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NURP 530 Adv Health Assessment > Week 3: Dermatology > Flashcards

Week 3: Dermatology Flashcards

1
Q

What are the eight characteristics that the FNP should describe of every skin lesion?

A

Number

Size

Color

Shape

Texture

Primary lesion

Location (specific landmarks)

Configuration (describing patterns)

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2
Q

What are examples of primary lesions?

A

Erosions Ulcers Nodules Ecchymosis Petechiae Palpable purpura

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3
Q

Flat lesion

A

can’t palpate with eyes closed

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4
Q

Macule

A

flat and < 1 cm

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5
Q

Patch

A

flat and > 1 cm

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6
Q

Raised lesion

A

palpate with eyes closed

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7
Q

Papule

A

raised, < 1 cm, not fluid filled

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8
Q

Plaque

A

raised, > 1cm, not fluid filled

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9
Q

What are some terms used to refer to the shape of a lesion?

A

Circular

Oval

Annular: ring-like with central clearing

Nummular: coin like, no central clearing

Polygonal

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10
Q

What are some terms used to refer to the texture of a lesion?

A

Smooth Fleshy Verrucous / warty Scaly Fine and dry (Tinea pedis) Hard and keratotic (Actinic keratoses) Greasy (Seborrheic dermatitis)

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11
Q

What characteristics would you expect of actinic keratoses? What conditions mimic actinic keratoses?

A

Hard and keratotic

  • mimics superficial xerosis or seborrheic dermatitis
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12
Q

What characteristics would you expect of basal cell carcinoma (BCC)? What conditions mimic BCC?

A

pinky patch that doesn’t heal, possible focal scaling

mimics actinic keratosis and SCC in situ

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13
Q

What exam findings are concerning for malignant melanoma?

A

A - assymmetry

B - irregular border, esp notching

C- color, esp colors black, blue and red

D- diameter >6mm

E- evolving

E - elevated

F- firm

Growing

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14
Q

What are the characteristics of a spider angioma?

A

Fiery red, very small to 2cm

Central body, sometimes raised, surrounded by erythema and radiating legs

Pressure on body causes blanching of the spider

Face, neck, arms, upper trunk

Almost never below waist

normal/common on face and chest

Also seen in pregnancy and liver disease

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15
Q

What are the characteristics of a spider vein?

A

Blueish

Size variable; small to several inches

Shape: variable, spider, linear, irregular, cascading

pulsatility and effect: absent; pressure over center DOESN’T blanch but diffuse pressure blanches the veins

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16
Q

What are the characteristics of a cherry angioma?

A

Bright ruby read, purplish with age

1-3mm

Shape: round, flat, sometimes raised, may be surrounded by pale halo

Pulsatility and effect of pressure:

Absent, partial blanching, esp if pressure applied with edge of pinpoint

Location: trunk, extremities

Sig: none, increases in size and #’s w/ aging

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17
Q

What are some examples of sun damage? How do they present?

A

Solar lentigo: bilateral symmetric brown macules located on sun exposed skin, face, shoulders, arms, hands

Solar elastosis: Yellowish white macules or papule in sun exposed areas, foreheads

Actinic purpura: ecchymoses only on dorsal forearms and hands but NOT extending above “shirt sleeve” line on upper arm

Poikiloderma: red patches in sun damaged areas, esp V neck, with fine telangiectasis and both hyper and hypopigmentation

Wrinkles: increased sun damage and tanning lead to deeper wrinkles at earlier age

Cutis rhomboidalis nuchae: deeper wrinkles on posterior neck that “criss cross)

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18
Q

What are some abnormal nail findings?

A
  • paronychia: staph aures/strep; superficial infection of lateral nail folds; red swollen, tender
  • clubbing: vasodilation w/ inc blood flow, hypoxia, CHD, interstitial lung disease, lung cancer, IBD, malignancies
  • Habit tic deformity: depression on central nail; “christmas tree” ; repetitive trauma from rubbing index finger over thumb
  • melanonychia: increased pigmentation in nail matrix; streaks; normal ethnic variation
  • onycholysis: painless separation of opaque nail bed from pink nail bed; trauma, psoriasis, fungal infection, allergic reactions to nail cosmetics
  • onychomycosis: nail thickening and debris; from tinea pedis, fungal
  • terry nails: white nail plate with ground glass; liver disease, cirrhosis, HF, diabetes
  • transverse linear depressions (beau lines): temp disruption of proximal nail growth from systemic illness; severe illness, trauma, raynaud’s disease
  • pitting: punctuate depressions of nail plate by defective layering of superficial nail plate; psoriasis
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19
Q

Skin findings of someone with chronic renal disease?

A

pallor

xerosis

uremic frost (crystallized urea)

pruritus

half & half nails

calciphylaxis (Ca accumulates in small blood vessels of fat and skin tissues)

blood clots, painful skin ulcers, infxns

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20
Q

skin findings of somone with crohn’s disease?

A
  • Erythema nodosum
  • Pyoderma gangrenosum
  • Enterocutaneous fistulas
  • Aphthous ulcers
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21
Q

skin findings of somone with Cushing disease?

A

Striae

Atrophy

Purpura

Ecchymoses

Telangiectasis

Acne

Moon facies

Buffalo hump

Hypertrichosis

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22
Q
A
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23
Q

skin findings of someone with diabetes

A

Pruritus

Diabetic dermopathy

Acanthosis nigricans

Candidiasis

Neuropathic ulcers

Necrobiosis lipoidica

Eruptive xanthomas

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24
Q

skin findings of Dyslipidemias

A

Xanthomas (tendon, eruptive, tuberous; Lesions on skin with cholesterol and fat)

Xanthelasma

25
skin findings of Hypothyroidism
Dry, rough, pale skin Coarse and brittle hair Myxedema (think coma!!!) Alopecia (lateral 3rd of eyebrows to diffuse) Skin cool to touch Thin and brittle nails
26
skin findings of hyperthyroidism
Warm, moist, soft, velvety skin Thin and fine hair Alopecia Vitiligo Pretibial myxedema (in graves disease) Hyperpigmentation (local or generalized)
27
skin findings of Kawasaki disease
Mucosa erythema Lips, tongue, pharynx Strawberry tongue Cherry red lips Polymorphous rash (trunk) Erythema of palms and soles Desquamation of fingertips
28
skin findings of liver disease
Jaundice Spider angiomas Telangiectasias Palmar erythema Terry nails Pruritus Purpura Caput medusae
29
skin findings of leukemia/lymphoma
Pallor Exfoliative erythroderma Nodules Petechiae Ecchymoses Pruritus Vasculitis Pyoderma gangrenosum Bullous disease
30
skin findings of meningococcemia
Angular stellate purpuric patches Plaques with gunmetal gray center Ecchymoses Bullae Necrosis
31
skin findings of Neurofibromatosis
Neurofibromas Cafe-au-lait spots Freckling in axillae (Crowe sign) Plexiform neurofibroma
32
skin findings of Systemic lupus erythematosus
palmar erythema (mid cheeks, spans bridge nose) Relative sparing of nasolabial folds Periungual erythema Interphalangeal erythema
33
34
In considering the APGAR, what does the score tell use about the newborn’s skin?
skin: 0 (pale, blue) 1 (pink body, blue extremities), 2 (pink all over)
35
How would you assess an infant’s skin for hydration?
Check turgor for hydration Roll a fold of loosely adherent skin on Abdomen wall between thumb and forefinger Tenting = NO NORMAL
36
Where would you assess an infant’s skin for cyanosis? What would you consider on the DDx for an infant with cyanosis?
Acrocyanosis (blue cast on hands and feet when exposed to cold) very common first few days Central cyanosis at any age = congenital heart disease Best area to look for central cyanosis: tongue and oral mucosa (NOT nail beds, lips, or extremities)
37
What are the four common dermatologic conditions in the newborn? How do they present?
Miliaria rubra: scattered vesicles on erythematous base; face/trunk; From obstructed sweat gland ducts; Disappears w/in few weeks Erythema toxicum: erythematous macules with central pinpoint vesicles scattered diffusely over entire body; "flea bites", disappear w/in 1st few weeks of birth Pustular melanosis: small vesiculopustular over brown macular base; lasts several months; common in black infants Milia: pinhead-sized smooth, white raised areas without surrounding erythema on nose, chin, forehead; retention of sebum in openings of sebaceous glands
38
What would be considering abnormal findings in the newborn skin assessment? What would be the DDx for these?
- jaundice: abnormal if present within 24 hours (hemolytic disease of newborn); normal on 2nd or 3rd day, peaks day 5, gone 1 week - midline hair tuft: over lumbosacral spinal region; Spinal cord defect
39
What are some benign birthmarks found in infants? What do they look like?
Eyelid patch - fades w/in 1st year Salmon patch / stork bite / angel kiss Cafe au lait spots: Isolated lesions have no significance but multiple lesions with sharp vorders suggest neurfibromatosis; light brown pigmented lesions have borders and uniform monogolian spots/Slate blue patches: common dark skinned babies Harlequin dyschromia: Transient cyanosis of ½ of body or 1 extremity, from vascular instability
40
In the pediatric population, what are some wart-like lesions and how do they appear on exam?
Verruca vulgaris (Dry, rough warts on hands) Verruca plana (small, flat warts) Plantar warts Molluscum contagiosum Adolescent acne
41
What are some commons skin lesions during childhood and how do they appear on exam?
Bacterial (impetigo, furuncle or boil, folliculitis, carbuncle) fungal (cadidiasis, tinea (capitis, corporis, veriscolor, pedis, cruris, unguium) viral (verrucace [common, plantar, flat], molluscum contagiosum, herpes simplex type 1 & 2) infestations (pediculosis, pediculosis capitis, scabies) inflammatory disorders (atopic dermatitis, diaper dermatitis, seborrheic dermatitis, contact dermatitis, acne vulgaris)
42
**cutis mamorata** Premature infants or first few months of life, trunk/legs Infants with conventional hypothyroidism or Down syndrome If acrocyanosis doesn’t disappear within 8 hrs or with warming, consider congenital heart disease in cold environment
43
**erythema toxicum** Very very common in NB Day 2-3 days of life Erythematous macules with central pinpoint macule Diffuse, flea bite looking
44
**Pustular Melanosis** More common in black infants Vesicle pustules that form over brown macular base Last several months Resolves w/o tx
45
**Miliaria Rubra** Scattered vesicles on erythematous base on face Caused by obstruction of sweat glands Disappear spontaneously No intervention needed, just reassurance
46
**Diaper Dermatitis** Skin is raw, excoriated, sloughed off Caused by irritant, stool, diaper Use barrier cream, letting air get to the area Common
47
Candida / yeast infection of diaper area Erythematous papules with some satellite lesions Any rash \> 72 hrs in diaper area has to do with yeast and will be treated as yeast
48
**impetigo** Bacterial infection of skin caused by strep or staph Very contagious Moist vesicles on erythematous base When vessels rupture, produce honey colored cresting Bullous impetigo present as larger lesions When erupt = see red, shiny rough skin under By staph
49
**Molluscum Contagiosum** Very very common in peds Caused by pox virus Pearly, colored dome shaped papules with central umbilication Form in clusters , even linear If scratch = spread
50
**head lice** Difficult to dx Significant pruritis Overnight worsens Occipital or postauricular areas Lice is oval shaped, firmly attached to hair shaft (½ inch up from scalp) Whitish gray nit attached to shaft
51
**Fifth disease (erythema infectiosum)** caused by parvovirus B19 Starts with mild fever, rhinitis, h/a Slapped cheap appearance 3-5 days into the illness Once rash shows, no longer contagious 5th disease bc 5th disease we used to see in childhood illness
52
**Coxackie Virus (Hand, foot, mouth disease)** Sometimes pruritic Mouth lesions very uncomfortable a/s with anorexia, sore throat, LOA, very very fussy kids/infants Supportive care for tx
53
**Roseola** By herpes virus Most kindergartens exposed by 5 Very common under 2 yo 2-3 days of high fever and irritability Break out in rash over trunk and extremities Pink maculopapular rash
54
**varicella/chicken pox** “Dew drop on a rose petal” Vesicle on erythematous base Pruritis, fever, unwell sx’s Lesions become infected with staph → sepsis → death
55
**measles** High fever, cough, runny nose, diffuse pinkish Red macupapulses forming together
56
What does blanching indicate? nonblanching?
blanchable: erythematous/inflamed; erythematous wheel suggest inflammation nonblanching (petechiae, purpura, vascular structures like cherry angioamas, vascular malformations): NOT erythematous but rather red, purple, violaceous/purple
57
petechia/pupura
deep red or reddish purple fading over time petechia, 1-3mm; pupura larger _shape_: rounded, sometimes irregular; flat NON-blanchable significance: blood outside vessels suggest bleeding disorder; palpable purpura in vasculitis
58
ecchymosis
purple or purplish blue, fading to green yellow and brown with time variable in size, larger than petechiae (\>3mm) _shape_: rounded, oval, irregular; may have central cubcutaneous fat nodule (hematoma) NON-blanchable significance: trauma, bleeding disorders

NURP 530 Adv Health Assessment (7 decks)

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