GU, Renal and Breast Flashcards
Normal urine output?
1ml/kg/hour, normally 1.5-2 - around 800mls-2L per day if drinking 2L of water
What are the most common herniae?
Indirect inguinal
What are indirect inguinal herniae?
Herniation through deep inguinal ring, through inguinal canal towards scrotum
What are direct inguinal herniae?
Herniation straight through weakness in abdominal wall (Hasselbachs triangle)
6 differentials for groin swelling?
Hernia Lymphadenopathy Saphenovarix Femoral aneurysm Ectopic testicle Lipoma/Fibroma/sebaceous cyst
3 differentials for a testicular swelling that you can’t get above?
Means it’s not true testicular - varicocoele, inguinal hernia, torsion
3 main causes of a true testicular swelling (can get above)?
Hydrocoele
Tumour
Epididymorchitis
What investigation is nearly always diagnostic in testicular swellings?
USS
What is the risk of not surgically operating on a hernia?
Risk of strangulation
Differentiating between direct and indirect inguinal hernia?
Reduce and apply pressure over mid inguinal point (deep inguinal ring) - get patient to cough, if it reappears then it is direct and if it doesn’t it is indirect
What is Paget’s disease of breast?
Eczema-like Sx around unilateral nipple indicating a rare type of breast cancer
Signs typical of a breast cancer?
Solid asymmetrical mass with irregular surface
Painless
Tethering at surface - dimpling, peau d’orange or fixation
Signs suggestive of fibroadenoma of breast?
‘Breast mice’ - rubbery, small, smooth and very mobile
Younger women
Benign overgrowths of terminal duct lobules
What are fibrocystic breast changes?
Cyclical and related to menstrual cycle - bilateral, upper outer quadrants
Often like fibroadenomas but painful
What is fat necrosis of the breast?
Trauma-related (including biopsy or ultrasound)
Firm round lumps, may look inflamed or dimpled
How might a breast access present?
Painful and inflamed
May occur with breast feeding, nipple damage
Breast lump which is solid and painless, irregular surface with overlying dimpling?
Cancer
Painful breast lumps with often occur symmetrically in UO quadrant, cyclically and related to menopause?
Fibrocystic changes
Small, rubbery painless breast lumps which are freely mobile in the breast?
Fibroadenoma
Breast lump presenting following a biopsy or US or other trauma, showing signs of inflammation?
Fat necrosis
3 major differentials for an acute swollen painful red testicle?
Testicular torsion
Mumps orchitis
Epididymorchitis
Where in the testicle does a hydrocoele form?
In the tunica vaginalis (anterior)
What is a varicocoele?
Varicosities of the pampiniform plexus which extend down into the testes (bag of worms which you can’t get above)
3 indications for catheterisation?
Need to monitor UO
Relieve acute retention
Incontinence or immobility
2 most common causes of urethritis?
Gonorrhoea
Chlamydia
Major symptoms of urethritis?
Dysuria
Discharge
Stuff like dyspareunia
Which of gonorrhoea and chlamydia are usually symptomatic?
Gonorrhoea more often symptomatic Chlamydia not (which is why it is randomly screened for)
Investigate process for urethritis Sx?
Urethral swab and gram stain for N gonorrhoea (gram -ve intracell diplococci) - if not = non-gonococcal urethritis
PCR for chlamydia - if not = non-specific urethritis
Management of gonorrhoea?
Ceftriaxone IM and single dose azithromycin
Management of chlamydia?
Doxycycline for 7 days or stat dose azithromycin
Potentially serious complications of gonorrhoea/chlamydia infection in women?
PID
Bartholin’s abscess
Neonatal conjunctivitis
Potentially serious complications of gonorrhoea and chlamydia in men and women?
Disseminated infection
Fitz-Hugh-Curtis syndrome (perihepatitis)
Potential complication of gonorrhoea/chlamydia in men only?
Epididymo-orchitis or prostatitis
3 infective causes of vaginal discharge?
BV
Candidiasis
Trichomonas
Describe the discharge in BV?
Grey, often malodorous
2 RFs for BV?
WSW
IVDU
Investigations for BV?
Sniff test (KOH) Swab - clue cells on smear
Rx for BV if necessary?
Metronidazole
Describe the discharge in candidiasis?
White, non-smelly
Associated with itch, pain, fissuring etc.
RFs for vaginal candidiasis?
Poor hygiene
Immunosuppression - DM, pregnancy, steroids, HIV etc.
Describe the discharge in trichomonas infection?
Malodorous and white, profuse and commonly very itchy
In what type of man is trichomonas often symptomatic?
Afro-Caribbean
5 most infective common causes of genital ulcers?
HSV Syphillis Scabies Chancroid Lymphogranuloma
Which HSV causes which type of ulcer?
HSV1 = oral HSV2 = genital
Early symptoms of acute Syphillis infection?
Genital ulcers (sore = primary chankre)
Rash (palmar-plantar)
Painless lymphadenopathy
Deranged LFTs
Late symptoms of Syphillis infection?
CN incl neurosyphillis
Gummatous liver Syphillis
2 lab tests for Syphillis?
VDRL
Treponemal IgG EIA
Common causes of genital warts?
HPV (6 and 11)
What cause of genital warts can be spread amongst school children and appear on arms etc?
Molloscum contagiosum
6 causes of urinary retention?
BPH
Prostatitis
Prostatic or other pelvic malignancy
Urethral stricture - infection or trauma
Neurogenic bladder - cauda equina, MS, PD
Medications - Anticholinergics e.g. Oxybutinine, tolterodine
What should you document in the catheter notes?
Time, date Size and material of catheter, expiry date Any problems inserting Colour of urine obtained Amount of fluid syringed into balloon Residual volume Name date signature etc.
