Malignant Ulcer

Question 1

What is an appropriate ulcer hx for a patient?

Answer 1

If acute or chronic
How long been present
Any symptoms - pain/ bleeding/ numbness
Changes in appearance

Question 2

What are key headings of ulcer hx?

Answer 2

Ulcer hx
Trauma history
MH
Drug hx
Family hx
SH - drugs/ alcohol/ betel/ paan

Question 3

If suspect a malignant ulcer - what are 4 things to check?

Answer 3

1. Inspect ulcer - no/ site/ size/ margins/ bleeding
2. IO inspection
3. Palpate ulcer - induration/ fixed to underlying tissue, raised margin
4. Palpate cervical lymph nodes

Question 4

What to say if pt asks if it is cancer?

Answer 4

Address patient concern
Don’t dismiss concerns - don’t say it is nothing to worry about
Eye contact/ actively listen
Advised you are trained to be more cautious/ suspicious and a second opinion is necessary
Reassure will be seen in hospital within 14 days

Question 5

What are reg flags of NICE guidelines for suspected cancer?

Answer 5

Ulcers persistent > 3 weeks

Question 6

What is nicorandril used for?

Answer 6

Angina

Question 7

What % of pt taking nicorandril get ulceration?

Answer 7

5% - usually develop within 24 months of drug intake

Question 8

What happens if biopsy comes back with non-specific inflammation?

Answer 8

Biopsy would need to be repeated if no known causes

Question 9

How can help pt manage pain caused by ulceration?

Answer 9

Symptomatic - benzydamine/ chlorhexidine, topical steroids

Question 10

If drug-induced ulcer, how proceed?

Answer 10

Liase w/ primary care to stop drug - should disappear few weeks of cessation of drug