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Clinical Skills I > derm > Flashcards

derm Flashcards

1
Q

epidermis two layers

A

outer: horny
- horny stratum corneum of dead keratinized cells

inner: cellular
- stratum basale
- stratum spinosum (malpighian): melanin and keratin are formed here

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2
Q

Blanchable vs nonblanching lesions

A

Blanchable:
- erythematous
- suggest inflammation

Nonblanching lesions:
- petechiae
- purpura,
- vascular structures (cherry angiomas, vascular malformations)
- not erythematous, but rather BRIGHT red, purple
- blood has extravasated out from the capillaries into the surrounding tissues.

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3
Q

dermis

A

layer of interconnecting collagen and elastic fibers

containing appendages:
- pilosebaceous glands (oil glands)
- sweat glands
- hair follicles
- terminals of the cutaneous nerves

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4
Q

Pallor, cyanosis and jaundice

A

Pallor: anemia
Cyanosis:
- decreased oxygen in blood
- decreased blood flow from cold environment
Jaundice:
- increased bilirubin

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5
Q

Hair two types:

A

vellus:
- Short
- fine
- inconspicuous
- relatively unpigmented

Terminal:
- Coarser
- thicker
- more conspicuous
- usually pigmented
-ex: scalp hair and eyebrows

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6
Q

What do pilosebaceous glands (oil glands) produce? and where are they not found

A

produce:
- Fatty substance secreted onto skin surface through hair follicles

not found?
- Palms and soles

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7
Q

apocrine sweat glands vs eccrine sweat glands

A

Apocrine:
- Axillary and genital regions
- open into hair follicles
- bacterial decomposition of apocrine sweat = body odor

Eccrine:
- widely distributed
- open directly onto skin surface
- control body temperature by sweat production

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8
Q

What causes body odor?

A

Bacterial decomposition

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9
Q

Angle between the proximal nail fold and nail plate is normally less than____ degrees.

A

180 degrees

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10
Q

Fingernails grow approximately ___ mm daily; toenails grow more_____ (fast vs slow).

A

0.1 mm
toenails grow more slow

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11
Q

What causes generalized itching w/o apparent rash?

A

Dry skin
Uremia
Jaundice
Lymphomas
Leukemia
Drug reactions
Polycythemia vera
Thyroid disease

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12
Q

What is hair shedding at the roots common in?

A

Telogen effluvium: + hair pull test
Alopecia areata

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13
Q

When does hair break along the shaft?

A

Damage from hair care
tinea capitis

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14
Q

Scarring vs nonscarring hair shedding

A

non-scarring hair shedding in young women?
- Iron deficiency anemia
- Hyper or hypothyroidism

scarring:
- central centrifugal scarring alopecia
- discoid lupus erythematosus

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15
Q

What are the ABCDEs of melanoma?

A

Asymmetry
Border irregularity
Color variation
Diameter >6mm
Evolution***

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16
Q

Cutaneous wound repair process: 4 phases

A

1) coagulation
2) inflammatory phase
3) proliferative migratory phase (tissue formation)
4) remodeling phase

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17
Q

what are the dimensions of this papule

A

▪ Measure in the
longest axis first, then
in the perpendicular
axis
* e.g., this papule is
6x4 mm

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18
Q

magnification tools + dermatoscopes

A

▪ Inexpensive magnifying
glasses may help detect
fine details
* Avoid LED lights, which
cast a blue hue
▪ Dermatoscopes help
evaluate patterns in
pigmented lesions
* Requires additional
training to become
proficient

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19
Q

Blanching vs. Non-blanching

A

Diascopy!!

20
Q

morphology

A

used by dermatologists to describe the form and structure of skin lesions

two steps in establishing the morphology of any given skin condition:
1. Careful visual and tactile inspection
2. Application of correct descriptors

21
Q

what are the main primary lesions

A

Macule, patch: Flat, color change only

Papule, plaque: raised, palpable

Vesicle, bulla: serous fluid-filled space in epidermis

Wheal: an edematous papule or plaque

Nodule, Tumor: raised lesion deeper in skin

Pustule, furuncle, abscess: pus-filled space

Cyst: a sac-like nodule that has an epithelial lining containing fluid
or debris

22
Q

special lesions: not primary or secondary; what are they

A

TELANGIECTASIA
- fine, irregular red lines
COMEDONES
- plugs of whitish or blackish sebaceous
- material lodged in the pilosebaceous follicles
MILIA
- whitish nodules with no visible opening to the skin surface
- 1-2 mm in diameter
BURROWS
- tortuous, long tunnel in the
epidermis
ex: scabies

23
Q

Distribution vs Configuration

A

Distribution:
- location(s) on the body
Configuration:
- how the lesions are
arranged or relate to each other
- lesions are grouped but also follow a linear pattern around the trunk
- This is an example of a segmentalor dermatomal distribution

24
Q

Clubbed fingernails description

A
  • Soft nail beds. The nails may seem to “float
  • The nails form a sharper angle with the cuticle.
  • The nail curves downward so it looks like the round
    part of an upside-down spoon.
25
Q

Clubbed fingernails causes

A

MC: Lung cancer !!!!!

Causes:
- heart and lung ds that
reduce the amount of oxygen in the blood.
*Heart defects
*Chronic lung infections that occur in people
with bronchiectasis, cystic fibrosis, or lung abscess
*Infection of the lining of the heart chambers
– Hyperthyroidism (about 1%)

26
Q

What are signs of chronic sun damage?

A

-solar lentigino on the shoulders and upper back
- Many melanocytic nevi
- Solar elastosis (yellow, thickened skin w/ bumps, wrinkles or furrowing)
- Cutis rhomboidalis nuchae (leathery thickened skin on the posterior neck)
- Actinic purpura
- wrinkles
- poikiloderma

27
Q

Schamroth’s sign

A

diamond-shaped window not
visible when the dorsal
surfaces of the terminal
phalanges of corresponding
fingers from opposite hands
are placed together.
- used to determine if nails are clubbed

Causes:
- pulmonary and cardiovascular diseases

28
Q

Spooned nails (Koilonychia)

A

high chances of cracking and breaking as they
become thin and soft

Causes:
- MCC: Iron deficiency anemia**
- Autoimmune diseases,
-Genetics
- Vitamin Deficiency

29
Q

Thin brittle nails

A

aging,
poor nutrition
exposure to harsh soaps, detergents
excessive moisture

symptom of:
- Raynaud’s syndrome
-hypothyroidism
- anemia

30
Q

Central Nail Ridge

A

Vertical ridges in nails.

Associated with aging*
-diabetes
-vitamin deficiency

31
Q

Central Nail Canal
(Median Nail Dystrophy)

A

Midline split in nail plate of
thumb nails.

Typically caused by trauma
to nail.
- Topical steroids have
proven to be effective.
* “Heller’s fir tree deformity”
* Cuticle is usually normal

32
Q

Nail pitting-

A

May need topical steroid
therapy and light therapy.

Cause: nail matrix inflammation
– Psoriasis (random
appearance of pits)
– Autoimmune conditions

33
Q

Beau’s Lines

A

Beau lines- Horizontal lines in fingernails or toenails
- can impede nail growth

MC: Illness or trauma

Can also be caused by:
- vitamin deficiency.
- Chronic conditions: diabetes
- hypothyroidism

34
Q

felon nail

A

trauma to the nail

infection of soft tissue near the nail

35
Q

vitiligo, Acanthosis nigricans, Splinter hemorrhages,

A

Acanthosis nigricans-dark thick velvety skin
- hyperpigmentation

Hypopigmentation: vitiligo

Splinter hemorrhages-area of bleeding under fingernails
- endocarditis

Felon nail- trauma to the nail, an infection affecting soft tissue near

36
Q

Nail lines (mee’s terry beau)

A

Terry lines-white proximal nail and reddened distal nail
- ground glass appearance

Beau lines- transverse linear depression

Mee’s lines- transverse white bands on fingernails

37
Q

Sparse hair is seen in ____thyroidism; fine, silky hair in ____thyroidism

A

Sparse hair is seen in hypothyroidism; fine, silky hair in hyperthyroidism

38
Q

Pressure Injury Staging System

A

Stage 1: Intact skin with a localized area of nonblanchable erythema

Stage 2: Partial-thickness loss of skin with exposed dermis

Stage 3: Full-thickness skin loss, in which adipose (fat) is visible in the ulcer and granulation tissue and rolled wound edges, is often present.

Stage 4: Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer.

39
Q

Pressure Injury Staging System Unstageable and Deep tissue pressure injury:

A

Unstageable: Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.

Deep tissue pressure injury: Persistent nonblanchable deep red, maroon, or purple discoloration

40
Q

Where does psoriasis frequently affect?

A

Scalp
Extensor surfaces of elbows and knees

41
Q

Where is hidradenitis suppurativa found?

A

Skin containing high density of apocrine glands (axillae, groin or under breasts)

42
Q

When can scaling be greasy vs dry and fine

A

greasy?
Seborrheic dermatitis
Seborrheic keratoses

dry and fine?
Tinea pedia

43
Q

What are nonblanching lesions?

A

Blood has extravasted out from capillaries into surrounding tissues

Petechiae
Purpura
Cherry angiomas
Vascular malformations

44
Q

What is the most common skin cancer?

A

BCC then SCC then melanoma

avoid UV and tanning beds!!!

45
Q

Squamous Cell Carcinoma

A

Keratoacanthomas are SCCs that arise rapidly and have a crateriform center

Often have a smooth but firm border

SCCs can become quite large if left untreated
- highest sites of metastasis are the scalp, lips, and ears

46
Q

Basal Cell Carcinoma

A

rarely spreads to other parts of the body

-pearly appearance and overlying telangiectasias

47
Q
A

Clinical Skills I (11 decks)

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