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From Flashcardlet > PD Skin and Nails > Flashcards

PD Skin and Nails Flashcards

1
Q

What is the largest organ of the body?

A

Skin

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2
Q

What are the functions of the skin?

A 
Protect from microbes, foreign substance, trauma
Prevents fluid loss
Regulates body temp
Sensory perception
Excretes sweat, urea, lactic acid
Synthesizes vitamin D
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3
Q

What are the appendages of the skin?

A

Eccrine and appocrine sweat glands
Sebaceous glands
Hair
Nails

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4
Q

What are the layers of the skin

A

Epidermis
Dermis
Hypodermis

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5
Q

What are the two main layers of the epidermis?

A

Outer horny layer (stratum corneum)

Inner cellular layer

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6
Q

What consists of the strata corneum?

A

Tightly packed dead squamous cells that contain keratin

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7
Q

What is formed in the inner cellular layer of the epidermis?

A

Melanin and keratin is formed from melanocytes and keratinocytes

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8
Q

Which layer of the epidermis is only located on thicker skin on the palms and soles?

A

Stratum lucidem

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9
Q

Where does the stratum lucid lie?

A

Just beneath stratum corneum

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10
Q

Where does the basement membrane lie and what does it connect to?

A

Just below epidermis, connecting it to the dermis

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11
Q

Does the epidermis have vasculature?

A

No, avasuclar, depending on the dermis for nutrition

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12
Q

How long does the migration from the inner layer to the top layer of the dermis take?

A

About one month

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13
Q

Is the dermis vascular?

A

Yes, richly vascular providing nourishment

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14
Q

What specific structures from the dermis penetrate the epidermis to provide nourishment?

A

Papillae

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15
Q

What does the dermis support and separate?

A

Supports and separates the epidermis from the adipose tissue

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16
Q

What fibers provide strength, resilience, and stability to the dermis?

A

Elastin, collagen, reticulin

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17
Q

What fibers are located in the dermis for pain, touch, and temp?

A

Sensory fibers

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18
Q

What do the autonomic motor nerves do in the dermis?

A

Inneverate blood vessels, glands, and arrestor pili muscles

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19
Q

What is another name for the subcutaneous layer?

A

Hypodermis

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20
Q

What is the hypodermis?

A

Loose connective tissue filled with adipose cells

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21
Q

How does the hypodermis help with temp regulation?

A

Generates heat and provides insulation

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22
Q

How else does the insulation of the subq tissue help the body?

A

Shock absorption

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23
Q

How does the subq tissue help with energy stores?

A

Reserve of calories

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24
Q

Where do eccrine sweat glands open to?

A

Directly onto skin surface

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25
Q

How do eccrine glands regulate temperature?

A

Through water secretion

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26
Q

Where are eccrine glands not located?

A

Lip margins
Eardrums
Nail beds
Glans penis

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27
Q

What is the function of sebaceous glands?

A

Keeps skin and hair from drying out by secreting sebum

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28
Q

Secretory activity varies according to what throughout a persons life?

A

Hormone levels

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29
Q

Where are apocrine glands found?

A 
Axillae
Nipples
Areola
Anogenital area
Eyelids
External ears
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30
Q

Which is larger and deeper, eccrine or apocrine?

A

Apocrine

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31
Q

What is the stimulus that causes apocrine glands to secrete white fluid?

A

Emotional stimuli

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32
Q

What produces body odor?

A

Bacterial decomposition of apocrine sweat

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33
Q

What are the components of a hair?

A

Root, shaft, follicle

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34
Q

What is the papilla of a hair?

A

Loop of capillaries at the follicle that provides nourishment

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35
Q

What provides the color of a hair?

A

Melanocytes

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36
Q

What are nails comprised of?

A

Epidermal cells converted to hard plates of keratin

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37
Q

What gives a nail its pink color?

A

Highly vascular nail bed that lies beneath the plate

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38
Q

What is the name for the cuticle?

A

Eponychium

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39
Q

What layer of the epidermis is the cuticle?

A

Stratum corneum layer of skin covering the nail root

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40
Q

What are the essentials of a good skin exam?

A 
Adquate exposure
Adquate light
Adequate history taking
Insepction
Look FOR lesion, not just AT them
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41
Q

Skin is the most… but often the most…

A

Skin is the most accessible, but often the most overlooked

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42
Q

Color

A 
Pallor
Cyanosis
Jaundice
Redness
Pigmentation
Look at:
Fingernails
Mucosa
Lips
Sole/palm
Sclera
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43
Q

Moisture

A

Dryness
Diaphoresis
Oiliness

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44
Q

Texture

A

Rough

Smooth

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45
Q

Mobility

A

How easily skin lifts

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46
Q

Turgor

A 
How quickly skin returns into place:
Hand
Sternum
Forearm
Abdomen
Forehead
Do not check elderly on hand or forearm
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47
Q

Jaundice cause, seen in

A

Caused by elevation of bilirubin

Easily seen in sclera (icterus)

48
Q

Cyanosis cause, seen in

A

Hypoxia and decreased perfusion

Seen in toes, fingers, lips

49
Q

Mottling, cause

A

Skin hypo perfusion leads to patchy, purplish discoloration

Septic shock

50
Q

Increased skin turgor

A

Edema

51
Q

Growth

Example

A

Discrete lesions resulting from proliferation of one or more of the skin’s components
Ex. nevi, cysts, cancer

52
Q

Rashes

Examples

A

Inflammatory processes that usually are more widespread than growths
Ex. psoriasis, urticaria, viral exanthems

53
Q

What are the characteristics of lesions we look for?

A 
Size
Shape
Color
Texture
Elevation or depression
Exudates
Pedunculation
Confirguration
Location/distribution
54
Q

Configuration

A 
Linear
Arciform
Annular
Geographic
Serpiginous
Clustered
Diffuse
55
Q

Location/distribution

A 
Generalized
Localized
Exposed surfaces
Exposed to irritants
Skin folds
Extensor versus flexor surface
56
Q

Macule

Examples

A

Small, flat, circumscribed area
Less than 1 cm

Moles, freckles, measles

57
Q

Patch

Examples

A

Flat, non palpable, irregularly shaped macule
Greater than 1 cm

Vtiligo, port wine stains, cafe au lait spot, mongolian spot

58
Q

Papule

Examples

A

Raised, firm, circumscribed area
Less than 1 cm

Verruca (wart), raised moles, lichen planus

59
Q

Vesicle

Examples

A

Elevated, circumscribed, superficial (epidermis)
Filled with serous fluid
Less than 1 cm

Varicella, shingles, HSV

60
Q

Bulla

Examples

A

Vesicle greater than 1 cm

Blister, pemphigus vulgaris, bullous erythema multiforme

61
Q

Pustule

Examples

A

Similar to vesicle except filled with purulent material

Acne, impetigo, smallpox

62
Q

Nodule

Examples

A

Elevated, firm, marble like, deeper than papule (dermis)
.5-2 cm

Erythema nodosum, dermatofibroma, lipoma

63
Q

Cyst

Example

A

Elevated, encapsulated lesion (dermis/subq)
Filled with liquid/semi solid material

Sebaceous cyst, cystic acne, inclusion cysts

64
Q

Plaque

Examples

A

Elevated, superficial, firm lesion with flat top surface
Greater than 1 cm

Psoriasis, actinic and seborrheic keratoses

65
Q

Crust

Examples

A

Dried residue on skin of serum, blood, or pus
Slightly elevated
Varies in size and color

Scabs (eschars), eczema, impetigo

66
Q

Scale

Examples

A

Thin flake of dead, exfoliated epidermis
Irregular, thick or thin, varies in size

Seborrheic dermatitis, dry skin, drug reaction/sunburn

67
Q

Lichenification

Example

A

Rough, thickened epidermis
Increased visibility of normal skin furrow
Chronic rubbing (flexor surface), itching, skin irritation

Chronic stasis dermatitis

68
Q

Erosion

Examples

A

Loss of superficial epidermis
Depressed, moist, glistening
Rupture of vesicle or bulla
Does not bleed

Apthous stomatitis, area after ruptured vesicle

69
Q

Fissue

Examples

A

Linear crack or break in skin, due to excessive dry skin

Athletes foot (tines pedis), cheilosis

70
Q

Ulcer

Examples

A

Deep loss of epidermis and dermis

Decubiti, vascular ulcers

71
Q

Excoriation

Examples

A

Linear or punctate hollowed out crusted areas

Scratch, abrasion

72
Q

Wheal

Examples

A

Elevated, irregularly shaped area of cutaneous edema
Variable diameter, solid, transient

Insect bite, urticaria, allergic reactions

73
Q

Atrophy

Examples

A

Thinning of skin surface and loss of normal skin markings
Skin translucent, paper like

Striae, aged skin, chronic steroid use

74
Q

Keloid

A

Irregularly shaped, hypertrophic elevated scar
Growth beyond boundary of wound
Excessive collagen formation during healing

75
Q

Petechiae

Causes

A

Red purple, non-blanching discoloration
1-3 mm

Intravascular defects like thrombocytopenia, increased INR, infection, vasculitis

76
Q

Purpura

A

Larger petechiae

May be palpable (vasculitis)

77
Q

Eccymoses

Causes

A

Purple or blue, fades to green, yellow, brown
Bruise
Variable size, non-blanching

Trauma, bleeding disorder

78
Q

Telangiectasia

Causes

A

Fine, irregular red lines
.5-1 mm
Dilation of capillaries
Blanch with palpation

Hereditary, pregnancy, liver disease, CREST syndrome

79
Q

Spider angioma

Causes

A

Fiery red, central body, sometimes raised
Surrounded by erythema and radiating legs
up to 2 cm
Face, neck, arms, trunk (almost never below waist)

Liver dz, pregnancy, vitamin B deficiency, normal variant

80
Q

What are some risks for skin cancer?

A 
Age over 50
Male
Fair, freckles
Light colored hair or eyes
Tendency to burn easily
Overexposure to sun, wing, frost, from recreation or work
FHx of skin cancer
Repeated trauma or irritation to skin
Chronic ulcers
Precancerous dermatoses
81
Q

What are some features of benign nevi?

A 
Uniform color
Round or oval
Well defined border
Smooth 
5 mm or smaller
Common in sun exposed surfaces above the waist
82
Q

Where are benign nevi common?

A

Sun exposed surfaces above the waist:

Scalp, breast, and buttocks rarely have normal nevi

83
Q

What are some features of malignant nevis?

A 
Sores that do not heal
Persistent lumps or swelling
New or preexisting nevi that are:
Various shades of color
Notching in the border
Loss of skin markings
Nodule, esp with erosion or ulceration
Bleeding
Changes in color, size, or thickness
84
Q

What is ABCDE of melanoma?

A 
Asymmetry
Irregular borders
Variation in color
Diameter greater than 6 mm
Elevation (could also be flat)
85
Q

What are some characteristics of changing nevi of concern?

A 
New swelling
Redness
Scaling
Oozing
Bleeding
Itching
Burning
Pain
86
Q

What is the most common form of skin cancer?

A

Basal cell carcinoma

87
Q

Is BCC fast or slow growing? Does it metastasize?

A

Slow growing, rarely metastasize

88
Q

Where does BCC usually appear?

A

Face

89
Q

What kind of vessels are often visible with BCC?

A

Telangiectatic

90
Q

What are the various clinical forms of BCC?

A 
Nodular
Pigmented
Cystic
Sclerosing
Superficial
91
Q

What are two risk factors for developing BCC?

A

Fair skin and sun exposure

92
Q

Where is SCC usually found?

A

Sun exposed areas like scalp, back of hands, lower lip, ear

93
Q

What do the lesions of SCC look like?

A

Soft, elevated with a suface scale
Base may be inflamed
Actinic keratosis

94
Q

Does SCC grow slow or fast?

A

Usually grows more quickly than BCC

95
Q

Compare the appearance of SCC to BCC

A

SCC looks firmer and redder

96
Q

What is actinic keratosis?

A

Superficial, flattened papules covered by dry scale
Often multiple
Round or irregular
Pink, tan, or gray

97
Q

Is actinic keratosis benign or malignant?

A

Benign, although 1/1000 develop into SCC

98
Q

What is seborrheic keratosis?

A

Common, benign, yellow-brown raised lesions
Slightly velvety, greasy, warty
“Stuck on” appearance
Multiple, symmetrically distributed

99
Q

Inspection of nails

A 
Pigmentation
Color
Length
Hemorrhages
Hygiene
Clubbing
100
Q

Palpation of nails

A

Nail bed adherence

Capillary refill time

101
Q

What is clubbing?

A

Distal phalanx of each finger becomes rounded and bulbous, nail plate more convex

102
Q

What angle is clubbing of the fingers?

A

Angle between plate and proximal nail fold can be more than 180 degress

103
Q

Causes of clubbing

A

Chronic hypoxia from
Respiratory (COPD, lung CA)
Cardiac (CHF)
Cirrhosis

104
Q

Beau’s lines

Example

A

Transverse grooving in the nails
Emerge from under proximal nail folds weeks later and gradually grow out
Acute severe illness

105
Q

Terry’s nails

Examples

A

Nails mostly white with distal band of reddish brown
Lunulae may not be visible

Aging and chronic disease (cirrhosis, CHF, DM)

106
Q

Sunungual hematoma

A

Collection of blood under nail due to trauma

107
Q

Paronychia

A

Infection of nail bed, often relation to trauma

108
Q

Splinter hemorrhage

Example

A

Linear hemorrhage in nail bed
Common in people who perform manual labor
Endocarditis

109
Q

Oncholysis

Causes

A

Separation of nail plate form nail bed
Starts distally
Multiple nails involved

Hyperthyroid, psoriasis, eczema, mycotic diseases of nails

110
Q

Koilonychia

Examples

A

Spoon nails
Central depression of nail with lateral elevation of nail plate

Iron deficiency anemia, syphilis, fungal dermatoses, hypothyroid

111
Q

Nail pitting

Causes

A

Small depression on nail surface

Psoriasis, lichen planus, eczema, alopecia areata, idiopathic

112
Q

Hair assessment

A

Color
Distribution
Texture
Quantity

113
Q

Tricholtillomania

A

Loss of scalp hair due to physical manipulation
Unconscious habit
Irregular border, decreased hair density
Site is not totally bald

114
Q

Alopecia areata

Causes

A

Sudden, rapid, patchy loss of hair
Smooth skin
Scalp or face
Emotional disturbances, infection, chemo

115
Q

Hirsuitism

Causes

A

Growth of hair in women in the male distraction pattern
Symptom, not a disease

PCOS, Cushing’s, adrenal hyperplasia, insulin resistance, glucocorticoids

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