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Derm 1

Lect 1

Melanocytes pigment cells in dermis layer
Langerhans cells immune system cells in dermis layer
Merkel cells mechanoreceptors in dermis layer
What cells are contained in Dermis? melanocytes, Langerhans cells, and Merkel cells
What are the layers of the skin? epidermis, dermis, hypodermis
Describe the epidermis cells and thickness. outermost layer composed of stratified squamous epithelium thickness ranges: 0.05mm (eyelid) to 1.5mm (palms and soles)
What are the steps in methodical approach for a derm pt? History, history, history, physical exam, diagnostics, treatments and re-assessment
What acronym-based and other methodical questions should you ask when obtaining derm patient history? 8 total 1. OLDCARTS 2. Associated symptoms 3. FHx 4. Medical Hx 5. Surgical Hx 6. Occupation and hobbies 7. Allergies 8. Current medications and previously attempted
Onset knowing if the symptoms occurred all of the sudden or were they had a gradual onset
Location where is the complaint on skin, do the symptoms radiate
Duration how long has this been bothering you or have you had any previous encounters
Character itching, burning, stabbing pain, etc
Aggravating factors what makes the symptoms worse (ex/ certain lotions, etc.)
Relieving factors what makes the symptoms better
Timing is it better or worse at certain times? Also, what is the timing of the events leading up to symptoms?
Severity 1-10 (10 being severe pain)
Why important to ask about associated symptoms or do Review of Symptoms (ROS)? Many skin symptoms are sequela of other disease processes (heart disease, SLE, etc.)
Why important to ask about hobbies work of patient? the pt may be exposed to certain chemicals or substances that are causing dermatological symptoms
What does OLDCARTS stand for? Onset, Location, Duration, Character, Aggravating factors, Relieving factors, Timing, Severity
Why important to ask about current medications or attempted treatments? failed treatments can exclude other diagnoses ex/ steroids would aggravate a fungal condition
Describe methodical approach to dermatological Physical Exam? 1. Examine where started 2. Identify old/ new lesions to determine if different; are lesions primary or secondary finding 3. Identify the distribution of the rash or lesions by examining pt completely, disrobe if necessary 4. do pertinent physical exam
Describe methodical approach to differential diagnoses of derm pt. Differential diagnoses= a list of possible diagnoses Order: most likely, most deadly, most common, zebras (refers to regionally-based areas and possible diagnosis)
What are some Dermatology-specific tests? biopsy, patch test (allergies), skin scrapings of scaly, or dry lesions (KOH for fungal, gram stain for bacterial), cultures (fungal, bacterial, viral), Tzank smear (herpes virus), Wood's light (fungal, dermatophyte)
What are some procedural treatments? cryotherapy, laser therapy, excision
What are medications for treatment? topical, intralesional (per-cutaneous injection), systemic (oral)
What education to provide patient? advise patient on 1. What to expect (peeling, dryness, or concerning side effects) or things to avoid (ex/ sun or bath w/ stitches) 2. Return precautions (ex/ if worsens with steroid Tx) 3. when to do follow up and why
Created by: mrjohnson78