Med 3 Study

Front 1

sudden onset scrotal pain, N& V, no relief from scrotal elevation.

Back 1

testicular torsion
Rx= immediate surgery - orchidoplexy if viable, orchidectomy if not.
manual if can't get surgery >6h

Front 2

Scrotal pain and swelling developing over days relieved by elevation of testis, associated fever, discharge, dysuria

Back 2

epididymitis

Front 3

cause of epididymitis in men <35

Back 3

Chlamydia, gonorrhea.

Rx. - Ceftriaxone, doxycycline

Front 4

Cause of epididymitis in men >35

Back 4

e.coli; enterococcus faecalis

Rx- ciprofloxacine

Front 5

Scrotal mass, transilluminates, can get above it with examination

Back 5

non communicating Hydrocele

Front 6

Painless scrotal mass. Palpation of enlarged veins during Valsalva manoeuvre

Back 6

Varicocele

- Doppler confirms Dx

Front 7

painless hard scrotal mass

Back 7

Tumour

Front 8

Inguinoscrotal swelling with inability to palpate the spermatic cord superiorly.

Back 8

indirect inguinal hernia

Front 9

reducible bulge superomedial to the pubic tubercle.

Back 9

indirect inguinal hernia

Front 10

Firm bulge in testicle following trauma, doesn't transilluminate

Back 10

haematocele

Front 11

What two tumour markers should be ordered following firm testicular mass

Back 11

Alpha feto protein (raised in non seminoma)
Beta hCG (mildly raised in seminoma and non seminoma)

Front 12

What is the major type of testicular cancer

Back 12

germ cell (95%)

Front 13

When should fine needle aspiratin biopsy be performed on a scrotal lesion or mass

Back 13

never

Front 14

what is the investigation of choice for scrotal mass

Back 14

U/S

Front 15

treatment of UTI

Back 15

trimethoprim/sulfamethoxazole

Front 16

patient with frequency, dysuria, fever, costovertebral angle tenderness

Back 16

UTI with asoc. pyelonephritis

Front 17

Treatment of kidney stone <10mm uncomplicated

Back 17

hydration (urine output >2l/day)
analgesia
alpha blocker potentially

Front 18

treatment of kidney stone - complicated
or >10mm

Back 18

shock wave therapy
percutaneous nephrolitomy if >2.5cm

Front 19

long term prevention of kidney stone recurrence

Back 19

low Na, low protein, heaps of fluid (>2l urine), citrus, normal calcium

Front 20

Flank pain, gross haematuria, palpable mass

Back 20

Renal cell carcinoma

Front 21

Rx of TCC of bladder that has invaded superficial muscle (T2a-T3)

Back 21

radical cystectomy with ileal conduit

Front 22

Rx of bladder Ca that hasn't invaded superficial muscle (T1)

Back 22

transurethral resection and intravesicular chemo.

Front 23

What is the most imporatnt Rf for TCC of bladder

Back 23

smoking

Front 24

Rx for Pt with dysuria, freq, urgency, fever, back/flank pain, N&V

Back 24

Pyelonephritis - most likely e.coli, cefixime, ciprofloxacin

Front 25

Which zone of the prostate does prostate ca usually effect

Back 25

peripheral

Front 26

which zone of prostate for BPH

Back 26

transitional

Front 27

Rx for testicular Ca

Back 27

orchidectomy plus
platinum based chemo

Front 28

tender mass in groin, mobile, can get above

Back 28

lymphadenopathy

Front 29

pulsatile mass below midpoint of inguinal ligament

Back 29

femoral artery aneurysm

Front 30

What is the Rx of femoral hernia

Back 30

surgery (high rates of strangulation)
suture inguinal lig to pectineal fascia
or mesh over femoral canal

Front 31

large golf ball like lump under inguinal ligament. empties with palpation and refills on release

Back 31

saphena varix

rx = high saphenous ligation

Front 32

painless, rounded, mobile masses, soft, doughy feel

Back 32

lipoma

if >3cm core needle biopsy for liposarcoma

Front 33

rounded firm subcutaneous nodule - when squeezed white exudate from central punctum

Back 33

epidermoid/ sebaceous cyst

white exudate is keratin
most commonly on face, scrotum, scalp and back

Front 34

firm mobile cyst on dorsum of hand, forearm, anke (over a joint)

Back 34

ganglion

Rx =
observe - aspirate - resect (or straight to resection if neurovascular compromise)

Front 35

most common site for soft tissue sarcoma

Back 35

thigh

US - mass deep to the deep fascia

Front 36

management of soft tissue sarcoma

Back 36

wide (2-3cm) excision followed by radiotherapy (chemo for Sx but no survival benefit)

Front 37

early complications of hernial repair

Back 37

wound infection, scrotal haematoma,

Front 38

late complications of hernial repair

Back 38

chronic groin pain, recurrence, testicualr atrophy (damage to T.artery)

Front 39

indications for surgical hernia repair

Back 39

irreducibility, local pain and tenderness, Sx of bowel obstruction.

Front 40

what % of mastalgia is associated with Ca

Back 40

10%

Front 41

What is the triple test? what is the specificity if all three components are concordant?

Back 41

1. clinical findings
2. Imaging - U/S; Mammography
3. non surgical biopsy (FNAB, coreNB)

99%

Front 42

what margin is needed in lumpectomy for Br Ca

Back 42

5-10mm is aim but can accept 1mm if clear margins

Front 43

When should an axillary disection be performed

Back 43

if sentinal lymph node biopsy is positive

Front 44

What are the complications of axillary disection?

Back 44

seroma, numbness/paraesthesiae, shoulder stiffness; Lymphoedema (5-7%)

Front 45

what % of Br Ca are ER +ve

Back 45

2/3

Front 46

most common breast lump <30

Back 46

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

Front 47

What mammographic changes are suggestive of malignancy?

Back 47

- poorly defined mass
- microcalcifications
- spiculated border
- changes between mammograms
- architectural distortion

Front 48

Who should be screened for Br Ca?

Back 48

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.

Front 49

when is nipple discharge worrying?

Back 49

single duct, unilateral
spontaneous
blood stained, serous, or clear

Front 50

What is ultrasound used for in assessment of breast lump

Back 50

differentiate between cystic and solid

Front 51

What drug is used in HER 2 +ve breast Ca

Back 51

trastuzamab

Front 52

What are the RF for Breast Ca?

Back 52

Family Hx
hormone - oestrogen exposure
- young menarche, late menopause, less pregnancies, no breast feeding, obesity,

Front 53

When is radiotherapy to the chest wall indicated in breast surgery

Back 53

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.)

Front 54

What options for therapy are available for ER + breast cancer

Back 54

oopherectomy, aromatase inhibitors (, tamoxifen (E antagonist in breast, agonist elsewhere)

Front 55

when is breast conserving (lumpectomy) a viable treartment of Br Ca

Back 55

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).

Front 56

what nerve can be damaged in axillary disection?

Back 56

intercostobrachial nerve
numbness over posterior arm, axilla, chest wall

Front 57

what 2 -ve features exclude melanoma

Back 57

- single colour
- symmetry of pigment

Front 58

what organisms are most commonly implicated in acute exacerbation of COPD

Back 58

H.Influenzae,
Strep. Pneumo
Moraxella cattarhalis

Rx = amoxycillin and doxycyclin

Front 59

When are inhaled corticosteroids indicated in the management of COPD

Back 59

FEV1 <50% pred
and >2 acute exacerbations over 12/12

Front 60

what are the Sx of Phaeochromocytoma

Back 60

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