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Physical Diagnosis > 2 Dermatology > Flashcards

2 Dermatology Flashcards

1
Q

Functions of epidermis?

A
  • barrier from environment

- waterproofing

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2
Q

What is in the dermis?

A
  • blood vessels
  • hair follicles
  • sebaceous glands
  • sweat glands
  • nails
  • apocrine glands
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3
Q

What is in the subcutaneous (hypodermis)?

A

-subcutaneous fat and connective tissue

conserves heat

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4
Q

What are the layers of epidermis?

A

“can lucy get some balm”

  • Stratum corneum: superficial with shedding dead skin
  • Stratum lucidum: layer found on palmar and plantar surface
  • Stratum granulosum: keritinization
  • Stratum spinosum: spiny-chaped cells (strength/flexible)
  • Stratum basale: cells germinate: keratinocytes
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5
Q

What are the 4 types of cells within the epidermis?

A
  • keratinocytes
  • melanocytes
  • merkel cells
  • langerhans cells
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6
Q

what are 3 layers of dermis?

A

-papillary dermis
superficial dermis
comprised of a loose network of collagen buncles
-reticular dermis
deep dermis
comprised of densely packed and thick collagen bundles
-ground substance

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7
Q

What is the function of eccrine glands and where?

A
  • produce sweat
  • cover most of the body
  • abundant on palms, soles and forehead
  • release salt and water to keep body cool
  • does not cause odor (does when mixed with bacteria on skin surface)
  • Duct opens in pore at skin’s SURFACE
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8
Q

What is the function of apocrine glands and where?

A

-produce thick clear odorless fluid (unless bacteria on surface breat them down and make odor)
-concentrated in axillary and genital regions
-Secretes into the SAC of hair follicle
-triggered by nervous system:
stress, exercise, hormones, emotion

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9
Q

What are two types of hairs and what is the bulb?

A

-vellus hairs: short and fine (forehead)
-Terminal hairs: long and thick (scalp/axillae)
-Bulb: enlargement at the base of follicle
matrix cells at inferior aspect of bulb
melanocytes within matrix contribute to pigment

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10
Q

What are morphologic characteristics of skin leasons?

A
  • distribution
  • shape/arrangement
  • border/margin
  • pigmentation/color
  • palpation
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11
Q

Distribution- what does localized mean?

A

lesions appear in one small area

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12
Q

Distribution- what does regional mean?

A

lesions appear in a specific region of the body

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13
Q

Distribution- what does generalized/disseminated mean?

A

lesions appear widely distributed or in multiple areas simultaneously

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14
Q

What is common with distribution of flexors?

A

atopic eczema

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15
Q

What is common with distribution of extensors and scalp?

A

psoriasis

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16
Q

What is common with seborrhoeic distribution?

A

seborrhoeic dermatitis on scalp and upper chest

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17
Q

What is common with sun-exposed sites?

A

light sensitive disorders

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18
Q

What does morbilliform shape mean?

A
  • measles-like

- erythematous maculopapular lesions that become confluent on the face and body

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19
Q

What are the ABCDEs of melanoma?

A
  • A: asymmetry
  • B: borders (irregular)
  • C: color (variegated)
  • D: diameter
  • E: evolution or elevation
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20
Q

What is a macule?

A

-flat, non-palpable
*< 1 cm in diameter
-circumscribed color change
-ex. freckles (ephelides)
1

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21
Q

What is a patch?

A

-flat, non-palpable
-can have irregular shape
* > 1 cm in diameter
-often hypo or hyperpigmented
-ex. cafe au lait
1

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22
Q

What is a papule?

A

-Palpable, firm
*< 1 cm in diameter
-circumscribed
-can be flesh colored, red, brown
-may be confluent
-ex. seborrheic keratosis
1

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23
Q

What is a plaque?

A

-elevated
-firm
-palpable
* > 1 cm in diameter
-ex. psoriasis
1

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24
Q

What is a nodule?

A

-elevated
-circumscribed
*often > 1.5 cm in diameter
-deeper and firmer than papule
-can be compressible, soft, rubbery, or firm to palpation
-ex. epidermoid inclusion cyst
1

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25
Q

What is a tumor?

A

-a large nodule
-deeper in the dermis
* > 2 cm in diameter
-ex. lipoma (benign subcutaneous soft tissue tumor)
1

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26
Q

What is a wheal?

A

-irregular
-transient: comes and goes
-superficial edema
-ex. hives (urticaria), mosquito bite
1

27
Q

What is a vessicle?

A

-elevated
-well circumscribed
* < 1 cm in diameter
-fluid-containing, usually clear
-ex. chickenpox “dew drops on a rose petal”
1

28
Q

What is a bulla?

A

-elevated
-well circumscribed
* > 1 cm diameter
-filled with serous fluid
-plural of bulla is bullae
-ex. bullous pemphigoid
1

29
Q

What is a pustule?

A

-elevated
-superficial
-well circumscribed
-filled with pus
-ex. folliculitis
1

30
Q

What is a furuncle?

A

-infection of a SINGLE hair follicle
-S. aureus
-also called a boil
1

31
Q

What is a carbuncle?

A

-infection of MULTIPLE hair follicles
-S. aureus
-an result from abscess
1

32
Q

What is crust?

A

-dried residue of serum, pus, or blood on the surface
-adherent
-may include bacteria
-ex. impetigo
2

33
Q

What is scale?

A

-hyperkeratosis
-accumulation of stratum corneum due to increased proliferation and/or delayed desquamation
-ex. psoriasis (micaceous- silvery- scale)
2

34
Q

What are fissures?

A

-linear cleft in skin
-often painful
-results from marked drying, skin thickening, and loss of elasticity
-ex. cracks on hand in knuckles
2

35
Q

What is erosion?

A

-partial, or sometimes complete. loss of the epidermis
-moist, oozing, and/or crusted lesion
-ex. pemphigus foliaceus
2

36
Q

What is an ulcer?

A

-a deeper defect (compared to an erosion), with loss of at least the entire epidermis PLUS superficial dermis
-may have loss of the entire dermis or even subcutis
-ex. venous (stasis) ulcer
2

37
Q

What is excoriation?

A

-exogenous injury to all or part of the epidermis
-may be linear or rounded
-usually due to scratching
-ex. neurotic excoriations
2

38
Q

What is atrophy?

A

-epidermal atrophy: thinning of the epidermis, leading to wrinkling and a shiny appearance
-Dermal atrophy: loss of dermal collagen and/or elastin, leading to a depression
-ex. striae (stretch marks) due to topical steroid use
2

39
Q

What is lichenification?

A

-thickenig of the epidermis
-increased visibility of skin markings
-ex. lichen simplex chronicus
2

40
Q

What is petechiae?

A

-deep red/purple-red lesions
*< 0.5 cm
-round
-irregular
*non-blanchable
-variable distribution
-represents blood outside of vessel
-seen with infections and bleeding disorders
V

41
Q

What is purpura?

A

-deep red/purple-red lesions
* >0.5 cm
-round
-irregular
* non-blanchable
-variable distribution
-represents blood outside of vessel
-seen with infections and bleeding disorders
V

42
Q

What is ecchymosis?

A

-aka bruising
-purple lesions of variable size
-fade to green, yellow, brown
-round/oval
-irregular borders
-represents blood outside of vessels due to trauma or bleeding disorder
V

43
Q

What is a spider angioma?

A

-fiery red lesion
-small in size (up to 2 cm)
-central body with surrounding erythema and radiating legs
*blanch with pressure
-seen on face, neck, arms and upper trunk
-usually develop in otherwise healthy women and children
-seen with liver disease
-pregnancy (often a normal finding)
V

44
Q

What is a cherry angioma?

A

-bright red papules
-1-6 mm in size
-can be flat or raised
-non-pulsatile
-usually seen on the trunk or upper extremities
*non blanchable
-associated with genetic and aging
V

45
Q

What are telangiectasias?

A

-permanently dilated superficial cutaneous blood vessels
-red to blue-violet in color
*blanchable
-fine
-irregular
-seen with basal cell carcinomas, sun-damaged skin, rosacea
V

46
Q

What is hemangioma?

A

*benign vascular neoplasm that represents the most common tumor of infancy
-red, irregular lesion seconary to dilation of dermal capillaries
-starts as a macular patch, can progress to a plaque or nodule
-spontaneously involutes by age 5-10
V

47
Q

What does umbilicated mean?

A

rolled borders

48
Q

What are 4 categories of skin disease?

A
  • papulosquamous
  • nodular
  • vesiculobullous
  • maculopapular
49
Q

What are papulosquamous lesions?

A
  • papules, plaques and scales

- ex. psoriasis

50
Q

What is lichen planus? hint the 5 P’s

A
  • pruriticy
  • polygonal
  • purple
  • planar
  • papules
51
Q

What are nodular lesions?

A

-benign and malignant epidermal and dermal nodules
-ex. of benign lesions
nevi
cherry angiomas
epidermoid cysts

-ex. of malignant lesions
-squamous cell carcinoma
isolated keratotic, eroded papule or nodule
located in sun exposed areas
-basal cell carcinoma
pearly nodules in sun exposed areas
associated with central ulcerations and telangiectasias

-ask how long has it been there

52
Q

What are vesiculobullous lesions?

A
  • vesicles and bullae

- ex. impetigo, herpes, pemphigus

53
Q

What are maculopapular lesions?

A

-macules and papules
-ex. viral exanthems
generalized, erythematous, macuopapular rash
-drug eruptions

54
Q

What is clubbing of the nail?

A

-rounded, bulbous nail base
-feels spongy
Diagnose by:
-flex the fingers of both hands
-bring index fingers together until distal phalanxes are touching
-diamond space between nails indicates no clubbing
Schamroth’s window
Schamroth’s sign
associated with lung cancer?

55
Q

What are Beau’s lines?

A

-transverse depressions secondary to trauma or acute illness
-lines grow out with nail
fingers take 6m
toes take 1y

56
Q

What is paronychia?

A
  • inflammation of the proximal and lateral nail folds
  • accute < 6 weeks
  • chronic > 6 weeks
57
Q

What is onychocryptosis?

A
  • ingrown toenail
  • usually involving the large toe
  • very common
  • nail grows into the dermis
  • may have pain
  • can become infected
58
Q

What are Terry’s nails?

A
  • mostly white with a distal band of reddish brown
  • characteristic “ground glass” appearance
  • without any lunula
59
Q

What is leukonychia?

A

-trauma to nails causing areas of white discoloration

60
Q

What is koilonychia?

A
  • “spoon nail”
  • spoon shaped, concave nail
  • iron deficiency
61
Q

What is onycholysis?

A

-painless separation of the nail plate from the nail bed

62
Q

What is onychomycosis?

A
  • fungal infection of the nail bed, plate or matrix

- common with increased age

63
Q

What is nail pitting?

A
  • small punctate depressions
  • caused by nail matrix inflammation
  • associated with hair loss

Physical Diagnosis (3 decks)

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