Describe the features you would note in examining a lump/an ulcer. How would these features help in your differential diagnoses.

LUMP
Look:

1. Inspect (shape, colour)
2. Measure (position, size)

Feel:

1. Temperature (warm?)
2. Surface (smooth, rough, bosselated)
3. Edge (clearly/poorly defined)
4. Consistency (stony-hard, rubbery-hard, spongy, soft)
5. Surrounding area (indurated)

Press:

1. Pulsatility (expansile pulsation, transmitted pulsation)*
2. Compressibility/reducibility*
3. Percussion (resonant/dull)
4. Fluctuation/fluid thrill*

Move:

1. Skin over lump (fixation)
2. In 2 planes at right angles to each other (mobility)
3. Tense underlying muscle (attachment to underlying muscle)

Listen:

1. Bruit/bowel sounds

Transilluminate:

1. transilluminable

Surrounding Tissues:

1. Regional lymph nodes (local lymphadenopathy)
2. Sensation (neurological deficit)
3. Power (weakness)

ULCERS

Look

1. Measure (position, size, shape)
2. Base (colour: red/granulation tissue, penetration: tendon/bone/blood/pus)
3. Edge (sloping/punched out/undermined/raised/raised and everted)
4. Depth

Feel

1. Tender?
2. Temperature

Surrounding Tissues

1. Regional lymph nodes (lymphadenopathy)
2. Sensation (local neurological deficit)
3. Power

* expansile pulsation = fingers pushed apart
* transmitted pulsation = fingers pushed in same direction
* compressible = lump disappears on pressure and reappears on release
* reducible = lump reappears only on application of another force, e.g. coughing, gravity
* fluctuant = two fingers move apart when middle area pressed (test for a small lump)
* fluid thrill (use for large swelling)