Breast & Urology Flashcards
National Breast Screening Programme
- every 3 years
- 50-70yrs
Stag Horn Calculus
Struvite
- urease producing bacteria
- slightly radio-opaque
THP (uromodulin)
Inhibits stones
Binds to crystals and prevent binding to renal epithelium
Dx for renal colic
- ureteric colic
- bowel colic
- leaking AAA
- ectopic
- MI
- pancreatitis
- pneumonia
- biliary colic (RUQ -> shoulder)
- pyelonephritis
- bleeding RCC
Ix for renal colic
- CT KUB
- low dose
- urate lucent
- urine dip for infection
- MSU
- FBC
- CRP
- U&E
Tx for renal colic
- analgesia = NSAIDs
- Tamsulosin
- removal
- hydration (2L/d)
- urate = allopurinol
- calcium = thiazides
Renal Clear Cell Carcinoma
- VHL
- polycythaemia
Renal Cancer Triad
- palpable mass
- flank pain
- macrohaematuria
Renal - transitional cell carcinoma
- occupational dyes and rubber
Renal Cancer Treatment
- TKI (sutinib, pazopanib sorafenib)
- IL2 (not if anaemic)
- mTORI (sirolimus, everolimus)
- nephrectomy if not metastatic
Bladder Cancer
- 2-Naphthylemene dye/paint
- smoking
- TCC
- SCC = schistosomiasis and smoking RF only not dye
Bladder Cancer Chemo
Cisplatin & Gentamycin
Cisplatin & Methotrexate
PSA Norm
<4
Prostate Cancer Tx
- bilateral orchidectomy
- gosrelein (GnRH agonist) with flutamide before
- if castration resistant = peripheral androgen receptor antagonist = bicalutamide
- Enzalutamide x 5 affinity overcoming bicalutamide resistance
- Cyp17 inhibitor and dexamethasone and oestradiol
Prostate Cancer Palliative Tx
- bone bisphosphonates, RANKL inhibitor (denosumab)
- Anaemia blood
- analgesia
- radiotherapy
Prostate Cancer Chemo
TAXANES
Docetaxel
Carbataxel
Testicular vs Prostate RF
Testicular = Caucasian Prostate = Afro-Caribbean
Testicular germ cell Tx
- chemo = cisplatin and etoposide and bleomycin
- stem cell rescue if relapse
Testicular cancer serum tumour markers
- LDH
- AFP
- BHCG
Penile Cancer Tx
- removal and nodal block dissection
- radiotherapy and drain inguinal nodes
- chemo = cisplatin, fluorouracil, docetaxel
Epididymo-orchitis
- infection of epididymis and testes
- pain and swelling
- chlam and gonorr of genital tract or bladder
- amiodorone causes
- ceftriaxone and doxycycline
- urethral discharge
Testicular torsion
- urethral stricture
- medical emergency to prevent ischaemia
- severe pain
- surgical exploration of both
- if cremasteric reflex present = torsion affects testicular appendage only
- elevation of testes does not alleviate pain
- if do not fix both = bell clapper testes
Hydronephrosis
- from obstruction
- children = from patent processus vaginalis
- remove obstruction and drain urine = nephrostomy tube if acute and ureteric stent if chronic
Breast Tx
- Surgery first line
- if <4cm = wide local excision (and if peripheral tumour)
- if >4cm = mastectomy (and if central tumour)
- radio after wide local to reduce recurrence
- radio after mastectomy if high stage tumour and >4 axillary nodes affected
- Hormonal if receptors positive
- biological = traztuzumab (Herceptin) only for HER2 positive tumours (not if heart disorders)
- chemo
Breast Hormonal Tx
- tamoxifen for pre and peri menopausal women
- aromatase inhibitors if post menopause = anastrozole
SE of tamoxifen
endometrial cancer
VTE
menopausal symp
Pagets
- nipple crusty lesion
- no areolar affect
- lymphadenopathy
- invasive carcinoma liekly
Breast Abscess
- mastitis from breast feeding = recommended to keep breastfeeding
- S. aureus
- tender, fluctulant
- AB and US
- overlying skin necrosis
- mammary duct fistula
Duct Ectasia
- discharge from single or multiple ducts
- thick and green
- NDI
- common during menopausal breast involution
Intraductal Papilloma
- single duct
- clear or bloody discharge
TB
- child bearing women
- chronic breast or axillary sinuses
- biopsy, culture, histology
Fibroadenoma
- from lobule
- mobile, firm
- 2yrs get smaller
- if >3cm surgery
- phyllodes widely excised
Cyst
- smooth, disceret
- increased risk of cancer if young
- aspirate and biopsy
Sclerosing adenosis
- lump, pain
- mimic carcinoma on mammography
- lobular distortion
- ANDI
- biopsy
Epithelial hyperplasia
- variable lumpiness
- FH
- conservative if no atypical features
Fat necrosis
- mimic carcinoma
- increases in mass and size
- core biopsy and image
- skin tethering
Cause of ED
- vascular
- SSRI
- Beta blockers
Renal Colic Management
- If <5nm = spontaneously pass in 4w
- if obstructing = nephrostomy tube, ureteric catheter, ureteric stent
- shockwave lithotripsy first (analgesia need, organ injury, obstruction)
- ureteroscopy (ureter-> pelvis, pregnancy, when lithotripsy not possible, complex stone, left with stent)
- percutaneous nephrolithotomy (remove via renal collecting system)
Calcium oxalate
- hypercalciuria
- radio-opaque
Cystine
- inherited metabolic disorder
- malabsorption of cysteine
- multiple stones
- radiodense as contain sulphur
Urate
- product of purine metabolism
- radiolucent
- low urine pH
- excessive tissue breakdown = malignancy
- children inborn errors of metabolism
Calcium phosphate
- renal tubular acidosis
- high urine pH
- radio-opaque
