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MSRA Content > Reproductive System - Level 3 > Flashcards

Reproductive System - Level 3 Flashcards

1
Q

Definition of fat necrosis of breast?

A
  • Fibrosis and calcification that occurs secondary to injury to breast and ischaemia of fat lobules
  • Scarring results in firm lump
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2
Q

Causes of fat necrosis of breast?

A 
o	Iatrogenic (breast biopsy, breast reduction, augmentation)
o	Trauma (seat-belt injury)
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3
Q

Risk factors of fat necrosis of breast?

A

o Large, fatty breats in overweight or obese women

o Trauma

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4
Q

Symptoms of fat necrosis of breast?

A
  • Painless lump
    o Hard, fixed masses
  • Skin red, bruised or dimpled
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5
Q

Assessment of fat necrosis of breast?

A 
Refer for triple assessment
o	Clinical Examination
o	Radiology – USS <35y, mammography and US for >35y
	Acoustic shadowing
o	Biopsy – FNA or core biopsy
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6
Q

Management of fat necrosis of breast?

A
  • If biopsy confirms fat necrosis – no further management needed, reassure
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7
Q

Definition of fibrocystic disease?

A
  • Characterised by lumpy breasts associated with pain and tenderness that fluctuate with menstrual cycle
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8
Q

Epidemiology of fibrocystic disease?

A
  • Most common benign breast disorder
  • 2/3 of women
  • Women 20-50
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9
Q

Risk factors of fibrocystic disease?

A 
o	Late-onset menopause
o	Later age at first childbirth
o	Nulliparity
o	Obesity
o	Oestrogen replacement
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10
Q

What effects symptoms of fibrocystic disease?

A
  • Hormonal changes thought to affect symptoms
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11
Q

Symptoms of fibrocystic disease?

A
  • Lumps in breasts
  • Pain and nodularity – usually bilateral
  • Symptoms greatest 1 week before menstruation and decrease when it starts
  • Exclude breast cancer, infection or pregnancy
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12
Q

Assessment of fibrocystic disease?

A
  • Breast pain diary for at least 2 months to aid diagnosis
  • Refer if symptoms persist
    o US or mammogram
    o Consider cyst aspiration or biopsy if suspicious
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13
Q

Management of fibrocystic disease - general advice?

A

o No pathological cause
o Better-fitting bra
o Soft support bra at night
o Oral paracetamol and ibuprofen PRN

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14
Q

Management of fibrocystic disease - if general measures fail?

A
  • Referral to breast specialist if does not respond within 3 months:
    o Danazol and tamoxifen (if severe, >6 months and interferes with ADLs)
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15
Q

Prognosis of fibrocystic disease?

A
  • 20-30% will resolve spontaneously

- Not a risk factor for developing breast cancer

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16
Q

Definition of hypospadias?

A
  • Congenital abnormality characterised by abnormal position of external urethral meatus on the ventral penis
  • Urethral tubularisation occurs in a proximal to distal direction due to testosterone
17
Q

How common is hypospadias?

A
  • Affects 1 in 350 male births
18
Q

Symptoms of hypospadias?

A
  • Difficulty urinating while standing
  • Cosmetic appearance problems
  • Erectile deformity
19
Q

Features of hypospadias?

A

Ventral urethral meatus
 Urethra opens on or adjacent to glans penis in most cases, can be on penile shaft or in perineum

Hooded dorsal foreskin
 Foreskin failed to fuse ventrally

Chordee (rare)
 Ventral curvature of the shaft, most apparent on erection

20
Q

Management of hypospadias?

A

Reconstructive surgical - urethroplasty
o Correction often taken <2 years
o Aims to produce terminal urethral meatus, straight erection, normal looking penis

Avoid circumcision

21
Q

Definition of undescended testis?

A
  • Defined as the incomplete descent of one or both testes and absence from the scrotum
  • Usually remain in the abdomen or inguinal canal
22
Q

Definition of cryptorchidism?

A

complete absence of testicle from scrotum (anorchism is absence of both)

23
Q

Definition of maldescended testes?

A

when testes lie along the normal path of descent in the abdomen or inguinal region and have never previously been present in the scrotum

24
Q

Definition of ectopic testes?

A

when testes lie outside of the normal path of descent, for example in the femoral region, perineum, or penile shaft

25
Q

Definition of retractile testes?

A

when testes have previously been present in the scrotum but have come to lie permanently outside it. Normally due to excessive cremasteric reflex. Treatment is reassurance.

26
Q

Epidemiology of undescended testis?

A
  • At birth about 3% of full-term boys (30% of premature boys)
  • Unilateral 4x > bilateral
27
Q

Risk factors of undescended testis?

A
  • First degree relative

* Low birth weight, small for gestational age, preterm delivery

28
Q

Aetiology of undescended testis?

A
  • Idiopathic

* Rarely chromosomal abnormalities or androgen receptor mutations

29
Q

Examination of undescended testis?

A
  • Examination carried out in warm room, warm hand and relaxed child
  • Testes can be brought down by massaging inguinal canal towards scrotum
30
Q

Screening performed of undescended testis?

A
  • Screening done at 48-72 hours and 6-8 weeks
31
Q

Examination findings of undescended testis?

A

Retractile
 Can be manipulated into bottom of scrotum without tension but subsequently retracts due to cremasteric reflex

Palpable
 Testis can be palpated in groin but cannot be manipulated into scrotum

Impalpable
 No testis found, could be in inguinal canal, intra-abdominal or absent

32
Q

Management of undescended testis - children 3 months or younger??

A

If ambiguous genitalia or hypospadias or undescended testes bilaterally – refer within 24 hours to senior paediatrician

If unilateral undescended testes:
 If persists at 6-8 weeks – re-examine at 3 months
 If still undescended – refer to paediatric surgeon before 6 months

33
Q

Management of undescended testis - boys or men?

A

• If one or both undescended – refer to paediatric surgeon/urologist or urologist

34
Q

Management of undescended testis - treatment of maldescended/ectopic testis?

A

Restores potential for spermatogenesis

Surgery
 Orchidoplexy
 Ideally before 6 months of age if picked up

Hormonal therapy
 Human chorionic gonadotrophin (hCG) if undescended testes in inguinal canal

35
Q

Complications of undescended testis?

A
  • Infertility
  • 40x increased risk of testicular cancer
  • Testicular torsion
  • Hernias

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