Ref: Examining A Mass
- Percussion and auscultation
- General patient
• Also, single vs. multiple.
• Distance from a bony prominence landmark.
• Remote surrounds first, then local surrounds.
• Also, surrounding neurological or motor deficits.
• Smooth vs. rough vs. indurated.
• Skin, scars.
• Clear vs. poorly defined.
- Transillumination, if applicable.
• Whether a torch behind lump will allow light to shine through.
• Esp. used in testicular mass.
• Feel with back of fingers on surface, surrounds.
• Ask to tell when feel pain.
• Nerve: can cause pins and needles.
• Soft, spongy, firm.
- Mobility and attachment
• Move lump in two directions, right-angled to each other. Then repeat
exam when muscle contracted:
• Bone: immobile.
• Muscle: contraction reduces lump mobility.
• Subcutaneous: skin can move over lump.
• Skin: moves with skin.
• Assess with 2 fingers on mass:
• Transmitted pulsation: both fingers pushed same direction.
• Expansile: fingers diverge (esp for AAA).
- Fluctuation [fluid-containing]
• Assess by placing 2 fingers in "peace sign" on either edge of
lump, then tapping lump center with index finger of other hand: fluctuant
lump will displace peace sign fingers.
• Very large masses can be assessed by a fluid thrill. See Ascites
• Compressible: mass decreases with pressure, but reappears immediately
• Reducible: mass reappears only on cough, etc.
- Regional lymph nodes around mass.
- Overall appearance of the patient.
4 Students and 3 Teachers around the CAMPFIRE:
Appearance of patient
Regional lymph nodes