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31 Cards in this Set
- Front
- Back
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Colorectal cancer referral |
> 40 years + PR bleeding + looser stools/more frequent bowel habit > 6 weeks > 60 years + PR bleeding > 6 weeks > 60 years + looser stools/more frequent bowel habit > 6 weeks Any age + right lower abdominal mass Any age + palpable rectal mass Unexplained iron deficiency in men and non-menstruating women |
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Risk factors for abdominal wall hernias |
obesity ascites increasing age surgical wounds |
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Inguinal hernia |
75 % 95 % men and have a 25 % life time risk Refer all congenital - high of complications Above and medial to pubic tubercle Strangulation is rare |
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Femoral hernia |
More common in mulitparous women Below and lateral to pubic tubercle High risk of strangulation Repair is required |
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Infantile umbilical hernia |
Symmetrical bulge under the umbilicus Premature and Afro-caribbean babies Usually resolve without intervention before 4-5 years Complications - rare |
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Alpha-1 antagonists |
Tamsulosin, alfuzosin Decrease smooth muscle tone Improve symptoms in 70 % Side-effects - dizziness, hypotension, dry mouth, depression |
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5 alpha-reductase inhibitors |
Finasteride Block conversion of testosterone to DHT Reduction in prostate volume May not improve symptoms for 6 months Decrease PSA concentrations by 50 % Side-effects - erectile dysfunction, reduced libido, ejaculation problems, gynaecomastia |
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Circumcision indications |
Phimosis Paraphimosis Recurrent balanitis balanitis xerotica obliterans |
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Duodenal ulcers |
More common than gastric ulcers Pain is relieved by eating |
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Gastric ulcers |
Pain is worsened by eating |
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Colorectal screening |
Faecal occult blood Offered every 2 years to all men and women 60-69 years Those > 70 can request screening Positive result - colonoscopy - 50 % NAD, 40 % polyps, 10 % cancer |
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Acute anal fissure |
< 6 weeks high fibre and fluid diet bulk forming laxatives lubricants topical anaesthetics |
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Chronic anal fissure |
> 6 weeks Continue acute treatments Topical GTN If not effective after 8 weeks - referral |
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Fibroadenoma |
< 30 years discrete, non-tender, highly mobile lumps |
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Fibroadenosis |
Middle-aged women Lumpy painful breasts Symptoms worsen prior to period |
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Epididymal cyst |
Most common scrotal swelling Posterior and separate to testicle Associated - polycystic kidneys, CF, von Hippel-Lindau Dx - ultrasound Mx - conservative or surgery |
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Hydrocele |
Fluid in the tunica vaginalis Soft non-tender swelling anterior and below testicle Can get above swelling Dx - ultrasouns Mx - conservative |
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Varicocele |
Enlargement of testicular veins Infertility > 80 % on left Bag of worms Dx - ultrasound with doppler Mx - conservative or surgery |
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Testicular cancer |
Most common cancer in men 20-30 years Germ-cell tumours Seminoma - 35 years Teratoma - 25 years Risk factors - cryptorchidism, infertility, fhx, klinefelters syndrome, mumps orchitis Painless testicular lump, hydrocele, gynaecomastia Dx - ultrasound Mx - orchidectomy +/- chemo/radiotherapy |
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False raise in PSA levels |
BPH Prostatitis and UTI - wait 1 month after treatment Ejaculation Vigorous exercise Instrumentation of urinary tract Urinary retention |
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Urgent Breast Cancer Referrals |
Lump with features of cancer Lump in post-menopausal women Lump > 30 years that persists beyond next period Lump + past history of breast cancer Unilateral bloody nipple discharge Unilateral eczema skin/nipple change that does not respond to topical treatment |
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Bariatric referral |
BMI > 35 with risk factors BMI > 40 with no risk factors |
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Inguinal hernia repair - return to work |
1-2 weeks - laparoscopic 2-3 weeks - open |
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Maximum safe dose of lidocaine |
3mg/kg BNF - 200mg - 20ml of 1 % solution or 10ml of 2 % solution |
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Circumcision benefits |
Reduces risk of penile cancer Reduces risk of UTI Reduces risk of STDs |
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Management T1/T2 Prostate cancer |
Conservative Radical prostatectomy Radiotherapy |
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Management T3/T4 Prostate cancer |
Hormonal therapy Radical prostatectomy Radiotherapy |
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Management metastatic prostate cancer |
Hormonal therapy - goserelin - gonadorelin analogue - initial increase in LH - need to cover with anti-androgen (cyproterone acetate). Can use anti-androgen Orchidectomy |
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PSA levels |
50-59 years - 3.0 60-69 years - 4.0 > 70 years - 5.0 |
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Lifetime risk of colorectal cancer in UK |
5 % |
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Gastric cancer risk factors |
H. pylori Blood group A gastric andenomatous polyps pernicious anaemia smoking salty and spicy diet |
