EMQs in Clinical Medicine.pdf - Peshawar Medical College

Presentation with a lump – answers 175
This usually occurs a few days post partum and is self-limiting.
Presentation a few weeks after delivery, with a more persistent pyrexia
and the presence of purulent discharge, implies the presence of infective
mastitis. It is important to stop direct breast-feeding of the child and
send a sample of the breast milk for microscopy, culture and sensitivity.
As Staphylococcus aureus is by far the most common infective agent,
flucloxacillin treatment can be started in the meantime. The major
complication of mastitis is the development of an abscess, which is
managed surgically by incision and drainage.
61 Presentation with a lump
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A 22-year-old man presents with a lump on the scalp. Examination
reveals a smooth, spherical, tense lump. A small punctum can be seen
on the surface.
Sebaceous cysts can occur anywhere where there are sebaceous glands.
There are no sebaceous glands on the palms of the hand and the soles of
the feet. The scalp is a commonly affected area. The punctum visible on
the surface of the lump is virtually diagnostic of sebaceous cyst.
A 33-year-old man presents with a swelling on the upper arm that
has been growing slowly for a number of years. Examination reveals
a soft, compressible, non-tender, lobulated mass.
This is a typical history of lipoma with slow growth over a number of
years. The lobulation is diagnostically important.
A 28-year-old man presents with a painless swelling on the dorsum
of the right hand. Examination reveals a smooth, spherical, tense,
1.5 cm swelling. The overlying skin can be drawn over it.
A ganglion is a cystic degeneration of fibrous tissue and is usually found
around joints, especially the dorsal surface of the wrist joint. Treatment
is by excision under general anaesthetic.
A 29-year-old man presents with two mobile fusiform-shaped lumps
on the forearm. Each swelling feels like firm rubber and causes
tingling in the hand on pressure.
Neurofibromas are often multiple and can appear at any age, but usually
present in adult life. The forearm is frequently affected. The presence of
multiple neurofibromas may indicate the presence of neurofibromatosis
(look out for café-au-lait spots, Lisch nodules in the eye, acoustic
neuroma, etc.). These patients need to be followed up because there is a
risk of sarcomatous change.