Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Paraphimosis presentation and management

A

Swelling, painful erection, necrosis

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Paraphimosis RF

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Low flow priapism

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Urethral stricture presentation

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Painful testicular lumps

A

Generally strangulated inguinal hernias, testicular torsion or epididymo-orchitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Painless scrotal lump

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Orchitis causes

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

DDx for testicular torsion

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

RF for testicular cancer

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Typical testicular cancer mets

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Semimona

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Choriocarcinoma

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Leydig tumour

A

Responds to LH, makes testosterone or oestrogen. Non germ cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Sertoli cell tumour

A

Can secrete oestrogen or testosterone. Non germ cell tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Germ cell tumours

A

Seminomas or teratomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Testicular cancer presentation

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Investigation of testicular tumours

A 
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Alpha fetoprotein for testicular cancer marker

A

Yolk sac teratoma (often benign but aggressive if malignant. Germ cell. Peak age is 25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

b-hcG in testicular cancer

A

teratoma and seminoma investigation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

milk production

A

15 lobules with milk glands empty into lactiferous duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Breast lymph drainage

A

75% to ipsilateral axilla, 25% to internal mammary lymph gland (runs alongside internal mammary artery - crosses midline and allows spread)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

benign breast lumps

A

tend to be smooth (examples are fibroadenoma, fibrocystic disease, breast cysts, breast abscesses, fat necrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

malignant breast lumps

A

Tend to be craggy, irregular, fixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

USS imaging in breast pathology

A

Generally under 35, if over this then mammorgram better.

USS used for lymph nodes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Imaging in recurrent breast cancer

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Imaging in lobular cancer

A

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Core needle biopsy

A

USS or MRI guided.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Fibroadenoma

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Fibrocystic disease

A

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
Q

Breast cyst

A

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
Q

Fat necrosis

A

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
Q

Phylloides tumour

A

Rapidly growing benign stromal tumour

45
Q

Lactational breast abscess

A

S aureus from baby’s nose.

Hot, red, swollen, lumo. May have pus, pyrexia, sepsis.

USS guided aspiration. Rest breast of breastfeeding. fluclox

46
Q

Non-puerperal breast abscess

A

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
Q

Most common breast cancer type

A

Invasive ductal (75-85%)

48
Q

Less common breast cancer types

A

Invasive lobular

49
Q

Breast cancer met sites

A

bone, lung, liver and brain

50
Q

Lobular breast cancer diagnosis

A

More difficult due to stromal thickening (best seen on MRI) rather than lump

51
Q

Breast cancer RF

A

female, FHx of breast ca, post menopausal, obesity, high alcohol consumption, BRCA1, BRCA2, lifetime oestrogen exposure (nulliparity, OCP, early menarchy, late menopause, HRT)

52
Q

Breast cancer presentations

A

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
Q

Paget’s disease of the nipple

A

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
Q

Breast caricnoma in situ

A

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
Q

BRCA1

A

autosomal dominant, tumour suppressor gene on chromosome 17. Increased risk of breast cancer and ovarian cancer, as well as prostate and colon cancer

56
Q

BRA2

A

autosomal dominant on chrom 13, increased risk of breast and ovarian cancer and also MALE breast cancer

57
Q

Who should be offered genetic testing for breast cancer

A

Young females with breast cancer

Relative may get prophylactic surgery if appropriate

58
Q

Reducible hernia

A

Can be manipulated back via wall defect into original position

59
Q

Irreducible hernia

A

Can’t be manipulated back into position without surgery

60
Q

Incarcarated hernia

A

Irreducible with contents trapped due to adhesions. Firm, tender, red

61
Q

Strangulated ihernia

A

ischaemic hernia (necrosis and sepsis). Severely painful

62
Q

Obstructed hernia

A

Bowel lumen obstructed. Abdo pain, distension, absolute constipation and N&V occur

63
Q

RF for hernia

A

weak abdo wall, increased abdominal pressure, abdominal surgery, male (central obesity), lifting, protein deficiency (less collagen for gut lining), increasing age (less collagen)

64
Q

Inguinal hernia

A

Can present with pain (Esp on coughing or stooping), altered bowel habit, constipation, burning sensation in groin, scrotal swelling

65
Q

Contents of inguinal canal in males and females

A

Males have spermatic cord with nerves

Females have round ligament with nerves

66
Q

Borders of the inguinal canal : Roof

A

Transversalis fascia, internal oblique, transversus abdominus

67
Q

Posterior wall of inguinal canal

A

transversalis fascia (only 1 wall so weakest side)

68
Q

Floor of inguinal canal

A

inguinal ligament, lacunalr ligament

69
Q

Anterior wall of inguinal canal

A

Aponeurosis of external oblique and internal oblique

70
Q

Deep ring location

A

Midpoint of inguinal ligament (lateral to epigastric vessels).
Half way between ASIS and PT

71
Q

Mid inguinal point

A

Half way between ASIS and PS

72
Q

Superficial ring

A

Superior to pubic tubercle

73
Q

Direct inguinal hernia

A

20% of inguinal hernias. Defect in posterior wall (Hesselbach’s triangle). Tend to reduce easily and not strangulate

74
Q

Indirect inguinal hernia

A

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
Q

Most common hernia

A

indirect inguinal

76
Q

Differentiating between indirect and direct inguinal hernias

A

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
Q

Hernia lateral to inferior epigastric vessels

A

indirect

78
Q

Hernia medial to inferior epigastric vessels

A

Direct hernia

79
Q

Femoral hernias

A

5% of hernias

Viscera or omentum pass through femoral ring into potential space

80
Q

Femoral hernia RF

A

female (wider pelvis), pregnancy (esp multiparous), raised intraabdominal pressure)

81
Q

Femoral canal

A

Medial to femoral vein, gives space for vein to expand

82
Q

Femoral triangle

A

Inguinal ligaement superiorly, medial border of sartorius laterally, lateral border of adductor longus medially

83
Q

Femoral hernia investigation and management

A

Can present as painless groin lump, but can progress quickly so needs urgent evaluation.
High strangulation risk (due to narrow femoral canal.

84
Q

Differentiating inguinal from femoral hernia

A

Inguinal tend to be superiomedial to pubic tubrecle, femoral hernias tend to be inferiolateral

85
Q

Richter’s hernia

A

Femoral hernia with only sidewall of bowel and not lumen - can give stranglation and perforation without obstruction

86
Q

Umbilical hernia

A

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
Q

Paraumbilical hernia

A

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
Q

Epigastric hernia

A

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
Q

Incisional hernia

A

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
Q

Divarication of recti

A

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
Q

Conservative hernia management

A

Weight loss and smoking cessation

92
Q

Hernia ddx

A

Lipoma, femoral artery aneurysm (pulsatile), saphenous ovarix (dilatation of saphenous vein in groin, lymph node

93
Q

Catheter indications

A

urinary retention, output monitoring (critical illness/perioperative patients), incontinence, aid in surgery

94
Q

Contraindications for catheter

A

urethral injury (e.g. pelvic fracture) or acute prostatitis (use suprapubic instead - bladder must be full for this).

95
Q

Sizing for catheter

A

12 for female, 14 for male

96
Q

Catheter maintenance

A

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
Q

Catheter complications

A

Infection, paraphimosis, creation of false passages, urethral strictures, urethral perforation, bleeding.

98
Q

Urine sample from catheter?

A

Never from bag, only from port in tubing or aseptic aspiration of tubing

99
Q

RF for post surgical infection

A

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
Q

Wound healing

A 
Haemostasis
Inflammation (oedema, infiltration)
Proliferation (fibroblasts give collagen, myofibroblasts secrete actin products. Angiogenesis and granulation)
Epithelialisation
Remodelling

CP1 revision (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions