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physical diagnosis > Skin, hair, nails examination > Flashcards

Skin, hair, nails examination Flashcards

1
Q

What are the three layers of the skin and the appendages?

A
  • epidermis (nails)
  • dermis (hair, sebaceous/oil glands, sweat glands)
  • subcutaneous tissue
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2
Q

What does SHAPES stand for in terms of what the skin does?

A
  • Sensation
  • heat regulation
  • Absorption
  • Protection/barrier against infection
  • Excretion (removal of waste from body)
  • Secretion (movement of material within the body)
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3
Q

What are the two types of hair?

A
  • Vellus hair= short, fine, less pigmented hair (small baby hair on arms, facial)
  • Terminal hair= coarse, pigmented hair (hair on your head, eyebrows, underarms)
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4
Q

What are the 2 types of sweat glands and where are they located?

A
  • Eccrine= throughout skin surface, secret thin watery sweat directly through ducts to the surface of the skin
  • Apocrine= in groin and axilla, secret thick sweat through opening in hair follicle to reach the surface of the skin
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5
Q

What are the three types of skin cancers and what do they look like?

A
  • Basel cell carcinoma (shiny and translucent, usually around location of sun exposure, can cause tissue loss and ulcers)
  • Squamous cell carcinoma (crusty, scaly, ulcerated)
  • Melanoma (mole with color variation and irregular borders)
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6
Q

Rate the skin cancers from most to least common and most to least dangerous.

A

Basal cell carcinoma= most common (around 80% of skin cancers) least dangerous (rarely metastasizes)
Squamous cell carcinoma= second most common (around 16% of skin cancers) Second dangerous (can metastasize)
Melanoma= Least common (around 4% of skin cancers) Most dangerous (rapidly increases frequency, spreads early and metastasizes quickly due to being deeper in the skin).

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7
Q

What are the HARMM / risk factors for melanoma?

A
  • History of previous melanoma
  • Age (50 +)
  • Regular dermatology absent
  • Mole changing
  • Male gender
  • more than 50 moles
  • light skin color
  • family history of melanoma
  • more than 1-4 atypical moles
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8
Q

What is the ABCDE for screening moles for melanoma?

A
  • Asymmetry
  • Borders irregularity
  • Color change
  • Diameter more than 6 mm
  • Elevation or Enlargement
    Get biopsy done if any of the above present and family history present
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9
Q

What is the basic skin examination technique?

A
  • general appearance survey (pt looking sick or well?)
  • drape pt appropriately
  • inspect skin surface in good natural lighting
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10
Q

What are the characteristics to keep in mind when inspecting a patient’s skin?

A
  • Color (change in pigmentation? cyanosis? pallor? erythematous? jaundice? Icterus/yellowing in eyes?)
  • Temperature (warm/cold to touch using back of fingertips?)
  • Texture (smooth or rough?)
  • moisture (dry? sweaty? oily?)
  • mobility and turgor (how skin moves when you pinch)
  • Lesions (macules? nevus?)
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11
Q

What are the hair and nails examination technique?

A

Hair: inspect and palpate (texture? distribution? any thinning (sign of nutritional deficit or endocrine issues?)
Nails: inspect and palpate fingertips (capillary refill? clubbing? color?)

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12
Q

What skin issues are bed bound patients more susceptible to?

A
  • Pressure sores/injury (due to obliteration of blood flow to the skin as a result of laying in one position for too long)
  • Inspect sacrum/buttock, knees, heels
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13
Q

Write an example of skin/nail examination

A
  • color good. skin warm and moist. Nails without clubbing or cyanosis. No suspicious nevi. No rash, petechiae, or ecchymosis(bruise). Even distribution of hair, no hair thinning.
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14
Q

What are the characteristics of linear lesions?

A
  • Straight line (contact dermatitis, scabies, poison ivy)
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15
Q

What are the characteristics of annular lesions?

A
  • Rings with central clearing (ring worms)
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16
Q

What are the characteristics of nummular lesions?

A
  • circular or coin shaped (psoriasis)
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17
Q

What are the characteristics of target/bull’s eye lesions?

A
  • rings with central duskiness (erythema multiforme)
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18
Q

What are the characteristics of reticulated lesions?

A
  • lacy or networked pattern, like spider webbing
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19
Q

What are the characteristics of herpetiform

A
  • grouped papules or vesicles (herpes)
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20
Q

What are the characteristics of Zosteriform?

A
  • clustered/distributed in a dermatome line (shingles)

- more than one dermatome line = immunocompromised

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21
Q

What is verrucous lesion texture?

A
  • Finger-like, irregular, pebbly, or rough surface (wart)
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22
Q

What is lichenification lesion texture?

A
  • thickening of skin resulting from repeated scratching or rubbing
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23
Q

What is the induration texture?

A
  • deep thickening of the skin and feels hard and resistant (edema, cellulitis, when skin gets infected it gets thicker)
24
Q

What is the Xanthomas lesion texture?

A
  • yellowish, waxy, raised lesions (contain cholesterol and fat, lipid disorder, fatty liver disease)
25
Q

What is umbilicated texture in lesion?

A
  • central indentation (looks like belly button with dimple in the middle, usually viral)
26
Q

What is the nikolsky sign?

A
  • epidermal exfoliation that occurs with gentle lateral pressure (basically when you press on the skin, the skin layers separate)
27
Q

What is auspitz sign?

A
  • pinpoint bleeding when the scale is removed from plaques in psoriasis
28
Q

What is koebner phenomenon?

A
  • development of lesions within areas of trauma (ulcers within lesions)
29
Q

What are the characteristics of macule?

A
  • Flat, non-palpable, less than 1 cm (freckles, usually red/brown in color)
30
Q

What are the characteristics of patch?

A
  • Flat, more than 1 cm (large macule)
31
Q

What are the characteristics of papule?

A
  • raised, less than 1 cm (warts, insect bites)
32
Q

What are the characteristics of plaques?

A
  • raised/elevated, more than 1 cm in diameter (larger papule, psoriasis)
33
Q

What are the characteristics of nodules?

A
  • raised, firm papules, greater than 1 cm (cyst), extends into all 3 layers of the skin.
34
Q

What are the characteristics of vesicles?

A
  • raised, fluid filled papules, less than 1 cm (herpes)
35
Q

What are the characteristics of bullae?

A
  • raised, fluid filled vesicles, more than 1 cm (allergic contact dermatitis, burns)
36
Q

What are the characteristics of pustules?

A
  • raised, pus filled vesicles, less than 1 cm, usually infected (acne)
37
Q

What are the characteristics of urticaria/wheals/hives?

A
  • round, elevated, red due to edema, almost always itchy (drug hypersensitivity reaction)
38
Q

What are the characteristics of scale?

A
  • accumulation of horny epithelium (areas of skin you can scrape off)
39
Q

What are the characteristics of crust?

A
  • accumulation of dry blood, pus or serum (aka scab)
40
Q

What are the characteristics of erosion and excoriation?

A
  • open area of skin due to loss of epidermis (will heal without scarring)
  • excoriation is linear erosion, occur due to trauma such as itching (scabies)
41
Q

What are the characteristics of ulcers?

A
  • complete loss of epidermis and some of dermis due to lack of blood flow or trauma (heal with scarring)
42
Q

What are the characteristics of petechiae?

A
  • small non-blanching punctate foci of hemorrhage (breakdown of capillaries or deposits) looks like tiny blood clots, can be caused by platelet disorder and can be dry or wet
43
Q

What are the characteristics of purpura?

A
  • large area of hemorrhage (smaller than ecchymosis/bruising)
44
Q

What are the characteristics of atrophy?

A
  • thinning of the skin, caused by too much sun exposure, age, or long term steroid use
45
Q

What are the characteristics of scar?

A
  • area of fibrosis that replaces normal skin after wound
46
Q

What are the characteristics of keloid?

A
  • hypertrophic scars that extend beyond wound margins, genetic disposition
47
Q

What are the characteristics of telangietases?

A
  • overgrowth of small capillaries, usually occurs in areas of sun damage (liver failure)
48
Q

What are the examples of raised lesions?

A
  • papule, plaque, nodule, scar, tumor, wheal(urticaria)
49
Q

What are the examples of flat lesions?

A
  • macule, nevi, patch
50
Q

What are the examples of depressed lesions?

A
  • erosions, ulcers, atrophy, sinus, striae
51
Q

What are the examples of fluid filled lesions?

A
  • cyst, vesicle, bulla, abscess, furuncle(skin abscess), pustule
52
Q

What are the examples of the vascular lesions?

A
  • petechiae, purpura, ecchymosis, telangietases
53
Q

actinic keratosis

A

rough dry scales

54
Q

sebborheic keratosis

A

large warty stuck on appearance

55
Q

basal cell carcinoma

A

pearly papule with telangiectasis

56
Q

squamous cell carcinoma

A

crusty eroded papule or plaque

physical diagnosis (7 decks)

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