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Surgery (OSCE / CCT essentials) > Lumps and bumps > Flashcards

Lumps and bumps Flashcards

1
Q

What are the general procedures of describing lumps and bumps?

A

6S: Site, Size, Shape, Surface, Skin, Scar
3T: Tenderness, Transillumination, Temperature
CAMPFIRE: Consistency, Attachment, Mobility, Pulsation, Fluctulance, Irreducibility, Regional lymph nodes, Edge

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2
Q

What are the characteristics of a lipoma?

A

-Smooth surface, soft in consistency, smooth / poorly defined borders
-Attachment to deeper tissues but not skin (Slip sign)
-Mobility decrease on muscle contraction
-Telangiectasia on surrounding skin

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3
Q

Give 3 ddx of a lipoma

A

Familial multiple lipomatosis: AD inheritance with multiple lipomas
Dercum disease: multiple painful lipoma + obesity + peripheral neuropathy
Madelung’s disease: diffuse lipoma, symmetrical, association with heavy alcholism

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4
Q

Pre-op Ix for lipoma?

A

USG, MRI for intramuscular involvement

*Bx not needed

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5
Q

Mx of non-infected lipoma?

A

-Observe if asymptomatic
-Surgery (linear incision), usually LA is enough, GA only indicated if intramuscular

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6
Q

Any alternative treatment for non-infected lipoma?

A

liposuction, injection lipolysis (indicated in small facial lipomas)

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7
Q

What to do if the lipoma is infected?

A

Abscess drainage, leave wound open and wait till infection subsides.
Then, perform surgery with linear incision.

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8
Q

What are the major characteristics of a mucous retention cyst?

A

Bluish, transparent, painless

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9
Q

What is the pathophysiology of mucous retention cyst?

A

Obstruction of excretory duct –> backpressure –> extravasation of mucus

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10
Q

What causes the formation of a ranula? What are the 3 major types of ranula? Which salivary gland is most commonly involved?

A

Due to extravasation of mucus from minor salivary glands.

-Oral: Above mylohyoid
-Plunging: Across mylohyoid + involvement of submandibular space
-Cervical: Along neck fascia planes

Sublingual gland.

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11
Q

What is the mx of a ranula?

A

Excision of ranula + parent gland

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12
Q

What are the two types of epidermal cysts?

A

Sebaceous cyst, inclusion cyst

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13
Q

What are the characteristics of a sebaceous cyst?

A

Hemispherical swelling, attachment to skin, hard in consistency, immobile, may have signs of inflammation

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14
Q

What are the common locations of sebaceous cysts?

A

Scalp, neck, shoulder, back, scrotum

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15
Q

What are the complications of sebaceous cysts?

A

Infection, ulceration, calcification, sebaceous horn formation, malignant change (BCC/malignant melanoma)

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16
Q

What is the treatment for non-infected sebaceous cysts? What to do if infected?

A

Elliptical incision, with complete removal of capsule +/- punctum

Give antibiotics +/- drain pus

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17
Q

Where do implantation dermoid (inclusion cyst) usually occur in?

A

Fingers, precipitated by previous injury

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18
Q

What are the characteristics of an inclusion cyst?

A

Hard, smooth, immobile, scarring (due to previous injury)

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19
Q

What is the mx of inclusion cyst?

A

Excision

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20
Q

What is the histological nature of a sebaceous horn? What are the common causes?

A

Hyperproliferative epithelium

Epidermal cyst, verruca vulgaris, seborrhoeic keratosis, premalignant conditions like SCC

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21
Q

What must be done when there is a sebaceous horn? Why?

A

Biopsy. (Usually excisional)
To rule out malignancy in the base

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22
Q

What are the risk factors for warts (verruca)? What pathogen is involved?

A

Trauma, eczema, immunocompromised
HPV

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23
Q

What are the types of warts?

A

Flat warts (plana)
Common warts (vulgaris)
Plantar warts (plantaris, may be painful)

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24
Q

What are the P/E characteristics of warts?

A

Painless (except plantar warts)
Greyish brown

*Common warts: Hard, rough surface with multiple keratotic spikes
*Flat warts: flat, smooth, macular

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25
Q

What are the ddx of warts?

A

Squamous papilloma, molluscum contagiosum, condylomata lata

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26
Q

How to treat warts?

A

Surgical excision if there is pain or cosmetic issues. Not compulsory.
Topical salicylic acid

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27
Q

What are the characteristics of a neurofibroma on inspection?

A

Multiple, pedunculated, soft/rubbery, mobile, well-defined border

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28
Q

What signs will you look for to confirm the presence of a neurofibroma?

A

-Buttonhole sign (press on the NF then invaginate to subcutis –> bounces back)
-Tinel sign positive
-Move side to side but not longitudinally along course of nerve
-NF1 features

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29
Q

How does a schwannoma be different from a neurofibroma?

A

Schwannoma:
-lack of NF1 features
-More radicular pain
-More neurological deficits

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30
Q

Where does a ganglion (cystic degeneration of tendon sheath) usually occur?

A

Wrist, hand

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31
Q

What are the characteristics of a ganglion?

A

Not attached to skin, smooth surface, soft / fluctuant, non-tender, transilluminable, non-mobile

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32
Q

What are the complications of a ganglion?

A

Infection, scar, tendon injury, neurovascular injury

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33
Q

What are the management of a ganglion?

A

-Watchful waiting
-Aspiration followed by 3w immobilisation

If there is pain, mass causing functional problem, cosmetic problems, or CNS symptoms,
-open / arthroscopic excision with GA

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34
Q

What is the pathology of papilloma (skin tags)?

A

Overgrowth of all layers of skin with a vascular core

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35
Q

What are the P/E characteristics of a papilloma (skin tag)?

A

Pedunculated, not warm, not malignant, with regular border

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36
Q

What are the risk factors of papilloma?

A

Pregnancy, intestinal polyposis, DM, obesity

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37
Q

How to manage papilloma?

A

Excision / non-surgical ligation of neck / cryotherapy

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38
Q

What is the pathology of dermatofibroma?

A

Benign dermal proliferation of fibroblasts from insect bites / trauma

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39
Q

Who would most probably have dermatofibroma?

A

Young to middle-aged women

40
Q

What are the P/E characteristics of dermatofibroma?

A

Nodular, firm, varying colour, fixation to subcutaneous tissues

41
Q

Give one specific P/E for dermatofibroma.

A

Pinch test to check for dimpling

42
Q

What is the management for dermatofibroma?

A

Conservative, excision (optional) for better cosmesis

43
Q

What is the management for dermatofibrosarcoma protuberans?

A

Wide excision + RT because easily progress to sarcoma

44
Q

What are the characteristics of a pyogenic granuloma?

A

-Rapidly growing capillary hemangioma associated with pregnancy
-Usually in HN region / in the digits
-Shiny red, fleshy

45
Q

What is the management of pyogenic granuloma?

A

Excision, cauterization

46
Q

What is the pathology of keratoacanthoma?

A

Overgrowth of squamous cell in hair follicles, with central plug of keratin

47
Q

What does a keratoacanthoma look like?

A

Similar to SCC except centre is dark / dirty with central crater
Confined to skin, mobile

48
Q

How is the prognosis of keratoacanthoma?

A

Good. Will generally regress in 2-3 months

49
Q

What investigation should be done in case of keratoacanthoma?

A

Biopsy, to rule out well-differentiated SCC (especially in elderly)

50
Q

What is the pathology of seborrheic keratosis?

A

Benign overgrowth of basal cells in elderly

51
Q

What are the P/E characteristics of seborrheic keratosis?

A

-Mainly in face, upper extremities
-Plaque-like, firm, well-defined borders

52
Q

What is Leser-Trelat sign?

A

Sudden appearance of multiple seborrheic keratoses with skin tags + acanthosis nigricans

Associated with lung malignancies

53
Q

What is the management of seborrheic keratosis?

A

Conservative, surgery (optional) with shaving / cautery

54
Q

How to differentiate between keloid and hypertrophic scar?

A

Keloid: go beyond boundary, will not regress spontaneously
Sx: painful, pruritic, raised, firm on palpation

Hypertrophic: within boundary, will regress spontaneously
Sx: pruritic

55
Q

What are the common sites of keloid scars?

A

Earlobe, mandible, sternum, shoulder, back

56
Q

What are the management for keloid and hypertrophic scars?

A

Keloid: Pressure therapy, intralesional steroids –> RT
Hypertrophic: Pressure, silicone sheet –> intralesional steroids / laser

57
Q

What are the characteristics of nevus sebaceous?

A

Congenital lesion in the scalp.
Elevated / nodular with well-defined borders, associated with alopecia

58
Q

Name a condition associated with nevus sebaceous. What treatment should be given?

A

BCC.
Full thickness excision.

59
Q

What malignant condition is solar keratosis associated with? How many percent of malignant transformation?

A

SCC. 25%.

60
Q

What are the characteristics of solar keratosis?

A

Scaly, plaque-like, yellow to brown, hard in consistency, immobile
In elderly

61
Q

What P/E should be included in suspected solar keratosis?

A

Check for tethering to rule out SCC

62
Q

What is the management of solar keratosis?

A

Cryotherapy, topical chemotherapy, curretage

63
Q

What malignant condition is Bowen’s disease associated with?

A

SCC

64
Q

What is the name when Bowen’s disease occurs on glans penis?

A

Erythroplasia of Querat

65
Q

What is the management of Bowen’s disease?

A

Excision with 4mm margin.
Topical 5-FU / imiquimod

66
Q

What is the pathology of a Marjolin ulcer?

A

SCC that arises from the malignant transformation of a CVI / sacral sore

67
Q

What are the risk factors of SCC of skin?

A

Sunlight exposure, smoking, immunocompromised, premalignant lesion

68
Q

What are the morphological characteristics of SCC?

A

Uglier than BCC, irregular + everted edge, raised with bloody discharge

69
Q

What are the investigations for suspected SCC?

A

Excisional bx for small SCC, incisional bx for large SCC

70
Q

What are the management for SCC?

A

-Excision with margins (0.5cm if lesion <1cm; 1-2cm if lesion >1cm)
-LN dissection
-RT

71
Q

What is Moh’s surgery?

A

Repeated dissection and histological assessment of the tumour aimed for maximum tissue preservation in cosmetically sensitive areas.

72
Q

What are the poor prognostic factors for SCC?

A

Marjorlin
Immunosuppression
Deep
Large
Poor histological grading
**Ear / lips involvement

73
Q

What are the clinical features of BCC?

A

Triad: Rolled edge, pigmentation, central ulceration

Nodular appearance, presence of telangiectasia

74
Q

What are the management of BCC?

A

Excision with 3-5mm margins (2mm for cosmetically sensitive areas)
Skin flap / Moh’s surgery
RT for elderly

75
Q

Give one premalignant lesion of malignant melanoma?

A

Atypical naevi

76
Q

What are the clinical features of malignant melanoma?

A

Most commonly in legs / trunk
Asymmetry, Border irregular, Change in colour, Diameter >6mm, Dark, Elevation
Presence of satellite lesions / nodules
Prone to lung / liver metastasis

77
Q

What are the subtypes of malignant melanoma?

A

Superficial spreading (most common), nodular (more aggressive), lentigo maligna, acral lentiginous

78
Q

What are the investigations for malignant melanoma?

A

Excisional bx with margin
Sentinel LN bx
Systematic seartch for regional nodes involved

79
Q

What are the management for malignant melanoma?

A

Wide margin excision
LN dissection
RT
Systemic chemo / intralesional BCG / immunotherapy

80
Q

What is Breslow thickness? How is it related to resection margins?

A

Depth of the deepest point of tumour
Breslow thickness <0.76mm: 1cm; 0.76-1mm: 2cm; >1mm: 3cm

81
Q

Where does dermoid cyst usually occur?

A

Medial / lateral ends of eyebrows

82
Q

What are the P/E characteristics of dermoid cyst?

A

Spherical, soft, mobile, clearly-defined borders, not attached to skin
Fluctuance +/- transilluminate if large

83
Q

What are the Ix and Mx of dermoid cysts?

A

Ix: CT to exclude bony defects in congenital lesions
Mx: Excision + monitoring

84
Q

What are the management of ingrown toenail?

A

Conservative: Topical steroids, soak foot
Surgical: Cutting off ingrown toenail under LA
Infected: Simple nail avulsion
Recurrent: Permanent nail avulsion + phenolization of nail matrix

85
Q

Reasons and sites for autotransplantation of parathyroid gland?

A

Primary hyperparathyroidism, CKD, PD, AVF, MEN
Forearm, SCM

86
Q

What are the symptoms of axillary vein thrombosis?

A

Dilated veins, heat, swollen UL, cyanosis of hands
Symptoms of brachial plexus compression

87
Q

What are the causes of axillary vein thrombosis?

A

Acute strenous activity
Repetitive injury

88
Q

What are the Ix of axillary vein thrombosis?

A

Duplex US
CT venography
Coagulability test

89
Q

What are the Mx of axillary vein thrombosis?

A

Elevation, NSAIDS
Anticoagulation (UFH, LMWH, fondaparinux)

90
Q

What are the types of LA, dosages and terms of effect?

A

Lignocaine (4mg/kg), 2hr
Lignocaine + adrenaline (7mg/kg for lignocaine, 1-2ug/kg for adrenaline), 3hr
Bupivacaine (1.5mg/kg), 4hr (6-8hr with adrenaline)

91
Q

What are the effects of adrenaline on LA?

A

Hastens onset + prolongs duration of action + allows higher dose limit

92
Q

In what situations shall adrenaline not be used for LA?

A

Excision of digits + penis (because vasoconstriction will lead to necrosis)

93
Q

What are the signs of LA toxicity?

A

CNS (1) circumoral numbness (2) lightheadedness (3) dizziness (4) visual/auditory-visual blurring and tinnitus (5) depressed consciousness (6) seizures CVS (1) chest pain (2) SOB (3) arrhythmias, arrest

94
Q

What is Bier’s block?

A

● commonly used in orthopaedics (bloodless field) for body’s extremities, for short surgeries.

95
Q

Name the reconstruction ladder.

A
  1. Dressing (healing by 2ndary intention)
  2. Primary closure
  3. Delayed closure (tertiary intention)
  4. Partial thickness skin graft
  5. Full thickness skin graft
  6. Tissue expansion
  7. Random pattern flap
  8. Pedicled flap
  9. Free flap
96
Q

What are the pros / cons of partial thickness and full thickness skin graft?

A

Partial thickness: easier to take, worse cosmesis
Full thickness: difficult to take, needs better blood supply, better cosmesis

97
Q

What are the side effects of RT?

A

Early
1. skin erythema desquamation
2. BM suppression
3. GI diarrhoea
4. myelopathy

Late
1. Pulmonary fibrosis
2. IHD
3. Radiation arteritis
4. Radiation cystitis
5. Radiation enteritis
6. Endocrine - hypogonadism, hypothyroidism, hypopituitarism
7. Secondary malignancy - solid and hematological

Surgery (OSCE / CCT essentials) (4 decks)

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