Expansion
Site, size, shape, surface, edge, consistency, mobility and more
Expansion
The six Ss and the rest
- Site, in relation to fixed anatomical landmarks
- Size, measured in two or three dimensions
- Shape
- Surface: smooth, irregular, nodular
- Skin: colour, punctum, ulceration, tethering, temperature, scars
- Symmetry and whether there are others elsewhere
- Edge: well defined or diffuse
- Consistency: soft, firm, hard, rubbery, fluctuant
- Tenderness
- Mobility and fixation: to skin, to underlying muscle (test with the muscle contracted) or to bone
- Pulsatility, and whether expansile (aneurysm) or transmitted
- Compressibility and reducibility, with a cough impulse for hernias
- Transillumination: positive in fluid filled swellings such as hydrocele
- Auscultation for a bruit
- Regional lymph nodes, always
Common answers from these features
| Lump | Distinguishing features |
|---|---|
| Lipoma | Soft, lobulated, mobile, slips under the finger, not fixed to skin |
| Sebaceous cyst | Fixed to skin with a punctum |
| Hydrocele | Transilluminates, can get above it |
| Inguinal hernia | Cough impulse, reducible, cannot get above it |
| Malignant node | Hard, fixed, irregular, painless |
| Abscess | Hot, tender, fluctuant, red |