Lumps & Bumps PDF Print E-mail

Introduction

It is important to be able to accurately describe lumps and bumps, as these can form popular OSCE stations. There are always a surprising amount of things you can say about every mass. Your description should be good enough for a doctor to come up with a differential diagnosis without seeing the patient (can someone visualise the mass if you described it to them over the telephone?). Your examination should also be recorded in the notes as a record of how the lump was on that particular day.


Always start by: washing your hands, introducing yourself and obtaining consent.

  

Inspection

Look for:

  • Site (describe in relation to fixed anatomical landmarks)
  • Size (make a visual estimate of the size - you will confirm this upon palpation)
  • Shape (often compared to real-life objects - e.g. fruit, golf balls, etc.)
  • Colour
  

Palpation

Feel for:

  • Tenderness (always ask if patient is in any pain first!)
  • Temperature
  • Size (use cm or comparisons with fruit/golf balls etc!)
  • Shape (3 dimensions)
  • Surface + edge
  • Composition (consistency, translucency, pulsatile, compressible)
  • Reducible (e.g. hernias - don't forget to palpate for a cough impulse to screen for herniae)
  • Relationship to other structures (e.g. origin and attachment)
  

Percussion

For:

  • Fluid thrill
  • Extent of mass (eg. thyroid lumps - percuss from the neck down the sternum to see if goitre mass extends 'retrosternally')
  

Auscultation

Listen for:

  • Bruits (especially if you suspect a vascular structure)
  

Extras

Don't forget:

  • Transillumination (especially for cystic lumps) - ideally look down through a small tube, such as a 'Smarties' tube, pressed down onto the midpoint of the lump, whilst illuminating the mass from the side using your pen-torch - in reality you probably won't be able to do this, so mention that 'ideally I would use a tube', but for the purposes of the examination you can then just illuminate with your pen-torch
  • Regional lymph nodes - always palpate for these
  • Say you would like to examine the local tissues for any pathology ? skin, muscle, bone, vessels, nerves
  • Say that you would ideally also perform a general examination ? always examine the whole patient to look for more of the same!


Common lumps encountered during examinations: lipomas, thyroid masses, aneurisms, hernias.