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Physical Diagnosis > Skin > Flashcards

Skin Flashcards

1
Q

Epidermis

A
  • Barrier from environment

* waterproof

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2
Q

Dermis

A

Blood vessels, hair follicles sebaceous glands, sweat glands nails, apocrine glands

Structural support, flexibility, sensation

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3
Q

Hypodermic (subq)

A

Subcutaneous fat and connective tissue

Deepest layer

Conserves heat

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4
Q

Layers of epidermis:

A 
Corneum: superficial, shed dead skin
Lucidum: only hands + feet (palmar and plantar
Granulosum: keratinization
Spinosum: spiny shaped calles (strength
Basale: cells germinate (keratinocytes
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5
Q

Keratinocytes

A

Hyperproliferation -> BCC and SCC

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6
Q

Melanocytes

A

Hyperproliferation -> melanoma

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7
Q

Papillary dermis

A

Superficial dermis

Loose network of collagen bundles

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8
Q

Reticular dermis

A

Deep dermis

Densely packed and thick collagen bundles

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9
Q

Ground substance

A

Layer of dermis

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10
Q

Eccrine glands

A

Cover most of body

No odor

Ducts open at skin surface

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11
Q

Apocrine glands

A

Concentrated in axilla and genitalia

Secretes into sac of hair follicles

Releases thick, odorless fluid -> mixes with skin bacteria -> produces odor

Triggered with stress, hormones, etc.

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12
Q

Vellus hair

A

Short and fine (forehead)

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13
Q

Terminal hairs

A

Long and thick (scalp/axillae)

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14
Q

Bulb of hair follicle

A

Enlargement at base

Melanocytes within matrix contribute to hair pigment

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15
Q

Skin lesion external factors

A

Topical irritant/allergens, seasonal, travel, temperature, previous treatment, occupation, hobbies, pregnancy

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16
Q

Color concerns

A

Hyper- vs hypopigmentation
Pallor
Central cyanosis (pulm or cardiac disease)
Peripheral cyanosis (cooler temps or anxiety)
Jaundice

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17
Q

General skin inspection

A

Moisture
Temperature
Texture (soft and smooth = normal)
Turgor (check hydration status)

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18
Q

Flexor Distribution

A

Atopic dermatitis (eczema)

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19
Q

Extensor distribution

A

Psoriasis

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20
Q

Seborrheic distribution

A

Scalp, face and presternal

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21
Q

Sun-exposed site distribution

A

Light sensitive disorder

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22
Q

Round/discoid shaped

A

Coin shaped

No central clearing = eczema

Umbilicated lesions

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23
Q

Ovoid shape

A

Pityriasis rosea

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24
Q

Annular shape

A

Round
Active margins with central clearing
Seen in tinea

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25
Q

Dermatomal arrangement

A

Follow nerve segment

Herpes or varicella zoster

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26
Q

Target shape

A

Pink macules with purple central papules

Seen in erythema multiforme

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27
Q

Linear arrangement

A

Phytophotodermatitis

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28
Q

Serpiginous arragement

A

Cutaneous larva migrans

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29
Q

Morbiliform arrangment

A

Erythematous maculopapular lesions that become confluent on face and body (measles like)

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30
Q

Primary lesions

A

Arise from previously normal skin

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31
Q

Secondary lesions

A

Arise from changes in primary lesions

Usually due to exogenous factors/changes (scratching, infection, rubbing, crusting)

32
Q

Macule

A

Primary lesion

Circumscribed flat, nonpalpable (primary lesion)

<1 cm in diameter

Ex: freckles

33
Q

Patch

A

Primary lesion

Flat, non-palpable

> 1cm in diameter

Can be well circumscribed or irregular shape

Ex: cafe au lait spot

34
Q

Papule

A

Primary lesion

Palpable, firm, raised

< 1cm in diameter

Flesh colored, red, brown

Ex: seborrheic keratosis

35
Q

Plaque

A

Primary lesion

Elevated, firm, palpable

> 1cm in diameter

Ex: psoriasis

36
Q

Nodule

A

Primary lesion

Elevated, circumscribed

Deeper and firmer than a papule

Often > 1.5cm in diameter

Can be compressible, soft, rubbery or firm

Ex: epidermal inclusion cyst

37
Q

Tumor

A

Primary lesion

Large nodule

Deeper in the dermis

> 2cm in diameter

Ex: lipoma

38
Q

Wheal

A

Primary lesion

Irregular

Transient

Superficial edema

Ex: hives (urticaria), insect bite

39
Q

Vesicle

A

Primary lesion

Usually associated with a virus

Elevated, well circumscribed

<1cm in diameter

Fluid containing, usually clear

Ex: Varicella Zoster and Herpes Zoster

40
Q

Bulla

A

Primary lesion

Elevated

Well circumscribed

> 1cm in diameter

Filled with serous fluid

Ex: bullous pemphigoid

41
Q

Pustule

A

Primary lesion

Elevated

Superficial

Well circumscribed

Filled with pus

Ex: folliculitis

42
Q

Furuncle

A

Primary lesion

Infection of a single hair follicle

Caused by S. Aureus

AKA boil

43
Q

Carbuncle

A

Primary lesion

Infection of multiple hair follicles

Caused by S. Aureus

Can form an abscess

44
Q

Crust

A

Secondary lesion

Dried residues of serum, pus or blood

Adherent

Ex: Impetigo

45
Q

Scale

A

Secondary lesion

Hyperkeratosis

Accumulation of stratum corneum due to increased proliferation and/or delayed desquamation

Ex: psoriasis

46
Q

Fissure

A

Secondary lesion

Linear cleft in skin

Often painful

Results from marked drying, skin thickening or loss of elasticity

Ex: hand dermatitis

47
Q

Erosion

A

Secondary lesion

Partial or complete loss of epidermis

Moist, oozing and or crusted lesion

Ex: Pemphigus foliaceus

48
Q

Ulcer

A

Secondary lesion

Deeper defect than erosion with loss of at least entire epidermis plus superficial dermis

May go deep through dermis

Ex: venous stasis ulcer

49
Q

Excoriation

A

Secondary lesion

Exogenous injury to all or part of the epidermis

Usually due to scratching

Ex: neurotic excoriations

50
Q

Atrophy

A

Secondary lesion

Epidermal: thinning of epidermis -> wrinkling and shiny appearance

Dermal: loss of dermal collagen and/or elastin -> depression

Ex: striae

51
Q

Lichenification

A

Secondary lesion

Thickening of epidermis

Increased visibility of skin markings

Ex: LSC

52
Q

Petechiae

A

Vascular lesions

Deep red/purple, round, irregular

<0.5cm

Non-blanchable

Blood outside of a vessel

53
Q

Purpura

A

Vascular lesion

Deep red/purple, round, irregular

> 0.5cm

Non-blanchable

Blood outside of a vessel

54
Q

Ecchymosis

A

Vascular lesion

Purple lesions of variable size

Fade to green/yellow/brown

Round/oval, irregular borders

Blood outside of vessel due to trauma

55
Q

Spider angioma

A

Vascular lesion

Fiery red lesions

Small in size (up to 2cm)

Central body with surrounding erythema

Blanchable

Common with liver disease and pregnancy

56
Q

Cherry angiomas

A

Vascular lesion

Bright red

1-6mm in size

Non-blanchable

Genetic component

57
Q

Telangiectasia

A

Vascular lesion

Permanently dilated superficial blood vessels

Blanchable

Irregular

Seen in BCC, rosacea

58
Q

Hemangioma

A

Benign vascular neoplasm

Most common tumor in infancy

Red, irregular

Secondary to dilation of capillaries

Starts as macular patch can progress to plaque or nodule

59
Q

Papulosquamous lesions

A

Papules, plaques and scales

Ex: psoriasis and lichen planus

60
Q

Nodular lesions (benign)

A

Epidermal and dermal nodules

Ex: Nevi, cherry angioms, epidermoid cysts

61
Q

SCC

A

Malignant nodular lesion

Isolated keratotic, eroded, papule or nodule

Sun exposed areas

62
Q

BCC

A

Malignant nodular

Pearly nodule in sun exposed areas

Central erosion

Telangiectasias

63
Q

Vesiculobullous lesions

A

Ex: impetigo, herpes, pemphigus

64
Q

Maculopapular lesions

A

Ex: viral exanthems, drug eruptions

65
Q

Nail clubbing

A

Rounded, bulbous nail base

Feels spongy

Often occurs with CF or lung diseases

66
Q

Schamroth’s window/sign

A

Flex fingers -> bring index fingers until distal phalanges touch

Diamond space in between nails = negative sign/window

No space = positive sign/window

67
Q

Beau’s lines

A

Transverse depressions secondary to trauma or acute/severe illness

68
Q

Paronychia

A

Inflammation of proximal and lateral nail folds

Acute: <6 weeks
Chronic >6weeks

69
Q

Onychocryptosis

A

Ingrown toenail

Nails grow into dermis

Can become infected

70
Q

Terry’s nails

A

Mostly white with distal band of reddish brown

“Ground glass” appearance

No lunula

71
Q

Leukonychia

A

Trauma to nails causing areas of white discoloration

72
Q

Koilonychia

A

Spoon shaped, concave nail

73
Q

Onycholysis

A

Painless separation of nail plate from nail bed

Seen in psoriasis

74
Q

Onychomycosis

A

Fungal infection of nail bed, plate or matrix

75
Q

Nail pitting

A

Small, punctate depressions

Caused by nail matrix inflammation, common in psoriasis

Physical Diagnosis (2 decks)

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