Sick Call Screener Course. Integumentary System
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1 Sick Call Screener Course Integumentary System (2.10)
2 Enabling Objectives 1.52 Utilize the knowledge of integumentary system anatomy while assessing a patient with a integumentary complaint 1.53 Utilize the knowledge of integumentary system physiology while assessing a patient with a integumentary complaint 1.54 Identify types of lesions 1.55 Perform a dermatological examination
3 Enabling Objectives (Cont.) 1.56 State signs and symptoms of common dermatological disorders 1.57 State treatments for common dermatological disorder 1.16 State Red Flag criteria
4 Introduction Helps maintain a constant body temperature Protects the body Provides sensory information about the surrounding environment
5 Integumentary System Skin Hair Oil & Sweat Glands Nails Sensory Receptors Skin, Hair, and Nails Seidel's Guide to Physical Examination
6 Epidermis Stratum Corneum: Protection from harmful environment Cellular Stratum: Keratin cells are synthesized Bates guide to physical examination and history taking [12th ed.]. My Athens/ STAT!Ref
7 Dermis Connective tissue layer of the skin Supports and separates the epidermis from the cutaneous adipose tissue Bates guide to physical examination and history taking [12th ed.]. Philadelphia, PA.) My Athens/ STAT!Ref
8 Hypodermis Also known as the subcutaneous layer (subq) Bates guide to physical examination and history taking [12th ed.]. My Athens/ STAT!Ref
9 Skin Appendages Sebaceous Glands Also known as the Oil Glands Sweat Glands The cells of these glands release sweat Skin graft Plastic Surgery: Volume 1: Principles. Scherer-Pietramaggiori, Saja S.; Pietramaggiori, Giorgio; Orgill, Dennis P... Published January 1, Pages e My Athens/ clinical key
10 Hair Hair Columns of dead keratinized epidermal cells Skin, nails and hair Hutchison's Clinical Methods: An Integrated Approach to Clinical Practice. Cerio, Rino... Published January 1, Pages Figure My Athens/ Clinical Key
11 Nails Nails Plates of tightly packed, hard, dead, keratinized epidermal cells The skin, hair and nails Macleod's Clinical Examination. Gawkrodger, David... Published January 1, Pages Fig My Athens/ Clinical Key
12 Functions of the Skin Thermoregulation Blood Reservoir Protection Cutaneous Sensation Excretion and Absorption Synthesis of Vitamin D Characterization and Management of Dermatologic Adverse Events With the NovoTTF-100A System, a Novel Anti-mitotic Electric Field Device for the Treatment of Recurrent Glioblastoma Seminars in Oncology. Lacouture, Mario E.; Elizabeth Davis, Mary; Elzinga, Grace Show all... Published June 1, Volume 41, Supplement 4. Pages S1-S Figure 3. My Athens/ Clinical Key
13 Functions of the Sebaceous Secrete an oily substance called sebum Glands Skin and Breast Stevens & Lowe's Human Histology. Lowe, James S., BMedSci, BMBS, DM, FRCPath; Anderson, Peter G., DVM, PhD... Published January 1, Pages FIGURE My Athens/ Clinical Key
14 Functions of the Sweat Glands Regulate body temperature through evaporation Skin and Breast Stevens & Lowe's Human Histology. Lowe, James S., BMedSci, BMBS, DM, FRCPath; Anderson, Peter G., DVM, PhD... Published January 1, Pages FIGURE My Athens/ Clinical Key
15 Functions of Hair Provides protection and decrease heat loss Structure and function of skin, hair and nails Medicine. Lai-Cheong, Joey E.; McGrath, John A... Published June 1, Volume 45, Issue 6. Pages Figure 4. My Athens/ Clinical Key
16 Functions of Nails Protects the distal end of the digits Structure and function of skin, hair and nails Medicine.Lai-Cheong, Joey E.; McGrath, John A... Published May 1, Volume 37, Issue 5. Pages Figure 4. My Athens/Clinical Key
17 Cutaneous Lesions Identified based upon clinical appearance Biopsy is necessary for definitive dignosis. Treatment of a Crohn's disease related cutaneous facial lesion with topical tacrolimus Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. Shah, Neha P., BDS; Goel, Rishi M., MBBS, Show all. Published September 1, Volume 118, Issue 3. Pages e71-e Fig. 1. My Athens/ Clinical Keys
18 Lesion Evaluation Irregularities should be evaluated for: A- Asymmetry B- Borders C- Color D- Diameter E- Evolution over time Seidel's Guide to Physical Examination.. Published December 31, Pages My Athens/ Clinical Key
19 Skin Lesion Description Good description includes: Number Size Color Shape Texture Primary lesion Location Configuration Seidel's Guide to Physical Examination. Published January 1, Pages My Athens/ Clinical Key
20 Primary Lesions Describing Findings: Primary Lesion Flat Macule Patch Seidel's Guide to Physical Examination. Published January 1, Pages Lichen planus. My Athens/ Clinical Key
21 Primary Lesions (Cont.) Describing Findings: Primary Lesion Raised Papule Plaque Vesicle Bulla Seidel's Guide to Physical Examination. Published January 1, Pages Lichen planus. My Athens/ Clinical Key
22 Number of Lesions Describing Findings: Number Solitary or multiple If multiple, record how many Seidel's Guide to Physical Examination. Published January 1, Pages FIG. 9.8 (From Hoffbrand et al, 2010.) Senile purpura. My Athens/ Clinical Key
23 Size Describing Findings: Size Measure with ruler Millimeters or Centimeters Seidel's Guide to Physical Examination. Published January 1, Pages FIG (From the Centers for Disease Control and Prevention/Carl Washington, MD, Emory University School of Medicine; Mona Saraiya, MD, MPH.) Malignant melanoma. My Athens/ Clinical Key
24 Shape Describing Findings: Shape Examples are "circular," "oval," "annular" Vesiculopustular Eruptions Pediatric Dermatology. Cohen, Bernard A... Published January 2, Pages Fig My Athens/Clinical Key Vesiculopustular Eruptions Pediatric Dermatology. Cohen, Bernard A... Published January 2, Pages Fig My Athens/ Clinical Key
25 Color Describing Findings: Color Refer to a color wheel Both images from Seidel's Guide to Physical Examination. Published January 1, Pages My Athens/ Clinical Key
26 Texture Describing Findings: Texture Palpate the lesion Both images from Seidel's Guide to Physical Examination. Published January 1, Pages My Athens/ Clinical key
27 Location Describing Findings: Location For single lesions, measure their distance from other landmarks Seidel's Guide to Physical Examination. Published January 1, Pages FIG (From Keimig, 2015.) Annular formation of lesions (granuloma annulare). My Athens/ Clinical Key
28 Configuration Describing Findings: Configuration Describing patterns is often very helpful Basic Principles of Dermatology Dermatology. High, Whitney A.; Tomasini, Carlo Francesco; Show all. Published January 1, Pages Fig My Athens/ Clinical Keys
29 Secondary Lesions Scales Crusts Excoriations Erosion Ulcer Scar Fissure Both images from Syphilis, Yaws, Bejel, and Pinta Andrews' Diseases of the Skin. James, William D., MD; Berger, Timothy G., Show all. Published January 1, Pages e Fig
30 History Subjective includes: CC HPI PMH Family History Personal and Social History Review of Systems Bates guide to physical examination and history taking [12th ed.]. Philadelphia, PA.) My Athens/ STAT!Ref
31 History of Present Illness Changes in skin Changes to lesions Onset Location Duration Characteristics Exposure to environment, travel, people What makes it better or worse Treatments tried
32 Past Med Hx Previous skin problems Sensitivities to light and touch Loss, growth or thinning of hair Systemic disease Infections
33 Family Hx Dermatologic disorders or diseases Allergies Hair loss
34 Personal and Social Hx Skin care Hair care Nail care Tobacco Alcohol STIs
35 Review of Systems Constitutional Cardio Gastro Blood/lymph Endocrine
36 Skin Examination Inspection Palpation Bates guide to physical examination and history taking [12th ed.]. Philadelphia, PA.) My Athens/ STAT!Ref
37 Hair Examination Inspection Scalp, face, neck, chest, back, arms, legs, pubic region Palpation Texture Dryness
38 Nail Examination Inspect Color, length, shape, configuration, cleanliness and symmetry Palpate Uniformity, thickness, hardness, softness and smoothness
39 Special Tests Woods Lamp Test Used to identify if a lesion is caused by a fungal infection Lesion will fluoresce if a fungus is present
40 Acne Vulgaris Signs and Symptoms Mild Acne Moderate Acne Severe Acne Seidel's Guide to Physical Examination. Published January 1, Pages FIG (From Swartz, 2014.) Acne in adolescent. My Athens/ Clinical key
41 Acne Plan Keep face clean and dry Mild Form Moderate Form Severe Form The Skin Textbook of Physical Diagnosis. Swartz, Mark H., MD, FACP... Published January 1, Pages e Figure 5 77 Acne. My Athens/ Clinical Key
42 Folliculitis Folliculitis Furuncles Carbuncles Folliculitis Dermatology Essentials. Published January 1, Pages Fig Courtesy, A. Paul Kelly, MD. Pseudofolliculitis barbae. Multiple firm hyperpigmented papules on the lower face and neck (beard distribution). My Athens/ Clinical Key
43 Folliculitis (Cont.) Signs and Symptoms Folliculitis Furuncles Carbuncle Folliculitis Dermatology Essentials. Published January 1, Pages Fig Courtesy, A. Paul Kelly, MD. Pseudofolliculitis barbae. Multiple firm hyperpigmented papules on the lower face and neck (beard distribution). My Athens/ Clinical Key
44 Folliculitis Plan Keep hands off the face Avoid squeezing lesions Immobilize area Avoid over manipulation Folliculitis Antibiotics Folliculitis Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Chen, Chen Mary ; Phelps, Robert G... Published January 1, Pages My Athens/ Clinical Key
45 Furuncle & Carbuncle Plan Furuncles Hot compress May require I&D Antibiotics Carbuncles Hot compressed I&D if fluctuant Antibiotics Skin and Soft Tissue Infections American Family Physician. Published September 15, Volume 92, Issue 6. Pages E Figure 3 Furuncle. My Athens/ Clinical Key Bacterial infection Staphylococcal and streptococcal Dermatology: An Illustrated Colour Text Published January 1, Pages Fig My Athens/ Clinical Key
46 Impetigo Signs and Symptoms Starts as a small papule Progresses into eroded vesicles Honey-colored crusted plaques" with erythematous base. Bacterial Infections Oral and Maxillofacial Pathology. Published January 1, Pages Fig. 5-2 Impetigo
47 Impetigo Plan Keep area clean and dry Antibiotics Refer to provider for isolation procedures Infections and infestations of the skin Paediatrics and Child Health. Goodyear, Helen... Published February 1, Volume 25, Issue 2. Pages Figure 1 Impetigo My Athens/ Clinical Key
48 Signs and Symptoms Large, well-defined area of erythema Edema and pain with touch The appearance and texture is that of an orange peel Cellulitis Cellulitis Clinical Overview. Published April 21, (2):96-9, 2008, Figure 1B. My Athens/ Clinical Key
49 Cellulitis Plan Warm soaks, bed rest, keep affected area elevated Antibiotics Refer to provider for isolation procedures Cellulitis Ferri's Clinical Advisor Published January 1, Pages e FIG. E1 From White GM, Cox NH, eds: Diseases of the skin, ed 2, St Louis, 2006, Mosby. Erysipelas of the leg.b My Athens/ Clinical Key
50 Pityriasis Rosea Signs and Symptoms Numerous flesh-colored or mildly erythematous papules and plaques with fine scaling Herald patch" and bilateral/symmetrical lesions Patient does not look ill Papulosquamous eruptions Dermatology: An Illustrated Colour Text. Gawkrodger, Published January 1, Pages e Fig My Athens/ Clinical Key
51 Pityriasis Rosea Plan Symptomatic treatment No medications can cure Expose affected areas to the sun Lesions sometime take as long as 8 weeks to cure If persistent Pityriasis Rosea: Diagnosis and Treatment, American Family Physician. Published January 1, Volume 97, Issue 1. Pages Figure 2 Reprinted with permission from Stulberg DL, Wolfrey J. Pityriasis rosea. Am Fam Physician. 2004;69(1):88. My Athens/ Clinical Key
52 Psoriasis Chronic Disease Over production of new skin Areas of body Cosmetics issue Psoriasis Emery and Rimoin's Principles and Practice of Medical Genetics. Published January 1, Pages FIGURE My Athens/ Clinical Key
53 Psoriasis (Cont.) Signs and Symptoms Irregularly shaped thickened plaques with flaky silver scales Excoriation Pitting of the nails Arthritis Psoriasis Emery and Rimoin's Principles and Practice of Medical Genetics. Published January 1, Pages FIGURE My Athens/ Clinical Key
54 Psoriasis Plan Mild Steroid cream & sun bathing Moderate Topical steroid Severe Dermatologic consultation Psoriasis Clinical Overview. Published July 19, Chronic plaque psoriasis, Psoriasis. Medicine. 37(5):235-41, Figure 1, My Athens/ Clinical Key
55 Tinea Infections Signs and Symptoms Findings range from mild scaling and erythema to exfoliation, fissuring and maceration. It is prudent to take samples of the scales Tinea Pedis, Tinea Cruris, Tinea Corporis: (Athlete s Foot, Jock Itch, Ringworm) Minor Emergencies. Published January 1, Pages Figure (From White G, Cox N: Diseases of the skin, ed 2. St Louis, 2006, Mosby.) Tinea corporis. My Athens/ Clinical Key
56 Tinea Capitis & Tinea Corporis Signs and Symptoms Tinea Capitis Evaluation and Management of the Hair Loss Patient in the Primary Care Setting Primary Care: Clinics in Office Practice. Published December 1, Volume 42, Issue 4. Pages Fig. 11. MY Athens/ Clinical Key Areas of alopecia, scaling Tinea Corporis Annular lesions Dermatophyte infections Ferri's Color Atlas and Text of Clinical Medicine. Published January 1, Pages Fig 26-1 (Courtesy of Dr. M. M. Black, Institute of Dermatology, London.) Tinea corporis. MY Athens/ Clinical Key
57 Tinea Cruris Signs and Symptoms Tinea Cruris Intertriginous areas on adjacent upper thigh and buttock Scrotum rarely ever involved Topical therapy and topical corticosteroids Clinical Dermatology. Published January 1, Pages FIGURE My Athens/ Clinical Key
58 Tinea Manus Signs and Symptoms Tinea Manus Usually in the dominant hand of a patient Fungal Infections Skin Disease: Diagnosis and Treatment. Published January 1, Pages Fig My Athens/ Clinical Key
59 Tinea Pedis Signs and Symptoms Tinea Pedis Intensely pruritic May look like annular lesions with an advancing serpinginous borders with central clearing Superficial fungal infections Clinical Dermatology. Published January 1, Pages FIGURE 13-6 Tinea pedis. My Athens/ Clinical Key
60 Tinea Plan Topical antifungals Oral antifungals Foot powder Hygiene practices Dermatitis (Eczematoid Reactions) Urgent Care Dermatology: Symptom-Based Diagnosis. Published January 1, Pages Fig My Athens/ Clinical Key
61 Tinea Versicolor Signs and Symptoms Fungal infection Primarily on the back and chest Hot, humid weather Patches can be either lighter or darker than the surrounding skin Tinea versicolor (pityriasis versicolor) Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Published January 1, Pages My Athens/ Clinical Key
62 Tinea Versicolor Plan Selsun shampoo Educate patient If no resolution The Skin Textbook of Physical Diagnosis. Published January 1, Pages e Figure My Athens/ Clinical Key
63 Eczema Signs and Symptoms Eczematous inflammation Redness, scaling, vesicles and itching Eczema Skin Disease: Diagnosis and Treatment. Published January 1, Pages Fig My Athens/ Clinical Key
64 Eczema Plan Topical and systemic corticosteroids Educate patients Eczema Skin Disease: Diagnosis and Treatment. Published January 1, Pages Fig My Athens/ Clinical Key
65 Contact Dermatitis Signs and Symptoms Intensely pruritic and becomes erythematous Grouped vesicles/bullae of varying sizes Lesions erupt, weep and painful Contact Dermatitis and Drug Eruptions Andrews' Diseases of the Skin Clinical Atlas. Published January 1, Pages Fig My Athens/ Clinical Key
66 Contact Dermatitis Plan Antihistamines Wash the exposed area with soap and water Topical medications Instruct patient to avoid irritating agents Contact Dermatitis and Drug Eruptions Andrews' Diseases of the Skin. Published January 1, Pages e
67 Atopic Dermatitis Signs and Symptoms Erythematous scaling skin Blisters, oozing and crusting Markedly dry, thickened and scratched Atopic dermatitis/ eczema Clinical Overview. Published December 14, Piel. 31(1):15-23, 2016, Figure 5. My Athens/ Clinical Key
68 Atopic Dermatitis Plan Topical steroids Oral antihistamines Oral antibiotics Good skin care Atopic Dermatitis and Food Allergy Food Allergy. Published January 1, 2012.Pages Figure 5.1. My Athens/ Clinical Key
69 Urticaria Signs and Symptoms Generalized distribution of well circumscribed wheals with red, raised borders May be the first sign of Anaphylaxis Urticaria, angioedema, and pruritus Clinical Dermatology. Published January 1, Pages FIGURE 6-11.My Athens/ Clinical Key
70 Urticaria Plan Antihistamines Call medical officer immediately if evidence of anaphylactic reaction Urticaria Skin Disease: Diagnosis and Treatment. Published January 1, Pages Fig My Athens/ Clinical Key
71 Scabies Signs and Symptoms May not appear up to a month Gray brown or skin colored ridges Secondary bacterial infections Scabies Crustosa Following Corticosteroid Therapy in an Elderly Patient American Journal of the Medical Sciences, The. Sivasubramanian, Published March 1, Volume 343, Issue 3. Pages Figure 2. My Athens/ Clinical Key Scabies Clinical Overview. Published May 12, My Athens/ Clinical Key
72 Scabies Plan Topical medication Close contacts should also be treated simultaneously Personal items should be washed Refer to provider for isolation procedures Scabies Clinical Overview. Published May 12, My Athens/ Clinical Key
73 Pediculosis Signs and Symptoms Itching in the involved areas Lice and eggs (nits) cemented to the bases of hair shafts close to the skin Pediculosis Clinical Overview. Published September 10, My Athens/ Clinical Key Lice (Pediculosis) Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. Published January 1, Pages e FIGURE My Athens/ Clinical Key
74 Pediculosis Plan Good hygiene measures Recommend shaving hair Lice (Pediculosis) Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. Published January 1, Pages e FIGURE My Athens/ Clinical Key
75 Warts Signs and Symptoms Flesh colored Dome shaped Firm papule Corrugated surface Warts, herpes simplex, and other viral infections Clinical Dermatology. Published January 1, Pages FIGURE My Athens/ Clinical Key
76 Warts Plan Cryotherapy with liquid nitrogen Only a medical provider should use cryotherapy on genital warts Wart Treatment Atlas of Essential Procedures. Published January 1, Pages FIGURE 7-4. My Athens/ Clinical Key
77 Herpes Signs and Symptoms Clustered vesicles Painful ulcerated lesions Erythematous base Develop on pharyngeal and oral mucosa Rapidly ulcerate, and increase in number Human herpes simplex virus infections: Epidemiology, pathogenesis, symptomatology, diagnosis, and management Journal of the American Academy of Dermatology. Published November 1, Volume 57, Issue 5. Pages Fig 7. My Athens/ Clinical Key
78 Herpes Plan Acyclovir Valacyclovir Avoid salty, acidic, or sharp foods Reinforce safe sexual practices Update on Oral Herpes Virus Infections Dental Clinics of North America. Published April 1, Volume 58, Issue 2. Pages Fig. 2. My Athens/ Clinical Key
79 Shingles (Herpes Zoster) Signs and Symptoms Prodromal Phase Tingling, paresthesias Itching Boring "knife-like" pain Acute Phase Rash Vesicles Herpes zoster infection (shingles) Clinical Overview. Published December 15, My Athens/ Clinical Key
80 Herpes Zoster Plan Antiviral agents Warn of potential risk of transmitting illness Herpes zoster infection (shingles) Clinical Overview. Published December 15, My Athens/ Clinical Key
81 Chickenpox Signs and Symptoms Rash Pruritic rash present in various stages Lesions may be present on mucous membranes Varicella Treatment of Skin Disease: Comprehensive Therapeutic Strategies. Published January 1, Pages My Athens/ Clinical Key Varicella Ferri's Clinical Advisor Published January 1, Pages e FIG. 1. My Athens/ Clinical
82 Chickenpox Plan Supportive: antipyretics for fever Avoid aspirin in children Local and/or systemic antipruritic agents for itching Varicella (Chickenpox) Conn's Current Therapy Mayans, Laura, MD, MPH... Published January 1, Pages Figure 2. My Athens/ Clinical Key
83 Skin Cancer Two distinct types: Non-Melanoma Skin Cancer (NMSC) Basal Cell Carcinoma (BCC) Squamous Cell Carcinoma (SCC) Melanoma Results of the treatment of skin cancer European Journal of Cancer. Published August 1, Volume 63. Pages Fig. 4. My Athens/ Clinical Key
84 Basal Cell Carcinomas Slow growing malignant lesion that rarely metastasize Both images from Malignant Skin Neoplasms Medical Clinics of North America. Published November 1, Volume 93, Issue 6. Pages Fig. 8. My Athens/ Clinical Key
85 Squamous Cell Carcinomas Extensive malignant lesion involving the dermis and epidermis Both images from Malignant Skin Neoplasms Medical Clinics of North America. Published November 1, Volume 93, Issue 6. Pages Fig. 8. My Athens/ Clinical Key
86 Malignant Melanoma Deadliest ABCDE of Melanoma Clinical and dermoscopic characterization of pediatric and adolescent melanomas: Multicenter study of 52 cases Journal of the American Academy of DermatologyPublished February 1, Volume 78, Issue 2. Pages My Athens/ Clinical Key. Melanoma Dermatology Secrets Plus. Published January 1, Pages My Athens/ Clinical Key
87 Malignant Melanoma (Cont.) (A) Asymmetrical (B) Borders irregular (C) Color variation (D) Diameter larger than pencil eraser (E) Elevated lesion Skin, Hair, and Nails Seidel's Guide to Physical Examination. Published January 1, Pages FIG My Athens/ Clinical Key
88 Skin Cancers Plan Referral to Dermatology is required for positive findings Skin Cancer Atlas of Diagnostic Oncology. Published January 2, Pages FIGURE My Athens/ Clinical Keys
89 Cancer Screening Test Screening and early detection 3 Point Checklist Cutaneous Manifestations of Internal Disease Skin Disease: Diagnosis and Treatment. Published January 1, Pages Fig My Athens/ Clinical Key
90 Three-Point Checklist Based on 3 dermoscopic criteria: Asymmetry of pattern and distribution Atypical network Blue-white structures Dermoscopy. Published January 1, Pages Figure 14. My Athens/ Clinical Key
91 Checklist Scoring One point is assigned to each criterion present Two points is considered positive
92 Enabling Objectives 1.52 Utilize the knowledge of integumentary system anatomy while assessing a patient with a integumentary complaint 1.53 Utilize the knowledge of integumentary system physiology while assessing a patient with a integumentary complaint 1.54 Identify types of lesions 1.55 Perform a dermatological examination
93 Enabling Objectives (Cont.) 1.56 State signs and symptoms of common dermatological disorders 1.57 State treatments for common dermatological disorder 1.16 State Red Flag criteria
94 Questions
95 Application Integumentary System, Job Sheet SCSC SCSC Performance Test
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