Outline for writing a case of Ulcer

A. History

Duration- For how long is the ulcer present.

Mode of onset- Following trauma or spontaneously or following a swelling.

Site- Where first noticed.

Progress of the ulcer-

    • Any pain over the ulcer

    • Any discharge- Serous/Purulent/Haemorrhagic

    • Any associated disease- Diabetes/ Sickle cell anaemia/ pulmonary tuberculosis/ Varicose vein/ Systemic malignancy/ AIDS.

6. Examination of chest in case of tuberculous ulcer.

B. Physical Examination

I. General Survey

II. Local examination of ulcer

1. Inspection:

    • Number

    • Site

    • Extent

    • Shape

    • Size

    • Margin

      • Undermined

      • Punched Out

      • Sloping

      • Raised or Rolled out

      • Everted

    • Floor of ulcer

    • Discharge- character, amount, smell

    • Adjacent area-

      • Any swelling

      • Any skin change

      • Any secondary changes

      • Any associated venous diseases

2. Palpation:

    • Temperature

    • Tenderness

    • Margin of ulcer- type, any induration

    • Base- The area on which ulcer rests. (Feel the base by picking up the ulcer in between the thumb, index and middle fingers)

    • Test mobility of ulcer over the deeper structure.

    • Any discharge during palpation- Bleeding or mucous discharge.

3. Examination of regional lymph nodes.

4. Examination of vascular disease.

5. Examination of any nerve lesion.