Physical Exam Information

 

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Your Neurological and Dermatological Exam

 

The Doctor Will do a Neurological Exam

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A neurological examination is the assessment of sensory neuron and motor responses, especially reflexes, to determine whether the nervous system is impaired. This typically includes a physical examination and a review of the patient's medical history but not deeper investigation such as neuroimaging. It can be used both as a screening tool and as an investigative tool, the former of which when examining the patient when there is no expected neurological deficit and the latter of which when examining a patient where you do expect to find abnormalities. If a problem is found either in an investigative or screening process then further tests can be carried out to focus on a particular aspect of the nervous system (such as lumbar punctures and blood tests).
Generally a neurological examination is focused towards finding out if there are lesions in the central and peripheral nervous systems or whether there is another diffuse process which is troubling the patient. Once the patient has been thoroughly tested, it is then the role of the physician to determine whether these findings combine to form a recognizable medical syndrome or neurological disorder such as Parkinson's disease or motor neuron disease. Finally, it is the role of the physician to find the etiological reasons for why such a problem has occurred, for example finding if the problem was due to inflammation or congenital.

The Doctor Will Check for Any Skin Abnormalities

What to expect when visiting a dermatologist for a full body skin exam and how to get the most out of the visit.

Your doctor will be looking at your skin during your physical exam, even though he or she may not make a specific point of making this a separate part of your exam.  In the even that abnormalities are found, you may be referred to a dermatologist.

Because the doctor sees you only during the office visits, it is important that you perform a self skin exams monthly. By doing so, you will be able to point out specific lesions about which you are concerned because they are growing or changing in size, color, or texture. Always point out any moles or growths that bleed or will not heal while the dermatologist is examining your skin. These characteristics make lesions suspicious for cancer and this will help direct the dermatologist to address any lesions you find concerning.

Because skin cancer can appear on any part of the body (sun exposed and non-sun exposed areas alike), be prepared for a "true" full body skin exam in which the entire body is scanned. This includes fingers, toes, and areas normally covered by undergarments. It is important to try to not be "shy" as a skin lesion is best examined when it can be seen and felt.

If your doctor feels there is a lesion suspicious for cancer, a biopsy may be performed. There are several different types of skin biopsy, depending on the size of the lesion and how much skin the dermatologist feels is necessary to ascertain the diagnosis. The most common biopsy technique is called a "shave biopsy." For this procedure, the area of interest in locally anesthetized with a fast acting injection followed by removal of the lesion using a blade (razor blade or scalpel blade). These biopsies are fairly superficial and do not require stitches. This technique is the most commonly employed technique when skin cancer is suspected.

It the dermatologist needs to get deeper tissue, a "punch" biopsy may be performed. For this procedure, the area again is injected with local anesthesia and then a small round shaped "cookie cutter" (usually around 3 mm in diameter) is used to remove a small plug of skin. This technique allows the dermatologist to reach tissue as deep as the fat to send for pathology. This small hole can be closed with 1 or 2 stitches or this small hole may be left open to heal on its own.

When a lesion is very suspicious for melanoma, an excisional biopsy may be performed in which the entire lesion is excised with a small margin of normal skin. Stitches are usually required and this technique provides the pathologist a large piece of tissue in order to correctly measure the depth of the melanoma. In comparison with the excisional biopsy, an "incisional" biopsy may be performed on a very large lesion. In this case, a piece of the skin tumor is excised but much of the lesion remains. This allows for deep piece of tissue to be sent to the pathologist.

Once the biopsy is performed, the sample is sent to a pathology lab where it is processed and sliced like a loaf of bread. The pathologist then views several "slices" in order to confirm the diagnosis. One should expect the result within one to two weeks.

    
       

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