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Clinical Assessment > Skin, Hair, Nails > Flashcards

Skin, Hair, Nails Flashcards

1
Q

Two open ended questions about skin

A

“Have you noticed any changes in your skin? hair? nails?”

“Have you noticed any new sores, lumps, bumps or changes in your skin color?”

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2
Q

Parts to ROS

A

Skin, hair & nail changes, itching, rashes, sores, lumps, new moles or change in existing moles

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3
Q

Questions Regarding Lesion Timing

A
  • When did it start or 1st noticed?
  • Sudden or gradual onset?
  • Specify change: size, shape or color
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4
Q

Technique for PE of Skin

A
  • Inspection & palpation
  • Good lighting and magnifying lens
  • Disrobe pt relative to CC
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5
Q

Part of Physical Evaluation of Skin

A
  • Color (overall): erythema, pallor, yellow, cyanosis
  • Moisture: dryness, sweating, oiliness
  • Temperature
  • Texture
  • Mobility & Turgor (rapid or less than 2-3 sec)
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6
Q

Aggravating/Alleviating Factors for Skin Conditions

A 
What did skin come into contact with?
Chemical irritants?
-Changes in topical exposures 
(skin lotions, fabric softeners, soaps, wool, lanolin, make-up)
-New medications: topical or systemic
-Switch brand name to generic
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7
Q

Severity/Character of Skin Conditions

A
  • what did it look like when it first started compared to now? Has it spread, if so pattern? Does it hurt or itch?
  • Additional descriptors: scaling, crust, weeping, bleeding, delayed healing, odor
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8
Q

Environmental Triggers of Skin Conditions

A

when/where does the lesion appear

-sun, home, work, outside, near pets

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9
Q

Erythema

A

bright red all over

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10
Q

Pallor

A

Paleness caused by loss of hemoglobin, vasovagle reaction

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11
Q

Central Cyanosis

A
  • lips, tongue, mucous membranes; usually related to COPD, heart problems
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12
Q

Peripheral Cyanosis Causes

A
  • poor perfusion
  • blood not returning to heart quickly due to viscosity
  • connective tissue disorders
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13
Q

Terminology to Describe Texture of Skin

A

rough, smooth, dry, scaly

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14
Q

Location of Psoriasis

A
  • extensor surfaces

- elbows, knees, across chest, vulva

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15
Q

Location of Tinea versicolor

A

fungus with general distribution all over body

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16
Q

Location of Eczema

A
  • flexor surfaces
    children: cheeks, around mouth
    adults: hairline
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17
Q

Components Physical Evaluation of Lesions

A 
Size (bi-dimensional)
Location and Distribution
Color
Patterns and Shapes
Types (Primary and Secondary)
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18
Q

café-au-lait

A
  • uniform tan patch
  • one spot not a big concern
  • associated with neurofibromatosis
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19
Q

T. versicolor

A

Pigmented macules on body

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20
Q

heliotrope

A

purple, violet, lilac

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21
Q

Examples of patterns & shapes of lesions

A 
Linear or dermatomal
geographic
clustered
serpiginous
annular
arciform
targetoid
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22
Q

Linear

A

straight line

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23
Q

Dermatomal

A
  • straight line following specific nerve pattern

- shingles is most common

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24
Q

Clustered

A

lesions separate but grouped together

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25
Q

Annular

A

ring/ round

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26
Q

Arciform

A

Arc

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27
Q

Targetoid

A

look like bullseye

28
Q

Primary Lesions

A

Flat: macule, patch,
Raised: papule, plaque, nodule/cyst, wheal, burrow
Raised & fluid filled: vesicle, bulla, pustule

29
Q

Primary Flat Lesions

A

Macule and Patch

30
Q

Primary Raised Lesions

A

Papule, plaque, nodule/cyst, wheal, burrow

31
Q

Primary Raised & fluid filled Lesions

A

vesicle, bulla, pustule

32
Q

Secondary Lesions

A

Flat: Scale, crust, lichenification, scars/keloids
Depressed: erosion, excoriation, fissure, ulcer

33
Q

Secondary Flat Lesions

A

Scale, crust, lichenification, scars/keloids

34
Q

Secondary Depressed Lesions

A

erosion, excoriation, fissure, ulcer

35
Q

Lichenification

A

skin becomes thick and rough due to chronic scratching or itching; does not happen overnight

36
Q

Scar vs. Keloid

A

Scar is superficial and filling in defect

Keloid goes beyond area of original injury and hypertrophies

37
Q

Stage 1 Pressure Ulcers

A
  • Erythema that fails to blanch

- in people who are bed ridden with limited mobility

38
Q

Stage 2 Pressure Ulcers

A

Partial thickness skin loss

39
Q

Stage 3 Pressure Ulcers

A

Full thickness skin loss & extends to underlying muscle but does not go through the muscle

40
Q

Stage 4 Pressure Ulcers

A

Full thickness skin loss w/ damage to muscle & bone

41
Q

Type of Lesions

A

Vascular and Purpuric

42
Q

Types of Vascular Lesions

A

Spider angioma, spider vein, cherry angioma

43
Q

Types of Purpuric Lesions

A

Petechia/purpura

Ecchymosis

44
Q

Spider Angioma

A
  • red
  • will not blanche
  • usually found above waist
  • commonly associated with liver disease
45
Q

Spider Veins

A
  • do not blanche with central pressure, but press on outer edges it may blanche
  • associated with lower extremities
  • typically people will also have varicose veins
46
Q

Cherry Angioma

A
  • bright fiery red, but benign

- very tiny

47
Q

Nevi (moles)

A
  • Congenital or acquired with malignant potential
  • Basal cell
  • Squamous cell
  • Melanoma
48
Q

Basal Cell CA

A

Grow slowly, seldom metastasizes
Most common: fair skin, 40+ y/o, common on face
Early: red macule or papule
Late: Depressed center, Firm elevated border, Translucent nodule w/telangiectasia

49
Q

Squamous Cell CA

A
  • Grows quicker than basal cell
  • Face, neck, back, tips of ears, hands
  • Most common: fair skinned, 60+ y/o
  • Firm, erythematous, Scale, crust
50
Q

ABCDE’s of Moles

A 
Asymmetry
Border
Color
Diameter
Evolution
51
Q

Causes of Hair Loss

A

Alopecia
Trichotillomania
Infection

52
Q

Alopecia

A
  • clearly delineated round or oval patches of hair loss

- various forms of balding

53
Q

Compulsive pulling out of hair

A

Trichotillomania

54
Q

Clubbing

A
  • change in angle of nail due to bulbous swelling of the tissue at the nail base
  • seen in long term COPD or heart failure
55
Q

Paronychia

A
  • superficial infection of cuticles

- cuticles are red, swollen, and tender

56
Q

Tinea Capitis

A
  • ringworm

- round scaling patches of alopecia

57
Q

Onycholysis

A
  • painless separation of the whitened opaque nail plate from the pinker translucent nail bed
  • from fungal infection; manicuring, trauma, dishwashing detergents, psoriasis
58
Q

Leukonychia

A

trauma to the nails causes white spots

59
Q

Mees’ Lines

A

-transverse white lines; usually due to repetitive manicuring

60
Q

Beau’s LInes

A
  • transverse linear depression

- due to systemic illness

61
Q

Pitting

A

punctate depressions of nail plate caused by defective layering of superficial nail plate

62
Q

Geriatric Changes

A

Capillary fragility (Actinic purpura)
Decreased turgor
Long term sun-exposure

63
Q

Patient Education

A
  • Skin Cancer types (ABCDE for early recognition)
  • Modifiable Risk Factors: sun exposure, blistering sunburns
  • Non-modifiable: FHx, fair skin, changing or atypical nevi, hx dysplastic nevi
  • Monthly self exam > 50 y/o; Annually/PCP
  • Shaving: prevent cross contamination
64
Q

Non-modifiable risk factors for skin cancer

A

FHx, fair skin, changing or atypical nevi, hx dysplastic nevi

65
Q

Modifiable Risk Factors for Skin Cancer

A

sun exposure, blistering sunburns

Clinical Assessment (11 decks)

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