for what conditions?

Answer 3

Nephrolithiasis
Pyelonephritis
Prostate cancer to assess for metastasis

Question 4

MRI used for what conditions?

Answer 4

Fibroids after ultrasound if ultrasound not conclusive

Prostate cancer to assess for metastasis

Question 5

Diagnostic procedure for endometriosis?

Answer 5

Laparoscopy

Question 6

Gold standard for bladder cancer diagnosis?

Answer 6

Cytoscopy

Question 7

Types of ultrasounds and indications?

Answer 7

Abdominal U/S -> Nephrolithiasis, pyelonephritis, renal failure (to see cysts)

Transrectal U/S -> BPH, Prostate cancer

Penile Duplex U/S -> Erectile dysfunction

Transvaginal U/S -> PCOS (12 or more follicles seen) Endometriosis (Chocolate Cysts)

Pelvic U/S -> Dysmenorrhea, PID

Question 8

Type of biopsy in BPH and Prostate Cancer?

Answer 8

Needle biopsy

Question 9

What serum marker is elevated in BPH, Acute Bacterial Prostatitis, and Prostate Cancer?

Answer 9

PSA - Prostate Specific Antigen

Question 10

What serum marker is best for PCOS?

Answer 10

Serum free testosterone - best measure of androgens

Other markers - Serum androstenedione

Question 11

Test to determine Glomerulonephritis etiology?

Answer 11

Anti-strep titer

Question 12

When is DRE indicated and contraindicated?

Answer 12

Indicated - BPH, Prostate Cancer

CI - Acute bacterial prostatitis

Question 13

What electrolytes are tested in Nephritic Syndrome? What must be ruled out?

Answer 13

Serum potassium and sodium to rule out Hyperkalemia and Hyponatremia

Question 14

What serum markers are hallmarks of Nephritic syndrome?

Answer 14

BUN and Creatinine are elevated, known as Azotemia.

Question 15

What test is run to evaluate suspected renal failure?

Answer 15

Urine Osmolarity

Question 16

When is the bimanual pelvic exam indicated?

Answer 16

Fibroids

Bladder cancer

Question 17

Which condition has a positive Murphy’s Punch Sign?

Answer 17

Pyelonephritis - one or both flanks positive for CVA angle tenderness

Question 18

What are urinalysis findings in Cystitis?

Answer 18

Elevated WBC count

Nitrites and Leukocyte esterase present (100,000 CFU/mL)

Question 19

Is urine culture required for Cystitis?

Answer 19

Urine culture is indicated in immunosuppressed or elderly patients, or patient w/ recent hx instrumentation, antibiotics or recurrent infection.

Otherwise, urine culture not required for initial treatment of symptomatic lower UTI with pyuria or bacteriuria or both - Urine Dipstick is adequate

Question 20

Workup for acute bacterial prostatitis?

Answer 20

CBC w/ differential -> Elevted WBC/leukocytes
Urinalysis -> Bacteria (+)
Urine culture and sensitivity -> E. coli
Serum PSA (elevated)

Question 21

Workup for BPH?

Answer 21

DRE
Serum PSA (elevated)
Urinalysis
Transrectal ultrasound to examine prostate size and for biopsy if needed

Question 22

Workup for erectile dysfunction?

Answer 22

Medical history -> meds, drugs, smoking, alcohol
Beck Depression Inventory
Bloodwork - HbA1C, metabolic markers
Hormone panel - Testosterone, hormones
Penile Duplex Ultrasound

Question 23

Workup for Prostate Cancer?

Answer 23

DRE - palpate for masses
PSA - elevated
Gleeson score
Transrectal ultrasound
Needle biopsy
CT and MRI to assess for metastasis

Question 24

Staging of Prostate Cancer?

Answer 24

T1 - Clinically undetectable tumor w/ normal DRE and transrectal ultrasound

T2 - Palpable mass limited to prostate

T3 - Tumor moves beyond and through prostate capsule

T4 - Tumor penetrates nearby structures beyond seminal vesicles

N1 - Tumor spread to regional lymph nodes

M0 - No metastasis
M1 - Distant metastasis

Question 25

Workup for PCOS?

Answer 25

History → menstrual pattern, obesity, hirsutism, acne → 4 questions can diagnose PCOS w/ 93.8% specificity and 77.1% sensitivity

Transvaginal Ultrasound → 12 or more small follicles seen

Serum androgens → Free testosterone best measure – 60% of pts have above normal levels - - also Androstenedione may be elevated

Question 26

Workup for Amenorrhea?

Answer 26

History of menarche, menses, pregnancy, lactation

Physical exam → Palpate thyroid, pelvic exam (obstruction or structural issue), acne/hirsutism

Pregnancy test to rule out pregnancy

Serum hormones → Estrogen, FSH, LH, Prolactin → Low FSH, Low estrogen, High prolactin

Question 27

Workup for renal failure?

Answer 27

Urinalysis → Proteinuria, possible foam appearance, volume, hematuria

Urine osmolarity test

Physical exam → Look for swelling, Blood Pressure, MSK and reflex tests, palpation of abdomen, flank, back

CBC → Monitor electrolytes
Blood test → Creatinine

Abdominal Ultrasound → Assess kidney size, look for cysts

GFR → determine kidney filtrate function