Examination of a Lump

For both exams and real life, describing every characteristic of a lump is rarely necessary. The important thing is to be able to describe a lump systematically, so that a person (e.g. your consultant) down the phone can picture it. If you are stuck for a differential diagnosis, go through the anatomical structures in the area or use a surgical sieve.

TO START

W2I2P4E

  • Wash your hands

  • Wear appropriate PPE

  • Introduce yourself and check patient’s Identity

  • Permission: “Would it be alright if I examined you?”

  • Privacy: Ensure curtains to the bay are closed

  • Pain: “Are you in any pain at all?” 

  • Position: Depends on where the lump is

  • Exposure: Lump site, and opposite side for comparison. Expose draining lymph nodes if appropriate

INSPECTION

  • From the end of the bed: is the patient well/unwell, cachectic, in pain?

  • Is the lump visible? Ask the patient to show you where they have noticed it

  • Skin changes (hair gain/loss, puckering, discharge, ulceration, skin tension, necrosis, scarring, inflammation, colour, texture)

PALPATE

Palpate the centre and the edges of the lump to characterise it, then palpate the surrounding area.

6 Students


  • Site, Size, Shape, Single/multiple, Surface (smooth/craggy), Skin changes

3 Teachers

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  • Temperature, Tenderness (ask about pain first!), Transillumination (does it light up when you put a torch behind it?)

CAMPFIRE

  • Consistency/fluctuation

  • Attachment

  • Mobility: is it tethered to the skin, muscle or underlying structure, or is it freely mobile?

  • Pulsatility (regular vs expansile - expansile in AAA) or Thrills (dialysis fistula)

  • Fluid thrill: tap one side and feel for pressure wave on the other

  • Irreducibility (hernia), Compressibility (eg venous lump),cough impulse (hernia/vascular)

  • Regional lymph nodes (can be distant eg Virchow’s node in left supraclavicular fossa for abdominal lump)

  • Edges: well/poorly demarcated, smooth/irregular





PERCUSS

  • Impalpable extent of lump (eg over sternum for retrosternal goitre)

  • Resonance (is the lump filled with gas, liquid or solid?)

AUSCULTATE

  • Bruits or murmurs (indicates vascular origin or high blood flow)

  • Bowel sounds (hernia)

CLOSURE

Closure

  • Thank the patient, ensure they are comfortable and dressed. 

  • Remove PPE

  • Clean equipment and wash hands

To complete

  • Palpate regional lymph nodes (if not already done)

  • General examination and examine surrounding tissue for pathology