Surgery

Question 1

What is Testicular Torsion?

Answer 1

• Surgical emergency
• Twisting of spermatic cord resulting in constriction of vascular supply and ischaemia of testicular tissue
• Intravaginal : twisting within tunica vaginalis (most common cause of acute scrotal pain in 10-18yo)

Extravaginal : entire testis and tunica vaginalis twists (happens in neonates)

Question 2

RF for Testicular Torsion

Answer 2

• Age under 25
• Bell clapper deformity
  • allows testicles to rotate freely within tunica vaginalis
  • accounts for most cases of intravaginal torsion

Question 3

H&E for Testicular Torsion

Answer 3

• Pain
• Swelling
• Unilateral
• High-riding testicle
• Absent cremasteric reflex
• Negative Prehn’s sign (elevation of affected testis does not relieve pain)

Question 4

Investigations for Testicular Torsion

Answer 4

Doppler USS will show whirlpool sign

Question 5

Management of Testicular Torsion

Answer 5

WITHIN 6 HOURS OF SYMPTOM ONSET, DO NOT DELAY FOR DOPPLER USS

• Emergency exploration of scrotum + bilateral orchidopexy

Manual de-torsion if surgery not available in 6 hours

Question 6

What is a Fibroadenoma?

Answer 6

Formed from glandular and stromal tissue
Develop from a whole lobule

Question 7

H&E of Fibroadenoma

Answer 7

• <30 years old
• Mobile, firm, smooth, rubbery lump (breast mouse)
• Non tender

Question 8

Investigations for Fibroadenoma

Answer 8

• USS + re-scan in 3-6 months to monitor growth
• Biopsy if >25/very large

Question 9

Management of Fibroadenoma

Answer 9

• <4cm : conservative management - should shrink over 2 years
• > 4cm, rapidly enlarging or symptomatic : excision

Question 10

What is a Extradural/ Epidural haematoma?

Answer 10

Collection of blood between skull and dura
Almost always caused by trauma - most typically ‘low-impact’

Question 11

MC place for Extradural haematoma to occur

Answer 11

Temporal region since skull at pterion overlies MIDDLE MENINGEAL ARTERY and is vulnerable to injury

Question 12

H&E of Extradural Haemorrhage

Answer 12

• Patient loses consciousness, gains it and then loses it again due to raising ICP + brain herniation - lucid interval
• Raised ICP
• Fixed and dilated pupil = compression of parasympathetic fibers of third CN

Question 13

Investigations for Extradural Haemorrhage

Answer 13

• CT head = biconvex (lentiform), hyper dense collection, limited by suture lines of the skull

Question 14

Management of Extradural Haemorrhage

Answer 14

Definitive is Craniotomy and evacuation of haematoma

• Life threatening ICP = IV mannitol/furosemide may be needed
• ICP monitoring for GCS 3-8
• Hyponatraemia due to SIADH
• Minimum cerebral perfusion pressure 70mmHg in adults and 40-70mmHg in kids