Spot diagnosis (Images) Flashcards
Leukoplakia
White hard spots on mucous membranes of mouth
Common in smokers
Diagnosis of exclusion – candidiasis, lichen planus first
Regular follow up to exclude malignant transformation to SCC (1% of all patients)
Cushing’s syndrome
Lipoma
Definition: benign tumour of mature fat cells/adipocytes, which is smooth, mobile and painless, most often occurs in middle aged adults
Presenting:
Hemispherical lump on back which was not lobulated.
The mass was 10x10 cm in size, with regular borders, a soft texture and fluctuance.
The skin moved freely over the lump and did not disappear with muscle contraction (ie subcut, not intramuscular)
There are no scars suggesting recurrence after previous treatment.
There was normal temperature and no transillumination.
The lump demonstrated the ‘slip sign’.
To complete:
Examine rest of patient to look for other lipomas e.g part of syndrome
Full history: has lump changed? Does it catch/QOL?
Important negatives: features of sarcomatous change
Size >5cm
Increasing size
Pain
Deep anatomical location
Common sites: shoulders, chest, arms, back, bottom or thighs
Mx
Watch and wait
Excision if large/painful
Suction lipolysis under LA
Surgical excision (nuchal ones have fibrous septae and are difficult to excise)
Associated syndromes/lumps
Angiolipomas: vascular component
Hibernomas: brown fat cells, as seen in hibernating animals
Bannayan Zonana syndrome: rare AD hamartomous disorder, macrocephaly, haemangiomas
Dercum’s: multiple, assoc with peripheral neuropathy
Horner’s Syndrome
Ptosis: partial – superior tarsal muscle
Enophthalmos
Anhydrosis
Small pupil
Leukoplakia
White hard spots on mucous membranes of mouth
Common in smokers
Diagnosis of exclusion – candidiasis, lichen planus first
Regular follow up to exclude malignant transformation to SCC (1% of all patients)
Erythema marginatum
+ subcutaneous nodules = suggests Rheumatic Fever
Subcutaneous nodules
+ Erythema marginatum = suggests Rheumatic Fever
Neuropathic ulcer
Painless ulcers
Punched out appearance
Variable in size and depth
Areas of abnormal pressure e.g. metatarsal heads, heels
Warm feet, good pulses
Secondary to joint deformity in DM
**Lentigines – spotty skin pigmentation **
Carney complex/LAME Syndrome
Lentigines
Atrial Myxoma – cause of clubbing
Endocrine Tumours e.g. pituitary
Schwannomas
Externally rotated and shortened right lower limb
Need hip X-ray
Sebaceous cysts
Specifically: epidermal cyst – arises from hair follicle infundibulum
Sebaceous cysts
Specifically: Trichilemmal cyst/Wen – arises from hair follicle epithelium, often multiple, may be autosomal dominant
Tenckhoff catheter
Arteriovenous fistula photo
Renal transplant, AV fistula, PD scars
