Surgical Lumps and Lesions

Question 1

Process of Examining a Lump

Answer 1

SSS

CCCC

TTTT

FSP

Site

Size

Shape

Colour

Consitsency

Contour

Cough impulse

Tenderness

Temperature

Transilluminence

Tethering

Fluctuance

Pulsatility

Spread LNs

Intradermal or Subcutaneous?

Completion: examine the draining lymph nodes, examine the neurovascular function distal to the lump, examine for other lumps

Question 2

Intradermal or Subcutaneous

Answer 2

Intradermal

Cannot draw skin over lump

Sebaceous cyst, neurofibroma, deratofibroma

Subcutaneous

Can move lump independently from skin

Lipoma, ganglion, lymph node

Question 3

Signs of Thyroid Disease on Examination

Answer 3

Hoarse voice: recurrent laryngeal nerve

Inspection

Nervous/ agitated

Slow lethargic

Body habitus

Sweaty

Skin and hair condition

Hnads

Thyroid acropachy

Palmar erythema

Temperature, sweating

Fine tremor

Pulse: AF in thyrotoxicosis

Eyes

Sympathetic overstimulation: lid-lag and lid retraction (sclera visible between iris and upper lid)

Grave’s: oedema (preorbital and chemosis), exophthalmos, opthalmoplegia (upgaze palsy)

Neck

Look for collar scars

Look in mouth for ingual thyroid

Legs

Pretibial myxoedema: brown swelling above lateral malleoli

Proximal myopathy: Graves

Ankle reflexes

Slow relaxing = hypothyroidism

Brisk reflexes = hyperthyroidism

Question 4

Differential for Exophthalmos

Answer 4

Graves

Orbital cellulitis

Trauma

Masses: meningioma, glioma

Carotid cavernous fistula: pulsatile exopthalmos

Idiopathic orbital inflammatory disease

Question 5

Differential for a Thyroid Goitre

Answer 5

Diffuse enlargement

Smooth

• Simple colloid goitre
• Graves
• Thyroiditis: Hashimoto’s, de Quervain’s, Riedel’s

Nodular

• Multinodular goitre
• Multiple adenomas

Solitary nodule

• Dominant nodule of a multinodular goitre
• Adenoma
• Malignant
  
  • Primary: papillary, follicular, medullar, anaplastic
  • Secondarty: breast
• Cyst