Female and male reproductive Med+surg

Question 1

Woman, Lower abdominal pain that radiates to right shoulder.

Rigid abdomen with diffuse tenderness and guarding. Low Bp. Normal hcg. Most likely diagnosis?

Answer 1

Ruptured ovarian cyst - can cause hemoperitoneum = rigid abdomen, tenderness, guarding, hemodynamic instabikity, irritation of phrenic nerve

Ovarian torsion does not cause hemoperitoneum or shoulder pain

Question 2

Even if you suspect fibroadenoma, in a patient under 30 with a breast mass you still do ultrasound. Over 40 = add on mammography

30-40 do mammography or ultrasound

Question 3

Management of simple breast cyst versus complex breast cyst?

Answer 3

Complex = biopsy

Simple and asymptomatic = observe

Simple and tender = FNA. If bloody aspirate or non resolving = biopsy !!

Question 4

Cause or presentation of breast abscess in new baby mother ? Management

Answer 4

Mastitis + fluctuant tender palpable mass

Untreated mastitis and milk buildup

Antibiotics and drainage

Question 5

Prophylactic mastectomy given for mutation or at least one immediate relative with breast cancer before age 50

Question 6

Patient undergoes breast reduction surgery.
Now has fixed mass in breast. Mamograllhy shows calcifications
Core biopsy shows foamy macrophages and fat globules

Patient undergoes mass excision. next step in management?

Answer 6

Reassurance and follow up

Fat necrosis! - surgery is risk factor

Sometimes you see findings seen in cancer - skin or nipple retractions, calcifications

Question 7

Unilateral bloody discharge WITHOUT a mass = intraductal papilloma

Question 8

in patient with severe burns, >20% of TBSA require what in addition to aggressive fluid resus?

Answer 8

urinary catheterization - for acurate monitoring of urine output

Question 9

hydrocele = fluid in tunica vaginalis

Question 10

after testicular trauma, if testicular torsion diagnosis is not clear/to rule it out, do testicular ultrasound

tt can present with tender swollen erythematous hemiscrotum with other signs

Question 11

BPH can reoccur again after a TURP procedure for BPH as the prostate tissue can grow back

Question 12

in a young man with signs of metastatic cancer, where would the primary cancer typically be located!!

Answer 12

testicle!!!

or lymphoma or leukemia!!

Question 13

recurent UTI + tender prostate. diagnosis is?

how else can it present?

management?

Answer 13

chronic bacterial prostatitis - ecoli main cause

can also present as chronic utis, normal prostate exam + pain with ejaculation

fluoroquinolones eg ciprofloxacin, levofloxacin!! for 6 weeks or trimethoprim!!!

Question 14

6 month old with unilateral undescended testes, first step in management?

Answer 14

surgical correction!!!

if less than 6 months = monitor for spontaneous descent

if bilateral undescended testes or hypospadias = evaluate for differences of sex development = karyotype, pelvic ultrasound, adrenal/gonadal hormones

Question 15

recurrent acute pyelonephritis + over the last year frequent nighttime urination and dribbling

most likely underlying cause of patients presentation?

Answer 15

BPH - causes the nightime urination and dribbling

• compresses urethra and increases risk of UTI

not infectious urethritis as this is caused by chlamydia and gonorrhea usually and the symptoms would be dysuria and urethral discharge

Question 16

penile fracture requires urgent operative repair.

what are the indications for retrogade urethrography prior to surgery?

Answer 16

blood at the meatus
dysuria
urinary retention
hematuria

Question 17

patient with priaprism,

first investigation to diagnose cause?

Answer 17

complete blood count!!

but note ->most cases are idiopathic

blood disorders causing altered blood viscosity or local microthrombi eg sickle cell, thalessemia, hematological malignancies, multiple myeloma

Question 18

priaprism management?

Answer 18

aspiration of blood from corpus cavernosa!!!

vs intracavernous injection of phenylephrine!!

Question 19

leydig cell tumors of testes cause gynaecomastia due to elevation of estrogen. tumor markers eg afp negative

Question 20

management of suspected testicular cancer?

Answer 20

ultrasound -> serum tumour markers -> radical orchiectomy

no biopsies!

Question 21

varicocele surgery is done to prevent?

Answer 21

infertility

Question 22

intermittent groin swelling and sharp scrotal pain is concerning for?

what do you do to elict sign more?

Answer 22

groin hernia

valsalva maneuvre

Question 23

severe testicular pain which improves with elevation but no positive cremasteric reflex. diagnosis and treatment?

Answer 23

epididymitis = antibiotic therapy

Question 24

wound dehiscence with an intact fascia is managed with?

Answer 24

regular dressing changes only

deep dehiscence involving fascia = surgical emergency

Question 25

in hospital. delayed onset delirium, elevated vitals (htn, tachycardia, hyperthermia) history of polysubstance use and schizoaffective disorder. on sertraline and aripirpazole but cant confirm last dose time. most likely cause of patients condition

Answer 25

alcohol withdrawal!! signs in keeping with delirum tremens - delirum , hyperthermia, hypertension, tachycardia history of polysubstance use management with benzos

Question 26

brown recluse spider bite = necrosis and eschar management?

Answer 26

local wound care only! no antibiotics

Question 27

frostbite first managed with warming in warm water bite, if this is insufficient for the limb, what do you do next?

Answer 27

angiography of limb!! to see if patient would benefit from thrombolysis

Question 28

high voltage electrical injuries carries the greatest risk of what complications?

Answer 28

skeletal muscle complications = acute compartment syndrome, rhabdomyolysis, acute kidney injury

Question 29

severe burns injury can cause hypermetabolic state = tachycardia, hypertension, hyperglycemia, fever metampphetamine INTOXICATION can also cause this, not withdrawal