Minor Lesions

Question 1

What are the causitive organisms of paronychia?

Answer 1

Staph

Strep pyogenes

Question 2

What is the most frequent organism in chronic paronychia?

Answer 2

Candida

Question 3

What is essential for the treatment of onychia? (Abcess under nail bed)

Answer 3

Removal of proximal portion of nail over abcess

Question 4

When is systemic antibiotic treatment indicated for paronychia?

Answer 4

If there is associated lymphangitis

Question 5

In what age is herpetic whitlow most common?

Answer 5

< 2 years

Question 6

When should parenteral acyclovir be considered for herpetic whitlow?

Answer 6

Immunocompromised patient

Question 7

What is a felon?

Answer 7

deep infection of the distal pulp space of the fingertip

Question 8

What are the potential complications of a felon?

Answer 8

osteomyelitis, flexor tenosynovitis, and septic arthritis of the distal interphalangeal (DIP) joint.

Question 9

How is a felon treated?

Answer 9

Incision & drainage + oral abx

Must extend excision beyond DIP to prevent contracture

Question 10

How should you treat the finger/nail after subungual foreign body removal?

Answer 10

soaked in warm, soapy water, and an antibiotic ointment and protective dressing applied. The finger should be soaked three times a day for 3 to 5 days.

Question 11

Where should the incision be made to cut a hair tourniquet off a penis?

Answer 11

3 or 9 o’clock or at 4 or 8 o’clock along the penile shaft

Question 12

What is a ganglion?

Answer 12

cystic outgrowth of the synovial lining of a tendon sheath or joint capsule

Question 13

Where are ganglions commonly found?

Answer 13

dorsal or volar surface of the wrist (usually on the radial side), the dorsum of the foot, and near the malleolus of an ankle

Question 14

What is the recurrence rate of ganglions after excision?

Answer 14

20%

Question 15

What does an epidermal inclusion cyst look like?

Answer 15

firm, slow-growing round nodules that can range in size from a few millimeters to centimeters

Question 16

Where are epidermal inclusion cysts found?

Answer 16

solitary lesions found about the scalp and face, although they also may be located on the trunk, neck, and scrotum

Question 17

What is Gardner syndrome?

Answer 17

autosomal dominant disorder characterized by multiple EICs, intestinal polyposis, desmoid tumors, and osseous lesions
High risk of intestinal malignancy

Question 18

How can dermoid cysts be distinguished from EICs?

Answer 18

younger age distribution and histologically by the possible presence of hair, glands, teeth, bone, and neural tissue, as well as keratin.

sites include the nasal bridge, midline neck, or scalp; the lateral brow (Fig. 120.5); anterior margin of the sternocleidomastoid; and midline scrotum or sacrum

Question 19

Why should midline dermoid cysts have imaging?

Answer 19

may have sinus tracts with deeper attachments extending intracranially or intraspinally

Question 20

What is a glioma?

Answer 20

benign growths composed of ectopic neural tissue derived from embryonic glial tissue

Question 21

What do gliomas look like clinically?

Answer 21

firm, gray, or red-gray nodule, ranging in size from 1 to 5 cm and can be mistaken for a hemangioma. Most are extranasal (60%), occurring on the bridge of the nose. The remainders are either solely intranasal masses (30%) or have both intranasal and extranasal elements (10%)

Question 22

What is an encephalocoele?

Answer 22

neural tissue that has herniated through a congenital defect in the midline of the calvarium

Question 23

What does an encephalocoele look like clinically?

Answer 23

soft, at times pulsatile, compressible masses that enlarge with crying or straining. Compression of the jugular veins (Furstenberg test) may also cause the mass to expand in size.

Question 24

What is found on nasopharyngoscopy with an encephalocoele?

Answer 24

Grape-like mass

Question 25

What is the most common congenital mass of the neck in chikdren?

Answer 25

Thyroglossal duct cyst

Question 26

At what age do thyroglossal duct cysts usually present?

Answer 26

< 10y

Question 27

How does a thyrogloss duct cyst present?

Answer 27

painless, smooth, mobile, cystic mass that is located in the midline or just slightly off-center
moves with protrusion of the tongue or swallowing.

Question 28

What are the usual causative organisms of acute lymphadenitis? Treatment?

Answer 28

Staph & strep

Amox-clav

Question 29

What is the most common cause of parotitis?

Answer 29

Viral - mumps virus, parainfluenza types 1 and 3, influenza, Coxsackie virus, and rarely, human immunodeficiency virus

Question 30

What is the treatment for sialadenitis?

Answer 30

hydration and avoidance of foods that require excessive chewing. Sour foods serve as sialagogues to hasten resolution

Question 31

Where are cystic hygromas most commonly found?

Answer 31

Posterior triangle of the neck

Question 32

where do cystic hygromas most commonly appear?

Answer 32

Posterior triangle of neck

Question 33

To where can cystic hygromas extend?

Answer 33

anterior triangle, sublingual space, retropharyngeal space, or mediastinum

Question 34

What type of branchial cleft anomaly is most common? & where are they found?

Answer 34

90% arise from the second branchial arch and are found along the anterior border of the sternocleidomastoid muscle

Question 35

Torticollis & lateral neck mass in early infancy is indicative of what?

Answer 35

fibromatosis colli of infancy

Question 36

What is fibromatosis colli of infancy associated with?

Answer 36

primiparous births, breech presentations, and difficult labor

Question 37

How does fibromatosis colli of infancy present?

Answer 37

nontender, firm, ovoid 1- to 3-cm mass is found along the inferior or middle third of the sternocleidomastoid muscle

Question 38

What coexists with fibromatosis colli of infancy 20% of the time and must be screened for?

Answer 38

Hip dysplasia

Question 39

What is the most common form of vascular malformations in infancy?

Answer 39

Salmon patches

Question 40

Where are salmon patches commonly found?

Answer 40

nape of the neck (stork bites), on the glabella, or over the eyelids (angel kisses)

Question 41

When do salmon patches usually resolve?

Answer 41

By 1 year

Question 42

What can lymphatic malformations cause?

Answer 42

Bony overgrowth of the affected side

Question 43

What is the most common benign neoplasm of infancy?

Answer 43

Infantile hemangiomas

Question 44

What are risk factors for infantile hemangiomas?

Answer 44

Caucasian, female, and premature infants

Question 45

What is the typical pattern of growth of infantile hemangiomas?

Answer 45

rapid growth over the first 6 to 12 months, then plateau. Subsequently, a slow process of involution begins, usually by 18 months. Approximately 50% of lesions involute completely by 5 years of age, and 95% by 9 years of age.

Question 46

What distribution of hemangioma is concerning for possible laryngeal hemangioma?

Answer 46

Beard distribution

Question 47

Who warrants investigation for visceral hemangiomas?

Answer 47

> 5 cutaneous hemangiomas

Question 48

What type / size of hemangioma is associated with PHACE syndrome?

Answer 48

On face & scalp, > 5cm

Question 49

What are pilomatrixomas?

Answer 49

Usually head and neck, but some arise on the trunk and extremities. They appear as firm (resulting from calcification), mobile, solitary nodules ranging in size from 0.5 to 5 cm. They are usually painless, but may be mildly tender. An overlying bluish hue

When pinched, the overlying skin “tents,”

Question 50

What is a pyogenic granuloma?

Answer 50

benign vascular lesion most commonly found on exposed skin surfaces such as the face, hands, and forearms. Occasionally, lesions form on oral or nasal mucosal surfaces. They are composed of granulation tissue with significant vascular overgrowth

usually solitary and pedunculated, measuring from 0.5 to 2 cm. At times, multiple satellite lesions are found around a central granuloma

Question 51

What is a granuloma annulare?

Answer 51

infiltrates of lymphocytes and altered collagen within the dermis.
appear first as raised nodules that gradually expand centrifugally to form annular rings with central clearing ranging from 1 to 5 cm in diameter. They have a firm, fibrous, sometimes-lumpy consistency on palpation. Overlying skin can range from normal, to erythematous, violaceous, or slightly hyperpigmented
Although most are asymptomatic, patients occasionally report mild pruritus

Question 52

Where are granuloma annulare usually found?

Answer 52

extensor surfaces of the lower portions of legs and the dorsum of the hands and feet and, less often, on the trunk or abdominal wall

Question 53

What is juvenlie xanthogranuloma?

Answer 53

nodular or plaque-like lesions with a firm or rubbery consistency.
Initially reddish in color, they evolve to have a distinct yellow or orange hue
While many are noted at birth, others appear within the first several months. They range in diameter from 0.5 to 4 cm. Like hemangiomas, they tend to grow rapidly in infancy, then spontaneously regress in early childhood leaving a hyperpigmented scar. Common sites include the scalp and face, proximal extremities, groin, and occasionally, the subungual area of a digit or a mucocutaneous junction

Question 54

Possible complications of reimplantation of avulsed permanent tooth

Answer 54

infection/abscess formation
ankylosis of reimplanted tooth to the surrounding bone
root resorption
tooth discoloration

Question 55

What are the methods available to remove a fish hook?

Answer 55

1. Barb cut - explain procedure. Position and restrain child. Cleanse area with antiseptic solution. Local anesthesia 1% lidocaine or digital block. Apply advancing pressure along the curve of the fish hook (proximal to distal) to force the barb end of the hook out through the skin. After the barb has been advanced through the skin, clip the barb with a wire cutter. The remainder of the hook can then be withdrawn along its original path of entry.
2. String removal - if lies too deep for barb cut. explain, cleanse, local anesthesia. Loop a piece of string around the hook (part 1). With the nondominant hand, depress the shaft of the hook against the skin (part 2). Grasp the end of the string with the dominant hand and pull sharply (part 3). This action should disengage the barb, and the hook can be removed through the entry wound.

Consider tetanus prophylaxis and antibiotic prophylaxis if immune compromised