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Lump Examination for Medical Student OSCE

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Introduce, identify, explain, consent, WASH HANDS!

1. Inspection

   1. Site – ventral / dorsal etc. Distance to nearest bony prominence.

   2. Size – w x l

   3. Shape – spherical / irregular; ovoid / circular / kidney

   4. Colour – red / white / skin / black

2. Palpation

   1. Feel

      1. Temperature

      2. Tender / non - tender

      3. Surface – smooth / rough / irregular

      4. Consistency – soft / spongy / rubbery / firm / stony hard

      5. Edges – clear / poorly defined

   2. Press

      1. Depressible / reducible (reappears only in response to gravity / coughing) / non-depressible

      2. Pulsatility – expansile (fingers pushed apart) or transmitted (fingers pushed upwards together)

      3. Fluid thrill – hold lump between index and thumb. Press centre of lump with other index finger; feel for transmitted vibrations

   3. Move

      1. Skin over lump – unattached / tethered or fixed to underlying structures (sebaceous cysts – within skin)

      2. Move lump itself – in 2 planes – carotid body tumour moves in 1 plane; with underlying muscles clenched – if lump attached to muscle = sarcoma

3. Percuss – dullness or resonance

4. Auscultate – bowel sounds: bowel involvement. Bruits: AV fistulae

5. Transilluminates – pen torch, observe through opaque tube on other side – ganglia, hydroceles

6. Surroundings

   1. Dermatomes – sensory loss

   2. Myotomes – power of surrounding muscles affected by lump

   3. Lymph nodes – neck, axillary (arm or thoracic wall), epitrochlear (forearm or hand), inguinal (lower abdomen and inguinoscrotal)

7. Differential diagnosis

   1. Sebaceous cyst

Blockage of sebaceous gland ? black spot ‘punctum’, exuding foul smelling, cheesy pus on infection. Commonly smooth, round, intradermal. Fluctuant, but cannot be transilluminated

1.  

   1. Lipoma

Overactive fat cells: commonest swelling of subcutaneous tissue. Small, soft, semi-fluctuant, spherical, with smooth surface and imprecise markings. Not attached to skin

1.  

   1. Fibroma

Tumour of fibrous tissue, anywhere in body, commonly under skin. Painless, whitish, firm, spherical. Independent of underlying structures

1.  

   1. Cutaneous abscess

Collections of pus. Commonly caused by Staphylococcus sp. Red, hot, tender, often with throbbing pain.

1.  
   1.  

      1. Boils – furuncles – infected hair follicle + gland.

      2. Carbuncles – larger boils. Subcutaneous tissue necrosis due to infection, discharging through sinuses (openings in the skin)

About the Author

by: Admin
Total views: 0
Word Count: 671
Date: Fri, 22 Jan 2010 Time: 4:07 PM
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