Lump History & Examination

Lump History

:

1- When was the lump first noticed? (Duration)

2- What made the patient notice the lump? (First symptom)

3- What are the symptoms related to the lump? (Other symptoms)

4- Has the lump changed since it was first noticed? (Progression)

5- Does the lump ever disappear (persistence)? What makes the lump to reappear?

6- Has the patient ever had any other lumps? (Multiplicity)

7- What does the patient think caused the lump? (Cause)

8- There is loss of body weight?

9- There is recurrence after operation or not?

Lump Examination

:

A- Local Examination:

1- Look:

Number of lumps

Shape (spherical, hemispheric, pear or kidney shape)

Site and extension

Size

Impulse on cough

Color and texture of overlying skin: (smother and shiny or thick and rough skin, scars,

ulcers, discharging sinuses)

2- Feel:

Temperature

Tenderness

Surface (smooth, irregular, nodular)

Edge (well defined, indistinct)

Consistency (stony hard, firm, rubbery, spongy, soft)

3- Press

:

Pulsatility (expansile pulsation, transmitted pulsation)

Compressibility (disappear on pressure and reappear on release)

Reducibility (reappear only on application of another force: cough)

Fluctuation (the 2 fingers moved apart when middle area pressed)

Fluid thrill: indicates presence of fluid

4- Percussion

(dull, resonant)

5- Move

:

Fixation to skin (pinching the skin)

Mobility (try to move the lump in 2 planes)

Attachment to underlying muscle (ask the patient to tense the muscle)

6- Listen:

(bruit, bowel sounds)

7- Transillumination: indicates

presence of clear fluid

8- Examine Surrounding Tissue:

Draining group of lymph nodes

Sensation in surrounding area

Power of related muscle

Distal effects (swelling, atrophy…)

State of local tissue: arteries (ischemia), nerves (muscle wasting and change in sensation),

lymphatic (edema), bones and joints (erosion).