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Physical Diagnosis > Lecture 2 - Skin Assessment > Flashcards

Lecture 2 - Skin Assessment Flashcards

(118 cards)

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1
Q

3 layers of skin

A

Epidermis, Dermis, Subcutaneous fat

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2
Q

Dermis

A

blood vessels, nerves, hair follicles, sweat glands, sebaceous glands

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3
Q

Appendages of skin

A

Hair - terminal and vellus, nails, sebaceous glands, sweat glands

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4
Q

Two types of sweat glands - which one has body odor?

A

Eccrine

Apocrine - groin and axillary

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5
Q

Physiology of skin

A

Protects from fluid loss, protects from trauma and infection, regulates body temperature, provides sensory info, produces vitamin D

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6
Q

History

A

Duration
Relationship of skin lesions to external factors
Associated symptoms
Constitutional symptoms - may be an internal disease - acute/chronic

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7
Q

Physical Exam

A 
Vital signs
General survey
Equipment needed
Adequate lighting 
Adequate exposure
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8
Q

Adequate lighting

A

Daylight - best illumination, esp. for color

Tangential lighting for contours - can use ophthalmoscope

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9
Q

Adequate exposure

A

check axillae, buttocks, back of thighs, between fingers and toes

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10
Q

Equipment needed for skin assessment

A

ruler, lighting source

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11
Q

Inspection

A

Symmetry
Color - inc/dec pigmentation, pallor v cyanosis, jaundice
Hair - distribution, quantity
Nails - color, lesions, capillary refill

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12
Q

Central v peripheral cyanosis

A

Central - consistent with pulmonary or cardiac disease; peripheral - cooler temps or anxiety

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13
Q

Palpation

A

Moisture
Temperature - use dorsum of hand
Texture - smooth and soft
Mobility and turgor - pinch section of skin on forearm, should return to place immediately; avoid back of hand. Pinch skin on thigh in elderly

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14
Q

Morphologic Characteristics of Skin Lesions

A

Distribution
Shape/arrangement
Border/margin
Pigmentation/color

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15
Q

Localized distribution

A

lesion appears in one small area (ex. acne)

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16
Q

Regional distribution

A

lesions appear in specific region of body (ex. shingles)

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17
Q

Generalized distribution/disseminated

A

lesions appear widely distributed or in multiple areas simultaneously

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18
Q

Flexor surfaces

A

antecubital or popliteal area – eczema

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19
Q

Extensor surfaces

A

knees, elbows – psoriasis

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20
Q

Round/discoid shape

A

coin-shaped
no central clearing
seen with eczema
umbilicated lesions - seen with molluscum contagiosum

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21
Q

Oval shape

A

ovoid, seen with pityriasis rosea

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22
Q

Annular

A

Round; active (advancing border) margins with central clearing; seen with tinea (fungal) infections

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23
Q

Zosteriform

A

dermatomal - follows nerve segment; ex herpes zoster

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24
Q

Iris/target

A

pink macules with purple central papules; usually assoc with erythema multiforme

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25
Arrangement of lesions
linear - contact dermatitis | serpiginous - cutaneous larva migrans (from hookworm larvae)
26
Morbilliform
measles-like | erythematous maculopapular lesions that become confluent on face and body
27
Borders/margins
Distinct - well-demarcated or defined, able to draw a line around area with confidence Indistinct - poorly defined, borders merge with normal skin Active - advancing - margin shows greater activity than center Irregular - notched margins Raised borders - center is depressed compared to edge
28
Example of active border
tinea infections
29
example of irregular border
malignant melanoma
30
example of raised borders
basal cell carcinoma
31
Color/Pigmentation
flesh, erythematous - variable shades of red, violaceous, tan-brown, black or blue-black, white
32
Palpation of Lesions
``` Consistency Mobility Blanchable Tenderness Depth of lesion Deviation in temp ```
33
ABCDEs of Malignant Melanoma
``` A - asymmetry B - borders (irregular) C - color (variegated) D - diameter ( > 6mm) E - elevation ```
34
Primary skin lesions arise from previously ________ skin. Key to __________ diagnosis.
normal, accurate
35
Secondary skin lesions
arise from changes in primary lesions; usually due to scratching and/or infection
36
Primary skin lesions: circumscribed, flat, nonpalpable
macule, patch
37
Primary skin lesions: superficial elevations by free fluid
vesicle, bulla, pustule
38
Primary skin lesions: palpable, elevated solid masses
papule, plaque, nodule, tumor, wheal
39
Macule characteristics
Flat, non-palpable Circumscribed color change <1 cm in diameter variable color
40
Ex of macules
measles, freckles, petechiae
41
Patch characteristics
flat, non-palpable irregular shape >1 cm in diameter
42
ex of patches
mongolian spots cafe au lait spots port wine stain vitilgo
43
Papule characteristics
``` Up to 1 cm Palpable, firm circumscribed colors - flesh-colored, red, brown May be confluent and form plaques ```
44
Examples of papules
molluscum contagiosum, warts, nevi
45
what kind of lesion is a wart?
papule
46
Plaque description
elevated, firm, rough > 1 cm well-circumscribed
47
Ex of plaques
Psoriasis | Eczema
48
Nodule characteristics
> .5 cm Deeper and firmer than a papule Usually round
49
Ex of nodules
lipomas, skin cancers - malignant melanoma, basal cell or squamous cell carcinomas
50
Tumor characteristics
A large nodule Deeper in dermis > 2 cm
51
Examples of tumors
Hemangioma | Benign tumor
52
Wheal definition
irregular, transient, superficial edema
53
Ex of wheals
Mosquito bites, hives, allergic reactions
54
Vesicle Characteristic
well-circumscribed Up to 1 cm filled with serous fluid
55
Ex of vesicles
herpes simplex - dew drops on rose petals
56
Bulla characteristics
Well-circumscribed, greater than 1 cm, filled with serous fluid
57
Ex of bullas
2nd degree burns, blisters
58
Pustule characteristics
Elevated, superficial, well-circumscribed, epidermal, FILLED WITH PUS
59
Ex of pustules
acne, impetigo, fire ant bites
60
Secondary skin lesions: result from changes in primary lesions
Loss of skin surface Miscellaneous lesions Material on the skin surface
61
Loss of skin surface examples
erosion, ulcer, fissure
62
miscellaneous lesions
lichenification, atrophy, scar, burrow, excoriation
63
material on skin surface
crust, scale
64
Erosion characteristics
Loss of superficial epidermis, surface is moist but doesn't bleed, heal without scarring
65
Erosion examples
ruptured varicella vesicles, eczema
66
Ulcer characteristics
deeper loss of epidermis and dermis, heals with scarring
67
Ulcer examples
stasis ulcer, decubitus
68
Fissure characteristics
Linear crack or break from epidermis to dermis
69
Examples of fissures
Eczema, tinea pedis, angular chellitis
70
Excoriation characteristics
abrasion or scratch marks, may be linear or rounded, usually due to scratching
71
Examples of excoriation
scabies, atopic dermatitis, dry skin
72
Crust characteristics
dried residue of serum, pus, or blood
73
Ex of crust
impetigo, tinea capitis, kerion - raised boggy secondarily infected fungal lesion of hair
74
Scale characteristics
thin flake of exfoliated epidermis
75
Ex of scales
dandruff, psoriasis, seborrheic dermatitis
76
Lichenification characteristics
thickening and roughening of the skin, increased visibility of skin markings
77
Lichenification examples
atopic dermatitis, chronic dermatitis
78
Atrophy characteristics
thinning of skin with loss of normal skin markings, skin looks shinier and more translucent
79
Atrophy examples
stretch marks, topical steroid use
80
Petechiae characteristics
deep red/purple-red lesions < .5 cm, round, irregular, non-blanchable, variable distribution, represent blood outside of vessel, seen with infections and bleeding disorders
81
Purpura characteristics
deep red/purple-red lesions; > .5 cm; same descriptors as petechiae, just larger
82
Ecchymosis characteristics (bruises)
purple lesions of variable size - fade to green, yellow, brown; round/oval, irregular borders; represent blood outside of vessels due to trauma or bleeding disorder
83
Spider angiomas
fiery red lesions - small in size - up to 2 cm; central body with surrounding erythema and radiating legs; blanch with pressure; seen on face, neck, arms, and upper trunk; seen with liver disease, pregnancy, may be normal
84
Cherry angiomas characteristics
bright - red papules, 1-3mm size, red, flat, or raised, non-pulsatile, seen on the trunk, don't blanch, associated with aging
85
Telangectasis characteristics
fine, irregular red lines secondary to dilation of capillaries; blanch; seen with basal cell carcinomas, sun-damaged skin, rosacea
86
Hemangioma characteristics
red irregular lesion secondary to dilation of dermal capillaries; starts as macular patch, can progress to plaque or nodule
87
What does this person have? Erythematous papules, nodules, and pustules on nose, chin, and cheeks bilaterally
acne rosacea; rosacea
88
Categories of skin diseases
papulosquamous, nodular, vesiculobullous, maculopapular
89
Papulosquamous lesions
papules, plaques and scales
90
examples of papulosquamous lesions
psoriasis, lichen planus
91
Lichen planus - 5 Ps
pruritic, polygonal, purple, planar, papules
92
nodular lesions
benign and malignant epidermal and dermal nodules
93
examples of benign nodular lesions
nevi - moles, cherry angiomas, epidermoid cysts
94
examples of malignant nodular lesions
squamous cell carcinoma - isolated keratonic, eroded papule or nodule; located in sun-exposed area basal cell carcinoma - "pearly" nodules in sun exposed areas, associated with central ulcerations and telangiectases
95
Vesiculobullous lesions
vesicles and bullas
96
ex of vesiculobullous lesions
impetigo, herpes zoster, pemphigus
97
pemphigus
autoimmune disease affecting skin and mucous membranes; associated with vesicles and bullas that can rupture and weep, can be fatal
98
maculopapular lesions
macules and papules
99
ex of maculopapular lesions
viral exanthem - generalized, erythematous maculopapular rash; drug eruptions
100
clubbing of nails
rounded, bulbous nail base, feels spongey
101
what causes clubbing of nails
chronic hypoxia, congenital heart disease, lung cancer
102
angle of proximal nail fold is ________ than 180 degrees
greater than
103
beau's lines
transverse depression; lines grow out with the nail
104
paronychia
acute or chronic inflammation of the proximal and lateral nail folds; nail fords swollen, reddened, and tender
105
what causes paranychia
frequent immersion in water
106
what causes beau's lines?
trauma or acute/severe illness
107
onchocryptosis
ingrown toenail, usually involves large toe; nail grows into dermis
108
what causes onchocryptosis
improperly cutting nails, tight shoes
109
terry's nails
mostly white with a distal band of reddish brown
110
what causes terry's nails
aging, chronic disease such as diabetes, cirrhosis, heart failure
111
leukonychia
trauma to nails causing areas of white discoloration
112
what causes leukonychia
trauma, repeated manicuring
113
koilonychia
spoon nail - possible iron deficiency anemia
114
onycholysis
painless separation of nail plate from nail bed
115
what causes onycholysis
trauma to long finger nails; psoriasis, contact dermatitis
116
onychomycosis
fungal infection of nail bed, plate, or matrix
117
causes of onychomycosis
occlusive footwear, dissemination of fungal infections, locker room exposure
118
nail pitting
psoriasis, RA, SLE, alopecia areata (all autoimmune)

Physical Diagnosis (4 decks)

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