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N507 Exam 1 > (6) Skin, Hair, Nails > Flashcards

(6) Skin, Hair, Nails Flashcards

1
Q

Epidermis

A

Stratum corneum- barrier made up of flat cells without nuclei and keratin
Cellular strata (3 or 4 layers) - synthesis and maturation of keratin cells
Melanocytes – scattered in stratum basale – make melanin pigments
(from tyrosine, via tyrosinase); melanin granules enter keratinocytes
and cluster over the nucleus to protect DNA

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2
Q

Dermis

A

Supporting connective tissue; supports epidermis
Blood supply (to epidermis via capillary loop in dermal papilla)
Contains sensory nerve fibers
Mesenchymal cells in dermis instruct the epithelial cells of the
dermis during development (e.g. ear epidermis placed on heel
dermis develops into thick heel skin)

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3
Q

Hair follicles

A

Hairs are anuclear and made of keratin, like skin

Anagen (growth – 2-6 years on scalp) and telogen (rest,1-3 mos)

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4
Q

Sebaceous glands

A

Sebum: fat-filled dead cell; lubricates skin and hair
In acne:
Cells shed in rather than out
Plugs in glands- “blackheads” are NOT dirt
Bacterial growth causes redness and swelling
Eccrine and apocrine (axillary/perineal) sweat glands

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5
Q

Subcutaneous fat

A

a landmark when suturing or during biopsy of skin

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6
Q

Skin Color

A

Erythematous means red
Purple discoloration that does not “blanch” with pressure:
Ecchymosis if caused by trauma (bruise)
Purpura from vasculitis or other causes- > 0.5 cm
Petechiae from similar causes < 0.5 cm

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7
Q

Skin Texture

A

Palpation)
Some lesions are more easily felt than seen
Example: actinic keratoses
Can help you assess size and depth of lesions
Assessment of hydration status- skin tenting if significantly dehydrated

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8
Q

Assessing and Describing Skin Lesions

A 
Size
Color
Texture
Shape; type of lesion (name)
Configuration (linear, annular, grouped, diffuse)
Location and distribution
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9
Q

Macule

A

flat, any color
< 1 cm
ex: freckle

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10
Q

Patch

A

flat, any color
> 1 cm
ex: birthmark

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11
Q

Papule

A

elevated
< 1 cm
ex: wart

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12
Q

Plaque

A

elevate
> 1 cm
ex: psoriasis

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13
Q

Wheal

A

elevated
transiet
irregular
ex: insect bite

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14
Q

Nodule

A

elevated
deeper in dermis
1-2 cm
ex: lipoma

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15
Q

Tumor

A

elevate
deeper in dermis
> 2 cm

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16
Q

Vesicle

A

elevated
filled with clear fluid
< 1 cm
ex: chickenpox

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17
Q

Bulla

A

elevated
filled with clear fluid
> 1 cm
ex: blister

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18
Q

Pustule

A

like vesicle but fluid is purulent

ex: acne, furncle

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19
Q

Cyst

A

elevated
deeper in dermis
filled w/ liquid of semisolid
ex: sebaceous cyst

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20
Q

Telangiectasia

A

dilated capillaries

ex: rosacea (adult acne)

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21
Q

Scale

A

flaking, heaped up keratin

ex: seborrhea

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22
Q

Lichenification

A

rough, thick epidermis

ex: chronic eczema

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23
Q

Crust

A

dried serum, blood, or pus

ex: scab

24
Q

Fissure

A

crack in dermis

ex: on lips

25
Erosion
loss of epidermis, often after a bulla ruptures
26
Ulcer
loss of epidermis and dermis, often from pressure (decubitus ulcers) or venous stasis
27
Distribution: Psoriasis
scaling plaques, extensor surfaces and hair-bearing areas | common condition; sometimes involves joints, too
28
Distribution: Actinic Keratoses
scaling papules, easier to feel than see, in sun-exposed areas (sign of high sun exposure; mark of skin cancer risk)
29
Distribution: seborrheic dermatitis
greasy scale, nasolabial/ eyebrows/ scalp/ chest | look bad, but harmless
30
common linear skin disorders
contact dermatitis (poison ivy)
31
common annular skin disorders
erythema chronic migraines (Lyme dz rash) ringworm
32
common dermatomal skin disorder
herpes zoster (shingles)
33
common skin papules
Cherry angiomas: over age 25, flat or raised, cherry red Seborrheic keratoses: over age 25, pigmented, “stuck on”, greasy or warty surface Nevi (moles): good or bad? Common types: Junctional, Intradermal, Compound Dysplastic nevi have concerning features, are a marker for increased risk of melanoma
34
WAYS TO TELL BENIGN MOLES FROM POSSIBLE MELANOMAS
ABCD checklist for diagnosis of melanoma ``` Asymmetry Can you divide it in half? Border irregularity Uneven or ragged Color irregularity 2 or more shades e.g. pink, blue, black Diameter over 6mm (pencil eraser size) Changes in size, shape, or color ``` Usefulness of ABCD has not been fully validated
35
hair exam: texture
Dry, brittle may suggest hypothyroidism | Fine, thin, silky may suggest hyperthyroidism
36
hair exam: patterns
``` Male pattern baldness Pubic hair distribution: Male- diamond, up to umbilicus Female- triangle apex down Hirsutism (male pattern of body hair growth) in ```
37
hair exam: loss
check underlying scalp and hair follicles Inflammation or scarring- fungal infection, others Broken hairs - fungal infection, hair pulling “trichotillomania” Smooth skin- alopecia areata
38
nail exam: anatomy
Plate- epidermal cells converted to hard keratin Matrix- site of growth, extends out to lunula (white crescent) Root- where nail begins Eponychium (epp-oh-NICK-ee-um)- the “cuticle” that protects Paronychium (pehr-oh-NICK-ee-um)- soft tissue that surrounds nail border When inflamed/infected, patient is said to have a paronychia
39
nail exam findings: bitten short
anxiety
40
nail exam findings: transverse ridging
One nail Local trauma All nails Systemic insult- severe illness, surgery Note: Fingernails grow in 3-6 months Toenails may take 6-12 months or more
41
nail exam findings: pitting
psoriasis
42
nail exam findings: clubbing
Nail base angle normally 160  Patient has nail clubbing if angle is near or above 180  (Possible causes: lung disease (e.g. cancer), liver cirrhosis
43
nail exam findings: onycholysis
fungal infection (tines unguum) one nail - trauma, infection all nails - hyperthyroidism
44
nail exam findings: splinter hemorrhages
under the nail hematoma one nail - local trauma all nails - endocarditis
45
nail exam
color, length, symmetry, cleanliness
46
Nails, Skin, Hair: common/concerning symptoms
growths rashes hair loss nail changes
47
itching w/o rash - abnormal dx?
``` dry skin pregnancy uremia jaundice lymphomas/leukemia drug reactions polycythemia vera thyroid dz ```
48
hair shedding at roots - abnormal dx?
teolgen affluvium | alopecia
49
hair breaks along shaft - abnormal dx
hair damage | tines capitis
50
most common cause of diffuse hair thinning
male and female pattern baldness
51
most common skin cancers
1. basal cell carcinoma 2. squamous cell carcinoma 3. melanoma
52
melanoma risk factors
- personal/family hx - >50 common moles - atypical/large moles, esp. dysplastic - red/light hair - solar lentiggine (acquired brown macules on sun areas) - freckles (inherited brown macules) - UV exposure - light eye/skin color, freckles/burns easily - severe blistering sunburn as kid - immunosuppression (HIV, chemo) - personal hx of other type skin CA
53
signs of chronic sun damage
- numerous solar lentigines on shoulders/upper back - many melanocytes nevi - solar elastosis (yellow, thickened skin w. bumps, wrinkles, furrowing) - cutis rhomboidalis niche (leathery thickened skin on post. neck) - actinic pupura
54
Melanoma Screening
``` ABCDE-EFG (2 or more present) Asymmetry Border irregularity Color variations Diameter >6mm Evolving ``` Elevated Firm to palpation Growing progressively over several weeks
55
hair pull test
pull 50ish hairs | if all have teolgen bulbs = telogen effluvium
56
hair tug test
tests for fragility
57
causes of diffuse no scarring hair shedding in young women
iron deficiency anemia | hyper/hypo thyroid

N507 Exam 1 (10 decks)

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