Soft Tissue

Question 1

Lipoma

Answer 1

Benign fatty lump, occurring wherever fat can expand

Question 2

Features of lipoma

Answer 2

Smooth, imprecise margins
Hint of fluctuance
Not fixed to skin or underlying structures
Sx only caused via pressure

Question 3

Polymyositis and dermatomyositis

Answer 3

Rare conditions characterised by insidious onset of progressive symmetrical proximal muscle weakness and AI-mediated striated muscle inflammation, associated with myalgia +/- arthralgia

Question 4

Sx of polymyositis and dermatomyositis

Answer 4

Myalgia +/- arthralgia
Muscle weakness may also cause dysphagia, dysphonia, respiratory weaknes
Dermatomyositis: additional skin signs (macular rash, lilac-purple rash on eyelids, nailfold erythema, subcutaneous calcifications)
Extra-muscular signs: fever, Raynaud’s, interstitial lung fibrosis, myocardial involvement (myocarditis, arrhythmia)

Question 5

Ix for polymyositis/dermatomyositis

Answer 5

Increased muscle enzymes: ALT, AST, LDH, CK, aldolase
EMG: characteristic fibrillation potentials
Muscle biopsy confirms Dx
AutoAb associations: anti-Mi2, anti-Jo1

Question 6

Mx for polymyositis/dermatomyositis

Answer 6

Prednisolone
Immunosuppressives and cytotoxics early in resistant cases
Hydroxychloroquine or tacrolimus may help with skin disease

Question 7

Bursitis

Answer 7

Inflammation of one or more bursae

Multi-factorial causes: trauma, AI disorders, infection, iatrogenic

Question 8

Bursitis: commonly affected joints

Answer 8

Shoulder
Elbow
Knee

Question 9

Mx of bursitis

Answer 9

If infected (fever, surrounding cellulitis): Abx therapy, steroids, surgery
Non-infected: RIE (no compression - pressure makes it worse!), physiotherapy, anti-inflammatories, analgesia, bursectomy if chronic

Question 10

Rhabdomyosarcoma

Answer 10

Sarcoma arising from skeletal muscle progenitor cells
Mostly occurs in areas naturally lacking in skeletal muscle (e.g. head, neck, genitourinary tract)
Typically seen in young children and adolescents

Question 11

Mx of rhabdomyosarcoma

Answer 11

Chemotherapy
Radiotherapy
Surgery (dependent on site of tumour)