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Flashcards in GU, Renal and Breast Deck (51):
1

Normal urine output?

1ml/kg/hour, normally 1.5-2 - around 800mls-2L per day if drinking 2L of water

2

What are the most common herniae?

Indirect inguinal

3

What are indirect inguinal herniae?

Herniation through deep inguinal ring, through inguinal canal towards scrotum

4

What are direct inguinal herniae?

Herniation straight through weakness in abdominal wall (Hasselbachs triangle)

5

6 differentials for groin swelling?

Hernia
Lymphadenopathy
Saphenovarix
Femoral aneurysm
Ectopic testicle
Lipoma/Fibroma/sebaceous cyst

6

3 differentials for a testicular swelling that you can't get above?

Means it's not true testicular - varicocoele, inguinal hernia, torsion

7

3 main causes of a true testicular swelling (can get above)?

Hydrocoele
Tumour
Epididymorchitis

8

What investigation is nearly always diagnostic in testicular swellings?

USS

9

What is the risk of not surgically operating on a hernia?

Risk of strangulation

10

Differentiating between direct and indirect inguinal hernia?

Reduce and apply pressure over mid inguinal point (deep inguinal ring) - get patient to cough, if it reappears then it is direct and if it doesn't it is indirect

11

What is Paget's disease of breast?

Eczema-like Sx around unilateral nipple indicating a rare type of breast cancer

12

Signs typical of a breast cancer?

Solid asymmetrical mass with irregular surface
Painless
Tethering at surface - dimpling, peau d'orange or fixation

13

Signs suggestive of fibroadenoma of breast?

'Breast mice' - rubbery, small, smooth and very mobile
Younger women
Benign overgrowths of terminal duct lobules

14

What are fibrocystic breast changes?

Cyclical and related to menstrual cycle - bilateral, upper outer quadrants
Often like fibroadenomas but painful

15

What is fat necrosis of the breast?

Trauma-related (including biopsy or ultrasound)
Firm round lumps, may look inflamed or dimpled

16

How might a breast access present?

Painful and inflamed
May occur with breast feeding, nipple damage

17

Breast lump which is solid and painless, irregular surface with overlying dimpling?

Cancer

18

Painful breast lumps with often occur symmetrically in UO quadrant, cyclically and related to menopause?

Fibrocystic changes

19

Small, rubbery painless breast lumps which are freely mobile in the breast?

Fibroadenoma

20

Breast lump presenting following a biopsy or US or other trauma, showing signs of inflammation?

Fat necrosis

21

3 major differentials for an acute swollen painful red testicle?

Testicular torsion
Mumps orchitis
Epididymorchitis

22

Where in the testicle does a hydrocoele form?

In the tunica vaginalis (anterior)

23

What is a varicocoele?

Varicosities of the pampiniform plexus which extend down into the testes (bag of worms which you can't get above)

24

3 indications for catheterisation?

Need to monitor UO
Relieve acute retention
Incontinence or immobility

25

2 most common causes of urethritis?

Gonorrhoea
Chlamydia

26

Major symptoms of urethritis?

Dysuria
Discharge
Stuff like dyspareunia

27

Which of gonorrhoea and chlamydia are usually symptomatic?

Gonorrhoea more often symptomatic
Chlamydia not (which is why it is randomly screened for)

28

Investigate process for urethritis Sx?

Urethral swab and gram stain for N gonorrhoea (gram -ve intracell diplococci) - if not = non-gonococcal urethritis
PCR for chlamydia - if not = non-specific urethritis

29

Management of gonorrhoea?

Ceftriaxone IM and single dose azithromycin

30

Management of chlamydia?

Doxycycline for 7 days or stat dose azithromycin

31

Potentially serious complications of gonorrhoea/chlamydia infection in women?

PID
Bartholin's abscess
Neonatal conjunctivitis

32

Potentially serious complications of gonorrhoea and chlamydia in men and women?

Disseminated infection
Fitz-Hugh-Curtis syndrome (perihepatitis)

33

Potential complication of gonorrhoea/chlamydia in men only?

Epididymo-orchitis or prostatitis

34

3 infective causes of vaginal discharge?

BV
Candidiasis
Trichomonas

35

Describe the discharge in BV?

Grey, often malodorous

36

2 RFs for BV?

WSW
IVDU

37

Investigations for BV?

Sniff test (KOH)
Swab - clue cells on smear

38

Rx for BV if necessary?

Metronidazole

39

Describe the discharge in candidiasis?

White, non-smelly
Associated with itch, pain, fissuring etc.

40

RFs for vaginal candidiasis?

Poor hygiene
Immunosuppression - DM, pregnancy, steroids, HIV etc.

41

Describe the discharge in trichomonas infection?

Malodorous and white, profuse and commonly very itchy

42

In what type of man is trichomonas often symptomatic?

Afro-Caribbean

43

5 most infective common causes of genital ulcers?

HSV
Syphillis
Scabies
Chancroid
Lymphogranuloma

44

Which HSV causes which type of ulcer?

HSV1 = oral
HSV2 = genital

45

Early symptoms of acute Syphillis infection?

Genital ulcers (sore = primary chankre)
Rash (palmar-plantar)
Painless lymphadenopathy
Deranged LFTs

46

Late symptoms of Syphillis infection?

CN incl neurosyphillis
Gummatous liver Syphillis

47

2 lab tests for Syphillis?

VDRL
Treponemal IgG EIA

48

Common causes of genital warts?

HPV (6 and 11)

49

What cause of genital warts can be spread amongst school children and appear on arms etc?

Molloscum contagiosum

50

6 causes of urinary retention?

BPH
Prostatitis
Prostatic or other pelvic malignancy
Urethral stricture - infection or trauma
Neurogenic bladder - cauda equina, MS, PD
Medications - Anticholinergics e.g. Oxybutinine, tolterodine

51

What should you document in the catheter notes?

Time, date
Size and material of catheter, expiry date
Any problems inserting
Colour of urine obtained
Amount of fluid syringed into balloon
Residual volume
Name date signature etc.