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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
Q

Erosion

A

loss of epidermis, often after a bulla ruptures

26
Q

Ulcer

A

loss of epidermis and dermis, often from pressure (decubitus ulcers) or venous stasis

27
Q

Distribution: Psoriasis

A

scaling plaques, extensor surfaces and hair-bearing areas

common condition; sometimes involves joints, too

28
Q

Distribution: Actinic Keratoses

A

scaling papules, easier to feel than see, in sun-exposed areas
(sign of high sun exposure; mark of skin cancer risk)

29
Q

Distribution: seborrheic dermatitis

A

greasy scale, nasolabial/ eyebrows/ scalp/ chest

look bad, but harmless

30
Q

common linear skin disorders

A

contact dermatitis (poison ivy)

31
Q

common annular skin disorders

A

erythema chronic migraines (Lyme dz rash)

ringworm

32
Q

common dermatomal skin disorder

A

herpes zoster (shingles)

33
Q

common skin papules

A

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
Q

WAYS TO TELL BENIGN MOLES FROM POSSIBLE MELANOMAS

A

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
Q

hair exam: texture

A

Dry, brittle may suggest hypothyroidism

Fine, thin, silky may suggest hyperthyroidism

36
Q

hair exam: patterns

A 
Male pattern baldness
Pubic hair distribution:
Male- diamond, up to umbilicus
Female- triangle apex down
Hirsutism (male pattern of body hair growth) in
37
Q

hair exam: loss

A

check underlying scalp and hair follicles
Inflammation or scarring- fungal infection, others
Broken hairs - fungal infection, hair pulling “trichotillomania”
Smooth skin- alopecia areata

38
Q

nail exam: anatomy

A

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
Q

nail exam findings: bitten short

A

anxiety

40
Q

nail exam findings: transverse ridging

A

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
Q

nail exam findings: pitting

A

psoriasis

42
Q

nail exam findings: clubbing

A

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
Q

nail exam findings: onycholysis

A

fungal infection (tines unguum)

one nail - trauma, infection
all nails - hyperthyroidism

44
Q

nail exam findings: splinter hemorrhages

A

under the nail hematoma

one nail - local trauma
all nails - endocarditis

45
Q

nail exam

A

color, length, symmetry, cleanliness

46
Q

Nails, Skin, Hair: common/concerning symptoms

A

growths
rashes
hair loss
nail changes

47
Q

itching w/o rash - abnormal dx?

A 
dry skin
pregnancy
uremia
jaundice
lymphomas/leukemia
drug reactions
polycythemia vera
thyroid dz
48
Q

hair shedding at roots - abnormal dx?

A

teolgen affluvium

alopecia

49
Q

hair breaks along shaft - abnormal dx

A

hair damage

tines capitis

50
Q

most common cause of diffuse hair thinning

A

male and female pattern baldness

51
Q

most common skin cancers

A
  1. basal cell carcinoma
  2. squamous cell carcinoma
  3. melanoma
52
Q

melanoma risk factors

A
  • 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
Q

signs of chronic sun damage

A
  • 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
Q

Melanoma Screening

A 
ABCDE-EFG (2 or more present)
Asymmetry
Border irregularity
Color variations
Diameter >6mm
Evolving

Elevated
Firm to palpation
Growing progressively over several weeks

55
Q

hair pull test

A

pull 50ish hairs

if all have teolgen bulbs = telogen effluvium

56
Q

hair tug test

A

tests for fragility

57
Q

causes of diffuse no scarring hair shedding in young women

A

iron deficiency anemia

hyper/hypo thyroid

N507 Exam 1 (10 decks)

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