2011 PD handout 7-13-11

8/6/2019 2011 PD handout 7-13-11

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Physical Examination of the SkinPhysical Examination of the SkinJuly 18 and 19, 2011July 18 and 19, 2011

Ma. Socorro W. Toledo, MD, DPDS, FPDSMa. Socorro W. Toledo, MD, DPDS, FPDS

DEAR STUDENTDEAR STUDENT

This handout is a study guide.This handout is a study guide.

ReadRead on terms & concepts and lon terms & concepts and lookook at pictures inat pictures in

dermatology references.dermatology references. Reference material available in library: DermatologyReference material available in library: Dermatology

in General Medicine by Fitzpatrickin General Medicine by Fitzpatrick

Use this handout for noteUse this handout for note--taking during the lecture.taking during the lecture.

The PD activityThe PD activity next weeknext week is based on the lecture.is based on the lecture.

We start promptly.We start promptly. To the class liaison officer: Ensure the LCD projector/To the class liaison officer: Ensure the LCD projector/

computer / sound system is ready to avoid delays.computer / sound system is ready to avoid delays.

THANK YOUTHANK YOU

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8/6/2019 2011 PD handout 7-13-11


A. GeneralA. General

Characteristics:Characteristics:

I. Inspection:I. Inspection: General color General color

NormalNormal ::

((--) pallor ) pallor

((--) jaundice) jaundice

((--) erythema) erythema

((--) hyperpigmentation) hyperpigmentation

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A. Gen. Char.A. Gen. Char. (cont·d.)(cont·d.)

II. Palpation:II. Palpation:a.a. Temperature:Temperature: NormalNormal = Afebrile / Not cold to touch= Afebrile / Not cold to touch

b.b. Turgor Turgor NormalNormal = Prompt return after finger pressure= Prompt return after finger pressure

AbnormalAbnormal = Delayed return after finger pressure= Delayed return after finger pressure

c.c. Degree of moistureDegree of moisture::

NormalNormal = No dryness, no excess moisture= No dryness, no excess moisture

AbnormalAbnormal = Dry (hypohidrosis, anhidrosis)= Dry (hypohidrosis, anhidrosis)

= Moist (hyperhidrosis)= Moist (hyperhidrosis)

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A. Gen. Char.A. Gen. Char. (cont·d.)(cont·d.)

d.d. Hardness /Sclerosis or LaxityHardness /Sclerosis or Laxity

Normal skinNormal skin = (= (--) sclerosis, () sclerosis, (--) laxity) laxity

Abnormal skinAbnormal skin::

1.1. ScleroticSclerotic ± ± Skin is hardened like scarredSkin is hardened like scarred

tissue (Ex. scleroderma)tissue (Ex. scleroderma)2.2. LaxLax ± ± Skin can be stretched to a greatSkin can be stretched to a great

extent (Ex.cutis laxa)extent (Ex.cutis laxa)

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B. Presence / AbsenceB. Presence / Absence

of Skin Lesionsof Skin Lesions

I. Normal = No skin lesionsI. Normal = No skin lesions

PRIMARY SKIN LESIONS (arisePRIMARY SKIN LESIONS (arise de novode novo))

A. A. Flat lesionsFlat lesions

1. Macule 2. Patch1. Macule 2. Patch

B.B. Raised or palpable lesionsRaised or palpable lesions1. Papule1. Papule 5. Vesicle5. Vesicle

2. Nodule2. Nodule 6. Bulla6. Bulla

3. Tumor 3. Tumor 7. Wheal7. Wheal

4. Plaque4. Plaque 8. Pustule8. Pustule

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I.A. Flat lesionsI.A. Flat lesions

1.1. MaculeMacule: A flat lesion <1.0 cm in greatest: A flat lesion <1.0 cm in greatest

dimensiondimension

2.2. PatchPatch: A flat lesion 1.0 cm or more in: A flat lesion 1.0 cm or more in

greatest dimensiongreatest dimension

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I.B. Raised / palpable lesionsI.B. Raised / palpable lesions

1.1. Papule*Papule*: A solid or cystic elevation, or : A solid or cystic elevation, or palpable lesion <1.0 cm in diameter palpable lesion <1.0 cm in diameter

2.2. Nodule*Nodule*: A solid or cystic elevation, or : A solid or cystic elevation, or palpable lesion 1.0 cm or more butpalpable lesion 1.0 cm or more butless than 2.0 cm in diameter less than 2.0 cm in diameter

**May be rounded, ovoid or ellipsoidalMay be rounded, ovoid or ellipsoidal

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3.3. Tumor*Tumor*: A solid or cystic elevation, or : A solid or cystic elevation, or palpablepalpable

lesion 2.0 cm or more in diameter lesion 2.0 cm or more in diameter

4.4. PlaquePlaque: A slightly raised lesion, wider : A slightly raised lesion, wider than it isthan it is

high (mesahigh (mesa--like), 1.0 cm or morelike), 1.0 cm or more

in greatest dimensionin greatest dimension

**May be rounded, ovoid or ellipsoidalMay be rounded, ovoid or ellipsoidal

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I.B. Raised or palpable lesionsI.B. Raised or palpable lesions

5.5. VesicleVesicle: A noncystic, transparent fluid: A noncystic, transparent fluid--

filled lesion <1.0 cm in diameter filled lesion <1.0 cm in diameter

6.6. BullaeBullae: A noncystic, transparent fluid: A noncystic, transparent fluid--

filled lesion 1.0 cm or more in greatestfilled lesion 1.0 cm or more in greatest

dimensiondimension

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7.7. WhealWheal: An evanescent papule or : An evanescent papule or

plaque that disappears within 24plaque that disappears within 24

hourshours

8.8. PustulePustule: A small, circumscribed raised: A small, circumscribed raised

lesion containing purulent exudate.lesion containing purulent exudate.Pus, composed of leucocytes with or Pus, composed of leucocytes with or

without cellular debris, may containwithout cellular debris, may contain

bacteria or may be sterile.bacteria or may be sterile.

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II. Abnormal:II. Abnormal: ExampleExample ---- (+)(+) ErythematousErythematous, scaly,, scaly,

eroded papules and plaques on the left side of the faceeroded papules and plaques on the left side of the face

A.A. LocationLocation

1. Localized1. Localized state what part of bodystate what part of body

2. Generalized2. Generalized

B.B. Color Color

1. Skin1. Skin--coloredcolored

2. Erythematous (pink, bright/ dusky red, violaceous)2. Erythematous (pink, bright/ dusky red, violaceous)

3. Hyperpigmented (brown, gray, black )3. Hyperpigmented (brown, gray, black )

4. Hypopigmented (whitish) vs. white4. Hypopigmented (whitish) vs. white

5. Others: yellow, orange, etc.5. Others: yellow, orange, etc.

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II. Abnormal: «II. Abnormal: « (cont·d.)(cont·d.)

C.C. Shape of individual lesionsShape of individual lesions::

-- linear linear

-- round, oval, annular (ringround, oval, annular (ring--like)like)

-- arciformarciform (like an arc),(like an arc),

-- polycyclic (confluent rings)polycyclic (confluent rings)

-- serpiginousserpiginous (snake(snake--like)like)-- reticular ( lacereticular ( lace--like)like)

D.D. PatternPattern (Versus: No pattern(Versus: No pattern random distribution)random distribution)

-- Extensor surfacesExtensor surfaces

-- Flexures or Flexures or intertriginousintertriginous areas =areas = antecubitalantecubital fossafossa,, axillaryaxillary vault,vault,inframammaryinframammary crease, inguinal crease,crease, inguinal crease, poplitealpopliteal vaultvault

-- SunSun--exposed areas = face, V of the neck & upper chestexposed areas = face, V of the neck & upper chest

-- TruncalTruncal

-- Acral Acral (ears, tip of nose, hands, feet)(ears, tip of nose, hands, feet)

-- DermatomalDermatomal

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II. Abnormal:II. Abnormal: «« (cont·d.)(cont·d.)

E .E . Secondary LesionsSecondary Lesions

a. Scalesa. Scales e. Fissurese. Fissuresb. Crustsb. Crusts f. Lichenificationf. Lichenification

c. Erosionsc. Erosions g.Atrophyg.Atrophy

d. Ulcersd. Ulcers h.Scarsh.Scars

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CC. Skin Appendages:. Skin Appendages:

HAIR & NAILSHAIR & NAILS

1. HAIR1. HAIRA. Loss or ExcessA. Loss or Excess

NORMALNORMAL

= No hair loss= No hair loss

= No hypertrichosis / No hirsutism (females)= No hypertrichosis / No hirsutism (females)

ABNOR

MALABNOR

MAL1. Hair loss = patchy vs. diffuse1. Hair loss = patchy vs. diffuse

2. Hair Excess2. Hair Excessa. Hypertrichosis (localized / generalized)a. Hypertrichosis (localized / generalized)

b. Hirsutism (in females only)b. Hirsutism (in females only)

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C. Skin appendages:C. Skin appendages:

1. HAIR (cont·d.)1. HAIR (cont·d.)B.B. Normal = (Normal = (--) structural abnormalities) structural abnormalities

((--) nodules) nodules

((--) brittle hair ) brittle hair

C.C. Describe hair color Describe hair color

-- white (vitiligo)white (vitiligo)

-- premature grayingpremature graying-- redred--brown (malnutrition)brown (malnutrition)

D.D. Normal = (Normal = (--) nits) nits

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C. Skin Appendages:C. Skin Appendages:

2. NAIL UNIT2. NAIL UNITA.A. Nail PlateNail Plate

Normal:Normal:

1. (1. (--) nail dystrophy (No structural deformities)) nail dystrophy (No structural deformities)Ex. Ridges, grooves, pitsEx. Ridges, grooves, pits

Ex. ClubbingEx. Clubbing

Ex. spoonEx. spoon--shaped nails (koilonychia)shaped nails (koilonychia)

2. (2. (--) No color changes (Normal = transparent)) No color changes (Normal = transparent)

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C. Skin Appendages:C. Skin Appendages:

2. NAIL UNIT2. NAIL UNIT (cont·d.)(cont·d.)

B.B. Nail BedNail Bed

Normal = (Normal = (--) nail bed lesions) nail bed lesions

C.C. Skin around nails:Skin around nails: Nail FoldsNail Folds

Normal =Normal =((--) lesions proximal and lateral nail folds) lesions proximal and lateral nail folds

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D. Mucosal ChangesD. Mucosal Changes

Normal = No oral*/ nasal/Normal = No oral*/ nasal/ conjunctivalconjunctival/ /genital/ anal/genital/ anal/ perianalperianal lesionslesions

Abnormal = Presence of (describe lesion)Abnormal = Presence of (describe lesion) ininthe (state area)the (state area)

*Note:*Note:

OralOral buccalbuccal / palatal / gingival // palatal / gingival /lingual / sublingual areaslingual / sublingual areas

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IN SUM: Use the above outline toIN SUM: Use the above outline to

report the physical examination of thereport the physical examination of the

skin. In askin. In a NORMALNORMAL patient, the skinpatient, the skin

findings are as follows:findings are as follows:

A. A. General Characteristics:General Characteristics:

1. Inspection (general color):1. Inspection (general color): ((--) pallor /) pallor / jaundice / jaundice / erythemaerythema // hyperpigmentationhyperpigmentation

2. Palpation2. Palpation::

Temperature:Temperature: Afebrile Afebrile/ not cold to touch/ not cold to touch

Turgor Turgor: Prompt return after finger pressure: Prompt return after finger pressure

((--)) HyperhidrosisHyperhidrosis // hypohidrosishypohidrosis

((--) Sclerosis / skin laxity) Sclerosis / skin laxity

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B. Presence/Absence of Skin LesionsB. Presence/Absence of Skin Lesions

NORMAL = No skin lesions: NoNORMAL = No skin lesions: No

maculesmacules/patches, papules/ plaques/ /patches, papules/ plaques/nodules/ tumors, blisters, pustules,nodules/ tumors, blisters, pustules,

wheals.wheals.

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C. Skin AppendagesC. Skin Appendages1.Hair = Color _____;1.Hair = Color _____;

((--) hair loss/excess) hair loss/excess

((--) structural abnormalities) structural abnormalities((--) No easy breakage) No easy breakage

((--) nits) nits

2.Nail unit = No lesions on the nail2.Nail unit = No lesions on the nail

plate/ bed/ foldsplate/ bed/ folds

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D. Mucosal changesD. Mucosal changes

Normal = No oral / nasal /Normal = No oral / nasal /

conjunctivalconjunctival / genital / anal / / genital / anal / perianalperianallesionslesions

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Instructions for PD activity:Instructions for PD activity:

A. Three (3) sheets of yellow pad paper willA. Three (3) sheets of yellow pad paper will

be provided.be provided.

Write name, date, year level and section.Write name, date, year level and section.

B. Slides of clinical cases will be flashed.B. Slides of clinical cases will be flashed.

Answer Answer BRIEFLY.BRIEFLY.

Give only pertinent data: Primary/Give only pertinent data: Primary/secondary lesions, pattern (if any),secondary lesions, pattern (if any),

distribution.distribution.

Diagnosis = bonus questionDiagnosis = bonus question

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Instructions (cont.):Instructions (cont.):

Total 20 cases. One minute per case.Total 20 cases. One minute per case.

5 minutes for last slide.5 minutes for last slide.

For immediate feedback: Answers will beFor immediate feedback: Answers will bediscussed after the activity.discussed after the activity.

Check your own papersCheck your own papers ± ± so noso no erasureserasuresallowed.allowed.

Submit papers to Secretary Wendy.Submit papers to Secretary Wendy.

Documents

2011 PD handout 7-13-11