Dermatology1.txt

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Author:
kavinashah
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84522
Filename:
Dermatology1.txt
Updated:
2011-05-08 13:55:53
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derm1
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derm1
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  1. what are the 10 main parts to the HPC of a dermatology patient?
    • 1. when: longstanding, enlarging (BCC), childhood (eczema), sudden onset (drug eruption)
    • 2. where: sun exposed (melanoma), hands (contact dermatitis), extensors, flexors
    • 3. what looked like & how changing (melanoma)
    • 4. symptoms: itch/bleed
    • 5. aggravating/relieving: sunlight in lupus
    • 6. impact on QOL: acne psych/relationships
    • 7. Rx already tried: emollient, photo, topical steroids, systemic
    • 8. risk factors: sun exposure (sailor, gardener, australia, red hair blue eye)
    • 9. atopic history: asthma, eczema, hayfever
    • 10. previous malignancy: recurrent BCC, metastasic disease
  2. what are the 4 things to include when describing a skin lesion?
    • description
    • surface characteristic
    • distribution
    • morphology
  3. what are the 7 main different descriptions?
    • macule/patch
    • papule
    • nodule
    • plaque
    • vesicle
    • pustule
    • bulla
  4. what is a macule?
    • FLAT
    • skin discolouration - white (loss of melanin), erythema (vascular dilatation+inflamm)
    • <0.5cm
  5. what is a patch?
    • larger than macule
    • >0.5cm
  6. what is a papule?
    elevated lesion <0.5cm
  7. what is a nodule?
    • elevated lesion >0.5cm
    • eg molluscum
  8. what is a plaque?
    • FLAT
    • raised lesion
    • (shelf like)
    • eg psoriasis
  9. what is a vesicle
    • fluid filled lesion
    • <0.5cm
    • eg herpes simplex
  10. what is a pustule?
    pus filled lesion eg acne
  11. what is a bulla?
    • fluid filled lesion
    • >0.5cm
    • eg after insect bite reaction
  12. what are the 5 different surface characteristics of a skin lesion?
    • scale
    • ulcer
    • crust
    • excoriation
    • lichenification
  13. what is scale?
    visible, palpable flake of aggregated EPIDERMAL CELLS
  14. what is crust?
    dried exudate
  15. what is lichenification?
    • flat surfaced
    • hard thickening of the skin with accentuated skin markings
    • reaction to long standing scratching and inflammation
  16. what is an excoriation?
    • superficial ulceration secondary to scratching
    • loss of epidermis
  17. what is a nummular lesion?
    coin like lesion
  18. what is the difference between an ulcer and an erosion?
    • erosion: superficial loss of EPIDERMIS that heals without scarring
    • ulcer: loss of whole thickness of epidermis and upper dermis
    • healing results in scar
  19. what are the different distributions?
    • localised: tumour
    • generalised: rash
    • regional: eg wrists
    • contact dermatitis
    • dermatomal: shingles
    • photosensitive area
  20. what are the different forms of a generalised rash?
    • peripheral v central
    • flexors
    • extensors
    • symmetrical: endogenous or exogenous from hairdresser or nurse with gloves
    • asymmetrical: exogenous - chef with knife in dominant hand
  21. what are the 5 different morphologies?
    • monomorphic: all look same
    • pleomorphic: eg looks different
    • clustered: eg HSV, insect bites
    • annular: tinea corporis
    • koebnerisation: eg psoriasis
  22. which rash can be described as pleomorphic?
    chickenpox
  23. what are the 3 main skin conditions that show koebnerisation?
    • psoriasis
    • Lichen planus
    • viral warts
  24. which 3 other places should you examine in dermatology?
    • mouth
    • nails
    • lymph nodes
    • organomegaly
    • pedal pulses - leg ulcers
  25. what is the difference between patch testing and prick testing?
    • patch testing places substances on the SURFACE of the skin
    • identifies SKIN allergies
    • prick testing tests for allergies that don't necessarily occur on skin eg allergy to pollen, foods,
  26. what is the difference in hypersensitivity reactions between patch and prick testing?
    • patch: cell mediated type IV hypersensitivity eg hair dye, nickel, latex - contact dermatitis
    • prick: IgE mediated, type 1 hypersensitivity - mast cells have IgE receptors and degranulate
  27. what investigations can be done in derm?
    • 1. photograph the skin lesion to monitor changes
    • 2. dermoscopy: magnifying glass- see different LAYERS of skin
    • 3. mycology: eg fungus - need to confirm the diagnosis as it is 6-8 weeks of oral Rx
    • 4. swabs - microbiology/PCR for viral
    • 5. biopsy: histology/stains/immunofluorescence studies

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