History taking 4

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Author:
prem77
ID:
280579
Filename:
History taking 4
Updated:
2014-08-13 11:40:08
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Examination an ulcer
Folders:
History taking
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  1. History
    • 1. Mode of Onset 
    • 2. Duration 
    • 3. Pain - 
    • - Painful - ulcers associated with inflammation
    • - Slightly painful - tuberculosis ulcers  
    • - Painless - tabes dorsalis, transverse myelitis, basal cell carcinoma (become painful if they infiltrate structures supplied by pain nerve endings)

    • 4. Discharge - serum, pus or blood
    • 5. Associated disease - tabes dorsalis, syringomyelia, transverse myelitis, peripheral neuritis, generalized tuberculosis, syphillis,
  2. Inspection
    • 1. Size and spape 
    • - oval - tuberculosis ulcers 
    • - Circular - syphilitic ulcers, later may unite to form a serpiginous ulcer 
    • - vertically oval - varicose ulcers 
    • - Irregular - carcinomatous

    • 2. Number 
    • - More than one in number - tuberculosis, gumma, varicose ulcers, soft chancres 

    • 3. Position 
    • - Medial malleolus - varicose vein 
    • - Upper part of face above the line joining the angle of mouth to the lobule of the ear - rodent ulcers 
    • - Neck, axilla, groin - tuberculosis 
    • - Face, fingers and hands - lupus 
    • - External genitalia - Hunterian cancre, soft sores 
    • - Tibia, sternum, skull - gummatous ulcers 
    • - Heel of foot - perforating or trophic ulcers 


    • 4. Edge 
    • - Inflammed and edematous - spreading ulcer 
    • - red granulation tissue - healing ulcer 
    • a. Undermined edge - tuberculosis
    • b. Punched out edge - gummatous ulcer
    • c. Sloping edge - healing traumatic, venous ulcers
    • d. Raised and pearly white beaded edge - rodent ulcer 
    • e. Rolled and everted - squamous celled carcinoma 

    • 5. Floor
    • - red granulation tissue - healthy and healing ulcer 
    • - pale and smooth granulation tissue - slowly healing ulcer 
    • - wash leather slough - gummatous ulcer 
    • - black mass - malignant melanoma 

    • 6. Discharge 
    • - scanty, serous discharge - healing ulcer
    • - purulent discharge - spreading and inflammed ulcer 
    • - Serosanginous discharge - tuberculous or malignant ulcers 
    • - Greenish - B-pyocyanea 

    • 7. Surrounding area 
    • - glossy, red and edematous - acutely  inflammed ulcer 
    • - eczematous and pigmented - varicose ulcer 
    • - scar or wrinkling in the surrounding skin - old cases of tuberculosis
  3. Palpation
    • 1. Tenderness 
    • - Extremly tender - acutely inflamed 
    • - Slightly tender - tuberculous, syphillitic, 
    • - Non tender - neoplastic ulcer 
    • - Pain may be present or absent - varicose ulcers 

    • 2. Edge and margin 
    • Edge - area between the margin and the floor of ulcer 
    • Margin - junction between normal epithelium and the ulcer 

    Marked induration of edge - carcinoma 

    • 3. Base (on which ulcer rests) and Floor (exposed surface within ulcer) 
    • - Slight induration of base - any chronic ulcer 
    • - marked induration of base - squamous cell carcinoma and hunterian cancre 

    • 4. Depth 
    • - trophic ulcers may be as deep as to reach even bone 

    • 5. Bleeding 
    • - Malignant ulcers bleed on touch

    • 6. Relation to deeper structures  
    • - Malignant ulcers are fixed to deeper structures 

    • 7. Surrounding skin 
    • - rise in temperature - inflammatoty oring 
    • - fixity to deeper structures - malignant nature 
    • - Palpation of arteries, arteries blocked in atherosclerosis, buerger's disease, raynauds disease
  4. Examination of lymph nodes
    • Enlarged and painful, later abscess formation -= inflamatory ulcers 
    • Enlarged, matted and slightly tendor - tuberculosis 
    • Hunterian chancre - discrete, firm and shotty
    • - Lymph nodes not involved - rodent ulcer, gummatous ulcers
    • - Stony hard - neoplastic
  5. Examination of vascular insufficiency
  6. Examination of nerve lesions

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