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Advanced Clinical Assessment Across Lifespan > Skin > Flashcards

Skin Flashcards

1
Q

How should you describe a skin lesion?

A
  • Distribution/Location
  • Configuration
  • Color
  • Morphology
  • Symmetry: uniform, multiform, polygonal
  • Size: in cm
  • Borders: demarcated, raised, ill defined
  • Surrounding tissue: induration, erythema, flaking, scaling
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2
Q

Induration

A

hardness/fullness from inflammation

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3
Q

Morbilliform

A
  • looks like a measles rash

- rash consists of macular lesions that are red and are usually 2-10 mm in diameter

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4
Q

Papulosquamous

A

papular rash with scales

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5
Q

Coalesce

A

grouping distribution

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6
Q

Exantham

A

macular/papular rash on the trunk

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7
Q

Erythroderma

A

whole body is red

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8
Q

Scarletiniform

A

sandpaper rash

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9
Q

Confluent

A

lesions in so many places they have formed together

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10
Q

Acral

A

lesions in distal part of the body, like hands/feet/ears

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11
Q

Dermatomal

A

lesions in a certain dermatome

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12
Q

Extensor

A

lesion is on the outside portion of the body

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13
Q

Flexor

A

lesion is on the inside portion of the body, where the skin touches

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14
Q

Follicular

A

lesions where your hair grows

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15
Q

Generalized distribution

A

lesions everywhere

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16
Q

Herpeiform

A

looks viral, vesicular

like herpes

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17
Q

Photosensitive

A

lesions on sun exposed areas

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18
Q

Seborrheic

A

lesions on scalp, nasal labial folds, behind ears

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19
Q

Linear configuration

A

lesions in a line

like with contact dermatitis

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20
Q

Nummular configuration

A

coined shaped lesions

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21
Q

Target configuration

A

bulls eye, dusty red in center

like erythema multiform

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22
Q

Gyrate configuration

A

reticular rash, lacy

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23
Q

Annular configuration

A

round in nature

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24
Q

Satellite lesion configuration

A

main area of redness with satellite lesions on the outskirts

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25
Q

Carotenaemia

A

yellowing of skin, not they eyes

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26
Q

Jaundice

A

yellowing of skin and sclera

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27
Q

Leukoderma

A

loss of pigmentation

like with vitiligo

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28
Q

Hyperpigmentation

A

darker pigmented skin

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29
Q

Hypopigmentation

A

lighter pigmented skin

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30
Q

Infarcts

A

dead, blackened skin

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31
Q

Erythema

A

reddened skin

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32
Q

Violaceous

A

purple skin

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33
Q

Macule

A
  • a circumscribed, flat, non palpable change in skin color

- up to 1 cm

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34
Q

Patch

A
  • macule larger than 1 cm
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35
Q

Papule

A
  • palpable, elevated, circumscribed, solid mass
  • up to 1cm
  • caused by superficial thickening of the epidermis
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36
Q

Plaque

A
  • flat, elevated surface
  • larger than 0.5cm
  • often formed by coalesce of papules
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37
Q

Psoriasis

A
  • Chronic inflammatory papulosquamous disease of unknown etiology
  • red, sharply defined, scaly papules that coalesce to form stable round to oval plaques
  • silvery white
  • may have nail or joint disease
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38
Q

Nodule

A
  • A solid, elevated, firm or soft mass
  • less than 1-2 cm
  • May be firmer and extend deeper into dermis than papule
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39
Q

Tumor

A
  • A solid elevated firm or soft mass larger than 1-2 cms
  • Extending deeper into dermis
  • Benign or malignant
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40
Q

Wheals, Uticaria, Hives

A

A superficial, raised, erythematous, transient lesion with somewhat irregular borders due to localized edema, multiple wheals/hives can coalesce to cause an intensely puritic lesion

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41
Q

Vesicles

A
  • A circumscribed, superficial, elevated cavity
  • Contains free fluid
  • Clear fluid flows if wall ruptured
  • Up to 1 cm in size
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42
Q

Bulla

A
  • Similar to vesicular lesions
  • larger usually >1.0cm
  • Filled with serous fluid
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43
Q

Pustule

A
  • A pustule is a purulent vesicle.
  • It is filled with neutrophils, and may be white, or yellow.
  • Not all pustules are infected
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44
Q

Burrow

A
  • A minute, slightly raised tunnel in the epidermis, commonly found on the finger webs and the fingers.
  • The burrowing will usually end with a papule, vesicle or pustule.
  • Burrowing is found in scabies
45
Q

Lichenification

A
  • secondary lesion

- thickening and hyper pigmentation of the skin

46
Q

Crusting

A
  • secondary lesion

- a scab

47
Q

Dystrophy

A
  • secondary lesion

- a change in formation, usually associated with nails

48
Q

Excoriation

A
  • secondary lesion

- scratch marks/irritation

49
Q

Scales

A
  • secondary lesion
  • fragments of the skin, flaking off
  • different than dry skin
50
Q

Fissure

A
  • secondary lesion

- a crack, usually from dryness

51
Q

Ulcer

A
  • secondary lesion

- breakdown of the epidermis

52
Q

Erosion

A
  • secondary lesion

- superficial loss of epidermis from friction/rubbing

53
Q

Hypertrophy (keloid)

A
  • secondary lesion

- excessive growth of scar tissue

54
Q

Granuloma

A
  • secondary lesion

- from chronic or prolonged inflammatory process that leaves a build up of cells

55
Q

What are vascular lesions from?

A

Bleeding into the tissue

56
Q

Petechia

A
  • vascular lesion
  • Small 1-3mm deep red or reddish purple macules
  • Rounded sometimes irregular in shape
  • Indicates blood outside of the vessels
  • Do not blanch
57
Q

Purpura v. Ecchymosis

A
  • A larger macule or papule of blood in the skin
  • purpura-from 0.5 to 1 cm
  • ecchymosis-more than 1 cm
  • maybe benign resulting from trauma or pathological
58
Q

Meningococcal Infection

A
  • Presents as sudden onset of fever, rash and signs of meningeal inflammation
  • Time from onset to sepsis can be less than 24 hours
  • Positive Kernig and Brudzinski Sign
  • Worrisome signs on presentation are:
  • Leg pain
  • Cold hands and feet
  • Abnormal skin color such as pallor indicating onset of sepsis
59
Q

Henoch-Schönlein Purpura

A
  • Inflammation and bleeding in the small blood vessels
  • self-limiting
  • reddish-purple spots on the lower extremities, swollen and sore joints, abdominal pain, or bloody urine
  • 90% in kids
60
Q

Hypersensitivity Vasculitis

A
  • Palpable purpura, Maculopapular rash, can be raised or flats
  • from coming in contact with an irritating substance
61
Q

Immune Thrombocytopenia Purpura

A
  • Isolated thrombocytopenia
  • Precedent viral illness
  • Development of self-reactive antibodies
  • Petechiae, purpura, and easy bruising are expected
62
Q

Atopic dermatitis (under age 2)

A
  • Eczematous eruption begins with erythema and severe pruritus
  • Lesions are red papules, patches of erythema and scaling.
  • Acute lesions may be vesicles and there can be serous exudates and crusting in severe cases
  • Often extensor surfaces, and symmetric
  • Begins early in life, characterized by remission and exacerbation
63
Q

Atopic dermatitis (ages 2-12)

A
  • Less exudation than infantile
  • Usually lichenified plaques
  • Flexural distribution, especially antecubital and popliteal fossae, volar aspect of the wrist, ankles and neck
64
Q

Atopic dermatitis (adult)

A
  • Adult presentation, more localized and lichenified
  • similar distribution as childhood, or primarily on the hands and feet
  • Thickened skin, increased skin markings, hyperpigmentation
65
Q

Nummular dermatitis

A
  • Pruritic patches of eczematous dermatitis
  • Evidence of papules, scaling and slight crusting
  • 1-50 lesions
  • Etiology unkown
  • “coin shaped” measuring 2-10cm
  • Usually trunk and lower extremities and head is spared
66
Q

Seborrheic Dermatitis

A
  • Erythematous, scaly plaques with some pruritus
  • Margins not as sharply demarcated as seen in psoriasis
  • Dandruff of scalp, mild form of seborrheic dermatitis
67
Q

Cradle Cap

A
  • Infantile seborrheic dermatitis
  • 3 weeks to 12 mths of age
  • Self-limiting
  • Unknown etiology
68
Q

Contact Dermatitis

A
  • Delayed –type 4 hypersensitivity reaction caused by skin contact with allergen
  • Characterized by vesicles, edema, redness and often pruritus
  • Usually in a linear presentation
69
Q

Stasis Dermatitis

A
  • Eczematous dermatitis of the legs
  • Associated with edema, varicosed/ dilated veins and hyper pigmentation
  • Dry, fissured, erythematous skin
  • Edema, brown discoloration, erosion or ulceration common.
70
Q

Rosacea

A
  • Chronic and relapsing inflammatory skin disorder
  • Involves the central face
  • Occurs in adults 30-60 yrs of age
  • Facial erythema, telangiectasia, and inflammatory skin lesions
  • No cure, treatment focused on symptom suppression
71
Q

Impetigo

A
  • Staph Aureus and Streptococcus are usual culprits
  • Causes superficial vesicles or pustules which cause erosions resulting in golden-yellow crusts
  • Highly contagious
72
Q

Cellulitis

A
  • Acute diffuse spreading edematous, suppurative inflammation of the dermis and subcutaneous tissue
  • Usual gram + organism such as Staph or Strep
  • Mode of infection maybe pre-existing lesion, bug bite, shot
  • Warm, hard, tender to palpation
73
Q

Folliculitis

A
  • Upper portion of hair follicle,
  • Follicular papule, pustule, erosion or crusting
  • Usually gram + organism
  • Predisposing factor: shaving hairy regions
74
Q

Folliculitis v. Furuncle v. Carbuncle

A
  • Folliculitis- 1mm red papule or pustule
  • Furuncle- 1cm red papule or nodule
  • Carbuncle- several cm in diameter, red plaque
75
Q

Furuncles/Carbuncles

A
  • Any hair-bearing site.
  • Sites of high friction and sweating most typical.
  • Furuncle- deep dermal or subcutaneous , red swollen and painful mass that drains through multiple openings.
  • Carbuncle –deep tender, firm subcutaneous erythematous papules enlarge to deep nodules
76
Q

Syphilis

A
  • Secondary syphilis occurs 2-6 months after primary

- Presence of a papulosquamous rash usually on the trunk, palms and soles

77
Q

Tinea or Dermatophytosis

A
  • Dermatophytes are fungi capable of infecting skin, nail and hair
  • Tinea is used for dermatophytosis and is modified according to the anatomic site of infection, i.e. tines pedis
78
Q

Where is tinea pedis located?

A

feet

79
Q

Where is tinea crurus located?

A

groin

80
Q

Where is tinea manuum located?

A

palms

81
Q

Where is tinea corporis located?

A

ringworm

82
Q

Where is tinea facials located?

A

face

83
Q

Where is tinea capitis located?

A

hair

84
Q

Ringworm/ Tinea Corporis

A
  • Pruritic circular or oval erythematous scaling patch or plaque
  • Spread centrifugally
  • Central clearing follow
  • Borders well delineated and red
  • Multiple lesions may run
    together
  • Differential dx nummular eczema
85
Q

Tinea Versicolor/ Pityriasis Versicolor

A
  • Dermatophyte caused by yeast called Malassezia
  • Numerous small, circular, white, scaling papules on the upper trunk
  • May involve the upper arms, neck and abdomen.
  • Lesions are hypopigmented in tanned skin and pink or salmon colored in untanned skin
86
Q

Pityriasis Rosea

A
  • Usually occurs b/w the ages of 10-30
  • Self-limited rash that is preceded by a ‘herald patch’
  • Differential dx: secondary syphilis due to similar truncal presentation, age, papulospquamous lesions
  • Christmas tree distribution rash
  • Hyperpigmentated rash in dark skin individuals
  • Differential dx: syphilis
87
Q

Molluscum Contagiosum

A
  • Self limiting (usually 1 yr), viral infection, poxvirus
  • Skin colored umbilicated papules
  • Occurring in children and sexually active adults
  • It is transmitted skin to skin contact
88
Q

Varicella/ Chicken Pox

A
  • Incubation 15 days after exposure
  • Prodromal fever, malaise, pharyngitis loss of appetite
  • 24 hours later, vesicular rash
  • Rash pruritic, successive crops over several days
  • Usually starts on the trunk
  • New vesicle formation usually stops after 4 days
  • Fully crusted by day 6, contagious until fully crusted
  • lesions in different stages of development
89
Q

Varicella/Shingles/Herpes Zoster

A
  • Erythematous papules that quickly develop into grouped vesicles or bullae
  • 3-4 days become pustule or hemorrhagic
  • Crusting 7-10 days
  • Follows usually one dermatome and does not cross the midline
  • Acute pain can lead to chronic pain at affected nerve
90
Q

Acanthosis Nigricans

A
  • Hyperpigmented velvety plaque on the skin
  • Intertiginous sites such as neck, axilla are common
  • Can be acquired due to insulin resistance or inherited with familiar acanthosis nigricans
91
Q

Erythema Multiforme

A
  • Acute immune-mediated condition
  • Distinctive target-like lesions
  • dusky central area or blister, dark red inflammatory zone, surrounded by a pale ring of edema and an erythematous halo
  • Multiforme, describes the myriad clinical manifestation that may be observed
92
Q

Lichen Planus

A
  • a chronic inflammatory disorder that affects the skin, oral cavity and genitalia
  • Skin: Flat topped polygonal papules
  • Occasionally pruritic
  • Etiology unknown; felt to be immunological response
  • Self limiting
  • May persist for months or years
93
Q

Acrochordon/Skin Tags

A
  • Soft, skin colored or tan or brown, round, oval or pedunculated, usually in intertriginous areas and neck and eyelids
94
Q

Seborrheic Keratosis

A
  • Hereditary lesions, do not appear until age 30
  • Surface may be smooth, velvety or verrucous
  • Lesions are usually papules or plaque
95
Q

Nevi

A
  • Moles
  • Common acquired nevi occur after 6 mths of age
  • Increase in number in children and adolescent peak at 30 and then regress
  • If over 6 mm- referral
96
Q

Actinic Keratosis Scalp

A
  • Premalignant Skin Lesion
  • Single or multiple discrete dry rough adherent scaly lesions occur on habitually exposed skin
  • May develop into squamous cell carcinoma
97
Q

Squamous Cell Carcinoma

A

Variety of clinical presentations
Fair skinned adults >60
Can metastasize

98
Q

Basal Cell Carcinoma

A
  • Most common type of skin cancer
  • Locally invasive aggressive destructive lesion
  • Rises from the basal layer of the epidermis,
  • Limited capacity to metastasize
  • Often with telengiectasia
99
Q

What are the signs of a malignant melanoma?

A 
Asymmetry
Border, irregular
Color, mottled
Diameter, larger than 6mm
Evolving, changing mole
100
Q

Alopecia Areata

A
  • Chronic inflammatory disorder that causes non-scarring hair loss
  • Rapid onset in a sharply defined, usually round or oval area
  • May be diffuse or patchy or band-like at the margins of the scalp
  • Autoimmune and can be associated with thyroiditis and vitiligo
101
Q

Tinea Capitis

A
  • Round scaling patches of alopecia
  • Hairs are broken off
  • Usually fungal infection
  • Differs from alopecia areata, in that the hair follicle is still present
  • Mimics seborrheic dermatitis
102
Q

Beau’s Line

A

horizontal line

- break in the nail bed

103
Q

Melanonychia

A

vertical line

- darker in color

104
Q

Terry Nails

A

no lenula

related to liver disease

105
Q

Paronychia

A
  • Acute- bacterial infection of the proximal and lateral nail fold
  • Rapid onset of pain and swelling
  • Pus accumulates behind cuticle
  • Chronic- irritant exposure
106
Q

Pitting

A

Incidence of nail involvement in psoriasis

107
Q

Oncychomycosis

A
  • fungal infection from a dermatophyte,
  • Skin under nail will flake, nail bed is raised
  • Nail surface is soft, dry and powdery and can easily be scraped away
108
Q

Common skin of older adults

A
  • wrinking
  • senile purpua (bruises)
  • dry skin (xerosis)
  • Senile letingines (liver spots)

Advanced Clinical Assessment Across Lifespan (12 decks)

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