Exam One Questions/Definitions Flashcards
Raised, fluid filled lesion larger than a vesicle
Bulla
Crack or break in the skin
Fissure
Flat, colored spot
<1 cm
Non-palpable
Macule
Solid, raised lesion extending into dermis or subcutaneous tissue
often indicative of systemic disease
>5mm-2cm in diameter
Nodule
Superficial layer of skin that provides protection
Epidermis
Deeper layer of skin that provides firmness and elasticity; contains sweat glands
Dermis
Thickness of skin
Varies from 8mm at soles of feet to 1mm at eyelid
Subcutaneous tissue
(Fat); Lies beneath the skin and outside the fascia and contains arteries, veins, and nerves
Layers of epidermis (outer to inner)
Stratum corneum - layered, dead, shedding cells
Granular cell layer
Spinous cell layer
Basal cell layer - active layer, rapidly multiplying cells, melanocytes
Cells migrate up from basal cell later, collect keratin protein, become flat and scaly (squamous epithelium) at the stratum corneum
Components of dermis
Sweat glands/dilated of BV help cool body
Sebaceous (oil) glands lubricate skin and help maintain barrier to water, chemicals, etc
Dermis has nerve endings of the skin
Vit D synthesis from sun exposure
Ridges (papilla) at top of dermis = fingerprints
Muscle contraction of erector pili (goosebumps)
Subcutaneous layer function
Insulation and energy storage
If fat collects to fast or too much, collagen and elastin fibers in dermis get stretched, causing dimpling of the skin (“cellulite”)
Physical exam general
Visualize skin signs: type, shape, arrangement, distribution (10-20x magnification)
Dermascope
Palate (soft, hard, scaly, temp, tender, mobility)
General appearance
Consider lab and special exam: direct culture, fungal 10% KOH, gram stain, tzanck smear, biopsy, woods lamp, patch testing, etc, blood, X-ray, UA, stool
Small, circular, raised lesion at the surface of skin (epidermis)
<5mm in diameter
Papule
Palpable solid elevated lesion in epidermis >5mm in diameter
Plaque
Raised lesion containing pus; often in a hair follicle or sweat pore
<5mm in diameter
Pustule
Lesion resulting from destruction of the skin and perhaps subcutaneous tissue
Ulcer
Small, fluid-filled raised lesion of serous fluid in epidermis; blister or bleb
<5mm in diameter
Vesicle
Smooth, rounding, slightly aided area often associated with itching; seen in urticaria sun as resulting from allergy
Wheal
Non palpable
localized change in skin color >1cm in diameter
Patch lesion
Solid elevated lesion extending into dermis or subcutaneous tissue >2cm in diameter
Tumor
Localized accumulation of serous fluid in epidermis
>5mm in diameter
Bullae
Fluid filled or solid mass in skin extending into dermis or subcutaneous tissue
Cyst
Purpura v vascular dilation glass slide test for red lesion
Redness remains under pressure = purpuric
Redness disappears = erythematous, due to vascular dilation
Seborrheic keratosis RF
AD
>30, avg 61
Most common benign skin neoplasms
Seborrheic keratosis
Nevi
Seborrheic keratosis Malignancy potential
None
Seborrheic keratosis sx
Lesions on head, neck, trunk, extremities
Flesh colored, tan, brown, black
Oval/round
“Pasted on” papule or plaque, may be greasy or scaly
Well circumcised border
2mm-3cm+
Older lesions more raised, darker
Slow growing
Can become irritated from skin
Types of Seborrheic keratosis
Rough type - verrucous, crumbly, dry, cracked, accentuation of hair follicles
Smooth type - smooth dome-shaped surface with tiny, round 1mm white or black horny cysts/pearls imbedded in surface
Seborrheic keratosis Tx
None required, cosmetic removal
If its an all black lesion without horn cysts > shave biopsy to confirm
Dermatosis papulosa nigra sx
Doesn’t cause any ulcerations, scaling, crusting
1-5mm in diameter, 1-3mm high
Start in adolescence as smooth bumps, gradually become rougher with time
May also grow in size and # with age
RF skin tags
Second decade, >50
Metabolic syndrome
Skin tag appearances
Acrochordon (obesity, DM, metabolic syndrome), cutaneous papilloma, soft fibroma
Soft, skin colored to slightly pigmented
1-10mm
Hyperpigmentation esp in darker skin
Pedunculated papule
Axilla, neck, groin, eye, mouth
When irritated may appear necrotic
Dermatofibroma RF/causes
Unknown etiology
Thought to be fibrous rxn to trauma, infection, insect bites
Multiple Dermatofibromas with untreated SLE
Dermatofibroma sx
3-10 mm
Slightly elevated
Scaly
Rarely seen with other skin lesions
Dimple sign; central dimpling of lesion when pinched between thumb and index fingers
Keloid vs hypertrophic scar
Keloid - enlargement of scar WITHIN BOUNDARY of original scar
Hypertrophic - beyond the boundary
RF keloids
10-30
Darker skin
Trauma
Tx keloids
Silicone based gel therapy
Corticosteroids
Acupuncture
Steroids
Etc
