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Lump examination

Please can you examine the lump on Mrs Roberts' back

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Actor briefing

You are Mrs Roberts, a 35-year-old lady, and you have a longstanding
lump on your back which has slowly been increasing in size and it now
irritates you as your bra strap sits on top of it.

Do not offer any information to the candidate, but you may respond to
questions asking if you are in pain, and be responsive to their
instructions.

Next question -+
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Pass the MRCS Ho me ' ta11, ,, : 11 E a ~ la''' [ ~ 11at ~ "'I' C>
.. .. - - ...

Please can you examine the lump on Mrs Roberts' back

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On inspection
There is a 6 x 4 cm lump on the upper left back overlying the spine of the
scapula. It appears irregular in shape and there are no overlying skin
changes or scars.

Inspection
-Site
-Size
-Shape - hemispherical
-Surface - smooth, irregular
-Skin - any overlying skin changes
-Scars

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On palpation
It is a non-tender, soft, fluctuant, lobulated mobile mass with well defined
margins. It is not reducible and non-pulsatile There is no tethering to the
skin.
On tensing the underlying muscle, it remains fully mobile.

Palpation
-Tenderness
-Temperature
-Surface
-Margins
-Consistency
-Surrounding area
-Pulsatility
-Compressibility
-Reducability
-Fluctuation

Next question <+

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Lump examination

Please can you examine the lump on Mrs Roberts' back

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Transilluminate
It does not transilluminate
Ausculate
There are no bruits

Listen for bruits in case of a vascular malformation

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Lump examination

Please can you examine the lump on Mrs Roberts' back

Click here
Regional lymph nodes
There is no regional lymphadenopathy

Depending on site of lump assess for regional lymph nodes

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Pass the MRCS Home ' tat1 ,, : 1, E a • ~ 1a11 I [ ~ 11at ~ 11t,, C>

Lump examination

Please can you examine the lump on Mrs Roberts' back

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Present your findings

Mrs Roberts is a 35-year-old lady who has a single, soft swelling on her
upper back over the spine of her left scapula. It measures 6cm x 4cm,
and the overlying skin looks normal. It is non-tender and feels soft,
fluctuant and lobulated. The edges were well demarcated. There was
no tethering to the skin or the underlying muscle. There was no
associated lymphadenopathy.

Next question <+

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_P~ ~ 1£:1 .. ~ • -A ~ • --
Pass the MRCS Home ' tat1 ,, : 1, E a • ~ 1a11 I [ ~ 11at ~ 11t,, C>

Lump examination

Please can you examine the lump on Mrs Roberts' back

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What is your differential diagnosis?

Lipoma
Sebaceous cyst
Abscess
Soft tissue tumour
Bone tumou r
Vascular malformation

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Lump examination

Please can you examine the lump on Mrs Roberts' back

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If you weren't sure what it was, what simple investigation could be
performed to help aid diagnosis?

Ultrasound

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Lump examination

Please can you examine the lump on Mrs Roberts' back

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The ultrasound confirms findings consistent with a lipoma. Would you excise
this under local or general?

If the patient were happy to have this done under a local anaesthetic
then that would be preferable.

Next question -+ ]
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Lump examination

Please can you examine the lump on Mrs Roberts' back

Click here
Key Information

Introduce yourself
Wash your hands
Permission - may I examine your back?
Exposure - ensure back adequately exposed
Position - ask patient to stand up

Inspection

-Site
-Size
-Shape - hemispherical
-Surface - smooth, irregular
-Skin - any overlying skin changes
-Scars

Palpation
-Tenderness
-Temperature
-Surface
-Margins
-Consistency
-Surrounding area
-Pulsatility
-Compressibility
-Reducability
-Fluctuation

Transilluminate, auscultate and assess for regional lymphadenopathy

Thank the patient and wash your hands

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