Yr 1 OSCE

Lumps and Bumps

Seth Forster
Lumps and bumps

Introduce yourself and purpose whilst washing hands

Explain that you talk to the patient about the history of the lump and will then do an examination
which will involve looking and touching of the bump

Get consent for doing this

Confirm the patients name and date of birth

History of the bump

● When did it appear

● How was it noticed
● Does it have any symptoms and what are they
● Has it ever changed
● Has it ever disappeared
● Do they have or have they had any similar lumps or bumps
● What are their ideas, concerns and expectations surrounding it

Examination

Explain that you are now going to do the examination which will involve looking, feeling, percussing
and listening to the bump and check they still give you their consent

Wash your hands whilst getting consent

Look

● Where is the location and position of it

● How big is it
● What colour is it
● How would you describe its shape, is it regular or irregular. Talk about the surface and edges
● Some words used to describe lumps and bumps include polypoid (looking like a polyp),
bosselated (covered in many small protuberances)

Feel

● First compare temperature with the back of your hand

● Is it tender
● Recheck size and shape as there may be unknown growth under the surface
● What is the texture and feel of the surface and edges like
● How would you describe it’s consistence; Soft, spongy, rubbery hard or stony hard
● When you compress it in one direction does it expand in the other – fluctuation
● Is it translucent when you shine a light on it
● Can you reduce it (push it back in)
● Is there a pulse
Percussion

Place the middle finger of the non-dominant hand over the lump or bump and then tap the middle
knuckle with the middle finger of the dominant hand

● Tympanic sounds (resonant) suggests the presence of air

● Dull sounds suggest that the lump or bump is solid or contains a liquid

Auscultation

Listen to the lump or bump with a stethoscope

● Turbulent noises heard are called bruit. This usually suggests the presence of an artery which
could be an aneurysm
● Sometimes bowel sounds can be heard in an intestinal hernia

Look at related structures

● Think about circulation, nerve supply and cellulitis

● Are there swollen lymph nodes nearby, could suggest some form of infection

Common types of lumps and bumps

Cyst

● A fluid containing sac, just under the skin

● They can appear almost anywhere on the body
● They feel stony hard
● No colour or temperature changes from the surrounding area usually
● In some cases they can be inflamed and swollen
● From the size of a pea to several centimetres across
● They may have an opening at the top (punctum) like a spot

Lipoma

● A benign tumour of adipose tissue

● Usually appear on the shoulders, neck, back, chest, arms, buttock and thigh
● Deeper in the skin than cysts
● They can feel soft or rubbery hard
● No colour or temperature changes from the surrounding area, they
don’t become inflamed like cysts
● Can range in size from a pea to several centimetres across
● An ultrasound can differentiate between cysts and lipomas

Ganglion cyst

● A smooth lump filled with synovial fluid

● Appear alongside joints and ligaments (most lumps at the wrist are
ganglions)
 ● Usually stony hard and normally painless
● They are the same colour as the surrounding tissue
● They can grow as large as a golf ball

Boil

● An infected area of skin filled with pus

● At the site of an infected hair follicle
● Red, warm, painful swellings which turn white with time
● They start off hard but become softer as they increase in size
● Boils clusters are called carbuncles and start to cause systemic
unwellness
● Boils in the eye are called styes

Abscess

● A collection of pus caused by a bacterial infection

● They can develop anywhere on the body
● Normally red, hot, swollen and tender
● Vary hugely in size
● A dull sound on percussion
● There are usually symptoms of systematic unwellness
● Abscesses may burst and release pus

Hernia

● When an internal part of the body pushes through a weakness its

surrounding tissues, for example the small intestines and the abdomen
● Usually not painful
● Clearly defined edges with no colour change
● May be reducible and fluctuant
● Consistence can vary depending on the body part involved
● Intestinal hernias may produce bowel sounds on auscultation unless it
is strangulated
● Strangulation creates a risk of avascular necrosis

Melanoma

● A type of skin cancer

● May appear as a new mole or a change in an existing one
● Usually an irregular shape and variegated (varying) colour
● Not usually painful but may be itchy
● Sometimes they can bleed

Swollen lymph nodes

● Swell up during an infection or from cancer

● Superficial lymph nodes are found by following veins, for deep ones follow arteries
● No colour or temperature changes
● Usually soft to the touch
● They can be quite tender
● The nodes can be moved around easily