Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 5 Conditions > reproductive > Flashcards

reproductive Flashcards

1
Q

aetiology of torsion of testis

A
  • Children/young adults – commonest in neonatal period and around puberty
  • Undescended testis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

clinical features of torsion of testis

A
  • Sudden onset severe painful testis – triggered by activity e.g. playing sports
  • Vomiting
  • Abdo pain
  • Testicular exam: Red, tender, firm, swollen testis
  • Opposite testis may lie horizontally (Angell’s sign)
  • Abnormal rotation so that epididymis is not in posterior position
  • Elevated (retracted) testicle
  • Bell clapper deformity: absence of fixation of the tesicle posteriorly to the tunica vaginalis
  • Lack of cremasteric reflex: testicle will not contract if torsion is present
  • Prehn’s sign – worse pain when elevation of the testicles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

investigation for torsion of testis

A

doppler USS - only if in double, otherwise straight to surgery

urine dip to check not infeective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

differentials to testis torsion

A

epididymitis - pain relieved when lifted

epididymo-orchitis 
hydrocele/varicocele - shine light 
testicular cancer 
inguinal hernia 
renal colic 
HSP 
acute appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

management of torsion of testis?

A

immediate referal to surgery - 6 our windwo before ischaemia is irrevesible

  • surgical scrotal exploration
  • untwisting of the testicle and orchiplexy (fixing both testicles to preventing further episodes)
  • orchiectomy if necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

aetiology of ectopic pregnancy

A

PIPPA

  • previous ectopic
  • intrauterine contraceptive device
  • PID
  • pelvic/tubal surgery
  • assisted reproduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

clinical features of ectopic pregnancy

A

presents around 6-8 weeks

usually a history of amenorrhoea (for around 8 weeks)/known to be pregnany

lower abdo pain - constant, iliac fossa

lower abdominal /cervical/adnexal tenderness

PV bleeding

breast tenderness

urinary symptoms

rectal pressure/pain on deification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

clinical features of a ruptured ectopic pregnancy

A 
collpase/fainting 
diarrhoea 
vomiting 
pain in the shoulder - haemorrhagic blood irritates the diaphragm 
shock 
Cullen's sign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

investigation for ectopic pregnancy

A

pregnancy test - +Ve

TV USS - establish the location of the pregnancy, the presence of adnexal massess or freee fluid

serum hCG at 0 and 48 hour

  • a rise > 63% suggests intrauterine pregnancy
  • a suboptimal rise is suspicious of an ectopic pregnancy
  • decrease of > 50% = likely failing pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

management of rupture of ectopic pregnancy

A

resuss A-E assessment

followed by salpingectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when will you use expectant management of ectopic pregnancy

A
  • stable
  • asymptomatic
  • hCG < 1500 iU
    • EP <3cm and no fetal cardiac activity on TV USS
    • No haemoperitoneum on TV USS
    • Fully understand symptoms and implications of EP.
    • Language should not be a barrier to understanding or communicating the problem to a third party (e.g. ambulance).
    • Live in close proximity to the hospital and have support at home.
    • You deem the patient will not default on follow up.
    • Requires serum hCG initially every 48 hours until repeated fall in level, then weekly until <15IU.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when will you use medical management of ectopic pregnancy

A

failed expectant management

Methotrexate is given IM as a single dose of 50mg/m2.
• Criteria:
• Follow up possible
• Unruptured
• Adnexal mass <35mm
• No visible heart beat
• No significant pain
• hCG level <1500 IU/l
• Confirmed absence of intrauterine pregnancy on USS
• hCG levels should be measured at 4 and 7 days and another dose of methotrexate given (up to 25% of cases) if the  in hCG is <15% on days 4-7
• Sexual intercourse should be avoided during treatment and reliable contraception used for 3 months after as meth
otrexate is teratogenic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

when will you use surgical management of ectopic pregnancy

A

when medical management fails

laparoscopy salpingectomy if 
- hemodynamically unstable 
- unable to return for follow up 
- significant pain 
- adnexal mass > 35 mm
- foetal heartbeat visible on USS 
- hcg level > 5000 
give methotrexate post-surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is another name for genital wart

A

condylomata acuminate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

aetiology of genital warts

A

Human Papilloma virus - subtype 6 and 11

early onset sexual activity
inc number of sexual patner
lack of barrier contraception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how is genital wart transmitted?

A

most often via sexual contact

incubation period between 3 weeks and 8 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

clinical features of genital warts

A

appearance varies

  • tiny flat patches on vulval skin
  • small papiliform (cauliflower-like) wellings
  • may affect the cervix

many asymptomatic

localized skin irritation

implications in pregnancy

  • tend to grow rapidly
  • usually regress after delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Ix for genital warts

A

clinical diagnosis

a biopsy might be taken to exclude neoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

differential for genital wart

A

syphilius
molluscum contagiosum
pearly penile papules
skin tags

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

management of genital warts

A
  • can just leave it if pt wishes
  • podophyllotoxin applied locally
  • or trichloroacetic acid for non keratinized lesions
  • or imiquimod (for both keratinized and non-keratinized warts)
  • cryotherapy or excision or electrosurgery or laser treatment

partner notification is not necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is molluscum contagiosum

A

Sexual transmission usually affecting young adults. Affects genitals, pubic region, lower abdomen, upper thighs, and/or buttocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

characteristic of molluscum contagiosum

A

Lesions are usually characteristic, presenting as smooth-surfaced, firm, dome-shaped papules with central umbilication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

treatment of molluscum contagiosum

A

no treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

investigation for molluscum contagiosum

A

clinical, on the basis of recognising the characteristic lesions

offer a routine STI screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how long is the incubation period of genital herpes

A

2-12 days

spread by skin to skin contact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

which herpes subtype causes genital herpes lesions

A

HSV-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

which herpes subtype causes oral herpes lesions

A

HSV-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

pathophysiology of genital herpes

A

HSV-2 spread via skin to skin spread

HSV-2 then infect the host local tissue, it then ascends via the sensory neuron to the sensory ganglion where it remain din latent state

the virus might then periodically reactivates, traveling down the axon and into the basal skin layers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

clinical features of primary genital herpes

A

usually the most severe and often result in

  • flu-like illness (muscle aches, malaise, headache)
  • women - fever, neuralgia, dysuria, constipation
  • discharge
  • inguinal lymphadenopathy
  • vulvitis and pain
  • if no pain - consider syphilis
  • small, characteristic vesicles and ulcers on the vulva (painful/tingling) - painful enough to cause urinary retention –> progress to ulceration –> crusted lesion
  • typcially lasts around 3 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

clinical features of secondary genital herpes

A

recurrent attacks result from reactivation of latent virus in the sacral ganglia - usually short and less severe - lesions and pain

  • can be triggered by stress, sex, menstruation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

investigation for genital herpes

A

clinical and history

viral PCR of versicle fluid = gold standard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

management of genital herpes

A
  • Reassure patient that recurrences are mild and short lived- saline baths and topical anaesthetic gels/creams/ice packs may help self-management
  • Abstain from sexual intercourse until follow up/lesions have cleared
  • Treatment with oral acyclovir may be effective if given within 5 days of onset of symptoms

in pregnancy
- if labour is within 6 weeks of primary infection then delivery by CS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

complications of genital herpes

A 
meningitis 
sacral radiclopathy 
transverse myelitis 
disseminated infection 
myalgia 
fulminant hepatitis 
pneumonia

Implications in pregnancy:
• Miscarriage
• Preterm labour.
• Neonatal risks:
• Transmission rate from vaginal delivery during primary maternal infection may be as high as 50% but is relatively uncommon during a recurrent attack (<5%).
• Neonatal herpes appears during the first two weeks of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the advise for those who is HIV +ve but want to conceive

A
  • Adviced to wait till viral load is low to conceive
  • Mother = self-insemination
  • Father = washing of sperm/donor
  • Continue HAART OR start at between 14-24 weeks if not already on
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what intervention will need to be taken in the delivery phase of a HIV mother

A
  • ↑ risk of transmission if:
  • <34 weeks
  • PROM
  • Invasive procedure conducted e.g. fetal blood sample

inc viral load (> 10000)/take zodovudine alone = C-section within 4 hours of SROM + IV infusion of zidovudine

otherwise vaginal delivery with IV infusion of zidovudine as soon as SROM occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what is the treatment of the newborn baby from a HIV +ve mother?

A

ART for 3-6 weeks

HIV DNA PCR necessary

  • less than 48 hour after birth
  • prior to discharge
  • @ 6 weeks, 12 weeks, 18 weeks..
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what causes gonorrhea

A

gram -ve diplococcus Neisseria gonorrhoeae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how long is the incubation period of gonorrhoea

A

2 to 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

clinical features of gonorrhoea

A

sometimes asymptomatic

female 
- greenish vaginal discharge, 2-7 days after intercourse 
- mucopurulent discharge 
- dysuria 
- IMB/PCB 
abdo pain 
Male
- discharge - yellow, green, white 
- dysuria 
- urethritis 
conjunctivitis 
- swelling of the foreskin 
- scrotal pain/swelling 
- testicular pain 
-  tender inguinal lymph nodes
- infection of rectum, throat and eyes 
- rectal pain and discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

investigation of gonorrhoea

A

women

  • VVS for NAAT testing
  • swab for culture and sensitivity

men

  • urien for NAAT testing
  • rectal swabs and pharyngeal swabs if MSM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

management of gonorrhoea

A

ceftriaxone 500mg IM stat as a single dose

test of cure 3 weeks after completion of course of antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

complications of gonorrhea

A 
PID 
dyspareunia 
epididymo-orchitis 
vulvo-vaginitis 
prostatitis 
tubal infertility
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is paraphimosis

A

foreskin of uncircumcised penis is retracted and left behind the glans penis leading to vascular engorgement and oedema of the distal glans  medical emergency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

aetiology of paraphimosis

A
  • Age 2-6 = normal physiology
  • Most common  foreskin left retracted by healthcare professionals after examining, catheterisaton or cystoscopy
  • Injury
  • Balanitis
  • STIs
  • Diabetes
  • Eczema
  • Psoriasis
  • Lichen planus
  • Lichen sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

clinical features of paraphimosis

A
  • Penile pain
  • Band of retracted foreskin tissue beneath the glans
  • Swollen glans penis
  • Redness of penis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

ix of paraphimosis

A

clinical diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

management of paraphimosis

A

Acute
With ischemia/necrosis = emergency debridement OTHERWISE
1) Manual manipulation – LA and compression until swelling improved
2) Puncture technique (perforation of the foreskin at multiple locations)
3) Surgical reduction + circumcision

Chronic
1) Surgical reduction + circumcision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

complication of paraphimosis

A

necrosis of the glans/foreskin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

pathophysiology of phimosis

A

foreskin is unable to be retracted
• The inner foreskin is attached to the glans
• Foreskin adhesions break down and form smegma pearls (white cysts under the foreskin) which are then extruded

50
Q

aetiology of phimosis

A
  • Age 2-6 = normal physiology
  • Injury
  • Balanitis
  • STIs
  • Diabetes
  • Eczema
  • Psoriasis
  • Lichen planus
  • Lichen sclerosis
51
Q

clinical features of phimosis

A
  • Erythema (balanitis)
  • Pain (balanitis)
  • Swelling (balanitis)
  • Ballooning during urination
  • Painful erection
  • Haematuria
  • Recurrent UTIs
52
Q

management of phimosis

A

• <2 years: watch and wait as normally self resolves
• Good hygiene – wash regularly with plain, warm water
• Avoid irritants + use lubrication during sex
1) Corticosteroid cream/gel/ointment
2) Surgical release of adhesions
2) Circumcision

53
Q

what are the stages of syphilis

A

primary secondary

terriary

54
Q

aetiology of syphilis

A

treponeum pallidum (spirocheate bacterium)

seuxally or vertical transmitted

white men

MSM

aged 25-34

55
Q

clinical features of primary syphilis

A
  • 10 – 90 days post-infection, resolves over 3-8 weeks
  • Solitary, painless, genital ulcer (chancre)
  • Inguinal lymphadenopathy
56
Q

clinical features of secondary syphilis

A

Secondary:
• Latent syphilis = People with untreated syphilis but no symptoms or signs of infection have latent syphilis 4-10 weeks after initial chancre
• Early stage = disease has been present for less than 2 years
• Late stage = disease has been present for more than 2 years.

  • Generalised polymorphic rash affecting palms and soles - symmetrical and non-itchy. Can be macular, popular (coppery red), papulosquamous, and, very rarely, pustular
  • Generalised lymphadenopathy
  • Genital/oral condyloma lata (highly infectious wart like lesions on the genitals or mouth)
  • Hepatitis, splenomegaly, glomerulonephritis
  • Acute meningitis, CN palsies, uveitis, optic neuropathy etc.
57
Q

clinical features of tertiary syphilis

A
  • Presents in up to 40% of people infected for >2 years.
  • Neurosyphillis
  • Meningovascular = Headache, 3rd/6th/8th CN involvement, papilloedema, hemiplegia.
  • Parenchymatous = tabes dorsalis ( ataxia, failing vision, sphincter disturbnces severe attacks of ‘lightening’ pain, degeneration of the posterior column  absent ankle and knee reflexes, impaired virbration and position sense, +ve Romberg sign) and general paraesis (early  irritability, fatigability, personality changes, headaches, impaired memory, tremors. Late  lack of insight, depression or euphoria, confusion and disorientation, delusions, seizures, transient paralysis
  • Signs: expressionless faces, tremor of lips, tongue and hands, dysarthria, impairement of handwriting, hyperactive tendon reflexes, pupillary abnormalities, optic atrophy, convulsions, extensor plantar responses)
  • Cardiovascular syphilis
  • aortic regurgitation common), aortitis (with or without coronary ostial stenosis), aneurysm of the ascending part
  • Gummata = inflammatory plaques or nodules (found in the skin or bones) that develop 3-12 years after the primary infection. Painless lesions that are indolent, firm, coppery red and about 0.5-1cm in diameter.
58
Q

clinical features of syphilis

A
  • 8th Nerve deafness
  • Hutchinson’s incisors
  • Interstitial keratitis
  • Rash (maculorpapular, bullous and desquamation)
  • Hepatosplenomegaly
  • Syphillitis snuffles
  • Periositis
  • Sabre shins
59
Q

investigation for syphilis

A
  • Serological testing
  • Smear from the primary lesion for PCR testing
  • Screen for other STI’s
60
Q

management of syphilis

A
  • Benzathine penicillin 2.4 MU single dose IM (used in pregnancy) – duration depends on which stage it is in
  • Contact tracing (potentially over several years)
  • Refrain from sexual intercourse until partner is treated.
61
Q

what is erectile dysfunction

A

persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance

62
Q

physiology of an erection

A
  • Erection occurs due a neurovascular mechanism
  • control of the smooth muscle tissue of the corpora cavernosa by the autonomic system
  • Swelling is due to a reduction in the alpha-sympathetic tonus of the cavernous tissue permitting influx of arterial blood, and to decreased venous flow from compression of the subalbugineal venous network against the tunica albuginea of the corpus cavernosurn
  • Once this obstruction to the venous return has been achieved, the arterial flow in the corpora cavernosa decreases but persists
  • Rigidity is due to an increase in intracavernous arterial pressure simultaneous with contraction of the perineal muscles (ischiocavernosus) under the somatic control of the pudendal nerve
63
Q

what are the nerves supplying the penis?

A

• Innervation via sympathetic (thoracolumbar segment T11-L2) and parasympathetic (sacrum S2-4) fibres

64
Q

aetiology of erectile dysfunction?

A

vasculogenic - CVS, HTN, hyperlidiaemia, DM, smoking, major pelvic surgery to do with prostate

neurogenic (central) - MS, parkinson’s disease and multiple atrophy, stroke, spinal cord trauma

neurogenic (peripheral) - DM, CKD, polyneuropathy, major surgery of the pelvis, urethral surgery

Structural - Peryonie’s disease (inflammatory condition resulting in deformity and bending of penis, penile cancer, micropenis

hormonal - hypogonadism, hyperprolactinaemia, hyperthyroidism, hypothyroidism, Cushing’s diseas, MEN

Psychogenic

drugs - antiHTN - b blocker, verapamil, diuretics, antidepressant, anti-arrhythmic drugs, antipsychotics, ranitidine, recreational drugs

65
Q

what are the different cardiac risk stratification for erectile dysfunction

A

low risk - no significant cardiac risk associated with sexual activity

intermediate risk - men with uncertain cardiac condition

high risk - cardiac condition that is sufficiently severe/unstable for sexual activity

66
Q

investigation for erectile dysfunction

A

international index for erectile function (also diagnostic criteria)

HbA1c, lipid profile, total testosteron (if low/borderline –> FSH,LH and prolactin) , PSA (if PR abnormal and > 50 yrs old)

67
Q

management of erectile dysfunction

A

low risk - management in primary care

intermediate risk - specialist testing

high risk - cardiac assessment and treatment, stop sexual activity until cardiac conditions have been stabilised/cardiologist says is okay to resume

changes to lifestyle and drugs

PDE-5 inhibitors eg Sidenafil

  • take around 1 hour before sex
  • contra - severe/unstable heart diseaes, hypotension, unstable angina/agina during sexual intercourse, recent stroke/MI, sever hepatic impairment, herediatary degenerative disorder

vacuumed erection device - urology review

intra- cavernous injection eg aprostadil

penil prosthesis - urology

68
Q

what are some side effect of sidenafil

A 
back pain 
dyspepsia 
flushing 
migraine 
mylagia 
nasal congestion 
dizziness 
N+V 
visual disturbances 
sudden hearing loss 
priapism (>4h)

interaction - nitrate, alpha blockers

69
Q

what is epididymo-orchitis

A

Epidiymitis = inflammation of the epididymis

Orchitis = inflammation of the testes

70
Q

aetiology of epididymo-orchitis

A 
multiple partners 
anal intercourse 
C.coli infection 
chlaymdia
gonorrhoea 
mumps 
elderly - due to BPH
TB
71
Q

clinical features of epididymo-orchitis

A
  • gradual onset (hours to days) pain
  • duration < 6 weeks
  • usually unilateral
  • palpable swelling of the epididymis +/- testis
  • dragging/heavy sensation
  • painful and tender
  • Prehn sign (relieve of pain when elevatino of the testes_

if infected by TB

  • painless
  • non-tender
  • epididymis is hard with an irregular surface
  • spermatic cord is thickened
  • vas deferens feels hard and irregular

can have urethral discharge, hydrocele, erythema, symptoms of UTI, parotid swelling (mumps)

72
Q

Ix for epididymo-orchitis

A 
urine dip +/- MSC 
swab of secretion 
NAAT urine
HIv + Syphilis screen 
USS 
PR exam
73
Q

management of epidiymo-orchitis

A

suspected TB - specialist referral

Abx if bacterial +/- analgesia

tight underwear for scrotal support

abstain from intercourse

74
Q

what is urethritis

A

inflammation of the urethra

75
Q

what are the 2 different types of urethritis

A

1) gonococcal - caused by neisseria gonorrhoea

2) non-gonococcal - eg by chlamydia

76
Q

what is post gonococcal urethritis

A

occurence of non-gonococcal urethritis after curative treatment of gonococcal urethritis

77
Q

aetiology of urethritis

A

gonorrhoea and chlamydia risk factor

STI

  • aged 15-24
  • female
  • new/mutple sexual partner
  • inconsistent use of condoms
  • low SES

trauma
UTI

78
Q

clinical features of urethritis

A

dysuria

urethral discharge - white or green

pruritus at the end of the urethra

orchalgia - heavy sensation in the male genitalia

79
Q

Ix for urethritis

A

urine dip - +ve leukocytes

NAAT swab for gonorrhoea and chlamydia

Gram stain of urethral discharge/urine sediment
- +ve for gram -ve diploccoci = gonorrhoea

standard STI screen +/- HIV +/- Hep B +/- Hep C testing

80
Q

management of urethritis

A

if gonorrhoea - IM ceftriaxone 250mg and azithromycin 1g orally

if chlamydia - doxycycline 100mg BD for 7 days

abstain from sexu until partner notified and complete of treatment - 7 days

81
Q

what are the 2 categories of testicular cancer?

A

germ cell tumours - 95%

  • seminoma (50%) - slow growth, more sensitive to radiation. good prognosis
  • non-seminoma - individual or mixture of cell tumour - fast growth and spread
  • teratoma (50%), embroyonal carcinoma, choriocarcinoma, york sac tumours

Non-germ cell tumour -5%
- leydig cell tumours
sertoli cell tumours

82
Q

where is testicular tumours likely to metastasis to?

A

lymphatics, lungs, liver, brain

83
Q

aetiology of testicular tumours

A
  • 15-40 yrs old
  • cryptorchidism - 1 or both testes fail to descend to the scrotum
  • germ cell neoplasia in situ (GCNIS)
  • FHx
  • klinefelter syndrome
  • Down’s syndrome
  • caucasian
84
Q

clinical features of testicular cancer

A
  • painless lump/swelling
  • dull ache in the groin/abdomen
  • dec sensation
  • hard testicle without fluctuance/translumination
  • irregular
85
Q

investigation of testicular cancer

A

USS
tumour marker
- alpha-fetoprotein (inc in yolk sac tumours/teratoma)
- beta-hCG (inc in yolk sac tumours/teratomas)
- lactate dehydrogenase (inc in 20% of seminomas)

staging 
- CXR 
CT 
MRI 
radial inguinal orchiectomy of the affected side
86
Q

management of testicular cancer

A

active surveillance
orchiectomy + testicular prosthesis

adj chemo/radio
stem cell transplant
monitor post-treatment with tumour markers and imaging

87
Q

what is cryptorchidism

A

undescended testis - • Incomplete migration of the testis during embryogenesis from the original retroperitoneal position (near the kidneys) to its final position in the scrotum

88
Q

what are the types of cryptorchidism?

A

true (on the tract of descending but stuck) - abdominal, inguinal, supra-scrotal

ectopic (not on a tract of descending) - prepenile, femoral

89
Q

aetiology of cryptorchidism?

A

FHx
low birth weight
preamature

90
Q

classification of cryptorchidism

A
  • Undescended but palpable
  • Retractile – can be pulled into the scrotum and remains there upon the release of traction
  • Cryptorchid
  • Unilaterally non palpable
  • Bilaterally non palpable – normal penis (if abnormal, refer immediately for disorder of sex development work up)
91
Q

management of cryptorchidism

A

• Referral by 6 months for surgical correction within the 1st year

92
Q

what is hypospadias

A

the urethra opens on the undersurface of the penis

more serious if at the shaft of the penis

93
Q

aetiology of hypospadias

A

• Due to partial/abnormal closure of the urethra during any part of the development

94
Q

management of hypospadias

A

corrected via surgery

circumcision is contra-indicated in infancy with this condition

95
Q

what is breast fibroadenoma

A

benign lump of glandular and fibrous tissue - develops from a whole lobule

consider part of normal physiology

96
Q

what are the different types of breast fibroadenoma

A

simplex - all the same cell type
complex - different cell type
giant - > 5 cm
juvenile - in teenagers

97
Q

what does the growth or regression of breast fibroadenoma depend on?

A

oestrogen and regress after menopause

98
Q

aetiology of fibroadenoma

A

< 35

unknown

99
Q

clinical features of fibroadenoma

A

painless
breast lump
smooth, well circumscribed, firm, mobile mass (aka breast mouse)

100
Q

investigation for breast fibroadenoma

A

tripel assessment

breast examination

mammogram - well defined mass, may have popcorn like calcifications

USS +/- fine needle aspiration/core needle biopsy

101
Q

what is the investigative pathway for <35 and suspected breast fibroadenoma

A

Triple assessment (no mammography)

if not compatible with FA - excise

if compatible with FA
- follow up every 6 month until 35

  • if regress - follow up until complete regression
  • no change at age 35 –> excise
  • if enlarge –> excise
102
Q

what is the investigative pathway for >35 and suspected breast fibroadenoma

A

triple assessment

if not compatible with FA - excise

if compatible with FA
- follow up every 6-12 months

  • if complete regression - routine follow up
  • if incomplete regression - excise
  • if enlarged - excise
103
Q

what is fat necrosis of the breast?

A

breast tissue being dmaged by breast biopsy, readiotherapy, breast surgery

typically firm and round but may present as irregular, mostly painless, skin tethering

will break down on its own over time

104
Q

management of breast fibroadenoma

A

conservative management - may disappear on their own

excision biopsy to remove

vacuum assisted mammotomy

alternative - high intensity focused US

105
Q

what is another name for breast abscess?

A

puerperal mastitis

106
Q

what is breast abscess

A

localised area of infection with a walled off collection of pus
Puerperal mastitis = mastitis (inflammation of the breast tissue with lactational)

107
Q

aetiology of breast abscess

A 
S.aureus infection 
breastfeeding 
sore/cracked nipples 
nipple piercing 
milk stasis

periductal mastitis - subareolar ducts are damaged/infected
Duct ectasia - dilation of the large breast duct, common around menopause, lump around areola +/- green nipple discharge

diabetes (immunosuppression) 
HIV (immunosuppression) 
RA 
trauma 
corticosteriod treatment

granulomatous lobular mastitis (GLM) - autoimmuen reaction to substances secreted from mammary ducts

poor soci-economical status

poor hygeine

108
Q

clinical features of breast abscess

A

painful, swollen lump in the breast - redness, hot, swelling of the overlying skin

pus discharge from the nipple

fever

flu like symptoms

malaise

109
Q

investigation for breast abscess

A

breast exam

USS

culture of fluid from the abscess

breast milk culture

110
Q

what is a fibrocystic disease of the breast?

A

lumpy breasts that fluctuate with the menstrual cycle

111
Q

aetiology of fibrocystic disease

A

• Obesity, nulliparity, OCP, late-onset menopause, later age of 1st child

112
Q

clinical features of fibrocystic disease

A

• Constant, dull pain/tenderness (can be cyclical) bilaterally, symmetrical lumpiness

113
Q

management of breast abscess

A

Continue breast feeding if possible, improve milk removal via breast feeding technique, do not wear a bra at night

2) Antibiotics
2) Analgesia
3) Incision and drainage via US guided needle aspiration/surgical drainage

114
Q

what are the different types of breast cancer?

A

Ductal carcinoma in situ - precancerous epithelial cells of the breast duct (30% will become cancerous)

Lobar carcinoma in situ = precancerous, typically in premenopausal women - 30% will become cancer

cellular dysplasia in situ - invasive –> ductal carcinoma, lobar carcinoma, inflammatory

115
Q

where does breast cancer mets to?

A

2Ls and 2Bs

Liver
lung
brain
bones

116
Q

aetiology of breast cancer

A

unopposed oestrogen - ir HRT, COP

obesity, hx of breast cancer, breast augmentation, nulliparity, 1st child after age of 30, age, FHx, BRACA1/2 gene

breast feeding = protective

History ALONE

  • past hx of breast cancer, FHx
  • Abortion/age
  • late menopause
  • obesity
  • nulliparity
  • early menarche
117
Q

clinical features of breast cancer

A 
painless dense lump 
puckered/indrawn nipple 
Peau d'orange - oedema 
skin red and warm = inflammatory carcinoma 
discharge - bloody 
lump under the arm

Paget’s - nipple eczema, erythematous, scaly rash (associated with invasive ductal carcinoma)

118
Q

what is the screening programme for breast cancer like?

A

mammogram for women aged 50-70 every 3 years

high-risk patients

  • strict criteria for referral foe genetic testing
  • annual mammograms
  • annual MRIs
119
Q

investigation of breast cancer

A

Triple Assessment

breast examination

bilateral mammogram +/- FNA - more effective in older women, picks up calcifications

USS of breast and regional lymph node +/- FNA

monoclonal antibody techniques - to identify PR, OR o HER2 receptors

staging - CT, CXR

120
Q

what are some differentials for breast cancer

A

fibroadenoma
fibrocystic disease
benign breast disease eg breast cyst

intraductal papilloma - the commonest cause of blood-stained nipple discharge in younger women, no palpable mass

mastitis

fat necrosis of the breast

121
Q

management of breast cancer

A

surgery - lumpectomy or wide local excision or mastectomy +/- axillary clearance\

sentinel node biopsy during surgery

radio post-surgery, chemo can be neoadjuvant, adjuvant, treatment of mets

if oestrogen receptor +ve - Tamoxifen

if ER +ve and post-menopausal
- anasrozole

HER2+Ve –> IV trastuzumab (herceptin)

Year 5 Conditions (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions