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Physical Diagnosis > Skin > Flashcards

Skin Flashcards

1
Q

Skin Function

A
  • Keep body in homeostasis from environment.
  • Boundary for body fluids.
  • Maintain body temperature, make vitamin D.
  • Protect underlying tissues from microorganisms, harmful substances, and radiation.
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2
Q

Epidermis

A

Most superficial, thin, devoid of blood vessels
2 layers
- outer horny layer of dead keratinized cells
- inner cellular layer where both melanin and keratin are formed
Depends on dermis for nutrition

Serves as barrier to prevent fluid loss and infection. Contains specialized organ cells. Keratinocytes, melanocytes, Langerhans cells

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3
Q

Dermis

A

Two layers of varying thickness. Provide circulation, nutrition, and support. Contains sebaceous and sweat glands, hair follicles. It merges with subq layer.
Contains specialized organs - vascular structures, nerves, mast cells, fibroblasts, macrophages, dendritic cells

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4
Q

Subcutaneous tissue

A

Layer of loose CT beneath dermis.

Contains adipose cells, fibroblasts, hair follicle roots, blood vessels, Lymphatic vessels, nerve free endings

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5
Q

Hair

A

Terminal, Vellus

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6
Q

Nails

A

Plate, Bed, Lunule, eponychium, hyponchium, proximal, and lateral nail folds

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7
Q

Primary lesions

A

Macula, patch, papule, plaque, nodule, vesicle, bulla, pustule, tumor, wheal

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8
Q

Secondary lesions

A

May have evolved from primary lesions. Or caused by external forces or over treatment

Scale, excoriation, fissure, crust, erosion, ulcer, cicatrix, atrophy

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9
Q

Special skin lesion

A

Comedone, milia, cyst, burrow, lichenification, telangiectasia, petechiae, purpura

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10
Q

Primary

A

Physical changes caused by disease process. Initial presentation. Not specific to a single disease

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11
Q

Macule ** TQ

A

Small, flat, non-palpable lesion. Less than 1 cm diameter

Ex. Junctional nevus (birthmark), ephelides (freckles), solar lentigo (sunspots)

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12
Q

Patch

A

Flat, non-palpable lesion

1 cm or larger in diameter (huge macula)

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13
Q

Papule

A

Raised, solid lesion, small superficial, elevated above skin surface. Less than 1 cm ex pimple

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14
Q

Plaque

A

Palpable lesion elevated above skin surface. 1 cm or larger in diameter ex. Psoriasis

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15
Q

Nodule

A

Firm lesion thicker and deeper than plaque. Huge plaque greater 0.5 cm elevation.
Ex. Huge boil

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16
Q

Vesicle

A

Elevated lesion with clear fluid. Less than 1 cm in diameter ex. Blister

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17
Q

Bulla

A

Elevated lesion with clear fluid. Greater than 1 cm diameter (huge vesicle)

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18
Q

Pustule

A

Elevated lesion with pus within or beneath epidermis. Pimple with pus

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19
Q

Wheal/Hives

A

Slightly reddened, changing in size/shape

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20
Q

Excoriation **TQ

A

Linear breaks in skin surface. Covered with blood/crusts ex. Scratch mark

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21
Q

Cicatrix (scar) ***TQ

A

Hypertrophic keloid

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22
Q

Ulcer

A

Lesion on surface/mucosal surface. Caused by loss of tissue with inflammation

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23
Q

Erosion

A

Wearing away or state worn away. Shallow ulcer

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24
Q

Crust

A

Hard outer layer or covering. Dried serum or pus on surface

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25
Q

Atrophy

A

Wasting of tissue from death/reabsorption of cells, ischemia, malnutrition, etc

26
Q

Sclerose

A

To harden, undergo sclerosis (hardening)

27
Q

Necrosis

A

Pathologic death from irreversible damage

28
Q

Lichenification ** TQ!

A

Leathery induration and thickening of the skin

29
Q

ABCDE’s of Melanoma ***** TQ!!

A 
A - asymmetry 
B- border irregularity 
C- color
D- diameter more than 6 mm
E- evolution/elevation 
F- funny looking
30
Q

Melanoma risk factors

A 
HARMM
History of previous melanoma
Age over 50
Regular dermatology absent
Mole changing 
Male Gender
Others- freckles, light eye or skin color, red or light hair, UV radiation from heavy skin exposure sunlamps or tanning booths, 50+ common moles, family history of melanoma, and Nevis that are changing or atypical, especially if > 50 y/o
31
Q

Skin color depends on

A

4 pigments

Melanin: brownish pigment, increased with exposure to sunlight, genetically predetermined
Carotene: golden yellow in subcutaneous fat and heavily keratinized areas (palms & soles)
Oxyhemoglobin: bright red, predominates in arteries and capillaries
Deoxyhemoglobin: darker bluer, predominates in capillaries and veins

32
Q

Appendages of skin

A

Hair: vellus (short, fine, nonpigmented) or terminal (courser, thicker, conspicuous, usually pigmented)

Nails: lanula (white free edge of nail plate), cuticle (seal between proximal nail fold and nail plate)

Sweat glands: eccrine= everywhere (reg body temperature); apocrine = axillary and genitals (stress, stench comes from bacterial decomposition)

Sebaceous glands: fatty substance produced through hair follicle = everywhere but palms and soles

33
Q

changes in skin which represent disease - color, moisture, temperature, texture, mobility, turgor, lesions

A

Color: increased pigment, pigment loss, redness, pallor, cyanosis, yellowing (carotenoma), cafe-au-lait spot (macule or patch of pigmentation), tinea versicolor (infection, hypopigmented, slightly scaly macule), vitiligo (loss of pigment completely), erythema (red hue), heliotrope (purple eyelids)

Moisture: dry, sweating, oiliness

Temperature: general or localized warm or cool

Mobility and turgor: decreased mobility, decreased turgor

Lesions: acne (face, upper chest, back), psoriasis (knees, elbows), Candida Infections (genitals), vesicles in unilateral dermatomal pattern (herpes zoster), local redness (impending necrosis )

34
Q

Changes in hair which represent symptoms of disease

A

Alopecia (hair loss), sparse hair, fine and silky hair

35
Q

Changes in nails which may represent symptoms of disease

A

Paronchia (red, swollen, and tender nail folds), clubbing, oncholysis (enlarged nail free edge), Terry’s nails (ground glass appearance, distal band of reddish brown, obliteration of lunula), white spots (leukoychia), traverse white bands (Mees’ lines), transverse linear depressions (Beau’s lines), pitting (punctuate nail plate depressions)

36
Q

Nail clubbing

A

A bulbous swelling of the soft tissue at the nail base with loss of the normal angle between the nail and the proximal nail fold (increased to 180 degrees or more), nail bed feels spongy or floating

The mechanism is unknown but involves vasodilation with increased blood flow to the distal portion of the fingers and changes in CT (possibly from hypoxia). It also involves changes in innervation, genetics, or a platelet derived GF from fragments of platelet clumps

Seen in congenital heart disease, interstitial lung disease, lung cancer, inflammatory bowel disease and malignancies

37
Q

Urticaria

A

Aka hives, a raised, itchy wheal that is usually a sign of an allergic reaction

38
Q

Pruritus

A

Clinical term for itch

39
Q

Erythema

A

Red hue due to increased blood flow (ie slapped cheeks seen in 5th disease)

40
Q

Petechiae

A

Small (1-3 mm) red or purple spot on the body, caused by a minor hemorrhage (broken capillary blood vessels)

41
Q

Purpura

A

Red or purple discoloration on the skin that do not blanch on applying pressure. Caused by bleeding underneath the skin. Purpura measure 0.3 (3 mm) - 1 cm, whereas petechiae measure less than 3 mm

42
Q

Ecchymosis

A

Bruise greater than 3 mm, purple, blood outside cells

43
Q

Scar

A

Connective tissue that arises from injury or disease

44
Q

Alopecia

A

Round or oval patches of hair loss, usually affecting young adults and children. No visible scaling or inflammation

45
Q

Keloid

A

Hypertrophic scarring extending beyond the borders of the initial injury

46
Q

Lichenification

A

Visible and palpable leathery induration and thickening of the epidermis, often from chronic rubbing

47
Q

Blanchable

A

When pressure applied to an area causes the area to become “white” as blood is pushed out of the blood vessel. Upon release, the blood returns to the area and the skin or nail turns pink.

Blanchable lesions:

  • erythema
  • spider angioma (liver disease)
  • spider vein (varicosities)
  • cherry Angioma (benign)
48
Q

Cyst

A

Nodule filled with liquid or semisolid material

49
Q

Burrow

A

(Scabies) slightly raised tunnel in epidermis, short gray line

50
Q

Fissure

A

A linear crack in the skin (ex athletes foot)

51
Q

Scale

A

Thin flake of exfoliated epidermis

52
Q

Burrow of scabies

A

A person with scabies has intense itching. Skin lesions include small papules, pustules, lichenified areas, and excoriations

53
Q

Comedo

A

The common blackhead

54
Q

Nevus

A

The common mole

55
Q

Telangiectasias

A

Dilated small vessels (can be venues, arterioles, including spider angioma or capillaries) that look either red or bluish (ex spider angioma, spider vein)

56
Q

Spider angioma- color, size, shape pulsatility, effect of pressure, distribution, significance

A

Color: Fiery red

Size: From very small to 2 cm

Shape: Central body, sometimes raised, surrounded by erythema and radiating legs

Pulsatility: Often demonstrable in the body of the spider, when pressure with a glass slide is applied

Effect of pressure: Pressure not he body causes blanching of the spider

Distribution: Face, neck, arms, upper trunk; almost never below the waist

Significance: liver disease, pregnancy, vitamin B deficiency, also occurs normally in some people

57
Q

Spider vein- color, size, shape pulsatility, effect of pressure, distribution, significance

A

Color: bluish

Size: variable, from very small to several inches

Shape: variable. May resemble a spider or be linear, irregular, cascading

Pulsatility: absent

Effect of pressure: pressure over the center does not cause blanching, but diffuse pressure blanches the veins.

Distribution: most often on the legs, near veins; also on the anterior chest

Significance: often accompanies increased pressure in the superficial veins, as in varicose veins

58
Q

Cherry angioma- color, size, shape pulsatility, effect of pressure, distribution, significance

A

Color: bright or ruby red, brownish with age

Size: 1-3 mm

Shape: round, flat, or sometimes raised, may be surrounded by a pale halo

Pulsatility: absent

Effect of pressure: may show partial blanching, especially if pressure is applied with the edge of a pinpoint

Distribution: trunk, also extremities

Significance: none; increase in size and numbers with aging

59
Q

Petechiae/purpura- color, size, shape pulsatility, effect of pressure, distribution, significance

A

Color: deep red, reddish, purple

Size: petechia, 1-3 mm; purpura- larger

Shape: rounded, sometimes irregular; flat

Pulsatility: absent

Effect of pressure: none

Distribution: variable

Significance: blood outside the vessels; may suggest a bleeding disorder or if petechiae, emboli to skin

60
Q

Ecchymosis- color, size, shape pulsatility, effect of pressure, distribution, significance

A

Color: purple, purplish blue, fading to green, yellow, brown

Size: variable, larger than petechiae

Shape: rounded, oval, or irregular; may have a central subq flat nodule (hematoma)

Pulsatility: absent

Effect of pressure: none

Distribution: variable

Significance: blood outside the vessels; often secondary to bruising or trauma; also seen in bleeding disorders

61
Q

Squamous cell carcinoma

A

May develop in conjunction with an actinic keratosis; firm, red

62
Q

Basal cell carcinoma

A

Initially translucent nodule; spreads; leaves a depressed center with a firm elevated border

Physical Diagnosis (6 decks)

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