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Pic of Ulcer describe,

Station 1. Pic of Ulcer describe, most common…….??.... (we do not know the exact Q but the most common organism : staph aureus ) !! 1 st : inspection 2 nd : palpation 3 rd : diagnosis Always compare with other leg Exposure ,Exposure ,Exposure . Station 2.

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Pic of Ulcer describe,

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  1. Station 1 Pic of Ulcer • describe, • most common…….??.... (we do not know the exact Q but the most common organism : staph aureus ) !! 1st : inspection 2nd : palpation 3rd : diagnosis • Always compare with other leg • Exposure ,Exposure ,Exposure

  2. Station 2 pic of leg ulcerarterial Hx & Exvenous Hx & Ex ( they asked about Trendelnberg test )

  3. Arterial • Hx: Clinical presentaion : • 6 Ps : • Paresthesia ( the 1st to appear ) • Pain ( mainly unilateral ) • Palloor • Piokilothermia (coldness) • Pulsesness • Paralysis These signs & symptoms cozed by chronic arterial ischemia ( peripheral disease ) Late signs

  4. Arterial • Ex Inspection Palpation Both legs

  5. Venous • Hx : • Age : >40  follow venous disease Young  post thrombotic disease Children & teenagers  congintal venous malformations • Sex : Women >men • Symptoms : Hx of aching pain ,Discomfort &Tenderness of the skin (lipodermatosclerosis & pigmentation ) Some ulcers are painful & others are not . Discharge : may be very smelly ( ask about depression & social isolation ) . Hx of trauma (initiates the breakdown of the skin ) Itching & scratching ( may start an ulcer ) Previous Hx : Venous thrombosis during illness or pregnancy . Previous episode ulceration

  6. Venous • Ex Inspection Palpation Both legs

  7. Trendelenburg test • determines the competency of the valves in communicating veins between the superficial and deep veins of the leg. The leg is raised above heart level until the veins become empty. A tourniquet is then applied around the upper thigh to compress the superficial veins. The leg is then lowered by asking the patient to stand. Normally the superficial veins will fill from below within 35 seconds; if the superficial veins fill more rapidly with the tourniquet in place there is valvular incompetence below the level of the tourniquet. If the veins fill rapidly from above when the tourniquet is removed, the incompetence is at the sapheno-femoral junction. • The test can be repeated with the tourniquet at different levels to further pinpoint the level of valvular incompetence: • above the knee  to assess the mid-thigh perforators • below the knee  to assess incompetence between the short saphenous vein and the popliteal vein.[1] • Superficial veins of the leg normally empty into deep veins, however retrograde filling occurs when valves are incompetent, leading to varicose veins.

  8. Station 3 • Pic of venous ulcer • Q. Describe : ( full description ) • Q. what is the most likely diagnosis ? Venous ulcer (Chronic Venous Insufficiency ) • Q. mention 2 features support your diagnosis: Site : medial malleolus Temperature : cold , depth : shallow & flat ….etc .

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