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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
Clubbed fingernails causes
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
What are signs of chronic sun damage?
-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
Schamroth’s sign
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
Spooned nails (Koilonychia)
high chances of cracking and breaking as they become thin and soft Causes: - MCC: Iron deficiency anemia** - Autoimmune diseases, -Genetics - Vitamin Deficiency
29
Thin brittle nails
aging, poor nutrition exposure to harsh soaps, detergents excessive moisture symptom of: - Raynaud’s syndrome -hypothyroidism - anemia
30
Central Nail Ridge
Vertical ridges in nails. Associated with aging* -diabetes -vitamin deficiency
31
Central Nail Canal (Median Nail Dystrophy)
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
Nail pitting-
May need topical steroid therapy and light therapy. Cause: nail matrix inflammation – Psoriasis (random appearance of pits) – Autoimmune conditions
33
Beau’s Lines
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
felon nail
trauma to the nail infection of soft tissue near the nail
35
vitiligo, Acanthosis nigricans, Splinter hemorrhages,
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
Nail lines (mee's terry beau)
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
Sparse hair is seen in ____thyroidism; fine, silky hair in ____thyroidism
Sparse hair is seen in hypothyroidism; fine, silky hair in hyperthyroidism
38
Pressure Injury Staging System
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
Pressure Injury Staging System Unstageable and Deep tissue pressure injury:
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
Where does psoriasis frequently affect?
Scalp Extensor surfaces of elbows and knees
41
Where is hidradenitis suppurativa found?
Skin containing high density of apocrine glands (axillae, groin or under breasts)
42
When can scaling be greasy vs dry and fine
greasy? Seborrheic dermatitis Seborrheic keratoses dry and fine? Tinea pedia
43
What are nonblanching lesions?
Blood has extravasted out from capillaries into surrounding tissues Petechiae Purpura Cherry angiomas Vascular malformations
44
What is the most common skin cancer?
BCC then SCC then melanoma avoid UV and tanning beds!!!
45
Squamous Cell Carcinoma
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
Basal Cell Carcinoma
rarely spreads to other parts of the body -pearly appearance and overlying telangiectasias
47

Clinical Skills I (11 decks)

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