Lump examination

Question 1

Introduction

Answer 1

W - gel before and after
I - hello, my name is An, I’m a 4th year medical student
P - can I confirm your name and DOB
E - I’d like to examine your lump. I will look feel move and ask you to perform some simple tasks for me. This is so we can work out what’s causing your lump
R - We will need to expose your lump

Q - do you have any questions
Q - do you have any pain?

Question 2

Possible underlying causes of lump

Answer 2

Lymph nodes

Tissues
-skin
-fat
-muscle
-bone
-nerve
-blood vessels

Organs
-thyroid
-breast
-parotid glands
-scrotum
-abdo organs

Question 3

Key questions

Answer 3

Timeline of lump development
Changes in size
Reduced movement of lump
Injuries or trauma
Tenderness, tingling, numbness, weakness
Systemic symptoms

Question 4

General inspection

Answer 4

Well or unwell?

Is lump affecting general function?

Question 5

Look

Answer 5

Anatomical location

Outline, contour

Overlying skin changes, abnormal vessels, pulsation

Signs of previous surgery

Observe lump changes in relation to joint movement

Observe any functional impairment

Question 6

Feel

Answer 6

Shape - ovoid, spherical, irregular

Surface, edges - smooth, regular, craggy, well demarcated

Size - measure for accuracy

Consistency - soft, hard, rubbery, nodular, uniform, varies

Tender

Pulsatile, expansile - vascular lesion?

Fluctuant - both axes

Compressible/reducible - hernias

Cough impulse

If possible, examine surrounding tissue and opposite side for comparison

Question 7

Move

Answer 7

Try to figure out the plane of origin and attachment

Skin
-attached to overlying skin?
-skin moves freely over it? - subcut

Muscles and tendons
-if attached to muscle or tendon, contraction limits mobility of lump

Nerves and vasculature
-immobile in longitudinal plane, mobile in transverse axis

Bone
-lump does not move

Question 8

Special tests

Answer 8

Auscultation
-bruit - vascular lump?
-bowel sounds - hernial lump?

Transillumination
-fluid filled, lights up with torch shone through

Cough impulse
-expansion on coughing - hernia

Swallow test for neck lumps
-thryoglossal cysts rise on swallow and tongue out

Percussion
-goitres will extend retrosternally - dull

Question 9

Regional lymph node examination

Answer 9

Number
Shape
Size
Consistency
Tenderness
Temperature
Mobility, attachment

Question 10

Further examinations

Answer 10

Systemic examinations as needed