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Medicine and Surgery Mushkies > Superficial Lesions Mushkies > Flashcards

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
Stuck on appearance?
Seborrhoeic keratosis
26
Neurofibroma defn?
Benign nerve sheath tumour arising from Schwann cells
27
Neurofibroma inspection?
Often pedunculated
28
Neurofibroma palpation?
Palpation, pressure can --> paraesthesia
29
When surgical Mx of neurofibromas?
Only if malignant growth suspected
30
Papilloma defn?
Overgrowth of all layers of the skin with a central vascular core, is flesh coloured and often pedunculated
31
Papilloma Mx?
Excision and diathermy to control bleeding
32
Pyogenic granuloma defn?
A rapidly growing capillary haemangioma, is neither pyogenic nor a granuloma
33
Pyogenic granuloma Mx?
1. Non-surgical = regression is uncommon | 2. Surgical = curettage with diathermy of the bases
34
Dermoid cyst defn?
A teratoma of a cystic nature that contains an array of developmentally mature, solid tissues
35
Teratoma defn?
A tumor made up of several different types of tissue, such as hair, muscle, teeth, or bone
36
Dermatofibroma defn?
A benign neoplasm of dermal fibroblasts, with a characteristic firm, woody feel
37
Dermatofibroma DDx?
Malignancy = melanoma, BCC
38
Dermatofibroma Mx?
Excision and histology
39
Kerato-acanthoma defn?
A benign overgrowth of hair follicle cells, that is dome shaped with a keratin plug
40
Exophthalmos Ddx?
1. Graves 2. Orbital cellulitis 3. SOL = meningioma, glioma 4. Carotid cavernous fistula = pulsatile exophthalmos 5. Idiopathic orbital inflammatory disease 6. Trauma
41
Mx of toxic multinodular goitre?
1. Propranolol + Carbimazole | 2. Radioiodine
42
Indications for surgical Mx of goitre?
5 Ms 1. Mechanicol obstruction 2. Malignancy 3. Marred beauty 4. Medical Rx failure 5. Mediastinal extension
43
Toxic multinodular goitre aka?
Plummer's disease
44
Plummer's disease association?
AF
45
What are 2 goitrogens?
Lithium and uncooked cabbage
46
Pathology of Graves exophthalmos?
Retro-orbital inflammation and lymphocytic infiltration --> orbital oedema
47
Pathology of lid-lag?
Sympathetic overstimulation --> restrictive myopathy of LPS
48
4 causes of thyroiditis with reduced uptake?
1. Hashimoto's 2. De Quervain's 3. Postpartum 4. Riedel's
49
How to distinguish b/w follicular adenoma and carcinoma?
Need excision histology (indistinguishable on FNAC)
50
Follicular adenoma Mx?
1. Cold = excision 2. Hot + <3cm = radioiodine 3. Hot + >3cm = surgical excision
51
Classification of solid thyroid nodules?
1. Benign = follicular adenoma, thyroid cyst | 2. Malignant = PFMA, Lymphoma
52
Papillary thyroid cancer Mx?
Total thyroidectomy + T4 to suppress TSH +/- node excision +/- radioiodine
53
Papillary thyroid cancer prognosis?
>95% at 10 years
54
Medullary thyroid cancer origins?
Parafollicular C Cells
55
MTC markers?
CEA and Calcitonin markers
56
Ix of thyroid nodule?
Triple assessment 1. Clinical examination 2. US 3. FNAC
57
MEN1?
1. Pituitary adenoma 2. Parathyroid hyperplasia/adenoma 3. Pancreatic tumour
58
MEN2A?
1. Parathyroid hyperplasia 2. Medullary thyroid carcinoma 3. Phaeochromocytoma
59
MEN2B?
1. Mucosal neuromas 2. Medullary Thyroid Carcinoma 3. Phaeochromocytoma 4. Marfanoid body habitus
60
Practicalities of thyroid surgery?
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
Neck lump classification?
Based on location 1. Anywhere 2. Midline 3. Anterior Triangle 4. Posterior triangle
62
Anywhere neck lumps?
Lipomas and sebaceous cysts
63
Midline neck lumps?
1. Solid = ectopic thyroid tissue, thyroid isthmus mass, inclusion desmoid 2. Cystic = thyroglossal cyst
64
Anterior triangle neck lumps?
1. Solid = LNs, chemodectoma, goitre, parotid tumour | 2. Cystic = Branchial cyst, laryngocele
65
Posterior triangle neck lumps?
1. Solid = LNs, cervical rib, pancoast tumour | 2. Cystic = cystic hygroma, pharyngeal pouch
66
Thyroglossal cyst defn?
Persistence of any part of the thyroglossal duct which marks the developmental descent of the thyroid from the foramen caecum
67
How can thyroglossal cyst undergo malignant transformation?
Contain thyroid tissue which can --> papillary thyroid Ca
68
Thyroglossal cyst features?
1. Young pt 2. Fluctuant midline neck lump, usually subhyoid 3. Elevation on swallowing and protrusion of tongue
69
Thyroglossal cyst complications?
1. Infection 2. Sinus formation 3. Fistula formation 4. Malignancy
70
Mx of thyroglossal cyst?
Sistrunk's operation = inject patent tract with dye at the start, excise cyst and patent tract
71
Branchial cyst defn?
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
Branchial cyst location?
Anterior margin of the SCM at junction of the upper and middle thirds
73
Complications of branchial cyst?
1. Infection 2. Sinus formation 3. Recurrence post-op
74
Branchial cyst mx?
1. Medical = sclerotherapy | 2. Surgical
75
Chemodectoma defn?
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
Is a chemodectoma pulsatile?
Yes
77
Chemodectoma movement?
Laterally but not vertically
78
Cystic hygroma defn?
Congenital multicystic lymphatic malformation in the posterior triangle of the neck
79
Cystic hygroma Fx?
1. Paediatric, lobulated cystic swelling 2. Soft and fluctuant 3. Transilluminates brilliantly
80
Complications of cystic hygroma?
1. Obstruction of swallowing | 2. Respiratory obstruction
81
Mx of cystic hygroma?
1. Surgical excision | 2. Hypertonic saline sclerosant
82
Pharyngeal pouch defn?
Herniation of the pharyngeal mucosa through its muscular coat at its weakest point, at Kilians dehiscence
83
Kilian's dehiscence?
A triangular area in the wall of the pharynx between the cricopharyngeus and thyropharyngeus
84
Symptoms of pharyngeal pouch?
Regurgitation, dysphagia and hallitosis
85
Complications of pharyngeal pouch?
1. Aspiration --> pneumonia | 2. Diverticular neoplasia (<1%)
86
Pharyngeal pouch Mx?
1. Non-surgical = if small and asymptomatic | 2. Surgical = Dohlman's procedure (minimally invasive endoscopic stapling)
87
Cervical rib defn?
Overdeveloment of the the transverse process of C7, occur in 1/150
88
Cervical rib presentation?
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
Causes of cervical lymphadenopathy?
LIST 1. Lymphoma and leukaemia 2. Infection 3. Sarcoidosis 4. Tumours = ENT, breast, lung, gastric
90
Infectious causes of cervical lymphadenopathy?
1. Bacterial = tonsillitis, dental abscess, TB, bartonella 2. Viral = EBV, HIV 3. Protozoal = toxoplasmosis
91
3 major salivary glands?
1. Parotid 2. Submandibular 3. Sublingual
92
Salivary gland (parotid) swelling classification?
1. Diffuse | 2. Localised
93
Diffuse salivary gland swelling?
1. Infection = Parotitis 2. Inflammation = Sarcoid 3. Autoimmune = Sjogrens 4. Systemic = CLD, DM, Anorexia, Bulimia
94
Localised salivary gland swelling?
1. Calculus 2. Neoplasm 3. Leukaemia = ALL 4. Lipoma
95
Salivary gland pain and swelling related to food?
Calculus
96
Salivary gland swelling with fever/malaise?
Mumps
97
Salivary gland swelling with dry eyes/mouth?
Sjogrens
98
Salivary gland swelling with SOB?
Sarcoidosis
99
Features of salivary gland neoplasms?
1. 80% in the parotid gland 2. 80% benign 3. 80% are pleiomorphic adenomas 4. Only 60% submandibular gland tumours are benign
100
Salivary gland neoplasms?
1. Benign | 2. Malignant
101
Benign salivary gland neoplasms?
1. Pleiomorphic adenoma = 80% | 2. Adenolymphoma = Warthins tumour (smoking)
102
Malignant salivary gland neoplasms?
1. Mucoepidermoid | 2. Adenoid cystic
103
Malignant features of salivary gland neoplasms?
1. Facial nerve palsy 2. Rapid growth and pain 3. Hyperaemic, hot skin 4. Hard consistency 5. Fixity to skin or underlying muscle
104
Mx of salivary gland neoplasms?
1. Benign = superficial --> superficial parotidectomy, deep --> total parotidectomy 2. Malignant = total parotidectomy +/- adjuvant radiotherapy
105
Complications of salivary gland surgery?
1. Immediate = facial nerve injury, reactionary haemorrhage 2. Early = temporary facial nerve weakness, salivary fistula, loss of pinna sensation 3. Frey's syndrome
106
What could cause loss of pinna sensation?
Greater auricular nerve damage
107
Frey's syndrome?
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
Hypertrophic scar?
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
Keloid scar?
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
Mx of hypertrophic and keloid scars?
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
Stages of clubbing?
1. Fluctuant nail bed 2. Loss of nail angle 3. Curvature of nail 4. Expansion of distal phalanx
112
Causes of clubbing classification?
1. Cardiac 2. Respiratory 3. GI 4. Miscellaneous
113
Cardiac causes of clubbing?
1. Atrial myxoma 2. Infective endocarditis 3. Congenital cyanotic heart disease
114
Respiratory causes of clubbing?
1. IPF 2. Lung cancer 3. Suppurative lung disease = bronchiectasis, CF 4. Sarcoid/TB
115
GI causes of clubbing?
1. IBD 2. Coeliac 3. Chronic liver disease esp. PBC 4. GI lymphoma
116
Miscellaneous causes of clubbing?
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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