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Urology > Diagnostic Testing > Flashcards

Diagnostic Testing Flashcards

(65 cards)

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1
Q

Hormones in Gonadal Function

A

Testosterone
FSH
LH

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2
Q

Symptoms of Testosterone Deficiency

A 
Decreased energy
Decreased libido
Decreased muscle mass
Decreased body hair
Hot flashes
Gynecomastia
Infertility
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3
Q

What is the single most important diagnostic test for male hypogonadism?

A

Testosterone

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4
Q

Test to Measure Testosterone

A

Serum total testosterone

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5
Q

What is measured with serum total testosterone

A

Free testosterone

Protein bound testosterone

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6
Q

Issues when Sex Hormone Binding Globulins (SHBG) is Increased & Less Free Testosterone

A 
Aging
Hyperthyroidism
Increased estrogen
Liver disease
HIV
Anti-seizure meds
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7
Q

Issues when Sex Hormone Binding Globulins (SHBG) is Decreased & More Free Testosterone

A 
Obesity
Insulin resistance
T2DM
Hypothyroidism
Increased GH
Exogenous androgens
Glucocorticoids
Nephrotic syndrome
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8
Q

When should one measure a testosterone level?

A

8 AM when testosterone levels are the highest

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9
Q

If testosterone is low twice, what should you measure next?

A

LH

FSH

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10
Q

What is the disorder if testosterone is low and LH & FSH is high?

A

Primary hypogonadism

Klinefelter

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11
Q

What is the disorder if testosterone is low and LH & FSH are not elevated?

A

Secondary hypogonadism
T2DM
Liver or kidney disease
Agining

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12
Q

Causes of Primary Hypogonadism

A 
Klinefelter syndrome
Cryptorchidism
Varicocele
Trauma
Testicular torsion
Medications
Autoimmune damage
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13
Q

Causes of Secondary Hypogonadism

A 
Prader Willi
Hyperprolactinemia
Glucocorticoids
Opiates
DM
Benign tumors & cysts
Trauma
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14
Q

Define PSA

A

Prostate specific antigen

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15
Q

Where is PSA secreted from?

A

Epithelial cells of the prostate

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16
Q

PSA Function

A

Liquefy semen in the seminal coagulum to allow sperm to swim freely

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17
Q

Causes of Elevated PSA

A

BPH
Prostate cancer
Prostatic inflammation or infection
Perineal trauma: bike riding, sexual activity, DRE (rare)

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18
Q

What is elevated PSA an indirect measurement of?

A

Prostate glandular size in men without cancer

Values increase with age

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19
Q

Causes of Decreased PSA

A

Obesity

Medications

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20
Q

Medications that Reduce PSA

A

5-alpha-reductase inhibitors (50% reduction)
NSAIDs
Statins
Thiazides

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21
Q

PSA & Prostate Cancer

A

Determine extent of cancer
Response to treatment
Screening method for detection??

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22
Q

What is most important for PSA values?

A

The trend of the individual

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23
Q

Parameters of PSA

A 
PSA density (serum PSA/prostate volume)
PSA velocity (change in PSA over time)
Free/Total PSA (PSAII)
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24
Q

PSA Density (PSAD)

A

Levels higher in men with BPH

Higher PSAD indicates greater likelihood of cancer

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25
How is PSAD measured?
Volume (size) of the prostate with a TRUS and divides the PSA number by the prostate volume
26
Define PSA Velocity (PSAV)
Rate of change in PSA over time
27
How is PSA velocity (PSAV) measured?
Transrectal prostate biopsy
28
Disorder with Free PSA Elevated Compared to Bound PSA
BPH
29
Disorder with High Level of Bound PSA
Likely prostate cancer
30
Semen Analysis
``` Mainstay in investigating male fertility potential Abstain from coitus 2-3 days Collect ejaculate Analyze within an hour Obtained via masturbation Provides immediate information ```
31
Macroscopic Semen Analysis
Viscosity Volume pH
32
Microscopic Semen Analysis
``` Sperm concentration/count Motility Morphology Viability Leukocyte count Search for immature germ cells ```
33
Normal Semen Analysis Values
Volume: >1 cc Concentration: >2,000,000 Initial forward motility: >50% Normal morphology: >60%
34
Define Azospermia
No measurable sperm in the semen
35
Define Oligospermia
Less than 20M sperm/mL
36
Disorders Resulting in Azospermia
Klinefelter's Hypogonadotropic-hypogonadism Ductal obstruction
37
Disorders Resulting in Oligospermia
Anatomic defects Endocrinopathies Genetic factors Exogenous (e.g. heat)
38
Disorders Resulting in Abnormal Volume of Semen
Retrograde ejaculation Infection Ejaculatory failure Medications
39
When should a provider avoid a prostatic massage?
Acute bacterial prostatitis
40
Risk of Prostatic Massage
Induction of bacteremia or sepsis
41
Gold Standard of Significant Bacteriuria
Urine culture & sensitivity
42
Urine Sensitivity
Measurement of sensitivity of bacteria to antibiotics
43
Methods of Urine Sensitivity
Agar diffusion: Kirby-Bauer discs, Etest strips | Broth dilution
44
Bladder Cancer Presentation
Painless hematuria
45
Diagnostics of Bladder Cancer
UA Some cytology Cystoscopy
46
Cytology of Bladder Cancer
Saline bladder wash | More sensitive in high grade tumors or carcinoma in situ
47
Types of Urodynamic Testing
``` Uroflowmetry Post-void residual measurement (PVR) Cystometry Electromyography Video dynamics ```
48
Define Peak Flow Urine Rates
Measures how fast urine is passed
49
Define Pressure Flow Study
Measures pressure & urine flow during voiding
50
Reason for Urodynamic Assessment
Assess how well the bladder & urethra are functioning
51
Indications for Urodynamic Assessment
``` Urinary incontinence Frequent urination Sudden, strong urges to urinate Painful urination Problems starting a urine stream Problems emptying the bladder Recurrent UTI ```
52
Measurements of Cystometry
Bladder pressure Leak point pressure Pressure flow studies
53
Uroflowmetry
Screening tool for patients with suspected bladder outlet obstruction Measures peak flow in mL/sec
54
Reason for Post- kid Residual (PVR)
Measure of amount of urine left in the bladder after urination
55
Normal PVR Values
56
Define Cystometrogram (CMG)
Graphic display of vesicle pressure | Pressure flow study can distinguish bladder outlet obstruction from impaired detrusor function
57
What does a cystometrogram assess?
Detrusor activity Sensation Capacity Compliance
58
What does a urethral pressure profile measure?
Urethral pressures at multiple levels
59
Indications for Urethral Pressure Profile
Sphincter dysfunction Urinary incontinence Detrusor sphincter dyssynergia
60
Video Urodynamics
Measurement of pressures with uroflow & EMG measurements under radiographic guidance to evaluate interplay between all these functions
61
STI Testing for Chlamydia
Nucleic acid amplification tests (NAATs)
62
Chlamydia Sample for Women
Vaginal swab
63
Chlamydia Sample for Men
Urine | Urethral swab
64
When to Test Men for Gonorrhea
Suspected urethritis
65
When to Test Females for Gonorrhea
Suspected cervicitis or urethritis

Urology (12 decks)

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