Approach to lumps/ bumps
Each lumps/ bumps have their own distinguished features. However, the physical examination uses similar step. It is wise to have few differentials ready during examination to enable picking up specific signs.
It starts with describing the salient features seen during this step. (6 S)
Site: describe the location and use a landmark if possible; dorsal, palmar, midline, etc
Size: estimate the size without touching the lump. Use dimension in centimetre or any other acceptable measurement.
Shape: describe what you see; oval, round, etc
Symmetry: apply to lump with two different appearance or nodule
Skin changes: pigmentation, regular or irregular, colour, etc
Scars: previous surgical scar, congenital mark, etc
Start with touching the lump and identifying the extension and margin. Then proceed to determine specific features and special signs for known lumps.
Surface: smooth or irregular
Edges: well or poorly defined
Temperature: feel with the dorsum of hand
Consistency: soft like the ‘lips’, firm like the ‘nose’ and hard like the ‘forehead’
Tenderness: remember not to cause unnecessary pain to the patient
Pulsatility: beware of you own pulsation
Transillumination test: always prepare a black coloured paper. Easy to make a cylinder shape and use a torch to illuminate the lump. A positive sign suggest presence of fluid.
Fluctuant: using two fingers and compress the lump. This test signify the presence of fluid within the lump.
Fluid thrill: use for large lumps. With patient hands at the centre, you can feel a thrill upon gentle flick of the finger at the side of the lump.
Fixation: determine whether the lump is fix to either the skin or muscle by moving the skin above the lump (skin fixation) or move the lump at two different angle while the muscle is tense (muscle fixation).
Gently tap your finger while placing it onto the lump. A dull sound suggest a solid mass while resonant suggest air filled mass.
Determine presence of bruits (turbulence within the vasculature) or other irregular sounds.
More info can be found in most physical examination textbook. This page is to meant for easy reference and the content might not be adequate.