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Men's Health Labs
Men's Health
| Question | Answer |
|---|---|
| USPSTF: prostate | insufficient evidence for/vs in men <75; men >75: harms outweigh risks |
| USPSTF: testicular ca | against routine screening in Asx |
| PSA elevations can precede clinical dz by: | 5-10 yrs |
| PSA index | PSA density (PSA conc divided by PSA volume); higher may be assoc w/cancer |
| Utility of free PSA | helps distinguish prostate cancer from BPH in DRE-negative pts with borderline-high PSA |
| Most common formula for prostate volume | ellipsoid formula |
| Acid phosphatase used for: | Dx of prostatic ca; monitor tx w/ neoplastic drugs, esp in metastatic dz |
| Acid phosphatase elevated in prostate: | Adenocarcinoma; Manipulation; Inflammation; Hypertrophy |
| Do not order acid phosphatase immediately after: | DRE, TURP, or prostatic massage |
| Acid phosphatase: specimen | 0.5ml serum separated & added to 10µl acid phosphatase preservative (pH 5) within 2 hours of collection |
| Cystoscopy: risks | Infection, bleeding, tear/perf, urinary retention, scar tissue, allergy to anesthetic, epididymitis/ orchitis |
| TRUS: utility | not useful as screening test; US alone cannot establish /exclude the dx; used to evaluate elevated PSA (to locate suspicious area for transrectal biopsy) |
| TRUS not accurate in: | determining local tumor extension |
| Prostate bx: eval men with azoospermia to: | rule out ejaculatory duct cysts or seminal vesicular cysts |
| Prostate bx best performed with: | a spring-driven needle core biopsy device (or biopsy gun) |
| Complications of prostate bx | hematuria, rectal bleeding, hematospermia, urosepsis, & perineal pain |
| Testosterone: indications | Hypogonadism (loss of libido, ED, gynecomastia, osteoporosis, infertility); delayed/ precocious puberty; monitor testost replacement tx or antiandrogen tx; eval ambiguous genitalia |
| Hgb | 3 g/dL higher in men |
| Uric acid | 2 mg/dL higher in men |
| Testicular U/S: utility | Inflam scrotum; epididymitis; hydrocele; absent/ undescended testicle; torsion; abnormal blood vessels; lump or tumor; most scrotal masses |
| If testicular mass, first do: | dx U/S |
| Use _____ to differentiate torsion from epididymitis | Doppler US |
| Male infertility: most common etiologies | varicocele (37%); idiopathic (25%) |
| Male factors contribute what percent to infertility cases? | 40% |
| Male infertility analysis: start with: | semen analysis (if abnormal, look for exposure to toxins (environment, workplace, EtOH, drugs, hypogonadism) |
| Semen analysis: specimen | 0.5 mL, room temp, no sex 2-3 (2-5?) days prior, macro & micro analysis within 1 hr |
| Semen analysis: normal volume | volume >2 ml |
| Semen analysis: normal appearance: | beige, opalescent |
| Semen analysis: normal liquefaction: | liquefied within 1 hour |
| Semen analysis: normal pH: | 7.2-7.8 |
| Semen analysis: normal motility: | ≥ 50%, >50% forward progression |
| Semen analysis: normal sperm concentration: | ≥ 20 x 10(6)/ml |
| Semen analysis: normal morphology: | ≥ 50% |
| Low sperm motility may be due to: | antisperm Ab or infection |
| Abnormal sperm morphology: may be due to: | varicocele, infection, exposure history |
| Low semen volume: may be due to: | retrograde ejaculation or androgen insufficiency |
| Elevated LH: causes | Testicular dysfn; primary testicular fail; CNS dysfn; precocious puberty; postviral orchitis |
| Decreased LH: causes | Testicular tumors; secondary testicular fail; hypopituitarism; hypothalamic-pituitary dysfn |
| FSH normal range | 1.5-14.0 mIU/mL |
| Elevated FSH causes | primary gonadal failure, testicular agenesis, alcoholism, gonadotropin-secreting pituitary tumors |
| Decreased FSH causes | Anterior pituitary hypofunction, hypothalamic disorders |
| Limitation of FSH levels | Pulsatile secretion throughout day (physiologic variation within reference range) |
| Primary testicular failure: labs | increased LH/FSH, decreased testosterone |
| Secondary testicular failure: labs | decreased LH, FSH, testosterone |
| Steroid tx for: | spontaneous autoimmunity; also genital infection, testicular obstruction, & IVF |
| Sims-Huhner test | During female LH surge, examine cervical mucus 2-8 hrs post coitus to evaluate sperm & quality of mucus |
| Sims-Huhner test provides info about: | number of sperm, progressive motility, morphology & interaction of spermatozoa with the cervical mucus |
| Seminal plasma fructose: to evaluate: | azoospermia with ejaculate < 1 ml |
| Seminal plasma fructose MOA | Fructose is produced in seminal vesicles (energy source); if absent in ejaculate, implies absence or obstruction of ejaculatory ducts |
| Seminal plasma fructose: specimen: | frozen seminal plasma |
| Post-vasectomy testing: check sperm counts: | After 20 ejaculations; 8-12 weeks post-vasectomy |
| Testicular cancer dx studies | US (shows hyperechoic area). AFP & HCG for staging. |
| Bladder cancer dx studies | Cystoscopy (dx & tx). Excision of small lesions. Excretory urography for large mass (eval renal pelvis / ureter). CT A/P |
Created by:
Abarnard
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