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Derm I

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riosju10's version from 2016-05-30 22:01

Section 1

Question Answer
in dermatology, what anatomy are we examining?epidermis, dermis, subcutaneous layer (superficial fascia), & appendiges (hair and nails)
methodological/systematic approach to derm diagnosishistory, distribution (where on body is it located? localized? widespread? systemic?); examine and describe lesions (arrangement and shape of lesions; primary lesions; secondary lesions)
When possible, classify the lesion ino a diagnostic group:1. eczematous disorders (erythematous patches) 2. maculopapular disorders & pigmented lesions 3. vesicular and bullous diseases 4. psoriasis and popularsquamous disorders 5. hair and nail disorders 6. vascular disorders
History: what do you ask?onset & duration (acute or chronic?); location (distribution); rate of change/progression (better or worse) (manipulation); aggravating/alleviating factors (seasonal flare ups? relationship to specific exposures? What has patient dones to try to treat it?); exposure/occupation/allergies; past/family/social history; ROS (itch, fever, pain?); meds/allergies to meds?
pattern of recognition: distributionlocalized, regional, generalized/systemic
pattern of recognition: distribution_localizedextensor/flexor surfaces, dermatomal, sun exposed areas, intertiginal areas, contact vs. non-contact areas, palms/soles
pattern of recognition: distribution_regionaltrunk, extremities, etc...
pattern of recognition: distribution_generalized/systemicdermatologic conditions affecting a high % of skin area; skin findings indicating systemic health problems
patient skin typesType I = always burn... to Type IV = dark pigment, rarely burn
Skin, Hair, and Nails Methods of general inspectionEXPOSE your patient and have another health care provider in the room for sensitive exams- as specific lesions are notes, they are evaluated (context of history, skin type, and described using specific terminology for arrangement, primary, and secondary lesions)
T/F: the same lesion can appear differently on different patients and at different points in the disease process?true
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Section 2

Question Answer
Pattern of Recognition: Arrangement and Shape Mnemonic:Larry Can Always Tell Certain Moles He Reviews
Llinear
Aannular
Ccircumscribed
Ttarget
Ccircinate/nummular
Mmorbiliform
Hherpetiform
Rreticulated
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Section 3

Question Answer
Primary Lesions MnemonicMy Parents Pick Potatoes Viciously But Poisonous Wasps Never Cease
Mmacule
Ppatch
Ppapule
Pplaque
Vvesicle
Bbulla
Ppustule
Wwheal
Nnodule
Ccyst
Primary Lesioncharacteristic skin changes caused directly by the disease process
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Section 4

Question Answer
flat, non-palpable, circumscribed, less than 1cm in diameter, brown red purple white tan in colormacule
flat, non-palpable, irregular in shape, greater than 1 cmpatch
elevated, palpable, firm, circumscribed, less than 1 cm, brown red pink tan or bluish in colorpapule
elevated, palpable, firm, rough (may be in coalesced papules), greater than 1cmplaque
elevated, palpable, irregular shaped area of cutaneous edema; solid, transient, changing, variable diameter, pale pink with lighter centerswheal
elevated, palpable, firm, circumscribed, deeper in the dermis than a papule, 1-2cmnodule
elevated, palpable, circumscribed, superficial, filled with serous fluid, less than 1cmvesicle
elevated, palpable, vesicle greater than 1 cm, fluid filledbulla
elevated, palpable, superficial, similar to vesicle but filled with purulent fluidpustule
elevated, palpable, circumscribed, encapsulated, filled with liquid of semi-solid materialcyst
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Section 5

Question Answer
secondary lesions mnemonicSome Cool Emos Erode Ulcers After Lunch So Fuckin Suckit
Sscale
Ccrust
Eexcoriation
Eerosion
Uulcer
Aatrophy
Llichenification
Sscar - keloid
Ffissure
Sstriae
secondary lesionchanges in area of primary pathology due to secondary events (scratching, infection, trauma, inappropriate treatments, etc...)
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Section 6

Question Answer
Vascular Findings MnemonicEvery Perfect Pepper Has Taste
Eecchymoses (bruising)
Ppetechiae
Ppurpura
Hhemangioma
Ttelangiectasia
red-purple nonblanchable discoloration of variable sizeecchymoses
causes of ecchymosesvascular wall destruction, trauma
red-purple nonblanchable discoloration less than .5 cm in diameterpetechiae
causes of petechiaeintravascular defects, infection, meningococcemia
red-purple nonblanchable discoloration greater than .5 cm in diameterpurpura
causes of purpuraintravascular deficit, infection, vasculitis
red, irregular macules or patches hemangioma
causes of hemangiomacollection/dilation of dermal capillaries
fine, irregular lines telangiectasia
causes of telangiectasiadilation of capillaries, inflammation, rosacea
red, central body with radiating spider-like legs; blanches with pressure to central bodyspider angioma
causes of spider angiomaliver disease, vitamin B deficiency, idiopathic
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Section 7

Question Answer
pedunculatedstalk (vs. flat topped) - another descriptive term
verrucouswart-like
umbilicatedhas little indents
pallorpale (abnormal skin color)
cyanosisblue
acrocyanosisblueness of palms and soles of feet
peripheral cyanosisblueness of arms and legs
central cyanosisblueness of mouth and tongue
erythemaredness
jaundice/scleral icterusyellow skin/yellow sclera
hyperpigmentation vs. hypopigmentation
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Section 8

Question Answer
summary - for each leasion, try and identify:HPI (onset, duration, etc.); the distribution (localized, widespread, systemic); primary lesion; any associated secondary lesions; arrangement of lesions; other descriptors (vascular, pigment, etc).
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