Examination swelling

Question 1

Overview of examination

Answer 1

Look
Feel
Move
Special tests
Regional lymph nodes

Question 2

Look (inspection)

Answer 2

Is contour visible on inspection

Location of lump

Colour of overlying skin (erythema, pigmented)

abnormalities of skin (peau d’orange)

Abnormal vessels, telangiectasia

Question 3

Feel / Palpation of a lump

Answer 3

Smooth, rough or irregular

Shape & Size

Consistency (soft, firm, hard, rubbery, lobulated)

Tenderness

Temperature (feel with back of hand)

Cough impulse? (hernia)

Compressible

Fluctuant

Pulsatile (high blood flow) or expansile

Question 4

Move

Answer 4

Skin tethering (attempt to pick up for of skin overlying)

Deep tethering (attempt to move swelling in different planes)

tethering to muscle (palpate whilst asking patient to move relevant muscle)

Question 5

Specific tests

Answer 5

Transillumination (if you suspect fluid filled e.g. hydrocoele)

Auscultation for bruits or bowel sounds