Module 4: Hair, Skin, & Nails Flashcards
(95 cards)
1
Q
What are some of the major functions of the skin to help keep the body in homeostasis?
A
Provide boundaries for body fluid, protects underlying tissues from microorganisms, harmful substances, and radiation, modulates body temperature, synthesizes vit. D.
2
Q
T or F: The skin is the heaviest single organ in the body.
A
True…16% of body weight.
3
Q
What are the 3 layers of the skin?
A
Epidermis, dermis, subcutaneous tissue.
4
Q
What are the hair, nails, and sebaceous and sweat glands in regards to the skin?
A
Appendages.
5
Q
What are some terms to describe hair?
A
Vellus hair - short, fine, less pigmentation.
Terminal hair - coarser, pigmented (scalp/eyebrows)
6
Q
What is the function of the nails?
A
Protect distal ends of fingers/toes.
7
Q
Where are sebaceous glands?
A
Present on all surfaces except palms/soles!! They produce a fatty substance secreted onto skin surface through hair follicles.
8
Q
What are the two types of sweat glands?
A
Eccrine and Apocrine
9
Q
What do eccrine glands do?
A
They help control body temperature. They’re widely distributed and open directly onto the skin surface.
10
Q
Where are apocrine glands found?
A
They’re found in the axilla and groin and are stimulated by emotional stress.
11
Q
What are some common or concerning symptoms regarding hair, skin, nails?
A
Hair loss, rash, and moles.
12
Q
What are the most common cancers in the US?
A
Skin cancers with the most prevalent being hands, neck, and head.
13
Q
What are some types of skin cancer?
A
Basal cell carcinoma, squamous cell carcinoma, and melanoma.
14
Q
What are the characteristics of basal cell?
A
Comprises 80% of skin cancers. Shiny and translucent, they grow slowly and rawly metastasize.
15
Q
What are the characteristics of squamous cell?
A
Comprises 16% of skin cancers. Crusted, scaly, and ulcerated, they can metastasize.
16
Q
What are the characteristics of melanoma?
A
Comprises 4% of skin cancers. Rapidly increasing in frequency, they spread rapidly.
17
Q
What are the HARRM risk factors for Melanoma?
A
First, not sure what HARRM is (might come across it when reading)….. History of previous melanoma, Age > 50, regular dermatologist absent, mole changing, and male gender.
18
Q
Other risk factors for Melanoma:
A
- ≥50 common moles
- ≥1-4 atypical or unusual moles (especially if dysplastic)
- Red or light hair
- Actinic lentigines, macular brown or tan spots (usually on sun exposed areas)
- Heavy sun exposure (especially severe childhood sunburns)
- Light eye or skin color (especially freckles/burns easily)
- Family history of melanoma
19
Q
What are the ABCDE’s of melanoma?
A
A for asymmetry
B for irregular borders, especially ragged, notched, or blurred
C for variation or change in color, especially blue or black
D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding
E for elevation or enlargementA for asymmetry
20
Q
Techniques for skin exam:
A
- Make sure the patient wears a gown
- Drape appropriately to facilitate close inspection of hair, anterior and posterior surfaces of body, palms and soles, and webspaces
- Inspect entire skin surface in good light
Preferably in natural light (or artificial light that resembles natural)
Artificial light often distorts colors
21
Q
What do you look for when inspecting and palpating the skin?
A
Color, moisture, temperature, texture, mobility and turgor, and lesions.
22
Q
T or F: A patient often notices a change in color before a physician.
A
True.
23
Q
When examining color:
A
- Look for increased pigmentation, loss of pigmentation
- Look for redness, pallor, cyanosis, and yellowing
- Red color of oxyhemoglobin best assessed at fingertips, lips, and mucous membranes
- In dark-skinned people, palms and soles
- For central cyanosis, look in lips, oral mucosa, and tongue
- Jaundice - sclera
24
Q
Additional items to note when examining the skin include:
A
1. Moisture Dryness, sweating, and oiliness 2. Temperature Use back of fingertips Identify warmth or coolness of skin 3. Texture Roughness or smoothness 4. Mobility and turgor Lift fold of skin and note ease with which it lifts up (mobility) and speed with which it returns to place (turgor)
25
When looking a lesion, it is good to note what?
Anatomic location and distribution, patterns and shapes, type of lesion (macules, papules, nevi and vesicles), and color.
26
What should you do when you see a skin lesion?
Look is up in a well-illustrated textbook of dermatology.To arrive at a dermatologic diagnosis, consider the type of lesions, location, and distribution, along with the patient’s history and physical.
27
T or F: When inspecting the hair, note the quantity, distribution, and texture.
True.
28
When inspecting the nails:
Inspect and palpate fingernails/toenails, note color and shape, note lesions, longitudinal bands of pigment may be a normal finding in people with darker skin.
29
What to examine with a bed bound patient:
People confined to bed are particularly susceptible to skin damage and ulceration. Pressure sores result when sustained compression obliterates arteriolar and capillary blood flow to the skin.
Assess these patients by carefully inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels. Roll patient onto one side to see sacrum and buttocks.
30
How should you record your findings?
Initially you may use sentences to describe findings; later you will use phrases:
Examples:
“Color good. Skin warm and moist. Nails without clubbing or cyanosis. No suspicious nevi. No rash, petechiae, or ecchymoses.”
“Marked facial pallor, with circumoral cyanosis. Palms cold and moist. Cyanosis in nailbeds of fingers and toes. One raised blue-black nevus, 1x2 cm, with irregular border on right forearm. No rash.”
31
Jaundice:
Jaundice that appears within the first 24 hours after both is likely to be pathologic jaundice due to hemolytic disease of newborn. Jaundice that persists beyond 2-3 weeks should raise suspicions of biliary obstruction or liver disease.
32
What can be misdiagnosed as ecchymosis, raising corn of intentional injury.
Mongolian Spots
33
Are benign skin lesions and rashes common in childhood?
YES
34
Dermatological problems result from a number of mechanisms including:
inflammatory, infectious, immunological, and environmental, (traumatic and exposure induced).
35
Examination involves the classification of __________ features.
Morphological. Analyze as follows: location, distribution, primary or secondary, shape, margins, pigmentation, texture and consistency, size.
36
Fever is common in viral rashes.
True. Fever and rash is not life threatening. However, fever, irritability, hypotension, and a macular or petechial rash may indicate meningoccemia.
37
What is associated with an allergic reaction?
Angioedema of the extremities, face, lips, tongue, and/or airway; cough; wheezing; shortness of breath; or heart palpitations.
38
What is toxic epidermal necrolysis?
Also called Stevens-Johnson Syndrome, is a tender, morbiliform erythematous rash accompanied by fever, conjunctivitis, oral ulcers, and diarrhea. It is usually drug induced.
39
Acute Rashes:
allergic or contact dermatitis, candida dermatitis (diaper rash, intertrigo) erythema infectiosum (fifth disease), erythema multiform, fixed drug eruptions, folliculitis, Herpes Simplex, Herpes Zoster/varicella zoster, impetigo, scabies, pediculosis, insect bites, Kawasaki disease, pityriasis rosea, septicemia, scarlet fever, tinea, urticaria, and measles. Box 25-1
40
Chronic Rashes:
Acne vulgaris, bullous pemphigus, eczema, erythema nodosum, kaposi sarcoma, mycosis fungoides, polyarteritis nodosa, psoriasis, rosacea, seborrheic dermatitis, and systemic lupas erythematosius. Box 25-1
41
Most skin lesions evolve over time but this varies from minutes to weeks or months.
True.
42
What does pityriasis rosea classically begin with?
A "herald patch", a single, scaly, erythemous patch usually on the truck, followed within days by a regional out breath of numerous smaller erythematous patches. May look like ringworm.
43
How does herpes simplex begin?
Begins with small vesicles that later umbilicate, possibly ooze, and eventually crust before healing.
44
What 3 groups help classify dermatoses?
Always itches, never itches, and variable itching.
45
When is pruritus worse, day or night?
Night
46
Where does swimmer's itch occur?
In areas unprotected by a swimsuit.
47
Where is sea bather's itch?
Under the swimsuit.
48
When does nocturnal pruritus occur?
In scabies.
49
Itching in the absence of rash may be an important clue to internal disease.
True.
50
Is pain common in rash?
No, it is a rare symptom. Pain can be associated with herpes zoster. Soreness is a more common symptom associated with numerous rashes.
51
Is fever a common presenting complaint in infectious disease?
Yes.
52
What occurs with mono?
Malaise, sore throat, nausea, or vomiting.
53
What are the two most common causes of a maculopapular eruption?
Drug reaction and viral illness.
54
How long can it take for a patient to develop a rash after travel?
Weeks or months.
55
Where is erythema nodosum common?
Southeast Asia
56
Where is leprosy common?
Africa, Southeast Asia, and South America.
57
What is the leading vector borne infectious disease?
Lyme Disease.
58
People exposed to _________ contaminated with Bacillus anthraces can develop cutaneous anthrax, characterized by lesions tha revolve from a papule, through a vesicular stage, to a depressed eschar.
Animal skin.
59
Where are insect bites usually?
On the legs.
60
What usually exacerbates rosacea?
Coffee, tea, alcohol, or spicy foods.
61
Stress can _________ or __________ many chronic rashes especially eczema and psoriasis.
trigger; worsen. Stress can also facilitate recurrent eruptions of HSV.
62
There are four types of dermatological effects of drugs:
Side effects, allergic reactions, commensal skin eruptions, and worsening of existing skin eruptions.
63
How long after a measles vaccination may a rash display?
10-14 days.
64
What are some common family problems of skin disease?
Psoriasis, seborrheic dermatitis, and rosacea.
65
What is diascopy?
It is used to assess for blanching on pressure and is accomplished by pressing a class or clear plastic slide on a lesion. It is helpful in evaluating purpuric lesions. Blood that is outside the vessel will not blanch, whereas that entrapped with dilated vessels will demonstrate this phenomenon.
66
What is long wave UV light (Wood's Light) used for?
The diagnosis of lesions caused by fungal infections. Many, not all, fungal rashes fluoresce.
67
Skin scraping and Potassium Hydroxide Prep:
Gently scrape a lesion using a scalpel (collect from the border); treat the cells with 20% KOH and then warm or allow to stand a few minutes to soften the keratin.
68
What is a Tzanck Smear?
It is an indirect test for herpesvirus infections. Cells are retrieved by swabbing the base of the lesion, smearing it onto a glass slide, then staining it with Giemsa or Wright solution. The presence of multinucleated giant cells confirms the diagnosis.
69
Bacterial Culture:
Exudate from a lesion is collected on a sterile swab and then cultured for growth. Antibiotic testing is performed when a bacterial isolate is known.
70
Viral Culture:
Cell from the base of a lesion (usually a vesicle) are collected on a Dacron swab and cultured for identification of viral infections (HSV or HZ).
71
How do you do a punch biopsy on a lesion?
Selected a punch size size about 2-3 mm larger than the lesion or sample an active area if the lesion is large. Gently swirl while exerting slight downward pressure on the punch. and excise the sample at its base. Place sample in a perservative.
72
How does an excisional biopsy work?
Excise the lesion, usually making an elliptical incision around the lesion beyond its margins. Excise the base and close the defect with sutures or cauterize bleeding vessels. Place sample in a perservative.
73
Acne Vulgaris
Presents as a chronic eruption of pilosebaceous unit, with noninflammatory lesions, and is most commonly a problem of adolescents. Face, neck, chest, back, and upper arms. Neonatal acne occurs between 2-4 weeks of age, lasting until 4-6 months of age. Persistence beyond 12 months may indicate endocrine dysfunction.
74
Rosacea
Vasomotor instability disorder characterized by sebaceous gland hypertrophy, papules, pustules, persistent erythema, and telangiectasias.
75
Folliculitis:
Presents as a superficial pustular infection of the hair follicles. Caused by staph, and occasionally strep or gram neg organisms including pseudomonas, klebsiella, proteus.
76
Impetigo
Presents as a superficial pustular, bullous, or nonbullous eruption followed by crusting. Caused by staph or strep. Contagion occurs via direct inoculation.
77
Furuncle
A boil, more extensive infection secondary to a folliculitis.
78
Carbuncle:
An abscess of conjoined or adjacent furuncles.
79
What is 5th's disease?
Erythema infectious also known as a slapped cheek disease, presents as a systemic illness of sudden onset characterized by coalescing, red, maculopapular eruption on the face. A reticular eruption occurs not he extremities 2-3 days later. Caused by parvovirus B19.
80
Measles:
Or rubeola, is caused by a viral exanthem, and the systemic illness that results is characterized by a fine, erthematous, morbiliform eruption on the face that spreads rapidly to the trunk and becomes confluent and reticulate. Cough, purulent coryza, photophobia and fever precede the rash.
81
Rubella
Results from viral exanthem similar to measles, starts as fine macules and papules on the face and progresses caudally.
82
Pityriasis Rosea
Presents with a rapidly evolving papulosquamous eruption of possible viral etiology. An initial "herald patch" is characteristic then faint patches on the trunk and upper extremities.
83
Scarlet Fever:
Systemic illness associated with group A beta hemolytic strep (GABHS). Characterized by a macular erthema of the face, except around mouth followed by a disseminated fine papular erythema which may then desquamate. Rash intensified in in the flexor folds. Sore throat, fever, circumoral pallor, and a white or strawberry tongue.
84
Roseola
Viral infection caused by human herpesvirus 6. 2-3 days of sustained fever in an irritable infant who otherwise appears well.
85
Hand-Foot-Mouth Disease
Coxsackievirus A16 (yes that is the name) is the causative organism of this viral exanthem and systemic illness. Painful mouth ulcers followed by painful white vesicles with a surrounding erythema on the fingers, palms, toes, and soles. Can have submandibular or cervical lymphadenopathy.
86
Insect Bites
Can cause a common blistering reaction. Deer tick bite causes a bullseye rash.
87
Herpes simplex virus
HSV lesions have vesicles that are surrounded by an erythematous base, with discrete, well demarcated areas that later crust. (lips and genitalia)
88
What is another name for Herpes Zoster?
Shingles!
89
What is candidiasis?
A yeastlike fungus that produces rashes at a variety of sites: vaginitis, thrush, intertrigo, diaper dermatitis. erythematous maculopapular eruption thats well demarcated, occasionally with satellite lesions at the periphery with maceration in moist areas.
90
Tinea
Fungal eruption that causes rashes at a variety of sites: body, foot, beard, groin, and scalp.
91
Pityriasis Versicolor
yeast infection characterized by a macular eruption of many colors, hypo pigmentation to hyperpigmentation, and fine scaling.
92
Eczema
Chronic relapsing inflammatory condition that can take several forms (atopic, nummular, or dyshidrotic).
93
Contact/Allergic Dermatitis
Inflammatory reaction to many substances.
94
Psoriasis
Chronic, relapsing autoimmune disorder characterized by well-demarcated erythematous plaques. patches, and papules which present with silvery scales.
95
Seborrheic Dermatitis
Chronic relapsing disorder charactered by erthematous scaling patches which are POORLY demarcated and may be pruritic.
