A Shortcut Method To Examine A Swelling

This is a shortcut to describe a swelling.
In general, it is divided into inspection and palpation
- SITE of the swelling
- SHAPE of the swelling
- SIZE of the swelling
- DEFINITION of the swelling: Well-defined or Ill-defined
- SURFACE of the swelling: Smooth, Nodular or Lubulated
- PULSATION: Is the swelling pulsatile?
- SKIN CHANGES on and around the swelling: colour changes, scars, sinuses

- TENDERNESS: Is the swelling tender?
- TEMPERATURE: Is there any local rise in temperature?
- Confirm all inspectory findings
- CONSISTENCY: Hard, Firm(feel something like the consistency of your nose), Soft
- Plane/Mobility: Where is the swelling lie on in relation of underlying structures such as bone, muscle, skin?

If the swelling is at the neck, you just have to add on some of the followings:
In INSPECTION, add on:
- SWALLOWING: Does the swelling moves with swallowing?
- PROTRUDE TONGUE: Does the swelling move with protruding the tongue?
- PEMBERTEN SIGN: Ask the patient to put both his/her hands on his/her head, wait for 10 seconds and look for any pressure signs/cyanosis on his/her face. Its significant is that, if it is positive, it suggest that there is something (such as retrosternal extension of goitre) compressing the iminent vein.
- TRACHEA POSITION: Is the trachea centrally placed?

In PALPATION, add on:
- CAROTID: Feel for the carotid pulse

In case the swelling is at the groin:
In INSPECTION, add on:
- COUGH IMPULSE: Does the swelling become more prominent on coughing?
- REDUCIBILITY: Is the swelling reducible (on its own or on manual reduction)?
- Check for the OPPOSITE SIDE

You may add other special tests on your examination if it is relevant. But the above are the important points that you must not miss.

Source: Class taken by Dr. Sivabalan, HOD of Surgery HPSF, Muar

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