Female and male reproductive Med+surg

Question 1

Woman, Lower abdominal pain that radiates to right shoulder.

Rigid abdomen with diffuse tenderness and guarding. Low Bp. Normal hcg. Most likely diagnosis?

Answer 1

Ruptured ovarian cyst - can cause hemoperitoneum = rigid abdomen, tenderness, guarding, hemodynamic instabikity, irritation of phrenic nerve

Ovarian torsion does not cause hemoperitoneum or shoulder pain

Question 2

Even if you suspect fibroadenoma, in a patient under 30 with a breast mass you still do ultrasound. Over 40 = add on mammography

30-40 do mammography or ultrasound

Question 3

Management of simple breast cyst versus complex breast cyst?

Answer 3

Complex = biopsy

Simple and asymptomatic = observe

Simple and tender = FNA. If bloody aspirate or non resolving = biopsy !!

Question 4

Cause or presentation of breast abscess in new baby mother ? Management

Answer 4

Mastitis + fluctuant tender palpable mass

Untreated mastitis and milk buildup

Antibiotics and drainage

Question 5

Prophylactic mastectomy given for mutation or at least one immediate relative with breast cancer before age 50

Question 6

Patient undergoes breast reduction surgery.
Now has fixed mass in breast. Mamograllhy shows calcifications
Core biopsy shows foamy macrophages and fat globules

Patient undergoes mass excision. next step in management?

Answer 6

Reassurance and follow up

Fat necrosis! - surgery is risk factor

Sometimes you see findings seen in cancer - skin or nipple retractions, calcifications

Question 7

Unilateral bloody discharge WITHOUT a mass = intraductal papilloma

Question 8

in patient with severe burns, >20% of TBSA require what in addition to aggressive fluid resus?

Answer 8

urinary catheterization - for acurate monitoring of urine output

Question 9

hydrocele = fluid in tunica vaginalis

Question 10

after testicular trauma, if testicular torsion diagnosis is not clear/to rule it out, do testicular ultrasound

tt can present with tender swollen erythematous hemiscrotum with other signs

Question 11

BPH can reoccur again after a TURP procedure for BPH as the prostate tissue can grow back

Question 12

in a young man with signs of metastatic cancer, where would the primary cancer typically be located!!

Answer 12

testicle!!!

or lymphoma or leukemia!!

Question 13

recurent UTI + tender prostate. diagnosis is?

how else can it present?

management?

Answer 13

chronic bacterial prostatitis - ecoli main cause

can also present as chronic utis, normal prostate exam + pain with ejaculation

fluoroquinolones eg ciprofloxacin, levofloxacin!! for 6 weeks or trimethoprim!!!

Question 14

6 month old with unilateral undescended testes, first step in management?

Answer 14

surgical correction!!!

if less than 6 months = monitor for spontaneous descent

if bilateral undescended testes or hypospadias = evaluate for differences of sex development = karyotype, pelvic ultrasound, adrenal/gonadal hormones

Question 15

recurrent acute pyelonephritis + over the last year frequent nighttime urination and dribbling

most likely underlying cause of patients presentation?

Answer 15

BPH - causes the nightime urination and dribbling

• compresses urethra and increases risk of UTI

not infectious urethritis as this is caused by chlamydia and gonorrhea usually and the symptoms would be dysuria and urethral discharge

Question 16

penile fracture requires urgent operative repair.

what are the indications for retrogade urethrography prior to surgery?

Answer 16

blood at the meatus
dysuria
urinary retention
hematuria

Question 17

patient with priaprism,

first investigation to diagnose cause?

Answer 17

complete blood count!!

but note ->most cases are idiopathic

blood disorders causing altered blood viscosity or local microthrombi eg sickle cell, thalessemia, hematological malignancies, multiple myeloma

Question 18

priaprism management?

Answer 18

aspiration of blood from corpus cavernosa!!!

vs intracavernous injection of phenylephrine!!

Question 19

leydig cell tumors of testes cause gynaecomastia due to elevation of estrogen. tumor markers eg afp negative

Answer 19

Leydig make you a lady (breasts)

Question 20

management of suspected testicular cancer?

Answer 20

ultrasound -> serum tumour markers -> radical orchiectomy

no biopsies!

Question 21

varicocele surgery is done to prevent?

Answer 21

infertility

Question 22

intermittent groin swelling and sharp scrotal pain is concerning for?

what do you do to elict sign more?

Answer 22

groin hernia

valsalva maneuvre

Question 23

severe testicular pain which improves with elevation but no positive cremasteric reflex. diagnosis and treatment?

Answer 23

epididymitis = antibiotic therapy

Question 24

wound dehiscence with an intact fascia is managed with?

Answer 24

regular dressing changes only

deep dehiscence involving fascia = surgical emergency

Question 25

in hospital. delayed onset delirium, elevated vitals (htn, tachycardia, hyperthermia) history of polysubstance use and schizoaffective disorder. on sertraline and aripirpazole but cant confirm last dose time. most likely cause of patients condition

Answer 25

alcohol withdrawal!! signs in keeping with delirum tremens - delirum , hyperthermia, hypertension, tachycardia history of polysubstance use management with benzos

Question 26

brown recluse spider bite = necrosis and eschar management?

Answer 26

local wound care only! no antibiotics

Question 27

frostbite first managed with warming in warm water, what do you do next?

Answer 27

Hospital admission for observation!!! CR angiography of limb is only done!!!! If Pedal pulses are not palpable!! -> concern for acute limb ischemia. Done to see if patient would benefit from thrombolysis

Question 28

high voltage electrical injuries carries the greatest risk of what complications?

Answer 28

skeletal muscle complications = acute compartment syndrome, rhabdomyolysis, acute kidney injury

Question 29

severe burns injury can cause hypermetabolic state = tachycardia, hypertension, hyperglycemia, fever metampphetamine INTOXICATION can also cause this, not withdrawal

Question 30

40 yo. TENDER left breast mass. Solitary and US shows that it is fluid filled. Next step in management?

Answer 30

Needle aspiration!!!!! AKA FNA Contrast to Solid lesions on imaging = core needle or excisional biopsies NBME subject paper q Note!! It is normal for breast cysts to be green brown or clear when aspirated. Contrast to a sanguinous aspirate which needs cytology due to concern for malignancy.

Question 31

68 yo woman. Intraductal breast carcinoma with two 1-mm áreas of microinvasion. Next step in management?

Answer 31

LUMPECTOMY + SENTINEL lymph node biopsy!!! Not mastectomy and axillary node dissection which is for locally advanced breast cancer. NBME past paper q

Question 32

42 Yo woman. 3.5cm mass with regular borders in upper outer quadrant of left breast. Aspiration of the mass shows a clear brown fluid. Which of the following is the likely diagnosis? Fibrocytic disease? Fibroadenoma?

Answer 32

Fibrocystic disease!!! Fibroadenoma is common in women under 35. It is a solid mass and is not Cystic

Question 33

Woman positive for BRACA gene. Next step in management?

Answer 33

Bilateral mastectomy AND OOPHORECTOMY!!! NBME past paper q

Question 34

PDE5 eg sildenafil is contraindicated in patients using nitrates and should be used in caution with alpha blockers due to risk of hypotension

Question 35

0 sperm concentration with normal FSH LH testosterone -> absence of vas deference/obstructive azospermia -> cystic fibrosis

Question 36

acute bacterial prostatitis suspected from examination and urine dipstick. next step in management?

Answer 36

urine gram stain and culture!!! to determine pathogen

Question 37

In patients with LUTS symptoms a urinalysis!! should always be obtained to rule out things like hematuria and infection. Even if it is a man in which you suspect it is BPH. so urinalysis + PSA!! PSA not routine but taken if experiencing LUTS

Question 38

use of what medication should be avoided in patients taking sildenafil?

Answer 38

doxasozin!! (alpha blocker) and nitrates risk of hypotension