PD Hair Skin and Nails Lecture

Question 1

Common general observations about the skin when observing patient

Answer 1

• Cyanotic skin
• Diaphoresis
• Pallor
• Flushed
• Clothing
• Odors
• Posture

Question 2

Common history questions for skin

Answer 2

• Noticed any change in hair/skin/nails? If so, what?
• What is location of the change, when did you notice, does it itch/burn/hurt?
• Any history of this or family history?
• What makes it better or worse and what have you tried?
• What medications (OTC and supplements) are you on recently?

Question 3

Open ended questions

Answer 3

Broad questions that require patient to explain their answer without leading them or giving them a yes/no outlet

Question 4

When should a skin exam be done?

Answer 4

Any patient encounter

Question 5

Total body skin exam

Answer 5

Systematic and deliberate search across entire skin surface, hair, nails, conjunctiva, and oral/genital mucosa

Question 6

Importance of natural light in skin exams

Answer 6

Artificial light can distort skin color and mask jaundice

Question 7

2 most important aspects of the skin exam

Answer 7

1) Observation

2) Palpation

Question 8

Language used to describe findings of skin exam

Answer 8

• Distribution:
• Arrangement
• Type of lesion
• Color
• Features based on touch/palpation

Question 9

Importance of looking at entire skin surface

Answer 9

Because of melanoma that can form anywhere on the body

Question 10

Distribution of skin disease

Answer 10

Generalized vs localized, exposed vs nonexposed areas, sun exposed or not, bilateral or unilateral, acral vs truncal, extensor surfaces vs flexor surfaces, upper or lower extremity, mucus membrane involvement

Question 11

Dermatomal distribution

Answer 11

Skin disease that follows the dermatomal structure of a spinal nerve root

Question 12

Koebner phenomenon

Answer 12

Lesion growth along the region of trauma

Question 13

Periungal

Answer 13

Around the fingernails

Question 14

Arrangement of skin disease

Answer 14

Isolated, scattered, groups, circular (annular - complete, arciform - incomplete ring, polycyclic - multiple rings), linear, angular, reticulated

Question 15

Herpetiform

Answer 15

Random grouping

Question 16

Zosteriform

Answer 16

Grouping in dermatomes

Question 17

Macule

Answer 17

A type of nonpalpable lesion with distinct borders less than 1cm in diameter

Question 18

Patch

Answer 18

A type of nonpalpable lesion with distinct borders greater than 1cm in diameter

Question 19

Papule

Answer 19

A type of palpable solid lesion less than 1cm in diameter

Question 20

Plaque

Answer 20

A type of palpable solid lesion greater than 1cm in diameter

Question 21

Nodule

Answer 21

A type of palpable lesion more than 1cm in diameter taller than wide

Question 22

Vesicle

Answer 22

A type of lesion fluid containing, superficial, thin walled cavity <1cm

Question 23

Bulla

Answer 23

A type of lesion fluid containing superficial thin walled cavity >1cm

Question 24

Erosion

Answer 24

A type of lesion skin defect where there has been loss of epidermis only

Question 25

Ulcer

Answer 25

A type of lesion skin defect where there has been loss of dermis and epidermis

Question 26

Pustule

Answer 26

A type of lesion pus containing, thin walled superficial cavity

Question 27

Abscess

Answer 27

A type of lesion pus containing thick walled cavity

Question 28

Secondary lesions

Answer 28

Changes in skin which are superimposed or the consequence of the primary process

Question 29

Scale

Answer 29

A 2ndary lesion Desquamating layers of stratum corneum

Question 30

Crust

Answer 30

A 2ndary lesion Dried serum, blood, or purulent exudate (sign of pyogenic infection)

Question 31

Lichenification

Answer 31

A 2ndary lesion Skin thickening that is result of chronic rubbing leading to accentuation of normal skin lines

Question 32

Atrophy

Answer 32

A 2ndary lesion Decrease # of epidermal cell layers due to decrease in dermal connective tissue

Question 33

Scar

Answer 33

A 2ndary lesion formed as result of dermal damage

Question 34

Excoriation

Answer 34

a 2ndary lesion superficial excavations of epidermis that result from scratching

Question 35

Fissure

Answer 35

A 2ndary lesion linear painful crack on the skin

Question 36

Colors of skin diseases

Answer 36

- Skin or flesh colored - Hypopigmented and hyperpigmented - White, brown, grey, black - Red (erythema), blue, violaceous, dark purple (purpura), yellow, orange, green

Question 37

Vitiligo

Answer 37

Loss of skin coloration due to melanocyte death in areas

Question 38

Tinea versicolor

Answer 38

Fungal infection causing small, discolored patches of skin

Question 39

Substances that contribute to skin color

Answer 39

- Melanin (brown) - carotenoids (yellow) - Oxyhemoglobin (red) - Reduced hemoglobin (bluish) - Jaundice (yellow) - Cyanosis (bluish)

Question 40

Jaundice vs icterus

Answer 40

Jaundice is in skin | Icterus is eye

Question 41

Skin exam texture observations

Answer 41

- Dry, rough - Moist, warm - Tight, bound skin suggests schleroderma - Excoriations may indicate lyme, lymphoma, etc - Soft or hard - Fixed vs mobile - Presence of tenderness

Question 42

Diagnostic aides in skin exam

Answer 42

Hand lens, wood lamp (UV light), diascopy (transparent to determine if blanching occurs

Question 43

Blanching

Answer 43

A change in skin, becoming more pale indicating a lack of blood flow, if disappears quickly indicative of good blood supply

Question 44

ABCDE for melanoma

Answer 44

1) Asymmetry 2) Border irregular 3) Color variation 4) Diameter larger than 6mm 5) Elevation or Evolving

Question 45

Hair and scalp observations in a skin exam

Answer 45

-Distribution, thickness, moisture of hair

Question 46

Nail bed angle

Answer 46

160 degrees

Question 47

Nail assessment

Answer 47

Transparent, smooth and convex, normally firm on palpation, grow at constant rate, surrounding cuticles are smooth without inflammation