Nipple discharge - serous, serosanguinous, bloody
mammary duct ectasia
epithelial hyperplasia of pregnancy
cancer or benign breast tumors
A serous or yellowish discharge is fairly common if patients have fibrocystic changes of the breast. Any blood-tinged (serosanguineous) or bloody discharge often indicates an intraductal papilloma or a malignancy of the breast. While very worrisome for malignancy, bloody nipple discharge is actually most likely to be due to a benign process.
After a thorough exam, a mammogram should be included to rule out underlying malignancy that is undetectable by physical exam. Any bloody nipple discharge needs surgical investigation even if the exam and the mammogram are negative.
Mrs. Grey is a friend from church
who confides in you about a problem she has with leaking of urine. She is 65
years old and has 4 children, married and living nearby. Her husband died last
year and she put off seeing a physician because of medical care duties
involving her husband. The urine leakage problem has been present for over 5
years and is worse with any lifting, coughing or sneezing. She gets an urge to
go to urinate and often leaks urine before she gets to the toilet.
Her medical health is good except for long standing diabetes (15 years) which is under control with oral pills. She has not taken estrogen replacement therapy because she didn't have any hot flashes when she underwent menopause.
In order to cure or improve the urine loss it must be determined what is the cause of her problem. Which of the following statements is correct about the diagnosis of urinary incontinence?
bladder spasms (detrusor instability) can be diagnosed by symptoms alone
interstitial cystitis is a cause of stress incontinence
mixed incontinence decreases as age increases
stress incontinence is diagnosed by observing urinary leakage with straining
a urinalysis is used to diagnose overflow incontinence
Stress incontinence is diagnosed by observing urine leakage with coughing or straining. It is almost always associated with urethrovesical neck hypermobility (bladder/urethra dropping). This is visually confirmed by a Q-tip test in which a sterile Q-tip is placed inside the urethra and as a woman strains, the end of the Q-tip rises more than 30 degrees. If this is present, surgery is often needed (bladder 'tack') if pelvic muscle exercises fail to cure the loss. If hypermobility is not present, different treatment is necessary. There may be an intrinsic weakness of the urethral sphincter muscle.
A 33-year-old man is referred to
you for an examination for medical clearance for an elective cholecystectomy.
He has a history of non-insulin-dependent diabetes mellitus and suffered three
fractured ribs in a motor vehicle accident 5 years ago. He is a smoker with a
15-pack/year history. He has a mild nonproductive cough and otherwise is
asymptomatic. His physical examination is essentially normal. A preoperative
chest radiograph reveals a left lower lung zone solitary nodule measuring
approximately 1.5 cm in diameter.
Your next step in managing this patient should be
a. Sputum examination for cytology
b. Elective resection of the nodule
c. Review previous chest radiographs
d. Fiberoptic bronchoscopy
e. Computerized tomography (CT) scan of the chest
compare the previous xray(s) with the current xray and see if there is any change in the size of the lesion.If it has not changed then proceed with the surgery.The lesion is probably benign.
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