Lumps, Bumps, Hernias and Abdo masses

Question 1

Describe a cavernous haemangioma

Answer 1

(strawberry naevus)
benign tumour of a blood vessel, cavity
involutes, no scar
usually regresses spontaneously

Question 2

How can a cavernous haemangioma be treated if intervention is required?

Answer 2

propranolol

Question 3

what name is given to the benign tumour of a capillary that appears flat, and is also known as port-wine stain?

Answer 3

capillary haemangioma

Question 4

how is a capillary haemangioma treated?

Answer 4

laser treatment

Question 5

what name is given to the benign red skin lesions seen in middle to older age, which are very common and of no concern?

Answer 5

Campbell de Morgan spots

Question 6

in what are the presence of spider naevi not pathological?

Answer 6

pregnancy

Question 7

Give 3 signs of liver cirrhosis in males which are due to excess oestrogens and explain why this occurs?

Answer 7

spider naevi
gynaecomastia
testicular atrophy

liver normally breaks down oestrogens so in liver cirrhosis, its function is lost and oestrogens accumulate.
oestrogens produced in male from dehydroepiandrosterone (DHEA), which is converted to oestrogens in adipose tissue, so overweight males often have a more feminine appearance.

Question 8

why does a spider naevus blanch?

Answer 8

central feeding arteriole compressed

on release, it rapidly refills from central arteriole

Question 9

what is a papilloma and what different types are there?

Answer 9

also known as a skin tag, benign tumour of skin epithelial cells
lump in the skin, so moves with it
may be smooth and pedunculated, sessile or pigmented- may have similar appearance to a malignant melanoma, although not all malignant melanomas appear pigmented!

Question 10

what is a neurofibroma?

Answer 10

a benign tumour of the peripheral nerve sheath

may be in skin or SC tissues

Question 11

type 1 neurofibromatosis has an autosomal dominant inheritence pattern and results in the presence of dermal neurofibromas. what are the diagnostic criteria?

Answer 11

if 2 of following found:
6 or more cafe au lait macules
2 or more neurofibromas of any type or 1 plexiform (involve multiple fascicles along nerve)
axillary or inguinal freckling
optic glioma
2 or more Lisch nodules= brown/translucent mounds on iris
osseous lesion
1st degree relative with type 1 NF

Question 12

in what condition are bilateral vestibular schwannomas characteristic, producing sensorineural hearing loss at around 20 yrs old?

Answer 12

type 2 neurofibromatosis

Question 13

characteristics of a hystiocytoma (dermatofibroma)?

Answer 13

benign neoplasm of fibroblasts of dermis
itchy lump in an exposed area of skin
history= occurs following insect bite, has become itchy
firm lump
typically asymptomatic
remains same size after initial growth
generally no tment required

Question 14

characteristics of lipomas (lipomata) ?

Answer 14

can be very large
soft
found beneath skin, so don’t move with skin when skin moved
no fluctuancy= on pressing the middle, if your fingers are at either side they are not pushed outwards. This would however be seen with cysts.
? semi fluctutant
most lobulated-on surface and at edges as fat in body=lobules
don’t reduce, pulsate or transilluminate

Question 15

characteristics of ganglia?

Answer 15

myxomatous degeneration of joint capsules (pathologic degeneration of CT), so found in areas of multiple joints= wrist and ankle
soft, not painful, smooth and under skin, jelly like
contain synovial fluid
tment= can be left, may disappear on their own
can aspirate to remove synovial fluid if cyst causes pain or interferes with joint movement.

Question 16

types of skin cysts?

Answer 16

epidermal (sebaceous)/pilar= contain keratin as blocked hair follicle, 50% have a punctum= a sharp point, not found on palms or soles of feet.
dermoid= skin beneath skin, found in midline, behind ear and just above eye (lateral canthus). Arise from cystic changes in epithelial remnants left behind at lines of embryological fusion. Contain keratin, hair, sebaceous glands.
implantation dermoid= occur in manual workers- push skin under skin. commonest in fingers.

Question 17

how can a midline dermoid cyst in the neck be distinguished from a thyroglossal cyst?

Answer 17

on protrusion of tongue, a thyroglossal cyst would move up in the neck due to origin of thyroid= foramen cecum= found on dorsum of posterior aspect of tongue.

Question 18

why are teratomas of benign in the female, but malignant in the male?

Answer 18

female= oocytes= very low turnover
male= spermatozoa= very high turnover

Question 19

2 most common tumours of testes?

Answer 19

seminoma= malignant germ cell tumour

teratoma

Question 20

what is a dermoid cyst of the ovary also known as?

Answer 20

an ovarian teratoma

Question 21

what is a pilonidal sinus?

Answer 21

an infected tract under the skin, between the buttocks, fills with pus. hair underneath. hair contained from neck.

Question 22

name given to the common benign skin growths originating from keratinocytes which are usually pigmented, and are harmless?

Answer 22

seborrheic keratoses

Question 23

characteristics of a pyogenic granuloma?

Answer 23

pus filled, collection of epitheliod histiocytes (modified macrophages)
history of injury
tment= excision

Question 24

define a sinus

Answer 24

a blind ended epithelial lined tract

Question 25

what is a keratoacanthoma?

Answer 25

squamoproliferative lesion, keratin contained in middle, thought to originate from neck of hair follicle-but unknown reason as to why originate from hair follicle skin cells, go away within a few yrs.
but variant of squamous cell carcinoma, and cannot be distinguished from skin Ca reliably clinically, so usually treated surgically.

Question 26

why is it important to observe scars from any previous surgery prior to carrying out surgery?

Answer 26

check for keloid scars= keloid will occur everytime a scar occurs, there is continued growth of scar tissue around a wound and ptnt must be aware of this prior to surgery.
often afro-caribbean origin

Question 27

in what patients is erytheme ab igna common?

Answer 27

those with chronic abdominal pain e.g. chronic pancreatitis, ptnt may frequently use a hot water bottle to relieve pain.

Question 28

define an ulcer

Answer 28

area of discontinuity of epithelium

Question 29

what a sloping ulcer characteristic of?

Answer 29

a healing venous ulcer

Question 30

what is a punched out ulcer (trophic- related to nutrition) characteristic of?

Answer 30

peripheral vascular disease or peripheral neuropathy, as may occur in diabetic ptnts

Question 31

what is an undermined ulcer characteristic of?

Answer 31

buttock pressure sore

Question 32

appearance of a basal cell carcinoma?

Answer 32

rolled

Question 33

appearance of a squamous cell carcinoma?

Answer 33

everted

Question 34

what is hidradenitis suppurativa?

Answer 34

(sometimes known as acne inversa) is a painful, long-term skin disease that causes abscesses and scarring on the skin.
inflammation of apocrine sweat gland–axillae, groin, under breats, pus produced

Question 35

what is a carbuncle?

Answer 35

red, swollen, and painful cluster of boils that coalesce under the skin

Question 36

what is often mistaken for a squamous cell carcinoma due to its rapid growth?

Answer 36

a keratoacanthoma

Question 37

the area in which spider naevi appear is drained by what blood vessel?

Answer 37

SVC

Question 38

usual content of a femoral hernia?

Answer 38

omentum
bowel may be contained- frequently in form of Richter’s hernia- only antimesenteric border of bowel protrudes, occurs most frquently on R, doesn’t cause bowel obstruction.

Question 39

femoral hernias frequently have no cough impulse, what is this?

Answer 39

no increase in swelling palpable on coughing-becomes more tense and expansile

Question 40

basic pathology of a femoral hernia?

Answer 40

defect in transversalis fascia and overlying muscle, allowing peritoneal protrusion to occur.

Question 41

differentials for femoral hernia?

Answer 41

inguinal hernia- neck felt superior and medial to pubic tubercle, points towards groin rather than down leg
psoas abscess/bursa
femoral aneurysm
enlarged LN
ectopic testis

Question 42

contrast features of direct and indirect inguinal hernias

Answer 42

indirect= can and often does descend into scrotum
reduces upwards, then laterally and backwards
controlled by pressure over internal (deep) inguinal ring after reduction
bulge reappears in middle of inguinal region and flows medially and obliquely towards scrotum after reduction
found in all age groups

direct= don’t go down into scrotum
reduces upwards and then straight backwards
bulge comes directly forwards after reduction
rare in children and young adults

Question 43

causes of RIF masses?

Answer 43

appendix mass/abscess
caecal carcinoma
crohn's disease
pelvic mass
intussusception
TB mass
transplanted kidney
tumour in undescended testis

Question 44

causes of LUQ masses?

Answer 44

splenomegaly
enlarged stomach, colon, kidney or pancreas?
cysts- true or pseudocyst- acute panceatitis

Question 45

what is an incarcerated hernia?

Answer 45

contents of hernial sac are stuck inside it by adhesions, but are alive and functioning normally

Question 46

contents of femoral canal?

Answer 46

fat and Cloquet’s node

Question 47

RFs for inguinal hernias?

Answer 47

male
chronic cough
heavy lifting
ascites
previous abdo surgery e.g. damage to iliohypogastric nerve during appendicectomy which innervates internal and transverse abdo muscles
constipation
urinary obstruction

Question 48

where is the superficial inguinal ring found?

Answer 48

it’s a split in the EO aponeurosis, just superior and medial to the pubic tubercle

Question 49

gold standard for determining if inguinal hernia direct or indirect?

Answer 49

at surgery with reference to inferior epigastric vessels

best way on exam.= to reduce hernia and occlude deep inguinal ring with 2 fingers, ask ptnt to cough or stand and if hernia restrained, it is indirect.