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FinalMB Part I - Medicine > Dermatology > Flashcards

Flashcards in Dermatology Deck (22)
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1

How to take a dermatological history ?

For dark lesions or moles, pay attention to questions marked with an asterisk (*).

PRESENTING COMPLAINT:

-Nature, site and duration of problem

HISTORY OF PRESENTING COMPLAINT:

-Initial appearance and evolution of lesion*
-Symptoms (particularly itch and pain)*
-Aggravating and relieving factors
-Previous and current treatments (effective or not):
-Recent contact, stressful events, illness and travel
-History of sunburn and use of tanning machines*
-Skin type (see page 70)*

PMH:

-History of atopy i.e. asthma, allergic rhinitis, eczema
-History of skin cancer and suspicious skin lesions

FAMILY HISTORY:

-Family history of skin disease*

SOCIAL HISTORY:

-Occupation (including skin contacts at work)
-Improvement of lesions when away from work

MEDICATION AND ALLERGIES:

-Regular, recent and over-the-counter medications

IMPACT OF QOL:

-Impact of skin condition and concerns

2

Structure of describing a rash ?

-Distribution – where is it? E.g. flexures/extensor

-Configuration – grouping of the rash – e.g. linear, annular, clustered

-Morphology – what sort of lesions

3

How to examine the skin ?

INSPECT:

-General observation
-Site and number of lesion(s)
-If multiple, pattern of distribution and configuration

DESCRIBE the individual lesion:

(SCAM)
-Size (the widest diameter), Shape
-Colour
-Associated secondary change
-Morphology, Margin (border)

*If the lesion is pigmented, remember ABCD (the presence of any of these features increase the likelihood of melanoma):
-(A)symmetry (lack of mirror image in any of the four quadrants)
-Irregular (B)order
-Two or more (C)olours within the lesion
-(D)iameter > 6mm

PALPATE the individual lesion:
-Surface
-Consistency
-Mobility
-Tenderness
-Temperature

SYSTEMATIC CHECK:

-Examine the nails, scalp, hair and mucous membranes
-General examination of all systems

4

What do each of these configuration terms mean ?

-Discrete
-Confluent
-Linear
-Target
-Annular
-Discoid/ nummular

-Discrete = Individual lesions separated from each other

-Confluent = Lesions merging together

-Linear = In a line

-Target = Concentric rings (like a dartboard)

-Annular = ring shaped

-Discoid / nummular = A coin-shaped/round lesion

5

What is a macule ?

Flat (non-palpable) area of altered colour <0.5cm e.g. freckle

6

What is a patch ?

Flat area of altered colour >0.5cm e.g. port-wine stain

7

What is a papule ?

Solid raised lesion <0.5cm e.g. xanthomata

8

What is a nodule ?

Solid raised lesion >0.5cm with deeper component e.g. granuloma

9

What is a vesicle ?

Raised, clear, fluid filled lesion <0.5cm e.g. HSV

10

What is a bulla ?

Raised, clear, fluid filled lesion >0.5cm

11

What is a pustule ?

Pus containing lesion <0.5cm e.g. acne

12

What is a abscess ?

Localised accumulation of pus in dermis or subcutaneous tissuee.g. periungual

13

What is a weal ?

Transient, raised lesion due to dermal oedema e.g. urticaria

14

What is a boil ?

Staphylococcus infection around or within hair follicle

15

What is excoriation ? (secondary lesion)

Loss of epidermis following trauma e.g. eczema

16

What is lichenification ? (secondary lesion)

Well-defined roughening of skin with attenuation of skin markings

17

What is scale ? (secondary lesion)

Flakes of stratum corneum e.g. psoriasis (silver scaling)

18

What is crust ? (secondary lesion)

Rough surface of dried blood, serum or bacteria e.g. burst blister

19

What is a scar ? (secondary lesion)

New fibrous tissue occurring post wound healing, may be atrophic (thinning), hypertrophic (hyperproliferation within boundary), or keloidal (beyond boundary)

20

What is an ulcer ? (secondary lesion)

Loss of epidermis and dermis

21

What is a fissure ? (secondary lesion)

Epidermal crack due to excess dryness, e.g. eczema

22

What are striae ? (secondary lesion)

Linear areas, purple, pink, or white e.g. steroids