Reproductive System - Level 3

Question 1

Definition of fat necrosis of breast?

Answer 1

• Fibrosis and calcification that occurs secondary to injury to breast and ischaemia of fat lobules
• Scarring results in firm lump

Question 2

Causes of fat necrosis of breast?

Answer 2

o	Iatrogenic (breast biopsy, breast reduction, augmentation)
o	Trauma (seat-belt injury)

Question 3

Risk factors of fat necrosis of breast?

Answer 3

o Large, fatty breats in overweight or obese women

o Trauma

Question 4

Symptoms of fat necrosis of breast?

Answer 4

• Painless lump
  o Hard, fixed masses
• Skin red, bruised or dimpled

Question 5

Assessment of fat necrosis of breast?

Answer 5

Refer for triple assessment
o	Clinical Examination
o	Radiology – USS <35y, mammography and US for >35y
	Acoustic shadowing
o	Biopsy – FNA or core biopsy

Question 6

Management of fat necrosis of breast?

Answer 6

• If biopsy confirms fat necrosis – no further management needed, reassure

Question 7

Definition of fibrocystic disease?

Answer 7

• Characterised by lumpy breasts associated with pain and tenderness that fluctuate with menstrual cycle

Question 8

Epidemiology of fibrocystic disease?

Answer 8

• Most common benign breast disorder
• 2/3 of women
• Women 20-50

Question 9

Risk factors of fibrocystic disease?

Answer 9

o	Late-onset menopause
o	Later age at first childbirth
o	Nulliparity
o	Obesity
o	Oestrogen replacement

Question 10

What effects symptoms of fibrocystic disease?

Answer 10

• Hormonal changes thought to affect symptoms

Question 11

Symptoms of fibrocystic disease?

Answer 11

• Lumps in breasts
• Pain and nodularity – usually bilateral
• Symptoms greatest 1 week before menstruation and decrease when it starts
• Exclude breast cancer, infection or pregnancy

Question 12

Assessment of fibrocystic disease?

Answer 12

• Breast pain diary for at least 2 months to aid diagnosis
• Refer if symptoms persist
  o US or mammogram
  o Consider cyst aspiration or biopsy if suspicious

Question 13

Management of fibrocystic disease - general advice?

Answer 13

o No pathological cause
o Better-fitting bra
o Soft support bra at night
o Oral paracetamol and ibuprofen PRN

Question 14

Management of fibrocystic disease - if general measures fail?

Answer 14

• Referral to breast specialist if does not respond within 3 months:
  o Danazol and tamoxifen (if severe, >6 months and interferes with ADLs)

Question 15

Prognosis of fibrocystic disease?

Answer 15

• 20-30% will resolve spontaneously

- Not a risk factor for developing breast cancer

Question 16

Definition of hypospadias?

Answer 16

• Congenital abnormality characterised by abnormal position of external urethral meatus on the ventral penis
• Urethral tubularisation occurs in a proximal to distal direction due to testosterone

Question 17

How common is hypospadias?

Answer 17

• Affects 1 in 350 male births

Question 18

Symptoms of hypospadias?

Answer 18

• Difficulty urinating while standing
• Cosmetic appearance problems
• Erectile deformity

Question 19

Features of hypospadias?

Answer 19

Ventral urethral meatus
 Urethra opens on or adjacent to glans penis in most cases, can be on penile shaft or in perineum

Hooded dorsal foreskin
 Foreskin failed to fuse ventrally

Chordee (rare)
 Ventral curvature of the shaft, most apparent on erection

Question 20

Management of hypospadias?

Answer 20

Reconstructive surgical - urethroplasty
o Correction often taken <2 years
o Aims to produce terminal urethral meatus, straight erection, normal looking penis

Avoid circumcision

Question 21

Definition of undescended testis?

Answer 21

• Defined as the incomplete descent of one or both testes and absence from the scrotum
• Usually remain in the abdomen or inguinal canal

Question 22

Definition of cryptorchidism?

Answer 22

complete absence of testicle from scrotum (anorchism is absence of both)

Question 23

Definition of maldescended testes?

Answer 23

when testes lie along the normal path of descent in the abdomen or inguinal region and have never previously been present in the scrotum

Question 24

Definition of ectopic testes?

Answer 24

when testes lie outside of the normal path of descent, for example in the femoral region, perineum, or penile shaft

Question 25

Definition of retractile testes?

Answer 25

when testes have previously been present in the scrotum but have come to lie permanently outside it. Normally due to excessive cremasteric reflex. Treatment is reassurance.

Question 26

Epidemiology of undescended testis?

Answer 26

- At birth about 3% of full-term boys (30% of premature boys) - Unilateral 4x > bilateral

Question 27

Risk factors of undescended testis?

Answer 27

* First degree relative | * Low birth weight, small for gestational age, preterm delivery

Question 28

Aetiology of undescended testis?

Answer 28

* Idiopathic | * Rarely chromosomal abnormalities or androgen receptor mutations

Question 29

Examination of undescended testis?

Answer 29

- Examination carried out in warm room, warm hand and relaxed child - Testes can be brought down by massaging inguinal canal towards scrotum

Question 30

Screening performed of undescended testis?

Answer 30

- Screening done at 48-72 hours and 6-8 weeks

Question 31

Examination findings of undescended testis?

Answer 31

Retractile  Can be manipulated into bottom of scrotum without tension but subsequently retracts due to cremasteric reflex Palpable  Testis can be palpated in groin but cannot be manipulated into scrotum Impalpable  No testis found, could be in inguinal canal, intra-abdominal or absent

Question 32

Management of undescended testis - children 3 months or younger??

Answer 32

If ambiguous genitalia or hypospadias or undescended testes bilaterally – refer within 24 hours to senior paediatrician If unilateral undescended testes:  If persists at 6-8 weeks – re-examine at 3 months  If still undescended – refer to paediatric surgeon before 6 months

Question 33

Management of undescended testis - boys or men?

Answer 33

• If one or both undescended – refer to paediatric surgeon/urologist or urologist

Question 34

Management of undescended testis - treatment of maldescended/ectopic testis?

Answer 34

Restores potential for spermatogenesis Surgery  Orchidoplexy  Ideally before 6 months of age if picked up Hormonal therapy  Human chorionic gonadotrophin (hCG) if undescended testes in inguinal canal

Question 35

Complications of undescended testis?

Answer 35

- Infertility - 40x increased risk of testicular cancer - Testicular torsion - Hernias