Lumps and bumps examination Flashcards
What are the general 6 Ss to describe a lump?
Site
Size
Shape
Surface
Substance
Surrounding structures
What mnemonic is used to describe lumps?
3 Students and 3 Teachers went to the CAMPFIRE
In the mnemonic, what are the 3 Students, and explain them?
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
How do you measure the size of the lump?
Use tape measure to measure length and width
Give size in at least 2 dimensions
What are the 3 Teachers of the mnemonic?
Tenderness
Temperature
Transillumination
How do you test tenderness of a lump?
Palpate the lump and ask the patient if it feels painful
How do you test temperature of a lump?
Palpate with back of hand and compare with surrounding skin
How do you test transillumination of a lump?
Use pen torch to press light source to surface of lump, if the lump is transilluminant it will allow light to pass through (glows)
What does CAMPFIRE in the mnemonic mean?
Consistency
Attachment
Mobility
Pulsatile (transmitted or expansile)
Fluctuation (and fluid thrill)
Irreducibility (and reducibility and compressibility)
Regional lymph nodes
Edges
How do you describe consistency of a lump with 4 options?
Feel the substance within lump to see if it is:
hard
soft
fluid-filled
firm (spongy or rubbery)
How do you describe the attachment of a lump?
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
How do you test mobility of a lump?
Push around with fingers to see if it can move freely or is fixed in place (immobile)
How do you test if a lump is pulsatile, and what are the 2 identifiable types of pulsation?
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.
How do you describe the shape of a lump in 2 steps?
- Geometric shape: round, oval, regular, irregular
- Flat or raised lump
How should you describe the colour of the lump?
If it is different from surrounding skin
How do you test fluctuation of a small or large lump?
- Put your fingers on either side of the lump, opposite each other.
- Press with one finger and feel whether the lump bounces against your other finger: Fluctuation
What sign can you identify in a large, fluctuating lump that is fluid-filled instead of fat-filled?
Fluid thrill:
- Tapping a large fluid-filled swelling causes a pressure wave which can be felt on the other side of the lump
How do you test irreducibility, reducibility and compressibility of a lump?
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
When testing mobility of a lump, what is important to test regarding the surrounding structures such as skin, muscle?
If the lump seems to be tethered to underlying structure
Why is it important to assess regional lymph nodes when examining a lump?
Provides information about the possible presence of a malignant or inflammatory process
Where are the regional lymph nodes of lumps in the upper limb?
Axillary lymph nodes
Where are the regional lymph nodes of lumps in the lower limb?
Inguinal lymph nodes
Where are the regional lymph nodes of lumps in the abdomen?
Cervical lymph nodes
How can assessing consistency and tenderness of the regional lymph node indicate if the lump has formed due to an infection or malignancy?
Consistency: Soft LNs are insignificant, hards LNs suggest malignancy or granulomatous infection
Tenderness: Tender indicates infection, non-tender indicates malignancy
How do you describe the edges of a lump?
Are the margins/borders of the lump well-defined or irregular (not well-defined)
Compare benign and malignant lumps, relative to surrounding tissues?
Benign: Don’t invade surrounding tissues
Malignant: Do invade surrounding tissues
Compare benign and malignant lumps, in terms of their shape and edges?
Benign: Regular shape with well-defined margins
Malignant: Irregular shape with not well-defined borders
Compare mobility of benign and malignant bumps?
Benign: Mobile
Malignant: Immobile
What can you ask the patient about the growth of the lump, to distinguish if it is benign or malignant?
Speed of lump growth:
Benign grow slowly
Malignant grow quickly
What 3 scans can be used to further investigate the underlying cause of the lump?
Soft-tissue ultrasound
MRI
CT
If you suspect that the lump is due to infection or inflammation, what blood test can you do?
FBC
What type of aspiration can you do to investigate the lump further to determine malignant or benign origin?
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
