Section 10: Surgery

Question 1

Indications for surgical repair of varicocele

Answer 1

• If the varicoceles are bilateral
• If varicocele are causing symptoms
• If there are signs of decreased testicular volume or infertility

Question 2

List the risk factors for spinal epidural abscess

Answer 2

1. Intravenous drug use
2. Immunocompromised state (e.g., DM, HIV, alcoholism)
3. Spread from contiguous/distant sources
4. Spinal trauma or surgery

Question 3

List the clinical features of spinal epidural abscess

Answer 3

• Classic triad: Fever, severe focal back pain and neurological deficits
• Progressive symptoms: Radiculopathy, motor & sensory deficits, bowel or bladder dysfunction & eventual paralysis

Question 4

Management of spinal epidural abscess

Answer 4

• Complete blood count
• Inflammatory markers (eg, ESR, CRP)
• Blood cultures
• MRI of spine with gadolinium
• CT-guided aspiration/biopsy
• Empiric antibiotics
• Surgical decompression

Intravenous glucocorticoids are not recommended empirically for patients with fever, back pain, and possible epidural abscess. They are indicated for spinal cord compression or cauda equina syndrome due to metastatic malignancy/traumatic injury

Question 5

Bile salt-induced diarrhea is usally seen with short bowel syndrome. this complication also occurs in 5-10% of cholecystectomies.

What is the Rx of choice for bile-salt induced diarrhea

Answer 5

Bile-acid binding resins eg cholestyramine

Question 6

What is the strongest known risk factor for male breast cancer?

Answer 6

Klinefelter’s syndrome. It carries a 50-fold increase in the rsik of breast cancer compared to men with normal genotype

N/B: Exogenous hormone (estrogen) administration does not seem to increase the risk of breast cancer significantly

Question 7

Which of the following is the most likely complication of untreated varicocele?

• A. Testicular atrophy
• Impotence
• Infection
• Development of hydrocele

Answer 7

A. Testicular atrophy. Venous drainage of the testes involves a complex network of veins called the pampiniform plexus, which are responsible for keeping the tempearture of the scrotal sacs below the normal body tempearture. Dilation of the pampiniform plexus (varicocele) results in an increased tempearture of the scrotal sacs, thereby causing testicular atrophy

Question 8

Which of the following is the most common life-threatening complication of acute compartment syndrome?

• A. Disseminated intravascular coagulation
• B. Rhabdomyolysis and renal failure
• Pulmonary embolism
• Gangrene of the limb
• Thrombocytopenia

Answer 8

B. Rhabdomyolysis and renal failure

Rhabdomyolysis and subsequent development of acute renal failure is one of the most comoon and severe life-threatening complications of acute compartment syndrome

Question 9

List the causes of transient PSA elevation

Answer 9

• Urine retention
• Mild acute prostrate infection/inflammation
• Urologic procedures (eg, cystoscopy)
• Digital rectal examination (minimal elevation in PSA)
• Recent ejaculation

Note: Reeat PSA in 4-6 weeks. Futher investigation is needed if the PSA level remains elevated on repeat testing or prostrate examination shows suspicioius findings

Question 10

True or False:

Surgical exploration should be performed immediately in scrotal trauma cases wherein there is evidence of significant trauma on physical examination

Answer 10

True