Revision Diseases

8/14/2019 Revision Diseases

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CARDIOVASCULAR

1.Hypertension

A common disorder defined as sustained elevation of systolic blood pressure (BP) > 160 mmHg and/or diastolic BP >

90 mmHg. Three successive readings are typically required for diagnosis.

What to revise

Risk factors and causes of primary and secondary hypertension

Long-term risks of uncontrolled hypertensionDrug treatment of hypertension

2.Ischaemic heart disease (IHD)

A condition caused by reduction or cessation of the blood supply to the myocardium. It gives rise to four main

syndromes: stable angina, unstable angina, myocardial infarction and sudden cardiac death. The most important cause

of IHD is atherosclerosis.

What to revise

The pathophysiology and causes of atherosclerosis

Cardiac risk factors

Diagnosis and management of myocardial infarction

Interventions and drugs in the long-term management of IHD

3.Heart failure

This can be defined as the inability of the heart to maintain sufficient cardiac output to adequately perfuse the tissues for

normal metabolism. It can be caused by conditions that damage heart muscle (e.g. IHD or cardiomyopathies) or that

demand increased work of the heart (e.g. systemic hypertension or valvular heart disease).

What to revise

Causes of heart failure

Symptoms and signs of right- and left-sided heart failure

Compensatory mechanisms in heart failure

Medical management of heart failure

4.Arrhythmia

Any deviation from the normal sinus rhythm of the heart is known as an arrhythmia. They are classified clinically by

site of origin (supraventricular or ventricular) and heart rate (bradycardia or tachycardia).

What to revise

How to spell 'arrhythmia'

Causes of and risk factors for arrhythmia

Recognition of the big four: atrial fibrillation (AF), heart block, ventricular tachycardia (VT) and VF (ventricular

fibrillation)

Treatment protocols - drugs, cardioversion, ablation and defibrillation

5.Thromboembolic disease

The pathological formation of thrombus and its acute complication of embolus, especially to the pulmonary vasculature;

pulmonary embolus accounts for 1% of all hospital deaths. Ninety per cent of deep vein thromboses (DVTs) occur in

the deep veins of the lower limb.

What to revise

Understand Virchow's triad and learn the specific risk factors for thrombosis: immobility, cardiac failure, pregnancy,

the combined oral contraceptive pill (COCP) and varicose veins

Symptoms and signs of DVT and pulmonary embolism (PE)

Classification of PE from major to minor and the emergency management of PE

Anticoagulation and its role in thromboembolic disease



6.Heart valve disorders

Disease of the heart valves produces two types of disorder - stenosis and regurgitation - which can coexist in the same

valve. Valvular disease can be caused by damage to the valve leaflets or to the valve ring, or can be secondary to

damage to the papillary muscles or chordae. Important mechanisms include degenerative calcification, rheumatic heart

disease (the incidence of which is declining) and infective endocarditis.

What to revise

Concentrate on the big four: mitral stenosis, mitral regurgitation, aortic stenosis and aortic regurgitationLearn the symptoms and signs of aortic and mitral valve disease

Learn the causes, in particular calcification, endocarditis and rheumatic heart disease

Know the types of valve replacement and the precautions necessary in patients who have these

7.Peripheral vascular disease

A common degenerative disease of the blood vessels, in particular of the arteries. It results in a number of specific

problems, including acute and chronic ischaemia of the legs, ischaemia of the organs (e.g. kidneys, brain, bowel) and

aortic aneurysm. It can be due to a number of pathological processes, including arteriosclerosis and atheroma formation.

What to revise

Risk factors for peripheral vascular disease: smoking, hypertension, lipids, etc.

Mechanisms of arteriosclerosis and atherosclerosis and the changes that occur in the artery wallsIschaemia of the legs: symptoms, signs and management

Aortic aneurysm: definitions, diagnosis and treatment

RESPIRATORY DISEASE

1.Chronic obstructive pulmonary disease (COPD)

A common condition occurring in 17% of men and 8% of women aged 45-64 years. It could perhaps more correctly be

called 'chronic bronchitis and emphysema' because both conditions coexist in all patients to varying degrees. Virtually

confined to smokers, mortality from COPD is related to the number of cigarettes smoked per day.

What to revise

Diagnostic definitions - clinical history for bronchitis and pathological for emphysema

Symptoms and signs, and the two subtypes of patient: pink puffers and blue bloaters

Management of acute exacerbations and long-term prophylaxisInterpretation of arterial blood gas results

2.Asthma

A common chronic inflammatory condition of the airways that causes reversible obstruction. The airways are

characteristically hyper-responsive to a wide range of stimuli. Oedema, smooth muscle hypertrophy and mucus

plugging cause obstruction.

What to revise

Classification into extrinsic and intrinsic asthma, and the triggering, exacerbating and relieving factors

Structural changes that occur in the airway, and their clinical features

Emergency management of acute asthma

Medical management of chronic asthma and inhaler technique

3.Lung cancer

Bronchogenic carcinoma is the most common cause of death from cancer in the UK, affecting 30 000 people per year.

Males are affected more than females but there is an increasing incidence in women. Peak incidence is between 40 and

70 years. The UK has the highest incidence of this disease in the world.

What to revise

The four main histological types: squamous cell (50%), small cell (20%), adenocarcinoma (20%) and large cell

anaplastic (10%)

Risk factors, clinical features and prognosis for each type

Symptoms and signs of pulmonary involvement, local spread, metastatic spread and also endocrine and neurological

syndromesManagement and palliation



4.Pneumonia

Pneumonia is defined as the consolidation of lung tissue caused by formation of intra-alveolar inflammatory exudates as

a result of a lung infection. This must be visible on X-ray to be properly called pneumonia, as opposed to 'chest

infection'. Pneumonia is the fifth most common cause of death, according to US data.

What to revise

Predisposing factors to chest infection and pneumonia

Common causative organisms and the distinction between community-acquired and hospital-acquired pneumoniaDiagnostic and pathological features of bronchopneumonia, lobar pneumonia and atypical pneumonia

The special features of pneumonia in immunocompromised patients

Appropriate antibiotic use for the various types of pneumonia

5.Pulmonary tuberculosis (TB)

This is a chronic granulomatous infection of the lung caused by Mycobacterium tuberculosis. It is uncommon in the UK

(incidence 7 per 100 000 per year) but extremely common worldwide. It is a very common exam topic because of the

increasing incidence in elderly, immunocompromised and homeless people, and the emergence of drug-resistant strains.

What to revise

Risk factors for infection and routes by which the organism can be spread

Pathogenesis: primary and secondary TB; the histopathological sequence of events that leads to granuloma formationSymptom, signs and diagnosis of TB

Non-pulmonary TB

Drug treatments for TB, public health measures to prevent spread and the problems of ensuring compliance with

treatment

6.Cystic fibrosis

A hereditary disease characterized by the production of abnormally thick mucus due to the presence of an abnormal

transmembrane chloride ion transporter. It primarily affects lung and pancreas. It is the most common autosomal

recessive disorder, affecting 1 in 2000 newborns. A common exam topic.

What to revise

Pathogenesis: learn the genetic and molecular mechanisms and the physiological effects that produce the clinicalfeatures of the disease

Symptoms, signs and methods of diagnosis

Prognosis and management of the pulmonary and pancreatic effects of the disease

7.Diffuse interstitial diseases (alveolitis)

A group of non-infectious, non-malignant disorders in which there is inflammation of the alveolar walls with a

thickening of the interstitium between the alveoli, usually with fibrosis. It is worth learning about the features of the

general disease process and one or two of the conditions in more detail.

What to revise

Histopathological changes for this general group of diseases, and management, which is similar for all of them

Symptoms, signs and diagnostic features of interstitial diseasesThe three main causes of chronic pulmonary fibrosis: (i) idiopathic (sarcoidosis and cryptogenic fibrosing alveolitis);

(ii) dust inhalation, which might be inorganic (coal workers' pneumoconiosis) or organic (farmers' lung); and (iii)

iatrogenic (radiation pneumonitis or drug-induced by amiodarone or anticancer drugs)

8.Pneumothorax

The presence of air in the pleural cavity. It is common and can be spontaneous or caused by trauma. The severity can

vary from mild to life threatening.

What to revise

Causes of pneumothorax: spontaneous (idiopathic or secondary to underlying disease) and traumatic (accidental or

iatrogenic)

Diagnosis and assessment of severityManagement and risks of recurrence



GASTROINTESTINAL DISEASE

1.Gastritis, gastro-oesophageal reflux disease (GORD) and peptic ulceration

A spectrum of disease comprising inflammation and ulceration of the oesophagus, stomach or duodenum caused by

mucosal damage due to particularly acid gastric secretions. In the West, 10% of the population experience this at some

time in their lives. GORD and ulcers normally develop in adulthood and follow a history of repeated healing and

relapse over many years.

What to reviseRisk factors, causative agents and protective mechanisms, in particular the role of Helicobacter pylori

Symptoms and signs of gastritis, gastro-oesophageal reflux and peptic ulcers

Diagnostic tests in peptic ulcer disease

Medical and surgical management

2.Inflammatory bowel disease (IBD)

A group of common disorders characterized by idiopathic inflammation of the intestinal wall. Crohn's disease and

ulcerative colitis (UC) are the two most important conditions. Prevalence in the UK is 30-50 per 100 000 for Crohn's

disease and 80 per 100 000 for UC. Neither aetiology is fully understood.

What to revise

The clinical and pathological features of UC and Crohn's disease - a common theme for questions is to compare andcontrast the two

The complications and sequelae of IBD

The systemic manifestations of IBD

Medical and surgical management

3.Viral hepatitis

This is a common condition caused by a group of unrelated hepatotrophic viruses, all of which cause a primary hepatitis

or inflammation of the liver. Clinical features are similar regardless of aetiology. Hepatitis viruses A to G are now

recognized and other, non-hepatotrophic viruses such as Epstein-Barr and cytomegalovirus have also been known to

cause hepatitis.

What to reviseThe characteristics and route of infection of hepatitis viruses A to E, with emphasis on B and C

Symptoms and signs of hepatitis, and diagnostic tests

The presence of serum antibody and antigen for hepatitis B and C through the course of the infection

Methods of treatment and immunization

4.Colorectal carcinoma

An adenocarcinoma derived from glandular epithelium in the mucosa of the large bowel. This is the second most

common cause of death from neoplasia in the UK, with a peak incidence between 60 and 70 years.

What to revise

Aetiology and risk factors for colorectal cancer. Understand the progression from previous adenomas and the genetic

model of successive mutations that cause neoplasiaSymptoms, signs and diagnosis

Classification, staging and grading

Methods of treatment and prognosis

5.Oesophageal cancer

Oesophageal cancer has an incidence of 5-10 per 100 000 per year in the UK. Squamous cell and adenocarcinoma are

the most common types. Prognosis is usually poor because the disease is advanced by the time symptoms arise.

What to revise

Aetiology and risk factors for oesophageal cancer. Understand the concept of metaplasia in Barrett's oesophagus and

how this can progress

Symptoms and signs, diagnosis by gastroscopyManagement options and prognosis



6.Gastric adenocarcinoma

A common cancer arising from the mucus-secreting epithelial cells in the stomach. Incidence is 20-40 per 100 000 per

year in the UK. It is typically seen after the age of 30, with an increased incidence over 50 years of age. The

male:female ratio is 3:2.

What to revise

Aetiology and risk factors for gastric cancer

The geographical distributionThe sequence of genetic changes leading to neoplasia

Classification of gastric cancers


Surgical and medical management

7.Malabsorption syndromes

A spectrum of disorders that produce the syndrome of weight loss, abdominal distension, diarrhoea with loose bulky

stool, steatorrhoea and anaemia. Mechanisms include disorders of intraluminal digestion by pancreatic enzymes,

solubilization by bile acids, terminal digestion by mucosal enzymes and transepithelial transport.

What to revise

The physiological mechanisms involved in digestion and how they can fail in the various types of malabsorptionsyndrome

Clinical and pathological features of coeliac disease and its treatment

Know an example for the each of the types of malabsorption mentioned above

ENDOCRINE AND METABOLIC DISEASE

1.Diabetes mellitus

A group of metabolic disorders characterized by chronic hyperglycaemia due to relative insulin deficiency. It is

common and affects around 40 million people worldwide. It is a large and important topic in medicine because of its

numerous complications, which affect almost all parts of the body.

What to revise

Have a reasonable overview of normal glucose metabolism

Classification of diabetes mellitus - types 1 and 2Symptoms, signs and diagnostic criteria

Complications of diabetes: cardiovascular, eyes, kidneys, neuropathy, feet, infections, skin and joints

Long-term management with diet, oral hypoglycaemics and insulin

Diabetic emergencies: ketoacidosis and hyperosmolar non-ketotic coma

Monitoring treatment

2.Obesity

A common and increasing problem in the West, obesity is defined as a body mass index (BMI) above 29 and is a risk

factor for a number of chronic illnesses, including hypertension, ischaemic heart disease and diabetes.

What to revise

BMI and classification of obesitySocioeconomic risk factors for obesity

Long-term problems associated with obesity

Management of obesity: diet, exercise, medication and surgery

3.Protein energy malnutrition

Starvation is a major cause of morbidity and mortality worldwide. Although not common in developed countries,

poverty, inappropriate diet and coexisting medical conditions (such as surgery, sepsis, cancer, anorexia nervosa and

malabsorption syndromes) can produce degrees of starvation.

What to revise

Pathophysiology of starvation: understand carbohydrate, fat and protein metabolism in the fed and starved states

Classification and clinical features of protein-energy malnutritionAssessing the degree of malnutrition

Treatment: resuscitation, refeeding and rehabilitation



4.Thyroid dysfunction

The metabolic activity of many tissues is regulated by the thyroid gland; over- and underactivity of the thyroid are the

most common of all endocrine problems. Hypothyroidism can be caused primary thyroid disease or be secondary to

hypothalamic or pituitary disease. Hyperthyroidism is nearly always caused by intrinsic thyroid disease and affects 2-

5% of females at some time, with a female:male ratio of 5:1.

What to revise

Causes and clinical features of hypothyroidismInvestigation and treatment of hypothyroidism

Causes and clinical features of hyperthyroidism

Graves' disease and thyroid eye disease

Acute and long-term management of hyperthyroidism

5.Adrenal dysfunction

The adrenal cortex secretes three main groups of steroid hormones: glucocorticoids, mineralocorticoids and adrenal

androgens. These have wide-ranging effects throughout the body and therefore the clinical features of adrenal

dysfunction are complex. Cushing's syndrome is common but the main cause is iatrogenic through use of steroid

therapy. Addison's disease is rare but is a common topic for exam questions.

What to revise Normal function of the adrenal axis - glucocorticoids and mineralocorticoids

Investigation and diagnostic tests in adrenal disease

Causes, clinical features and management of Cushing's syndromes

Causes, clinical features and management of Addison's disease

Hyperaldosteronism and Conn's syndrome

Problems associated with corticosteroid therapy

6.Parathyroid dysfunction

Parathyroid hormone (PTH) is a polypeptide secreted by the chief cells of the parathyroid glands. It acts on the bones

and kidneys to increase levels of serum calcium and decrease levels of serum phosphate. Primary hyperparathyroidism

is the most common of the thyroid disorders and has a prevalence of 1 per 800 in the UK. Over 90% of patients are over

50 and the female:male ratio is 2:1.

What to revise

Understand the basics of normal calcium metabolism and the mechanisms by which PTH acts to regulate calcium and

phosphate

Causes, clinical features and management of primary hyperparathyroidism

Definitions of secondary and tertiary hyperparathyroidism, and of renal osteodystrophy

Hypoparathyroidism and clinical features of hypocalcaemia

7.Pituitary tumours

These are the most common cause of pituitary disease. Clinical features are the result of excess hormone secretion, local

effects of the tumour or inadequate hormone production by the remainder of the gland.

What to revise

Understand the normal function of the hypothalamus and pituitary

The common tumour types and clinical syndromes that they cause: prolactinoma, acromegaly, Cushing's disease, non-

functioning tumours

Diagnostic tests used in pituitary disease

RENAL

1.Urinary tract infection (UTI)

UTIs are common infection in women but rare in men because of the longer urethra. Recurrent or untreated infection

can cause considerable morbidity, including renal disease and end-stage renal failure. It is of particular significance in

children because of the need for early diagnosis of abnormal urinary tracts.

What to reviseCommon causative organisms and risk factors for infection

Symptoms, signs and diagnosis

Complications of UTIs , Management and further investigation (especially in children)



2.Benign prostatic hypertrophy (BPH)

This commonly occurs in men over the age of 60 years. The aetiology is not known but BPH is characterized by

hyperplasia of the glandular and connective tissue in the prostate, resulting in compression of the urethra and bladder

outflow obstruction.

What to revise

Symptoms and signs of bladder outflow obstruction or 'prostatism'

Diagnostic proceduresMedical and surgical management

3.Prostate cancer

Carcinoma of the prostate is the fourth most common cause of death from malignancy in men in the UK - accounting

for 7% of cancers in men. By the age of 80 years, 80% of men have malignant cells within the prostate, although most

remain dormant.

What to revise

Clinical features and diagnosis

Treatment with hormone analogues, radiotherapy and surgery

Prognosis

4.Renal and vesical calculi

About 2% of the UK population have a urinary tract stone at any given time. Most are composed of calcium oxalate and

phosphate but mixed infective stones are also common. It is commonly a recurrent problem - 50% of patients will have

formed a further stone within 10 years.

What to revise

Aetiology and risk factors for the various types of stone

Symptoms, signs and diagnostic tests

Conservative and surgical management of renal and vesical calculi

5.Renal failureThe term refers to the failure of renal excretory function due to depression of the glomerular filtration rate. It is often

associated with failure of other renal functions: acid-base balance; regulation of salt, water and blood pressure; secretion

of erythropoietin and activation of vitamin D.

What to revise

Definitions of renal failure: prerenal, renal and postrenal; acute versus chronic renal failure

Causes of renal failure, which can be grouped into failure of renal perfusion, disease of the renal vasculature,

glomerulonephritis and tubulointerstitial disease


Management of end-stage renal failure: CAPD (Continuous Ambulatory Peritoneal Dialysis), haemodialysis, transplant

and ancillary treatment (e.g. erythropoietin, calcium supplementation)

HAEMATOLOGY1.Anaemia

A state in which the level of haemoglobin in the blood is below the normal range for the patient's age and sex: 13.5-18.0

g/dL in males and 11.5-16.0 g/dL in females. Causes are numerous and can be divided roughly into three categories: (i)

reduced production of haemoglobin or red blood cells; (ii) increased red cell destruction; or (iii) blood loss (acute or

chronic).

What to revise

The causes of anaemia as outlined above

Symptoms and signs of anaemia

Investigations to find the cause of anaemia

2.Sickle-cell diseaseA common inherited disease caused by a point mutation in the beta-globin gene, which results in the substitution of

valine for glutamate. The resultant haemoglobin variant, HbS, polymerizes at low oxygen saturations, causing the

characteristic sickle deformity of the red cells, which 'sludge' in the small vessels and undergo haemolysis.



What to revise

Epidemiology and pathophysiology of sickle-cell disease: association with malaria-endemic regions

Classification of sickle-cell disease: heterozygous and homozygous forms

Clinical features of sickle-cell disease

Management of sickle-cell crises

3.LeukaemiaA spectrum of diseases caused by malignant proliferation of haemopoietic precursor cells in the bone marrow. They are

not common - the incidence is 5 per 100 000 per year for all types - but they are important because of their

responsiveness to treatment.

What to revise

Classification of the four main types: acute lymphoblastic, acute myeloblastic, chronic lymphocytic and chronic

myeloid. Be aware of the subclassification within these main types (FAB, RAI, etc.)

Aetiological factors: especially genetic mutations such as the Philadelphia chromosome and the BCR-ABL fusion

product

Symptoms and signs of leukaemia

Diagnostic tests (blood film, bone marrow biopsy and cytogenetics)

Management of leukaemia: chemotherapy - especially STI571, GM-CSF (Granulocyte, Monocyte - Colony Stimulating

Factor) and ATRA (All-Trans Retinoic Acid) and supportive treatment (i.e. blood transfusions)

4.Lymphoma

The lymphomas are caused by neoplastic proliferation of cells in the lymphoid system. Classification is based on

histological appearance of the abnormal cells and is divided into Hodgkin's and non-Hodgkin's lymphoma (NHL).

What to revise

Classification of the lymphomas and how the disease is staged and graded


A differential diagnosis of causes of lymph node enlargement

Prognosis and management of lymphoma

5.Myeloma

A disease caused by malignant proliferation of plasma cells in the bone marrow. It is part of a spectrum of diseases

characterized by the presence of a serum paraprotein that can be demonstrated as a monoclonal band on electrophoresis.

It occurs mainly in people over 50 years of age. The clinical features are caused by bone destruction, bone marrow

infiltration and failure, and renal failure due to deposition of the light chain paraprotein.

What to revise

Pathophysiology of the disease and mechanisms by which the clinical features are produced

Symptoms, signs and diagnostic tests: blood film, protein electrophoresis, Bence-Jones proteins in urine and bone

marrow biopsy in particular

Prognosis and management

6.Haemophilia A

An X-linked recessive inherited disease characterized by a deficiency of clotting factor VIII. The incidence is 1 in 7500

of the male population per year. Clinical features depend on the level of factor VIII - if it is less than 1% of normal the

patient will experience frequent spontaneous bleeds from early life. Bleeds commonly occur into the large joints

(haemarthroses) and lead to crippling deformity if the condition is untreated.

What to revise

Understand the clotting pathway and how factor VIII plays a central role. Make sure you are learning the up-to-date

version and not the old intrinsic/extrinsic model

Classification of the severity of haemophilia, and clinical features

Management of haemophilia: factor VIII, activated factor VII, ddAVP (1-deamino-8-D-arginine vasopressin, also

known as desmopressin) and potential for gene therapyRisks of treatment with blood products and the effects of human immunodeficiency virus (HIV) and hepatitis C

infection on people with haemophilia



SURGICAL DISEASE

1.Acute abdomen

The most common surgical presentation, rather than a disease in itself. It is important to have a clear approach to the

assessment and management of this condition.

What to revise

The differential diagnosis of an acute abdomen

Symptoms and signs of peritonitisThe diagnostic approach and investigations required

Initial management

2.Appendicitis

A common surgical problem that can present at any age but with a peak incidence in the teens and early adulthood.

Diagnosis can be problematic because classic symptoms occur in only 55% of cases.

What to revise

Aetiology of appendicitis, and vulnerable groups

Symptoms, signs and differential diagnosis of appendicitis

Clinical course of the disease

Management of acute appendicitis

3.Diverticular disease

This is a very common condition in the West and is caused by lack of dietary fibre. It affects two-thirds of the

population by the age of 70 years and is more common in women than men (3:2). Many cases are asymptomatic and the

most common presentation is with abdominal pain.

What to revise

Aetiology and risk factors for diverticular disease

Definitions of diverticular disease: diverticulosis, diverticulitis

Symptoms, signs and differential diagnosis

Clinical features and complications

Conservative and surgical management

4.Pancreatitis

This occurs in 10-20 per 100 000 people per year in the UK. Most cases of acute pancreatitis are caused by gallstones or

alcohol. It is a potentially life-threatening condition with an overall mortality of 8-10%.

What to revise

Aetiology and risk factors for pancreatitis


Ranson's criteria for assessment of severity, and clinical course of the disease

Management of acute pancreatitis

5.Large bowel obstruction

This is a common cause of an acute abdomen and is characterized by the symptoms and signs of abdominal pain,

distension, vomiting and inability to pass stool or flatus. Common causes include simple constipation, cancer of the

colon, diverticular stricture and sigmoid volvulus.

What to revise

Symptoms, signs and differential diagnosis of large bowel obstruction

Diagnostic investigations


6.Cholecystitis

Gallstones are very common but only a small minority of adults with gallstones develop acute cholecystitis, which in95% of cases is due to the impaction of a gallstone in Hartmann's pouch.



What to revise

Aetiology and risk factors for gallstones - the F's (Fat, Fertile Females)

Symptoms and signs of acute cholecystitis

Clinical course and diagnosis of acute and chronic cholecystitis

Conservative, endoscopic and surgical management

7.HerniaThe abnormal protrusion of a viscus, or of part of a viscus, through the coverings that contain it. Incisional hernias are

the most common type, followed by inguinal, femoral and finally umbilical hernias. Inguinal hernia occurs in 1-2% of

children, mostly boys (9:1) and in 112 per 100 000 adults per year in the UK. The ratio of inguinal to femoral hernias is

40:1 in men and 3:1 in women.

What to revise

The anatomy of the inguinal and femoral canals, and aetiology of hernias

Classification of hernias by location, type and severity

Symptoms, signs and differential diagnosis for the above types of hernia


Refresh your knowledge of the regional anatomy

Risk factors for testicular torsion

Symptoms, signs and differential diagnosisSurgical management

8.Testicular torsion

An acute and painful condition caused by rotation of a testis on its mesentery, so that blood supply is impaired resulting

in ischaemic pain and oedema. It is a surgical emergency and the torsion must be corrected within hours to save the

testis. It occurs at any age but most often in adolescents.

What to revise

Aetiology and risk factors for haemorrhoids

Symptoms, signs and classification of haemorrhoids

Conservative and surgical management, and prognosis

9.Haemorrhoids

This is a common problem caused by hypertrophy of vascular cushions of tissue at the anal margin. It is a condition of

mid- to late adulthood - half of all patients are over the age of 50. Symptoms are rectal bleeding, prolapse, pain, mucus

discharge and prutitus ani.

Revision Diseases

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