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Clinical Methods > Skin Exam and Diseases > Flashcards

Skin Exam and Diseases Flashcards

1
Q

Physical Attributes of Skin

A

Heaviest organ at 16% of body weight

Composed of 3 layers = epidermis, dermis, and SubQ

Functions to maintain homeostasis, provides boundaries and protection for body contents, regulates body temperature

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2
Q

Describe the Epidermis

A

Thin and devoid of blood vessels
Divided into outer horny and inner cell layers
Dependent on dermis for nutrition

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3
Q

Describe the Dermis

A

Supplied with blood

Contains: connective tissue, sebaceous glands, sweat glands, and hair follicles

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4
Q

Describe the Hypodermis/SubQ

A

A layer of fat

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5
Q

4 Pigments of skin color

A

Melanin: brownish, genetic, increased by sun

Carotene: gold/yellow, located in SubQ & heavy keratinized areas of soles and palms

Oxyhemoglobin: a bright red pigment found in arteries and capillaries

Deoxyhemoglobin: dark blue pigment, increase causes cyanosis

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6
Q

Types of Hair

A

Vellus Hair: short, fine, inconspicuous, unpigmented

Terminal Hair: coarse, thick, more conspicuous, and pigmented (scalp and eyebrows)

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7
Q

Nails

A

Protect distal end of fingers and toes

Nail plate pink from underlying vasculature

Luna, proximal nail fold, cuticle, and lateral nail fold

Fingernails grow 0.1mm/day while toenails grow slower

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8
Q

Glands

A

Sebaceous: produce fatty substance secreted on skin through hair follicles. Present on all skin surface except palms and soles of feet

Sweat:
Eccrine Glands: widely distributed and open directly to skin surface to control body temp

Apocrine Glands: found in axillary and genital regions, open to hair follicles, stimulated by stress

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9
Q

ABCs of Mole and Melanoma Screening

A

A - Asymmetry
B - Border irregularity, ragged, notched, or blurred
C - Change in color or variation, esp. blue or black
D - Diameter > or equal to 6mm, esp. if changing, itching, or bleeding
E - Elevation or enlargement

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10
Q

Skin Exam

A

Look For:
Color - increase or loss of pigment, redness & pallor
Moisture - dryness, sweating, and oiliness
Temperature - use back of fingers to check for warmth
Texture - roughness or smoothness
Mobility & Turgor - lifting (mobility), shape return (turgor)
Lesions - location, pattern, types, and color

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11
Q

Cafe-Au-Lait Spot

A

Uniformly pigmented patch with irregular border
Usually 0.5-1.5 cm in diameter
6 or more with diameters > 1.5 cm suggests neurofibromatosis

Neurofibromatosis (NF) refers to a number of inherited conditions that are clinically and genetically distinct and carry a high risk of tumor formation, particularly in the brain.

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12
Q

Vitiligo

A

Depigmented patches on hands and feet
Brown pigment is normal while pale areas are affected
May be hereditary

Michael Jackson thought to have had this

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13
Q

Raynaud Phenomenon

A

Excessively reduced blood flow in response to cold or stress with discolouration of fingers, toes, and other areas. May also cause nails to become brittle with longitudinal ridges.
Named after French physician Maurice Raynaud (1834–1881), believed to be the result of vasospasms that decrease blood supply to the respective regions.

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14
Q

Tetralogy of Fallot

A

A birth defect of the heart consisting of four abnormalities resulting in poorly oxygenated blood pumped to the body. Infants may not show the signs of the cyanosis but may develop episodes of bluish skin from crying or feeding called “Tet spells”.

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15
Q

Jaundice

A

Yellow skin seen in the sclera and mucous membranes

Caused by high blood bilirubin levels from liver disease and hemolysis of RBCs

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16
Q

Erythema

A

Red hue of skin from increased blood flow

“slapped cheeks” or “fifth disease”

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17
Q

Psoriasis

A

Happens when immune system mistakes skin as pathogen sending out faulty signals that speed up skin growth. Silvery scaly lesions on extensor surfaces. Often associated with strokes.

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18
Q

Atopic Eczema

A

Allergic disease associated with asthma

Dry recurring rashes characterized by redness, edema,

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19
Q

Lupus-Malar Rash

A

Red or purple and mildly scaly

Butterfly rash over the nose sparing the nasolabial folds of the face

Macular with sharp edges and not itchy. Present in about 46 to 65% of lupus patients

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20
Q

Plaques

A

Patches of closely grouped papules more than 2/5 inches (1cm) across

Seen in Psoriasis patient

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21
Q

Papules

A

Solid raised lesion that is less than 1 cm across

Seen in warts, syphilis, psoriasis, seborrheic and actinic keratoses, lichen planus, and skin cancer

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22
Q

Nodules

A

Solid lesions less than 0.5 cm that has distinct edges and deeply rooted

Described as palpable

Associated with keratinous cysts, lipomas, fibromas, and some types of lymphomas

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23
Q

Cyst

A

A nodule filled with expressible material like liquid or semisolid

Epidermal Inclusion Cyst or Sebaceous Cyst

24
Q

Wheal

A

AKA Hives; Urticaria

Itchy skin swelling that can disappear after erupting

Associated with allergic reactions like drugs or insect bites

25
Q

Angioedema

A

Vascular swelling of the deep dermis or subQ or submucosal layer caused by increased permeability of capillaries. Characterized by development of giant wheals. Can be hereditary but most often caused by medication.

26
Q

Vesicles

A

Raised lesions less than 5mm across and filled with clear fluid.

Seen in Herpes simplex or chicken pox or shingles

27
Q

Herpes Simplex

A

Gross nasty shit on your junk

28
Q

Bulla

A

Vesicles more than 5mm across are called bullae or blisters

May be the result of sunburns, insect bites, and chemical irritation.

29
Q

Erythema Multiforme

A

Stevens-Johnson Syndrome (SJS)
Toxic Epidermal Necrolysis (TEN)

Two forms of life threatening skin conditions in which cell death causes epidermis to separate from the dermis.

30
Q

Pustules

A

Raised lesion filled with pus

Usually the result of an infection, acne, impetigo, or boils (abscesses)

31
Q

Burrows-Scabies

A

Small, slightly raised tunnel of the epidermis commonly found on finger webs and sides of fingers.

Appears short 5-15 mm linear or curved lines ending in a tiny vesicle

32
Q

Scale

A

Dry, horny build-up of dead skin cells that often flake off the surface of skin

Diseases that promote scales include fungal infections, psoriasis, and seborrheic dermatitis

33
Q

Crust

A

Dried collection of blood, serum, or pus.

Also known as a scab

34
Q

Lichenification

A

Rough, thick epidermis with exaggerated skin lines

Often characteristic of scratch dermatitis and atopic dermatitis.

35
Q

Scars

A

Discolored fibrous tissue that permanently replaces normal skin after destruction of the dermis

36
Q

Keloid

A

Hypertrophic scarring that extends beyond the borders of the initial injury.

37
Q

Erosion

A

Nonscarring loss of superficial epidermis

Surface is moist but does not bleed

38
Q

Excoriation

A

Linear or punctate erosions caused by scratching or picking at a primary lesion (Cat Scratch)

39
Q

Fissure

A

A linear crack in the skin, often resulting from excessive dryness like athlete’s foot

40
Q

Ulcers

A

A deep loss of epidermis and dermis; may bleed and scar

Stasis ulcer = venous insufficiency
Syphilitic chancre

41
Q

Stages of pressure ulcers

A

Stage 1: Skin is not broken but is red or discolored
Stage 2: Epidermis is broken, with shallow open sore
Stage 3: Skin break extends into subQ and fat tissue
Stage 4: Breakdown extends into muscle and possibly bone. Lots of dead tissue and drainage present

42
Q

Cellulitis

A

Local or diffuse inflammation of connective tissue with severe inflammation of dermal and subq layers

Caused by normal skin flora or exogenous bacteria.
Occurs when skin has been broken
Common in diabetics and immunocompromised

43
Q

Spider Angioma

A

Fiery red, up to 2 cm
Central body surrounded by radiating legs
Found on face, neck, arms, and upper trunk
Associated w/ liver disease, pregnancy, & low vitamin B

44
Q

Spider Veins

A

Bluish, variable in size, and resembles a spider
Can be linear, irregular, or cascading
Found on legs near veins or anterior chest
Accompanies increased pressure in the superficial veins, as in varicose veins

45
Q

Cherry Angiomas

A

Bright or ruby red 1-3 mm
Round, flat, sometimes raised
Found on trunk or extremities
increase size and numbers with aging

46
Q

Petechiae/Purpura

A 
Deep red or reddish purple
Petechiae (1-3 mm) Purpura larger
Rounded, sometimes irregular; flat
Distributed variably
Suggests blood outside the vessels; may
suggest a bleeding disorder or if petechia, emboli
to skin; palpable purpura in vasculitis
47
Q

Ecchymosis

A

Purple or purplish blue, fades to green, yellow, and
brown with time.
Variable size, larger than petechia > 3mm
Rounded, oval, or irregular; may have central subcutaneous flat nodule (a hematoma)
Variable distribution
Suggests blood outside the vessels; secondary to bruising or trauma, also seen in bleeding disorders.

48
Q

Splinter Hemorrhages

A

Small linear subungual hemorrhage which is red when fresh and brown when aged, located at the distal 1/3of the nail bed, classically associated with mitral stenosis

49
Q

Clubbing

A

Build-up of tissue in the fingers, causing the end of the fingers to become enlarged and the nails to curve downward.
Results in the fingers appearing bulb-like, or like an upside down spoon.
Seen most commonly with diseases of the heart and lungs that result in less oxygen in the blood.

50
Q

Skin Tumors: Basal Cell Carcinoma

A

Grows slowly and seldom metastasizes
Most common in fair-skinned adults over age 40 and usually appears on the face.
Initial translucent nodule w/ depressed center and firm elevated border.

51
Q

Skin Tumors: Squamous Cell Carcinoma

A

Usually appears on sun exposed skin of fair-skinned adults > 60 yrs age.
Grows quicker than a BCC, is firmer, and looks redder.
Face and back of hands often affected.

52
Q

AIDS-Kaposi’s Sarcoma

A

KS lesions are nodules or blotches that may be red, purple, brown, or black, and are usually papular.

Typically found on skin, but common elsewhere, especially the mouth, GI tract and respiratory tract.

Growth can range from very slow to explosively fast, and associated with significant mortality and morbidity.

53
Q

1st Degree Burn

A

1st-degree burn: The least serious burns are those in which only the outer layer of skin is burned, but not all the way through.

54
Q

2nd Degree Burn

A

2nd-degree burn: When the first layer of skin has been burned through and the second layer of skin (dermis) also is burned

55
Q

3rd Degree Burn

A

3rd-degree burn: Burns involving all layers of skin causing permanent tissue damage. Fat, muscle and bone may be affected. Areas may be charred black or appear dry and white. Difficulty inhaling and exhaling, carbon monoxide poisoning, or other toxic effects may occur if smoke inhalation accompanies the burn.

56
Q

Necrotizing Fasciitis

A

Commonly known as flesh-eating disease or flesh-eating bacteria syndrome.
Rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue.
Quickly progressing, having greater risk of developing in the immunocompromised due to conditions like diabetes & cancer.
Treatment: IV antibiotics/Amputation

Clinical Methods (2 decks)

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