Block 1 - Skin, Hair, Nails Exam

Question 1

Describe the phases of hair growth

Answer 1

Anagen: phase of active growth that lasts 3-4 years. Approx. 84% of scalp in agagen growth.
Catagen: phase that marks follicular regression that lasts approx 2-3 weeks. 1-2% scalp in catagen growth.
Telogen: phast that represents resting period that lasts approx 3 months. 10-15% of scalp in telogen growth.

Question 2

Describe different colors of skin lesions (brown, white, red, yellow, blue - localized vs generalized)

Answer 2

Brown: (localized) nevi, (generalized) pituitary, adrenal, liver disease.
White: (localized) vitiligo, (generalized) albinism.
Red: (localized) inflammation, (generalized) fever, urticaria (hives), (generalized from increased RBCs) polycythemia.
Yellow: (genealized from bile) liver disease, (generalized from carotene pigment) hypothyroidism, increased caotene intake.
Blue: (mouth, lips, nail beds) CV and pulmonary diseases.

Question 3

Discribe different arrangements of skin lesions (annular, arcuate/arciform, circinate, confluent, discoid/round, eczematoid, grouped, iris, keratotic, linear, reticulated, serpiginous, telangiectatic, zosteriform)

Answer 3

Annular - round (eg tinea); arcuate/arciform - semi-circle; circinate - shape of “C”; confluent - sporadic cluster; discoid/round - filled in cluster (eg eczema); eczematoid - plaque of clustered papules; grouped - organized in defined groups; iris - dark center, lighter outer ring (eg erythema multiforme); keratotic - mesh of linear scales; linear - in a line (eg contact dermatitis); reticulated - netlike formation (eg polyarteritis nodosa); serpiginous - snakelike (cutanea larva migrans); telangiectatic - spider web; zosteriform - along nerve pathway (eg herpes zoster).

Question 4

Describe different distributions and locations of skin lesions (localized, regional, generalized)

Answer 4

Localized: one small area (eg impetigo, tinea).
Regional: found in specific part of body (eg acne vulgaris, psoriasis). Sun-exposed vs covered; flexoral vs extensor; stocking and glove; face, shoulders, back; truncal.
Generalized: widely distributed (eg urticaria).

Question 5

Describe different morphologies of skin lesions (macule, papule, patch, plaque, nodule, vesicle, bulla, pustule)

Answer 5

Macule: Flat, cutaneous color, 0.5cm (vitiligo, port-wine stains/birthmark).
Plaque: Elevated, firm, rough, >0.5cm (eg psoriasis).
Nodule: Elevated, firm, enclosed, extends into dermis 1-2cm (eg lipoma).
Vesicle: Elevated, circumscribed, superficial, filled with serous fluid 0.5cm (eg blister).
Pustule: Elevated superficial, filled with purulent fluid - contains leukocytes (eg impetigo, acne vulgaris).

Question 6

Describe the assessment of skin turgor

Answer 6

Procedure: Gently pinch skin. Should be resilient, move easily, immediately return to place. Older pts may have tenting - this is not a good exam for them.

Question 7

Define and describe pallor, rubor, and cyanosis

Answer 7

Unhealthy/pale skin; redness - response to inflammation/irritation; bluish - lack of oxygen or circulation. (Respectively).

Question 8

Define and describe clubbing

Answer 8

Instead of growing relatively flat and straight, nail angle increases. Can be due to prolonged cardiac or respiratry disease or idiopathic.

Question 9

Define and describe hirsutism

Answer 9

Growth of terminal hair in patterns normally associated with male hair distribution (facial hair, increased body hair). Associated with endocrine disorder.

Question 10

Define and describe Beau’s lines

Answer 10

Horizontal/transverse grooves on nail plate. Indicative of infection, trauma, systemic disease, other causes.

Question 11

Define and describe varicosities

Answer 11

Varicose (enlarged, twisted) veins. Due to failure of valves to prevent backflow. Often seen in superficial veins of lower extremities.

Question 12

Define and describe oncholysis

Answer 12

Spontaneous painless separation of the nail from the bed or trauma.

Question 13

Define and describe alopecia

Answer 13

Hair loss.

Question 14

Define and describe striae

Answer 14

Skin irregularity that resembles stripes. Many causes and presentations (eg stretch marks, endocrine disorders, others).

Question 15

Define and describe edema

Answer 15

Swelling/extracellular fluid accumulation. In dependent edema, fluid remains in low points (lower extremities). Can be due to cardiac insufficiency.

Question 16

Define and describe nail pitting

Answer 16

Small pock-mark type indentations in the nail. Seen in psoriasis.

Question 17

Define and describe koilonychia

Answer 17

“Spoon nail.” Nail takes on a spoon-like appearance. Can be due to anemia or hypothyroidism.

Question 18

Define and describe paronychia

Answer 18

Infection or disease around the nail. Usually presents with pain, swelling, redness.

Question 19

Define and describe leukonychia

Answer 19

White spots on the nail plate. Causs include cuticle manipulation or mild trauma.