Skin, Hair, and Nails

Question 1

Major Functions of the Skin

Answer 1

1. Provides boundaries for body fluid
2. Protects underlying tissues from microorganisms, harmful substances, and radiation
3. Modulates body temperature
4. Synthesizes vitamin D

Question 2

The skin makes up what % of body weight?

Answer 2

16%

Question 3

Hair A & P

Answer 3

1. Vellus hair – short, fine, less pigmentation

2. Terminal hair – coarser, pigmented (scalp/eyebrows)

Question 4

Sebaceous glands distribution

Answer 4

present all surfaces except palms/soles; produce a fatty substance secreted onto skin surface through hair follicles

Question 5

Sweat glands

Answer 5

1. Eccrine glands – widely distributed, open directly onto skin surface, help control body temperature
2. Apocrine glands – found in axilla and groin, stimulated by emotional stress

Question 6

Basal cell carcinoma

Answer 6

1. Comprises 80% of skin cancers

2. Shiny and translucent, they grow slowly and rarely metastasize

Question 7

Squamous cell carcinoma

Answer 7

1. Comprises 16% of skin cancers

2. Crusted, scaly, and ulcerated, they can metastasize

Question 8

Melanoma

Answer 8

1. Comprises 4% of skin cancers

2. Rapidly increasing in frequency, they spread rapidly

Question 9

Additional Risk Factors for Melanoma

Answer 9

≥50 common moles
≥1-4 atypical or unusual moles (especially if dysplastic)
Red or light hair
Actinic lentigines, macular brown or tan spots (usually on sun exposed areas)
Heavy sun exposure (especially severe childhood sunburns)
Light eye or skin color (especially freckles/burns easily)
Family history of melanoma

Question 10

ABCDE: Screening Moles for Possible Melanoma

Answer 10

A for asymmetry
B for irregular borders, especially ragged, notched, or blurred
C for variation or change in color, especially blue or black
D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding
E for elevation or enlargement

Question 11

Techniques of Examination

Answer 11

Note characteristics of:
Color
Moisture
Temperature
Texture
Mobility and turgor
Lesions

Question 12

Techniques of Examination: Color

Answer 12

1. Patients often notice change in color before physician
2. Look for increased pigmentation, loss of pigmentation
3. Look for redness, pallor, cyanosis, and yellowing
4. Red color of oxyhemoglobin best assessed at fingertips, lips, and mucous membranes
5. In dark-skinned people, palms and soles
6. For central cyanosis, look in lips, oral mucosa, and tongue
7. Jaundice - sclera

Question 13

Techniques of Examination: Moisture

Answer 13

Dryness, sweating, and oiliness

Question 14

Techniques of Examination: Temperature

Answer 14

Use back of fingertips

Identify warmth or coolness of skin

Question 15

Techniques of Examination: Texture

Answer 15

Roughness or smoothness

Question 16

Techniques of Examination: Mobility and turgor

Answer 16

Lift fold of skin

Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)

Question 17

Techniques of Examination: Lesions

Answer 17

Note characteristics
Anatomic location and distribution
Patterns and shapes
Type of lesion (macules, papules, nevi, vesicles)
Color

Question 18

Techniques of Examination: Hair

Answer 18

Inspect and palpate

Note quantity, distribution, and texture

Question 19

Techniques of Examination: Nails

Answer 19

Inspect and palpate fingernails/toenails
Note color and shape
Note lesions
Longitudinal bands of pigment may be a normal finding in people with darker skin

Question 20

Evaluating the Bedbound Patient

Answer 20

1. Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels
2. Roll patient onto one side to see sacrum and buttocks

Question 21

Pressure sore etiology

Answer 21

Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin

Question 22

Stage 1 Pressure Sores

Answer 22

Intact skin with nonblanchable redness