Ulcer history

how to take ulcer history for FCPS ,MCPS,MDS,MOMS STUDENTS?

1. Ulcer history
q.1) how long you had the ulcer?
q.2) how many are there?
q.3) where is the ulcer located?
q.4) is it painful?
q.5) do u know of anything that may have caused the ulcer?
q.6) have u ever had ulcers before?
q.7) if yes then how many? How often?how long do they last?
q.8) are there any associated problems? Pain ,bleeding,halitosis?
Q.9) is it getting bigger,smaller or staying the same size?
q.10) do u get itching or tingling before the ulcers appear?(viral aetiology)
q.11) do the ulcers start as blisters?
q.12) do u get ulcers at other body sites?
SOCIAL HISTORY:
Do u smoke? If so,how many cigarettes/day and for how long?
Do u drink alcohol?
Do u chew tobacco? If so how much and how often?
Do u chew betel nuts? IF SO HOW OFTEN?
Past medical history: medications, serious skin,GIT and hematological illnesses.
Patient as a whole examination :extraoral (lympgnodes,swellings,asymmetry)
Examination of ulcer:
INSPECTION:
Upper lip + lower lip
SITE: GIVE A CLUE TO THE CAUSE. e.g adjacent to sharp tooth edge---- trauma, interdental papilla ---
anug.
Posterior part of mouth: coxsackie virus ,e.g Herpangina.

2. Record in notes. Draw diagram take photo.
Number of ulcers: multiple ulcers suggest viral infections: e.g coxsackie,herpes or recurrent apthae.
Size: measure in mm
Shape: round or cresentric(e.g traumatic ulcers), ireegular(cmv) and coalescing( herpes) , angular or
stellate( TB), Punched out(tertiary syphilis), malignant (irregular or uneven shape)\
Floor: note the color, the presence of slough, scab,fungating granulation or bleeding.
EDGE: RAISED , ROLLED, EVERTED (MALIGNANT ULCERS) , undermined /overhanging(tuberculous
ulcers) .Punched out( tertiary syphilis) , rolled and pearly(rodent ulcer) .