Dermatological History and Examination

Question 1

What are you looking to find out from the presenting complaint?

Answer 1

Nature, site and duration of issue
Initial appearance and changes
Symptoms - itch, pain
Aggravating/Relieving
Treatments?
Recent contact, stress, travel history, illness, sun exposure
Skin type

Question 2

What things would you look at in the past medical history?

Answer 2

Atopy - asthma, hayfever, eczema

History of skin cancer & suspicious lesions

Question 3

What other things do you ask about in a dermatological history?

Answer 3

Social history
Family history
Medication/Allergies
Impact on QoL

Question 4

What is crucial when examining the skin?

Answer 4

Good exposure and lighting

Question 5

What areas should you assess in a dermatological examination?

Answer 5

Hair
Scalp
Nails
Mucous membrane

Question 6

What are the 4 principles when examining the skin?

Answer 6

Inspect
Describe
Palpate
Systematic check

Question 7

How would you describe a skin lesion?

Answer 7

SCAM

S - size and shape
C - colour
A - associated secondary shape
M - Morphology and Margin

Question 8

What features raise suspicion of melanoma in a pigmented lesion?

Answer 8

ABCD

Asymmetry
Border - irregular
Colours -2 or more within lesion
Diametre >6mm

Question 9

What do you examine when palpating a lesion?

Answer 9

Surface
Consistency
Mobility
Tenderness
Temperature

Question 10

Where would you assess during a systematic check?

Answer 10

Nails
Scalp
Hair
Mucous membranes

Question 11

What is pruritis?

Answer 11

Itching

Question 12

What is a lesion?

Answer 12

An area of altered skin

Question 13

What is a rash?

Answer 13

An eruption

Question 14

What is a naevus?

Answer 14

A localised malformation of tissue structures

Question 15

What is a comedone?

Answer 15

A plug in a sebaceous follicle containing altered sebum, bacteria and cellular debris

Question 16

How can comedone present?

Answer 16

Open - blackheads

Closed - whiteheads

Question 17

What terms can be used to describe the distribution of lesions?

Answer 17

Generalised
Widespread
Localised
Flexural
Extensor
Pressure areas
Dermatomal
Photosensitive

Question 18

What areas are considered pressure areas?

Answer 18

Sacrum
Buttocks
Ankles
Heels

Question 19

What terms can be used to describe the configuration of a dermatological lesion?

Answer 19

Discrete
Confluent - lesions merge
Linear
Target - concentric rings
Annular - a circle/ring
Discoid/Nummular - coin shaped/round

Question 20

What terms are used to describe the colour of a lesion?

Answer 20

Erythema
Purpura - don't blanch 
Hypopigmented
Depigmented
Hyperpigmented

Question 21

What terms are used to describe the morphology of a lesion?

Answer 21

Macule
Patch
Plaque
Papule
Nodule
Vesicle
Bulla
Pustule
Abscess

Question 22

What is a macule?

Answer 22

Flat area of altered colour

Question 23

What is a patch?

Answer 23

Larger flat area of discolouration (>2cm)

Question 24

What is a papule?

Answer 24

Palpable, raised lesion <0.5cm diameter

Question 25

What is a nodule?

Answer 25

Palpable, raised lesion >0.5cm diameter

Question 26

What is a plaque?

Answer 26

Palpable, scaling raised lesion >0.5cm diameter

Question 27

What is a vesicle?

Answer 27

Raised, clear fluid filled lesion <0.5cm diameter

Question 28

What is a bulla?

Answer 28

Raised, clear fluid filled lesion >0/5cm diameter

Question 29

What is a pustule?

Answer 29

Pus-containing lesion <0.5cm diameter

Question 30

What is an abscess?

Answer 30

Localised accumulation of pus in the dermis or subcutaneous tissue

Question 31

What are excoriations?

Answer 31

Loss of epidermis due to trauma - scratching

Question 32

What is lichenification?

Answer 32

Well defined, roughening of skin with exaggerated skin markings

Question 33

What are scales?

Answer 33

Flakes of stratum corneum

Question 34

What is crusting?

Answer 34

A rough surface consisting of died serum, blood, bacteria and cellular debris that has exuded through an eroded epidermis seen in Impetigo

Question 35

What is a scar?

Answer 35

New fibrous tissue which occurs post wound healing

Question 36

What is the difference between a hypertrophic scar and a keloid scar?

Answer 36

Keloid - hyperproliferation beyond wound boundary | Hypertrophic - within wound boundary

Question 37

What is an ulcer?

Answer 37

Loss of epidermis and dermis

Question 38

What is a fissure?

Answer 38

Epidermal crack often due to excess dryness

Question 39

What are striae?

Answer 39

Linear area which progress from purple to pink/white with histological appearance of a scar

Question 40

What is alopecia?

Answer 40

Loss of Hair

Question 41

What is Hirsutism?

Answer 41

Androgen dependent hair growth in a female

Question 42

What is hypertrichosis?

Answer 42

Non-androgen dependent excessive hair growth

Question 43

What is clubbing? and what is it associated with?

Answer 43

Loss of angle between posterior nail fold and nail plate Associated with - suppurative lung disease, cyanotic heart disease, IBD and can be idiopathic

Question 44

What is Koilonychia? What is it associated with?

Answer 44

Spoon shaped depression of nail plate Associated with iron deficiency anaemia

Question 45

What is Onycholysis and what is it associated with?

Answer 45

Separation of distal end of nail plate from nail bed Trauma, psoriasis, fungal nail infection, hyperthyroidism

Question 46

What is pitting and what is it associated with?

Answer 46

Punctate depression of nail plate Psoriasis, eczema, alopecia areata