H&P of Derm PE Flashcards
History Approach
Questions related to CC vs General Skin Exam
With general exam, ask about lesions of concern.
Age, Sex, Ethnicity, etc
When did the problem start? Why now?
Where did it start? What areas is affected now? Does it migrate?
Come or go? Is the problem constant?
Have you had this before?
Social contacts with similar problems?
Associated Sx - itch vs pain etc
What medications are you taking? What products do you use? New Products?
Have you seen anyone else with this problem? What have you tried? Did they Help? How long have you been using them?
Blood tests?
Past Bx
PMH/FamHx/SocialHx
Social includes work, exposures, hobbies, athletics.
Hx of sun exposures
Remember that Derm includes hair and nails
Ask about hair related Hx
Care practices
Chemical processes
systemic Sx
Surgical Hx - Anesthesia –> telogen effluvuums
Dietary Habits
Pregnancy
Medications
Stressors
Nails
Trauma
habit tics
nail care
artificial nails
all nails or one nail?
Physical Exam
Good eyesight and good lighting
Magnifying glass
ruler
tape measure
Look everywhere; should be in a gown with mostly everythign off; if they refuse then document
take pictures
know descriptive terms
a general skin exam is head to toe.
of a complaint specific exam you want to check all related areas (think psoriasis or AD)
During the PE
Note:
color, texture, temperature, turgor
patterns and shapes of eruptions,\
Lesion size shape, color, flat v raised
Hair distributions, texture, quantity, alopecia
Nails - color shape, lesions, trauma, subungal debris
Pt Education is Key
May be getting multiple Rx for one problem
Warning S/S of CA
lsun safety
warn about the internet
Good Pt education resources
Avoid call backs to the office
When to refer
Get the opinion of your collaborating doc
Refer if manifestation of other underlying problems - CA, thyroid, Kidney
Refer for Rare Dx
Surgical referral
Or if neither you or your sup doc can figure it out
Lesions
Primary - GRowth that appears at birth or later in life; mac, pap, nod, wheal, ves
Secondary - Signs that appear in the primary lesion. As in from inflammation or manipulation by the Pt; crust, scale, flake, excoriation
Thermal Burns
Injury to the skin caused by heat/flame/electricity/radiation
Various factors influence severity;
Rate of heat transfer, thickness of affected skin, temp, duration of exposure (111F x 6hours is max tolerance)
Burn classifications
Intervention and outcome based on depth
Superficial is only the epidermis
Partial thickness epidermis and portions of the dermis and characterized by depth; superficial (blisters) and deep (includes glands and hair follicles)
Fullthickness all layers of dermis and ofgten the underlying SQ tissue; escars; anesthetic
4th degree burn is extension into the deep tussues and life threatening.
Burn Management
Cooling, pain management, fluid management, airway management, cleaning, debridement, dressings, infection, tetanus prophylaxis, referral
