Skin,Hair, Nail Assessment Flashcards
(81 cards)
1
Q
Dermatological HPI
A
- changes in hair, skin, nails
- Temporal sequence
- symptoms
- Location
- associated symptoms
- recent exposure
- Apparent cause
- Travel history
- Treatments tried
- Adjustment made
- Diet status
2
Q
Dermatological Medical History
A
- previous hair problems
- previous skin problems
- previous nail problems
- tolerance to sunlight
- cardiac, respiratory, liver, endocrine, autoimmune.
3
Q
Skin exam includes?
A
Skin surface, hair, nails, conjunctiva, oral, genital mucosa.
1- observe patient skin color
2- palpate patient level of moisture, temperature, texture, mobility and turgor
4
Q
A
- Melanoma
- can appear anywhere , if you don’t look you going to miss it
5
Q
A
Oral erosion in SLE
6
Q
1- observe skin color
( Brown) Epiderms
A
Melanin
7
Q
1- observe skin color Epiderms
( yellow)
A
Carotenoids
8
Q
red, located in arterial plexus
Dermis
A
Oxyhemoglobin
9
Q
bluish-
red, located in the venous plexusDermis
A
hemoglobin
10
Q
A
Increased pigmentation may suggest Addison’s disease or metastatic
melanoma
11
Q
A
Cyanosis or a bluish color to the lips may suggest hypoxia
12
Q
2- palpate
Dry, rough
A
hypothyroidism
13
Q
2- palpate
Moist, warm
A
underlying febrile illness or
hyperthyroidism
14
Q
2- palpate
excoriations
A
pruritic skin eruption such as scabies or
an underlying systemic disease such as lymphoma
15
Q
2- palpate
tight, bound-down skin over the hands or face
A
diagnosis of autoimmune condition like scleroderma
16
Q
A
Beau’s lines
17
Q
A
Mees’ bands
18
Q
A
Lindsay’s nails
19
Q
A
Terry’s nails
20
Q
A
Koilonychia
21
Q
A
Clubbing
22
Q
A
Psoriasis
23
Q
Features based on touch or palpation
A
• Consistency
• soft, doughy, rubbery, firm, hard
• Dry, flaky, moist
• Temperature
24
Q
Skin Lesions based on touch:
A
• Fixed vs mobile
• Presence or absence of tenderness
• Surface characteristics
• smooth, velvety, pebbled
25
Examples of Skin Features Based on Touch
Rubbery, Mobile, Non-tender
26
Examples of Skin Features Based on Touch
Firm, Fixed, Rough, Non- tender
27
Examples of Skin Features Based on Touch
Tender, hard,
Warm to touch
28
Examples of Skin Features Based on Touch
Dry, flaky, cool, non- tender
29
Examples of Skin Features Based on Touch
Firm, tight, bound-down, moist
30
Examples of Skin Features Based on Touch
Wet, Tender, ulcerated
31
Identify and describe any lesions
Dr. FACT
◦ Distribution
◦ Arrangement
◦ Type of lesion
◦ Primary lesion
◦ Secondary lesion
◦ Color
◦ Features based on touch/palpation
32
A- Distribution
33
Examples of Distributions
Sun-exposed: a malar rash of acute cutaneous lupus
34
Examples of Distributions
Symmetric, generalized rash from a drug reaction
35
Examples of Distributions
Dermatomal pattern: Herpes zoster
36
Examples of Distributions
Flexor pattern: atopic dermatitis
37
B- Arrangements
38
Examples of Arrangements
Linear
39
Examples of Arrangements
Grouped herpetiform
40
Examples of Arrangements
Annular
41
Examples of Arrangements
Reticulated
42
C. Type of lesions
( Non-palpable lesion with distinct borders, less than 1 cm in diameter)
Macule
43
C. Type of lesions
( Non-palpable lesion with distinct borders, greater than 1 cm in diameter)
Patch
44
C. Types of lesions
( Palpable, solid lesion less than 1 cm in diameter)
Papule
45
C. Types of lesions
( Palpable, solid lesion greater than 1 cm in diameter)
Plaque
46
C. Types of lesions
( Palpable, lesion more than 1 cm in diameter which is taller than it is wide)
Nodule
47
C. Types of lesions
( Fluid- containing, superficial, thin-walled cavity less than 1 cm )
Vesicle
48
C. Types of lesions
( Fluid-containing ,superficial, thin-walled cavity greater than 1 cm )
Bulla
49
C. Types of lesions
( A skin defect where there has been loss of the epidermis only )
Erosion
50
C. Types of lesions
( A skin defect where there has been loss of the epidermis and dermis)
Ulcer
51
C. Types of lesions
( Pus containing, superficial, thin-walled cavity )
Pustule
52
C. Types of lesions
( Thick-walled cavity containing pus )
Abscess
53
C. Color
Erythematous
54
C. Color
Hyperpigmented
55
C. Color
Black
56
Skin cancers & keratosis
Actinic keratosis
57
Skin cancers & keratosis
Seborrheic keratosis
58
Skin cancers & keratosis
Squamous cell carcinoma
59
Skin cancers & keratosis
Malignant melanoma
60
Skin cancers & keratosis
Basal cell carcinoma
61
screening for melanoma
A - for asymmetry
B - for irregular borders, especially ragged, notched, or blurred
C - for variation or change in color, especially blue or black
D - for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding E for elevation or enlargement
62
1 - Rash
In regard to a rash, it is first important to know he context in which the rash developed:
◦ On what part of the body did it start? Where did it spread to next?
◦ Determine the date of onset of the eruption – evaluate if any other
significant events occurred at that time (new medications, exposure to new substance or food)
◦ Have you ever had a rash like this before?
Next, gather more accessory information about the rash itself:
◦ Is the rash itchy? Is it painful or tender when you touch it?
◦ Have you tried anything to make it better? Did it help?
63
Rash - Alarm symptoms
Although the vast majority of skin conditions are not life-thre
life threatening processes like anaphylaxis, severe systemic infections, and severe drug reactions :
◦ severely painful skin
◦ diffuse erythema
◦ erythroderma (redness and scaling involving > 90% of the skin)
◦ dusky or grayish-purple skin (signals impending necrosis)
◦ widespread blistering or sloughing skin
◦ painful erosions of the mucous membranes
◦ palpable purpura
◦ swelling of the lips or tongue
◦ high fever
◦ difficulty breathing
64
Rash - Differential diagnosis
Exanthematous eruptions
•Drug eruption
•Scarlet fever
•Viral exanthems, such as measles (rubeola), rubella (German measles
65
Rash - Differential diagnosis
Papulosquamous dermatoses
•Psoriasis
•Seborrheic dermatitis •Lupus erythematosus •Tinea corporis/cruris/faciei (ringworm, jock itch)
66
Rash - Differential diagnosis
Eczematous dermatoses
•Atopic dermatitis
•Irritant contact dermatitis (80% of contact dermatitis)
•Venous stasis dermatitis
67
Rash - Differential diagnosis
Vesiculobullous disorders
•Stevens-Johnson syndrome/toxic epidermal necrolysis
•Bullous pemphigoid
•Herpes simplex viral infection (cold sores, fever blisters)
•Varicella (chickenpox)
•Zoster (shingles)
68
Rash - Differential diagnosis
Pustular dermatoses
•Acne vulgaris
•Acne rosacea
•Folliculitis
69
Rash - Differential diagnosis
Purpuras
•Thrombocytopenic purpura
•Acute bacterial endocarditis
•DIC
70
Rash - Differential diagnosis
Erythemas and urticaria
•Urticaria
•Cellulitis
•Necrotizing fasciitis
•Lyme disease
71
2 - Pruritus
First, allow the patient to describe the itching and when it began and where it is located:
◦ When did the itching first start?
◦ Is it in a single area of the body, or is it widespread?
After listening to the itching history, consider possible alarm symptoms and ask questions to narrow the differential diagnosis
72
Pruritus - itching without rash ?
Itching, without rash, is usually a systemic problem and will likely require a full exam and possibly laboratory evaluations so do not expect a clear diagnosis at the end of your history and physical.
73
3 - Hair Loss
The first goal is to determine whether the alopecia is scarring or nonscarring. Ask the patient to precisely describe the hair
loss:
◦ When did the hair loss start? Was it sudden or gradual?
◦ What is the pattern of the hair loss? Is it breaking, coming out at
the root, patchy, overall thinning? ◦ Were there any precipitating events? Frequent hair treatments?
Medications? Systemic illness?
74
Hair loss - Alarm symptoms
◦ Itching
◦ Pain
◦ Crusting
◦ Bleeding
◦ Pustulation
◦ Scaling of the scalp
75
Hair loss - Types
76
Hair loss - Differential diagnosis
( Sudden hair loss that starts with one or more circular bald patches that may overlap )
Alopecia areata
Cause:
Autoimmune diseases – not reversible
77
Hair loss - Differential diagnosis
( Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic "M" shape )
Androgenetic alopecia
Cause:
Common genetic hair loss – not reversible
78
Hair loss - Differential diagnosis
( Itching, scaly, inflamed balding areas on the scalp )
Tinea capitis
Cause:
Fungal infection - reversible
79
Hair loss - Differential diagnosis
( Overall thinning and shedding of hair that begins within 2 months of starting a new drug or after a serious illness )
Drug-related hair loss or serious illness related
Cause:
Drug or stress, reversible
80
Hair loss - Differential diagnosis
( Itching, Pain, Crusting, Bleeding, Scaling of the scalp )
Inflammatory alopecias
• Discoid lupus
•Lichen planopilaris •Autoimmune blistering disorders
Cause:
Typically autoimmune disorders
81
Hair loss - Differential diagnosis
( hair loss that's caused by repeatedly pulling on hair (braids, hair clips, ponytails)
Traction alopecia
Cause:
May not be reversible due to scaring
