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

3. History of a lump When did you noticed it? How did you noticed it?
Is the lump symptomatic? Pain, pressure effect
Any change in size since first noticed?
Does the lump ever disappear/ reduce in size? Hernia
Aggravating / relieving factors
? Any other lump
? Any cause- Trauma? Heavy wt. lifting?

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

5. General examination Patient permission A nurse present Vital signs
Adequate exposure

6. Examination of a lump- Inspection:
Site: Lipoma- limbs, trunk, Ganglion- hand, Sebaceous cyst- scalp, back
Size
Shape: spherical- lipoma, sebaceous cyst
Surface: lobulated- lipoma, punctum- sebaceous cyst

9. Examination of a lump- Inspection
Colour: Red- inflammatory swellings , capillary haemangioma Blue- haemangioma, hematoma
Pulsation: aneurysm
Cough impulse: hernia
Any other lump?

15. Examination of a lump- Palpation
Site
Size
Shape
Surface
Edge- well-defined/ ill-defined

16. Pulsation: True vs transmitted - 2 finger technique

17. Examination of a lump- Palpation
Temperature
Tenderness
Consistency- hard, firm, soft

18. Soft swelling- palpation
Fluctuation
Transillumination
Reducibility
Compressibility
Cough impulse

19. Examination of a lump- FLUCTUATION
TRANSMISSION OF IMPULSE IN TWO DIRECTIONS AT RIGHT ANGLES TO EACH OTHER.
IMPLIES PRSENCE OF FLUID IN THE SWELLING.
Fluctuation- for fixed & mobile lump, tested in 2 axis

20. Examination of a lump- palpation
Transillumination
Compressibility: Sustained pressure empties swelling which refills on release of pressure- haemangioma

21. Examination of a lump- palpation
Reducibility: reduced into another space Does not return spontaneously
Attachments- overlying skin, underlying muscle/bone
Regional lymph nodes

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

23. Systemic examination
Complete examination of the patient

24. Thank you!