swellings

Question 1

what kind of lump would be seen in cellulitis?

Answer 1

a generalised swelling rather than a discreet lump

Question 2

what kind of presentation would be seen with cellulitis?

Answer 2

pain, swelling, erythema

Question 3

what organisms could it be in cellulitis?

Answer 3

beta-haemolytic streps

staph

Question 4

what is the management of cellulitis?

Answer 4

Rest, elevation, analgesia, splint Antibiotics; oral vs IV; penicillin NOT SURGERY

Question 5

what is an abscess?

Answer 5

discreet collection of pus

Question 6

how would an abscess present?

Answer 6

Defined and fluctuant swelling
Erythema, pain
History of trauma (eg. bite, IVDU)

Question 7

what’s the management of an abscess?

Answer 7

surgical incision & drainage
rest, elevation, analgesia, splint
antibiotics

Question 8

what is the management of septic arthritis?

Answer 8

Urgent orthopaedic review
Aspiration
Urgent Open/arthoscopic washout + debridement

Question 9

what presentation is usually seen in septic arthritis?

Answer 9

Acute monoarthropathy
↓↓ ROM +/- swelling
Systemic upset
Raised WCC + inflam markers

Question 10

what are ganglia?

Answer 10

Outpouchings of the synovium lining of joints and filled with synovial fluid

Question 11

describe the appearance of ganglia?

Answer 11

discreet, round swellings

Non-tender

Question 12

what is a baker’s cyst?

Answer 12

cyst/ganglion of the popliteal fossa

Question 13

what is the normal presentation of a baker’s cyst?

Answer 13

Can appear as general fullness of the popliteal fossa
Soft and non-tender
Associated with OA
Painful rupture

Question 14

what is the management of a baker’s cyst?

Answer 14

non-operative

Question 15

what is bursitis?

Answer 15

inflammation of the synovium lined sacs that protect bony prominence & joints

Question 16

what can happen to the bursa in bursitis?

Answer 16

Can become secondarily infected and form an abscess

Question 17

what is the management of bursitis?

Answer 17

NSAIDs / Analgesia
Antibiotics
Incision and drainage (secondary infection)
V. rarely excision (chronic cases)

Question 18

what are rheumatoid nodules?

Answer 18

Appear around joints in rheumatoid patients, again, associated with repetitive trauma

Question 19

describe the normal presentation of rheumatoid nodules?

Answer 19

Chronic, more severely affected RA patients, rheumatoid factor +ve

Question 20

what’s seen histologically in rheumatoid nodules?

Answer 20

intense inflammatory changes

Question 21

what are bouchard’s & heberden’s nodes?

Answer 21

bony swellings of the interphalangeal joints in hands caused by bony spurs due to chronic trauma

Question 22

describe bouchard’s nodes

Answer 22

Proximal IPJ

Less common OA or RA

Question 23

describe heberden’s nodes

Answer 23

Distal IPJ More common

OA

Question 24

what is dupuytren’s disease

Answer 24

Progressive disease resulting in digital flexion contractures

Question 25

describe the pathogenesis of dupuytren's disease

Answer 25

Excessive myofibroblast proliferation and altered collagen matrix composition lead to thickened and contracted palmar fascia, avascular process involving O2 free radicals

Question 26

what type of collagen are the bands commonly in dupuytren's disease

Answer 26

collagen type 3

Question 27

what is the management of dupuytren's disease?

Answer 27

``` Needle fasciotomy Collaginase injection Limited fasciectomy Dermofasciectomy + graft can recur ```

Question 28

what is an osteochondroma?

Answer 28

Benign tumour most commonly occurring near the knee | Distal femur / proximal tibia metaphyseal regions

Question 29

what does an osteochondroma look like macroscopically?

Answer 29

Cartilage capped ossified pedicle

Question 30

what is the normal presentation of an osteochondroma?

Answer 30

Painless, hard lump Symptoms with activity (pain from tendons; numbness from nerve compression)

Question 31

what is the management of an osteochondroma?

Answer 31

Close observation | Surgical excision

Question 32

what is Ewings sarcoma?

Answer 32

Malignant primary bone tumour of the endothelial cells in the marrow

Question 33

describe the normal presentation of ewings sarcoma

Answer 33

The great mimic: Hot, swollen, tender joint or limb with raised inflammatory markers Can mimic infection Be suspicious; ask about night pain and duration of symptoms; investigate early

Question 34

describe the management of wings sarcoma

Answer 34

Poor prognosis Surgical excision problematic Often radio- and chemo-sensitive

Question 35

what is a lipoma

Answer 35

Benign neoplastic proliferation of fat | Often subcutaneous

Question 36

describe the normal presentation of a lipoma

Answer 36

``` Can be discreet or less well defined Slow growing and painless/non-tender Can be large (several cms) Characteristic consistency No overlying skin changes ```

Question 37

describe the management of a lipoma

Answer 37

Based on symptoms Can be left alone Surgical excision is causing symptoms

Question 38

what is myositis ossificans

Answer 38

Abnormal calcification of a muscle haematoma