Examination for the Assessment of a Surgical Patient

Question 1

Assessing a lump

Answer 1

THINK: which layer is the lump in, what structures or organs could be associated

LOOK: size, shape, symmetry, colour and overlying skin changes (e.g. dimpling, retraction, swelling), characteristic features (e.g. punctum)

FEEL: tender vs not, soft vs hard, mobile vs fixed, fluctuant, associated crepitus

Question 2

How can the different causes of abdominal distension be distinguished clinically?

Answer 2

Flatus: tympanic percussion note

Fluid: dull percussion note, shifts

Fat: won’t do what the other things do!

Faeces: indentable

Foetus: arises from pelvis, female, palpable

Frightfully big tumour: variable features

Question 3

What further examination step should be performed if an abdominal mass is detected?

Answer 3

Ask patient to tense abdominal muscles to see if mass is superficial or deep

Question 5

List 6 possible causes of a superficial abdominal mass

Answer 5

Lipoma

Hernia

Cyst

LN

Seroma

Abscess

Question 6

List 5 possible deep causes of abdominal mass

Answer 6

Organomegaly

Collection or abscess

Aneurysm

Tumour

Urinary retention

Question 7

What steps should be added on to the examination if the patient is a vasculopath?

Answer 7

Radio-radial and radio-femoral delay

BP in both arms

Palpation of all peripheral pulses (note thrills) and auscultation for bruits (beware presence of AVF)

Consider ABI, Buerger’s test

If varicose veins or ulceration, consider Trendelenberg test

Question 8

List 8 important clinical features of a lump

Answer 8

Does it disappear when the patient lies down

Pulsatile

Trans-illumination

Can you get above it or reduce it

Colour changes

Tenderness

Soft vs hard

Fixed vs mobile