Skin, Hair and Nails

Question 1

Most superficial layer of the skin

Answer 1

Epidermis

Question 2

Second most inner layer of the skin

Answer 2

Dermis

Question 3

Dermis

Answer 3

• Contains vascular and capillary beds
• Hair follicles, Sweat glands, sebaceous glands
• Collagen and elastic fibers

Question 4

Melanin

Answer 4

Skin color is dependent on this

Question 5

Cyanosis

Answer 5

Blue color: can indicate decreased oxygen in the blood or decreased blood flow in response to cold environment

Question 6

Jaundice

Answer 6

Yellowing of the skin: increased bilirubin

Question 7

3 inner layers past the dermis

Answer 7

Subcutaneous (adipose tissue), Deep Fascia, Skeletal muscle

Question 8

Lesion

Answer 8

single altered area of the skin.

-Look for lesions suggesting melanoma, basal cell carcinoma (BCC), or squamous cell carcinoma (SCC)

Question 9

Rash

Answer 9

Widespread area or eruption of lesions.

-ask about itching (pruritus)

Question 10

Causes of generalized itching (pruritus)

Answer 10

• Rash
• Pregnancy
• Uremia
• Dry skin
• lymphomas & leukemias
• drug reactions
• jaundice
• Less commonly: polycythemia vera and thyroid disease

Question 11

Describing Skin Lesions

Answer 11

ABCDEFG Method

• Asymmetry
• Border irregularity
• Color variation
• Diameter >6cm
• Elevated
• Firm to palpation
• Growing progressively over several weeks

Question 12

Primary Lesion

Answer 12

Lesions that develop as a direct result of the disease process

Question 13

Primary Lesion: Macule

Answer 13

Circumscribed flat area of change in color of the skin <1cm

-examples: freckles, flat moles, rubella, measles, port-wine stains

Question 14

Primary Lesion: Patch

Answer 14

Circumscribed flat area of change in color of the skin >1cm
-Examples: Drug rash, heat rash (miliaria), atopic dermatitis, contact dermatitis, swimmers itch, shingles, ring worm (tinea corporis)

Question 15

Primary Lesion: Papule

Answer 15

small solid elevation of the skin <1cm

-Examples: nevi, warts, insect bites, some lesions of acne, skin cancers,

Question 16

Primary Lesion: Plaque

Answer 16

Larger flatter elevation of skin, sometimes formed by papules
-Examples Psoriasis and granulomas

Question 17

Primary Lesion: Nodule

Answer 17

Solid elevation of the skin >1cm that usually extends into the deeper skin layers
-Examples: Cysts, lipomas and fibromas

Question 18

Primary Lesion: Pustule

Answer 18

Small circumscribed elevation of the epidermis filled with purulent fluid
-Examples: Pustules are common in bacterial infections and folliculitis

Question 19

Primary Lesion: Vesicle

Answer 19

Small circumscribed elevation of epidermis containing clear fluid <1cm
-Examples: herpes, acute allergic contact dermatitis, some autoimmune blistering disorders such as dermatitis herpetiformis

Question 20

Primary Lesion: Bulla

Answer 20

Circumscribed elevation of the epidermis containing clear fluid >1cm

Question 21

Primary Lesion: Wheal

Answer 21

Raised lesion consisting of dermal edema and is also known as hives or urticaria. Typically last <24hours
-Examples: common manifestation of hypersensitivity to drugs; stings or bites; autoimmunity and less commonly physical stimuli including temperature, pressure and sunlight

Question 22

Primary Lesion: Petechaie

Answer 22

non-blanchable hemorrhage

Question 23

Primary Lesion: Purpura

Answer 23

non-blanchable, raised and palpable. Bright red or purple

Question 24

Annular configuration

Answer 24

Ring-like, with central clearing

Question 25

Nummular or Discoid Configuration

Answer 25

coin-shaped, no central clearing

Question 26

Stage 1 pressure injury

Answer 26

Intact skin with a localized area, non-blanchable erythema (can appear differently in dark pigmented skin)

Question 27

Stage 2 pressure injury

Answer 27

Partial-thickness loss of skin with exposed dermis

Question 28

Stage 3 pressure injury

Answer 28

Full thickness skin loss, in which adipose (fat) is visible in the ulcer and granulation tissue and rolled wound edges

Question 29

Stage 4 Pressure injury

Answer 29

Full thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage or bone in the ulcer

Question 30

Unstageable pressure injury

Answer 30

full thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar

Question 31

Basal Cell Carcinoma

Answer 31

Most common cancer in the world. Rarely spreads to other parts of the body. Can invade and destroy local tissues, causing significant morbidity to the eye, nose, or brain

Question 32

Vascular Lesions

Answer 32

Spider Angioma, Spider Vein, Cherry Angioma

Question 33

Clubbing of fingers

Answer 33

Seen in congenital heart disease, interstitial lung disease and lung cancer, inflammatory bowel diseases and malignancies

Question 34

Onycholysis of the nail

Answer 34

Painless separation of the whitened opaque nail plate from the pinker translucent nail bed
-Examples: Local causes-fungal infections, allergic reactions, psoriasis. SYSTEMIC-Diabetes, anemia, hyperthyroidism, peripheral ischemia, bronchiectasis and syphilis

Question 35

Terry Nails

Answer 35

Nail plate turns white with a ground-glass appearance, a distal band of reddish brown
Examples: liver disease (cirrhosis), heart failure, diabetes. May arise from vascularity and increase connective tissue in nail bed.