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Physical Assessment > Skin > Flashcards

Skin Flashcards

1
Q

Layers of the skin

A

Epidermis: outer layer- horny; dead keratin

inner layer-cellular, melatonin and keratin formed

inner layer migrates to outer layer in a month

superficial thin layer, no blood vessles

Dermis: nourish epidermis, connective tissue, sweat glands, sebaceous glands, hair follicles

Subcutaneous: adipose tissue/fat

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2
Q

Skin pigmentation

A

Melanin- brownish

Carotene- golden yellow

Oxyhemoglobin- bright red

Deoxyhemoglobin- dark blue pigment

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3
Q

Cyanosis

A

depends on oxygen concentration

Central; low O2 level in blood

Advanced lung disease, congenital HD, hemoglobinopathys

Peripheral; occurs when cutaneous blood flow decreased and slow- may be normal

CHF, reflects low blood flow, venous obstruction

PEdema can e both

Tissues extract more oxygen than usual from the blood

Can be normal response to anxiety or cold

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4
Q

Hair

A

Vellus: short, fine, inconspicuous, relatively unpigmented

Terminal: coarser, thicker, more conspicuous, usually pigmented, scalp hair and eyebrows

Changes with hair distribution d/t systemic effects from Thyroid gland

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5
Q

Nails

A

protect distal ends of fingers and toes

fingernails grow 0.1mm daily

toenails grow slower

angle between nail fold and plate <180degrees

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6
Q

Glands

A

Sebaceous: produce fatty substance screened onto the skin surface through the hair follicles. Absent from palms and soles

Sweat :

Eccrine: widely distributed, open directly onto skin, sweat production helps control body temp.

Apocrine: Axillary & genital regions, usually opens into hair follicle, stimulated by emotional stress, bacterial decomposition of apocrine sweat is responsible for adult body odor

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7
Q

Health History

A

Changes with hair, nails, skin??

Noticed: rash, sores, lumps, itching

Family Hx of skin CA

Personal Hx of skin Bx

Seen Dermatologist

Any special skin products

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8
Q

Pruritis

A

causes: dry skin, aging, pregnancy, uremia, jaundice, lymphoma, leukemia, lice, drugs

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9
Q

Moles

A

Concerning moles?

Changes with size, shape, color, sensation, new moles?

A- asymmetry

B-borders

C-color change

D-diameter >/= 6mm

E-elevation/evolving

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10
Q

Skin Cancer

A

Basal Cell: 80%- basal level of epidermis, pearly white, head and neck, slow growth, no mets

Squamos Cell: 16%- upper layer, crusted, red, ulcerated, mets

Melanoma: 4% Lethal, mets to lymph, int organs. Half detected by patient

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11
Q

Skin 4 letter words

A

skin

itch

burn

peel

rash

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12
Q

ROS

A

onset pruritis, repsonse to Tx

Associated constitution or systemic Sx

home/OTC Tx/response

skin lesions: change in size/color

Bleeding

Unusual dryness/ Increased sweating

painful lesions

hair changes

nail changes

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13
Q

Dyshydrotic

A

related to water or sweat

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14
Q

Hyperhydrosis

A

excessive/profuse sweating

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15
Q

Xerosis

A

excessive dryness

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16
Q

Induration

A

process of becoming firm or hard

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17
Q

Usual Suspects

A

Contact Dermatitis

Pyodermas- Bacterial Infection

Viral infection

fungal infection

candida/monolial overgrowth

BCC/SCC potential for overlap

Medication effects

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18
Q

Derm Principles

A

Be alert and integrate exams

keep a good derm text near

Find out what pt has beend oing, treating with, what they think, their Dx

Maintain low threshold for Bx for any lesions that don’t respond to Tx- esp ulcers and nodules

Speak and write language fluently

ID by location, distribution, morphology, pregression, symptomatology- can always reference treatment

ABCDE of moles

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19
Q

Physical Exam

A

General Survey:

Closely inspect hair, nail, skin. Palms, soles, web spaces, mucous membranes

Bedridden patient: sacrum, coccyx, buttock, greater trocanter, knees, heels

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20
Q

Skin

A

Color- cyanosis, pallor

Moisture

Temperature- warm=Hyperthroid, fever: cool= hypothyroid: local warmth=inflammation/cellulitis

Texture: rough=hypothyroid: velvety=hyperthyroid

Mobilty/Turgor: decr mobility with edema & scleroderma, decr turgor=dehyration

Lesions

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21
Q

Alopecia

A

Hair loss

Causes: genetic, local inflammatory process, systemic disease

diffuse patchy or total

Hypothyroid=sparse

Hyperthyroid=fine/silky

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22
Q

Distribution

A

Acne: face chest, back

psoriasis: knees, elbows

Candida: intertriginous

Herpes Zoster: unilateral dermatomal pattern

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23
Q

Skin Lesions

A

location: general/local

distribution

blanchable?

pattern/shape: linear, clustered, annular, arciform, geographical, serpiginous

size

shape

type- macule,papule, vesicle, nevi

color

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24
Q

Scabies

A

Mites can be loosened with scapel blade

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25
Q

Derm Colors

A

Flesh

Erythematous- red

Violaceous- blue

brawny- brown

jaundice- yellow- seen in sclera

hyperpigmented- dark

hypopigmented- light

vitiligo- absense of melanin

heliotropic- changing

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26
Q

Cafe Au Lait Spots

A

uniformly pigmented spots, macule/papule (0.5-1.5 cm diameter). Benign. 6 or more with diameter > 1.5cm c/w neurofibrmatosis

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27
Q

Heliotrope

A

viloceous eruptions over eyelids in collagen vascular disease, dermatoyositis

28
Q

Tinnea Versicolor

A

sup fungal infection->decr pigmentation, scaly macules on neck and upper arms

easy to see dark skin, light skin may be red/tan instead of pale

29
Q

Fifth’s Disease

A

Slapped cheeks, erythema infection

30
Q

Vitiligo

A

depigmented macules on face, hands, feet, ext surfaces. May coalecse into large areas without melatonin: hereditary

31
Q

Herpes Zoster

A

Shingles, reactivation of chicken pox virus (Varicella).

follow dermatomal pattern

often preceded by prodromal symptoms of pain, burning, tingling

vesicles erupt on erythematous base

can be painful

may need long term pain management

32
Q

Pityrisis Rosea

A

scaly fine paules/plaques

dull pink or tawny

christmas tree distribution- on trunk and prox ext.

Herald pattern- 2-5cm bright red slightly raised plaque with fine scale at periphery

more common fall/spring

sontaneous recovery in ~ 6 wks

33
Q

Intertriginous

A

dark in skin folds

34
Q

Macule

A

<1cm spot, different color, not raised or depressed

35
Q

Patch

A

> or = 1 cm spot different in color, nat raised or depressed

36
Q

Papule

A

circumscribed solid elevation < 1 cm

37
Q

Plaque

A

circumscribed solid elevation > or = 1 cm
confluence of papule

38
Q

Nodule

A

palpable solid round elevated mass/lesion > 0.5cm

39
Q

Tumor

A

palpable solid round elevated mass/lesion > 2cm

40
Q

Erosion

A

breakdown of epidermis to dermis

41
Q

Lichenification

A

thickening of skin

42
Q

Atrophy

A

thinning of skin layers

43
Q

Ecchymosis

A

bruising

44
Q

Scale

A

small thin plate of horny epithelium heaved up keratin

45
Q

Crust

A

accumulation of debris: thick/thin

46
Q

Ulcer

A

open area caused by superficial loss of tissue, usually with inflammation

47
Q

Keloid

A

hypertrophic scarring extending beyond borders of the initiating injury

48
Q

Fissure

A

deep furrow, cleft or slit

49
Q

Warts

A

Caused by HPV, > 65 types

subclinical infection/ benign lesion

skin/mucus membranes affected

infect keratinized skin

firm papular lesions

plaque may have hyper keratotic surface, studded with black/brown dots

Tx: cyrotherapy, slaicylic acid, duct tape

50
Q

Skin tags

A

Acrochordon/cutaneous papilloma/soft fibroma

common

soft, skin colored/tan/brown, round/oval pedunculated fleshy skin lesion (polyp)

tender after trauma/torsion, may crust/bleed

common in skin folds

often increase with pregnancy, insulin resistance

51
Q

Trichotillomania

A

compulsion to pul out hair

52
Q

Nail DO

A

Paronychia: sup inf of prox/lat nail fold(staph/strep)

Pitting: punctuate depression of nails

Clubbing: nail angle >180 degrees

Transverse/Linear depression: Beau’s line: transverse depress of nail plate, usually following illness: severe febrile, malnutrition, trauma, coronary occlusion

Longitudinal bands of pigment may be normal in people with darker skin

53
Q

Nail inspection

A

inspect, palpate nails/toenails

color, shape, lesion

54
Q

Seborrheic Keratosis

A

starts as macule

skin colored lesion or light tan with more pigment over time

flat to raised

stuck on warty looking lesions

plaque-like

yellow brown velvety/warty

white pearly nodules within

not associated with risk for malignancy

Tx: cryotherapy

55
Q

Actinic Keratosis

A

superficial flattened papules covered by dry scale

often multiple

can be round/irregular

pink/tan/grey

appear on sun-exposed skin of older, fair skinned of people

1/1000 per year develop into squamos cell carcinoma

56
Q

Basal Cell

A

80% skin cancer

pearly white

round border, depressed center/firm elevated borders

flesh color

central divot

translucent

telegectacias

ulcerates/bleeds

rarely metatasized

slow growing

fairskinned > 40 years

57
Q

Squamos Cell

A

Suddenly shows up, grows quick

upper layer of epidermis

crusted/scaly/ firm red

inflammed/ulcerated

can metastasize on skin exposed to sun

can be evolving AK, usually > 60yo

58
Q

Melanoma

A

from pigmented layer of epidermis

lethal, most rapidly increasing US malignancy

Inc risk with severe blistering sunburn

80% of deaths from skin cancer

rare cases of amelneous melanoma

59
Q

HARRM Risk Model

A

Hx previous melanoma

Age > 50yo

Reg derm absent

mole changing

male gender

60
Q

Spider Bite Epidemic

A

Community acquired MRSA

MRSA

often difficult to Tx d/t resistance

PCP

Can be sup pyoderma

absess, impetigo, folliculitis, cellulitis

visual Dx inadequate

secondary infection

61
Q

Derm Emergencies

A

Urticaria w/Angiodedema

Anaphylactic Reaction

Toxic Epidermoid Necrolysis (TEN)

Necrotizing Fascititis

TSS

62
Q

Health Promotion

A

Risk factors

Skin self exams

Avoid tanning beds

Avoid excessive sun exposure: daily SPF UVA/UVB 15 or greater, reapply every 2 hours or if skin wet

63
Q

Bedbound patient

A

shaering, sustained compression, friction

localized redness,warmth sign of impending necrosis

64
Q

Age related Skin changes

A

Flattening of dermoepidermal junction: less resistance to shearing forces/thinning of skin

Reduced collagen/elastin: wrinkling

Decr epidermal cell turnover rate: reduce healing

Decr vasc responsiveness: red vasodil(cooling) and dec transdermal absorption

Decr subq fat: dim bony protection of prominences & thermoreg

Decr epidermal :angerhan cells: decr hypersensitivity response

Atrophy of eccrine/sebaceous gland: reduce oil/sweat, decr thermoreg. and pliabilibty of skin

65
Q
A

Physical Assessment (7 decks)

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