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fourth year > surgery > Flashcards

surgery Flashcards

1
Q

breast Fibroadenoma examination appearance

A

small, mobile, smooth, firm, swell circumscribed lump. usually up to 3cm

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2
Q

fibroadenoma hormone dependent?

A

yes, regresses after menopause commonly.

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3
Q

fibrocystic breast disease (fibroadenosis) hormone related?

A

yes

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4
Q

fibrocystic breast disease (fibroadenosis) symptoms

A

bilateral breast lumpiness, pain and fluctuating size

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5
Q

Tx for fibrocystic breast disease (fibroadenosis)

A

supportive clothing, NSAIDS, weight loss and consider stopping hormonal contraception

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6
Q

breast abscess symptoms

A

acute. associated with fever and pus with tenderness and heat.

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7
Q

fat necrosis examination presentation

A

firm, irregular, fixed lump with skin dimpling or nipple inversion

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8
Q

phyllodes tumour presentation

A

large fast growing periductal stromal neoplasm

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9
Q

phyllodes tumour Tx

A

local excision

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10
Q

breast cancer examination presentation

A

hard, irregular, painless, fixed lesion and tethered to skin or chest wall. ma cause nipple retraction, skin dimpling or oedema

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11
Q

what would make you consider a two week wait referral (urgent) for breast

A

discrete lump with fixation that enlarges.

women >30yrs with persistent lumpiness after menstruation

prior breast cancer with new symptoms

skin or nipple changes that are suggestive

unilateral bloody nipple discharge

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12
Q

mammary duct ectasia presentation

A

blood stained discharge, mastalgia, nipple inversion/retraction.

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13
Q

mammary duct ectasia Tx

A

conservatively or surgical excision if necessary

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14
Q

intraductal papilloma presentation

A

post menopausal, serous or bloody discharge with wart like lesion.

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15
Q

intraductal papilloma Ix

A

breast ductography

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16
Q

intraductal papilloma Tx

A

surgical excision and breast screening

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17
Q

what hormone blocks prolactin

A

dopamine

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18
Q

symptoms of a prolactinoma

A

gynaecomastia, sexual dysfunction, amenorrhoea, infertility, bitemporal hemianopia and galactorrhoea

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19
Q

prolactinoma is associated with which genetic condition

A

MEN1

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20
Q

Tx for prolactinoma

A

bromocriptine or surgery

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21
Q

drugs that may cause galactorrhoea include

A 
Female contraceptives
SSRIs
Antipsychotics, domperidone and metoclopramide (dopamine antagonists)
Methyldopa
Beta blockers
Digoxin
Spironolactone
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22
Q

other causes of galactorrhoea include

A

liver failure and CKD

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23
Q

RF for breast cancer

A 
Female (99% of breast cancers)
Oestrogen Exposure (years of menstruation, few/no children/no breastfeeding)
Alcohol
Obesity
Family history (first-degree relatives)
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24
Q

breast cancer occurrence

A

1/8

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25
Q

BRCA1 chromosome location

A

17

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26
Q

BRAC1 increase risk of

A

breast cancer as well as ovarian, bowel and prostate

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27
Q

BRAC2 is located on chromosome

A

13

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28
Q

breast cancer metastasis

A

Lungs, Liver, Bones, Brain

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29
Q

invasive breast cancer originates from cells in the

A

breast ducts

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30
Q

differential for breast abscess or mastitis

A

inflammatory breast cancer

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31
Q

eczema of the nipple/areolar makes you consider

A

Paget’s disease of the nipple, DCIS-> Ductal carcinoma in situ

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32
Q

follow up for Paget’s disease of the nipple includes

A

biopsy, staging and treatment

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33
Q

NHS screening for breast cancer

A

50-70yr, mammogram every 3 years

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34
Q

high risk breast cancer groups receive screening at what age?

A

40-59

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35
Q

triple diagnostic assessment involves

A

clinical assessment, imaging and biopsy

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36
Q

before breast cancer surgery every patient is offered what assessment

A

axillary US and US biopsy of abnormal nodes

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37
Q

breast cancer T1

A

<2cm

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38
Q

breast cancer T2

A

2-5cm

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39
Q

Breast cancer T4

A

skin or chest wall

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40
Q

breast cancer surgical clear margin is

A

2mm

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41
Q

SE of breast cancer RT

A

fatigue, skin irritation, fibrosis, shrinking of tissue and skin colour changes

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42
Q

premenopausal breast cancer ER +ve chemotherapy involves

A

tamoxifen

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43
Q

postmenopausal breast cancer ER +ve chemotherapy involves

A

aromatase inhibitor letrozole

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44
Q

HER2 positive women breast cancer Tx

A

trastuzumab (herceptin)

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45
Q

HER2 positive women Tx requires monitoring

A

heart function

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46
Q

trastuzumab CI

A

congestive heart failure

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47
Q

trastuzumab SE

A

diarrhoea, tumour pain and headache

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48
Q

Reconstructive breast surgery options

A

implants, latissimus dorsi flap, transverse rectus abdominis flap and deep inferior epigastric perforator flap

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49
Q

reconstructive breast surgery Transverse rectus abdominis flap (TRAM flap) risks

A

abdominal hernia

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50
Q

surveillance mammography for early breast cancer regime

A

yearly mammogram for 5 years

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51
Q

rule for limbs with lymphoedema

A

do not take blood

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52
Q

primary lymphoedema is due to

A

idiopathic

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53
Q

venous ulcers are due too

A

pooling of venous blood and waste products

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54
Q

arterial ulcers are due to

A

poor blood supply to skin

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55
Q

features of an arterial ulcer

A

absent pulses, pallor, smaller, regular border, grey, less likely to bleed, painful, pain at night with leg elevation, improved with hanging

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56
Q

features of a venous ulcer

A

oedema, hyperpigmentation, varicose eczema, larger, broader, likely to bleed, relieved by elevation and worse on hanging

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57
Q

varicose veins arise form pathology within

A

perforator vein valves that run between deep and superficial veins, results in blood pooling in superficial veins

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58
Q

in venous disease haemoglobin breaks down into

A

haemosiderin, which is deposited around the shins leading to discolouration

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59
Q

in venous disease the process of skin and soft tissue becoming fibrotic is called

A

lipodermatosclerosis

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60
Q

what test is positive in venous disease

A

trendelenburg’s test

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61
Q

simple measures for varicose veins

A

mobilising, elevation and compression stockings

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62
Q

surgical options for varicose veins

A

endothermal ablation, sclerotherapy and stripping.

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63
Q

presentation of aortic dissection is

A

tearing chest pain, radiates to back, initial hypertension that progresses to hypotension

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64
Q

RF for aortic dissection are

A

Ehlers-danlos syndrome and marfans.

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65
Q

presentation of an abdominal aortic aneurysm is

A

asymptomatic, non specific abdo pain, palpable expansile pulsation,

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66
Q

surgical options for AAA

A

endovascular stenting, laparoscopic repair and open surgery

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67
Q

what size of an AAA would you consider surgical intervention

A

> 5cm

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68
Q

AAA rupture presentation

A

pulsatile mass, severe abdo pain radiation to back and loin and haemodynamic instability

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69
Q

RF for atherosclerosis

A

age, FH, male, lifestyle, obesity and diabetes

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70
Q

Critical Limb Ischaemia definition

A

is the end-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest.

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71
Q

intermittent claudication definition

A

symptom of having ischaemia in a limb during exertion that is relieved by rest. It is typically a crampy, achy pain in the calf muscles associated with muscle fatigue when walking beyond a certain intensity.

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72
Q

Leriche’s syndrome refers too

A

clinical triad of thigh/buttock claudication, absent femoral pulses, male impotence due to occlusion of distal aorta or proximal common iliac artery

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73
Q

what assessment may you perform for peripheral vascular disease?

A

Buerger’s test

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74
Q

Ix for peripheral vascular disease

A

Ankle-Brachial Pressure Index (ABPI)
Arterial Doppler
Angiography (CT or MRI)

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75
Q

normal ankle brachial pressure index is

A

> 0.9

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76
Q

severe ankle brachial pressure index is

A

<0.3

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77
Q

critical limb ischaemia 6 P’s are

A

Pain, pallor, pulseless, paralysis, paraethesia and perishingly cold

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78
Q

medical Tx for peripheral vascular disease

A

atorvastatin 80mg, clopidrogrel 75mg once daily, naftidrofuryl oxalate

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79
Q

surgical Tx for peripheral vascular disease

A

angioplasty, stenting and bypass

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80
Q

critical limb ischaemia Mx

A

urgent referral, analgesia, urgent revascularisation with bypass, angioplasty or stenting

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81
Q

Tx dose for DVT

A

LMWH enoxaparin 15mg/kg for >5days

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82
Q

target warfarin INR for DVT

A

2-3

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83
Q

long term anticoagulation for DVT should continue for how long?

A

3 months

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84
Q

prophylactic dose of LMWH is

A

40mg of enoxaparin

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85
Q

tenesmus refers too

A

symptoms of full rectum/needing to open bowels after having emptied bowels

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86
Q

hartmann’s procedure refers too

A

removing rectum and/or sigmoid colon and forming a colostomy

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87
Q

Kocher incision refers too

A

open cholecystectomy

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88
Q

mercedes benz incision is for

A

liver transplant

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89
Q

rooftop incision is for

A

iver transplant, Whipples/ pancreatic surgery, upper GI surgery

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90
Q

McBurney incision is for

A

open appendicectomy

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91
Q

battle incision is for

A

appendicectomy

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92
Q

lanz incision is for

A

open appendicectomy

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93
Q

Rutherford Morrison incision is for

A

renal transplant

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94
Q

Pfannenstiel incision is for

A

Caesarean section and abdominal hysterectomy

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95
Q

RUQ pain differentials

A

Biliary Colic
Acute Cholecystitis
Acute Cholangitis

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96
Q

RIF pain differentials

A

Acute Appendicitis
Ectopic Pregnancy
Ovarian Cyst
Meckel’s Diverticulitis

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97
Q

epigastric pain differentials

A

Pancreatitis
Peptic Ulcer Disease
Abdominal Aortic Aneurysm

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98
Q

central abdominal pain differentials

A

Abdominal Aortic Aneurysm
Intestinal Obstruction
Ischaemic Colitis

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99
Q

LIF pain differentials

A

Diverticulitis
Ectopic Pregnancy
Ovarian Cyst

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100
Q

suprapubic pain differentials

A

Acute Urinary Retention

Pelvic Inflammatory Disease

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101
Q

loin to groin pain differentials

A 
Renal Colic (kidney stones)
Abdominal Aortic Aneurysm
Pyelonephritis
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102
Q

what test would you want for an indication of pancreas inflammation

A

amylase

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103
Q

symptoms of appendicitis

A

RIF pain, loss of appetite, nausea and vomiting

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104
Q

sign’s of appendicitis

A

tender to Mcburney’s point, guarding RIF, rebound tenderness, and Rovsing’s sign (palpation of left iliac fossa causes pain in RIF)

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105
Q

Dx of appendicits is through

A

blood tests revealing inflammatory markers, CT and US

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106
Q

common differentials of appendicitis

A

ectopic, ovarian cysts, meckel’s diverticulitis, mesenteric adenitis

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107
Q

mesenteric adenitis is associated with

A

cough or cold, inflammation via abdo lumph nodes.

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108
Q

appendix mass Tx

A

supportive treatment and antibiotics with appendicectomy once acute condition resolved

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109
Q

three causes of intestinal obstruction

A

adhesions, malignancy and hernia

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110
Q

signs and symptoms of intestinal obstruction

A

Increasing abdominal distention and diffuse pain
Absolute constipation and lack of flatulence
Vomiting

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111
Q

initial management of intestinal obstruction

A

Nil by mouth
IV fluids
NG tube on free drainage

112
Q

Ix for intestinal obstruction

A

X-ray, CT

113
Q

upper limits of normal size for the bowel is

A

Upper limits of normal are: 3 cm small bowel, 6 cm colon, 9 cm caecum

114
Q

small bowel markings on X-ray are

A

valvulae conniventes, mucosal folds that cover full width of the small bowel

115
Q

large bowel markings on x-ray are demarcated by

A

haustra

116
Q

causes of ileus

A

post surgery, infection, trauma, pneumonia, and electrolyte imbalance

117
Q

Mx of ileus

A 
Nil by mouth / sips of water
NG tube if vomiting
Mobilise (to stimulate peristalsis)
IV fluids to prevent dehydration
Consider parenteral nutrition
118
Q

sigmoid volvulus twists

A

counter clockwise

119
Q

caecal volvulus twists

A

clockwise

120
Q

RF for volvulus

A 
Psychiatric disorders
Neurological disorders
Nursing home residents
Chronic constipation
Pelvic masses (including pregnancy)
Adhesions
121
Q

Dx of volvulus involves

A

AXR coffee bean sign (sigmoid) and CT

122
Q

Tx of volvulus is

A

endoscopic decompression or laparotomy (hartmann’s for sigmoid or right hemicolectomy for caecal)

123
Q

1st degree haemorrhoids

A

none

124
Q

2nd degree haemorrhoids

A

prolapse on straining, returns on relaxing

125
Q

3rd degree haemorrhoids

A

prolapse when straining, requires pushback

126
Q

4th degree haemorrhoids

A

permanent prolapse

127
Q

symptoms of haemorrhoids

A

constipation, painless red bleeding, sore itchy nus and anal lump

128
Q

differentials for haemorrhoids

A

inflammatory bowel disease, fissure and cancer

129
Q

Tx for haemorrhoids include

A

cream, laxatives, band ligation and surgical haemorrhoidectomy

130
Q

third most prevalent cancer in the u.k. is

A

colorectal

131
Q

symptoms of colorectal cancer are

A

change in bowel habit, weight loss, PR bleeding, tenesmus, iron deficiency anaemia and bowel obstruction

132
Q

gold standard Ix for colorectal cancer

A

colonoscopy

133
Q

Ix for colorectal cancer

A

colonoscopy, Ct colonography, staging CT, and carcinoembryonic antigen

134
Q

colorectal classification is

A

dukes

135
Q

T1 colorectal cancer

A

submucosal

136
Q

T2 colorectal cancer

A

muscularis propria

137
Q

T3 colorectal cancer

A

invasion of subserosa

138
Q

covering loop ileostomy refers too

A

temporary ileostomy created to protect a distal anastomosis

Typically left for 6-8 weeks to allow healing

139
Q

cancer of the low sigmoid colon or higher rectum would require what procedure

A

anterior resection

140
Q

cancer of the lower rectum are excised with what procedure

A

Abdominoperineal Resection (APR)

141
Q

follow up to curative colorectal resection are

A

CT T.A.P. at 1 and 2 or 3 years
Colonoscopy at 1 and 5 years
CEA 6 monthly for 3 years

142
Q

diverticulitis signs and symptoms

A 
Left iliac fossa / lower left abdominal pain and tenderness
Fever
Diarrhea
PR blood / mucus
Nausea and vomiting
143
Q

diverticulitis Mx

A 
Consider admission if unwell
Antibiotics
Analgesia
Fluid resuscitation
May require surgical resection
144
Q

diverticulitis management

A 
Haemorrhage
Perforation
Abscess
Fistula (e.g. between colon and bladder / vagina)
Ileus / obstruction
145
Q

celiac artery supplies

A

Stomach and part of duodenum, biliary system, liver, pancreas

146
Q

superior mesenteric artery supplies

A

Duodenum to 1st half of transverse colon

147
Q

inferior mesenteric supplies

A

2nd half of transverse colon to rectum

148
Q

acute mesenteric ischaemia presents with

A

raised lactate, abdominal pain, shock, peritonitis

149
Q

RF for acute mesenteric ischaemia

A

Older age
Atrial fibrillation
Atherosclerosis
Coagulation disorders

150
Q

MX for acute mesenteric ischaemia

A

Fluid resuscitation
Thrombolysis
Surgical intervention

151
Q

Cholelithiasis refers too

A

gallstones present

152
Q

Choledocholithiasis refers too

A

gallstone(s) in the bile duct

153
Q

Biliary colic refers too

A

Intermittent right upper quadrant pain caused by gallstones irritating bile ducts

154
Q

Cholecystitis refers too

A

Inflammation of the gallbladder

155
Q

Cholangitis refers too

A

Infection and obstruction of the biliary system

156
Q

Gallbladder empyema refers too

A

Pus in the gallbladder

157
Q

Gallstone RF

A

Fat
Fair
Female
Forty

158
Q

step 1 for Ix gallstone disease

A

Liver function tests and ultrasound

159
Q

step 2 gallstone disease investigations indication

A

Indicated if USS doesn’t show ductal stones but the is bile duct dilitation or raised bilirubin

160
Q

Step 2 gallstone Ix

A

MRCP

161
Q

Step 3 gallbladder Ix indication

A

Indicated for established CBD stones / obstructing ductal tumours on USS or MRCP

162
Q

Step three gallstone IX

A

ERPC

163
Q

step 4 gallstone IX

A

cholecystectomy

164
Q

Acute cholecystitis us finding

A

thickened gallbladder wall, stones / sludge in gallbladder and fluid around the gallbladder

165
Q

LFT’s for the biliary tree

A

raised bilirubin, raised ALK P and raised aminotransferase

166
Q

raised bilirubin in gallbladder disease indicates

A

obstruction

167
Q

raised ALK P indicates in gallbladder disease

A

cholestasis, or liver/bone metastasis (none specific)

168
Q

raised ALT/AST indicates

A

hepatocellular injury =, slight rise in obstructive jaundice

169
Q

acute cholecystitis symptoms and signs

A

Murphy’s sign:
RUQ tenderness exacerbated by deep inspirationMurphy’s sign:
RUQ tenderness exacerbated by deep inspiration

170
Q

Tx for acute cholecystitis

A

fasting, fluids, antibiotics (if evidence of infection) and eventual laparoscopic cholecystectomy

171
Q

acute cholangitis symptoms and signs

A

Charcot’s triad: Right Upper Quadrant Pain, Fever, Jaundice

172
Q

Tx for acute cholangitis

A

antibiotics, treatment of sepsis and mechanical intervention (ERCP or PTC)

173
Q

acute pancreatitis causes

A

alcohol, gallstones and post ERCP

174
Q

Glasgow score for pancreatitis

A 
P – Pa02 < 60
A – Age > 55
N – Neutrophils (WBC > 15)
C – Calcium < 2
R – uRea >16
E – Enzymes (LDH > 600 or AST/ALT >200)
A – Albumin < 32
S – Sugar (Glucose >10)
175
Q

pancreatitis complications

A

Pancreatitic necrosis
Infection in necrotic areas
Pseudocysts
Chronic pancreatitis

176
Q

majority of pancreatic cancer are

A

adenocarcinomas

177
Q

pancreatic cancer metastasize to

A

liver, peritoneum, lungs and bones

178
Q

presentation of pancreatic cancer is

A 
Non-specific upper abdominal/back pain
Painless obstructive jaundice
Unintentional weight loss
Pale stools (due to lack of bile)
Steatorrhoea (greasy stools due to malabsorption due to lack of bile)
Dark urine (due to obstructive jaundice)
Palpable mass in epigastric region
179
Q

Dx for pancreatic cancer

A

CA19-9, CT and endoscopic US with biopsy

180
Q

Courvoisier’s law refers too

A

Painless jaundice plus a non-tender palpable gallbladder is pancreatic cancer until proven otherwise

181
Q

whipple’s procedure involves

A

removing head of pancreas, gallbladder, duodenum and pylorus

182
Q

Permanent (end) Ileostomy often used for

A

After total colectomy for Inflammatory Bowel Disease (UC/Crohns) or Familial Adenomatous Polyposis (FAP)

183
Q

Permanent (end) Ileostomy often located

A

lower right abdomen

184
Q

Colostomy often used for

A

After abdomino-perineal resections (APR) for low rectal cancers

185
Q

colostomy often located

A

Most often in lower left abdomen

186
Q

three complications of hernias

A

incarceration (cannot be reduced), obstruction and strangulation

187
Q

three options for hernia repair

A

conservative, tension repair and tension free repair (mesh)

188
Q

indirect inguinal hernia herniates via

A

the inguinal canal via the superficial ring and deep ring. due to failure of the processus vaginalis not being obliterated.

189
Q

inguinal canal (hasselbach’s triangle boundaries)

A

Recus abdominis (medial)
inferior epigastric vessels (superior and lateral border)
poupart’s ligament (inferior border)

190
Q

femoral triangle boundaries

A

Sarorius (lateral), adductor longus (medial) and inguinal ligament (superior)

191
Q

direct inguinal hernia is due to

A

weakness in the abdominal wall around hasselbach’s triangle

192
Q

inguinal hernia differentials

A 
Femoral hernia
Lymph node
Saphena varix (dilation of saphenous vein at junction with femoral vein in groin)
Femoral aneurysm
Abscess
Undescended/ectopic testes
Kidney transplant
193
Q

lateral to medial groin surface

A

nerve
artery
vein
Y fronts and femoral canal

194
Q

borders of the femoral canal

A

Femoral vein laterally
Lacunar ligament medially
Inguinal ligament superiorly
Pectineal ligament posteriorly

195
Q

why is the femoral hernia at higher risk of complications?

A

narrow base

196
Q

site of femoral hernia is

A

below the inguinal ligament

197
Q

Spigelian hernia is one that occurs

A

Through abdominal wall between lateral border of rectus abdominis and linea semilunaris.

198
Q

Spigelian hernia Dx

A

US

199
Q

Diastasis Recti refers too

A

the space between the rectus abdominis diastasis and recti divarication

200
Q

Diastasis Recti hernia arises due to

A

gap is created because the linea alba is stretched and broad

201
Q

appearance of the diastasis recti hernia

A

protruding bulge along the middle of the abdomen

202
Q

what can extenuate the diastasis recti hernia

A

when the patient lies on their back and lifts their head off

203
Q

howship–Romberg sign is for

A

obturator hernia

204
Q

howship–Romberg sign

A

Pain extending from the inner thigh to the knee when the hip is internally rotated due to compression of the obturator nerve

205
Q

type 1 hiatus hernia is

A

sliding - stomach slides up along with the oesophagus through the diaphragm

206
Q

type 2 hiatus hernia is

A

rolling - separate portion of the stomach (i.e. the fundus), folds around and enters through the diaphragm opening along with the oesophagus

207
Q

type 3 hiatus hernia is

A

sliding and rolling

208
Q

type 4 hiatus hernia is

A

A large hernia allows other intraabdominal organs to pass through the diaphragm opening

209
Q

Richter’s hernia refers too

A

a incarcerated and ischaemic hernia

210
Q

upper urinary tract obscuration refers too

A

Loin to groin / flank pain on affected side (result of stretching / irritation of ureter and kidney
Reduced / no urine output
Non-specific symptoms (e.g. vomiting)
Reduced renal function on bloods

211
Q

lower urinary tract obstruction refers too

A

Acute urinary retention (unable to pass urine and increasingly full bladder)
Lower urinary tract symptoms (e.g. poor flow, difficulty initiating urination, terminal dribbling)
Reduced renal function on bloods

212
Q

common causes of upper urinary tract obstruction

A

Kidney stones
Local cancer masses pressing on the ureters
Ureter strictures (scar tissue narrowing tube)

213
Q

lower urinary tract obstruction

A

Benign prostatic hyperplasia (enlarged prostate)
Prostate cancer
Ureter or urethra strictures (from scar tissue)
Neurogenic bladder (no neurological signal telling bladder to contract)

214
Q

urinary obstruction complications

A 
Acute Kidney Injury (postrenal AKI)
Eventually chronic kidney disease
Infection (from pooling of urine and retrograde infection – bacteria tracking back up urinary tract)
Dilated kidney / ureters / bladder
Pain
215
Q

common type of renal tumour is

A

renal cell carcinoma (clear cell)

216
Q

pathognomonic signs of renal cell carcinoma metastatic spread

A

cannonball

217
Q

presentation of renal cell carcinoma is

A

Often asymptomatic
Haematuria
Vague loin pain
Non-specific symptoms of cancer (e.g. weight loss, fatigue, anorexia, night sweats)

218
Q

renal cell carcinoma is children often is

A

Wilm’s tumour

219
Q

RF for clear cell carcinoma is

A 
Smoking
Obesity
Hypertension
Long-term dialysis
Von Hippel-Lindau Disease
220
Q

paraneoplastic features of renal cell carcinoma are

A

Polycythaemia (RCC secretes unregulated erythropoietin)
Hypercalcaemia (RCC secretes a hormone that mimics the action of PTH)
Stauffer Syndrome

221
Q

Stauffer Syndrome is

A

abnormal liver function tests demonstrating an obstructive jaundice – without any localised liver or biliary metastasis!)

222
Q

commonest bladder cancer presentation

A

transitional

223
Q

typical presentation of bladder cancer is

A

dye factory worker with painless haematuria

224
Q

Dx of bladder cancer is through

A

cystoscopy and biopsy

225
Q

associations for bladder cancer

A

dehydration chronically

carcinogens such as aromatic amines, arsenic, smoking

226
Q

Schistosomiasis causes

A

bladder squamous cell carcinoma

227
Q

bladder cancer not invading muscle Tx

A

ransurethral Resection of a Bladder Tumour (TURBT)
Chemo into bladder after surgery (use barrier contraception afterwards)
Weekly treatments for 6 weeks with BCG vaccine

228
Q

bladder cancer muscle invasive Tx

A

Radical cystectomy with ileal conduit
Radiotherapy (as neoadjuvant, primary treatment or palliative)
IV chemotherapy as neoadjuvant or palliative

229
Q

benign prostatic hyperplasia symptoms

A 
Hesitancy
Urgency
Frequency
Intermittency
Straining to void
Terminal dribbling
Incomplete emptying
230
Q

assessment of benign prostatic hyperplasia is with

A

urine dipstick, PSA prior to rectal examination

231
Q

meds Tx for benign prostatic hyperplasia

A

alpha blockers and 5-alpha reductase inhibitors

232
Q

alpha blocker Tx for benign prostatic hyperplasia

A

tamsulosin 400 mcg once daily

233
Q

5-alpha reductase inhibitors Tx for benign prostatic hyperplasia

A

block testosterone and actually help reduce the size of the prostate; e.g. finasteride

234
Q

surgical options for benign prostatic hyperplasia

A

Transurethral resection of the prostate (TURP)
Transurethral electrovaporisation of the prostate (TUVP)
Holmium laser enucleation of the prostate (HoLEP)
Open prostatectomy via abdominal or perineal incision

235
Q

complications of TURP

A 
F – Failure to resolve symptoms
I – Incontinence
R – Retrograde ejaculation (semen goes backwards and is not produced from the urethra during ejaculation)
E – Erectile dysfunction
S – Strictures
236
Q

RF for prostate cancer

A

age, family history, being black, being tall and use of anabolic steroids

237
Q

prostate cancer grading system

A

gleason grading

238
Q

Mx options for prostate cancer

A

brachytherapy and hormonal

239
Q

Tx hormonal therapy for prostate cancer

A

Hormonal therapy aims to block androgens and slow or stop prostate cancer growth

240
Q

SE for hormonal prostate cancer therapy

A

hot flushes, sexual dysfunction, gynaecomastia, fatigue and osteoporosis

241
Q

androgen receptor blocker example

A

Androgen receptor blockers (e.g. bicalutamide)

242
Q

LHRH agonists example

A

goserelin

243
Q

gold standard hormonal treatment for prostate cancer is

A

Bilateral orchidectomy

244
Q

causes of epididymo orchitis

A

E. coli
Chlamydia trachomatis
Neisseria gonorrhea
Mumps

245
Q

presentation of epididymo orchitis

A

gradual onset over hours, testicualr pain and heaviness, dragging, urethral discharge, pain on palpitation, swelling and erythema

246
Q

Mx of epididymo orchitis

A

cirpofloxacin for 2 weeks and abstain from intercourse

247
Q

testicular torsion window

A

6 hours

248
Q

examination signs for testicular torsion

A

tender, firm, absent cremasteric reflex and abnormal lie (horizontal, retracted and rotated)

249
Q

what is the name given to the deformity that predisposes to testicular torsion

A

bell-clapper deformity (absent of fixation to tunica vaginalis)

250
Q

testicular cancer presentation

A

non tender, hard with no fluctuance or transillumination, irregular

251
Q

hydrocele arise due to fluid within

A

the tunica vaginalis

252
Q

hydrocele presentation

A

soft, fluctuant and large

253
Q

hydrocele may indicate

A

underlying cancer

254
Q

varicocele presentation

A

soft bag of worms, dragging or sore

255
Q

varicocele arises from

A

pampiniform venous plexus

256
Q

Epididymal cyst presentation

A

top of testicle soft fluctuant lump

257
Q

The right testicular vein arises from the

A

IVC

258
Q

left testicular vein arises from

A

left renal vein

259
Q

left sided varicocele can indicate

A

an obstruction of the left testicular vein, for example caused by a renal cell carcinoma

260
Q

testicular tumour markers

A

Alpha-fetoprotein may be raised in teratomas (not seminomas)
Beta-hCG may be raised in teratomas and seminomas, but more often in teratomas
Lactate dehydrogenase

261
Q

metastatic spread of testicular cancer is

A

Lymphatics
Lungs
Liver
Brain

262
Q

common organisms that cause pyelonephritis

A

Escherichia coli is the most common cause
Klebsiella
Enterococcus
Pseudomonas

263
Q

presentation of pyelonephritis

A

High fever and rigors
Loin to groin pain
Dysuria and urinary frequency
Haematuria
Other non-specific symptoms (e.g. vomiting)
Pain on bimanual palpation of the renal angle (over kidney)

264
Q

urine dipstick findings for pyelonephritis

A

blood, protein, leukocyte esterase and nitrites

265
Q

imaging for pyelonephritis

A

CT, US and DMSA scans for scarring

266
Q

antibiotic for pyelonephritis

A

co-amoxiclav

267
Q

80% of renal stones are

A

calcium oxolate

268
Q

what renal stone isn’t visible on x-ray

A

uric acid

269
Q

staghorn calculus is produced by

A

struvite - magnesium ammonium phosphate

270
Q

struvite arises from

A

recurrent infections - bacteria can hydrolyse the urea in urine to ammonia, creating the solid struvite

271
Q

presentation of renal stones

A

renal colic, loin to groin pain, haematuria, nausea, vomiting, oliguria

272
Q

Dx of renal stones

A

urine dipstick, bloods, AXR, CT KUB

273
Q

Mx of renal stones

A

NSAIDS, antiemetics, antibiotics, fluids, tamsulosin

274
Q

surgical interventions for stones

A

Extracorporeal Shock Wave Lithotripsy

Ureteroscopy and Laser Lithotripsy

Percutaneous Nephrolithotomy

open surgery

275
Q

oxalate-rich foods

A

spinach, nuts, rhubarb, tea

276
Q

urate- rich foods

A

kidney, liver, sardines

fourth year (12 decks)

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