Ch. 13 Hair, Skin, Nails

Question 1

Epidermis

Answer 1

• Thin but tough.
• Epidermis is replaced completely every 4 weeks.
• Stratum basale or Basal cell layer – forms new skin cells that move up in layers. Made of Keratin and contain melanocytes.
• Stratum corneum or horny cell layer – dead keratinized cells that are shed.

Question 2

Dermis

Answer 2

• Inner supportive layer made of connective tissue or collagen.
• Contains nerves, sensory receptors, blood vessels, and lymphatics.
• Contains hair follicles, sebaceous glands, sweat glands.

Question 3

Subcutaneous Layer

Answer 3

• Adipose tissue
• Stores fat for energy, provides insulation for temperature control, and cushioning.

Question 4

Vellus Hair

Answer 4

• covers most of the body EXCEPT palms, soles, umbilicus, glans penis, and inside the labia
• Fine, faint hair

Question 5

Terminal Hair

Answer 5

• Darker, thicker hair that grows on scalp, eyebrows, axillae, and pubic area (face and chest in males)

Question 6

Eccrine Glands (Sweat)

Answer 6

• Coiled tubules that open directly onto skin
• on palms and soles and reduce body temp
• Dilute, saline solution called sweat.
• Widely distributed and mature in 2 month old infant

Question 7

Apocrine Glands (sweat)

Answer 7

• Produce milky, thick secretion and open into hair follicles.
• Mainly in axillae, anogenital area, nipples, and navel
• contributes to earwax
• function decrease in aging adult
• when reacting with normal flora on the skin, a musky body odor is produced

Question 8

Functions of the Skin

Answer 8

• protection
• prevents penetration
• perception
• fluid balance
• temperature regulation
• identification
• communication
• wound repair
• absorption and excretion
• production of vitamin D

Question 9

Lanugo

Answer 9

• fine, downy hair on skin of newborn

Question 10

Vernix Caseosa

Answer 10

• thick, cheesy substance made of sebum and shed epithelial cells at birth

Question 11

The Aging Adult

Answer 11

• underlying dermis thins and flattens – wrinkles
• loss of elastin, collagen, and subcutaneous fat and reduction in muscle tone
• loss of collagen increases risk of shearing or tearing injuries
• decrease in sweat and sebaceous glands – dry skin
• wound healing delayed
• decrease vascularity and nutrients

Question 12

Senile purpura

Answer 12

• dark, red discolored areas

Question 13

Sebaceous Glands

Answer 13

• produce protective lipid substance called sebum
• lubricate skin and hair and forms emulsion that retards water loss from the skin
• most abundant on scalp, forehead, face, chin
• found everywhere except palms and soles

Question 14

Keloids

Answer 14

• raised scars that form at a wound site and grow beyond the normal boundaries of the wound
• African Americans predisposed because of compact collagen bundles below the epidermis

Question 15

Hypopigmentation
Hyperpigmentation

Answer 15

• light or dark spots after common acne has resolved

Question 16

Pseudofolliculitis

Answer 16

• razor bumps or ingrown hairs
• occur when shaving too closely with electric or straight razor

Question 17

Seborrhea

Answer 17

oily

Question 18

Xerosis

Answer 18

excess dryness

Question 19

Pruritus

Answer 19

skin itching

Question 20

Alopecia

Answer 20

significant loss

Question 21

Vitiligo

Answer 21

absence of melanin pigment in patchy areas of white or light skin on face, neck, hands, feet, and body folds around orifices

Question 22

Freckles

Answer 22

small, flat macules of bown melanin pigment that occur on sun-exposed skin

Question 23

Mole

Answer 23

• clump of melanocytes, tan-to-brown color, flat or raised
• acquired nevi have symmetry, 6mm or less, smooth borders, single uniform pigmentation

Question 24

Danger Signs of Pigmented Lesions

Answer 24

ABCDEF

Asymmetry

Border irregularity

Color variation

Diameter greater than 6mm

Elevation or Evolution

Funny looking

Additional Symptoms: itching, burning, or bleeding in a mole; newly pigmented lesion; rapidly changing lesion

Question 25

Pallor

Answer 25

- ashen gray color in dark skin - pale, white in light skin - occurs with anemia, shock, arterial insufficiency, poor oxygenation

Question 26

Erythema

Answer 26

- red color - inflammation, fever, carbon monoxide poisoning - palpate darker skinned people for inflammation by feeling for heat, looking for edema since its harder to see redness

Question 27

Cyanosis

Answer 27

- blue - low oxygen; hypoxemia - occurs with shock, cardiac arrest, heart failure, chronic bronchitis, and congenital heart disease

Question 28

Jaundice

Answer 28

- yellowish skin color indicates rising bilirubin in blood - first noted in hard and soft palate in mouth and in sclera of eyes that extends to edge of iris - occurs with hepatitus, cirrhosis, sickle-cell disease, transfusion reaction, and hemolytic disease of newborn - light or clay stools + dark urine accompany this usually in both light and dark skinned people

Question 29

Hypothermia

Answer 29

- Generalized coolness may be induced such as in hypothermia used for surgery or high fever. Localized coolness is expected with an immobilized extremity, as when a limb is in a cast or with an intravenous infusion. - General hypothermia accompanies shock, cardiac arrest. - Localized hypothermia occurs in peripheral arterial insufficiency and Raynaud disease.

Question 30

Hyperthermia

Answer 30

Generalized hyperthermia occurs with an increased metabolic rate such as in fever or after heavy exercise. A localized area feels hyperthermic with trauma, infection, or sunburn.

Question 31

Diaphoresis

Answer 31

profuse perspiration, accompanies an increased metabolic rate such as occurs in heavy activity, fever, or during perimenopause in women. - occurs with thyrotoxicosis, heart attack, anxiety, or pain.

Question 32

Anasarca (generalized edema)

Answer 32

generalized over the whole body (anasarca)—consider a central problem such as heart failure or kidney failure

Question 33

Cherry (senile) angiomas

Answer 33

small (1 to 5 mm), smooth, slightly raised bright red dots that commonly appear on the trunk in all adults older than 30 years. They normally increase in size and number with aging and are not significant.

Question 34

Capillary Refill

Answer 34

nails must turn pink again in 2 seconds or less

Question 35

Carotenemia

Answer 35

yellow-orange color in light-skinned persons but no yellowing in the sclera or mucous membranes. It comes from ingesting large amounts of foods containing carotene, a vitamin A precursor.

Question 36

clubbing

Answer 36

inner edge of nail elevates. nail bed angle straightens out to 180 degrees common in pulmonary diseases

Question 37

Confluent Lesions

Answer 37

run together

Question 38

discrete lesions

Answer 38

distinct and seperate

Question 39

linear

Answer 39

scratch, streak, line, or stripe

Question 39

grouped lesions

Answer 39

clusters of lesions

Question 40

zosteriform

Answer 40

linear arrangement following unilateral nerve route i.e. Herpes Zoster (shingles)

Question 41

Tumors and Nodule

Answer 41

large in diameter, firm or soft, deeper into dermis, may be benign or malignant

Question 42

Urticaria (hives)

Answer 42

wheals (superficial, raised, transient, erythematous, slightly irregular from edema) coalesce to form extensive pruritic reaction

Question 43

Vesicles and Bulla

Answer 43

Vesicles are multiple elevated cavities containing fluid, clear serum, up to 1cm ( herpes simplex or zoster) Bulla is one and bigger than vesicles >1cm (blister)

Question 44

cysts

Answer 44

encapsulated fluid filled cavity

Question 45

pustules

Answer 45

pus in cavity that is circumscribed and elevated <1cm; acne

Question 46

macule

Answer 46

solely a color change, flat and circumscribed less than 1cm i.e freckles

Question 47

papule

Answer 47

solid, elevated, circumscribed less than 1 cm diameter superficial thickening of the epidermis i.e. mole or wart

Question 48

crust

Answer 48

thickened dried out exudate

Question 49

scale

Answer 49

compact flakes of dessicated skin from shedding of excess keratin cells

Question 50

fissures

Answer 50

linear crack with abrupt edges extending into dermis

Question 51

erosions

Answer 51

scooped out but shallow depression

Question 52

ulcers

Answer 52

deeper depression extending into dermis with irregular shape, may bleed, leaves scar

Question 53

excoriations

Answer 53

self-inflicted abrasion that is superficial

Question 54

scars

Answer 54

permanent fibrotic change after healing

Question 55

atrophic scars

Answer 55

resulting skin level is depressed with loss of tissue and thinning

Question 56

lichenifications

Answer 56

prolonged intense scratching leads to thickened skin producing tightly packed set of papules

Question 57

keloids

Answer 57

benign excess of scar tissue beyond original injury

Question 58

Pressure or Decubitus Ulcer

Answer 58

deep depression extending into dermis, irregular shape, may bleed and leaves scar when heals Stage 1: non-blanchable erythema Stage 2: Partial-thickness skin loss Stage 3: Full-thickness skin loss Stage 4: Full thickness skin and tissue loss

Question 59

Vascular Lesions (Petechiae, Purpura, Contusion)

Answer 59

caused by blood flowing out of breaks in the vessels

Question 60

Petechiae

Answer 60

tiny punctate hemorrhages indicating abnormal clotting factors (check mouth, buccal mucosa, conjuctivae)

Question 61

Purpura

Answer 61

greater than 3mm, flat, red to purple macular hemorrhage seen with thrombocytopenia and old age blood leaks from capillaries in response to minor trauma

Question 62

Contusion (bruise)

Answer 62

red-blue or purple immediately then blue-green, yellow and brown from trauma

Question 63

Seborrheic Keratosis non cancerous

Answer 63

dark, greasy and "stuck on" develop mostly on trunk, hands, and face on both unexposed and sun exposed areas

Question 64

actinic keratosis non cancerous (can become squamous cell)

Answer 64

red-tan scaly plaques, raised roughened. may have silvery white scale adherent to plaque occurs on sun exposed surfaces and related to sun exposure

Question 65

senile lentigines (lentigo) non cancerous

Answer 65

common variation of hyperpigmentation, liver spots, flat brown macules and do not require treatment

Question 66

Basal Cell carcinoma

Answer 66

small pink or red papule with pearly translucent top and broken blood vessel at center then develops rounded, pearly borders with central red ulcer or large open pore with central yellowing slow growing

Question 67

Squamous cell carcinoma

Answer 67

arises from actinis keratoses or denovo eythematous scaly patch with sharp margins, 1cm or more, develops central ulcer and surrounding erythema- fast growing

Question 68

Malignant Melanoma

Answer 68

brown, tan, black, pink-red, purple, or mixed pigmentation irregular borders, scaling, flaking, oozing

Question 69

abrasions

Answer 69

scrapes away superficial layers of skin caused by friction as body scrapes across a rough surface

Question 70

Incision

Answer 70

caused by clean, sharp-edged scalpel, knife, razor, glass shard clean edges such as a surgical incision

Question 71

Laceration

Answer 71

irregular tear-like wounds caused by blunt trauma and has jagged edges

Question 72

Puncture

Answer 72

sharp pointed object entering skin, something passes through or is impaled

Question 73

avulsion

Answer 73

characterized by a flap

Question 74

Classic Signs of Wound Infection

Answer 74

- increased pain around wound bed - redness or warmth - fever chills or other flu-like symptoms - pus draining from the wound bed - increasing odor from the wound - increased firmness of skin or swelling around wound bed

Question 75

plaque

Answer 75

elevated, firm, coarse/scaly lesions >1cm psoriasis, suborrheic dermatitis

Question 76

Methods of Assessment for Hair, Skin, and Nails

Answer 76

Inspection Palpation