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28 Cards in this Set

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What is a saphena varix?
dilation of the long saphenous vein in the groin, just proximal to its junction with the femoral vein
Signs and symptoms
Cough impulse - transmits thrill
Swelling of soft and diffuse
Empties with minimal pressure and refills on release
Venous hum on auscultation
Bluish tinge
Dissapears on lying down
Usually substantial varicose veins elsewhere in the long saphenous system
How do you diagnse a saphena varix?
doppler US
How do you treat a saphena varix?
high saphenous ligation, varicose vein excision
What is the aetiology of psoas abscesses?
Collection of pus in the ileopsoas mm compartment
Can arise from haematogenous spread, contiguous spread from intraabdominal or pelvic process or nearby bony structures
What are the organisms commonly found in psoas abscesses?
S. aureus, mix or enteric organisms including aerobic and anaerobic gram -ve bacilli
What is the sign that can elicit tenderness of the psoas muscle
Psoas sign - pain brought on by hip extension
Clinical presentation of psoas abscess?
Fever
Lower abomdinal or back pain
or pain referred to hip or knee
+ psoas sign - pain brought on by extension of the hip
Hip pain is diminished with hip flexion
inguinal mass
limp, anorexia, weight loss
What is the most useful diagnostic test for psoas abscess?
CT
How do you treat psoas abscess?
CT guided drainage and antibiotics, surgical drainage if no clinical improvement after 2 days
What is a lipoma?
Benign tumour of fat
= commonest form of benign soft tissue tumours
What are the characteristics of a lipoma?
Soft and non tender
Asymptomatic
Fluctulant and lobulated
Neither fixed to skin or deep tissues
Usually do not enlarge
quickly
Management of lipoma
Conservative
Surgery if:
painful, enlarging, pressure effects on adjacent structures, > 5cm, deep to the deep fascia (more likely to be malignant if in limbs)
What are the 3 main causes of enlarged lymph nodes?
Infective
Neoplastic - lymphoma/other malignancies
Reactive - CT, sarcoidosis, amyloidosis, drugs
Hwere do the inguinal lymph nodes lie?
Horizontal group lies along the inguinal ligament
A vertical group lies beside the great saphenous vein in the proximal thigh
Which lymph nodes do tumours of the testis and scrotal cancer met to?
They met to the paraaortic nodes and do NOT involve the inguinal nodes
Scrotal cancer spreads to the inguinal nodes
Differential of localised inguinal lymph nodes
STIs
Malignant melanoma of lower limb
Anal or vulval or scrotal cancer
Are lymph nodes reducible?
no
Symptoms of lymphadenopathy?
Tender - reactive
Non-tender - haematological disease
Can be fixed or mobile
Are not reducible
soft or firm, rubbery, hard, discrete, matted
What do nodes containing metastatic cancer feel like?
hard, nontender, nonmovable
What do nodes containing lymphoma feel like?
large, discrete, symmetric, rubbery, firm, mobile, non tender
What is the most common peripheral aneurysm?
femoral artery
How do femoral artery aneurysms present?
Asymptomatic
Local pain or pulsatile groin mass
severe ischaemia of lower extremity - claudication, rest pain, gangrene (42% of patients)
Indications for surgical management of femoral artery aneurysms?
local symptoms, limb threatening sx
> 2.5cm
What is a femoral neuroma?
= a nerve cell tumour that arises either sponardically as cutaneous nodules or due to previous trauma
Commonly associated with type 1 neurofibromatosis
Symptoms of a femoral neuroma?
Compression causes pain and paraesthesia in the distribution of the femoral nerve
small, firm in texture
What is a cord lipoma?
It is the most common benign tumour of the spermatic cord
What is a hydrocele?
fluid remnant within the remnant processus vaginalis
Noncommunicating - processus has closed proximally (Normal spermatic cord can usually be palpated above the level of the hydrocele)