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60 Cards in this Set

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sudden onset scrotal pain, N& V, no relief from scrotal elevation.
testicular torsion
Rx= immediate surgery - orchidoplexy if viable, orchidectomy if not.
manual if can't get surgery >6h
Scrotal pain and swelling developing over days relieved by elevation of testis, associated fever, discharge, dysuria
epididymitis
cause of epididymitis in men <35
Chlamydia, gonorrhea.

Rx. - Ceftriaxone, doxycycline
Cause of epididymitis in men >35
e.coli; enterococcus faecalis

Rx- ciprofloxacine
Scrotal mass, transilluminates, can get above it with examination
non communicating Hydrocele
Painless scrotal mass. Palpation of enlarged veins during Valsalva manoeuvre
Varicocele

- Doppler confirms Dx
painless hard scrotal mass
Tumour
Inguinoscrotal swelling with inability to palpate the spermatic cord superiorly.
indirect inguinal hernia
reducible bulge superomedial to the pubic tubercle.
indirect inguinal hernia
Firm bulge in testicle following trauma, doesn't transilluminate
haematocele
What two tumour markers should be ordered following firm testicular mass
Alpha feto protein (raised in non seminoma)
Beta hCG (mildly raised in seminoma and non seminoma)
What is the major type of testicular cancer
germ cell (95%)
When should fine needle aspiratin biopsy be performed on a scrotal lesion or mass
never
what is the investigation of choice for scrotal mass
U/S
treatment of UTI
trimethoprim/sulfamethoxazole
patient with frequency, dysuria, fever, costovertebral angle tenderness
UTI with asoc. pyelonephritis
Treatment of kidney stone <10mm uncomplicated
hydration (urine output >2l/day)
analgesia
alpha blocker potentially
treatment of kidney stone - complicated
or >10mm
shock wave therapy
percutaneous nephrolitomy if >2.5cm
long term prevention of kidney stone recurrence
low Na, low protein, heaps of fluid (>2l urine), citrus, normal calcium
Flank pain, gross haematuria, palpable mass
Renal cell carcinoma
Rx of TCC of bladder that has invaded superficial muscle (T2a-T3)
radical cystectomy with ileal conduit
Rx of bladder Ca that hasn't invaded superficial muscle (T1)
transurethral resection and intravesicular chemo.
What is the most imporatnt Rf for TCC of bladder
smoking
Rx for Pt with dysuria, freq, urgency, fever, back/flank pain, N&V
Pyelonephritis - most likely e.coli, cefixime, ciprofloxacin
Which zone of the prostate does prostate ca usually effect
peripheral
which zone of prostate for BPH
transitional
Rx for testicular Ca
orchidectomy plus
platinum based chemo
tender mass in groin, mobile, can get above
lymphadenopathy
pulsatile mass below midpoint of inguinal ligament
femoral artery aneurysm
What is the Rx of femoral hernia
surgery (high rates of strangulation)
suture inguinal lig to pectineal fascia
or mesh over femoral canal
large golf ball like lump under inguinal ligament. empties with palpation and refills on release
saphena varix

rx = high saphenous ligation
painless, rounded, mobile masses, soft, doughy feel
lipoma

if >3cm core needle biopsy for liposarcoma
rounded firm subcutaneous nodule - when squeezed white exudate from central punctum
epidermoid/ sebaceous cyst

white exudate is keratin
most commonly on face, scrotum, scalp and back
firm mobile cyst on dorsum of hand, forearm, anke (over a joint)
ganglion

Rx =
observe - aspirate - resect (or straight to resection if neurovascular compromise)
most common site for soft tissue sarcoma
thigh

US - mass deep to the deep fascia
management of soft tissue sarcoma
wide (2-3cm) excision followed by radiotherapy (chemo for Sx but no survival benefit)
early complications of hernial repair
wound infection, scrotal haematoma,
late complications of hernial repair
chronic groin pain, recurrence, testicualr atrophy (damage to T.artery)
indications for surgical hernia repair
irreducibility, local pain and tenderness, Sx of bowel obstruction.
what % of mastalgia is associated with Ca
10%
What is the triple test? what is the specificity if all three components are concordant?
1. clinical findings
2. Imaging - U/S; Mammography
3. non surgical biopsy (FNAB, coreNB)

99%
what margin is needed in lumpectomy for Br Ca
5-10mm is aim but can accept 1mm if clear margins
When should an axillary disection be performed
if sentinal lymph node biopsy is positive
What are the complications of axillary disection?
seroma, numbness/paraesthesiae, shoulder stiffness; Lymphoedema (5-7%)
what % of Br Ca are ER +ve
2/3
most common breast lump <30
fibroadenoma

smooth, rubbery, well circumscribed, non-tender, mobile, hormone dependent.
needle aspiration yields no fluid
Dx ==> Core NB,

Rx ==> watch; consider excision if >2-3cm, rapid growth, Sx
What mammographic changes are suggestive of malignancy?
- poorly defined mass
- microcalcifications
- spiculated border
- changes between mammograms
- architectural distortion
Who should be screened for Br Ca?
all women aged 50-69 every 1-2 years.

if +ve family Hx in 1st degree relative every 1-2 years 10 years before youngest presentation.
when is nipple discharge worrying?
single duct, unilateral
spontaneous
blood stained, serous, or clear
What is ultrasound used for in assessment of breast lump
differentiate between cystic and solid
What drug is used in HER 2 +ve breast Ca
trastuzamab
What are the RF for Breast Ca?
Family Hx
hormone - oestrogen exposure
- young menarche, late menopause, less pregnancies, no breast feeding, obesity,
When is radiotherapy to the chest wall indicated in breast surgery
all lumpectomies needs adjuvant radiotherapy (without radiotherapy relapse rate is about 5-6% per year)

Mastectomy - when tumour >5cm or >4 nodes involved (relapse on chest wall is ~1/400/year.)
What options for therapy are available for ER + breast cancer
oopherectomy, aromatase inhibitors (, tamoxifen (E antagonist in breast, agonist elsewhere)
when is breast conserving (lumpectomy) a viable treartment of Br Ca
stage 2 or less (tumour less than 5cm; only ipsilateral node involvement)
axillary node disection is needed in stage 1 and 2. Radiotherapy is needed in all lumpectomy and masectomies where tumour >5cm or >4nodes).
what nerve can be damaged in axillary disection?
intercostobrachial nerve
numbness over posterior arm, axilla, chest wall
what 2 -ve features exclude melanoma
- single colour
- symmetry of pigment
what organisms are most commonly implicated in acute exacerbation of COPD
H.Influenzae,
Strep. Pneumo
Moraxella cattarhalis

Rx = amoxycillin and doxycyclin
When are inhaled corticosteroids indicated in the management of COPD
FEV1 <50% pred
and >2 acute exacerbations over 12/12
what are the Sx of Phaeochromocytoma
cells secrete adrenaline and / or noradrenaline. Signs and Symptoms include throbbing, headache, fear, anxiety, tenseness, restlessness, tremor, pallor, palpitations, sweating, weakness and dizziness. Hypertension is usually present and is often labile