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Physical Diagnosis > Lecture 2 - Skin Assessment > Flashcards

Lecture 2 - Skin Assessment Flashcards

1
Q

3 layers of skin

A

Epidermis, Dermis, Subcutaneous fat

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2
Q

Dermis

A

blood vessels, nerves, hair follicles, sweat glands, sebaceous glands

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3
Q

Appendages of skin

A

Hair - terminal and vellus, nails, sebaceous glands, sweat glands

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4
Q

Two types of sweat glands - which one has body odor?

A

Eccrine

Apocrine - groin and axillary

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5
Q

Physiology of skin

A

Protects from fluid loss, protects from trauma and infection, regulates body temperature, provides sensory info, produces vitamin D

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6
Q

History

A

Duration
Relationship of skin lesions to external factors
Associated symptoms
Constitutional symptoms - may be an internal disease - acute/chronic

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7
Q

Physical Exam

A 
Vital signs
General survey
Equipment needed
Adequate lighting 
Adequate exposure
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8
Q

Adequate lighting

A

Daylight - best illumination, esp. for color

Tangential lighting for contours - can use ophthalmoscope

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9
Q

Adequate exposure

A

check axillae, buttocks, back of thighs, between fingers and toes

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10
Q

Equipment needed for skin assessment

A

ruler, lighting source

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11
Q

Inspection

A

Symmetry
Color - inc/dec pigmentation, pallor v cyanosis, jaundice
Hair - distribution, quantity
Nails - color, lesions, capillary refill

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12
Q

Central v peripheral cyanosis

A

Central - consistent with pulmonary or cardiac disease; peripheral - cooler temps or anxiety

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13
Q

Palpation

A

Moisture
Temperature - use dorsum of hand
Texture - smooth and soft
Mobility and turgor - pinch section of skin on forearm, should return to place immediately; avoid back of hand. Pinch skin on thigh in elderly

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14
Q

Morphologic Characteristics of Skin Lesions

A

Distribution
Shape/arrangement
Border/margin
Pigmentation/color

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15
Q

Localized distribution

A

lesion appears in one small area (ex. acne)

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16
Q

Regional distribution

A

lesions appear in specific region of body (ex. shingles)

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17
Q

Generalized distribution/disseminated

A

lesions appear widely distributed or in multiple areas simultaneously

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18
Q

Flexor surfaces

A

antecubital or popliteal area – eczema

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19
Q

Extensor surfaces

A

knees, elbows – psoriasis

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20
Q

Round/discoid shape

A

coin-shaped
no central clearing
seen with eczema
umbilicated lesions - seen with molluscum contagiosum

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21
Q

Oval shape

A

ovoid, seen with pityriasis rosea

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22
Q

Annular

A

Round; active (advancing border) margins with central clearing; seen with tinea (fungal) infections

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23
Q

Zosteriform

A

dermatomal - follows nerve segment; ex herpes zoster

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24
Q

Iris/target

A

pink macules with purple central papules; usually assoc with erythema multiforme

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25
Q

Arrangement of lesions

A

linear - contact dermatitis

serpiginous - cutaneous larva migrans (from hookworm larvae)

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26
Q

Morbilliform

A

measles-like

erythematous maculopapular lesions that become confluent on face and body

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27
Q

Borders/margins

A

Distinct - well-demarcated or defined, able to draw a line around area with confidence
Indistinct - poorly defined, borders merge with normal skin
Active - advancing - margin shows greater activity than center
Irregular - notched margins
Raised borders - center is depressed compared to edge

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28
Q

Example of active border

A

tinea infections

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29
Q

example of irregular border

A

malignant melanoma

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30
Q

example of raised borders

A

basal cell carcinoma

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31
Q

Color/Pigmentation

A

flesh, erythematous - variable shades of red, violaceous, tan-brown, black or blue-black, white

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32
Q

Palpation of Lesions

A 
Consistency
Mobility
Blanchable
Tenderness
Depth of lesion
Deviation in temp
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33
Q

ABCDEs of Malignant Melanoma

A 
A - asymmetry
B - borders (irregular)
C - color (variegated)
D - diameter ( > 6mm)
E - elevation
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34
Q

Primary skin lesions arise from previously ________ skin. Key to __________ diagnosis.

A

normal, accurate

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35
Q

Secondary skin lesions

A

arise from changes in primary lesions; usually due to scratching and/or infection

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36
Q

Primary skin lesions: circumscribed, flat, nonpalpable

A

macule, patch

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37
Q

Primary skin lesions: superficial elevations by free fluid

A

vesicle, bulla, pustule

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38
Q

Primary skin lesions: palpable, elevated solid masses

A

papule, plaque, nodule, tumor, wheal

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39
Q

Macule characteristics

A

Flat, non-palpable
Circumscribed color change
<1 cm in diameter
variable color

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40
Q

Ex of macules

A

measles, freckles, petechiae

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41
Q

Patch characteristics

A

flat, non-palpable
irregular shape
>1 cm in diameter

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42
Q

ex of patches

A

mongolian spots
cafe au lait spots
port wine stain
vitilgo

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43
Q

Papule characteristics

A 
Up to 1 cm
Palpable, firm
circumscribed
colors - flesh-colored, red, brown
May be confluent and form plaques
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44
Q

Examples of papules

A

molluscum contagiosum, warts, nevi

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45
Q

what kind of lesion is a wart?

A

papule

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46
Q

Plaque description

A

elevated, firm, rough
> 1 cm
well-circumscribed

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47
Q

Ex of plaques

A

Psoriasis

Eczema

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48
Q

Nodule characteristics

A

> .5 cm
Deeper and firmer than a papule
Usually round

49
Q

Ex of nodules

A

lipomas, skin cancers - malignant melanoma, basal cell or squamous cell carcinomas

50
Q

Tumor characteristics

A

A large nodule
Deeper in dermis
> 2 cm

51
Q

Examples of tumors

A

Hemangioma

Benign tumor

52
Q

Wheal definition

A

irregular, transient, superficial edema

53
Q

Ex of wheals

A

Mosquito bites, hives, allergic reactions

54
Q

Vesicle Characteristic

A

well-circumscribed
Up to 1 cm
filled with serous fluid

55
Q

Ex of vesicles

A

herpes simplex - dew drops on rose petals

56
Q

Bulla characteristics

A

Well-circumscribed, greater than 1 cm, filled with serous fluid

57
Q

Ex of bullas

A

2nd degree burns, blisters

58
Q

Pustule characteristics

A

Elevated, superficial, well-circumscribed, epidermal, FILLED WITH PUS

59
Q

Ex of pustules

A

acne, impetigo, fire ant bites

60
Q

Secondary skin lesions: result from changes in primary lesions

A

Loss of skin surface
Miscellaneous lesions
Material on the skin surface

61
Q

Loss of skin surface examples

A

erosion, ulcer, fissure

62
Q

miscellaneous lesions

A

lichenification, atrophy, scar, burrow, excoriation

63
Q

material on skin surface

A

crust, scale

64
Q

Erosion characteristics

A

Loss of superficial epidermis, surface is moist but doesn’t bleed, heal without scarring

65
Q

Erosion examples

A

ruptured varicella vesicles, eczema

66
Q

Ulcer characteristics

A

deeper loss of epidermis and dermis, heals with scarring

67
Q

Ulcer examples

A

stasis ulcer, decubitus

68
Q

Fissure characteristics

A

Linear crack or break from epidermis to dermis

69
Q

Examples of fissures

A

Eczema, tinea pedis, angular chellitis

70
Q

Excoriation characteristics

A

abrasion or scratch marks, may be linear or rounded, usually due to scratching

71
Q

Examples of excoriation

A

scabies, atopic dermatitis, dry skin

72
Q

Crust characteristics

A

dried residue of serum, pus, or blood

73
Q

Ex of crust

A

impetigo, tinea capitis, kerion - raised boggy secondarily infected fungal lesion of hair

74
Q

Scale characteristics

A

thin flake of exfoliated epidermis

75
Q

Ex of scales

A

dandruff, psoriasis, seborrheic dermatitis

76
Q

Lichenification characteristics

A

thickening and roughening of the skin, increased visibility of skin markings

77
Q

Lichenification examples

A

atopic dermatitis, chronic dermatitis

78
Q

Atrophy characteristics

A

thinning of skin with loss of normal skin markings, skin looks shinier and more translucent

79
Q

Atrophy examples

A

stretch marks, topical steroid use

80
Q

Petechiae characteristics

A

deep red/purple-red lesions < .5 cm, round, irregular, non-blanchable, variable distribution, represent blood outside of vessel, seen with infections and bleeding disorders

81
Q

Purpura characteristics

A

deep red/purple-red lesions; > .5 cm; same descriptors as petechiae, just larger

82
Q

Ecchymosis characteristics (bruises)

A

purple lesions of variable size - fade to green, yellow, brown; round/oval, irregular borders; represent blood outside of vessels due to trauma or bleeding disorder

83
Q

Spider angiomas

A

fiery red lesions - small in size - up to 2 cm; central body with surrounding erythema and radiating legs; blanch with pressure; seen on face, neck, arms, and upper trunk; seen with liver disease, pregnancy, may be normal

84
Q

Cherry angiomas characteristics

A

bright - red papules, 1-3mm size, red, flat, or raised, non-pulsatile, seen on the trunk, don’t blanch, associated with aging

85
Q

Telangectasis characteristics

A

fine, irregular red lines secondary to dilation of capillaries; blanch; seen with basal cell carcinomas, sun-damaged skin, rosacea

86
Q

Hemangioma characteristics

A

red irregular lesion secondary to dilation of dermal capillaries; starts as macular patch, can progress to plaque or nodule

87
Q

What does this person have? Erythematous papules, nodules, and pustules on nose, chin, and cheeks bilaterally

A

acne rosacea; rosacea

88
Q

Categories of skin diseases

A

papulosquamous, nodular, vesiculobullous, maculopapular

89
Q

Papulosquamous lesions

A

papules, plaques and scales

90
Q

examples of papulosquamous lesions

A

psoriasis, lichen planus

91
Q

Lichen planus - 5 Ps

A

pruritic, polygonal, purple, planar, papules

92
Q

nodular lesions

A

benign and malignant epidermal and dermal nodules

93
Q

examples of benign nodular lesions

A

nevi - moles, cherry angiomas, epidermoid cysts

94
Q

examples of malignant nodular lesions

A

squamous cell carcinoma - isolated keratonic, eroded papule or nodule; located in sun-exposed area
basal cell carcinoma - “pearly” nodules in sun exposed areas, associated with central ulcerations and telangiectases

95
Q

Vesiculobullous lesions

A

vesicles and bullas

96
Q

ex of vesiculobullous lesions

A

impetigo, herpes zoster, pemphigus

97
Q

pemphigus

A

autoimmune disease affecting skin and mucous membranes; associated with vesicles and bullas that can rupture and weep, can be fatal

98
Q

maculopapular lesions

A

macules and papules

99
Q

ex of maculopapular lesions

A

viral exanthem - generalized, erythematous maculopapular rash; drug eruptions

100
Q

clubbing of nails

A

rounded, bulbous nail base, feels spongey

101
Q

what causes clubbing of nails

A

chronic hypoxia, congenital heart disease, lung cancer

102
Q

angle of proximal nail fold is ________ than 180 degrees

A

greater than

103
Q

beau’s lines

A

transverse depression; lines grow out with the nail

104
Q

paronychia

A

acute or chronic inflammation of the proximal and lateral nail folds; nail fords swollen, reddened, and tender

105
Q

what causes paranychia

A

frequent immersion in water

106
Q

what causes beau’s lines?

A

trauma or acute/severe illness

107
Q

onchocryptosis

A

ingrown toenail, usually involves large toe; nail grows into dermis

108
Q

what causes onchocryptosis

A

improperly cutting nails, tight shoes

109
Q

terry’s nails

A

mostly white with a distal band of reddish brown

110
Q

what causes terry’s nails

A

aging, chronic disease such as diabetes, cirrhosis, heart failure

111
Q

leukonychia

A

trauma to nails causing areas of white discoloration

112
Q

what causes leukonychia

A

trauma, repeated manicuring

113
Q

koilonychia

A

spoon nail - possible iron deficiency anemia

114
Q

onycholysis

A

painless separation of nail plate from nail bed

115
Q

what causes onycholysis

A

trauma to long finger nails; psoriasis, contact dermatitis

116
Q

onychomycosis

A

fungal infection of nail bed, plate, or matrix

117
Q

causes of onychomycosis

A

occlusive footwear, dissemination of fungal infections, locker room exposure

118
Q

nail pitting

A

psoriasis, RA, SLE, alopecia areata (all autoimmune)

Physical Diagnosis (4 decks)

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