THE UNIVERSITY OF
WESTERN
AUSTRALIA
History
Taking, Patient
Examination
and Lesion
Evaluation
Dr Agnieszka Frydrych
Dr Agnieszka Frydrych
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Clinical photo showing a patient's mouth during an oral examination. A gloved hand holds dental instruments (likely a mouth mirror and explorer) to inspect the teeth and gingiva. The image demonstrates the physical act of patient examination relevant to the slide title 'History Taking, Patient Examination and Lesion Evaluation'.
Why this topic?
To ensure accurate diagnosis
🔈
#### Objectives of Clinical Diagnosis
- To ensure accurate diagnosis
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Clinical intraoral photograph showing the buccal mucosa with a prominent white, plaque-like lesion. The image is used to demonstrate the visual finding relevant to accurate diagnosis as stated in the slide's text.
# History taking – presenting complaint
- Date of onset / Duration
- Location(s)
- Aggravating and relieving factors
- Past investigations
- Past treatments
When evaluating the presenting complaint, the following details should be recorded:
- Date of onset / Duration
- Location(s)
- Aggravating and relieving factors
- Past investigations
- Past treatments
## History taking – medical history
### Important!
- Diagnosis
- Treatment
- Prognosis
#### Clinical Significance of Medical History
A thorough medical history is essential for determining the following:
- Diagnosis
- Treatment
- Prognosis
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Clinical photo showing a medical history document on a clipboard with a stethoscope and pen resting on it. The text 'Medical History' is visible on the paper.
# History taking – medical history
<table>
<tr>
<th>Question</th>
<th>Selection</th>
<th>Notes</th>
</tr>
<tr>
<td>Cardiovascular disease e.g. hypertension, heart disease</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Blood disorders e.g. anaemia</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Bleeding / clotting disorders. Any history of excessive bleeding?</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Respiratory disease e.g. asthma, emphysema</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Neurological disorders e.g. epilepsy</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Gastrointestinal disease e.g. coeliac disease, inflammatory bowel disease, gastritis</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Endocrine disease such e.g. diabetes, thyroid disorders, dyslipidaemia</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Liver disease e.g. hepatitis</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Kidney disease</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Any history of a bone modifying agent use such as bisphosphonates, denosumab</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Skin disease</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Psychological disorders e.g. anxiety, depression, dental phobia</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Any cancer history</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Any history of radiation therapy to the head and neck</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Any history of infectious disease such as tuberculosis, hepatitis, HIV</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>All past operations and hospitalization. Any history of complications?</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Possibility of pregnancy (if yes, due date)</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Allergy to medications, foods and chemicals</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Current medications, including supplements</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Any history of recreational drug use</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Smoker / former smoker (including e-cigarettes) Please specify product type, how many per day or week and for how long</td>
<td>No</td>
<td></td>
</tr>
<tr>
<td>Alcohol use (please specify product type, how many drinks per day/week/month/year and for how long)</td>
<td>No</td>
<td></td>
</tr>
</table>
#### Medical History Questionnaire
- **Cardiovascular disease**: e.g., hypertension, heart disease
- **Blood disorders**: e.g., anaemia
- **Bleeding / clotting disorders**: Any history of excessive bleeding
- **Respiratory disease**: e.g., asthma, emphysema
- **Neurological disorders**: e.g., epilepsy
- **Gastrointestinal disease**: e.g., coeliac disease, inflammatory bowel disease, gastritis
- **Endocrine disease**: e.g., diabetes, thyroid disorders, dyslipidaemia
- **Liver disease**: e.g., hepatitis
- **Kidney disease**
- **Bone modifying agent use**: History of bisphosphonates, denosumab, etc.
- **Skin disease**
- **Psychological disorders**: e.g., anxiety, depression, dental phobia
- **Cancer history**
- **Radiation therapy**: Any history of radiation to the head and neck
- **Infectious disease**: e.g., tuberculosis, hepatitis, HIV
- **Operations and hospitalization**: All past procedures and any history of complications
- **Pregnancy**: Possibility of pregnancy and due date
- **Allergies**: Medications, foods, and chemicals
- **Current medications**: Including all supplements
- **Recreational drug use**: Any history of use
- **Smoking status**: Smoker / former smoker (including e-cigarettes); specify product type, frequency, and duration
- **Alcohol use**: Specify product type, frequency, and duration
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A digital medical history form displayed as a structured table with three columns: 'Question', 'Selection', and 'Notes'. The 'Question' column lists medical categories such as cardiovascular disease, blood disorders, respiratory disease, neurological disorders, gastrointestinal disease, endocrine disease, liver disease, kidney disease, bone modifying agent use, skin disease, psychological disorders, cancer history, radiation therapy history, infectious disease history, past operations, pregnancy possibility, allergies, current medications, recreational drug use, smoking history, and alcohol use. Each row includes example conditions or clarifications (e.g., 'hypertension, heart disease' under cardiovascular; 'asthma, emphysema' under respiratory). The 'Selection' column contains dropdowns set to 'No' for all entries. The 'Notes' column is empty. At the bottom are two buttons: 'Complete and Perform Actions' and 'Cancel'. This visual structure captures the complete semantic unit of the medical history intake process.
**History taking – medical history**
- Important points to note:
→ Cardi
**vascular disease**
→ Respiratory disease
→ CNS disease
→ Skin disease
→ GIT disease
→ Liver disease
→ Endocrine disorders
#### Key Systems Review
Important points to note regarding systemic health:
- Cardiovascular disease
- Respiratory disease
- CNS disease
- Skin disease
- GIT disease
- Liver disease
- Endocrine disorders
# History taking – dental history
## Important points to note:
- Regularity of attendance
- Recent dental problems
#### Dental Attendance and Concerns
- Regularity of attendance
- Recent dental problems
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Clinical photograph showing dental examination tools (mouth mirror and explorer) resting on patient registration forms labeled 'PATIENT REGISTRATION' and 'DENTAL HISTORY', illustrating the context of dental history taking.
**History taking – social history**
• Important points to note:
→ Single / married, etc.
→ Attitudes to medical treatment
→ Socioeconomic status
→ Overseas travel
→ Sexual history
→ Occupation
→ Life stressors
→ Habits
#### Social and Lifestyle Factors
- Marital status (Single / married, etc.)
- Attitudes to medical treatment
- Socioeconomic status
- Overseas travel
- Sexual history
- Occupation
- Life stressors
- Habits
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Silhouette figure of a group of people walking, illustrating the social aspect of 'History taking – social history'.
**Examination - extraoral**
Extraoral head and neck examination
Look for:
Swellings
Pallor
Rashes
During the head and neck inspection, look for:
- Swellings
- Pallor
- Rashes
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Clinical photo showing a close-up of a patient's face with eyes closed. It demonstrates the finding 'Rashes' listed in the text, specifically showing erythematous (red) and textured skin on the cheeks and nose bridge.
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Clinical photo of a male neck demonstrating the finding 'Swellings'. A black circle highlights a specific area on the side of the neck/jawline where a lump or swelling is located.
<html><body><table><tbody><tr><td colspan="2"><b>Examination - extraoral</b></td></tr><tr><td><i>→</i></td><td>Examine the neck</td></tr><tr><td colspan="2">IMAGE</td></tr></tbody></table></body></html>
Examine the neck.
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Anatomical diagram of the human head and neck in profile view, illustrating extraoral examination landmarks. The image includes labeled structures such as the Masseter muscle, Jugulodigastric (tonsillar), Facial, Submandibular, Submental, and Jugulo-omohyoid muscles on the left side; Preauricular, Postauricular, Suboccipital, Trapezius muscle, Sternomastoid muscle, Posterior cervical, and Supraclavicular regions on the right side. Purple dots indicate specific anatomical points or lymph node locations corresponding to each label.
# Examination - extraorral
## Examine the neck
### Area | Draining lymph nodes
| Area | Draining lymph nodes |
| --- | --- |
| Scalp, temporal region | Superficial parotid (pre-auricular) |
| Scalp, posterior region | Occipital |
| Scalp, parietal region | Mastoid |
| Ear, external | Superfical cervical over upper part of sternomastoid muscle |
| Ear, middle | Parotid |
| Over angle of mandible | Superfical cervical over upper part of sternomastoid muscle |
| Medial part of brontal region, medial eyelids, skin of nose | Submandibular |
| Lateral part of brontal region, lateral part of eyelids | Parotid |
| Cheek | Submandibular |
| Upper lip | Submandibular |
| Lower lip | Submental |
| Lower lip, lateral part | Submandibular |
| Mandibular gingivae | Submandibular |
| Maxillary teeth | Deep cervical |
| Maxillary gingivae | Deep cervical |
| Tongue tip | Submental |
| Tongue, anterior two-thirds | Submandibular, some midline cross-over of lymphatic drainage |
| Tongue, posterior third | Deep cervical |
| Tongue ventrum | Deep cervical |
| Floor of mouth | Submandibular |
| Palate, hard | Deep cervical |
| Palate, soft | Retropharyngeal and deep cervical |
| Tarsil | Juglodicastic |
#### Lymphatic Drainage Patterns
| Area | Draining Lymph Nodes |
| :--- | :--- |
| Scalp, temporal region | Superficial parotid (pre-auricular) |
| Scalp, posterior region | Occipital |
| Scalp, parietal region | Mastoid |
| Ear, external | Superficial cervical over upper part of sternomastoid muscle |
| Ear, middle | Parotid |
| Over angle of mandible | Superficial cervical over upper part of sternomastoid muscle |
| Medial part of frontal region, medial eyelids, skin of nose | Submandibular |
| Lateral part of frontal region, lateral part of eyelids | Parotid |
| Cheek | Submandibular |
| Upper lip | Submandibular |
| Lower lip | Submental |
| Lower lip, lateral part | Submandibular |
| Mandibular gingivae | Submandibular |
| Maxillary teeth | Deep cervical |
| Maxillary gingivae | Deep cervical |
| Tongue tip | Submental |
| Tongue, anterior two-thirds | Submandibular, some midline cross-over of lymphatic drainage |
| Tongue, posterior third | Deep cervical |
| Tongue ventrum | Deep cervical |
| Floor of mouth | Submandibular |
| Palate, hard | Deep cervical |
| Palate, soft | Retropharyngeal and deep cervical |
| Tonsil | Jugulodigastric |
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A table titled 'Area | Draining lymph nodes' listing anatomical regions and their corresponding draining lymph node groups. The table includes rows for Scalp (temporal, posterior, parietal), Ear (external, middle), Mandible angle, Frontal region, Cheek, Lip, Gingivae, Teeth, Tongue (tip, anterior two-thirds, posterior third, ventrum), Mouth floor, Palate (hard, soft), and Tonsil.
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Clinical photo showing a gloved hand palpating the patient's submandibular area (jawline).
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Clinical photo showing a gloved hand palpating the patient's neck/jugular region.
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Clinical photo showing a gloved hand palpating the lateral aspect of the patient's neck near the ear/angle of mandible.
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Clinical photo showing a gloved hand palpating the lower jaw/submental area.
**Examination - extraoral**
→ Examine the TMJs and muscles of mastication
✓ Facial asymmetry
✓ Mandibular opening and closing paths
✓ Mandibular opening extent (Restricted mandibular opening <40mm)
✓ Lateral excursions (8mm)
✓ Joint noises
Examine the TMJs and muscles of mastication for the following:
- Facial asymmetry
- Mandibular opening and closing paths
- Mandibular opening extent (Restricted mandibular opening <40mm)
- Lateral excursions (8mm)
- Joint noises
# Examination - extraoral
## Cranial nerve exam
<table>
<thead>
<tr>
<th>Nerve</th>
<th>Classification</th>
<th>Major functions</th>
<th>Assessment</th>
</tr>
</thead>
<tbody>
<tr>
<td>I Olfactory</td>
<td>Sensory</td>
<td>Smell</td>
<td>Have patient identify a familiar scent with eyes closed (usually deferred).</td>
</tr>
<tr>
<td>II Optic</td>
<td>Sensory</td>
<td>Vision (acuity and field of vision); pupil reactivity to light and accommodation (afferent impulse)</td>
<td>Have patient read from a card or newspaper, one eye at a time. Test visual fields by having patient cover one eye, focus on your nose, and identify the number of fingers you're holding up in each of four visual quadrants.</td>
</tr>
<tr>
<td>III Oculomotor</td>
<td>Motor</td>
<td>Eyelid elevation; most EOMs; pupil size and reactivity (efferent impulse)</td>
<td>Check pupillary responses by shining a bright light on one pupil; both pupils should constrict. Do the same for other eye. To check accommodation, move your finger toward the patient's nose; the pupils should constrict and converge. Check EOMs by having patient look up, down, laterally, and diagonally.</td>
</tr>
<tr>
<td>IV Trochlear</td>
<td>Motor</td>
<td>EOM (turns eye downward and laterally)</td>
<td>Have patient look down and in.</td>
</tr>
<tr>
<td>V Trigeminal</td>
<td>Both</td>
<td>Chewing; facial and mouth sensation; corneal reflex (sensory)</td>
<td>Ask patient to hold the mouth open while you try to close it and to move the jaw laterally against your hand. With patient's eyes closed, touch her face with cotton and have her identify the area touched. In comatose patients, brush the cornea with a wisp of cotton; the patient should blink.</td>
</tr>
<tr>
<td>VI Abducens</td>
<td>Motor</td>
<td>EOM (turns eye laterally)</td>
<td>Have patient move the eyes from side to side.</td>
</tr>
<tr>
<td>VII Facial</td>
<td>Both</td>
<td>Facial expression; taste; corneal reflex (motor); eyelid and lip closure</td>
<td>Ask patient to smile, raise eyebrows, and keep eyes and lips closed while you try to open them. Have patient identify salt or sugar placed on the tongue (usually deferred).</td>
</tr>
<tr>
<td>VIII Acoustic/ Vestibularcochlear</td>
<td>Sensory</td>
<td>Hearing; equilibrium</td>
<td>To test hearing, use tuning fork or rub your fingers, place a ticking watch, or whisper near each ear. Equilibrium testing is usually deferred.</td>
</tr>
<tr>
<td>IX Glossopharyngeal</td>
<td>Both</td>
<td>Gagging and swallowing (sensory); taste</td>
<td>Touch back of throat with sterile tongue depressor or cotton-tipped applicator. Have patient swallow.</td>
</tr>
<tr>
<td>X Vagus</td>
<td>Both</td>
<td>Gagging and swallowing (motor); speech (phonation)</td>
<td>Assess gag and swallowing with CN IX. Assess vocal quality.</td>
</tr>
<tr>
<td>XI Spinal accessory</td>
<td>Motor</td>
<td>Shoulder movement; head rotation</td>
<td>Have patient shrug shoulders and turn head from side to side (not routinely tested).</td>
</tr>
<tr>
<td>XII Hypoglossal</td>
<td>Motor</td>
<td>Tongue movement; speech (articulation)</td>
<td>Have patient stick out tongue and move it internally from cheek to cheek. Assess articulation.</td>
</tr>
</tbody>
</table>
| Nerve | Classification | Major Functions | Assessment |
| :--- | :--- | :--- | :--- |
| I Olfactory | Sensory | Smell | Have patient identify a familiar scent with eyes closed (usually deferred). |
| II Optic | Sensory | Vision (acuity and field of vision); pupil reactivity to light and accommodation (afferent impulse) | Have patient read from a card or newspaper, one eye at a time. Test visual fields by having patient cover one eye, focus on your nose, and identify the number of fingers you're holding up in each of four visual quadrants. |
| III Oculomotor | Motor | Eyelid elevation; most EOMs; pupil size and reactivity (efferent impulse) | Check pupillary responses by shining a bright light on one pupil; both pupils should constrict. Do the same for other eye. To check accommodation, move your finger toward the patient's nose; the pupils should constrict and converge. Check EOMs by having patient look up, down, laterally, and diagonally. |
| IV Trochlear | Motor | EOM (turns eye downward and laterally) | Have patient look down and in. |
| V Trigeminal | Both | Chewing; facial and mouth sensation; corneal reflex (sensory) | Ask patient to hold the mouth open while you try to close it and to move the jaw laterally against your hand. With patient's eyes closed, touch her face with cotton and have her identify the area touched. In comatose patients, brush the cornea with a wisp of cotton; the patient should blink. |
| VI Abducens | Motor | EOM (turns eye laterally) | Have patient move the eyes from side to side. |
| VII Facial | Both | Facial expression; taste; corneal reflex (motor); eyelid and lip closure | Ask patient to smile, raise eyebrows, and keep eyes and lips closed while you try to open them. Have patient identify salt or sugar placed on the tongue (usually deferred). |
| VIII Acoustic/ Vestibularcochlear | Sensory | Hearing; equilibrium | To test hearing, use tuning fork or rub your fingers, place a ticking watch, or whisper near each ear. Equilibrium testing is usually deferred. |
| IX Glossopharyngeal | Both | Gagging and swallowing (sensory); taste | Touch back of throat with sterile tongue depressor or cotton-tipped applicator. Have patient swallow. |
| X Vagus | Both | Gagging and swallowing (motor); speech (phonation) | Assess gag and swallowing with CN IX. Assess vocal quality. |
| XI Spinal accessory | Motor | Shoulder movement; head rotation | Have patient shrug shoulders and turn head from side to side (not routinely tested). |
| XII Hypoglossal | Motor | Tongue movement; speech (articulation) | Have patient stick out tongue and move it internally from cheek to cheek. Assess articulation. |
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A detailed table summarizing the extraoral cranial nerve examination. The table is organized into four columns: 'Nerve', 'Classification', 'Major functions', and 'Assessment'. It lists all twelve cranial nerves (I through XII), providing their sensory/motor classification, primary functions, and specific clinical assessment steps for each.
**Examination - intraoral**
* **Intraoral examination**
* -> Proper light
* -> Dental mouth mirror
* -> Gauze squares
* -> PPE
* -> Visual aids
#### Essential Tools and Equipment
To perform a thorough intraoral examination, the following armamentarium is required:
- Proper lighting
- Dental mouth mirror
- Gauze squares
- Personal Protective Equipment (PPE)
- Visual aids
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Clinical photo showing a dental instrument tray containing a dental mouth mirror and gauze squares, illustrating equipment for an intraoral examination.
# Examination - intraoral
Examination - intraoral
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Clinical photograph labeled 'Normal', showing a close-up of a healthy human mouth with closed lips and no visible lesions or inflammation.
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Clinical photograph labeled 'Solar cheilitis', showing a close-up of a mouth exhibiting signs of sun damage to the lower lip, including redness, scaling, and crusting.
Examination - intraoral
Examination - intraoral
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Clinical intraoral examination photo showing a patient's upper anterior teeth and gingiva. Gloved hands retract the upper lip to expose the maxillary arch, revealing healthy-looking teeth with visible interdental papillae and pink mucosa.
**Examination - intraoral**
Examination - intraoral
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Clinical photo showing an intraoral examination procedure. A gloved hand uses a dental mirror to retract the patient's lip and cheek for inspection of the teeth and gingiva.
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Clinical photo providing a close-up view of the buccal mucosa (inner cheek). The image shows the pink tissue with visible vascular patterns and a partial view of a tooth and crown on the right side.
# Examination - intraoral
Examination - intraoral
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Clinical intraoral examination photo showing a patient's mouth held open by a transparent plastic cheek retractor. Gloved hands are visible holding the retractor handles on either side of the face. The image clearly displays the upper and lower dental arches with teeth and gingiva.
The image contains a slide titled "**Examination - intraoral**" with two photos of an open mouth showing the tongue and gum line. The text on the slide is:
**Examination - intraoral**
Examination - intraoral
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Clinical photo showing an intraoral examination of a patient's mouth with the tongue protruded, revealing the underside of the tongue and gum line.
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Clinical photo showing another angle of an intraoral examination of a patient's mouth with the tongue protruded, revealing the underside of the tongue and gum line.
**Examination - intraoral**
Examination - intraoral
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Clinical intraoral photograph showing a tongue protruded with the mouth open. The image captures the dorsal surface of the tongue, visible teeth (incisors), and lips. The title 'Examination - intraoral' is displayed above the image.
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Clinical photo showing a gloved hand retracting the patient's cheek during an intraoral examination to visualize the buccal mucosa and teeth.
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Clinical photo showing a similar intraoral examination step, with a gloved hand retracting the cheek to expose the oral cavity for visual inspection.
**Examination - intraoral**
Examination - intraoral
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Clinical intraoral photograph showing a patient's mouth open to display the upper dental arch. The image captures the maxillary teeth and the hard palate from a superior view. Visible findings include the palatal rugae on the anterior part of the roof of the mouth and the posterior region of the palate. A yellowish-orange discoloration is present in the posterior midline area near the soft palate junction. There are also small white particulate deposits or debris visible on the anterior surface of the palate.
# Lesion evaluation
Lesion evaluation
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Clinical photo of an oral lesion on the buccal mucosa showing a white, irregular patch with surrounding erythema.
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Clinical photo of an intraoral lesion on the gingiva near teeth, showing a raised, possibly ulcerated area.
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Clinical photo of an extensive oral lesion involving the hard palate and tongue, showing widespread whitish patches.
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Clinical photo of an oral lesion on the buccal mucosa showing diffuse redness (erythema) with some white exudate.
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Clinical photo of an oral lesion adjacent to a tooth, showing localized inflammation and possible ulceration.
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Clinical photo of a relatively normal-appearing oral mucosa with a small focal lesion or spot visible.
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Clinical photo of a white coffee cup on a saucer with a spoon in the liquid, placed on a blue and white checkered tablecloth. Part of a comparative 'Lesion evaluation' figure.
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Clinical photo of a white coffee cup on a saucer with a fork resting on the plate, placed on a blue and white checkered tablecloth. Part of a comparative 'Lesion evaluation' figure.
| **Lesion evaluation** |
| :--- |
| **Problem history** |
| **Medical and social history** |
| **Clinical examination** |
| **Differential diagnosis** |
| **Diagnostic tests** |
| **Definitive diagnosis** |
| **Management** |
#### Components of Lesion Evaluation
- Problem history
- Medical and social history
- Clinical examination
- Differential diagnosis
- Diagnostic tests
- Definitive diagnosis
- Management
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Flowchart diagram titled 'Lesion evaluation' showing a hierarchical structure. The main title is in a white box with a pink border at the top left. A vertical pink line branches out to seven yellow rectangular boxes labeled: 'Problem history', 'Medical and social history', 'Clinical examination', 'Differential diagnosis', 'Diagnostic tests', 'Definitive diagnosis', and 'Management'. These represent sequential or related steps in lesion evaluation.
**Lesion evaluation**
* Medical and social history
* General medical history
#### History Assessment
- Medical and social history
- General medical history
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Clinical photo showing multiple small red papules and a larger nodule on the dorsal aspect of a wrist. The visual supports the context of 'Lesion evaluation' and 'Medical and social history', likely illustrating a cutaneous manifestation such as an insect bite reaction or dermatological condition.
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Clinical photo of oral mucosa (likely buccal mucosa) displaying white reticular streaks and erythema. This is consistent with lichen planus, supporting the theme of lesion evaluation in medical history.
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Photo of white pills spilling from a green bottle. This relates to the context of 'Medical and social history', potentially representing medication intake or drug history relevant to the patient's lesions.
# Lesion evaluation
* Medical and social history
$\rightarrow$ General medical history
- Medical and social history
- General medical history
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Clinical photo of the oral cavity showing the hard palate. A black arrow points to a reddish erythematous lesion on the palatal mucosa. The surrounding text context is 'Lesion evaluation' and 'Medical and social history', indicating this image demonstrates a specific finding relevant to that topic.
# Lesion evaluation
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Clinical photo of an oral lesion on the buccal mucosa near molars, showing a whitish patch with erythema. The image is part of a 'Lesion evaluation' set.
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Clinical photo of another oral lesion, possibly on the tongue or floor of mouth, showing irregular red and white areas. Part of the same 'Lesion evaluation' set.
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Clinical photo of an oral lesion adjacent to teeth with restorations, showing a reddish area on the gingiva or mucosa. Included in the 'Lesion evaluation' series.
**Lesion evaluation**
**Lesion evaluation***
| | **Problem history** |
|---|---|
| | **Medical and social history** |
| | **Clinical examination** |
| | **Differential diagnosis** |
| | **Diagnostic tests** |
| | **Definitive diagnosis** |
| | **Management** |
#### Evaluation Workflow
- Problem history
- Medical and social history
- Clinical examination
- Differential diagnosis
- Diagnostic tests
- Definitive diagnosis
- Management
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A flowchart diagram illustrating the 'Lesion evaluation' process. The diagram features a blue background with a central white box labeled 'Lesion evaluation' at the top left, connected by pink lines to a vertical column of yellow rectangular nodes. These nodes list the sequential steps: 'Problem history', 'Medical and social history', 'Clinical examination', 'Differential diagnosis' (highlighted in red), 'Diagnostic tests', 'Definitive diagnosis', and 'Management'. A speaker icon is visible on the left side.
# Lesion evaluation
## Differential diagnosis
* **Inherited**
* **Inflammatory**
* **Infection**
* **Iatrogenic**
* **Idiopathic**
* **Neoplastic**
*"The eye does not see what the mind does not know"*
Anonymous
#### Diagnostic Categories
- Inherited
- Inflammatory
- Infection
- Iatrogenic
- Idiopathic
- Neoplastic
> "The eye does not see what the mind does not know"
> — Anonymous
Lesion evaluation
Lesion evaluation
- Problem history
- Medical and social history
- Clinical examination
- Differential diagnosis
- **Diagnostic tests**
- Definitive diagnosis
- Management
#### Clinical Pathway
- Problem history
- Medical and social history
- Clinical examination
- Differential diagnosis
- **Diagnostic tests**
- Definitive diagnosis
- Management
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A hierarchical flowchart diagram titled 'Lesion evaluation'. The main title is in a white box with a pink border. It branches into seven sequential steps represented by yellow rectangular nodes connected by purple lines: 'Problem history', 'Medical and social history', 'Clinical examination', 'Differential diagnosis', 'Diagnostic tests' (highlighted in red), 'Definitive diagnosis', and 'Management'.
**Lesion evaluation**
* Diagnostic tests
* Tissue biopsy
* Smears and cultures
* Blood testing
* Skin tests
* Imaging
#### Types of Diagnostic Investigations
- Tissue biopsy
- Smears and cultures
- Blood testing
- Skin tests
- Imaging
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Clinical photograph demonstrating a tissue biopsy procedure on an oral lesion. The image shows the inside of a mouth with instruments (forceps and suction) manipulating a reddish ulcerated area on the mucosal tissue.
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