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Lewis 50-54

Anti-mullerian hormone (AMH) Measures ovarian function. Level reflects size of the remaining egg supply (“ovarian reserve”). May be done when a woman has manifestations of polycystic ovarian syndrome (PCOS). Used to monitor AMH-producing ovarian tumor.
Anti-mullerian hormone (AMH) Females with higher AMH have a better response to ovarian stimulation during fertility treatments. Females 13-45 years: 0.9-9.5 ng/mL Females >45 years: <1.0 ng/mL
Estradiol Measures ovarian function. Useful in assessing estrogen-secreting tumors and states of precocious female puberty. May be used to confirm perimenopausal status. Increased serum estradiol levels in men may be indicative of testicular tumors.
Estradiol Female: Follicular phase: 20-150 pg/mL (73-1285 pmol/L) Luteal phase: 30-450 pg/mL (110-1652 pmol/L) Postmenopause: ≤20 pg/mL (≤73 pmol/L) Male: 10-50 pg/mL (37-184 pmol/L)
Fluorescent treponemal antibody absorption (FTA-Abs) Detects antibodies to syphilis. Reference interval: Negative or nonreactive.
Follicle-stimulating hormone (FSH) Assesses gonadal function and abnormal levels may indicate pituitary tumors or dysfunction. Increased in menopause. May be used to validate menopausal status.
Follicle-stimulating hormone (FSH) - in 24 hour urine sample In 24-hr urine samples: Female: Follicular phase: 2-15 U/24 hr Midcycle: 8-60 U/24 hr Luteal phase: 2-10 U/24 hr Postmenopause: 35-100 U/24 hr Male: 3-11 U/24 hr
Follicle-stimulating hormone (FSH) - in blood In blood: Female: Follicular phase: 1.37-9.9 mU/mL Ovulatory phase: 6.17-17.2 mU/mL Luteal phase: 1.09-9.2 mU/mL Postmenopause: 19.3-100.6 mU/mL Male: 1.42-15.4 mU/mL
Human chorionic gonadotropin (hCG) Detects pregnancy. Also detects hydatidiform mole and chorioepithelioma (in men and women). Can be done in urine or blood. Qualitative: Negative Quantitative: <5 mIU/mL (<5 IU/L) (males and nonpregnant females)
Luteinizing hormone (LH) Associated with ovulation in women and testosterone production in men. Particularly useful in women in the workup of infertility and menstrual irregularities.
Luteinizing hormone (LH) Female: Premenopause: 5-25 IU/L With higher peaks at ovulation Female: Postmenopause: 14-52.3 IU/L Male: 1.8-8.6 IU/L
Prolactin Detects pituitary dysfunction that can cause amenorrhea, decreased libido, and impotence. Female: 3.8-23.2 ng/mL (3.8-23.2 mg/L) Male: 3.0-14.7 ng/mL (3.0-14.7 mg/L)
Progesterone Used to assess infertility, monitors success of drugs for infertility or the effect of treatment with progesterone, determines whether ovulation is occurring, and diagnoses problems with adrenal glands and some types of cancer.
Progesterone Female: Follicular phase: 15-70 ng/dL (0.5-2.2 nmol/L) Luteal phase: 200-2500 ng/dL (6.4-79.5 nmol/L) Postmenopause: <40 ng/dL (1.28 nmol/L) Male: 13-97 ng/dL (0.4-3.1 nmol/L)
Prostate-specific antigen (PSA) Detects prostate cancer. Also used to monitor response to therapy. Reference interval: <4 ng/mL (<4 mcg/L)
Rapid plasma reagin (RPR) (agglutination) Screening test for syphilis. Test is most sensitive during secondary stage. Reference interval: Negative or nonreactive
Testosterone Detects tumors and developmental anomalies of the testicles. Used to assess male infertility. In 24-hr urine samples: Female: 2-12 mcg/24 hr Male: 40-135 mcg/24 hr In blood: Female: 15-70 ng/dL Male: 280-1100 ng/dL
Dark-field microscopy Direct examination of specimen obtained from potential syphilitic lesion (chancre) is performed to detect Treponema pallidum. During: Avoid direct skin contact with open lesion.
Wet mounts Direct microscopic examination of specimen of vaginal discharge is performed immediately after collection. Determines presence or absence and number of Trichomonas organisms, bacteria, white and red blood cells, and candidal buds or hyphae.
Wet mounts Before: Explain procedure and purpose to patient. Instruct patient not to douche before examination. During: Prepare for collection of specimens (glass slide, cover slips, 10%-20% KOH solution, sodium chloride solution, and applicators).
Cultures Specimens from urine or vaginal, urethral, or cervical discharge are cultured to assess for gonorrhea or Chlamydia organisms. Rectal and throat cultures may also be taken, depending on data obtained from sexual history.
Cultures Before: Obtain specific contact and sexual history, including oral and rectal intercourse. During: Obtain urethral specimen from men before they void.
Nucleic acid amplification test (NAAT) Nonculture test used to ID small amounts of DNA/RNA in test samples with sensitivity similar to culture tests. Uses ligase or polymerase chain reaction that amplifies the signal of the nucleic acids in the test sample so that they are easier to identify.
Nucleic acid amplification test (NAAT) Can be done on a wide variety of samples, including vaginal, endocervical, urethral, and urine specimens. Preferred method to test for gonorrhea, Chlamydia, and trichomoniasis.
Gram stain Used for rapid detection of gonorrhea. Presence of gram-negative intracellular diplococci generally warrants treatment. Not highly accurate for women. Also a valid alternative for Chlamydia testing.
Papanicolaou (Pap) test Microscopic study of exfoliated cervical cells to detect abnormal cells. Conventional cytology entails fixing cells directly to a slide at the time of collection and sending the slide to the laboratory for interpretation.
Papanicolaou (Pap) test In liquid-based cytology the specimen is sent to the laboratory in a liquid solution that preserves it and is processed for microscopic evaluation at the laboratory. Testing for HPV may be done on specimen obtained for liquid-based Pap test
Papanicolaou (Pap) test Before: Obtain data about menstrual history and current HT use. Instruct women that best time to schedule examination is 10-14 days after the first day of LMP and to avoid vaginal medications, lubricants, contraceptives, or douches 2 days prior to test.
Nipple discharge test Cytologic study of nipple discharge. Before: Find out if patient is taking hormonal preparations or other drugs, is breastfeeding, or has a history of amenorrhea. Document this information.
Mammography X-ray image used to assess breast tissue. Detects benign and malignant masses.
Mammography Before: Instruct patient to avoid use of deodorants, antiperspirants, powders, lotions, or creams under the arms or on breasts. Try to schedule test the week after menses when breasts are least likely to be tender.
Ultrasound (US) (breast, pelvic, testicular, transvaginal [TV], rectal [TRUS]) Measures and records high-frequency sound waves as they pass through tissues of variable density. Breast US useful in detecting fluid-filled masses and for follow-up screening after mammography in women with dense breast tissue.
Ultrasound (US) (breast, pelvic, testicular, transvaginal [TV], rectal [TRUS]) In women, pelvic and TV US useful to detect pelvic masses such as ectopic pregnancy, ovarian cysts, fibroids, and other pelvic masses. In men, US used to detect testicular masses and testicular torsion. TRUS is useful for diagnosing prostate tumors.
Ultrasound-guided biopsy Use of ultrasound guidance while performing a biopsy. Ultrasound is used to direct the biopsy needle into the region of interest and obtain a sample of tissue. Removal of small tissue sample to diagnose infection, inflammation, or mass.
Ultrasound-guided biopsy Before: Inform patient of purpose for this procedure. It is usually done as an outpatient procedure. After: Instruct patient to monitor for signs and symptoms of infection at biopsy site.
CT scan of pelvis Detects tumors in the pelvis. Before: Inform patient of procedure. During: Patient must lie still during the procedure. If IV contrast medium is used, check for iodine allergy.
MRI Radio waves and magnetic field are used to assess soft tissue. Useful after an abnormal mammogram or in women with dense breast tissue.
MRI Breast MRI may be used in addition to mammography to detect breast cancer in women at high risk for breast cancer. Also used to diagnose abnormalities in female and male reproductive systems.
Hysteroscopy Allows visualization of uterine lining through insertion of scope through cervix. Used mainly to diagnose and treat abnormal bleeding such as polyps and fibroids. Biopsy may be taken during procedure. May be used as part of infertility assessment.
Hysteroscopy Before: Explain purpose and method of procedure and that it may be done in the physician's office or an outpatient setting. Inform patient that mild cramping and slight bloody discharge after procedure is normal.
Hysterosalpingogram Involves instillation of contrast media through cervix into uterine cavity and subsequently through fallopian tubes. X-ray images taken to detect abnormalities of uterus and its adnexa (ovaries and tubes) as contrast progresses through them.
Hysterosalpingogram Most useful in diagnostic assessment of fertility (e.g., to detect adhesions near ovary, abnormal uterine shape, blockage of tubal pathways).
GnRH Hormone made in hypothalamus that triggers the pituitary to release FSH, LH and Prolactin
FSH Hormone from pituitary that stimulates ovarian change in females and sperm production in males.
LH Hormone made in pituitary that triggers ovulation in females and sperm maturation in males
Prolactin Hormone made in pituitary that triggers lactation
Five P's of sexual history Partners, Practices, Protection (barrier), Past history of infection, Pregnancy (attempting/prevention methods)
Vulvar Discharge: White, thick, curdy, frequent itching and inflammation, lack of odor or yeast-like smell Candidiasis (Candida or yeast infection), vaginitis
Vulvar Discharge: Thin gray or white, copious flow, malodorous or fishy, vulvar irritation Bacterial vaginosis infection
Vulvar Discharge: Frothy green or yellow color; malodorous Trichomonas vaginalis
Vulvar Discharge: Bloody discharge Chlamydia trachomatis or Neisseria gonorrhoeae infection, menstruation, trauma, cancer
Vulvar Erythema: Bright or beefy red color, itching Candida albicans, allergy, chemical vaginitis
Vulvar Erythema: Reddened base, painful vesicles or ulcerations Genital herpes
Vulvar Erythema: Macules or papules, itching Chancroid, contact dermatitis, scabies, pediculosis
Vulvar Growths: Soft, fleshy growth, nontender Condyloma acuminatum
Vulvar Growths: Flat and warty appearance, nontender Condyloma latum
Vulvar Growths: Same as either of above, possible pain Neoplasm
Vulvar Growths: Reddened base, vesicles, and small erosions; pain Lymphogranuloma venereum, genital herpes, chancroid
Vulvar Growths: Indurated, firm ulcers, no pain Chancre (syphilis), granuloma inguinale
Female abdominal pain: Intermittent or consistent tenderness in right or left lower quadrant Salpingitis (infection of fallopian tube), ectopic pregnancy, ruptured ovarian cyst, PID, tubal or ovarian abscess
Female abdominal pain: Periumbilical location, consistent occurrence Cystitis, endometritis (inflammation of endometrium), ectopic pregnancy
Penile Growths or Masses: Indurated, smooth, disklike appearance. Absence of pain. Singular presentation Chancre
Penile Growths or Masses: Papular to irregularly shaped ulceration with pus, lack of induration Chancroid
Penile Growths or Masses: Ulceration with induration and nodularity Cancer
Penile Growths or Masses: Flat, wartlike nodule Condyloma latum
Penile Growths or Masses: Elevated, fleshy, moist, elongated projections with single or multiple projections Condyloma acuminatum
Penile Growths or Masses: Localized swelling with retracted, tight foreskin Paraphimosis (inability to replace foreskin to its normal position after retraction), trauma
Male Vesicles, Erosions, or Ulcers: Painful, erythematous base. Vesicular or small erosions Genital herpes, balanitis (inflammation of glans penis), chancroid
Male Vesicles, Erosions, or Ulcers: Painless, singular, small erosion with eventual lymphadenopathy Lymphogranuloma venereum, cancer
Scrotal Masses: Localized swelling with tenderness, unilateral or bilateral presentation Epididymitis (inflammation of epididymis), testicular torsion, orchitis (mumps)
Scrotal Masses: Swelling, tenderness Incarcerated hernia
Scrotal Masses: Swelling without pain. Unilateral or bilateral presentation. Translucent, cordlike or wormlike appearance Hydrocele (accumulation of fluid in outer covering of testes), spermatocele (firm, sperm-containing cyst of epididymis), varicocele (dilation of veins that drain testes), hematocele (accumulation of blood within scrotum)
Scrotal Masses: Firm, nodular testes or epididymis. Frequent unilateral presentation Tuberculosis, cancer
Penile Discharge: Clear to purulent color, minimal to copious flow Urethritis or gonorrhea, Chlamydia trachomatis infection, trauma
Penile or Scrotal Erythema: Macules and papules Scabies, pediculosis
Inguinal Masses: Bulging unilateral presentation during straining Inguinal hernia
Inguinal Masses: 1- to 3-cm nodules Lymphadenopathy
Colposcopy Direct visualization of cervix with binocular microscope that allows magnification of cervix and study of cellular abnormalities.
Colposcopy Used as follow-up for abnormal Pap test and for examination of women exposed to DES in utero. Biopsy(ies) of cervix may be taken during examination. Also used to assess for vaginal or vulvar dysplasia.
Colposcopy Before: Instruct patient about this procedure. Inform patient that this examination is similar to speculum examination.
Conization Cone-shaped sample of squamocolumnar tissue of cervix is removed for direct study.
Conization Before: Explain purpose and method of procedure and that it requires use of surgical facilities and anesthesia. After: Instruct patient to avoid sexual intercourse and tampons for about 3-4 wk. Also discuss necessity for 3-wk follow-up.
Loop electrosurgical excision procedure (LEEP) Excision of cervical tissue via an electrosurgical instrument. Diagnoses and treats cervical dysplasia. Minimal amount of tissue removed and preserves childbearing ability.
Loop electrosurgical excision procedure (LEEP) Before: Explain that it may be done in the physician's office. Patient may feel slight tingling or abdominal cramping during procedure. After: Tell patient that discharge, bleeding, and cramping may occur for 1-3 days after procedure.
Culdotomy, culdoscopy, and culdocentesis Culdotomy is an incision made through posterior fornix of cul-de-sac and allows visualization of peritoneal cavity (i.e., uterus, tubes, and ovaries).
Culdotomy, culdoscopy, and culdocentesis Culdoscopy can then be used to closely study these structures. This technique is valuable in fertility evaluations. Withdrawal of fluid (culdocentesis) allows examination of fluid.
Culdotomy, culdoscopy, and culdocentesis Before: Explain purpose and method of procedure. Prepare patient for vaginal operation with preoperative instruction and sedation. After: Perform assessment of bleeding and discomfort after surgery.
Laparoscopy Allows visualization of pelvic structures via fiberoptic scopes inserted through small abdominal incisions. Instillation of CO2 into cavity improves visualization.
Laparoscopy Used in diagnostic assessment of uterus, tubes, and ovaries (Fig. 50-9, on following page). Often used for tubal sterilization or part of infertility assessment.
Laparoscopy Before: Instruct patient about procedure, prepare abdomen, and reassure patient about sedation. Inform patient of probability of referred shoulder pain secondary to residual air in the abdomen.
Dilation and curettage (D&C) Operative procedure that dilates cervix and allows curetting of endometrial lining. Used in assessment of abnormal bleeding and cytologic evaluation of lining.
Dilation and curettage (D&C) Before: Instruct patient about procedure and sedation. After: Perform assessment of degree of bleeding (frequent pad check during first 24 hr).
Semen analysis Semen is assessed for volume (2-5 mL), viscosity, sperm count (>20 million/mL), sperm motility (60% motile), and percent of abnormal sperm (60% with normal structure).
Semen analysis Before: Instruct patient that no more than 1 hr should elapse between collection and examination of sample. Do not have any sexual activity that causes ejaculation 2-3 days before the test.
Basal body temperature assessment Measurement indirectly indicates whether ovulation has occurred. (Temperature rises at ovulation and remains elevated during secretory phase of normal menstrual cycle.)
Basal body temperature assessment Before: Instruct woman to take temperature using special basal temperature thermometer (calibrated in tenths of degrees) every morning before getting out of bed. Instruct to record temperature on graph.
Urinary LH Over-the-counter “ovulation predictor kits.” Identifies midcycle LH surge that precedes ovulation by 1 to 2 days.
Urinary LH Inform patient to follow directions carefully of specific test used.
A normal male reproductive function that may be altered in a patient who undergoes a orchiectomy (removal of testes) is a. production of GnRH b. production of testosterone. c. production of progesterone. d. production of seminal fluid. B
Male orgasm is characterized by a. resolution. b. increased testicular size. c. vasodilation and dystonia. d. vasocongestion and myotonia. D
An age-related finding during the assessment of the older woman's reproductive system is a. dyspareunia. b. vaginal atrophy. c. nipple enlargement. d. increased vulvar skin turgor. B
Cultures used in the diagnosis of STIs can be obtained from (select all that apply) a. urine. b. vagina. c. urethra. d. rectum. e. endocervix. A,B,C,D,E
An abnormal finding noted during physical assessment of the male reproductive system is a. descended testes. b. symmetric scrotum. c. slight clear urethral discharge. d. the glans covered with prepuce. C
DCIS ductal carcinoma in situ
LCIS lobular carcinoma in situ
tamoxifen Blocks estrogen receptors (ERs) ER-positive breast cancer in premenopausal and postmenopausal women Used as a preventive measure in high-risk premenopausal and postmenopausal women
toremifene (Fareston) Blocks ERs ER-positive breast cancer in postmenopausal women only
fulvestrant (Faslodex) Blocks ERs ER-positive breast cancer in postmenopausal women only
anastrozole (Arimidex) Prevents production of estrogen by inhibit­ing aromatase ER-positive breast cancer in postmenopausal women only
letrozole (Femara) Prevents production of estrogen by inhibit­ing aromatase ER-positive breast cancer in postmenopausal women only
exemestane (Aromasin) Prevents production of estrogen by inhibit­ing aromatase ER-positive breast cancer in postmenopausal women only
Aromatase Inhibitors anastrozole (Arimidex) letrozole (Femara) exemestane (Aromasin)
Estrogen Receptor Blockers tamoxifen toremifene (Fareston) fulvestrant (Faslodex)
Estrogen Receptor Modulator raloxifene (Evista)
raloxifene (Evista) In breast blocks the effect of estrogen In bone promotes effect of estrogen and prevents bone loss Postmenopausal women
Immunotherapy and Targeted Therapy trastuzumab (Herceptin) pertuzumab (Perjeta) lapatinib (Tykerb) ado-trastuzumab emtansine (Kadcyla) everolimus (Afinitor) palbociclib (Ibrance)
trastuzumab (Herceptin) Blocks HER-2 receptor HER-2-positive breast cancer
pertuzumab (Perjeta) Blocks HER-2 receptor HER-2-positive breast cancer
lapatinib (Tykerb) Inhibits HER-2 tyrosine kinase and EGFR tyrosine kinase HER-2-positive breast cancer
ado-trastuzumab emtansine (Kadcyla) trastuzumab connected to a chemotherapy drug called DM1 HER-2-positive breast cancer
everolimus (Afinitor) Binds to mammalian target of rapamycin (mTOR), thereby suppressing T cell activation and proliferation ER-positive, HER-2-negative breast cancer in postmenopausal women
palbociclib (Ibrance) Kinase inhibitor ER-positive, HER-2-negative breast cancer in postmenopausal women
Tamoxifen side effects Irregular vaginal bleeding/spotting Decreased visual acuity, corneal opacity, and retinopathy with high dose. These problems may be irreversible. Monitor for signs of DVT, PE, and stroke, including shortness of breath, leg cramps, and weakness.
Trastuzumab (Herceptin) side effects • Use with caution in women with preexisting heart disease. • Monitor for signs of ventricular dysfunction and heart failure.
Chlamydia cause Chlamydia trachomatis
Gonorrhea cause Neisseria gonorrhoeae
Syphilis cause Treponema pallidum
Genital herpes cause Herpes simplex virus (HSV 1 or 2)
Genital warts (condylomata acuminata) cause Human papillomavirus (HPV)
Acquired immunodeficiency syndrome (AIDS) cause Human immunodeficiency virus (HIV)
Molluscum Molluscum contagiosum
Trichomoniasis Trichomonas vaginalis
Doxycycline (Vibramycin) side effects Patients on this drug should avoid unnecessary exposure to sunlight. Do not take with antacids, iron products, or dairy products. • Pregnant women should not take doxycycline.
azithromycin (Zithromax)
levofloxacin (Levaquin)
ceftriaxone (Rocephin) IM
famciclovir (Famvir)
acyclovir (Zovirax)
valacyclovir (Valtrex)
penicillin G benzathine (Bicillin LA)
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