Passmed Breast, Vascular and Urology Mushkies Flashcards
1
Q
Fibroadenoma description?
A
Discrete, non-tender, highly mobile lumps
2
Q
‘Lumpy’ breasts that worsen prior to menstruation?
A
Fibroadenosis
3
Q
Fibroadenosis aka?
A
Fibrocystic disease or Benign mammary dysplasia
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
5
Q
Mammary duct ectasia defn?
A
- Dilatation and shortening of the terminal breast ducts within 3cm of the nipple
- Most common around the menopause
- May present with a tender lump around the areola +/- a green nipple discharge
6
Q
Blood stained breast discharge?
A
Duct papilloma
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
8
Q
Rash starting on nipple and spreads outwards involving the areola?
A
Paget’s disease of the nipple
9
Q
5 possible breast surgery mx?
A
- Surgery
- Radio
- Chemo
- Hormone therapy
- Biological therapy
10
Q
What determines breast Ca mx prior to surgery?
A
The presence/absence of axillary lymph nodes
11
Q
Breast ca pt who presents with clinically palpable lymphadenopathy mx?
A
Axillary node clearance at primary surgery
12
Q
2 s/e of axillary node clearance?
A
- Arm lymphoedema
2. Functional arm impairment
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
14
Q
4 indications for mastectomy?
A
- Multifocal tumour
- Central tumour
- Large lesion in small breast
- DCIS > 4cm
- Pt choice
15
Q
4 indications for wide local excision?
A
- Solitary lesion
- Peripheral tumour
- Small lesion in large breast
- DCIS < 4cm
- Pt choice
16
Q
When is whole breast radiotherapy recommended?
A
- After a WLE (reduced risk of recurrence by around 2/3rds)
2. After a mastectomy if T3-T4 tumour/4+ positive axillary nodes
17
Q
When is adjuvant hormone therapy given for breast ca?
A
If tumours are positive for hormone receptors
18
Q
When is tamoxifen used?
A
In pre and peri-menopausal women
19
Q
Oetrogen receptor positive Ca in post-menopausal woman?
A
Aromatase inhibitor e.g. Anastrozole/Letrozole
20
Q
3 s/e of tamoxifen?
A
- Increased risk of endometrial cancer
- VTE
- Menopausal sx
21
Q
Most common biological therapy for Breast Ca?
A
Herceptin (Trastuzumab) if HER2 positive
22
Q
Trastuzumab C/I?
A
If Hx of heart disorders
23
Q
Fat necrosis pt features?
A
More common in obese women with large breasts, following trivial or unnoticed trauma
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
25
Brown-green nipple discharge?
Duct ectasia
26
6 causes of nipple discharge?
1. Physiological e.g, breastfeeding
2. Galactorrhoea
3. Hyperprolactinaemia
4. Mammary duct ectasia
5. Carcinoma
6. Intraductal papilloma
27
M for mammography scoring system?
1. No abnormality
2. Abnormality with benign fx
3. Intermediate probably benign
4. Intermediate probably malignant
5. Malignant
28
Breast surgery if tumour <4cm?
Usually WLE
29
Breast surgery if tumour >4cm?
Usually mastectomy
30
Inflammatory breast cancer stage?
T4d
31
Breast cancer staging?
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
32
Most common type of breast ca?
Invasive ductal carcinoma
33
Survival after breast cancer scoring?
Nottingham Prognostic Index
34
Nottingham Prognostic Index calculation?
(Tumour size x 0.2) + Lymph node score + Grade score
35
Snowstorm sign on US of axillary lymph node?
Extracapsular breast implant rupture
36
Periductal mastitis fx?
1. Present w/ inflammation, abscess or mammary duct fistula
2. Strongly associated with smoking
3. Usually tx w/ abx, abscess will require drainage
37
Bilateral, small volumes of pale discharge in a young girl?
Hormonal changes of puberty
38
Any increase in risk of malignancy with fibroadenomas?
No
39
Phyllodes tumours mx?
WLE
40
Breast cyst mx?
Aspiration
41
Sclerosing adenosis defn?
benign proliferative condition of the terminal duct lobular units characterised by an increased number of acini and their glands
42
Duct papilloma mx?
Microdochectomy
43
Why aromatase inhibitors for mx of post-menopausal breast ca?
Aromatisation accounts for the majority of oestrogen production in post-menopausal women
44
Paget's disease of the nipple associated with?
Invasive ductal carcinoma
45
Soft consistency breast ca that has a grey, gelatinous surface macroscopically?
Mucinous carcinoma
46
Comedo necrosis is a feature of?
High grade DCIS
47
Non-surgical option to manage axillary metastases?
Axillary radiotherapy
48
What chemo is used in breast Ca pts who are node +ive?
FEC-D chemotherapy
49
Symmetrical slit like retraction of the nipple?
Duct ectasia, as the ducts shorten and dilate
50
Halo sign on mammogram?
Breast cyst
51
Fibroadenoma >4cm mx?
Core biopsy to exclude a Phyllodes tumour
52
Natural hx of fibroadenomas?
1. 10% will increase in size
2. 30% regress
3. Remainder stay the same
53
Breast screening?
Mammogram every 3 years from 47-73 y/o
54
Progressive erythema and oedema of the breast in the absence signs of infection such as fever, discharge or elevated WCC and CRP?
Inflammatory breast cancer
55
When does one do surgical excision for a breast fibroadenoma?
If >3cm
56
What % of breast cancers do BRCA1/2 account for?
5-10%
57
BRCA mutation inheritance?
AD
58
RFs for breast Ca?
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
59
NACT?
Neoadjuvant chemotherapy
60
Periductal mastitis mx?
Co-amoxiclav
61
Mondor's disease of the breast?
Localised thrombophlebitis of a breast vein
62
Invasive ductal carcinoma aka?
No special type (NST)
63
Inflammatory breast ca pathophysiology?
Cancerous cells block the lymph drainage, resulting in an inflamed appearance of the breast
64
Triple negative breast cancer?
Tests negative for oestrogen receptors, progesterone receptors, and excess HER2 protein
65
What % of breast cancers are triple negative?
10-20%
66
How is bladder voiding measured?
Urodynamic studies
67
Classification of LUTS in men?
1. Voiding
2. Storage
3. Post-micturition
68
Voiding LUTS in men?
1. Poor stream
2. Hesitancy
3. Incomplete emptying
4. Terminal dribbling
5. Straining
69
Storage LUTS in men?
1. Frequency
2. Urgency
3. Nocturia
4. Incontinence
70
Post-micturition LUTS in men?
1. Post-micturition dribbling
| 2. Sensation of incomplete emptying
71
IPSS?
International prostate symptom score (mild, moderate, severe impact on pts life)
72
Mx of voiding LUTS?
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
73
Mx of overactive bladder in men?
1. Conservative = moderate fluid intake, bladder retraining
2. Medical = oxybutinin, tolterodine, darifenacin (all antimuscarinics)
a. Mirabegron = 2nd line
74
Nocturia mx?
1. Moderating fluid intake at night
2. Furosemide 40mg in late afternoon may be considered
3. Desmopressin
75
What is PSA?
A serine protease enzyme produced by normal and malignant prostate epithelial cells
76
Causes of raised PSA?
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
77
Which renal stones are radiolucent?
Urate and xanthine
78
Which renal stones are semi-opaque?
Cystine stones
79
Testicular torsion presentation?
A unilateral swollen and retracted testicle with loss of the cremasteric reflex
80
Testicular torsion defn?
A twist of the spermatic cord, resulting in testicular ischaemia and necrosis
81
Testicular torsion epidemiology?
Males aged 10-30
82
Bell clapper testis?
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.
83
Erectile dysfunction definition?
A persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance, it is a symptoms not a disease
84
Classification of causes of ED?
1. Organic
2. Psychogenic
3. Mixed
85
3 factors favouring an organic cause of erectile dysfunction?
1. Gradual onset of symptoms
2. Lack of tumescence
3. Normal libido
86
2 drugs that cause ED?
1. SSRIs
| 2. BBs
87
RFs for ED?
1. CVS = obesity, DM, dyslipidaemia, metabolic syndrome, smoking, HTN
2. Alcohol use
3. Drugs = SSRIs, BBs
88
ED Ix?
1. QRISK score
| 2. Free testosterone between 9 and 11am
89
Mx of ED?
1. PDE-5 inhibitors e.g. sildafenil
| 2. Vacuum erection devices if cant/wont take PDE-5 inhibitor
90
Causes of hyndronephrosis classification?
1. Unilateral
| 2. Bilateral
91
Unilateral causes of hydronephrosis?
PACT
1. Pelvic-ureteric obstruction (cong/acquired)
2. Aberrant renal vessels
3. Calculi
4. Tumours of renal pelvis
92
Bilateral causes of hydronephrosis?
SUPER
1. Stenosis of the urethra
2. Urethral valve
3. Prostatic enlargement
4. Extensive bladder tumour
5. Retro-peritoneal fibrosis
93
Hydronephrosis Ix?
1. US
2. IV urogram = assess position of obstruction
3. Antegrade/retrograde pyelography = allows tx
4. CT KUB if stones
94
Mx of hydronephrosis?
Remove obstruction and urine drainage
1. Acute upper urinary tract obstruction = nephrostomy tube
2. Chronic upper urinary tract obstruction = ureteric stent/pyelopasty
95
BPH ethnicity?
Black > White > Asian
96
BPH age?
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.
97
How does BPH present?
Voiding symptoms, storage symptoms, and post-micturition symptoms
98
What are 3 complications of BPH?
1. UTIs
2. Retention
3. Obstructive uropathy
99
Mx of BPH?
1. Conservative = watchful waiting
2. Medical = alpha-1 antagonists (1st line), 5a-reductase inhibitors
3. Surgical = TURP
100
Trial that supported combination use of a1 antagonist and 5a reductase inhibitors?
MTOPS trial = Medical Therapy of Prostatic Symptoms
101
2 examples of alpha-1 antagonists?
Tamsulosin and alfuzosin
102
Tamsulosin MOA?
Alpha 1 antagonist that decreases smooth muscle tone of the prostate and bladder, improves sx in 70% of BPH
103
4 s/e of tamsulosin?
DDD P
1. Dizziness
2. Postural hypotension
3. Dry mouth
4. Depression
104
Example of 5 alpha reductase inhibitor?
Finasteride
105
Finasteride MOA?
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%
106
4 s/e of finasteride?
E LEG
1. Erectile dysfunction
2. Reduced libido
3. Ejaculation problems
4. Gynaecomastia
107
How does proteus cause staghorn calculi?
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.
108
5 types of renal stone?
1. Calcium Oxalate
2. Struvite (MAP)
3. Uric Acid
4. Calcium Phosphate
5. Cystine
109
3 causes of calcium oxalate stones?
1. Hypercalcuria
2. Hyperoxaluria
3. Hypercitraturia (citrate forms complexes with calcium, making it more soluble)
110
Cause of MAP (struvite) stones?
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
111
Uric acid stones pathophysiology?
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
112
Calcium phosphate stone causes?
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)
113
Cystine stone pathophysiology?
Inherited recessive disorder of transmembrane cystine transport leading to decreased absorption of cystine from intestine and renal tubule
Multiple stones may form
114
pH variation of urine?
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).
115
Renal lesion in tuberous sclerosis?
Angiomyolipoma
116
Renal cell carcinoma presentation?
Haematuria in 50%
117
2 paraneoplastic features of renal cell carcinoma?
HTN and polycythaemia
118
Renal cell carcinoma spread mechanism?
Haematogenous metastasis
119
Mx of renal cell carcinoma?
Radical or partial nephrectomy
120
Most common extracranial tumour of childhood?
Neuroblastoma
121
Transitional cell carcinoma distribution?
1. 90% of lower urinary tract tumours, but only 10% of renal tumours
122
Transitional cell carcinoma occupation?
Industrial dyes and rubber chemicals
123
Mx of transitional cell carcinoma?
Radical nephroureterectomy
124
Angiomyolipoma defn?
A tumour composed of blood vessels, smooth muscle and fat
125
Acute urinary retention defn?
When a person suddenly, over a period of hours or less, becomes unable to voluntarily pass urine
126
5 medications that can cause acute urinary retention?
1. Anticholinergics
2. TCAs
3. Antihistamines
4. Opioids
5. Benzodiazepines
127
Dx of acute urinary retention?
A volume >300cc on Bladder US
128
Mx of acute urinary retention?
Decompressing bladder via catheterisation
129
1st line investigation in suspected prostate cancer?
Multiparametric MRI, NOT TRUS biopsy
130
5 complications of TRUS biopsy?
1. Pain
2. Fever
3. Haematuria
4. Rectal bleeding
5. Sepsis
131
How are multiparametric MRI scores reported?
5 point Likert scale
132
Most common form of prostate cancer?
Adenocarcinoma
133
Normal upper limit for PSA?
4ng/ml
134
Grading of Prostate cancer?
Gleason score (2-10)
135
Lymphatic spread of prostate cancer?
First to the obturator nodes
136
Mx of prostate cancer?
1. Conservative
2. Radiotherapy
3. Hormonal therapy
4. Surgery
137
What pts get conservative mx of prostate ca?
Watch and wait for elderly, multiple co-morbidities, low Gleason score
138
Radiotherapy types for prostate ca?
Curative and palliative
139
2 complications of prostate ca radiotherapy?
1. Radiation proctitis
| 2. Rectal malignancy
140
S/e of radical prostatectomy?
ED
141
Hormonal tx for prostate ca?
1. LHRH analogues
2. Anti-androgens
3. Combination of the 2
142
Candidates for active surveillance of prostate ca should have what done?
1. At least 10 biopsy cores taken
| 2. At least one re-biopsy
143
Ix for renal colic?
Non-contrast CT KUB
144
What do staghorn calculi involve?
The renal pelvis and extend into at least 2 calyces
145
1st line Ix of testicular mass?
US
146
Most common malignancy in men aged 20-30 y/o?
Testicular cancer
147
Classification of testicular cancer?
1. Germ cell tumours (95%)
| 2. Non-germ cell tumours
148
Germ cell tumours?
1. Seminomas
| 2. Non-seminomas
149
Non-seminomas?
1. Embryonal
2. Yolk sac
3. Teratoma
4. Choriocarcinoma
150
Non-germ cell tumours?
1. Leydig cell
| 2. Sarcomas
151
Peak incidence of teratomas?
25 y/o
152
Peak incidence of seminomas?
35 y/o
153
5 RFs for testicular cancer?
1. Infertility
2. Cryptorchidism
3. FHx
4. Klinefelter's
5. Mumps orchitis
154
Most common presentation of testicular cancer?
Painless lump
155
Testicular cancer markers?
1. AFP = 60% germ cell tumours
2. LDH in 40% germ cell tumours
3. hCG in 20% seminomas
156
Mx of testicular cancer?
1. Orchidectomy
2. Chemo
3. Radio
157
Prognosis of testicular cancer?
Generally excellent
158
4 RFS for prostate cancer?
1. Increasing age
2. Obesity
3. Afro-Caribbean
4. FHx
159
Prostate ca on DRE?
Asymmetrical, hard, nodular enlargement with loss of median sulcus
160
Unresolving left varicocoele?
Renal tract cancer, due to embryological anatomy linking the left renal vein and the left testicular vein
161
Most common renal cancer/
Clear cell
162
4 associations of renal cancer?
1. Middle aged men
2. Smoking
3. vHL
4. TS
163
Classical triad of renal cell carcinoma?
1. Haematuria
2. Loin pain
3. Abdominal mass
164
4 endo features of renal cell carcinoma?
1. EPO --> polycthaemia
2. PTH --> hypercalcaemia
3. Renin
4. ACTH
165
Stauffer syndrome?
Paraneoplastic hepatic dysfunction syndrome in renal cell carcinoma, presenting as cholestasis/hepatosplenomegaly, thought to be secondary to increased levels of IL6
166
Prehn's sign?
Relief of pain on elevation of the testis, a sign of epididymo-orchitis
167
Mx of epididymo-orchitis?
Ceftriaxone 500mg IM single dose AND Doxycycline 100mg BD 10-14d
168
Most common cause of scrotal swelling in primary care?
Epididymal cyst
169
3 conditions associated with epididymal cysts?
1. PCKD
2. CF
3. vHL
170
Hydrocoele defn?
Accumulation of fluid within the tunica vaginalis
171
Classification of hydrocoeles?
1. Communicating
| 2. Non-communicating
172
Communicating hydrocoele?
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
Non-communicating hydrocoeles?
Caused by excessive fluid production within the tunica vaginalis
174
3 secondary causes of hydroceles?
1. Epididymo-orchitis
2. Testicular torsion
3. Testicular tumours
175
Bag of worms?
Varicocoele
176
Mx of varicocoele?
1. Usually conservative
| 2. Surgery if pt is troubled by pain
177
80% of varicocoeles on which side?
Left
178
1st line mx of pts with chronic urinary retention?
Intermittent self catheterisation
179
What has better prognosis out of seminomas and teratomas?
Seminomas
180
Useful Ix for priapism?
Cavernosal blood gas analysis to differentiate b/w ischaemic and non-ischaemic priapism to further guide mx
181
Priapism defn?
A persistent penile erection not associated with sexual stimulation
182
Ischaemic priapism pahophysiology?
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
Non-ischaemic priapism pathophysiology?
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
Causes of priapism?
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
Non-ischaemic priapism 1st line Mx?
Not a medical emergency, usually suitable for observation
186
Ischaemic priapism mx?
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
Renal stones associated with an inherited metabolic disorder?
Cystine
188
1st line analgesia for renal colic?
NSAIDs (parenteral e.g. 75mg IM diclofenac)
189
Mx of renal stones?
1. <5mm = will usually pass spontaneously within 4 weeks
2. ESWL
3. Ureteroscopy (in pregnant woman who cant have ESWL)
4. Percutaneous nephrolithotomy
190
Mx of Stone burden less than 2cm in aggregate?
Lithotripsy
191
Mx of Stone burden of less than 2cm in pregnant females?
Ureterosocopy
192
Mx of Complex renal calculi and staghorn calculi?
Percutaneous nephrolithotomy
193
Mx of Ureteric calculi less than 5mm?
Manage expectantly
194
Prevention of uric acid stones?
1. Allopurinol
| 2. Urinary alkalinisation e.g. oral bicarbonate
195
Prevention of oxalate stones?
Cholestyramine and pyridoxine reduces urinary oxalate secretion
196
Prevention of calcium stones?
1. High fluid intake
2. Low animal protein, low salt diet
3. Thiazide diuretics
197
Mx of infantile hydroceles?
Infantile hydroceles are generally repaired if they do not resolve spontaneously by the age of 1-2 years
198
Most common cause of acute epididymo-orchitis?
Chlamydia
199
Testicular malignancy surgery route?
Orchidectomy via inguinal approach, to allow high ligation of the testicular vessels and avoid exposure of another lymphatic field to the tumour
200
LHRH agonist for prostate ca?
Goserelin (Zoladex), cover with anti-androgen to prevent rise in testosterone e.g. flutamide
201
Anti-androgen for prostate Ca?
Cyproterone acetate prevents DHT binding from intracytoplasmic protein complexes
202
Pelvic fracture and lower abdominal peritonism?
Bladder rupture
203
Pelvic fracture and highly displaced prostate?
Membranous urethral rupture
204
Worse LUTS after being started on goserelin?
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
PSA can be done how long after a prostate biopsy?
6 weeks
206
PSA can be done how long after a proven UTI/prostatitis?
4 weeks
207
PSA can be done how long after a DRE?
1 week
208
PSA can be done how long after vigorous exercise?
48 hours
209
PSA can be done how long after ejaculation?
48 hours
210
Recurrent balanitis mx?
Circumcision
211
4 causes of balanitis?
1. STI
2. Dermatitis
3. Bacterial infection
4. Fungal infection e.g. Candida
212
Acute mx of balanitis?
Saline baths and tx of underlying cause
213
Mx of balanitis dermatitis?
Topical hydrocortisone
214
Mx of candida balanitis?
Topical clotrimazole/miconazole/nystatin cream
215
Medical benefits of circumcision?
1. Reduces risk of penile cancer
2. Reduces risk of UTI
3. Reduces risk of acquiring STIs incl. HIV
216
Medical indications for circumcision?
1. Phimosis
2. Recurrent balanitis
3. Balanitis xerotica obliterans
4. Paraphimosis
217
Acute upper urinary tract obstruction mx?
Nephrostomy tube
218
Chronic upper urinary tract obstruction mx?
Ureteric stent or pyeloplasty
219
2 benign tumours of the bladder?
1. Urothelial papilloma
| 2. Nephrogenic adenoma
220
3 bladder malignancies?
1. Transitional cell carcinoma (>90%)
2. Squamous cell carcinoma (1-7%)
3. Adenocarcinoma (3%0
221
Most common presentation of transitional cell carcinoma?
Painless, microscopic haematuria
222
TURBT?
Trans urethral resection of bladder tumour
223
When is cremasteric reflex preserved in a clinical torsion?
Torsion of the testicular appendage
224
AFP in seminomas?
Usually normal
225
Most common testicular tumour?
Seminoma
226
How does infection usually get to epididymis/orchids?
From the urethra or bladder
227
Non-infective cause of epididymitis?
Amiodarone
228
Mx of hydrocele in adults?
Lords or Jabouley procedure
229
Surgical Mx of hydrocele in children?
Transinguinal ligation of PPV
230
How can renal cell carcinoma present with haemoptysis?
Cannonball metastases
231
Most common cause of epididymitis in males >35y/o/
E. coli
232
Ix of choice for diagnosing bladder cancer?
Flexible cystoscopy
233
4 causes of urethral stricture?
1. Iatrogenic e.g. traumatic placement of indwelling urinary catheters
2. STIs
3. Hypospadias
4. Lichen sclerosus
234
Infertile men are how many times more likely to develop testicular cancer?
3 times
235
Most common cause of acute bacterial prostatitis?
E. coli (gram negative bacteria entering the prostate via the urethra)
236
Mx of acute bacterial prostatitis?
14 day course of quinolone
237
4 RFs for acute bacterial prostatitis?
1. Recent UTI
2. Urogenital instrumentation
3. Intermittent bladder catheterisation
4. Recent prostate biopsy
238
C/I to circumcision in infancy?
Hypospadias as the foreskin is used in the repair
239
Most common organic cause of ED?
Vascular problems
240
Organic causes of ED?
1. Vascular
2. Hormonal
3. Neurogenic (central or peripheral)
4. Structural
241
2 RFs for SCC of bladder?
1. Schistosomiasis
| 2. Smoking
242
4 RFs for TCC of bladder?
1. Smoking
2. Aniline dye exposure
3. Rubber manufacture
4. Cyclophosphamide
243
Mx of pt with overactive bladder?
Antimuscarinic drugs
244
What cancers are at increased risk following radiotherapy for prostate cancer?
1. Bladder
2. Colon
3. Rectal
245
Finasteride tx of BPH, how long before results are seen?
May take 6 months
246
Eponym for renal adenocarcinoma?
Grawitz tumour
247
HCG in seminomas?
Only elevated in 10%
248
LDH in seminomas?
Only elevated in 10-20%
249
What happens after relief of outflow obstruction in urinary retention pts?
Physiological diuresis (24hrs) than can sometimes become pathological (48 hours)
250
Mx of staghorn calculus?
Percutaneous nephrolithotomy
251
Pathophysiology or TURP syndrome?
Venous destruction and absorption of irrigation fluid
252
RFs for TURP syndrome?
1. Surgical time >1hr
2. Height of bag >70cm
3. Resected >60g
4. Large blood loss
5. Perforation
253
TURP syndrome defn?
Fluid overload and iso-osmolar hyponatraemia during TURP from large volumes of irrigation fluid being absorbed through venous sinuses
254
What irrigation fluid is used in TURP?
Glycine 1.5%
255
Most common cause of AKI?
ATN
256
2 main causes of ATN?
1. Ischaemia = shock and sepsis
| 2. Nephrotoxins
257
Nephrotoxins that cause ATN?
1. Aminoglycosides
2. Rhabdomyolysis
3. Radiocontrast agents
4. Lead
258
3 phases of ATN?
1. Oliguric phase
2. Polyuric phase
3. Recovery phase
259
Most effective mx for renal cell carcinoma?
Radical nephrectomy
260
Complications of vasectomy?
1. Bruising
2. Haematoma
3. Infection
4. Sperm granuloma
5. Chronic testicular pain (affects 5-30% men)
261
Success rate of vasectomy reversal?
Up to 55% if done within 10 years, 25% after more than 10 years
262
Aneurysm screening?
All men age 65 years are offered aneurysm screening with a single abdominal US, reducing death from AAA by 44% over 4 years
263
Aneurysm defn diameter?
>3cm
264
Primary event in aneurysm formation?
Loss of the intima with loss of elastic fibres from the media
265
2 CTDs than cause AAAs?
ED Type 1 and Marfans
266
Champagne bottle legs aka?
Lipodermatosclerosis
267
Brown pigmentation in venous eczema?
Haemosiderin
268
Mx of venous ulcer?
4 layer compression banding after exclusion of arterial disease or surgery
269
Skin grafting for venous leg ulcer considered when?
If fail to heal after 12 weeks or >10cm2 skin affected
270
Marjolin's ulcer?
Squamous cell carcinoma occurring at sites of chronic inflammation e.g. burns, osteomyelitis after 10-20 years
271
Condition that most commonly leads to amputation in diabetics?
Plantar neuropathic ulcer
272
<3cm aorta Mx?
Normal
273
3-4.4cm aorta Mx?
Rescan every 12 months, small aneurysm
274
4.5-5.4cm aorta Mx?
Rescan every 3 months, medium aneurysm
275
>=5.5cm aorta Mx?
Refer within 2 weeks to vascular surgery for probable intervention
276
Mx of aortic aneurysm?
EVAR (endovascular repair) or open repair if unsuitable
277
Complication of EVAR?
Endo-leak, where the stent fails to exclude blood fully from the aneurysm
278
ABPI > 1 cause?
Vessel calcification common in diabetes
279
ABPI defn?
Ratio of SBP in lower leg to that in the arms
280
ABPI <0.9 sensitivity and specificity?
Sensitivity of 90% and specificity of 98%
281
At what ABPI is compression bandaging generally considered acceptable?
>=0.8
282
Claudication affecting femoral vessels fx?
Calf pain
283
Claudication affecting iliac vessels fx?
Buttock pain
284
3 main patterns of peripheral arterial disease?
1. Intermittent claudication
2. Critical limb ischaemia
3. Acute limb-threatening ischaemia
285
Aching/burning in the leg muscles following walking?
Intermittent claudication
286
Leg pulses?
1. Femoral
2. Popliteal
3. Posterior tibial
4. Dorsalis pedis
287
1st line Ix of peripheral arterial disease?
Duplex US
288
Claudication ABPI?
0.6-0.9
289
Critical limb ischaemia ABPI?
0.3-0.6
290
Acute limb-threatening ischaemia ABPI?
<0.3, resulting in gangrene and ulcerative changes
291
6 Ps of acute limb-threatening ischaemia?
1. Pale
2. Pulseless
3. Perishingly cold
4. Pain
5. Paralysis
6. Paraesthesia
292
Mx of peripheral arterial disease?
1. Conservative = quit smoking, exercise training
2. Medical = Atorvastatin 80mg, Clopidogrel 75mg
3. Surgical = angioplasty, stenting, bypass surgery, amputation
293
Neurological and circulatory compromise in arms when working above the head?
Cervical rib
294
3 criteria for aneurysm surgery?
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
Can pyoderma gangrenosum occur at stoma sites?
Yes
