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Methods and techniques for examining patients with skin and venereal diseases

For successful treatment of the patient, a correctly diagnosed disease is necessary. However, the diagnosis of the disease is the most difficult process. An important role in the diagnosis is played by experience, the ability to conduct differential diagnosis, use diagnostic methods and techniques that help establish the correct diagnosis.

We present some of the most common and used in everyday practice methods and techniques for examining skin and venereal patients, which nurses with higher education may well use in their practice.

Allergic tests are drip. They are used to detect allergen more often in occupational skin diseases. To apply them to healthy skin on the front surface of the forearm or epigastric region, a weak concentration of an aqueous or alcoholic solution of the test substance is applied with a pipette. For control, drops of solvent are applied. The reaction is taken into account after 24, 48, 72 hours. With a positive reaction, erythema, papule, vesicles, and bubble appear at the site of application of the sample.

Compression allergic tests (patchwork, application). A gauze napkin with an area of ​​1 cm2 is moistened with a weak solution of the test substance, applied to the skin of the front surface of the forearm, coated with cellophane on top and fixed with adhesive tape. The reaction is taken into account after 24, 48, 72 hours. A test is considered positive when erythema (redness) occurs at the site of contact (+); erythema, edema, papule (++); pronounced inflammation against the background of which papules and vesicles appear (+++); blisters and necrosis (++++).

Identification of itch moves. The affected area of ​​the skin is smeared with 3-5% iodine solution or aniline dye. The paint enters a linear slit and is observed as a colored line.

Thompson's two-glass test. It is used for topical diagnosis of urethral lesions. Before the test, the patient does not urinate for 4-6 hours. Urine is collected in two glasses: in the first - 50-60 ml, in the second - the rest. If the urine in the first glass is cloudy, and the second is transparent, then the process is localized in the front of the urethra. The presence of turbidity in both glasses indicates a total lesion of the urethra.

Dermographism allows you to determine the state of the autonomic nervous system. A dermograph, a blunt end of the stick, or a spatula rib draws a strip along the front surface of the chest. A white or red line appears at the pressure site.

Diagnosis of molluscum contagiosum. When squeezing the papule with two fingers or tweezers, a mushy mass is released.

Diagnostic triad for psoriasis. When scraping psoriatic papules, peeling increases and the scales resemble a drop of crushed stearin (the phenomenon of “stearin stain.”) Further scraping of the scales removes and exposes a wet pink film (phenomenon of the “terminal” or “psoriatic” film). Blood droplets appear on the film surface "spot bleeding" or "blood dew").

Diagnostic technique for condylomas. Genital warts (of viral origin) have a thin “leg” at their base. With wide (secondary syphilis) - the base of the elements is wide. With sticks, with cotton wound around their ends, the condylomas are pushed apart and inspect their base.

The study of tactile sensitivity. A piece of cotton wool is touching a specific area of ​​the skin. With leprosy, the patient does not feel touch.

Luminescent diagnosis of microsporia. A Wood lamp is used - glass soaked (impregnated) with nickel salts through which ultraviolet rays are passed. With microsporia, a bright green glow is noted in the lesions; Lighting is carried out in a dark room.

Examination of the genitals in women is performed in the position of the patient on the back in the gynecological chair. First, examine the labia majora, perineum, anal area, pay attention to color, the presence of rashes and secretions. Then, the vestibular vestibule, the mouth of the excretory ducts of the large glands of the vestibule are examined, palpating them with the thumb and forefinger. Inspect the external opening of the urethra, pay attention to color, swelling, discharge. Palpate the channel with the index finger. Using Cuzco mirrors, they examine the vagina, determine the size, shape of the cervix, the opening of the canal, color, swelling, erosion, discharge.
For microscopic examination, excretions from the cervical canal are taken with a grooved probe or a Folkmann spoon.

Examination of the genitals in men. The patient does not urinate for 4-6 hours. The skin of the lower abdomen, inner thighs, inguinal and femoral lymph nodes are examined. Then the penis, the outer and inner sheets of the foreskin, the head, the sponges of the external opening of the urethra are examined. If erosion or ulcers are detected, palpate them, and the discharge is examined for the presence of a pale spirochete. If there is a discharge from the urethra with sterile cotton, the first drop is removed, several smears are made, which are sent to the laboratory for research on gonococci or other flora. Then examine the scrotum, testicles, their appendages, spermatic cord. After inspection, conduct a two-glass test of Thompson.

Palpation of solid chancre. To identify the seal, the solid chancre is pressed at the base with two fingers and pulled up.

Balcer's test. It is used to diagnose pityriasis (multicolored) lichen. The spots are smeared with 5% iodine solution. Due to the loosening of the stratum corneum, the iodine solution is absorbed and the stain stains more intensively than healthy skin.

The reaction of Yarish - Herksheimer - Lukashevich. The exacerbation reaction develops with secondary fresh syphilis. After the introduction of antibiotics (usually after the third and fourth injections), the temperature rises to 38-390 C, rashes become bright, new rashes may appear. The reaction develops due to the death of a large number of spirochetes and the entry of endotoxin into the blood.

Wickham's net, a symptom of lichen planus. After lubricating the papules with any oil, a whitish-opal colored dot in the form of a grid is visible. This phenomenon is formed due to the uneven thickening of the granular layer of the epidermis.

Symptom visor for syphilis. When pulling the foreskin, a cartilaginous seal in the form of a dense visor is determined. The seal resembles a twisted eyelid.

Symptom P.V. Nikolsky. The first option: when pulling over scraps of the bladder tire, detachment of the upper layers of the epidermis is observed within apparently healthy skin. The second option: when rubbing healthy-looking skin between the bubbles, an epidermal detachment occurs. The third option: with the friction of apparently healthy skin in areas remote from the bubbles, the epidermis detaches. Nikolsky's symptom can be positive with true pemphigus, with bullous pemphigoid, Lyell syndrome, family pemphigus. When a finger is pressed on a whole bubble, its area increases due to the detachment of the tire on the periphery. This phenomenon is called a symptom of Asbo - Hansen.

Symptom of the failure of the Pospelov probe. With tuberculosis lupus, as a result of the destruction of collagen and elastic fibers, the tubercles acquire a soft consistency. When pressing on a tubercle with a button probe (match head), there remains an indentation, which very slowly disappears.

The symptom of a female heel is used to diagnose discoid lupus erythematosus. When removing the scales - crusts in the lesion, the patient feels soreness (sign Benier - Meshchersky), and on the inner surface of the crust visible spike formed due to follicular hyperkeratosis.

Symptom of "apple jelly." It is characteristic of lupus erythematosus and sarcoidosis. When the glass slide is pressed against the lesion site, blood is squeezed out of the dilated vessels of the tubercle and a brownish-yellow coloration appears that resembles the color of apple jelly (lupoma color).

The Kebner phenomenon (isomorphic reaction) is characteristic of psoriasis and lichen planus in the progressive stage of the disease. At the place of application of any scratches, burns, cuts to the skin, papules characteristic of this disease appear. In clinical conditions, for diagnostic purposes, the Koebner phenomenon is checked by irradiation in limited areas of the skin with suberythemic doses of quartz. On average, a reaction develops in one to two weeks.

The phenomenon of "honeycombs." In patients with infiltrative - suppurative trichophytosis with pressure on the inflammatory infiltration (celion Celsus), droplets of pus appear, reminiscent of a honeycomb.
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Methods and techniques for examining patients with skin and venereal diseases

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