Ref: Examining A Mass
  1. Inspection
  2. Palpation
  3. Percussion and auscultation
  4. General patient
  5. Mnemonic
Inspection
  1. Site
    Also, single vs. multiple.
    Distance from a bony prominence landmark.
  2. Size
  3. Shape
  4. Surrounds
    Remote surrounds first, then local surrounds.
    Also, surrounding neurological or motor deficits.
  5. Surface
    Smooth vs. rough vs. indurated.
    Skin, scars.
  6. Edge
    Clear vs. poorly defined.
  7. Transillumination, if applicable.
    Whether a torch behind lump will allow light to shine through.
    Esp. used in testicular mass.
Palpation
  1. Temperature
    Feel with back of fingers on surface, surrounds.
  2. Tenderness
    Ask to tell when feel pain.
    Nerve: can cause pins and needles.
  3. Consistency
    Soft, spongy, firm.
  4. Mobility and attachment
    Move lump in two directions, right-angled to each other. Then repeat exam when muscle contracted:
    Bone: immobile.
    Muscle: contraction reduces lump mobility.
    Subcutaneous: skin can move over lump.
    Skin: moves with skin.
  5. Pulsatile
    Assess with 2 fingers on mass:
    Transmitted pulsation: both fingers pushed same direction.
    Expansile: fingers diverge (esp for AAA).
  6. Fluctuation [fluid-containing]
    Assess by placing 2 fingers in "peace sign" on either edge of lump, then tapping lump center with index finger of other hand: fluctuant lump will displace peace sign fingers.
    Very large masses can be assessed by a fluid thrill. See Ascites examination.
  7. Irreducible
    Compressible: mass decreases with pressure, but reappears immediately upon release.
    Reducible: mass reappears only on cough, etc.
Percussion and auscultation
General patient
  1. Regional lymph nodes around mass.
  2. Overall appearance of the patient.
Mnemonic

4 Students and 3 Teachers around the CAMPFIRE:

Site
S
ize
Shape
Surface
Tenderness
Temperature
Transillumination
Consistency
Appearance of patient
Mobility
Pulsation
Fluctuation
Irreducibility
Regional lymph nodes
Edge