Examinations and signs 2

Question 1

What is the Prehns test?

Answer 1

Prehn’s test is used to differentiate testicular pain caused by acute epididymitis and testicular torsion. The test involves elevating the testes to assess the impact on testicular pain. A reduction in testicular pain is associated with epididymitis.

Question 2

What are the types of hernia?

Answer 2

Reducible - can be moved back
Irreducible - can't be moved back
Obstructed - blood supply OK to bowel
Strangulated - blocked blood supply
Incarcerated - faeces in obstructed bowel

Question 3

How do you do a breast exam?

Answer 3

3 fingers. Clock pattern or circles towards the middle.

Question 4

What method is used for testing breast lumps in younger women (<40)?

Answer 4

Ultrasound in <40

Question 5

What are the two biopsies that can be used in breast exams?

Answer 5

Core biopsy. Preserves architecture and allows you to work out staging.
FNAC - fine needle aspiration cytology allows you to study specific cells

Question 6

What should you always check in a breast exam history?

Answer 6

Menstrual cycle

Question 7

What causes traumatic fat necrosis?

Answer 7

Iatrogenic (surgeries) or trauma like seatbelt injuries.

Question 8

What is traumatic fat necrosis?

Answer 8

Mimics breast carcinoma.
Irregular, firm but painless
Resolve with biopsy

Question 9

What causes gynecomastia?

Answer 9

Liver cirrhosis

Cimetidine, spirnolactone and digoxin

Question 10

What is periductal mastitis?

Answer 10

The presentation is of information.
around the areola, so there can be pain
discharge from the nipple or nipple changes, such as contraction, signs of cellulitis,
redness, a spurt of spreading redness and warmth, for example.

Question 11

What is a phyllodes tumour?

Answer 11

Like a fibroadenoma, but leaf like pattern

Question 12

What is the triple assessment for breast cancers?

Answer 12

Clinical exam
Imaging
Biopsy - FNAC or core biopsy

Question 13

How should the patient be positioned?

Answer 13

45 degrees with arm behind head

Question 14

What should be checked after an exam?

Answer 14

Lymph nodes

Question 15

Who are aromatase inhibitors used in?

Answer 15

Older women (a older age = aromatase)

Question 16

What is the most common breast cancer?

Answer 16

Invasive ductal carcinoma (IDC)

Question 17

What type of breast cancer in pre-invasive?

Answer 17

DCIS

Question 18

What are some key features of malignant breast disease?

Answer 18

Clinical features associated with malignant breast disease include:

Hard, irregular, fixed lump
Change to breast shape or contour
Axillary or supraclavicular lymphadenopathy
Overlying skin changes - including peau d’orange
Immobile lumps tethered to skin or fixed to underlying structures
Nipple change - inversion, blood discharge or unilateral scale affecting the nipple and then spreading to the areola

Question 19

What does normal breast tissue feel like?

Answer 19

Remember that normal breast tissue can feel ‘lumpy’. Smooth, well circumscribed, mobile lumps are more characteristic of benign disease (such as fibroadenoma). Signs of inflammation (red, hot, swollen, tender) are typical of mastitis or abscess, but are rarely caused by inflammatory breast cancer.