SWELLING ( SEBACEOUS CYST, DERMOID CYST, LIPOMA)

PATIENT NAME:

AGE/SEX:

OCCUPATION:

ADDRESS:

RELIGION:

RACE :

SOCIO ECONOMIC STATUS:

CHIEF COMPLAINTS:

• SWELLING IN THE………………………..DURATION
• PAIN IN THE SWELLING…………………….DURATION

HISTORY OF PRESENTING ILLNESS:

PATIENT WAS APPARENTLY NORMAL BEFORE………………..THEN

• HE/SHE DEVELOPED SWELLING IN THE……………………

➢ NOTICED THE SWELLING
▪ WHILE TAKING BATH
▪ WHILE SEEING THE MIRROR
▪ NOTICED BY NEIGHBOUR
➢ ONSET
▪ SUDDEN
▪ INSIDIOUS
➢ PROGRESSION-
▪ STATIC
▪ SLOWLY PROGRESSIVE – BENIGN SWELLING
▪ RAPDILY PROGRESSIVE – MALINGNANT SWELLING
▪ INITIALLY SLOWLY LATER RAPIDLY PROGRESSIVE – FROM BENIGN TO MALIGNANT CHANGE
▪ INITIALLY INCREASING SIZE, LATER THE SWELLING REGRESSIVE - INFLAMMATORY
• H/O PAIN IN THE SWELLING…………………….DURATION
➢ SITE
➢ SIDE
➢ ONSET – SUDDEN/ INSIDIOUS
➢ PROGRESSION
➢ TYPE
➢ CHARCTER
➢ RADIATING PAIN
➢ SHIFTING PAIN
➢ AGGARAVATED BY
➢ RELIEVED BY
 ➢ ASSOCIATED SYMPTOMS
• H/O TRAUMA
• H/O FEVER
• H/O LOSS OF WEIGHT
• H/O LOSS OF APPETITE
• H/O ANY OTHER SWELLINGS IN THE BODY
• H/O ULCERATION IN SWELLING
• H/O FUNGATION IN SWELLING
• H/O DISCHARGE FROM THE SWELLING
• H/O CHEST PAIN
• H/O CHRONIC COUGH
• H/O HEMOPTYSIS
• H/O BREATHLESSNESS
• H/O ABDOMINAL PAIN
• H/O ABDOMINAL DISTENSION
• H/O JAUNDICE
• H/O BONY PAIN
• H/O BACK PAIN
• H/O LOSS OF CONSCIOUS
• H/O HEAD ACHE
• H/O VOMITING
• H/O SEIZURES

PAST HISTORY:

• H/O SIMILAR EPISODES IN THE PAST

• K/C CASE OF DM/SHT/ASTHMA/ ALLERGY/ HEART DISEASE/KIDNEY DISEASE/ TB/ EPILEPSY/ ALLERGY
• H/O PREVOIUS SURGERY

PERSONAL HISTORY:

• DIET –
• SMOKER –
• ALCOHOLIC –
• ANY ADDICTION -
• BOWEL AND BLADDER HABITS –
• SLEEP PATTERN -

FAMILY HISTORY:

• TOTAL FAMILY MEMBERS-

• NO OF MALES –
• NO OF FEMALES –
• SIMILAR EPISODES IN THE FAMILY MEMBERS –
MENSTRUAL HISTORY:

• AGE AT MENARCHE –
• CYCLES – REGULAR/IRREGULAR CYCLES
• EACH CYCLES………./30
• LOW/NORMAL/HIGH
• ASSOCIATED WITH PAIN, CLOTS
• LMP –

OBSTETRIC HISTORY:

• AGE AT MARRIAGE –
• AGE AT FIRST CHILD BIRTH –
• OBSTETRIC CODE – G P L A
• NUMBER OF CHILDREN –
• MALE – FULL TERM/PRETERM/POST TERM, HOSPITAL /HOME DELIVERY
• FEMALES – FULL TERM/PRETERM/POST TERM, HOSPITAL/HOME DELIVERY
• AGE AT LAST CHILD BIRTH –
• EACH CHILD BREAST FED FOR………………..YEARS

GENERAL EXAMINATION:

• CONSCIOUS
• ORIENTED
• COPERATIVE
• COMFORTABLE
• FEBRILE/AFEBRILE
• HYDRATION –
• DYSPNEIC OR NOT
• TACHYPNEIC OR NOT
• ANEMIA
• JAUNDICE
• BUILT
• NOURISHMENT
• CLUBBING
• CYANOSIS
• PEDAL EDEMA
• GENERALIZED LYMPH ADENOPATHY
• VITAL SIGNS
➢ PR –
➢ BP-
➢ RR –
➢ T–
 • HEAD TO FOOT EXAMINATION:
➢ HEAD
➢ EARS
➢ FACE
➢ EYES
➢ NOSE
➢ ORAL CAVITY
➢ NECK
➢ UPPER LIMBS
➢ HANDS
➢ CHEST
➢ ABDOMEN
➢ BACK
➢ LOWER LIMBS
➢ FOOT
➢ GENETALIA
➢ GAIT

EXAMINATION OF THE SWELLING:

AFTER GETTING CONSENT FROM THE PATIENT WITH ADEQUATE EXPOSURE

INSPECTION:

• NUMBER
▪ SINGLE – DERMOID CYST
▪ MULTIPLE – NEUROFIBROMAS, LIPOMATOSES, MULTIPLE EXOSTOSIS, SEBACEOUS CYST.
• SITE
▪ POSTAURICULAR DERMOID – BEHIND THE EAR
▪ EXTERNAL ANGULAR DERMOID – LATERAL END OF EYEBROW
▪ DERMOID – MIDLINE
▪ MENINGOCELE – INFRONT OF THE NECK NEAR THE THYROID CARTILAGE
• SIZE
▪ VERTICAL AND HORIZONTAL DIMENSION

• COLOUR
▪ BLUE – VENOUS HEMANGIOMA
▪ RED – ARTERIAL HEMANGIOMA
▪ BLACK COLOUR – NEVUS OR MELANOMA
▪ BLUE - RANULA
• SHAPE
▪ GLOBULAR
▪ HEMISPHERICAL
▪ OVAL
▪ PEAR SHAPE
▪ PYRIFORM
▪ IRREGULAR
 ▪ KIDNEY SHAPE
▪ BUTTERFLY SHAPE
▪ DIFFUSED
▪ WELL LOCALIZED

• EXTENT
▪ VERTICAL FROM BONY PROMINENCE
▪ HORIZONTAL FROM BONY PROMINENCE
• SURFACE
▪ SMOOTH - CYST
▪ LOBULAR - LIPOMA
▪ NODULAR – MULTINODULAR GOITRE
▪ IRREGULAR – PAPILLOMA, CARCINOMA
▪ CAULIFLOWER LIKE – SQUAMOUS CELL CARCINOMA
▪ BOSSULATED
• MARGIN
▪ WELL DEFINED REGULAR – LIPOMA, SEBACEOUS CYST
▪ WELL DEFINED IRREGULAR – MALIGNANT SWELLING
▪ ILL DEFINED – INFLAMMATORY SWELLING
▪ PEDUNCULATED – PEDUNCULATED LIPOMA
▪ DEEP SEATED - SARCOMA
• SKIN OVER THE SWELLING
▪ RED AND EDEMATOUS – INFLAMMATORY SWELLING
▪ TENSE AND GLOSSY WITH PROMINENT VEINS – SARCOMA
▪ SCAR – PRESENT MEANS RECURRENT SWELLING
▪ SINUS - TUBERCULOUS SINUS,
▪ PUNTUM – SEBACEOUS CYST
▪ PIGMENTATION – COMMON AFTER RADIOTHERAPY
▪ DILATED VEINS – SARCOMA, MALIGNANCY
▪ PEAU D ‘ORANGE – CARCINOMA BREAST
▪ ULCER
▪ SATELLITE NODULES
▪ ANY DISCHARGE
▪ LOSS OF HAIR – SEBACEOUS CYST
• VISIBLE PULSATION – CLOSE TO THE ARTERY OR ADHERENT TO THE ARTERY – PULSATILE

• IMPULSE ON COUGH – COMMUNICATING IN TO DEEP CAVITY

▪ HERNIA
▪ ILIOPSOAS ABSCESS
▪ EMPYEMA NECESSITANS
▪ PHARYNGEAL POUCH
▪ MENINGOCELE
▪ OCCIPITAL MENINGO – ENCHALOCELE
 • MUSCLE WASTING
▪ TRAUMA
▪ DISUSE ATROPHY
▪ NERVE INJURY
▪ NERVE ISCHEMIA
• LYMPH NODES ENLARGEMENT – INFLAMMATORY, CARCINOMA, SARCOMA

PALPATION:

• TEMPERATURE
• TENDERNESS
• SITE,
• SIZE,
• SHAPE,
• EXTENT
• SURFACE
• MARGIN
• CONSISTENCY
▪ FIRM
▪ SOFT
▪ CYSTIC
▪ HARD
▪ BONY HARD
▪ VARIABLE
• FLUCTUATION IF THE SWELLING IS CYSTIC
• TRANSILLUMINATION, IF SWELLING IS CYSTIC
• REDUCIBLE OR NOT
• COMPRESSIBLE OR NOT
• MOBILITY – HORIZONTAL AND VERTICAL DIRECTION
• PULSATILITY
▪ TRANSMITTED PULSATION
▪ EXPANSILE PULSATION
• THRILL
• EXPANSILE COUGH IMPULSE
• PLANE OF THE SWELLING
▪ CUTANEOUS – SKIN PINCHABLE OR NOT.
▪ SUB CUTANEOUS – SKIN PINCHABLE, MOVABLE IN ALL DIRECTION.
▪ SUB FASCIAL – SWELLING BECAMES MORE PROMINENT.
▪ INTER MUSCULAR -
▪ INTRAMUSCULAR -
▪ BONY
• MUSCLE WASTING
• PULSES DISTAL TO THE SWELLING
 • EXAMINATION OF NERVOUS SYSTEM
▪ TOUCH
▪ PAIN
▪ POSITION SENSE
▪ JOINT SENSE
▪ MUSCLE POWER
• ADJACENT JOINT MOVEMENTS
▪ ACTIVE MOVEMENTS
▪ PASSIVE MOVEMENTS
• UPPER OR LOWER LIMB MEASUREMENTS
• EXAMINATION OF THE LYMPHNODES

PERCUSSION:

• IN CASE OF HERNIA, LARYNGOCELE, ABDOMINAL MASS.

AUSCULTATION:

• BRUITS OVER THE SWELLING LIKE A-V FISTULA, ARTERIAL STENOSIS, ANEURYSMS.

OTHER SYSTEM EXAMINATION:

CARDIOVASCULAR SYSTEM:

▪ S1 S2 PRESENT
▪ ADDED SOUNDS

RESPIRATORY SYSTEM:

▪ NVBS PRESENT
▪ ADDED SOUNDS

ABDOMEN:

• SOFT
• BOWEL SOUNDS
• ORGANOMEGALY
• MASS PALPABLE
• FREE FLUIDS

CENTRAL NERVOUS SYSTEM:

• NFND

DIAGNOSIS:

▪ BENIGN / MALIGNANT SWELLING

▪ SITE
▪ SIDE
▪ PROBABLE LIPOMA/ SEBACEOUS CYST/DERMOID CYST.