Clin Med Exam 3

Dermatology is primarily a visual specialty

What fundamental principle makes inspection the most important part of the dermatologic exam?

Inspection

What is the most important component of the dermatologic physical examination?

A complete skin examination

What type of exam is recommended at the patient's first dermatology visit?

Mucocutaneous examination

What examination includes the skin, scalp, nails, and oral mucosa?

Good lighting

What environmental factor is critical during a dermatologic examination?

Growths and rashes

What are the two major categories of dermatologic conditions?

Growth

What term describes a discrete lesion resulting from proliferation of one or more skin components?

Rash

What term describes an inflammatory skin process that is usually more widespread than a growth?

Morphology

What is the single most important characteristic to identify before diagnosing a rash?

Morphology takes priority over configuration

If morphology and configuration seem to conflict, which should be weighted more heavily?

Configuration

What term describes the pattern of lesion arrangement?

Distribution

What term describes where lesions occur on the body?

Linear, grouped, annular, and geographic

What are common lesion configurations?

Location, duration, symptoms, and prior treatment

What four major historical features should be obtained for any dermatologic complaint?

How long, where, symptoms, and treatment attempted

What are the four general dermatology history questions?

Primary lesion

What lesion represents the earliest physical finding of a disease process?

Secondary lesion

What lesion develops during evolution of disease or from patient interaction with a lesion?

Macule

What primary lesion is a flat discoloration less than 0.5 cm with no elevation or depression?

Freckle

What is a classic example of a macule?

Patch

What primary lesion is a flat discoloration greater than 0.5 cm?

Vitiligo

What is a classic example of a patch?

Papule

What primary lesion is a solid elevated lesion less than 1 cm?

Acne and warts

What are classic examples of papules?

Plaque

What primary lesion is a solid elevated lesion greater than 1 cm or a confluence of papules?

Psoriasis

What is the classic example of a plaque?

Nodule

What primary lesion is a deeper solid elevated lesion greater than 0.5 cm?

Depth into the dermis

What feature distinguishes a nodule from a papule?

Cyst

What primary lesion is a fluid- or semisolid-filled nodule?

Vesicle

What primary lesion is a small fluid-filled lesion less than 0.5 cm?

Varicella and herpes zoster

What are classic examples of vesicles?

Bulla

What primary lesion is a fluid-filled lesion greater than 0.5 cm?

Size greater than 0.5 cm

What is the key distinction between a vesicle and a bulla?

Pustule

What primary lesion contains pus and is essentially a purulent vesicle?

Acne

What common disorder frequently produces pustules?

Ulcer

What primary lesion involves loss of epidermis and at least part of the dermis?

Decubitus ulcer (pressure ulcer)

What is a classic example of an ulcer?

Wheal

What primary lesion is a transient pruritic edematous papule or plaque?

Hives (urticaria)

What is the classic example of a wheal?

Telangiectasia

What primary lesion consists of visibly dilated superficial blood vessels?

Burrow

What primary lesion is a linear epidermal tunnel created by a scabies mite?

Scabies

What disease classically produces burrows?

Comedo

What primary lesion results from keratin plugging of the pilosebaceous canal?

Acne

What disease classically produces comedones?

Scale

What secondary lesion consists of visibly thickened stratum corneum?

Crust

What secondary lesion consists of dried liquid debris on the skin surface?

Impetigo

What disease classically produces crusting lesions?

Ruptured vesicles, pustules, or bullae

Crust formation most commonly results from rupture of what lesions?

Oozing

What secondary lesion describes active fluid exudation onto the skin surface?

Lichenification

What secondary lesion is characterized by thickened skin with accentuated skin markings?

Chronic rubbing or scratching

What process commonly causes lichenification?

Induration

What secondary lesion refers to dermal thickening that feels firm?

Fissure

What secondary lesion is a thin linear tear in the epidermis?

Atrophy

What secondary lesion represents loss of skin tissue?

Wrinkled, thinned skin

What is the appearance of epidermal atrophy?

Depressed skin surface

What is the appearance of dermal atrophy?

Macule vs papule

Which comparison distinguishes a flat lesion from an elevated lesion?

Patch vs plaque

Which comparison distinguishes a flat large lesion from an elevated large lesion?

Vesicle vs pustule

Which comparison distinguishes clear fluid from purulent fluid?

Vesicle vs bulla

Which comparison is based primarily on lesion size?

Papule vs nodule

Which comparison is based primarily on lesion depth?

Ulcer vs fissure

Which comparison distinguishes deep tissue loss from a superficial linear tear?

Grouped vesicles in a dermatomal distribution

What lesion pattern is classic for herpes zoster?

Dermatomal distribution

What distribution pattern is characteristic of shingles?

Grouped configuration

What lesion arrangement is characteristic of herpes zoster?

Body's largest organ

What is the skin?

Barrier protection

What is the skin's most important function?

Epidermis

What skin layer provides the major protective barrier?

Dermis

What skin layer provides nutrition and support to the epidermis?

Subcutaneous fat

What is the deepest layer of the skin?

Sweat glands, sebaceous glands, and hair follicles

What structures are contained within the dermis?

Shock, fluid loss, and sepsis

Why do extensive burns have high mortality?

Skin cancer

What is the most common cancer in the United States?

Ultraviolet radiation exposure

What is the major risk factor for most skin cancers?

No routine screening test exists

What important fact should be remembered regarding skin cancer screening?

Prevention and careful skin examination

What are the most important approaches to reducing skin cancer mortality?

Perform thorough skin examinations

What is the clinician's most important screening tool for skin cancer?

UV index of 3 or higher

When does the CDC recommend taking active sun-protective measures?

Shade

What is the first CDC-recommended skin cancer prevention strategy?

Broad-spectrum sunscreen

What type of sunscreen should be recommended?

UVA and UVB protection

What must a sunscreen provide to be considered broad spectrum?

15 minutes before sun exposure

When should sunscreen be applied?

Every 2 hours and after swimming or sweating

When should sunscreen be reapplied?

Children younger than 6 months

For what age group is sunscreen generally not recommended?

SPF (Sun Protection Factor)

What does SPF stand for?

Protection against UVB rays

What does SPF measure?

Amount of UV radiation required to produce sunburn

What does SPF actually quantify?

SPF 30

What SPF is generally considered the point beyond which additional protection becomes marginal?

Approximately 97% of UV rays

How much UV radiation does SPF 30 block?

Melanin provides approximately SPF 13 protection

What natural UV protection does darker skin provide?

Advanced-stage diagnosis

What unfortunate trend is seen with skin cancers in Black patients?