Intro To Derm Flashcards
1
Q
Average adult surface area
A
3000 in2
2
Q
Varies in thickness from ___ to ___
A
.5 to 3 mm
3
Q
Functions
A
- Protect against infection, desiccation, harmful light rays
- Maintain body temperature
- Receives stimuli from environment
- Stores chemical compounds
- Excretes waste products
- Synthesizes vit. D
4
Q
Epidermis
A
4 layers (except 5 layers in soles and palms)
5
Q
Deepest layers of the Epidermis
A
2 deepest layers- Stratum basale and Stratum spinosum
6
Q
What forms during the process of degeneration?
A
Keratin (a waterproofing protein)
7
Q
Outermost layer of the epidermis is?
A
Stratum corneum- 25-30 rows of flat dead cells that are filled with keratin and are shed and replaced continuously
8
Q
Complete turnover of epidermis occurs?
A
28-30 days
9
Q
Epidermal cells
A
Keratinocytes
10
Q
Keratinocytes are bound by what?
A
intracellular junctions called desmosomes (vital for skin integrity)
11
Q
Which two cells serve as protective functions in the epidermis?
A
Melanocytes and Langerhans cells
12
Q
The dermis contains…
A
blood vessels, nerves, glands, and hair follicles
13
Q
Upper layer of dermis
A
loose connective tissue
14
Q
Deeper layer of dermis
A
netlike collagenous fibers that branch through subcutaneous tissue and attach to underlying bones and muscles
15
Q
What are appendages of the skin?
A
Structures that develop from embryonic epidermis including hair, glands, and nails
16
Q
Hair that’s soft and covers the body
A
vellus
17
Q
Coarse hairs that develop at puberty, plus hairs of scalp and eyebrows
A
terminal hairs
18
Q
External portion (outside the skin)
A
hair shaft
19
Q
Internal portion (inside the skin)
A
hair root
20
Q
Surrounding the root
A
Hair follicle (epidermis dipping down into the dermis to surround the root)
21
Q
What are associated with the hair follicle?
A
Sebaceous glands, arrector pili muscles, and root hair plexuses *sometimes apocrine sweat gland
22
Q
Color is a combination of what?
A
3 pigments (brown, black, theo melanin)
23
Q
Graying?
A
Loss of pigment
24
Q
Sebaceous glands
A
secrete sebum, at the hair follicle which protects the hair and skin from becoming too dry
25
Two types of sweat(sudoriferous) glands
Apocrine and Eccrine
26
Which glands begin at puberty?
Apocrine sweat glands located in axilla, pubic region, and breast areolae
27
Eccrine glands
Distributed throughout the skin
28
Parts of the nail
free edge, nail body, nail root, lunula (white area), cuticle (epidermis around the nail), nail bed (epidermis under the nail)
29
Skin color?
determined by melanin and carotene and by blood in the capillaries of the dermis
30
All races have...
same number of melanocytes but the amount of melanin produced varies
31
Increased melanin production is caused by
UV radiation increasing enzymatic activity
32
Carotene
pigment found in people of central and east Asian descent, adds yellowish hue to their skin
33
Epidermal ridges
genetically determined, unique for each individual, does not change throughout life except to enlarge, increase friction
34
Lines of cleavage/Langer's lines/ skin tension lines
Collagenous fibers in dermis tend to run more in one direction, predominant direction is called Langer's lines etc. (an incision made across the lines of cleavage ends to heal with broad, thick scar)
35
HPI
History of present illness
36
Dermatology HPI
taken before the physical exam is done, this is an exception. Doing the physical exam at the same time as taking the history can be more productive
37
Questions to ask when taking a Derm HPI
1. Are your symptoms limited to the skin, or are you acutely ill (fever, cough) or chronically ill (fatigue, weight loss)
2. When did the problem start?
3. Where did the problem start?
4. What symptoms are with it (Itch, hurt, bleed, ooze)
5. How has it changed? (shape, color, spread)
6. Does anything make it better or worse? (heat, cold, foods, excercise)
7. What previous treatments have you tried?
38
Two things to do when performing a general examination of the skin
1. Inspection
2. Palpation
- consistency
- tenderness
- blanching/non-blanching
39
What is evaluated with overall inspection/palpation of the skin
color, moisture, temperature, texture, mobility, and turgor
40
Tools to use in an examination
magnifying glass and/or oblique lighting, alcohol pads, gloves, ruler, wood's lamp (UV light)
41
What do you need to have in your documentation?
1/ type of lesion
2. shapes of individual lesions
3. pattern and distribution of multiple lesions
4. color
5. consistency
6. anatomic component/location
42
Macule
any change in skin color that is not palpable (not raised or depressed)
43
Patch
similar to macule, but often quite large, OR barely raised plaque
44
Flat Lesions
macule, patch
45
Papule
elevated, superficial, solid lesion, <0.5 cm
46
Plaque
a plateau-like elevation, usually well defined
47
Nodule
solid, larger and often starting at a deeper level than a papule
48
Wheals
pink papules or plaques that change or disappear within hours
49
Comedones
dilated and plugged hair follicles
50
Horn
conical mass
51
Scar
proliferation of fibrous tissue that replaces normal collagen after a wound that breaches the dermis
52
Raised Lesions
papule, plaque, nodule, wheals, comedones, horn, scar
53
Cyst
encapsulated cavity containing fluid or semisolid material
54
Vesicle
clear fluid filled cavity, <0.5 cm, often thinned roofed
55
Bulla (Blister)
clear fluid filled cavity, >0.5 cm. often thinned roofed
56
Pustule
cavity is filled with purulent exudate
57
Abscess
accumulation of purulent material deep in the dermis or subcutaneous tissue, often fluctuant
58
Fluid filled lesions
cyst, vesicle, bulla (blister), pustule, abscess
59
Erosion
loss of a portion of the epidermis, usually moist, won't scar
60
Ulcer
loss of epidermis and part of the dermis, heals with scarring
61
Atrophy
diminution of epidermal cells resulting in thinning, glossy, transparent, and wrinkled appearance
62
Poikiloderma
pigmentary changes often associated with atrophy
63
Striae
linear depressions that occur from rapid stretching of the skin
64
Sclerosis
a diffuse, slightly depressed, hardened area of skin
65
Depressed lesions
erosion, ulcer, atrophy, poikiloderma, striae, sclerosis
66
Scale
flakes of skin
67
Crust
develop when serum, blood, or purulent exudate dries on the skin surface
68
Excoriations
surface excavations that result from scratching
69
Lichenification
thickening of the epidermis and some changes in the dermis may be due to continual rubbing of the skin
70
Lesions with surface changes
scale, crust, excoriations, lichenification
71
Purpura
reddish-purple lesion that is non-blanchable, indicating blood having left the vessels and moving through other tissues
72
Petechiae
pinpoint purpura
73
Ecchymosis
large purpura; bruise
74
Telangiectasia
Persistent dilations of small capillaries. May or may not be blanchable
75
Angioma
benign tumor with blood vessels; some types blanch others don't
76
Vascular lesions
purpura, petechiae, ecchymosis, telangiectasia, angioma
77
Types of lesions
1. Annular- ring shaped; the edge differs from the center
2. Round-also called nummular or discoid; coined-shaped
3. Arcuate-are shaped
4. Linear- resembling a straight line
5. Reticular- net like
6. Targetoid- also called iris; has three distinct zones
78
Patterns and Distributions of Lesions
1. Grouped- clustered together
2. Scattered- irregularly distributed
3. Dermatomal- Lying in the distribution of a single spinal nerve root
4. Sun exposed- also called photo distribution; occurs in areas usually not covered by clothing
5. Sun protected- occurs in areas usually covered by clothing
6. Acral- occurs on distal locations, such as hands and feet
7. Truncal- occurs on central body
8. Extensor- extensor surfaces of knees, elbows, and other joints
9. Flexor- flexor surfaces of knees, elbows, and other joints
10. Intertriginous- occurring in the skin folds
11. Localized- confined to single location
12. Generalized- widespread
79
Gram Stain
bacterial infection; guides antibiotic selection, purple gram positive, pink gram negative
*does not substitute for a culture
80
Tzanck smear
viral infections; placed on slide allowed to air dry and stained; GIANT multi-nucleated cells; does not indicate which virus
*does not replace a culture
81
KOH prep
fungal infection; scraped from skin and placed on slide, potassium hydroxide is added; septated tube like= dermatophyte
spaghetti and meatballs= candidal infection
82
Direct examination of pathogen
sample is scraped from skin and placed on slide with a drop of mineral oil
ex. scabies, mites
83
Cultures
all types of pathogens; bacterial cultures can show a sensitivity to antibiotic, fungal cultures are slow and less reliable; different tubes
84
Biopsy
punch, elliptical (wedge excision), saucerization (scoop), shave
85
What is done if a definitive diagnosis is needed?
biopsy
86
Used if the lesion is very large or very small
punch biopsy
87
Which biopsy is used if you suspect melanoma?
elliptical excisional biopsies
88
Which biopsy is used if basal or squamous cell carcinoma is suspected?
Saucerization biopsies
89
Which biopsy is used for lesions limited to the epidermis?
Shave biopsies (not used if there is potential for metastasis)
90
Patch test
testing what you are allergic to by touch
91
Prick test
testing what you are allergic to that you don't touch
92
RAST test
same thing as prick test but uses blood serum; not as sensitive or reliable. Used if pt. does not have clear skin
