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H&P Exam 1 > Skin Abnormalities > Flashcards

Skin Abnormalities Flashcards

1
Q

What are the 3 layers of skin?

A
  • Epidermis
  • Dermis: blood vessels, hair follicles, sebaceous glands, sweat glands
  • Subcutaneous
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2
Q

What are the appendages of the skin?

A
  • Hair
  • Nails
  • Sebaceous glands
  • Sweat glands
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3
Q

What do sebaceous glands do and where are they located?

A
  • Produce fatty substance onto skin surface through hair follicles
  • Present on all skin surfaces except palms and soles
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4
Q

What are the different types of sweat glands and what do they do?

A
  • Eccrine: Widely distributed, open directly onto skin surface, help control body temp (via sweat production)
  • Apocrine: Found chiefly in axillary and genital regions, usually open into hair follicles. Can be stimulated by emotional stress. Bacterial decomposition of apocrine sweat causes body odor
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5
Q

What are the key history questions for skin (HPI/ROS)

A
  • Color changes?
  • Rashes?
  • Lumps?
  • Itching?
  • Dryness?
  • Hair and nail changes?
  • Weight changes, fever, chills or difficulty sleeping?
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6
Q

Describe the differences between Central and Peripheral cyanosis

A
  • Central cyanosis: consistent with cardiac or pulmonary disease
  • Peripheral cyanosis: may be seen with cold temperature or anxiety
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7
Q

What can be associated with jaundice?

A

Icterus-conjunctivae

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8
Q

What are the Skin- Color of lesions?

A
  • Flesh-colored: same color as surrounding skin
  • Erythematous: variable shades of red (pink, bright red, dull red)
  • Violaceous: light violet
  • Tan-brown
  • Black or blue-black
  • White
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9
Q

Describe the Morphology of Primary and Secondary Lesions

A
  • Primary skin lesions: initial presentation, arise from previously normal skin –> Key to diagnosis
  • Secondary skin lesions: results from changes to primary lesions –> Usually due to overtreatment, scratching or infection of the primary lesion
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10
Q

What are the Primary skin lesions?

A
  • Flat: Macule or patch
  • Palpable: Papule, plaque, nodule, tumor or wheal
  • Palpable with contents: Vesicle, bulla, pustule or cyst
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11
Q

Describe a Macule

A
  • <1 cm diameter
  • Flat, non-palpable
  • Variable color
  • Examples: freckles, petechiae
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12
Q

Describe a Patch

A
  • ≥1 cm diameter
  • Flat, non-palpable
  • Irregular shape
  • Examples- Café au lait spots, vitiligo
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13
Q

Describe a Papule

A
  • <1 cm diameter
  • Palpable, firm
  • Circumscribes
  • Flesh-colored, red, brown
  • May be confluent and form plaques
  • Examples- Molluscum contagiosum, warts, nevi (moles)
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14
Q

Describe Plaque

A
  • ≥ 1 cm diameter
  • Elevated, firm, rough
  • Circumscribed
  • Example- psoriasis
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15
Q

Describe a Nodule

A
  • ≥ 1 cm but <2 cm diameter
  • Deeper and firmer than a papule (must palpate to determine)
  • Usually round
  • Examples- lipoma, some skin cancers
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16
Q

Describe a Tumor

A
  • ≥ 2 cm
  • A larger nodule
  • Examples- hemangioma, tumors, lipoma
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17
Q

Describe a Wheal

A
  • Irregular, transient, superficial edema

- Examples- mosquito bites, urticaria (hives)/allergic reaction

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18
Q

Describe a Vesicle

A
  • <1 cm diameter
  • Well-circumscribed
  • Filled with serous fluid
  • Examples- Herpes simplex “Dew drops on a rose petal”
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19
Q

Describe a Bulla (plural = bullae)

A
  • ≥ 1 cm diameter
  • Well-circumscribed
  • Filled with serous fluid
  • Examples- blisters, 2nd degree burns
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20
Q

Describe a pustule

A
  • Well-circumscribed
  • Elevated, superficial, epidermal
  • Filled with pus
  • Example- acne
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21
Q

Describe a cyst

A

-Nodule filled with liquid or semisolid material

22
Q

What are the Secondary skin lesions?

A
  • Loss of skin surface- erosion, ulcer or fissure
  • Material on skin surface- scale or crust
  • Other- Excoriation, lichenification or atrophy
23
Q

Describe Erosion

A
  • Loss of superficial epidermis
  • Surfaces is moist but doesn’t bleed
  • Heals without scarring
  • Examples- ruptured vesicle, atopic dermatitis
24
Q

Describe an ulcer

A
  • Deeper loss of epidermis and dermis
  • Heals with scarring
  • Examples- stasis ulcer
25
Q

Describe a fissure

A
  • Linear crack or break from the epidermis to the dermis

- Examples- atopic dermatitis, tinea pedis, angular cheilitis

26
Q

Describe a scale

A
  • A thick flake of exfoliated epidermis

- Examples- seborrhea, psoriasis

27
Q

Describe crust

A
  • Dried residue of serum, pus or blood

- Example- impetigo

28
Q

Describe excoriation

A
  • Abrasion or scratch mark
  • May be linear or rounded
  • Usually due to scratching
  • Examples- scabies, atopic dermatitis, dry skin
29
Q

Describe Lichenification

A
  • Thickening and roughening of the skin
  • Increased visibility of skin markings
  • Examples- atopic dermatitis, chronic dermatitis
30
Q

Describe atrophy

A
  • Thinning of the skin with loss of normal markings
  • Skin looks shinier and more translucent
  • Example- striae (stretch marks)
31
Q

Describe a keloid

A
  • Hypertrophic scarring

- Extends beyond the borders of initial injury

32
Q

What are the Skin Lesions? Describe if they blanch or not.

A

Do NOT blanch

  • Petechiae
  • Purpura
  • Ecchymosis
  • Cherry angioma

Blanch

  • Spider angioma
  • Spider veins
  • Telangiectasia
  • Hemangioma
33
Q

Describe Petechia (pleural = petechiae)

A
  • 0.1-0.3 cm (1-3 mm) diameter
  • Represent blood outside of a vessel
  • Round or irregular
  • Deep red or purple-red
  • Seen with infections and bleeding disorders
  • Do NOT blanch
34
Q

Describe Purpura

A
  1. 3-1 cm
    - Same as petechiae but larger
    - Do NOT blanch
35
Q

Describe Ecchymosis

A
  • Generally >1 cm diameter
  • “Bruise”
  • Represent blood outside of vessels due to trauma, bleeding disorders
  • Round, oval or irregular borders
  • Purple lesions of variable size. Fade to green, yellow, brown
  • Does NOT blanch
36
Q

Describe Cherry angioma

A

1-3 mm diameter

  • Flat or raised
  • Red
  • Non-pulsatile
  • Seen on trunk
  • Associated with aging
  • Do NOT blanch
37
Q

Describe Spider angioma

A
  • Very small up to 2 cm diameter
  • Central body with surrounding erythema, and radiating legs (spider)
  • Seen on face, neck, arm and upper trunk
  • Associated with- liver disease, pregnancy
  • Do blanch
  • A type of telangiectasia
38
Q

Describe Spider veins

A
  • Very small to several inches
  • Variable shape, may resemble spider, be linear or irregular
  • Most often seen on legs (varicose veins)
  • Blanch with diffuse pressure only
39
Q

Describe Telangiectasia

A
  • Irregular lines secondary to dilations of capillaries
  • Red
  • Seen with basal cell skin cancers, sun-damage, rosacea
  • Do blanch
40
Q

Describe Hemangioma

A
  • Irregular lesion secondary to dilation of dermal capillaries
  • Red
  • Starts as a macule, can progress to plaque or nodule
  • Example- “strawberry hemangioma”
41
Q

Describe Maculopapular lesions

A

-Macules with papules
-Examples:
♣ Viral exanthems: generalized, erythematous, maculopapular rash
♣ Drug eruptions

42
Q

Describe Papulosquamous lesions

A

-Papules with plaques and scales
-Examples
♣ Lichen planus
♣ Pityriasis rosea

43
Q

Describe Vesiculobullous lesions

A
  • Vesicles and bullae
  • Examples: Herpes simplex, Herpes zoster, Pemphigus vulgaris, Serious autoimmune disease affecting skin and mucous membranes

-Associated with a positive Nikolsky’s sign- slight rubbing of the skin results in exfoliation of the outermost layer

44
Q

Describe Skin lesions- distribution

A
  • Localized: lesions or abnormality appears in one small area
  • Regional: lesions appear in a specific region of the body
  • Examples- flexor surfaces, extensor surfaces

-Generalized/disseminated- Lesions or abnormality appears widely distributed or in multiple areas simultaneously

45
Q

Describe the different characteristic distribution of skin lesions

A

Acne vulgaris: Face, chest, upper back
Atopic Dermatitis: Flexor surface (behind the knees/elbow crease)
Photosensitive eruptions: places exposed to the sun
Pitybiasis rosea: Tank top region and butt
Psoriasis: Knees and elbows
Seborrehic dermatitis: head

46
Q

Describe Round/discoid lesions

A
  • Coin shaped with no central clearing
  • Example- nummular eczema (a form of atopic dermatitis)
  • Umbilicated lesions
  • Example- seen with molluscum contagiosum
47
Q

Describe Oval/Ovoid lesions

A

-Example- Pityriasis rosea

48
Q

Describe Annular lesions

A
  • Round; active margins with central clearing

- Seen with tinea (fungal) infections

49
Q

Describe shape/arrangement of lesions

A
  • Dermatomal: Following a nerve segment (Herpes Zoster)
  • Linear
  • Serpiginous: Cutaneous larva migrans from hookworm larvae)
  • Morbilliform: Measles-like (Erythematous maculopapular lesions that become confluent on the face and body)
  • Target/targetoid: Pink macules with purple central papules (Erythema multiforme)
50
Q

Describe Skin borders/margins

A
  • Distinct: Well-demarcated or defined; able to draw a line around the area with confidence
  • Indistinct: Poorly defined; borders merge with normal skin
  • Active: Margin of lesion shows greater activity than center (Tinea infections)
  • Irregular: Margins are notched, not smooth (malignant melanoma)
  • Raised borders: Center of lesion is depressed compared to edge (Basal cell carcinoma)
51
Q

What are the ABCDEs of Melanoma?

A 
A- Asymmetrical shape
B- Borders (irregular)
C- Color (variation)
D- Diameter (> 6mm, pencil eraser)
E- Evolving

H&P Exam 1 (4 decks)

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