Superficial Lesions Flashcards

Question

presentation and treatment branchial cysts

Answer 1

• Embryological remnant 2nd branchial cleft Presentation • Age <20yrs • Ant. margin of SCM at junction of upper and middle 3rd • May become infected → abscess abx if infected excise may form fistula

Answer 2

``` Carotid Body Tumour: Chemodectoma • Very rare • Carotid bodies § Located @ carotid bifurcation § Detect pO2, pCO2 and H+ Presentation • Just anterior to upper 3rd of SCM. • Pulsatile • Move laterally but not vertically • May be bilateral • Pressure may → dizziness and syncope • Mostly benign (5% malignant) Ix: Doppler or angio: splaying of bifurcation Rx: extirpation by a vascular surgeon ```

Answer 3

* Cystic dilatation of the laryngeal saccule * Congenital or acquired * Exacerbated by blowing may be seen in wind instrument players (rare)

Answer 4

divided by sternocleidomastoid QED

Answer 5

``` Developmental inclusion of epidermis along lines of skin fusion. Presentation • Common <20yrs • Found at junctions of embryological fusion § Neck midline § Lateral angles of eyebrow § Under tongue • Contains ectodermal elements § Hair follicles, sebaceous glands treat with excision ```

Answer 6

Cyst formed from persistent thyroglossal duct § Path of thyroid descent from base of tongue § Usually just inferior to the hyoid: subhyoid § Or, just above the hyoid: suprahyoid • Fluctuant lump that moves up on tongue protrusion • Can become infected → thyroglossal fistula treatment= • Sistrunk’s Op: excision of cyst and thyroglossal duct with segment of hyoid bone

Answer 7

Overdevelopment of transverse process of C7 • Occur in 1:150 Presentation • Mostly asymptomatic • Hard swelling • ↓ radial pulse on abduction and external rotation of arm

Answer 8

``` • Can → vascular symptoms § Compresses subclavian A § Raynaud’s § Subclavian steal § ↓ venous outflow → oedema ``` • Can → neurological symptoms § Compresses lower trunk of brachial plexus, T1 nerve root or stellate ganglion. § Wasting of intrinsic hand muscles § Paraesthesia along medial border of arm

Answer 9

``` Presentation • Swelling on left side of neck • Regurgitation and aspiration • Halitosis • Gurgling sounds • Food debris → pouch expansion → oesophageal compression → dysphagia. Ix: barium swallow Rx • Excision and cricopharyngeal myotomy • Endoscopic stapling ```

Answer 10

• Congenital multiloculated lymphangioma arising from the jugular lymph sac Presentation • Infants • Lower part of post. triangle but may extend to axilla. • ↑ in size when child coughs/cries • Transilluminates brilliantly Rx: excision or hypertonic saline sclerosant • May recur

Answer 11

``` Key Features • Consistency • Number • Fixation • Symmetry • Tenderness ``` ``` Additional Examination • Face and scalp for infection or neoplasm • Chest exam: infection or neoplasm • Breast examination • Formal full ENT examination • Rest of reticuloendothelial system ``` ``` History • Symptoms from the lumps § E.g. EtOH-induced pain • General symptoms § Fever, malaise, wt. loss • Systemic disease § PMH § Previous operations • Social history § Ethnic origin § HIV risk factors ```

Answer 12

``` • Lymphoma and Leukaemia • Infection • Sarcoidosis • Tumours Infection • Bacterial § Tonsillitis, dental abscess § TB § Bartonella henselae (Cat-scratch disease) • Viral § EBV § HIV • Protozoal § Toxoplasmosis ```

Answer 13

Blood • FBC, ESR, film (atypical lymphocytes) • TFTs, serum ACE • Monospot test, HIV test Radiological • US • CT scan Pathology • FNAC • Excision biopsy

Answer 14

Hypertrophic • Scar confined to wound margins • Across flexor surfaces and skin creases • Appear soon after injury and regress spontaneously • Any age: commonly 8-20yrs • M=F • All races ``` Keloid • Scar extends beyond wound margins • Earlobes, chin, neck, shoulder, chest • Appear months after injury and continue to grow • Puberty to 30yrs • F>M • Black and Hispanic ```

Answer 15

Non-surgical • Mechanical-pressure therapy • Topical silicone gel sheets • Intralesional steroid and LA injections Surgical • Revision of scar ¯c closure by direct suturing

Answer 16

diffuse multinodular solitary lump

Answer 17

``` Diffuse • Simple colloid goitre § Endemic: iodine deficiency § Sporadic: autoimmune, hereditary, goitrogens (e.g. sulphonylureas) • Graves’ • Thyroiditis § Hashimoto’s § De Quervain’s § Subacute lymphocytic (e.g. post-partum) • (multinodular goitre ¯c nodules too small to palpate) ```

Answer 18

Multinodular • Multinodular colloid goitre (commonest) • Multiple cysts • Multiple adenomas

Answer 19

``` Solitary nodule • Dominant nodule in multinodular goitre • Adenoma (hot or cold) • Cyst • Malignancy ```

Answer 20

``` Bloods • TFTs: TSH, fT3, fT4 • Other: FBC, Ca2+, LFTs, ESR • Antibodies: anti-TPO, TSH Imaging • CXR: goitres and mets • High resolution US • CT • Radionucleotide (Tc or I) scan (hot vs. cold) Histology or cytology • FNAC (can’t distinguish adenoma vs. follicular Ca) • Biopsy Laryngoscopy • Pre-operative assessment of vocal cords ```

Answer 21

``` diffuse painless goitre Mass effects: - dysphagia - stridor - SVC obstruction Usually euthyroid ``` cause = iodine deficiency goitrogens - sulphonylureas give thyroxine or remove if pressure symptoms

Answer 22

evolves from long term simple goitre | treat as for that - thyroxine and remove if probs

Answer 23

Multinodular goitre Thyrotoxicosis Uneven iodine uptake with hot nodule treat with carbimazole radioiodine or removal

Answer 24

``` Diffuse goitre ¯c bruit Ophthalmopathy Dermopathy Thyrotoxicosis Assoc. ¯c other AI disease (T1DM, PA) ↑ uptake on radionucleotide scan ``` anti TSHr Propanolol Carbimazole Radioiodine Thyroidectomy

Answer 25

diffuse painless goitre thyrotoxic phase followed by hypothyroid may have viral trigger? anti TPO thyroxine

Answer 26

painful! diffuse goitre viral trigger esp URTI Cocksackie common trigger too start toxic then go hypo then resolve themselves supportive

Answer 27

Diffuse painless goitre May occur post-partum Thyrotoxicosis → hypo → eu resolves

Answer 28

Single thyroid nodule ± thyrotoxicosis (majority are cold) May get pressure symptoms remove half thyroid

Answer 29

s Solitary thyroid nodule Asympto or pressure symptoms Can → localised pain due to cyst bleed sort cyst

Answer 30

rare btw, just FYI Firm, fixed, irregular thyroid mass Mass effects Assoc. ¯c retroperitoneal fibrosis

Answer 31

papillary 80% Thyroglob marker follicular 10% thyroglob marker medullary - parafollicular C cells, calcitonin + CEA markers (screen phaeo pre op) lymphoma - MALToma in Hashimoto's anaplastic <1% for ALL -> remove nodes + thyroid, give radioiodine

Answer 32

* Mechanical obstruction * Malignancy * cosmetic * Medical Rx failure: thyrotoxicosis * Mediastinal extension: can’t monitor changes

Answer 33

• Render euthyroid pre-op ¯c antithyroid drugs § Stop 10 days prior to surgery (they ↑ vascularity) § Alternatively just give propronalol • Check for phaeo pre-op in medullary carcinoma • Laryngoscopy: check vocal cords pre- and post-op

Answer 34

early - reactive bleed, laryngeal oedema, recurrent laryngeal nerve palsy (hoarse), hypocalcaemia, hyperthyroidism late - low thyroid, recurrent high thyroid, scarring

Answer 35

pt is tingling + has wheeze, Chvostek (zygoma tap) + Trousseau (BP cuff) signs give 10ml 10% cal gluconate

Answer 36

``` Whole gland § Parotitis § Sjogren’s / Sicca Syndrome § Sarcoid § Amyloid § ALL § Chronic liver disease § Anorexia or bulimia • Localised § Tumours § Stones ```

Answer 37

Viral: mumps, coxsackie A, HIV • Bacterial: S. aureus - Assoc. ¯c calculi and poor oral hygiene

Answer 38

* Recurrent unilateral swelling and pain * Worse on eating * Red, tender, swollen gland (80% submandibular) * Ix: plain x-ray or sialography * Rx: gland excision

Answer 39

* 80% are in the parotid (80% are superficial) * 80% are pleiomorphic adenomas * Deflection of ear outwards is classic sign * CN VII palsy = malignancy

Superficial Lesions Flashcards

(63 cards)