Skin, Hair, Nails

Question 1

How can you identify bruising associated with physical abuse?

Answer 1

Bruising associated with physical abuse occurs over soft tissue whereas children who accidentally bruise themselves do so over bony prominences.

Question 2

What is impetigo and how is it characterized?

Answer 2

A contagious superficial skin infection that is characterized by honey color lesion crusts as the vesicles rupture.

Question 3

What is Lyme Disease and how is it characterized?

Answer 3

A tick-borne disease with a single erythema skin lesion that is round in shape with ventral clearing. (bulls’ eye)

Question 4

How is herpes zoster characterized?

Answer 4

It looks like a single dermatome that consists of red, swollen vesicles that become filled with purulent fluid.

Question 5

How is psoriasis characterized?

Answer 5

Dry, silvery, scaling papules/plaque.

Question 6

What diagnoses are clubbing associated with?

Answer 6

Respiratory and cardiovascular diseases
Cirrhosis
Colitis
Thyroid disease

Question 7

What does a single black/blue nail indicate?

Answer 7

Melanoma or bruising/bleeding from trauma.

Question 8

What can green-black nail discoloration indicate?

Answer 8

Pseudomonas Infection- Painless
Subungual Hematoma- Painful. Caused by injury to the nail bed.

Question 9

How does cellulitis spread on the skin?

Answer 9

It advances and expands at the margins.

Question 10

What skin diseases have a linear shape to them?

Answer 10

Poison ivy and herpes zoster (shingles)

Question 11

What skin disease has an annular shape to them?

Answer 11

Tinea corpus (Ringworm) or Lyme Disease

Annular meaning it has a circle structure with a hollow center (central clearing)

Question 12

What are the different primary lesions that are important to identify?

Answer 12

Macule: flat and <1 cm
Papule: elevated and <1 cm
Patch: Flat, > 1cm (Ex: Vitiligo, port-wine stains, cafe au lait patch)
Plaque: Elevated and > 1 cm (Ex: Psoriasis)
Vesicle: Elevated, filled with fluid, and <1cm (Ex: Shingles).

Question 13

What do cafe au lait spots look like and what does a certain number of these spots indicate?

Answer 13

They look like coffee beans spilled onto the skin that are flat, evenly pigmented brown spots. More than 6 spots that are >5mm indicate a neurologic condition known as neurofibromatosis–> MRI.

Question 14

What is a Wood’s lamp and how is it used in assessment?

Answer 14

A lamp that uses UV rays to enhance depigmented lesions such as vitiligo, hyperpigmentation of cafe au lait spots, and yellow-green fluorescence indicates fungal infections.

Question 15

How do you assess the temperature of the skin?

Answer 15

Use the dorsal surface of the hands because this area is more sensitive to temperature perception.

Question 16

How can you differentiate between atypical nevi and melanoma?

Answer 16

Atypical nevi: occur mainly in the trunk, large (> 5mm) with an ill-defined border.

Melanoma: Irregular border and lesions tend to be larger (> 6mm)

Question 17

What are commonly occurring nevi (moles)?

Answer 17

Junction Nevus: Uniform color and shape, flat or slightly elevated.

Compound Nevus: Center is elevated, and surrounding area is flat with an indistinct border.

Dermal Nevus: Raised with a domelike shape and a soft, wrinkled surface.

Question 18

What family history do you check when assessing the skin, hair, and nails?

Answer 18

1. Allergic diseases associated with eczema
2. Psoriasis
3. Skin cancers
4. Bacterial, fungal, viral infection
5. Familial hair loss

Question 19

What are normal findings of the skin, hair, and nails in the older adult?

Answer 19

1. graying hair from decrease in the number of melanocytes
2. axillary and public hair decline due to reduction of hormone production.
3. terminal scalp becomes vellus hair (hair baldness), and the opposite occurs in the ears and nares where vellus hair becomes terminal.
4. peripheral extremity hair loss occur when PVD or diabetes is present
5. nails become brittle and slow down because of decreased peripheral circulation.

Question 20

What is it called when pregnant patients have increased pigmentation?

Answer 20

Melasma. This can be seen on the face, nipples, areola, axillae, umbilicus, and vulva.