Kuliah Pengayaan HISTORY & PE

7/28/2019 Kuliah Pengayaan HISTORY & PE

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History takingPhysical examination

Hannah K Damar


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Preliminary history

Physical exam:

Identify the morphology of the lesion

Configuration, distribution

Consider clinicopathologic correlation

Follow up history Laboratory test

Primary

secondary


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Let the patient talk uninterrupttedly Clarify : Duration

Symptoms

Distribution

Treatment

Expand the history

Confirm diagnose

Differential diagnose

Underlying disease/ condition/past

medications


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Onset and evolution When it start

Getting better or worse

Is it the first time? Repeatedly?

Symptoms Does it itch?

Does it pain?

Do you have fever?

Treatment to date Ask for Over the counter preparation


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Review of systems Photosensitivity

Hair loss

Mouth ulcers

Family history Atopic diseases

Inherited diseases

Social history / Skin exposure history Expose to blood product

Expose to chemical substance

Hobby


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Special occasion contact dermatitis

Skin exposure history , at work & at play

Industrial dermatitisworkers disability

Outdoor activities

Detective type search


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Skin problem in Indonesia Infection

Infestation

Allergy ( contact, food /drug & herbs,

inhalation,photo /

UV ) Trauma

Endocrine

Malignancy

Others ( Inherated


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KEY POINTS Complete skin examination at the first visit

The entire skin surface should be examined as

well as hair, nails and mucosal surfaces Good lighting ( natural lighting/ flourescent/

side light)

Describe the morphology of the eruption

Ask approval for


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Tools Lighting

Magnifying lens/ hand held lens

Woods light ( UV 365nm)

Dermatoscope

Lesions need to belooked for
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Colour

Contour = primary & secondary skinlesion

Distribution Configuration

Development - spreading

Start by examining the affected areas

need to examine the entire skin surfaceReason :

Lesions that may accompany the presenting complaint

Unrelated but important incidental findings


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Red

Pale Brown

Black

Yellow Bluish

Green

Woods Lamp:Golden yellowCoral red

Green


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Woods lamp M canis fluorescence
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The typical appearance of erythrasma is well-

demarcated, brown-red macular patches. Theskin has a wrinkled appearance with finescales


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What to inspect and palpate ?

Characterize the appearance

Consider clinicopathologic correlation


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Palpation helps to:

Assess texture and consistency

Evaluate tenderness

Reassure patients that they are not contagious


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Diascopy a test for blanchability applyingpressure (finger or glass slide) observe color

changes

Dimple sign lateral compression causes thecentral portion of lesion to dimple

Nikolskys Sign the top layers of the skin slipaway from the lower layers when slightly rubbed

Dariers sign a change observed after strokingthe skin it becomes swollen, itchy and red

Auspitzs Sign simply bleeding after psoriaticscales have been removed


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Patch testing Prick test (Type 1 hypersensitivity reactions)

Photopatch Testing

Photo Testing Dermoscopy for pigmented lesions to diagnose

melanoma.

Skin biopsy (histology & direct immuno fluoresc. )

Skin scrapings or nail clippings for mycology

Skin swabs and smears for bacteria yeast & viralinfections.


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Racket nails: the distal phalanx is shorter &

wider than normal

Congenital abnormalities:

o Anonychia (complete absence)

o Micro- or Macronychia

o Onychoheterotopia (abnormally situated

nail)

o Racket nail

o Leuconychia totalis (completely white nail)


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Beau's lines: Transverse ridges on nails

Longitudinal ridges

Trachyonychia: Means roughness of nails

Pachyonychia: Thickening of nail plate

Onychorrhexis: Nail separates at lunula & is

shed partially or completely

Onychomadesis: Complete shedding of nail,

begins distally or laterallyOnycholysis: Detachment of nail from its

nail- bed


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Gastrointestinal , Endocrine

CNS, Idiopathic

-Unilateral clubbing

-Unidigital clubbing

Longitudinal brownish streaks

Others:

Egg-shell nails: In avitaminosis A

Quincke's sign: Increased capillary pulsations

Brittle nails : Iron deficiency anemia
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THANK YOU

Kuliah Pengayaan HISTORY & PE

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