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1 Reason The integumentary system is often a window that we can - PDF document

Sep 11, 2023 •584 likes •796 views

SOCM Physical Exam of the Skin, Hair, and Nails PFN: SOMPYL0J Hours: 1.0 JSOMTC, SWMG(A) Slide 1 Terminal Learning Objective Action: Communicate knowledge of Physical Examination of the Skin, Hair, and Nails Condition: Given a

  1. SOCM Physical Exam of the Skin, Hair, and Nails PFN: SOMPYL0J Hours: 1.0 JSOMTC, SWMG(A) Slide 1 Terminal Learning Objective  Action: Communicate knowledge of “Physical Examination of the Skin, Hair, and Nails”  Condition: Given a lecture in a classroom environment  Standard: Received a minimum score of 75% IAW course standards on the formative quizzes and the Physical Exam Practical Test grade sheet JSOMTC, SWMG(A) Slide 2 References  Bates’ Guide to Physical Examination And History Taking (11 th edition; 2013; Lynn S. Bickley) JSOMTC, SWMG(A) Slide 3 1

  2. Reason The integumentary system is often a window that we can look into, finding problems with the other systems of the body. Failure to recognize these problems could lead to a catastrophic end, while on the other hand recognizing these problems could be the first step to a sound treatment. JSOMTC, SWMG(A) Slide 4 Agenda  Define the key terms related to the physical exam of the skin, hair, and nails  Communicate the steps in examining the skin  Identify the basic types of lesions  Communicate the inspection of hair and nails, and how to record exam findings JSOMTC, SWMG(A) Slide 5 The Key Terms Related to the Physical Exam of the Skin, Hair, and Nails JSOMTC, SWMG(A) Slide 6 2

  3. Vocabulary Development  Mobility ‐ the ease with which a fold of skin moves (by grasping the fold and lifting)  Turgor ‐ the resistance of the skin to deformity, or the speed in which a fold of skin returns into place after checking for mobility  Metastasize ‐ to invade distant structure of the body JSOMTC, SWMG(A) Slide 7 Vocabulary Development  Basal cell carcinoma ‐ lesion arising in the lowest, or basal, level of the epidermis  Squamous cell carcinoma ‐ lesion in the upper layer of the epidermis  Melanoma ‐ lesion arising from the melanocytes of the epidermis  Nevus (nevi plural form) ‐ congenital circum‐scribed area of the skin due to pigmentation JSOMTC, SWMG(A) Slide 8 Vocabulary Development  Pallor ‐ paleness, lack of color  Edema ‐ the generalized condition in which the body tissue contains an excessive amount of fluid  Induration ‐ hardened tissue  Sclerosis ‐ the hardening, or induration, of an organ or tissue  I ntertrigo ‐ skin chafing in or under folds of skin JSOMTC, SWMG(A) Slide 9 3

  4. Vocabulary Development  Umbilicate ‐ dimpled, pitted, or shaped like a navel  Acral ‐ pertaining to the extremities  Coalesce ‐ to fuse, to run or grow together  Violaceous ‐ purple or violet discoloration  Heliotrope / heliotropic ‐ violaceous rash  Associated with dermatomyositis  Often seen as discoloration of the eyelids, forehead and nasolabial folds JSOMTC, SWMG(A) Slide 10 Vocabulary Development  Nasolabial folds ‐ commonly known as "smile lines" or "laugh lines”  Vellus hair ‐ short, fine, inconspicuous, and relatively unpigmented hair  Terminal hair ‐ coarser, thicker, more conspicuous, and usually pigmented hair JSOMTC, SWMG(A) Slide 11 Vocabulary Development  Classic signs of inflammation:  Calor ‐ heat  Dolor ‐ pain  Rubor ‐ erythema or redness  Tumor ‐ swelling  Functio laesa ‐ loss, or disturbance, of function JSOMTC, SWMG(A) Slide 12 4

  5. Steps in Examining the Skin JSOMTC, SWMG(A) Slide 13 The Skin Exam  Beginning the examination  Changes in the skin, hair, or nails  Any: • Rashes • Sores • Lumps • Itching  You may defer further questions about the skin until the physical examination JSOMTC, SWMG(A) Slide 14 The Skin Exam  Steps of the examination  Begin with general survey  Continue through physical examination  Inspect entire surface – everywhere  Use good light – natural if possible  Correlate findings of skin with those of mucous membranes  Be able to Identify • Skin color • Patterns and types of lesions JSOMTC, SWMG(A) Slide 15 5

  6. The Skin Exam  Inspection and palpation  Color: • Ask if any changes • Assess discoloration  General discoloration / areas of discoloration  Oxyhemoglobin and pallor in its absence  Moisture • Dry vs. diaphoretic • Oily JSOMTC, SWMG(A) Slide 16 The Skin Exam  Skin color, changes in pigmentation:  Widespread increase in melanin may be caused by Addison’s disease JSOMTC, SWMG(A) Slide 17 The Skin Exam  Changes in Pigmentation  Cyanosis – bluish color • Readily visible in:  Fingers / fingernails  Toes / toenails  Lips / oral mucosa  Erythema – reddish color / hue • Can be caused by:  Increased dermal blood supply, infection, etc. JSOMTC, SWMG(A) Slide 18 6

  7. The Skin Exam  Changes in Pigmentation  Jaundice • Sign, not a disease • Affects the skin and sclera • Caused by increased bilirubin  Increased hemolysis / liver disease JSOMTC, SWMG(A) Slide 19 The Skin Exam  Inspection and palpation (cont’d)  Temperature  Texture • Rough / smooth  Mobility and turgor • Mobility = lift skin‐fold • Turgor = Release skin‐fold: speed it returns  Lesions JSOMTC, SWMG(A) Slide 20 The Basic Types of Lesions JSOMTC, SWMG(A) Slide 21 7

  8. Skin Lesions  Recognition of specific lesions is essential to make a diagnosis  Specific types of lesions are seen in individual disease processes  Correct terminology is required to document the condition and to communicate findings to a consultant, if needed JSOMTC, SWMG(A) Slide 22 Skin Lesions  Note  Type of lesion  Location / distribution  Pattern / shapes  Review their appearance in a well‐ illustrated textbook of dermatology  Whenever you see a skin lesion, look it up in such a text JSOMTC, SWMG(A) Slide 23 Skin Lesions  Primary Lesions  Represents early stage of the lesion  How they look when they start, prior to evolving  Secondary Lesions  Represents a later stage after the lesion has evolved or been altered  May help determine where in the skin the process is occurring • e.g. , epidermis, dermis, fat JSOMTC, SWMG(A) Slide 24 8

  9. Types of Skin Lesions  Primary lesions  Secondary lesions  Macule  Scar  Ulcer  Patch  Keloid  Atrophy  Papule  Excoriation  Tumor  Plaque  Scale  Nodule  Crust  Cyst  Lichenification  Vesicle  Fissure  Bulla  Erosion  Pustule JSOMTC, SWMG(A) Slide 25 Primary Skin Lesions  Flat, nonpalpable Macule lesions with change to skin color:  Macule – small / up to 1.0 cm  Patch – large / 1.0 cm Patch or larger JSOMTC, SWMG(A) Slide 26 Primary Skin Lesions  Palpable elevated with solid Papule Nodule mass:  Papule – up to 1.0 cm  Nodule – larger than 0.5 cm • Marble‐like lesion, often deeper and firmer than papule Plaque Cyst  Plaque – 1.0 cm or larger • Often formed by coalescence of papules  Cyst – nodule (> 0.5 cm ) • Filled with expressible material • Liquid or semisolid JSOMTC, SWMG(A) Slide 27 9

  10. Primary Skin Lesions  Palpable elevated with Vesicle Bulla / Vesicle fluid ‐filled cavities: • Vesicle ‐ Up to 1.0 cm • Bulla ‐ 1.0 cm or larger  Filled with serous fluid • Pustule ‐ size irrelevant  Filled with pus Pustule Burrow • Burrow ‐ 5‐15 mm  Tunnels in epidermis  Curving line; ends at vesicle  May include other lesions JSOMTC, SWMG(A) Slide 28 Secondary Skin Lesions  Causes include: Scale  Evolved from primary lesion  From external forces  Scale – thin, dead, exfoliated epidermis  Crust – dried residue of Crust exudates:  Pus  Serum  Blood JSOMTC, SWMG(A) Slide 29 Secondary Skin Lesions  Lichenification: Lichenification  Thickening of epidermis  Roughening of the skin  Increased visibility of furrows  Usually from rubbing or scratching  Scars – connective tissue from Scarring Keloid Scarring injury site or disease  Keloids ‐ hypertropic scar • Extends beyond border of original injury JSOMTC, SWMG(A) Slide 30 10

  11. Secondary Skin Lesions  Depressed Erosion Excoriation  Erosion • Superficial loss of epidermis • Non‐scarring • Surface is moist / no bleeding  Excoriation – linear or punctate erosion from scratching Fissure Ulceration  Fissure – linear crack in skin • Extends into dermis  Ulcer‐ necrosis of epidermis / dermis • May extend into subcutaneous • Can bleed and leave scar JSOMTC, SWMG(A) Slide 31 Secondary Skin Lesions  Wheal – localized area of skin edema  Examples: • “Hives” • Insect bite • Wheal from a sensitivity test – injection JSOMTC, SWMG(A) Slide 32 Secondary Skin Lesions  Tumor  Characteristics • Elevated, but with depth too • Solid • > 2 cm diameter  Examples • Malignancy JSOMTC, SWMG(A) Slide 33 11

  12. Secondary Skin Lesions  Atrophy  Characteristics • Thinning of epidermis • Translucent • Loss of skin markings  Example • Age‐related changes • Medication side effect JSOMTC, SWMG(A) Slide 34 Skin Lesions  Patterns and shapes include:  Linear (line)  Clustered (grouped)  Geographic  Serpiginous  Annular/arciform JSOMTC, SWMG(A) Slide 35 Vascular Skin Lesions  Petechiae  Purpura  Ecchymosis  Telangiectasia  Hemangioma JSOMTC, SWMG(A) Slide 36 12

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