Surgery Clinical Demonstration: Skin & Subcutaneous Lesions

Question 1

History

Answer 1

1. Duration
2. Origin (possible cause?)
3. Progression
4. Persistence
5. Symptoms
6. Multiplicity (>=1 lump)

Question 3

Inspection

Answer 3

1. Site + Number (solitary / multiple)
2. Shape
3. Size
4. Surface
5. Condition of skin + surrounding tissue
   - radiation changes
6. Scars

Question 4

Description of lumps and bumps

Answer 4

記: 4S

1. Site
   - use anatomical landmark
2. Size
   - use ruler
   - 2 dimensions
3. Shape
   - round / ovoid
4. Surface
   - colour
   - appearance
   - pigmented / red
   - smooth / rough
   - ulcer: describe edge + base

Question 5

Percussion + Auscultation

Answer 5

Percussion: Retrosternal goitre
Auscultation: Vascular lesions

Question 6

Palpation

Answer 6

1. Reassess size
   - feel for induration
2. Consistency
   - soft / firm / hard
3. Tenderness
   - sign of inflammation
4. Temperature
   - sign of inflammation
5. Mobility
   - tethered to skin / underlying structure
   - **Cystic: confirm with transillumination
   - **Pulsatile: suggestive of vascular origin
   - ***Fluctuant lesion: fluid-filled lump e.g. Abscess
6. Assess regional LN if suspect malignant lesion