Skin

Question 1

Functions of Integumentary System

(hair, nails, glands)

Answer 1

• protects underlying structures
• provides sensory information: pain, temp, pressure
• protects from UV rays
• regulate body temperature
• prevents dehydration
• synthesizes vitamin D

Question 2

Physical Exam of Integumentary System Includes

Answer 2

skin, hair, nails

mucous membranes: mouth, eyes, anus, genitals

Question 3

Skin Exam Techniques Used

Answer 3

• inspection
  
  • color and uniform appearance
  • thickness
  • symmetry
  • hygiene
  • lesions
  • odors
• palpation
  
  • moisture (min perspiration or oiliness)
  • temperature (cool to warm; symmetrical)
  • texture (smooth, soft, even)
  • turgor (fullness produced by fluid in skin)
  • mobility

Question 4

Skin Exam Equipment

Answer 4

• pen light
• centimeter ruler
• magnifying glass or dermatoscope
• Wood’s lamp
• gloves

Question 5

flat or slightly elevated, dark brown mole

Answer 5

junctional nevus - remove

Question 6

slightly elevated brownish papule w/ indistinct border

Answer 6

compound nevus - remove

Question 7

dome-shaped, raised, flesh to black colored mole

(can be pedunculated -stalk- or hair baring)

Answer 7

intradermal nevus - not necessary to remove

Question 8

sharp oval or circular mole with depigmented ring surrounding

Answer 8

halo nevus - biopsy

Question 9

sometimes present at birth and can cover large area

(hair growth can occur after several years)

Answer 9

hairy nevus - remove

Question 10

Normal vs Dysplastic Nevi

Answer 10

color: uniform v. mixture of colors
shape: well defined borders v. irregular/notched borders
surface: smooth bump v. scaly/rough
size: <6mm v. >6mm
number: 10-4 v. >100
location: sun-exposed areas v. anywhere

Question 11

ABC’s of Pigmented Lesions

Answer 11

A- asymmetry of shape

B- border irregular

C- color irregular

D- diameter > 6mm

E- evolving/changing

Question 12

Risk factors of Melanoma

Answer 12

• Previous hx
• Family hx
• Mole changes
• UV exposure
• Fair skin
• Sun sensitivity

Question 13

pigmented benign lesions on sun exposed areas of

immature keratinocytes

Answer 13

seborrheic keratosis

Question 14

causes of skin color changes

Answer 14

• striae (stretch marks)
• freckles
• birthmarks
• melasma/chloasma- facial discoloration, “mask of pregnancy”
• vitiligo- “geographic skin depigmentation”

Question 15

Skin Color Meanings

Answer 15

• brown: darkening of melanin pigment
  
  • generalized: pituitary, adrenal, liver disease
  • localized: nevi, neurofibromatosis
• white: absence of melanin
  
  • generalized: albinism
  • localized: vitiligo
• red: increased cutaneous blood flow
  
  • generalized: fever, viral xanthema, urticaria (hives)
  • localized: inflammation
• yellow:
  
  • jaundice- liver disease
  • increased carotene pigmentation- hypothyroid, veggies
• blue: hypoxia- VC and pulmonary disease

Question 16

Vascular Discolorations

Answer 16

• Non-blachable
  
  • purpura, petechiae, ecchymosis
• Vasculature
  
  • spider angioma
  • venous star
  • telangiectasia (spider veins)
  • capillary hemangioma (extra vessels in skin)

Question 17

Causes of Odors

Answer 17

• rotten apples- Clostridium gas gangrene
• mousy- Proteus infection
• grapelike- Pseudomonas
• stale beer- Tuberculous lymphadenopathy
• putrid- anaerobic (scurvy)
• feculent- intestinal obstruction, peritonitis
• mousy/musty- phenylketonuria

Question 18

Primary vs Secondary Lesion

Answer 18

• primary- initial spontaneous manifestation or pathologic process
• secondary- evolution or trauma to primary lesion

Question 19

How to Describe Lesions

Answer 19

• characteristics (name or describe)
• exudates
• configuration
• location
• distribution

Question 20

primary lesion: flat, <0.5cm

Answer 20

macule

Question 21

primary lesion: flat, >0.5cm

Answer 21

patch

Question 22

primary lesion: solid, elevated, <0.5cm

Answer 22

papule

Question 23

primary lesion: solid, elevated, >0.5cm

Answer 23

plaque

Question 24

white to pink edematous papule or plaque lasting < 24h

Answer 24

wheal

Question 25

primary lesion: dermal or subcutaneous solid, elevated, \>0.5cm

Answer 25

nodule

Question 26

primary lesion: fluid/blood filled blister \<0.5cm

Answer 26

vesicle

Question 27

primary lesion: fluid/blood filled blister \>0.5cm

Answer 27

bulla

Question 28

primary lesion: cavity filled with pus \<0.5cm

Answer 28

pustule

Question 29

primary lesion: cavity filled with pus or keratin \>0.5cm

Answer 29

cyst

Question 30

secondary lesion: loose or adherent flake

Answer 30

scale

Question 31

secondary lesion: yellow, brown, black or green deposit of serum, blood or pus

Answer 31

crust

Question 32

secondary lesion: thickening of epidermis

Answer 32

lichenification

Question 33

secondary lesion: deep crack in skin

Answer 33

lesion

Question 34

secondary lesion: localized loss of superficial epidermis

Answer 34

erosion / excoriation

Question 35

secondary lesion: epidermal defect due to loss of tissue

Answer 35

ulcer

Question 36

secondary lesion: black, hard, crust of necrosis

Answer 36

eschar

Question 37

secondary lesion: depression/surface change due to diminution

Answer 37

atrophy

Question 38

secondary lesion: depressed or elevated connective tissue

Answer 38

scar

Question 39

Describing Lesion Characteristics | (if not using primary/secondary names)

Answer 39

* size * shape * color * texture * elevation/depression * attachment at base: * peunculated, sessile, verrucous

Question 40

Describing Exudates

Answer 40

* color * odor * amount * consistency

Question 41

Describing Lesion Configuration

Answer 41

* annular (ring) * grouped * linear * aciform (needle-shaped) * diffuse

Question 42

Describing Lesion Location/Distribution

Answer 42

* localized / generalized * symmetric / assymetric * discrete / grouped * coalescing * body region

Question 43

Inflammatory & Infectious Conditions

Answer 43

* acne * eczematous dermatitis * folliculitis * furuncle/carbuncle * cellulitis * tinea (fungal) infections * pityriasis rosea (herald patch, christmas tree) * psoriasis * rosacea (rhinophyma) * herpes simplex * herpes zoster * erythema migrans (lyme disease) * erythema multiforme (target lesions hand, white tongue- immunologic/Steven-Johnson's syndrome) * scabies * bed bugs

Question 44

Cutaneous Reactions

Answer 44

* drug eruptions (morbiliform rash) * acanthosis nigricans (thickening on back of neck

Question 45

Pre-malignant/malignant Lesions

Answer 45

* actinic keratosis (pre) * basal cell carcinoma- pearly/translucent/shiny nodule * squamous cell carcinoma- scaly red patch w/ central depression * malignant melanoma * kaposi sarcoma

Question 46

Hair/Scalp PE Techniques

Answer 46

* Inspection * color, distribution, quantity * Palpation * texture, scalp

Question 47

Nail PE Techniques

Answer 47

* Inspection: * color, length, configuration, symmetry, cleanliness

Question 48

Nail color associated conditions

Answer 48

* pigment deposits- normal in dark skin people * yellow- psoriasis, fungal infections * diffuse darkening- candida, hyperbilirubinemia * greenish black- pseudomonas * single blue or black- melanoma, trauma * general blue- cyanosis * splinter hemorrhage- endocarditis, vasculitis * leukonychia punctate- cuticle manipulation, matrix trauma

Question 49

Nail plate associated conditions

Answer 49

* ridging (longitudinal lines)- lichen planus * beau lines- injury, infection, nutrition * mee's bands- hodgkins, CHF, carbon monoxide poisoning * lindsay's nails- renal disease * terry's nails- hepatic failure, cirrhosis * depressions- syphilis, high fever, PVD, DM * pitting- psoriasis * clubbing- CV disorder, cirrhosis, colitis, thyroid, respiratory * 160 degrees normal, \>180 degrees abnormal * kollonychia (spoon)- Fe deficiency, Plummer-Vinson

Question 50

infection between nail fold and plate

Answer 50

paronychia

Question 51

fungal infection of nail

Answer 51

onychomycosis

Question 52

loosing of nail from bed

Answer 52

onycholysis