History & Examination of

swelling,ulcer,sinus and Fistula

 Lump vs. Swelling

Lump-Vague mass of body tissue

Swelling-A vague term which denote any
enlargement or protuberance in the body &
may include tumors
 History
 Duration
 Mode of Onset
 Other symptoms associated with the lump
 Pain
 Progress of the swelling
 Exact site
 Fever
 Presence of other lump
 Secondary changes
 Impairment of the function
 History contd.
 Recurrence of the swelling
 Loss of body weight
 Past History
 Personal History
 Family History
 Local Examination
Inspection
 situation
 color
 Shape
 Edge
 Number
 pulsation
 Peristalsis
 Movement with respiration
 Impulse on coughing
 Movement on deglutition
 Movement with protrusion of tongue
 skin over the swelling
 any pressure effect
 Palpation
 Temperature  Pulsability
 Tenderness  Fixed to the overlying skin
 Size, Shape & Extent  Relation to surrounding
 Surface structures
 Edge  Skin, subcutaneous tissue,
 Consistency deep fascia,
muscle,tendon,bone
 Fluctuation  Sate of regional Lymph
 Fluid thrill nodes
 Translucency
 Impulse on coughing
 Reducibility
 Compressibility
 Fungating bleeding mass-
 -
 -
 Breast lump  Inguinal swelling
-Thyroglossal cyst
 -
 Congenital dermoid
 --

 Percussion-Hydratid thrill
 Auscultation
 Measurement
 Movement
 Examination of Pressure effect
General Examination-
 malignancy

 syphilitic stigma

 tuberculosis
 History for Ulcer
Ulcer is a break in the continuity of covering epithelium
 Mode of onset

 Duration

 Pain

 Discharge

 Associated Disease
 Examination
Inspection
 Size
 Shape
 number
 Position
 Edge
 Discharge
 Surrounding area
 Whole limbs
 Palpation
 Tenderness
 Edge& Margin
 Base
 Depth
 Bleeding
 Related with deeper structure
 Surrounding skin
-
 -
 Undermined
 Punched out
 sloping
 Raised &pearly white beaded
 rolled out(everted)
 Venous ulcer
 -
 -
 Examination of Lymph node
 Examination for vascular insufficiency
 Examination for nerve lesions
 General Examination-
tuberculosis
syphilitic stigma
trophic
ischemic
 History for sinus/ fistula
 Sinus-A sinus is a blind track leading from the
surface down to the tissue
 Fistula-It is a communicating track between
two epithelial surfaces commonly between a
hollow viscus & the skin or between two
hollow viscera
 Causes of persistence of a sinus
 Presence of foreign body or necrotic tissue in
the depth
 Absence of the rest
 Nondependent drainage or inadequate drainage
of an abscess
 Chronic infections
 Dense fibrosis
 History
 Pain
 Fever & redness of the surrounding skin
 Past history
 Family history
 Local Examination

Inspection
 Number

 Position

 Opening of the sinus

 Discharge

 Surrounding skin
 -

Palpation Examination with Probe

 Tenderness  Direction/ depth of

 Wall of the sinus sinus

 Mobility  Presence of any

 Lump f.b/sequestrum
 Communication with
Examination of Lymph
nodes hollow viscera
 Fresh discharge on with
General Examination
drawl of probe
-
 -
 Sinus at left inguinal region

Thyroglossal fistula
 -
-