Skin

Question 1

Give examples of skin function

Answer 1

1. Protect against microbe and foreign substance invasion
2. Retard body fluid loss
3. Regulate body temp
4. Provide sensory perception
5. Make Vit D from precursors
6. Help reg blood pressure
7. Repair surface wounds
8. Sebaceous glands (sebum)
9. Hair
10. Nails

Question 2

In someone’s PMH who has a rash or integument issue, what would be notable?

Answer 2

1. Chronic med conditions
2. Meds
3. Allergies
4. SH (occupation, hobbies, travel, stress, chem exposure)
5. FH

Question 3

On skin exam, what are the first two important parts? What tools are essential?

Answer 3

Inspection and palpation;

NEED adequate lighting and perhaps a magnifying glass or dermatoscope!!

Question 4

On general physical exam, what should you have with you?

Answer 4

Centimeter ruler, Wood’s lamp (for fungal infections mostly) and a flashlight/transilluminator;
optional magnifying lens

Question 5

On inspection of the patient, what are you looking for?

Answer 5

1. Lesion type and DISTRIBUTION
2. Secondary characteristics
3. Shape of the lesions
4. How are lesions arranged?
5. Color
6. Consistency and feel

Question 6

Things to look for on palpation?

Answer 6

1. Moisture (should be minimal perspiration, oiliness)
2. Temp
3. Texture (smooth, soft and even? or rough, patchy, scaly)
4. Turgor (could be due to dehydration or edema)
5. Mobility (can it move or is it fixed and immobile?)

Question 7

Associate the following with appropriate examples:

Macule, Papule, Nodule, Vesicle, Pustule, Wheal

Answer 7

1. Macule: non-palpable, skin color change, < 1 cm; e.g. blister
2. Pustule: pus-filled, e.g. acne
3. Wheal: palpable, irregular borders e.g. mosquito bite

Question 8

What are four primary lesions? Give examples of that

Answer 8

1. Plaques (confluence of papules that are large; psoriasis)
2. Cysts (enclosed cavities with liquid or semisolid material; sebaceous cyst)
3. Telangiectasia (superficial blood vessel; N/A)
4. Bullae (large vesicles; pemphigus)

Question 9

For suspicious changes for skin cancer, what mnemonic do you use?

Answer 9

Asymmetry
Border
Color
Diameter (greater than 6 mm)
Evolution (how is skin changing over time?)

Question 10

What is the most common form of skin cancer? What would you see on presentation?

Answer 10

Most common form of skin cancer; usually won’t metastasize, usually is sun damaged skin, smooth pearly borders with central pallor

Question 11

What is characteristic of SCC?

Answer 11

Think sun exposure; ulceration, scabs; gets deeper and ulcerated over time

Question 12

Where would you see malignant melanoma?

Answer 12

Non-sun exposed areas

Question 13

What is Kaposi’s sarcoma?

Answer 13

These purply lesions due to neoplasm of the endo and epithelial layer of the skin caused by HHV8

Question 14

What is a hallmark of chronically dry skin? What could be causes?

Answer 14

Eczematous dermatitis (maybe caused by dish soap, chemicals, other environmental cause)

Question 15

What microorganism typically causes folliculitis?

Answer 15

Staph aureus

Question 16

What could cause cellulitis? What features do you see on the skin? What can be used for treatment?

Answer 16

S aureus; bullae; large-spectrum antibiotics

Question 17

Psoriasis tends to run in _______; what is thought to cause it? What else can trigger this? How can you improve this condition? What other things can you see on presentation?

Answer 17

families; immune system function errors;
emotional stress, skin injury, infection, meds;
SUN EXPOSURE!!;
Some lichenification, nail pitting, onycholysis

Question 18

How is SLE different from rosacea?

Answer 18

It tends to be more ulcerated; classic butterly rash and could be triggered by UV light, stress, meds, antibiotics, hormonal changes, seen in women 15-45

Question 19

What causes acanthosis nigricans? What is the presentation?

Answer 19

Could be obesity, diabetes or glucose intolerance, PCOD;

velvet, leathery thickening of the skin

Question 20

What is herpes zoster/shingles? What’s the virus? What is a potential sequelae? What is characteristic of the patients who end up with herpes zoster?

Answer 20

Grouped vesicles on an erythematous base, following a sensory dermatome pattern;
varicella;
postherpetic neuralgia;
had chicken pox as a child

Question 21

What is vitiligo?

Answer 21

Autoimmune disorder; attacks pigmented cells (depigmentation)

Question 22

What do you want to not confuse cherry hemangioma with? What is the difference?

Answer 22

Telangiectasia; don’t see blanching if you press the cherry angiomata/hemangioma

Question 23

Seborrheic keratoses?

Answer 23

Get more as you get older; DON’T PULL THEM OFF!!

Question 24

What is seen with chronic venous stasis?

Answer 24

Brown stasis edema with pigment leaking out from veins and there are small ulcers due to poor venous return

Question 25

What are you looking for if someone’s bitten their nails? Treatment?

Answer 25

Paronychia; antibiotics

Question 26

What do you see with onychomycosis? Who is at risk of this?

Answer 26

Nails rough and ragged; seen in diabetics or immunosuppressed

Question 27

What pathology would flouresce under a Wood’s lamp?

Answer 27

Tinea Cruris

Question 28

Which path can be treated topically and appears hypopigmented?

Answer 28

Tinea Versicolor