Skin, Hair, & Nails

Question 1

3 layers of skin

Answer 1

epidermis, dermis, subcutaneous

Question 2

4 Pigments of skin

Answer 2

melanin, carotene, oxyhemoglobin, deoxyhemoglobin

Question 3

Anagen phase

Answer 3

(growing phase)
lasts 2-5 years
85-90% of scalp hair is in anagen
this % decreases with age & male pattern baldness

Question 4

Catagen phase

Answer 4

short transitional phase lasting a few days

Question 5

Telogen phase

Answer 5

(resting phase)
approx 3 months
Hair is shed in the telogen stage or when a new hair pushes it out during the next anagen.

Question 6

Vellus Hair

Answer 6

short and fine

Question 7

Terminal Hair

Answer 7

coarser, thicker, pigmented

Question 8

2 layers of nail plate

Answer 8

Outermost layer: formed by proximal nail matrix
Innermost layer: formed by distal nail matrix, which can be seen as the lunula or white crescent of the proximal nail plate

Question 9

Alopecia universalis

Answer 9

permanent total hair loss

Question 10

Alopecia totalis

Answer 10

permanent hair loss of eyebrows and up

Question 11

Alopecia areata

Answer 11

Round shaped areas of hair loss; usually stress-related

Question 12

Erythema

Answer 12

Red hue, increased blood flow, “slapped cheeks” (cellulitis, rosacea)

Question 13

Violaceous

Answer 13

Purpling of the skin

senile purpura, kaposi’s sarcoma, benign vascular collection (venous lake), dermatomyositis (heliotrope=purple eyelids)

Question 14

Pallor

Answer 14

Pale appearance

anemia, arterial insufficiency, arterial occlusion

Question 15

Peripheral Cyanosis

Answer 15

Blue color of hands, nails, feet

severe heart disease, venous obstruction, anxiety, cold room

Question 16

Central Cyanosis

Answer 16

Blue color of lips, oral mucosa, tongue

advanced lung disease, COPD, congenital heart disease, hemoglobinopathies

Question 17

Jaundice

Answer 17

Yellowing of skin (sclera affected)

liver disease, hemolysis of RBCs

Question 18

Carotonemia

Answer 18

Yellowing of skin (sclera not affected)

diet high in yellow vegetables

Question 19

Hyperpigmentation

Answer 19

Darkening of skin

tan, melasma, post-inflammatory change

Question 20

Depigmentation

Answer 20

absence of any pigment
vitiligo, albinoism
Pigment cells destroyed, hairs will be white

Question 21

Hypopigmentation

Answer 21

skin lighter than normal

post-inflammatory, like after eczema inflammation becomes controlled; will return with time;

Question 22

Warm/Hot skin indicative of

Answer 22

Inflammation, fever

Question 23

Cool/Cold skin indicative of

Answer 23

Decreased perfusion, cold exam room

Question 24

Moist skin indicative of

Answer 24

Anxiety, hyperthyroidism, ↑ oil production

Question 25

Dry skin indicative of

Answer 25

Hypothyroidism, xerosis

Question 26

Most common cutaneous symptom

Answer 26

Pruritis

Question 27

Pruritis: definition and indications

Answer 27

Itching May be a symptom of skin disease (dry skin, eczema, contact dermatitis, parasitic) or systemic illness (anemia, thyroid disorder, liver/kidney dz, lymphoma)

Question 28

Things to look for in a mole to diagnose melanoma

Answer 28

ABCDE: Asymmetry, Border irregularity, Color (blue/black mixed with white/red), Diameter (>6mm), Evolution

Question 29

Name the Primary Lesions

Answer 29

Macule, Patch, Papule, Nodule, Plaque, Wheal, Vessicle, Bulla, pustule, cyst

Question 30

Macule

Answer 30

FLAT, nonpalpable lesions with change in color

Question 31

Patch

Answer 31

FLAT, nonpalpable lesions with change in color >1 cm (vitiligo) 1°

Question 32

Papule

Answer 32

RAISED, palpable, solid lesions (no fluid)

Question 33

Nodule

Answer 33

RAISED, palpable, solid lesions (no fluid) >5mm (lipoma) 1°

Question 34

Plaque

Answer 34

RAISED, palpable, solid lesions (no fluid) Elevated area of confluent papules (psoriasis) 1°

Question 35

Wheal

Answer 35

RAISED, palpable, solid lesions (no fluid) Raised, edematous, evanescent (come and go) plaque (hive) 1°

Question 36

Vesicle

Answer 36

Papule that contains yellowy serous fluid;

Question 37

Bulla

Answer 37

Larger variant of a vesicle; >5mm (large blister) 1°

Question 38

Pustule

Answer 38

Papule that contains white purulent material (acne) 1°

Question 39

Cyst

Answer 39

Nodule that contains purulent or semisolid material (acne) 1°

Question 40

What is a primary lesion?

Answer 40

Initial presenting lesion that has NOT been altered by trauma, manipulation, scratching or natural regression over time

Question 41

What is a secondary lesion?

Answer 41

Created by scratching, scrubbing, infection or natural regression of lesion with time (scale).

Question 42

TELANGIECTASIA

Answer 42

Small dilated blood vessel (rosacea); will blanch 1°

Question 43

Petechiae

Answer 43

Reddish purple discoloration caused by extravasation of blood;

Question 44

Purpura

Answer 44

Reddish purple discoloration caused by extravasation of blood; >5mm (bruise) 1°

Question 45

Comedo

Answer 45

Follicular collection of sebum & keratin (whitehead/blackhead) 1°

Question 46

Burrow

Answer 46

Linear tunnel of epidermis produced by a parasite (scabies) 1°

Question 47

Abscess

Answer 47

Circumscribed collection of pus associated with infection 1°

Question 48

Furuncle

Answer 48

Acute, deep seated, hot, tender nodule or abscess (inflamed hair follicle) 1°

Question 49

Carbuncle

Answer 49

Deeper infection comprised of interconnecting abscesses (multiple furuncles) 1°

Question 50

Name the secondary lesions

Answer 50

Crust, Erosion, Ulcer, Fissure, Excoriation, Scar, Scale

Question 51

Crust

Answer 51

Dried residue of serum, pus or blood (scab) 2°

Question 52

Erosion

Answer 52

Loss of superficial epidermis, heals without scarring (popped blister) 2°

Question 53

Ulcer

Answer 53

Deeper loss of epidermis & dermis (bed sore) 2°

Question 54

Fissure

Answer 54

Vertical crack or split in the epidermis & dermis (after primary lesion, like with athlete’s foot between toes) 2°

Question 55

Excoriation

Answer 55

Linear erosion induced by scratching (pickers!) 2°

Question 56

Scar

Answer 56

Collection of new fibrous connective tissue (keloid) 2°

Question 57

Scale

Answer 57

Thick stratum corneum or flaking of skin (dandruff) Overproduction of oil in the scalp can cause overgrowth of yeast in the skin. This causes inflammation, which causes skin to peel. 2°

Question 58

Linear

Answer 58

Pattern of lesions in a linear fashion

Question 59

Annular

Answer 59

Pattern of lesions: round area with central clearing

Question 60

Arcuate

Answer 60

Pattern of lesions: arc like

Question 61

Gyrate

Answer 61

Pattern of lesions: like a worm crawling around AKA serpiginous

Question 62

Reticular

Answer 62

Pattern of lesions: lacy patches

Question 63

Confluent

Answer 63

Pattern of lesions: everything is colliding everywhere

Question 64

Generalized

Answer 64

Pattern of lesions: head to toe

Question 65

Dermatomal

Answer 65

Pattern of lesions: along one dermatome/nerve root. Unilateral. Can see in midline and off to one side. Ex: shingles and HSV (If bilateral, rule these out)

Question 66

Grouped

Answer 66

Pattern of lesions: just like it sounds. Grouped together lesions. Grouped vesicles are almost always some type of herpes virus

Question 67

Pitting

Answer 67

Change affecting nails: Small pinpoint depressions; psoriasis

Question 68

Splitting

Answer 68

Change affecting nails: Frequent hand washing, trauma, artificial nails, etc.

Question 69

Dystrophy

Answer 69

Change affecting nails: Resulting from inflammation of skin overlying matrix or invasion of fungus (subungal debris)

Question 70

Thickening

Answer 70

Change affecting nails: Psoriasis, onychomycosis (fungus)

Question 71

Separation of nail bed

Answer 71

Change affecting nails: Trauma

Question 72

Detachment of cuticle

Answer 72

Change affecting nails: Allows moisture & bacteria to invade in a normally sealed off environment, causing soft tissue swelling around the nail (paronychia)

Question 73

Ridging of nails

Answer 73

Change affecting nails: Severe illness, trauma, or fever may cause temporary arrest of nail growth, resulting in horizontal grooving (Beau’s lines); longitudinal grooving (lichen planus).

Question 74

Discoloration

Answer 74

Change affecting nails: Trauma (bruising/hematoma) Blue nails (drugs like minocycline or anti-malarials) Green nails (pseudomonas bacteria) Gray linear streak: deposition of lead Splinter hemorrhages: reddish-black linear streaks of nail (trauma, endocarditis)