Inspection
Site of ulcer
Number (solitary/multiple)
Size (length × breadth)
Shape (round/oval/irregular)
Orientation
Margin
Edge (sloping/undermined/punched-out/everted/rolled)
Floor (granulation tissue/slough/necrotic tissue)
Base (visible characteristics)
Discharge (serous/purulent/blood-stained/foul smelling)
Surrounding skin changes:
- Hyperpigmentation
- Edema
- Induration
- Eczema
- Callosity
- Scarring
- Dilated veins
- Inflammation
Bleeding
Sinus/Fistula
Satellite lesions
Deformity of the affected part
Palpation
Local rise of temperature
Tenderness
Confirmation of size
Margin and edge
Floor (smooth/irregular)
Base (soft/indurated/hard)
Mobility (mobile/fixed to underlying structures)
Induration (presence and extent)
Bleeding on touch
Surrounding tissue examination:
• Edema
• Cellulitis
• Varicosities
• Sensory loss
• Muscle wasting
• Trophic changes
Regional lymph nodes:
(Size, Number, Consistency, Tenderness, Mobility, Matting)
Peripheral pulses
Sensory examination
Motor examination
Special Tests (if indicated)
Buerger’s test (arterial ulcer)
Brodie-Trendelenburg test (venous ulcer)
Perthes test (venous ulcer)
Monofilament test (diabetic neuropathy)
Vibration sense assessment
Ankle-Brachial Pressure Index (ABPI)
📋 Ulcer Examination Summary
The patient is conscious and oriented to time, place and person. He/She is examined in a well-lit room, adequately exposed, after taking verbal consent.
General physical examination revealed pulse _/min, blood pressure _ mmHg, respiratory rate _/min, temperature ___°C and BMI _. Pallor/Icterus/Cyanosis/Clubbing/Lymphadenopathy/Pedal edema are present or absent accordingly.
On local examination, a solitary/multiple ulcer measuring approximately _ × _ cm is/are present over the ______ region. The ulcer is oval/round/irregular in shape and oriented ______. The margins are ______ and the edge is ______ (sloping, undermined, punched-out, everted or rolled). The floor showed healthy granulation tissue/slough/necrotic tissue accordingly.
The surrounding skin showed ______( such as hyperpigmentation, edema, induration, eczema, callosity, scarring, dilated veins or signs of inflammation.) Discharge is present/absent and is serous/purulent/blood-stained/foul smelling accordingly.
No active bleeding, sinus are noted.
My inspection findings are confirmed by palpation. Local rise of temperature is present/absent and tenderness is present/absent. The ulcer measured approximately _ × _ cm. Its margins are _____ and edges are ______. The floor is smooth/irregular and the base is soft/indurated/hard.
The ulcer is mobile/fixed to underlying structures. Induration is present/absent and extended for approximately ___ cm beyond the edge of the ulcer. Bleeding on touch is present/absent.
The surrounding tissues are examined for edema, cellulitis, varicosities, sensory loss, deformity, muscle wasting or trophic changes as applicable.
Regional lymph nodes are palpable/not palpable. When palpable, they are assessed for size, number, consistency, tenderness, mobility and matting.
Examination of the arterial system revealed ______ peripheral pulses. Examination of the venous system revealed/no evidence of venous insufficiency. Neurological examination of the affected limb revealed normal/impaired sensations and motor functions.
Special tests relevant to the suspected etiology were performed and findings were noted accordingly.
On systemic examination, CVS revealed normal S1 and S2. Respiratory system showed bilateral air entry with no added sounds. Abdomen was soft and non-tender with no organomegaly.
In summary, this is a solitary/multiple ulcer over the ______ region measuring _ × _ cm, having a ______ edge, ______ floor and ______ base, with/without regional lymphadenopathy and with clinical features suggestive of ______ ulcer.
🩺 Common Closing Diagnoses
- Venous ulcer over the medial malleolus associated with varicose veins.
- Arterial (ischemic) ulcer associated with peripheral arterial disease.
- Diabetic (neuropathic) ulcer over the plantar aspect of the foot.
- Trophic ulcer secondary to peripheral neuropathy.
- Tuberculous ulcer with undermined edges.
- Malignant ulcer (Marjolin’s ulcer / Squamous cell carcinoma) with everted edges and indurated base.
- Basal cell carcinoma (Rodent ulcer) with rolled edges.
- Pressure sore (Decubitus ulcer) over a pressure point.
- Traumatic ulcer with healthy granulation tissue.
🎤 One-Line Exam Case Presentation
“This is a solitary ulcer measuring _ × _ cm over the ______ region, with a ______ edge, ______ floor and ______ base, associated with ______ findings, clinically suggestive of a ______ ulcer.”
🎓 Edge-Based Viva Recall
- Sloping edge → Healing ulcer / Venous ulcer
- Undermined edge → Tuberculous ulcer
- Punched-out edge → Arterial ulcer / Trophic ulcer
- Everted edge → Squamous cell carcinoma
- Rolled edge → Basal cell carcinoma
