Dr.Ahmed Sabra
21-Nov-2007, 11:04 AM
ORAL QUESTIONS IN CLINICAL SURGERY" is a book for CLINICAL SURGERY, I found while searching on internet so , I hoped you ge benefit from ... Just I hope !!!!!
Q. What is your diagnosis?
A. Subcutaneous lipoma.
Q. Why this is a lipoma?
A. Because it is a very slowly growing swelling which is soft, pseudofluctuant with a slippery edge.
Q. Why the edge of the lipoma is slippery ?
A. Because it is present within a very loose capsule so that pressure on one edge moves the swelling within the capsule.
Q. Why the lipoma is pseudofluctuant ?
A. Because the fat globules constituting the lipoma are very soft in consistency.
Q. How do you elicit fluctuation in a very small swelling ?
A. By Paget's test; the swelling is fixed by the index and thumb of the left hand and pressure is applied on the center of the swelling by the index of the right hand. If there is yeilding in the center of the swelling, it is considered fluctuant.
Q. Why this is a subcutaneous and not a subfascial lipoma ?
A. Because it is attached to the skin at multiple sites while in subfascial lipoma the skin is not attached to the swelling at all. Also, making the fascia tense does not make the swelling smaller.
Q. How did you detect the skin attachment ?
A. There are two methods to detect skin attachment; either by pinching or by gliding
Q. Mention the different sites of lipoma ?
A. 1. Subcutaneous lipoma
2. Subfascial lipoma,
3. Intermuscular lipoma
4. Intramuscular lipoma
5. Subperiosteal,
6. Subserous lipoma,
7. Extradural lipoma
8. Retroperitoneal lipoma
9. Subsynovial
10. Intraglandular
Q. Which site is famous for being precancerous ?
A. Retroperitoneal lipoma.
Q. What are the multiple skin swellings ?
A. 1. Multiple Lipomata
2. Multiple Sebaceous Cysts
3. Multiple Naevi
4. Multiple Haemangiomata
5. Multiple Lymphangiomata
6. Multiple Neurofibromata
7. Multiple Papillomata
8. Multiple Warts
9. Multiple Keloids
10. Multiple Boils
11. Multiple Skin Metastases
Q. What is the commonest multiple skin swelling ?
A. Multiple naevi.
Q. How do you treat this patient ?
A. The treatment of lipoma is usually conservative. Excision is indicated if 1) cosmetically annoying the patient , 2) complicated, 3) painful, or 4) causing pressure on a surrounding structure.
Q. What are the complications of a lipoma ?
A. Pressure on a surrounding structure e.g. a retroperitoneal lipoma compressing the ureters, hindering the movement of a nearby joint, calcification, myxomatous degeneration, and very rarely malignant transformation (liposarcoma).
Q. What is Dercum's disease ?
A. It is a painful lipoma, also called "adiposa dolorosa".
Case 2. HAEMANGIOMA
Q. What is your diagnosis ?
A. Cavernous haemangioma of the ......(mention the site).........
Q. Why this is a haemangioma ?
A. Because it is a skin swelling dating since birth (may be shortly after), it is pink in color and compressible.
Q. Why the haemangioma is compressible ?
A. Haemangioma consists of multiple blood-filled vascular spaces. These spaces communicate with the surrounding veins. Haemangioma is compressible because its contained blood empties into the veins communicating with the haemangioma.
Q. What are the compressible swellings you know ?
A. Haemangiomas, lymphangiomas, aneurysms, pharyngeal pouch, saphena varix, varicocoele, pneumatocoele, laryngeocoele, tracheocoele and hernias.
Q. What is the commonest site of a haemangioma ?
A. The head and neck region.
Q. Does it affect internal organs ?
A. Yes, for example the liver and spleen.
Q. What are the different types of haemangioma you know ?
A. The different types of haemangioma are :
1. Capillary Haemangioma :
Port wine stain, Strawberry angioma, Salmon patch, Spider naevi
2. Venous Haemangioma (Cavernous haemangioma)
3. Arterial Haemangioma (Circoid aneurysm)
Q. What is the commonest complication of a haemangioma ?
A. Haemorrhage.
Q. What is the treatment of a cavernous haemangioma ?
A. The different lines of treatment are :
1. Injection of a sclerosant material
2. Embolization injection
3. Surgical excision
4. Laser radiation
Q. As regards injection sclerotherapy, what is the commonest material to be used ?
A. Ethanolamine oleate.
Q. What do you mean by embolization injection ?
A. That is the injection of some material into the feeding artery of the haemangioma through angiography to produce occlusion of this artery and so necrosis of the haemangioma.
Q. What are the famous materials to be used in this regard ?
A. Gelfoam, alcohol foam and silicon particles.
Q. What is a hamartoma ?
A. A hamartoma is "a developmental tumour-like malformation characterized by being formed of the same tissues particular to the part of their origin and these tissues are arranged in a haphazard fashion. It is also characterized by a rate of growth similar to the surrounding structures".
Q. Mention the different types of hamartomas you know ?
A.
1. Haemangiomas 2. Lymphangiomas
3. Neurofibromas 4. Benign naevi.
Q. What are the types of lymphangioma ?
A. There are two types :
1. Capillary lymphangioma (lymphangioma circumscriptum)
2. Cavernous lymphangioma (cystic hygroma)
Q. What is the commonest site of a cystic hygroma ?
A. The neck.
Q. Is lymphangioma compressible or not ?
A. Lymphangioma is partially compressible.
Q. A cavernous lymphangioma in the neck has a character that differentiates it from other neck cysts, what is this character ?
A. It is the only translucent neck cyst.
Q. When does it become opaque ?
A. When it becomes infected
Q. What are the types of neurofibroma ?
A.1. Solitary neurofibroma
2. Generalized neurofibromatosis (von Recklinghausen's disease of nerves)
3. Molluscum fibrosum
4. Plexiform neurofibroma (pachydermatocoele)
5. Elephantiasis neuromatosa
Q. Mention the types of benign pigmented naevi (moles) ?
A. Benign pigmented naevi include the following types :
1. Intradermal naevus
2. Junctional naevus
3. Compound naevus
4. Blue naevus
5. Juvenile naevus
6. Congenital giant naevus
7. Halo naevus
8. Spindle cell naevus
9. Naevus of Ota
10. Naevus of Spilus
11. Lentigo
Q. At what age do benign pigmented naevi start to appear ?
A. They present in childhood and adolescence, rarely they present at birth.
Q. What are the characteristic features of congenital giant naevus ?
A. It is present since birth, may occupy very large areas of the body, usually hairy, and what is more important is that it is precancerous in about 15% of the cases
منقول للافادة
Q. What is your diagnosis?
A. Subcutaneous lipoma.
Q. Why this is a lipoma?
A. Because it is a very slowly growing swelling which is soft, pseudofluctuant with a slippery edge.
Q. Why the edge of the lipoma is slippery ?
A. Because it is present within a very loose capsule so that pressure on one edge moves the swelling within the capsule.
Q. Why the lipoma is pseudofluctuant ?
A. Because the fat globules constituting the lipoma are very soft in consistency.
Q. How do you elicit fluctuation in a very small swelling ?
A. By Paget's test; the swelling is fixed by the index and thumb of the left hand and pressure is applied on the center of the swelling by the index of the right hand. If there is yeilding in the center of the swelling, it is considered fluctuant.
Q. Why this is a subcutaneous and not a subfascial lipoma ?
A. Because it is attached to the skin at multiple sites while in subfascial lipoma the skin is not attached to the swelling at all. Also, making the fascia tense does not make the swelling smaller.
Q. How did you detect the skin attachment ?
A. There are two methods to detect skin attachment; either by pinching or by gliding
Q. Mention the different sites of lipoma ?
A. 1. Subcutaneous lipoma
2. Subfascial lipoma,
3. Intermuscular lipoma
4. Intramuscular lipoma
5. Subperiosteal,
6. Subserous lipoma,
7. Extradural lipoma
8. Retroperitoneal lipoma
9. Subsynovial
10. Intraglandular
Q. Which site is famous for being precancerous ?
A. Retroperitoneal lipoma.
Q. What are the multiple skin swellings ?
A. 1. Multiple Lipomata
2. Multiple Sebaceous Cysts
3. Multiple Naevi
4. Multiple Haemangiomata
5. Multiple Lymphangiomata
6. Multiple Neurofibromata
7. Multiple Papillomata
8. Multiple Warts
9. Multiple Keloids
10. Multiple Boils
11. Multiple Skin Metastases
Q. What is the commonest multiple skin swelling ?
A. Multiple naevi.
Q. How do you treat this patient ?
A. The treatment of lipoma is usually conservative. Excision is indicated if 1) cosmetically annoying the patient , 2) complicated, 3) painful, or 4) causing pressure on a surrounding structure.
Q. What are the complications of a lipoma ?
A. Pressure on a surrounding structure e.g. a retroperitoneal lipoma compressing the ureters, hindering the movement of a nearby joint, calcification, myxomatous degeneration, and very rarely malignant transformation (liposarcoma).
Q. What is Dercum's disease ?
A. It is a painful lipoma, also called "adiposa dolorosa".
Case 2. HAEMANGIOMA
Q. What is your diagnosis ?
A. Cavernous haemangioma of the ......(mention the site).........
Q. Why this is a haemangioma ?
A. Because it is a skin swelling dating since birth (may be shortly after), it is pink in color and compressible.
Q. Why the haemangioma is compressible ?
A. Haemangioma consists of multiple blood-filled vascular spaces. These spaces communicate with the surrounding veins. Haemangioma is compressible because its contained blood empties into the veins communicating with the haemangioma.
Q. What are the compressible swellings you know ?
A. Haemangiomas, lymphangiomas, aneurysms, pharyngeal pouch, saphena varix, varicocoele, pneumatocoele, laryngeocoele, tracheocoele and hernias.
Q. What is the commonest site of a haemangioma ?
A. The head and neck region.
Q. Does it affect internal organs ?
A. Yes, for example the liver and spleen.
Q. What are the different types of haemangioma you know ?
A. The different types of haemangioma are :
1. Capillary Haemangioma :
Port wine stain, Strawberry angioma, Salmon patch, Spider naevi
2. Venous Haemangioma (Cavernous haemangioma)
3. Arterial Haemangioma (Circoid aneurysm)
Q. What is the commonest complication of a haemangioma ?
A. Haemorrhage.
Q. What is the treatment of a cavernous haemangioma ?
A. The different lines of treatment are :
1. Injection of a sclerosant material
2. Embolization injection
3. Surgical excision
4. Laser radiation
Q. As regards injection sclerotherapy, what is the commonest material to be used ?
A. Ethanolamine oleate.
Q. What do you mean by embolization injection ?
A. That is the injection of some material into the feeding artery of the haemangioma through angiography to produce occlusion of this artery and so necrosis of the haemangioma.
Q. What are the famous materials to be used in this regard ?
A. Gelfoam, alcohol foam and silicon particles.
Q. What is a hamartoma ?
A. A hamartoma is "a developmental tumour-like malformation characterized by being formed of the same tissues particular to the part of their origin and these tissues are arranged in a haphazard fashion. It is also characterized by a rate of growth similar to the surrounding structures".
Q. Mention the different types of hamartomas you know ?
A.
1. Haemangiomas 2. Lymphangiomas
3. Neurofibromas 4. Benign naevi.
Q. What are the types of lymphangioma ?
A. There are two types :
1. Capillary lymphangioma (lymphangioma circumscriptum)
2. Cavernous lymphangioma (cystic hygroma)
Q. What is the commonest site of a cystic hygroma ?
A. The neck.
Q. Is lymphangioma compressible or not ?
A. Lymphangioma is partially compressible.
Q. A cavernous lymphangioma in the neck has a character that differentiates it from other neck cysts, what is this character ?
A. It is the only translucent neck cyst.
Q. When does it become opaque ?
A. When it becomes infected
Q. What are the types of neurofibroma ?
A.1. Solitary neurofibroma
2. Generalized neurofibromatosis (von Recklinghausen's disease of nerves)
3. Molluscum fibrosum
4. Plexiform neurofibroma (pachydermatocoele)
5. Elephantiasis neuromatosa
Q. Mention the types of benign pigmented naevi (moles) ?
A. Benign pigmented naevi include the following types :
1. Intradermal naevus
2. Junctional naevus
3. Compound naevus
4. Blue naevus
5. Juvenile naevus
6. Congenital giant naevus
7. Halo naevus
8. Spindle cell naevus
9. Naevus of Ota
10. Naevus of Spilus
11. Lentigo
Q. At what age do benign pigmented naevi start to appear ?
A. They present in childhood and adolescence, rarely they present at birth.
Q. What are the characteristic features of congenital giant naevus ?
A. It is present since birth, may occupy very large areas of the body, usually hairy, and what is more important is that it is precancerous in about 15% of the cases
منقول للافادة