Skin, Hair, and Nails Exam

Question 1

What questions would you ask when taking history for a derm exam?

Answer 1

Any changes with your skin, hair or nails? Any discolorations? Any lumps? Any rashes?

Question 2

What causes dryness of the skin?

Answer 2

A decreased oil layer, often due to over-bathing

Question 3

What causes itchy skin?

Answer 3

Stimulation of nerve fibers

Question 4

When examining the quantity of the hair, what are two things you should consider?

Answer 4

Cicatricial vs non-cicatricial, generalized vs localized

Question 5

What could cause lumps?

Answer 5

Immunologic reactions or neoplastic transformation

Question 6

What could cause rashes?

Answer 6

Infections, trauma, immunologic reactions, ischemia, or neoplastic transformation

Question 7

What is red discoloration caused by?

Answer 7

Increased oxyhemoglobin (increased blood flow or increased redness of hemoglobin)

Question 8

What causes blue discoloration?

Answer 8

Increased deoxyhemoglobin (bruise, poor blood flow, poor oxygenation)

Question 9

What is pallor to black discoloration caused by?

Answer 9

Decreased oxyhemoglobin

Question 10

What is yellow discoloration caused by?

Answer 10

Increased or abnormal breakdown of hemoglobin

Question 11

What are examples of skin lesions with less tissue?

Answer 11

Erosion, fissure, ulcer

Question 12

What is erosion?

Answer 12

Nonscarring loss of the superficial epidermis; the surface is moist, but does not bleed

Question 13

What is excoriation?

Answer 13

Linear or punctate erosion caused by scratching

Question 14

What is a fissure?

Answer 14

A linear crack in the skin

Question 15

What is an ulcer?

Answer 15

A deeper loss of epidermis and dermis; may bleed and scar

Question 16

What are examples of skin lesions with a “normal” amount of tissue?

Answer 16

Macule, patch, purpura (petechiae, ecchymosis)

Question 17

What is the difference between a macule and a patch?

Answer 17

Both are non-palpable, but a macule is less than 1 cm while a patch is greater than 1 cm

Question 18

What is purpura?

Answer 18

The name given to the discoloration of the skin or mucous membranes due to hemorrhage from small blood vessels

Question 19

What are examples of solid lesions with more tissue?

Answer 19

Papule, plaque, nodule, scale, crust, lichenification

Question 20

What are examples of fluid-filled lesions with more tissue?

Answer 20

Vesicle, bulla, cyst, pustule

Question 21

What is the difference between a papule and a plaque?

Answer 21

Both are solid, palpable lesions, but a papule is less than 1 cm while a plaque is greater than 1 cm

Question 22

What is a nodule?

Answer 22

A solid plaque greater than 0.5 cm and deeper than a papule

Question 23

What is a scale?

Answer 23

Thin flakes of exfoliating epidermis

Question 24

What is the difference between a vesicle and a bulla?

Answer 24

Both are serous fluid filled lesions, but a vesicle is less than 1 cm and a bulla is larger than 1 cm

Question 25

What is a cyst?

Answer 25

A fluid filled lesion that is deeper than a vesicle or bulla

Question 26

What is a pustule?

Answer 26

A pus filled lesion

Question 27

What are some of the arrangements of skin lesions?

Answer 27

Annular, arciform (like annular plaque of tinea faciale); serpignious (like that of tinea corporus); linear (like that of linear epidermal nevus); clustered (like that of grouped vesicles of herpes simplex); geographic (like that of mycosis fungoides)

Question 28

What could cause increased pigmentation of the skin?

Answer 28

Neurofibromatosus, addison's disease

Question 29

What could cause either increased or decreased pigmentation of the skin?

Answer 29

Tinea versicolor

Question 30

What are the signs of melanoma?

Answer 30

Asymmetry (when half of the mole doesn't match the other half), border (when the border of the mole is ragged or irregular), color (when the color of the mole varies throughout), and diameter (when the mole's diameter is larger than a pencil eraser)

Question 31

What could cause decreased pigmentation of the skin?

Answer 31

Vitiligo

Question 32

What is the common description of normal skin characteristics?

Answer 32

Warm and dry

Question 33

What is skin mobility vs turgor?

Answer 33

Mobility is how easily a fold of skin lifts up and turgor is how quickly it returns to place

Question 34

When would you expect to see decreased skin mobility

Answer 34

Edema

Question 35

When would you expect to see decreased skin turgor?

Answer 35

Dehydration

Question 36

What is onycholysis?

Answer 36

A nail lifting up so it is no longer completely attached

Question 37

What are the likely causes of onycholysis?

Answer 37

Injury from an aggressive manicure, injury from cleaning under the nails with a sharp object, a fungal infection, or psoriasis

Question 38

Deep grooves that run the width of the nail suggest what?

Answer 38

That something (fever, injury, chemotherapy, or major stress) slowed or stopped the nail from growing for a while

Question 39

What causes paronychia?

Answer 39

Infection from bacteria or fungi

Question 40

Patients with pits in their nails may have which conditions?

Answer 40

Psoriasis, atopic dermatitis, alopecia areata

Question 41

What is onychogryphosis?

Answer 41

Ram's horn nails, where nails thicken and overgrow

Question 42

Onychogryphosis is secondary to what?

Answer 42

Familial predisposition, psoriasis, ichthyosis, circulation problems

Question 43

What does koilonychia suggest?

Answer 43

Iron deficiency

Question 44

What is koilonychia?

Answer 44

Thin, spoon-shaped nails

Question 45

What can cause onychotillomania?

Answer 45

A habit of picking at (or pushing back) the cuticles on your thumbnails

Question 46

What does clubbing of the nails look like?

Answer 46

Nails curve downward, fingertips often swell, and nails start to feel spongy when pressed on; angle between nail plate and cuticle exceeds 180 degrees

Question 47

What can curved nails be a sign of?

Answer 47

They can be a harmless trait that runs in the family or a sign of disease of the lungs or heart

Question 48

What are white nails associated with?

Answer 48

Liver disease, diabetes, and anemia

Question 49

What can cause yellow nails?

Answer 49

Lung disease, rheumatoid arthritis, and infections

Question 50

What are red lunula associated with?

Answer 50

Lupus, heart disease, alopecia areata, arthritis, and dermatomyositis

Question 51

What do blue lunula indicate?

Answer 51

Silver poisoning

Question 52

What could a dark streak on the nails be caused by?

Answer 52

Melanoma