History & Examination of a lump M K ALAM MS; FRCS Professor of Surgery

History of a lump When did you noticed it? How did you noticed it? Is the lump symptomatic? Pain, pressure Any change in size since first noticed? Does the lump ever disappear or reduce in size? Hernia Any other lump on the body? Any cause? Trauma? Heavy wt. lifting?

History Remaining history as usual Systemic inquiry Past medical/ surgical history Medications Allergies Social

General examination Patient permission A nurse present Vital signs Adequate exposure

Examination of a lump Inspection: Site Size Shape Surface Colour Pulsation Cough impulse Any other lump in the area or on the body

Examination of a lump Palpation: Site Size Shape Surface Colour Pulsation (true or transmitted)- 2 finger technique Cough impulse

Examination of a lump Temperature Tenderness Consistency- hard, firm, soft Edge

Examination of a lump Regional lymph nodes Fluctuation- for fixed & mobile lump, tested in 2 axis Transillumination Compressibility: Sustained pressure empties swelling which refills on release of pressure- hemangioma Reducibility: reduced into another space. Does not return spontaneously Attachments- overlying skin, underlying muscle/bone Regional lymph nodes

Examination of a lump Percussion: Auscultation: Dull (solid, fluid) Resonant (gas) Auscultation: Bruit (vascular) Bowel sounds(hernia)

Systemic examination Complete examination of the patient

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