Evaluation and workup Flashcards
Secondary amenorrhea: workup
- pregnancy test
- labs: TSH, prolactin, FSH
- if needed: further workup for PCOS, Asherman’s
Anovulation: Hx and labs
Hx:
- amenorrhea (hypothalamus, ovarian issues) vs oligoamenorrhea (PCOS, pituitary issues)
- vasomotor symptoms? (primary ovarian failure)
Labs:
- TSH, prolactin, FSH, estrogen, testosterone
- Antral follicle count or Anti-Mullerian Hormone (AMH)
How to assess ovarian reserve?
Antral follicle count or Anti-Mullerian Hormone (AMH)
Male infertility: Hx, PE, labs
Hx:
- Medications, lifestyle, exposures
PE:
- Testicular size, presence of epididymis/vas deferens
- Varicoceles present?
- Hypospadias?
2x semen analysis for sperm concentration, motility, ejaculate volume
Labs: TSH, FSH, prolactin, testosterone, inhibin B
First trimester bleeding in pregnancy: Hx, PE, labs
Hx:
- Heavy bleeding with clots (ectopic), but both can present with spotting
- Risk factors for ectopic? (prior ectopic, STI’s, PID, smoking, young age)
- Both can be asymptomatic
PE:
- Vital signs stable? (unstable - ruptured ectopic)
- Cervical exam (dilation?)
Workup:
- Ultrasound to localize pregnancy (ectopic vs intrauterine)
- If undetermined, follow with serial serum beta-hCG (ectopic pregnancies have slower doubling time)
Constitutional growth delay vs familial short stature in children
Bone age
- bone age matches real age in familial short stature
- bone age younger than real age in constitutional growth delay
Growth Hormone deficency: workup
IGF-1, IGF binding protein-3 levels
GH stimulation test
Evaluating short stature in children
Bone age
Systemic factors:
- BMP, CBC, ESR
Thyroid, IGF-1
GH stimulation
Karyotype
Evaluating obesity in children: labs
24 hr urine cortisol: Cushing’s
LH/FSH: PCOS
TSH/T3/T4: Hypothyroidism
A1C: diabetes
Global developmental delay: workup
Chromosomal microarray (SNP)
Follow with whole exome sequencing if necessary
Delayed puberty: workup
Bone age
- assess constitutional growth delay
Labs: LH, FSH, testosterone, estrogen
- LH/FSH high: hypergonadotropic
- LH/FSH normal»_space; do GnRH stimulation test to determine if hypogonadotropic hypogonadism (LH/FSH would remain at prepubertal levels)
Benign prostatic hyperplasia: workup
- Digital rectal exam: assess prostate size
- PSA levels: prostate cancer
- Urinalysis: UTI, hematuria
- Neurologic exam: neurogenic bladder
- MRI: exclusion of prostate cancer
Triple test for breast cancer: components
- PE
- Mammogram (+BI-RADS, >= 4 is definite indication for biopsy)
- Biopsy (FNA) - at UCSF done before mammogram (rapid turnaround, accurate and diagnostic)
Breast mass: what are benign features? malignant features?
Benign features:
- Rubbery, mobile (suggests well-demarcated)
Malignant:
- Firm and immobile
- Fixed lymph nodes
- Nipple discharge, nipple retraction
- Orange peel skin
Ductal carcinoma in situ: appearance on mammogram
Microcalcifications
