Lumps and bumps examination

Question 1

What are the general 6 Ss to describe a lump?

Answer 1

Site

Size

Shape

Surface

Substance

Surrounding structures

Question 2

What mnemonic is used to describe lumps?

Answer 2

3 Students and 3 Teachers went to the CAMPFIRE

Question 3

In the mnemonic, what are the 3 Students, and explain them?

Answer 3

Site: Where lump is located relative to anatomical structures

Size: Use tape measure to measure length and width of lump

Shape: Geometric shapes such as round, oval, regular or irregular

Question 4

How do you measure the size of the lump?

Answer 4

Use tape measure to measure length and width

Give size in at least 2 dimensions

Question 5

What are the 3 Teachers of the mnemonic?

Answer 5

Tenderness

Temperature

Transillumination

Question 6

How do you test tenderness of a lump?

Answer 6

Palpate the lump and ask the patient if it feels painful

Question 7

How do you test temperature of a lump?

Answer 7

Palpate with back of hand and compare with surrounding skin

Question 8

How do you test transillumination of a lump?

Answer 8

Use pen torch to press light source to surface of lump, if the lump is transilluminant it will allow light to pass through (glows)

Question 9

What does CAMPFIRE in the mnemonic mean?

Answer 9

Consistency

Attachment

Mobility

Pulsatile (transmitted or expansile)

Fluctuation (and fluid thrill)

Irreducibility (and reducibility and compressibility)

Regional lymph nodes

Edges

Question 10

How do you describe consistency of a lump with 4 options?

Answer 10

Feel the substance within lump to see if it is:
hard
soft
fluid-filled
firm (spongy or rubbery)

Question 11

How do you describe the attachment of a lump?

Answer 11

Look at surrounding structures of the lump and see if it can move freely away from them or is fixed

eg. a bony prominence is fixed

Question 12

How do you test mobility of a lump?

Answer 12

Push around with fingers to see if it can move freely or is fixed in place (immobile)

Question 13

How do you test if a lump is pulsatile, and what are the 2 identifiable types of pulsation?

Answer 13

Rest a finger of each hand on opposite side of the lump for few seconds, then watch your
fingers:

Transmitted: Fingers will be pushed in the same direction

Expansile: both fingers will be pushed apart.

Question 14

How do you describe the shape of a lump in 2 steps?

Answer 14

1. Geometric shape: round, oval, regular, irregular
2. Flat or raised lump

Question 15

How should you describe the colour of the lump?

Answer 15

If it is different from surrounding skin

Question 16

How do you test fluctuation of a small or large lump?

Answer 16

1. Put your fingers on either side of the lump, opposite each other.
2. Press with one finger and feel whether the lump bounces against your other finger: Fluctuation

Question 17

What sign can you identify in a large, fluctuating lump that is fluid-filled instead of fat-filled?

Answer 17

Fluid thrill:

1. Tapping a large fluid-filled swelling causes a pressure wave which can be felt on the other side of the lump

Question 18

How do you test irreducibility, reducibility and compressibility of a lump?

Answer 18

Compressible: Lump disappears as pressure increases, but reappears spontaneously when pressure deceases

Reducible: Lump disappears with pressure increase, doesn’t spontaneously reappear when pressure decreases, will only reappear with other force eg. cough

Irreducible: Lump doesn’t disappear as pressure increases

Question 19

When testing mobility of a lump, what is important to test regarding the surrounding structures such as skin, muscle?

Answer 19

If the lump seems to be tethered to underlying structure

Question 20

Why is it important to assess regional lymph nodes when examining a lump?

Answer 20

Provides information about the possible presence of a malignant or inflammatory process

Question 21

Where are the regional lymph nodes of lumps in the upper limb?

Answer 21

Axillary lymph nodes

Question 22

Where are the regional lymph nodes of lumps in the lower limb?

Answer 22

Inguinal lymph nodes

Question 23

Where are the regional lymph nodes of lumps in the abdomen?

Answer 23

Cervical lymph nodes

Question 24

How can assessing consistency and tenderness of the regional lymph node indicate if the lump has formed due to an infection or malignancy?

Answer 24

Consistency: Soft LNs are insignificant, hards LNs suggest malignancy or granulomatous infection

Tenderness: Tender indicates infection, non-tender indicates malignancy

Question 25

How do you describe the edges of a lump?

Answer 25

Are the margins/borders of the lump well-defined or irregular (not well-defined)

Question 26

Compare benign and malignant lumps, relative to surrounding tissues?

Answer 26

Benign: Don’t invade surrounding tissues

Malignant: Do invade surrounding tissues

Question 27

Compare benign and malignant lumps, in terms of their shape and edges?

Answer 27

Benign: Regular shape with well-defined margins

Malignant: Irregular shape with not well-defined borders

Question 28

Compare mobility of benign and malignant bumps?

Answer 28

Benign: Mobile

Malignant: Immobile

Question 29

What can you ask the patient about the growth of the lump, to distinguish if it is benign or malignant?

Answer 29

Speed of lump growth:

Benign grow slowly

Malignant grow quickly

Question 30

What 3 scans can be used to further investigate the underlying cause of the lump?

Answer 30

Soft-tissue ultrasound

MRI

CT

Question 31

If you suspect that the lump is due to infection or inflammation, what blood test can you do?

Answer 31

FBC

Question 32

What type of aspiration can you do to investigate the lump further to determine malignant or benign origin?

Answer 32

Fine needle aspiration (FNA), also called fine needle biopsy, is a type of biopsy where a needle is inserted into a lump or mass to collect a sample of cells