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QL4 > EO 001.05 - Dermatological Examination > Flashcards

EO 001.05 - Dermatological Examination Flashcards

1
Q

What are six focused history questions that should be asked during a dermatological exam?

A
  1. Changes in moles or birthmarks;
  2. Itching, change in sweating, dry skin;
  3. Lesions that do not heal;
  4. General symptoms (eg, fever, arthralgia, weight loss, malaise);
  5. History of skin disease; and
  6. Family history of skin cancer, psoriasis, etc
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2
Q

What five qualities should be noted of a lesion?

(SCAMD)

A
  1. Size
  2. Color
  3. Arrangement / Arrangement (ex: 1 single patch, several small vesicles)
  4. Morphology
  5. Distribution
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3
Q

What are the eight steps of a dermatological exam?

A

Prior to exam, obtain vital signs

  1. Focused history: HPI, (CHLORIDE AAA PMA), Fam./Soc. Hx
  2. Perform 1st inspection of lesions and note (SCAMD):
  3. Palpate the lesion (O/E):
  4. Perform a 2nd inspection:
  5. Palpation of the scalp.
  6. Make a Note in CFHIS or on CF2138 (record relevant positive and negative findings)
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4
Q

Keratin

A

Keratin is a protein that helps strengthen and protect certain connective tissue cells.

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5
Q

Dermatophytes

A

Dermatophytes are fungi which propagate and survive solely on the cornified outer layers of skin.

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6
Q

Dermatophyte infections

A

Dermatophyte infections are yeast infections - infections of the skin caused by “keratinophilic” fungi (dermatophytes which eat keratin)

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7
Q

What are host and local factors that facilitate a dermatophyte infection?

A

Host Factors
- Atopy
- Glucocorticoid use
- Skin Disorders

Local Factors
- Sweating or Humid conditions
- Occlusion
- Exposure

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8
Q

Tinea Corporis (Ring Worm) Overall

A

Classification: Dermatophyte Fungal Infection

Transmission:
- Autoinoculation from other parts of the body
(from tinea pedis or tinea capitis.)
- Skin to skin contact with people or animals

Prevalence:
- (Geographic) More common in tropical and
subtropical regions
- All ages. All genders

Incubation period:
- Days to months since contact with vector

Hx Findings:
- Other family members who have similar lesions
- Contact with animals.
- Previous use of topical steroids

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9
Q

What is Tinea Corporis classified as?

A

Dermatophyte Fungal Infection

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10
Q

How is Tinea Corporis transmitted?

A
  • Autoinoculation from other parts of the body
    (from tinea pedis or tinea capitis.)
  • Skin to skin contact with people or animals
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11
Q

What is the prevalence of Tinea Corporis?

A
  • (Geographic) More common in tropical and
    subtropical regions
  • All ages. All genders
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12
Q

How long is the incubation period of Tinea Corporis?

A

Days to months since contact with vector

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13
Q

What HX findings would be consistent with Tinea Corporis?

A
  • Other family members who have similar lesions
  • Contact with animals.
  • Previous use of topical steroids
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14
Q

If Tinea Corporis was present, what would be found on exam?

A
  • Small well circumscribed plaques with or without
    scaling, pustules, or vesicles,
  • Peripheral enlargement and central clearing, - Annular configuration with concentric rings. - Light to bright red, sharply marginated and occur
    alone or in groups of 3-4
  • Hyperpigmentation (occasionally)
  • Mildly pruritic to intense itching.
  • No associated findings.
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15
Q

Where is Tinea Corporis generally found on the body?

A

Exposed areas. Trunk, limbs, face, neck (excluding the feet, hands, and groin)

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16
Q

In addition to Tinea Corporis, what Deferential Diagnosis should be considered?

A
  • Psoriasis
  • Seborrheic dermatitis
  • Nummular eczema
  • Contact dermatitis
  • Lyme disease
  • Pityriasis rosea
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17
Q

What are common management strategies for Tinea Corporis?

A
  • Refer to MO
  • Rx (Prescription) : Clotrimazole (OTC) 1%
    cream/Ketoconazole (Rx) 2% topical BID X 1-3
    weeks.
  • Pt education: Hygiene, avoid skin to skin contact,
    loose breathable clothes to allow skin to dry.
  • Tests: Fungal Scraping, Woods Lamp (most cases
    do not fluoresce)
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18
Q

What is the common name for Tinea Corporis?

A

Ring Worm

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19
Q

Tinea Cruris (Jock Itch) Overall

A

Classification: Dermatophyte Fungal Infection

Transmission: Autoinoculation from other parts of the body, usually Tinea Pedis

Prevalence:
- Any age, but rare in children
- Males > Females

Onset: Sub acute/Chronic

Hx Findings:
- Warm, humid environment
- Tight clothing worn by men
- Possible Obesity
- Chronic topical glucocorticoid application
- Past or current Hx of Tinea Pedis/Cruris
- Quite pruritic

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20
Q

What is Tinea Cruris classified as?

A

Dermatophyte Fungal Infection

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21
Q

How is Tinea Cruris transmitted?

A

Autoinoculation from other parts of the body, usually Tinea Pedis

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22
Q

What is the prevalence of Tinea Cruris?

A
  • Any age, but rare in children
  • Males > Females
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23
Q

What is the onset of Tinea Cruris?

A

Sub acute/Chronic

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24
Q

What HX findings would be consistent with Tinea Cruris?

A
  • Warm, humid environment
  • Tight clothing worn by men
  • Possible Obesity
  • Chronic topical glucocorticoid application
  • Past or current Hx of Tinea Pedis/Cruris
  • Quite pruritic.
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25
Q

If Tinea Cruris was present, what would be found on exam?

A
  • Usually bilateral
  • Well demarcated erythematous plaques
  • Large, scaling, central clearing
  • Vesicles may be present at margins
  • Clearly defined, raised borders
  • *Pruritus is common (often what has made Pt
    seek care)
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26
Q

Where is Tinea Cruris generally found on the body?

A
  • Often begins on the proximal medial thigh then
    spreads to groin and pubic regions
  • Unlike yeast infections, the scrotum and penis
    are usually spared
  • Occasionally the gluteal cleft is affected too
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27
Q

In addition to Tinea Cruris, what Deferential Diagnosis should be considered?

A
  • Candida
  • Psoriasis
  • Pityriasis versicolor
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28
Q

What are common management strategies for Tinea Cruris?

A
  • Rx (Prescription): Clotrimazole 1%
    cream/Ketoconazole 2% Topical BID X 1-3 weeks,
    including at least 1 week after lesions have
    cleared.
  • Tmt co-existing locations of fungal infections
    (Ring worm & athletes foot)
  • Pt education:
    • Hygiene, avoid skin to skin contact,
    • Loose breathable cloth to allow skin to dry.
    • Dry off before putting on clothes.
    • Put on your socks before you put on your
      underwear.
  • Refer to MO (Medical Officer) /PA (Physician
    Assistant) for long term Tx (tmt).
  • Suggest Dermatologist referral in worst cases.
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29
Q

What is the common name for Tinea Cruris?

A

Jock Itch

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30
Q

Tinea Pedis (Athlete’s Foot) Overall

A

Classification: Dermatophyte Fungal Infection

Transmission: Barefoot walking on floors

Prevalence:
- Males more prominent than females
- Approx. 4% of population
- Rare in children/can be common in teens

Incubation period: May be from4 to 10 days

Hx Findings:
- Present from months to years
- Often prior history of tinea pedis, tinea unguium
of toenails
- May flare in hot climate
- Sweaty feet or Hx of Excessive sweating
- Occlusive Tightfitting footwear (boots)
- Immunosuppression
- Prolonged application of topical steroids

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31
Q

What is Tinea Pedis classified as?

A

Dermatophyte Fungal Infection

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32
Q

How is Tinea Pedis transmitted?

A

Barefoot walking on floors

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33
Q

What is the prevalence of Tinea Pedis?

A
  • Males more prominent than females
  • Approx. 4% of population
  • Rare in children/can be common in teens
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34
Q

How long is the incubation period of Tinea Pedis?

A

May be from4 to 10 days

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35
Q

What HX findings would be consistent with Tinea Pedis?

A
  • Present from months to years
  • Often prior history of tinea pedis, tinea unguium
    of toenails
  • May flare in hot climate
  • Sweaty feet or Hx of Excessive sweating
  • Occlusive Tightfitting footwear (boots)
  • Immunosuppression
  • Prolonged application of topical steroids
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36
Q

If Tinea Pedis was present, what would be found on exam?

A
  • Erythema, Scaling, Maceration, Burning, Possible
    bulla formation
  • Frequently Asymptomatic. Pruritus
  • 4 Types of Skin Lesions: interdigital, moccasin,
    inflammatory/bullous, and ulcerative.
37
Q

Where is Tinea Pedis generally found on the body?

A

Feet (usually bilateral)

38
Q

In addition to Tinea Pedis, what Deferential Diagnosis should be considered?

A
  • Interdigital type: erythrasma (bacterial), impetigo
    (bacterial)
  • Moccasin type: Psoriasis vulgaris, eczematous
    dermatitis (eczema), dyshidrotic oedema
  • Inflammatory/bullous type: Bullous impetigo,
    allergic contact dermatitis.
39
Q

What are common management strategies for Tinea Pedis?

A
  • Rx: Clotrimazole 1% cream/Ketoconazole Topical
    BID X 1-3 weeks
  • Pt education
  • Refer to MO/PA for long term Tx (treatment)
  • Suggest Dermatologist referral in worst cases
40
Q

What is the common name for Tinea Pedis?

A

Athlete’s Foot

41
Q

Malasezzia SPP (Tinea Versicolor) Overall

A

Classification: Superficial fungal infection

Transmission: Skin-to-skin contact, contact with contaminated objects

Prevalence:
- Predominantly adolescents and young adults
- Up to 50% in tropical climates

Hx Findings:
- Immunosuppression (glucocorticoids)
- Use of topical skin oils
- NOT related to personal hygiene
- FHx in 21%!

42
Q

What is Malasezzia SPP classified as?

A

Superficial fungal infection

43
Q

How is Malasezzia SPP transmitted?

A

Skin-to-skin contact, contact with contaminated objects

44
Q

What is the prevalence of Malasezzia SPP?

A
45
Q

What HX findings would be consistent with Malasezzia SPP?

A
  • Immunosuppression (glucocorticoids)
  • Use of topical skin oils
  • NOT related to personal hygiene
  • FHx in 21%!
46
Q

If Malasezzia SPP was present, what would be found on exam?

A
  • Small hyper/hypopigmented macules, patches
    and plaques that coalesce into larger patches
  • Variance in pigmentation with skin colour
  • May be mildly pruritic.
47
Q

Where is Malasezzia SPP generally found on the body?

A

Most commonly on the upper trunk and proximal upper extremities

48
Q

In addition to Malasezzia SPP, what Deferential Diagnosis should be considered?

A

Seborrheic dermatitis, pityriasis rosea, vitiligo

49
Q

What are common management strategies for Malasezzia SPP?

A
  • Rx: Clotrimazole 1%
    cream/Ketoconazole/Terbinafine 1% Topical BID
    X 1-4 weeks
  • Pt Edu.: Changes in pigmentation often persist after treatment. Restoration may take months!
  • Ref. to MO/PA for long term Tx (tmt)
  • Suggest Dermatologist referral in worst cases
50
Q

What is the common name for Malasezzia SPP?

A

Tinea Versicolor

51
Q

Candidiasis (Yeast Infection) Overall

A

Pathophysiology: Fungal infection caused by a yeast. Candida belongs to your normal flora.

Symptomatic reactions are due to a variety of host factors: Eg.: Diabetes, antibiotics, stress, nutrient deficiencies, immunocompromised, oral contraceptives, etc.

Candidiasis generally occurs on moist, occluded skin.

52
Q

What is Candidiasis classified as?

A

Fungal Infection

53
Q

If Candidiasis was present, what would be found on exam?

A
  • May have erosions of the skin, - White plaques, - Pruritus
54
Q

Where is Candidiasis generally found on the body?

A

Oropharyngeal or vulvovaginal

55
Q

What HX findings would be consistent with Candidiasis?

A
  • Diabetes
  • Antibiotics
  • Stress
  • Nutrient Deficiencies
  • Immunocompromised
  • Oral contraceptives
56
Q

What are common management strategies for Candidiasis?

A
  • Topical antifungal treatment (Clotrimazole 1%
    a.k.a. Canesten)
  • Oral antifungals (Fluconazole, Nystatin)
  • Pt Edu. Prevention (smoking cessation, personal
    hygiene, nutrition)
  • Refer to higher medical authority (MO/PA)
57
Q

What is the common name for Candidiasis?

A

Yeast Infection

58
Q

Pediculosis (Lice) Overall

Transmission: Most commonly by direct contact with infected individuals. May also occur indirectly (sharing of combs, etc.).

Prevalence: Predominantly in younger children. More common in females than males.

A
59
Q

How is Pediculosis transmitted?

A

Most commonly by direct contact with infected individuals. May also occur indirectly (sharing of combs, etc.).

60
Q

What is the prevalence of Pediculosis?

A

Predominantly in younger children. More common in females than males.

61
Q

If Pediculosis was present, what would be found on exam?

A
  • Pruritus (itchiness ++)
  • Lesions due to burrowing and biting of lice
  • Lice or scabs may be seen
  • Excoriation may cause secondary changes and infection!
62
Q

What are common management strategies for Pediculosis?

A
  • Prevention/Education/Reassurance
  • Topical insecticides (permethrin/ivermectin)
  • Systemic Therapy (oral ivermectin)
  • Refer to higher medical authority
63
Q

What is the common name for Pediculosis?

A

Lice

64
Q

How is Scabies transmitted?

A

Scabies burrow into skin, then breed/lay eggs.

65
Q

If Scabies were present, what would be found on exam?

A
  • Burrow lines: gray/skin colored ridges. Either
    linear or wavy
  • Inflammatory papule or nodule
  • Well-demarcated plaques covered by a very thick crust or scale
66
Q

Define Scabies

A

An infestation of the skin by mites

67
Q

In addition to Scabies, what Deferential Diagnosis should be considered?

A

Bedbugs can be easily confused with Scabies

68
Q

What are common management strategies for Scabies?

A
  • PT education (wash all clothing/bedding at a high temperature)
  • Scabicides (Permethrin or Ivermectin)
  • Antihistamines
  • Refer to higher medical authority
69
Q

List the differences between Scabies VS Bedbugs

A

Scabies:
- Microscopic
- Burrow marks into skin
- Intense itching
- Prefer moist folds of skin

Bedbugs:
- Bugs can be seen with naked eye
- Bites and moves on in a pattern
- Bites any exposed skin

70
Q

Define Urticaria

A

Vascular reaction of the skin that release from the release of histamines and other vasoactive substances

71
Q

If Urticaria was present, what would be found on exam?

A
  • Pruritus
  • Sharply defined wheals may remained small or
    enlarged
  • Erythema
  • Edema
72
Q

True or False, Urticaria can be chronic

A

True

73
Q

What are common management strategies for Urticaria?

A
  • Prevention (Mitigating or eliminating the cause, it
    etiology is known)
  • Antihistamines
  • Oral glucocorticoids
  • Refer to higher medical authority
74
Q

Define cellulitis

A

Bacterial infection characterized by an acute reaction spreading to the dermis or subcutaneous tissues and originating at the site of bacterial entry

75
Q

If Cellulitis was present, what would be found on exam?

A
  • Erythema, Hot and Edema
  • Shiny plaque with tender area originating at the
    site
  • Borders usually sharply defined, irregular and
    slightly elevated
  • Vesicles, bullae, erosions, abscesses, hemorrhage
    and necrosis may form in the area
76
Q

What are common management strategies for Cellulitis?

A
  • Meds : Oral or IV antibiotics (Abx) + Analgesics
  • Dressings (sterile saline dressings for local pain)
  • Supportive Measures (rest, immobilization,
    elevation)
  • Refer to higher medical authority
77
Q

Define Ingrown Toenail

A

Incurvation of nail border into adjacent nail fold, causing pain

78
Q

What causes an Ingrown Toenail?

A
  • Tight shoes
  • Trauma/abnormal gait
  • Toe shape/genetics
  • Excess nail trimming
79
Q

If an Ingrown Toenail was present, what would be found on exam?

A
  • Painful nail folds with various degrees of
    erythema and swelling
  • Abscess may form secondary to it and produce
    discharge
80
Q

What are common management strategies for Ingrown Toenail?

A
  • Conservative approach for mild cases:
    • Soak in warm water & Epsom salts
    • Cotton wedge between nail and painful fold
    • Change footwear
  • Antimicrobial therapy
  • Potential surgical removal of nail (Nail resection) - Refer to higher medical authority
81
Q

Define Blisters (Bullae/Vesicles)

A

A collection of fluid below or within the epidermis

82
Q

What causes blisters?

A

Rounded, elevated lesion containing serous fluid (plasma), due to burns, bites, friction, contact dermatitis, and drug reactions. Also present in skin frailty disorders

83
Q

What are common management strategies for Blisters?

A
  • Area cleaned/dried and protective dressing
    applied (2nd skin, moleskin, etc.)
  • Unless blister is painful or interferes with
    function due to its size, it should not be
    punctured
  • Activity as tolerated
  • Pt Edu: Consider proper precaution against
    future blisters (Double socks, foot powder,
    better boots)
84
Q

Define Warts (Verrucae)

A

Warts are small benign growths on the skin caused by Human Papillomavirus (HPV)

85
Q

If Warts were present, what would be found on exam?

A
  • Rough, flat or raised papules, sometimes
    blanched
  • Ranging from 1-10 mm in diameter
  • Commonly asymptomatic
  • Common on hands, knees and elbows
  • Can be single or clustered
  • Patient may request removal due to cosmetic
    disfigurement
86
Q

What are common management strategies for Warts?

A
  • Wart Parade: freezing = cryotherapy, liquid
    nitrogen
  • Topical salicylic acid
  • Refer to higher medical authority
87
Q

Define Contact Dermatitis

A

Generic term applied to acute or chronic inflammatory reactions caused by substances that were in contact with the skin.

Cell-mediated (delayed) hypersensitive reaction in normal skin due to contact with a strong allergen

88
Q

If Contact Dermatitis was present, what would be found on exam?

A
  • May create rashes or dry skin,
  • Acute Irritation: burning, erythema, swelling, blisters,
  • Chronic Irritation: erythema, itching, tinging/pain if fissures develop, dryness, scaling and crusting
89
Q

What are common management strategies for Contact Dermatitis?

A
  • Avoidance/remove irritant/wash area,
  • Clean secondary sources like hair and nail,
  • Use barrier cream, moisturizers, and topical
    corticosteroids (betamethasone),
  • Antihistamines,
  • Refer to higher medical authority

QL4 (11 decks)

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