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Internal Medicine > OHCEPS - Skin, Hair, and Nails > Flashcards

OHCEPS - Skin, Hair, and Nails Flashcards

1
Q

What is also important to keep in mind about the skin?

A

Has an important psychosocial function - When we look at another person we are in fact looking at their skin.

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2
Q

What is almost 90% of epithelial cells of epidermis?

A

Keratinocytes.

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3
Q

What is the time taken from forming in the basal layer to shedding?

A

Usually 3 months.

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4
Q

What determines the skin tone?

A

The size and the number of melanin granules and NOT by the number of melanocytes.

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5
Q

What do we find inside the dermis?

A
  1. Skin appendages
  2. Muscles
  3. Nerves
  4. Blood vessels
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6
Q

What is the hypodermis?

A

Also known as the subcutaneous layer or the superficial fascia, this consists of adipose tissue and serves BOTH as a lipid store + provides insulation.
Also contributes to the body contours and shape.

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7
Q

After infancy, when do sebaceous glands become active again?

A

At puberty + secrete sebum - A mixture of fatty acids and salts, directly onto the skin or into the necks of hair follicles.

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8
Q

In which sites are the sebaceous glands particularly numerous?

A
  1. Upper chest
  2. Back
  3. Face
  4. Scalp
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9
Q

What do sweat glands secrete?

A

A mixture of:

  1. Water
  2. Electrolytes
  3. Urea
  4. Urate
  5. Ammonia
  6. Mild acids
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10
Q

Where do we find ECCRINE glands?

A

All over the body surface, besides the mucosa.

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11
Q

Where do we find APOCRINE sweat glands?

A
  1. Axillae
  2. Pubic regions
  3. Secrete a more viscous sweat and are under clear autonomic control.
  4. These do not function until puberty.
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12
Q

Human are covered with hair, apart from which sites?

A
  1. Palms
  2. Soles
  3. Inner surface of the labia minora
  4. Prepuce
  5. Glans penis
    Most is fine, unpigmented, vellous hair –> NOT EASILY SEEN.
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13
Q

Growth is cyclical with each follicle shedding its hair and then regrowing. How much does a cycle last?

A

4 years for scalp hair.

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14
Q

What are basically the nails?

A

Sheets of keratin which are continuously produced by the matrix at the proximal end of the nail plate.

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15
Q

How fast do nails grow?

A

0.1mm/day –> toenails growing slower than fingernails.

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16
Q

What is important to keep in mind about the dermatological history?

A

Don’t waste time listening to the patient describe what the rash looks like –> You’re about to examine it yourself.

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17
Q

During dermatological history, what factors which either trigger or relieve the problem should specifically asked?

A
  1. UV light
  2. Foods
  3. Temperature
  4. Contact with any other substances
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18
Q

What should be asked during PMH?

A
  1. Previous skin problems?
  2. Diabetes, connective tissue disease, IBD, asthma?
  3. What does the patient use on their skin? - soaps, creams, cleansers.
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19
Q

What should be asked during the family history?

A
  1. Atopy
  2. Eczema
  3. Psoriasis
  4. Skin cancers
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20
Q

How should we treat alopecia?

A

In much the same way as any other symptom:
1. Mode of onset (sudden/gradual)
2. Associated symptoms
3. Pain
4. Rash
5. Family history of hair loss
Note ALSO –> Regions of hair loss - recognizable pattern?

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21
Q

If the patient reports abnormal hair growth, treat as any other symptom, BUT what must also be asked?

A
  1. FHx of similar problem.
  2. Menstrual cycle - when was the last one, regular or erratic?
  3. Symptoms of virilization –> voice change, clitoromegaly.
  4. DHx
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22
Q

What happens in male pattern baldness and when does it start?

A
  1. Commonly occurs from the 2nd decade.

2. Hair is lost first from the temporal regions, frontal and crown.

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23
Q

What is the alopecia areata?

A
  1. Associated with autoimmune disorders and occurs in the 2nd or 3rd decade.
  2. Sharply defined, non-inflammatory patches on the scalp.
  3. May be “exclamation mark” hairs which are thinner at the base.
  4. Also affects eyebrows and beard.
  5. Nails may be slow-growing and show pitting.
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24
Q

What is alopecia totalis?

A

Loss of hair from all of the scalp.

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25
Q

What is alopecia universalis?

A

Loss of all body hair.

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26
Q

What is telogen effluvium?

A
  1. Normally, hairs are growing and shedding at different times and at different rates.
  2. A severe illness, high fever, or childbirth may synchronize all the hair follicles causing them to shed at the same time –> about 3 months later.
  3. This gives a brief total hair loss which grows back.
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27
Q

What is scarring alopecia?

A

Inflammatory lesions causing hair loss include:

  1. Lichen planus
  2. Burns
  3. Infection
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28
Q

Mention altogether the important hair disorders/signs?

A
  1. Male-pattern baldness
  2. Alopecia areata
  3. Alopecia totalis
  4. Alopecia universalis
  5. Telogen effluvium
  6. Scarring alopecia
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29
Q

In which persons may splinter hemorrhages be a NORMAL finding?

A

In manual workers, caused by trauma.

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30
Q

With what conditions is pitting of the nails associated with?

A
  1. Psoriasis
  2. Eczema
  3. Lichen planus
  4. Alopecia
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31
Q

What is the pitting of the nails?

A

Tiny indentations in the surface of the nail.

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32
Q

What is onycholysis?

A

Premature lifting of the nail.

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33
Q

What is leukonychia?

A

White discoloration of the nail.

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34
Q

What does leukonychia indicate?

A

A sign of low albumin or chronic ill-health.

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35
Q

What are the Beau’s lines?

A

Transverse depressions in the nail.

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36
Q

What is paronychia?

A

Infection of the skin adjacent to the nail –> causing pain, swelling, redness, and tenderness

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37
Q

What is koilonychia?

A

Spooning (concave indentation) of the nail.

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38
Q

With what is koilonychia associated with?

A

With severe iron-deficiency.

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39
Q

What is important to keep in mind during skin examination?

A

The WHOLE skin needs to be examined, not just the area with the problem.

40
Q

What skin areas are usually missed during skin examination?

A
  1. Inner thighs
  2. Undersurfaces of female breasts
  3. External genitalia
  4. Axillae
  5. Natal cleft (between the buttocks)
  6. ALSO –> mucosal surfaces of mouth + nails, hair, scalp.
41
Q

What should be carefully noted while inspecting a lesion?

A
  1. Grouped or solitary? Pattern if grouped
  2. Distribution/location –> Symmetrical/asymmetrical, peripheral, in only light exposed areas, dermatomal.
  3. Color
  4. Shape
  5. Size
  6. Surface
  7. Edge
  8. Nature of the surrounding skin
42
Q

What should be beared in mind, when noting the distribution of a skin lesion?

A

What clothing is usually at the site and what other objects/substances that part of the body would come into contact with –> Belt buckles, watches, gloves, and jewellery.

43
Q

Each skin lesions should be palpated. What should be noted?

A
  1. Tenderness (watch the patient’s face)
  2. Consistency
  3. Temperature –> Use back of hand (inflamed lesions are usually hot).
  4. Depth/height
  5. Mobility –> What skin layer is the lesion in and is it attached to any underlying or nearby structures?
44
Q

What should also be examined beyond the skin lesion?

A

Remember to palpate the regional lymph nodes - also other organ systems should be examined.

45
Q

What is the Koebner’s phenomenon?

A

This is the tendency for certain rashes or lesions to form at the site of skin trauma - including surgical scars.

46
Q

Mention some common skin abnormalities.

A
  1. Jaundice
  2. Carotenemia
  3. Hemochromatosis
  4. Addison’s
  5. Albinism
  6. Vitiligo
47
Q

What are the 2 patterns of flat, non-palpable changed in skin color?

A
  1. Macule

2. Patch

48
Q

What is a macule?

A
  1. Flat, non-palpable change in skin colour.
  2. <0.5cm diameter
  3. Freckles are pigmented macules.
49
Q

What is a patch?

A
  1. Flat, non-palpable change in skin color.

2. >0.5cm diameter.

50
Q

Mention the 4 patterns of elevation due to fluid in a cavity.

A
  1. Vesicle
  2. Blister
  3. Pustule
  4. Bulla
51
Q

What is a vesicle?

A

Fluid below the EPIdermis <0.5cm

52
Q

What is a blister?

A

Fluid below the EPIdermis >0.5cm diameter.

53
Q

What is a bulla?

A

Large, fluid-filled lesion below the EPIdermis >10cm diameter.

54
Q

What is a pustule?

A

Visible collection of pus in the subcutis.

55
Q

Mention the 5 patterns of elevation due to solid masses.

A
  1. Papule
  2. Nodule
  3. Callus
  4. Plaque
  5. Wheal
56
Q

What is a papule?

A

Raised area <0.5cm.

57
Q

What is a nodule?

A

A mass or lump >0.5cm.

58
Q

What is a callus?

A

Hyperplastic epidermis, often found on the soles, palms or other areas of excessive friction/use.

59
Q

What is a plaque?

A

Raised area >2cm

60
Q

What is wheal?

A

Dermal edema.

61
Q

Mention the 4 patterns of loss of skin?

A
  1. Erosion
  2. Ulcer
  3. Fissure
  4. Atrophy
62
Q

What is an erosion?

A

Partial epidermal loss - heals without scarring.

63
Q

What is an ulcer?

A

Full thickness skin loss

64
Q

What is a fissure?

A

A linear crack.

65
Q

What is atrophy?

A

Thinning of the EPIdermis

Loss of tissue (epidermis/dermis +/or subcutis)

66
Q

Mention the 4 patterns of secondary skin lesions?

A
  1. Scale
  2. Excoriation
  3. Crust
  4. Lichenification
67
Q

What is a scale?

A

A small thin piece of horny epithelium resembling that of a fish.

68
Q

What is a crust (scab)?

A

Dried exudate is a crust of blood/plasma.

69
Q

What is excoriation?

A

A scratch mark.

70
Q

What is lichenification?

A

Thickening of the epidermis with exaggerated skin markings (bark-like) usually due to repeated scratching.

71
Q

Mention the 6 patterns of vascular skin lesions.

A
  1. Telangiectasia
  2. Purpura
  3. Ecchymosis
  4. Spired naevus
  5. Petechia
  6. Erythema
72
Q

What is telangiectasia?

A

Easily visible superficial blood vessels.

73
Q

What is a spider naevus?

A

A single telangiectatic arteriole in the skin.

74
Q

What is petechia?

A

Micro-hemorrhage 1-2mm diameter.

75
Q

What is purpura?

A

A rash caused by blood in the skin - often multiple petechiae.

76
Q

What is ecchymosis?

A

A bruise - technically a form of purpura.

77
Q

What is erythema?

A

Reddening of the skin due to local vasodilation.

78
Q

Melanoma is more common in men or women?

A

More common in women.

79
Q

What is the American ABCD system to assist diagnosis of melanoma?

A

A: Assymetry
B: Border (irregular)
C: Color (irregular)
D: Diameter >1cm

80
Q

What is the British Glasgow 7-point checklist to assist diagnosis of melanoma?

A 
Major features:
1. Change in size
2. Change in shape
3. Change in color
Minor features:
1. Diameter >5mm
2. Inflammation
3. Oozing or bleeding
4. Itch or altered sensation
81
Q

When examining a lump, there are some points to pay particular attention to. Mention some of them:

A

Which layer is the lump in:
1. Does it move with the skin? –> Epiderma/dermal.
2. Does it move with muscular contraction? –> Muscle/tendon.
3. Does the skin move over the lump? –> Subcutis.
4. Does it move only in one direction? –> Tendon or nerve.
If the lesion belongs to a nerve, the patient may feel pins-and-needles in the distribution of the nerve when the lump is pressed.
5. Is it immobile? (Bone)

82
Q

Mention some additional characteristics that should be kept in mind while examining a lump.

A
  1. Consistency
  2. Fluctuation
  3. Fluid thrill
  4. Translucency
  5. Resonance
  6. Pulsatility
  7. Compressibility
  8. Reducibility
83
Q

Should we auscultate a lump?

A

YES - Always listen with a stethoscope over any lump –> Listen especially for:

  1. Vascular bruits
  2. Bowel sounds
84
Q

What should be examined regarding ulcers?

A

Everything as with the other skin lesions:

  1. Position
  2. Distribution
  3. Color
  4. Shape
  5. Size
  6. Surface
  7. Edge
  8. Nature of the surrounding skin
  9. Tenderness
  10. Consistency
  11. Temperature
85
Q

Mention 4 characteristics of the ulcer that should also be considered?

A
  1. Base
  2. Edge
  3. Depth
  4. Discharge
86
Q

What should be examined regarding the base of an ulcer?

A
  1. Should be carefully examined and described.
  2. Usually have either slough or granulation tissue at the base.
  3. Look especially for bone, tendons, and blood vessels.
87
Q

What should be examined regarding the edge of the ulcer?

A
  1. Sloping
  2. “Punched out”
  3. “Undermined”
  4. “Rolled”
  5. Everted
88
Q

What may the discharge of the ulcer be?

A
  1. Serous
  2. Pus
  3. Blood
89
Q

What can lead to leg ulcers?

A

Often a result of mixed venous and arterial disease.

However, one pathology may predominate giving the findings below.

90
Q

What is the basis of venous ulceration?

A
  1. Venous HTN causes fibrin to be laid down at the pericapillary cuff –> Lipodermatosclerosis –> Interfering with the delivery of nutrients to the surrounding tissues.
  2. May be brown discoloration –> Hemosiderin deposition.
  3. May also be eczema, telangiectasia and, eventually, ulcer formation with a base of granulation tissue and a serous exudate.
91
Q

What are the common sites of venous ulcers?

A

At the medial or lateral malleoli.

92
Q

What is the fate of venous ulcers?

A

Will often heal with time and care.

93
Q

What are the main features of arterial ulceration?

A
  1. Other symptoms/signs of leg ischemia.
  2. May be loss of hair and toenail dystrophy.
  3. Chronic arterial insufficiency may lead to deep, sharply defined and painful ulcers which will not heal without intervention to restore the blood supply.
94
Q

What is the site of arterial ulcers?

A

Especially appear on the foot or mid-shin.

95
Q

What is the role of the skin?

A
  1. Temperature regulation
  2. Synthesis of vitD
  3. Prevention of water loss
  4. Antigen presentation
  5. Sensation

Internal Medicine (107 decks)

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