The Dermatologic Examination

Question 1

Define Primary Lesion

Answer 1

–first recognizable skin lesion or involved basic skin changes.

Question 2

Define Secondary lesion

Answer 2

–evolve from primary skin lesions, either because of the natural history of the disorder (e.g., crusts in chicken pox) or because of scratching or infection.

Question 3

Define Distrubtion of skin lesions

Answer 3

–refers to where on the body the lesions are found (e.g., hands, face, trunk, flexor or extensor surfaces).

Question 4

What are the three layers of the skin?

Answer 4

1. Epidermis
2. Dermis
3. Subcutaneous

Question 5

Define Vellus Hair

Answer 5

–short, fine, inconspicuous and usually unpigmented (peach fuzz).

Question 6

Define Terminal Hair

Answer 6

–coarser, thicker and pigmented. Example: - scalp, eyebrows, pubic region.

Question 7

What are the three growth phases of hair?

Answer 7

–Catagen phase – transitional phase – 3%

–Telogen phase – resting phase – 10-15%

–Anagen phase – Growing phase – 85-90%

Question 8

What is nail clubbing?

Answer 8

-rounding of the nail. Soft and spongy.

Question 9

What are etiologies of nail clubbing?

Answer 9

Congenital

Chronic hypoxia

Heart disease

Lung cancer

Hepatic cirrhosis

Question 10

What is an etiology of nail pits?

Answer 10

Psoriasis- nail can also thicken.

Question 11

What are the two kinds of nail lines discussed and what causes them?

Answer 11

Mee’s lines and Beau’s Lines

Emerge from the proximal nail folds, may follow an acute or chronic illness, chemotherapy

Question 12

What are the 4 skin pigments discussed and what causes each one?

Answer 12

–Brown – Melanin (melanocytes)

–Yellow – Carotene, Jaundice (bilirubin)

–Red - Carboxyhemoglobin–(CO poisoning), Polycythemia

–Bluish-red - De-oxyhemoglobin–(cyanosis)

Question 13

Where in the cell do melanocytes make melanin?

Answer 13

Melanosomes

Question 14

What determines a persons skin pigment?

Answer 14

The ammount melanin present

Question 15

Define Macule

Answer 15

Small flat spot, <1.0 cm

Question 16

Define Patch:

Answer 16

Patch: Flat spot or lesion, >1.0 cm

Question 17

Define Papule

Answer 17

Papule: Raised lesion, <1.0 cm

Question 18

Plaque:

Answer 18

Plaque: Raised lesion, >1.0 cm

Question 19

Nodule:

Answer 19

Nodule: Firm, hard lesion, deeper than a papule, >0.5 cm

Question 20

Cyst:

Answer 20

Cyst: Nodule filled with material, liquid or semi-solid, often encapsulated.

Question 21

Vesicles:

Answer 21

Vesicles: Fluid filled lesions, <1.0 cm, single or in clusters

Question 22

-Bulla:

Answer 22

-Bulla: Fluid filled lesion, >2.0 cm

Question 23

-Wheal:

Answer 23

-Wheal: Superficial localized raised area of skin, blanches with pressure

Question 24

-Pustule:

Answer 24

-Pustule: Open lesions filled with pus.

Question 25

Scale:

Answer 25

Scale: Flaking of dead exfoliated epidermis.

Question 26

-Crust:

Answer 26

-Crust: Dried residue of skin exudates such as serum, pus or blood.

Question 27

Fissure:

Answer 27

Fissure: Linear crack in skin

Question 28

-Ulcer:

Answer 28

-Ulcer: Deeper loss of epidermis

Question 29

Lichenification :

Answer 29

thickening of the epidermis and roughing of the skin surface often from rubbing or scratching.

Question 30

Excoriation

Answer 30

Excoriation – linear erosions caused by scratching.

Question 31

Koebner phenomena

Answer 31

Koebner phenomena – skin trauma from scratching may cause new lesions

Question 32

You do a KOH prep to look for?

Answer 32

hyphae or pseudohyphae indicate a fungal infection/yeast infection.

Question 33

You do a gram stain to look for?

Answer 33

gram + or gram - bacteria.

Question 34

You do a Tzanick stain to look for?

Answer 34

looking for herpes virus infection with rounded, multinucleated keratinocytes.

Question 35

You do an Oil mount to look for?

Answer 35

Oil mount: Skin scraping from base of burrow or non-excoriated papule, looking for mites/eggs and scabies infection.