2. SESSION 2.1: Skin, Hair & Nails Flashcards
1
Q
What are the eight functions of the skin?
A
1) Protection
2) Prevents penetration
3) Perception
4) Temperature regulation
5) Identification
6) Wound repair
7) Absorption and excretion
8) Synthesizes Vitamin D
2
Q
Three layers of the skin and their general composition
A
1) Epidermis: Thin, outermost layer (Stratum corneum + Stratum germinativum)
2) Dermis - CT
3) Subcutaneous (adipose)
3
Q
Differentiate between eccrine glands and apocrine glands.
A
- Eccrine glands are saline sweat; mature by the time we are 2 years old.
- Apocrine glands secrete more of a milky solution (around hair follicles). Mature after puberty, during sexual stimulation.
4
Q
List four locations of apocrine sweat glands.
A
- Ear canal
- Axillae
- Nipples
- Ano-genital region
5
Q
List four locations of eccrine sweat glands.
A
- Forehead
- Axillae
- Palms
- Soles
6
Q
What objective data should you gather for the skin? (7)
A
- Color: General pigmentation
- Color: Widespread color change
- Moisture
- Temperature
- Texture
- Mobility and Turgor
- Any lesions
7
Q
What are five different types of widespread color change you might note?
A
- Pallor
- Erythema
- Cyanosis
- Jaundice
- Increased pigmentation
8
Q
What is Reynod’s Phenomenon / Reynod’s disease? What does the disease mean?
A
- Change in pallor: Skin is pink and white.
- If it’s constant, it’s a disease, and is associated with CT diseases or anemia.
9
Q
Jaundice is due to a rise of _________ in the blood.
A
Bilirubin
10
Q
What are seven possible sources of jaundice?
A
- Hepatitis
- Really severe fatty liver
- Malaria
- Sickle cell disease
- Gallstones blocking the bile duct
- INH for TB can cause hepatitis from the medication
- Cancer
11
Q
Five signs of malignant melanoma
A
A: Asymmetry of eye
B: Border (eyes irregularly scalloped)
C: Color is mottled. Haphazard display of color.
D: Diameter: Unusually large (greater than the tip of a pencil earaser)
E: Evolving (change in size, shape, surface, shades of color, or symptoms.
12
Q
MACULE:
- Definition
- Size
- Examples (5)
A
- A circumscribed, flat, nonpalpable change in skin color.
- up to 1 cm
- Freckles, flat nevi, hypopigmentation, petechiae, measles rash.
13
Q
PATCH
- Definition
- Size
- Examples (4)
A
- A macule (nonpalpable change in skin color) larger than 1 cm
- Mongolian spot, vitiligo, cafe au lait spot, chloasma, measles rash
14
Q
PAPULE
- Definition
- Cause
- Size
- Examples (3)
A
- A palpable, elevated, circumscribed, solid mass; caused by superficial thickening in the epidermis.
- Up to .5 cm
- Elevated nevus, lichen planus, molluscum, wart
15
Q
PLAQUE
- Definition
- Size
- Examples (3)
A
- A flat, elevated surface larger than .5 cm, often formed by the coalescence of papules.
- Psoriasis, lichen planus, xanthoma
16
Q
NODULE
- Definition
- Size
- Examples (3)
A
- A solid, elevated, firm or soft mass larger than .5 cm. May be firmer and extended deeper into the dermis than a papule.
- .5 to 1-2 cm
- Xanthoma, fibroma, intradermal nevi
17
Q
TUMOR
- Definition
- Size
- Examples (2)
A
- A solid, elevated firm or soft mass extending even deeper into dermis, may be benign or malignant.
- Larger than 1-2 cm
- Lipmoa, hemangioma
18
Q
Wheal
- Definition
- Size
- Examples (3)
A
- A superficial, raised, erythematous, transient lesion with somewhat irregular borders due to localized edema (fluid held diffusely in the tissues.
- Size varies.
- Mosquito bite, allergic reaction, dermographism.
19
Q
Urticaria
- Definition
- Size
- Example
A
- Wheals coalescing to form an extensive reaction; intensely pruritic.
- Size varies.
- HIVES.
20
Q
Vesicle
- Definition
- Size
- Examples (4)
A
- A circumscribed, superficial elevated cavity containing free fluid; clear fluid flows if wall is ruptured.
- Up to 2 cm.
- Herpes simplex, early varicella (chx pox)
- Herpes zoster (shingles)
- Contact dermatitis
21
Q
BULLA
- Definition
- Size
- Examples (4)
A
- A larger vesicle. Usually single chambered (unilocular; superficial in epidermis. It is thin-walled, so it ruptures easily.
- Larger than 1cm
- Friction blister, pemphigus, burns, contact dermatitis.
22
Q
PUSTULE
- Definition
- Size
- Examples (2)
A
- A circumscribed, superficial, elevated cavity containing turbid fluid (pus)
- Up to one cm
- Impetigo, acne
23
Q
CYST
- Definition
- Size
- Examples (2)
A
- An encapsulated, fluid- or pus-filled cavity in dermis or subcutaneous later, tensely elevating the skin.
- Larger than 1cm
- Sebaceous cyst, wen
24
Q
ERYTHEMA
- Definition
- 4 causes
A
- Redness due to excess blood in the surface capillaries
- due to fever, localized infection, embarrassment, or Carbon Monoxide poisoning.
25
CYANOSIS
- What it it?
- What do you look for?
- Lack of oxygen due to decreased profusion of oxygenated blood for whatever reason.
- We look to see if it's local or generalized.
- Anemic person may not look blue, but might not have enough Hb carrying oxygen.
26
______ is the name of the condition where skin lacks pigment -- like Michael Jackson had.
Vitiligo
27
Darkening on the neck, probably due to increased insulin resistance on its way to diabetes.
Acanthosis Nigricans
28
3 possible causes of pallor
- Anxiety
- Fear
- Anemia
29
3 possible causes of Jaundice
- Chirrhosis
- Sickle Cell
- Hepatitis
30
Cause of Cyanosis
Hypoxemia
31
A birth mark called _______________ refers to a flat, harmless color change that WILL fade away.
Mongolian Spots
32
Name and describe the two types of acne.
- Comedonal: Whitehead or blackhead. Pore is clogged.
| - Pustular: Pimples. More than just a clogged pore.
33
Name five skin changes that occurs in older adults
- More wrinkling
- Senile purpura
- Dry skin (xerosis)
- Senile lentigines
- Skin takes about 4x longer to heal.
34
SENILE PURPURA
- Definition
- Size
- Appearance
- Purple bruises on forearms - benign
- .3-1cm
- Purple, does not blanch.
35
_____ is a fancy word for dry skin.
Xerosis
36
_______ are "liver spots" - flat, brown clusters of melanoma due to sun use. Normal variation.
Senile lentigines
37
Six things you inspect for in a skin exam.
- Termperature
- Moisture
- Texture
- Thickness
- Edema
- Mobility and turgor
38
__________ refers to "too much moisture"
Diaphoresis
39
What happens to the skin in hypothyroidism?
Rough, scaly, thick skin
40
What happens to the skin in hyperthyroidism?
Smooth, dried or moist.
41
Five possible causes for edema
- Deep venous thrombosis (DVT)
- Chronic venous insufficiency
- Lymphedema
- Orthostatic edema
- Congestive heart failure
42
How is Edema graded?
1+, 2+, 3+ or 4+
43
With edema, if you leave a dent when you push with your thumb, it is called _______
PITTING.
44
What is mobility? What does "normal" look like?
- Skin's sense of rising
- Reflects elasticity
- Normal rises easily
45
What is turgor?
Ability to return to place promptly when released. Reflects elasticity and moisture content.
46
What is tenting?
Due to dehydration: When pinched skin takes its time going back to normal.
47
What four components do you note when assessing a wound?
- Type
- Appearance
- Dressing
- Drainage
48
_________ refers to "chafing"
excoriation
49
_______ refers to a black wound
Eschar
50
ECCHYMOSES
- Definition
- Size
- Appearance
- A small hemmorrhagic spot on the skin or mucus membrane where blood escaped into tissues from ruptured vessels.
- 1 cm (larger than a petechia)
- Non-elevated, rounded or irregular blue or purplish patch.
51
_________ refers to serous with a little bit of blood tinting
Serosanguinous
52
____________ refers to puss drainage
Purulent
53
____________ refers to itchy
pruritis
54
A diagnosis of lesions is based on (1), (2) and (3).
1) Distribution of lesions
2) Their morphology
3) Their configuration
55
What are we referring to when we talk about the morphology of a lesion?
Primary verses secondary.
PRIMARY: Developed on its own (ex hives from poison ivy)
SECONDARY: Result of primary lesion (ex skin tears from itching the hives)
56
Visual features to note when looking at a lesion
- Color
- Sharpness of edge
- Surface contour (dome, pedunculated, flat, spire-like etc)
- Geometric shape or configuration
57
A _______ refers to a long stalk or tissue, so a _________ lesion refers to a mass that is supported by a little stalk on the skin.
Peduncle, Pedunculated
58
What is crust? What causes it (3)
- Thickened, dried residue of burst vesicles, pustules or blood.
- Eczema, impetigo, crust phase of herpes simplex virus.
59
____________ is more commonly known as "athlete's foot."
Tinea pedis.
60
What are fissures?
| - 3 characteristics
- A linear crack with abrupt edges
- Extends into the dermis
- Can be dry or moist
61
Four causes of fissures.
- Cheilosis (fissures on side of mouth in wintertime)
- Athlete's foot
- Anal fissure
- Renal failure (esp if patchy fissures are on skin of arms and abdomen
62
What is erosion? 4 characteristics.
- A superficial, circumscribed loss of epidermis.
- Leaves a scooped-out but shallow depression
- Moist but no bleeding
- Heals without a scar because it does not extend into the dermis.
63
What is an ulcer?
- Definition
- 3 examples
- A circumscribed depression extending into the dermis. Irregular shape, may bleed, leaves a scar.
- Statis ulcer, pressure sore, chancre (syphilis sore)
64
Excoriation (def, 5 examples)
- A superficial scratch mark
| - Scratch from foreign body, insect bites, scabies, dermatitis, varicella
65
What is a scar?
A replacement of destroyed normal skin tissue by fibrous connective tissue. A permanent change.
66
_________ is a depressed skin level resulting from loss of tissue. A thinning of the epidermis with loss of normal skin furrows, resulting in shiny, transluscent skin. (3 examples)
ATROPHY.
Striae, senile skin, arterial insufficiency.
67
LICHENIFICATION
- Definition
- Results from...
- Appearance
- Two examples
- Thickening and roughening of the skin usually as a result of intense scratching
- Results from a tightly packed set of papules
- Increased visibility of the superficial skin markings
- Ex: Long standing eczema, atopic dermatitis
68
_________ is a hypertrophic scar. What causes it?
- Keloid
| - Elevation by an excess scar tissue, which is invasive beyond the site of the original injury.
69
An ANNULAR lesion is
CIRCULAR
70
CONFLUENT lesions are
CLOSE TOGETHER
71
A DISCRETE lesion is
OFF BY ITSELF
72
What is an example of GROUPED lesions?
POISON IVY
73
A GYRATE lesion
makes sort of a snake-like loop
74
What is an example of a TARGET lesion?
Lyme's
75
a LINEAR configuration of lesions is
A STRAIGHT LINE
76
a POLYCYCLIC configuration of lesions is
GROUPED ANNULAR (Circular)
77
A ZOSTERIFORM lesion is grouped
along a dermatome. Like Herpes Zoster.
78
PETECHIAE
- Definition
- Size
- Appearance
- Pin-sized macules of blood in the skin
- < 3 mm
- Color = red
79
CAMPBELL DE MORGAN SPOTS
- Definition
- Other name
- Appearance
- Benign angiomas common on the trunks of the middle-aged and elderly
- Cherry angioma
- Small bright red papules of no consequence
80
SPIDER ANGIOMA
- Definition
- If diagnosis is in doubt...
- If .... then check ....
- May be normal _____________
- May erupt ____________
- Stellate telengiectases that look like spiders with legs radiating from a central, often palpable, feeding vessle.
- If diagnosis in doubt, press on center with a slide and lesion will disappear
- If many on trunk, check liver function.
- May be normal in faces of children
- May erupt during pregnancy.
81
Telangiectasia
- Refers to...
- 3 possible appearances
- Can be caused by... (drug)
- Refers to permanently dilated and visible vessles in the skin
- They can appear as linear, punctuate, or stellate-crimson (star shaped) purple markings
- Can be caused by Nifedipine (BP med)
82
Angiomas
Benign turmors
83
Port Wine Stain
- Medical Term
- Caused by...
- Appearance
- Location on body
- Nevus Flammeus
- Caused by dilated dermal capillaries
- Pale, pink to purple macules
- Mostly on face and trunk
84
Basal cell carcinoma on the forehead (4 facts)
- Most common malignancy
- Locally invasive and destructive
- Slow growing, rarely metastasized
- Almost translucent, dome-shaped papule with overlying telangiectasias
85
What to look for when inspecting / palpating the hair (4)
- Color
- Texture
- Distribution
- Lesions
86
What to look for when inspecting and palpating the nails (3)
- Shape / contour
- Consistency
- Color
87
Alopecia
Losing hair
88
Alopecia Areata
Losing hair in just one area (most likely immunological phenomenon)
89
____________ is excessive hairiness on women in those parts of the body where terminal hair does not usually occur or is minimal.
HIRSUTISM
