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PDR II > Integumentary System > Flashcards

Integumentary System Flashcards

1
Q

What depends on the underlying vascularized dermis for nutrition?

A

Epidermis

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2
Q

What is a dense layer of interconnecting collagen and elastic fibers containing sebaceous glands, sweat glands, hair follicles, and most of the terminals of the cutaneous nerves?

A

Dermis

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3
Q

What inferiorly merges with subcutaneous fatty tissue, or adipose tissue?

A

Dermis

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4
Q

Normal skin color depends on the amount and type of what?

A

Melanin

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5
Q

Normal skin color is also influenced by underlying vascular structures, changing hemodynamics, and changes in what?

A

Carotene and bilirubin

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6
Q

What is genetically determined and increased by exposure to sunlight?

A

Amount of melanin, a brownish pigment

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7
Q

What is found in the subcutaneous fat and heavily keratinized areas such as the palms and soles?

A

Carotene, a yellow pigment

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8
Q

What arises from the breakdown of heme in the red blood cells?

A

Bilirubin, a yellow-brown pigment

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9
Q

What transports oxygen in the form of
oxyhemoglobin, a bright red pigment in the arteries and capillaries
that causes reddening of the skin?

A

Hb

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10
Q

After passing through the capillary bed and releasing oxygen to the tissues, the darker bluer pigment of what circulates in the veins?

A

Deoxyhemoglobin

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11
Q

What makes the veins look bluer and less red than circulating venous blood?

A

The scattering of light through the turbid superficial layers of the skin
or blood vessels

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12
Q

Adults have two types of hair:

A
  1. Vellus hair

2. Terminal hair

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13
Q

What is is short, fine, inconspicuous, and relatively

unpigmented?

A

Vellus hair

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14
Q

What is coarser, thicker, more conspicuous, and

usually pigmented?

A

Terminal hair

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15
Q

What can protect the distal ends of the fingers and toes?

A

Nails

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16
Q

What is the whitish moon?

A

Lunula

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17
Q

Roughly one-fourth of the nail plate, the nail root, is covered by what?

A

Proximal nail fold

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18
Q

What extends from the fold and, functioning as a seal, protects
the space between the fold and the plate from external moisture?

A

Cuticle

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19
Q

What cover the sides of the nail plate?

A

Lateral nail folds

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20
Q

The angle between the proximal nail fold and nail plate is normally what?

A

Less than 180°

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21
Q

Fingernails grow approximately how many mm daily?

A

0.1 mm

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22
Q

What produce a fatty substance secreted onto the skin surface through the hair follicles?

A

Sebaceous glands

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23
Q

What glands are present on all skin

surfaces except the palms and soles?

A

Sebaceous glands

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24
Q

Sweat glands are of two types:

A

eccrine and apocrine

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25
Q

What are widely distributed, open directly onto the skin surface, and by their sweat production help to control body temperature?

A

Eccrine glands

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26
Q

What are found chiefly in the axillary and genital regions and usually open into hair follicles?

A

Apocrine glands

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27
Q

What is responsible for adult body odor?

A

Bacterial decomposition of apocrine sweat

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28
Q

COMMON OR CONCERNING SYMPTOMS:

A
  • Growths
  • Rashes
  • Hair loss or nail changes
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29
Q

If the patient reports a new growth, it is important to what?

A
  • Pursue the patient’s personal and family history of skin cancer
  • Note the type, location, and date of any past skin cancer and ask about regular self-skin examination
  • Use of sunscreen
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30
Q

For itchy rashes, ask about seasonal allergies with itching and watery eyes, asthma, and atopic dermatitis, often accompanied by

A

Rash on the inside of the elbows and knees in childhood

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31
Q

Causes of generalized itching, without apparent rash, include:

A
  • Dry skin
  • Pregnancy
  • Uremia
  • Jaundice
  • Lymphomas and leukemia
  • Drug reactions
  • Less commonly, polycythemia vera and thyroid disease
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32
Q

Common nail changes:

A

Onychomycosis, habit tic deformity, and melanonychia

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33
Q

What is a fungal infection of the nails that causes discoloration, thickening, and separation from the nail bed?

A

Onychomycosis

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34
Q

What is a form of nail degeneration that results from constant external trauma to the nail matrix (where the fingernails start to grow, the root) that manifests as nail plate (top of the nail) changes?

A

Habit tic deformity

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35
Q

What is characterized by brown-black discoloration of the nail plate and the pigment referred to is conventionally melanin?

A

Melanonychia

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36
Q

The most common causes of diffuse hair thinning are what?

A

Male and

female pattern baldness

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37
Q

What s common in telogen effluvium and

alopecia areata?

A

Hair shedding at the roots

38
Q

What suggest damage from hair care or tinea

capitis?

A

Hair breaks along the shaft

39
Q

What are caused by a combination of genetic predisposition and
ultraviolet radiation exposure?

A

Skin cancer

40
Q

Who has the highest risk of skin cancer?

A

Fair-skinned individuals

41
Q

What is the most common skin cancer?

A

Basal cell carcinoma (BCC), followed

by squamous cell carcinoma (SCC), and melanoma

42
Q

What is the least common skin cancer?

A

Melanoma

43
Q

What is the most lethal due to its high rate of metastasis and high mortality at advanced stages, causing over 70% of skin cancer deaths?

A

Melanoma

44
Q

Increasing lifetime sun exposure correlates directly with

A

Increasing risk of skin cancer

45
Q

What appears to be more harmful than chronic

exposure?

A

Intermittent sun exposure

46
Q

What is the best defense against skin cancers?

A 
- avoid ultraviolet radiation
exposure by limiting time in the sun
- avoiding midday sun
- using
sunscreen
- wearing sun-protective clothing with long sleeves
and hats with wide brims
47
Q

Use of these especially before age 35 years, increases

risk of melanoma by as much as 75%.

A

Indoor tanning beds

48
Q

Signs of chronic sun damage include what?

A 
- numerous solar lentigines on
the shoulders and upper back
- many melanocytic nevi
- solar elastosis
(yellow, thickened skin with bumps, wrinkles, or furrowing)
- cutis
rhomboidalis nuchae (leathery thickened skin on the posterior neck)
- actinic purpura
49
Q

Who recommends full body
examinations for patients over age 50 years or at high risk,
because melanoma can appear in any location?

A

American Cancer Society (ACS) and the AAD

50
Q

High-risk patients of skin cancer are those

A

With a personal or family history of

multiple or dysplastic nevi or previous melanoma

51
Q

Patients who have a clinical skin examination within the 3 years prior
to a melanoma diagnosis have

A

Thinner melanomas than those who

did not have a clinical skin examination

52
Q

Both new and changing nevi should be closely examined, as at least
half of melanomas arise de novo from

A

Isolated melanocytes rather than pre-existing nevi

53
Q

Screening for Melanoma

A

The ABCDEs

54
Q 
What is done in screening moles
for melanoma (this does not apply for non-melanocytic lesions like
seborrheic keratoses)?
A

ABCE-EFG method

55
Q

The sensitivity of this tool for detecting melanoma ranges from

A

43% to 97%

56
Q

The specificity of this tool for detecting melanoma ranges from

A

36% to 100%

57
Q

What depends on how many criteria are used to define

abnormality?

A

Diagnostic

accuracy

58
Q

If two or more of these features are present, what should be

considered?

A

Biopsy

59
Q

The most sensitive is E, which stands for what?

A

Evolution or change

60
Q

What used for many years to teach clinicians
and patients about features suspicious for melanoma, to help detect
aggressive nodular melanomas?

A

ABCDE method

61
Q

Instruct patients with risk factors for skin cancer and melanoma,
especially those with what

A

a history of high sun exposure, prior or family
history of melanoma, and ≥50 moles or >5 to 10 atypical moles, to
perform regular self-skin examinations

62
Q

What is an increasingly useful office practice for deciding

whether a melanocytic lesion is benign or malignant?

A

Dermoscopy

63
Q

This handheld device provides cross-polarized or unpolarized light to
visualize patterns of pigmentation or vascular structures

A

Dermoscope

64
Q

It is important for you to palpate lesions for what?

A
  • Texture
  • Firmness
  • Scaliness
65
Q

Because frequent handwashing increases the risk of irritant contact
dermatitis, dermatologists recommend using what?

A

Hand sanitizers, which

are less drying than soap and water

66
Q

Good descriptions include each of the following elements:

A

number,
size, color, shape, texture, primary lesion, location, and
configuration

67
Q

For example, for seborrheic keratosis, examine and record:

A

Multiple
5 mm to 2 cm tan to brown oval stuck-on flat-topped verrucous
plaques on the back and abdomen, following skin tension lines

68
Q

What are flat or raised?

A

Primary lesions

69
Q

You cannot palpate the lesion with your eyes closed

A

Flat

70
Q

Lesion is flat and <1 cm

A

Macule

71
Q

Lesion is flat and >1 cm

A

Patch

72
Q

You can palpate the lesion with eyes closed

A

Raised

73
Q

Lesion is raised, <1 cm, and not fluid filled

A

Papule

74
Q

Lesion is raised, >1 cm, but not fluid filled

A

Plaque

75
Q

If you run your finger over the lesion but do not feel the

lesion, the lesion is what?

A

Flat spots

76
Q

If you run your finger over the lesion and it is palpable

above the skin, it is what?

A

Raised Spots

77
Q

Number

A

Lesions can be solitary or multiple. If multiple, record how many.
Also consider estimating the total number of the type of lesion you
are describing.

78
Q

Size

A

Measure with a ruler in millimeters or centimeters. For oval lesions,
measure in the long axis, then perpendicular to the axis.

79
Q

Shape

A

Some good words to learn are “circular,” “oval,” “annular” (ring-like,
with central clearing), “nummular” (coin-like, no central clearing),
and “polygonal.”

80
Q

Color

A
  • Use your imagination and be creative. Refer to a color wheel, if
    needed. There are many shades of tan and brown, but start with tan,
    light brown, and dark brown if you are having trouble.
  • Use “skin-colored” to describe a lesion that is the same shade as the
    patient’s skin.
  • For red lesions or rashes, blanch the lesion by pressing it firmly with
    your finger or a glass slide to see if the redness temporarily lightens
    then refills.
81
Q

Texture

A

Palpate the lesion to see if it is smooth, fleshy, verrucous or warty, or
scaly (fine, keratotic, or greasy scale).

82
Q

Location

A

Be as specific as possible. For single lesions, measure their distance
from other landmarks (e.g., 1 cm lateral to left oral commissure).

83
Q

Configuration

A

Patterns

84
Q

Examining the Patient with Hair Loss

A

Inspect the scalp for erythema, scaling, pustules, tenderness,
bogginess, and scarring.

85
Q

To examine the hair for shedding from the roots, perform a hair pull
test by

A

gently grasping 50 to 60 hairs with your thumb and index

and middle fingers, pulling firmly away from the scalp

86
Q

If all the hairs

have telogen bulbs, the most likely diagnosis is what?

A

telogen effluvium

87
Q

To examine the hair for fragility, perform the tug test by

A

holding a
group of hairs in one hand, pulling along the hair shafts with the
other; if any hairs break, it is abnormal.

88
Q

Possible internal causes of diffuse nonscarring hair shedding in
young women are

A

iron-deficiency anemia and hyper- or

hypothyroidism

89
Q

Focal patches may be

lost suddenly in

A

alopecia areata

90
Q

What is seen in hypothyroidism?

A

Sparse hair

91
Q

What is seen in hyperthyroidism?

A

Fine, silky hair

PDR II (6 decks)

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