Palpable masses, lumps and bumps

Question 1

Where can thyroglossal duct cysts form?

Answer 1

Anywhere in the midline neck and move on swallowing and tongue protrusion

Question 2

What mnemonic can you use to do a lump examination?

Answer 2

Size, Shape, Surface
Position
Attachments
Consistency & Colour
Edge

Pulsation/thrills/fluctuance
Inflammation
Transillumination

Question 3

What are the different methods for determining the origin and content of a lump?

Answer 3

Transilluminate
Fluctuance - fluid containing
Auscultate

Question 4

Which layers are the below lumps within?
Can be moved anyway
Immobile
Medial to lateral direction
Move - cause pain/tingling/sensory loss
moved by muscle contraction

Answer 4

Can be moved anyway - skin
Immobile - bone mass
Medial to lateral direction - neural mass
Move - cause pain/tingling/sensory loss - neural mass
moved by muscle contraction - muscle or tendon mass

Question 5

What can lympadenopathy present as?

Answer 5

Palpable relatively non-mobile mass

Enlargement can be unilateral during cancer or infection

Question 6

What;s the difference between a hydrocele and a spermatocele/epididymal cyst? How would you know the diff clinically?

Answer 6

Hydrocele - located in peritoneum - can’t feel the testicle (covered in liquid) but can feel the spermatic cord - transillumonate
Spermatocele - sits as top of testicle, can palpate testicle

Question 7

A 10 year old boy presents with a swelling in his scrotum. His mother tells you it is not there in the morning but appears during the day, then disappears if he lies down. Examination reveals the swelling transilluminates, but you can’t get your hand above the swelling. What is this?

Answer 7

Patent processus vaginalis

• serous fluid fills the tunica vaginalis
• Can’t be a hydrocele - as you should be able to feel the spermatic cord

Question 8

What is a hernia?

Answer 8

Protrusion of a tissue/organ through a retaining tissue

Question 9

What is a femoral hernia, what do you see in patients?

Answer 9

Descend the femoral canal; Appear via the saphenous opening; Separately, varicosities can form on the saphenous vein at the opening (saphena varix)

Question 10

Are men or women more likely to get a femoral hernia?

Answer 10

Women - femoral canal is wider and larger pelvis

Question 11

How can the femoral canal be accessed?

Answer 11

Via the femoral ring - surrounded by a lot of ligaments and bone - high chances of strangulation of the hernial sac contents