Ulcer Examination
Introduce yourself
Exposure: till area L.N. drainage
1- Inspection (3S FED 2S)
a- Site
b- Shape (circular / oval / irregular /
healing)
c- Size (in cms)
d- Skin surrounding
e- Floor (granulation tissue /
slough [dead tissue])
f- Edge (sloping / raised /
everted / punched out / undermined)
g- Discharge (serous / blood
stained / purulent) Depth
h- Surrounding structures (lymph
nodes, V→ Varicose, A → Ischemia, Trophic ulcers)
2- Palpation Ask
about pain [NOT done (painful)]
a- Tenderness
b- Edema
c- Base hold edges between fingers &
move to feel (indurated /
attached to deeper structures)
d- Surrounding structures (Other Swelling, A→ Feel the PULSE)
Lipoma
Introduce yourself
Exposure: till area L.N. drainage [Common sites: Back,
Shoulder, Thigh, Trunk, Neck, forearm]
1- Inspection (4SMS)
a- Site b- Shape c- Size (in cms) d- Skin: Scars (Ask about hidden scars?)
e- Relation to Muscle: contraction ms → more palpable = superficial to ms
(SC lipoma)
→ less
palpable = deep to ms (IM or subfascial lipoma)
[- Back→1Serratus
ant.& 2Latiss.dorsi - Shoulder→1+2+trapezius
–Thigh→adductors & quadriceps]
زق الحيطة كوعك لورا ارفع كتفك ضم
رجلك افرد رجلك
Test all against
resistance except serratus ant.
2- Palpation Ask about painful area first (TT ESCR SMSL)
a- Temperature b- Tenderness
c- Edge → Slippery(Slip
sign)
d- Surface → Lobulated (usually
in SC)
e- Consistency → soft
f- Relations: Mobility in 2 perpendicular
directions
Relation
to Skin → not attached
Relation
to Muscle: contraction ms
→ more palpable = superficial to ms
→ less
palpable = deep to ms
h- L.N. & other
swellings (very..very imp.)
I would like to finish my examination
by:
1- Examination of draining lymph nodes هام جدا
2- Assessing the neurovascular status of the limb/area (feel
distal pulse)
Dermoid cyst
(Cong. Or acquired)
Introduce yourself
Exposure: till area L.N. drainage [C. Sites: Cong.→Ext.&Int.angular, Pre&post-auric.& midline]
Acq. (Implantation)
→ at site scar
1- Inspection (4SMS)
a- Site b- Shape c- Size (in cms) d- Skin: Scars (Ask about hidden scars?) in implantat.
e- Relation to Muscle: contraction ms → more palpable = superficial to ms
(e.g,
angular dermoid → contract occiptofrontalis ارفع حواجبك )
2- Palpation Ask about painful area first (TT ESCR SMSL)
a- Temperature b- Tenderness
c- Edge → well
defined d- Surface → smooth
e- Consistency → cystic
f- Relations: Mobility in 2 perpendicular
directions
Relation
to Skin → not attached
(cong)/ teethered (implantation)
Relation
to Muscle: contraction ms
→ more palpable = superficial to ms
g- Special Tests · Fluctuation
(Paget’s test) & Trans-illumination
h- L.N. & other
swellings (very..very imp.)
I would like to finish my examination
by:
1- Examination of draining lymph nodes هام جدا
2- Assessing the neurovascular status of the limb/area (feel
distal pulse)
Sebaceous cyst
Introduce yourself
Exposure: till area L.N. drainage [C. Sites: Hairy area (esp,
scalp & scrotum) never in palm or sole]
1- Inspection (4SMS)
a- Site b- Shape c- Size (in cms) d- Skin: Scars (Ask about hidden scars?)
e- Relation to Muscle: contraction ms → more palpable = superficial to ms
2- Palpation Ask about painful area first (TT ESCR SMSL)
a- Temperature b- Tenderness
c- Edge → well
defined d- Surface → smooth
e- Consistency → soft/ firm (thick sebum)
f- Relations: Mobility in 2 perpendicular
directions
Relation
to Skin → attached at punctum
(50%)
Relation
to Muscle: contraction ms
→ more palpable = superficial to ms
h- L.N. & other
swellings (very..very imp.)
I would like to finish my examination
by:
1- Examination of draining lymph nodes هام جدا
2- Assessing the neurovascular status of the limb/area (feel
distal pulse)
Ganglion (As above but,…)
e- Consistency → cystic
f- Relations: Mobility in 1 direction only &
become limited after ms contraction
Relation
to Skin → not attached
Relation
to Muscle: contraction ms
→ less palpable & limited (related to tendon)
g- Special Tests · Fluctuation
(Paget’s test) & Trans-illumination
h- L.N. & other
swellings
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