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Skin Flashcards

(65 cards)

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1
Q

Layers of the skin

A

Epidermis: outer layer- horny; dead keratin

inner layer-cellular, melatonin and keratin formed

inner layer migrates to outer layer in a month

superficial thin layer, no blood vessles

Dermis: nourish epidermis, connective tissue, sweat glands, sebaceous glands, hair follicles

Subcutaneous: adipose tissue/fat

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2
Q

Skin pigmentation

A

Melanin- brownish

Carotene- golden yellow

Oxyhemoglobin- bright red

Deoxyhemoglobin- dark blue pigment

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3
Q

Cyanosis

A

depends on oxygen concentration

Central; low O2 level in blood

Advanced lung disease, congenital HD, hemoglobinopathys

Peripheral; occurs when cutaneous blood flow decreased and slow- may be normal

CHF, reflects low blood flow, venous obstruction

PEdema can e both

Tissues extract more oxygen than usual from the blood

Can be normal response to anxiety or cold

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4
Q

Hair

A

Vellus: short, fine, inconspicuous, relatively unpigmented

Terminal: coarser, thicker, more conspicuous, usually pigmented, scalp hair and eyebrows

Changes with hair distribution d/t systemic effects from Thyroid gland

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5
Q

Nails

A

protect distal ends of fingers and toes

fingernails grow 0.1mm daily

toenails grow slower

angle between nail fold and plate <180degrees

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6
Q

Glands

A

Sebaceous: produce fatty substance screened onto the skin surface through the hair follicles. Absent from palms and soles

Sweat :

Eccrine: widely distributed, open directly onto skin, sweat production helps control body temp.

Apocrine: Axillary & genital regions, usually opens into hair follicle, stimulated by emotional stress, bacterial decomposition of apocrine sweat is responsible for adult body odor

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7
Q

Health History

A

Changes with hair, nails, skin??

Noticed: rash, sores, lumps, itching

Family Hx of skin CA

Personal Hx of skin Bx

Seen Dermatologist

Any special skin products

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8
Q

Pruritis

A

causes: dry skin, aging, pregnancy, uremia, jaundice, lymphoma, leukemia, lice, drugs

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9
Q

Moles

A

Concerning moles?

Changes with size, shape, color, sensation, new moles?

A- asymmetry

B-borders

C-color change

D-diameter >/= 6mm

E-elevation/evolving

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10
Q

Skin Cancer

A

Basal Cell: 80%- basal level of epidermis, pearly white, head and neck, slow growth, no mets

Squamos Cell: 16%- upper layer, crusted, red, ulcerated, mets

Melanoma: 4% Lethal, mets to lymph, int organs. Half detected by patient

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11
Q

Skin 4 letter words

A

skin

itch

burn

peel

rash

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12
Q

ROS

A

onset pruritis, repsonse to Tx

Associated constitution or systemic Sx

home/OTC Tx/response

skin lesions: change in size/color

Bleeding

Unusual dryness/ Increased sweating

painful lesions

hair changes

nail changes

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13
Q

Dyshydrotic

A

related to water or sweat

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14
Q

Hyperhydrosis

A

excessive/profuse sweating

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15
Q

Xerosis

A

excessive dryness

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16
Q

Induration

A

process of becoming firm or hard

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17
Q

Usual Suspects

A

Contact Dermatitis

Pyodermas- Bacterial Infection

Viral infection

fungal infection

candida/monolial overgrowth

BCC/SCC potential for overlap

Medication effects

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18
Q

Derm Principles

A

Be alert and integrate exams

keep a good derm text near

Find out what pt has beend oing, treating with, what they think, their Dx

Maintain low threshold for Bx for any lesions that don’t respond to Tx- esp ulcers and nodules

Speak and write language fluently

ID by location, distribution, morphology, pregression, symptomatology- can always reference treatment

ABCDE of moles

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19
Q

Physical Exam

A

General Survey:

Closely inspect hair, nail, skin. Palms, soles, web spaces, mucous membranes

Bedridden patient: sacrum, coccyx, buttock, greater trocanter, knees, heels

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20
Q

Skin

A

Color- cyanosis, pallor

Moisture

Temperature- warm=Hyperthroid, fever: cool= hypothyroid: local warmth=inflammation/cellulitis

Texture: rough=hypothyroid: velvety=hyperthyroid

Mobilty/Turgor: decr mobility with edema & scleroderma, decr turgor=dehyration

Lesions

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21
Q

Alopecia

A

Hair loss

Causes: genetic, local inflammatory process, systemic disease

diffuse patchy or total

Hypothyroid=sparse

Hyperthyroid=fine/silky

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22
Q

Distribution

A

Acne: face chest, back

psoriasis: knees, elbows

Candida: intertriginous

Herpes Zoster: unilateral dermatomal pattern

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23
Q

Skin Lesions

A

location: general/local

distribution

blanchable?

pattern/shape: linear, clustered, annular, arciform, geographical, serpiginous

size

shape

type- macule,papule, vesicle, nevi

color

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24
Q

Scabies

A

Mites can be loosened with scapel blade

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25
Derm Colors
Flesh Erythematous- red Violaceous- blue brawny- brown jaundice- yellow- seen in sclera hyperpigmented- dark hypopigmented- light vitiligo- absense of melanin heliotropic- changing
26
Cafe Au Lait Spots
uniformly pigmented spots, macule/papule (0.5-1.5 cm diameter). Benign. 6 or more with diameter \> 1.5cm c/w neurofibrmatosis
27
Heliotrope
viloceous eruptions over eyelids in collagen vascular disease, dermatoyositis
28
Tinnea Versicolor
sup fungal infection-\>decr pigmentation, scaly macules on neck and upper arms easy to see dark skin, light skin may be red/tan instead of pale
29
Fifth's Disease
Slapped cheeks, erythema infection
30
Vitiligo
depigmented macules on face, hands, feet, ext surfaces. May coalecse into large areas without melatonin: hereditary
31
Herpes Zoster
Shingles, reactivation of chicken pox virus (Varicella). follow dermatomal pattern often preceded by prodromal symptoms of pain, burning, tingling vesicles erupt on erythematous base can be painful may need long term pain management
32
Pityrisis Rosea
scaly fine paules/plaques dull pink or tawny christmas tree distribution- on trunk and prox ext. Herald pattern- 2-5cm bright red slightly raised plaque with fine scale at periphery more common fall/spring sontaneous recovery in ~ 6 wks
33
Intertriginous
dark in skin folds
34
Macule
\<1cm spot, different color, not raised or depressed
35
Patch
\> or = 1 cm spot different in color, nat raised or depressed
36
Papule
circumscribed solid elevation \< 1 cm
37
Plaque
circumscribed solid elevation \> or = 1 cm confluence of papule
38
Nodule
palpable solid round elevated mass/lesion \> 0.5cm
39
Tumor
palpable solid round elevated mass/lesion \> 2cm
40
Erosion
breakdown of epidermis to dermis
41
Lichenification
thickening of skin
42
Atrophy
thinning of skin layers
43
Ecchymosis
bruising
44
Scale
small thin plate of horny epithelium heaved up keratin
45
Crust
accumulation of debris: thick/thin
46
Ulcer
open area caused by superficial loss of tissue, usually with inflammation
47
Keloid
hypertrophic scarring extending beyond borders of the initiating injury
48
Fissure
deep furrow, cleft or slit
49
Warts
Caused by HPV, \> 65 types subclinical infection/ benign lesion skin/mucus membranes affected infect keratinized skin firm papular lesions plaque may have hyper keratotic surface, studded with black/brown dots Tx: cyrotherapy, slaicylic acid, duct tape
50
Skin tags
Acrochordon/cutaneous papilloma/soft fibroma common soft, skin colored/tan/brown, round/oval pedunculated fleshy skin lesion (polyp) tender after trauma/torsion, may crust/bleed common in skin folds often increase with pregnancy, insulin resistance
51
Trichotillomania
compulsion to pul out hair
52
Nail DO
Paronychia: sup inf of prox/lat nail fold(staph/strep) Pitting: punctuate depression of nails Clubbing: nail angle \>180 degrees Transverse/Linear depression: Beau's line: transverse depress of nail plate, usually following illness: severe febrile, malnutrition, trauma, coronary occlusion Longitudinal bands of pigment may be normal in people with darker skin
53
Nail inspection
inspect, palpate nails/toenails color, shape, lesion
54
Seborrheic Keratosis
starts as macule skin colored lesion or light tan with more pigment over time flat to raised stuck on warty looking lesions plaque-like yellow brown velvety/warty white pearly nodules within not associated with risk for malignancy Tx: cryotherapy
55
Actinic Keratosis
superficial flattened papules covered by dry scale often multiple can be round/irregular pink/tan/grey appear on sun-exposed skin of older, fair skinned of people 1/1000 per year develop into squamos cell carcinoma
56
Basal Cell
80% skin cancer pearly white round border, depressed center/firm elevated borders flesh color central divot translucent telegectacias ulcerates/bleeds rarely metatasized slow growing fairskinned \> 40 years
57
Squamos Cell
Suddenly shows up, grows quick upper layer of epidermis crusted/scaly/ firm red inflammed/ulcerated can metastasize on skin exposed to sun can be evolving AK, usually \> 60yo
58
Melanoma
from pigmented layer of epidermis lethal, most rapidly increasing US malignancy Inc risk with severe blistering sunburn 80% of deaths from skin cancer rare cases of amelneous melanoma
59
HARRM Risk Model
Hx previous melanoma Age \> 50yo Reg derm absent mole changing male gender
60
Spider Bite Epidemic
Community acquired MRSA MRSA often difficult to Tx d/t resistance PCP Can be sup pyoderma absess, impetigo, folliculitis, cellulitis visual Dx inadequate secondary infection
61
Derm Emergencies
Urticaria w/Angiodedema Anaphylactic Reaction Toxic Epidermoid Necrolysis (TEN) Necrotizing Fascititis TSS
62
Health Promotion
Risk factors Skin self exams Avoid tanning beds Avoid excessive sun exposure: daily SPF UVA/UVB 15 or greater, reapply every 2 hours or if skin wet
63
Bedbound patient
shaering, sustained compression, friction localized redness,warmth sign of impending necrosis
64
Age related Skin changes
Flattening of dermoepidermal junction: less resistance to shearing forces/thinning of skin Reduced collagen/elastin: wrinkling Decr epidermal cell turnover rate: reduce healing Decr vasc responsiveness: red vasodil(cooling) and dec transdermal absorption Decr subq fat: dim bony protection of prominences & thermoreg Decr epidermal :angerhan cells: decr hypersensitivity response Atrophy of eccrine/sebaceous gland: reduce oil/sweat, decr thermoreg. and pliabilibty of skin
65

Physical Assessment (7 decks)

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