Scribd Logo
Upload

Welcome to Scribd!

  • 50 views

    Mass

    Uploaded by

    Yara Yousef
    This document provides guidance on how to examine different types of local swellings or masses. It describes how to inspect sites, shapes, sizes, surfaces, and perform palpation tests like temperature, tenderness, thrill, mobility, consistency, compressibility, and distal effects. It also discusses percussion, auscultation and transillumination tests and how to make an anatomical, pathological and functional diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Mass

    Uploaded by

    Yara Yousef
    50 views8 pages
    This document provides guidance on how to examine different types of local swellings or masses. It describes how to inspect sites, shapes, sizes, surfaces, and perform palpation tests like temperature, tenderness, thrill, mobility, consistency, compressibility, and distal effects. It also discusses percussion, auscultation and transillumination tests and how to make an anatomical, pathological and functional diagnosis.

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides guidance on how to examine different types of local swellings or masses. It describes how to inspect sites, shapes, sizes, surfaces, and perform palpation tests like temperature, tenderness, thrill, mobility, consistency, compressibility, and distal effects. It also discusses percussion, auscultation and transillumination tests and how to make an anatomical, pathological and functional diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    50 views8 pages

    Mass

    Uploaded by

    Yara Yousef
    This document provides guidance on how to examine different types of local swellings or masses. It describes how to inspect sites, shapes, sizes, surfaces, and perform palpation tests like temperature, tenderness, thrill, mobility, consistency, compressibility, and distal effects. It also discusses percussion, auscultation and transillumination tests and how to make an anatomical, pathological and functional diagnosis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 8

    LOCAL EXAMINATION

    Inspection (NSD):
    Number: usually single (the commonest multiple swellings: Lymph nodes.)
    Site: The anatomical region (usually diagnostic).
    Shape:

    Rounded Oval Oblong U-shape Butterfly


    Should be described in 3D: Hemispherical or dome shaped. If asymmetrical, you may use terms such as 'pear shaped' or 'kidney shaped'.

    Size : The largest 2 diameters in (cm x cm)


    N.B: 3rd diameter (depth) may be needed.
    Width, length and height or depth.

    Surface: (better by palpation)

    Regular Irregular

    Skin over:
    - Dilated veins,
    - Scar,
    - Ulcer,
    - Redness as inflammation.
    - Black punctum in sebaceous cyst.
    Special sign :
    - Pulsation as Aneurysm.
    - Expansile impulse on cough as Hernia
    - Move up & down with deglutition as Thyroid Swelling.
    - Move up &. Down with protrusion of Tongue as Thyrogiossal cyst.

    7
    Deep structure : i.e. (Relation to deep muscle).
    Ask the patient to contract the muscle against resistance & note the degree of
    prominence to differentiate between the swelling deep or superficial the muscle

    The Result:
    More prominent  Superficial to muscle .
    The same size  Within the muscle .
    Less prominent  Deep to muscle .

    Distal effect :
    (V) Vein  oedema & varicose vein (if lower limb)
    (A) Artery  colour changes & trophic changes.
    (N) Nerve  deformity.
    Draining L.Ns: For "metastasis"

    8
    Palpation: (TMSEC D)

    Temp:
    - By dorsum of hand (More sensitive, less sweat). ‫بظهر اليد‬
    - Elevated in inflammation or vascular swellings.
    Tenderness:
    - Palpate during watching patient's face. ‫بص علي عينه‬

    Thrill: If present (systolic or continuous). In:


    - Over arterial aneurysm
    - Arterio-venous fistula
    - Primary toxic goiter.
    Mobility: Grasp the swelling & try to push it in all directions.

    - Swelling mobile in All directions  subcut in origin


    - Swelling mobile in One direction  from longitudinal structure.
    - Swelling Fixed  bone.
    Site, Shape, Size: (as inspection)
    Surface: ‫ريح ايدك علي الكلكيعة‬

    9
    Skin over: ‫زحلق و ارفع‬
    - To know if swelling attached to skin or not by:
    - pinching up skin over
    - Or Sliding the skin over.
    - Or Gliding test
    Special sign :
    1)-Pulsation : may be
     Transmitted pulsation i.e. over artery
     Expansile pulsation i.e. Aneurysm
    DD: 2 fingers, one from each hand are placed over the swelling:
    - If raised and separated  Expansile swelling.
    - If raised only  Transmitted swelling.

    2)- Impulse on cough : (swelling connected to a cavity)


    True: Expansile impulse on cough as
    -Hernia.
    -Meningocele.
    -Pneumatocele.
    False: Transmitted impulse on
    cough as Varicose vein

    Edge : well defined or ill defined.


    N.B. : may be slippery edge as in subcut. lipoma

    10
    Consistency:
    - Is the swelling solid or cystic, by (Fluctuation test).
    - If solid, is it:
    o Firm = Like a Nose
    o Hard = Like a Bone
    o Soft = Like a Lobule of Ear
    o Fleshy= Like muscle
    oDoughy= Like dough
    - If cystic: there is no subtypes

    Fluctuation Test

    Defenition: Test used to differentiate between solid and cystic swelling.


    Technical Types:
    1- Ordinary method:
     The Two index fingers are applied as far as the swelling allows.
     One finger is watching finger & the other move towards it.
     +ve fluctuation test indicates presence of gas or fluid as in cyst.

    N.B.:
    1- Fluctuation must be done in two perpendicular directions.
    2- Pseudofluctuation can be elicited in lipoma
    2- Paget’s test:
    Indicated if:
    1- Swelling Too Tender.
    2- Too Tense.
    3- Too Deep.
    4- Too Small < 2 cm
    Depend on:
    - Compares the consistency at the center with that at periphery.
    - By using only one figure (the index)
    Results:
    I ) Solid: Center is harder than periphery.
    2) Cystic : Center is softer than periphery.

    11
    3- Cross fluctuation
    - Detect if two adjacent swellings connected to each other or not.
    - e.g. Psoas abscess in iliac fossa with an extension below inguinal lig.
    4- Bipolar fluctuation:
    - e.g. in Hydrocele

    N.B: Moulding (Indentation)Test:

    - Special test done in Soft, or Cystic swellings.


    - Press index finger in the swelling for one minute, then relive it.

    - If the swelling remain indented, this indicates that the content pultaceous
    material (putty-like).
    - Seen in:
    - Sebaceous cyst.

    - Dermoid cyst.
    - Colonic mass with fecal impaction.

    Compressibility/ Reducibilty:
    Compressibility
    Disappear partially or completely on pressing the whole swelling &
    return to its normal size on releasing pressure" e.g. Saphena Varix.
    Reducibility
    Decrease in size or disappear when compressed into certain direction &
    reappear only on cough" e.g. Hernia

    12
    Distal effect:
    1- Deep structure i.e (Muscle)
    Examine mobility before & after contracting muscle.
    a)- In the superficial swelling:
    Before After Result

    Mobile Mobile Not attached.

    Mobile Fixed Attach to muscle.

    Mobile Limited Attach to fascia

    b)- In deep swelling: clinically can’t be elicited.


    2- Distal effect:
     (V) Vein oedema, (pitting or non pitting).
     (A) Artery : pulsation .
     (N) Nerve : sensory & motor examination.
    3- Draining L.Ns For "metastasis"

    Percussion:
    Over swelling may be
    Resonent = gas swelling e.g Hernia.
    Dullness = solid or cystic e.g Lipoma.

    Auscultation:

    Over vascular swelling may be


    - Systolic murmur as Aneurysm.
    - Continuous murmur as A-V Fistula
    - Venous hum as in portal hypertension
    - Gurgling of intestine . as Enterocele.

    Transillumination:
    As Hydrocele or Meningocele

    Diagnosis
    [1] Anatomical Site or Organ involved.
    [2] Pathological  Congenital, traumatic, inflammatory, neoplastic,…..
    [3] Functional Complicated or not Compensated or not (Liver)

    13

    You might also like