Derm Hx and Examination Flashcards

1
Q

What questions should you ask in a hx of presenting complaint for a new skin lesion?

A

SOCRATES

Site - whereabouts is the lesion?

Onset - when did you first notice it? Any particular trigger? Had you been ill recently? Anything changed in your diet or skincare? Any new medications?

Character
Pain, itch, bleeding, discharge

Radiation - do you have similar lesions anywhere else?

Associated sxs - do systems review at the end

Time - has the lesion changed over time?

Exacerbating / Relieving

Severity - can you tell me about the impact that this is having on you?

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2
Q

What should you cover in a systems review for someone with a new skin lesion?

A

Systemic: fevers (e.g. cellulitis)
Cardiovascular: peripheral oedema
Respiratory: wheeze, dyspnoea (e.g. anaphylaxis)
Gastrointestinal: abdominal pain and diarrhoea (e.g. Crohn’s disease)
Neurological: confusion (e.g. meningococcal sepsis)

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3
Q

What triggers should you ask about for someone with a new skin lesion?

A

Any preceding illness? (before lesion appeared)
Any recent travel?
Any contact with people with similar lesions?
Any changes to your diet?
Any changes to your usual skincare/laundry detergent?

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4
Q

What conditions should you specifically ask about in the PMH of anyone with a new skin lesion?

A

Previous skin cancer/ skin conditions
Atopy / allergic reactions - what type of reaction do they have??
Diabetes
Inflammatory bowel disease (linked w pyoderma gangrenosum, erythema nodosum)
Conditions requiring systemic immunosuppression (HIV, transplant)

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5
Q

What should you ask in the family hx of someone presenting with a new skin lesion?

A

Any family hx of skin cancer or other skin conditions
At what age did they develop?

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6
Q

What should you ask in the social hx of someone with a new skin lesion?

A

Smoking and alcohol
Diet
Have they ever lived outside of the UK?
Do they regularly travel abroad?
How does their skin react to sun - do they tan or burn? How may sunburns have they had?
What so they do for work - outdoor occupation?
Have they ever used sunbeds?

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7
Q

How should you approach a systematic dermatological examination?

A

Inspect – Observe the overall appearance of the lesion i.e. site, number, pattern of distribution

Describe – Inspect the individual lesions i.e. size, colour, morphology.

Palpate – Feel the texture, temperature, tenderness, consistency and mobility.

Expose – Thoroughly examine the other systems as appropriate i.e. nails, hair, mucous membranes and any other body system required.

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8
Q

How may skin lesions be distributed?

A

Acral distribution: distal areas including hands and feet (e.g. hand, foot and mouth disease)
Extensor distribution: extensor surfaces incl elbows and knees (e.g. psoriasis)

Flexural distribution: flexural surfaces (e.g. eczema)

Follicular distribution: affecting areas with increased numbers of sebaceous glands such as the face, chest and axillae (e.g. acne)

Dermatomal distribution: confined to one or several dermatomes and do not cross the midline (e.g. herpes zoster).

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9
Q

How should you inspect a skin lesion?

A

Size
Colour
Configuration
Morphology

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10
Q

What should you look at when screening for features suggestive of malignant melanoma using the ABCDE criteria?

A

Asymmetry
Border irregularity
Colour variation or changes
Diameter
Elevation/evolution

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11
Q

What is the configuration of a skin lesion?

A

Configuration refers to the shape or outline of skin lesions

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12
Q

Give 6 examples of how to describe configuration of a skin lesion

A

Discrete lesions: clearly separated from one another (e.g. normal mole).

Confluent lesions: merging together (e.g. urticaria).

Linear lesions: lesions in the shape of a line (e.g. excoriations).

Discoid lesions: coin-shaped lesions (e.g. discoid eczema, discoid lupus).

Target lesions: concentric rings resembling a bullseye (e.g. erythema multiforme).

Annular lesions: ring-like lesions (e.g. tinea corporis).

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13
Q

Give 4 examples of how you would describe the colour of a skin lesion

A

Hyper or hypopigmented:
* Hyperpigmentation may be diffuse (e.g. Addison’s) or discrete (e.g. linea nigra in pregnancy)
* An example of hypopigmentation would be pityriasis versicolor as opposed to vitligo which is DEpigmentation

Erythematous (blanching redness)

Purpuric (non-blanching redness)
* Petechiae are spots (less than 2mm)
* Purpura are usually below 10mm
* Ecchymoses/bruises are usually above 10mm

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14
Q

How could you describe a flat lesion?

A

Macule: less than 5mm
Patch: more than 5mm

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15
Q

How could you describe a mildly raised lesion?

A

Plaque: more than 1 cm of skin which is usually slightly elevated from the skin

Wheal/weal: dermal oedema causing blanching erythema with central paleness usually a feature of urticaria

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16
Q

How could you describe an elevated lesion?

A

Papule: solid lesion less than 5mm
Pustule: pus filled papule
Vesicle: fluid-filled papule

Nodule: solid lesion more than 5mm
Abscess: pus-filled nodule
Bullae: fluid-filled nodule

17
Q

How can you describe the surface of skin lesions?

A

Scaling or hyperkeratosed
Crusting: yellow or bloody dried discharge
Excoriated (itched)
Granular (fibrous healing tissue)
Lichenification (thickened skin from rubbing)
Ulcers

18
Q

What are you assessing for on palpation of a skin lesion?

A

Consistency
Fluctuance
Mobility: assess if the lesion feels mobile or is tethered to other local structures
Tenderness

19
Q

What are you looking for in the hands in a dermatology examination?

A

Nail pitting: punctate depressions of the nail plate associated with eczema, psoriasis and alopecia areata.

Onycholysis: separation of the distal end of the nail plate from the nail bed associated with psoriasis and fungal nail infection.

Koilonychia: spoon-shaped nails, associated with iron deficiency anaemia (e.g. malabsorption in Crohn’s disease).

20
Q

What are you looking for on the elbows in a dermatology examination?

A

psoriasis plaques, xanthomas (hyperlipidaemia) or rheumatoid nodules (rheumatoid arthritis)

21
Q

What are you looking for on the scalp in a dermatology examination?

A

Hair loss:
Alopecia areata
Alopecia totalis

Excess hair growth
Hirsutism: androgen-dependent excess hair growth in females.
Hypertrichosis: non-androgen-dependent excess hair growth.

Scalp:
Scalp psoriasis
Seborrhoeic dermatitis

22
Q

What are you looking for on the mucous membranes in a dermatology examination?

A

Hyperpigmented macules: pathognomonic for Peutz-Jeghers syndrome

Bullae: associated with bullous pemphigoid, and pemphigus vulgaris, both autoimmune blistering disorders.

Whickham’s striae: a sign of lichen planus and can be in the buccal mucosa, but also on the genital skin.

23
Q

What further investigations may you propose after you finish your dermatology exam?

A

Local lymph node assessment

Swabs/skin scrapings of lesions: for microbiology, virology and fungal culture.

Dermatoscopy of lesions: to more accurately assess a skin lesion

Perform a biopsy of the skin lesion: for histological analysis.