'Lumps and Bumps' Examination

Introduction

It is important to be able to accurately describe lumps and bumps as this can be a popular OSCE station. 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. It should also be recorded in the notes as a record of how the lump was on that particular day. Here are the main headings:

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

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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, eg. fruit, golf balls, etc.)
- Colour

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Palpation

Feel for:

- Tenderness (always ask if patient is in any pain first!)
- Temperature
- Size (use cm or fruit!)
- Shape (3 dimensions)
- Surface + edge
- Composition (consistency, translucency, pulsatile, compressible)
- Reducible (eg. hernias - don't forget cough impulse for these)
- Relationship to other structures (eg. origin and attachment)

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Percussion

For:

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

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Auscultation

Listen for:

- Bruits (especially if you suspect a vascular structure)

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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 examination lumps: lipomas, thyroid masses, aneurisms, hernias.

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