Examination of the skin

Question 1

what to ask in HPC (6)

Answer 1

-timing

>macro

>evolution also covered in DCM - growth, change

-about the HPC

>site also covered in DCM - at onset, spread

>itch

>pain, burning

>bleeding

>wet, dry, blister

>exaxerbating, relieving factors - any treatments can be covered in drug hx

Question 2

what to ask in SR (2)

Answer 2

• fever
• joint complaints

Question 3

what to ask in PMH (7)

Answer 3

-past history of skin disorders

-asthma

-hay fever

-joint conditions

-autoimmune conditions

-organ transpants

-recent infection - streptococcal tonsilitis can trigger plaque psoriasis

Question 4

-what to ask (2)

Answer 4

-family Hx skin disorders

> may mean family have tendency to a disorder or family exposed to common infectious agent, scabies or chemical

-family Hx other disorders

Question 5

what to ask about in SH (7)

Answer 5

-hobbies

-sun exposure

>time spent out doors, indoors, by windows

>protection

>sunbed use

-travel hx > relation to hpc

-occupation > relation to hpc

-alcohol

Question 6

-what to ask about in DH (4)

Answer 6

-drugs used to treat present skin condition can be covered in HPC

>topical, systemic, physician prescribed, patient initiated

-immunosupressants eg steroids

-drugs for other disorders

-side effects

Question 7

what to ask (2)

Answer 7

• concerns
• impact

Question 8

-layers of the skin

Answer 8

Question 9

layer of skin inc epidermal layers

Answer 9

Question 10

distribution

configuration

morphology

eruption

lesion

pruritis

Answer 10

distribution = where a rash is locatied

• configuration=if there are seperate components of a rash is there a pattern in their positioning
• morphology=what individual components look like
• eruption=rash
• lesion=any single small area of skin disease
• pruritus=sensation of itching

Question 11

distribution

-how can distrubition be described (4)

• examine where (4)
• look out for/note (2)

Answer 11

-localized

-extensor , flexor

-universal

-broadly symmetrical

examine

-as much of skin as poss

-special areas depending on disease

>eg hand eczema check feet, suspectied psoriasis look in gluteal cleft

-mouth

-hair

-nails

look out for

-incidental skin cancers

-note negative findings eg shielded areas spared in a photo senstive dermitis

Question 12

• what origin of disease does symmetry imply
• what origin does unilateral or asymmetry imply

Answer 12

• systemic
• external cause

Question 13

-configuration

-the six main configuration types

Answer 13

• grouped groups of lesions
• linear lesions in a line
• -*serpiginous line curving up and down
• -*arcuatie curved in an arc

-nummular round or coin shaped

-annular in a ring

Question 14

-morphology

>aim to find an early/primary lesion for morphology

-describe a lesion systemacially how (7)

Answer 14

• a - (a)symmetry, shape
• b - borders/margins
• c - colour
• d - diameter
• e - evolving, extra surface characteristics, tenderness

Question 15

-define.

small (<0.5cm)

>macule

>papule

large( >0.5cm)

>patch

>plaque

>nodule

Answer 15

small (<0.5cm)

• macule = flat/non-palpable area of altered colour or texture
• papule = small elevated/palpable solid elevation of skin

large( >0.5cm)

-patch = flat/nonpalpable area of colour or texture

• small version is macule*
• plaque = elevated/palpable solid lesion >0.5 width but w/o substantial depth. small version is papule
• nodule = elevated/palpable solid lesion >0.5cm in both width and depth. small version is papule
• large macule = flat/nonpalpable area of colour or texture small version is macule

Question 16

-define

small <0.5cm

_-_vesicle

• pustule
• petechia (pin sized) , purpura
• wheal - can be any size

large >0.5cm

• bulla
• abscess/furuncle
• ecchmosis/bruise
• haematoma
• angioedema

Answer 16

small

-vesicle=fluid filled blister

-pustule=pus filled lesion

-petechia (pin sized) , purpura = extravasation of blood into skin

-wheal = accumulation of dermal oedema

large

• bulla=fluid filled blister. small version is vesicle
• abscess/furuncle=pus filled blisted. small version is pustule
• ecchymosis/bruis=extravasation of blood into skin
• small version is petechia or purpura*

haematoma=gross extravasation of blood into skin causing swelling

-angioedema=accumulation of dermal oedema. small version is wheal

Question 17

-define

• erythema
• erythroderma
• scaling
• keratosis
• crust

Answer 17

• erythema=redness caused by vascular dilatation
• erythroderma=generalized redness of skin that may be scaling or smooth
• scale=flake arising from horny layer. visible white loosening.
• keratosis=horn-like thickening of stratum corneum
• crust=may look like scale, but is composed of dried blood or tissue fluid

Question 18

define

• ulcer
• erosion
• excoriation
• lichenification
• scar

Answer 18

• ulcer=area of skin from which the whole of the epidermis has been lost. may extend into subcutanous fat deeper. may heal w/o scarring
• erosion=area of skin denuded by loss of only epidermis. erosions heal w/o scarring
• excoriation=an ulcer or erosion produced by itching
• lichenification=area of thickened skin w. increased markins due to chronic scratching or rubbing
• scar = result of healing, where normal tissue is replaced by fibrous tissue

Question 19

define

• fissure
• sinus
• atrophy
• pigmentation

Answer 19

fissue=slit in skin

sinus=cavity of channel that permits escape of pus or fluid

atrophy=thinning of skin caused by diminution of epidermis, dermis or subcutaneous fat

pigmentation=colouration. can be more or less than surroudning skin