Skin, hair nails

Question 1

Why should you inspect the nails?

Answer 1

Systemic illnesses can manifest in skin/nail sx, especially in the elderly

Question 2

What diseases should you think about which could involve/present in the nails?

Answer 2

• psoriasis
• eczema
• fungal infections
• acute/chronic disease

Question 3

What disease should you consider if the pt’s skin is rough?

Answer 3

Hypothyroidism

Question 4

What should you consider if there is a decrease mobility on skin exam?

Answer 4

edema or scleroderma

Question 5

What should you consider if there is a decrease in turgor?

Answer 5

dehydration

Question 6

What should you consider if a pt has pitting edema?

Answer 6

• CHF
• Use of calcium channel blocker
• liver disease

Question 7

What should you consider if a pt has non-pitting edema?

Answer 7

lymphedema, myxedema in hpothyroidism

Question 8

What is the hair pull test?

Answer 8

grab 50-60 hairs at root w/ thumb and pull away gently and firmly

Question 9

What is the hair tug test?

Answer 9

grab a section of hair, hold with two hands one near root, other near tip (if the hair breaks, it is abnormal)

Question 10

What should you be concerned about w/ diffuse non-scarring shedding?

Answer 10

iron deficiency anemia, hypo/hyperthyroidism

Question 11

What is the trendenlenburg test used to asses?

Answer 11

retrograde filling to asses valve competency

Question 12

What should you consider if pt has enlarged lymph nodes?

Answer 12

infection, malignancy or other systemic inflammatory illness (especially concerned about malignancy in firmness of node)

Question 13

Translucent nodule that spreads, depressed center and firm elevated border, often w/ telangiectasias?

Answer 13

BCC

Question 14

Firm, ulcerated, non-healing lesion often found on lower lip, ear, perauricular, forehead, scalp and back of the hand (sun exposed areas)

Answer 14

SCC

Question 15

which skin lesion should you evaluate with the ABCDE rule?

Answer 15

malignant melanoma

Question 16

Small, circumscribed, pigmented macule surrounded by normal skin

Answer 16

lentigo

Question 17

Rough, scaly pupules/plaques, can transform to invasive SCC

Answer 17

AK

Question 18

Circumscribed, waxy, stuck on appearance

Answer 18

SK

Question 19

Blanching, fiery red, central body which radiating telangeictasias?

Answer 19

spider angioma

Question 20

round, uniform red papule, increase in size and number with age

Answer 20

Cherry angioma

Question 21

Deep red, purplish patches (blood outside vessels, bleeding disorder, old age)

Answer 21

purpura

Question 22

Petechiae

Answer 22

deep red, purplish macules, non-blanching

Question 23

purple/bluish fading to green, yellow brown, may have a subcutaneous flat nodule (usually secondary to bruising/trauma/bleeding disorder)

Answer 23

ecchymosis

Question 24

Terry’s nails

Answer 24

nail plate turns white, distal band of reddish brown.

seen in liver disease, heart failure, aging

Question 25

Lindsay’s nails

Answer 25

“half and half” nails. seem w/ chronic renal failure

Question 26

Mee’s lines

Answer 26

curving transverse lines that cross nail parallel to lanula.

- arsenic poisoning, heart failure, hodgkins disease, chemotherapy, carbon monoxide poisoning and leprosy

Question 27

Beau’s lines

Answer 27

transverse depressions of the nail plate

- severe illness, trauma and exposure to cold in Raynaud’s disease

Question 28

What should you make sure to do when inspecting the skin?

Answer 28

Inspect the whole organ, including hidden areas

Question 29

What does alopecia areata look like?

Answer 29

Clearly demarcated round or oval patches of hair loss, usually affecting young adults and children. There is no visible scaling or inflammation

Question 30

What does trichotillomania look like?

Answer 30

will have hair shafts that are broken and of varying lengths. Is more common in children

Question 31

What does tinea capitis look like?

Answer 31

Round scaling patches of alopecia, hairs are broken off to the surface of the scalp. Usually caused by fungal infections, can mimic seborrhea dermatitis