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Superficial Lesions Mushkies Flashcards

1
Q

Lump examination?

A

3S, 4C, 4T, FP

  1. Size, Site, Shape
  2. Colour, Consistency, Contour, Cough Impulse
  3. Tenderness, Temperature, Transilluminence, Tethering
  4. Fluctuance, Pulsatility, Spread (LN)
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2
Q

How to distinguish intradermal from subcutaneous lesion?

A
  1. Intradermal = cannot draw skin over lump, e.g. sebaceous cyst, neurofibroma, dermatofibroma
  2. Subcutaneous = can draw skin over lump e.g. lipoma, ganglion, lymph node
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3
Q

Completion of lump examination?

A
  1. Examine draining lymph nodes
  2. Examine neurovascular function distal to lmp
  3. Look for similar lumps elsewhere
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4
Q

Lipoma defn?

A

Benign tumour of mature adipocytes

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5
Q

Features of lipomas?

A
  1. Doesnt occur on scalp or palms
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6
Q

Causes of Lipomas?

A
  1. Idiopathic
  2. Familial multiple lipomatosis
  3. Adiposis Dolorosa (Dercum’s disease)
  4. Bannayan-Zonana syndrome
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7
Q

Dercum’s disease?

A

Multiple painful lipomas, associated with peripheral neuropathy, commonly in obese postmenopausal women

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8
Q

Bannayan-Zonana syndrome?

A

Autosomal dominant disease characterised by

  1. Multiple lipomas
  2. Macrocephaly
  3. Haemangiomas
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9
Q

Sebaceous cyst defn?

A

Epithelial lined cyst containing keratin, with 2 distinct histological subtypes: Epidermal cysts and Trichelemmal Cysts

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10
Q

Epidermal cyst arise from?

A

Hair follicle infundibulum

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11
Q

Trichelemmal cyst arise from?

A

Hair follicle epithelium, often multiple, may be autosomal dominant

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12
Q

Where do sebaceous cysts occur?

A

At sites of hair growth, not soles or palms

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13
Q

Characteristic fx of sebaceous cyst?

A

Central punctum

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14
Q

3 complications of sebaceous cyst?

A
  1. Infection = pus dicharge
  2. Ulceration
  3. Calcification
  4. Cock’s peculiar tumour
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15
Q

Cock’s peculiar tumour?

A

Large ulcerating trichelemmal cyst on the scalp which resembles a SCC

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16
Q

Gardners Syndrome?

A

FAP + TODE

  1. Thyroid tumours
  2. Osteomas
  3. Dental abnormalities
  4. Epidermal cysts
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17
Q

Syndrome associated with multiple sebaceous cysts?

A

Gardners

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18
Q

Ganglion defn?

A

A small cystic tumour associated with synovium-lined structures e.g. joint membrane/tendon sheath. It is a myxoid degeneration of fibrous tissue, and contains a thick, gelatinous material.

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19
Q

Ganglions most commonly found?

A

Dorsum of hand or wrist, but can be found anywhere

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20
Q

Ganglion DDx?

A
  1. Bursae

2. Cystic protrusion from synovial cavity of an arthritic joint

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21
Q

Mx of ganglion?

A
  1. Non-surgical = aspiration and 3wks immobilisation

2. Surgical = recurrence in 50%

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22
Q

Seborrhoeic keratosis defn?

A

A benign hyperplasia of keratinocytes with associated hyperkeratosis, acanthosis, and hyperplasia of basal cells

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23
Q

Hyperkeratosis defn?

A

Thickening of the stratum corneum

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24
Q

Acanthosis defn?

A

Thickening of the stratum spinosum

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25
Q

Stuck on appearance?

A

Seborrhoeic keratosis

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26
Q

Neurofibroma defn?

A

Benign nerve sheath tumour arising from Schwann cells

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27
Q

Neurofibroma inspection?

A

Often pedunculated

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28
Q

Neurofibroma palpation?

A

Palpation, pressure can –> paraesthesia

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29
Q

When surgical Mx of neurofibromas?

A

Only if malignant growth suspected

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30
Q

Papilloma defn?

A

Overgrowth of all layers of the skin with a central vascular core, is flesh coloured and often pedunculated

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31
Q

Papilloma Mx?

A

Excision and diathermy to control bleeding

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32
Q

Pyogenic granuloma defn?

A

A rapidly growing capillary haemangioma, is neither pyogenic nor a granuloma

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33
Q

Pyogenic granuloma Mx?

A
  1. Non-surgical = regression is uncommon

2. Surgical = curettage with diathermy of the bases

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34
Q

Dermoid cyst defn?

A

A teratoma of a cystic nature that contains an array of developmentally mature, solid tissues

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35
Q

Teratoma defn?

A

A tumor made up of several different types of tissue, such as hair, muscle, teeth, or bone

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36
Q

Dermatofibroma defn?

A

A benign neoplasm of dermal fibroblasts, with a characteristic firm, woody feel

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37
Q

Dermatofibroma DDx?

A

Malignancy = melanoma, BCC

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38
Q

Dermatofibroma Mx?

A

Excision and histology

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39
Q

Kerato-acanthoma defn?

A

A benign overgrowth of hair follicle cells, that is dome shaped with a keratin plug

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40
Q

Exophthalmos Ddx?

A
  1. Graves
  2. Orbital cellulitis
  3. SOL = meningioma, glioma
  4. Carotid cavernous fistula = pulsatile exophthalmos
  5. Idiopathic orbital inflammatory disease
  6. Trauma
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41
Q

Mx of toxic multinodular goitre?

A
  1. Propranolol + Carbimazole

2. Radioiodine

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42
Q

Indications for surgical Mx of goitre?

A

5 Ms

  1. Mechanicol obstruction
  2. Malignancy
  3. Marred beauty
  4. Medical Rx failure
  5. Mediastinal extension
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43
Q

Toxic multinodular goitre aka?

A

Plummer’s disease

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44
Q

Plummer’s disease association?

A

AF

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45
Q

What are 2 goitrogens?

A

Lithium and uncooked cabbage

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46
Q

Pathology of Graves exophthalmos?

A

Retro-orbital inflammation and lymphocytic infiltration –> orbital oedema

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47
Q

Pathology of lid-lag?

A

Sympathetic overstimulation –> restrictive myopathy of LPS

48
Q

4 causes of thyroiditis with reduced uptake?

A
  1. Hashimoto’s
  2. De Quervain’s
  3. Postpartum
  4. Riedel’s
49
Q

How to distinguish b/w follicular adenoma and carcinoma?

A

Need excision histology (indistinguishable on FNAC)

50
Q

Follicular adenoma Mx?

A
  1. Cold = excision
  2. Hot + <3cm = radioiodine
  3. Hot + >3cm = surgical excision
51
Q

Classification of solid thyroid nodules?

A
  1. Benign = follicular adenoma, thyroid cyst

2. Malignant = PFMA, Lymphoma

52
Q

Papillary thyroid cancer Mx?

A

Total thyroidectomy + T4 to suppress TSH +/- node excision +/- radioiodine

53
Q

Papillary thyroid cancer prognosis?

A

> 95% at 10 years

54
Q

Medullary thyroid cancer origins?

A

Parafollicular C Cells

55
Q

MTC markers?

A

CEA and Calcitonin markers

56
Q

Ix of thyroid nodule?

A

Triple assessment

  1. Clinical examination
  2. US
  3. FNAC
57
Q

MEN1?

A
  1. Pituitary adenoma
  2. Parathyroid hyperplasia/adenoma
  3. Pancreatic tumour
58
Q

MEN2A?

A
  1. Parathyroid hyperplasia
  2. Medullary thyroid carcinoma
  3. Phaeochromocytoma
59
Q

MEN2B?

A
  1. Mucosal neuromas
  2. Medullary Thyroid Carcinoma
  3. Phaeochromocytoma
  4. Marfanoid body habitus
60
Q

Practicalities of thyroid surgery?

A
  1. Render euthyroid pre-op with drugs
  2. Stop 10 days prior as they increase vascularity
  3. Laryngoscopy = check vocal chords pre and post op
61
Q

Neck lump classification?

A

Based on location

  1. Anywhere
  2. Midline
  3. Anterior Triangle
  4. Posterior triangle
62
Q

Anywhere neck lumps?

A

Lipomas and sebaceous cysts

63
Q

Midline neck lumps?

A
  1. Solid = ectopic thyroid tissue, thyroid isthmus mass, inclusion desmoid
  2. Cystic = thyroglossal cyst
64
Q

Anterior triangle neck lumps?

A
  1. Solid = LNs, chemodectoma, goitre, parotid tumour

2. Cystic = Branchial cyst, laryngocele

65
Q

Posterior triangle neck lumps?

A
  1. Solid = LNs, cervical rib, pancoast tumour

2. Cystic = cystic hygroma, pharyngeal pouch

66
Q

Thyroglossal cyst defn?

A

Persistence of any part of the thyroglossal duct which marks the developmental descent of the thyroid from the foramen caecum

67
Q

How can thyroglossal cyst undergo malignant transformation?

A

Contain thyroid tissue which can –> papillary thyroid Ca

68
Q

Thyroglossal cyst features?

A
  1. Young pt
  2. Fluctuant midline neck lump, usually subhyoid
  3. Elevation on swallowing and protrusion of tongue
69
Q

Thyroglossal cyst complications?

A
  1. Infection
  2. Sinus formation
  3. Fistula formation
  4. Malignancy
70
Q

Mx of thyroglossal cyst?

A

Sistrunk’s operation = inject patent tract with dye at the start, excise cyst and patent tract

71
Q

Branchial cyst defn?

A

Cyst that arises due to failed fusion of 2nd and 3rd branchial arches, lined by squamous epithelium, and contains glary fluid with cholesterol crystals

72
Q

Branchial cyst location?

A

Anterior margin of the SCM at junction of the upper and middle thirds

73
Q

Complications of branchial cyst?

A
  1. Infection
  2. Sinus formation
  3. Recurrence post-op
74
Q

Branchial cyst mx?

A
  1. Medical = sclerotherapy

2. Surgical

75
Q

Chemodectoma defn?

A

A rare tumour of the paraganglion cells of the carotid bodies (measure pH, PaO2 and PaCO2), located at the carotid bifurcation, of which 95% are benign

76
Q

Is a chemodectoma pulsatile?

77
Q

Chemodectoma movement?

A

Laterally but not vertically

78
Q

Cystic hygroma defn?

A

Congenital multicystic lymphatic malformation in the posterior triangle of the neck

79
Q

Cystic hygroma Fx?

A
  1. Paediatric, lobulated cystic swelling
  2. Soft and fluctuant
  3. Transilluminates brilliantly
80
Q

Complications of cystic hygroma?

A
  1. Obstruction of swallowing

2. Respiratory obstruction

81
Q

Mx of cystic hygroma?

A
  1. Surgical excision

2. Hypertonic saline sclerosant

82
Q

Pharyngeal pouch defn?

A

Herniation of the pharyngeal mucosa through its muscular coat at its weakest point, at Kilians dehiscence

83
Q

Kilian’s dehiscence?

A

A triangular area in the wall of the pharynx between the cricopharyngeus and thyropharyngeus

84
Q

Symptoms of pharyngeal pouch?

A

Regurgitation, dysphagia and hallitosis

85
Q

Complications of pharyngeal pouch?

A
  1. Aspiration –> pneumonia

2. Diverticular neoplasia (<1%)

86
Q

Pharyngeal pouch Mx?

A
  1. Non-surgical = if small and asymptomatic

2. Surgical = Dohlman’s procedure (minimally invasive endoscopic stapling)

87
Q

Cervical rib defn?

A

Overdeveloment of the the transverse process of C7, occur in 1/150

88
Q

Cervical rib presentation?

A
  1. Vascular = subclavian steal, Raynaud’s
  2. Neurological = paraesthesia along medial arm, wasting of intrinsic hand muscles (compress lower roots of brachial plexus, T1 or stellate ganglion)
89
Q

Causes of cervical lymphadenopathy?

A

LIST

  1. Lymphoma and leukaemia
  2. Infection
  3. Sarcoidosis
  4. Tumours = ENT, breast, lung, gastric
90
Q

Infectious causes of cervical lymphadenopathy?

A
  1. Bacterial = tonsillitis, dental abscess, TB, bartonella
  2. Viral = EBV, HIV
  3. Protozoal = toxoplasmosis
91
Q

3 major salivary glands?

A
  1. Parotid
  2. Submandibular
  3. Sublingual
92
Q

Salivary gland (parotid) swelling classification?

A
  1. Diffuse

2. Localised

93
Q

Diffuse salivary gland swelling?

A
  1. Infection = Parotitis
  2. Inflammation = Sarcoid
  3. Autoimmune = Sjogrens
  4. Systemic = CLD, DM, Anorexia, Bulimia
94
Q

Localised salivary gland swelling?

A
  1. Calculus
  2. Neoplasm
  3. Leukaemia = ALL
  4. Lipoma
95
Q

Salivary gland pain and swelling related to food?

96
Q

Salivary gland swelling with fever/malaise?

97
Q

Salivary gland swelling with dry eyes/mouth?

98
Q

Salivary gland swelling with SOB?

A

Sarcoidosis

99
Q

Features of salivary gland neoplasms?

A
  1. 80% in the parotid gland
  2. 80% benign
  3. 80% are pleiomorphic adenomas
  4. Only 60% submandibular gland tumours are benign
100
Q

Salivary gland neoplasms?

A
  1. Benign

2. Malignant

101
Q

Benign salivary gland neoplasms?

A
  1. Pleiomorphic adenoma = 80%

2. Adenolymphoma = Warthins tumour (smoking)

102
Q

Malignant salivary gland neoplasms?

A
  1. Mucoepidermoid

2. Adenoid cystic

103
Q

Malignant features of salivary gland neoplasms?

A
  1. Facial nerve palsy
  2. Rapid growth and pain
  3. Hyperaemic, hot skin
  4. Hard consistency
  5. Fixity to skin or underlying muscle
104
Q

Mx of salivary gland neoplasms?

A
  1. Benign = superficial –> superficial parotidectomy, deep –> total parotidectomy
  2. Malignant = total parotidectomy +/- adjuvant radiotherapy
105
Q

Complications of salivary gland surgery?

A
  1. Immediate = facial nerve injury, reactionary haemorrhage
  2. Early = temporary facial nerve weakness, salivary fistula, loss of pinna sensation
  3. Frey’s syndrome
106
Q

What could cause loss of pinna sensation?

A

Greater auricular nerve damage

107
Q

Frey’s syndrome?

A

Damage to the auriculotemporal branch of the mandibular nerve - parasympathetic nerve fibers may switch course to a sympathetic response, resulting in “gustatory sweating” or sweating in the anticipation of eating, instead of the normal salivatory response

108
Q

Hypertrophic scar?

A
  1. Scar more prominent than surrounding skin
  2. Scar confined to wound margins
  3. Appear soon after injury and regress spontaneously
  4. All races, commonly 8-20 y/o
109
Q

Keloid scar?

A
  1. Scar more prominent than surrounding skin
  2. Extends beyond wound margins
  3. Appear months after injury and continue to grow
  4. F>M, black and hispanic
110
Q

Mx of hypertrophic and keloid scars?

A
  1. Non-surgical = mechanical pressure therapy, topical silicone gel sheets, intralesional steroid + LA injections
  2. Surgical = revision of scar with closure by direct suturing
111
Q

Stages of clubbing?

A
  1. Fluctuant nail bed
  2. Loss of nail angle
  3. Curvature of nail
  4. Expansion of distal phalanx
112
Q

Causes of clubbing classification?

A
  1. Cardiac
  2. Respiratory
  3. GI
  4. Miscellaneous
113
Q

Cardiac causes of clubbing?

A
  1. Atrial myxoma
  2. Infective endocarditis
  3. Congenital cyanotic heart disease
114
Q

Respiratory causes of clubbing?

A
  1. IPF
  2. Lung cancer
  3. Suppurative lung disease = bronchiectasis, CF
  4. Sarcoid/TB
115
Q

GI causes of clubbing?

A
  1. IBD
  2. Coeliac
  3. Chronic liver disease esp. PBC
  4. GI lymphoma
116
Q

Miscellaneous causes of clubbing?

A
  1. Pregnancy
  2. Acromegaly
  3. Thyroid acropachy
  4. Familial clubbing
  5. Axillary artery aneurysms
  6. Brachial AVMs

Medicine and Surgery Mushkies (52 decks)

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