Lec 1 Swellings Flashcards
1
Q
What is the definition of swelling in a surgical context?
A
A common surgical complaint classified based on consistency and sites.
2
Q
How can swellings be classified according to consistency?
A
- Solid swellings
- Cystic swellings
3
Q
What are the common sites for swellings?
A
- Face
- Hand
- Neck
4
Q
What factors are considered in the diagnosis of swelling?
A
- Age
- Nature of the swelling
- Incidence
- Sex of incidence
- Etiology
- Pathology
- Macroscopic picture
- Microscopic picture
- Clinical picture
5
Q
What are the types of complaints associated with swellings?
A
- Painless or painful
- Slowly or rapidly growing
6
Q
What are the general signs of swelling?
A
- Hotness
- Redness
- Tenderness
- Edema
7
Q
What are some key diagnostic methods for swellings?
A
- Inspection
- Palpation
- Percussion
- Auscultation
8
Q
What is a lipoma?
A
A benign tumor arising from adipose tissue, forming palpable lumps.
9
Q
What are the classifications of lipoma based on structure?
A
- Pure lipoma
- Fibrolipoma
- Hemangiolipoma
- Myxolipoma
10
Q
What is the gross picture of a lipoma?
A
- Skin is stretched
- Non-tender
- Variable size
- Flattened, discoid, or hemispherical shape
- Lobulated surface
- Always soft consistency
11
Q
What is Dercum’s disease?
A
A type of diffuse lipomatosis usually found in females, post-menopausal.
12
Q
What are the special types of lipoma?
A
- Subcutaneous lipoma
- Subfascial lipoma
- Subsynovial lipoma
- Submucous lipoma
- Inter or intramuscular lipoma
- Subperiosteal lipoma
- Extradural lipoma
- Subserous lipoma
- Intraglandular lipoma
- Retroperitoneal lipoma
13
Q
What are some complications associated with lipomas?
A
- Respiratory obstruction from submucous lipoma
- Malignant transformation of retroperitoneal lipoma
- Pressure manifestations from extradural lipoma
14
Q
What investigations are specific for diagnosing lipomas?
A
- Excisional biopsy
- X-Ray for subperiosteal lipoma
- CT scan for extradural lipoma
15
Q
What are the indications for surgical removal of a lipoma?
A
- Becomes painful or tender
- Becomes infected or inflamed
- Interferes with movement or function
- Increases in size
- Becomes unsightly or for cosmetic reasons
16
Q
What is the prognosis for subcutaneous lipomas?
A
They never turn malignant, but those in thighs and buttocks have a higher incidence of malignant transformation.
17
Q
What are neurofibromas?
A
Benign tumors of the peripheral nerves.
Neurofibromas can be solitary or multiple.
A tumor-like mass formed from nerve sheaths, considered a hamartoma.
18
Q
What characterizes dermal neurofibromas?
A
Well circumscribed solid cutaneous tumors with limited size.
19
Q
What is Multiple Neurofibromatosis type 1 (NF1)?
A
An autosomal dominant genetic disease with an incidence of approximately 1 in 3000.
20
Q
What are common features of neurofibromatosis?
A
- Present at birth
- Familial
- Size: variable
- Consistency: firm
- Mobility: mobile across but not along the nerve.
21
Q
What special characters are associated with neurofibromas?
A
- Tenderness
- Increased CSF if arising from the intracranial nerve
- No sensory or motor loss.
22
Q
What skin abnormalities are associated with neurofibromatosis?
A
- Fibro-epithelial skin tags
- Cafe au lait patches
- Neuromas on major nerves
- Malignant change (neurofibrosarcoma) in 5% of cases.
23
Q
What is plexiform neurofibromatosis?
A
An excessive overgrowth of neural tissue in the subcutaneous fat, leading to an edematous appearance.
24
Q
What is the presentation of solitary neurofibromas?
A
- Size: variable
- Consistency: firm, tender
- Mobility: mobile across but not along the nerve.
25
What characterizes acoustic neuroma?
A tumor associated with the acoustic nerve, often showing familial incidence as a Mendelian dominant trait.
26
What are the complications of neurofibromas?
* Pressure symptoms (e.g., deafness in acoustic neuroma)
* Malignant transformation (neurofibrosarcoma).
27
What is the differential diagnosis for multiple swellings?
* Multiple neurofibromatosis
* Multiple lipomatosis
* Multiple melanoma
* Multiple angioma
* Multiple lymph node enlargement.
28
What is the treatment for large painful tumors?
Surgical excision is the treatment of choice.
29
What is ganglioneuroma?
A benign tumor arising from the ganglion of the sympathetic trunk or suprarenal gland, usually affecting children.
30
What is neuroblastoma?
A highly malignant tumor affecting young infants, arising from the sympathetic chain.
31
What is stump neuroma?
A traumatic neuroma arising in a divided nerve, composed of fibrous tissue.
32
What is a neurofibrosarcoma?
A malignant tumor that may arise de novo or develop from a neurofibroma, characterized by rapid growth and pain.
33
What is a hamartoma?
Mal-arrangement of normal tissue.
34
What is a hemangioma?
A benign tumor of endothelial cells of capillaries, most common in infancy.
35
What are the stages of hemangioma lesion development?
* Proliferation phase
* Involution phase
* Regression.
36
What complications can arise from hemangiomas?
* Squint
* Amblyopia
* Blindness
* Infection
* Airway obstruction.
37
What is the treatment for hemangiomas?
* Propranolol
* Oral or intralesional steroids
* Laser coagulation
* Surgical debulking.
38
What defines vascular malformations?
Malformation of vascular development in utero.
39
What are the types of vascular malformations?
* Low flow malformation
* High flow malformation.
40
What is a portwine stain?
A low flow capillary malformation present since birth, dark purple in color.
41
What syndrome is associated with port wine stains of the face and lesions in the meninges?
Sturge Weber Syndrome
## Footnote
This syndrome is characterized by vascular malformations.
42
What is the treatment of choice for port wine stains during childhood?
Pulsed dye laser
## Footnote
Requires general anesthesia and multiple sessions may be needed.
43
What treatment is used for port wine stains during adulthood?
YAG laser
## Footnote
Results are not as favorable as in children.
44
What are the characteristics of a salmon patch?
Pink, flat marks on the skin
## Footnote
Nearly half of all babies have salmon patches, usually on the forehead, back of the neck, or lip.
45
What is the definition of a venous malformation?
Multiple large intercommunicating sinus (vascular spaces)
## Footnote
Formerly known as cavernous hemangioma.
46
Where is the most common site for venous malformations?
Liver
## Footnote
External sites include cheeks, lips, tongue, eye, and ear.
47
What is a characteristic feature of venous malformations?
Compressible swelling with sign of emptying
## Footnote
Pressure causes blanching but color returns immediately after release.
48
What imaging studies are used in the investigation of vascular malformations?
Arteriography and CT scan
## Footnote
Arteriography is both diagnostic and therapeutic.
49
What are two treatments for venous malformations?
* Compression therapy
* Surgical excision
## Footnote
Percutaneous sclerosis may also be performed.
50
Define arterial malformation.
Congenital A-V fistula
## Footnote
Often presents as a plexiform hemangioma.
51
What are common complaints associated with arterial malformations?
* Cosmetic disfigurement
* Headache
## Footnote
Fever may occur if inflamed.
52
What is the most common complication of arterial malformations?
Hemorrhage
## Footnote
This is particularly dangerous due to its arterial nature.
53
What is a lymphatic malformation?
Classified as microcystic or macrocystic
## Footnote
May have a component of venous malformation.
54
What is a common cause of congenital macroglossia?
Lymphatic malformation
## Footnote
Also associated with macrocheilia and macro-otia.
55
What is the definition of a true cyst?
Lined by endothelium or epithelium responsible for fluid secretion
## Footnote
Examples include thyroglossal cyst and dermoid cyst.
56
What is a sebaceous cyst?
Retention cyst of sebaceous gland
## Footnote
Caused by obstruction of sebaceous gland duct.
57
What are the characteristics of a sebaceous cyst?
* Slow-growing
* Painless subcutaneous swelling
## Footnote
Usually presents with a 'punctum' where sebum can be discharged.
58
What is the commonest complication of any cyst?
Inflammation
## Footnote
This can cause the cyst to increase in size and become tender.
59
What is the treatment for a glomus tumor?
Excision
## Footnote
These tumors arise from A-V shunt in extremities.
60
What is hereditary hemorrhagic telangiectasia?
Multiple angiomas in skin and mucosa with a tendency to bleed
## Footnote
Often associated with liver cirrhosis.
61
What is Sturge Weber Syndrome characterized by?
* Leptomeningeal A-V malformation
* Capillary vascular malformation in face
* A-V malformation in extremities
## Footnote
The facial malformation does not cross the midline.
62
What are the common complications of a sebaceous cyst?
* Infection
* Suppuration
* Dried inspissated sebum
* Ulceration
## Footnote
These complications may lead to increased size and tenderness of the cyst.
63
What is the clinical diagnosis for sebaceous cysts?
Clinical diagnosis is usually sufficient; biopsy may be needed with complications.
## Footnote
Not typically requiring extensive investigation.
64
What is the treatment for uncomplicated sebaceous cysts?
* Excision through an elliptical incision to include the punctum
## Footnote
This is to ensure complete removal of the cyst.
65
What is a dermoid cyst?
A cyst lined by stratified squamous epithelium, containing sebaceous material and sometimes hairs, and can be congenital or acquired.
## Footnote
Commonly found in the neck and face.
66
What are the types of congenital dermoid cysts?
* Sequestration dermoid cysts
* Inclusion dermoid cysts
* Teratomatous dermoid cysts
## Footnote
Each type has distinct characteristics and locations.
67
What is a ganglion?
A cystic swelling due to myxomatous degeneration of fibrous tissue, primarily found on the wrist and hand.
## Footnote
Often arises without connecting to the joint cavity.
68
What are bursae?
Fluid-filled cavities lined with flattened endothelium, allowing easier movement between tendons, bones, and skin.
## Footnote
Adventitious bursae can develop in areas of friction.
69
What causes lymph gland enlargement?
* Inflammatory processes
* Lymphoma
* Leukemia
* Metastatic infiltration
## Footnote
Enlarged glands can be solitary or multiple and vary in texture.
70
What is a subcutaneous abscess?
An accumulation of pus due to bacterial infection, typically from Staphylococcus aureus.
## Footnote
Characterized by swelling, redness, and fluctuance as the pus forms.
71
What are the key treatments for a subcutaneous abscess?
* Surgical drainage
* Bed rest
* Antibiotics
* Analgesic and antipyretic
## Footnote
These treatments help manage infection and alleviate symptoms.
72
What is a thyroglossal cyst?
A congenital cyst resulting from a non-obliterated thyroglossal tract, moves with swallowing and tongue protrusion.
## Footnote
Often requires surgical excision, including the tract.
73
What is a plunging ranula?
A retention cyst of the sublingual gland that presents as a neck mass after piercing the mylohyoid muscle.
## Footnote
Distinguished from a simple ranula which is unilateral in the oral cavity.
74
What is a branchial cyst?
A cyst, sinus, or fistula resulting from the persistence of a portion of the branchial apparatus.
## Footnote
Commonly presents as a soft, fluctuating swelling in the neck.
75
What is a laryngocele?
A soft, compressible lateral neck mass that distends with increases in intralaryngeal pressures.
## Footnote
Can be internal, external, or combined and may harbor underlying laryngeal carcinoma.
76
What is a carotid body tumor?
A neurogenic tumor, mostly benign, associated with chronic hypoxia and hyperplasia.
## Footnote
Typically presents in the 5th decade of life with firm, rubbery texture.
77
What characterizes a sternomastoid tumor of infancy?
A firm mass due to hematoma and subsequent fibrotic replacement, causing torticollis.
## Footnote
Physical therapy is often effective, with surgery as a last resort.
