The following document was written by Mr Vik Veer MBBS(lond) MRCS(eng) DoHNS(eng) in Dec 2007. You may use the information here for personal use but if you intend to publish or present it, you must clearly credit the author and www.clinicaljunior.com
This site is not intended to be used by people who are not medically trained. Anyone using this site does so at their own risk and he/she assumes any and all liability. ALWAYS ASK YOUR SENIOR IF YOU ARE UNSURE ABOUT A PROCEDURE. NEVER CONDUCT A PROCEDURE YOU ARE UNSURE ABOUT.

Examination of a Lump

Ask for consent and then continue with inspection

“Is there any pain at all? (response) and would it be alright if, while i am examining you, that i speak to the examiner about you?"

(remember to wait for response - too often we rehearse these examinations so often that we forget to wait for the answers to these questions in the panic of an exam)

Expose the area as widely as possible (preferably exposing the draining lymphnodes)

INSPECTION
Try and remember a list which can be used in all situations for my MRCS i used Size, Site, Shape, Skin (scars and colour), Surface, and Margin.

for example
“On the dorsal aspect of the hand there is a 2x2cm, hemispherical lump that appears to have a smooth surface and a well defined margin. The overlying skin is of normal colour and I can’t see any scars or other similar lumps nearby”

PALPATION

Surface (describe as either smooth, nodular or craggy)
Edge
Temperature (use the back of your hand to assess this)
Consistency (soft=like nostrils, firm=like tips of nose, hard=like bridge of nose)
Fluctuation (demonstratable fluid thrill or impulse)
Compressibility (like a vein can be compressed flat)
Reducibility (like a hernia - should really have a cough impulse)
Pulsatile
Fixation (to skin and underlying tissue in two planes)

for example
“The findings on inspection are confirmed on palpation, there is a 2x2cm lump with a smooth surface and a well defined edge. The temperature is similar to the surrounding skin and the consistency is firm. There is no fluctuation, nor is it compressible or reducible. There is no detectible pulse and the lump is not tethered to the overlying skin nor is it fixed to the underlying tissues in two planes.”

PERCUSS (dull or resonant)

AUSCULATE (bruits or bowel sounds)

TRANSILLUMINATE

COMPLETION

“I would then continue on to examine the draining lymph nodes, assess the neurovascular status of the surrounding area, and finish with a general examination of the patient.”

ULCERS
if you are faced with a ulcer rather than a lump - use the following terms and try and stick to your normal method as much as possible.

Base – how deep is the ulcer (down to muscle, bone, fascia). Look for granulation tissue, slough, or malignant change.
Edge

Sloping = healing ulcer (venous or traumatic)
Punched out = ischaemic or neuropathic (rarely syphilis)
Undermined = pressure necrosis or tuberculosis
Rolled = basal cell carcinoma
Everted = squamous cell carcinoma
Discharge – serous (clear), blood stained, purulent

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