MedCosmos Surgery - History Taking

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W E D N E S D A Y, S E P T E M B E R 3 , 2 0 0 8
History & Examination in Rheumatoid Arthritis
Rheumatoid History
1. Presenting complaint
2. Pain: joints, limbs, elsewhere
3. Stiffness, swelling
4. Deformity, Raynaud's Labels
5. Eyes, mouth
History Taking (6)
6. Systemic
7. Past medical, surgical history Important Eponyms (1)
8. Family, social, disability, drug history MCQ : Breast (1)
Presenting complaint
MCQ : Cardiac Surgery (1)
· What is the problem lately?
Pain: joints MCQ : Endocrine (1)
· Site, onset, duration, character, radiation aggravating & relieving MCQ : General Surgery (1)
factors, severity, associatedsymptoms
MCQ : Hernia-Acute Abdomen (1)
· Site: number of joints, symmetrical/ asymmetrical, large/ small
MCQ : Large Intenstine (1)
joints, sequence affected.
· Timing: acute/ chronic. MCQ : Liver-Pancreas (1)
· Exacerbating factors: rest, exercise. MCQ : NeuroSurgery (1)
Pain: limbs
MCQ : Oncology (1)
· Site, onset, duration, character, radiation aggravating & relieving
factors, severity, associated MCQ : Pediatric Surgery (1)
symptoms MCQ : Small Intenstine (1)
· Bone pain. MCQ : Spleen (1)
· Severe pain of sudden onset (vascular disease).
MCQ : Stomach-Esophagus (1)
· Nerve entrapment.
· In amputated limb (phantom pain). MCQ : Thoracic Surgery (1)
Pain: elsewhere MCQ : Thyroid Gland (1)
· Site, onset, duration, character, radiation aggravating & relieving
MCQ : Transplantation (1)
factors, severity, associated
symptoms MCQ : Trauma and Burns (1)
· Back is common. MCQ : Urology (1)
· Spinal cord: localize to dermatome. MCQ : Vascular Surgery (1)
Stiffness
Surgery Books (7)
· Generalized or specific to certain joints.
1 of 18 12-Aug-15 12:31 AM
MedCosmos Surgery: History Taking http://medcosmossurgery.blogspot.com/search/label/History Taking
· Number of joints, symmetrical/ asymmetrical, large/ small joints, Surgery Lectures (1)
sequence affected. Surgery Must Read (1)
· Worse in morning (RA, other inflammatory).
Surgery Pamphlets (2)
· Duration before wears off (severity).
Swelling
Blog Archive
· Number of joints, symmetrical/ asymmetrical, large/ small joints,
sequence affected. ▼ 2008 (48)
· When first noticed. ▼ September (48)
· Getting larger or smaller. Paradoxical Aciduria
Deformity Thoracic Surgery MCQ
· Misshapen joints.
Cardiac Surgery MCQ
· Time course of the deformity.
NeuroSurgery MCQ
Raynaud's Urology MCQ
· Assess Raynaud's phenomenon (scleroderma). Pediatric Surgery MCQ
Eyes, mouth
Vascular Surgery MCQ
· Dry eyes, mouth (Sjogren's).
· Red eyes, painful eyes (seronegatives). Liver and Pancreas MCQ
· Unilateral loss of visual acuity (seronegatives). Large Intenstine MCQ
Systemic Stomach and Esophagus MCQ
· Rash (SLE).
Hernia and Acute Abdomen
· Fatigue, breathlessness.
MCQ
· Fever (connective tissue disease).
· Weight loss (dysphagia or malabsorption 2° to scleroderma). Trauma and Burns MCQ
· Abdominal pain, GI bleeding (NSAID s/e). General Surgery MCQ
Past medical, surgical history Thyroid Gland MCQ
· Time of menopause [if applicable].
Small Intenstine MCQ
· Current problem in past.
· Trauma in past. Oncology MCQ
· Fractures, sprains. Transplantation MCQ
· Infections: Enocrine Surgery MCQ
• Gonorrhea [especially if monoarticular, young].
Breast MCQ
• Staphylococcus
• Streptococcus Spleen MCQ
• Hepatitis Technical Basis Of Radiation
• TB Therapy
• Dysentery Metastasis of Prostate Cancer
· Gout (gouty arthritis).
Schwartz Manual Surgery 8th
· IBD (IBD-associated arthritis).
Edition
· Psoriasis (psoriatic arthritis).
· Thyroid problems (osteoporosis). Bailey & Love's Short Practice of
Surgery
· Tick bites (Lyme disease) [usu. USA only].
· Arthritis as a child. Sabiston Textbook of Surgery
· Depression [common in chronic disability]. A History of Plastic Surgery
· Seen a rheumatologist before?.
Endoscopic Surgery of Potential
· Physiotherapy, occupational therapy.
anatomical spaces
· Joint surgery, bone surgery.
1000 Eponyms in Surgery
Family history
· The current complaint in parents/ siblings/ children: health, cause of Sentinel Lymph Node
death, age of onset, age of History & Examination in
death. Rheumatoid Arthritis
· Hereditary disease suspected: do a family tree.
2 of 18 12-Aug-15 12:31 AM
· IBD. Varicose veins examination

· Gout. Examination for a diabetic foot
· Rheumatoid arthritis.
Thyroid Examination
· Osteoarthritis.
· Seronegatives: PAIR: Lump History & Examination
• Psoriasis Named Hernia
• Anklyosing Deep Vein Thrombosis
• IBD-associated
Post Operative Fever
• Reiter's
Staging of breast cancer
Social history PERIPHERAL VASCULAR DISEASE
· Smoking: ever smoked, how many per day, for how long, type History
[cigarette, pipe, chew] (increases Q-A Scrotal Swelling
NSAID risk).
Management of Differentiated
· Alcohol: do you drink. If yes: type, how much, how often (fall risk,
Thyroid Carcinoma
increases NSAID risk).
Top 100 Secrets in Surgery
· Present occupation.
· Any other factors that you wish to mention? Burns
Disability Sister Mary Joseph Nodule
· Who is with you there at home [important for managing daily
DD of rectal bleeding
activities].
· Describe your home: stairs, if apartment what floor, handles (fall risk). DD of scrotal swelling
· Difficulties with cooking, dressing, bathing. DD of breast lumps
· How interrupts life. Lots of Surgery Pamphlets
· Home aids, utensils, appliances.
Drug history
· Prescriptions currently on [gold, etc], noting side effects.
· Over-the-counters, esp. NSAIDs.
· Steroids.
· Recreational drugs [most rheumatoid pt's are older than this, but may
use for pain escape].
· Estrogen replacements [if menopausal], other hormones.
· Calcium supplements.
· Allergies: if allergic to drug, make sure not an allergy, not just a
common side-effect.
Examination in Rheumatoid
1-Knee Examintion:
1- Inspection:* While lying: swelling, scars, redness, muscle waisting.
* Standing: valgus, varus, post aspect for bakers cyst
* While walking: limping to the side of the problem.
2- Palpation:[/LEFT]* Temprature
* Effusion
* Patellofemoral compartment (push the patella and press)
3- Movement:
* Range of movement
3 of 18 12-Aug-15 12:31 AM
* Pain while moving

* Stability: ant and post cruciate ligaments , lateral and medial
collateral ligaments.
**********************
2- Spine Examination:
1- Inspection:
At rest: for deformities.
While moving: rotation , lateral flexion, ant and post flexion.
cervical spine is always examined while the patient is sitting BUT
lumbosacral spine is examined while the patient is standing.
2- Palpation:
palpate paraspinal muscles and spine for tenderness.
Every time you Examine the spine U should perform a full neuro-exam
for the lower limbs.
# Special examination in the spine:
1- Lumbosacral spine:
straight leg raising test ( Thomson's test):

while the patient is lying in the supine position. In normal individuals
maximum stretch is at 70 degrees in patients with lumbosacral
involvement nerve root stretches at 30 degrees and patient feels the
pain.
2- Sacroiliac joint:
sacroilitis occrs in: seronegative arthrits such as Ankylosing spondylitis,
or inflammatory bowel disease.
Manouvers to stress the sacroiliac joint:

pain is felt in the joint in the following cases:
1- open a book:
while the patient lying supine hold his both iliac bones and press on
them as if U R opening a book.
2- lateral position ( close the book):

while the patient is lying on his lateral postion press the iliac bone as if
U R closing a book.
3- Faber test ( Patrik test)

faber stands for
F: flexion
Ab: abduction
ER: External Rotation
all these movement at the hip joint.
******************
3- Hand:
1- Inspection:
At rest:
4 of 18 12-Aug-15 12:31 AM
1- finger tips for pitting scars in scleroderma

2- nails for pitting nails in psoriasis, psoriatic changes, clubbing, splinter
hemorrage...... etc.
3-muscles for wasting
4- skin for scaling, loss of hair, discoloration, atrophy.... etc
5- deformities
While moving:
for range the movement
for painful movement
ask the patient to flex his fingers extend them, make a fist.
opposition, adduction, abduction, extension and flexion of the thumb.
extension and flexion of the wrist joint.
Examine for carpal tunnel syndrome:

tap along the distribution of the median nerve.
phalen's test:
ask the patient to dorsiflex his both wrists
if positive patient will feel tingling along the distribution of the nerve.
2- Palpation:
palpate each interphalengeal joint medially lateraly anteriorly and
posteriorly and passively flex and extend each joint looking for
tenderness and effusion.
palpate each carpophalengeal joint and flex and extend each joint again
looking for tenderness and effusion.
again palpate the wrist joint in the middle and extend and flex the joint
looking for tenderness and effusion
Posted by MedCosmos at 6:06 PM No comments:

Labels: History Taking
Varicose veins examination

Varicose veins examination
Taking a history
You should take a full history from any person presenting with varicose
veins, bearing in mind that pelvic masses, trauma, and previous deep
venous thrombosis are recognised causes. You should ask about if they
have aching leg pain; if their legs fatigue easily or feel heavy; and if
there is any swelling. All of these symptoms become worse as the day
progresses especially with long periods of standing. In severe cases,
people may describe acute, bursting pain on walking that is relieved by
rest and leg elevation. This is called venous claudication. People with
severe venous hypertension may complain of skin changes including
venous eczema and ulceration, classically in the gaiter region of the
lower leg. You should also ask about any previous treatments. For some
5 of 18 12-Aug-15 12:31 AM
people, cosmetic issues may be the most important, but you should
remember that some people with symptoms might have few visible
varicose veins.
Examination
Inspection
You should start the examination by inspecting the patient standing--if

he or she is able to stand--with both legs appropriately exposed to the
groin. If varicose veins seem present then gently press on the affected
areas, release, and watch the varicosities refill. By doing this, you are
simply confirming that the areas are vascular. Consider whether the
affected areas are warmer than the surrounding skin by using the back
of your hand. Next try to see if the varicosities follow the long or short
saphenous vein distribution. Varicosities in the short saphenous vein are
seen only below the knee and are usually at the back and to the outer
edge of the leg (posterolateral). Long saphenous varicosities may be
found along the length of the leg, usually on the medial aspect. Some
people have a large accessory vein on the back (posterior) part of the
thigh, which may become varicose. This is the accessory vein of
Giacomini.
On inspection, look for:
- Venous stars (venulectasias). These are bluish vessels that may distend
above the skin surface and are usually 1-2 mm in diameter
- Superficial thrombophlebitis, which shows as a red, painful lump
- The brown pigmentation of haemosiderin deposition characteristic of
increased venous pressure
- Venous eczema
- Ulceration and scarring from previous ulceration, especially in the
gaiter area
- Lipodermatosclerosis; this is caused by chronic venous hypertension
when fibrin deposition results in progressive sclerosis of the skin and
subcutaneous fat
- Scars from previous vein surgery (look for harvesting of vein grafts for
coronary artery bypass grafting).
Locating the saphenofemoral junction
Once you have finished the inspection, ask the patient to lie down and
identify the saphenofemoral junction. One good way to do this is by
locating the femoral artery--which lies between the anterior superior
iliac spine and the pubic tubercle--by feeling for the pulse. The vein is
medial to the artery and the saphenofemoral junction about two fingers'
breadths below the inguinal ligament.
Next ask the patient to stand if he or she can. You then should place one
hand on the varicosities and tap on the saphenofemoral junction. If the
saphenofemoral junction is incompetent you may feel a fluid thrill. You
can confirm the incompetence with a handheld Doppler ultrasonograph
6 of 18 12-Aug-15 12:31 AM
if you put it at the saphenofemoral junction and press on the

varicosities. You should be able to hear blood flowing up the vein to the
junction and with an incompetent valve at the saphenofemoral junction,
you can hear the blood flowing back again.
Trendelenberg test
Again ask the patient to lie down, raise his or her leg, and empty the
engorged varicosities. To do this, press on the saphenofemoral junction
to occlude it. Then ask the patient to stand up and see if the
varicosities refill immediately. If by putting pressure at the
saphenofemoral junction the varicose veins are controlled
saphenofemoral incompetence is present. If the veins simply refill then
there is a leaky perforating vein further down. This is known as the
Trendelenberg test.
Tourniquet test
If there is a leaky perforating vein--or as an alternative to the
Trendelenberg test--you can do the tourniquet test. For this you ask the
patient to lie down and lift the affected leg. By doing this, the veins will
empty and you should put on the tourniquet, in turn, to the thigh, the
lower thigh, and then below the knee. If the tightened tourniquet
controls the varicose veins then the defect is above the tourniquet, if
the veins refill then the defect is below. Reflux from venous valvular
incompetence accounts for most chronic venous disease.
Once you have diagnosed varicose veins, you should consider the cause
(aetiology). You should also do a full abdominal and scrotal examination
to rule out intra-abdominal or pelvic pathology and do an arterial
examination.
Investigations
You may need to do further investigations to clarify the area of valvular

incompetence. This is best done by using Duplex ultrasonography.2 With
the patient standing, cuffs are placed on the thigh, calf, and foot. The
cuffs are inflated and then rapidly deflated to create retrograde venous
blood flow in segments of valvular incompetence. It is possible to map
valvular incompetence at the common and superficial femoral, long and
short saphenous, popliteal, posterior tibial, and perforator veins.
Treatment
Surgery is indicated in people with saphenofemoral incompetence and in
those with significant symptoms such as superficial thrombophlebitis,
bleeding from
varicosities, or skin changes. This entails identifying the saphenofemoral
junction in the groin and ligating it. The long saphenous vein is then
disconnected in the groin and stripped to remove its tributaries.
Isolated varicosities in the leg can be removed through small incisions
(avulsion).
Sclerotherapy can be effective in treating small varicose veins without

reflux. If reflux occurs at the saphenofemoral junction the surgeon
7 of 18 12-Aug-15 12:31 AM
should correct this first. Sclerotherapy entails marking varices while the
patient is standing and then injecting a sclerosant, such as sodium
tetradecylsulfate, into the lumen of larger veins to cause an
inflammatory reaction. Compression stockings are worn after
sclerotherapy.
Conservative management may include:
- Reassurance and advice

- Weight reduction
- Exercise and avoidance of long periods of sitting or standing
- Elevation of the legs
- Compression stockings may be used to manage chronic venous
insufficiency, with the greatest compression at the ankle. However,
people with peripheral vascular disease should not wear compression
stockings unless an ankle brachial pressure index is satisfactory.
__________________
Posted by MedCosmos at 6:05 PM 1 comment:

Examination for a diabetic foot

Examination for a diabetic foot
By inspection:
See the color of the skin( any pigmentation)

Any muscle wasting (motor innervations)
If there is dryness of the skin
Comment on hair distribution
Describe any ulcer (type, if there is any discharge))
Any scars
See if there is any deformity
1-hammer toes
2-hallux valgus
3-charcot joints
if there is any amputation
any infection
by palpation
any tenderness
the temperature
take the pulse
see if there is any sensation loss (sensory innervations))
why the ulcer affect the foot af DM people??

1-arterial insufficiency
2-peripheral neuropathy
3-impaired immunity
8 of 18 12-Aug-15 12:31 AM
4-high glucose level and this a good environment to bacteria to live in

Thyroid Examination
Thyroid Examination
Make the patient sitting, expose the head, neck and upper chest
1- look at the whole patient- sitting still or agitated, looking nervous or

slow in his/her movement
- thin or fat
- wasting or fating
- generalized loss of weight or localized wasting to face, shoulder, hand
- is he/she sweaty or feel cold
- myxoedema face
- any hair loss (especially the outer tow thirds of the eyebrows)
2- look at the hand- feel the pulse : Tachycardia thyrotoxcosis

Bradycardia myxoedema
Collapsing pulse
- the palms moist, sweaty?
- palmar erythema
- peripheral cyanosis
- pallor
- test for fine tremor (patient hold his/her arms out in front of them,
elbow and wrist straight , fingers straight and separated)
3- look at the eye

- lid retraction (upper eyelid is higher than the normal)
- lid lag
- exophthalmos (eyeball is pushed forwards)
- ophthalmoplegia (patient can not look upwards or outwards)
- chemosis (edema of conjunctiva)
4- inspect the neck from the front and either side- surface,
- site,
- Shape (diffuse, nodular. Symmetrical, asymmetrical)
- size,
- color (redness)
- there is any scar for a previous surgery?
- any other swellings
- is there any distended veins?
- look for the position of thyroid cartilage, at center or deviated?
- It moves with the swallowing or not??
- It moves with the protrusion of the tongue or not?
- pemberton's sign
5- palpate the neck from the front

- tenderness,
9 of 18 12-Aug-15 12:31 AM
- temperature
- measure the circumference
- mobility ( relation to surrounding tissues : -muscles
- Skin --tethering
-- fixation
- trachea (at center or deviated)
- carotid artery pulse (is it displaced?)
6- palpate the neck from behind

- ask the patient to swallow while you are palpating
- tenderness, shape, surface, size, consistency, thrill, Pulsatility,
borders, mobility, temperature
- determine the lower border of the gland
- Palpate the cervical lymph nodes
7- percussion
To define the lower extent of a swelling that extends below the
suprasternal notch
8- auscultation:
For a systolic bruit
-Look for any proximal myopathy

-Check the reflexes
(Note: if you suspect cervical lymphadenopathy, or enlargement of a

salivary glands there is another examination for them)
Here is Video
around 20 MB
http://www.etu.sgul.ac.uk/cso/skills...id/thyroid.wmv

Lump History & Examination
Lump History
10 of 18 12-Aug-15 12:31 AM
1- When was the lump first noticed? (Duration)
2- What made the patient notice the lump? (First symptom)
3- What are the symptoms related to the lump? (Other symptoms)
4- Has the lump changed since it was first noticed? (Progression)
5- Does the lump ever disappear (persistence)? What makes the lump to
reappear?
6- Has the patient ever had any other lumps? (Multiplicity)
7- What does the patient think caused the lump? (Cause)
8- There is loss of body weight?
9- There is recurrence after operation or not?
Lump Examination
A- Local Examination:
11 of 18 12-Aug-15 12:31 AM
1- Look:
Number of lumps
Shape (spherical, hemispheric, pear or kidney shape)
Site and extension
Size
Impulse on cough
Color and texture of overlying skin: (smother and shiny or thick and
rough skin, scars,
ulcers, discharging sinuses)
2- Feel:
Temperature
Tenderness
Surface (smooth, irregular, nodular)
12 of 18 12-Aug-15 12:31 AM
Edge (well defined, indistinct)
Consistency (stony hard, firm, rubbery, spongy, soft)
3- Press
Pulsatility (expansile pulsation, transmitted pulsation)
Compressibility (disappear on pressure and reappear on release)
Reducibility (reappear only on application of another force: cough)
Fluctuation (the 2 fingers moved apart when middle area pressed)
Fluid thrill: indicates presence of fluid
4- Percussion
(dull, resonant)
13 of 18 12-Aug-15 12:31 AM
5- Move
Fixation to skin (pinching the skin)
Mobility (try to move the lump in 2 planes)
Attachment to underlying muscle (ask the patient to tense the muscle)
6- Listen:
(bruit, bowel sounds)
7- Transillumination: indicates
presence of clear fluid
14 of 18 12-Aug-15 12:31 AM
8- Examine Surrounding Tissue:
Draining group of lymph nodes
Sensation in surrounding area
Power of related muscle
Distal effects (swelling, atrophy…)
State of local tissue: arteries (ischemia), nerves (muscle wasting and change in
sensation),
lymphatic (edema), bones and joints (erosion).

PERIPHERAL VASCULAR DISEASE History

PERIPHERAL VASCULAR DISEASE
Disorder caused by acute or chronic interruption of blood supply to the

limbs usually due to atherosclerosis. Males>Females.
Presentation:
General presentation is of calf pain, brought on by exercise. The pain will

generally occur at the same distance walked each time, and then relieved by
stopping. This is called ‘Intermittent Claudication’ and the distance walked
before needing to stop the ‘Claudication Distance’. The Claudication
distance is very important to elicit as it can be used to monitor progression of
the diseased vessels. Other symptoms related to claudication are numbness
and paraesthesia .
When does the pain start?
15 of 18 12-Aug-15 12:31 AM
How far can you walk before you need to stop?
Does the pain go away when you stop?
Do you ever tried to ‘walk through the pain’?
If a patient is unsure about how far they can walk in meters, then suggest
local marks to them, such as can you go as far as your front gate? Can you
manage to walk to the shop? Then they will be able to quantify their
claudication distance which should be noted for future comparison.
Does the pain ever occur at rest?
This may indicate progression of the disease in those with a known

claudication distance or worse, a sudden onset of rest pain may indicate
distal embolisation. Rest pain is a continuous pain due to Ischaemia. This
pain is very severe aching type pain mainly in the forefoot, it may be relieved
by the patient dangling their leg over the side of the bed. Rest pain indicates
critical Ischaemia, that is, arterial insufficiency severe enough to threaten the
viability of the foot or leg.
Have you noticed any change in the colour of your legs?
Patients may commonly notice their leg looking paler than the other and
when they go to put their sock on they may feel it colder too, prompting
them to wear two pairs!
Have you noticed any change in the skin on you legs, such as sores that
wont heal?
Patient may present due to loss of tissue of their lower limb from prolonged
compromise. Quite often a carer may notice a blackened toe, or multiple
small areas of discolouration over the distal phalanges- ‘trash foot’, this is
due to multiple microemboli from atheromatous plaques more promixmal.
Ask questions regarding the known risk factors for peripheral Vascular
Disease.
Do you smoke? How many? For how long?
If the patient used to smoke, find out for how long and again how many per
day, as smoking has long lasting and far reaching effects.
16 of 18 12-Aug-15 12:31 AM
Do you have high blood pressure? Are you on any medication for your
blood pressure? For how long? When did you last have it checked? Was
it normal at that time?
Again the same questions need to be asked about hyperlipidaemia and a

family history of same.
Many patients will be on a statin and not know that this is for their
cholesterol so ask specifically about each medication, what it is for, and for
how long they have been on it.
Are you a diabetic?
The following are essential questions to obtain from all patients with
diabetes.
How long have you been a diabetic?
Do you need insulin/injections or are you on diet and exercise alone?
If on insulin/oral hypoglycaemics ask if they have ever had a

hypoglycaemic episode, and if so how many.
What is your normal blood suger range, can I see you book?
What was your last HbA1C?
This test is a marker of their glycaemic control over the last 12 weeks.
Do you have any problems with your eyesight? Is this related to your
diabetes?
Do you have any kidney problems? Is this related to your diabetes
As diabetes is a systemic diseae and affects all the vasculature especially the
small and medium sized vessels, poor eyesight and kidney impairment are an
indication of the condition of the bodies’ vasculature albeit not a very precise
one!

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MedCosmos Medical Blogs

.All MedCosmos Series

History & Examination in Rheumatoid Arthritis

· IBD. Varicose veins examination

* Pain while moving

# Special examination in the spine:

straight leg raising test ( Thomson's test):

Manouvers to stress the sacroiliac joint:

2- lateral position ( close the book):

3- Faber test ( Patrik test)

1- finger tips for pitting scars in scleroderma

Examine for carpal tunnel syndrome:

Posted by MedCosmos at 6:06 PM No comments:

Varicose veins examination

You should start the examination by inspecting the patient standing--if

On inspection, look for:

Locating the saphenofemoral junction

if you put it at the saphenofemoral junction and press on the

You may need to do further investigations to clarify the area of valvular

Sclerotherapy can be effective in treating small varicose veins without

Conservative management may include:

- Reassurance and advice

Posted by MedCosmos at 6:05 PM 1 comment:

Examination for a diabetic foot

See the color of the skin( any pigmentation)

why the ulcer affect the foot af DM people??

4-high glucose level and this a good environment to bacteria to live in

Posted by MedCosmos at 6:05 PM No comments:

1- look at the whole patient- sitting still or agitated, looking nervous or

2- look at the hand- feel the pulse : Tachycardia thyrotoxcosis

3- look at the eye

5- palpate the neck from the front

6- palpate the neck from behind

-Look for any proximal myopathy

(Note: if you suspect cervical lymphadenopathy, or enlargement of a

Posted by MedCosmos at 6:04 PM No comments:

Lump History & Examination

1- When was the lump first noticed? (Duration)

2- What made the patient notice the lump? (First symptom)

3- What are the symptoms related to the lump? (Other symptoms)

4- Has the lump changed since it was first noticed? (Progression)

6- Has the patient ever had any other lumps? (Multiplicity)

7- What does the patient think caused the lump? (Cause)

8- There is loss of body weight?

9- There is recurrence after operation or not?

Shape (spherical, hemispheric, pear or kidney shape)

Site and extension

ulcers, discharging sinuses)

Surface (smooth, irregular, nodular)

Edge (well defined, indistinct)

Consistency (stony hard, firm, rubbery, spongy, soft)

Pulsatility (expansile pulsation, transmitted pulsation)

Compressibility (disappear on pressure and reappear on release)

Reducibility (reappear only on application of another force: cough)

Fluctuation (the 2 fingers moved apart when middle area pressed)

Fluid thrill: indicates presence of fluid

Fixation to skin (pinching the skin)

Mobility (try to move the lump in 2 planes)

Attachment to underlying muscle (ask the patient to tense the muscle)

(bruit, bowel sounds)

presence of clear fluid