REPRODUCTIVE Flashcards
** Torsion of the testes
CF:
peak age:
IVX:
Management
1.
2.
- Due to abnormal mobile mesentery of testes –> ischaemia
CF: SUDDEN ONSET SEVERE PAIN in scrotum and groin. Worse when testicle elevated. walking uncomfortable Testes tender- may lie high - Scrotal skin RED + oedematous Absent Cremaster reflex N+V
Peak age 12 yrs (11-30)
RF: undescended
IVX: Examine both
Transilumination (+ve is hydrocele)
Doppler USS compare both and obsevre blood flow
reduced blood flow is diagnostic for torsion
Management:
- Manual external detorsion by outward rotation of testes - success = immediate releif of all symptoms
- Urgent surgical exploration within 6 HOURS - untwist and fix both testes Orchiopexy
** Suspected Ectopic Pregnancy
Most common site?
RF:
CF:
IVX:
TX:
acute
subacute - doses
-Mainly Fallopian tube ampulla
RF: Tubal disease e.g PID, advanced maternal age, smoking
CF: Key features:
Amenorrhoea for 6-8 weeks,
Lower abdominal pain: non-specific,
Classically U/L colicky intermittent → constant, localised to iliac fossa, Abnormal vaginal (PV) bleeding
Shoulder tip pain, Collapse and dizzy, D+V
IVX: Bi-Manual to elicit cervical motion tenderness
Speculum, Abdo exam, Bloods
Urine HCG pregnancy test
BHCG- if raised conduct Transvaginal US
TX: ADMIT, IV Fluids, Cross-match 4-6 units, Anti-D if patient known Rhesus -ve.
Haemodynamically unstable = Urgent Laparoscopy- salpingostomy
SUBACUTE
- Surgical or Medical with Methotrexate 50mg single dose and review hCG on day 4 and 7 and if falls less than 15% repeat dose
Genital Warts aka condylomata Accuminata
HPV type
CF:
Management
HPV 6/11 causes most
Median incubation = 3 months
Most contagious when visible
CF: asymptomatic or multiple vulval warts- painless and slow growing. Local skin irritation.
IVX: Smear test, colposcopy, full STI screen.
Management: Podophyllin paint -apply weekly.
Advise barrier contraception with new partners
Clinic: Crypotherapy with liquid nitrogen
Vaccine includes 6/11 now
Genital herpes
types
RF:
CF: prodrome
IVX
Managment
drug + topical
HSV 1 = mouth
HSV2 = Angogential
RF: Multiple sexual partners, STI, early age 1st intercourse
CF: Febrile Flu prodrome 5-7 days, painful blisters in genital area, tender lymph nodes
IVX: Viral culture PCR from ulcer
Management: Refer to GUM clinic, infection lifelong
5 days Aciclovir TDS
+ topical tidnocaine
HIV
RF
Treatment
RF: msm, IVDU, Sex workers, sex with person from africa/ caribeean /sea
cd4 count low
Opportunistic infections
HAART treatment
Gonorrhoea
Gram -ve
symptomatic % in who?
Syx:
IVX
Management:
RF: 15-24, Recent sexual activity abroad, inconsistent condom use
CF: symptomatic in most men + 50% women
Men–> urethreal infection pain on weeing, rectal infection
Women: altered vaginal discharge
IVX: NAAT test
- urine in men and endocervical or vulvovaginal in women
Management: GUM clinic, partner notfication
CEFTRIAXONE 500MG IM + 1G AZITHROMYCIN 1G stat
GC = gemma collins
Syphillis
Trep Pallidium
Primary
Secondary
Tertiary
TX
Primary: Chancre at site of infection, small painless ulcer heals 2-6 weeks
Secondary: systemic syx- night time headache, malaise, fever, aches
Tertiary: dementia
IVX: NAAT
TX: screen other STIs and HIV
BEN PEN 2.4 IM single dose
Prostatitits
Most comon cause under 35s
RF
CF
Management
Antibiotic
- Inflammation of the prostate gland
Bacterial most common in under 35s- usually E.coli
RF: STIs and UTIs
CF: fever, malaise, arthralgia, urinary freq, dysuria, nocturne, pain on ejaculation + premature ejaculation
Gland may feel nodular
IVX: FBC, U+E, culture,
Management: Analgesia
Acute: Suprapubic urine catheter if retention
Ciprofloxacin 4 weeks
Balantitis
Causes:
RF:
Management:
Inflammation of glans penis
Cause: candidia, staph, psoriasis, irritation
RF: Diabetes + use of oral abx
IVX: blood/ urine test if DM possible, swab discharge for microscopy
Management: Daily cleaning with warm water, avoid triggers
candida = clotrimazole
Phimosis
• When foreskin can not be pulled back past the galns (shouldnt be before 2)
CF: painful erections,swelling and redness, adhesions
IVX: swab
Management: personal hygeiene, topical steroid application
Paraphimosis
- Occurs when a tight prepuce is retracted and then unable to be replaced as the glans swells = This is a urological emergency
CF: Oedema and pain on erection
Management: gentle compression with a saline soaked swab
gradual manual reduction - glans pushed back while index fingers pull precupuce back over glans –> if fail refer to urologist
Erectyl dysfunction
IVX in all patients?
MAnagement;
1st line
• Inability to attain and maintain an erection sufficient for satisfactory sexual performance
Cause: Vascular e.g CVD, HTN, smoking, neurological hormonal, drugs eg antihypertensivves, diuretics, psychological, DM
RF: obesity, lack of exercise
CF: Sudden onset, Early collapse of erection, Self-stimulated or waking erections
IVX: GU exam PR > 50yrs, morning sample total testosterone, fasting glucose HbA1c in all patients
Management: stop RF
testicular failure- give testosterone
Sex therapy
1st line = Phosphodiesterase inhibitors SILDENAFIL
Epididymo-orchitits
CF
Common age?
IVX
Management
- Pain, swelling and inflammation of the epididymis, with or without inflammation of the testes.
Patients 15-30 and over 60
mumps orchitis occurs in up to 40% postpubertal boys
Cause: chalmydia, gonnorhea, e.coli, mumps
CF: UNILATERAL scrotal pain and swelling of relatively acute onset +- symptoms of urtethritis
Signs: Tenderness to palpation on affected side
IVX: STI swab and cultures, microscopy and culture midstream urine, clour doppler USS to differentiate with torsion.
Management: Screen and treat STIs, rest, analgesia and scrotal support
NSAIDS
Empirical therapy CEFTRIOXONE IM + doxycycline 100mg by mouth
Urethritis
Common cause
IVX
Treatment
- Inflammation of the urethra. Usually (but not always) caused by a sexually transmitted infection (STI).
- Classified as gonococcal urethritis, non-gonococcal urethritis (NGU), or persistent/recurrent urethritis.
CF: Urethral discharge, urethreal pruritis, mucopurulent +-blood
IVX: FPU or NAAT, Urine tip to exclude UTI
Management:
NGU - Doxycycline
Gonoccocla: Ceftriaxone 500mg IM stat
Prevention: safe sex and regular STI testing
Testicular Cancer
95% are germ cell tumours
seminoma + non-seminomatous
RF: male infertility, kleinfelters, infantile hernia
CF: lump in body of testis, testicular or abdo pain. dragging sensation, recent hx of trauma made them notice, hydrocele, gynaecomastia
IVX: bilateral USS, assay of tumour markers
- AFP and beta hCG
Staging via thoraco-abdo CT
Management: Radical Orchidectomay or Chemo or radio + sperm storage for those if required.
Breast Fibroadenoma
CF:
IVX
Management
- Benign tumours common in young women
CF: firm non tender and highly mobile
IVX: Palpation, refer to specialist breast clinic.
US < 40 years or mammogram
Management: Careful monitoring, relief symptoms supportive bra and analgesia NSAIDS
Breast cancer
Signs of mets?
RF: Age, FH, braca, First child over 30, early menarche and late menopause
CF: palpable lump, nipple inversion, nipple discharge, skin changes, lumps
Signs of mets:
brain: headache
bone: pain in spine
lung: cough
liver: pain and jaundice
URGENT 2 WEEK WAIT Triple assessment Clinical exam Fine needle aspiration Imaging
Management: surgery + radio
Hormonal
- Tamoxifen if ER +ve
- Herceptin if HER +ve
BRACA = elective mastctomy
Breast Abscess
CF:
associated with?
Management
A breast abscess = localised collection of pus within the breast
CF: localised breast oedema, tenderness, erythema, warmth, pain, nipple discharge, associated with mastitis
IVX: ultrasonography, cultures
Management: Urgent referral to general surgeon
to drain abscess
US needle aspiration
Antibiotics
Gynaecological causes of abdo pain
-Ectopic pregnancy
- Ovarian Hyperstimulation syndrome
- Placental abruption
- Ovarian cancer
-PID
- Ovarian torsion
- Endometriosis
-
Vaginal Discharge
Bv Candida Chlamydia TV Gonorrhea Retained foriegn body
Commonest = BV and thrush
BV - thin fishy smelling
Candida - thick, curd white non-offensive with itch
Chlamydia: lots of purulent dishanrge
TV: Offensive yellow discharge frothy with vulval itch
Gonorrhea; purulent vaginal discharge
Retained foreign body: foul smelling discharge
IVX: STI screening and PH testing
Vaginal bleeding
- Primary amenorrhea = failure to start menstruating in 15 year old or 14 year old with no breast development
- Secondary amenorrhea when periods stops >6 months other than pregnancy
- Oligomennorhea: infrequent period, common at extremes of reproductive life
- Menorrhagia: Increased menstrual blood loss >80ml cycle
- Dysnemorrhea: painful periods +- N+V
- Intermenstrual bleeding
- Post Coital bleeding
Fat necrosis of breast
More likely to occur in larger, fatty breasts in overweight or obese women
Fibrocystic disease
when worse?
TX?
Very common and often presents with pain and nodulatiry
- Pain worse week before menstruation
- Palpable lump
TX: NSAIDS and supportive bra
Hypospadias
when to operate?
• Urethral opening below head of penis
operation when child 4-18 months
Undescended testis
- Testis that is absent from the scrotum
- If still present at 3 months, refer to paediatric surgeon before 6 months
- Rx completed by 12-18 months via surgery
