Examination Of An Ulcer

Question 1

What are the five stages of examining an ulcer?

Answer 1

Look, feel, move, examine the regional lymphatic drainage, special tests

Question 2

What are the ten stages of inspecting an ulcer?

Answer 2

Number of lesions, site, size, shape, margin, edge, floor, discharge, surrounding skin, whole limb

Question 3

What are you looking for when looking at the number of lesions?

Answer 3

Single or multiple. Multiple ulcers are commonly seen in arterial disease

Question 4

How do you measure the size of an ulcer?

Answer 4

Use a tape measure to measure the ulcer. Estimate the depth in millimetres.

Question 5

What are you looking for when looking at the shape of an ulcer?

Answer 5

For example, varicose veins are typically vertically oval, malignant ulcers and typically irregular in shape

Question 6

Give 6 examples of how the edge of an ulcer could be

Answer 6

Sloping, punched out, undermined, raised, rolled, everted. Note whether the marginal epithelium is attempting to grow over the surface

Question 7

What are the nine examples of the floor of an ulcer

Answer 7

Healthy granulation tissue, unhealthy granulation tissue, slough, scab, fat, muscle, tendon, periosteum or bone

Question 8

What 5 things are you looking for when assessing the discharge of an ulcer?

Answer 8

Quantity, consistency, colour, composition and odour

Question 9

Give 4 examples of types of discharge

Answer 9

Serous (watery), sanguineous (bloodstained), purulent or green (which usually indicates Psuedomonas colonisation/infection)

Question 10

List 5 things you are looking for in surrounding skin?

Answer 10

Hyperpigmentation, oedema, erythema, stretch marks and wrinkling (which may indicate resolving inflammation)

Question 11

What are you looking for in the whole limb?

Answer 11

Venous and arterial insufficiency and neurological disease. Muscle wasting may be present

Question 12

What 4 things are you checking for on palpation?

Answer 12

Tenderness, temperature, the edge of the ulcer for induration, whether the ulcer bleeds on gentle touch or not

Question 13

Why do you palpate the edge of the ulcer for induration

Answer 13

A feature of chronic benign ulcers and of malignant ulcers

Question 14

Why do you determine whether the ulcer bleeds on gentle touch or not

Answer 14

This is often a feature of malignancy

Question 15

How do you move an ulcer?

Answer 15

Gently attempt to move the base of the ulcer using your thumb and forefinger. Fixation to deeper structures may be suggestive of malignancy

Question 16

What 3 special tests can you do?

Answer 16

Palpate the peripheral pulses. Examine light-touch and pressure sensation. If there is evidence of bony structures examine the nearby joints