TOPIC 4 KEY TERMS

Question 1

skin turgor

Answer 1

Skin Turgor is the skin’s ability to return to place promptly when released. This reflects the elasticity of the skin.

Question 2

poor turgor

Answer 2

Poor turgor is evident in severe dehydration or extreme weight loss; the pinched skin recedes slowly or “tents” and stands by itself.

Question 3

Good skin turgor

Answer 3

Good skin turgor reflects adequate hydration.

Question 4

ABCDE

Answer 4

asymmetry, border, color, diameter, evolving

Question 5

Asymmetry

Answer 5

not regularly round or oval, two halves of lesion do not look the same)

Question 6

Border irregularity

Answer 6

notching, scalloping, ragged edges, poorly defined margins)

Question 7

Color variation

Answer 7

areas of brown tan, black, blue, red, white, or combination)

Question 8

Diameter

Answer 8

greater than 6mm (the size of a pencil eraser), although early melanomas may be diagnosed at a smaller size.

Question 9

Procedure for assessing nails

Answer 9

Observe the shape and contour (smooth), uniform-curved or flat? Nail looks consistent? Color?

Question 10

normal findings of nails

Answer 10

View the index finger at its profile and note the angle of the nail base; it should be about 160 degrees. The nail base is firm to palpation. Curved nails are a variation of normal with a convex profile. They may look like clubbed nails, but notice that the angle between nail base and nail is normal (i.e., 160 degrees or less).

Question 11

abnormal finding of nails

Answer 11

Clubbing: often occurs with congenital cyanotic heart disease, lung cancer, and pulmonary diseases.

Question 12

Capillary Refill

Answer 12

Þ With the index or middle fingertip at heart level, depress the nail edge at least 5 seconds to blanch and then release, noting the return of color. Normally: color return is instant or at least within a few seconds in a cold environment. This indicates the status of the peripheral circulation. A healthy color return takes 1 or 2 seconds. Abnormal: Sluggish color return takes longer than 1 or 2 seconds. Cyanotic nail beds or sluggish color return: consider cardiovascular or respiratory dysfunction, septic shock.

Question 13

Lesions: if any are present, note

Answer 13

· Color
· Elevation (flat, raised, or pedunculated)
· Pattern or shape: the grouping or distinctness of each lesion (annular, grouped, confluent, linear)
· Size (in centimeters): use a ruler to measure
· Location and distribution on body: is it generalized or localized to area of specific irritant; around jewelry, watchband, eyes?
· Any exudate: note color and odor

Question 14

to detect fluorescing lesions use…

Answer 14

Use a Wood’s light (ultraviolet light filtered through special glass)

Question 15

Edema

Answer 15

fluid accumulation in the interstitial spaces.

Question 16

Scale to grade pitting:

Answer 16

• 1+ mild, slight indentation, no perceptible swelling
• 2+ moderate, indentation subsides rapidly
• 3+ deep, indentation remains for short time, appears swollen
• 4+ very deep, indentation last long time, appears very swollen

Question 17

Primary lesion

Answer 17

when a lesion develops on previously unaltered skin

Question 18

Macule

Answer 18

solely a color change; flat and circumscribed, of less than 1 cm

Question 19

Papule

Answer 19

something you can feel (solid, elevated, circumscribed, less than 1 cm diameter)

Question 20

Patch

Answer 20

macules larger than 1 cm

Question 21

Plaque

Answer 21

coalesce to form surface elevation wider than 1 cm. A plateaulike, disk-shaped lesion

Question 22

Nodule

Answer 22

Solid, elevated, hard or soft, larger than 1cm, may extend deeper into the dermis than papule

Question 23

Wheal

Answer 23

Superficial, raised, transient, and erythematous; slightly irregular shape from edema (fluid held diffusely in the tissues)

Question 24

Tumor

Answer 24

Larger than a few centimeters in diameter, firm or soft, deeper into dermis; may be benign or malignant

Question 25

Urticaria

Answer 25

Wheal coalesce to form extensive reaction, intensely pruritic

Question 26

Vesicle

Answer 26

Elevated cavity containing free fluid, up to 1 cm; a "blister." Clear serum flows if wall is ruptured.

Question 27

Bulla

Answer 27

Larger than 1 cm diameter; usually single chambered (unilocular); superficial in epidermis; thin-walled and ruptures easily.

Question 28

Cyst

Answer 28

Encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin.

Question 29

Pustule

Answer 29

Turbid fluid (pus) in the cavity. Circumscribed and elevated

Question 30

· Pigmented nevi (moles)

Answer 30

Papule

Question 31

· Freckles

Answer 31

Macule

Question 32

Xanthoma

Answer 32

Nodule

Question 33

· Mosquito bite

Answer 33

Wheal

Question 34

· Chicken Pox

Answer 34

Vesicle

Question 35

Crust

Answer 35

The thickened, dried out exudate left when vesicles/pustules burst or dry up. Color can be red-brown, honey, or yellow, depending on fluid ingredients (blood, serum, pus)

Question 36

Scale

Answer 36

Compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells

Question 37

Fissure

Answer 37

Linear crack with abrupt edges; extends into dermis; dry or moist.

Question 38

Erosion

Answer 38

Scooped out but shallow depression. Superficial; epidermis lost; moist but no bleeding; health without scare because erosion does not extend into dermis

Question 39

Ulcer

Answer 39

Deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals

Question 40

Excoriation

Answer 40

Self-inflicted abrasion; superficial; sometimes crusted; scratched from intense itching.

Question 41

Scar

Answer 41

After a skin lesion is repaired, normal tissue is lost and replaced with connective tissue (collagen). This is a permanent fibrotic.

Question 42

Atrophic Scar

Answer 42

The resulting skin level is depressed with loss of tissue; a thinning of epidermis

Question 43

Lichenification

Answer 43

Prolonged, intense scratching eventually thickens skin and produces tightly packed sets of papules; looks like surface of loss (or lichen)

Question 44

Keloid

Answer 44

A benign excess of scar tissue beyond sited of original injury: surgery, acne, ear piercing, tattoos, infections, burns. Looks smooth, rubbery, shiny and "clawlike"; feels smooth and firm. Found in ear lobes, back of neck, scalp. Chest, and back; may occur months to years after initial trauma. Most common ages are 10-30 years; higher incidences in blacks, Hispanics and Asians.

Question 45

Petechiae

Answer 45

Tiny punctate hemorrhages, 1 to 3 mm, round and discrete; dark red, purple, or brown in color. Caused by bleeding from superficial capillaries; will not blanch. May indicate abnormal clotting factors. In dark-skinned people petechiae are best visualized in the areas of lighter melanization

Question 46

Purpura

Answer 46

Þ Confluent and extensive patch of petechiae and ecchymoses; >3 mm, flat, red to purple, macular hemorrhage. Seen in generalized disorders such as thrombocytopenia and scurvy. Also occurs in old age as blood leaks from capillaries in response to minor trauma and diffuses through dermis.

Question 47

Ecchymosis (bruise)

Answer 47

Þ - A purplish patch resulting from extravasation of blood into the skin, >3 mm in diameter. A mechanical injury (e.g., a blow) results in hemorrhage into tissues. Skin is intact.

Question 48

Angioma - Spider or Star Angioma

Answer 48

A fiery red, star-shaped marking with a solid circular center. Capillary radiations extend from the central arterial body. With pressure, note a central pulsating body and blanching of extended legs. Develops on face, neck, or chest; may be associated with pregnancy, chronic liver disease, or estrogen therapy or may be normal.

Question 49

Seborrhea

Answer 49

oily

Question 50

xerosis

Answer 50

dry

Question 51

alopecia

Answer 51

significant hair loss

Question 52

· Hirsutism

Answer 52

shaggy or excessive hair

Question 53

pallor

Answer 53

pale/white; the red-pink tones from the oxygenated hemoglobin in the blood are lost

Question 54

cyanosis

Answer 54

blueish mottled color from decreased perfusion; the tissues have high levels of deoxygenated blood

Question 55

· Erythema

Answer 55

red; intense redness of the skin is from excess blood (hyperemia) in the dilated superficial capillaries

Question 56

jaundice

Answer 56

A yellowish skin color indicates rising amounts of bilirubin in the blood

Question 57

brown-tan

Answer 57

bronzed appearance; an "eternal tan" most apparent around nipples, perineum, genitalia and pressure points (inner thighs, buttocks, elbow, axillae)

Question 58

stage I pressure ulcer

Answer 58

Non-Blanchable Erythema: intact skin, red, unbroken, localized redness, lighter skin-does not blanch, darker skin remains darker-does not blanch

Question 59

stage II pressure ulcer

Answer 59

partial-Thickness Skin Loss: Partial thickness erosion, loss of epidermis, shallow abrasion or open blister looking, red-pink wound bed

Question 60

Stage III pressure ulcer

Answer 60

· Full-thickness Skin loss: full thickness extending into SQ, crater like, fat may be visible

Question 61

stage IV pressure ulcer

Answer 61

Full-thickness skin/tissue loss: full thickness, all layers to supporting structures, muscle, tendon, bone,

Question 62

stages of bruising

Answer 62

(1) red-blue or purple immediately after or within 24 hours of trauma and generally progresses to (2) blue to purple (3) blue-green (4) yellow (5) brown to disappearing.