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CLASS 22005 DERM > PHYSICAL EXAM > Flashcards

PHYSICAL EXAM Flashcards

1
Q

Derm Specific History

A

(1) Onset: Abrupt or gradual onset.
(2) Location: Where lesions first noted and where they are now.
(3) Duration: Recurrences, remissions, exacerbations.
(4 ) Evolution: Has it spread? Gotten itchier? More painful?***
(5) Character: Pruritus/pain, bleeding, non-healing wounds
(6) Aggravating/Alleviating: UVR exposure, heat/cold, exposures (chemicals, medications,cosmetics, perfumes, plants, metals)
(7) Temporal: Constant, intermittent, worse at night, climate change
(8) Severity: Severity of pain or pruritus (0/10 works for both)
(9 )Pertinent Derm Questions: Previous occurrence(s), any close contacts with similar symptoms, new/change in hygiene products

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2
Q

Skin Specific Social History

A

(1) Medication History: Prescriptions, nonprescription medications, vitamins, dietary supplements, herbal remedies started recently.
(2) Allergies: Medications, foods, environmental antigens, and contactants
(3) Social History: Occupation, hobbies/leisure activities, diet, bathing habits, pets, living conditions.
(4) Family History: Of skin disease, atopy or skin cancer.
(5) Travel History: Deployments, training missions, PCS
(6) Prior Medical History: Blistering sunburns or chronic UVR exposure during youth and adolescence.

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3
Q

Exaggerated IgE-mediated immune response triggering a histamine response.

A

Atopy

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4
Q

Any exaggerated immune response to a foreign antigen regardless of mechanism

A

Allergy

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5
Q

(a) Atopic dermatitis, allergic asthma, allergic rhinitis, allergic conjunctivitis, latex and some food allergies
(b) Anaphylaxis, some cases of angioedema, urticaria

A

Atopic disorders

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6
Q

Is atopy hereditatry

A

yes.

family history may reveal other manifestations of atopy in close family members.

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7
Q

the most common disorders among people.

A

Atopic/Allergic disorders

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8
Q

Hair and Nail Specific History

A

(1) Hair:
(a) Changes in hair patterns: Hair loss or growth, distribution, texture, color
(b) Treatment: Perms, coloring, weaves, commercial hair products or chemicals
(2) Nails:
(a) Change in nails: Thickening, thinning, brittleness, color changes
(b) Treatment: Nail salons, nail clipping habits
(3) Both Hair and Nails:
(a) Occurrence/recurrence: sudden or gradual onset, symmetric or asymmetric, recurrence.
(b) Exposure: drugs, environmental or occupational toxins or chemicals

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9
Q

History Essentials:

A

(1) Customize the history depending on the chief complaint and capture the pertinent information.
(2) Adjust the patient encounter methodology (examination) to capture pertinent exam findings in an efficient manner.

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10
Q

(1) A complete skin examination includes:

A

(a) Entire skin surface
(b) Hair and Nails
(c) Mucous membranes (eyes, nose, mouth, genitals, anus)

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11
Q

(2) Highly focused Derm complaints do not typically require a complete skin examination

A

(a) A focused clinical examination includes:
1) Evaluation of the specific dermatologic complaint
2) Cursory examination of the hair and nails

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12
Q

(a) Rated as I – VI on the scale

(b) Quasi-objective metric of amount of melanin pigment in the skin

A

Fitzpatrick Skin type (AKA pigmentary photo-type)

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13
Q

(a) UVR resistance is largely determined by ___ and melanocytic pigmentation of the skin.
(b) UVA induces oxidative damage to DNA in the presence of melanin and UV causes damage directly to DNA
(c) Accumulation of unrepaired DNA/UVR damage increases the risk of skin cancer

A

melanocyte activity

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14
Q

___ is an umbrella term used in dermatology

(a) Any observed skin changes or findings
(b) Can be normal or pathologic

A

Lesion

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15
Q

Ring shape with central clearing

A

Annular

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16
Q

a) Coin-shaped; solid circle or oval

b) Uniform appearance from the edges to the center

A

Round (nummular)

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17
Q

Often results from incomplete formation of an annular lesion

A

Arcuate (arc-shaped)

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18
Q

Multiple different shapes located closely together (grab-bag)

A

Multiform:

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19
Q

Formed from coalescing circles, rings, or incomplete rings

A

Polycyclic:

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20
Q

Target-like, with a center darker than the periphery.

A

Targetoid:

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21
Q

Dot-like; typically around 1mm

A

Punctate:

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22
Q

a) With a central depression of the surface.

b) Also known as “delled”

A

Umbilicated:

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23
Q

a) Resembling a straight line

Ex: Poison Ivy or scratch marks

A

Linear:

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24
Q

a) Serpentine or snake-like

Ex: Lymphadenitis

A

Serpiginous:

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25
Q

Most important additional feature of a lesion other than primary morphology.

A

Lesion Color

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26
Q

The most common types of color on the skin are:

A

1) Variations in brown
2) Hyperpigmentation
3) Hypopigmentation
4) Variations in red (erythema)

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27
Q

1) Borders are clearly defined and have a definitive ‘stop’ point
2) AKA ‘Discrete’ or ‘well defined’

A

Demarcation (Borders)

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28
Q

1) Tight borders on a round lesion

2) Clear “beginning & end”

A

Circumscribed

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29
Q

1) Borders are indistinct and lack a definitive start/stop point
2) AKA ‘indistinct’ or ‘confluent’

A

Not well-demarcated

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30
Q

1) Expanding at margins

Ex: Cellulitis, erysipelas, necrotizing fasciitis, etc.

A

Advancing

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31
Q

1) AKA ‘central clearing

2) Similar to annular or arcuate except the border is being considered vice theshape.

A

Border raised above center

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32
Q

Protein-rich fluid containing cellular elements extruded from blood vessels secondary to inflammation or injury

A

Exudate:

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33
Q

Thin, pink-colored discharge associated with normal wound healing.

A

Serosanguinous:

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34
Q

Mild, yellow and cloudy discharge associated with mild infections.

A

Seropurulent:

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35
Q

Thick, yellow to green discharge typically associated with infection.

A

Purulent:

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36
Q

Thin, clear discharge associated with and expected in inflammatory stage of wound healing.

A

Serous:

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37
Q

Thin, darker red drainage associated with capillary permeability and/or capillary injuries.

A

Sanguineous:

38
Q

Dried Crust

39
Q

Unilateral and lying in the distribution of a single spinal afferent nerve root

A

Dermatomal/Zosteriform

40
Q

Lying along the distribution of a lymph vessel; implies infectious agent spreading from an acral (distal) site

A

Lymphangitic

41
Q

1) Occurring in distal locations, such as on the hands, feet, wrists, ankles, ears, orpenis.

A

Distal (Acral)

42
Q

Occurring on the trunk or central body.

43
Q

Occurring in areas usually not covered by clothing, face, dorsal hands

A

Sun Exposed (AKA Photo-distributed)

44
Q

Occurring in areas usually covered by one or more layers of clothing

A

Sun Protected

45
Q

Occurring over the dorsal extremities (extensor muscles, knees, or elbows)

46
Q

Overlying the flexor muscles of the extremities (antecubital & popliteal fossae)

47
Q

Occurring in the skin folds, where 2 skin surfaces are in contact: (axillae, inguinal folds, inner thighs, inflammatory skin)

A

Intertriginous (Latin inter, “between”; trigo, “rubbing“)

48
Q

1) Favoring the hair-bearing locations of the skin

2) Scalp, eyebrows, beard, central chest, axillae, genitals, nasolabial andpostauricular creases.

A

Seborrheic

49
Q

Confined to a single body location.

50
Q

1) Widespread
2) Exanthem: Generalized eruption of inflammatory lesions
3) Medical term for ‘rash’

A

Generalized

51
Q

Lesions which develop as a direct result of the disease process.

A

Primary Lesions:

52
Q

(a) Evolve from primary lesions or develop because of the patient’s activities
(b) Lesions which develop from longstanding/untreated disease

A

Secondary:

53
Q

Flat, circumscribed area of color change less than 1 cm in diameter.

(a) Size
1) < 1 cm
(b) Shape
1) Circumscribed
(c) Color
1) Color change
(d) Texture
1) None (non-palpable)
(e) Elevation / Depression
1) None (flat)
(f) Attachment at the base
1) None
(g) Exudates
1) None
(h) Fluid/Solid
1) None

54
Q

flat, non-palpable, irregularly shaped macule greater than 1 cm in diameter.

(a) Size
1) > 1 cm
(b) Shape
1) Irregular
(c) Color
1) Different from surrounding skin
(d) Texture
1) None (non-palpable)
(e) Elevation / Depression
1) None (flat)
(f) Attachment at the base
1) None
(g) Exudates
1) None
(h) Fluid/Solid
1) None

55
Q

An elevated, firm, circumscribed area less than 1 cm in diameter.

(a) Size
1) < 1cm
(b) Shape
1) Circumscribed
(c) Color
1) Variable
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) None
(g) Exudates
1) None
(h) Fluid/Solid
1) Solid

56
Q

An elevated firm, rough, lesion with flat top greater than 1 cm in diameter.

(a) Size
1) > 1 cm
(b) Shape
1) Irregular
(c) Color
1) Variable
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) None
(g) Exudates
1) None
(h) Fluid/Solid
1) Solid

57
Q

Elevated, circumscribed, superficial fluid-filled (clear/serous). Less than 1 cm.

(a) Size
1) <1cm
(b) Shape
1) Circumscribed
(c) Color
1) Variable
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) Not attached
(g) Exudates
1) Clear serous fluid
(h) Fluid/Solid
1) Solid

58
Q

Elevated, superficial lesion. Similar to a vesicle but filled with purulent fluid

(a) Size
1) Variable
(b) Shape
1) Typically circumscribed
(c) Color
1) White to Yellow to Green
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) Not attached
(g) Exudates
1) Purulent material
(h) Fluid/Solid
1) Fluid

59
Q

Vesicle greater than 1 cm

(a) Size
1) > 1 cm
(b) Shape
1) Circumscribed
(c) Color
1) Variable
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) Not attached
(g) Exudates
1) Clear serous fluid
(h) Fluid / Solid
1) Fluid

60
Q

An elevated, irregularly-shaped area of cutaneous edema. Solid,transient and variable diameter.

(a) Size
1) Variable
(b) Shape
1) Irregular
(c) Color
1) Pink to white
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) None
(g) Exudates
1) None
(h) Fluid/Solid

A

Wheal (Hive) -

61
Q

Elevated, firm, circumscribed lesion; deeper in the dermis than a papule. 1-2cm in diameter.

(a) Size
1) 1-2 cm
(b) Shape
1) Annular with circumscribed border
(c) Color
1) Variable
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) May be attached
(g) Exudates
1) None
(h) Fluid/Solid
1) Solid

62
Q

Elevated and solid lesion; may or may not be clearly demarcated; deepin dermis. Greater than 2 cm.

(a) Size
1) > 2 cm
(b) Shape
1) Variable
(c) Color
1) Variable
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) May be attached
(g) Exudates
1) None
(h) Fluid/Solid
1) Solid

A

Tumor (Mass) -

63
Q

Encapsulated lesion in the dermis or hypodermis; filled with liquid or semi-solidmaterial.

(a) Size
1) Variable
(b) Shape
1) Typically circumscribed
(c) Color
1) Variable
(d) Texture
1) Palpable
(e) Elevation/Depression
1) Elevated
(f) Attachment at the base
1) May be attached at the base
(g) Exudates
1) Liquid or semi-solid material
(h) Fluid/Solid
1) Fluid or solid

64
Q

Fine, irregular, red line produced by capillary dilation

(a) Size
1) Variable
(b) Shape
1) Capillary-like
(c) Color
1) Pink to red
(d) Texture
1) Typically non-palpable
(e) Elevation / Depression
1) Very slightly elevated
(f) Attachment at the base
1) Not attached to the base
(g) Exudates
1) None
(h) Fluid / Solid
1) Fluid filled (blood)

A

Telangiectasia-

65
Q

Secondary Skin Lesions Can be secondary to trauma or infection and are Typically categorized in three ways

A

1) Accumulation of material
2) Change in skin integrity or thickness
3) Loss of layers or skin breakdown

66
Q

Loose or adherent flake composed of stratum corneum cells. The term hyperkeratotic is used for small areas of thick adherent scale

67
Q

Rough & thickened epidermis secondary to persistent rubbing, itching, or irritation. Accentuation of skin markings is often seen.

A

Lichenification:

68
Q

Dried serum, blood, or purulent exudates; slightly elevated

69
Q

Thick & fibrous tissue that replaces normal skin after injury to the dermis. Epithelial tissue is replaced with connective tissue during the healingprocess.

70
Q

Overgrowth of scar tissue that remains confined to the site of initial injury. May be raised or flat.

A

Hypertrophic Scar:

71
Q

Irregularly shaped, elevated scar that grows beyond the boundaries of the initial injury or wound.

A

Keloid:

a)Common in Skin types IV-VI.

72
Q

Thinning of the skin and loss of skin markings. Skin can turn translucent and paper-like

73
Q 
Loss of part of epidermis (not dermis)
   a)Does not bleed
   b)Heals without scarring
   c)Follows rupture of a vesicle or bulla
   d)Examples
      (1 Varicella
      (2 Variola after rupture
74
Q 
Loss of epidermis and dermis
   a)Concave
   b)May bleed
   c)Heals with scarring
   d)Examples
      (1 Decubitus ulcer
      (2 Stasis ulcer
75
Q 
Loss of epidermis
   a)Linear, hollowed-out crusted area
   b)Due to mechanical trauma (scratching)
   c)Examples
      (1 Abrasions
      (2 Scratches
      (3 Scabies
A

Excoriation:

76
Q 
Linear crack in skin continuity from epidermis to dermis
   a)Can be moist or dry
   b)Examples
      (1 Athlete's foot
      (2 Intertrigo
      (3 Angular chelitis
77
Q

Hair Loss

variable patchy & round hair loss on scalp

A

Alopecia Areata:

78
Q

Hair Loss

Hair loss secondary to excessive/constant traction

A

Traction Alopecia:

79
Q

Hair Loss

Hair loss secondary to scar formation & follicle loss

A

Scarring Alopecia:

80
Q

Hair Loss

Loss of all scalp hair

A

Alopecia Totalis

81
Q

Hair Loss

loss of all body hair.

A

Alopecia Universalis:

82
Q

Male pattern baldness

A

andropause

83
Q
  1. well circumscribed areas of thickened epidermal keratin that develop at locations of repeated pressure or friction.
  2. infrequently painful in themselves, but pressure on underlying structures, especially periosteum, may cause pain.
    * *CAN STILL SEE FINGER PRINT LINES
84
Q

develop similarly, but have a central hyperkeratotic core that is often painful.

A

Corns (clavus)

85
Q

(a) papillomavirus (HPV) lesions that occur on the soles of the feet.
(b) The thrombosed vessels within the warts appear as black dots.
(c) disrupt normal skin lines. Corns and callus do not disrupt normalskin lines.

A

Plantar Warts

86
Q

1) Accumulation of melanocytes/nevus cells in dermis
2) Symmetric brown macule or papule with smooth, regular borders
3) Typically have homogeneous beige, pink, or brown
4) Usually < 6 mm ***
5) Number associated with sun exposure
6) Pathologic nevi are covered in MDT portion.

A

Nevus (mole)

87
Q

Abnormalities of the Nails are typically grouped into 3 categories:

A

(a) Injury
(b) Infection
(c) Systemic disease

88
Q

1) Bleeding from nail bed secondary to trauma

2) May lead to onycholysis

A

Subungal hematoma

89
Q

1) Nail separates from distal nail bed

2) Secondary to trauma, hematoma, fungus

A

Onycholysis

90
Q

Ingrowing of nail, secondary to improper trimming technique, shoe compression

A

Onychocryptosis

91
Q

1) Yellow, crumbling nail plate
2) Hyperkeratotic debris beneath
3) Onycholysis
4) Due to fungal infection

A

Onychomycosis

92
Q

1) Infection around nail

a) Bacteria

A

Paronychia

CLASS 22005 DERM (25 decks)

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