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Final Prep > AS PACES Lumps > Flashcards

AS PACES Lumps Flashcards

1
Q

Dercum’s disease

A

Multiple, painful lipomas
Assoc peripheral neuropathy
Obese PM women

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2
Q

DDx Lipoma

A

Benign tumour of mature adipocytes, occur anywhere fat can expand
Dercum’s disease
Familial Multiple Lipomatosis

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3
Q

Epidermal cyst vs trichilemmal cyst

A

Epidermal from hair follicle infundibulum

Trichilemmal cyst - ?AD, often multiple arising from hair follicle epithelium

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4
Q

Gardener’s syndrome

A

Thyroid tumours
Osteomas
Dental abnormalities
Epidermal cysts

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5
Q

Mx Ganglion

A

Conservative - watch and wait
Non surgical - aspiration followed by 3wks immobilisation
Excision - 50% recur, risk of neuromuscular damage

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6
Q

NF1 - O/E

A 
Neurofibromas (nerve sheath from schwann cells), pedunculated
Pressure --> parasthesia
Cafe au Lait
Lisch nodules (eye)
Axillary freckling
CN VII 
BP
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7
Q

Papilloma - def

A

Overgrowth of all layers of skin with central vascular core

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8
Q

Dermoid cyst - congenital vs acquired

A

Congenital –> along line of skin fusion (midline neck and nose, medial/lateral eyebrows)
Acquired –> can be 2* to trauma
Smooth spherical swelling, SNT, SC
CT will establish extent, surgical Ex

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9
Q

Keratoacanthoma

A

Benign overgrowth of hair follicle cells. Cytology similar to well differentiated SCC
Fast growing, dome shaped keratin plug, intradermal
Excision to reduce scar and obtain histology

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10
Q

DDx Exopthalmos

A

Grave’s
Orbital cellulitis
Trauma
Meningioma, glioma

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11
Q

DDx goitre

A

Diffuse smooth –> simple colloid goitre, graves, thyroiditis (Hashimoto’s, Riedel’s, de Quervains)
Diffuse nodular –> MNG, multiple adenomas
Solitary nodule –> MNG, adenoma, malignancy, cyst

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12
Q

Multinodular goitre

A

Commonest in UK, middle aged women, +FH, may cause hyperthyroid, malignant change 5% if untreated
Medical: Thyroxine (suppress TSH, regresses 50-70%); propranolol + carbimazole, RI
Surgical if malignant, obstructive, cosmetic, medical therapy fails –> total thyroidectomy

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13
Q

Plummer’s vs Graves

A

P: Older, nodular, no extra features, AF 40%, no AI disease
G: Diffuse enlargement, eyes/derm/nail signs, AF uncommon, AI disease

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14
Q

Simple colloid goitre

A

Physiological hyperplasia 2* to TSH
Iodine def (worldwide most common)
Increased demand (pregos/puberty)
Goitrogens: Li, uncooked cabbage

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15
Q

Grave’s Disease

A

0.5% prevalence, 60% cases of thyrotoxicosis, F9>1M, 40-60 years
Opthalmopathy –> oedema, lid lag (sympathetic stimulation), exophthalmos (antiTSH ab, opthalmoplegia (esp upper gaze), optic neuropathy (RAPD and reduced acuity)
Dermopathy –> pretibial myxoedema
Acropachy
Ass –> T1DM, vitiligo, pernicious anaemia
Rx –> Propranolol + carbimazole / PTU; RI, surgery

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16
Q

Which thyroid Ca is only one to spread via blood?

A

Follicular to bone and lungs

17
Q

MEN1

A

Pituitary adenoma
Parathyroid hyperplasia / adenoma
Pituitary endocrine tumour

18
Q

MEN2

A

Medullary thyroid
Phaeochromocytoma
A –> hyperparathyroid
B –> Marfanoid habitus

19
Q

Complications of thyroid surgery

A

Preop –> render euthyroid but stop drugs 10 days before as cause hypervascularity, laryngoscopy pre and post op
Early –> Haematoma, RLN palsy, hypocalcaemia, thyroid storm
Late –> Hypothyroidism and hypoparathyroidism, recurrence, keloid

20
Q

Neck lumps

A

Midline –> Ectopic thyroid, thyroid isthmus mass, inclusion dermoid, thyroglossal cyst
Ant triangle –> LN, chemodectoma, goitre, parotid, branchial cyst, laryngocele
Post triangle –> LN, cervical rib, pancoast tumour, cystic hygroma, pharyngeal pouch

21
Q

Thyroglossal cyst - Ant T

A

Thyroglossal duct marks developmental descent of thyroid from foramen caecum
Ectopic tissue can be found anywhere along this path, cysts can contain thyroid tissue - can undergo malignant change (papillary Ca)
40% in first decade, M=F, infection/sinus/Ca/recurrence
Sistrunk’s operation (inject tract with dye, excise cyst and patent tract

22
Q

Branchial cyst - Ant T

A

Failed fusion of 2nd and 3rd branchial arches, lined by squamous epithelium, “glary” fluid and cholesterol crystals.
Ant SCM junction of middle/upper thirds
Infection/sinus/recurrence
Surgical –> Bonney’s blue dye injected into fistula allowing accurate excision, close proximity of carotids

23
Q

Chemodectoma - Ant T

A

Tumour of paraganglion cells of carotid bodies (measure pH/PaCO2/PaO2)
Ant triangle @ angle of jaw, pulsatile, moves laterally not vertically
Pressure –> syncope
Ix: Duplex US, angiography, CT/MRI

24
Q

Cystic hygroma - post T

A

Congenital multicystic lymphatic malformation
Transiluminate brilliantly, + in size on cough/cry, cyst may extend into retropharyngeal space
Obstruction of swallow / reps
Surgery

25
Q

Pharyngeal Pouch - post T

A

Kilian’s dehiscence - between thyro and crico pharyngeal muscles which form inferior constrictor
Hallitosis, gurgling, regurg, dysphagia, aspiration,
Ix –> Barium swallow
Surgical –> endoscopic stapling

26
Q

Cervical rib

A

Overdevelopment of transverse process of C7
1:150
Vascular - sublavian A compression, subclavian steal, Raynaud’s
Neuro - mower roots of brachial plexus, T1, wasting of intrinsic hand muscles, parasthesia

27
Q

DDx cervical lymphadenopathy

A

Lymphoma / Leukaemia
Infection (tonsils / dental abscess / TB / Bartonella henselae (cat scratch) / EBV / HIV)
Sarcoidosis
Tumours (ENT / Breast / Lung / Gastric)

28
Q

DDx Parotid swelling

A

Diffuse –> parotitis, Sjorgen’s, sarcoid, CLD, DM, bulimia

Local –> calculus, lipoma, neoplasm, ALL

29
Q

Salivary gland neoplasms

A

80% benign, 80% pleomorphic adenomas, Warthin’s tumour in smokers >50
80% parotid gland
80% sublingual malignant

30
Q

Malignant features of salivary gland swelling

A

VII palsy
Rapid growth and pain
Hyperaemic, hot skin
Hard and tethered

31
Q

Management of salivary neoplasms

A

Benign –> superficial / deep parotidectomy

Malignant –> total parotidectomy ± adjuvant radiotherapy

32
Q

Complications of parotid surgery

A

Immediate –> VII palsy, haemorrhage
Early –> temp VII weakness, salivary fistula, loss of pinna sensation (greater auricular nerve)
Late –> Frey’s syndrome (gustatory sweating due to re innervation of divided sympathetic nerves by fibres from secretomotor branch of CNV3

Final Prep (19 decks)

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