skin, hair, nails

Question 1

anatomy of the skin

Answer 1

epidermis, dermis, subcutaneous

Question 2

types of hair

Answer 2

vellus, terminal

Question 3

what is hair made of?

Answer 3

keratin, dead cells

Question 4

nails

Answer 4

hard plate of keratin, protects fingers and toes, angle of nail bed should be 160 degrees

Question 5

ROS, health history questions

Answer 5

past history of skin disease? excessive dryness? rash or lesions? change in nails? etc.

Question 6

inspection of skin

Answer 6

general pigmentation of skin, expected v. unexpected findings

Question 7

pallor

Answer 7

pale or grey or yellow brown, caused by anemia or circulatory issues

Question 8

erythema

Answer 8

may appear red or purple, caused by inflammation

Question 9

cyanosis

Answer 9

blue or purple undertones, caused by lack of oxygen

Question 10

jaundice

Answer 10

yellowish skin, caused by bilirubin

Question 11

petechia

Answer 11

small round reddish dots, caused by bleeding under skin

Question 12

palpation of skin

Answer 12

temperature, moisture, texture, edema, turgor

Question 13

turgor

Answer 13

pinch large fold of skin below clavicle, should return promptly when released, reflects elasticity and hydration

Question 14

edema

Answer 14

fluid in the extremities, push with your thumb, note how long it stays (1-4 scale)

Question 15

expected skin findings

Answer 15

skin is smooth, intact, uniformly dry, warm, instant return with skin turgor

Question 16

expected variations of skin

Answer 16

acne, wrinkles, scars, older people may have more elastic skin

Question 17

unexpected findings of skin

Answer 17

velvet skin, roughness or flaky, diaphoresis, skin lesions, hypothermia, hyperthermia, skin tenting, edema

Question 18

vitiligo

Answer 18

acquired skin condition that is loss of pigment in skin

Question 19

primary skin lesions

Answer 19

macules, papules, patches, plaques, nodules, wheals, tumors, urticaria, vesicles, cysts, bullas, pustules

Question 20

macules

Answer 20

solely a color change, flat, less than 1 cm

Question 21

papules

Answer 21

felt and caused by superficial thickening of the epidermis

Question 22

patches

Answer 22

macules that are larger than 1 cm

Question 23

plaques

Answer 23

papules coalescing to form surface elevation wider than 1 cm

Question 24

nodules

Answer 24

solid, elevated, hard or soft, greater than 1 cm that may extend deeper into dermis than papule

Question 25

wheals

Answer 25

superficial, raised, transient and erythematous, irregular in shape due to edema

Question 26

tumors

Answer 26

larger in diameter, firm or soft, deeper into dermis, may be benign or malignant

Question 27

urticaria

Answer 27

wheals coalesce to form extensive pruritic reaction

Question 28

vesicles

Answer 28

elevated cavity containing fluid up to 1 cm

Question 29

cysts

Answer 29

encapsulated fluid filled cavity

Question 30

bullas

Answer 30

larger than 1 cm, usually single chamber, superficial in dermis and ruptures easily

Question 31

pustules

Answer 31

pus in cavity that is circumscribed and elevated

Question 32

secondary skin lesions

Answer 32

debris on skin surfaces, break in continuity of skin surface

Question 33

crust

Answer 33

thickened, dried out exudate

Question 34

scale

Answer 34

compact flakes of desiccated skin from shedding of dead excess keratin cells

Question 35

fissures

Answer 35

linear crack with abrupt edges extending into dermis

Question 36

erosions

Answer 36

scooped out but shallow depression

Question 37

ulcers

Answer 37

deeper depression extending into dermis with irregular shape, may bleed, leaves scar

Question 38

excoriations

Answer 38

self inflicted abrasion that is superficial

Question 39

scars

Answer 39

permanent fibrotic change after healing

Question 40

keloids

Answer 40

benign excess of scar tissue beyond original injury

Question 41

how to document skin lesions

Answer 41

color, elevation, pattern or shape, size, location and distributions, exudate

Question 42

locations and distributions of lesions

Answer 42

annular, confluent, linear, grouped, zosteriform, target

Question 43

annular/circular lesions

Answer 43

begins in center and spreads to periphery

Question 44

confluent lesions

Answer 44

lesions run together

Question 45

discrete lesions

Answer 45

distinct and separate

Question 46

grouped lesions

Answer 46

cluster of lesions

Question 47

gyrate lesions

Answer 47

twisted, coiled, or snakelike

Question 48

target or iris lesions

Answer 48

resembles iris of eyes, concentric rings

Question 49

linear lesions

Answer 49

scratch, streak, line, or stripe

Question 50

polycyclic lesions

Answer 50

annular lesions grow together

Question 51

zosteriform lesions

Answer 51

linear arrangement following a unilateral nerve route

Question 52

pressure injuries stages

Answer 52

stage I - non blanchable erythema stage 2 - partial thickness skin loss stage 3 - full thickness skin loss stage 4 - full thickness skin and tissue loss

Question 53

risk factors for pressure ulcers

Answer 53

reduced sensory perception, moisture, reduced mobility, malnutrition, friction and shear, thin fragile skin

Question 54

what to inspect in hair

Answer 54

color, texture, distribution, lesions

Question 55

inspecting and palpating nails

Answer 55

profile signs, curved, clubbing, consistency, color, cap refil

Question 56

capillary refill

Answer 56

should take less than 3 seconds

Question 57

unexpected conditions of the nails

Answer 57

paronychia, beau line, splinter hemorrages, onychomycosis, late clubbing, pitting, color variations, delayed cap refill

Question 58

acral lentiginous melanoma

Answer 58

skin cancer under the nail

Question 59

ABCDE of skin cancer

Answer 59

asymmetry, borders, color variation, diameter greater than 6 mm, elevation/evolution, funny looking

Question 60

red flags for skin

Answer 60

ABCDE of melanoma, sore that does not heal, skin changes over bony prominences, discoloration, new onset rash, expanding redness and heat around wound

Question 61

unexpected hair conditions

Answer 61

AIDS related kaposi sarcoma; toxic alopecia; tinea capitis; traction alopecia; cradle cap, pediculosis capitis (lice), folliculitis barbae (razor bumps), hirsutism, furuncel and abscess