Palpable masses

Question 1

Methods for lump examination

Answer 1

Site, Size, Shape

Position

Attachments

Consistency, Colour

Edge

Thrills, Fluctuance

Inflammation and Tenderness

Transillumination

Question 2

Annular lump

Answer 2

Ring shaped

Question 3

Arcuate lump

Answer 3

Curved

Question 4

Nodule

Answer 4

Palpable mass >1cm

Question 5

Papule

Answer 5

Palpable mass <1cm

Question 6

Macule

Answer 6

Flat region with a colour change on the surface

Question 7

Pustule

Answer 7

Small raised lump containing pus

Question 8

What features help to identify a neural mass?

Answer 8

Neural masses tend to only move left to right

Pressing on a neural mass can cause pain, tingling or sensory loss

Question 9

How can you start to determine the tissue location of a mass?

Answer 9

Bone masses are immobile

Muscle/tendon masses can be moved, or have their movement limited, by muscle contraction

Neural masses only tend to move left-to-right. Pressing on a neural mass can cause pain/tingling/sensory loss

Lymphadenopathy can present as a palpable non-mobile mass

Question 10

Sister Mary Joseph nodule

Answer 10

Lymph drainage site to the umbilicus from the bladder via the urachus (remnant of the allantois)

Question 11

Examination of a varicocele

Answer 11

Doesn’t transilluminate

Feels like a bag of worms

Question 12

Examination of a hydrocele

Answer 12

Hydrocele is an accumulation of fluid in the scrotal sac due to a patent processus vaginalis

Transilluminates

Possible tp palpate above it

Sits at the level of the testicle

Question 13

Identification of spermatocele

Answer 13

Spermatocele is a small cystic accumulation of semen in dilated efferent ducts or ducts of the rete testis.

Doesnt transilluminate

Possible to palpate above it

Question 14

Which three scrotal swellings is it possible to access/palpate above?

Answer 14

Hydrocele

Varicocele

Spermatocele

Question 15

How can you identify a femoral hernia on inspection

Answer 15

Below and lateral to the pubic tubercle

Question 16

How would you identify an inguinal hernia n general inspection?

Answer 16

Above and medial to the pubic tubercle

(tend to be in men)

Question 17

How would you examine an inguinal hernia?

Answer 17

Patient lying down & standing
Observe site and direction
Compare sides

Test cough impulse
Reducible/irreducible
Pressure over alternate inguinal rings

Auscultate

Other regional observations!

Question 18

Common causes of groin swellings in females

Answer 18

Femoral hernia

Bartolin gland cyst

Question 19

Methods for lump examination

Answer 19

Size, shape, surface

Position

Attachments

Consistency and colour

Edge

Thrills, pulsation, fluctuance

Inflammation

Transillumination

Question 23

Thyroglossal duct cyst

Answer 23

Embyrologically the thyroid develops at the base of the tongue and descends to the anterior neck.

Remnants of the tract may persist, producing cysts.

Move on swallowing and tongue protrusion

Question 24

Branchial cyst

Answer 24

Benign cysts that appear on the upper lateral aspect of the neck along the sternocleidomastoid

Arise from remnants of the second branchial sinus (where pharyngeal arch 2 grows over the lower arches)

Normally contain lymphoid tissue with prominent germinal centres. May have watery, mucinous or granular contents. Enlarge slowly.

Question 25

Grading of a skin tumour

Answer 25

Asymmetry

Borders

Coloour

Dimensions

Question 29

Bartholin cyst

Answer 29

Glands lie in the crease between the hymen and labium minora

Caused by infection and acute inflammation of the bartholin gland, results in obstruction of the duct.