Intro To Derm

Question 1

What are the 7 “rights”?

Answer 1

patient
drug
dose
route
time
indication
signature

Question 2

What things are included on a prescription?

Answer 2

clinic info
pt name, age, DOB
date of service
medication name
strength/formulation
command
amount
formulation
route
frequency
duration
indication
quantity
refills
your name & signature

Question 3

What does DAW mean?

Answer 3

dispense as written

Question 4

When should you check the DAW box on a prescription?

Answer 4

when writing the brand name medication and DO NOT want the pharmacy to fill with a generic version

Question 5

When should you check the generics permitted box on a prescription?

Answer 5

when you write a name brand on the prescription line but are okay with a generic brand being substituted

Question 6

Can you check both the DAW box AND the generics permitted box on the same prescription?

Answer 6

no

Question 7

If a generic name is written on the prescription line should you check the generics permitted box?

Answer 7

no

Question 8

What question(s) can be asked for the “O” part of the derm HPI?

Answer 8

Onset: when it started

Question 9

What question(s) can be asked for the “L” part of the derm HPI?

Answer 9

Location: where did it start? has it changed? how has it changed?

Question 10

What question(s) can be asked for the “D” part of the derm HPI?

Answer 10

Duration: acute vs chronic, intermittent vs constant

Question 11

What question(s) can be asked for the “C” part of the derm HPI?

Answer 11

Characteristics: is it itchy? is it painful?

Question 12

What question(s) can be asked for the “A” part of the derm HPI?

Answer 12

Aggravating/alleviating: cold, heat, travel, meds, products

Question 13

What question(s) can be asked for the “R” part of the derm HPI?

Answer 13

Radiation: has it spread?

Question 14

What question(s) can be asked for the “T” part of the derm HPI?

Answer 14

Treatments tried: topical or systemic, OTC

Question 15

What question(s) can be asked for the “S” part of the derm HPI?

Answer 15

Severity: would you say mild, moderate, or severe? how does it impact your daily life? how does it impact your sleep?
Similar episodes: has this happened before?

Question 16

Pruitic

Answer 16

Itchy

Question 17

What are some derm questions to ask at a routine preventative exam?

Answer 17

have you noticed anything new or changing skin lesions since your last visit?
do you have a history of excessive sun exposure?
do you have a personal or FH of chronic skin conditions or skin cancer?

Question 18

What are constitutional symptons?

Answer 18

fevers, chills, changes in appetite, change in weight

Question 19

PMH questions

Answer 19

recent illnesses, allergies, meds, atopic history, transfusions
any history of skin problems?

Question 20

Social History Questions

Answer 20

smoking, alcohol, substance abuse
travel, occupation, exposures
sexual history (SDI/STI)

Question 21

Pertinent Family History Questions

Answer 21

any skin cancers, psoriasis, atopy that you know of in your family?

Question 22

What should you examine during a physical exam?

Answer 22

Skin
Hair
Nails

Question 23

What are you doing during a physical exam?

Answer 23

inspect color, lesions, and palpate

Question 24

What are general tips for the physical exam?

Answer 24

start with vitals and general appearance
expose appropriately (only the area being inspected)
use proper lighting and magnification PRN
measure (and chart this)

Question 25

What/where are you inspecting the skin?

Answer 25

inspect color and for lesions all over the body including mucous membranes (mouth) and genitals PRN

Question 26

What are some examples of color to look for when inspecting the skin?

Answer 26

hypopigmentation hyperpigmentation depigmentation erythema pallor cyanosis juandice

Question 27

Where is it important to look for lesions?

Answer 27

intertriginous areas (folds) extensor and flexor surfaces waistband

Question 28

What are examples of lesion patterns and shapes?

Answer 28

linear clusters serpiginous annular dermatomal

Question 29

What are 3 things you may want to do when inspecting a lesion?

Answer 29

measure mark photograph

Question 30

What is included in palpating the skin?

Answer 30

moisture: is the skin dry, oily, moist? temperature: is the skin warm or cool (use back of hands/fingers to feel)? texture: is the skin rough or smooth? Mobility or turgor

Question 31

turgor

Answer 31

ease with which the skin lifts and returns to normal

Question 32

How do you describe skin turgor findings?

Answer 32

tenting/no tenting sluggish/brisk elastic/inelastic good/poor

Question 33

What are things to note when inspecting and palpating the hair?

Answer 33

quantity distribution texture

Question 34

What are some descriptive words to use when inspecting the hair?

Answer 34

sparse patchy silky oily/greasy coarse dry

Question 35

Should you look at the scalp?

Answer 35

YES

Question 36

What are you looking for when inspecting the scalp?

Answer 36

redness scaliness

Question 37

What are some things to note when inspecting and palpating the nails?

Answer 37

color shape lesions

Question 38

What is pitting?

Answer 38

indents on the nail

Question 39

What does clubbing look like?

Answer 39

when the finger/nail is arched

Question 40

Auspitz sign

Answer 40

when slight scratching of a scaly lesion (removal of the scale) revels pinpoint bleeding within a lesion

Question 41

Nikolsky Phenomenon

Answer 41

When the epidermis is dislodged from the dermis by shearing pressure, resulting in erosion and a red base (top layers slip away from deeper layers when rubbed)

Question 42

Koebner Phenomenon

Answer 42

when a skin lesion appears at the site of trauma or injury

Question 43

what is the greatest magnification you can get with a hand lens?

Answer 43

7x

Question 44

What is woods lamp?

Answer 44

black light allows you to see subtle color changes in melanin pigmentation easier

Question 45

diascopy

Answer 45

firmly pressing a slide against skin to determine whether redness is due to capillary dilation (erythema -- blanches) or extravasation of blood (purpura -- does not blanch) dilation=dilatation

Question 46

dermoscopy

Answer 46

hand lens with built in lighting and magnification (10x-30x) permits noninvasive inspection of epidermis and beyond helpful in distinguishing between benign and malignant patterns of growth (helps with decision to biopsy or not)

Question 47

What are common allergy tests?

Answer 47

patch testing prick testing

Question 48

What is acetowhitening?

Answer 48

application of vinegar genital verruca/verrucae: white

Question 49

What is a culture and sensitivity test?

Answer 49

swab can be taken from skin cells, blood, pus, sputum this test can confirm the presence of bacteria, virus, fungus, and direct antimicrobial choice

Question 50

What is KOH (potassium hydroxide) Examination?

Answer 50

distinguishes fungal infections (looking for budding yeast and/or hyphae)

Question 51

What is Tzanck smear?

Answer 51

scraping an ulcer base to look for giant multinucleated cells this is NOT commonly performed anymore (PCR test is better) THINK HSV

Question 52

What is scabies test (skin scraping)?

Answer 52

unroofing a lesion or burrow (with a scalpel and mineral oil) to find mites, ova, or feces on microscopy

Question 53

What are 3 types of biopsies?

Answer 53

shave punch excisional

Question 54

What is a shave biopsy?

Answer 54

superficial layer removed with a blade does not require sutures

Question 55

What is a punch biopsy?

Answer 55

tubular knife cuts through epidermis, dermis, and SQ tissue sutures are sometimes required depending on diameter

Question 56

What is an excisional biopsy?

Answer 56

remove lesion in entirety margins examined to ensure they are clear requires sutures

Question 57

Ecchymosis

Answer 57

bruise

Question 58

Eschar

Answer 58

dark colored crust of dead tissure

Question 59

fissure

Answer 59

thin crack in the skin

Question 60

follicular

Answer 60

lesions arising from hair follicles

Question 61

maceration

Answer 61

moist. peeling skin, often whitish in color pruny skin

Question 62

nummular

Answer 62

round, coin-shaped lesion discoid

Question 63

pedunculated

Answer 63

on a stalk lesion on a stalk

Question 64

pruritus

Answer 64

itching

Question 65

verrucous

Answer 65

wart-like

Question 66

petechiae

Answer 66

pinpoint bleeding into the skin does NOT blanch small red, purple, or brown spots

Question 67

Purpura

Answer 67

larger bleeding into the skin does NOT blanch may be palpable internal bleeding from small blood vessels

Question 68

What is Mohs Procedure?

Answer 68

skin-sparing procedure used often for the face and to remove malignancies in the most efficient way possible done outpatient and ONLY by dermatologists

Question 69

Atopic History

Answer 69

Eczema, nasal allergies, asthma

Question 70

Erythema

Answer 70

Redness blanches capillaries being dilated

Question 71

Pallor

Answer 71

More pale

Question 72

Depigmentation

Answer 72

Loss of melanin

Question 73

Intertriginous

Answer 73

in the folds where there is more moisture think fungal

Question 74

Lesion Pattern: Linear

Answer 74

following along a line

Question 75

Lesion Pattern: Clusters

Answer 75

Grouped together

Question 76

Lesion Patterns: Serpiginous

Answer 76

snake like

Question 77

Lesion Patterns: Annular

Answer 77

ring shaped Central clearing

Question 78

Lesion Pattern: Dermatomal

Answer 78

following the nerve innervations

Question 79

Example of Dermatomal lesion

Answer 79

shingles chicken pox

Question 80

Positive Auspitz =?

Answer 80

psoriasis

Question 81

Positive Nikolsky Phenomenon =?

Answer 81

Stevens Johnsons Syndrome

Question 82

verruca/verrucae

Answer 82

lesion turns white

Question 83

What is the most common thing culture and sensitivity tests can confirm?

Answer 83

bacteria

Question 84

Telangiectasias

Answer 84

spidery type of vessels (rosacea)