Integumental: Examination
  1. Environment
  2. General inspection
  3. Inspect: entire skin, lesions
  4. Palpate: lesions, nodes
Environment
  • N/A so far.
General appearance
  • Pt undresses, so entire skin can be examined.
  • Pt. is scratching.
Inspect: entire skin
  • Dry skin (hypothyroid).
  • Thick skin (acromegaly, androgens).
  • Thin skin (Cushing's, hypothyroid, liver dz).
  • Stretched skin (scleroderma).
  • Scratch marks.
  • Swollen lymph nodes.
  • Systemic rash.
Inspect: lesion
  • Location:
    Sun exposed vs. covered.
    Asymmetrical vs. symmetrical.
    Number.
    Peripheral vs. trunk.
    Hallmark locations. See Hallmark Rashes Reference
  • Pattern:
    See Skin Lesion Patterns Reference.
    Discrete vs. confluent.
  • Colour.
  • Size.
  • Shape.
  • Edges:
    Well demarcated vs. poorly demarcated.
  • Surface:
    Scaling, crusting.
    Shiny vs. dull.
    Thickening, blistering.
    Ulceration, skin breaks, fissures.
    Elevation.
  • Discharge, bleeding.
  • Type of lesion. See Skin Lesion Terminology Reference.
Palpate: lesions
  • Ask pt. if tender, first.
  • Palpate lesions/masses. See Examining A Mass Reference.
  • Flat vs. raised.
  • Temperature (inflammatory).
  • Apply pressure:
    Blanches on pressure.
    Doesn't blanche on pressure (purpura).
  • Record type of lesion. See Skin Lesion Terminology Reference.
  • See if similar lumps can be found elsewhere (eg RA nodules).
Palpate: nodes
  • If inflammation or carcinoma: palpate draining nodes for the lesions.
  • See Nodes Reference.