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Q1 > skin hair nails hape > Flashcards

skin hair nails hape Flashcards

1
Q

what does pallor indicate?

A

anemia

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2
Q

cyanosis

A

a blue color, can indicate decreased oxygen in the blood or decreased blood flow in response to a cold environment.

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3
Q

jaundice

A

or yellowing of the skin, results from increased bilirubin.

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4
Q

what does the cuticle do?

A

protects the space between the fold and the plate from external moisture.

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5
Q

what is the angle between the proximal nail fold and nail plate?

A

less than 180 degrees

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6
Q

pilosebaceous glands

A

produce a fatty substance secreted onto the skin surface through the hair follicles. These glands are present on all skin surfaces except the palms and soles.

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7
Q

eccrine sweat glands

A

widely distributed, open directly onto the skin surface, and help to control body temperature by their sweat production

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8
Q

apocrine sweat glands

A

found chiefly in the axillary and genital regions and usually open into hair follicles. Bacterial decomposition of apocrine sweat is responsible for adult body odor.

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9
Q

common or concerning symptoms of the integumentary system

A

Lesions
Rashes and itching (pruritus)
Hair loss and nail changes

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10
Q

what kind of lesions should you look for on a pt skin?

A

Look for lesions suggesting melanoma, basal cell carcinoma (BCC), or squamous cell carcinoma (SCC) throughout the skin examination regardless of the patient’s skin color. Detecting skin cancer at an early stage can increase the likelihood of successful treatment

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11
Q

what are causes of generalized itching without apparent rash?

A

dry skin; pregnancy; uremia; jaundice; lymphomas and leukemia; drug reactions; and, less commonly, polycythemia vera and thyroid disease

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12
Q

what should you encourage pt to use to replace lost moisture barrier?

A

moisturizers

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13
Q

what are the most common causes of difffuse hair thinning?

A

male and female pattern baldness

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14
Q

what do hair breaks along the shaft suggest?

A

damage from hair care or tinea capitis

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15
Q

what is hair shedding at the roots common of?

A

telogen effluvium and alopecia areata

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16
Q

what are good descriptions to describe skin lesions and rashes?

A

number, size, color, shape, texture, primary lesion, location, and configuration.

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17
Q

what is a primary skin lesion?

A

those that develop as a direct result of, and therefore are most characteristic of, the disease process

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18
Q

examples of macules

A

Examples include freckles, flat moles, and port-wine stains and the rashes of rickettsial infections, rubella, and measles.3

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19
Q

examples of papules

A

Examples include nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers

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20
Q

examples of plaques

A

Lesions of psoriasis and granuloma annulare commonly form plaques.3

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21
Q

examples of nodules

A

cysts, lipomas, and fibromas

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22
Q

what are pustules common in?

A

common in bacterial infections and folliculitis

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23
Q

what are vesicles characteristic of?

A

herpes infections, acute allergic contact dermatitis, and some autoimmune blistering disorders such as dermatitis herpetiformis

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24
Q

classic autoimmune bullous diseases

A

pemphigus vulgaris and bullous pemphigoid

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25
Q

what are wheals?

A

common manifestation of hypersensitivity to drugs; stings or bites; autoimmunity; and, less commonly, physical stimuli including temperature, pressure, and sunlight

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26
Q

what areas does psoriasis frequently effect?

A

scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft.

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27
Q

where does lichen planus frequently arise?

A

wrists, forearms, genitals, and lower legs.

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28
Q

characteristics of vitiligo

A

may be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth.

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29
Q

Discoid lupus erythematosus

A

characteristic lesions on sun-exposed skin of the face, especially the forehead, nose, and the ear.

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30
Q

Hidradenitis suppurativa

A

involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts.

31
Q

examples of configuration of skin lesions

A

herpes zoster with unilateral and dermatomal vesicles; herpes simplex, with grouped vesicles or pustules on an erythematous base; tinea pedis with annular lesions; and poison ivy allergic contact dermatitis with linear lesions.

32
Q

examples of textures of lesions

A

Scaling can be greasy, like seborrheic dermatitis or seborrheic keratoses, dry and fine like tinea pedis, or hard and keratotic like actinic keratoses or SCC.

33
Q

blanchable lesions

A

erythematous and suggest inflammation

34
Q

nonblanching lesions

A

petechiae, purpura, and vascular structures (cherry angiomas, vascular malformations) are not erythematous, but rather bright red, purple, or violaceous. They are nonblanching because blood has extravasated out from the capillaries into the surrounding tissues.

35
Q

what is the dermoscope used for?

A

With adequate clinician training, use of dermoscopy improves the sensitivity and specificity of differentiating melanomas from benign lesions

36
Q

what is the first requirement for the skin examination?

A

Ask the patient to change into a gown with the opening in the back and clothes removed except for underwear

37
Q

parts of the full skin exam when patient is seated

A

Inspect the hair and scalp (distribution, texture, and quantity).
Inspect the head and neck, including forehead, eyebrows, eyelids, eyelashes, conjunctivae, sclerae, nose, ears, cheeks, lips, oral cavity, chin, and beard. Inspect the upper back.
Inspect the shoulders, arms, and hands including palpation of fingernails.
Inspect the chest and abdomen.
Inspect the anterior thighs and legs.
Inspect the feet and toes including soles, interdigital areas, and toenails.

38
Q

parts of the full skin exam where pt is standing

A

Inspect the lower back.
Inspect the posterior thighs and legs.
Inspect the breasts, axillae, and genitalia including axillary and pubic hair.

39
Q

what can you do to be less likely to miss part of the skin exam?

A

perform it in the same order everytime

40
Q

alopecia

A

can be diffuse, patchy, or total. Male and female pattern hair loss are normal with aging. Focal patches may be lost suddenly in alopecia areata.6 Refer scarring alopecia to a dermatologist.

41
Q

what is associated with sparse hair and what is associated with fine, silky hair

A

hypothyroidism for sparse hair and fine silky hair for hyperthyroidism

42
Q

what is the best way to learn to distinguish normal skin lesions from abnormal lesions and potential skin cancers

A

Instead of documenting what is not present on the skin, document what is present

43
Q

what are possible internal causes of diffuse nonscarring hair shedding in young women

A

anemia, hypo or hyper thyroidism

44
Q

what do fever, chills, and pain suggest in the bed bound patient?

A

underlying osteomyelitis

45
Q

revised pressure injury staging system

A

*Stage 1: Intact skin with a localized area of nonblanchable erythema, which may appear differently in darkly pigmented skin.
*Stage 2: Partial-thickness loss of skin with exposed dermis
*Stage 3: Full-thickness skin loss, in which adipose (fat) is visible in the ulcer and granulation tissue and rolled wound edges, is often present.
*Stage 4: Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer.
*Unstageable: Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.
*Deep tissue pressure injury: Persistent nonblanchable deep red, maroon, or purple discoloration.

46
Q

important topics for health promotion and counseling

A

Skin cancer prevention
Skin cancer screening including melanoma

47
Q

risk factors for melanoma

A

-Personal or family history of previous melanoma
- ≥50 common moles
-Atypical or large moles, especially if dysplastic
-Red or light hair
-Solar lentigines (acquired brown macules on sun-exposed areas)
-Freckles (inherited brown macules)
-Ultraviolet radiation from heavy sun exposure, sunlamps, or tanning booths
-Light eye or skin color, especially skin that freckles or burns easily
-Severe blistering sunburns in childhood
-Immunosuppression from human immunodeficiency virus (HIV) or from chemotherapy
-Personal history of nonmelanoma skin cancer

48
Q

what is the best way to prevent against skin cancer?

A

avoid UV radiation exposure by limiting time in the sun, avoiding midday sun, using sunscreen, and wearing sun-protective clothing with long sleeves and hats with wide brims. Advise patients to avoid indoor tanning, especially children, teens, and young adults.

49
Q

signs of chronic sun damage

A

numerous solar lentigines on the shoulders and upper back, many melanocytic nevi, solar elastosis (yellow, thickened skin with bumps, wrinkles, or furrowing), cutis rhomboidalis nuchae (leathery thickened skin on the posterior neck), and actinic purpura

50
Q

how much does the use of indoor tanning beds (especially before age 35) increase your risk of melanoma?

A

75%

51
Q

how many melanomas arise de novo from isolated melanocytes rather than pre-existing nevi

A

at least half

52
Q

what is the most sensitive aspect of the ABCDE method?

A

E, evolution or change

53
Q

blue or black color within a larger pigmented lesion is especially concerning for melanoma except for….?

A

homogenous blue color in a blue nevus

54
Q

Approximately half of melanomas are initially detected by…..

A

patients or their partners

55
Q

burrows

A

Small linear or serpiginous pathways in the epidermis created by the scabies mite

56
Q

what is the most common skin cancer in the world?

A

BCC

57
Q

‘ugly duckling’

A

the nevus that looks different from the patient’s other nevi. A patient may make many atypical nevi with surrounding macular components and central papular components, but they all look the same. Find the patient’s signature nevus, then search for the ugly duckling that looks different from the patient’s typical “signature” nevi.

58
Q

tinea captitis

A

There are round scaling patches of alopecia, mostly seen in children. There may be “black dots” of broken hairs and comma or corkscrew hairs on dermoscopy. Usually caused by Trichophyton tonsurans from humans, and less commonly, Microsporum canis from dogs or cats. Boggy plaques are called kerions.

59
Q

monilethrix

A

a rare inherited disorder characterized by sparse, dry, and/or brittle hair that often breaks before reaching more than a few inches in length

60
Q

clubbing of the fingers

A

a bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and the proximal nail fold. The angle increases to 180 degrees or more, and the nail bed feels spongy or floating.

61
Q

habit tic deformity

A

There is depression of the central nail with a “Christmas tree” appearance from small horizontal depressions, resulting from repetitive trauma from rubbing the index finger over the thumb or vice versa.

62
Q

mealnonychia

A

ncreased pigmentation in the nail matrix, leading to a streak as the nail grows out

63
Q

onycholysis

A

painless separation of the whitened opaque nail plate from the pinker translucent nail bed

Local causes include trauma from excess manicuring, psoriasis, fungal infection, and allergic reactions to nail cosmetics. Systemic causes include diabetes, anemia, photosensitive drug reactions, hyperthyroidism, peripheral ischemia, bronchiectasis, and syphilis.

64
Q

terry nails

A

Seen in liver disease, usually cirrhosis, heart failure, and diabetes

64
Q

beau lines (transverse linear depression)

A

Transverse depressions of the nail plates, usually bilateral, resulting from temporary disruption of proximal nail growth from systemic illness. Timing of the illness may be estimated by measuring the distance from the line to the nail bed

Seen in severe illness, trauma, and cold exposure if Raynaud disease is present.

64
Q

how fast do nails grow?

A

1 mm every 6 to 10 days

65
Q

pitting of the nails

A

Usually associated with psoriasis but also seen in reactive arthritis, sarcoidosis, alopecia areata, and localized atopic or chemical dermatitis.

66
Q

addison disease

A

Hyperpigmentation of oral mucosa as well as sun- exposed skin, sites of trauma, and creases of palms and soles

66
Q

chagas disease

A

Unilateral conjunctivitis and lid edema associated with preauricular lymphadenopathy

67
Q

CREST syndrome

A

Calcinosis, Raynaud phenomenon, sclerodactyly, matted telangiectasias of face and hands (palms)

68
Q

secondary lesions associated with acne

A

pitting and scars

69
Q

solar elastosis

A

Yellowish white macules or papules in sun-exposed skin, especially on the forehead

70
Q

Cutis Rhomboidalis Nuchae

A

Deep wrinkles on the posterior neck that “crisscross”

Q1 (15 decks)

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