Derm Flashcards
1
Q
What is the MAJOR function of the skin?
A
keep body in homeostasis by:
- provide boundaries for body fluid
- protect underlying tissues from microorganisms, harmful subs, and radiation
- modulate body temp
- synthesize vit D
2
Q
What is the heaviest single organ?
A
SKIN
3
Q
percent of body weight is skin?
A
16%
4
Q
Layers of the skin
A
- epidermis (most superficial)
- dermis
- subcutaneous tissue
5
Q
Appendages of skin
A
- hair
- nails
- sebaceous and sweat glands
6
Q
what layer of skin is avasculr?
A
Epidermis
7
Q
Layers of epidermis and what are they made of?
A
- Outer horny stratum corneum–dead keratinized cells
- inner cellular layer
- stratum basale (melanin) and stratum spinosum
8
Q
Dermis layer: what is found here and what is it made of
A
- dense collagen and elastic fibers
- sebaceous glands
- sweat glands
- hair follicles
- terminal ends of cutaneous nerves
9
Q
subcutaneous layer made of?
A
fatty or adipose tissue
10
Q
Which skin layer is vascularized?
A
DERMIS
11
Q
Melanin
- color?
- determined by?
A
brownish pigment
-genetically determined and increased by sun exposure
12
Q
Carotene
- color?
- found where
A
yellow pigment
-found in SQ fat and heavily keratinized layers
EX: palms and soles
13
Q
what causes reddening of skin?
A
oxyhemoglobin–bright red pigment in arteries and caps
14
Q
De-oxyhemoglobin
- color
- found?
A
darker blue pigment
-circulates in veins.
15
Q
Bilirubin
- color
- formed?
A
yellow-brown pigment
-formed– b/d of heme in RBC
-
16
Q
What makes skin or BVs look blue vs red?
A
-scattering of light through turbid superficial layer of skin
17
Q
Pallor indicates?
A
anemia
18
Q
Cyanosis indicates?
A
- decr oxygen in blood
- decr blood flow in resp to cold
19
Q
Jaundice results from?
A
increase bilirubin
20
Q
Vellus hair
A
short, fine, less pigmentation
21
Q
Terminal hair
found where?
A
coarser, pigmented
on scalp or eyebrow
22
Q
Causes of generalized itching WITHOUT rash? (8)
A
- dry skin
- pregnancy
- uremia
- jaundice
- lymphomas
- Leukemias
- drug rxns
- polycythemia vera and thyroid diseases are less common
23
Q
Sebaceous glands produce?
- found where?
- not found where?
A
fatty substance secreted onto the skin via hair follicles
-found everywhere on body EXCEPT: palms and soles
24
Q
Role of nails?
A
protect distal ends of fingers/toes
25
fingernails grow approx _____ daily
0.1mm/daily
26
do toenails grow slower or faster than finger nails?
slower
27
two types of sweat glands
eccrine glands
| apocrine
28
Eccrine glands
- found?
- open on??
- role?
widely distributed
open directly onto skin surface
control body temp
29
Apocrine glands
- found?
- stimulated by?
- open into?
- found in axilla and groin
- stimulated by emotional stress
- open into hair follicles
30
What makes body odor?
bacterial decomposition of apocrine sweat
31
What happens to appearance of dermis as it becomes less vascular w/ age?
appears paler and more opaque
32
What happens to skin on back of hands/forearms as we age?
appears thin fragile, loose, transparent
33
Actinic purpura
- morphology?
- Caused by?
- common in who?
purplish spots caused by blood that has leaked into dermis from poorly supported capillaries
- can develop then fade over time
- common in aging skin
34
where does hair first recede? then recedes into the....?
first, at the temples and then the vertex
35
What do you think of if PT presents with hair breaking along the shaft?
tinea capitis
36
What do you think of it PT presents with hair shedding at the roots?
Telogen effluvium (hair shed from stress) and alopecia areata
37
MC cancer in us?
SKIN CAs
38
MC cancers in order and their percents
1. basal cell carcinoma--80%
2. squamous cell carcinoma--16%
3. melanoma--4%
39
Most prevalent areas for skin CA (3)
- hands
- neck
- head
40
MC skin cancer?
BCC
41
Most lethal skin CA?
melanoma
| -high met rate
42
- shiny
- translucent
- grow slowly and rarely met *
- can be pink patch that does not heal
- can be focal scalding
- can appear as a non-healing ulcer
- can appear has a pink plaque with central depression with telangiectasis boarders
BCC
43
ABCDE-EFG
rule
*which is the most sensitive?
screening for melanoma
A: asymmetry
B: border irregularity
-ragged, notched or blurred
C: Color variations
>2 colors esp blue/black/white (hypopigmentation) or red (inflam rxn to abnormal cells)
D: Diameter
>6mm...size of a pencil eraser
E: Evolution*****MOST SENSITIVE
-changing rapidly in size, s/s, or morphology
E--elevated
F--firm to palpation
G--growing progressively over several weeks
44
crusted
scaly
ulcerated
-Can met
SCC
45
RFs for melanoma (11)
- fam hx
- >50 common moles
- Atypical. or large moles--esp dysplastic
- red or light hair
- solar lentigines
- freckles
- ultraviolet radiation exposure
- light eye or skin color
- severe blistering sunburns in childhood
- immunosuppresion
- person hx of non-melanoma skin cA
46
- solar lentigines
| - rf for what?
acquired brown macules on sun exposed areas
| -RF for melanoma
47
PT counseling for melanoma/skin CA
| *which is the best defense against melanoma?
1. avoid UV radiation and tanning beds********* best defense against skin CA
2. reg use of sunscreen: SPF 30+
48
Four cardinal techniques?
IPPA
- inspect--look
- palpation--touch/feel
- Percussion-tap
- Auscultation--listen
49
Characteristics to note when doing skin exam (6)
1. color--hyper/hypopigmentation
2. moisture
3. temp
4. texture
5. mobility/turgor
6. lesions
50
Color of oxyhemoglobin best done where? Where do you do it for dark-skinned PT?
-fingertips
-lips
-mucous mems
DARK PT: palms and soles
51
to check skin temp, use?
back of fingertips
52
If a lesion is present during exam, what do you want to note about it?
- characteristics
- anatomic location and distribution
- patterns
- shapes
- type of lesion--macule, papule, nevus, vesicle
- color
53
Mist sensitive criteria for the ABCDE rule?
EVOLUTION
54
Which of the following is not considered a risk factor for the development of melanoma?
A. Light hair and eyes
B. Female gender
C. Severe sunburns in childhood
D. 1-4 dysplastic moles
B
| **Males have increased risk of melanoma ****
55
Macule
description?
examples?
flat
cannot palpate
<1cm
EX: freckles, moles
56
Patch
description?
examples?
flat
cannot palpate
>1cm
EX: vitiligo
57
Papule
description?
examples?
```
can palpate
raised
not fluid filled
<1cm
EX: nevus, wart
```
58
Plaque
description?
examples?
```
can palpate
raised
not fluid filled
-flat, elevated superficial papule with surface area greater than height
>1cm
EX: psoriasis, seb. keratosis
```
59
Vesicle
description?
examples?
raised
<1cm
filled with serous fluid
EX: blister, herpes simplex
60
Bulla
description?
examples?
raised
>1cm
filled with serous fluid
EX: blister, pemphigus vulgaris
61
Blanching lesions suggest?
inflammation
62
EX of Non blanching lesions
petechiae
purpura
vascular structures (cherry angiomas,
63
Greasy scaling lesion?
seborrheic dermatitis or keratitis
64
scaling on the feet that is Dry and fine? +itching +burning
tinea pedis
65
scaling that is hard and keratotic?
actinic keratoses or SCC
66
Wheal
description?
examples?
superficial area of cutaneous edema
| EX: hives, insect bite
67
unilateral and dermatomal vesicles
Herpes Zoster
68
Grouped vesicles or pustules on an erythematous base
Herpes Simplex
69
Describe tinea pedis
annular (ring) lesions
70
Describe poison ivy allergic contact dermatitis
Linear lesions
71
Tumor morphology
palpable, solid mass >2cm
72
Nodule morphology
palpable solid mass b/w 1-2 m
73
Pustule
description?
examples?
Similar to vesicle, but filled with pus
| EX: acne, impetigo
74
The following findings suggest?
"Marked facial pallor, and circumoral cyanosis. Palms cold and moist. Cyanosis in nail beds or fingers/toes. Numerous palpale purpura on lower legs bilaterally"
- central cyanosis
| - vasculitis
75
Comedo
plugged opening of sebaceous gland
76
Special primary skin lesions?
- comedo
- burrow
- cyst
- abcess
- furnucle
- carbuncle
- milia
77
Furnuncle
inflamed hair follicle
78
Carbuncle
multiple grouped furnuncles
79
What does "fluctuance" indicate?
that there is a deep infection
| *abscesses*
80
Cyst
- morphology
- found in which layer of the skin?
palpable lesion filled with semiliquid material or fluid
| *subcutaneous*
81
Excision reveals Pearly white balls--indicates what type of cyst?
pilar cyst
82
Mobile, rubbery, subcutaneous mass--indicates?
lipoma
83
2-cm solitary, tethered subcutaneous cyst with overlying punctum releasing caseous whitish yellow substance with foul odor---indicates what type of cyst?
epidermal inclusion cyst
84
Burrows indicates?
scabies
85
wheals
urticaria
86
Keratoacanthomas are____?
| -morphology?
SCC
| -arise rapidly and have a crateriform center
87
What are the MC sites of metastasis for SCC?
- scalp
- lips
- ears
88
What skin disorder is described below:
- verrucous texture
- stuck on appearance or flattened ball of wax
- may crumble or bleed if picked
Seb. Keratosis
89
Seb. Keratosis can mimic which carcinoma?
SCC
90
Actinic keratosis can mimic which carcinoma?
BCC
91
milia
tiny keratin-filled cysts representing an accumulation of keratin in the distal portion of sweat gland
92
Erosion
- morphology
- ex
loss of part or all of the epidermis
-surface is moist
EX: rupture of vesicle
93
Ulcer
- morphology
- ex
Loss of epidermis and dermis
-dermis may bleed
EX: stasis ulcer or chancre
94
which is deeper: ulcer or erosion?
ulcer--because loss of epidermis AND dermis where erosion is just loss of the epidermis
95
fissure
- morphology
- ex
linear crack from epidermis to dermis
| EX: athletes foot
96
Excoriation
superficial linear or "dug out" traumatized area
| -self inflicted from scratching
97
Atrophy
- morphology
- ex
thinning of the skin with loss of skin markings
| EX: striae
98
Sclerosis
diffuse or circumscribed hardening of skin
99
Erythema
| -characteristics (3)
pink or red discoloration
secondary to dilation of BVs
+blanches with pressure
100
Petechiae vs purpura
| -indicates?
PETECHIAE: red/purple smaller than 0.5cm
NON blanching
PURPURA: red/purple greater than 0.5cm
NON blanching
-both indicate intravascular defects
101
Ecchymosis
reddish-purple non-blanching
variable size
EX: trauma, vasculitis
102
Telangiectasia
fine
| irreg dilated BVs
103
central red body with radiating spider-like arms that +blanch with pressure to the central area
Spider angioma
104
roughening and thickening of epidermis
-accentuated skin markings
-seen with what skin disorder?
Lichenification
| SEEN WITH ATOPIC DERM
105
Annular
ring shape
| EX: ring worm
106
Arcuate
partial rings
| EX: syphilis
107
Confluent
lesions that run together
| EX: childhood exanthems
108
Discoid
disc shaped w/o central clearing
| EX: lupus
109
Discrete
lesions remain separate
110
Iris
circle within a circle... a bull's eye lesions
| EX: erythema multiforme
111
Papulosquamous
papules or plaques assoc with scaling
| EX: psoriasis
112
Zosterifor or dermtomal
linear arrangement along a nerve distribution
| EX: herpes zoster
113
plaques with a silvery scale?
psoriasis
114
Extensor surfaces?
psoriasis
115
Flexor surfaes
Atopic derm
116
Herald patch
pityriasis rosea
117
Terms "rolled border" and "pearly" used to describe appearance of____?
BCC
118
Dislodgement of intact superficial epidermis by shearing force (rubbing)
nikolsky sign
| EX: pemphigus, staph scalded skin syndrome
119
pinpoint bleeding that occur when surace of a rash has been removed or scratched
auspitz sign
120
PTs with many displastic nevi are at high risk for?
melanoma
121
asymmetric blue/black lesions highly suggestive of?
melanoma
122
open + closed comedones?
mild acne
123
comedones, papules and pustules?
Mod acne
124
skin findings with infective endocarditis?
- jane way lesions
- oslar nodes
- splinter hemms
- petechia
125
- warm moist soft and velvety skin
- thin and fine hair
- alopecia
- vitiligo
- pretibial myxedema (graves)
- hyperpigmentation
All suggest _____?
Derm findings with hyperthyroidism
126
- dry, rough and pale skin
- coarse and brittle hair
- myxedema
- skin cool
- thin brittle nails
derm findings for hypothyroidism
127
- pruritus
- acanthosis nigricans
- candidasis
- neuropathic ulcers
- necrobiosis lipodicia
- eruptive xanthomas
all can be findings in ____?
Derm findings for DM
128
Dyslipidemia derm findings
- xanthomas (tendon, eruptive and tuberous)
| - xanthelasma--can also occur in healthy ppl
129
what diseases/conditions cause nail pitting? (4)
- psoriasis
- eczema
- alopecia areata
- linchen planus
130
What causes nail clubbing?
```
cardiovascular disease
COPD
IBD
AIDS
Liver disease
```
131
MCC of nail spooning?
iron deficiency anemia
132
+ hair pull test w. bulbs and PT has normal hair distribution can indicate
Telon Effluvium
133
Hair pull test show little to no hairs with bulbs and PT has diffuse hair loss from roots----indicates?
Anagen Effluvium
134
```
It is the MC hand infection:
superficial infection of proximal and lateral nail folds adjacent to nail plate
+red
+swollen
+tender
MCC causative agents?
```
Paronychia
| STAPH or STREP
135
What is it called when paronychia infection extends into the pulp?
Felon
136
MC causes of paronychia (not the microorganism) (4)
nail biting
trauma
manicuring
frequent hand immersion in water
137
What is the most common cause of nail thickening?
| MC agent?
Onychomycosis
| Dermtophytes
138
Solar lentigines and actinic purpura are signs of?
sun damage
139
signs of chronic sum damage?
- solar lentigines on shoulder upper back
- many melanocytic nevi
- solar elastosis (yellow thickened skin with bumbs)
- wrinkles
- cutis rhomboidalis nuchae
- actinic purpura
