Other 'general' surgery

Question 1

Lumps

1. History
2. Examination (6 S)
3. Examination - other
4. Transilluminatable - differentials
5. Lipomas - features
6. Lipomas (multiple + painful) - disease + demographic
7. Sebaceous cyst - features
8. Lymph nodes - causes
9. Cutaneous abscesses - common organisms
10. Ganglia - cause + features
11. Ganglia - management
12. Fibroma - appearance + components
13. Dermoid cysts - location
14. Malignancy connective tissue tumours
15. Intradermal - differentials
16. Subcutaneous - differentials

Answer 1

1. How long, painful, other symptoms e.g. itch, getting bigger, abroad, otherwise well
2. Site, size, shape, smoothness, surface, surroundings
3. Fixed/tethered, transillumination
4. Fluid-filled, e.g. hydrocoele, ganglia
5. Smooth imprecise margins, a little fluctuance, not fixed to skin/deeper structures
6. Dercum disease, post-menopausal women
7. Firm, round, subcutaenous, central punctum (scalp face, neck, trunk)
8. Infection, infiltration (carcinoma, lymphoma, sarcoid)
9. Staphylococci; hand (haemolytic streptococci), proteus (axilliary), below waist (faecal aerobes/anaerobes)
10. Degenerative cysts from adjacent joint/synovial sheath, wrist/hand/dorsum of foot, may transilluminate
11. 50% disappear spontaenously / aspiration with sterois hyaluronidase
12. Whitish, under skin, collagen/fibroblasts/fibrocytes
13. Junction of embryonic cutaneous boundaries (midline, lateral to eye)
14. Fibrocarcoma, liposarcoma, leiomyosarcoma, rhabdomyosarcoma
15. Sebaceous cyst, abscess, dermoid cyst, granuloma
16. Lipoma, ganglion, neuroma, lymph node

Question 2

Skin tumours

Melanoma

1. Checklist to use for features
2. Features
3. Diagnostic criteria
4. Management

Squamous cell

5. Presentation
6. May begin as (2)
7. Name for SCC ulcer on chronic inflamed place
8. Can be confused with
9. Management

Basal cell

10. Features
11. Location
12. Management

Answer 2

1. Glasgow 7 point
2. Change in size/shape/colour (2), inflammation/sensory change/diameter >7mm/crusting or bleeding (1) - refer if 3+
3. ABCDE - asymmetry, border (irregular), colour (non-uniform, diameter (>7mm), elevation
4. Urgent excision, chemo, ipilumumab if metastatic
5. Ulcerated with hard/raised edges in sun-exposed area
6. Solar keratoses (crumbly, yellow-white crusts), or Bowen’s disease (slow growing red-brown scaly plaque on lower leg, full thickness dysplasia, Queyrat’s erythroplasia if on penis) - give cryotherapy/flurouracil cream
7. Marjolin’s ulcer
8. Keratoacanthoma (fast growing, benign, keratin-plugged papule)
9. Excision + radiotherapy
10. Pearly nodule, rolled telangiectatic edge, or red scaly plaque with raised smooth edge
11. Nodule (face/sun-exposed), superficial (trunk/shoulders)
12. Excision, cryotherapy, flurouracil if superficial