EXAMINATION OF LIPOMA

EXAMINATION OF LIPOMA:

 

INSTRUCTION: EXAMINE THIS LUMP.

 

 

TO PATIENT:

 

HELLO MR.JOHN MY NAME IS DR. NAZISH. HOW ARE YOU FEELING TODAY? REPLY ACCORDINGLY.

 

MAY I PLEASE EXAMINE YOU? THANK YOU.

 

LET ME JUST DRAW THE CURTAINS TO ENSURE PRIVACY. I HAVE ALREADY WASHED MY HANDS.

 

COULD YOU PLEASE SIT ON THIS CHAIR AWAY FROM THE WALL WITH YOUR SHIRT OFF.? LET ME HELP YOU WITH IT.

 

ARE YOU COMFORTABLE SIR?

 

DO YOU MIND IF I TALK ABOUT YOU TO THE EXAMINERS AS I GO ALONG?

 

I AM JUST GOING TO HAVE A LOOK FIRST OF ALL.

 

ACT:

LOOK CLOSELY AT THE LUMPON THE SHOULDER AND SAY.

 

 

TO EXAMINER:

THERE IS ON INSPECTION IN THIS GENTLEMAN A SMALL/LARGE LUMP ON THE FRONT OF RIGHT SHOULDER/ BACK/ARM/FOREARM/NECK/TRUNK.IT IS ABOUT 3 BY 4 CMS IN SIZE AND IS HEMISPHERICAL IN SHAPE. THERE IS/ IS NO EVIDENCE OF ANY SCAR, REDNESS, VISIBLE VEINS IN THE OVERLYING SKIN AND THE SURROUNDING SKIN APPEARS TO BE NORMAL.

 

TO PATIENT:

I AM NOW GOING TO GENTLY FEEL THE LUMP. DOES IT HURT AT ALL? I WILL BE VERY GENTLE.

 

TO EXAMINER:

THE OVERLYING SKIN IS NOT WARM (COMPARE WITH SURROUNDING SKIN). IT IS A NON TENDER LUMP (LOOK AT PATIENTS FACE AND ALSO ASK PATIENT IF IT HURTS WHEN I TOUCH YOU HERE) WITH A SMOOTH LOBULATED SURFACE. THE EDGES ARE ALSO LOBULATED AND SLIP AWAY FROM THE FINGERS (SLIP SIGN). IT IS SOFT IN CONSISTENCY AND IS FLUCTUANT (CHECK IN TWO PLANES) (LARGE LIPOMA)/ DOES NOT FLUCTUATE (SMALL LIPOMA).

 

TO PATIENT:

I AM NOW GOING TO MOVE THE SKIN OVER THE LUMP AND ALSO MOVE THE LUMP IN TWO PLANES IN THE DIRCETION OF THE UNDERLYING MUSCLE AND AT RIGHT ANGLES TO IT. NOW COULD YOU PLEASE TENSE THAT MUSCLE AGAINST MY HAND, I AM REASSESSING THE MOBILITY OF LUMP IN TWO PLANES TO CHECK IF THE LUMP BECOMES LESS PROMINENT OR LESS MOBILE.

 

ACT:

IN SHOULDER LUMP PUSH ELBOW DOWN AND ASK PATIENT TO TENSE MUSCLE AGAINST MY HAND AND REASSESS MOBILITY IN TWO PLANES.

 

CAN CHECK DIAGRAM IN CLINICAL DAS.

 

TO EXAMINER:

THE LUMP LIES SUPERFICIAL TO MUSCLE AS IT BECOMES MORE DISTINCT ON CONTRACTION OF UNDERLYING MUSCLE AND THE SKIN MOVES EASILY OVER IT. IT THEREFORE ARISES FROM SUBCUTANEOUS TISSUES AND IS NEITHER TETHERED TO THE SKIN NOR FIXED TO THE DEEP TISSUES.

 

NOTE: IF LUMP BECOMES LESS PROMINENT AND LESS MOBILE ON TENSING THE MUSCLE IT MEANS THAT IT IS ARISING FROM MUSCLES.

 

 TO PATIENT:

I AM JUST GOING TO FEEL THE LYMPH GLANDS IN YOUR ARMPIT. JUST RELAX YOUR ARM AND LET ME TAKE YOUR ELBOW. HAVE YOU NOTICED ANY LUMPS HERE YOURSELF.

 

CAN CHECK BARBARA BATES CLINICAL CD ON BREAST EXAMINATION ON HOW TO CHECK AXILLARY LYMPH NODES.

 

TO EXAMINER:

THE REGIONAL LYMPH NODES ARE NOT ENLARGED.

 

TO PATIENT:

THANK YOU SIR. LET ME HELP YOU WITH YOUR SHIRT. THANK YOU AGAIN.

 

TO EXAMINER:

TO COMPLETE MY EXAMINATION I WOULD LIKE TO ASK PATIENT A FEW QUESTIONS:

HOW THE LUMP AFFECTS THEIR LIVES/ HOW DOES IT BOTHER THEM.

WHETHER THEY HAVE NOTICED SIMILAR LUMPS ELSEWHERE.

HOW LONG HAS THE LUMP BEEN PRESENT FOR?

 

MY DIAGNOSIS IS LIPOMA.

 

I WOULD LIKE TO WASH MY HANDS.

 

 

FOR DIAGRAM:

NORMAN BROWSE FIGURE 3.29 PAGE 79.

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