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Dermatology: A day in the Office + Some Useful Photos (aka You Can’t Learn It All in One Day)

February 16, 2011

Dermatology is a pretty interesting field.  I had the privilege of working with my town’s local dermatologist last week. She’s quite skilled and has a very interesting range of patients. Doctors (including myself) are sometimes too quick to refer, so I thought I’d try and learn about clear management plans for some common issues and a bit more about diagnosing some of the weirder ones. While you can biopsy just about anything, it’s much nicer for the patient if you can treat it without needing to take that step. Saves time, relieves the stress of waiting for results, and avoids creating a scar (however little).

I was shocked by how emotional people could be in a specialist’s office. There were patients afraid of skin cancer, one who’d been battling an ulcer for a year with little progress and much frustration, and those with (to others) tiny cosmetic issues that proved central to their self-view. Tears flew, people fainted, oh it was dramatic! But what struck me most was how a clear plan from an experienced specialist could give them hope for their acne/eczema/actinic keratoses or whatever. Even putting a name to what they were confronting seemed to make a world of difference.

There are lots of diseases that are simply restricted to the skin. The more fascinating dermatological concerns are the ones that signal other illness. Dermatologists have to be like radiologitsts – knowing a bit about all kinds of diseases, so they can put the skin – like the CT image – in context . I thought I’d never see a Derm specialist order a chest x-ray, but sure enough, for a patient with cutaneous sarcoidosis, that was the thing to do.

Being very much based on the visual sense, pattern recognition, and remembering that atypical presentations of common diseases are more frequent than rare diseases, seeing lots and lots of patients with a knowledgeable preceptor or colleague seems the way to learn. That, or looking at lots and lots of pictures.

To that end, here are the best 10 slide shows from 2010 on MedScape: some of the key ones are Derm. Of course you can learn more than just skin diagnoses from slideshows; I didn’t take the Radiology and Cardiology out of this post since they are pretty useful for browsing too. You’ll need a login (free) to access:

Medscape from WebMD
Top Slideshows of 2010

Review “cannot miss” common skin rashes, critical findings of plain chest radiographs, pediatric rashes that range from the seemingly innocuous to the clearly alarming, subtle findings on chest radiographs, rashes that require urgent care, underlying causes of nail disease, severe pathologies on abdominal radiographs, best practices for foreign body removal, subtle myocardial infarctions that may be easily overlooked on an ECG, and steps for reducing a dislocated shoulder.

Common Rashes Common Rashes Not to Miss 

Skin rashes are common complaints. Although many symptoms overlap, there are identifiable factors for each disease. Do you know the factors?

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Plain Chest X-Ray Can’t Miss Critical Findings on Plain Chest Radiography 

Chest radiographs, first viewed by non-radiologists, are the most common radiologic tests performed in hospitals and emergency departments. Can you identify the “can’t miss” findings?

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Pediatric Rashes Pediatric Rashes to Worry About 

Pediatric patients can present with rashes that range from the seemingly innocuous to the clearly alarming. Use our case-based slideshow to identify key clues for can’t-miss diagnosis.

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Chest Radiographs Easy-to-Miss Findings on Chest Radiographs 

While there are many disease processes that are very obvious at first glance of chest radiographs, healthcare providers must be careful not to miss more subtle findings.

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Worrisome Rashes Which Rashes to Worry About 

When is a rash not just a rash? Review this slideshow and test your knowledge on differentiating benign rashes versus those requiring emergent care.

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Diseases of the Nails Diseases of the Nails 

Diseases of the nails can result in significant social, psychological, and physical damages. Can you match the nail to the disease?

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Intestinal Complications Can’t Miss Intestinal Complications on Abdominal Radiographs 

Do you know your way around a plain radiograph for patients with abdominal pain? Test your knowledge on intestinal pathologies.

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Foreign Objects Foreign Objects Found in Patients 

Foreign bodies carry a unique set of presentations, risks, and treatment options. This slideshow presents some common foreign bodies and what appropriate steps and treatment options to take.

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Missing an MI? Are You Missing an MI? 

The subtle myocardial infarction may be easily overlooked. Use our slideshow to test your skill.

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SDRT Shoulder Dislocation Reduction Technique 

Shoulder dislocations affect approximately 1.7% of the population and are most frequently secondary to trauma. Do you know what the different procedures are in relocating a shoulder?

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3 Comments leave one →
  1. February 16, 2011 2:47 am

    I love the emed slide shows. Thanks for posting! I just went through the peds not-to-miss one. Yikes.

  2. February 16, 2011 7:24 am

    Thanks! Very useful resource, especially since my school did a horrid job of teaching derm.

  3. February 22, 2011 1:57 am

    OMG…kill it with fire!

    I just looked at the slide show on poisonous spiders and bites. I think I will have nightmares.

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