Exam 1 - Integumentary System

Question 1

Nails

Answer 1

Nails

Protect the distal end of the fingers and toes

Question 2

Lunula

Answer 2

Lunula-white area, part of matrix

Question 3

Cuticle

Answer 3

Cuticle: prevents infection/moisture from getting under the skin

Question 4

Common or concerning symptoms?

What do you ask?

Answer 4

Hair loss, rash, moles

“Have you noticed any changes in your skin or your hair?”
“Have you noticed any moles that have changed size, shape, color, or sensation?”
“Have you noticed any new moles?”

Question 5

Skin cancers are most common cancers in the US. Where is it most prevalent?

Answer 5

Most prevalent on hands, neck, and head

Question 6

Role of PA and Skin

Answer 6

Early detection of suspicious moles
Protective measures for skin care
Hazards of excessive sun exposure

Question 7

Basal cell carcinoma

Answer 7

Comprises 80% of skin cancers

Shiny and translucent, they grow slowly and rarely metastasize

Question 8

Squamous cell carcinoma

Answer 8

Comprises 16% of skin cancers

Crusted, scaly, and ulcerated, they can metastasize

Question 9

Melanoma

Answer 9

Melanoma
Comprises 4% of skin cancers
Rapidly increasing in frequency, they spread rapidly
Most lethal, but if found early almost 100% curable
Common between age 25-29, indoor tanning increases risk 75%

Question 10

ABCDE: screening lesions for possible melanoma

Answer 10

A for asymmetry
B for irregular borders, especially ragged, notched, or blurred
C for variation or change in color, especially blue or black
D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding
E for evolution

Question 11

Health Promotion Tips

Answer 11

Examine your body front and back in mirror
Look at right and left sides with arms raised
Bend elbows and look carefully at forearms, upper underarms, and palms
Look at backs of legs and feet
Spaces between toes
Soles
Examine back of neck and scalp with hand mirror
Part hair for closer look
Check back and buttocks with a hand mirror

Question 12

Patient education on sun exposure

Answer 12

Avoiding excess sun exposure
Use umbrellas/protective hats, sunglasses, clothing
SPF 15 minimum to all sun exposed skin
SPF 15 blocks over 90% of UVB

Question 13

SPF

Answer 13

SPF rating denotes #minutes it takes for skin to redden when exposed to UVB
Indoor tanning beds considered “carcinogenic to humans”

Question 14

Skin Exam

Answer 14

Color, moisture, temperature, turgor, mobility, texture, lesions

Question 15

Color of skin

Answer 15

Patients often notice change in color before physician
Look for increased pigmentation, loss of pigmentation
Look for redness, pallor, cyanosis, and yellowing

Question 16

Where is red color best assessed?

Answer 16

Red color of oxyhemoglobin best assessed at fingertips, lips, and mucous membranes
In dark-skinned people, palms and soles

Question 17

Where is cyanosis best assessed?

Answer 17

For central cyanosis, look in lips (circumoral cyanosis), oral mucosa, and tongue

Question 18

Where is jaundice best assessed?

Answer 18

Jaundice - sclera

Question 19

Parts of skin exam:

Answer 19

Moisture
>Dryness, sweating, and oiliness

Temperature
>Use back of fingertips
>Identify warmth or coolness of skin

Texture
>Roughness or smoothness

Mobility and turgor
>Lift fold of skin
>Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)

Question 20

What do you do when you encounter a lesion?

Answer 20

Note characteristics
Anatomic location and distribution
Patterns and shapes
Type of lesion (macules, papules, nevi, vesicles)
Color

Question 21

Hair

Answer 21

Note quantity, distribution, and texture

Question 22

Nails

Answer 22

Inspect and palpate fingernails/toenails
Note color, shape, lesions
Longitudinal bands of pigment may be a normal finding in people with darker skin

Question 23

Decubitus ulcers

Answer 23

People confined to bed are particularly susceptible to skin damage and ulceration (decubitus ulcers)

Question 24

When do ulcers occur?

Answer 24

Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin

Question 25

How are bed sores assessed?

Answer 25

Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels.

Question 26

Nonpalpable flat lesions

Answer 26

Nonpalpable flat lesions
Macule
Patch

Question 27

Depressed Lesions

Answer 27

Depressed lesions
Erosion
Excoriation
Fissure
Ulcer

Question 28

Palpable raised lesions

Answer 28

Palpable raised lesions
Papule
Plaque
Nodule
Cyst
Wheal
Vesicle
Bulla
Pustule
Burrow
Scale crust
Lichenification
Scar
keloid

Question 29

Good skin and bad skin documentation examples

Answer 29

“Color good. Skin warm and moist. Nails without clubbing or cyanosis. No suspicious nevi. No rash, petechiae, or ecchymoses.”

“Marked facial pallor, with circumoral cyanosis. Palms cold and moist. Cyanosis in nailbeds of fingers and toes. One raised blue-black nevus, 1x2 cm, with irregular border on right forearm. No rash.”