Question | Answer |
If find mass on CBE: | Order a diagnostic mammogram (not screening), unless age <30, then order U/S |
fibroadenoma Dx | FNA; Cyto study of bloody fluid or solid tumor aspirate; U/S to differentiate solid from cystic mass; excisional bx |
Age <30 yo, palpable lump, still there after menses, order: | unilateral breast U/S |
Age > 30yo, palpable lump, order: | unilateral dx mammogram & U/S; |
Palpable lump, age >40 yo & due for screening mammo: | get mammogram on unaffected side at same time |
BI-RADS category 0-4: | Needs additional imaging evaluation |
BI-RADS category 4: | Suspicious abnormality |
BI-RADS category 6: | biopsy-proven malignancy |
Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is: | less than 15% |
Primary diagnosis of syphilis | Darkfield microscopy of chancre |
Diagnosis of neurosyphilis | CSF examination recommended in symptomatic, late-latent, HIV co-infection (lumbar puncture) |
VDRL becomes positive __ after inoculation with syphilis | About 2 weeks |
Gram stain with a “school of fish” appearance is probably what | Chancroid (Haemophilus ducreyi) |
Best source of HSV for testing | Unroofing the vesicle |
Gold standard for HSV testing | Culture |
__% of US have positive herpes Abs on serological testing | 50 |
Most appropriate way to test for herpes | Culture (not serological) |
Primary test of menopause: | FSH |
GnRH Low: | hypothalamic hypogonadism, dopamine, opiates |
GnRH high: | primary hypopituitary hypogonadism, epinephrine |
GnRH testing: avoid: | steroids, ACTH, gonadotropin or estrogen medications for ≥48hrs |
FSH low: | secondary gonadal failure, stress, malnutrition/anorexia, severe illness, hyperprolactinemia, PG |
FSH high: | primary gonadal failure, castration, alcoholism |
LH low = | pit or hypothalamic failure, severe stress, anorexia, malnutrition, severe illness, PG, hemochromatosis, sickle cell anemia, hyperprolactinemia |
LH high = | gonadal failure, precocious puberty, pituitary adenoma, menopause, PCOS |
LH: Best time to obtain single specimen | between 11am and 3pm |
Progesterone low = | preeclampsia, threatened abortion, placental failure, fetal demise, ovarian neoplasm, amenorrhea, ovarian hypofunction, PCOS |
Progesterone High = | ovulation, PG, hyperadrenocorticalism, adrenocortical hyperplasia, luteal cysts, molar pregnancy, choriocarcinoma |
FSH assays done to dx: | menopause, menstrual irregularities, gonadal failure, predicting ovulation, evaluating infertility, pituitary disorders |
Estrogen: high = | precocious puberty, ovarian tumor, adrenal tumor, gonadal tumor, normal pregnancy, cirrhosis, liver necrosis, hyperthyroidism |
Estrogen: Low = | failing PG, Turner syndrome, hypopituitarism, hypogonadism, Stein-Leventhal syndrome, menopause, anorexia, PCOS |
Max testosterone values when: | around 7am and 8pm |
testosterone high = | ovarian tumors, adrenal tumor, congenital adrenocortical hyperplasia, trophoblastic tumor, PCOS, idiopathic hirsutism, drugs |
testosterone low = | primary/ secondary ovarian failure, drugs |
Progesterone w/drawal test evaluates: | H-P-gonadal axis |
Progesterone withdrawal test: in normal cycle, progesterone surge: | inhibits FSH/LH and leads to withdrawal bleeding |
Progesterone withdrawal test: probs causing failure of bleeding: | Estrogen production inadequate; Hypothalamic dysfunction; Uterus abnormal |
Prolactin high = | pit adenoma, 2d amenorrhea, galactorrhea, hypothyroid, hypoglycemia, PCOS, anorexia, paraneoplastic syndromes, dz of hypothalamus /pituitary stalk, renal fail, drugs lowering dopamine, high estrogen |
Prolactin low = | Sheehan syndrome, pituitary destruction by tumor |
Prolactin levels should be collected: | 3-4hrs after waking |
Ovarian cancer workup | US (if pos: CXR for mets). CA-125. HCG. Ex-lap. CT or MRI prn. Colonoscopy. Mammogram if breast mass. |
Ovarian failure / amenorrhea: associated hormones | elevated FSH / LH |