History taking and Physical exam Flashcards
Key areas in history taking?
- onset
- duration
- nature of symptoms
- quality of life
- patient language
- patient pre-conception and expectations
- past history
- drugs
- family history
- occupation and hobbies
Onset?
how, where, what kind of lesions started
Duration?
how long have you had the lesion
- beware as patients may only describe lesions which bother them
Nature of symptoms?
e.g. itch
1. what time
2. where on body
3. how severe (i.e. how it affects usual activities normal for age: sleep, work
4. who else is scratching
5. exacerbation factors.
Quality of life?
How the disease impacts on their life and self image
- Never to be under estimated!
Patient language?
Be careful not to just buy into terms patients tell you, but rather insist on description of what actually erupted;
e.g. ‘i had fungus,’ ‘she is usually troubled by allergy,’ ‘zipele,’ ‘zidzolo’ etc.
Patient preconception and expectations?
If any, take note of what they think might have caused their problem or what it is, their fears and expectations
e.g. ‘my friends told me its a cancer, ‘can I pass it to my child?’ ‘is it curable?’)
Past history?
- general problems
- DM, TB - past skin problems
- significant allergies
Drugs?
To ask in history taking
- Systemic and topical
- Prescribed and OTC
e.g. contraceptives, appetite enhancers, anti-pain, sleeping pills - cosmetics
- traditional
Family history?
- Some disorders are infectious
- others have strong genetic backgrounds
Occupation and hobbies?
The skin is frequently affected by materials encountered at work and in the home
Examination?
- Always in good light (ideally open day sunlight!!!)
- Examine from head to toe as a rule
- where this is not realistically possible, have at least an overall look of the affected area. - For some diseases, look for relevant areas
e.g, nails in psoriasis, palate in HIV/AIDS patients
What is a primary skin lesion?
Basic lesions of the skin are called primary lesions.
- its the first change of the skin
What is a secondary lesion?
They may undergo a variety of changes to become secondary lesions
e.g. patches of eczema becoming infected to form crusts.
In what case can lesions be primary in one condition but secondary in another?
e.g a macule may occur primarily in vitiligo, but be a secondary change in post-inflammatory hyperpigmentation of acne (following healing of acne papules)
In relation to normal skin level and contour skin lesions could be?
- Flat and at same level as normal skin
- Raised above normal skin
- Depressed beneath skin level
- Basic changes on the skin surface
- Fluid filled
- Changes due to vascular tissues
Steps in identifying lesions?
Primary Morphology
- Establish whether lesions are raised or not.
- Palpation is a must for this!! - Whether a solid mass or contains fluid.
- Size of the lesion
- No clear consensus
- 1 cm used to demarcate macule from a patch in other textbooks, as opposed to 0.5 cm in others.
Flat lesions?
- macule
- patch
- erythema
- erythroderma
Macule?
a flat localised change in skin color, up to 1 cm in diameter
Patch?
a large macule more than 1 cm in diameter.
Erythema?
blanchable reddening of the skin due to dilatation of blood vessels
NB: An erythema equivalent in the mucous membrane is called enanthema
Erythroderma?
generalised redness of the skin surface involving more than 90% of the skin
- Occurs over days or a few weeks.
Name Raised lesions?
- papule
- plaque
- nodule
- tumor
- cyst
- wheal/urticaria/hive
- scar
- comedo
Papule?
a solid raised area of the skin up to 1 cm in diameter.
