Lump Examination (OSCE)

Introduction 

 Greet patient and introduce yourself 

 Confirm patient details 

 Briefly explain the procedure 

 Wash hands ✋

 Explain that a chaperone will be present throughout the examination 

 Get patient consent ✅

 Adequately expose the patient 

 Check the patient is not in any pain 

Inspection

Inspection of patient: 

 Identify pain 😪

 Observe the patient’s colour (pallor/anaemia) 

 Identify abdominal distension 

 Identify muscle wastage/cachexia 

 Identify any relevant objects (vomit bowls or medication) 

Inspection of lump:

 Position: identify the specific position of the lump (multiple lumps indicates superficial lymph nodes/lesions or dermatological issues) 

 Size: measure the lump with a tape measure 📏

 Shape: assess the outline of the lump 

 Colour: assess whether it is consistent or different to the surrounding skin 

 Contour: asses the appearance and texture of the skin on the lump 

Palpation

Palpation of the lump:

 Tenderness: press the lump to identify if it is completely or partly tender 

 Temperature: compare the temperature of the lump using the back of your hand, to the surrounding skin (raised temperature indicates erythema) 🌡

 Consistency: hard/ soft/ firm/ nodular❓

 Tethering: mobile/ tethered to skin or muscle 

 Pulsatility: if the lump is pulsatile it indicates vascular aetiology 💓

 Lymphadenophathy: palpate the relevant lymph nodes, lymphadenopathy around the lump indicates infection or malignancy 

Auscultation

Auscultate the lump:

 Auscultate the lump to identify a bruit 

 Bruit sounds suggests the lump contains bruit 👂

Further tests 

Compress the lump: 

 Used when a hernia is suspected 

 Assess by pressing the lump or asking the patient to lie down 😪

 If the lump is reducible, it is probably a hernia  

 If the lump is painful and reducible, it is probably a trangulated hernia 😪

Cough impulse test: 

 Used when a hernia is suspected 

 Palpate the lump as the patient coughs 

 If the size of the lump increases when the coughs, it indicates communication between the lump (hernia) and the intra-abdominal cavity 

Transillumination test: 

 Shine light through the lump 🔦

 If the lump illuminates, it suggests it is cystic 

Completion 

1. Tell the patient the examination is complete ✅
2. Thank patient 
3. Document what the examination revealed ✍
4. Explore alternative diagnoses 

Summary:

1. Greet the patient and explain the procedure
2. Inspect the patient and lump
3. Palpate the lump
4. Auscultate the lump to assess whether there are bruit sounds
5. Compress the lump to assess whether it is painful/reducible which indicates that it is a hernia
6. Perform a cough impulse test to assess if there is communication between the lump and the intra-abdominal cavity
7. Perform a transillumination test to assess if the lump is cystic