Physical Assessment Thacker

Macule

  • Flat, circumscribed area
  • Change in color
  • Less than 1 cm diameter
  • Ex: freckles, flat moles, petechiae, measles

Papule

  • Elevated, firm, circumscribed area
  • Less than 1 cm diameter
  • Ex: warts, elevated moles, lichen planus

Patch

  • Flat, nonpalpable, irregular shaped macule
  • Greater than 1 cm in diameter
  • Ex: vitiligo, port-wine stains, mongolian spots

Plaque

  • Elevated, firm, rough lesion with flat top
  • Greater than 1 cm in diameter
  • Ex: psoriasis, suborrheic/actinic keratoses

Wheal

  • Elevated, irregular-shaped area of cutaneous edema
  • Variable diameter
  • Ex: insect bites, urticaria, allergic reaction

Nodule

  • Elevated, firm, circumscribed lesion
  • Deeper in dermis than papule
  • 1-2 cm in diameter
  • Ex: erythema nodosum, lipomas

Tumor

  • Elevated, solid lesion
  • Deeper in dermis
  • Greater than 2 cm in diameter
  • Ex: neoplasms, benign tumor, lipoma

Vesicle

  • Elevated, circumscribed, superficial lesion
  • Not into dermis
  • Filled with serous fluid
  • Less than 1 cm in diameter
  • Ex: varicella, herpes zoster

Bulla

  • Vesicle greater than 1 cm in diameter
  • Ex: blister, pemphigus vulgaris

Pustule

  • Elevated, superficial lesion
  • Similar to vesicle but filled with purulent fluid
  • Ex: impetigo, acne

Cyst

  • Elevated, circumscribed, encapsulated lesion
  • In dermis or subcutaneous layer
  • Filled with liquid or semi-solid material
  • Ex: sebaceous cyst, cystic acne

Telangiectasia

  • Fine, irregular, red lines produced by capillary dilation
  • Ex: rosacea

Scale

  • Heaped-up, keratinized cells
  • Flaky skin
  • Ex: seborrheic dermatitis, post scarlet fever, post drug reaction, dry skin

Lichenification

  • Rough, thickened epidermis secondary to persistent rubbing, itching, skin irritation
  • Often involves flexor surface of extremitiy
  • Ex: chronic dermatitis

Keloid

  • Irregular shaped, elevated, progressively enlarged scar
  • Grows beyond boundary of wound
  • Caused by excessive collagen formation during healing
  • Ex: post surgery

Scar

  • Thin to thick fibrous tissue that replaces normal skin following injury or laceration to dermis
  • Ex: healing wound or surgical incision

Excoriation

  • Loss of epidermis
  • Linear, hollowed-out, crusted area
  • Ex: abrasion, scratch, scabies

Fissure

  • Linear crack or break from epidermis to dermis
  • Ex: athletes foot, cracks at corner of mouth

Erosion

  • Loss of part of epidermis
  • Depressed, moist, glistening
  • Follows rupture of vesicle or bulla
  • Ex: varicella, variola after rupture

Ulcer

  • Loss of epidermis and dermis
  • Concave, varies in size
  • Ex: decubiti, stasis ulcers

Crust

  • Dried serum, blood, purulent exudates
  • Slightly elevated, size varies
  • Ex: scab on abrasion, eczema

Atrophy

  • Thinning of skin surface and loss of skin margins
  • Skin translucent, paper-like
  • Ex: striae, aged skin

Basal Cell Carcinoma: Warning Signs

  1. Open sore > 3 weeks
  2. Reddish patch
  3. Shiny nodule
  4. Pink growth
  5. Scarlike area

Squamous Cell Carcinoma: Warning Signs

  1. Wart-like growth
  2. Persistent scaly red patch
  3. Open sore
  4. Elevated growth with central depression

Malignant Melanoma: Warning Signs

  1. Asymmetry
  2. Borders
  3. Color
  4. Diameter > 6 mm

Clubbing

  • Associated with cardiac/respiratory diseases, cirrhosis, colitis, thyroid disease
  • Schamroth Technique — place dorsal surface of fingertips together from right and left hand

Longitudinal Ridging in Older Patients
A common nail finding
Subungual Hematoma
Caused by injury
Habit-tic deformity
Caused by injury
Paronychia
Caused by an infection
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