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PNP: Physical Assessment > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Three Skin Layers (3)

A
  1. Epidermis: Horny layer of dead cells, melanin and keratin are formed
  2. Dermis: supportive layer, connective tissue, appendages embedded vasculature and peripheral nervous system
  3. Subcutaneous fatty layer: fat storage
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2
Q

Anatomic Depth of a Lesion: Epidermis (5)

A

Altered Surface Markings with scales, crust and color changes

  1. Vitiligo
  2. Atopic dermatitis
  3. Café au lait spot
  4. Impetigo
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3
Q

Anatomic Depth of a Lesion: Epidermis and Dermis (5)

A
  1. Altered surface markings plus distinct borders, edema, scales, vesicles, crust, color changes including red
  2. Psoriasis
  3. Atopic dermatitis
  4. Cutaneous lupus erythematosus
  5. Contact dermatitis
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4
Q

Anatomic Depth of a Lesion: Dermis (5)

A
  1. Normal surface markings with color changes and dermal firmness
  2. Urticaria
  3. Granuloma annulare
  4. Hemangioma
  5. Blue nevus
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5
Q

Anatomic Depth of a Lesion: Subcutaneous Tissue (3)

A
  1. Normal surface markings with normal or red skin color and altered skin firmness
  2. Hematoma
  3. Erythema Nodosum
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6
Q

Vitiligo (3)

A
  1. Associated with autoimmune disease such as thyroid disease destruction of melanocytes with loss of melanocytes
  2. Can be localized, generalized or segmental
  3. Can have zones of transition from normal to hypopigmented skin
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7
Q

Ectodermal Dysplasia

A

Lack the ability to sweat; run high fevers and may get seizures as a result

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8
Q

Mongolian Spots

A

Excess melanocytes in one area; seen more commonly in darker skinned children because they have more melanocytes

Over time, the melanocytes migrate so the children loose their mongolian spots (usually around age 2 but can stay longer)

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9
Q

Post-inflammatory hyperpigmentation

A

Scratching leads to increased melanocytes; skin gets darker and many times it thickens (lichenification)

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10
Q

Pityriasis Alba

A

Essentially dry skin; patches of white or paler skin will come up, mainly occurring in summer and winter

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11
Q

Oculocutaneous Albinism (4)

A
  1. MUST protect skin since will develop freckles, actinic keratoses and carcinoma of the skin
  2. Unable to produce melanin
  3. Red orange hair
  4. Nystagmus and photophobia
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12
Q

Addison’s Disease

A

Causes increased pigmentation due to adrenal insufficiency

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13
Q

Acanthosis Nigricans (3)

A
  1. Hyperpigmentation and hyperkeratosis in intertriginous areas and over bony prominences.
    * Seen on nape of neck, knuckles of hands
  2. Skin lines are accentuated, and the skin surface of involved areas may have a velvety, leathery, or warty appearance
  3. Occurs with hyperinsulinism or obesity
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14
Q

Assessment of Nevi (ABCDE)

A 
ABCDE
– Asymmetry
– Border irregularity
– Color variation
– Diameter of > 6 mm
– Evolution

*Ugly duckling sign: A nevi outside the common
pattern may need biopsy

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15
Q

Six Pronged Approach to a Rash

A
  1. What kind of lesion is it?
    – Primary or secondary?
  2. Where is located on the body?
  3. How are the lesions configured?
  4. How are the lesions spreading?
  5. What is the original color and what are the secondary color changes?
  6. What symptoms are associated with the rash?
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16
Q

Exanthem

A

Rash on the skin; could be chicken pox, coxi virus, etc.

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17
Q

Enanthem

A

Rash inside a mucous membrane; can get this from varicella or other infections (ex: rash in penis, mucous membranes of mouth, etc)

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18
Q

Macule

A

flat, distinct, discolored area of skin that is usually less than 1 centimeter wide.

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19
Q

Patch

A

a macule greater than 1cm wide

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20
Q

Papule, Plaque

A

Solid raised lesion that has distinct borders and is less than 1 cm in diameter.

  • may have a variety of shapes in profile (domed, flat-topped, umbilicated) and may be associated with secondary features such as crusts or scales.
  • Two erythematous papules next to each other is the hallmark of spider bites

Plaque: greater than 1cm diameter; bigger and raised
*Associated with psoriasis; when you scratch it, it bleeds (aspitz sign)

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21
Q

Nodule, Tumor

A

Nodule: A nodule is a raised solid lesion more than 1 cm. and may be in the epidermis, dermis, or subcutaneous tissue.

Tumor: larger than nodule

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22
Q

Wheal, uticaria

A

wheal: A wheal is an area of edema in the upper epidermis.
uticaria: hives

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23
Q

Vessicle, Bulla

A

Vessicle: Vesicles are raised lesions less than 1 cm. in diameter that are filled with clear fluid.

Bulla: greater than 1cm

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24
Q

Pustule

A

Pustules are circumscribed elevated lesions that contain pus. They are most commonly infected (as in folliculitis) but may be sterile (as in pustular psoriasis)

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25
Q

Cyst

A

A cyst is a closed sac that contains liquid or semisolid material. On palpation a cyst is usually resilient.

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26
Q

Psoriasis

A
  1. Red, welldemarcated plaques covered with dry, thick, silvery scales
  2. tend to be located on the extensor surfaces of the
    extremities, the scalp, and the buttocks, or large lesions over the pressure points of the knees and elbows
  3. Ausptiz sign: scratching a psoriasis scale causes bleeding
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27
Q

Guttate

A

Drop-like lesion

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28
Q

Tumor - Lipoma

A

Under the skin, generally involving subcutaneous fatty layers

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29
Q

Varicella Zoster

A

vesiculopustular exanthems; goes in line of dermatome track (dermatomal)
*usually seen across chest or back

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30
Q

Varicella

A

vesicles, papules, and scabs can occur all in the same stage of the illness

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31
Q

Vesicles in Groups

A

Herpes until proven otherwise!; the vesicles in herpes crust over and are grouped together in a cluster
*Think of herpes any time you see vesicles

*Herpes leaves scabbing after the vessicles go away

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32
Q

Vesicles

A

In groups: herpes simplex

In chains: herpes zoster

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33
Q

Secondary Skin Lesions (10)

A
  1. Crust
  2. Scale
  3. Fissure
  4. Erosion
  5. Ulcer
  6. Excoriation
  7. Scar
  8. Atrophic Scar
  9. Lichenification
  10. Keloid
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34
Q

Ehler Danlos syndrome

A

connective tissue disorder marked by cigarette thin; has atrophic scars

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35
Q

Erosion v. Ulcer

A

Erosion: a loss of epidermis

Ulcer: a loss of epidermis and dermis

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36
Q

Fissure

A

Break in the skin

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37
Q

Excoriation

A

if erosions and/or ulcers are produced by scratching

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38
Q

Atrophic scar

A

have a thin papery quality, sometimes likened to cigarette paper (Ehler Danlos syndrome)

39
Q

Keloid

A

firm, rubbery nodules or plaques that result from the proliferation of fibroblasts and deposition of collagen after injury to the skin

40
Q

Tinea Pedis

A

Athlete’s foot; causes scaling and fissures

41
Q

Impetigo

A

Primarily an epidermal disorder; hallmark is red sores on the face that turn into honey-crusted scabs

42
Q

Lichenification

A

thickening of the skin, can occur due to intense scratching

*Can occur with psoriasis

43
Q

Dermpagraphism

A

Can be red or white; occurs due to a lot of scratching

*initial white line secondary to reflex vasoconstriction is supplanted by pruritic, erythematous linear swelling, as seen in a classic wheal and flare reaction

44
Q

Striae

A

type of atrophy; stretch-marks

45
Q

How do you know something is petechiae?

A

Take hands and push down and stretch skin, petechiae will not go away with pressure

  • Numerous very small red dots
  • Can occur from vomiting, will take ~4 days to go away
  • Can cause hemorrhage in sclera if from vomiting
46
Q

Hemangioma

A

Benign vascular tumors or neoplasms that are dynamic, having the capacity for rapid growth as a result of endothelial cell proliferation; look like very red, soft, raised lesions

  • Proliferates in the first 4 months of life; the mark begins small and then gets bigger as child gets older
  • If it proliferates, it stays there 85% of the time
47
Q

Flexural Distribution Skin Disorders (6)

A

Occur on flexural areas of the body; buttocks, back of knees, front bends of elbows, ankles

  1. Atopic dermatitis
  2. Fungal infections like tinea curis
  3. Inverse psoriasis
  4. Inetrigo
  5. Candidiasis
  6. Toilet seat dermatitis
48
Q

Acneform rashes (2)

A

Occur mainly on chest and face

  1. Acne
  2. Pityriasis versicolor
49
Q

Acrodermatitis Rashes (4)

A

Occur on hands and feet

  1. Viral exanthem caused by coxsackie
  2. Dyshidrotic eczema
  3. Post streptococcal peeling
  4. Tinea pedis
50
Q

Sun-exposed area rashes (2)

A

Occur mainly on face and chest, also some front of arms and legs

  1. Viral exanthem photo enhancements
  2. Lupus erythematous (butterfly distribution = hallmark)
51
Q

Pityriasis distribution (4)

A

Mainly on chest, all of abdominal area, groin

  1. Pityriasis rosea
  2. Drug reaction
  3. Secondary syphilis - on palms and chest
  4. Guttate psoriasis - commonly associated with strep
52
Q

Clothing-Covered Site Rashes (3)

A

1 allergen in terms of clothes: nickel

Occur mainly on chest and abdominal area but also groin and front of legs

  1. Contact dermatitis
  2. Miliaria
  3. Psoriasis in summer
53
Q

Rash Configurations (5)

A
  1. Linear lesions: Occur in a line
  2. Herpetiform lesions: are grouped lesions
  3. Dermatomal: Example is Zoster
  4. Annular: Ringlike (doesn’t itch)
  5. Arciform lesions
54
Q

discoid vs. nummular

A

Discoid: disk shaped

Nummular: coin shaped

55
Q

Koebner Phenomenon

A

LINEAR PAPULES that occur after being scratched in an area.

56
Q

Allergic Contact Dermatitis

A

Type IV T-cell mediated disease; linear streaks of erythematous papules and vesicles

*Most commonly due to poison ivy

57
Q

Identifying Pattern of Spread (3)

A
  1. Does it spread from the trunk outward?
  2. Does it spread from head downward?
  3. Did it start at a area and then spread in trunk?

Ex: measles hides behind the ears first then goes to the face then spreads downwards

58
Q

General approach to a rash

A

What is the original color and how have they changed?

59
Q

Symptoms of a lesion (3)

A
  1. Itchy
  2. Painful
  3. Nothing
60
Q

Eczematous

A

inflammatory skin lesions that are poorly marginated, erythematous and sometimes with vesiculations

61
Q

Hyperkeratosis

A

Thickening of corneum stratum

62
Q

What to include when charting rashes (8)

A
  1. Lesion type
  2. Color
  3. Postinflammatory changes
  4. Size and shape
  5. Border
  6. Location
  7. Consistency
  8. Configuration
63
Q

Atopic Dermatitis (7)

A
  1. Affected children more likely to be urban, Black, and living in homes with higher education level
  2. Pruritis and itch
  3. History of itch is required to make the diagnosis
  4. Fussiness and poor sleep are characteristics of
    children who are unable to sleep
  5. Most manifest symptoms in the first year of life
  6. Unknown pathology; associated with T-cell immunodeficiency problems (higher bacterial fungal infections as a result)
  7. Can get very leathery/lichenification if you itch it a lot
64
Q

Atopic Dermatitis Physical Exam of Infants (4)

A
  1. Involves face, neck and extensor surfaces
  2. On the cheeks may develop weeping dermatitis
  3. Persistent, bright red plaques may develop on cheeks
  4. Characteristic sparing of the diaper area

REMEMBER: can lead to secondary infection because of the T-cell defect; may get herpes or staph in it

65
Q

Atopic Dermatitis Physical Exam of Children and Adolescents (4)

A
  1. Flexural patches and plaquesin antecubital and
    popliteal fossa
  2. Hand and foot plantar dermatisis
  3. In severe cases, thickened plaques on the dorsal hand, feet, and kneed with lichenified or leathery appearance
  4. Darker skin children have pebbled appearance

REMEMBER: can lead to secondary infection because of the T-cell defect; may get herpes or staph in it

66
Q

General Physical exam of Atopic Dermatitis (5)

A
  1. Skin is overall dry and flay
  2. Platelike ichthyosis of distal extremities
  3. Superinfection is very common especially with severe disease
  4. Staphylococcal colonization with crusting and pustules
  5. Punched out ulcers and vesicopustules with eczematous plaques with or without fever can indicate a superimposed herpes infection (eczema herpeticum)
67
Q

Atopic dermatitis Distribution of Lesions in Adults

A

around front and back of neck, on fronts of the elbow bends, back of wrists, back of knees, fronts of ankles

68
Q

Keratosis Pilaris

A

Bumpy skin/Dryness of skin; goes away when you get older (AG)

Scales over the extensor surfaces of the extremities and sometimes the trunk and abdomen

69
Q

Seborrhea (3)

A
  1. Manifests around 3-4 weeks of life as asymptomatic erythema and scaling of scalp that will spread to face, behind the ears, and the body folds
  2. If it persists and is extensive with hepatosplenomegaly, arthritis, adenopathy and failure to thrive,
  3. Differential diagnosis includes (if severe and doesn’t go away)
    -Immunodeficiency
    –Langerhans cell histiocytosis
70
Q

Seborrhea (age of patient, physical exam, key features)

A

Age of patient: Newborns (under 2 months) and teens

Physical exam: Symmetric, well demarcated flexural bright red plaques and greasy scale (atopy is dry scale)

Key features: It is asymptomatic and can involve diaper area; NO ITCH

71
Q

Allergic Atopic Dermatitis (age of patient, physical exam, key features)

A

Age of patient: any age but usually school age

Physical exam: unusual distribution with exzematous papules and plaques at site of exposure

Key features: May produce an “id reaction” with widespread pruritc papules far from area of original exposure

72
Q

Scabies (age of patient, physical exam, key features)

A

Age of patient: Any age

Physical exam: Polymorphic (papules, vesicles, nodules often on intertriginous sites

Key features: Spares faces usually

73
Q

Allergic Contact Dermatitis

A

Offending allergen; May be localized to area on contact but can spread without contact since it is a type 4 T cell mediated reaction

  • May see classic Koebner phenomenon and weeping vessicles
  • Itchy!!
74
Q

Psoriasis in Infants

A

Diaper rash that is refractory to multiple treatments

75
Q

Psoriasis in Older Children (2)

A
  1. Asymptomatic scaly rash and or with refractory or severe dandruff or cradle cap
  2. May be pruritic
76
Q

Psoriasis Triggers (6)

A
  1. trauma
  2. skin irritation
  3. infections with strep resulting in guttate psoriasis
  4. emotional stress
  5. medications
  6. Overweight or obesity
77
Q

Physical Exam of Psoriasis (2)

A
  1. Chronic plaques
    – Extensor surfaces
    – Scalp: can be only sign; Scale can be thick and called tinea amiantacea; More likely to be pruritic
    – Trunk
  2. Guttate
    – Small drop like
78
Q

Tinea Corpis (5)

A
  1. Typically involves exposed surfaces
  2. Close contact with contact with this
  3. Itchy, erythematous scaling annular plaque of varying size with active peripheral leading scales and central clearing
  4. Tinea starts in center as papule and then gets more round; anular ring-like and itchy
  5. Has classic papules and spreads circumfrencially as it gets bigger
79
Q

Tinea Pedis (3)

A
  1. Warm, moist environment
  2. Transmitted on floors of locker rooms, swimming pools or house
  3. Four kinds of presentations: Moccasin, interdigital inflammatory, ulcerative
80
Q

Candidiasis History: Duration of Eruption

A

> 72 hours without relief from common treatment consider bacterial or candidiasis

81
Q

Candidiasis History: Cleaning Routine (2)

A
  1. Frequency

2. Cleanser used—wash clothes versus baby wipes

82
Q

Candidiasis History: Diapers (5)

A
  1. Disposable versus cloth
  2. Presence of elastic dyes
  3. Frequency of changes/urination
  4. Presence of zinc oxide, petrolatum
  5. Products used in diaper area: barrier emollient creams/pastes, powder
83
Q

Candidiasis Physical Exam (3)

A
  1. Candidiasis presents as fiery red sharp marginated patches with fine peripheral scale involving the inguinal fold buttocks, genitalia, thighs and abdominal area, interfold areas (ex: under breasts)
  2. Oral thrush may accompany it
  3. Results from moisture and maceration in the diaper area
84
Q

Diaper Dermatitis Clinical Findings: Mild Disease (3)

A
  1. Mild erythema over limited surface areas
  2. Minimal maceration and chafing
  3. Asymptomatic
85
Q

Diaper Dermatitis Clinical Findings: Moderate Disease (2)

A
  1. More extensive erythema with maceration or superficial erosion
  2. Pain discomfort
86
Q

Diaper Dermatitis Clinical Findings: Severe Disease (3)

A
  1. Punched out lesions or erosion with elevated borders (jacquet’s diaper dermatitis)
  2. Pseudoverrucous eroded papules and nodules
  3. Pain
87
Q

Consider Infection with Diaper Dermatitis If… (5)

A
  1. Maceration > 72 hours
  2. Satelite superficial erythematous papules and pustules
  3. Superficial vesicles or bullae, erosion (bacterial)
  4. Follicular based erythematour papules and pustules (bacterial)
  5. Punched out grouped erosions (HSV)
88
Q

Herpes History Taking (3)

A
  1. History of Exposure to household contact
  2. Previous recurrent lesions in the same area
  3. If febrile, history of exposure to varicella, CMV, new HSV
89
Q

Warts History Taking (2)

A
  1. Household or school exposure

2. Trauma Previously in the area of the wart

90
Q

Warts Physical Exam

A

Non pruritic papules in linear configuration

91
Q

History of Hair Loss (4)

A
  1. Did the hair loss occur over months or days
    – Alopecia areata is very rapid loss over days
    – Traction alopecia is gradual thinnning of the hairline or where ever there is traction
    – Telogen effluvium, starts rapidly but shedding stabilized
  2. There is increased but steading shedding over weeks to months
  3. Evaluation of general health—history of autoimmunity, thyroid disease, anemia, diabetes
  4. Potential infections in the house—tinea capitis
92
Q

Hair Pull Test

A

Gently Pull 20 to 60 hairs between the thumb and fore
finger
– Anagen or growing hairs will remain rooted in place
– Telogen phase hair will come out
– If 2 hairs come out of 20 hairs, telogen is 10%
– Normal telogen is between 10-20%.
– Hair washing affects the test
• Hair washed on the same day of the exam, fewer hairs will be shed
• One week before, more telogen hairs
– Look at eye brows, loss of outer 1/3 points to thyroid disease

93
Q

Alopecia Areata

A

Patches of balding; can also have areas of grey hair due to loss of melanocytes

PNP: Physical Assessment (21 decks)

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