Developmental Considerations (Skin, Hair, Nails)

Question 1

Skin Colour: General Pigmentation.

Melanotic colour is evident in the nail beds and scrotal folds.

Answer 1

Infants

Question 2

Newborns of ___ descent initially have lighter toned skin than their parents because pigment production is not yet fully functional.

Answer 2

African

Question 3

Abnormal Findings in Infants

Multiple bruises in various stages of healing, or pattern injury, suggest ______.

Answer 3

child abuse

Question 4

A common hyperpigmentation in newborns of Aboriginal, African, East Indian, or Hispanic descent.

• Appearance: Blue-black to purple macular area at the sacrum or buttocks, but sometimes it occurs on the abdomen, thighs, shoulders, or arms. Due to deep dermal melanocytes. Fades during the first year. Adulthood, spots are lighter but frequently still visible.
• Recognizing this normal variation is important to avoid identifying children as victims of child abuse.

Answer 4

A mongolian spot

Question 5

Presence of six or more café au lait macules, each more than 1.5 cm in diameter, is diagnostic of ____, an inherited neurocutaneous disease.

Answer 5

neurofibromatosis

Question 6

Skin Colour Change. Three erythematous states are common variations in the neonate:

Answer 6

1. The newborn’s skin has a beefy-red flush for the first 24 hours because of vasomotor instability; then the colour fades to its normal shade.
2. Harlequin colour change, occurs when the baby is in a side-lying position. The lower half of the body turns red, and the upper half blanches with a distinct demarcation line down the midline. Cause unknown.
3. Erythema toxicum, a common rash appears in the first 3 to 4 days of life. Called the “flea bite” rash or “newborn rash,” it consists of tiny, punctate, red macules and papules on the cheeks, trunk, chest, back, and buttocks. Cause unknown.

Question 7

Occurs when the baby is in a side-lying position. The lower half of the body turns red, and the upper half blanches with a distinct demarcation line down the midline. Cause unknown.

Answer 7

Harlequin colour change

Question 8

a common rash appears in the first 3 to 4 days of life. Called the “flea bite” rash or “newborn rash,” it consists of tiny, punctate, red macules and papules on the cheeks, trunk, chest, back, and buttocks. Cause unknown

Answer 8

Erythema toxicum

Question 9

Two temporary cyanotic conditions may occur in Infants:

Answer 9

Acrocyanosis.

Cutis marmorata

Question 10

Appearance: bluish colour around the lips, on the hands and fingernails, and on the feet and toenails. This may last for a few hours and disappear with warming.

Answer 10

Acrocyanosis

Question 11

A transient mottling in the trunk and extremities due to cooler room temperatures.
Appearance: Reticulated red or blue pattern over the skin.

Answer 11

Cutis marmorata

Question 12

Abnormal Findings:

Persistent generalized _____ indicates distress (i.e., congenital heart disease).

Answer 12

cyanosis

Question 13

Persistent or pronounced cutis marmorata occurs with ___& ___.

Answer 13

Down syndrome and prematurity

Question 14

Green-brown discoloration of the skin, nails, and umbilical cord occurs with passing of ____, which produces fetal distress.

Answer 14

meconium in utero

Question 15

• A common variation in about half of all newborns.
  Appearance: A yellowing of the skin, sclera, and mucous membranes develops after the third or fourth day of life due to increased numbers of red blood cells that hemolyze after birth.

Answer 15

Physiological Jaundice:

Question 16

Abnormal Findings:

Jaundice: First day of life =

Answer 16

Hemolytic disease

Question 17

Jaundice: After 2 weeks of age =

Answer 17

biliary tract obstruction

Question 18

Produces a yellow-orange colour in light-skinned persons but no yellowing in the sclerae or mucous membranes. It results from ingestion of large amounts of foods containing carotene
Example: Vitamin A precursor (i.e., carrots)
It fades to normal within 2 to 6 weeks after carotene-rich foods are withdrawn from the diet.

Answer 18

Carotenemia:

Question 19

Moisture. ____, the moist, white, cream cheese–like substance that covers part of the skin of all newborns. Perspiration is present after 1 month of age.

Answer 19

Vernix caseosa

Question 20

Texture. ____are tiny while papules on the cheeks, forehead, and across the nose and chin caused by sebum that occludes the opening of the follicles. Tell parents not to squeeze the lesions; these resolve spontaneously within a few weeks.

Answer 20

Milia

Question 21

Thickness. In neonates, the epidermis is normally ____, but there are well-defined areas of subcutaneous fat.

Answer 21

thin

Question 22

Mobility and Turgor. Test mobility and turgor over the _____ in an infant.

Answer 22

abdomen

Question 23

Vascularity or Bruising. Some _____ are common birthmarks in the newborn.

Answer 23

vascular markings

Question 24

A flat, irregularly shaped red or pink patch found on the forehead, eyelid, or upper lip but most commonly at the back of the neck (nuchal area).
Present at birth, usually fades during the first year

Answer 24

A storkbite (salmon patch)

Question 25

Unusual skin marks caused by benign conditions related to RBC’s are: (3)

Answer 25

1. Port-wine stains (formed from mature capillaries),
2. Strawberry marks (immature hemangioma), and
3. Cavernous hemangiomas

Question 26

Hair. Newborn’s skin is covered with fine downy ____, especially in a preterm infant. Dark-skinned newborns have more _____ than do light-skinned newborns.

Answer 26

lanugo

Question 27

Scalp hair may be lost in the few weeks after birth, especially at the ___ & ____. It grows back slowly.

Answer 27

temples and occiput

Question 28

Nails. Newborn’s nail beds may be _____ for the first few hours of life; then they turn pink.

Answer 28

blue (cyanotic)

Question 29

In adolescents, increase in sebaceous gland activity creates ____ & ____.

Answer 29

increased oiliness and acne

Question 30

The most common skin problem of adolescence.

Answer 30

Acne

Question 31

Almost all teenagers have some acne, even if it is the milder form of open comedones ((a)) and closed comedones (_(b)__).

Answer 31

blackheads

whiteheads

Question 32

Severe acne includes _____, ______, and ____.

Answer 32

papules, pustules, and nodules.

Question 33

Where does acne usually appeears

Answer 33

Appears on the face and sometimes on the chest, back, and shoulders.

Question 34

Peak of Acne in Girls

Answer 34

14-16

Question 35

Peak of Acne in Boys

Answer 35

16-19

Question 36

Jagged linear “stretch marks” coloured silver to pink that appear during the second trimester on the abdomen, breasts, and sometimes thighs. Fade but do not disappear.

Answer 36

Striae.

Question 37

A brownish black line down the midline of the abdomen.

Answer 37

Linea nigra.

Question 38

Irregular brown patch of hyperpigmentation on the face. May occur with pregnancy or in women taking oral contraceptive pills

Answer 38

Chloasma.

Question 39

These lesions have tiny red centres with radiating branches and occur on the face, neck, upper chest, and arms

Answer 39

Vascular spiders.

Question 40

Small, flat, brown macules “liver spots”. Appear on the forearms and dorsa of the hands.

Answer 40

Senile Lentigines.

Question 41

Raised, thickened lesions of pigmentation that look crusted, scaly, and warty. Develop mostly on the trunk but also on the face and hands and on both unexposed and sun-exposed areas.

Answer 41

Keratoses.

Question 42

Red-tan scaly plaques that enlarge over the years to become raised and roughened. A silvery white scale may adhere to the plaques. Directly related to sun exposure. Are premalignant, may develop into squamous cell carcinoma.

Answer 42

Actinic (senile or solar) keratosis.

Question 43

Moisture. Dry skin (_____) is common in older adults because of a decline in the size, number, and output of the sweat glands and sebaceous glands. Dry skin itches and looks flaky and loose.

Answer 43

(xerosis)

Question 44

Texture. Variations especially prevalent among older adults are ______ which are overgrowths of normal skin that form a stalk and are polyplike. They occur frequently on eyelids, cheeks, neck, axillae, and trunk.

Answer 44

acrochordons, or “skin tags,”

Question 45

Thickness. Skin looks as _____, and the subcutaneous fat diminishes.
- Thinner skin is evident over the dorsa of the hands, forearms, lower legs, dorsa of feet, and bony prominences. The skin may feel thicker over the abdomen and chest.

Answer 45

thin as parchment

Question 46

Mobility and Turgor. The turgor is ______, and the skin recedes slowly or “tents” and stands by itself.

Answer 46

decreased (less elasticity)

Question 47

Hair. Growth ____, and the amount in the axillae and pubic areas _____.

Answer 47

decreases

Question 48

Women: After menopause, women may develop bristly hairs on the chin or upper lip as a result of _______.

Answer 48

unopposed androgens

Question 49

Men: Develop coarse ____ in the ears, nose, and eyebrows, although the beard is unchanged.

Answer 49

Terminal hair

Question 50

Male-pattern balding, or _____, is a genetic trait.

Answer 50

Alopecia

Question 51

In men and women, scalp hair gradually turns grey because of the decrease in _______.

Answer 51

melanocyte function

Question 52

Nails. With aging, the _________ decreases, and local injuries in the nail matrix may produce longitudinal ridges. he surface may be brittle or peeling and sometimes yellowed. Toenails also are thickened and may grow misshapen, almost grotesque.

Answer 52

nail growth rate

Question 53

The thickening may be a process of aging, or it may be caused by ______________.

Answer 53

chronic peripheral vascular disease.