NBE CME programme for DNB consultants - National Board Of ...

NBE CME programme for DNB consultantsSurgical Management - Generally for – malignant disease and consist of partial or completeamputation ; Inguinal block dissection depending upon requirementRadiotherapy - For malignant cases (Proper indication and ways to give radiotherapy must beknown)Soft tissue swellings/ tumorsHistory-Duration and pattern of progress of swelling eg if history of sudden increase recently orbecame more painful; Associated fever; Painful or pain free; Associated edema / motor dysfunction/ sensory loss; Any ulceration of swellingClinical examination - General physical exam – all routine; Local exam – Complete evaluation ofswelling specially anatomical plane of swelling, mobility , consistency, evidence of involvement ofdeeper structures viz muscles , nerves or vessels or even bone; Relevant pulsations; Movement ofjoint (if relevant to location of swelling); Multiplicity of swellings over body; Systemic exam – allroutineInvestigations - Apart from routine; Ultrasonic evaluation of swelling; If deeper infiltration , CT/MRI;Chest X-ray for sarcomas for knowing secondaries; FNAC / Trucut needle biopsyDifferential diagnosis - Sebaceous cyst, Lipoma, Neurofibroma; Ganglion; Parasitic cyst; Papilloma;Hamartomas; Fibrous histiocytomas; Fibrosarcoma; Other rare causes may be mentioned in lastNon- Surgical management - By and large no role; Inj Hyaluronidase for Ganglion if small andsimpleSurgical management - Enucleation/ Excision for swellings like lipoma, Seb cyst etc; Wide excisionfor locally recurrent tumors viz histiocytoma , hamartomas etc; Three dimensional excision /disarticulation for sarcomas, Any other - NilSoft tissue tumors of trunkHistory-Swelling – onset and progress pattern; Any h/o recent rapid increase in size or pain; Previoush/o surgery for same site swelling; Symptoms pertaining to local structures involvement ;Constitutional symptomsClinical examination - General physical examination – Routine; Local examination - Venousprominences; Visible pulsations; Complete examination of swelling specially to know clinically theanatomical plane of origin , consistency, fixity/mobility, pulsatility, surface and margins; Completeexamination of affected surrounding structures viz peripheral nerves / vessels / joint movements ifrelevant to that particular case-Bruit if any audible; Detailed evaluation of regional lymphadenopathyInvestigations - Plain radiography; Chest X-ray for evidence of metastasis; Ultrasonic assessment, if relevant to the site - CT/MRI evaluation for extent and depth / involvement of surrounding structuresor relations with vascular & neural structures; FNAC; Core needle biopsyDifferential Diagnosis - Benign viz Lipoma , Solitary neurofibroma , Nerve sheath tumor; Desmoids;Hamartomas; Fibrous histiocytoma; Dermatofibroma protuberns; Sarcoma like Liposarco.Fibrosarco. etc; Other rare causes at the endNon- Surgical Management - No primary role; Chemotherapy for malignant tumors mostly asadjuvant or sometimes as neo-adjuvantSurgical Management - Wide excision is the mainstay of therapy and that may sometimes involveremoval of muscles from origin to insertion; Followed by primary closure / grafting / use of flaps forclosure depending upon individual case, Any other – Radiotherapy as adjuvantOral ulcer / growthHistory-Pain – local or referred; Excessive salivation; Foul smell; Difficulty in protruding tongue /opening mouth; Alteration of voice; H/O smoking, Tobacco and alcohol; Spicy food consumption;Betalnut chewing; Dental plate / Sharp tooth95