Physical Examination Techniques for Lesions
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Questions and Answers

What is the main purpose of a diagnostic ultrasound for soft tissue tumors?

  • To detect metastatic tumors
  • To provide detailed information about the tumor
  • To track response to therapy
  • To distinguish edema from localized mass (correct)

    • Which imaging technique is used to detect the metabolism of different organs by attaching a radioactive substance to a naturally-utilized chemical?

  • Positron emission tomography (PET) (correct)
  • Nuclear medicine
  • Biopsy
  • Diagnostic ultrasound

    • What is the typical role of nuclear medicine in relation to soft tissue tumors?

  • Locating and detecting metastatic tumors (correct)
  • Ruling out other similar conditions
  • Providing tissue for histopathological analysis
  • Detailed analysis of the tumor characteristics

    • Which of the following is NOT considered as specific bloodwork for soft tissue tumors?

    <p>Lactate dehydrogenase</p> Signup and view all the answers

    What is the primary purpose of a biopsy for soft tissue tumors?

    <p>To provide tissue for histopathological analysis</p> Signup and view all the answers

    Which imaging method can help differentiate between a fluid-filled ganglion cyst and a lipoma based on echogenicity?

    <p>Diagnostic ultrasound</p> Signup and view all the answers

    What is the purpose of transillumination during physical examination of a mass?

    <p>To check if the mass is fluid-filled</p> Signup and view all the answers

    Which feature is more likely to be observed in a benign lesion during physical examination?

    <p>Transilluminates when light is applied</p> Signup and view all the answers

    Which imaging technique provides the best soft tissue contrast according to the text?

    <p>Magnetic Resonance Imaging</p> Signup and view all the answers

    When are abdominal and chest tumors often detected using plain film radiography?

    <p>For monitoring purposes</p> Signup and view all the answers

    What is a common use of Computed Tomography (CT) in differentiating tumors from infections?

    <p>Identifying intra-osseous gas from infections</p> Signup and view all the answers

    Which lesion characteristic is more indicative of a malignant lesion based on the given information?

    <p>&gt;5cm diameter, firm, fixed, and transilluminates</p> Signup and view all the answers

    What is the main function of the organ mentioned in the text?

    <p>Increase blood flow to the skin in cold temperatures</p> Signup and view all the answers

    Which clinical examination technique involves applying a pin or pencil to the nail plate to elicit intense pain over a suspected mass?

    <p>Loves test</p> Signup and view all the answers

    What imaging technique is useful for revealing intra-tumor vasculature in glomus tumors?

    <p>Ultrasound with color Doppler</p> Signup and view all the answers

    What is the recommended treatment for asymptomatic glomus tumors?

    <p>Observation</p> Signup and view all the answers

    Which imaging finding indicates a well-defined, hypointense lesion in glomus tumors?

    <p>Hypointense T1 signal</p> Signup and view all the answers

    What sign involves applying a tourniquet to a toe, causing transient pain relief followed by worsened pain upon release?

    <p>Hildreth’s sign</p> Signup and view all the answers

    What is the recommended treatment for Synovial Sarcoma?

    <p>Wide surgical excision</p> Signup and view all the answers

    What factor is associated with decreased disease specific survival in Synovial Sarcoma?

    <p>Presence of bone or neurovascular invasion</p> Signup and view all the answers

    Which sarcoma is often described as "Melanoma of the soft parts"?

    <p>Clear Cell Sarcoma</p> Signup and view all the answers

    What is a common clinical feature of Clear Cell Sarcoma?

    <p>Painless palpable mass in deep seated regions</p> Signup and view all the answers

    Which imaging modality may show a homogenous slight hyperintensity or isointense appearance in Clear Cell Sarcoma?

    <p>MRI</p> Signup and view all the answers

    What percentage of all soft tissue sarcomas are represented by Synovial Sarcoma?

    <p>50%</p> Signup and view all the answers

    What is the primary treatment modality for clear cell sarcoma?

    <p>Wide local excision</p> Signup and view all the answers

    What is a common feature of fibrosarcoma imaging on MRI?

    <p>Hyperintensity on T2</p> Signup and view all the answers

    Which tumor has a pathology described as a 'Herringbone pattern'?

    <p>Fibrosarcoma</p> Signup and view all the answers

    What is the overall 5-year survival rate for clear cell sarcoma?

    <p>60%</p> Signup and view all the answers

    Where is fibrosarcoma more commonly found?

    <p>Trunk and upper extremity</p> Signup and view all the answers

    What is the primary treatment modality for fibrosarcoma based on the text?

    <p>Surgical resection</p> Signup and view all the answers

    Which of the following is NOT a common prognostic factor for clear cell sarcoma according to the information provided?

    <p>Lymph node involvement</p> Signup and view all the answers

    Which imaging technique may show a distinct 'Herringbone pattern' in the pathology of fibrosarcoma?

    <p>MRI</p> Signup and view all the answers

    What imaging technique provides the best soft tissue contrast according to the information given?

    <p>Ultrasound</p> Signup and view all the answers

    What is the primary purpose of a biopsy in the context of soft tissue tumors?

    <p>To obtain tissue for histopathological analysis</p> Signup and view all the answers

    Which treatment option would NOT be considered for clear cell sarcoma according to the information provided?

    <p>Immunotherapy</p> Signup and view all the answers

    What is a common prognostic factor associated with decreased disease-specific survival in soft tissue tumors?

    <p>Size greater than 5cm</p> Signup and view all the answers

    Which imaging technique may show a homogenous slight hyperintensity or isointense appearance in Clear Cell Sarcoma?

    <p>Magnetic Resonance Imaging</p> Signup and view all the answers

    Where is fibrosarcoma more commonly found?

    <p>Deep in the subcutaneous tissue</p> Signup and view all the answers

    What is the primary purpose of a biopsy for soft tissue tumors?

    <p>To confirm the type of tumor for treatment planning</p> Signup and view all the answers

    What feature is more likely to be observed in a benign lesion during physical examination?

    <p>'Fleshy/soft' consistency</p> Signup and view all the answers

    What is a characteristic feature of fibrosarcoma that can be observed on MRI imaging?

    <p>Diffuse hypointensity on T2-weighted images</p> Signup and view all the answers

    What imaging technique provides the best soft tissue contrast according to the text?

    <p>Computed Tomography</p> Signup and view all the answers

    Which of the following prognostic factors is associated with decreased disease-specific survival in Synovial Sarcoma?

    <p>Large tumor size</p> Signup and view all the answers

    What is a common feature of Clear Cell Sarcoma's imaging findings on MRI?

    <p>Cystic appearance with fluid-fluid levels</p> Signup and view all the answers

    Which imaging technique is particularly useful in distinguishing gouty tophi from other soft tissue masses?

    <p>Dual Energy CT</p> Signup and view all the answers

    What is a recommended treatment option for Clear Cell Sarcoma?

    <p>Surgical resection</p> Signup and view all the answers

    Which imaging modality allows for the use of color-coded images and 3-D reconstruction to distinguish gouty tophi from bone?

    <p>Dual Energy CT</p> Signup and view all the answers

    What is a distinguishing characteristic of capillary hemangiomas?

    <p>Tightly packed small capillaries</p> Signup and view all the answers

    Which imaging finding is typically seen in cavernous hemangiomas?

    <p>Characteristics of 'bag of worms'</p> Signup and view all the answers

    What is a common treatment option employed before resection for cavernous hemangiomas?

    <p>Beta blocker medication</p> Signup and view all the answers

    Which soft tissue tumor is sometimes misapplied to acquired tumors of adulthood, like cherry hemangioma?

    <p>Capillary hemangioma</p> Signup and view all the answers

    What MRI appearance is characteristic of hemangiomas?

    <p>T1 intermediate, T2 hyperintense</p> Signup and view all the answers

    What distinguishes compound hemangiomas from other subtypes?

    <p>Mix of capillary and cavernous types</p> Signup and view all the answers

    What is the primary clinical examination technique used to detect a glomus tumor by applying pressure to the nail plate?

    <p>Love's test</p> Signup and view all the answers

    Which imaging technique is nondiagnostic for a glomus tumor itself but can help rule out other nail bed pathologies?

    <p>Plain film X-ray</p> Signup and view all the answers

    What is the recurrence rate like for glomus tumors that have involvement with the nail matrix?

    <p>Recurrence rate is elevated</p> Signup and view all the answers

    Which imaging modality for glomus tumors shows well-defined, hyperintense lesions on T2-weighted sequences with contrast enhancement?

    <p>MRI</p> Signup and view all the answers

    What is the recommended treatment approach for asymptomatic glomus tumors?

    <p>Observation</p> Signup and view all the answers

    Which clinical examination technique involves applying a tourniquet to the toe, causing temporary pain relief followed by worsened pain upon release?

    <p>Hildreth's sign</p> Signup and view all the answers

    What factor is associated with a worse prognosis in soft tissue sarcomas?

    <p>Tumor size greater than 5cm</p> Signup and view all the answers

    Which of the following soft tissue sarcomas is derived from connective tissue that supports and connects body structures?

    <p>Fibrosarcoma</p> Signup and view all the answers

    What is the peak incidence age range for Synovial Sarcoma?

    <p>Between 15 and 35 years</p> Signup and view all the answers

    What is the primary origin thought to be for Synovial Sarcoma?

    <p>Mesenchymal cells</p> Signup and view all the answers

    Which imaging modality shows intense enhancement with contrast in distinguishing Synovial Sarcoma from cystic lesions?

    <p>Computed Tomography (CT)</p> Signup and view all the answers

    What are the clinical features commonly associated with Synovial Sarcoma?

    <p>Slow growing, often painful mass, located on extremities in par-articular regions</p> Signup and view all the answers

    What is a potential complication associated with surgical resection of plantar fibromatosis?

    <p>Hypertrophic plantar scar</p> Signup and view all the answers

    What is a common characteristic feature of PVNS lesions detected using MRI?

    <p>Intense enhancement with contrast</p> Signup and view all the answers

    Which soft tissue tumor may present with paresthesia, numbness, and exhibit a positive Valleix sign?

    <p>Neurilemmoma (Schwannoma)</p> Signup and view all the answers

    What is the treatment approach for diffuse Pigmented Villonodular Synovitis (PVNS) that can lead to high recurrence rates?

    <p>Open synovectomy</p> Signup and view all the answers

    What characteristic imaging feature may be seen in Giant Cell Tumor of the Tendon Sheath (GCTTS) on MRI?

    <p>Peripherally high T2 signal</p> Signup and view all the answers

    What histological feature is shared by both Giant Cell Tumor of the Tendon Sheath (GCTTS) and Pigmented Villonodular Synovitis (PVNS)?

    <p>'Villous, nodular or both types of proliferations of the synovium stained with hemosiderin'</p> Signup and view all the answers

    In the context of Schwannoma, what does the treatment approach of 'marginal excision' involve?

    <p>Resection through the pseudo-capsule of the tumor</p> Signup and view all the answers

    What is a common clinical manifestation indicating the course of Giant Cell Tumor of the Tendon Sheath (GCTTS)?

    <p>'Catching', 'Locking', stiffness, or instability</p> Signup and view all the answers

    'Positive Valleix sign' may be observed in which soft tissue tumor?

    <p>'Neurilemmoma (Schwannoma)'</p> Signup and view all the answers

    What is a distinguishing feature of ganglion cysts on ultrasound?

    <p>Well defined</p> Signup and view all the answers

    What is a common characteristic of lipomas on MRI?

    <p>High signal intensity on T2 weighted images</p> Signup and view all the answers

    Which soft tissue tumor is more likely to involve the plantar fascia?

    <p>Fibroma</p> Signup and view all the answers

    What is a common feature of mucoid cysts in adults?

    <p>Translucent to flesh-colored appearance</p> Signup and view all the answers

    Which soft tissue tumor is more common in individuals aged 40-60 years?

    <p>Lipoma</p> Signup and view all the answers

    What differentiates deep fibromatosis from superficial fibromas?

    <p>Spread along fascia, nerve, or tendon sheath</p> Signup and view all the answers

    What is a common presentation of Plantar Fibromatosis on ultrasound?

    <p>&quot;Thickening&quot; of plantar fascia</p> Signup and view all the answers

    Which imaging finding may be observed in ganglion cysts but not lipomas?

    <p>&quot;Fluid filled appearance&quot;</p> Signup and view all the answers

    What symptom is commonly associated with fibromas according to clinical features?

    <p>+/- Pain presence with dorsiflexion of great toe</p> Signup and view all the answers

    "What MRI signal intensity pattern is usually observed in Lipomas?"

    <p>&quot;Low signal intensity on T1 weighted MRI&quot;</p> Signup and view all the answers

    What is the key to successful management of any soft tissue tumor?

    <p>Detailed patient history</p> Signup and view all the answers

    Which factor is crucial in determining the treatment approach for soft tissue masses?

    <p>Soft-tissue cell type</p> Signup and view all the answers

    What is a common clinical question to ask a patient about a soft tissue lesion?

    <p>Recent uptick in growth</p> Signup and view all the answers

    Why is a proper diagnosis essential before initiating treatment for soft tissue masses?

    <p>To avoid unnecessary surgeries</p> Signup and view all the answers

    What plays a crucial role in determining the type of treatment needed for different soft tissue masses?

    <p>Histological diagnosis</p> Signup and view all the answers

    Why must the treatment of soft tissue masses vary based on their diagnosis?

    <p>To optimize patient outcomes</p> Signup and view all the answers

    What is the purpose of transillumination during physical examination of a mass?

    <p>To determine if the mass is fluid (or air) filled</p> Signup and view all the answers

    When considering the clinical features review, which characteristic is NOT typically associated with benign lesions?

    <p>Fixed</p> Signup and view all the answers

    Which diagnostic imaging modality can help differentiate some tumors from infections, even though it does not provide as much soft tissue contrast as MRI?

    <p>Computed Tomography</p> Signup and view all the answers

    What is a common presentation of malignant lesions based on the physical exam findings?

    <p>&gt;5cm diameter</p> Signup and view all the answers

    In the context of diagnostic imaging, which technique is often used for monitoring abdominal and chest tumors?

    <p>Plain film radiography</p> Signup and view all the answers

    What is a distinguishing feature between deep and superficial masses during transillumination?

    <p>(+) Fluid-filled</p> Signup and view all the answers

    What is a characteristic feature of dual-energy CT imaging technology mentioned in the text?

    <p>Distinguishes gouty tophi from other soft tissue masses using color-coded images</p> Signup and view all the answers

    Which imaging technique allows for a more detailed image by using a smaller field of view based on prior examinations?

    <p>Magnetic Resonance Imaging (MRI)</p> Signup and view all the answers

    What is a distinguishing characteristic of Ledderhose disease and plantar fibromatosis when viewed in the transverse plane?

    <p>The tumor in Ledderhose disease appears nearly identical to plantar fibromatosis</p> Signup and view all the answers

    In MRI and CT imaging, what anatomical feature may not be evident in some cases?

    <p>Anatomical landmarks</p> Signup and view all the answers

    Which imaging modality may show a homogenous slight hyperintensity or isointense appearance in Clear Cell Sarcoma?

    <p>Magnetic Resonance Imaging (MRI)</p> Signup and view all the answers

    'Ledderhose disease' is nearly identical to which other condition when viewed in imaging scans?

    <p>'Plantar fibromatosis'</p> Signup and view all the answers

    Which soft tissue tumor is characterized by villous, nodular, or both types of proliferations of the synovium stained with hemosiderin?

    <p>Pigmented Villonodular Synovitis</p> Signup and view all the answers

    What is the primary soft tissue affected by Neurilemmoma (Schwannoma)?

    <p>Peripheral nerve sheath</p> Signup and view all the answers

    What is a common clinical feature of Giant Cell Tumor of the Tendon Sheath?

    <p>Pressure erosions in bone</p> Signup and view all the answers

    What is the 'gold standard' for diagnosis of soft tissue tumors?

    <p>Excisional Biopsy</p> Signup and view all the answers

    Which biopsy type involves the removal of the entire lesion and is recommended for symptomatic presumed benign lesions?

    <p>Excisional Biopsy</p> Signup and view all the answers

    What modification of fine needle biopsy involves removing a 'core' of tissue to improve accuracy?

    <p>Fine Needle Aspiration</p> Signup and view all the answers

    Which biopsy should be carried out at the planned treatment center to avoid misdiagnoses and delays?

    <p>Biopsies performed off-site</p> Signup and view all the answers

    What is the purpose of using intra-operative frozen sections during a biopsy?

    <p>To diagnose tumors and distinguish benign from malignant features in minutes</p> Signup and view all the answers

    Which needle biopsy type is less accurate compared to other methods and may require a second biopsy for diagnosis?

    <p>Fine Needle Aspiration</p> Signup and view all the answers

    Which biopsy involves the removal of a 'core' of tissue and has a sensitivity of 81%-100% and specificity of 91%-100%?

    <p>Core Needle Biopsy</p> Signup and view all the answers

    Which biopsy type is recommended for lesions suspected to be malignant and should be performed at the planned treatment center?

    <p>'Gold Standard' Incisional Biopsy</p> Signup and view all the answers

    'Longitudinal incision, incision parallel to the long axis of the limb, shortest route to lesion, and avoidance of neurovascular anatomy' are rules associated with which type of biopsy?

    <p>'Aspiration' Open Biopsy</p> Signup and view all the answers

    'This biopsy type expedites care by removing the lesion entirely and should not violate multiple anatomical compartments or neurovascular bundles.' Which biopsy type does this statement describe?

    <p>'Symptomatic Benign' Excisional Biopsy</p> Signup and view all the answers

    Which age group is more commonly affected by Synovial Sarcoma?

    <p>Young adults in their 20s and 30s</p> Signup and view all the answers

    In which age range is Clear Cell Sarcoma most frequently seen?

    <p>Middle-aged individuals between 40-50</p> Signup and view all the answers

    What is the typical age range for the onset of Clear Cell Sarcoma?

    <p>40-50 years</p> Signup and view all the answers

    At what age are women slightly more affected by Clear Cell Sarcoma compared to men?

    <p>Middle age (40s)</p> Signup and view all the answers

    What age group experiences the most common painful presentation in Clear Cell Sarcoma cases?

    <p>Middle-aged adults in their 40s</p> Signup and view all the answers

    Which of the following age groups is NOT typically associated with the presentation of synovial sarcoma?

    <p>Elderly individuals above 70</p> Signup and view all the answers

    What makes dual-energy CT imaging particularly useful in detecting gouty tophi in soft tissue masses?

    <p>It utilizes CT scans taken at different kilovoltages</p> Signup and view all the answers

    Which imaging modality is especially beneficial in providing detailed images with a smaller field of view, based on prior examinations?

    <p>Magnetic Resonance Imaging (MRI)</p> Signup and view all the answers

    In MRI and CT imaging, what anatomical feature may not be evident in some cases on the transverse plane view?

    <p>Anatomical landmarks</p> Signup and view all the answers

    Which soft tissue tumor is commonly confused with Plantar Fibromatosis due to being nearly identical?

    <p>Fibrosarcoma</p> Signup and view all the answers

    Why does MRI offer superior soft tissue contrast, especially with injectable contrast media?

    <p>It has color-coded images and 3-D reconstruction capabilities</p> Signup and view all the answers

    What distinguishes the T1 phase of MRI from other phases in terms of image detail?

    <p>Better visualization of bony structures</p> Signup and view all the answers

    What age group is most commonly affected by soft tissue tumors according to the text?

    <p>Adults between 30-50 years old</p> Signup and view all the answers

    Which age range is associated with a higher risk of metastases to the foot and ankle in patients with a history of malignancy?

    <p>Elderly individuals over 65 years old</p> Signup and view all the answers

    At what age range do patients commonly present with a history of malignancy that puts them at risk for metastases to the foot and ankle?

    <p>Elderly individuals over 65 years old</p> Signup and view all the answers

    Which age group is more likely to have soft tissue masses that are benign if they are under 3cm in size?

    <p>Children under 10 years old</p> Signup and view all the answers

    What is the age group that has a higher likelihood of malignant soft tissue lesions if the lesions exceed 5cm?

    <p>Elderly individuals over 65 years old</p> Signup and view all the answers

    Which age group is more likely to have diffuse soft tissue masses that are difficult to distinguish based on size?

    <p>Elderly individuals over 65 years old</p> Signup and view all the answers

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