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Physical Assessment 1 > Derm > Flashcards

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
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2
Q

What is the heaviest single organ?

A

SKIN

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3
Q

percent of body weight is skin?

A

16%

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4
Q

Layers of the skin

A
  • epidermis (most superficial)
  • dermis
  • subcutaneous tissue
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5
Q

Appendages of skin

A
  • hair
  • nails
  • sebaceous and sweat glands
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6
Q

what layer of skin is avasculr?

A

Epidermis

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7
Q

Layers of epidermis and what are they made of?

A
  1. Outer horny stratum corneum–dead keratinized cells
  2. inner cellular layer
    - stratum basale (melanin) and stratum spinosum
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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
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9
Q

subcutaneous layer made of?

A

fatty or adipose tissue

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10
Q

Which skin layer is vascularized?

A

DERMIS

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11
Q

Melanin

  • color?
  • determined by?
A

brownish pigment

-genetically determined and increased by sun exposure

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12
Q

Carotene

  • color?
  • found where
A

yellow pigment
-found in SQ fat and heavily keratinized layers
EX: palms and soles

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13
Q

what causes reddening of skin?

A

oxyhemoglobin–bright red pigment in arteries and caps

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14
Q

De-oxyhemoglobin

  • color
  • found?
A

darker blue pigment

-circulates in veins.

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15
Q

Bilirubin

  • color
  • formed?
A

yellow-brown pigment
-formed– b/d of heme in RBC
-

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16
Q

What makes skin or BVs look blue vs red?

A

-scattering of light through turbid superficial layer of skin

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17
Q

Pallor indicates?

A

anemia

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18
Q

Cyanosis indicates?

A
  • decr oxygen in blood

- decr blood flow in resp to cold

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19
Q

Jaundice results from?

A

increase bilirubin

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20
Q

Vellus hair

A

short, fine, less pigmentation

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21
Q

Terminal hair

found where?

A

coarser, pigmented

on scalp or eyebrow

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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
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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

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24
Q

Role of nails?

A

protect distal ends of fingers/toes

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25
Q

fingernails grow approx _____ daily

A

0.1mm/daily

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26
Q

do toenails grow slower or faster than finger nails?

A

slower

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27
Q

two types of sweat glands

A

eccrine glands

apocrine

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28
Q

Eccrine glands

  • found?
  • open on??
  • role?
A

widely distributed
open directly onto skin surface
control body temp

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29
Q

Apocrine glands

  • found?
  • stimulated by?
  • open into?
A
  • found in axilla and groin
  • stimulated by emotional stress
  • open into hair follicles
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30
Q

What makes body odor?

A

bacterial decomposition of apocrine sweat

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31
Q

What happens to appearance of dermis as it becomes less vascular w/ age?

A

appears paler and more opaque

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32
Q

What happens to skin on back of hands/forearms as we age?

A

appears thin fragile, loose, transparent

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33
Q

Actinic purpura

  • morphology?
  • Caused by?
  • common in who?
A

purplish spots caused by blood that has leaked into dermis from poorly supported capillaries

  • can develop then fade over time
  • common in aging skin
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34
Q

where does hair first recede? then recedes into the….?

A

first, at the temples and then the vertex

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35
Q

What do you think of if PT presents with hair breaking along the shaft?

A

tinea capitis

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36
Q

What do you think of it PT presents with hair shedding at the roots?

A

Telogen effluvium (hair shed from stress) and alopecia areata

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37
Q

MC cancer in us?

A

SKIN CAs

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38
Q

MC cancers in order and their percents

A
  1. basal cell carcinoma–80%
  2. squamous cell carcinoma–16%
  3. melanoma–4%
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39
Q

Most prevalent areas for skin CA (3)

A
  • hands
  • neck
  • head
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40
Q

MC skin cancer?

A

BCC

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41
Q

Most lethal skin CA?

A

melanoma

-high met rate

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42
Q
  • 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
A

BCC

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43
Q

ABCDE-EFG
rule

*which is the most sensitive?

A

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

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44
Q

crusted
scaly
ulcerated
-Can met

A

SCC

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45
Q

RFs for melanoma (11)

A
  • 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
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46
Q
  • solar lentigines

- rf for what?

A

acquired brown macules on sun exposed areas

-RF for melanoma

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47
Q

PT counseling for melanoma/skin CA

*which is the best defense against melanoma?

A
  1. avoid UV radiation and tanning beds******* best defense against skin CA
  2. reg use of sunscreen: SPF 30+
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48
Q

Four cardinal techniques?

A

IPPA

  • inspect–look
  • palpation–touch/feel
  • Percussion-tap
  • Auscultation–listen
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49
Q

Characteristics to note when doing skin exam (6)

A
  1. color–hyper/hypopigmentation
  2. moisture
  3. temp
  4. texture
  5. mobility/turgor
  6. lesions
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50
Q

Color of oxyhemoglobin best done where? Where do you do it for dark-skinned PT?

A

-fingertips
-lips
-mucous mems
DARK PT: palms and soles

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51
Q

to check skin temp, use?

A

back of fingertips

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52
Q

If a lesion is present during exam, what do you want to note about it?

A
  • characteristics
  • anatomic location and distribution
  • patterns
  • shapes
  • type of lesion–macule, papule, nevus, vesicle
  • color
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53
Q

Mist sensitive criteria for the ABCDE rule?

A

EVOLUTION

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54
Q

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

A

B

**Males have increased risk of melanoma **

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55
Q

Macule
description?
examples?

A

flat
cannot palpate
<1cm
EX: freckles, moles

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56
Q

Patch
description?
examples?

A

flat
cannot palpate
>1cm
EX: vitiligo

57
Q

Papule
description?
examples?

A 
can palpate 
raised 
not fluid filled 
<1cm 
EX: nevus, wart
58
Q

Plaque
description?
examples?

A 
can palpate 
raised
not fluid filled 
-flat, elevated superficial papule with surface area greater than height 
>1cm 
EX: psoriasis, seb. keratosis
59
Q

Vesicle
description?
examples?

A

raised
<1cm
filled with serous fluid
EX: blister, herpes simplex

60
Q

Bulla
description?
examples?

A

raised
>1cm
filled with serous fluid
EX: blister, pemphigus vulgaris

61
Q

Blanching lesions suggest?

A

inflammation

62
Q

EX of Non blanching lesions

A

petechiae
purpura
vascular structures (cherry angiomas,

63
Q

Greasy scaling lesion?

A

seborrheic dermatitis or keratitis

64
Q

scaling on the feet that is Dry and fine? +itching +burning

A

tinea pedis

65
Q

scaling that is hard and keratotic?

A

actinic keratoses or SCC

66
Q

Wheal
description?
examples?

A

superficial area of cutaneous edema

EX: hives, insect bite

67
Q

unilateral and dermatomal vesicles

A

Herpes Zoster

68
Q

Grouped vesicles or pustules on an erythematous base

A

Herpes Simplex

69
Q

Describe tinea pedis

A

annular (ring) lesions

70
Q

Describe poison ivy allergic contact dermatitis

A

Linear lesions

71
Q

Tumor morphology

A

palpable, solid mass >2cm

72
Q

Nodule morphology

A

palpable solid mass b/w 1-2 m

73
Q

Pustule
description?
examples?

A

Similar to vesicle, but filled with pus

EX: acne, impetigo

74
Q

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”

A
  • central cyanosis

- vasculitis

75
Q

Comedo

A

plugged opening of sebaceous gland

76
Q

Special primary skin lesions?

A
  • comedo
  • burrow
  • cyst
  • abcess
  • furnucle
  • carbuncle
  • milia
77
Q

Furnuncle

A

inflamed hair follicle

78
Q

Carbuncle

A

multiple grouped furnuncles

79
Q

What does “fluctuance” indicate?

A

that there is a deep infection

abscesses

80
Q

Cyst

  • morphology
  • found in which layer of the skin?
A

palpable lesion filled with semiliquid material or fluid

subcutaneous

81
Q

Excision reveals Pearly white balls–indicates what type of cyst?

A

pilar cyst

82
Q

Mobile, rubbery, subcutaneous mass–indicates?

A

lipoma

83
Q

2-cm solitary, tethered subcutaneous cyst with overlying punctum releasing caseous whitish yellow substance with foul odor—indicates what type of cyst?

A

epidermal inclusion cyst

84
Q

Burrows indicates?

A

scabies

85
Q

wheals

A

urticaria

86
Q

Keratoacanthomas are____?

-morphology?

A

SCC

-arise rapidly and have a crateriform center

87
Q

What are the MC sites of metastasis for SCC?

A
  • scalp
  • lips
  • ears
88
Q

What skin disorder is described below:

  • verrucous texture
  • stuck on appearance or flattened ball of wax
  • may crumble or bleed if picked
A

Seb. Keratosis

89
Q

Seb. Keratosis can mimic which carcinoma?

A

SCC

90
Q

Actinic keratosis can mimic which carcinoma?

A

BCC

91
Q

milia

A

tiny keratin-filled cysts representing an accumulation of keratin in the distal portion of sweat gland

92
Q

Erosion

  • morphology
  • ex
A

loss of part or all of the epidermis
-surface is moist
EX: rupture of vesicle

93
Q

Ulcer

  • morphology
  • ex
A

Loss of epidermis and dermis
-dermis may bleed
EX: stasis ulcer or chancre

94
Q

which is deeper: ulcer or erosion?

A

ulcer–because loss of epidermis AND dermis where erosion is just loss of the epidermis

95
Q

fissure

  • morphology
  • ex
A

linear crack from epidermis to dermis

EX: athletes foot

96
Q

Excoriation

A

superficial linear or “dug out” traumatized area

-self inflicted from scratching

97
Q

Atrophy

  • morphology
  • ex
A

thinning of the skin with loss of skin markings

EX: striae

98
Q

Sclerosis

A

diffuse or circumscribed hardening of skin

99
Q

Erythema

-characteristics (3)

A

pink or red discoloration
secondary to dilation of BVs
+blanches with pressure

100
Q

Petechiae vs purpura

-indicates?

A

PETECHIAE: red/purple smaller than 0.5cm
NON blanching

PURPURA: red/purple greater than 0.5cm
NON blanching

-both indicate intravascular defects

101
Q

Ecchymosis

A

reddish-purple non-blanching
variable size
EX: trauma, vasculitis

102
Q

Telangiectasia

A

fine

irreg dilated BVs

103
Q

central red body with radiating spider-like arms that +blanch with pressure to the central area

A

Spider angioma

104
Q

roughening and thickening of epidermis
-accentuated skin markings

-seen with what skin disorder?

A

Lichenification

SEEN WITH ATOPIC DERM

105
Q

Annular

A

ring shape

EX: ring worm

106
Q

Arcuate

A

partial rings

EX: syphilis

107
Q

Confluent

A

lesions that run together

EX: childhood exanthems

108
Q

Discoid

A

disc shaped w/o central clearing

EX: lupus

109
Q

Discrete

A

lesions remain separate

110
Q

Iris

A

circle within a circle… a bull’s eye lesions

EX: erythema multiforme

111
Q

Papulosquamous

A

papules or plaques assoc with scaling

EX: psoriasis

112
Q

Zosterifor or dermtomal

A

linear arrangement along a nerve distribution

EX: herpes zoster

113
Q

plaques with a silvery scale?

A

psoriasis

114
Q

Extensor surfaces?

A

psoriasis

115
Q

Flexor surfaes

A

Atopic derm

116
Q

Herald patch

A

pityriasis rosea

117
Q

Terms “rolled border” and “pearly” used to describe appearance of____?

A

BCC

118
Q

Dislodgement of intact superficial epidermis by shearing force (rubbing)

A

nikolsky sign

EX: pemphigus, staph scalded skin syndrome

119
Q

pinpoint bleeding that occur when surace of a rash has been removed or scratched

A

auspitz sign

120
Q

PTs with many displastic nevi are at high risk for?

A

melanoma

121
Q

asymmetric blue/black lesions highly suggestive of?

A

melanoma

122
Q

open + closed comedones?

A

mild acne

123
Q

comedones, papules and pustules?

A

Mod acne

124
Q

skin findings with infective endocarditis?

A
  • jane way lesions
  • oslar nodes
  • splinter hemms
  • petechia
125
Q
  • warm moist soft and velvety skin
  • thin and fine hair
  • alopecia
  • vitiligo
  • pretibial myxedema (graves)
  • hyperpigmentation

All suggest _____?

A

Derm findings with hyperthyroidism

126
Q
  • dry, rough and pale skin
  • coarse and brittle hair
  • myxedema
  • skin cool
  • thin brittle nails
A

derm findings for hypothyroidism

127
Q
  • pruritus
  • acanthosis nigricans
  • candidasis
  • neuropathic ulcers
  • necrobiosis lipodicia
  • eruptive xanthomas

all can be findings in ____?

A

Derm findings for DM

128
Q

Dyslipidemia derm findings

A
  • xanthomas (tendon, eruptive and tuberous)

- xanthelasma–can also occur in healthy ppl

129
Q

what diseases/conditions cause nail pitting? (4)

A
  • psoriasis
  • eczema
  • alopecia areata
  • linchen planus
130
Q

What causes nail clubbing?

A 
cardiovascular disease 
COPD 
IBD 
AIDS 
Liver disease
131
Q

MCC of nail spooning?

A

iron deficiency anemia

132
Q

+ hair pull test w. bulbs and PT has normal hair distribution can indicate

A

Telon Effluvium

133
Q

Hair pull test show little to no hairs with bulbs and PT has diffuse hair loss from roots—-indicates?

A

Anagen Effluvium

134
Q 
It is the MC hand infection: 
superficial infection of proximal and lateral nail folds adjacent to nail plate
\+red
\+swollen
\+tender 
MCC causative agents?
A

Paronychia

STAPH or STREP

135
Q

What is it called when paronychia infection extends into the pulp?

A

Felon

136
Q

MC causes of paronychia (not the microorganism) (4)

A

nail biting
trauma
manicuring
frequent hand immersion in water

137
Q

What is the most common cause of nail thickening?

MC agent?

A

Onychomycosis

Dermtophytes

138
Q

Solar lentigines and actinic purpura are signs of?

A

sun damage

139
Q

signs of chronic sum damage?

A
  • solar lentigines on shoulder upper back
  • many melanocytic nevi
  • solar elastosis (yellow thickened skin with bumbs)
  • wrinkles
  • cutis rhomboidalis nuchae
  • actinic purpura

Physical Assessment 1 (7 decks)

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