GU, Renal and Breast

Question 1

Normal urine output?

Answer 1

1ml/kg/hour, normally 1.5-2 - around 800mls-2L per day if drinking 2L of water

Question 2

What are the most common herniae?

Answer 2

Indirect inguinal

Question 3

What are indirect inguinal herniae?

Answer 3

Herniation through deep inguinal ring, through inguinal canal towards scrotum

Question 4

What are direct inguinal herniae?

Answer 4

Herniation straight through weakness in abdominal wall (Hasselbachs triangle)

Question 5

6 differentials for groin swelling?

Answer 5

Hernia
Lymphadenopathy
Saphenovarix
Femoral aneurysm
Ectopic testicle 
Lipoma/Fibroma/sebaceous cyst

Question 6

3 differentials for a testicular swelling that you can’t get above?

Answer 6

Means it’s not true testicular - varicocoele, inguinal hernia, torsion

Question 7

3 main causes of a true testicular swelling (can get above)?

Answer 7

Hydrocoele
Tumour
Epididymorchitis

Question 8

What investigation is nearly always diagnostic in testicular swellings?

Answer 8

USS

Question 9

What is the risk of not surgically operating on a hernia?

Answer 9

Risk of strangulation

Question 10

Differentiating between direct and indirect inguinal hernia?

Answer 10

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

Question 11

What is Paget’s disease of breast?

Answer 11

Eczema-like Sx around unilateral nipple indicating a rare type of breast cancer

Question 12

Signs typical of a breast cancer?

Answer 12

Solid asymmetrical mass with irregular surface
Painless
Tethering at surface - dimpling, peau d’orange or fixation

Question 13

Signs suggestive of fibroadenoma of breast?

Answer 13

‘Breast mice’ - rubbery, small, smooth and very mobile
Younger women
Benign overgrowths of terminal duct lobules

Question 14

What are fibrocystic breast changes?

Answer 14

Cyclical and related to menstrual cycle - bilateral, upper outer quadrants
Often like fibroadenomas but painful

Question 15

What is fat necrosis of the breast?

Answer 15

Trauma-related (including biopsy or ultrasound)

Firm round lumps, may look inflamed or dimpled

Question 16

How might a breast access present?

Answer 16

Painful and inflamed

May occur with breast feeding, nipple damage

Question 17

Breast lump which is solid and painless, irregular surface with overlying dimpling?

Answer 17

Cancer

Question 18

Painful breast lumps with often occur symmetrically in UO quadrant, cyclically and related to menopause?

Answer 18

Fibrocystic changes

Question 19

Small, rubbery painless breast lumps which are freely mobile in the breast?

Answer 19

Fibroadenoma

Question 20

Breast lump presenting following a biopsy or US or other trauma, showing signs of inflammation?

Answer 20

Fat necrosis

Question 21

3 major differentials for an acute swollen painful red testicle?

Answer 21

Testicular torsion
Mumps orchitis
Epididymorchitis

Question 22

Where in the testicle does a hydrocoele form?

Answer 22

In the tunica vaginalis (anterior)

Question 23

What is a varicocoele?

Answer 23

Varicosities of the pampiniform plexus which extend down into the testes (bag of worms which you can’t get above)

Question 24

3 indications for catheterisation?

Answer 24

Need to monitor UO
Relieve acute retention
Incontinence or immobility

Question 25

2 most common causes of urethritis?

Answer 25

Gonorrhoea | Chlamydia

Question 26

Major symptoms of urethritis?

Answer 26

Dysuria Discharge Stuff like dyspareunia

Question 27

Which of gonorrhoea and chlamydia are usually symptomatic?

Answer 27

``` Gonorrhoea more often symptomatic Chlamydia not (which is why it is randomly screened for) ```

Question 28

Investigate process for urethritis Sx?

Answer 28

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

Question 29

Management of gonorrhoea?

Answer 29

Ceftriaxone IM and single dose azithromycin

Question 30

Management of chlamydia?

Answer 30

Doxycycline for 7 days or stat dose azithromycin

Question 31

Potentially serious complications of gonorrhoea/chlamydia infection in women?

Answer 31

PID Bartholin's abscess Neonatal conjunctivitis

Question 32

Potentially serious complications of gonorrhoea and chlamydia in men and women?

Answer 32

Disseminated infection | Fitz-Hugh-Curtis syndrome (perihepatitis)

Question 33

Potential complication of gonorrhoea/chlamydia in men only?

Answer 33

Epididymo-orchitis or prostatitis

Question 34

3 infective causes of vaginal discharge?

Answer 34

BV Candidiasis Trichomonas

Question 35

Describe the discharge in BV?

Answer 35

Grey, often malodorous

Question 36

2 RFs for BV?

Answer 36

WSW | IVDU

Question 37

Investigations for BV?

Answer 37

``` Sniff test (KOH) Swab - clue cells on smear ```

Question 38

Rx for BV if necessary?

Answer 38

Metronidazole

Question 39

Describe the discharge in candidiasis?

Answer 39

White, non-smelly | Associated with itch, pain, fissuring etc.

Question 40

RFs for vaginal candidiasis?

Answer 40

Poor hygiene | Immunosuppression - DM, pregnancy, steroids, HIV etc.

Question 41

Describe the discharge in trichomonas infection?

Answer 41

Malodorous and white, profuse and commonly very itchy

Question 42

In what type of man is trichomonas often symptomatic?

Answer 42

Afro-Caribbean

Question 43

5 most infective common causes of genital ulcers?

Answer 43

``` HSV Syphillis Scabies Chancroid Lymphogranuloma ```

Question 44

Which HSV causes which type of ulcer?

Answer 44

``` HSV1 = oral HSV2 = genital ```

Question 45

Early symptoms of acute Syphillis infection?

Answer 45

Genital ulcers (sore = primary chankre) Rash (palmar-plantar) Painless lymphadenopathy Deranged LFTs

Question 46

Late symptoms of Syphillis infection?

Answer 46

CN incl neurosyphillis | Gummatous liver Syphillis

Question 47

2 lab tests for Syphillis?

Answer 47

VDRL | Treponemal IgG EIA

Question 48

Common causes of genital warts?

Answer 48

HPV (6 and 11)

Question 49

What cause of genital warts can be spread amongst school children and appear on arms etc?

Answer 49

Molloscum contagiosum

Question 50

6 causes of urinary retention?

Answer 50

BPH Prostatitis Prostatic or other pelvic malignancy Urethral stricture - infection or trauma Neurogenic bladder - cauda equina, MS, PD Medications - Anticholinergics e.g. Oxybutinine, tolterodine

Question 51

What should you document in the catheter notes?

Answer 51

``` 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. ```