Short Case Examination

Diagnostic criteria Sebaceous cyst Dermoid cyst Lipoma Neurofibroma

Inspection
Anywhere(SCALP,
vulva, scrotum, face, Along the midline,
Site back of the trunk) post auricular area, Anywhere in the body Subcutaneous tissue
★Except palm & sole ovary
★Punctum present
Size Varying size Varying size Rounded
Shape ★Globular ★Globular ★Lobulated Rounded
Color Normal Normal Normal Normal
Palpation
Temperature Normal Normal Normal Normal
Surface Smooth Smooth ★Lobulated Smooth
Margin Well defined Well defined/regular Well defined/regular Well defined
Consistency ★Trench cystic ★Trench cystic Soft ★Firm
Compressibility Non-compressible Non-compressible Non-compressible
Tenderness Non-tender Non-tender Non-tender ★Tender
★Fixed with skin but
Free from skin & ★Free from skin & Free from skin &
Fixity free from underlying
underlying structure underlying structure underlying structure
structure
Slipping sign Negative Negative ★Positive
Fluctuation Negative Positive Negative
Trans illumination Negative Negative Negative
★Positive: Pressing
Finger indentation/ ★Movement side to
★Press → Compress cyst upward there will
Bony indentation/ side, not along nerve
Release → Normal be depression in lower
Movement axis
area
Palpable cuff muscle Negative
Tinnel sign ★Positive:

Differential Diagnosis
Sebaceous cyst Dermoid cyst Lipoma Neurofibroma
Lipoma Sebaceous cyst Sebaceous cyst Fibroma
Neurofibroma Lipoma Neurofibroma Lipoma
Hemangioma Meningocele Hemangioma Lymph node

Investigation/Confirmatory test
RBS, HBsAg, FNAC, X-ray of skull both ant- FNAC(Fine Needle Aspiration
FNAC
FNAC: not usually post & lateral view Cytology)

Treatment
Excision of sebaceous Excision of dermoid cyst Excision of lipoma
Complete excision
cyst(elliptical incision)(•) (skin craze incision) (skin craze incision)
Diagnostic criteria Hernia Hydrocele
Inspection
★Direct → Inguinal hernia
Site Scrotal swelling(left/right)
Indirect → Inguino-scrotal hernia
Size Variable Variable
Direct → Globular
Shape Elongated
Indirect → Preforming
Cough impulse ★Positive or present Negative or absent
Palpation
Temperature Normal Normal
Surface Smooth Smooth
★Doughy fillings → Omentum present
Consistency ★Cystic: Fluid present
Soft → Intestine present
Tenderness Non-tender Non-tender
★Possible(only spermatic cord can find
Gait above the swelling Not possible
not other content)
Reducible ★Reducible(mainly)/Non-reducible ★Non-reducible
Fluctuation ★Negative ★Positive
Trans illumination ★Negative ★Positive
Testis/Separation Separate from swelling Not separated from swelling
Deep ring oculation test Positive

Difference between hernia & hydrocele

Trait Hernia Hydrocele
Protrusion of the viscous or part of the Abnormal accumulation of fluid
Definition viscous through an abnormal opening between two layers of the processus
with its containing cavity vaginalis
Direct → Inguinal hernia
Site Scrotal swelling(left/right)
Indirect → Inguino-scrotal hernia
Direct → Globular
Shape Elongate
Indirect → Preforming
Cough impulse Positive or present Negative or absent
Temperature Normal Normal
Surface Smooth Smooth
Doughy fillings → Omentum present
Consistency Cystic: Fluid present
Soft → Intestine present
Tenderness Non-tender Non-tender
Separation Separate from swelling Not separated from swelling