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AKT use > General Surgery > Flashcards

General Surgery Flashcards

1
Q

Which type of ulcer is worse after eating?

A

Gastric ulcers

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2
Q

Which type of ulcer is better after eating?

A

Duodenal

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3
Q

Failure rate of vasectomy

A

1 in 2,000

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4
Q

Follow up investigations from vasectomy

A

Semen analysis at 16 and 20 weeks

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5
Q

Complications from vasectomy

A

Bruising

Haematoma

Infection

Sperm granuloma

Chronic testicular pain in 5%

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6
Q

Success rate of vasectomy reversal

A

up to 55% within 10 years

25% over 10 years

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7
Q

Which type of varicocele requires urgent referral to urology?

A

Solitary right sided

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8
Q

Which side do 90% of varicoceles occur on?

A

Left side

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9
Q

Treatment of non-specific dermatitis causing balanitis

A

topical hydrocortisone 1%

Imidazole cream

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10
Q

At which BMI should you refer for bariatric surgery?

A

With risk factors >35

Without risk factors >40

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11
Q

When should women stop taking combined oral contraception or HRT prior to surgery?

A

4 weeks before surgery

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12
Q

Benefits of circumcision

A

Reduced penile cancer
Reduced UTI
Reduced STI

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13
Q

Medical indications for circumcision

A

Phimosis

Recurrent balanitis

Balanitis xerotica obliterans

Paraphimosis

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14
Q

What percentage of patients with a positive FIT test have bowel cancer at colonoscopy?

A

10%

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15
Q

How is bowel cancer screened for?

A

Faecal immunochemical test
Every 2 years
Between ages 60 and 74

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16
Q

At what ABPI can compression stockings be used?

A

ABPI ≥ 0.8

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17
Q

Can patients over 74 have bowel screening?

A

They can self refer for faecal immunochemical testing

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18
Q

What is erythroplasia of Queyrat?

A

Insitu squamous cell carcinoma found on the penis

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19
Q

What scoring system is used to predict prognosis in prostate cancer?

A

Gleason score

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20
Q

What is the range of the Gleason score?

A

2 to 10

gives grade from 1 to 5

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21
Q

How to interpret the Gleason score

A

Higher the gleason score the worse the prognosis

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22
Q

What does the Gleason score predict?

A

Prognosis in prostate cancer

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23
Q

Complication of radial prostatectomy

A

Erectile dysfunction

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24
Q

Side effect of radiotherapy for prostate cancer

A

Increased risk of bladder, colon and rectal cancer

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25
Q

Management of cyclical mastalgia

A 
Supportive bra
Oral analgesia
Flaxseed oil 
Evening primrose oil
Refer if affecting QoL
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26
Q

How many breastfeeding women are affected by mastitis?

A

1 in 10

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27
Q

Management of mastitis

A

Continue breastfeeding

Fluclox for 10-14 days

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28
Q

Which BMI should prompt considering batriatric surgery as first line treatment?

A

50

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29
Q

Treatment for hot flushes in men undergoing hormonal treatment for prostate cancer

A

Cyproterone acetate

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30
Q

What medication should be co-prescribed for the first three weeks when starting gonadorelin for prostate cancer?

A

Anti-androgen treatment e.g. cyproterone acetate

Start 3 days before

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31
Q

Most common organism causing mastitis

A

Staphylococcus aureus

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32
Q

Antibiotic choice in mastitis

A

Flucloxacillin

If pen allergic: erythromycin

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33
Q

What percentage of boys/men will get a varicocele?

A

15%

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34
Q

For which symptoms should we offer PSA + PR?

A 
Erectile dysfunction
Haematuria
Lower back pain
Bone pain
Weight loss
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35
Q

What simple test should be done prior to PSA?

A

Urine dipstick to exclude UTI

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36
Q

How long should you wait after UTI before doing PSA testing?

A

1 month

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37
Q

Contraindication to circumcision

A

Hypospadias as foreskin is used in the repair

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38
Q

Removal time for non-absorbable sutures on the face

A

3-5 days

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39
Q

Removal time for non-absorbable sutures on the scalp, limb or chest

A

7-10 days

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40
Q

Removal time for non-absorbable sutures on the hand, foot or back

A

10-14 days

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41
Q

Maximum safe dose of local anaesthetic

A

3mg/kg

Max 200mg
Or max 500mg if contains adrenaline

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42
Q

Features of acute epididymo-orchitis

A

Dysuria, urethral discharge

Tender testicular swelling

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43
Q

Main cause of acute epididymo-orchitis

A

Chlamydia

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44
Q

Which ABPI suggests calcified, stiff arteries?

A

> 1.2

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45
Q

What is a normal ABPI?

A

1.0-1.2

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46
Q

What is an acceptable ABPI?

A

0.9-1.0

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47
Q

What ABPI suggests peripheral arterial disease?

What ABPI suggests severe peripheral arterial disease?

A

<0.9

<0.5 = severe disease

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48
Q

Post procedure VTE prophylaxis in elective hip replacement

A

LMWH for 10 days then aspirin for 28 days

OR LMWH for 28 days

OR rivaroxaban

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49
Q

Post procedure VTE prophylaxis in elective knee replacement

A

Aspirin for 14 days

OR LMWH for 14 days

OR rivaroxaban

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50
Q

Post procedure VTE prophylaxis for fragility fractures of the pelvis, hip and proximal femure

A

28 days with LMWH or fondaparinux

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51
Q

Head injury - who needs immediate CT head?

A

GCS <13 initial assessment

GCS <15 2 hours post injury

Suspected open or depressed skull fracture

Any sign of basal skull fracture

Post traumatic seizure

Focal neuro deficit

> 1 episode vomiting

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52
Q

Head injury - who needs a CT within 8 hours?

A

Age 65+

History of bleeding or clotting disorders

Dangerous mechanism of injury

More than 30 minutes retrograde amnesia of events before injury

Warfarin

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53
Q

Side effects of sildenafil

A

Chest pain

Prolonged painful erections

Postural hypotension

Headaches

Hot flushes

Colour tinge to vision

Blurred vision

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54
Q

Infrapatellar bursitis - typical history

A

Kneeling

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55
Q

Prepatella bursitis - typical history

A

Upright kneeling

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56
Q

Features of anterior cruciate ligament injury

A

Twisting injury
Popping noise
Rapid onset effusion
Positive draw test

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57
Q

Posterior cruciate ligament injury typical history

A

Anterior force applied to proximal tibia

e.g. knee hitting dashboard during RTA

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58
Q

Erb-Duchenne palsy - where is damaged?

A

Upper trunk of brachial plexus

C5, C6

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59
Q

Erb-Duchenne palsy - what is the cause?

A

Shoulder dystocia

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60
Q

Erb-Duchenne palsy - features

A

Arm hangs by side, internally rotated, elbow extended

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61
Q

Klumpke injury - where is damaged?

A

Lower trunk of brachial plexus

C8, T1

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62
Q

Klumpke injury - what is the cause?

A

Shoulder dystocia

Sudden upward jerk of the hand

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63
Q

Peripheral arterial disease - features

A 
Intermittent claudication
Ischaemic rest pain in severe disease
Leg is cold, pale, lack of hair
Weak or absent pulses
Poorly healing wounds
Ulcers
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64
Q

Peripheral arterial disease - investigations

A

Full cardiovascular assessment
ABPI
Doppler ultrasound
CT/MRI aniography

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65
Q

Peripheral arterial disease - when to refer

A

Any doubt re: diagnosis
Severe uncontrolled symptoms
Concerns about critical limb ischaemia
Otherwise healthy young adults

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66
Q

Peripheral arterial disease - management

A

Optimise risk factors
Exercise programme
Naftidrofuryl oxialate
Angioplasty/bypass

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67
Q

Medication that can be used in peripheral arterial disease

A

Naftidrofuryl oxialate

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68
Q

Chronic pancreatitis - causes

A 
Alcohol
Smoking
Genetic
Biliary tract disease
Iatrogenic - ERCP
Abdominal radiotherapy
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69
Q

Chronic pancreatitis - features

A

Epigastric pain radiating to back
Nausea and vomiting
Malabsorption, weight loss
Diabetes

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70
Q

Chronic pancreatitis - investigations

A

Normal amylase
Secretin stimulation test
CT/MRI/MRCP
Pancreatic biopsy

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71
Q

Chronic pancreatitis - management

A

Analgesia
Pancreatic enzymes for malabsorption
Stop alcohol
Surgery

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72
Q

Renal stones - initial management

A

IM diclofenac

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73
Q

Renal stones - initial investigations

A

Urine dipstick and culture
U+E
Non contrast CT KUB

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74
Q

Renal stones - management if <5mm

A

Pass spontaneously

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75
Q

Renal stones - management of ureteric obstruction

A

Nephrostomy

Ureteric stent

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76
Q

Renal stones - management if stone burden <2cm

A

Shockwave lithotripsy

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77
Q

Renal stones - management if stone burden <2cm and pregnant

A

Ureteroscopy

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78
Q

Renal stones - management if complex renal calculi or staghorn calculi

A

Percutaneous nephrolithostomy

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79
Q

Prevention of calcium renal stones

A

Lots of fluids
Low animal protein, low salt
Thiazide diuretics

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80
Q

Prevention of oxalate renal stones

A

Cholestyramine

Pyridoxine

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81
Q

Prevention of uric acid stones

A

Allopurinol

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82
Q

Acute pancreatitis - causes

A

Alcohol
Gallstones
post ERCP
Mumps

Drugs:

  • steroids
  • azathioprine
  • mesalazine
  • sodium valproate
  • bendroflumethiazide
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83
Q

Acute pancreatitis - drug causes

A 
Steroids
Azathioprine
Mesalazine
Sodium valproate
Bendroflumethiazide
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84
Q

Acute pancreatitis - features

A

Severe epigastric pain radiating to the back
Vomiting
Cullen’s sign (umbilicus)
Grey Turner’s sign (flanks)

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85
Q

Acute pancreatitis - investigations

A

Amylase 3x upper limit of normal

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86
Q

Acute pancreatitis - management

A

Analgesia, antiemetics
IV fluids
Severe cases in ITU

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87
Q

Types of colorectal cancer

A

1) Sporadic - 95%
2) Hereditary non-polyposis colorectal cancer - 5%
3) Familial adenomatous polyposis - <1%

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88
Q

What is the screening for colorectal cancer?

A

Faecal immunochemical test = FIT

a type of faecal occult blood test

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89
Q

When do people get screened for colorectal cancer?

A

Age 60-74 in England
Age 50-74 in Scotland

Over 74 can request screening

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90
Q

How regularly do people get screened for colorectal cancer?

A

Every 2 years

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91
Q

What is the outcome at colonoscopy for people called from the screening programme?

IE how many are normal, how many have polyps and how many have cancer

A

5/10 normal
4/10 polyps
1/10 cancer

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92
Q

When to urgently refer for suspected colorectal cancer?

A

≥40 + weight loss + abdo pain

≥50 + unexplained rectal bleeding

≥60 + IDA OR change in bowel habit

Tests show occult blood in faeces

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93
Q

When to consider urgent referral for suspected colorectal cancer?

A

Rectal or abdominal mass

Unexplained anal mass or ulcer

<50 years + rectal bleeding + one of:

  • abdo pain,
  • change in bowel habit,
  • weight loss,
  • IDA
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94
Q

What test should you do for people with new symptoms concerning for colorectal cancer who don’t meet urgent referral criteria?

A

FIT testing

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95
Q

Causes of spontaneous SAH

A

Intracranial aneurysm

AVM

Pituitary apoplexy

Arterial dissection

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96
Q

Medication used in SAH

A

Nimodipine to prevent vasospasm

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97
Q

Voiding symptoms (urinary)

A

Hesitancy

Poor flow

Straining

Incomplete emptying

Terminal dribbling

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98
Q

Storage symptoms (urinary)

A

Urgency
Frequency
Nocturia
Urinary incontinence

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99
Q

Lower urinary tract symptoms in men - examination

A

Urinalysis - infection, haematuria
PR
PSA

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100
Q

Lower urinary tract symptoms in men - what questionnaires should you ask them to do?

A

Urinary frequency-volume chart

International prostate symptom score

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101
Q

Conservative management of voiding symptoms in men

A

Pelvic floor muscle training
Bladder training
Moderate fluid intake

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102
Q

Medical management of voiding symptoms in men

A

Alpha blocker - tamsulosin

If enlarged prostate then 5-alpha reductase inhibitor - finasteride

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103
Q

What type of medication is tamsulosin?

A

Alpha blocker

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104
Q

Give an example of an alpha blocker

A

Tamsulosin

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105
Q

What type of medication is finasteride?

A

5-alpha reductase inhibitor

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106
Q

Give an example of a 5-alpha reductase inhibitor

A

Finasteride

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107
Q

Medical management of mixed voiding and overactive bladder symptoms in men

A

Antimuscarinic - oxybutynin

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108
Q

Give an example of an antimuscarinic

A

Oxybutynin

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109
Q

What type of medication is oxybutynin?

A

Antimuscarinic

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110
Q

Management of nocturia in men

A

Moderate fluid intake at night
Furosemide 40mg in afternoon
Desmopressin

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111
Q

Management of overactive bladder symptoms in men

A

Moderate fluid intake
Bladder training
Antimuscarinic - oxybutynine

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112
Q

What is Scheurmann’s disease?

A

Epiphysitis of vertebral joints

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113
Q

Scheurmann’s disease - presentation

A

Adolescents
Back pain
Stiffness
Progressive kyphosis

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114
Q

Scheurmann’s disease - xrays

A

Epiphyseal plate disturbance

Anterior wedging

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115
Q

Scheurmann’s disease - management

A

PT
Analgesia
Surgery/bracing if severe

116
Q

What is spondylolisthesis?

A

One vertebrae is displaced

117
Q

Management of spondylolisthesis

A

Conservative

If severe = spinal decompression and stabilisation

118
Q

Nipple discharge - features suggesting carcinoma

A

Blood stained

Underlying mass or axillary lymphadenopathy

119
Q

Nipple discharge - features in intraductal papilloma

A

Younger patients
Blood stained discharge
No palpable lump

120
Q

Nipple discharge - features in mammary duct ectasia

A

Menopausal women

Thick green discharge

121
Q

Management of mammary duct ectasia

A

Stop smoking

Total duct excision if severe

122
Q

Causes of proctitis

A

Crohn’s
UC
Clostridium difficile

123
Q

Bacterial causes of anorectal abscess

A

E coli

Staph aureus

124
Q

Most common anal neoplasm

A

Squamous cell carcinoma

125
Q

What is solitary rectal ulcer associated with?

A

Chronic straining and constipation

126
Q

Causes of pruritis ani in children

127
Q

Causes of pruritis ani in adults

A

Idiopathic

Haemorrhoids

128
Q

Features of inguinal hernias

A

Above and medial to pubic tubercle

Strangulation rare

129
Q

When can you return to work after inguinal hernia repair?

Open and lap

A

Open - 2 to 3 weeks

Lap - 1 to 2 weeks

130
Q

Who gets femoral hernias?

A

Mulliparous women

131
Q

Who gets inguinal hernias?

What % of men will get inguinal hernias?

A

Men

Will affect 25% of men

132
Q

Where is a femoral hernia found?

A

Below and lateral to pubic tubercle

133
Q

Management of femoral hernia

A

Surgical repair as high strangulation risk

134
Q

Management of congenital inguinal hernia

A

Repair when identified due to incarceration risk

135
Q

Who gets congenital inguinal hernias?

A

1% term babies

more common in boys and prems

136
Q

Who gets infantile umbilical hernias?

A

Prems

Africo-Caribbean

137
Q

When do infantile umbilical hernias typically resolve by?

138
Q

What is the screening for AAA?

A

Single abdo ultrasound age 65

139
Q

<3cm aortic diameter

A

Normal

no further action

140
Q

3 - 4.4cm aortic diameter

A

Small aneurysm

Scan every 12 months

141
Q

4.5 - 5.4cm aortic diameter

A

Medium aneurysm

Scan every 3 months

142
Q

> 5.4cm aortic diameter

A

Large aneurysm

Urgent 2 week referral to vascular

143
Q

Features of AAA with low rupture risk

A

Asymptomatic

Size <5.5cm

144
Q

Management of AAA with low rupture risk

A

Ultrasound surveillance

Optimise cardiovascular risk factors

145
Q

Features of AAA with high rupture risk

A

Symptomatic
Size ≥5.5cm
Rapidly enlarging >1cm per year

146
Q

Management of AAA with high rupture risk

A

2 week vascular referral

Elective endovascular repair or open surgery

147
Q

Risk factors for AAA

A 
Smoking
HTN
Syphilis
Ehlers Danlos type 1
Marfans
148
Q

Acute bacterial prostatitis - cause

A

Escherichia coli

149
Q

Acute bacterial prostatitis - risk factors

A

Recent UTI
Urogenital instrumentation
Intermittent catheterisation
Recent prostate biopsy

150
Q

Acute bacterial prostatitis - features

A

Pain - perineum, penis, rectum, back
Obstructive voiding symptoms
Fever, rigors

151
Q

Acute bacterial prostatitis - PR findings

A

Tender boggy prostate

152
Q

Acute bacterial prostatitis - management

A

14 days of ciprofloxacin

Screen for STIs

153
Q

Epididymal cysts - features

A

Separate to body of testicle

Posterior to testicle

154
Q

What is the most common scrotal swelling in primary care?

A

Epididymal cysts

155
Q

Epididymal cysts - associations

A

Polycystic kidney disease
Cystic fibrosis
von Hippel-Lindau syndrome

156
Q

Epididymal cysts - diagnosis

A

Ultrasound

157
Q

Epididymal cysts - management

A

Supportive

Surgical removal/sclerotherapy if large and symptomatic

158
Q

What is a hydrocele?

A

Accumulation of fluid within tunica vaginalis

159
Q

Causes of hydrocele

A

Epididymo-orchitis
Testicular torsion
Testicular tumours

160
Q

Features of hydrocele

A

Soft non-tender swelling of hemi-scrotum
Confined to scrotum, can “get above” swelling
Transilluminates

161
Q

Diagnosis of hydrocele

A

Clinical

Ultrasound

162
Q

Management of hydrocele in infants

A

Repair if doesn’t resolve by 1-2 years

163
Q

Management of hydrocele in adults

A

Conservative

Repair if severe

164
Q

Features of fibroadenoma

A

Young women

Discrete non-tender mobile lumps

165
Q

Features of fibroadenosis

A

Middle aged women
Lumpy breasts, may be painful
Symptoms worse prior to menstruation

166
Q

Features of breast cancer on examination

A

Hard, irregular lump
Nipple inversion
Skin tethering

167
Q

Features of paget’s disease of the nipple

A

Redding and thickening of the nipple

Looks like ecsema

168
Q

Features of duct papilloma

A

blood stained discharge

169
Q

Features of mammary duct ectasia

A

Around menopause
Tender lump around nipple
Green nipple discharge

170
Q

Features of fat necrosis in the breast

A

Obese women
Trivial or unnoticed trauma
Firm and hard lesion causing hard, irregular breast lump

171
Q

Two main categories of testicular cancers

A

1) Germ cell tumours - 95%

2) Non-germ cell tumours

172
Q

Types of germ cell testicular tumours

A

1) Seminomas

2) Non-seminomas

173
Q

Types of non-seminoma testicular tumours

A

Embryonal
Yolk sac
Teratoma
Choriocarcinoma

174
Q

Types of non-germ cell testicular tumours

A

Sarcomas

Leydig cell tumours

175
Q

Presentation of testicular tumours

A

Painless lump
May have pain
Hydrocele
Gynaecomastia

176
Q

Tumour markers in testicular cancer

A

HCG (in seminomas and non-seminomas)

AFP (in non-seminomas)

LDH (in germ cell tumours)

177
Q

Diagnosis of testicular tumours

A

Ultrasound

178
Q

Prognosis of testicular tumours

A

Seminomas 95% 5 year if stage 1

Teratomas 85% 5 year if stage 1

179
Q

Management of testicular tumours

A

Orchidectomy

Chemo/radiotherapy

180
Q

Peak incidence of teratomas

181
Q

Peak incidence of seminomas

182
Q

Risk factors for testicular tumours

A 
Infertility
Cryptorchidism
FHx
Klinefelter's syndrome
Mumps orchitis
183
Q

Who to refer urgently for suspected breast cancer?

A

Age >30 + unexplained lump, with or without pain

Age >50 + nipple discharge, nipple retraction or skin changes

184
Q

Who to consider referring urgently for suspected breast cancer?

A

Skin changes

Age >30 + axillary lump

185
Q

Who to refer routinely to the breast clinic?

A

Age <30 + unexplained breast lump, without or without pain

186
Q

Biological treatment for HER2 positive breast cancer

A

Herceptin (trastuzumab)

187
Q

When is herceptin used?

A

HER2 positive breast cancer

188
Q

Contraindications of herceptin

A

heart disorders

189
Q

Hormonal therapy for hormone receptor positive breast cancer in pre and perimenopausal women

190
Q

How long to prescribe tamoxifen in pre and perimenopausal women?

191
Q

Side effects of tamoxifen

A

Increased endometrial cancer
VTE
Menopausal symptoms
Reduced bone mineral density

192
Q

Hormonal therapy for hormone receptor positive breast cancer in post menopausal women

A

Anastrozole - an aromatase inhibitor

193
Q

Who gets screened for breast cancer?

A

Age 47-73 years
Every 3 years
Can ask for appointment if age over 70

194
Q

Which features in the history should prompt referral to breast clinic in a person with one 1st/2nd degree relative?

A 
Diagnosis <40
Bilateral 
Male
Ovarian ca
Jewish ancestry
Sarcoma in relative <45
Glioma or childhood adrenal cortical ca
Complicated pattern of multiple cancers at young age
2+ relatives on fathers side
195
Q

Which relatives affected by breast cancer should prompt referral to breast clinic?

A

1st degree female <40
1st degree male any age
1st degree bilateral breast ca with first <50
2x 1st degree or 1st degree + 2nd degree
1st degree + 2nd degree with ovarian ca at any age
3x 1st degree or 3x 2nd degree

196
Q

Grade 1 haemorrhoids

A

Do not prolapse

197
Q

Grade 2 haemorrhoids

A

Prolapse on defecation but reduce spontaneously

198
Q

Grade 3 haemorrhoids

A

Can be manually reduced

199
Q

Grade 4 haemorrhoids

A

Can’t be reduced

200
Q

Features of haemorrhoids

A

Painless rectal bleeding
Can be painful
Pruritis

201
Q

Management of haemorrhoids

A

Soften stool
Topical anaesthetics + steroids
Rubber band ligation
Surgery

202
Q

Thrombosed haemorrhoids - presentation

A

Significant pain and tender lump

Purple oedematous subcutaneous perianal mass

203
Q

Thrombosed haemorrhoids - management

A

within 72 hours can refer for excision
Stool softeners
Ice packs
Analagesia

204
Q

Superficial thrombophlebitis - risk factors

A 
Varicose veins
Thrombophilia
IV cannulation
Pregnancy 
Cancer
205
Q

Superficial thrombophlebitis - features

A

Pain, itchy, erythema of skin
Hardening of surrounding soft tissue
Pigmentation changes

206
Q

Superficial thrombophlebitis - investigations

A

Doppler US to exclude DVT

207
Q

Superficial thrombophlebitis - management

A

NSAIDs

Compression stockings - ABPI first

LMWH for 30 days or fondaparinux for 45 days

If affecting saphenofemoral junction then anticoagulate for 6-12 weeks

208
Q

Balanitis - general treatment

A

Gentile saline washes
Wash under foreskin
1% hydrocortisone

209
Q

Candida balanitis - features

A

Itchy

White discharge

210
Q

Candida balanitis - management

A

14 days of topical clotrimazole

211
Q

Contact/allergic dermatitis balanitis - features

A

Itchy, painful

Clear discharge

212
Q

Contact/allergic dermatitis balanitis - management

A

Mild potency topical steroids - hydrocortisone

213
Q

Anaerobic balanitis - features

A

Very offensive yellow discharge

214
Q

Anaerobic balanitis - management

A

Saline washes

Oral/topical metronidazole

215
Q

Bacterial balanitis - features

A

Painful

Yellow discharge

216
Q

Bacterial balanitis - main cause

217
Q

Bacterial balanitis - management

A

Oral flucloxacillin

Clarithromycin if penicillin allergic

218
Q

Lichen planus balanitis - features

A

Itchy
Wickham’s striae
Violaceous papules

219
Q

Plasma cell balanitis of zoon - features

A

Middle aged/old men
Not itchy
Clearly circumscribed areas of inflammation

220
Q

Plasma cell balanitis of zoon - management

A

High potency steroids - clobetasol
Circumcision
CO2 laser therapy

221
Q

What is another name of lichen sclerosus balanitis?

A

Balanitis xerotica obliterans

222
Q

What is balanitis xerotica obliterans also known as?

A

lichen sclerosus balanitis

223
Q

Balanitis xerotica obliterans - features

A

Itchy
White patches
Scarring

224
Q

Balanitis xerotica obliterans - management

A

High potency topical steroids - clobetasol

Circumcision

225
Q

Circinate balanitis - features

A

Painless erosions

Associated with reactive arthritis

226
Q

Circinate balanitis - management

A

Mild potency steroids - hydrocortisone

227
Q

Bladder cancer - risk factors

A

Smoking
Exposure to hydrocarbons
Schistosomiasis

228
Q

Bladder cancer - types

A

Transitional cell carcinoma (90%)
Squamous cell carcinoma (higher rate in areas with schistosomiasis)
Adenocarcinoma

229
Q

Bladder cancer - presentation

A

Painless macroscopic haematuria

Incidental microscopic haematuria

230
Q

Bladder cancer - investigations

A 
Cytoscopy
Biopsy
TURBT
Pelvic MRI for local spread
CT for distant spread
231
Q

Bladder cancer - management

A

Superficial lesions managed with TURBT
Intravesical chemotherapy
Radical cystectomy + ileal conduit
Radiotherapy

232
Q

What is priapism?

A

Persistent penile erection >4 hours not associated with sexual stimulation

233
Q

Types of priapism

A

Ischaemic - impaired vasorelaxation, trapped deoxygenated blood in corpus cavernosa

Non-ischaemic - typically fistula due to trauma or congenital causing high arterial inflow

234
Q

Priapism - causes

A

Idiopathic

Sickle cell

Erectile dysfunction medication

Cocaine, ecstasy, cannabis

Trauma

235
Q

Priapism - management

A

Aspiration of blood
Intercavernosal injection of vasoconstrictor
Surgery if all else fails

236
Q

Prostate cancer - risk factors

A

Increasing age
Obesity
Afro-Caribbean
Family history

237
Q

Prostate cancer - features

A

Asymptomatic if localised
Bladder outlet obstruction = hesitany, urinary retention
Haematuria, haematospermia
Back, perineal or tesitcular pain

238
Q

Prostate cancer - PR findings

A

Asymmetrical, hard, nodular enlargement

Loss of median sulcus

239
Q

Prostate cancer - investigations

A

Multiparametric MRI first line

If Linkert score ≥3 then prostate biopsy

If Linkert score 1-2 then discuss pros/cons of biopsy

240
Q

Side effects of transrectal US guided prostate biopsy

A

Sepsis
Pain for more than 2 weeks in 15%, severe in 7%
Fever
Haematuria and rectal bleeding

241
Q

Prostate cancer - management

A

Localised = monitor, radical prostatectomy, radiotherapy

Localised advanced = hormone therapy, radical prostatectomy, radiotherapy

242
Q

Prostate cancer - hormone therapy options

A

Anti-androgen therapy

  • synthetic GnRH agonist e.g. goserelin
  • bilateral orchidectomy
243
Q

What percentage of people with a PSA rise have prostate cancer?

A

PSA 4-10 then 33%

PSA 10-20 then 60%

244
Q

What percentage of people with prostate ca have normal PSA?

245
Q

Age adjusted limits for PSA

A

50-59 years = 3.0

60-69 years = 4.0

70+ years = 5.0

246
Q

When do NICE say to refer urgently for suspected prostate ca?

A

Men 50-69 with PSA ≥3.0

Or abnormal PR exam

247
Q

Causes of raised PSA

A

Prostate ca

BPH

Prostatitis and UTI

Ejaculation

Vigorous exercise

Urinary retention

Instrumentation of urinary tract

248
Q

How long to wait after prostatitis or UTI before testing PSA?

249
Q

How long to wait after ejaculation before testing PSA?

250
Q

How long to wait after vigorous exercise before testing PSA?

251
Q

Varicocele - features

A

‘bag of worms’

Subfertility

252
Q

Varicocele - what percentage are left sided?

253
Q

Variocele - diagnosis

A

ultrasound

254
Q

Varicocele - management

A

Conservative
Surgery if lots of pain
Refer if isolated right sided varicocele

255
Q

Varicocele - does surgery improve chances of pregnancy?

256
Q

Erectile dysfunction - factors favouring organic cause

A

Gradual onset
Lack of engorgement
Normal libido

257
Q

Erectile dysfunction - factors favouring psychogenic cause

A 
Sudden onset
Decreased libido
Good spontaneous or self stimulated erections
Major life events
Problems/changes in relationships
Previous psychological problems
History of premature ejaculation
258
Q

Erectile dysfunction - drug causes

A

SSRIs

beta blockers

259
Q

Erectile dysfunction - investigations

A

Calculate 10 year cardiovascular risk - so need to test lipids and fasting glucose

Free testosterone - if abnormal then recheck free testosterone with FSH, LH and prolactin

260
Q

Erectile dysfunction - what bloods?

A

Lipids, fasting glucose, free testosterone

261
Q

Erectile dysfunction - management

A

Sildenafil (viagra)
Vacuum erection devices
Refer to urology if ALWAYS had problems
Don’t cycle more than 3 hours per week

262
Q

What type of drug is sildenafil?

A

PDE-5 inhibitor

263
Q

Anal fissure - features

A

Painful, bright red rectal bleeding
90% in posterior midline
Consider sinister underlying cause if located elsewhere

264
Q

Anal fissure - when does it become chronic?

265
Q

Anal fissure - risk factors

A 
Constipation
Inflammatory bowel disease
HIV
Syphilis
Herpes
266
Q

Anal fissure - acute management

A

Soften stool - high fibre diet, high fluid, bulk forming laxatives (fybogel)
Lube before defecation
Topical anaesthetics
Analgesia

267
Q

Anal fissure - chronic management

A

Topical GTN

Refer to secondary care if topical GTN not effective after 8 weeks for surgery or botox

268
Q

Varicose veins - risk factors

A

Increasing age
Female
Pregnancy
Obesity

269
Q

Varicose veins - features

A 
Aching, itching
Varicose eczema
Lipodermatosclerosis
Haemosiderin deposition
Bleeding
Superficial thrombophlebitis
Venous ulcers
DVT
270
Q

Varicose veins - management

A

Conservative = elevate leg, weight loss, graduated compression stocks

In secondary care = endothermal ablation, foam slcerotherapy, surgery

271
Q

Varicose veins - when to refer

A 
Significant symptoms
Bleeding
Skin changes
Superficial thrombophlebitis
Active or healing venous leg ulcers
272
Q

What percentage of men have BPH?

A

50% at age 50

80% at age 80

273
Q

BPH features

A

Lower urinary tract symptoms

Voiding (obstructive) = weak flow, straining, hesitancy, terminal dribbling

Storage (irritative) = urgency, frequency, incontinenace, nocturia

Post-micturation dribbling

274
Q

BPH complications

A

UTI
Urinary retention
Obstructive uropathy

275
Q

BPH - management

A

Watchful waiting
Alpha-1 antagonists = tamsulosin
5-alpha reductase inhibitors = finasteride
Surgery (TURP)

276
Q

What is an example of an alpha-1 antagonist?

A

Tamsulosin

277
Q

What type of drug is tamsulosin?

A

Alpha-1 antagonist

278
Q

What is an example of a 5 alpha reductase inhibitor?

A

Finasteride

279
Q

How does tamsulosin work?

A

Reduces smooth muscle tone

280
Q

1st line medication for BPH

A

Tamsulosin (alpha-1 antagonist), reduces smooth muscle tone

Improvement in 70%

281
Q

Side effects of tamsulosin

A

Dizziness
Postural hypotension
Dry mouth
Depression

282
Q

How does finasteride work?

A

Reduces prostate volume, slows disease progression

283
Q

How long does finasteride take to work?

284
Q

Side effects of finasteride

A

Erectile dysfunction
Reduced libido
Ejaculation problems
Gynaecomastia

285
Q

Effect of finasteride on PSA

A

Reduces PSA

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