1. General
    2. 1. General scheme of case-taking
    2. A few special symptoms and signs
    3. Examination of a lump or a swelling
    4. Examination of an ulcer
    5. Examination of a Sinus or a Fistula
  2. Vascular system
    3. 6. Examination of Peripheral Vascular Diseases and Gangrene
    7. Examination of Varicose veins
    8. Examination of the Lympathic system
  3. Muscles, Tendons and Fasciae
    4. 9. Diseases of Muscles, Tendons and Fasciae
  4. Bones and Joints
    5. 10. Examination of diseases of bone
    11. Examination of bone and joint injuries
    12. Examination of injuries about individual joints
    13. Examination of pathological joints
    14. Examination of individual joint pathologies
  5. Head
    6. 15. Examination of Head injuries
    16. Investigation of intracranial space-occupying lesions
    17. Examination of spinal injuries
    18. Examination of spinal abnormalities
    19. Examination of peripheral nerve lesions
  6. Hand and Foot
    7. 20. Examination of the Hand
    21. Examination of the Foot
  7. Head and Face
    8. 22. Examination of the Head and Face
    23. Examination of the Jaws and Temporomandibular joint
    24. Examination of the Palate, Cheek, Tongue and Floor of the mouth
    25. Examination of the Salivary gland
  8. Neck
    9. 26. Examination of the Neck
    27. Examination of the Thyroid gland
  9. Chest
    10. 28. Examination of injuries of the chest
    29. Examination of diseases of the Chest
    30. Examination of the Breast
  10. Abdomen
    11. 31. Examination of Abdominal injuries
    32. Examination of an Acute abdomen
    33. Examination of Chronic abdominal conditions
    34. Examination of an Abdominal lump
  11. Pelvic
    12. 35. Examination of a swelling in the inguinoscrotal region or groin (Except inguinal and femoral hernias)
    36. Examination of male external genitalia
  12. Case study
    13. 37. Examination of dysphagia case
    38. Examination of a rectal case
    39. Examination of a urinary case
    40. Examination of hernia case
General
4. Examination of an ulcer
  • •
    An ulcer is a break in the continuity of the covering epithelium - skin or mucous membrane.
  • •
    It may either follow
    1. molecular death of the surface epithelium
    2. or its tramatic removal
HISTORY
Mode of onset
Duration
Pain
Discharge
Associated disease
PHYSICAL EXAMINATION
General survey
LOCAL EXAMINATION
Inspection
Size
Shape
Number
Position
Edge
Floor
Discharge
Surrounding area
Whole limb
Palpation
Tenderness
Edge
Margin
Base
Depth
Bleeding
Relations with the deeper structures
Surrounding skin
Examination of Lymph nodes
Examination of vascular insufficiency
Examination for nerve lesion
GENERAL EXAMINATION
SPECIAL INVESTIGATION
Routine examination of the blood
Examination of the Urine
Bacteriological examination of the discharge
Skin test
Chest X-ray
Biopsy
X-ray of the Bone and Joint
Contrast radiography
Imaging technique
CLASSIFICATION OF ULCERS
Clinically
Spreading ulcer
  1. Surrounding skin of the ulcer is inflamed.
  2. Floor is covered with profuse and offensive slough without any evidence of granulation tissue.
  3. Edge is inflamed, oedematou and ragged.
  4. It is painful ulcer.
  5. Drainage lymph nodes are inflamed, enlarged and tender and may be suppurated with abscess formation.
Healing ulcer
  1. It means ulcer is healing.
  2. The floor is covered with pinkish or red healthy granulation tissue.
  3. The edge is reddish with granulation.
  4. Margin is bluish with growing epithelium.
  5. Discharge is slight and serous.
Callous or Chronic ulcer
  1. Ulcer shows no tendency towards healing.
  2. Floor is covered with pale granulation tissue.
  3. Sometimes it show typical wash-leather slough in gummatous ulcer.
  4. Discharge is scanty or absent.
  5. Base, Edge and Surrounding skin ar considerably indurated.
Pathologically
Non-specific ulcers
Traumatic
Mechanical
Dental ulcer of the tongue from jagged tooth, from pressure of a splint
Physical
From electrical or X-ray burn
Chemical
Application of caustics
Arterial
  1. Atherosclerosis
  2. Buerger's disease
  3. Raynaud's disease (Primary and Secondary)
Venous
  1. Varicose ulcer in postphlebitic limb
Neurogenic (tropic)
  1. Bed sore ulcer
  2. Perforating ulcer
Associated with malnutrition
  1. Tropical ulcer
    • •
      Occurs in the legs and feet of th epeople in the tropical countries.
  2. Infection by Vincent's organisms
Associated with other disease
  1. Gout
    • •
      The skin over the gouty deposit (tophi) ulcerates and the chalky contents exude.
  2. Diabetes
    • •
      Slight injury to the glucose laden tissue may cause chronic infection and subsequently in ulcer.
    • •
      It can also occur from ischaemia due to diabetic atherosclerosis and diabetic polyneuropathy.
  3. Anaemia
  4. Avitaminosis
  5. Erythrocyanosis frigida
  6. Rheumatoid arthritis
Other types
  1. Bazin's ulcer
    • •
      It is found in fatty adolescent girls particularly on the calves as purplish nodules followed by indolent ulcers.
  2. Martorell's ulcer
    • •
      It is found in person suffering from hypertension so also called as Hypertension ulcer.
    • •
      It often affects legs where patches of skin necrosis are first noticed.
Specific ulcers
  1. Tuberculous
  2. Syphilitic
  3. Soft sores
  4. Actinomycosis
  5. Meleney's ulcers
Malignant ulcers
  1. Epithelioma
  2. Marjolin's ulcer
  3. Rodent ulcer