JC128 (Family Medicine) - Visual spot diagnosis Flashcards
Outline history taking questions (HPI only) for skin conditions
Major complaint:
o Site
o Duration
o Time scale of changing symptoms (minutes? hours? days?)
o Itch, pain, scaling
o Extent of involvement
o Exacerbating and relieving factors: exposure to sunlight, food, emotion, menstrual cycle, contact…etc
o History of previous investigations and treatments
o Reason for consultation: ideas, concerns, expectations
o Impacts on quality of life
Relevant history taking questions for skin conditions (after HPI)
Past health – previous skin diseases, medical diseases, drug history
History of sexually transmitted diseases, sexual history if appropriate (sexual orientation, behaviour)
Menstrual, gynaecological, and obstetric history if relevant
Occupational history – effects of skin problem on work, effect of work on skin problem
Social history – smoking, alcohol, substances of abuse
Contact history – travel history, been to hospital/home-for-the-aged, close contacts having similar rash
Left: Stye/ Hordeolum
Remains painful and localizes to eyelid margin* due to infection by
Acute onset
Tearing, photophobia, foreign body sensation
Right: Chalazion
Chronic infection, localizes to the body* of the eyelid
Due to occlusion of the sebaceous gland
Both treat with warm compress and conservatively
Xanthelasma and xanthomata
e.g. familial hypercholesterolemia
Top left:
Subconjunctival hemorrhage
Bottom middle:
Viral conjunctivitis - usually preceded by URTI
Right top:
Bacterial conjunctivitis
Episcleritis
Swollen vessels in radial orientation
No pain or moderate discomfort with localized tenderness
1/3 with systemic conditions, and resolves in few weeks
NSAID eyedrops treatment
Acute close angle glaucoma
Fixed oval mid-dilated, non-reactive pupil
Cloudy cornea
Loss of red reflex
Visual loss
Other symptoms: seeing halo around object, nausea, vomiting, abdominal pain
Top left: Pinguecula
- Yellow, raised, lipid-like deposit in the nasal and temporal limbal conjunctiva
- Does not cross limbus and affect vision**
- Middle age with chronic sun exposure
- Can become vascularised and inflamed - pingueculitis
Bottom right: Pterygium
- triangular fibrovascular deposit
- CAN cross into limbus and affect cornea and vision
Top right: Retention cyst
- Clear fluid
- Asymptomatic and spontaneously resolve
- Maybe foreign body sensation
Herpes labialis (cold sore)
Crosses border of lips
Attacks trigger by sunlight, fever, psychological stress, menstrual period
Lesion lasts 2-21 days and vesicles contain virus
Followed by remission
Apthous ulcer/ canker sores
Painful, crater like ulcer that localizes inside mouth on NKSS mucosa of lips, buccal mucosa, tongue
Round to ovoid ulcers with white, gray, yellow shallow base
Erythematous halo
Top left: Mucocele/ retention cyst
Caused by rupture/ minor trauma to salivary gland duct with mucin spillage into surrounding soft tissue
Bottom right: SCC of tongue
Usually at lateral side of tongue
Lesion start with red or white base with nodularity or ulceration causing pain and discomfort
Lack of erythematous halo for ddx against aphthous ulcer
Top left: Oral candidiasis/ oral thrush
Fungus candida albicans overgrowth
Roof of mouth, tongue, inner cheeks, gums and tonsils
Bottom right: Tonsiliths/ tonsil stones
Foreign body sensation in tonsils
Putrid breath, bad breath
Yellow-white mass within tonsillar crypts
Top left:
Gingivitis
Bottom middle
Periodontitis
** differentiate gingivitis vs periodontitis by the presence of alveolar bone involvement **
Loss of supportive connective tissue including supporting connective tissue
Gingival bleeding on probing, increase probing depth and tooth mobility
Top right:
Dental abscess
4 stages of gum disease
Acne vulgaris
Comedones, inflammatory papules and pustules Post-inflammatory hyperpigmentation Open comedones (blackheads) or closed comedones (whiteheads, non-inflammatory bases)
Nodules and cysts result in scarring, pitting or hypertrophic scar
Rosacea
Erythema of central portion of face for at least 3/12 portion
Supporting criteria: facial flushing, telangiectasia, inflammatory papulopustular eruptions that resemble acne
Common in middle ages, telangiectasia, rhinophyma, hyperplasia of sebaceous gland
Seborrhoeic dermatitis
Papulosquamous disorder
Occurs on sebum-rich area of scalp, face and trunk
Scaling over red, inflamed skin with adherent crusts
Plaques are rare
May be patchy and quite widespread
Linked to Malassezia or pityrosporum ovale
Plaque psoriasis
Chronic, non-infectious inflammatory dermatitis
Well-defined, disc shaped, red plaque covered by waxy white scale
Auspitz +ve
Involvement of other sites e.g. extensor surface of elbow, knee, sacrum
Seborrheic psoriasis
Top left:
Atopic eczema
Bottom Middle: Nummular eczema
Top middle: post-inflammatory hyperpigmentation
Top right: Lichenification
Dyshidrotic eczema or dyshidrosis
Related to sweating
Family history of atopic eczema
Flares during hot weather or emotional upset
Recurrent crops of deep-seated blisters on palms and soles
Intense itch
Tinea erythematous
scaly plaque with Central clearing
Well-defined, may be associated with pustules/ papules/ vesicular eruptions
Tinea corporis, cruris and pedis
Pityriasis versicolor
HYPOpigmentation due to fungal infection inhibiting taning
Some scaling, oval shape
Look for multiple hyperpigmented or hypopigmented macule and patches or thin papules/ plaques with fine bran-like scale
Lesions are oval, enlarge radially and frequently coalesce
Distribution in chest, back, upper arm
Pityriasis rosea
Herald patches** caused by HSV-6 infection
Scaly oval patches over trunk in christmas tree distribution
Oval or circular patches and plaques with associated fine collarette of scale
Shingles
Chicken pox - VZV infection
Begins as small red dots on the face, scalp, torso, upper arms
4 different progressions at the same time
Molluscum contagiosum
Melanoma
Basal cell carcinoma
SCC
Top left: Wart - infection by human papillomavirus
Right: Herpetic whitlow - infection by HSV-1, grouped vesicles or erosions on distal finger
Top left: OA
Top right: RA
Bottom: Psoriatic arthropathy
Ganglion
Herniation of synovial tissue
Left: callus
Bottom: Corn
Top right: wart (thrombosed capillaries)
Tinea pedis
Pitted keratolysis
Onychomycosis
Left: Discoloration
Right: Onycholysis
Subungual keratosis
Koilonychia
Iron deficiency, lichen planus, occupational exposure to chemicals
Left:
Psoriasis nails, alopecia aerata
Right:
Beau’s line - temporary arrest of proximal nail matrix proliferation due to systemic illness or
