EXAMINATION OF SEBACEOUS CYST

EXAMINATION OF SEBACEOUS CYST:

 

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 THE BUTTONS OF YOUR SHIRT UNDONE?

 

ARE YOU CONFORTABLE 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 LUMP AND SAY..

 

 

TO EXAMINER:

THERE IS IN THIS GENTLEMAN, ON INSPECTION A SMALL LUMP ON THE RIGHT SCALP WHICH IS ABOUT 3 BY 2 CMS IN SIZE. IT IS SPHERICAL IN SHAPE. THERE IS/ IS NO EVIDENCE OF PUNCTUM, SCAR, REDNESS, HAIRLOSS OR DISCHARGE 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 SURFACE AND WELL DEFINED EDGE. IT IS HARD IN CONSISTENCY AND IS NON FLUCTUANT (CHECK IN TWO PLANES).

 

TO PATIENT:

I AM NOW GOING TO MOVE THE SKIN OVER THE LUMP AND ALSO MOVE THE LUMP IN TWO PLANES.

 

TO EXAMINER:

THE LUMP MOVES WITH THE SKIN FREELY OVER THE UNDERLYING STRUCTURES HENCE IT ARISES FROM THE SKIN. IT IS NEITHER TETHERED NOR FIXED.

 

 TO PATIENT:

I AM JUST GOING TO FEEL THE LYMPH GLANDS IN YOUR NECK. JUST BEND YOUR NECK SLIGHTLY PLEASE.

 

ACT:

FEEL BOTH HORIZONTAL AND VERTICAL CHAIN OF LYMPH NODES.

 

TO EXAMINER:

THE REGIONAL LYMPH NODES ARE NOT ENLARGED.

 

TO PATIENT:

THANK YOU SIR. LET ME HELP YOU WITH YOUR BUTTONS. 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 SEBACEOUS CYST/ EPIDERMAL CYST.

 

I WOULD LIKE TO WASH MY HANDS.

 

 

FOR DIAGRAM:

NORMAN BROWSE FIGURE 3.26 A PAGE 73

CATHERINE PARCHMENT SMITH CLINICAL BOOK PAGE 57.

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