Test 1 Flashcards
(110 cards)
1
Q
FSH in males
A
- acts on seminiferous tubules to produce sperm
- acts on seminiferous tubules to release inhibin B
2
Q
inhibin B
A
acts on anterior pituitary to inhibit production of FSH
3
Q
LH in males
A
- acts on Leydig cells to produce testosterone
- testosterone has negative feedback on anterior pituitary to inhibit LH
4
Q
hypogonadotropic hypogonadism pathophysiology
A
- secondary
- pituitary does not secrete enough LH and FSH
5
Q
hypogonadotropic hypogonadism causes
A
- hyperprolactinemia (increased dopamine inhibits GnRH)
- Kallmann’s syndrome
- opiates
- diabetes
- GnRH agonist therapy (prostate cancer)
6
Q
hypogonadotropic hypogonadism labs
A
- low or normal LH
- low FSH
- low testosterone
7
Q
Kallmann’s Syndrome characteristics
A
- X linked recessive trait
- most common congenital gonadotropin deficiency
- micropenis and cryptorchidism
- cleft lip
- hearing loss
- abnormal tooth
- can’t distinguish odors
8
Q
hypergonadotropic hypogonadism
A
- primary gonadal dysfunction
- failure in testosterone = increased LH
- sertoli cell dysfunction = increased FSH
9
Q
hypergonadotropic hypogonadism labs
A
- low testosterone
- increased LH
- increased FSH
- usually low sperm count
10
Q
Klinefelter’s Syndrome
A
- hypergonadotropic hypogonadism
- XXY (diagnose with chromosome analysis)
- infertile or reduced fertility
11
Q
Klinefelter’s Syndrome physical characteristics
A
- breast development
- small testicular size
- female pubic hair pattern
- tall, thin, long arms
- azoospermia
12
Q
cryptorchidism
A
- one or both testes fail to descend from abdomen
- most common defect of male genitals
- most descend within first year
13
Q
cryptorchidism treatment
A
- orchioplexy
- untreated has higher risk of testicular cancer
14
Q
anorchia
A
- both testes absent at birth
- fail to develop within 8 weeks = female genitalia develop
- develop but lose function 8-10 weeks = ambiguous genitalia
- function loss after 14 weeks = partial male genital with no testes
15
Q
HCG stimulation/challenge
A
- collect basal and post HCG injection testosterone
- Increase = cryptorchidism
- Absence = anorchia
HCG causes leydig cells to secrete androgens
16
Q
natural decline in testosterone
A
- decreased libido
- fatigue
- elevated LH
- low testosterone
- low sperm
17
Q
defects in androgen action physiology
A
- testosterone normally binds to androgen receptors
- absence of receptors cause testicular feminization
18
Q
defects in androgen action labs
A
- elevated testosterone
- elevated LH
19
Q
defects in androgen action labs
A
- intersex
- 5 alpha reductase enzyme deficiency
20
Q
intersex physiology
A
- born with primary sex characteristics of one sex
- develop secondary sex characteristics different than expected
- cryptorchid
21
Q
androgen insensitivity
A
- partial resistance to testosterone
- hypogonadism
- cryptorchidism
- gynecomastia
- serum testosterone is normal
22
Q
testosterone labs
A
- evaluate in morning with highest level at 0800
- excess production induces premature puberty in males
- assess hypogonadism, pituitary gonadotropin, impotency, cryptorchidism, and part of infertility
23
Q
FSH in females
A
- stimulates development of follicles in ovaries
- acts on granulosa cells
24
Q
LH in females
A
- stimulates development of corpus luteum in ovaries
- acts on theca interna cells
- surge causes ovulation
25
how is number of days in menstrual cycle determined
time required for development of follicles and corpus luteum after menstruation and feedback effect of estrogen and progesterone
26
estrogen
- estradiol, estrone, and estriol
| - made by ovary
27
estrogen stimulate growth and development of
- uterus, fallopian tubes, vagina, external female sex organs
- endometrial proliferation
- breast development
- skeletal growth
- fat deposition
28
progesterone
- produced by corpus luteum
| - best test to determine if ovulation has occurred
29
menses steps
1. pituitary secretes LH and FSH
2. estrogen inhibits secretion of LH and FSH
3. pituitary secretes large amount of LH (despite inhibition) immediately before ovulation
4. after ovulation corpus luteum secretes estrogen and progesterone to inhibit LH and FSH
5. degradation of corpus luteum causes estrogen and progesterone levels to fall, allowing LH and FSH levels to rise
30
primary amenorrhea
-no menses by age 16
or
-no menses by 14, absence of breast development, and less than 3% height for age range
31
primary amenorrhea pearls
- if normal pubertal development think structural
| - if delayed pubertal development thing genetic
32
turner syndrome
- primary amenorrhea cause (premature ovarian failure)
- most common chromosomal abnormality, XO
- short stature with webbing of neck
33
turner syndrome labs
- high LH
| - high FSH
34
turner syndrome treatment
- growth hormone
- age <12 androgen therapy
- age >12 hormone replacement with estrogen/progesterone
35
secondary amenorrhea
-had menses but no menses for 3-6 months
36
causes of secondary amenorrhea
- pregnancy most common
- menopause second most common
- premature ovarian failure
37
menopause
- high FSH
| - no menses for 12 months
38
premature ovarian failure
- menopause under the age of 40
| - FSH and LH are elevated
39
secondary amenorrhea caused by hypothalamic pituitary issues
- low frequency of GnRH pulses
- hyperprolactinemia
- Low to normal FSH
- high prolactin
40
PCOS pathophysiology
- rapid GnRH pulses increase LH synthesis with excessive androgen secretion
- excess androgens cause hirsutism, development of male characteristics, and amenorrhea
- infertility varies
41
PCOS physical presentation
- history irregular menses
- androgenic features
- central obesity
- mood disturbance
42
PCOS labs
- insulin resistance
- LH exaggerated surge
- testosterone >20
- dyslipidemia
- pelvic ultrasound not required for diagnosis
43
asherman syndrome
- caused by infection of uterine lining (endometriosis) or vigorous curettage causing scarring
- causes secondary amenorrhea with normal FSH
- estrogen and progesterone given after scar tissue removed
- high risk for spontaneous abortion
44
progesterone withdraw test
- administer progesterone for 10 days
- therapeutic and diagnostic
- withdraw of medication should cause bleeding
- absence of bleeding indicates lack of estrogen or uterine abnormality
45
nonobstructive azoospermia
- failure of testes to produce sperm due to absence of germ cells and failure of spermatogenesis
- often have elevated FSH
46
obstructive azoospermia
- blockage of ducts
- cystic fibrosis
- STDs
47
semen analysis components
- sperm count
- semen examination
- seminal cytology
48
semen analysis indications
- evaluate sperm quality
- infertility
- document adequate vasectomy
49
causes of abnormal semen analysis
- heat/cold
- light
- inadequate abstinence
50
low or absent fructose in semen analysis
-associated with congenital absence of the vas deferens and seminal vesicles
or
-ejaculatory duct obstruction
51
fern test (cervical mucus) indications
- timing of ovulation
- determine ovarian function near menopause
- determine spontaneous rupture of membranes
52
post coital cervical mucus indications
measure ability of sperm to penetrate mucus and maintain motility
53
anti-Mullerian hormone
- in males, high levels inhibit the development of the female reproductive tract
- in females, low levels until puberty when produced by ovaries
- disappears from ovary when menopause starts
54
anti-Mullerian hormone clinical usage
- assess ovarian reserve (predict menopause timing)
- IVF
- predict ovarian loss after chemo
- biomarker for PCOS
- can be measured at any point during cycle
55
fetal nuchal translucency
- screens for pregnancies that need diagnostic testing
| - increased could indicate trisomy 18, 21, or cardiac anomalies
56
chorionic villus sampling indications
- abnormal nuchal translucency
- advanced maternal age
- history genetic disorder
57
chorionic villus sampling risks
- miscarriage
| - leakage of amniotic fluid
58
amniocentesis indications
- fetal maturity in respiratory distress
- genetic abnormalities
- Rh incompatibility
- neural tube defects
- high risk patients
59
cell free DNA
- prenatal screening for trisomy and other genetic abnormalities
- amniocentesis or CVS are the gold standard
60
triple marker
- AFP, estriol, HCG
- identifies down's, neural tube defects, placental insufficiency, oligohydramnios
- is not diagnostic and needs follow up confirmation testing
61
alpha-fetoprotein indications
- neural tube defect
- body wall defect
- also used as tumor marker
62
estriol
- predominant estrogen in pregnancy
| - decreased values can indicate fetal distress
63
serum HCG rule of 10's
10 units at missed period
100,000 units at 10 week peak
10,000 units at term
64
HCG utility
- not used to determine week of pregnancy
| - used in evaluation of triple marker
65
HCG and ectopic pregnancy
- serial HCG every 48 hours
- HCG can both rise and fall in ectopic
- the initial 48 hour rise can mimic intrauterine pregnancy
66
down syndrome triple marker
- low AFP
- low estradiol
- high HCG
67
trisomy 18 triple marker
- low AFP
- low estradiol
- low HCG
68
neural tube defect triple marker
- high AFP
| - estradiol and HCG not applicable
69
fetal fibronectin
- used to detect rupture of membranes
- help to predict preterm delivery to initiate early intervention
- 24 to 34 week gestation
- <3 cm dilated and intact membrane
70
fetal fibronectin predictive value
- negative highly predictive that labor will not occur next 7 to 14 days
- positive indicates delivery likely next 7-14 days
71
group B strep
- common cause of neonatal pneumonia
- screen at 35-37 weeks
- positive gets ABX
- if positive once then positive for all subsequent pregnancies
72
TORCH
```
Toxoplasmosis
Other agents (syphilis, HIV, varicella, fifth disease)
Rubella
CMV
HSV
```
disease that can cause microcephaly, mental impairment, or death
73
toxoplasmosis
- immunosuppressed can have CNS lesions
| - congenital microcephaly, chronic retinitis, convulsions
74
syphilis
- sores on infected infants are contagious
| - most symptoms develop later after birth
75
CMV
- most common congenital viral infection with majority asymptomatic
- hearing loss is most common manifestation
76
CMV screening
- only screened if symptomatic or exposed
| - be suspicious of mono like symptoms during pregnancy
77
HSV patterns
- localized to skin, eyes, mouth
- localized to CNS
- disseminated involving multiple organs
78
stool for occult blood pearls
- fecal DNA more sensitive for cancer screening
| - fecal immunochemical test (FIT) more specific for lower GI bleeding
79
fecal immunochemical test
- positive needs colonoscopy
- detects hemoglobin with no lifestyle changes prior to test
- high temperature and delayed time to sample can alter results
80
APT test
- done on newborn
- differentiate if bloody stool source is maternal or newborn
- normal is no newborn blood detected
81
fecal fat
- gold standard for diagnosing steatorrhea
- deficiency of pancreatic digestive enzymes or bile
- falsely high: enema, laxative, mineral oil
- falsely low: Metamucil, barium
82
fecal leukocytes
- evaluate diarrhea due to infection/inflammation
- 10 to 15% of stools with invasive pathogen have absence of fecal leukocytes
- normal stool has no leukocytes
83
stool culture
- must be ordered separately from other stool tests
- one negative is not end point with patients showing infectious disease
- normal flora can become pathogenic after alterations by ABX
- after some Tx repeat culture for test of cure
84
C. Diff toxin assay
- patients with diarrhea who have recently taken ABX
- immunosuppressed patient with diarrhea without history of ABX use
- symptoms occur 4-10 days after ABX
- usually hospital acquired
85
LP contraindication
- increased ICP
- severe degenerative joint disease
- infection near LP site
86
CSF critical values
neutrophils >20
glucose <20
protein >45
87
traumatic blood in CSF
- blood decreases with subsequent vials
- clotting may be present
- centrifuge of sample has clear supernatant
88
glucose in CSF
- changes in blood sugar reflected in CSF 1 hour later
- decreases with bacterial infection
- CSF glucose <60% of BG = infection or neoplasm
89
protein in CSF
- normally very little protein due to difficulty crossing blood brain barrier
- reliable indication of CSF pathology
90
serum vs CSF protein electrophoresis in regards to multiple sclerosis
-abnormal result is finding 2 or more bands in the CSF not present in the serum
91
lactic acid in CSF
- used to differentiate between bacterial and nonbacterial meningitis
- increased in cerebral hypoxia or ischemia
92
lactate dehydrogenase in CSF
-can differentiate between bacterial and viral meningitis
93
syphilis serology in CSF
-ordered if serum RPR is positive
94
glutamine in CSF
- most prominent amino acid in CSF
| - detect and evaluate hepatic encephalopathy/coma
95
CRP in CSF
- acute phase reactant
| - non elevated levels = no bacterial meningitis
96
cloudy CSF
-potentially contagious until proven otherwise
97
most common causes of bacterial meningitis in children
- H influenzae type B
| - Group B strep
98
most common causes of bacterial meningitis in adults
- meningococci
| - pneumococci
99
peritoneal transudate appearance
- clear
- serous
- light yellow
100
peritoneal exudate appearance
- cloudy
- turbid
- milky
101
transudates
- extravascular fluid from increased fluid pressure or decreased colloid oncotic forces
- low protein
- low specific gravity
102
transudate causes
- CHF
- cirrhosis
- nephrotic syndrome
103
exudates
- extravascular fluid due to vessel alteration during inflammation
- increased protein
- increased specific gravity
104
exudates causes
- infection
- malignancy
- vascular disease
- trauma
105
CSF tubes and tests
1. chemistry/serology
2. microbiology
3. hematology
4. additional studies/repeat cell count
106
light's criteria
fluid is exudate if one or more conditions met
1. serum protein exceeds 0.5
2. LDH pleural:serum exceeds 0.6
3. pleural LDH exceeds 2/3 upper level of normal for serum
107
inflammatory versus non-inflammatory synovial fluid
- non inflammatory: high viscosity, clear, <2000 WBC
| - inflammatory: low viscosity, cloudy, 5000-75000 WBC
108
gout crystal analysis
-negatively birefringent under polarized light (yellow)
109
pseudo gout crystal analysis
-positively birefringent (blue)
110
sweat chloride
gold standard to diagnosis cystic fibrosis
