Surgery Case Taking

RIGHT LUMBAR REGION LUMP CASE SHEET
Name Age/Sex Profession
Address Socioeconomic status Religion
Chief Complaint
Lump in the right central abdomen – 3 months
History of present illness
Patient was apparently normal /maintaining normal health 3 months ago, when he noticed a
lump in the central abdomen to the right side of umbilicus.
When he first noticed, the size of the lump was around 5 x 5 cm.
The lump gradually increased in size and attained the present size of around 10 cm
There is also history of loss of weight (loss of appx.7-8 kg in 30 days) and loss of appetite
No history of blood in urine / any difficulty in micturition
Lump is not associated with pain, fever
No history of trauma
No history of sudden increase in the size of the lump
No history of similar lump on opposite side of umbilicus or anywhere else in body.
No history of nausea, vomiting.
No history of recent onset of jaundice, abdominal distention, obstipation, upper/lower GI

bleed.
No history of alteration in bowel habits in terms of frequency and consistency.
No history of swelling of lower limbs
No history suggestive of TB
No history suggestive of metastasis.

Past History
No history of similar complaints in the past.
No co-morbid illness in the past
No surgical intervention in past
Personal History
Takes mixed diet
Bowel and bladder habits are normal.
Sleep and appetite are normal.
Non smoker and non alcoholic
Family history
No history of any cancer related death in the family.
Treatment History
Patient hasn`t underwent any type of treatment for the complaints.
Summary of History
A 46 yr old gentleman, without any co-morbid illness presented with a painless, progressive
lump in the right central part of abdomen for 3 months. Lump is associated with history of
loss of weight and loss of appetite. No history of blood in urine / any difficulty in micturition.
No history of any altered bowel symptoms. No history of swelling of lower limbs. No history
suggestive of TB. No history suggestive of metastasis.
Physical Examination & General Survey
I have examined the patient with informed consent in a well lit room and adequate exposure
in the presence of family attendant.
Patient is conscious, coherent, co-operative
BMI - Wt - Ht-
Hydration status – Well maintained
Performance scale –
Pallor / Icterus / Cyanosis / Clubbing / Generalized lymphadenopathy / Pedal Edema
Vital signs
Pulse – 78/min in the right radial artery , normal volume, regular rhythm, no radio-radial
delay and radio-femoral delay.
BP: 120/80 mmHg in right arm supine position.
A febrile
Respiratory rate : 14 cycles / min (abdomino-thoracic in male)
Examination of abdomen
Inspection
• Abdomen is flat
• Umbilicus is in midline and inverted
• No engorged/dilated veins, abnormal arterial pulsations/ visible peristalsis can be

seen over abdomen
• Fullness is present in the right lumbar and upper right iliac fossa regions.
• Renal angles are normal
• Hernial orifices including external genitalia appears normal
• No supraclavicular fossa fullness is seen
Palpation
• No local rise of temperature over abdomen
• A non-tender intra abdominal, retro-peritoneal lump of size 10 x 7 cm in vertical to

horizontal direction is present and is occupying lower right lumbar and upper right
iliac fossa regions.
• Lump is having smooth surface.
• Except for the superior margin, rest all margins are well defined.
• Superior margin of the swelling is not palpable as it is merging beneath the coastal
margins.
Fingers can be insinuated between the coastal margin and the lump.
• Inferior border of swelling in 10 cm below the right coastal margin in mid-clavicular

line, medial margin of the lump is palpable 3 cm lateral to midline and lateral margin
is 10 cm lateral to midline on right side.
• This lump is firm in consistency, immobile, not moving with respiration.

• Lump is non-ballotable and is bimanually not palpable.
• Liver & Spleen are not palpable
• No other abdominal lump was palpable
• Palpation of renal angles, left supraclavicular regions – normal
• Hernial orifices and external genitalia – normal
Percussion
• Liver span is 14 cm
• Lump is dull on percussion and is not continuous with liver dullness.
• Rest of the abdomen is resonant.
• No evidence of free fluid
Ausculation
• Normal bowel sounds heard
Per rectal examination – Normal
Systemic examination
• Cardio vascular system, respiratory system and abdominal examination is normal.
Summary of case
• A 46 yr old gentleman, without any co-morbid illness presented with a painless,

progressive lump in the right central part of abdomen for 3 months. On examination, a
non-tender intra abdominal, retro-peritoneal lump of size 10 x 7 cm is occupying lower
right lumbar and upper right iliac fossa regions. Lump is having smooth surface. Except
for the superior margin, rest all margins are well defined. Fingers can be insinuated
between the coastal margin and the lump. This lump is firm in consistency, not moving
with respiration and immobile on manipulation. Lump is not crossing the midline, non-
ballotable and is bimanually not palpable. Lump is dull on percussion and is not
continuous with liver dullness. Rest of the abdominal and systemic examination is
normal.
Clinical Diagnosis (Provisional)

I would like to give a differential diagnosis. My 1st provisional diagnosis is a Retroperitoneal
tumor (malignant in origin) and 2nd diagnosis is Renal cell carcinoma of right kidney.
BREAST LUMP - CASE SHEET

Chief Complaint
Lump in the right breast - 3 months
Patient was apparently normal /maintaining normal health 3 months ago, when she noticed a
lump in the right breast which was insidious in onset, started as a swelling of size 1 x 2 cm,
gradually progressed and attained the present size of around 5 x 5 cm.
The swelling is not associated with pain, fever (To rule out abscess) and trauma (To rule out
fat necrosis).
No history of sudden increase in the size of the swelling.
No history of skin changes overlying the swelling.
No history of nipple discharge/nipple retraction/nipple destruction
No history of change in the size of the swelling with menstrual periods
No history of other swelling in the same side axilla /opposite breast and axilla / neck or
anywhere else in the body.
No history of loss of weight /loss of appetite
No history suggestive of metastasis (hemoptysis, dyspnea, postural headache, focal

neurological deficits or recent onset of bony pains)
Past History
No co-morbid illness in the past.
No surgical intervention to breast in past.

Personal History
Takes mixed diet
Menstrual History
Patient attained menarche at 12 years of age.
Having regular periods for 5 days in a 30 day cycle.
She was married at 20 yrs of age.
No history of oral contraceptive usage.
First live child birth - 22 yrs of age.
Adequately breast fed the baby.
Family history
Her family includes husband, 2 children, mother and father. No history of breast cancer in any
of 1st degree relatives. No history of cancer related death in family.
Treatment History
Patient underwent a needle test for the swelling elsewhere and report was awaited.
Summary of History
A 45 yr old lady has come with a painless, progressive lump in the right breast for 3 months.
Lump is not associated with any pain, fever, trauma, nipple discharge, skin changes, loss of
weight, loss of appetite and features of metastasis. No history of any swelling in the other
breast, ipsilateral or contra lateral axilla.
I have examined the patient with informed consent in a well lit room under adequate
exposure in the presence of a family attendant.
I have inspected the patient in supine, sitting and bending forward positions with arms by the
side, elevated above head and palpated in semi-recumbent & sitting positions.
Patient is conscious, coherent, and cooperative

BMI - Wt - Ht-
Vital signs
Pulse – 82/min in the right radial artery, normal volume, regular rhythm, no radio-radial delay
and radio-femoral delay.
A febrile
Respiratory rate: 14 cycles / min
Examination of Breast:
• Left sided breast and axillary examination is essentially normal.
Inspection
• Right sided breast is in asymmetry with left breast with respect to size, contour and
shape.
• Fullness is present in the upper outer quadrant.
• No engorged veins, scars, sinuses, ulcers or any other skin changes (Dimpling,
tethering or paeu-d-orange) overlying lump.
• Nipple Areola Complex (NAC)
• Lying at higher level compared to left NAC
• Deviated upwards & outwards
• Nipple is retracted in circumferential manner
• No active secretion from nipple.
• Infra mammary regions – normal
• Supra & infraclavicular regions – normal
• No right sided arm edema
• No visible swellings in right sided axilla

Palpation
• No local rise of temperature or tenderness overlying the lump.
• A lump of 4x5 cm in greatest dimensions is present in the upper outer quadrant of

right breast. This lump is occupying
• Lump is having well defined margins. Surface appears smooth.
• Lump is hard in consistency, fixed to breast tissue but not to chest wall, underlying
muscles and to the skin.
• Right side axillary lymphadenopathy present – A 2x1 cm single lymph node in

pectoral group which is non-tender, mobile and not fixed to surrounding tissue.
• No supra-clavicular lymphadenopathy
• Cardio vascular system, respiratory system and abdominal examination are normal.
Summary of Case
• A 45 yr old lady has come with a painless, progressive lump in the right breast for 3
months. On examination a lump of 4x5 cm in greatest dimensions is present in the
upper outer quadrant of right breast which is hard in consistency, fixed to breast tissue
but not to chest wall, underlying muscles or to the overlying skin. Nipple areola
complex is deviated upwards &outwards to the lump in upper outer quadrant. Nipple is
retracted in circumferential manner. A single, mobile 2x1 cm pectoral group of lymph
node is present in right axillary region. Rest of systemic examination is normal.
Right sided carcinoma breast in a pre-menopausal lady with clinical TNM Stage – T2 N1M0
Points supporting in history – A painless, progressive lump in the right breast for 3 month in a
45 year old lady
Points supporting in examination – Lump is hard in consistency, having ill defined margins.
This lump is fixed to breast tissue. NAC is circumferentially retracted. A lymph node is
enlarged in the ipsilateral axilla.
CERVICAL LYMPHADENOPATHY - CASE SHEET

Chief Complaint
Swelling over the left side of neck – 2months
swelling over left side of neck which was insidious in onset, started as a swelling of size 1 x 1
cm and enlarged to 3x3 cm size within a span of 2 weeks and was static from then.
There is history of loss of weight - 10 kg in 2 months and history of loss of appetite
The swelling is not associated with pain, fever.
No history of other swellings in the neck or elsewhere in the body.
No history of any chronic ulcer in the mouth/ alteration in speech/ any difficulty or pain
while swallowing/ difficulty in breathing
No history of any earache/ bleeding from nose
No history of any difficulty in opening the mouth or protrusion of tongue
No history suggestive of metastasis (haemoptysis, dyspnoea, postural headache, focal

neurological deficits or recent onset of bony pains
A known hypertensive for last 2 years and on regular medication (Tab Amlodipine 5 mg once a
day)
Past History
No history of similar complaints in the past/ No co morbid illness in the past
No history of any previous surgeries
No history of DM, TB, Asthma, Epilepsy.
Personal History
Takes mixed diet
A known bidi smoker – 35 years, 15-20 bidis /day, Smoking index > 550
No history of tobacco intake in any other form
Non – alcoholic
Sleep is normal.
Family history
Treatment History
Patient hasn’t undergone any kind of treatment earlier.
Summary of History
A 58 yr gentleman, known hypertensive, a chronic bidi smoker for last 35 yrs (Smoking Index >
550) presented with a painless swelling over the left side of neck with H/O significant loss of
weight and appetite.
BMI - Wt - Ht-
Vital signs
Pulse is 82/min in the right radial artery, normal volume, regular rhythm, no radio-radial
A febrile
Examination of Neck:
A 3 x 4 cm single cervical lymph node (Deep to deep fascia) - Level – III
LN is hard in consistency, Fixed to underlying structures, Not fixed to overlying skin
Surface is smooth, No skin changes overlying swelling
No any other enlarged cervical LN on same/opposite side.
Examination of Head:
Symmetry of head – maintained
Mouth opening is adequate (>3 cm)
Halitosis & poor oro-dental hygiene present
Mucosa over lips, upper & lower gingivo-labial sulcus and gingivo-buccal sulcus on both sides
normal
Multiple patches of melanoplakia & leukoplakia present over floor of mouth, mucosa over
hard palate and buccal mucosa.
Tobacco staining of tooth present
No loss of teeth
No well defined ulcer/lesion seen
Tongue movements – Normal
Retro molar trigone – normal
Salivary duct openings – normal
Rest of oral cavity examination including cranial nerves X, XI, XII is normal.
Spine, Scalp examination – Normal
ENT examination – Normal

B/L tonsils – grossly appears normal
Thyroid & parotid examination normal
Summary of Case
A 58 yr gentleman, a known HTN & smoker presented with a painless swelling over the left
side of neck. On examination anemia + and a hard, fixed cervical lymph node present in
Level III on left side. No generalized lymphadenopathy. Oral examination revealed multiple
patches melanoplakia and leukoplakia. ENT & systemic examination – normal.
Level III cervical lymphadenopathy on left side? Malignant with clinically unknown primary
Points supporting in history - A 58 yr gentleman, a chronic smoker with smoking index of

>550 presented with a painless progressive swelling over the left side of neck with history of
significant loss of weight and appetite.
Points supporting in examination - A hard, fixed cervical lymph node present in Level III on
left side. Oral examination revealed multiple patches melanoplakia and leukoplakia.
HYPOGASTRIAL LUMP CASE SHEET
Chief Complaint
Fullness in the lower abdomen – 1 year
Patient was apparently normal /maintaining normal health 1 year ago, when she noticed
fullness of the lower abdomen below the umbilicus.
This distention was insidious in onset, gradually progressing.
But for last 2 months she noticed a lump in the lower abdomen. When he first noticed, the
size of the lump was ill defined and was of size around 6 x 7 cm.
The lump gradually increased in size and attained the present size of around 10 cm.
There is also history of loss of weight (loss of appx.7-8 kg in 2 months) and loss of appetite
No history of blood in urine / any difficulty in micturition
Lump is not associated with pain, fever
No history of trauma
No history of sudden and rapid increase in the size of the lump
No history of similar lump anywhere else in body.
No history of nausea, vomiting.
No history of recent onset of jaundice, obstipation, upper/lower GI bleed.
No history of swelling of lower limbs (Pedal edema)
No history suggestive of TB

Past History
No history of similar complaints in the past.
Personal History
Takes mixed diet
Sleep is normal.
Menstrual History
Patient attained menarche at 12 years of age
She was married at 20 yrs of age
Having irregular cycles for last 3-4 months
No history of excessive bleeding.
Family history
Treatment History
Patient hasn`t underwent any type of treatment for the complaints.
Summary of History
A 46 yr old gentleman, without any co-morbid illness presented with a painless, progressive
lump in the right central part of abdomen for 3 months. Lump is associated with history of
loss of weight and loss of appetite. No history of blood in urine / any difficulty in micturition.
No history of any altered bowel symptoms. No history of swelling of lower limbs. No history
suggestive of TB. No history suggestive of metastasis.

BMI - Wt - Ht-
Vital signs
A febrile
Inspection
• Abdomen is flat
• All quadrants are moving equally with respiration

seen over abdomen
• Fullness is present in the hypogastrium
• No fullness is seen in flanks.
Palpation
• No local rise of temperature over abdomen
• A non tender, intra abdominal lump of size 14 x 8 cm is occupying hypogastrium, and

partially iliac fossa bilaterally.
• Superiorly the lump is extending upto umbilicus and laterally extending 7 cm lateally
on either side of midline. Inferior extent of the swelling couldn`t be felt.
• Lump is having smooth surface.
• This lump is firm in consistency and is having limitted mobility side to side. This lump
is immobile in vertical direction.
Percussion
• Lump is dull on percussion.
• Rest of the abdomen including flanks is resonant.
Ausculation
Per rectal examination - Normal
Per Vaginal examination – Movement of the cervix can be appreciated while swelling is
moved side to side.
Summary of case
• A 46 yr old gentleman, without any co-morbid illness presented with a painless,

progressive lump in the right central part of abdomen for 3 months. On examination, a
non-tender intra abdominal, retro-peritoneal lump of size 10 x 7 cm is occupying lower
right lumbar and upper right iliac fossa regions. Lump is having smooth surface. Except
for the superior margin, rest all margins are well defined. Fingers can be insinuated
between the coastal margin and the lump. This lump is firm in consistency, not moving
with respiration and immobile on manipulation. Lump is not crossing the midline, non-
ballotable and is bimanually not palpable. Lump is dull on percussion and is not
continuous with liver dullness. Rest of the abdominal and systemic examination is
normal.
Lump arising from uterus uterus ( Malignant in origin)

INGUINAL HERNIA CASE SHEET
Chief Complaint
Swelling in the right groin -3 months
swelling in the right groin while lifting some heavy weight. Initially the swelling was of size
2x2 cm gradually progressed to the present size of approximately 10 cm. and reached up to
bottom of scrotum.
Swelling increases in size on coughing, straining and after some activity.
Earlier swelling used to get reduced completely on lying down, but for the last 1 month
manipulation is needed to reduce it.
No episodes of irreducibility of swelling
No history suggestive of intestinal obstruction
No history of pain, fever, skin changes overlying swelling (Suggestive of strangulation)
No history of similar swellings on the other side or elsewhere in the body.
No history of chronic cough with expectoration, breathlessness
No history of constipation/excess straining while passing stools
No history of difficulty in micturition.
Past History
Personal History
Takes mixed diet

Family history
No similar history present in family
Treatment History
Patient hasn`t underwent any treatment for the same
Summary of History
A 45 yr old gentleman, presented with a painless, progressive swelling which was started in
the right groin and gradually reached up to bottom of scrotum. Swelling increases in size on
straining and used to get reduced completely on lying down, but for the last 1 month
manipulation is needed to reduce it. No history suggestive of irreducibility and intestinal
obstruction.
I have examined the patient in both standing and lying down positions.
BMI - Wt - Ht-
Pallor / Icterus / Cyanosis / Clubbing / Generalized lymphadenopathy / Pedal edema
Vital signs
Pulse – 82/min in the right radial artery, normal volume, regular rhythm, no radio radial delay
A febrile
Examination of bilateral inguino-scrotal region:

• Left sided inguino-scrotal examination is normal
Inspection
• Right side inguino-scrotal region – A pyriform shaped swelling of size 10 x 8 cm in

vertical- horizontal direction is present in the right inguino-scrotal region extending
from mid-inguinal region up to the bottom of scrotum.
• Borders of swelling are ill defined
• Surface appears smooth
• No scars/sinuses over swelling
• Skin over the swelling normal.
• Visible peristalsis can be seen over the swelling
• On coughing, expansile cough impulse is present over the swelling.
Palpation
• No local rise of temperature or tenderness overlying the swelling
• All inspectory findings (site, size, shape, surface, overlying skin) are confirmed
• I couldn`t able to get above the swelling
• Swelling lies above & medial to public tubercle.
• Expansile cough impulse is demonstrable over the swelling
• Consistency of the swelling is soft & elastic
• Swelling can be reduced completely with manipulation. During reduction there is

slight difficulty initially but later on easily reduced.
• Deep ring occlusion test is positive.
Percussion
• Resonant note can be appreciated
Auscultation
• Bowel sounds can be heard
Testis couldn`t be felt separately
Malgagnie bulges are absent

Per rectal examination is normal
External genitalial examination is normal
No meatal stenosis
No urethral stricture is palpable
Other hernia orifices - normal
Summary of Case
• A 45 yr old gentleman, presented with a painless, progressive swelling in the right

groin for 3 months. On examination, an inguino scrotal swelling of size 10 x 8 cm,
reaching up to bottom of scrotum. This swelling is having expansile cough impulse with
visible peristalsis over the swelling. Swelling is soft & elastic in consistency and can be
completely reduced. Deep ring occlusion test is positive. Contra lateral side
examination is normal.
Right side complete reducible indirect inguinal hernia with bowel as content
Points in favour of inguinal hernia –
A 45 year old gentleman presented with history of swelling in the right groin which gradually
increased and reached up to bottom of scrotum. On examination a completely reducible
inguino scrotal swelling was present with expansile cough impulse. (Suggestive of reducible,
inguinal hernia).
Deep ring occlusion test is positive (Suggestive of indirect type of hernia)
Contents are soft & elastic in consistency with visible peristalsis. There is difficulty in
reduction initially followed by easy reducibility. Contents are resonant in percussion and
bowel sounds are heard in auscultation. (Suggests bowel is the content)
RIGHT ILIAC FOSSA LUMP CASE SHEET
Chief Complaint
Pain in the right lower abdomen – 7 days
Patient was apparently normal /maintaining normal health 7 days ago, when he developed
sudden onset of continuous, dull aching pain in the umbilical region. This pain
gradually shifed to right lower abdomen in a span of few hours.
Pain in the right lower abdomen is severe in intensity, continuous, sharp, non-colicky and non-
radiating type which is gradually increasing in severity.
This pain is Pain aggravates on movement, food intake and relieves partially on taking
medications.
Pain is associated with 7-8 episodes of non-bilious vomiting- which was minimal in quantity &
containing food particles.
Pain is also associated with anorexia and loss of appetite.
No postural/diurnal variation of pain.
No history of recent onset of jaundice, upper/lower GI bleed.
No history of fever
No history of loss of weight
Past History
Patient was complaining of similar episodes of mild, dull aching pain in the right
upper abdomen for last few months especially after food intake, which used to get
reduced spontaneously after few hours.
Personal History
Takes mixed diet
Family history
Treatment History
Patient was treated conservatively by a physician, but without much improvement.
Summary of History
A 36 yr old gentleman, without any co-morbid illness presented with sudden onset of severe,
non-radiating pain in the right upper abdomen for 7 days. Pain aggravates on movement, food
intake and relieves partially on taking medications. These symptoms are also associated with
loss loss of appetite.
BMI - Wt - Ht-
No signs of liver failure
Scratch marks are present over abdomen and limbs
Vital signs
A febrile
Inspection
• Abdomen is flat

seen over abdomen
• No visible fullness/lump is seen over abdomen
Palpation
• No local rise of temperature or tenderness over abdomen
• A tender intra abdominal,intra peritoneal globular lump of size 8 x 6 cm in vertical to

horizontal direction is present and is occupying lower right hypochondrial and right
lumbar region, having smooth surface, rounded margins. Superior margin of the
swelling is not palpable as it is merging beneath the coastal margins.
• This swelling is firm in consistency, can be moved side to side and moving above
downward with respiration.
• Herrnial orifices and external genitalia – normal
Percussion
• Lump is dull on percussion and is continuous with liver dullness.
Ausculation
Summary of case
• A 36 yr old gentleman, presented with continuous pain in the right upper abdomen for
7 days.. On examination, a tender intra abdominal, intra peritoneal globular lump of
size 8 x 6 cm is occupying lower right hypochondrial and right lumbar region, having
smooth surface, rounded margins. Superior margin of the swelling is not palpable as it
is merging beneath the coastal margins.This swelling is firm in consistency, can be
moved side to side and moving above downward with respiration. Lump is dull on
percussion and is continuous with liver dullness. No hepato-splenomegaly.
Gall bladder lump – Benign in origin (Probably Mucocele of GB)

OBSTRUCTIVE JAUNDICE CASE SHEET
Chief Complaint
Yellowish discoloration of eyes and urine – 30 days
Pain in upper abdomen – 20 days
Patient was apparently normal /maintaining normal health 30 days ago, when he noticed
yellowish discoloration of urine followed by eyes, which was insidious in onset, gradually
increasing in severity without waxing and waning.
This is associated with itching all over the body – started 1 week after onset of jaundice,
progressive in nature, continuously present throughout day and night disturbing his sleep.
There is also history of passage of clay colored stools – noticed 1 week after onset of jaundice
Jaundice is also associated with mild, dull aching pain in the upper abdomen, which started
10 days after onset of jaundice. Pain in upper abdomen, is continuous, non-progressive
without any radiation, postural variation, and diurnal variation. There are no specific
aggravating and relieving factors. There is no relation with food intake.
There is also history of loss of weight (loss of appx.7-8 kg in 30 days) and loss of appetite.
No history of passage of black, tarry fouls smelling stools (History suggestive of malena)
No history of hematemesis, hematochezia
No history of nausea, vomiting, abdominal distention (History to rule out gastric outlet
obstruction) , fever with chills & rigors. (History suggestive of cholangitis)
No history of arthalgia, any constitutional symptoms (History suggestive of medical cause of

jaundice)
No history of blood transfusion (History suggestive of medical cause of jaundice)
No history of high risk behavior/ other drug intake (History suggestive of medical cause of
jaundice)

Past History
No co morbid illness in the past
Personal History
Takes mixed diet
A known bidi smoker for 35 years, 15-20 bidi /day with Smoking index > 550. Patient is also
giving history of chewing pan every day 3 or 4 times for the last 20 years.
History of occasional alcohol intake was present.
Family history
Treatment History
Summary of History
A 62 yr old gentleman presented with gradually deepening jaundice for 1 month. This
jaundice is without waxing & waning and associated with generalized bothersome itching all
over the body and passage of clay colored stools. Jaundice is also associated with mild dull
aching, continuous, non- radiating pain in the upper abdomen. These symptoms are also
associated with loss of weight and loss of appetite.
I have examined the patient with informed consent in a well lit room under adequate
exposure in the presence of family attendant.
BMI - Wt - Ht-

Vital signs
Pulse rate is 78/min in the right radial artery, normal volume, regular rhythm, no radio-radial
A febrile
Inspection
• Abdomen is flat

seen over abdomen
Palpation
• A non tender intra abdominal, intra peritoneal globular lump of size 6x3 cm is present
and is occupying lower part of right hypochondrium and upper part of right lumbar
region, having smooth surface, rounded margins but superior margin of the swelling is
not palpable as it is merging beneath the coastal margins.
downward with respiration
• Lower border of liver is palpable 3 cm below the right coastal margin in mid-clavicular
line – which is non tender, having round borders, surface is soft & smooth.
• Spleen is not palpable
Percussion
Auscultation
Summary of case
• A 62 yr old gentleman presented with gradually deepening jaundice without waxing &
waning and is associated with generalized itching, passage of clay colored stools and
mild dull aching, continuous, non- radiating pain in the upper abdomen. He is also
giving history of loss of weight and loss of appetite. On examination, there is
hepatomegaly with palpable gall bladder. Liver is non tender, having round borders,
surface is soft & smooth. No other lump is palpable in abdomen.
Obstructive Jaundice – malignant in origin (Peri-ampullary carcinoma / pancreatic head

carcinoma)
Points in favor of obstructive jaundice – An elderly patient who is a known chronic smoker
and alcoholic with history of gradually progressive jaundice without waxing & waning and is
associated with generalized itching, passage of clay colored stools.
Points in favor of malignancy - An elderly patient who is a known chronic smoker and
alcoholic with history of jaundice associated with significant loss of weight and appetite.
ORAL CARCINOMA - CASE SHEET
Chief Complaint
Ulcer over the right side of tongue -6 months
Swelling below the jaw on right side – 10 days
Patient was apparently normal /maintaining normal health 6 months ago, when he noticed an
ulcer growth over right side of tongue which was insidious in onset, started as a small ulcer
of size 1 x 1 cm gradually progressed and attained the present size.
This growth is associated with mild dull aching continuous pain.
There is history of slurring of speech which is progressing from last 3 months.
There is also history of recurrent episodes of bleeding from the lesion. In each episode the
bleed was around 30-40 ml.
There is history of excessive salivation, difficulty in mastication and difficulty in protrusion

of tongue.
Patient also noticed a swelling below the jaw on the right side which was insidious onset,
started as a swelling of size 1x 1 cm and gradually progressed to a size of 4 x 4 cm.
This swelling is associated with mild pain.
There is history of loss of weight (Lost around 10 kg in last 2 months) and loss of appetite.
No history of unexplained tooth mobility
No history of earache
No history of difficulty in opening the mouth
No history of difficulty in respiration.

neurological deficits or recent onset of bony pains)
day)
Past History
No other co morbid illness in the past
Personal History
A known bidi smoker for 35 years, 15-20 bidi /day with Smoking index > 550. Patient is also
giving history of chewing pan every day 3 or 4 times for the last 20 years.
Previously used to take mixed diet but he could able to tolerate only liquid diet for last 1
week due to difficulty in mastication.
Non alcoholic
No history of high risk behaviour.
Family history
No history of oropharyngeal / aero digestive cancer or any other cancer related death in the
family.
Treatment History
Patient has not taken any treatment for the same.
Summary of History
A 50 yr old gentleman, known hypertensive has come with a progressive ulcer over the right
side of tongue for 6 months. This ulcer is associated with mild dull aching pain, slurring of
speech, excessive salivation, difficulty in protrusion of tongue, difficulty in mastication with
loss of weight and loss of appetite. Patient is also giving history of a painless, progressive
swelling below the right side of jaw.

BMI - Wt - Ht-
Pallor / Icterus / Cyanosis / Clubbing / No generalized lymphadenopathy but I will comment

on cervical lymphadenopathy in-detail in loco-regional examination / Pedal edema
Vital signs
Pulse – 82/min in the right radial artery, normal volume, regular rhythm, no radio radial delay
A febrile,Respiratory rate: 14 cycles / min
Examination of Head & Neck

• Facial symmetry is normal
• Mouth opening is adequate – approximately 3 cm
• Halitosis present
• Poor oro-dental hygiene present
• Sub mucous fibrosis present over angles of mouth
• Mucosa over lips, upper and lower gingivo-labial sulcus and bilateral upper and lower
gingivo buccal sulcus appear normal.
• Multiple patches of melanoplakia & leukoplakia present over floor of mouth, mucosa
over hard palate and buccal mucosa.
• Tobacco staining of tooth present
• No loss of teeth
• An ulcero-proliferative lesion of size 3 x 4 cm is arising from the lateral border of the

tongue in the middle 1/3rd of tongue.
• From the lateral border, this growth is extending over both dorsal and ventral surface
of tongue – for approximately 1-2 cm. But, this growth is not crossing midline.
• This growth is also extending on to the floor of mouth causing impaired mobility of
tongue.
• This growth is tender to touch, hard in consistency and there is induration around the
growth which is extending 1 cm beyond the margins.
• Protrusion of tongue is restricted.
• Retro molar trigone – normal and is free of tumor
• Salivary ductal openings – normal
• Cranial nerve examination – 10,11 and 12 cranial nerves –normal
• Multiple enlarged cervical lymph nodes present involving level I b, II and III ranging in
size from 1cm to largest measuring 4 cm.
• This largest 3 x 4 cm sized cervical lymph node (Deep to deep fascia ) is present in
Level – II which is hard in consistency, fixed to underlying structures, not fixed to
skin.
• Surface is smooth, No skin changes overlying swelling
• B/L tonsils – grossly appears normal
Spine, Scalp, ENT examination – Normal
Summary of Case
• A 50 yr old gentleman, known hypertensive has come with a progressive ulcer over the
right side of tongue for 6 months. This ulcer is associated with mild dull aching pain,
slurring of speech, excessive salivation, difficulty in protrusion of tongue, difficulty in
mastication with loss of weight and loss of appetite. Patient is also giving history of a
painless, progressive swelling below the right side of jaw. On examination, an ulcero-
proliferative lesion of size 3 x 4 cm is arising from the lateral border of the tongue in
the middle 1/3rd of tongue. This growth is also extending on to the floor of mouth
causing impaired mobility of tongue. This growth is tender to touch, hard in
consistency and there is induration around the growth which is extending 1 cm beyond
the margins. Protrusion of tongue is restricted. Multiple enlarged cervical lymph nodes
present involving level I b, II and III ranging in size from 1cm to largest measuring 4 cm.
This largest 3 x 4 cm sized cervical lymph node (Deep to deep fascia) is present in
Level – II which is hard in consistency, fixed to underlying structures, not fixed to
skin.
Carcinoma middle 1/3rd of tongue over right lateral border with clinical stage – T4A N2A M0
Points supporting in history – A 50 year old gentleman with history of bidi smoking ( smoking
index - >550) with history of a non healing ulcer over right lateral border of tongue
associated with slurring of speech, excessive salivation, difficulty in protrusion of tongue,
difficulty in mastication with loss of weight and loss of appetite.
Points supporting in examination – An ulcero-proliferative lesion of size 3 x 4 cm is arising

from the lateral border of the tongue in the middle 1/3rd of tongue extending onto floor of
mouth. This growth is tender to touch, hard in consistency and there is induration around the
growth which is extending 1 cm beyond the margins. Protrusion of tongue is restricted.
Multiple enlarged cervical lymph nodes present involving level I b, II and III ranging in size from
1cm to largest measuring 4 cm. This largest 3 x 4 cm sized cervical lymph node (Deep to
deep fascia) is present in Level – II which is hard in consistency, fixed to underlying
structures, not fixed to skin.
PANCREATIC PSEUDOCYST CASE SHEET

Chief Complaint
Pain in the upper abdomen – 3 months
Lump in the upper abdomen – 2 months
Patient was apparently normal /maintaining normal health 3 months ago, when he developed
Upper abdominal pain which was sudden in onset, started in central part of upper abdomen
later involved whole upper abdomen. Pain was continuous, severe in intensity, agonizing in
nature and radiating to the back. Pain aggravates with movement or food intake and partially
relieved with pain killers and by sitting in bending forward position
Pain was also associated with nausea, vomiting and low grade fever. Vomiting was of multiple
episodes, non-bilious, non bloody and food particles as content.
Patient was denying any history of trauma, jaundice.
Patient was admitted with above mentioned complaints in a nearby hospital and was managed
conservatively with IV fluids with Ryle`s tube insertion, IV antibiotics and IV pain killers. Pain
was increasing in intensity for 1 week and subsided with this conservative management.
Patient started on normal diet and was discharged in stable condition. Total hospital stay was
15 days.
Two weeks after discharge patient noticed a feeling of discomfort, heaviness and fullness in
the central part of upper abdomen. Gradually the upper abdominal fullness progressed to a
palpable lump of size approximately 10 cm in 2 months. Lump is associated with feeling of
heaviness and mild vague aching pain which was non-radiating in nature. No specific
aggravating and relieving factors for the pain. Lump is not associated with any fever,
jaundice, vomiting, and change in bowel habits in terms of consistency, frequency, and
hematemesis/malena.
No history of loss of weight or loss of appetite.
No history of any other lump anywhere in body.
Past History
Personal History
Takes mixed diet
Sleep and appetite were normal.
Family history
Summary of History
Patient is conscious, coherent, and co-operative
BMI - Wt - Ht-

Vital signs
Pulse rate is 78/min in the right radial artery, normal volume, regular rhythm, no radio-radial
A febrile
Inspection
• There is fullness present in the epigastric and umbilical regions.
• Umbilicus - Midline, inverted.
• All the quadrants of the abdomen are moving equally with respiration.
• No scars, sinuses and no dilated veins seen over the abdomen.
• No abnormal arterial pulsations/ visible peristalsis can be seen over abdomen
Palpation
• There is no local rise of temperature but there is minimal tenderness present over the
lump.
• An intra-abdominal, retroperitoneal lump of size 12 x 10 cm is palpable and it is

occupying the epigastric, umbilical and partially occupying the both hypochondriac
regions.
• Superior limit of lump is not defined, supero-lateral boundaries are merging beneath
coastal margins and inferior boundary is palpable 2 cm above the umbilicus.
• Fingers can be insinuated between costal margins and the lump.
• Surface appears smooth and firm in consistency.
• Lump is immobile and even not moving with respiratory activity.
• No other organomagaly.
• No other mass is palpable in abdomen.
Percussion
• Lump is dull on percussion and character of dullness is different from liver dullness.
Auscultation
Summary of case
PANCREATIC PSEUDOCYST- FOLLOWING PROBABLY ACUTE BILIARY PANCREATITIS
Points supporting the diagnosis
Patient developed sudden onset of severe upper abdominal pain which was radiating to the
back which aggravates with movement or food intake and partially relieved with pain killers
and by sitting in bending forward position. Pain was also associated with nausea, vomiting and
low grade fever. Patient was managed conservatively with IV fluids with Ryle`s tube insertion,
IV antibiotics and IV pain killers. Pain was increasing in intensity for 1 week and subsided with
this conservative management (Suggestive of acute pancreatitis)
Patient was also giving history of multiple episodes of mild, dull aching pain in the
right upper abdomen for last few months especially after food intake, which used to
get reduced spontaneously after few hours. (Suggests biliary cause)
Two weeks after discharge patient noticed fullness in the central part of upper abdomen
which gradually progressed to a palpable lump of size approximately 10 cm in 2 months. On

examination, an intra-abdominal, retroperitoneal lump of size 12 x 10 cm is palpable and it is
occupying the epigastric, umbilical and partially the both hypochondriac regions. Superior
limit of lump is not defined, supero-lateral boundaries are merging beneath coastal margins
and inferior boundary is palpable 2 cm above the umbilicus. Lump is immobile and even not
moving with respiratory activity. Lump is dull on percussion and character of dullness is
different from liver dullness. (Suggests pseudo cyst of pancreas)
PAROTID SWELLING - CASE SHEET

Chief Complaint
Swelling over right upper part of neck below ear lobule -3 months
swelling over right upper part of neck below ear lobule which was insidious in onset, started
as a swelling of size 1 x 2 cm gradually progressed and attained the present size of around 3 x
3 cm.
The swelling is not associated with pain, fever.(Rules out inflammatory etiology)

No history of increase in size of swelling associated with pain while mastication. (Rules out
salivary colicky pain with sialedinitis)
No history of any chronic lesion /ulcer in mouth. (To know source of primary if it`s a
lymph node)
No history of difficulty in deglutition, difficulty in respiration, or change in voice. (To know

source of primary if it`s a lymph node)
No history suggestive of VII nerve palsy (Deviation of mouth, Difficulty in closing eyes etc)
(Features of malignant parotid tumor)
No difficulty in opening the mouth. (Features of malignant parotid tumor)
No history suggestive of tuberculosis (unexplained loss of weight, evening rise of

temperature, cough with expectoration (Always rule out TB in any neck case especially in
India)

day)
Past History
No co morbid illness in the past
Personal History
Takes mixed diet
Family history
Treatment History
Summary of History
A 45 yr old gentleman, known hypertensive has come with a painless, progressive swelling
over right upper part of neck below ear lobule for 3 months without any history of increase in
size of the swelling while mastication, features of VII nerve palsy.
BMI - Wt - Ht-
Vital signs
Pulse rate is 82/min in the right radial artery, normal volume, regular rhythm, no radio radial
A febrile
Examination of Head & Neck:
Inspection
• Facial symmetry normal
• An oval shaped swelling of size 4 x 3 cm in vertical to horizontal dimensions is present

in the right parotid region displacing the ear lobule upwards and outwards.
• This swelling is obliterating the groove between ramus of mandible and mastoid
process.
• The swelling is having well defined margins in all boundaries.
• The surface of the swelling appears smooth
• Skin over the swelling appears normal.
• No engorged veins / visible arterial pulsations over the swelling.

• No any other swelling noted in the neck.
Palpation
• The swelling is firm in consistency, having limited mobility.
• Plane of the swelling is deep to deep fascia and is not fixed to underlying muscle or
to overlying skin and to the surrounding structures.
• No cervical lymphadenopathy
Percussion
Auscultation
Oral cavity
• Mouth opening is adequate.
• No medial displacement of tonsillar region - ( No deep lobe enlargement)
• Parotid duct – Normal
• Parotid duct opening (Bidigital examination) – normal
• Rest of oral cavity examination including cranial nerves X, XI, XII is normal.
Temporo-mandibular (TM) joint examination – Normal
Facial nerve examination – Normal
Opposite side parotid gland including other salivary glands – normal
Summary of Case
• A 45 yr old gentleman, known hypertensive for last 2 years has come with a painless,
progressive swelling over right upper part of neck below ear lobule for 3 months. On
examination, an oval shaped swelling of size 4 x 3 cm in present in the right parotid
region, displacing the ear lobule upwards and outwards & obliterating the groove
between ramus of mandible and mastoid process. Plane of the swelling is deep to deep
fascia and is not fixed to surrounding structures. No deep parotid lobe enlargement.
Parotid duct and ductal opening appears normal. No features of VII nerve palsy.
Opposite side parotid gland examination is normal.
I would like to give a differential diagnosis. My 1st provisional diagnosis is Parotid tumor –
probably benign in origin, and 2nd diagnosis is an enlarged deep parotid group of lymph
node.
Points supporting the diagnosis of parotid tumor
History of a painless, progressive swelling over right upper part of neck below ear lobule for 3
months. On examination an oval shaped swelling of size 4 x 3 cm in present in the right
parotid region, displacing the ear lobule upwards and outwards & obliterating the groove
between ramus of mandible and mastoid process. Plane of the swelling is deep to deep fascia.
PERIPHERAL VASCULAR DISEASE CASE SHEET

Chief Complaint
Pain in the left lower limb - 6 months
Blackening of left great toe – 15 days
Patient was apparently normal /maintaining normal health 6 months ago, when he noticed
pain in the left lower limb for 6 months. Pain was insidious in onset; progressive in nature.
Initially, cramping pain used to appear in left calf region after walking for around 1 km which
compels the patient to take rest for some time to get relieved of pain.
Gradually, patient experienced pain even walking for a distance of 200-300m.
But, for last 2-3 months patient is experiencing dull aching pain in the left foot which was
continuous throughout day and night and disturbing his sleep & life style. The pain slightly
reduces by hanging down the legs below the level of bed and taking some pain killers.
Patient is also complaining of blackening of left great toe for 15 days, which started at the tip
and gradually progressed to involve whole of the great toe in a span of 10 days. This
blackening occurred spontaneously without any history of trauma. This blackening is also
associated with pain, tingling & numbness in the adjacent area of the normal skin.
No history of fever
No history of painful swelling with discoloration along the veins.
No history of similar complaints in the other limbs
No history of paleness of palms & soles after exposure to cold (History suggestive of Reynaud’s
phenomenon)
No history suggestive of angina pectoris, TIA`s, mesenteric angina, impotence.
Past History
No similar history in the past
Personal History
History of tobacco intake present in the form of cigarette smoking – for the last 20 years, 30
cigarettes per day with a smoking index of 600. No history of tobacco usage in any other
form.
History of occasional alcohol intake is present
Takes mixed diet
Appetite is normal and sleep is disturbed due to pain

Family history
No history of similar complaints in the family.
Summary of History
BMI - Wt - Ht-
Pallor / Icterus / Cyanosis / Clubbing / Generalized lymphadenopathy/pedal edema
Vital signs
Pulse – 78/min in the right radial artery , normal volume, regular rhythm, vessel wall is
thickened, no radio-radial delay and radio-femoral delay.
BP: 120/80 mmHg in both right arm & left arm in supine position.
A febrile
Respiratory rate: 14 cycles / min (abdomino-thoracic in male)
Examination of bilateral lower limbs

• I have examined the asymptomatic side ( i.e, right lower limb) which was normal
On examination of left lower limb
Inspection
• Patient is lying on the bed with extension at the hip & knee joints
• No apparent shortening/lengthening of the limb
• No deformity
• Limping gait is present
• Muscle wasting can be seen in the calf region

• Skin is thinned and shiny with loss of sub cutaneous fat, loss of hair, brittle nails – all
these changes present below knee
• Blackening of great toe present which is extending upto base of great toe with a well
formed line of demarcation delineated by a line of granulation tissue at the margin of
normal skin and gangrenous area.
• Sorrounding skin is edematous.
• Apart from this no other ulcer/wound can be seen proximal to this gangrenous area /
at pressure points.
Palpation
• All of the inspector findings are confirmed
• Decreased temperature/ coldness is present below the knee level
• Dry gangrene of the great toe is present with line of demarcation at the level of the
base of great toe.
• There is hyperaesthesia with tenderness present at the region of line of demarcation.
• Buerger`s angle is at 30 degrees
• Guttering of veins can be observed at 20 degrees
• There is increase in capillary filling time and venous filling time.
Examination of pulses
• Arterial pulses are palpable in the right limbs which are normal in volume and
character.
• On the left side…. Femoral pulses are palpable which are normal. Popliteal pulses are
diminished. Dorsalis pedis, anterior tibial and posterior tibial arteries are not
palpable.
Plantar arches
• There is distortion of plantar arches on left side compared to right side
Joint movements and measurements
Muscle bulk diameter
• Mid thigh level – 38 cm on both right and left sides
• Calf level – 27 cm on right side and 19 cm on left side
Joint movements
• Joint movements are lost in the left metatarso-phalyngeal joint
• Rest of movements are normal
Nervous system examination – normal
Tendon reflexes – Normal
Ausculatation – No bruit heard at any level
Lymphatic system examination - No enlarged lymph nodes in the bilateral inguinal region
Summary of case
• A 62 yr old gentleman, presented with gradually deepening jaundice without waxing &
Critical limb ischaemia of left lower limb – block at femoro-popliteal level with dry
gangrene of left great toe.
RIGHT HYPOCHONDRIAL LUMP CASE SHEET

Chief Complaint
Pain in the right upper abdomen – 7 days

Patient was apparently normal /maintaining normal health 7 days ago, when he developed
sudden onset of severe pain in the right upper abdomen which is gradually increasing in
severity.
Pain is continuous and non-radiating in nature.
Pain aggravates on movement, food intake and relieves partially on taking medications.
Pain is associated with 7-8 episodes of non-bilious vomiting- which was minimal in quantity &
containing food particles.
Pain is also associated with anorexia and loss of appetite.
No postural/diurnal variation of pain.
No history of recent onset of jaundice, upper/lower GI bleed.
No history of fever
No history of loss of weight
Past History
Personal History
Takes mixed diet
Family history
Treatment History

Summary of History
A 36 yr old gentleman, without any co-morbid illness presented with sudden onset of severe,
non-radiating pain in the right upper abdomen for 7 days. Pain aggravates on movement, food
intake and relieves partially on taking medications. These symptoms are also associated with
loss loss of appetite.
BMI - Wt - Ht-
Vital signs
A febrile
Inspection
• Abdomen is flat

seen over abdomen
Palpation
• A tender intra abdominal,intra peritoneal globular lump of size 8 x 6 cm in vertical to

horizontal direction is present and is occupying lower right hypochondrial and right
lumbar region, having smooth surface, rounded margins. Superior margin of the
swelling is not palpable as it is merging beneath the coastal margins.
downward with respiration.
Percussion
Ausculation
Summary of case
• A 36 yr old gentleman, presented with continuous pain in the right upper abdomen for
7 days.. On examination, a tender intra abdominal, intra peritoneal globular lump of
size 8 x 6 cm is occupying lower right hypochondrial and right lumbar region, having
smooth surface, rounded margins. Superior margin of the swelling is not palpable as it
is merging beneath the coastal margins.This swelling is firm in consistency, can be
moved side to side and moving above downward with respiration. Lump is dull on
percussion and is continuous with liver dullness. No hepato-splenomegaly.
Gall bladder lump – Benign in origin (Probably Mucocele of GB)
SUB MANDIBULAR SWELLING - CASE SHEET

Chief Complaint
Swelling below the right side of jaw -3 months
swelling below the right side of jaw which was insidious in onset, started as a swelling of size
1 x 2 cm gradually progressive and attained the present size of around 3 x 3 cm.
The swelling is not associated with pain, fever.
No history of increase in size of swelling associated with pain while mastication.
No history of any chronic lesion /ulcer in mouth.
No history of difficulty in deglutition, difficulty in respiration, or change in voice.

temperature, cough with expectoration

day)
Past History
No comorbid illness in the past
Personal History
Takes mixed diet
Menstrual History – Need to be mentioned in female patients
Family history
Treatment History
Summary of History
A 45 yr old gentleman, known hypertensive for last 2 years has come with a painless,
progressive swelling below the right side of jaw without history of increase in size of swelling
while mastication, and features of metastasis.
BMI - Wt - Ht-
Vital signs
Pulse – 82/min in the right radial artery , normal volume, regular rhythm, no radioradial
Afebrile
Respiratory rate : 14 cycles / min (abdominothoracic in male and thoracoabdominal in

female)
Inspection
• An oval shaped swelling of size 4 x 3 cm in vertical to horizontal dimensions is present

below the angle of mandible in right submandibular region.
• The swelling is having ill defined margins.

• Skin over the swelling appears normal.
• No engorged veins / visible arterial pulsations over the swelling or in the neck.
Palpation
• All inspectory findings (site, shape, and surface, overlying skin) are confirmed,
however the size of the swelling is found to be more (i.e, 4x5 cm).
• The swelling is firm in consistency, having limited mobility in all directions.
• Swelling is not fixed to underlying masseter muscle, overlying skin and to the
surrounding structures.
Percussion
Auscultation
Oral cavity
• Mouth opening is adequate.
• Deep lobe of submandibular gland is not palpable.(On bi-digital palpation)
• Sub mandibular salivary gland opening is normal.
• Rest of oral cavity examination including cranial nerves X, XI, XII is normal.
Opposite side submandibular gland including other salivary glands – normal
Summary of Case
progressive swelling below the right side of jaw for 3 months. On examination, an oval
shaped swelling of size 4 x 5 cm in present in the right submandibular region. Deep
lobe is not palpable in bidigital examination. Submandibular ductal opening appears
normal. Swelling is not fixed to surrounding structures. Opposite side submandibullar
gland examination is normal.
I would like to give a differential diagnosis. My 1st provisional diagnosis is an enlarged sub
mandibular group of lymph node, and 2nd diagnosis is submandibular gland tumor –
probably benign in origin.
TESTICULAR SWELLING CASE SHEET


Chief Complaint
Swelling in the right side of scrotum -3 months
swelling in the right side of scrotum which was insidious in onset, gradually increasing in
size and attained the present size of around 9 cm.
Swelling is associated with dragging sensation
No history of pain, trauma
No history of fever, burning micturition
No history of change in size of swelling during his dialy activities.
No history of any swelling groin, abdomen or neck
No history suggestive of TB (Evening rise of temperature, cough with expectoration, weight

loss)
No history suggestive of filariasis (History of reddish, painful streaks with swelling of lower
limbs with painful multiple swellings in groin)
No history of back pain / swelling of lower limbs
No history of loss of weight/loss of appetite
Past History
No surgical intervention to scrotum/elsewhere in past
Personal History
Takes mixed diet
Sleep and appetite is normal.

Family history
No history of thyroid malignancy or any cancer related death in the family.
Treatment History
Summary of History
A 29 yr old gentleman, presented with a painless, progressive swelling in the right side of
scrotum. There is no history of trauma, pain, fever, change in the size of the swelling during
dialy activities. No history of swelling anywhere else in body. No history suggestive of TB,
filariasis. No history suggestive of metastasis.
I have examined the patient in both standing and lying down positions.
Patient is conscious, coherent, cooperative
BMI - Wt - Ht-
Vital signs
Afebrile
Respiratory rate : 14 cycles / min
Examination of bilateral inguino-scrotal region:
Inspection
• Left sided inguino-scrotal examination is normal
• Examination of right sided inguino-scrotal region

• Right sided enlargement of scrotum of size 10 x 8 cm present with loss of
rugae due to stretching of skin
• No skin changes over scrotum
• Midline of scrotum with penis is deviated to the left
• No cough impulse seen over inguinal region
Palpation
• I have examined the left sided testis first which is normal in size, contour, sensation
and consistency.
• No local rise of temperature or tenderness overlying the right sided scrotal swelling
• I could able to get above the swelling and it suggests a pure scrotal swelling
• Testicular swelling of size 10x8 cm in largest dimensions, non fluctuant, non-

transilluminant, hard in consistency throughout swelling, freely mobile in scrotal
pouch and is not fixed to scrotal skin
• There is loss of testicular sensation
• Spermatic cord and epididymis is normal
• No lymphadenopathy in groin
• No left sided supra-clavicular lymphadenopathy.
Percussion
• Dull note on percussion
Auscultation
Penis examination is normal
Hernia orifices - normal
Summary of Case
• A 29 yr old gentleman, presented with a painless, progressive swelling in the right side
of scrotum for 3 months. On examination, a testicular swelling of size 10x8 cm which
is hard in consistency, and with loss of testicular sensation. No scrotal involvement and
inguinal lymphnodal involvement.
Right sided testicular carcinoma
Note – It is always better to mention [ a.) No other lump seen at the sites of testicular
ectopia.b.)Secondary sexual characters are age appropriate ] in case of absence of testis
in scrotal sac i.e, Undescended testis or ectopic testis
THYROID CASE SHEET
Chief Complaint
Swelling in front part of neck -3 months
swelling in front part of the neck just left side of midline which was insidious in onset, started
as a swelling of size 1 x 2 cm gradually progressive and attained the present size of around 3 x
3 cm.
The swelling is not associated with pain, fever. No history of sudden increase in the size of
the swelling. No history of skin changes overlying the swelling. No history of other
swellings in the neck or elsewhere in the body.
No history of pressure symptoms (difficulty in deglutition, respiratory distress particularly

on lying down position, change in voice).
No history of hypo or hyper thyroid symptoms.


day)
Past History
No history of irradiation to the neck in past.
Personal History
Takes mixed diet
Bowel and bladder habits normal.
Sleep and appetite normal.
Menstrual History – Need to be mentioned in female patients
Family history
Treatment History
Patient underwent a needle test for the swelling elsewhere and report awaited.
Summary of History
progressive swelling over front part of neck without hypo or hyperthyroid symptoms, pressure
symptoms and features of metastasis.
I have inspected the patient from front and palpated from behind.
BMI - Wt - Ht-
Vital signs
Afebrile

female)
Inspection
• An oval shaped swelling of size 4 x 3 cms in present in the thyroid region with
horizontal extent -from the midline to 3 cm laterally on the left side, vertical extent –
2 cm below the thyroid prominence to 3 cm above the supra-sternal notch.
• The swelling is having well defined margins in all boundaries.
• No engorged veins / visible arterial pulsations over the swelling or in the neck.
• Skin over the swelling normal.
• Swelling moves with deglutition but not with protrusion of tongue
• Lower border of the swelling is seen
Palpation
• The swelling is firm in consistency, mobile side to side but having limited mobility
vertically.
• Plane of the swelling is deep to deep fascia and is not fixed to underlying structures
and overlying skin.
• Rest of the thyroid gland is not palpable
• Trachea is in the midline

• Bilateral carotid palpable
Percussion
Auscultation
• No bruit heard over the swelling
No eye signs
No pretibial myxedema
Summary of Case
progressive swelling over front part of neck without hypo or hyperthyroid symptoms,
pressure symptoms and features of metastasis. On examination an oval shaped
swelling of size 4 x 3 cms in present in the thyroid region, moving with the deglutition
but not with protrusion of tongue. No evidence of retrosternal extension.
Solitary thyroid nodule – probably benign, Clinically Euthyroid

UNILATERAL LIMB SWELLING CASE SHEET
Chief Complaint
Swelling of the left lower limb – 4 yrs
Non healing wound below the knee joint – 6 months
Patient was apparently normal /maintaining normal health 4 years ago, when she noticed
Swelling of the left lower limb which was of insidious onset, started in the left foot and
gradually progressed up to upper thigh in a span of 3 years. This enlargement increases on
walking or on standing for long time and decreases partially on lying down.
This swelling is painless in nature.
The skin over the swollen limb has thickened, hardened and discoloured started 1 year after
onset of swelling and progressed also in the same way from foot to thigh.
There is no history of trauma, fever
No history of reddish streaks with painful enlarged swellings in groin.
The swelling of the limb is interfering with routine activities for last 6 months and patient was
almost bedridden for last one & half month.
Patient is also complaining of an ulcer formation over left leg just below knee joint for 1
month. This ulcer was 1 x 1 cm in size and painless to start with. It gradually increased in size
in spite of daily dressings and attained the present size of 3-4 cm. This ulcer was
spontaneous, progressive in nature, associated with mild to moderate, continuous, dull aching
pain which aggravates with movement and relieves partially with rest. No history of fever, No
history of bleeding episodes from the ulcer.
No history of similar swelling in the other limb.
No history of prolonged immobilisation, hospitalisation, features of DVT.
No history of pain/lump in the abdomen
Past History
Personal History
Takes mixed diet
Sleep and appetite are normal
Family history
Summary of History
BMI - Wt - Ht-
Pallor / Icterus / Cyanosis / Clubbing / Generalized lymphadenopathy
Vital signs
A febrile
Examination of bilateral lower limbs

On examination of left lower limb
• No gross muscle wasting noted
• No deformity
• Patient can`t ambulate
• There is non-pitting edema of the left lower limb extending from the toes to the upper
thigh with thickened, hard, keratinized, brown-blackish discolored scaly skin over the
lower limb. The skin over the limb. There are multiple fissures present over the
edematous limb from which serous oozing can be appreciated.
• Squaring of the toes present with sparing of skin crease between leg and ankle.
• A single ulcer of size 4 x 5 cm in greatest dimensions is present over the upper anterior
leg 4 cm below the tibial tuberosity. This ulcer is having irregular margins, edges at
superior & medial boundaries are everting and inferior & lateral boundaries are
sloping. Floor is covered by necrotic slough. Base is formed by underlying bony tissue
and ulcer is not fixed to underlying bone. There is copious sero-purulent discharge
could be seen from the ulcer. Sorrounding skin of the ulcer is inflamed with tenderness
and mild elevation of temperature.
Arterial pulses are palpable in both limbs which are normal in volume and character.
Sensory & motor examination
Tendon reflexes – not done
No enlarged lymph nodes in the bilateral inguinal region
Measurements
Joint mobility – partially decreased on left side
Arches of foot – Normal
Per rectal/per vaginal examination – normal

Cardio vascular system, respiratory system and abdominal examination is normal.
Summary of case
Lymphedema of left lower limb - Elephentiasis
Percussion
Auscultation
• No bruit heard over the swelling
No eye signs
Summary of Case
pressure symptoms and features of metastasis. On examination an oval shaped
swelling of size 4 x 3 cms in present in the thyroid region, moving with the deglutition
but not with protrusion of tongue. No evidence of retrosternal extension.
Solitary thyroid nodule – probably benign, Clinically Euthyroid

VARICOSE VEINS CASE SHEET
Chief Complaint
Enlargement of the veins of the left lower limb – 4 yrs
Non healing wound over the inner aspect of lower leg – 6 months
Patient was apparently normal /maintaining normal health 4 years ago, when he noticed
Enlargement of the veins of left lower limb, which was of insidious onset, started in the ankle
region and gradually progressed up to upper thigh in a span of 2 years. This enlargement
increases on walking or on standing for long time and decreases on lying down.
This enlargement of veins is associated with a dull aching pain in the left lower leg which is of
mild – to- moderate intensity, started few months after noticing of venous enlargement. This
pain is progressive in nature, which intensifies towards the end of the day and aggravates on
walking, prolonged standing and relieves on lying down.
These symptoms are also associated with swelling of the lower leg & ankle region for 2 years.
This swelling partially reduces on lying down and aggravates on walking, standing for
prolonged times. This swelling is also associated with blackish discoloration around lower leg
and ankle region.
For the last 6 months, he complained of development of an ulcer in the inner aspect of lower
leg – spontaneously. This ulcer was 1 x 1 cm in size and painless to start with.It gradually
increased in size inspite of dialy dressings and attined the present size of 3-4 cm. This non
healing wound is associated with continuous dull aching pain, watery discharge.
No history of fever, No history of bleeding episodes from the ulcer.
No history of episode of pain, discoloration along the enlarged veins.
No history of prolonged immobilisation, hospitalisation, features of DVT.
No history of pain/lump in the abdomen
No history of trauma to the limb
No history of similar complaints in the other limb

Past History
Personal History
Takes mixed diet
Sleep and appetite are normal
Family history
Summary of History
BMI - Wt - Ht-
Pallor / Icterus / Cyanosis / Clubbing / Generalized lymphadenopathy
Vital signs
A febrile
• On examination of left lower limb
• No gross muscle wasting noted
• No deformity
• Normal gait
• There are engorged, tortuous, dilated veins extending from medial malleolar region,
passing over the medial aspect of leg, knee joint and reaching upto upper thigh –
suggesting the great saphenous venous system. No cough impulse present at SFJ.
• Hyperpigmentation with eczematous changes present over the left gaiter`s area along
with brawny pitting edema.
• A single ulcer of size 4 x 5 cm in greatest dimensions is present in the gaiter area with
irregular margins, edges at superior & medial boundaries are everting and inferior &
lateral boundaries are sloping. Floor is covered by necrotic slough. Base is formed by
underlying soft tissue and not fixed to underlying bone. There is copious sero-purulent
discharge could be seen from the ulcer.
• Sorrounding skin of the ulcer is hyperpigmented, edematous, inflamed with tenderness

and mild elevation of temperature. There is induration extending 1 cm
circumferentially from the edge.
• Apart from this no other abnormality in left leg.
• Brodie – Trendelenburg test – Imcompetence of SFJ
• Modified perthe`s test – Negative
• Schwartz`s test – positive
• Cough impulse test – positive
Arterial pulses are palpable in both limbs which are normal in volume and character.
Sensory & motor examination examination – normal
Tendon reflexes – Normal
No enlarged lymph nodes in thebilateral inguinal region
Measurements
Joint mobility – Normal at all levels

Arches of foot – Normal
Per rectal/per vaginal examination – normal
Summary of case
• A 62 yr old gentleman, presented with gradually deepening jaundice without waxing &
Obstructive Jaundice – malignant in origin ( Peri-ampullary carcinoma/ pancreatic head

carcinoma)
THYROID CASE SHEET
Chief Complaint
Swelling in front part of neck -3 months
Patient was apparently normal /maintaining normal health 3 months ago, when he noticed
a swelling in front part of the neck just left side of midline which was insidious in onset,
started as a swelling of size 1 x 2 cm gradually progressive and attained the present size
of around 3 x 3 cm.
The swelling is not associated with pain, fever. No history of sudden increase in the size
of the swelling. No history of skin changes overlying the swelling. No history of other
swellings in the neck or elsewhere in the body.
No history of pressure symptoms (difficulty in deglutition, respiratory distress particularly

on lying down position, change in voice).
No history of hypo or hyper thyroid symptoms.

No history suggestive of metastasis(hemoptysis, dyspnea, postural headache, focal

A known hypertensive for last 2 yearsand on regular medication (Tab Amlodipine 5 mg

once a day)
Past History
No history of irradiation to the neck in past.
Personal History
Takes mixed diet

Bowel and bladder habits normal.
Sleep and appetite normal.
Menstrual History Need to be mentioned in female patients
Family history
Treatment History
Patient underwent a needle test for the swelling elsewhere and report awaited.
Summary of History
pressure symptoms and features of metastasis.
I have examined the patient with informed consent in a well lit room and adequate
exposure in the presence of family attendant.
I have inspected the patient from front and palpated from behind.
BMI - Wt - Ht-
Hydration status Well maintained
Performance scale
Vital signs
Pulse 82/min in the right radial artery , normal volume, regular rhythm, no radioradial
Afebrile

female)

Inspection
∑ Facial symmetry normal ∑ An oval shapedswelling of size 4 x 3 cms in present in the

thyroid region with horizontal extent - from the midline to 3 cm laterally on the left side,
vertical extent 2 cm below the thyroid prominence to 3 cm above the supra-sternal
notch. ∑ The swelling is having well defined marginsin all boundaries. ∑ The surface of the
swelling appears smooth ∑ No engorged veins / visible arterial pulsations over the swelling
or in the neck. ∑ Skinover the swelling normal. ∑ Swelling moves with deglutition but not
with protrusion of tongue ∑ Lower border of the swelling is seen ∑ No any other swelling
noted in the neck.
Palpation
∑ No local rise of temperature or tenderness overlying the swelling ∑ All inspectory

findings (site, size, shape, surface, overlying skin) are confirmed ∑ The swelling is firm in
consistency, mobileside to side but having limited mobilityvertically. ∑ Plane of the
swelling is deep to deep fascia and is not fixed to underlying structures and overlying
skin. ∑ Rest of the thyroid glandis not palpable ∑ Trachea is in the midline ∑ Bilateral
carotid palpable ∑ No cervical lymphadenopathy
Percussion
Auscultation
∑ No bruitheard over the swelling
No eye signs
Spine, Scalp, ENT examination Normal
Systemic examination ∑ Cardio vascular system, respiratory system and abdominal

examination is normal.
Summary of Case
∑ A 45 yr old gentleman, known hypertensive for last 2 years has come with a painless,
pressure symptoms and features of metastasis. On examination an oval shaped swelling of
size 4 x 3 cms in present in the thyroid region, moving with the deglutition but not with
protrusion of tongue. No evidence of retrosternal extension.
Solitary thyroid nodule probably benign,Clinically Euthyroid

Surgery Case Taking

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Surgery Case Taking

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RIGHT LUMBAR REGION LUMP CASE SHEET

Name Age/Sex Profession

Address Socioeconomic status Religion

Lump in the right central abdomen – 3 months

History of present illness

No history of blood in urine / any difficulty in micturition

Lump is not associated with pain, fever

No history of sudden increase in the size of the lump

No history of similar lump on opposite side of umbilicus or anywhere else in body.

No history of nausea, vomiting.

No history of recent onset of jaundice, abdominal distention, obstipation, upper/lower GI

No history of alteration in bowel habits in terms of frequency and consistency.

No history of swelling of lower limbs

No history suggestive of metastasis.

No history of similar complaints in the past.

No co-morbid illness in the past

No surgical intervention in past

Takes mixed diet

Bowel and bladder habits are normal.

Sleep and appetite are normal.

Non smoker and non alcoholic

No history of any cancer related death in the family.

Patient hasn`t underwent any type of treatment for the complaints.

Physical Examination & General Survey

Patient is conscious, coherent, co-operative

Hydration status – Well maintained

Pallor / Icterus / Cyanosis / Clubbing / Generalized lymphadenopathy / Pedal Edema

BP: 120/80 mmHg in right arm supine position.

Respiratory rate : 14 cycles / min (abdomino-thoracic in male)

• Umbilicus is in midline and inverted

• No engorged/dilated veins, abnormal arterial pulsations/ visible peristalsis can be

• Renal angles are normal

• Hernial orifices including external genitalia appears normal

• No supraclavicular fossa fullness is seen

• No local rise of temperature over abdomen

• A non-tender intra abdominal, retro-peritoneal lump of size 10 x 7 cm in vertical to

• Lump is having smooth surface.

• Inferior border of swelling in 10 cm below the right coastal margin in mid-clavicular

• This lump is firm in consistency, immobile, not moving with respiration.

• Liver & Spleen are not palpable

• No other abdominal lump was palpable

• Palpation of renal angles, left supraclavicular regions – normal

• Hernial orifices and external genitalia – normal

• Lump is dull on percussion and is not continuous with liver dullness.

• Rest of the abdomen is resonant.

• No evidence of free fluid

• Normal bowel sounds heard

Per rectal examination – Normal

• Cardio vascular system, respiratory system and abdominal examination is normal.

• A 46 yr old gentleman, without any co-morbid illness presented with a painless,

Clinical Diagnosis (Provisional)

BREAST LUMP - CASE SHEET

Address Socioeconomic status Religion

Lump in the right breast - 3 months

History of present illness

No history of sudden increase in the size of the swelling.

No history of skin changes overlying the swelling.

No history of nipple discharge/nipple retraction/nipple destruction

No history of change in the size of the swelling with menstrual periods

No history of loss of weight /loss of appetite

No history suggestive of metastasis (hemoptysis, dyspnea, postural headache, focal

No co-morbid illness in the past.

No surgical intervention to breast in past.

Takes mixed diet