Examination Of Lumps, Bumps And Ulcers

Question 1

What is a lump

Answer 1

A localized swelling

Question 2

How do you examine a lump

Answer 2

You check the anatomical plane
You check the physical characteristic of the lump
Diagnosis

Question 3

What are some examples of the physical characteristics of a lump

Answer 3

Its tenderness
Size
Shape
Consistency

Question 4

What are some physical signs for lumps

Answer 4

Signs of emptying
Sign of indentation
Expansile impulse
Tumour from muscle

Question 5

Examples of lumps where you see a sign of emptying

Answer 5

Cavernous hemangioma
Lymphangioma
Meningocele

Question 6

What is a cyst

Answer 6

A swelling consisting of a collection of fluid in a sac lined by the epithelium and endothelium

Question 7

What is a true cyst

Answer 7

A cyst lined by epithelium or endothelium lining composed of granulation tissue if infected

Question 8

What are the contents of a true cyst

Answer 8

Serous
Mucoid
Brown-staining (altered blood) or colourless

Question 9

What are false cysts

Answer 9

They are usually exudation and degeneration cysts

Question 10

Examples of false cysts

Answer 10

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)

Question 11

Types of congenital cysts

Answer 11

Sequestration dermoid
Tubulo-embryonic dermoid

Question 12

Sites where sequestration dermoids are found

Answer 12

Midline of the body especially the neck
Above the outer canthus (external angular dermoid)
Anterior triangle of the neck (branchial cyst)

Question 13

Sequestration dermoids are due to

Answer 13

Dermal cells buried along lines of closure of embryonic clefts and sinuses by skin fusion

Question 14

Tubulo-embryonic cysts are also called

Answer 14

Tubulo-dermoid cysts

Question 15

Where are tubulo-embryonic cysts found

Answer 15

They are found in the track of an ectodermal tube used in development

Question 16

Examples of tubulo-embryonic cysts

Answer 16

Thyroglossal cyst - from thyroglossal duct
Post-anal dermoid - from post anal gut
Ependymal cysts - from sequestration of cells of infolding neuroectodern

Question 17

Acquired cysts

Answer 17

Retention cyst
Distention cyst
Exudation cyst
Cystic tumors
Implantation dermoids
Trauma
Degenerative cysts
Parasitic

Question 18

How are retention cysts caused

Answer 18

They are caused due to the accumulated secretions of glands following the obstruction of a duct

Question 19

Examples of glands that could develop retention cysts

Answer 19

Pancreas
Parotid
Breast
Epididymis
Bartholin’s gland

Question 20

Example of a retention cyst

Answer 20

Sebaceous cyst

Question 21

How do sebaceous cysts come about

Answer 21

Obstruction of the sebaceous gland followed by the downgrowth and accumulation of desquamated epidermal cells making it an epidermoid cyst also

Question 22

Examples of distention cysts

Answer 22

Lymphatic cysts
Cystic hygroma

Question 23

Organs in which distention cysts may develop

Answer 23

Occurs in the thyroid from the dilatation of acini
Ovary from a follicle

Question 24

When do exudation cysts occur

Answer 24

Occurs when fluid exudes into the anatomical space lined by endothelium

Question 25

Examples of exudation cysts

Answer 25

Hydrocele
Bursa
When a collection of exudates becomes encysted (false cyst)

Question 26

Examples of cystic tumors

Answer 26

Cystic teratomas (dermoid cyst of ovary)
Cystadenomas

Question 27

How do implantation dermoids occur

Answer 27

It occurs from squamous epithelium driven beneath the skin by a penetrating wound. Eg. Fingers in women who sew

Question 28

A case in which a trauma resolve into a cyst

Answer 28

Hematoma may resolve into a cyst

Question 29

What are parasitic cysts

Answer 29

Encysted forms in the life cycle of various worms

Question 30

An example of a parasitic cyst

Answer 30

Hydatid cyst of Taenia echinococcus

Question 31

What is an ulcer

Answer 31

A discontinuity of an epithelial surface

Question 32

What are the classification of ulcers

Answer 32

Specific
Non-specific
Malignant

Question 33

What are specific ulcers

Answer 33

Ulcers caused by a known organism. Eg. Buruli ulcer

Question 34

What is a non-specific ulcer

Answer 34

An ulcer caused by infection of a wound, physical or chemical agents, varicose vein disease, sickle-cell, etc

Question 35

Examples of malignant ulcers

Answer 35

Basal cell carcinoma
Squamous cell carcinoma
Malignant melanoma
Kaposi sarcoma

Question 36

Life history of an ulcer

Answer 36

Acute/proliferative/extension phase
Transition phase
Healing/repair phase
Chronic phase

Question 37

Clinical examination of ulcers

Answer 37

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

Question 38

A lump can change in which areas

Answer 38

Size
Appearance
Pain
Itching

Question 39

What are some questions to ask patient about his lump

Answer 39

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