QUICK GUIDE FOR OPD CASES

LUMP ULCER PERIPHERAL GENERAL CONSIDERATIONS:

Number Temperature VASCULAR DISEASE Greeting, introduction, informed
Tenderness Tenderness Temperature consent, privacy, exposure, proper
Temperature Number Tenderness
Site
positioning, comments on general
Site Skin condition
Size Hair loss
appearance. At end, cover and
Size
Shape
Shape Ulcers thanks.
Surface Vascular angle
Edges: SINUS / FISTULA
Edges Capillary filling
Sloping Temperature
Color of skin Punched out Venous filling
Depth Tenderness
Undermined ABPI
Composition: Site
Rolled out Pulses bilateral (details)
Consistency (soft firm hard) Number
Raised AREA OF GANGRENE
Fluctuation Discharge
Floor Extent
Transillumination Color Palpable track?
Base
Pulsatiliy Demarcation Mobility
Discharge
(expansile\transmissible) Dry or wet Surrounding skin
Surrounding skin condition Neurovascular of
Thrill Discharge
Reducibility/Compressibility Nearby important structures region
Smell
Fixity / mobility (from superficial Regional lymph nodes Crepitus Regional lymph
and deep structures) Neurovascular of region nodes
Cough impulse
INGUINOSCROTAL SWELLING
Regional lymph nodes BREAST Can reach above the swelling? If YES
Neurovascular status of area 1- Arms at side then scrotal swelling, proceed this table
2- Hands on hips (press and relax) INSPECTION:
VENOUS DISEASE
3- Arms elevated Site (unilateral, Bilateral)
Site
4- Patient bending forward Engorged veins
Distribution (great of
INSPECTION Skin changes / Scar
small)
Symmetry of nipple and breast Sinus / discharge
Skin Pigmentation Nipple (central, retraction, inversion) Ulceration
Edema Vascularity Relation with genitalia
Ulcers Pigmentation PALPATION (normal side first)
Cough impulse at Peau d’orange skin Temperature
saphenous opening Skin nodules/puckering/tethering Tenderness
Champagne bottle leg Ulceration Testes separately palpable?
Trendelenberg test Size/ shape/ margins
PALPATION
Tourniquet test Consistency
Temperature
Perthe’s test Fluctuation
Tenderness
Shwartz test Transillumination
Lump? (table for lump)
Bruit on auscultation Ulcer (table for ulcer) Cough impulse
Abdominal examination Testes / sperm cord / epididymis
Digital rectal examination Axillary lymph nodes
Inguinal and supraclavicular lymph nodes
Systemic examination for metastasis Gynecomastia/ sec. sex characters
MIDLINE NECK SWELLING Abdominal examination
Site, Size Digital rectal examination
FUNCTIONAL THYROID
Skin color/ pigmentation
ASSESSMENT
Skin sinus (examine as sinus) INGUINAL HERNIA
Pulse
Visible veins Can reach above the swelling? If NO then
Palm sweating
Pemberton’s sign inguinal hernia, proceed this table
Fine temors
Visible pulsations INSPECTION (standing)
Hoarseness
Hoarseness Side (right left)
Pretibial edema
PALPATION Size (funicular, bubonocoele , complete)
Skin/Hair texture
FROM FRONT Cough impulse
Ankle jerk / clonus
Temperature Skin changes
Growth retardation/abdominal hernia
Tenderness Primary and secondary sexual features
(children)
Consistency PALPATION: (lying)
Nodularity EYE SIGNS
Lid lag (von Graffe’s sign) Spontaneous reducibility
Fixity Cough impulse (visible and palpable)
Swallowing test Lid retraction (Stellwag’s sign)
Exophthalmos Reduce the swelling / or ask the patient to
Tracheal position and kocher test
Joffroy’s sign (Forehead wrinkling) Deep ring occlusion test
B/L carotid pulse (berry sign)
Mobius sign (Convergence) Penis (uretheral stricture)
FROM BEHIND
Opthalmoplegia (eyeball movements) Testes, S.cord, epididymis
Confirm above findings
Retrosternal extension Corneal ulceration Examine opposite side
Cervical lymph nodes Other potential hernia sites
PERCUSSION Examine abdomen
Retrosternal extension Digital rectal exam
AUSCULTATION for bruit Chest examination (if indicated)

Dr Adnan Zafar Dr Salman Farooq Dar Professor Dr Muhammad Ateeq

Teaching Surgery Unit Aziz Bhatti Shaheed Teaching Hospital