1
Q
List 6 examples of color to look for in a skin examination.
A
- Hyperpigmentation
- Hypopigmentation
- Redness
- Pallor
- Cyanosis
- Jaundice
2
Q
How are skin lesions initially classified (2 categories)?
A
- Primary
2. Secondary
3
Q
How are primary skin lesions initially classified (2 categories)?
A
- Small
2. Large
4
Q
What are the other features of primary skin lesions (6)?
A
- Flat
- Raised - solid, rounded
- Raised - fluid filled
- Raised - pus filled
- Raised - mesa-like
- Special category
5
Q
List the 6 SMALL primary skin lesions according to the following categories:
- Flat
- Raised - solid, rounded
- Raised - fluid filled
- Raised - pus filled
- Raised - mesa-like
- Special category
A
- Macula
- Papule
- Vesicle
- Pustule
- Plaque
- Wheal
6
Q
List the 6 LARGE primary skin lesions according to the following categories:
- Flat
- Raised - solid, rounded
- Raised - fluid filled
- Raised - pus filled
- Raised - mesa-like
- Special category
A
- Patch
- Nodule
- Bulla
- [Abscess]
- Plaque
- Wheal
7
Q
What is a macule?
A
Primary small skin lesion
Flat (lacks elevation or depression), different color from surrounding skin
8
Q
What is a patch?
A
Primary large skin lesion
Flat skin discoloration
9
Q
What is a plaque?
A
Primary small or large skin lesion
Mesa-like elevation that occupies a large surface area in comparison to its height (raised and flat)
> 1.0cm
10
Q
What is a papule?
A
Primary small skin lesion
Solid, raised lesion
Generally <0.5 cm in diameter
“Papules pop up”
11
Q
What is a nodule?
A
Primary large skin lesion
Palpable, deeper than a papule
>0.5 cm in diameter
Feels like a marble in the skin
12
Q
What is a pustule?
A
Primary small skin lesion
Raised lesion that contains a purulent exudate
13
Q
What is a vesicle?
A
Primary small skin lesion
Elevated lesion that contains (clear) fluid; the wall is thin and the lesion appears translucent
<0.5 cm in diameter
14
Q
What is a bulla?
A
Primary large skin lesion
Vesicle >0.5 cm in diameter
15
Q
What is a wheal?
A
Primary large or small skin lesion
Firm, edematous plaque that is evanescent (comes and goes) and pruritic
16
Q
What is another name for a wheal?
A
Hive
17
Q
What are secondary skin lesions?
A
Lesions that are created by scratching, scrubbing, or infection
18
Q
List the secondary skin lesions (8).
A
- Ulcer
- Scar
- Atrophy
- Scale
- Crusts
- Fissure
- Erosion
- Excoriation
19
Q
What is an ulcer?
A
“Hole in the skin”
Destruction of the epidermis and upper dermis; will heal with scarring
20
Q
What is a scar?
A
Healed wound or ulcer
21
Q
What is a keloid scar?
A
An abnormal formation of connective tissue
22
Q
What is atrophy?
A
Thinning of the epidermis and dermis
23
Q
What is a scale?
A
Abnormal shedding or accumulation of stratum corneum in perceptible flakes
24
Q
What is a crust?
A
Hardened deposit that results when serum, blood, or purulent exudate dries on the skin surface
25
What is another name for a crust?
Scab
26
What is a fissure?
Linear cleavage or cack in the skin; may be painful
27
What is an erosion?
Partial loss of skin surface; superficial (compared to an ulcer, which is deep)
28
What is an excoriation?
Linear erosion induced by scratching
29
List 5 other miscellaneous skin lesions.
1. Burrows
2. Lichenification
3. Telangiectasias
4. Petechiae
5. Purpura
30
What is a burrow?
Elevated channel in the superficial epidermis produced by a parasite such as scabies or worms
31
What is a lichenification?
Focal area of thickened skin produced by chronic scratching or rubbing; skin lines are exaggerated or accentuated
32
What is a telangiectasia?
Small, dilated superficial blood vessels (capillaries, arterioles, or venules) that blanch with pressure
33
What are 4 causes of telangiectasias?
1. UV radiation
2. Topical steroid use
3. Collagen vascular disorders
4. Certain tumors
34
What are petechiae?
Tiny red macules that result from the extravasation of RBCs into the dermis; do NOT blanch with pressure, usually <5mm in diameter
35
What are purpura?
Larger patches of extravasated RBCs; do NOT blanch with pressure
36
List some skin lesion configurations (6).
1. Annular
2. Arcuate/polycyclic
3. Gyrate
4. Target
5. Dermatomal
6. Linear
7. Serpiginous
37
What is an annular skin lesion?
Ring-shaped
38
What is an arcuate/polycyclic skin lesion?
Incomplete circular
39
What is a gyrate skin lesion?
Wood-grain pattern (rare)
| "To turn around in a circle"
40
What is a target lesion?
```
Consists of three zones:
1. Dark or blistered center
2. Center surrounded by a pale zone
3. Rim of erythema
Looks like a bullseye
```
41
What is a dermatomal skin lesion?
Follows neurocutaneous dermatomes
42
What is a serpiginous skin lesion?
Snakelike, winding eruption
43
List and define arrangements of skin lesions (6).
1. Discrete - isolated
2. Clustered - small group
3. Confluent - joined together
4. Dermatomal
5. Reticular - fishnet/lacy
6. Morbilliform - measles-like
44
List and define distribution of skin lesions (4).
1. Intertrigenous - under skin folds
2. Photodistributive - sun-exposed areas
3. Symmetric
4. Widespread
45
What are the ABCDEs of melanoma?
1. Asymmetry
2. Borders are irregular
3. Color varies
4. Diameter >6mm
5. Elevation
46
What are the 2 superficial secondary lesions above the skin?
1. Erosions
| 2. Excoriations
47
What are the 3 superficial secondary lesions below the skin?
1. Scales
2. Scars (sometimes)
3. Crusts
48
What are the 2 deep secondary lesions?
1. Fissure
| 2. Ulceration
49
What does a scale indicate (what histologic process)?
Hyperkeratosis
50
___ are shown by the patient to you but are covering for the underlying deeper issue which is the core pain or process.
Seed resistances
51
What are examples of core pains?
```
Fear of the unknown
Fear of physical pain
Loss of hope
Loss of internal control
Loss of external control
Feeling wronged
Loss of meaning
Self-loathing
Fear of death
Loneliness
```
52
What is content discussion?
Deals with the actual question directly or meets the patient's style of resistance by remaining focused on the facts of the situation at hand; authoritarian; may lead to debates or impasses
53
What is process discussion?
Comment or ask about the underlying emotion or frustration; empathize; leads to better compliance
54
What is side stepping?
Find a less threatening topic and go there temporarily
55
Personality type - a patient who asks many questions, doesn't want you to leave the room, calls you frequently, fears you won't find them worth treating, fears you will abandon them
Dependent
56
How can you help a patient who has a dependent personality?
Regular, brief sessions; set tactful limits; say to them you will come back later and briefly do
57
Personality type - patients are insistent, detailed, want all of the information; may be angry when they are not in control
Obsessive
58
How can you help a patient who has an obsessive personality?
Give detailed explanations, provide choices when possible, try to use the patient input in a collaborative way
59
Personality type - self-centered, criticize others, believe that no one is qualified to care for them; fearful, threatened, and vulnerable, but cannot admit this
Narcissistic
60
How can you help a patient who has a narcissistic personality?
Avoid confrontation, emphasize that they deserve the best the staff can give, be sure staff are all on the same page
61
Personality type - always symptoms, always wants attention, may not follow through with plan; possible secondary gain, views illness and its treatment as punishments, but keeps coming back for more
Suffering victim
62
How can you help a patient who has a suffering victim personality?
Regular visits, no matter how variable the complaints are
63
Personality type - do not trust doctors, refuse to participate in treatment, may leave AMA, always feels that others are taking advantage of them/neglecting/harming them
Paranoid
64
How can you help a patient who has a paranoid personality?
Stay calm, don't argue, offer understanding of the patient's position, provide clear recommendations
65
Personality type - very lonely, isolative, tend to avoid medical care, have a tough time around people, feel that their privacy or space is being invaded
Schizoid
66
How can you help a patient who has a schizoid personality?
Engage patient in making the medical decisions, don't feel that you have to have a great rapport
67
What are the 6 steps for delivering bad medical news?
1. Schedule the meeting (have enough time)
2. Determine if the patient understands the seriousness of the illness
3. Does the patient want to know more?
4. Deliver the news, then listen
5. Ask how the patient feels, offer support
6. Move forward
68
SPIKES - pneumonic
```
Setting
Patient's perception of condition
Invitation from patient to give information
Knowledge (explain the facts)
Explore emotions; empathize
Strategy/summary
```
69
What technique is indicated when there is pain on rotation of the head, unilateral or bilateral trapezius pain, suboccipital pain or headache, or radicular pain in the distribution of C1-8?
Anterior and posterior flexion of the neck, anterior flexion against resistance; rotate head "like in the exorcist"
70
What is normal for neck flexion/extension/rotation?
Touch chin to chest
Extended >30 degrees
Rotate 75-90 degrees
71
If neck flexion/extension/rotation is abnormal, what is on the DDX?
C-spine DJD or inflammatory arthritis, disc disease
72
What technique is indicated with trapezius pain, retro-occipital headache, or cervical nerve radicular pain?
Lateral flexion of head (touch ear to shoulder)
73
What is normal for lateral flexion of the head?
At least 30 degrees toward shoulder
74
If neck lateral flexion is abnormal, what is on the DDX?
No pain - DJD, inflammatory C-spine disease
Ipsilateral decreased or normal flexion with pain - nerve impingement
Contralateral trapezius pain - paracervical muscle spasm secondary to C-spine DJD
75
What technique is indicated if there is pain on abducting >90 degrees or rotating the shoulder?
Arm abduction, external rotation, resist pushing arm down; flex elbow, supinate against resistance (normal if abduct past 90 degrees without pain)
76
What is on the DDX if the above test is abnormal?
Gleno-humeral arthritis (pain in the AP passive movement)
Rotator cuff disease (abduction and resistance)
Bicepital tendonitis (supination)
77
Pain on flexion and extension of the elbow indicates ___.
Intra-articular disease
78
No pain on flexion/extension of the elbow but large effusion with or without signs of inflammation indidcates ___
Olecranon bursitis
79
Thickened ulnar groove bilaterally indicates ___
Systemic inflammatory arthritis
80
Nodules on the proximal posterior forearm indicate ___.
RA
81
Hard or bony swellings that can develop in the distal interphalangeal joints
Heberden's nodes
82
Hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints
Bouchard's nodes
83
What causes arthritis mutlians?
Untreated psoriasis
84
Knee pain at night might indicate what?
Anserine bursa (location of insertion of gracilius, sartorius, semitendonosus)
