examination of the skin

Question 1

when looking at a rash, try to determine if it came from ______

Answer 1

outside or inside

Question 2

if you don’t know what the cells are in a lesion, what should you do?

Answer 2

biopsy

Question 3

what would biopsy of an outside lesion show?

Answer 3

abnormal stratum corneum, inflammatory cells in the epidermis and sometimes blister – clinically this looks like red, scaley skin ± blister

Question 4

keys to an outside rash (4)

Answer 4

scaley red thickened skin
Straight lines
Geometic shapes
Spares folds

Question 5

biopsy of an insider lesion

Answer 5

biopsy – scattered inflammatory cells in the dermis – clinically this looks red – the epidermis is unaffected (no inflammatory cells, no change in stratum corneum, no blisters)

Question 6

clinical appearance of an inside lesion

Answer 6

clinically flat and smooth – this type of eruption comes from the inside and therefore does not spare folds or have sharp cutoffs –

Question 7

what can cause an inside rash? (4)

Answer 7

drug eruptions
Rocky Mountain Spotted Fever
Meningococcemia
Hepatitis

Question 8

what are the keys to an inside lesion?

Answer 8

flat
Does not spare folds
No straight lines
No sharp cutoffs

Question 9

older skin, particulary on sun exposed area is: TDSB

Answer 9

Thinner
Dryer
Scaley
Bruises more easily

Question 10

t/f. Almost all aging of the skin is due to photoaging

Answer 10

true

Question 11

very common benigh lesion tan to pigmented waxey plaques – looks like someone threw mud against a wall

Answer 11

seborrheic keratosis

Question 12

benigh flesh colored tags usually located in the axilae, sides of the neck and under the breasts

Answer 12

skin tags

Question 13

benign – red papules and nodules made up of blood vessels

Answer 13

cherry angiomas

Question 14

dome shaped nodule usually with a hyperpigmented border – feels like a “BB” under the skin

Answer 14

Dermatofibroma

Question 15

large blue vascular lesion on the lower lip – compressible – benign

Answer 15

venous lake

Question 16

keratotic horn shaped projection produced by multiple causes such as warts, seborrheic keratoses, and squamous cell carcinoma – must biopsy base for diagnosis

Answer 16

cutaneous horn

Question 17

due to lower leg swelling-the lower leg is scaley and red
diagnose edema by pressing with finger on the anterior tibial area for 10 seconds – if there is an indentation when you let up – then the patient has edema progression from scaley red to erosions to ulcers without treatment –
ulcers heal with large scars so you can tell a person has had a stasis induced leg ulcer
long term edema and stasis dermatitis can have a brown-orange deposition called hemosiderin

Answer 17

stasis dermatitis

Question 18

– with aging, nails can become thick, yellow and hard to cut – difficult to distinguish normal aging vs fungal infection – need to culture for fungus

Answer 18

nail description

Question 19

normal variant of aging – unusually long difficult to cut nails

Answer 19

Onychogryphosis –

Question 20

black, necrotic area on distal extremities – finger, toes due to something circulating and hammering into vessels of distal extremities – can be due to infectious agent, cholesterol, cancer – need to find cause

Answer 20

infarcts

Question 21

flat – discolored spot on skin not raised above the surface

Answer 21

macular

Question 22

small blister contains serous fluid

Answer 22

Vesicle –

Question 23

pus filled blister

Answer 23

pustule

Question 24

large bump – greater than 4mm

Answer 24

nodule

Question 25

well defined elevated area of skin

Answer 25

plaque

Question 26

scaley, red macules, papules or plaques commonly seen on the elbows and knees

Answer 26

Psoriasis –

Question 27

– red, scaley rash found on posterior neck, popliteal and antecubital fossae

Answer 27

Atopic dermatitis

Question 28

multiple scaley, red, oval plaques commonly begins with a single lesion (herald patch) and then days to weeks later multiple lesions develop – lesions are in cleavage lines and have Christmas tree distribution – some lesions have trailing scale (the scale trails behind the edge of the lesion) – usually only on trunk

Answer 28

Pityriasis rosea –

Question 29

– similar lesions as pityriasis rosea but effects the palm and soles - check RPR

Answer 29

Secondary syphilils

Question 30

scaley rough lesions on long term sun exposed skin – 1/1000 turn into squamous cell carcinoma

Answer 30

Actinic keratoses –

Question 31

round pearly lesions with telangicctasias (small blood vessels) – due to long term sun exposure – spreads wide and deep but rare to metastasize

Answer 31

Basal cell carcinoma

Question 32

Due to long term sun exposure and arising in sun exposed skin acts like a basal cell carcinoma. Keratotic nodule with firm base usually begins as an actinic keratosis and becomes a ____________

Answer 32

squamous cell carcinoma

Question 33

On non-sun-exposed areas __________ is more likely to metastasize.

Answer 33

squamous cell carcinoma

Question 34

ABCD of melanoma

Answer 34

Asymmetry Border irregularity Color (variations within a single lesion) Diameter-greater than 6 millimeters

Question 35

what is RPR?

Answer 35

which is a blood test for syphilis-always positive in secondary syphilis.

Question 36

The main thing to remember about melanoma is that any ________ in appearance of a pigmented lesion is a clue that it might be malignant. The

Answer 36

change

Question 37

. The lesion must undergo at least _______ growth for the patient to notice it.

Answer 37

30%

Question 38

t/f. Increased educational status correlates with increased risk of developing melanoma.

Answer 38

true

Question 39

lifetime risk of melanoma in men? women?

Answer 39

Lifetime risk of melanoma: Men 1:36; Women 1:55

Question 40

increase in risk of melanoma

Answer 40

Over the past 40 years people aged 18-39 - 800% increase in young women; 400% in young men.

Question 41

what are three clues that a rash is getting better?

Answer 41

decreased redness, desquamation, wrinkling

Question 42

redness clue

Answer 42

If the redness decreases (goes from bright to dull to light red), the rash is getting better.

Question 43

what does desquamation tell you about a rash?

Answer 43

The skin peels off in sheets. It tell us that the rash is getting better and the skin was previously red

Question 44

what does wrinkling tell you about a rash?

Answer 44

This tells you the swelling and inflammation has gone down and wrinkled the skin, thus the rash is better today than it was yesterday