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CP1 revision > Deck 12 > Flashcards

Deck 12 Flashcards

1
Q

Phimosis presentation and management

A

Can’t retract foreskin
May have weak stream, dribbling, haematuria, painful erections, recurrent UTIs

Management with hygiene, steroid cream, circumcision

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2
Q

Paraphimosis presentation and management

A

Swelling, painful erection, necrosis

Can use analgesia, compression, osmotic reduction (50% dextrose), puncture, cicumcision

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3
Q

Paraphimosis RF

A

Foreskin scaring, vigorous sexual activity, chronic valanitis, urinary catheterisation

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4
Q

Priapism

RF

Types

A

Erection >4h, despite ejaculation
Affects cavernosum

RF: sickle cell, sildenafil, antidepressants, cannibis, cocaine, leukaemia, pelvic tumour

Can be low flow or high flow

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5
Q

Low flow priapism

A

Blood doesn’t drain, intermittent but has risk of scarring if >4h. Can lead to impotence and fibrosis

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6
Q

High flow priopism

A

Rarer than low flow, less painful, often due to trauma/spinal cord injury

Tx may be cold pack and compression

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7
Q

Penis carcinoma

RF

Presentation

Mets

A

SCC of gland/prepuce

RF: phimosis, HPB 16 and 18,

Presents as burning itch, mass, ulceration

Can spread to liver/lung

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8
Q

Urethral stricture presentation

A

weak urinary stream, dyuria, incomplete voiding, may have retention

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9
Q

Urethral stricture causes and diagnosis

A

Narrowing. Can be injury, urethral instrumentation, infection, inflammatory conditions (e.g. lichen sclerosis)

Can be congenital or malignancy related

Diagnosed by cystoscopy

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10
Q

Painful testicular lumps

A

Generally strangulated inguinal hernias, testicular torsion or epididymo-orchitis

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11
Q

Painless scrotal lump

A

Often testicular tumour, haematocoele, epididymal cyst, varicocoele, hydrocoele

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12
Q

Varicocoele

A

Bag of worms, lump, dragging sensation, painless or dull ache

Disappears lying down, reappears on standing/valsalva

Needs investigating for malignancy obstructing left renal vein, so much do abdo exam
May have subfertility
Can manage with embolisation/ligation but ONLY if painful, infertility or occurance in children

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13
Q

Hydrocoele

A

Can be congenital, may be unilateral/bilateral

Peritoneal fluid collects between parietal and visceral tunica vaginalis (can be patent processus vaginalis (congenital or in raised intra abdo pressure such as fluid overload or dialysis) but can be imbalance of fluid secretion/reabsorption in older patients)
Can also occur in minor trauma, torsion or epididymitis

Aspiration possible but can reoccur inless roort cause resolves

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14
Q

Epididymal cyst/spermatocoele

A

Common, esp in middle age.
No increased malignancy risk.

Painless, smooth, well defined, fluctuant lumo, transilluminates. Separate to testes, chronic onset. Often superior and posterior

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15
Q

Epididymo-orchitis

A

Inflammation of epididimus/testicle, due to infection
In <35, often STI (Chlamydia/gonorrhoea), in >35 then more likely UTI (E/coli/pseudomonas)

Tender, oedema. Dysuria, fever, urethral discharge. Positive Phren sign (relief on testicular elevation)

Mumps can also cause orchitis so need to palpate parotid if fever prodrome
Bilateral mumps associated with infretility

If no STI/UTI symptoms then ? torsion instead

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16
Q

Orchitis causes

A

Can be extrapulmonary TB (also has thickened spermatic cord), or mumps (palpate parotid if fever prodrome)

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17
Q

Torsion of testicular appendage

A

Less painful than testicular torsion. Get small, blue nodule visible under the scrotum
No testicular elevation

Classically occurs at start of puberty

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18
Q

DDx for testicular torsion

A

Torsion of testicular appendage, epididymitis, indirect, inguinal strangulated hernia

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19
Q

RF for testicular cancer

A

RF: white, FHx testicular ca, undescended testes, infertility, infant hernia, klinefelters, hypospadia

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20
Q

Typical testicular cancer mets

A

Typically spread it to para-aortic lymph nodes, and to liver and lungs.

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21
Q

Semimona

A

50% of testicular cancer. From seminiferous tubules.
Peak age is 35
Malignant

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22
Q

Teratoma testicular cancer

A

Germ layer mix. Peak age 25

Can be embryonal, yolk sac(often benign but aggressive if malignant), choriocarcinoma (early lung mets, poor prognosis)

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23
Q

Non germ cell testicular cancers

A

Can be lymphoma, leydig tumour (respongs to LH, makes Testosterone or oestrogen), sertoli cells (can secrete oestrogen or teststerone)

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24
Q

Choriocarcinoma

A

Malignant trophoblast teratoma germ cell tumour. Poor prognosis. Early lung mets

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25
Leydig tumour
Responds to LH, makes testosterone or oestrogen. Non germ cell
26
Sertoli cell tumour
Can secrete oestrogen or testosterone. Non germ cell tumour
27
Germ cell tumours
Seminomas or teratomas
28
Testicular cancer presentation
painless, fixed, film, irregular mass that does not transilluminate. May cause a secondary hydrocoele. May present with haematospermia. Can present with hormone secretion or mets (gynaecomastia, weight loss, back pain, dysponoea, SOB)
29
Investigation of testicular tumours
``` tumour markers (alpha fetoprotein in yolk sac tumour, b-hCG in teratomas and seminomas), USS, excision biopsy, staging (CT CAP). Royal marsden system for staging (1 is no mets, 2 is abdo node mets, 3 is supradiaphragmatic node mets and 4 is extra lymphatic mets) ```
30
Alpha fetoprotein for testicular cancer marker
Yolk sac teratoma (often benign but aggressive if malignant. Germ cell. Peak age is 25
31
b-hcG in testicular cancer
teratoma and seminoma investigation
32
milk production
15 lobules with milk glands empty into lactiferous duct
33
Breast lymph drainage
75% to ipsilateral axilla, 25% to internal mammary lymph gland (runs alongside internal mammary artery - crosses midline and allows spread)
34
benign breast lumps
tend to be smooth (examples are fibroadenoma, fibrocystic disease, breast cysts, breast abscesses, fat necrosis)
35
malignant breast lumps
Tend to be craggy, irregular, fixed
36
USS imaging in breast pathology
Generally under 35, if over this then mammorgram better. USS used for lymph nodes.
37
Imaging in recurrent breast cancer
MRI
38
Imaging in lobular cancer
MRI
39
Core needle biopsy
USS or MRI guided.
40
Fibroadenoma
Most common benign. Stromal tissue. Common in young females Painless, rubbery, firm, well demarcated. Highly mobile. No lymphadenopathy. Can be multiple, bilateral. No treatment as 1/3 involute. if >4cm then patient may want removal
41
Fibrocystic disease
Very common. General lumpiness (rope like texture). See cysts, fibrosis, hyperplasia of duct epithelium. Can get cysts. May be cyclical Presents: lumpy breast, swelling, generalised pain, tenderness, armpit pain, green/dark brown nipple discharge (no blood) Triple assessment, then management conservatively (supportive bra, COC, evening primrose oil)
42
Breast cyst
Benign, fluid filled cyst. Common in 30-50 Sudden onset swelling,symmetrical smooth, fluctuating with menstruation. Often solitary. FNA under USS to diagnose. Straw coloured but if blood stain the ?cancer. Check breast as can co-exist with cancer
43
Fat necrosis
RF are BMI>30 and Hx of breast trauma Firm, painless lump (may be tenderness surrounding it), irregular outline, thick/retracted skin, red/bruising Needs triple assessment. Analgeia as Tx as reabsorbs over time
44
Phylloides tumour
Rapidly growing benign stromal tumour
45
Lactational breast abscess
S aureus from baby's nose. Hot, red, swollen, lumo. May have pus, pyrexia, sepsis. USS guided aspiration. Rest breast of breastfeeding. fluclox
46
Non-puerperal breast abscess
RF are diabetes and smoker. Gram negative bacteria (metronidazole) See hot, red, swollen lump. May have pus dicharge. Can have pyrexia/sepsis. USS guided aspiration
47
Most common breast cancer type
Invasive ductal (75-85%)
48
Less common breast cancer types
Invasive lobular
49
Breast cancer met sites
bone, lung, liver and brain
50
Lobular breast cancer diagnosis
More difficult due to stromal thickening (best seen on MRI) rather than lump
51
Breast cancer RF
female, FHx of breast ca, post menopausal, obesity, high alcohol consumption, BRCA1, BRCA2, lifetime oestrogen exposure (nulliparity, OCP, early menarchy, late menopause, HRT)
52
Breast cancer presentations
thickened areas, dimpling, nipple crush, bump, growing vein, sunken nipple, new shape/size/asymmetry, red/hot, discharge, skin sore, peau d'orange, hard lump, axillary lump (axillary lump is breast ca until proven otherwise).
53
Paget's disease of the nipple
rare skin condition associated with 1-4% of breast cancers - can mimic eczema. Intra ductal. Presents as rough, reddened, ulceration of nipple, flaking skin and itching. Skin biopsy and triple assessment required.
54
Breast caricnoma in situ
pre-cancerous lesion (yet to breach basement membrane). Normally ductal carcinoma in situ (DCiS) but can be lobular - seen as microcalcifications on mammogram. Needs triple assessment.
55
BRCA1
autosomal dominant, tumour suppressor gene on chromosome 17. Increased risk of breast cancer and ovarian cancer, as well as prostate and colon cancer
56
BRA2
autosomal dominant on chrom 13, increased risk of breast and ovarian cancer and also MALE breast cancer
57
Who should be offered genetic testing for breast cancer
Young females with breast cancer Relative may get prophylactic surgery if appropriate
58
Reducible hernia
Can be manipulated back via wall defect into original position
59
Irreducible hernia
Can't be manipulated back into position without surgery
60
Incarcarated hernia
Irreducible with contents trapped due to adhesions. Firm, tender, red
61
Strangulated ihernia
ischaemic hernia (necrosis and sepsis). Severely painful
62
Obstructed hernia
Bowel lumen obstructed. Abdo pain, distension, absolute constipation and N&V occur
63
RF for hernia
weak abdo wall, increased abdominal pressure, abdominal surgery, male (central obesity), lifting, protein deficiency (less collagen for gut lining), increasing age (less collagen)
64
Inguinal hernia
Can present with pain (Esp on coughing or stooping), altered bowel habit, constipation, burning sensation in groin, scrotal swelling
65
Contents of inguinal canal in males and females
Males have spermatic cord with nerves | Females have round ligament with nerves
66
Borders of the inguinal canal : Roof
Transversalis fascia, internal oblique, transversus abdominus
67
Posterior wall of inguinal canal
transversalis fascia (only 1 wall so weakest side)
68
Floor of inguinal canal
inguinal ligament, lacunalr ligament
69
Anterior wall of inguinal canal
Aponeurosis of external oblique and internal oblique
70
Deep ring location
Midpoint of inguinal ligament (lateral to epigastric vessels). Half way between ASIS and PT
71
Mid inguinal point
Half way between ASIS and PS
72
Superficial ring
Superior to pubic tubercle
73
Direct inguinal hernia
20% of inguinal hernias. Defect in posterior wall (Hesselbach's triangle). Tend to reduce easily and not strangulate
74
Indirect inguinal hernia
80% of hernias. Most common hernia in women. Goes through both deep and superficial ring (incomplete processus vaginalis). More likely to strangulate as superficial ring is not dilated. More likely to enter scrotum
75
Most common hernia
indirect inguinal
76
Differentiating between indirect and direct inguinal hernias
Direct reappears on coughing once pressure applied over inguinal ligament midpoint. On surgical exploration, indirect as lateral to inferoir epigastric vessels. Direct are medial to inferior epigastric vessels
77
Hernia lateral to inferior epigastric vessels
indirect
78
Hernia medial to inferior epigastric vessels
Direct hernia
79
Femoral hernias
5% of hernias | Viscera or omentum pass through femoral ring into potential space
80
Femoral hernia RF
female (wider pelvis), pregnancy (esp multiparous), raised intraabdominal pressure)
81
Femoral canal
Medial to femoral vein, gives space for vein to expand
82
Femoral triangle
Inguinal ligaement superiorly, medial border of sartorius laterally, lateral border of adductor longus medially
83
Femoral hernia investigation and management
Can present as painless groin lump, but can progress quickly so needs urgent evaluation. High strangulation risk (due to narrow femoral canal.
84
Differentiating inguinal from femoral hernia
Inguinal tend to be superiomedial to pubic tubrecle, femoral hernias tend to be inferiolateral
85
Richter's hernia
Femoral hernia with only sidewall of bowel and not lumen - can give stranglation and perforation without obstruction
86
Umbilical hernia
defect in transversalis fascia (umbilical ring site)- more common in children, but also in pregnancy and gross ascites. Low strangulation risk. Generally not operated on until over 2 years
87
Paraumbilical hernia
adjacent to unbilicus (superior or inferior) due to linea alba weakness. More common in women 35-50 (often obesity or gross ascites) and have high risk of strangulation
88
Epigastric hernia
Hernia from fat overlying bowel through linea alba ABOVE umbilicus (often slightly off midline), 1cm or less in diameter. More common in young males. Can cause discomfort on eating/exercise with nausea and bloating. Relieved by reclining.
89
Incisional hernia
Risk from any abdo surgery. Mesh repair possible. Needs mentioning as part of consent. RF: poor surgical technique, emergency surgery, midline incisions, wound infection, reduced healing capacity (diabetes, smoking, vascular disease, immunosuppression, pre op chemo), absorbable stiches
90
Divarication of recti
Not really a hernia. Separation of rectus abdominus due to linea alba laxity. More common in truncal obesity in men and pregnancy in women, but also repeated midline ops and chronically raised intra-abdominal pressure. Diagnosed by USS and by prominent midline bulge when patient head is raised.
91
Conservative hernia management
Weight loss and smoking cessation
92
Hernia ddx
Lipoma, femoral artery aneurysm (pulsatile), saphenous ovarix (dilatation of saphenous vein in groin, lymph node
93
Catheter indications
urinary retention, output monitoring (critical illness/perioperative patients), incontinence, aid in surgery
94
Contraindications for catheter
urethral injury (e.g. pelvic fracture) or acute prostatitis (use suprapubic instead - bladder must be full for this).
95
Sizing for catheter
12 for female, 14 for male
96
Catheter maintenance
Tube and site of entry should be cleaned twice daily, bag changed at least weekly. Empty bag when 2/3 full. Proper care reduces change of stricture formation and infection.
97
Catheter complications
Infection, paraphimosis, creation of false passages, urethral strictures, urethral perforation, bleeding.
98
Urine sample from catheter?
Never from bag, only from port in tubing or aseptic aspiration of tubing
99
RF for post surgical infection
Age, malnutrition, cancer, immunosuppresion, obesity, hypoxia, anaemia, type of surgery, length of procedure, foreign body insertion, ischaemia, lack of abx prophylaxis, virulence of organism
100
Wound healing
``` Haemostasis Inflammation (oedema, infiltration) Proliferation (fibroblasts give collagen, myofibroblasts secrete actin products. Angiogenesis and granulation) Epithelialisation Remodelling ```

CP1 revision (16 decks)

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