skin hair nails hape

Question 1

what does pallor indicate?

Answer 1

anemia

Question 2

cyanosis

Answer 2

a blue color, can indicate decreased oxygen in the blood or decreased blood flow in response to a cold environment.

Question 3

jaundice

Answer 3

or yellowing of the skin, results from increased bilirubin.

Question 4

what does the cuticle do?

Answer 4

protects the space between the fold and the plate from external moisture.

Question 5

what is the angle between the proximal nail fold and nail plate?

Answer 5

less than 180 degrees

Question 6

pilosebaceous glands

Answer 6

produce a fatty substance secreted onto the skin surface through the hair follicles. These glands are present on all skin surfaces except the palms and soles.

Question 7

eccrine sweat glands

Answer 7

widely distributed, open directly onto the skin surface, and help to control body temperature by their sweat production

Question 8

apocrine sweat glands

Answer 8

found chiefly in the axillary and genital regions and usually open into hair follicles. Bacterial decomposition of apocrine sweat is responsible for adult body odor.

Question 9

common or concerning symptoms of the integumentary system

Answer 9

Lesions
Rashes and itching (pruritus)
Hair loss and nail changes

Question 10

what kind of lesions should you look for on a pt skin?

Answer 10

Look for lesions suggesting melanoma, basal cell carcinoma (BCC), or squamous cell carcinoma (SCC) throughout the skin examination regardless of the patient’s skin color. Detecting skin cancer at an early stage can increase the likelihood of successful treatment

Question 11

what are causes of generalized itching without apparent rash?

Answer 11

dry skin; pregnancy; uremia; jaundice; lymphomas and leukemia; drug reactions; and, less commonly, polycythemia vera and thyroid disease

Question 12

what should you encourage pt to use to replace lost moisture barrier?

Answer 12

moisturizers

Question 13

what are the most common causes of difffuse hair thinning?

Answer 13

male and female pattern baldness

Question 14

what do hair breaks along the shaft suggest?

Answer 14

damage from hair care or tinea capitis

Question 15

what is hair shedding at the roots common of?

Answer 15

telogen effluvium and alopecia areata

Question 16

what are good descriptions to describe skin lesions and rashes?

Answer 16

number, size, color, shape, texture, primary lesion, location, and configuration.

Question 17

what is a primary skin lesion?

Answer 17

those that develop as a direct result of, and therefore are most characteristic of, the disease process

Question 18

examples of macules

Answer 18

Examples include freckles, flat moles, and port-wine stains and the rashes of rickettsial infections, rubella, and measles.3

Question 19

examples of papules

Answer 19

Examples include nevi, warts, lichen planus, insect bites, seborrheic keratoses, actinic keratoses, some lesions of acne, and skin cancers

Question 20

examples of plaques

Answer 20

Lesions of psoriasis and granuloma annulare commonly form plaques.3

Question 21

examples of nodules

Answer 21

cysts, lipomas, and fibromas

Question 22

what are pustules common in?

Answer 22

common in bacterial infections and folliculitis

Question 23

what are vesicles characteristic of?

Answer 23

herpes infections, acute allergic contact dermatitis, and some autoimmune blistering disorders such as dermatitis herpetiformis

Question 24

classic autoimmune bullous diseases

Answer 24

pemphigus vulgaris and bullous pemphigoid

Question 25

what are wheals?

Answer 25

common manifestation of hypersensitivity to drugs; stings or bites; autoimmunity; and, less commonly, physical stimuli including temperature, pressure, and sunlight

Question 26

what areas does psoriasis frequently effect?

Answer 26

scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft.

Question 27

where does lichen planus frequently arise?

Answer 27

wrists, forearms, genitals, and lower legs.

Question 28

characteristics of vitiligo

Answer 28

may be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth.

Question 29

Discoid lupus erythematosus

Answer 29

characteristic lesions on sun-exposed skin of the face, especially the forehead, nose, and the ear.

Question 30

Hidradenitis suppurativa

Answer 30

involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts.

Question 31

examples of configuration of skin lesions

Answer 31

herpes zoster with unilateral and dermatomal vesicles; herpes simplex, with grouped vesicles or pustules on an erythematous base; tinea pedis with annular lesions; and poison ivy allergic contact dermatitis with linear lesions.

Question 32

examples of textures of lesions

Answer 32

Scaling can be greasy, like seborrheic dermatitis or seborrheic keratoses, dry and fine like tinea pedis, or hard and keratotic like actinic keratoses or SCC.

Question 33

blanchable lesions

Answer 33

erythematous and suggest inflammation

Question 34

nonblanching lesions

Answer 34

petechiae, purpura, and vascular structures (cherry angiomas, vascular malformations) are not erythematous, but rather bright red, purple, or violaceous. They are nonblanching because blood has extravasated out from the capillaries into the surrounding tissues.

Question 35

what is the dermoscope used for?

Answer 35

With adequate clinician training, use of dermoscopy improves the sensitivity and specificity of differentiating melanomas from benign lesions

Question 36

what is the first requirement for the skin examination?

Answer 36

Ask the patient to change into a gown with the opening in the back and clothes removed except for underwear

Question 37

parts of the full skin exam when patient is seated

Answer 37

Inspect the hair and scalp (distribution, texture, and quantity). Inspect the head and neck, including forehead, eyebrows, eyelids, eyelashes, conjunctivae, sclerae, nose, ears, cheeks, lips, oral cavity, chin, and beard. Inspect the upper back. Inspect the shoulders, arms, and hands including palpation of fingernails. Inspect the chest and abdomen. Inspect the anterior thighs and legs. Inspect the feet and toes including soles, interdigital areas, and toenails.

Question 38

parts of the full skin exam where pt is standing

Answer 38

Inspect the lower back. Inspect the posterior thighs and legs. Inspect the breasts, axillae, and genitalia including axillary and pubic hair.

Question 39

what can you do to be less likely to miss part of the skin exam?

Answer 39

perform it in the same order everytime

Question 40

alopecia

Answer 40

can be diffuse, patchy, or total. Male and female pattern hair loss are normal with aging. Focal patches may be lost suddenly in alopecia areata.6 Refer scarring alopecia to a dermatologist.

Question 41

what is associated with sparse hair and what is associated with fine, silky hair

Answer 41

hypothyroidism for sparse hair and fine silky hair for hyperthyroidism

Question 42

what is the best way to learn to distinguish normal skin lesions from abnormal lesions and potential skin cancers

Answer 42

Instead of documenting what is not present on the skin, document what is present

Question 43

what are possible internal causes of diffuse nonscarring hair shedding in young women

Answer 43

anemia, hypo or hyper thyroidism

Question 44

what do fever, chills, and pain suggest in the bed bound patient?

Answer 44

underlying osteomyelitis

Question 45

revised pressure injury staging system

Answer 45

*Stage 1: Intact skin with a localized area of nonblanchable erythema, which may appear differently in darkly pigmented skin. *Stage 2: Partial-thickness loss of skin with exposed dermis *Stage 3: Full-thickness skin loss, in which adipose (fat) is visible in the ulcer and granulation tissue and rolled wound edges, is often present. *Stage 4: Full-thickness skin and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer. *Unstageable: 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. *Deep tissue pressure injury: Persistent nonblanchable deep red, maroon, or purple discoloration.

Question 46

important topics for health promotion and counseling

Answer 46

Skin cancer prevention Skin cancer screening including melanoma

Question 47

risk factors for melanoma

Answer 47

-Personal or family history of previous melanoma - ≥50 common moles -Atypical or large moles, especially if dysplastic -Red or light hair -Solar lentigines (acquired brown macules on sun-exposed areas) -Freckles (inherited brown macules) -Ultraviolet radiation from heavy sun exposure, sunlamps, or tanning booths -Light eye or skin color, especially skin that freckles or burns easily -Severe blistering sunburns in childhood -Immunosuppression from human immunodeficiency virus (HIV) or from chemotherapy -Personal history of nonmelanoma skin cancer

Question 48

what is the best way to prevent against skin cancer?

Answer 48

avoid UV radiation exposure by limiting time in the sun, avoiding midday sun, using sunscreen, and wearing sun-protective clothing with long sleeves and hats with wide brims. Advise patients to avoid indoor tanning, especially children, teens, and young adults.

Question 49

signs of chronic sun damage

Answer 49

numerous solar lentigines on the shoulders and upper back, many melanocytic nevi, solar elastosis (yellow, thickened skin with bumps, wrinkles, or furrowing), cutis rhomboidalis nuchae (leathery thickened skin on the posterior neck), and actinic purpura

Question 50

how much does the use of indoor tanning beds (especially before age 35) increase your risk of melanoma?

Answer 50

75%

Question 51

how many melanomas arise de novo from isolated melanocytes rather than pre-existing nevi

Answer 51

at least half

Question 52

what is the most sensitive aspect of the ABCDE method?

Answer 52

E, evolution or change

Question 53

blue or black color within a larger pigmented lesion is especially concerning for melanoma except for....?

Answer 53

homogenous blue color in a blue nevus

Question 54

Approximately half of melanomas are initially detected by.....

Answer 54

patients or their partners

Question 55

burrows

Answer 55

Small linear or serpiginous pathways in the epidermis created by the scabies mite

Question 56

what is the most common skin cancer in the world?

Answer 56

BCC

Question 57

'ugly duckling'

Answer 57

the nevus that looks different from the patient’s other nevi. A patient may make many atypical nevi with surrounding macular components and central papular components, but they all look the same. Find the patient’s signature nevus, then search for the ugly duckling that looks different from the patient’s typical “signature” nevi.

Question 58

tinea captitis

Answer 58

There are round scaling patches of alopecia, mostly seen in children. There may be “black dots” of broken hairs and comma or corkscrew hairs on dermoscopy. Usually caused by Trichophyton tonsurans from humans, and less commonly, Microsporum canis from dogs or cats. Boggy plaques are called kerions.

Question 59

monilethrix

Answer 59

a rare inherited disorder characterized by sparse, dry, and/or brittle hair that often breaks before reaching more than a few inches in length

Question 60

clubbing of the fingers

Answer 60

a bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and the proximal nail fold. The angle increases to 180 degrees or more, and the nail bed feels spongy or floating.

Question 61

habit tic deformity

Answer 61

There is depression of the central nail with a “Christmas tree” appearance from small horizontal depressions, resulting from repetitive trauma from rubbing the index finger over the thumb or vice versa.

Question 62

mealnonychia

Answer 62

ncreased pigmentation in the nail matrix, leading to a streak as the nail grows out

Question 63

onycholysis

Answer 63

painless separation of the whitened opaque nail plate from the pinker translucent nail bed Local causes include trauma from excess manicuring, psoriasis, fungal infection, and allergic reactions to nail cosmetics. Systemic causes include diabetes, anemia, photosensitive drug reactions, hyperthyroidism, peripheral ischemia, bronchiectasis, and syphilis.

Question 64

terry nails

Answer 64

Seen in liver disease, usually cirrhosis, heart failure, and diabetes

Question 64

beau lines (transverse linear depression)

Answer 64

Transverse depressions of the nail plates, usually bilateral, resulting from temporary disruption of proximal nail growth from systemic illness. Timing of the illness may be estimated by measuring the distance from the line to the nail bed Seen in severe illness, trauma, and cold exposure if Raynaud disease is present.

Question 64

how fast do nails grow?

Answer 64

1 mm every 6 to 10 days

Question 65

pitting of the nails

Answer 65

Usually associated with psoriasis but also seen in reactive arthritis, sarcoidosis, alopecia areata, and localized atopic or chemical dermatitis.

Question 66

addison disease

Answer 66

Hyperpigmentation of oral mucosa as well as sun- exposed skin, sites of trauma, and creases of palms and soles

Question 66

chagas disease

Answer 66

Unilateral conjunctivitis and lid edema associated with preauricular lymphadenopathy

Question 67

CREST syndrome

Answer 67

Calcinosis, Raynaud phenomenon, sclerodactyly, matted telangiectasias of face and hands (palms)

Question 68

secondary lesions associated with acne

Answer 68

pitting and scars

Question 69

solar elastosis

Answer 69

Yellowish white macules or papules in sun-exposed skin, especially on the forehead

Question 70

Cutis Rhomboidalis Nuchae

Answer 70

Deep wrinkles on the posterior neck that “crisscross”