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Physical Diagnosis Exam 1 > Derm > Flashcards

Derm Flashcards

1
Q

Epidermis

A

Superficial layer

Barrier from environment, waterproof

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2
Q

Dermis

A

Blood vessels, hair follicles, sebaceous glands, sweat glands, nails, apocrine glands

-Provides flexibility, strength, and sensation

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3
Q

Subcutaneous hypodermis

A

Deepest layer, Subq fat (conserves heat) and connective tissue, fibroblasts, macrophages

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4
Q

Layers of Epidermis (5)

A
  • Corneum: superficial, shedding skin
  • Lucidum: on palms and plantar
  • Granulosum: keratinization
  • Spinosum: spiny cells, strength and flexibility
  • Basale: keratinocytes
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5
Q

Types of cells in Epidermis (4)

A

-Keratinocytes, melanocytes, merkels, langerhans

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6
Q

Papillary Dermis

A

superficial dermis, loose collagen bundles

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7
Q

Reticular dermis

A

Deep dermis, densely packed and thick collagen bundles

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8
Q

Eccrine glands

A
  • palms, soles, forehead
  • No odor
  • releases salt and water to cool body
  • covers most of body, opens to skin surface
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9
Q

Apocrine Glands

A
  • axillary/genital regions
  • thick colorless fluid
  • bacteria react with fluid to cause odor
  • Triggered by nervous system: stress, exercise, hormones
  • Secretes into the sac of hair follices
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10
Q

Vellus hairs

A

short and fine (forehead)

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11
Q

Terminal hairs

A

Long/thick (scalp)

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12
Q

Bulb of hair

A
  • base of follicle
  • matrix cells at inferior aspect
  • melanocytes within matrix- pigmentation
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13
Q

Functions of skin (5)

A

-Protection, fluid loss, vitamin D, sensory info, body temperature regulation

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14
Q

Equipment needed for derm exam

A

Light source (daylight is best), tape measure

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15
Q

During history taking, consider these aspects…

A

-Recent travel, hx sun exposure, occupation, pregnancy, duration of condition, new medications, new hygiene products, food allergies, comorbid conditions

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16
Q

Make sure to check between..

A

Toes, axillae, thighs, between legs, fingers, buttocks, genitals

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17
Q

Dermoscopy

A
  • Trans illuminating light with magnification

- Requires additional training to be proficient

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18
Q

General skin inspection

A
  • Symmetry
  • Color: pigmentation, cyanosis, jaundice
  • Hair: distribution, quantity
  • Nails: capillary refil, color, lesions
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19
Q

Skin palpation

A

Moisture, temperature, texture, turgor

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20
Q

Turgor

A

checks for dehydration, skin should rebound after pinching

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21
Q

Checking temperature hand positioning

A

Dorsal side touching patient

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22
Q

Checking texture hand positioning

A

Palmar side touching patient

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23
Q

Morphology of skin lesion is assessed by?

A

Visual inspection, tactile inspection

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24
Q

Characteristics of Skin lesions (5)

A
  • Distribution
  • Shape/arrangement
  • Border
  • Pigmentation
  • Palpation
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25
Q

Distribution (3)

A
  • Localized: one small area
  • Generalized: widely distributed on multiple areas at same time (back, face, UE, flexor/extensor regions) one place
  • Regional: specific region of body
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26
Q

Round/discoid

A

Coin shaped, no central clearing, umbilicated

-seen with eczema

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27
Q

Oval

A

ovoid

seen in pityriasis rosea

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28
Q

Annular

A

Round, central clearing, active/jagged margins

-tinea infections

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29
Q

Dermatomal

A

Follows nerve pattern

-varicella zoster

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30
Q

Target lesion

A
  • Pink macules with target in center

- Erythema multiforme

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31
Q

Linear

A

Erythematous streaks

-phytophotodermatitis

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32
Q

Serpiginous

A

Cutaneous larva migrans

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33
Q

Morbilliform

A

Measles-like

_erythematous maculopapular

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34
Q

Distinct Borders

A

Well-demarcated, can draw line around area

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35
Q

Indistinct

A

diffuse, poorly defined, rough edges

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36
Q

Irregular

A

Seen with malignant melanoma

-jagged edges, no sort of pattern

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37
Q

Raised

A

Center of lesion is depressed compared to surrounding edge

38
Q

Flesh colored

A

surrounding skin color

39
Q

Erythematous

A

variable shades of pink, red, coppery, salmon

40
Q

Violaceous

A

light violet

41
Q

Other coloration

A

Tan, brown, black, blue, hyperpigmented, hypopigmented

42
Q

Blanchable

A

erythematous lesion that loses redness when pressed upon

43
Q

Palpation of lesions look for (7)

A
  • Consistency
  • Mobility
  • Blanchability
  • Tenderness
  • Depth
  • Temperature
  • Fluctuant
44
Q

ABCDEs of melanoma

A
  • Asymmetry
  • Borders
  • Color variation
  • Diameter
  • Evolution/elevation
45
Q

Primary lesions

A

Arise from previously normal skin

46
Q

Secondary lesions

A

Arise from changes in primary lesions usually due to infection, rubbing, crusting, scratching, malignancy

47
Q

Macule

A

flat, non-palpable circumscribed color change

  • <1cm diameter
  • freckles
48
Q

Patch

A
  • flat, non-palpable, irregular shape at times
  • > 1 cm in diameter
  • Hypo/hyper pigemented

-cafe au lait

49
Q

Papule

A
  • Palpable, firm, circumscribed, flesh colored, red or brown
  • <1cm

-seborrheic keratosis

50
Q

Plaque

A
  • Elevated, firm, palpable, skin colored/pinkish/red, may be scale
  • > 1 cm
  • psoriasis
51
Q

Nodule

A
  • elevated, circumscribed, deeper and firmer than papule
  • > 1.5 cm

-epidermal inclusion cyst

52
Q

Tumor/Lipoma

A
  • large nodule deep in dermis
  • > 2cm

-lipoma

53
Q

Wheal

A
  • irregular, raised, comes and goes, superficial edema

- hives, insect bites

54
Q

Vesicles

A
  • elevated, well circumscribed
  • <1 cm
  • fluid containing, usually clear

-chickenpox, herpes virus

55
Q

Bullae

A
  • elevated, well circumscribed
  • > 1 cm
  • Serous fluid

-bullous pemphigoid

56
Q

Pustule

A

-elevated, superficial, well circumscribed

–pus filled

-folliculitis

57
Q

Furuncle

A
  • Boil
  • usually staph aureus

-one hair follicle infected

58
Q

Carbuncle

A
  • multiple hair follicles infected with staph aureus

- may progress to abscess

59
Q

Primary Lesions (10)

A
  • Macule,papule
  • Vesicle, bulla, pustule
  • Papule, plaque, nodule, tumor, wheal
60
Q

Secondary Lesions (8)

A
  • Crust, scale
  • Fissure, erosion, ulcer
  • Excoriation, atrophy, lichenification
61
Q

Crust

A
  • dried serums, pus, blood
  • adherent
  • bacterial

-impetigo

62
Q

Scale

A
  • hyperkeratosis
  • accumulation of corneum
  • increased proliferation or delayed desquamation

-psoriasis

63
Q

Fissures

A
  • linear cleft, painful
  • drying, skin thickening, loss of elasticity

-irritant dermatitis

64
Q

Erosion

A
  • partial or complete loss of epidermis
  • moist, oozing, crusted lesion

-SJS, pemphigus foliaceus

65
Q

Ulceration

A

deeper defect with loss of entire epidermis plus superficial dermis

  • loss or entire dermis
  • venous stasis ulcer
66
Q

Excoriation

A
  • scratch marks
  • liner or rounded
  • exogenous injury

-neurotic excoriations

67
Q

Epidermal atrophy

A

thinning of epidermis, shiny appearance, wrinkling

68
Q

Dermal atrophy

A

loss of collagen, leads to depression

69
Q

Lichenification

A

thickening of epidermis

increased visibility of skin markings

lichen simplex chronicus

70
Q

Petichiae

A
71
Q

Purpura

A

> 0.5 cm

non-blanchable

round, irregular, deep red

72
Q

Ecchymosis

A

purple lesions of variable size

fades to green yellow

bruising

blood outside vessels due to trauma or bleeding disorder

73
Q

Spider angiomas

A

fiery red lesions

up to 2cm

blanch with pressure

seen with liver disease, sometimes pregnancy

74
Q

Cherry angiomas

A

1-6 mm in size, non blanchable

75
Q

Telangiectasias

A

blanchable, fine, irregular, rosacea, sun damaged skin, BCC

76
Q

Hemangioma

A

benign vascular neoplasm that represents the most common tumor of infancy

red, irregular lesion secondary to dilation of dermal capillaries

77
Q

Papulosquamous lesions

A

papules, plaques, and scales

psoriasis

78
Q

Lichen PLanus

A

5 Ps

Pruritic, polygonal, purple, planar, papules

79
Q

Nodular Lesions

A

Nevi

Cherry angiomas

Epidermoid cysts

80
Q

Malignant Lesions

A

SCC- isolated keratotic and eroded papule or nodule

sun exposed areas

BCC: central ulcerations and telangietasias, pearly

81
Q

Vesiculobullous lesions

A

Vesicles and bullae

Impetigo, herpes, pemphigus

82
Q

Maculopapular lesions

A

Macules and papules

drug eruptions

viral exanthems

83
Q

Clubbing

A

rounded, bulbous nail base

feels spongy

  • Schamroths sign-diamond space between nails indicates no clubbing
  • Lines grow out with the nails
  • transverese depressions
84
Q

Beaus line

A

inflammation of proximal and lateral nail folds

acute <6 weeks

chronic >6 weeks

85
Q

Paronychia

A

nail grows into dermis

can become infected

86
Q

Onychocryptosis

A

most white with a distal band of redish brown

no lunula

87
Q

Terry Nails

A

areas of discoloration caused by trauma

88
Q

Leukonychia

A

spoon shaped concave nail, iron deficiency

89
Q

Koilonychia Spoon

A

painless separation of the nail plate from the nail bed

90
Q

Onycholysis

A

fungal infection, plate of matrix

91
Q

Onychomycosis

A

small punctate depressions

caused by nail matrix inflammation

Physical Diagnosis Exam 1 (4 decks)

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