PHYSICAL EXAMINATION OF THE SKIN, HAIR AND NAILS Flashcards
Derm Specific History what to ask
Onset:
Abrupt or gradual onset?
Derm Specific History what to ask
Location:
Where lesions first noted and where they are now.
Derm Specific History what to ask
Location:
Where lesions first noted and where they are now.
Derm Specific History what to ask
Duration:
Recurrences, remissions, exacerbations
Derm Specific History what to ask
Evolution:
Has it spread? Gotten itchier? More painful?
Derm Specific History what to ask
Character:
Pruritus/pain, bleeding, non-healing, wounds
Derm Specific History what to ask
Aggravating/Alleviating:
UV exposure, heat/cold, exposures (chemicals,medications, cosmetics, perfumes, plants, metals)
Derm Specific History what to ask
Temporal:
Constant, intermittent, worst at night, climate change.
Derm Specific History what to ask
Severity:
Severity of pain or pruritus (0/10 works for both).
Derm Specific History what to ask
Pertinent Derm Questions:
Previous occurrence(s), any close contacts with similar symptoms, new/change in hygiene products
Overall Skin Inspection algorithm
(CUTSHP)
Color (rule out potentially actue issues)
Uniform Appearance
Thickness
Symmetry (unilateral vs. bilateral presentation)
Hygiene (some conditions have predisposing hygienic concerns)
Presence of any lesions
Definition of what?
(a)Rated as I-VI on the scale
(b)Quasi-objective metric of amount of melanin pigment in the skin
Fitzpatrick Scale
_____ resistance is largely determined by melanocyte activity and melanocytic pigmentation of the skin.
UVR
What is the umbrella term used in dermatology for any observed skin change or finding
Lesions
Size of lesion is measured on what dimensions and in what measurement scale?
1)Length
2)Width
3)Depth is covered by noting elevation or depression
Always in mm or cm!
Lesion Shapes:
Ring shape with central clearing
Annular (Ring shaped)
Lesion Shapes:
a)Coin-shaped; solid circle or oval
b)Uniform appearance from the edges to the center
Round (nummular)
Lesion Shapes:
Often a result of incomplete formation of an annular lesion
Arcuate (arc-shaped)
Lesion Shapes:
Multiple different shapes located closely together (grab-bag)
Multiform:
Lesion Shapes:
Formed from coalescing circles, rings, or incomplete rings
Polycyclic:
Lesion Shapes:
Target-like, with a center darker than the periphery
Targetoid
Lesion Shapes:
Dot-like, typically around 1 mm
Punctate
Lesion Shapes:
a)With a central depression of the surface.
b)Also known as “delled”.
Umbilicated
Lesion Shapes:
a)Resembling a straight line
b)Ex: Poison Ivy or scratch marks
Linear
Lesion Shapes:
a)Serpentine or snake-like
b)Ex: Lymphadenitis
Serpiginous
What is the most important additional feature of a lesion other than primary morphology(Shape)
Lesion Color
The most common types of color on the skin are:
1) Variations in brown
2) Hyperpigmentation
3) Hypopigmentation
4) Variations in red (erythema)
What part of the lesion inspection can be referred to as either ‘borders’ or ‘margins’?
Demarcation (Borders)
What level of demarcation?
1) Borders are clearly defined and have a definitive ‘stop’ point
2) AKA ‘Discrete’ or well defined’
Well demarcated
What level of demarcation?
1)Tight borders on a round lesion
2)Clear “beginning & end”
Circumscribed
What level of demarcation?
1) Borders are indistinct and lack a definitive start/stop point
2) AKA ‘indistinct’ or ‘confluent’
Not well-demarcated
Border/Margins definition
1) Expanding at margins
2) Ex: Cellulitis, erysipelas, necrotizing fasciitis, etc.
Advancing
Border/Margins definition
1) AKA ‘central clearing
2) Similar to annular or arcuate except the border is being considered vice the shape.
Border raised above center
This defines what?
Protein-rich fluid containing cellular elements extruded from blood vessels secondary to inflammation or injury
Exudate
This defines what?
Thick, yellow to green discharge typically associated with infection.
Purulent
This defines what?
Dried Crust discharge
Serum
Location and Distribution Terms:
Unilateral & lying in the distribution of a single spinal afferent nerve root
Dermatomal/Zosteriform
Location and Distribution Terms:
Lying along the distribution of a lymph vessel; implies infectious agent spreading from an acral (distal) site
Lymphangitic
Location and Distribution Terms:
Occurring in distal locations, such as on the hands, feet, wrists, ankles, ears, or penis.
Distal (Acral)
Location and Distribution Terms:
Occurring on the trunk or central body.
Truncal
Location and Distribution Terms:
Occurring in areas usually not covered by clothing: face, dorsal hands
Sun Exposed (AKA Photo-distributed)
Location and Distribution Terms:
Occurring in areas usually covered by one or more layers of clothing
Sun Protected
Location and Distribution Terms:
Occurring over the dorsal extremities, (extensor muscles, knees, or elbows)
Extensor
Location and Distribution Terms:
Overlying the flexor muscles of the extremities (antecubital & popliteal fossae)
Flexor
Location and Distribution Terms:
Occurring in the skin folds, where 2 skin surfaces are in contact: (axillae,inguinal folds, inner thighs, inframammary skin)
Intertriginous (Latin inter, “between”’ trigo, “rubbing”)
Location and Distribution Terms:
1) Favoring the hair-bearing locations of the skin
2) Scalp, eyebrows, beard, central chest, axillae, genitals, nasolabial and postauricular creases.
Seborrheic
Location and Distribution Terms:
Confined to a single body location.
Localized
Location and Distribution Terms:
Widespread
Generalized
What type of lesion?
Flat, circumscribed area of color change less than 1 cm in diameter.
Macule
What type of lesion?
A flat, non-palpable, irregularly shaped macule greater than 1 cm in diameter.
Patch
What type of lesion?
An elevated, firm, circumscribed area less than 1 cm in diameter.
Papule
What type of lesion?
An elevated firm, rough, lesion with flat top greater than 1 cm in diameter.
Plaque
What type of lesion?
Elevated, circumscribed, superficial fluid-filled (clear/serous). Less than 1 cm.
Vesicle
What type of lesion?
Elevated, superficial lesion. Similar to a vesicle but filled with purulent fluid
Pustule
What type of lesion?
Vesicle greater than 1 cm
Bulla
What type of lesion?
An elevated, irregularly-shaped area of cutaneous edema. Solid, transient and variable diameter.
Wheal (Hive)
What type of lesion?
Elevated, firm, circumscribed lesion; deeper in the dermis than a papule. 1-2cm in diameter.
Nodule
What type of lesion?
Elevated and solid lesion; may or may not be clearly demarcated; deep in dermis. Greater than 2 cm.
Tumor (Mass)
What type of lesion?
Encapsulated lesion in the dermis or hypodermis; filled with liquid or semi-solid material.
Cyst
What type of lesion?
Fine, irregular, red line produced by capillary dilation
Telangiectasia
Secondary Skin Lesions
Typically categorized in what three ways:
1) Accumulation of material
2) Change in skin integrity or thickness
3) Loss of layers or skin breakdown
What is this?
Irregularly shaped, elevated scar that grows beyond the boundaries of the initial injury or wound.
Keloid
What is this?
Overgrowth of scar tissue that remains confined to the site of initial injury. May be raised or flat.
Hypertrophic Scar
What is this?
Thinning of the skin and loss of skin markings. Skin can turn translucent and paper-like.
Atrophy
What type of skin loss?
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
Erosion
What type of skin loss?
Loss of epidermis and dermis
a) Concave
b) May bleed
c) Heals with scarring
Ulcer
Loss of epidermis
a) Linear, hollowed-out crusted area
b) Due to mechanical trauma (scratching)
Excoriation
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
Fissure
True/False
Dermatoglyphics (fingerprint lines) are preserved over the surface in warts
FALSE
Dermatoglyphics (fingerprint lines) are preserved over the surface in Corns and callus