Intro To Derm Flashcards
What are the 7 “rights”?
patient
drug
dose
route
time
indication
signature
What things are included on a prescription?
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
What does DAW mean?
dispense as written
When should you check the DAW box on a prescription?
when writing the brand name medication and DO NOT want the pharmacy to fill with a generic version
When should you check the generics permitted box on a prescription?
when you write a name brand on the prescription line but are okay with a generic brand being substituted
Can you check both the DAW box AND the generics permitted box on the same prescription?
no
If a generic name is written on the prescription line should you check the generics permitted box?
no
What question(s) can be asked for the “O” part of the derm HPI?
Onset: when it started
What question(s) can be asked for the “L” part of the derm HPI?
Location: where did it start? has it changed? how has it changed?
What question(s) can be asked for the “D” part of the derm HPI?
Duration: acute vs chronic, intermittent vs constant
What question(s) can be asked for the “C” part of the derm HPI?
Characteristics: is it itchy? is it painful?
What question(s) can be asked for the “A” part of the derm HPI?
Aggravating/alleviating: cold, heat, travel, meds, products
What question(s) can be asked for the “R” part of the derm HPI?
Radiation: has it spread?
What question(s) can be asked for the “T” part of the derm HPI?
Treatments tried: topical or systemic, OTC
What question(s) can be asked for the “S” part of the derm HPI?
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?
Pruitic
Itchy
What are some derm questions to ask at a routine preventative exam?
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?
What are constitutional symptons?
fevers, chills, changes in appetite, change in weight
PMH questions
recent illnesses, allergies, meds, atopic history, transfusions
any history of skin problems?
Social History Questions
smoking, alcohol, substance abuse
travel, occupation, exposures
sexual history (SDI/STI)
Pertinent Family History Questions
any skin cancers, psoriasis, atopy that you know of in your family?
What should you examine during a physical exam?
Skin
Hair
Nails
What are you doing during a physical exam?
inspect color, lesions, and palpate
What are general tips for the physical exam?
start with vitals and general appearance
expose appropriately (only the area being inspected)
use proper lighting and magnification PRN
measure (and chart this)
What/where are you inspecting the skin?
inspect color and for lesions
all over the body including mucous membranes (mouth) and genitals PRN
What are some examples of color to look for when inspecting the skin?
hypopigmentation
hyperpigmentation
depigmentation
erythema
pallor
cyanosis
juandice
Where is it important to look for lesions?
intertriginous areas (folds)
extensor and flexor surfaces
waistband
What are examples of lesion patterns and shapes?
linear
clusters
serpiginous
annular
dermatomal
What are 3 things you may want to do when inspecting a lesion?
measure
mark
photograph
What is included in palpating the skin?
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
turgor
ease with which the skin lifts and returns to normal
How do you describe skin turgor findings?
tenting/no tenting
sluggish/brisk
elastic/inelastic
good/poor
What are things to note when inspecting and palpating the hair?
quantity
distribution
texture
What are some descriptive words to use when inspecting the hair?
sparse
patchy
silky
oily/greasy
coarse
dry
Should you look at the scalp?
YES
What are you looking for when inspecting the scalp?
redness
scaliness
What are some things to note when inspecting and palpating the nails?
color
shape
lesions
What is pitting?
indents on the nail
What does clubbing look like?
when the finger/nail is arched
Auspitz sign
when slight scratching of a scaly lesion (removal of the scale) revels pinpoint bleeding within a lesion
Nikolsky Phenomenon
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)
Koebner Phenomenon
when a skin lesion appears at the site of trauma or injury
what is the greatest magnification you can get with a hand lens?
7x
What is woods lamp?
black light
allows you to see subtle color changes in melanin pigmentation easier
diascopy
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
dermoscopy
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)
What are common allergy tests?
patch testing
prick testing
What is acetowhitening?
application of vinegar
genital verruca/verrucae: white
What is a culture and sensitivity test?
swab can be taken from skin cells, blood, pus, sputum
this test can confirm the presence of bacteria, virus, fungus, and direct antimicrobial choice
What is KOH (potassium hydroxide) Examination?
distinguishes fungal infections (looking for budding yeast and/or hyphae)
What is Tzanck smear?
scraping an ulcer base to look for giant multinucleated cells
this is NOT commonly performed anymore (PCR test is better)
THINK HSV
What is scabies test (skin scraping)?
unroofing a lesion or burrow (with a scalpel and mineral oil) to find mites, ova, or feces on microscopy
What are 3 types of biopsies?
shave
punch
excisional
What is a shave biopsy?
superficial layer removed with a blade
does not require sutures
What is a punch biopsy?
tubular knife cuts through epidermis, dermis, and SQ tissue
sutures are sometimes required depending on diameter
What is an excisional biopsy?
remove lesion in entirety
margins examined to ensure they are clear
requires sutures
Ecchymosis
bruise
Eschar
dark colored crust of dead tissure
fissure
thin crack in the skin
follicular
lesions arising from hair follicles
maceration
moist. peeling skin, often whitish in color
pruny skin
nummular
round, coin-shaped lesion
discoid
pedunculated
on a stalk
lesion on a stalk
pruritus
itching
verrucous
wart-like
petechiae
pinpoint bleeding into the skin
does NOT blanch
small red, purple, or brown spots
Purpura
larger bleeding into the skin
does NOT blanch
may be palpable
internal bleeding from small blood vessels
What is Mohs Procedure?
skin-sparing procedure used often for the face and to remove malignancies in the most efficient way possible
done outpatient and ONLY by dermatologists
Atopic History
Eczema, nasal allergies, asthma
Erythema
Redness
blanches
capillaries being dilated
Pallor
More pale
Depigmentation
Loss of melanin
Intertriginous
in the folds
where there is more moisture
think fungal
Lesion Pattern: Linear
following along a line
Lesion Pattern: Clusters
Grouped together
Lesion Patterns: Serpiginous
snake like
Lesion Patterns: Annular
ring shaped
Central clearing
Lesion Pattern: Dermatomal
following the nerve innervations
Example of Dermatomal lesion
shingles
chicken pox
Positive Auspitz =?
psoriasis
Positive Nikolsky Phenomenon =?
Stevens Johnsons Syndrome
verruca/verrucae
lesion turns white
What is the most common thing culture and sensitivity tests can confirm?
bacteria
Telangiectasias
spidery type of vessels (rosacea)