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Definitions > Gynae 2 > Flashcards

Gynae 2 Flashcards

1
Q

hydrocoele

A

Defined as a collection of fluid within the tunica vaginalis (between the visceral and parietal layers) of the testis

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2
Q

congenital hydrocele

A

Communicating (“vogbreuk”) Infantile/fluid hernia
Interstitial
Cord

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3
Q

acquired primary hydrocele

A

Idiopathic (aetiology not known)

Imbalance between the fluid secretion and absorption (decreased) of the tunica vaginalis

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4
Q

acquired secondary hydrocele

A 
Infection
Trauma
Tumor
Torsion
Abnormalities in inguinal lymph nodes
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5
Q

hydrocele Rx

A

Communicating- May close spontaneously
Tying off the patent processus vaginalis

Primary- Hydrocelectomy
Aspiration + injection of sclerosing agent
Secondary- Treat underlying pathology

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6
Q

differentiating btwn hydrocele and inguinal hernia

A

hydrocele- palpable cord above mass, transclucent, fluctuate, fluid thrill
inguinal hernia- testis palpable, cough impulse, reducible, bowel sounds

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7
Q

colour of fluid of supratesticular cystic masses

A

Cord hydrocele- Straw color

Spermatocele- Milky or Grey opaque (barleywater) Epididymis cyst- Clear

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8
Q

varicocele

A

Defined as an abnormal dilatation of the veins of the pampiniform plexus of the spermatic cord

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9
Q

varicocele aetiology

A

Abnormality/absence of the venous valves
Left spermatic vein joining the left renal vein directly at a 90° angle
Longer left spermatic vein with increased hydrostatic pressure
Pressure of superior mesenteric artery on the left renal vein (Nutcracker phenomenon)

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10
Q

varicocele sx and s/s

A

Complaints of a scrotal mass (“Bag of worms”)
Complaints of scrotal discomfort
Fertility problems
Smaller left testis (atrophy

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11
Q

varicocele classification

A

Primary- Abnormality of valves in the spermatic vein
Secondary- Tumor of the left kidney (Tumor thrombus from renal cell CA)
Retro-peritoneal masses
Trauma

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12
Q

varicocele Rx

A

Spermatic venography plus embolisation with heated contrast/resin/coils (Antegrade or retrograde procedure)
Surgery- Open (Ivanissevitch, Paloma)
Laparoscopic

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13
Q

risk factors of penis cancer

A

Smoking
UV radiation
Foreskin (Phimosis, poor hygiene, smegma)
HPV infection 16 & 18

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14
Q

penis cancer presentation

A

A sore that fails to heal
Induration
Phimosis – obscures it and grows undetected
Rarely – mass, ulceration , suppuration or haemorrhage from inguinal mets
Usual delay in presentation due to Embarrassment, fear

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15
Q

Natural history of penis cancer

A

Begins as small lesion, papillary & exophytic or flat & ulcerative
Pattern in lymphatic spread
Metastatic nodes cause erosion into vessels, skin necrosis, chronic infection
Distant metastasis uncommon
Death within 2 years for untreated patients

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16
Q

Condyloma Acuminatum facts

A

Genital warts related to HPV (16 & 18)
Associated with SCC
Soft, multiple lesion on glans, prepuce & shaft
Dx: Biopsy
Treatment: Podophyllin, fulgaration, cryotherapy

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17
Q

Erythroplasia of Queyrat – non keratinising

A

Occur on glans
Red velvety circumscribed painless lesion
May ulcerate and painful – 10X more likely to progress than Bowen’s disease

Treatment- Penile preserving – topical 5-FU or imiquimod
Laser
Mohs surgery

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18
Q

Balanitis Xerotica Obliterans

A

Lichen sclerosis et atrophicus
>10% - penile cancer
White patch on glans and prepuce. Also meatus Aetiology – chronic infection, phimosis
Treatment – Steroid cream, Surgical

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19
Q

Bowenoid papulosis

A 
Resembles carcinoma in situ
Multiple papules or flat glanular lesion
Dx – biopsy
sx- pruritis, burning, dysuria
Treatment - electrodesiccation, cryotherapy, laser, topical 5-fluorouracil cream, excision with skin grafting
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20
Q

Giant condyloma acuminata – BuscheLowenstein tumour

A

Displaces, invades ad destroys adjacent structures
No metastasis
Treat wide excision

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21
Q

other penile CA condition

A

Cutaneous horn – extreme hyperkeratosis
Psuedo-epitheliomatous micaceous & keratotic balanitis
Leukoplakia – whitish lanular plaque invove meatus

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22
Q

renal tumours presentation

A

Classic triad- hematuria, pain and a flank mass
Para-neoplastic syndrome
Varicocele

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23
Q

renal tumours Rx

A

Surgery
Renal tumors are notoriously radio-resistant
Novel therapies are at present only investigational- Cryotherapy, Radiofrequency ablation, HIFU

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24
Q

testicular CA

A

35 years old male
hemoptysis, abdominal discomfort
no child
Big R testis , normal Left testis

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25
Q

testicular CA Risk Factors

A 
Previous history of testicular tumour
UDT
Infertility
Atrophic testis
CIS (carcinoma in situ)
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26
Q

testicular CA aetiology

A 
Gonadal dysgenesis
Environmental factors
Chemical carcinogens
Infections
7-10% in undescended testis- dysgenesis, high temperature, abnormal blood supply, endocrine dysfunction
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27
Q

testicular CA classification

A

Germ cell- Seminoma -Non seminoma: Teratocarcinoma, Yolk sac tumour, Choriocarcinoma, Embryonal, Mixed variant

Non Germ cell- Leydig cell, Sertoli cell, Sarcoma, Leukaemia, Lymphoma, Metastasis

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28
Q

Non-seminoma tumour facts

A

Choriocarcinoma- Can present with extensive metastasiss with paradoxically small primary
Teratoma- mature and immature elements
Yolk sac tumour- In infants and young children

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29
Q

Frequency of testicular CA types

A

Seminoma, Embryonal Carcinoma, Teratocarcinoma Teratoma, Mixed, Choriocarcinoma

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30
Q

secondary tumours

A

Lymphoma
Leukaemic infiltration
Metastasis- prostate, breast, kidney

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31
Q

testicular CA presentation

A

50% have metastasis at diagnosis- Neck mass, respiratory, GIT, bone pain, neurological, lower extremities
Heavy feeling or painless swelling around testicular region
acute testicular pain
Gynaecomastia

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32
Q

Metastasis of testicular CA primary “landing zone”

A

left-sided tumours: para-aortic, left renal hilar lymph nodes
right-sided: inter-aortocaval and paracaval nodes

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33
Q

testicular CA Treatment

A 
Multimodal- Radical orchidectomy
Radiotherapy
Chemotherapy
Retroperitoneal lymph node dissection
Follow up 
(surgical approach is inguinal)
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34
Q

Risk of incontinence

A 
Abdominoperineal resection
Polio (almost always recovers) 
Diabetic neuropathy
Lumbar disc disease
Stroke 
Meningomyelocele
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35
Q

risk factors of bladder tumours

A 
Smoking 
Chemical exposure – exposure to carcinogen – Dye, rubber, aluminium, leather
Radiation - pelvic
Chemotherapy cyclophosphamide
Bladder.Parisitic infection
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36
Q

Clinical presentation of bladder & upper tract tumours

A

Haematuria – painless
LUTS – Dysuria, urgency, Frequency
Pelvic pain – advanced disease

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37
Q

urothelial tumours mx

A

Superficial low grade disease – Resection or fulgeration
Superficial high grade disease – Resection or fulgeration – Intravesical immune therapy: BCG installations
– Intravesical chemotherapy: Mitomycin C Installations

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38
Q

Management - TCC

A

Muscle invasive disease
– Clinically resectable: pelvic lymph adenectomy + radical cystectomy + urinary diversion, Partial cystectomy
– Clinically unresectable: Radiation therapy, Chemotherapy + re-assessment regarding salvage surgery

Metastatic disease – Chemotherapy: Methotrexate,vinblastine,doxorubicin,cisplatin
Newer agents = Taxoids,gemcitabine

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39
Q

Management - SquamousCa of bladder

A

Resectable – Pelvic lymphadenectomy + radical cystectomy + urinary diversion
Unresectable – Radiation

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40
Q

upper tract tumours presentation and mx

A

Haematuria, Flank pain, Colic pain, Flank mass, Weight loss

Mx- Gold standard: Nephro-ureteroctomy and cuff of bladder

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41
Q

CausesofabnormalSHBGinmales&females

A

decr- obesity, hypothyroidism, PCOS, high doses of glucocorticoids, androgens

icr- anorexia nervosa, hyperthyroidism, liver dz, anit convulsants, oestrogens

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42
Q

Symptomsandsignsofmalehypogonadism

A

physical- gynocomastia, decr muscle mass aand/or BMD
psychological- depression, lack of energy
sexual- erectile dysfunction, decr libido

43
Q

countries with highest rates of femicide

A 
hondura
jamaica
lesotho
RSA
guinea bissau
44
Q

Intimate Partner Violence

A

IPV includes physical violence, sexual violence, stalking and psychological
aggression by a current or former intimate partner (spouse,
boyfriend/girlfriend, dating partner or ongoing sexual partner)

45
Q

risk factors for IPV

A

Individual risk factors- younger age, intellectual disability
Relationship risk factors- separated relationship status, marital disagreements
Community risk factors- high levels of crime, poverty and unemploymen
Social risk factors- gender inequality, devaluation of women

46
Q

protocol for IPV assessment

A

Screen in a safe setting with the woman alon
Use professional language interpreters
Incorporate screening for IPV into routine medical history
Keep printed take home resources such as hotline numbers

47
Q

Documentation

A

encounters may become forensic evidence of the abuse
Direct quotations and photos should be included after informed consent is given by patient
Complete documentation should include the history, timeline, examination, symptoms, witnesses and results of imaging and laboratory studies as well as referrals and law enforcement notification

48
Q

Belmont report 3 core principles

A

respect for persons
Beneficence
Justice

49
Q

virtue

A

A dispositional trait of character that is socially valuable and reliably
present in a person, and a moral virtue is a dispositional trait of
character that is morally valuable and reliably present

50
Q

The cardinal virtues

A

courage, prudence, temperance, and justice

51
Q

B&C five virtues

A

applicable to the medical practitioner:
trustworthiness, integrity, discernment, compassion, and
conscientiousness

52
Q

Conservative management of female sexual dysfunction

A

Lifestyle changes such as weight loss, decreasing
fatigue, stress management, and smoking/alcohol
cessation
Manage contributary co morbidities.
Physical therapy and pelvic floor rehabilitation
Psychological intervention: Couples and individual
counselling, sex therapy, psychiatry

53
Q

medical management of female sexual dysfunction

A 
Hormone therapy
Serotinergic/dopaminergic agents
Apomorphine
Bremelanotide
Phosphodiesterase inhibitors
54
Q

medical management of female sexual dysfunction GPPD

A 
Topical anaesthetics, hormones
Ospemifine
Antidepressants
Oral neuropathic pain meds i.e Gabapentin
Botox
Injectable steroids
Vaginal laser therapy
Vestibulectomy
55
Q

acute pelvic pain Also seen with disorders of

A

gastrointestinal
Urinary
Musculoskeletal systems

56
Q

most probable causes of acute pelvic pain 0-21yrs

A 
dysmenorrhea
PID
ovarian cysts
rupture
haemorrage
57
Q

most probable causes of acute pelvic pain 21-35yrs

A 
ovarian cystes
endometriosis
pregnancy
spontaneous abortion
ectopic pregnancy
58
Q

most probable causes of acute pelvic pain 35yrs to menopause

A 
uterine fibroids
endometriosis
ovarian cancer/tumour
pregnancy
abortion
59
Q

progesterone in leiomyomas

A 
Results in increased cell
proliferation and survival
and enhancement of
extracellular matrix
formation
60
Q

Renal colic

A
  • Acute flank pain
  • On and off character (traditional definition)
  • Loin to groin radiation
  • Associated n+v
61
Q

referred pain of renal colic

A 
gastric
liver and biliary
colonic
ureteral and kidney
diaphragmatic irritation
62
Q

renal colic causes

A 
Renal
• Benign
-infective- pyelonephritis
perinephric abscess
• Malignant
-renal cell carcinoma
Non-renal
• Bowel related-
-appendicitis (rt sided pain)
-diverticulitis
Gynae related-
-p.i.d
-ectopic pregnancy
63
Q

renal colic mx

A 
• Conservative management
Medical Expulsive Therapy (MET)
• Intervention
- Minimally invasive- ESWL
- Endoscopic- stenting- retrograde stent
insertion
- Ureterorenoscopy + lithotripsy
64
Q

Indications for surgical intervention in renal colic

A
  • Obstructive calculus with Infection
  • Solitary kidney with calculus
  • Bilateral ureteric calculus obstruction
  • Renal insufficiency with calculi
  • Intractable pain
  • Failed conservative management
65
Q

Relative indications for surgical intervention in renal colic

A

• Occupational- high risk duty like pilots
• Abberant anatomy- ureterocele, ectopic
kidneys, post-reimplantation ureters.

66
Q

what composition of stones is suited to which procedure

A
  • ESWL- wedelite- CaOx Dihydrate

- URS- brushite (colorless to pale yellow monoclinic prismatic crystals), cysteine, whewelite -hydrated calcium oxalate

67
Q

most common renal stones formed

A

calcium
struvite
uric acid
cysteine

68
Q

ureterorenoscopic complications

A

Early: mucosal injury
• ureteral perforation
• bleeding
• avulsion

Late: stricturing sepsis
• reflux hematuria
• persistence of colic

69
Q

Renal colic in pregnancy

A
  • Be as conservative as possible
  • Severe colic: u/s
  • if fails,
  • limited Intravenous pyelogram (control,x2films)
  • Mx- URS (ESWL is c/i)
  • holmium YAG preferable (smaller penetr)
70
Q

Renal colic in children

A

• Amenable to ESWL, URS
• Small calibre ureter, urethra, ESWL bias
Stone types- ?cysteine; ?brushite
calcium oxalate stones and calcium phosphate stones, are the most common types of kidney stones in children

71
Q

viral STI

A 
Common
– HIV-1 & 2
– HSV 1 & 2*
– HPV*
– HBV

• Less common
– HCV
– Molluscum contagiosum*
– CMV (in immunosuppressed individuals)*

72
Q

HIV TRANSMISSION (through genital mucosa)

A

direct penetration
transcytosis
infx of Langerhans cells

73
Q

Factors influencing sexual transmission of HIV

A
  • High HIV viral load
  • Other STIs - ↑ CD4 lymphocytes, genital ulcers
  • Female gender – at ↑ risk than males
  • Circumcision status - ↑ risk in uncircumcised men
  • Vaginal tears – during sexual intercourse
74
Q

HIV transmission routes high to low

A 
blood products
IV drugs
penile anal 
needle stick
penile vaginal
75
Q

genital herpes Complications

A 
– recurrency
– aseptic meningitis
– meningo-encephalitis
– urinary retention
– transmission to the foetus/neonate
76
Q

HSV Treatment & prophylaxis

A

• Acyclovir, Valacyclovir*, Famcyclovir for 7 days
– Early antiviral treatment alleviates symptoms &
prevents serious complications
• Resistant infections: Foscarnet, Cidofovir

77
Q

pathophysiology of stricture

A 
Noxious stimulus (bacterial, chemical, physical)
Denuded epithelium
Squamous metaplasia
Fissures develop in epithelium
Urine extravasation
Fibrosis develops in the corpus spongiosum
Fibrotic plaques coalesce
Stricture
78
Q

Aetiology of strictures

A

Congenital
Acquired
• Infections
• Trauma

79
Q

Clinical presentation of strictures

A 
• Obstructive /Irritative LUTS
• Urinary tract infections
• Acute urinary retention
• Overflow incontinence
• Renal failure
• Haematuria
Asymptomatic
80
Q

Non invasive tests for stricture

A

Uroflow
SONAR- Useful for bulbar
strictures? limited

81
Q

invasive tests for stricture

A 
Catheterisation
• Radiology
– Contrast studies- retrograde urethrogram,
voiding cystogram.
• VCUG
• Urethrocystoscopy
– urethral
– suprapubic
– Does not show length
82
Q

Rx of stricutures

A 
• Optical urethrotomy
• Dilatation
• Laser urethrotomy (holmium:YAG laser)
• Urethroplasty
– One stage
– Two stage
83
Q

complications of penile fracture

A 
 Sepsis/ abscess
 Urine leak
 Venogenic e.d
 Acquired lateral curvature
 Recurrence of fracture
84
Q

Rx of penile fracture

A 
Optimize the surgical exposure.
Evacuate the hematom
Identify the site of injury.
Correct the defect in the tunica albuginea.
Repair the urethral injury
85
Q

Mx- penile amputation

A 
 Sterile saline-soaked gauze
 Salvage 18 hours
 Microvascular repair- artery, nerve
 Tunical repair- interrupted sutures
 Urethra, if involved: 2 layer repair over catheter
86
Q

Botched circumcision

A

Penile stumps
Perineal urethrostomies
Psychological morbidity, body-image issues among previously fit young men

87
Q

Technicalities of transplant

A

 1,5mm cavernosal artery reanastomosis
 Full sensation not yet achieved (may take up to 2yrs)
 Indefinite immunosuppressive medication
 Ethical, social concerns

88
Q

Testicular and scrotal injuries

A

 Blunt (85%)
 Penetrating (10-15%; gsw and stabs)
 Avulsion (work-related)

 Causes: sport-related
 self-mutilation
 animal-bites

89
Q

mx of bites to testicules

A 
Mx- dog bites- irrigate, debride
primary closure
a/b- prev- Pen V + cephalexin
ATT
antirabies vaccine
 Human bites- n.b- do not close primarily
90
Q

Scrotal trauma

A

 <50% surface area- primary closure
 If extensive- delay closure- thigh pouch
 Reconstruction – local skin flaps- medial thigh
rectus

91
Q

Mechanisms of injury in urter

A

• Traumatic- blunt vs penetrating

• Iatrogenic- more common cause of injury- gynaecologic
urologic- endoscopic, open
general surg
radiation related

92
Q

imaging in ureteral injuries

A
  • non-invasive
    IVP- ? obsolete
    CT ivp – gold standard
  • Invasive
    Retrograde pyelogram
    Antegrade pyelogram (where nephrostomy present)
93
Q

Management of ureteric injury

A
  • Stent insertion
  • Primary Anastomosis- ureteroureterostomy
  • Transureteroureterostomy
  • Ureteric reimplantation
  • Urinary diversion; percutaneous or ureterostomy
94
Q

Jj stent insertion

A

• Incomplete/partial ureteric stenosis
• Post ureteric repair- ureteroneocystostomy
uretero-ureterostomy

95
Q

complications of transureteroureterostomy/ Ileal interposition

A 
• Early:
Urinomas
Retroperitoneal abscesses
• Late:
Ureteric strictures - renal damage
fistulae
96
Q

Mechanisms of injury to bladder

A 
• Traumatic
- blunt; *MVA most common cause- pelvic fracture
blow/kick to full bladder
fall from height
- Penetrating; GSW
stab
- Iatrogenic; gynae- hysterectomy, c/s
uro- open
endoscopic- e.g turbt
laparoscopic
97
Q

Principles of intraperitoneal repair

A
  • Avoid pelvic hematoma; stay midline
  • Visualise u.o’s
  • Post-op drainage
  • Catheter 7 to 10 days; then cystogram
98
Q

Indications for open repair

A
  • Intraperitoneal rupture
  • Laparatomy for other reasons- ortho- open pelvic # needing orif
  • Penetrating injury
  • Bladder neck injury
  • Rectal or vaginal injury
  • Spicules in bladder
  • Relative- unresolving gross hematuria
99
Q

Surgical options for urethral stricture

disease

A

• Urethral dilation
• Internal urethrotomy- cold knife, laser
• Permanent urethral stents
• Open reconstruction- primary repair
tissue transfer repair technics- buccal, preputial, bladder, t.vaginalis

100
Q

Surgical options for delayed repair

A

• Endoscopic-
‘cutting to the light’
• Open- perineal approach
• transpubic approach

101
Q

Risk Factorsfor POP

A

Aging
Menopause
Pregnancy & parity ( esp. associated prolonged labour, instrumental
delivery, big baby, episiotomy)
Obesity
Chronic constipation
Genetic factors ( connective tissue disorders; Ehlers Danlos, Marfan)

102
Q

metabolic acidosis causes

A

Diarrhea (loss of HCO3)
– Diabetic ketoacidosis
– Renal failure

103
Q

High anion gap metabolic acidosis

A
  • M = methanol
  • U = uraemia
  • D = diabetic ketoacidosis
  • P = propylene glycol (in diazepam inj)
  • I = isoniazid
  • L = lactic acidosis
  • E = ethylene glycol / ethonol
  • S = salicylates

• CUTE DIMPLES (includes cyanide & Touline)

104
Q

Imaging modalities for the urinary tract

A 
• Radiography
• Ultrasound
• Computed Tomography (CT)
• Magnetic Resonance Imaging
(MRI)
• Angiography/Intervention
• Nuclear Medicine

Definitions (11 decks)

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