(Ds) Skin: Physical Diagnosis

Front 1

Define primary lesions

Back 1

Primary lesions are those that occur as initial spontaneous manifestations of a pathologic process

Front 2

Define secondary lesions

Back 2

Secondary lesions are those that result from later evolution of or external trauma to a primary lesion

Front 3

Recall categories of skin morphology including color, shape, size, distribution and location, border, and associated changes.

Back 3

Self explanatory

Front 4

Differentiate lesions based on morphological description

Back 4

Primary lesions - macule, papule, patch, plaque, wheal, nodule, tumor, vesicle, bulla, pustule, cyst, and telangiectasia

Secondary lesions - scale, lichenification, keloid, scar, excoriation, fissure, erosion, ulcer, crust, and atrophy

Front 5

Describe differential diagnoses for a patient presenting with skin discoloration (Acne)

Back 5

1. Androgens stimulate the pilosebaceous units at the time of puberty to enlarge and produce large amounts of sebum
2. Simultaneously, the keratinization process in the pilosebaceous canal is disrupted with impaction and obstruction of the outflow of sebum resulting in comedo formation-open blackheads and closed whiteheads
3. Wall of the closed comedo may rupture, spilling the follicular contents into the dermis, leading to the development of inflammatory papules
4. The presence of Propionibacterium acnes brings in neutrophils, which cause the inflammatory response
5. Most commonly reported by adolescent, may occur initially as an adult or continue into the adult years, patient reports comedones/papules/and pustules over the forehead/nose/cheeks/lower face/chest/and back that evolve on the face/chest/back

Front 6

Describe differential diagnoses for a patient presenting with skin discoloration (Rosacea)

Back 6

1. Cause unknown, occurs most often in persons with a fair complexion
2. Lasts for years, with episodes of activity followed by quiescent periods of variable length
3. Itching always absent, many patients report a stinging pain associated with flushing episodes, common triggers: exposure to the sun/cold weather/sudden emotion/hot beverages/spicy foods/alcohol consumption

Front 7

Describe differential diagnoses for a patient presenting with skin discoloration (Bacterial cellulitis)

Back 7

1. Majority of cases caused by Streptococcus pyogenes or Staphylococcus aureus
2. Break in the skin/such as a fissure/cut/laceration/insect bite/or puncture wound, pain and swelling at the site, may have fever

Front 8

Describe differential diagnoses for a patient presenting with skin discoloration (Erysipelas)

Back 8

1. An acute, sometimes recurrent disease caused by a bacterial infection

2. It is characterized by large, raised red patches on the skin especially that of the face and legs, with fever and severe general illness

3. They differ in that erysipelas involve the upper dermis and superficial lymphatics, whereas cellulitis involves the deeper dermis and subcutaneous fat

Front 9

Describe differential diagnoses for a patient presenting with skin discoloration (Pressure ulcers)

Back 9

Localized area of discolored intact skin (purple or maroon) or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear.

The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue

Front 10

Perform a physical examination of the skin.

Back 10

1. Size, shape, color, texture, elevation or depression, attachment at base: pedunuculated (stalk) or sessile (without stalk), exudates (color/odor/amount/consistency), configuration (annular/grouped/linear/arciform/diffuse), location and distribution

Front 11

Recognize and discuss normal variation of the skin associated with infants

Back 11

1. Smoother than that of adults
2. Desquamation of the stratum corneum may be present at birth or shortly after. The degree can be from mild flakiness to shedding of large sheets of cornified epidermis
3. Postterm infants often have cracked, peeling skin
4. The newborn’s body is covered with fine, silky hair called lanugo

Front 12

Recognize and discuss normal variation of the skin associated with adolescents

Back 12

1. The apocrine glands enlarge and become active, causing increased axillary sweating and sometimes body odor.
2. Sebaceous glands increase sebum production in response to increased hormone levels, primarily androgen, giving the skin an oily appearance and predisposing the individual to acne
3. Coarse terminal hair appears in the axillae and pubic areas of both female and male adolescents and on the males face.

Front 13

Recognize and discuss normal variation of the skin associated with pregnant patients

Back 13

1. Increased blood flow to the skin, especially to the hands and feet
2. Acceleration of sweat and sebaceous gland activity occurs
3. Vascular spiders and hemangiomas that are present may increase in size
4. Skin thickens, fat is deposited in the subdermal layers
5. Increased pigmentation on face, nipples, areolae, axillae, vulva, perianal skin, and umbilicus

Front 14

Recognize and discuss normal variation of the skin associated with elderly

Back 14

1. Appear more transparent and paler in light skinned individuals
2. Pigment deposits, increased freckling, and hypopigmented