Swellings and Lumps Flashcards
(20 cards)
What are goitres?
An enlarged thyroid gland.
What are hernias?
A profusion of (or part of) an organ through the wall that contains it.
This includes inguinal and incisional hernias.
How do you consider onset in the history of swelling?
Gradual - benign.
Rapid - inflammatory.
Acute - bleeding into cyst.
Instantaneous - traumatic.
Accidental - most others.
How do you consider course in the history of swelling?
Progressive - malignant / benign / inflammatory.
Regressive - resolving inflammation.
Stationary - no change.
How do you consider duration in the history of swelling?
Malignancy is unlikely with a long duration. However, recent changes to a longstanding swelling may indicate malignancy.
How do you consider painlessness in the history of swelling?
Most lumps.
The onset of pain on a previously painless lump can indicate the onset of complications.
How do you consider painfulness in the history of swelling?
Traumatic / inflammatory.
Malignancy can indicate an infiltration of local nerves or surrounding structures.
How do you consider other lumps in the history of swelling?
Same type (two hernias).
Effect (tumour spread?).
How do you consider symptoms in the history of swelling?
Benign / early malignant - none.
Inflammatory - sepsis (fever).
Malignant - metastasis (appetite loss).
Overactivity - hyperthyroidism (weight loss).
How do you consider causes in the history of swelling?
History of trauma / previous surgery / heavy lifting.
How do you inspect in the examination of swelling?
Site / size / shape.
Surface - smooth or irregular.
Skin overlying - normal or inflamed or scarred or dilated veins.
What are special signs of inspection in the examination of swelling?
Cough impulse - hernias.
Pulsations - related to artery.
Movement with swallowing - thyroid.
Movement with tongue protrusion - thyroglossal cyst.
How do you palpate in the examination of swelling?
Tenderness - ask first before palpating.
Temperature - compare.
Size.
Surface - smooth or irregular.
Edge - well or ill defined.
Draining lymph nodes.
How do you palpate the skin in the examination of swelling?
Separate from overlying skin - pinch the skin over the lump.
Lump is fixed to the skin - moves together.
Check if the lump is tethered or moves.
How do you palpate the muscle in the examination of swelling?
Feel the swelling before and after contraction.
Superficial - prominent.
Deep - not prominent.
Inside - less prominent.
How do you check for consistency in the examination of swelling?
Cystic - fluid containing swelling.
Cross fluctuation in two perpendicular directions.
Solid - soft / firm / hard / indurated.
Use Paget’s Test.
What are special signs for palpation in the examination of swelling?
Transillumination - glows under a torch.
Pulsations - expansive or transmitted.
What else do you check for in a local examination?
Percussion.
Auscultation - particularly for swellings over the course of arteries / swelling.
What are other examples of swellings and lumps?
Breast lumps.
Enlarged lymph nodes.
What else do you check for in the history of swelling?
If the lump disappears.
