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Scott's Notes > Superficial lesions > Flashcards

Superficial lesions Flashcards

1
Q

What are you looking for on examination of a lump?

A

SCT FPS

Site
Size
Shape

Colour
Consistency
Contour
Cough impulse

Tenderness
Temperature
Transilluminence
Tethering

Fluctuant
Pulsatility
Spread

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2
Q

How would you complete your lump examination?

A

Examine relevant LNs
Examine NV function distally
Look for similar lumps elsewhere

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3
Q

What are the features of a lipoma, and name one syndrome with which they are associated?

A

Soft, subcutaneous, with imprecise margins and are fluctuant

Familial Multiple Lipomatosis

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4
Q

What is the structure of a sebaceous cyst?

A

Epithelial lined cyst containing keratin

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5
Q

What would you find on inspection and palpation of a sebaceous cyst?

A

Inspection
Occur where hair grows
Central puncture

Palpation
Firm
SMooth
Intradermal

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6
Q

What are the complications of a sebaceous cyst?

A

Infection
Ulceration
Calcification

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7
Q

What is Gardener’s syndrome?

A 
FAP 
Thyroid tumours
Osteomas
Dental abnormalities
Epidermal cysts
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8
Q

What is a ganglion?

A

A cystic swelling related to a synovial lined structure which contains a thick, gelatinous material

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9
Q

What would you find on inspection and palpation of a ganglion?

A

Inspection
Often at dorm of hand or wrist

Palpation
Soft
Subcutaneous
May be tethered to tendon

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10
Q

What is the management of a ganglion?

A

Non-surgical
Aspiration followed by 3/52 immobilisation

Surgical
Excision - recurrence in 50% and risk of NV damage

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11
Q

What are seborrheic keratoses?

A

Benign hyperplasia of the basal cell layer causing hyperkeratosis

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12
Q

What would you find on inspection and palpation of a seborrheic keratosis?

A

Stuck on appearance
Dark brown
Greasy

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13
Q

What is a neurofibroma?

A

A benign nerve sheath tumour arising from schwann cells

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14
Q

What would you find on inspection and palpation of a neurofibroma?

A

Inspection
Solitary or multiple?
Pedunculated nodule

Palpation
Fleshy consistency
Pressure ->parasthesia

Other
Lisch nodules
Cafe au lait spots
Axillary freckles

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15
Q

What are the features of neurofibromatosis 1?

A 
AD inheritance 
>6 CaL spots
Axillary freckling
Neurofibromata
Lisch nodules
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16
Q

What is a pyogenic granuloma?

A

Neither pyogenic nor granulomatous, but a rapidly growing capillary haemangioma

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17
Q

What would you find on inspection and palpation of a pyogenic granuloma?

A

Inspection
Commonly on hands, face gums, lips
Bright red hemispherical nodule +- discharge

Palpation
Soft
Bleed easily

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18
Q

What would you find on inspection and palpation of a dermoid cyst?

A

Inspection
Smooth spherical swelling
Scar from recurrence

Palpation
Soft non tender
Subcutaneous

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19
Q

What is a keratoacanthoma?

A

Benign overgrowth of hair follicle cells cytologically similar to SCC

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20
Q

What would you find on inspection and palpation of a keratoacanthoma?

A

Fast growing
Dome shaped with a keratin plug
Intradermal

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21
Q

What are the components of a thyroid examination?

A 
Inspection:
Nervous/agitated or slow/lethargic
Body habitus
Sweat
Skin/hair condition
Hands
Thyroid acropachy
Palmar erythema
Sweating/temp
Fine tremor (paper)
Pulse (AF?)

Eyes
Lid retraction and lid lag seen in sympahthetic overstimulation
Graves -> Oedema, exophthalmos, ophthalmoplegia

Neck

Inspect from front and side, stick out tongue and swallow water, look in mouth for lingual thyroid

Palpate from behind
Swallow and protrusion test
Laopathy
trach deviation

Percuss for retrosternal extension

Auscultate for bruits

Legs
Pretibial myxoedema (brown swelling above lat malleoli)
Proximal myopathy (stand arm crossed)
Ankle reflexes

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22
Q

What are the differentials for a diffuse goitre?

A

Smooth
Simple colloid
Graves
Thyroiditis (Hashimoto/Quervains/Reidels)

Nodular
Multinodular goitre
Multiple adenomata

23
Q

What are the differentials for a solitary thyroid nodule?

A

Adenoma
1ary or 2ary (breast) malignancy
Cyst

24
Q

What is a multi nodular goitre?

A

Commonest goitre in the UK, commonly in middle aged women with a mild thyrotoxicosis due to overactivity in parts of the thyroid

Malignant change in 5%

25
Q

What is the management of a multi nodular goitre?

A

Medical
Thyroxine to suppress TSH
If toxic, -> propranolol, carbimazole, radio iodine

Surgical
Total thyroidectomy

26
Q

What are the indications for thyroidectomy?

A

5Ms

Malignancy
Mechanical obstruction
Marred beauty
Mediastinal extension
Medical Rx failure
27
Q

What other conditions is Grave’s disease associated with?

A

T1DM
Vitiligo
Pernicious anaemia

28
Q

What is the management of a follicular adenoma?

A

Hot + <3cm - radioiodine
Hot + >3cm - excision
Cold - excision

29
Q

What is the commonest type of thyroid malignancy, and what is its prognosis?

A

Papillary (80%) seen in 20-40 year olds

> 95% 10 year surivval

30
Q

Which type of thyroid disease is most associated with syndromes?

A

Medullary (MEN2_

31
Q

Which thyroid cancer has the worst prognosis?

A

Anaplastic (<1% 10 year)

32
Q

What are the complications of thyroid surgery?

A 
Early
Reactionary haematoma
Rec laryngeal nerve palsy
Hypocalcaemia
Thyroid storm

Late
Hypothyroid/hypoparathyroid
Recurrence
Keloid scar

33
Q

How would you examine a neck lump?

A

Inspect - scar, sinus, mass
Neck
Mouth
Eyes

Palpate
From behind on swallow
LA opathy
Trach deviation

Percuss

Auscultate

34
Q

What are the differentials for a midline neck lump?

A

Thyroid isthmus mass
Thyroglossal cyst
Lipoma
Sebaceous cyst

35
Q

What are the differentials for an anterior triangle neck lump?

A 
LNs
Goitre
Parotid tumour
Branchial cyst
Laryngocele
36
Q

What are the differentials for a posterior triangle neck lump?

A 
LNs
Cervical rib
Pancoast tumour
Cystic hygroma
Pharyngeal pouch
37
Q

What are the borders of the anterior triangle?

A

SCM
Midline
Mandible

38
Q

What are the borders of the posterior triangle?

A

SCM
Trapezius
Omohyoid muscle inferiorly

39
Q

What is a Richter’s hernia?

A

Where only part of the circumference of bowel is within the sac, commonly seen as femoral hernias, they can strangulate without obstruction

40
Q

What is:

Herniotomy
Herniorrhaphy
Hernioplasty

A

Herniotomy is excision of the hernial sac

Herniorrhaphy is suture repair of hernial defect

Hernioplasty is mesh repair of a hernial defect

41
Q

What is the aetiology of congenital and acquired hernias?

A

Congenital
Patent processus vaginalis which should be obliterated following testicular descent

Acquired
Raised intra-abdominal pressure

42
Q

What are the two primary types of hernia?

A

Indirect
80% - common in younger ppl
Emerge through deep ring
Commonly strangulate

Indirect
20% - common in elderly ppl
Emerge through Hesselbach’s triangle
Rarely strangulate or descend into scrotum

43
Q

What are the borders of Hesselbach’s triangle?

A

Medial - lateral rectus
Lateral - inferior epigastric vessels
Inferior - inguinal ligament

44
Q

What is the management of inguinal hernias?

A

Medical
Treat RFs e.g. constipation
Lose weight
Truss

Surgical
Tension free meshes better than suture repair
Primary unilateral hernias should be open incisions

45
Q

What are the complications of inguinal hernia surgery?

A 
Early
Haematoma
IA injury
Infection
Urinary retention

Late
Recurrence
Ischaemic orchitis
Chronic groin pain/parasthesia

46
Q

Which gender experiences more femoral hernias and why?

A

Females due to pelvis shape accommodating for child birth

47
Q

What are the clinical features of a femoral hernia?

A

Groin lump inferolateral to the pubic tubercle
Often irreducible
Commonly strangulate -> tender, red, hot, pain, vomiting, constipationd, distension

48
Q

What is the management of a femoral hernia?

A

50% strangulate in 1 year so requires urgent surgery

Elective Lockwood approach or

Emergency McEvedy approach

49
Q

What are the risk factors for an incisional hernia?

A 
Pre-op
Old age
Obesity
Comorbidities 
Steroids, chemo, radio

Intra-op
Surgical technique/skill
Incision type
Presence of drains through wound

Post-op
Raised IAP e.g. cough, ileus
Infection
Haematoma

50
Q

What is the management of incisional hernias?

A

Conservative
Manage RFs
Weight loss
Corset/truss

Surgical
Pre-op care Re RFs and surgical technique

51
Q

What are the risk factors for umbilical hernias?

A

Afro-carribean
T21
Congenital hypothyroidism

52
Q

What is the management of umbilical hernias?

A

Usually resolve by 2/3 years of age

53
Q

What are the features of paraumbilical hernias?

A

Middle aged obese man

Defect in linea alba above/below the umbilicus

54
Q

What is the management of a paraumbilical hernia?

A

Mesh repair

Scott's Notes (21 decks)

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