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Medicine and Surgery Mushkies > Passmed Breast, Vascular and Urology Mushkies > Flashcards

Passmed Breast, Vascular and Urology Mushkies Flashcards

1
Q

Fibroadenoma description?

A

Discrete, non-tender, highly mobile lumps

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2
Q

‘Lumpy’ breasts that worsen prior to menstruation?

A

Fibroadenosis

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3
Q

Fibroadenosis aka?

A

Fibrocystic disease or Benign mammary dysplasia

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4
Q

Paget’s disease of the breast?

A

Intraductal carcinoma associated with a reddening and thickening (may resemble eczematous changes) of the nipple/areola

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5
Q

Mammary duct ectasia defn?

A
  1. Dilatation and shortening of the terminal breast ducts within 3cm of the nipple
  2. Most common around the menopause
  3. May present with a tender lump around the areola +/- a green nipple discharge
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6
Q

Blood stained breast discharge?

A

Duct papilloma

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7
Q

Duct papilloma defn?

A

Local areas of epithelial proliferation in the large mammary ducts, that are hyperplastic lesions rather than malignant or premalignant

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8
Q

Rash starting on nipple and spreads outwards involving the areola?

A

Paget’s disease of the nipple

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9
Q

5 possible breast surgery mx?

A
  1. Surgery
  2. Radio
  3. Chemo
  4. Hormone therapy
  5. Biological therapy
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10
Q

What determines breast Ca mx prior to surgery?

A

The presence/absence of axillary lymph nodes

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11
Q

Breast ca pt who presents with clinically palpable lymphadenopathy mx?

A

Axillary node clearance at primary surgery

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12
Q

2 s/e of axillary node clearance?

A
  1. Arm lymphoedema

2. Functional arm impairment

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13
Q

Breast Ca pt with no palpable axillary lymphadenopathy mx?

A

Pre-operative axillary US before primary surgery –> if positive then should have sentinel node biopsy to assess nodal burden

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14
Q

4 indications for mastectomy?

A
  1. Multifocal tumour
  2. Central tumour
  3. Large lesion in small breast
  4. DCIS > 4cm
  5. Pt choice
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15
Q

4 indications for wide local excision?

A
  1. Solitary lesion
  2. Peripheral tumour
  3. Small lesion in large breast
  4. DCIS < 4cm
  5. Pt choice
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16
Q

When is whole breast radiotherapy recommended?

A
  1. After a WLE (reduced risk of recurrence by around 2/3rds)

2. After a mastectomy if T3-T4 tumour/4+ positive axillary nodes

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17
Q

When is adjuvant hormone therapy given for breast ca?

A

If tumours are positive for hormone receptors

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18
Q

When is tamoxifen used?

A

In pre and peri-menopausal women

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19
Q

Oetrogen receptor positive Ca in post-menopausal woman?

A

Aromatase inhibitor e.g. Anastrozole/Letrozole

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20
Q

3 s/e of tamoxifen?

A
  1. Increased risk of endometrial cancer
  2. VTE
  3. Menopausal sx
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21
Q

Most common biological therapy for Breast Ca?

A

Herceptin (Trastuzumab) if HER2 positive

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22
Q

Trastuzumab C/I?

A

If Hx of heart disorders

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23
Q

Fat necrosis pt features?

A

More common in obese women with large breasts, following trivial or unnoticed trauma

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24
Q

Duct ectasia pathophysiology?

A

Shortening and widening of the terminal breast ducts around the nipple, typically around menopause as the breasts undergo involution

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25
Q

Brown-green nipple discharge?

A

Duct ectasia

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26
Q

6 causes of nipple discharge?

A
  1. Physiological e.g, breastfeeding
  2. Galactorrhoea
  3. Hyperprolactinaemia
  4. Mammary duct ectasia
  5. Carcinoma
  6. Intraductal papilloma
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27
Q

M for mammography scoring system?

A
  1. No abnormality
  2. Abnormality with benign fx
  3. Intermediate probably benign
  4. Intermediate probably malignant
  5. Malignant
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28
Q

Breast surgery if tumour <4cm?

A

Usually WLE

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29
Q

Breast surgery if tumour >4cm?

A

Usually mastectomy

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30
Q

Inflammatory breast cancer stage?

A

T4d

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31
Q

Breast cancer staging?

A
  1. T1 = <2cm
  2. T2 = 2-5cm
  3. T3 = 5+cm
  4. T4a = invades chest wall
  5. T4b = invades skin
  6. T4c = invades chest wall and skin
  7. T4d = inflammatory breast cancer
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32
Q

Most common type of breast ca?

A

Invasive ductal carcinoma

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33
Q

Survival after breast cancer scoring?

A

Nottingham Prognostic Index

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34
Q

Nottingham Prognostic Index calculation?

A

(Tumour size x 0.2) + Lymph node score + Grade score

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35
Q

Snowstorm sign on US of axillary lymph node?

A

Extracapsular breast implant rupture

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36
Q

Periductal mastitis fx?

A
  1. Present w/ inflammation, abscess or mammary duct fistula
  2. Strongly associated with smoking
  3. Usually tx w/ abx, abscess will require drainage
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37
Q

Bilateral, small volumes of pale discharge in a young girl?

A

Hormonal changes of puberty

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38
Q

Any increase in risk of malignancy with fibroadenomas?

A

No

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39
Q

Phyllodes tumours mx?

A

WLE

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40
Q

Breast cyst mx?

A

Aspiration

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41
Q

Sclerosing adenosis defn?

A

benign proliferative condition of the terminal duct lobular units characterised by an increased number of acini and their glands

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42
Q

Duct papilloma mx?

A

Microdochectomy

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43
Q

Why aromatase inhibitors for mx of post-menopausal breast ca?

A

Aromatisation accounts for the majority of oestrogen production in post-menopausal women

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44
Q

Paget’s disease of the nipple associated with?

A

Invasive ductal carcinoma

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45
Q

Soft consistency breast ca that has a grey, gelatinous surface macroscopically?

A

Mucinous carcinoma

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46
Q

Comedo necrosis is a feature of?

A

High grade DCIS

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47
Q

Non-surgical option to manage axillary metastases?

A

Axillary radiotherapy

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48
Q

What chemo is used in breast Ca pts who are node +ive?

A

FEC-D chemotherapy

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49
Q

Symmetrical slit like retraction of the nipple?

A

Duct ectasia, as the ducts shorten and dilate

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50
Q

Halo sign on mammogram?

A

Breast cyst

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51
Q

Fibroadenoma >4cm mx?

A

Core biopsy to exclude a Phyllodes tumour

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52
Q

Natural hx of fibroadenomas?

A
  1. 10% will increase in size
  2. 30% regress
  3. Remainder stay the same
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53
Q

Breast screening?

A

Mammogram every 3 years from 47-73 y/o

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54
Q

Progressive erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP?

A

Inflammatory breast cancer

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55
Q

When does one do surgical excision for a breast fibroadenoma?

A

If >3cm

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56
Q

What % of breast cancers do BRCA1/2 account for?

A

5-10%

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57
Q

BRCA mutation inheritance?

A

AD

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58
Q

RFs for breast Ca?

A
  1. BRCA1/2
  2. Nulliparity
  3. Early menarche
  4. Late menopause
  5. Past breast cancer
  6. Not breastfeeding
  7. Ionising radiation
  8. Obesity
  9. p53 gene mutations
  10. COCP/Combined HRT
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59
Q

NACT?

A

Neoadjuvant chemotherapy

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60
Q

Periductal mastitis mx?

A

Co-amoxiclav

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61
Q

Mondor’s disease of the breast?

A

Localised thrombophlebitis of a breast vein

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62
Q

Invasive ductal carcinoma aka?

A

No special type (NST)

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63
Q

Inflammatory breast ca pathophysiology?

A

Cancerous cells block the lymph drainage, resulting in an inflamed appearance of the breast

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64
Q

Triple negative breast cancer?

A

Tests negative for oestrogen receptors, progesterone receptors, and excess HER2 protein

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65
Q

What % of breast cancers are triple negative?

A

10-20%

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66
Q

How is bladder voiding measured?

A

Urodynamic studies

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67
Q

Classification of LUTS in men?

A
  1. Voiding
  2. Storage
  3. Post-micturition
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68
Q

Voiding LUTS in men?

A
  1. Poor stream
  2. Hesitancy
  3. Incomplete emptying
  4. Terminal dribbling
  5. Straining
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69
Q

Storage LUTS in men?

A
  1. Frequency
  2. Urgency
  3. Nocturia
  4. Incontinence
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70
Q

Post-micturition LUTS in men?

A
  1. Post-micturition dribbling

2. Sensation of incomplete emptying

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71
Q

IPSS?

A

International prostate symptom score (mild, moderate, severe impact on pts life)

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72
Q

Mx of voiding LUTS?

A
  1. Conservative = PFMT, bladder training, prudent fluid intake
  2. Medical = alpha blocker
    a. enlarged prostate –> 5a-reductase inhibitor
    b. mixed voiding and strorage sx –> antimuscarinic added
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73
Q

Mx of overactive bladder in men?

A
  1. Conservative = moderate fluid intake, bladder retraining
  2. Medical = oxybutinin, tolterodine, darifenacin (all antimuscarinics)
    a. Mirabegron = 2nd line
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74
Q

Nocturia mx?

A
  1. Moderating fluid intake at night
  2. Furosemide 40mg in late afternoon may be considered
  3. Desmopressin
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75
Q

What is PSA?

A

A serine protease enzyme produced by normal and malignant prostate epithelial cells

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76
Q

Causes of raised PSA?

A
  1. Infection = prostatitis and UTI
  2. Inflammation = BPH
  3. Malignancy
  4. Ejaculation (in past 48 hours)
  5. Vigorous exercise (in past 48 hours)
  6. Urinary retention
  7. Instrumentation of the urinary tract
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77
Q

Which renal stones are radiolucent?

A

Urate and xanthine

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78
Q

Which renal stones are semi-opaque?

A

Cystine stones

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79
Q

Testicular torsion presentation?

A

A unilateral swollen and retracted testicle with loss of the cremasteric reflex

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80
Q

Testicular torsion defn?

A

A twist of the spermatic cord, resulting in testicular ischaemia and necrosis

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81
Q

Testicular torsion epidemiology?

A

Males aged 10-30

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82
Q

Bell clapper testis?

A

Failure of normal posterior anchoring of the gubernaculum, epididymis and testis is called a bell clapper deformity because it leaves the testis free to swing and rotate within the tunica vaginalis of the scrotum much like the gong (clapper) inside of a bell.

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83
Q

Erectile dysfunction definition?

A

A persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance, it is a symptoms not a disease

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84
Q

Classification of causes of ED?

A
  1. Organic
  2. Psychogenic
  3. Mixed
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85
Q

3 factors favouring an organic cause of erectile dysfunction?

A
  1. Gradual onset of symptoms
  2. Lack of tumescence
  3. Normal libido
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86
Q

2 drugs that cause ED?

A
  1. SSRIs

2. BBs

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87
Q

RFs for ED?

A
  1. CVS = obesity, DM, dyslipidaemia, metabolic syndrome, smoking, HTN
  2. Alcohol use
  3. Drugs = SSRIs, BBs
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88
Q

ED Ix?

A
  1. QRISK score

2. Free testosterone between 9 and 11am

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89
Q

Mx of ED?

A
  1. PDE-5 inhibitors e.g. sildafenil

2. Vacuum erection devices if cant/wont take PDE-5 inhibitor

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90
Q

Causes of hyndronephrosis classification?

A
  1. Unilateral

2. Bilateral

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91
Q

Unilateral causes of hydronephrosis?

A

PACT

  1. Pelvic-ureteric obstruction (cong/acquired)
  2. Aberrant renal vessels
  3. Calculi
  4. Tumours of renal pelvis
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92
Q

Bilateral causes of hydronephrosis?

A

SUPER

  1. Stenosis of the urethra
  2. Urethral valve
  3. Prostatic enlargement
  4. Extensive bladder tumour
  5. Retro-peritoneal fibrosis
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93
Q

Hydronephrosis Ix?

A
  1. US
  2. IV urogram = assess position of obstruction
  3. Antegrade/retrograde pyelography = allows tx
  4. CT KUB if stones
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94
Q

Mx of hydronephrosis?

A

Remove obstruction and urine drainage

  1. Acute upper urinary tract obstruction = nephrostomy tube
  2. Chronic upper urinary tract obstruction = ureteric stent/pyelopasty
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95
Q

BPH ethnicity?

A

Black > White > Asian

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96
Q

BPH age?

A
  1. Around 50% 50 y/o men will have evidence of BPH and 30% will have symptoms.
  2. Around 80% of 80 year old men have evidence of BPH.
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97
Q

How does BPH present?

A

Voiding symptoms, storage symptoms, and post-micturition symptoms

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98
Q

What are 3 complications of BPH?

A
  1. UTIs
  2. Retention
  3. Obstructive uropathy
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99
Q

Mx of BPH?

A
  1. Conservative = watchful waiting
  2. Medical = alpha-1 antagonists (1st line), 5a-reductase inhibitors
  3. Surgical = TURP
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100
Q

Trial that supported combination use of a1 antagonist and 5a reductase inhibitors?

A

MTOPS trial = Medical Therapy of Prostatic Symptoms

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101
Q

2 examples of alpha-1 antagonists?

A

Tamsulosin and alfuzosin

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102
Q

Tamsulosin MOA?

A

Alpha 1 antagonist that decreases smooth muscle tone of the prostate and bladder, improves sx in 70% of BPH

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103
Q

4 s/e of tamsulosin?

A

DDD P

  1. Dizziness
  2. Postural hypotension
  3. Dry mouth
  4. Depression
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104
Q

Example of 5 alpha reductase inhibitor?

A

Finasteride

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105
Q

Finasteride MOA?

A
  1. 5 alpha reductase inhibitor that blocks the conversion of testosterone to DHT, which is known to induce BPH
  2. Unlike alpha-1 antagonists causes a reduction in prostate volume and hence may slow disease progression. This however takes time and symptoms may not improve for 6 months. They may also decrease PSA concentrations by up to 50%
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106
Q

4 s/e of finasteride?

A

E LEG

  1. Erectile dysfunction
  2. Reduced libido
  3. Ejaculation problems
  4. Gynaecomastia
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107
Q

How does proteus cause staghorn calculi?

A

It has a urease producing enzyme. This will tend to favor urinary alkalinisation which is a relative pre-requisite for the formation of staghorn calculi.

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108
Q

5 types of renal stone?

A
  1. Calcium Oxalate
  2. Struvite (MAP)
  3. Uric Acid
  4. Calcium Phosphate
  5. Cystine
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109
Q

3 causes of calcium oxalate stones?

A
  1. Hypercalcuria
  2. Hyperoxaluria
  3. Hypercitraturia (citrate forms complexes with calcium, making it more soluble)
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110
Q

Cause of MAP (struvite) stones?

A
  1. Occur as a result of urease producing bacteria (and are thus associated with chronic infections)
  2. Under the alkaline conditions produced, the crystals can precipitate
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111
Q

Uric acid stones pathophysiology?

A
  1. Uric acid is a product of purine metabolism
  2. May precipitate when urinary pH low
  3. May be caused by diseases with extensive tissue breakdown e.g. malignancy
  4. More common in children with inborn errors of metabolism
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112
Q

Calcium phosphate stone causes?

A
  1. May occur in renal tubular acidosis, high urinary pH increases supersaturation of urine with calcium and phosphate
  2. Renal tubular acidosis types 1 and 3 increase risk of stone formation (types 2 and 4 do not)
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113
Q

Cystine stone pathophysiology?

A

Inherited recessive disorder of transmembrane cystine transport leading to decreased absorption of cystine from intestine and renal tubule
Multiple stones may form

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114
Q

pH variation of urine?

A

Urine pH will show individual variation (from pH 5-7). Post prandially the pH falls as purine metabolism will produce uric acid. Then the urine becomes more alkaline (alkaline tide).

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115
Q

Renal lesion in tuberous sclerosis?

A

Angiomyolipoma

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116
Q

Renal cell carcinoma presentation?

A

Haematuria in 50%

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117
Q

2 paraneoplastic features of renal cell carcinoma?

A

HTN and polycythaemia

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118
Q

Renal cell carcinoma spread mechanism?

A

Haematogenous metastasis

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119
Q

Mx of renal cell carcinoma?

A

Radical or partial nephrectomy

120
Q

Most common extracranial tumour of childhood?

A

Neuroblastoma

121
Q

Transitional cell carcinoma distribution?

A
  1. 90% of lower urinary tract tumours, but only 10% of renal tumours
122
Q

Transitional cell carcinoma occupation?

A

Industrial dyes and rubber chemicals

123
Q

Mx of transitional cell carcinoma?

A

Radical nephroureterectomy

124
Q

Angiomyolipoma defn?

A

A tumour composed of blood vessels, smooth muscle and fat

125
Q

Acute urinary retention defn?

A

When a person suddenly, over a period of hours or less, becomes unable to voluntarily pass urine

126
Q

5 medications that can cause acute urinary retention?

A
  1. Anticholinergics
  2. TCAs
  3. Antihistamines
  4. Opioids
  5. Benzodiazepines
127
Q

Dx of acute urinary retention?

A

A volume >300cc on Bladder US

128
Q

Mx of acute urinary retention?

A

Decompressing bladder via catheterisation

129
Q

1st line investigation in suspected prostate cancer?

A

Multiparametric MRI, NOT TRUS biopsy

130
Q

5 complications of TRUS biopsy?

A
  1. Pain
  2. Fever
  3. Haematuria
  4. Rectal bleeding
  5. Sepsis
131
Q

How are multiparametric MRI scores reported?

A

5 point Likert scale

132
Q

Most common form of prostate cancer?

A

Adenocarcinoma

133
Q

Normal upper limit for PSA?

A

4ng/ml

134
Q

Grading of Prostate cancer?

A

Gleason score (2-10)

135
Q

Lymphatic spread of prostate cancer?

A

First to the obturator nodes

136
Q

Mx of prostate cancer?

A
  1. Conservative
  2. Radiotherapy
  3. Hormonal therapy
  4. Surgery
137
Q

What pts get conservative mx of prostate ca?

A

Watch and wait for elderly, multiple co-morbidities, low Gleason score

138
Q

Radiotherapy types for prostate ca?

A

Curative and palliative

139
Q

2 complications of prostate ca radiotherapy?

A
  1. Radiation proctitis

2. Rectal malignancy

140
Q

S/e of radical prostatectomy?

A

ED

141
Q

Hormonal tx for prostate ca?

A
  1. LHRH analogues
  2. Anti-androgens
  3. Combination of the 2
142
Q

Candidates for active surveillance of prostate ca should have what done?

A
  1. At least 10 biopsy cores taken

2. At least one re-biopsy

143
Q

Ix for renal colic?

A

Non-contrast CT KUB

144
Q

What do staghorn calculi involve?

A

The renal pelvis and extend into at least 2 calyces

145
Q

1st line Ix of testicular mass?

A

US

146
Q

Most common malignancy in men aged 20-30 y/o?

A

Testicular cancer

147
Q

Classification of testicular cancer?

A
  1. Germ cell tumours (95%)

2. Non-germ cell tumours

148
Q

Germ cell tumours?

A
  1. Seminomas

2. Non-seminomas

149
Q

Non-seminomas?

A
  1. Embryonal
  2. Yolk sac
  3. Teratoma
  4. Choriocarcinoma
150
Q

Non-germ cell tumours?

A
  1. Leydig cell

2. Sarcomas

151
Q

Peak incidence of teratomas?

A

25 y/o

152
Q

Peak incidence of seminomas?

A

35 y/o

153
Q

5 RFs for testicular cancer?

A
  1. Infertility
  2. Cryptorchidism
  3. FHx
  4. Klinefelter’s
  5. Mumps orchitis
154
Q

Most common presentation of testicular cancer?

A

Painless lump

155
Q

Testicular cancer markers?

A
  1. AFP = 60% germ cell tumours
  2. LDH in 40% germ cell tumours
  3. hCG in 20% seminomas
156
Q

Mx of testicular cancer?

A
  1. Orchidectomy
  2. Chemo
  3. Radio
157
Q

Prognosis of testicular cancer?

A

Generally excellent

158
Q

4 RFS for prostate cancer?

A
  1. Increasing age
  2. Obesity
  3. Afro-Caribbean
  4. FHx
159
Q

Prostate ca on DRE?

A

Asymmetrical, hard, nodular enlargement with loss of median sulcus

160
Q

Unresolving left varicocoele?

A

Renal tract cancer, due to embryological anatomy linking the left renal vein and the left testicular vein

161
Q

Most common renal cancer/

A

Clear cell

162
Q

4 associations of renal cancer?

A
  1. Middle aged men
  2. Smoking
  3. vHL
  4. TS
163
Q

Classical triad of renal cell carcinoma?

A
  1. Haematuria
  2. Loin pain
  3. Abdominal mass
164
Q

4 endo features of renal cell carcinoma?

A
  1. EPO –> polycthaemia
  2. PTH –> hypercalcaemia
  3. Renin
  4. ACTH
165
Q

Stauffer syndrome?

A

Paraneoplastic hepatic dysfunction syndrome in renal cell carcinoma, presenting as cholestasis/hepatosplenomegaly, thought to be secondary to increased levels of IL6

166
Q

Prehn’s sign?

A

Relief of pain on elevation of the testis, a sign of epididymo-orchitis

167
Q

Mx of epididymo-orchitis?

A

Ceftriaxone 500mg IM single dose AND Doxycycline 100mg BD 10-14d

168
Q

Most common cause of scrotal swelling in primary care?

A

Epididymal cyst

169
Q

3 conditions associated with epididymal cysts?

A
  1. PCKD
  2. CF
  3. vHL
170
Q

Hydrocoele defn?

A

Accumulation of fluid within the tunica vaginalis

171
Q

Classification of hydrocoeles?

A
  1. Communicating

2. Non-communicating

172
Q

Communicating hydrocoele?

A
  1. Caused by patency of the processus vaginalis allowing peritoneal fluid to drain down into the scrotum.
  2. Communicating hydroceles are common in newborn males (clinically apparent in 5-10%) and usually resolve within the first few months of life
173
Q

Non-communicating hydrocoeles?

A

Caused by excessive fluid production within the tunica vaginalis

174
Q

3 secondary causes of hydroceles?

A
  1. Epididymo-orchitis
  2. Testicular torsion
  3. Testicular tumours
175
Q

Bag of worms?

A

Varicocoele

176
Q

Mx of varicocoele?

A
  1. Usually conservative

2. Surgery if pt is troubled by pain

177
Q

80% of varicocoeles on which side?

A

Left

178
Q

1st line mx of pts with chronic urinary retention?

A

Intermittent self catheterisation

179
Q

What has better prognosis out of seminomas and teratomas?

A

Seminomas

180
Q

Useful Ix for priapism?

A

Cavernosal blood gas analysis to differentiate b/w ischaemic and non-ischaemic priapism to further guide mx

181
Q

Priapism defn?

A

A persistent penile erection not associated with sexual stimulation

182
Q

Ischaemic priapism pahophysiology?

A

Ischaemic priapism is typically due to impaired vasorelaxation and therefore reduced vascular outflow resulting in congestion and trapping of de-oxygenated blood within the corpus cavernosa

183
Q

Non-ischaemic priapism pathophysiology?

A

Non-ischaemic priapism is due to high arterial inflow, typically due to fistula formation often either as the result of congenital or traumatic mechanisms.

184
Q

Causes of priapism?

A
  1. Idiopathic
  2. SCD/haemoglobinopathies
  3. ED mx = sildafenil, intercavernosal injected therapies
  4. Trauma
  5. Drugs prescribed = anti-HTN/coagulants/depressants
  6. Drugs recreational = cocaine, cannabis, ecstasy
185
Q

Non-ischaemic priapism 1st line Mx?

A

Not a medical emergency, usually suitable for observation

186
Q

Ischaemic priapism mx?

A

Medical emergency

  1. If the priapism has lasted longer than 4 hours, the first-line treatment is aspiration of blood from the cavernosa, this is often combined with injection of a saline flush to help clear viscous blood that has pooled.
  2. If aspiration and injection fails, then intracavernosal injection of a vasoconstrictive agent such as phenylephrine is used and repeated at 5 minute intervals.
  3. If medical therapy fails then surgical options can be considered.
187
Q

Renal stones associated with an inherited metabolic disorder?

A

Cystine

188
Q

1st line analgesia for renal colic?

A

NSAIDs (parenteral e.g. 75mg IM diclofenac)

189
Q

Mx of renal stones?

A
  1. <5mm = will usually pass spontaneously within 4 weeks
  2. ESWL
  3. Ureteroscopy (in pregnant woman who cant have ESWL)
  4. Percutaneous nephrolithotomy
190
Q

Mx of Stone burden less than 2cm in aggregate?

A

Lithotripsy

191
Q

Mx of Stone burden of less than 2cm in pregnant females?

A

Ureterosocopy

192
Q

Mx of Complex renal calculi and staghorn calculi?

A

Percutaneous nephrolithotomy

193
Q

Mx of Ureteric calculi less than 5mm?

A

Manage expectantly

194
Q

Prevention of uric acid stones?

A
  1. Allopurinol

2. Urinary alkalinisation e.g. oral bicarbonate

195
Q

Prevention of oxalate stones?

A

Cholestyramine and pyridoxine reduces urinary oxalate secretion

196
Q

Prevention of calcium stones?

A
  1. High fluid intake
  2. Low animal protein, low salt diet
  3. Thiazide diuretics
197
Q

Mx of infantile hydroceles?

A

Infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years

198
Q

Most common cause of acute epididymo-orchitis?

A

Chlamydia

199
Q

Testicular malignancy surgery route?

A

Orchidectomy via inguinal approach, to allow high ligation of the testicular vessels and avoid exposure of another lymphatic field to the tumour

200
Q

LHRH agonist for prostate ca?

A

Goserelin (Zoladex), cover with anti-androgen to prevent rise in testosterone e.g. flutamide

201
Q

Anti-androgen for prostate Ca?

A

Cyproterone acetate prevents DHT binding from intracytoplasmic protein complexes

202
Q

Pelvic fracture and lower abdominal peritonism?

A

Bladder rupture

203
Q

Pelvic fracture and highly displaced prostate?

A

Membranous urethral rupture

204
Q

Worse LUTS after being started on goserelin?

A

During the first stages of treatment, goserelin may cause a transient increase in symptoms of prostatic cancer. This is known as the ‘flare effect’ and is caused by an initial increase in luteinizing hormone production prior to receptor down-regulation.

Flutamide, a synthetic antiandrogen, can be used preemptively to attenuate the tumour flare through its antagonistic effects at androgen receptors.

205
Q

PSA can be done how long after a prostate biopsy?

A

6 weeks

206
Q

PSA can be done how long after a proven UTI/prostatitis?

A

4 weeks

207
Q

PSA can be done how long after a DRE?

A

1 week

208
Q

PSA can be done how long after vigorous exercise?

A

48 hours

209
Q

PSA can be done how long after ejaculation?

A

48 hours

210
Q

Recurrent balanitis mx?

A

Circumcision

211
Q

4 causes of balanitis?

A
  1. STI
  2. Dermatitis
  3. Bacterial infection
  4. Fungal infection e.g. Candida
212
Q

Acute mx of balanitis?

A

Saline baths and tx of underlying cause

213
Q

Mx of balanitis dermatitis?

A

Topical hydrocortisone

214
Q

Mx of candida balanitis?

A

Topical clotrimazole/miconazole/nystatin cream

215
Q

Medical benefits of circumcision?

A
  1. Reduces risk of penile cancer
  2. Reduces risk of UTI
  3. Reduces risk of acquiring STIs incl. HIV
216
Q

Medical indications for circumcision?

A
  1. Phimosis
  2. Recurrent balanitis
  3. Balanitis xerotica obliterans
  4. Paraphimosis
217
Q

Acute upper urinary tract obstruction mx?

A

Nephrostomy tube

218
Q

Chronic upper urinary tract obstruction mx?

A

Ureteric stent or pyeloplasty

219
Q

2 benign tumours of the bladder?

A
  1. Urothelial papilloma

2. Nephrogenic adenoma

220
Q

3 bladder malignancies?

A
  1. Transitional cell carcinoma (>90%)
  2. Squamous cell carcinoma (1-7%)
  3. Adenocarcinoma (3%0
221
Q

Most common presentation of transitional cell carcinoma?

A

Painless, microscopic haematuria

222
Q

TURBT?

A

Trans urethral resection of bladder tumour

223
Q

When is cremasteric reflex preserved in a clinical torsion?

A

Torsion of the testicular appendage

224
Q

AFP in seminomas?

A

Usually normal

225
Q

Most common testicular tumour?

A

Seminoma

226
Q

How does infection usually get to epididymis/orchids?

A

From the urethra or bladder

227
Q

Non-infective cause of epididymitis?

A

Amiodarone

228
Q

Mx of hydrocele in adults?

A

Lords or Jabouley procedure

229
Q

Surgical Mx of hydrocele in children?

A

Transinguinal ligation of PPV

230
Q

How can renal cell carcinoma present with haemoptysis?

A

Cannonball metastases

231
Q

Most common cause of epididymitis in males >35y/o/

A

E. coli

232
Q

Ix of choice for diagnosing bladder cancer?

A

Flexible cystoscopy

233
Q

4 causes of urethral stricture?

A
  1. Iatrogenic e.g. traumatic placement of indwelling urinary catheters
  2. STIs
  3. Hypospadias
  4. Lichen sclerosus
234
Q

Infertile men are how many times more likely to develop testicular cancer?

A

3 times

235
Q

Most common cause of acute bacterial prostatitis?

A

E. coli (gram negative bacteria entering the prostate via the urethra)

236
Q

Mx of acute bacterial prostatitis?

A

14 day course of quinolone

237
Q

4 RFs for acute bacterial prostatitis?

A
  1. Recent UTI
  2. Urogenital instrumentation
  3. Intermittent bladder catheterisation
  4. Recent prostate biopsy
238
Q

C/I to circumcision in infancy?

A

Hypospadias as the foreskin is used in the repair

239
Q

Most common organic cause of ED?

A

Vascular problems

240
Q

Organic causes of ED?

A
  1. Vascular
  2. Hormonal
  3. Neurogenic (central or peripheral)
  4. Structural
241
Q

2 RFs for SCC of bladder?

A
  1. Schistosomiasis

2. Smoking

242
Q

4 RFs for TCC of bladder?

A
  1. Smoking
  2. Aniline dye exposure
  3. Rubber manufacture
  4. Cyclophosphamide
243
Q

Mx of pt with overactive bladder?

A

Antimuscarinic drugs

244
Q

What cancers are at increased risk following radiotherapy for prostate cancer?

A
  1. Bladder
  2. Colon
  3. Rectal
245
Q

Finasteride tx of BPH, how long before results are seen?

A

May take 6 months

246
Q

Eponym for renal adenocarcinoma?

A

Grawitz tumour

247
Q

HCG in seminomas?

A

Only elevated in 10%

248
Q

LDH in seminomas?

A

Only elevated in 10-20%

249
Q

What happens after relief of outflow obstruction in urinary retention pts?

A

Physiological diuresis (24hrs) than can sometimes become pathological (48 hours)

250
Q

Mx of staghorn calculus?

A

Percutaneous nephrolithotomy

251
Q

Pathophysiology or TURP syndrome?

A

Venous destruction and absorption of irrigation fluid

252
Q

RFs for TURP syndrome?

A
  1. Surgical time >1hr
  2. Height of bag >70cm
  3. Resected >60g
  4. Large blood loss
  5. Perforation
253
Q

TURP syndrome defn?

A

Fluid overload and iso-osmolar hyponatraemia during TURP from large volumes of irrigation fluid being absorbed through venous sinuses

254
Q

What irrigation fluid is used in TURP?

A

Glycine 1.5%

255
Q

Most common cause of AKI?

A

ATN

256
Q

2 main causes of ATN?

A
  1. Ischaemia = shock and sepsis

2. Nephrotoxins

257
Q

Nephrotoxins that cause ATN?

A
  1. Aminoglycosides
  2. Rhabdomyolysis
  3. Radiocontrast agents
  4. Lead
258
Q

3 phases of ATN?

A
  1. Oliguric phase
  2. Polyuric phase
  3. Recovery phase
259
Q

Most effective mx for renal cell carcinoma?

A

Radical nephrectomy

260
Q

Complications of vasectomy?

A
  1. Bruising
  2. Haematoma
  3. Infection
  4. Sperm granuloma
  5. Chronic testicular pain (affects 5-30% men)
261
Q

Success rate of vasectomy reversal?

A

Up to 55% if done within 10 years, 25% after more than 10 years

262
Q

Aneurysm screening?

A

All men age 65 years are offered aneurysm screening with a single abdominal US, reducing death from AAA by 44% over 4 years

263
Q

Aneurysm defn diameter?

A

> 3cm

264
Q

Primary event in aneurysm formation?

A

Loss of the intima with loss of elastic fibres from the media

265
Q

2 CTDs than cause AAAs?

A

ED Type 1 and Marfans

266
Q

Champagne bottle legs aka?

A

Lipodermatosclerosis

267
Q

Brown pigmentation in venous eczema?

A

Haemosiderin

268
Q

Mx of venous ulcer?

A

4 layer compression banding after exclusion of arterial disease or surgery

269
Q

Skin grafting for venous leg ulcer considered when?

A

If fail to heal after 12 weeks or >10cm2 skin affected

270
Q

Marjolin’s ulcer?

A

Squamous cell carcinoma occurring at sites of chronic inflammation e.g. burns, osteomyelitis after 10-20 years

271
Q

Condition that most commonly leads to amputation in diabetics?

A

Plantar neuropathic ulcer

272
Q

<3cm aorta Mx?

A

Normal

273
Q

3-4.4cm aorta Mx?

A

Rescan every 12 months, small aneurysm

274
Q

4.5-5.4cm aorta Mx?

A

Rescan every 3 months, medium aneurysm

275
Q

> =5.5cm aorta Mx?

A

Refer within 2 weeks to vascular surgery for probable intervention

276
Q

Mx of aortic aneurysm?

A

EVAR (endovascular repair) or open repair if unsuitable

277
Q

Complication of EVAR?

A

Endo-leak, where the stent fails to exclude blood fully from the aneurysm

278
Q

ABPI > 1 cause?

A

Vessel calcification common in diabetes

279
Q

ABPI defn?

A

Ratio of SBP in lower leg to that in the arms

280
Q

ABPI <0.9 sensitivity and specificity?

A

Sensitivity of 90% and specificity of 98%

281
Q

At what ABPI is compression bandaging generally considered acceptable?

A

> =0.8

282
Q

Claudication affecting femoral vessels fx?

A

Calf pain

283
Q

Claudication affecting iliac vessels fx?

A

Buttock pain

284
Q

3 main patterns of peripheral arterial disease?

A
  1. Intermittent claudication
  2. Critical limb ischaemia
  3. Acute limb-threatening ischaemia
285
Q

Aching/burning in the leg muscles following walking?

A

Intermittent claudication

286
Q

Leg pulses?

A
  1. Femoral
  2. Popliteal
  3. Posterior tibial
  4. Dorsalis pedis
287
Q

1st line Ix of peripheral arterial disease?

A

Duplex US

288
Q

Claudication ABPI?

A

0.6-0.9

289
Q

Critical limb ischaemia ABPI?

A

0.3-0.6

290
Q

Acute limb-threatening ischaemia ABPI?

A

<0.3, resulting in gangrene and ulcerative changes

291
Q

6 Ps of acute limb-threatening ischaemia?

A
  1. Pale
  2. Pulseless
  3. Perishingly cold
  4. Pain
  5. Paralysis
  6. Paraesthesia
292
Q

Mx of peripheral arterial disease?

A
  1. Conservative = quit smoking, exercise training
  2. Medical = Atorvastatin 80mg, Clopidogrel 75mg
  3. Surgical = angioplasty, stenting, bypass surgery, amputation
293
Q

Neurological and circulatory compromise in arms when working above the head?

A

Cervical rib

294
Q

3 criteria for aneurysm surgery?

A
  1. An asymptomatic aneurysm larger than 5.5 cm in diameter.
  2. An asymptomatic aneurysm which is enlarging by more than 1 cm per year.
  3. A symptomatic aneurysm. This is the only criteria, apart from emergency rupture, which requires urgent surgery rather than an elective procedure.
295
Q

Can pyoderma gangrenosum occur at stoma sites?

A

Yes

Medicine and Surgery Mushkies (52 decks)

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