Examination of an ulcer

Points to be emphasised while examining an ulcer in an OSCE station

Ulcers

Inspection

Palpation

Description

  • Number
  • Site
  • Shape
  • Size (and Depth)
  • Floor
  • Edge
  • Margin
  • Discharge
  • Temperature
  • Tenderness
  • As inspection
  • Base
    • Extent
    • Induration
    • Tenderness
    • Motility
Draining L.N.s
Neuro-Vascular Bundle

How to take a history from a patient with an ulcer

Differential Diagnosis of an Ulcer

According to the cause

Example

Character

Trauma Sloping edge
inflammation TB undermined edges

associated with pain

Venous various veins i.e. Venous Ulcer Sloping edges
Lymphatic With lymphoedema
Neurologic diabetic neuropathy Neuropathic ulcer

Without pain

Neoplastic SCC

BCC

Everted edges

Beaded edges

 

According the site
Face Leg Foot Tongue
Rodent ulcer

Epithilioma

Keratoacanthoma

Ulcerated seb. Cyst

Ulcerated M.M.

TB ulcer

Vascular Venous

Arterial

Lymphatic

neuropathic Dyspeptic

Dental

Malignant

TB

Herpes

syphilis

Traumatic Vascular Ischemia
Infection TB Traumatic
Neoplastic -1ry as MM or BCC

-Ulcerated deep malignancy

Neoplastic
Signs suggestive of malignancy in an ulcer
  • Rapid increase in size
  • Rapid increase in ulceration
  • Bleeding
  • Change in color
  • Halo of pigmentation
  • Satellite nodules
  • Irritation
  • Lymph node enlargement
  • Distant metastasis
Floor of an ulcer
  • Malignant necrotic tissue
  • Granulation tissue
    • Healing
      • Pink
      • Finley granular
      • Bleed in touch
      • Level with skin
    • Non-healing
    • Non specific
      • Pale or yellow
      • Very vascular
    • Specific
      • Like TB caseation