Final-Breast/Venipuncture/Hair/Skin/Nails Flashcards
(139 cards)
1
Q
What are the risk factors for breast CA? lifestyle
A
2 or more alcoholic drinks/day Overweight Sedentary lifestyle Nulliparous Not breastfeeding Birth control Hormones (estrogen) after menopause Breast implants
2
Q
Risk factors for breast CA you cannot change
A
Woman 55+ 5-10% BRCA1/BRCA2 Family history of breast CA Personal history of breast BA AA under 45, or white over 45 Dense breast tissue Early menstruation Menopause after 55 Radiation to your chest Exposure to DES
3
Q
How often should females perform examinations
A
Monthly
4
Q
3 patterns of breast palpation
A
Concentric circles: out-> in
Vertical strip pattern: outer edge—> in
Wedge pattern: nipple outward like spokes of a wheel
5
Q
The D’Souza associated with potentially pathological breast changes
A
Discharge Depresssion/retraction Discoloration Dermatological changes Deviation to one side
6
Q
Where is tourniquet placed
A
3-4 inches above site
7
Q
Angle needle goes in during venipuncture
A
15-30 degrees
8
Q
Where is needle inserted to in the vein
A
The lumen
9
Q
When remove tourniquet
A
When last tube is filling
10
Q
Layers of epidermis
A
Stratum corneum: protection and restrict water loss
Cellular stratum: synth of keratin
11
Q
What layer of skin is avascular
A
Epidermis-outermost
12
Q
What connects epidermis to dermis
A
BM
13
Q
Very vascular layer of skin
A
Dermis
14
Q
What separates epidermis from cutaneous adipose
A
Dermis
15
Q
Functions of dermis
A
Resilience, strength, stability, sensory nerve fibers= sensation of pain, touch and temp
16
Q
What layer of skin contains sensory nerve fibers and autonomic motor nerve (innervate BV, glands, are to pills)
A
Dermis
17
Q
What layer of skin connects dermis to underlying organs
A
Hypodermics
18
Q
What is the subcutaneous fat layer of skin
A
Hypodermis
19
Q
Function of hypodermis
A
Heat
Insulation
Shock abs portion
Calorie reserve
20
Q
Eccrine sweat glands
A
Open directly to skin surface to regulate body temp through water secretion
21
Q
Where are eccrine glands absent
A
Lip margins, eardrums, nailbeds, inner prepuce and glans/penis
22
Q
Apocrine sweat glands
A
White Odorless secretions due to emotional stimuli containing protein, carbs and more
23
Q
Body odor produced when
A
Bacterial decomposition of apocrine sweat
24
Q
Where are apocrine glands found
A
Axilla, nipples, aureoles, anogenital, eyelids, external ears
25
Sebaceous glands
Secrete sebum that’s lipids rich and prevents hair and skin from drying out
Stimulated by sex hormones (testosterones)
26
Vellus hair
Short, fine, soft, nonpigmented
“Peach fuz”
27
Terminal hair
Coarser, longer, thick pigmented
Ex: head
28
Hair formed by _____ cells that invaginate into _____ layers
Epidermal
| Dermal
29
Nails created by ______ cells converted to ____ ____ of _____
Epidermal
| Hard plates of keratin
30
What forms the cuticle
Stratum corneum layer covering root
31
Cuticle aka
Eponychium
32
Name of soft tissue surrounding nail boarder
Paronychium
33
What covers infant at birth
Vernix caseosa
Mixture of sebum and cornfield epidermis
34
Why are babies predisposed to hypothermia at birth
Subcutaneous fat poorly distributed
35
______ of stratum corneum may be present at birth of infant
Aka peeking
Desquamation
36
Lanugo
Fine, silky hair covering newborn—shoulders and back
Shed within 10-14 days
37
When is infant hair shed
2-3months of age
Replaced my new hair with diff color/text
38
Eccrine glands function after in infants?
1 month
39
Do apocrine glands function in infants?
No
40
When do apocrine glands enlarge and become active
Adolescent
41
Apocrine gland changes in adolescent
Increased sebum production due to hormones—androgen
Oily appearance and acne
42
Glands in pregnancy
Increased blood flow to skin due to increased capillaries and 40-50% increase in blood vol.
Increase in sweat and sebaceous glands (reduce heat due to increase metabolism)
Vascular spiders/hemangioma increase in size
43
Skin/CT changes in pregnancy
Skin thickens
+ fat in subdermal
CT fragile= separation —> striae
Skin darkening—> cholasma/Malasma “mask of pregnancy)
-nipples, umbilicals, aureoles axillae darken 90%
44
Cholasma/malasma
Mask of pregnancy due to darkening of skin
45
Older adults gland/skin changes
Sebaceous/sweat gland decrease
Epidermis thins-“parchment” appearance
Dermis less elastic—wrinkled
*lifetime of sun damage and Caucasian’s= early onset
46
Tissue in adults
Subcutaneous tissue decreases = “bony”
Hollow in thoracic, axillary, supraclavicular
47
Gray hair due to
Decreased melanocytes
48
Terminal scalp hair progressively transistors into vellus hair in who?
Elderly
49
In elderly hair changes
Terminal scalp hair goes to vellus hair
Balding
And vellus to terminal in nares and Travis of men
(CRAZY THICK ASS SHIT)
50
What is a nevus
Mole
51
Mc areas for nevus (mole)
Upper back: M
| Legs: F
52
Turgor
Elasticity
Altered if dehydrated or edema
53
Fluid-filled lesions will transilluminate with what? Solid lesions with what?
Fluid filled= red glow
| Solid=none
54
Hirsutism
Growth of terminal hair in a male distribution pattern on face, body, pubic
55
What may indicate poor circulation or nutritional deficit in regards to hair
Feet and toes for hair loss
56
MC inflammatory skin disorder
Eczematous dermatitis
57
Forms of eczematous dermatitis
Irritant contact dermatitis
Allergic contact dermatitis
Atopic dermatitis
58
Patients with what often report history of allergy
Atopic dermatitis
59
3 phases of eczematous dermatitis
Acute: erythematous pruritic (itchy), weeping vesicles
Subacute: erythema and scaling
Chronic: thick, lichenified, pruritic plaques
60
Atopic dermatitis in childhood
Lesions involve flexures, nape and dorsal aspects of limbs
61
Atopic dermatitis in adolescence and adulthood
Lichenfied plaques in flexures, head and neck
62
Folliculitis
Inflammation and infection of the hair follicle and surrounding dermis
63
S/s of folliculitis
Acute onset of Paulsen and pustules associated with pruritus(itch) or pain with deep folliculitis
64
Pyretic
Pyroretic
Pruritic
Hot/warm
Pus
Itch
65
Risk factors for folliculitis
```
Frequent shaving
Immunosuppression
Hot tubs without chlorine
Long term antibiotics
Occlusive clothing
Hot/humid
DM
Obesity
Use of EGFR inhibitors (epithelial growth factor receptor)
```
66
Primary lesion of folliculitis
Small pustule 1-2cm
Located over pilosebaceous orifice and may be perforated with hair
Any hair hearing site affected
67
Furuncle aka?
Boil
68
Furunle
Deep infection of pilosebaceous unit
Staph MC organism
Start as small abcess and then spread to surrounding dermis and subcutaneous tissue
69
What forms when many adjacent furuncles?
Coalescing purulent mass
Carbuncle!!
70
S/s furuncle
Tender, red, hot nodule—> pustular
Center fills with pus and forms a core
Face neck arms axillae breast thighs butt MC spots
71
Cellulitis due to what organism
Strep pyogenes or staph A
72
Cellulitis
Break in the skin allows bacteria in and causes a diffuse skin infection
73
S/s of cellulitis
```
Pain and swelling at site
Fever
Red, hot, tender
Boarders not well demarcated
Lymphatic streaks!! bad
Regional lymphadenopathy
```
74
Tinea (dermatophytosis)
Fungal infections that involved stratum corneum, nails, hair
Through direct contact of infected humans
75
```
Tinea: corporis/ringworm
Cruruis
Capitals
Pedis
Unguium
```
Corporis-body
Cruris: groin/inner thigh
Unguium: nails
76
S/s of dermatophytosis/tinea
Pruritus
Pustular, vesicular, red, 2 infection present
Nails yellow and thick and separate
77
Pityriasis rosea
Self-limiting, idiopathic, not contagious
“Herald” patch/lesion, sudden onset with round/oval plaque over trunk/body
78
Pityriasis rosea s/s (lesions)
Pale, red, fine scaling
Lesions on extremities and trunk
**palms/soles/face: NO
Christmas tree pattern
79
Psoriasis
Chronic/recurrent disease of keratin synthesis.
Abnormal differentiation of keratin expression, more stem cells and turnover. Leads to thick skin
80
S/s psoriasis
Dry, silver scales and pitted nails
MC on back, butt, extensor surfaces of extremities and scalp
30% psoriatic arthritis
81
Rosacea triggers
```
Sun
Cold weather
Emotion
Hot beverages
Spicy food
Alcohol
Caffeine
```
82
Rosacea s/s
Itching
Stinging pain and flushing episodes
Appears like acne with no comedomes
Tissue hypertrophy of nose-rhinphyma
83
Herpes zoster and s/s
Varicella-zoster viral infection
Dormant in poster spinal gangia
Pain, itching, dermatome area
Red swollen plaques filled with fluid
84
Herpes simplex s/s
HHV1/2
Tenderness, pain, Paresthesia BEFORE onset of lesions
Vesicles then erode and crust
2-6 weeks
85
Lyme disease 3 stages
Tick borne-borrelia burgdorferi
```
Early localized
-singly central clearing; 5+ cm
Early disseminated
-multiple skin lesions and neurologic and carditis symptoms: facial palsy, meningitis, encephalitis, lightheaded, dyspnea, syncope, chest pain
Late disease:
-arthritis atrophicans
```
86
Acanthosis nigricans
Nonspecific reaction associated with obesity, endocrine or inherited disorders
Symmetric, brown thickening of skin
87
S/s of acanthosis nigricans
Symmetric, brown thickening of skin with plaques
MC: axillae, also flex. Of neck, Groupon and arms
88
Where affected may indicated malignant association of acanthosis nigricans
Dorsal/palmar hands or mucosal surfaces
89
Anthrax
Spore-forming bacillus anthracis
Central necrosis developed with painless ulcer covered by black Escher
90
Small pox
Variola virus via saliva droplets
91
Smallpox s/s
Rash on mucosa, pharynx, face and forearms.
Lesions become vesicular then pustular then crust
S/s: high fever, fatigue, HA, backache
92
Mc form of skin CA
Basal cell carcinoma
93
Where does basal cell carcinoma mc occur
Exposed parts of body-face, ears, neck, scalp, shoulders
94
Squamous cell carcinoma
2nd MC skin CA
95
Squamous cell carcinoma mc occurs where
Sun-exposed: scalp, back of hands, LOWER LIP and EAR
Wart-like growth with central depression
96
Malignant melanoma
Lethal develops from melanocytes
ABCDE changes in moles
New or pre-existing mole that has changed/changing
97
Kaposi sarcoma
HHV8 associated with HIV infection
Bluish/purple painless skin lesions
Skin or mucosa, viscera and lymph
98
Alopecia areata
Sudden rapid, patchy loss of hair in sharply defined round areas
Regrowth begins 1-3 months
99
Scarring alopecia
Scarring and destruction of hair follicles and permanent hair loss
Seen with concurrent skin disorders
PATCHY hair loss
Hair follicles may be pustular or plugged
100
Traction alopecia
Reversible due to loss due to traction
History of wearing certain hairstyles
Patchy hair loss corresponding to ares of stress
101
Hirsutism due to
High androgen levels of hair follicles more sensitive to normal androgen levels
102
Paronychia
Inflammation of paronychium due to bacteria between nail fold and nail plate
Acute: trauma
Chronic: repeated moisture exposure
103
S/s paronychia
Redness, swelling, tender at lateral and proximal nail folds
| -purulent drainage under cuticle
104
Onychomycosis
Fungus grows in nail plate causing it to crumble
Distal nail plate turns yellow
105
Subungual hematoma
Trauma causes bleeding/bruising under nail. Remains until nail grows out
106
Onycholysis
Loosening of nail plate with separation from nail bed
Non-adherent portion of nail white, yellow or green tinge
107
Koilonychia
Spoon nails
Central depression of nail with lateral elevation of nail plate
Associated with iron deficient anemia, syphilis and hypothyroidism
108
Koilonychia associated with?
Iron deficiency anemia
Spoon appearance of nails
109
Beau Lines
Transverse white depression in nail bed due to temporary interruption of nail formation due to systemic disorder
Assoc: coronary occlusion, hypercalcemia, skin disease
110
Beau lines associated with?
Coronary occlusion, hypercalcemia and skin disease
111
White banding/terry nails
Transverse white bands with NO GROOVES
Associated with cirrhosis, CHF, adult onset-DM and age
Looks like many white streaks over entire nail
112
White banding associated with
Cirrhosis, CHF, adult-onset DM and age
113
Warts
Epidermal neoplasm due to HPV
@ nail folds
114
Digital mucous cysts
Longitudinal nail groove from cysts located at proximal nail fold
Cyst contain clear jelly-like substance
115
Pruritic urticaria Papuans and plaques of pregnancy (PUPPP)
Benign usually late in 3rd trimester of 1st pregnancy
-eruption after delivery and doesn’t return with later pregnancies
116
S/s PUPPP
Intense pruritus rash beginning on abdomen with periumbilical area spared
No lesions on face, palms or soles
Often halos of blanching surrounding Papules
117
Herpes gestationis-aka pemphigoid gestationis
NOT RELATED TO HERPES VIRUS INFECTION
Rare autoimmune disorder or pregnancy
Complications: necrosis of infected skin and kidney damage
118
S/s of herpes gestationis/pemphigoid gestationis
Urticaria patches (hives) that are periumbilical
Lesions become vesicles/blisters
PALMS AND SOLES AFFECTED
Infants may be born with but clears
119
Seborrheic dermatitis
Chronic, recurrent scaling eruption where sebaceous glands are concentrated (scalp, back, diaper area)
Mc first 3 months
120
S/s seborrheic dermatitis
Scalp lesions are scaling, adherent, thick, yellow and crusted
**cradle cap
121
Miliaria
Occlusion of sweat ducts during heat/humidity
Irregular, red rash on covered areas of skin
122
Impetigo
Staphylococcal or streptococcal
Usually face
Honey/amber color crusts
Regional lymphadenopathy
123
Acne vulgaris
Impaction and obstruction of outflow of sebum
Adolescents
Comedones
“Icepick scarring” from previous lesions
124
Ice pick scarring present from previous lesions from what
Acne vulgaris
125
Chickenpox (varicella)
VZV
Remains dormant in sensory nerve roots for life
Maculopapular and vesicular lesions on truck, extremities, face, buccal mucosa, palate or conjunctivae
126
Complications from Varicella
Chicken pox
```
Secondary bacterial infection
Viral pneumonia
Encephalitis
Meningitis
Myelitis
G-B syndrome
Reye syndrome
```
127
Measles aka
Rubeola
128
Measles
Rubeola
Invasion of respiratory epithelium
Fever, rash first on face then spread to trunks and extremities (4-7 days)
**KOPLIK spots (white macular lesion on buccal mucosa)
Complications: infection of Respiratory. Tract and CNS
129
German measles AKA
Rubella
130
German Measules
Rubella
Mild, fever, reddish spots on soft palate during prodrome or on first day of rash (forschheimer spots)
Starts as cold s/s then rash in UE/LE
131
Forscheimer spots seen with?
German measles (Rubella)
132
Infection during first trimester of pregnancy may lead to congenital rubella syndrome
German measles
133
Trichotillomania
Loss of hair due to manipulation, twisting, pulling
irregular boarder (recall alopecia has reg. Boarder) but site is not bald fully
134
Irregular boarder of hair loss bit not all hair is lost
Trichotillomania
135
S/s of infant/children abuse
- Bruising on soft tissue, or any on child not mobile ye
- lacerations of lips/frenulum = forced feeding
- Burns: hands/feet, cigarette, or immersion
- hair loss: patchy
136
Stasis dermatitis
Venous insufficiency in lower legs
Fullness, aching of lower legs
Gradual increase in pigmentation/redness
Bad: scaling, weeping, ulceration
137
Solar keratosis (actinic keratosis) may lead to what?
Squamous cell carcinoma
138
Solar keratosis (actinic keratosis)
May lead to squamous cell car income
Secondary to C. Sun damage
Increase # with age
Slightly raised, less than one cm with irregular round surface
Dorsal surfaces of hand, arm, neck, face
139
Abuse in elderly
- bruising in hidden areas: axilla, inner thighs, soles/palms
- determine mental status of patient—self harm and not know
