Examination of Ulcer: How to describe.

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Examination of an Ulcer

(The description below does not match with the images given beside the text. The images are only for illustrative purposes.)

Inspection

Ulcer over the sole.

On inspection of the right leg, the leg is slightly elevated on the pillow and slightly flexed over the knee joint. (Attitude of the limb).

A single (number), irregularly shaped (shape) ulcer of size around 10 cm x 5cm (size) is present over the dorsum of the foot (site), extending from the lateral malleolus up to the base of the toes (extension).

The floor of the ulcer is pinkish to red (color) with minimal (amount) serous (type of discharge) discharge. No slough, foreign bodies or any other debris (Content on the floor). Multiple tendons are visible towards the distal end (base).

The edge of the ulcer is sloping type (character), with healthy pink granulation tissue (content) and the margin is sharp and regular.

The surrounding skin is exfoliated upto the level of ankle joint. The skin around the ulcer is non-erythematous, and non-edematous. No scars, abnormal pigmentation, or excoriation marks present.

The joint mobility of the proximal and distal joint along with that of the entire limb is not impaired. (Gross motor status and Range of motion of the affected joints)

Palpation

Ulcer over the dorsum of foot

On palpation, there is local rise in temperature and mid tenderness over the ulcer.

The edges are not indurated and the base of the wound are also not indurated. The ulcer is 3-4mm deep, does not bleed on touch, and mobile over the underlying base.

The skin around the ulcer has mild rise in temperature locally with tenderness present. The skin is freely mobile on the underlying structure.

Dorsalis pedis artery, anterior tibial and posterior tibial artery are palpable and bilaterally symmetrical. Capillary refill time over the distal phalanges is more than 2 s.(Gross vascular status)

Active and passive range of motion over the limb is not restricted. Sensation is grossly intact over the area distal to the ulcer. (Gross Neurological status and range of motion)

The draining lymph nodes over the left inguinal region are not palpable significantly.

Ulcer examination is incomplete without draining lymph nodes palpation. 

Learn How to describe other systems and pathological conditions.

Abdominal | Respiratory | Cardiovascular | Nose and PNS | Oral Cavity | Ear | Digital Rectal Examination | Ulcer | 

Rule of Two: Xray

There are various topics in medicine that can briefly be remembered with a single number and such topics are included in this page titled RULE OF NUMBERS.

Rule of Two

Reading X-ray in Orthopedics

While reading  X-ray in orthopedics, rule of two applies. That is when-ever you read a X ray you need to have 2 views, one joint above the suspected injury site and 1 joint below, comparing both the limbs, repeated/taken 2 weeks apart and commented by 2 orthopedicians.

2 View: AP and lateral view recommended in mostly to see the deformity/ displacement , angulation

2 abnormalities: If one abnormality found always look for the next one as finding one might mask the concurrent another injury.

2 Joints: One joint above and 1 joint below to rule out involvement of joints (r/o assosciated subluxation and dislocations)

2 limbs:  If doubtful always compare with contralateral limb.

2 occasions: Always compare with previous Xray  if available.

2 evaluations: If no previous films, reevaluate the patient and repeat Xray on followup.

2 reviews:  If doubtful should always be reviewed by another observer.

Rule of Two: Meckel's Diverticulum

Meckel’s Diverticulum

It is a blind ended tube arising from the ante-mesenteric border of the intestine and is a remnant of Vitellointestinal Duct. It also follows the rule of two i.e it is 2 inch in length, 2 feet proximal to ileocaecal junction, occurring in only 2 % of population, 2% being symptomatic and 2 types of ectopic tissues found i.e Gastric and Pancreatic. 2 times more common in male and onset is around 2 years of age.

Rule of two in Meckel's Diverticulitis

OSTEOCHONDRITIS

osteochondritis