Examination Of Lumps, Bumps And Ulcers Flashcards
What is a lump
A localized swelling
How do you examine a lump
You check the anatomical plane
You check the physical characteristic of the lump
Diagnosis
What are some examples of the physical characteristics of a lump
Its tenderness
Size
Shape
Consistency
What are some physical signs for lumps
Signs of emptying
Sign of indentation
Expansile impulse
Tumour from muscle
Examples of lumps where you see a sign of emptying
Cavernous hemangioma
Lymphangioma
Meningocele
What is a cyst
A swelling consisting of a collection of fluid in a sac lined by the epithelium and endothelium
What is a true cyst
A cyst lined by epithelium or endothelium lining composed of granulation tissue if infected
What are the contents of a true cyst
Serous
Mucoid
Brown-staining (altered blood) or colourless
What are false cysts
They are usually exudation and degeneration cysts
Examples of false cysts
Pseudocyst of pancreas (collection of fluid in lesser sac)
TB peritonitis (fluid walled off in cystic form by adherent coils of intestine)
Fluid collection in the center of a tumour (cystic degeneration) or due to hemorrhage or colliquative necrosis (eg. apoplectic cyst in the brain)
Types of congenital cysts
Sequestration dermoid
Tubulo-embryonic dermoid
Sites where sequestration dermoids are found
Midline of the body especially the neck
Above the outer canthus (external angular dermoid)
Anterior triangle of the neck (branchial cyst)
Sequestration dermoids are due to
Dermal cells buried along lines of closure of embryonic clefts and sinuses by skin fusion
Tubulo-embryonic cysts are also called
Tubulo-dermoid cysts
Where are tubulo-embryonic cysts found
They are found in the track of an ectodermal tube used in development
Examples of tubulo-embryonic cysts
Thyroglossal cyst - from thyroglossal duct
Post-anal dermoid - from post anal gut
Ependymal cysts - from sequestration of cells of infolding neuroectodern
Acquired cysts
Retention cyst
Distention cyst
Exudation cyst
Cystic tumors
Implantation dermoids
Trauma
Degenerative cysts
Parasitic
How are retention cysts caused
They are caused due to the accumulated secretions of glands following the obstruction of a duct
Examples of glands that could develop retention cysts
Pancreas
Parotid
Breast
Epididymis
Bartholin’s gland
Example of a retention cyst
Sebaceous cyst
How do sebaceous cysts come about
Obstruction of the sebaceous gland followed by the downgrowth and accumulation of desquamated epidermal cells making it an epidermoid cyst also
Examples of distention cysts
Lymphatic cysts
Cystic hygroma
Organs in which distention cysts may develop
Occurs in the thyroid from the dilatation of acini
Ovary from a follicle
When do exudation cysts occur
Occurs when fluid exudes into the anatomical space lined by endothelium
Examples of exudation cysts
Hydrocele
Bursa
When a collection of exudates becomes encysted (false cyst)
Examples of cystic tumors
Cystic teratomas (dermoid cyst of ovary)
Cystadenomas
How do implantation dermoids occur
It occurs from squamous epithelium driven beneath the skin by a penetrating wound. Eg. Fingers in women who sew
A case in which a trauma resolve into a cyst
Hematoma may resolve into a cyst
What are parasitic cysts
Encysted forms in the life cycle of various worms
An example of a parasitic cyst
Hydatid cyst of Taenia echinococcus
What is an ulcer
A discontinuity of an epithelial surface
What are the classification of ulcers
Specific
Non-specific
Malignant
What are specific ulcers
Ulcers caused by a known organism. Eg. Buruli ulcer
What is a non-specific ulcer
An ulcer caused by infection of a wound, physical or chemical agents, varicose vein disease, sickle-cell, etc
Examples of malignant ulcers
Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma
Kaposi sarcoma
Life history of an ulcer
Acute/proliferative/extension phase
Transition phase
Healing/repair phase
Chronic phase
Clinical examination of ulcers
To be conducted in a systematic way
Site
Shape - round, oval, irregular
Size - long and short diameter (in cms)
Edge - sloping, undermined, punched out
Floor - what is seen by observer
Base - what can be palpated. May be indurated or attached to a deeper structure
Discharge - purulent in active infection, blue greenish colouration suggests infection with Pseudomonas pyocyaneus, blood stained in acute phase of ulcer
Surrounding tissues - signs of inflammation, varicosity, pigmentation, etc
Lymph nodes
General examination - to exclude systemic disease
A lump can change in which areas
Size
Appearance
Pain
Itching
What are some questions to ask patient about his lump
Ask the patient if there was a lump at the same side some time ago
Ask patient his work and any previous medical conditions
Ask patient if he’s noticed anyone with around him with similar swelling
Ask patient what he thinks about the swelling, what he thinks caused it
