Integumentary System

Question 1

What depends on the underlying vascularized dermis for nutrition?

Answer 1

Epidermis

Question 2

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?

Answer 2

Dermis

Question 3

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

Answer 3

Dermis

Question 4

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

Answer 4

Melanin

Question 5

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

Answer 5

Carotene and bilirubin

Question 6

What is genetically determined and increased by exposure to sunlight?

Answer 6

Amount of melanin, a brownish pigment

Question 7

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

Answer 7

Carotene, a yellow pigment

Question 8

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

Answer 8

Bilirubin, a yellow-brown pigment

Question 9

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

Answer 9

Hb

Question 10

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

Answer 10

Deoxyhemoglobin

Question 11

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

Answer 11

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

Question 12

Adults have two types of hair:

Answer 12

1. Vellus hair

2. Terminal hair

Question 13

What is is short, fine, inconspicuous, and relatively

unpigmented?

Answer 13

Vellus hair

Question 14

What is coarser, thicker, more conspicuous, and

usually pigmented?

Answer 14

Terminal hair

Question 15

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

Answer 15

Nails

Question 16

What is the whitish moon?

Answer 16

Lunula

Question 17

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

Answer 17

Proximal nail fold

Question 18

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

Answer 18

Cuticle

Question 19

What cover the sides of the nail plate?

Answer 19

Lateral nail folds

Question 20

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

Answer 20

Less than 180°

Question 21

Fingernails grow approximately how many mm daily?

Answer 21

0.1 mm

Question 22

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

Answer 22

Sebaceous glands

Question 23

What glands are present on all skin

surfaces except the palms and soles?

Answer 23

Sebaceous glands

Question 24

Sweat glands are of two types:

Answer 24

eccrine and apocrine

Question 25

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

Answer 25

Eccrine glands

Question 26

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

Answer 26

Apocrine glands

Question 27

What is responsible for adult body odor?

Answer 27

Bacterial decomposition of apocrine sweat

Question 28

COMMON OR CONCERNING SYMPTOMS:

Answer 28

- Growths - Rashes - Hair loss or nail changes

Question 29

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

Answer 29

- 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

Question 30

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

Answer 30

Rash on the inside of the elbows and knees in childhood

Question 31

Causes of generalized itching, without apparent rash, include:

Answer 31

* Dry skin * Pregnancy * Uremia * Jaundice * Lymphomas and leukemia * Drug reactions * Less commonly, polycythemia vera and thyroid disease

Question 32

Common nail changes:

Answer 32

Onychomycosis, habit tic deformity, and melanonychia

Question 33

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

Answer 33

Onychomycosis

Question 34

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?

Answer 34

Habit tic deformity

Question 35

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

Answer 35

Melanonychia

Question 36

The most common causes of diffuse hair thinning are what?

Answer 36

Male and | female pattern baldness

Question 37

What s common in telogen effluvium and | alopecia areata?

Answer 37

Hair shedding at the roots

Question 38

What suggest damage from hair care or tinea | capitis?

Answer 38

Hair breaks along the shaft

Question 39

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

Answer 39

Skin cancer

Question 40

Who has the highest risk of skin cancer?

Answer 40

Fair-skinned individuals

Question 41

What is the most common skin cancer?

Answer 41

Basal cell carcinoma (BCC), followed | by squamous cell carcinoma (SCC), and melanoma

Question 42

What is the least common skin cancer?

Answer 42

Melanoma

Question 43

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?

Answer 43

Melanoma

Question 44

Increasing lifetime sun exposure correlates directly with

Answer 44

Increasing risk of skin cancer

Question 45

What appears to be more harmful than chronic | exposure?

Answer 45

Intermittent sun exposure

Question 46

What is the best defense against skin cancers?

Answer 46

``` - 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 ```

Question 47

Use of these especially before age 35 years, increases | risk of melanoma by as much as 75%.

Answer 47

Indoor tanning beds

Question 48

Signs of chronic sun damage include what?

Answer 48

``` - 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 ```

Question 49

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

Answer 49

American Cancer Society (ACS) and the AAD

Question 50

High-risk patients of skin cancer are those

Answer 50

With a personal or family history of | multiple or dysplastic nevi or previous melanoma

Question 51

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

Answer 51

Thinner melanomas than those who | did not have a clinical skin examination

Question 52

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

Answer 52

Isolated melanocytes rather than pre-existing nevi

Question 53

Screening for Melanoma

Answer 53

The ABCDEs

Question 54

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

Answer 54

ABCE-EFG method

Question 55

The sensitivity of this tool for detecting melanoma ranges from

Answer 55

43% to 97%

Question 56

The specificity of this tool for detecting melanoma ranges from

Answer 56

36% to 100%

Question 57

What depends on how many criteria are used to define | abnormality?

Answer 57

Diagnostic | accuracy

Question 58

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

Answer 58

Biopsy

Question 59

The most sensitive is E, which stands for what?

Answer 59

Evolution or change

Question 60

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

Answer 60

ABCDE method

Question 61

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

Answer 61

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

Question 62

What is an increasingly useful office practice for deciding | whether a melanocytic lesion is benign or malignant?

Answer 62

Dermoscopy

Question 63

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

Answer 63

Dermoscope

Question 64

It is important for you to palpate lesions for what?

Answer 64

- Texture - Firmness - Scaliness

Question 65

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

Answer 65

Hand sanitizers, which | are less drying than soap and water

Question 66

Good descriptions include each of the following elements:

Answer 66

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

Question 67

For example, for seborrheic keratosis, examine and record:

Answer 67

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

Question 68

What are flat or raised?

Answer 68

Primary lesions

Question 69

You cannot palpate the lesion with your eyes closed

Answer 69

Flat

Question 70

Lesion is flat and <1 cm

Answer 70

Macule

Question 71

Lesion is flat and >1 cm

Answer 71

Patch

Question 72

You can palpate the lesion with eyes closed

Answer 72

Raised

Question 73

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

Answer 73

Papule

Question 74

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

Answer 74

Plaque

Question 75

If you run your finger over the lesion but do not feel the | lesion, the lesion is what?

Answer 75

Flat spots

Question 76

If you run your finger over the lesion and it is palpable | above the skin, it is what?

Answer 76

Raised Spots

Question 77

Number

Answer 77

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.

Question 78

Size

Answer 78

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

Question 79

Shape

Answer 79

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

Question 80

Color

Answer 80

- 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.

Question 81

Texture

Answer 81

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

Question 82

Location

Answer 82

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

Question 83

Configuration

Answer 83

Patterns

Question 84

Examining the Patient with Hair Loss

Answer 84

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

Question 85

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

Answer 85

gently grasping 50 to 60 hairs with your thumb and index | and middle fingers, pulling firmly away from the scalp

Question 86

If all the hairs | have telogen bulbs, the most likely diagnosis is what?

Answer 86

telogen effluvium

Question 87

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

Answer 87

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

Question 88

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

Answer 88

iron-deficiency anemia and hyper- or | hypothyroidism

Question 89

Focal patches may be | lost suddenly in

Answer 89

alopecia areata

Question 90

What is seen in hypothyroidism?

Answer 90

Sparse hair

Question 91

What is seen in hyperthyroidism?

Answer 91

Fine, silky hair