CLINICAL EXAMINATION OF SWELLING

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ppt on clinical examination of swelling prepared &presented by dr.M.Ravichandra,M.S, Assistant professor of general surgery,Rajiv gandhi Institute of Medical Sciences Srikakulam, Andhrapradesh.India

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By: socradan (18 month(s) ago)

well prepared

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POWER POINT CLINICS:

POWER POINT CLINICS

CLINICAL EXAMINATION OF SWELLING:

CLINICAL EXAMINATION OF SWELLING DR.M.RAVI CHANDRA,M.S(G.S) ASST. PROF. OF SURGERY RIMS SRIKAKULAM

INSPECTION:

INSPECTION 1. SITE- EXACT ANATOMICAL LOCATION IMPORTANT AS SOME SWELLINGS OCCUR IN A TYPICAL POSITION WHICH IS DIAGNOSTIC EXAMPLES POST AURICULAR DERMOID-BEHIND EAR EXTERNAL ANGULAR DERMOID –LATERAL END OF EYE BROW MENINGOCELE- OVER THE BACK IN MIDLINE

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*Image via Bing EXTERNAL ANGULAR DERMOID

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*Image via Bing EXTERNAL ANGULAR DERMOID

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*Image via Bing POST AURICULAR DERMOID

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*Image by 12498905@N02 via Flickr SUB MANDIBULAR DERMOID

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*Image by 48276084@N00 via Flickr

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*Image via Bing DERMOID CYST OF SCALP

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*Image via Bing DERMOID CYST IN MID LINE

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*Image via Bing ATYPOCAL LOCATION OF DERMOID – MEDIAL END OF EYE BROW

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*Image via Bing MENINGOCELE

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*Image via Bing MENINGOCELE

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*Image via Bing HUMAN TAIL?

2.NUMBER:

2.NUMBER USUALLY SINGLE , SOME TIMES MULTIPLE MULTIPLE EXAMPLES MULTIPLE NEUROFIBROMATOSIS(VON RECK LING HAUSENS DISEASE) MULTIPLE LIPAMATOSIS(DERCUMS DISEASE) DIAPHYSEAL ACLASIS HYDRADENITIS SUPPURATIVA MULTIPLE LYMPHOGLANDULAR SWELLINGS

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*Image via Bing

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*Image via Bing

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*Image via Bing MULTIPLE LIPAMATOSIS

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*Image via Bing HYDREDENITIS SUPPURATIVA OF AXILLA

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*Image via Bing

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*Image via Bing

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*Image via Bing EXTEXNSIVE SCARRING UNDER THE ARMS DUE TO HYDREDENITIS SUPPURATIVA

3.SHAPE:

3.SHAPE SPHERICAL OVOID KIDNEY /BEAN SHAPED/RENIFORM IRREGULAR

4.SIZE:

4.SIZE EXACT SIZE USING A MEASURING TAPE LONGITUDINAL & TRANSVERSE ON INSPECTION DEPTH BETTER JUDJED ON PALPATION USUALLY NOTED IN CENTIMETRES

5.SURFACE:

5.SURFACE COLOUR SPECIAL CHARACTER OF SURFACE OVERLYING SKIN

A)COLOUR:

A)COLOUR ARTERIAL HAEMANGIOMA – BRIGHT RED VENOUS HAEMANGIOMA— PURPLE MALIGNANT MELANOMA- BLACK BENIGN NAEVUS – BLACK RANULA –BLUE

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*Image via Bing CAPILLARY HAEMANGIOMA OVER FORE HEAD

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*Image via Bing BENIGN NEVUS

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*Image via Bing BENIGN NEVUS

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*Image via Bing HERIDITARY DYSPLASTIC NAEVUS SYNDROME

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*Image via Bing

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*Image via Bing MALIGNANT MELANOMA

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*Image via Bing

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*Image via Bing MALIGNANT MELANOMA OF FOOT

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*Image via Bing RANULA

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*Image via Bing

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*Image via Bing RANULA OF RIGHT SUBLINGUAL

b)Character of surface:

b)Character of surface TWO CHARACTERISTIC SURFACES ON INSPECTION CAULIFLOWER SURFACE – SQUAMOUS CELL CARCINOMA FILIFORM BRANCHED SURFACE – PAPILLOMA (IRREGULAR NUMEROUS BRANCHED SURFACE)

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*Image via Bing SQUAMOUS CELL CARCINOMA

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*Image via Bing

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*Image via Bing SCC OF TONGUE

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*Image via Bing FILIFORM SURFACE OF PAPILLOMA

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*Image via Bing INDONESIAN TREE MAN H.P.V. AFFECTING HANDS &LEGS

c)Skin over lying swelling :

c)Skin over lying swelling TENSE , SHINY WITH PROMINENT VEINS – SARCOMA RED &EDEMATOUS – INFLAMMATORY BLACK PUNCTUM – SEBACEOUS CYST PIGMENTATION-MOLES , NAEVI OR REPEATED X-RAYS SCAR PREVIOUS OPERATION(REGULAR SCAR WITH SUTURE MARKS) INJURY(REGULAR SCAR) SUPPURATION(PUCKERED ,BROAD &IRREGULAR) PEAU - D ORANGE APPEARANCE(MAINLY IN CA. BREAST) ULCERS

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*Image via Bing ABSCESS

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*Image via Bing ABDOMINAL WALL ABSCESS

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*Image via Bing NASAL ABSCESS

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*Image via Bing INFECTED SEBACEOUS CYST WITH PUNCTUM

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*Image via Bing SOFT TISSUE SARCOMA

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*Image by 88761406@N00 via Flickr POST THYROIDECTOMY SURGICAL SCAR

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*Image via Bing

6.VISIBLE PULSATIONS:

6.VISIBLE PULSATIONS PULSATION A MOVEMENT OR INCREASE IN SIZE SYNCHRONOUS WITH EACH HEART BEAT 2 TYPES EXPANSILE PULSATIONS – SWELLINGS ARISING FROM ARTERIES EX: AORTIC ANEURYSM , CAROTID BODY TUMOUR TRANSIMITTED PULSATIONS – SWELLINGS CLOSE TO ARTERIES REMEMBER NOT TO TOUCH THE PATIENT DURING INSPECTION

7.VISIBLE COUGH IMPULSE:

7.VISIBLE COUGH IMPULSE PERFORMED WHEN SWELLING IS OVER ABDOMEN,CHEST,SPINAL CANAL OR CRANIUM COUGH IMPULSE VISIBLE INCREASE IN THE SIZE OF SWELLING SYNCHRONOUS WITH COUGH POSITIVE IN SWELLINGS COMMUNICATING WITH ABDOMEN,THORACIC CAVITY,SPINAL CANAL OR CRANIAL CAVITY

POSITIVE COUGH IMPULSE:

POSITIVE COUGH IMPULSE HERNIA MENINGOCELE VARICOCELE SAPHENA VARIX IN CHILDREN CRYING ACTS AS COUGHING

8.VISIBLE PERISTALYSIS:

8.VISIBLE PERISTALYSIS OBSERVED IN ABDOMINAL LUMPS AND INGUINAL SWELLINGS CONGENITAL HYPERTROPHIC PYLORIC STENOSIS – VISIBLE GASTRIC PERISTALYSIS INGUINAL HERNIAS (ENTEROCELE) INTESTINAL PERISTALYSIS LUMPS DUE TO INTESTINAL MALIGNANCY PERISTALYSIS IS SEEN

9.MOVEMENT WITH RESPIRATION:

9.MOVEMENT WITH RESPIRATION SEEN IN ABDOMINAL LUMPS SWELLINGS ARISING FROM STOMACH LIVER SPLEEN GALLBLADDER HEPATIC FLEXURE OF COLON SPLENIC FLEXURE OF COLON RENAL LUMP THOUGH NOT IN CONTACT WITH DIAPHRAGM ,MOVES WITH RESPIRATION

10.Movement with deglutition:

10.Movement with deglutition IN CASE OF NECK SWELLINGS SWELLINGS MOVING WITH DEGLUTITION THYROID SWELLING THYROGLOSSAL CYST THYROGLOSSAL FISTULA SUBHYOID BURSA PRE/PARA TRACHEAL LYMPH NODES EXTRINSIC CARCINOMA OF LARYNX

WHY THYROID MOVES UP WITH DEGLUTITION?:

WHY THYROID MOVES UP WITH DEGLUTITION? THYROID IS ENCLOSED IN PRETRACHEAL FASCIA PTF ATTACHES TO THYROID &CRICOID CARTILAGES(BERRY’S LIGAMENT) SUPERIOR CONSTRICTOR MUSCLE CONTRACTION DURING DEGLUTITION THESE CARTILAGES MOVE UP ALONG WITH THESE THYROID MOVES UP

11)MOVEMENT WITH TONGUE PROTRUSION:

11)MOVEMENT WITH TONGUE PROTRUSION IN CASE OF MID LINE NECK SWELLINGS EG:THYROGLOSSAL CYST &FISTULA WHY? ATTACHED TO FORAMEN CAECUM OF TONGUE

12)PRESSURE EFFECTS:

12)PRESSURE EFFECTS WHEN SWELLING IS PRESENT ON LIMBS AN AXILLARY SWELLING WITH LIMB EDEMA – LYMPHNODAL SWELLING PARESIS – PRESSURE ON NERVES WASTING OF MUSCLES OF DISTAL LIMB- TRAUMATIC SWELLING(WASTING DUE TO NON-USE/INJURY TO NERVES) SWELLING IN NECK WITH VENOUS ENGORGEMENT(RETROSTERNAL EXTENSION)

PALPATION:

PALPATION DEFINITE CLUE TO DIAGNOSIS METHODICAL,FOLLOW DEFINITE ORDER BE GENTLE SHOULD NOT HURT THE PT.

1.TEMPERATURE:

1.TEMPERATURE IT IS AN ABSOLUTE STANDARD PRACTICE TO TEST FOR TEMP FIRST-WHY? BEST FELT BY BACK OF THE HAND-WHY? INCREASED IN INFLAMMATORY SWELLING WELL VASCULARISED TUMOURS- SARCOMA

2.TENDERNESS:

2.TENDERNESS PAIN DUE TO PRESSURE EXERTED OVER THE SWELLING IS TENDERNESS PALPATE GENTLY OVER ALL THE AREA IT IS A SIGN FEATURE OF INFLAMMATORY SWELLINGS SWELLING RELATED TO NERVES -NEUROFIBROMA

3.SIZE& SHAPE:

3.SIZE& SHAPE CONFIRM VERTICAL & HORIZONTAL DIMENSIONS NOTE THE THIRD DIMENSION DEPTH WHICH COULD NOT BE EXACTLY DETERMINED BY INSPECTION

4.SURFACE:

4.SURFACE WITH PALMAR SURFACE SMOOTH –CYSTIC SWELLINGS LOBULARWITH SMOOTH BUMPS-LIPOMA NODULAR –MULTI NODULAR GOITRE/MATTED LYMPH NODES IRREGULAR - CARCINOMA

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*Image via Bing SMOOTH SURFACE OF A SEBACEOUS CYST

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*Image via Bing

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*Image via Bing M..N.G. WITH NODULAR SURFACE

5.EDGE:

5.EDGE 1)WELL DEFINED & REGULAR – BENIGN NEOPLASMS 2)WELL DEFINED & IRREGULAR –MALIGNANT NEOPLASM 3)ILLDEFINED &DIFFUSE –INFLAMMATORY SWELLINGS

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*Image by 9085776@N08 via Flickr ABSCESS WITH ILL DEFINED MARGINS

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*Image by 72310117@N07 via Flickr LIPOMA WOTH WELL DEFINED MARGINS

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*Image by 78523246@N00 via Flickr LARGE LIPOMA WITH WELL DEFINED MARGINS

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*Image by 78523246@N00 via Flickr

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*Image via Bing IRREGULAR BORDERS IN CARCINOMA BREAST

SLIP SIGN:

SLIP SIGN TO DEFFERENTIATE BETWEEN LIPOMA AND CYSTIC SWELLING(BOTH HAVE WELL DEFINED ,REGULAR BORDERS) WHEN EDGE OF A SWELLING IS PALPATED WITH A FINGER ,IF IT SLIPS UNDER THE FINGER,. DOES NOT YIELD TO IT , IT IS A LIPOMA,IF IT YIELDS TO FINGER IS A CYST *Image via Bing

6.CONSISTENCY:

6.CONSISTENCY SOFT – LIPOMA CYSTIC- CYSTS &CHRONIC ABSCESSES FIRM –FIBROMA HARD BUT YIELDING-CHONDROMA BONY HARD-OSTEOMA STONY HARD- CARCINOMA VARIABLE CONSISTENCY- MALIGNANCY

HOW TO ASSESS CONSISTENCY:

HOW TO ASSESS CONSISTENCY SOFT – EAR LOBULE,ALAE OF NOSE FIRM- TIP OF NOSE,UN CONTRACTED MUSCLE HARD -BRIDGE OF NOSE,CONTRACTED MUSCLE

SIGN OF MOULDING OR INDENTATION:

SIGN OF MOULDING OR INDENTATION LOOK FOR THIS SIGN IN SOFT &CYSTIC SWELLINGS PRESS A FINGER INTO SWELLING FOR 1-2 MTS AND RELEASE IT IF SWELLING REMAINS INDENTED IT INDICATES PRESENCE OF PULTACEOUS MATERIAL(PUTTY LIKE) SEEN IN 1.SEBACYOUS CYST 2.DERMOID CYST 3.COLONIC MASS WITH FAECAL MATTER

PAGET’S TEST:

PAGET’S TEST DONE FOR SMALL SWELLINGS TO KNOW THE CONSISTENCY(CYSTIC/SOLID) THE CENTRE AND PERIPHERIES ARE PALPATED WITH INDEX FINGER CYSTIC SWELLING FEELS SOFTER AT CENTRE THAN PARIPHERY SOLID SWELLING FEELS FIRMER ATCENTRE THAN PERIPHERY

SPECIAL TESTS:

SPECIAL TESTS DONE IN CASE OF SOFT/CYSTIC SWELLING 7.FLUCTUATION 8.TRANSILLUMINATION 9.COUGH IMPULSE 10.REDUCIBILITY 11.COMPRESSIBILITY IN SOLID SWELLINGS DIRECTLY PROCEED TO TEST FOR RELATION TO OTHER STRUCTURES

7.FLUCTUATION:

7.FLUCTUATION TRANSMISSION OF IMPULSE IN TWO DIRECTIONS AT RIGHT ANGLES TO EACH OTHER IMPLIES PRSENCE OF FLUID IN THE SWELLING

HOW TO ELICIT FLUCTUATION?:

HOW TO ELICIT FLUCTUATION? IF THE SWELLING IS MOBILE FIRST FIX IT OR ASK THE ASST. TO HOLD IT KEEP 2 INDEX FINGERS ON OPPOSITE POLES WHEN ONE FINGER IS PRESSED THE FINGER AT OPPOSITE END FEELS THE IMPULSE & PASSIVELY LIFTED UP REPEAT THE MANUVERE IN A PLANE AT RIGHT ANGLES TO THE 1 ST ONE IF IMPULSE IS FELT IN BOTH PLANES IT IS A POSITIVE FLUCTUATION TEST

LAW BEHIND FLUCTUATION!:

LAW BEHIND FLUCTUATION! PASCAL’S LAW PRESSURE EXERTED TOA FLUID IS TRANSMITTED EQUALLY IN ALL THE DIRECTIONS *Image via Bing *Image via Bing

PRINCIPLES WHILE DOING FLUCTUATION TEST:

PRINCIPLES WHILE DOING FLUCTUATION TEST ALWAYS PERFORM IN 2 DIRECTIONS AT RIGHT ANGLES TO EACH OTHER TWO FINGERS SHOULD BE KEPT AS FAR APART AS POSSIBLE FREELY MOBILE SWELLINGS SHOULD BE FIXED FIRST(AS IN HYDROCELE) SMALL SWELLINGS –WATCHING FINGER & DISPLACING FINGER VERY LARGE SWELLINGS MORE THAN ONE FINGFR SHOLD BE USED

PSEUDO FLUCTUATION:

PSEUDO FLUCTUATION A FALSE SENSE OF FLUCTUATION FELT IN LARGE SOFT SWELLINGS CONTAINING NO FLUID SEEN IN LARGE LIPOMA MYXOMA SOFT FIBROMA VASCULAR SARCOMA FAIL TO EXPAND IN OTHER PARTS OF A SWELLING LIKE A TRUE FLUCTUANT SWELLING

CROSS FLUCTUATION:

CROSS FLUCTUATION FLUCTUATION BETWEEN TWO SEPARATE CYSTIC SWELLINGS COMMUNICATING WITH EACH OTHER SEEN IN COMPOUND PALMAR GANGLION PSOAS ABSCESS PLUNGING RANULA

8.TRANSILLUMINATION:

8.TRANSILLUMINATION DEMONSTRATION OF TRANSMISSION OF LIGHT THROUGH A SWELLING POSITIVE IN SWELLINGS CONTAINING CLEAR FLUID AND THIN TRANSPARENT WALLS NO TRANSILLUMINATION IF WALL IS THICK, OR TURBID FLUID IS PRESENT(BLOOD,PUS, LYMPH) DARK ROOM , TRANSILLUMINOSCOPE

BRILLIANTLY TRANSILLUMINANT SWELLINGS:

BRILLIANTLY TRANSILLUMINANT SWELLINGS 1.CYSTIC HYGROMA 2.EPIDIDYMAL CYST 3.MENINGOCELE WITH THIN SKIN 4.RANULA 5.CONGENITAL HYDROCELE

9.COUGH IMPULSE:

9.COUGH IMPULSE PERFORMED IN SWELLINGS LIKELY TO BE IN CONTACT WITH ABDOMINAL ,CRANIAL ,SPINAL OR CHEST CAVITY SWELLING IS HELD WITH FINGERS AND PATIENT IS ASKED TO COUGH IF THE SWELLING BECOMES TENSE OR INCREASES IN SIZE IT IS POSITIVE COUGH IMPULSE IN CHILDREN CRYING ACTS AS COUGH

SWELLINGS WITH POSITIVE COUGH IMPULSE:

SWELLINGS WITH POSITIVE COUGH IMPULSE IN CONTINUITY WITH ABD. CAVITY HERNIA ILIO-PSOAS ABSCSS LUMBAR ABSCESS IN CONTINUITY WITH PLEURAL CAVITY EMPYEMA NECESSITANS IN CONTINUITY WITH SPINAL /CRANIAL CAVITY SPINAL/CRANIAL MENINGOCELE

10.REDUCIBILITY:

10.REDUCIBILITY INDICATION SAME AS FOR COUGH IMPULSE PATIENT IS ASKED TO RELAX SWELLING IS COMPRESSED FROM ALL THE SIDES UNIFORMLY REDUCIBLE SWELLINGS DECREASESIN SIZE OR COMLETELY DISAPPEAR

REDUCIBLE SWELLINGS:

REDUCIBLE SWELLINGS 1.HERNIA 2.MENINGOCELE 3.VARICOCELE 4.SAPHENA VARIX A REDUCIBLE SWELLING ONCE REDUCED REAPPEARS ONLY BY STRAINING,COUGHING, OR FORCE OF GRAVITY AS IT INVOLVES DISPLACEMENT OF VISCERS TO AN ADJOINING CAVITY

11.COMPRESSIBILITY:

11.COMPRESSIBILITY WHEN PRESSURE IS APPLIED TO A SWELLING IT DECREASES IN SIZE AND WHEN PRESSURE IS RELEASED SWELLING REGAINS ITS SIZE ITSELF WITH OUT ANY EXTERNAL FACTORLIKE STRAINING OR COUGHING CHARECTARISTIC SIGN OF VASCULAR HAEMANGIOMA

12.PULSATILITY:

12.PULSATILITY WHEN FINGER IS PLACED OVER A PULSATILE SWELLING IT RAISESWITH EACH BEAT TO TYPES OF PULSATIONS TRANSMITTED PULSATIONS- SEEN IN SWELLINGS PRESENT NEAR AN ARTERY EX:CA STOMACH LUMP NEAR ABD.AORTA EXPANSILE PULSATIONS-SEEN IN SWELLINGS ARISING FROM ARTERIES EX:AORTIC ANEURYSM

HOW TO DIFFERENTIATE?:

HOW TO DIFFERENTIATE? TWO FINGERS ARE PLACED OVER THE SWELLING AND FINGER MOVEMENTS ARE NOTED TRANSMITTED PULSATIONS – FINGERS ARE SIMPLY LIFTED UP EXPANSILE PULSATIONS- FINGERS ARE LIFTED UP AND MOVE APART

IN AN ABDOMINAL LUMP?:

IN AN ABDOMINAL LUMP? KNEE ELBOW POSITION WHEN KEPT IN KNEE ELBOW POSITION PULSATIONS DISAPPEAR – TRANSMITTED PULSATIONS PULSATIONS PERSIST –EXPANSILE PULSATIONS

13.FIXITY TO SKIN:

13.FIXITY TO SKIN SKIN PINCHED OVER DIFFERENT PARTS OF THE SWELLING -CANNOT BE PINCHED IF FIXED TO SKIN SKIN IS MADE TO MOVE OVER THE SWELLING- THE SKIN WILL NOT MOVE IF IT IS FIXED TO SKIN SWELLINGS ARISING FROM SKIN ARE FIXED TO SKIN EX:SEBACEOUS CYST , PAPILLOMA , EPITHELIOMA

14.RELATION TO SURROUNDING STRUCTURES:

14.RELATION TO SURROUNDING STRUCTURES 1)SUBCUTANEOUS TISSUE SWELLINGS IN SUB CUTANEOUS TISSUE ARE NOT ADHERENT TO SKIN OR UNDERLYING MUSCLE LIPOMA-PUSHED SIDEWAYS PUCKERING IS SEEN IN SOME PLACES – DUE PRESENCE OF FIBROUS SEPTA 2)DEEP FASCIA SWELLING ARISING FROM DEEP FASCIA WILL NOT BE AS MOBILE AS SUBCUTANEOUS SWELLINGS IT IS DIFFICULT MAKE OUT FIXATION TO DEEP FASCIA AS DEEP FASCIA CANNOT BE MADE TAUT EVEN IF TUMOUR IS ATTACHED TO UNDERLYING DEEP FASCIA &MUSCLE TUMOUR CAN BE MOVED SIDEWAYS

3)RELATION TO MUSCLE:

3)RELATION TO MUSCLE RELATION SHIP TO MUSCLE IS KNOWN BY THROWING THE CONCERNED MUSCLE INTO CONTRACTION TUMOURS IN SUB CUTANEOUS TISSUE- BECOME MORE PROMINENT &REMAIN MOBILE TUMOURS ARISING FROM MUSCLE / INCORPORATED IN MUSCLE-FIXED&IMMOBILE TUMORS DEEP TO MUSCLE –LESS PROMINENT, OR DISAPPEARS,DIFFICULT TO PALPATE

4)SWELLING IN RELATION TO TENDON:

4)SWELLING IN RELATION TO TENDON MOVES ALONG WITH TENDON&BECOMES FIXED WHEN MUSCLE CONTRACTS 5)IN CONNECTION WITH VESSELS &NERVES DO NOT MOVE ALONG VESSELS OR NERVES BUT MOVE TO A LITTLE EXTENT AT RIGHT ANGLES TO THEIR AXES 6)IN CONNECTION WITH BONE IS ABSOLUTELY FIXED IRRESPECTIVE OF MUSCLE CONTRACTION

PERCUSSION:

PERCUSSION LIMITED VALUE IN SWELLINGS 1.TYMPANIC NOTE ENTEROCELE PHARYNGOCELE 2.HYDATID THRILL HYDATID CYST

AUSCULTATION:

AUSCULTATION BRUIT OVER PULSATILE &VASCULAR SWELLINGS BRUIT SHORT,MEDIUM PITCHED MURMUR HEARD OVER THE SWELLING WITH EACH PULSE WAVE EX:ANEURYSM THYROTOXIC GOITRE

REGIONAL LYMPH NODES:

REGIONAL LYMPH NODES DRAINING LYMPH NODES EXAMINED IF INVOLVED NEXT HIGHER GROUP EXAMINED IF THE SWELLING ITSELF IS ALYMPH NODE EXAMINE 1.OTHER LYMPH NODAL GROUPS 2.SPLEEN 3.LIVER TO EXCLUDE SYSTEMIC CAUSE EXAMINE DRAINAGE AREA TO EXCLUDE INFECTION

PRESSURE EFFECTS:

PRESSURE EFFECTS 1.OVER BONE – FEEL FOR BONY EROSION AS IN DERMOID CYST 2.IN LIMBS DISTAL PULSES- PRESSURE OVER ARTERIES EDEMA &DILATED VEINS – PRESSURE OVER VEINS PARESIS& MUSCLE WASTING – PRESSURE OVER NERVES MOVEMENTS OF JOINTS

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*Image via Bing WASTING OF THENAR MUSCLES DUE PRESSURE OVER MEDIAN NERVE

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*Image via Bing SPINAL LIPOMA

GENERAL EXAMINATION:

GENERAL EXAMINATION

Question time?:

Question time? WHAT IS UNIVARSAL TUMOUR? WHAT ARE THE PROCESSESS FUSING IN EXTERNAL ANGULAR DERMOID? WHAT IS THE TUMOUR SHOWING POSITIVE SLIP SIGN? WHAT IS THE SITE AT WHICH A LIPOMA MOST COMMONLY UNDERGOES SARCOMATOUS CHANGE? WHAT IS THE MOST COMMON SITE FOR CYSTIC HYGROMA? WHAT IS THE OTHER NAME FOR BASAL CELL CARCINOMA?

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*Image by 40501877@N04 via Flickr THANKS FOR PATIENT LISTENING