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MSII Practice of Medicine > Unit 1 - Integument and Rash > Flashcards

Unit 1 - Integument and Rash Flashcards

1
Q

functions of skin

A
  1. protects against microbial and foreign substance invasion and minor physical trauma
  2. retards body fluid loss by providing mechanical barrier
  3. regulates body temperature
  4. provides sensory perception by free nerve endings and specialized receptors
  5. provides vitamin D from precursors in skin
  6. contributes to BP regulation through constriction of skin blood vessels
  7. repairs surface wounds by exaggerating normal process of cell replacement
  8. excretes sweat (apocrine glands), urea, lactic acid
  9. sebaceous glands secrete sebum
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2
Q

what is sebum?

A

a lipid-rich substance that keeps skin and hair from drying out (dry skin can cause infections to come in)

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3
Q

describe hair

A

formed by epidermal cells that invaginate into dermal layers

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4
Q

describe nails

A

epidermal cells converted into hard plates of keratin, with highly vascular nail beds beneath the plate, giving nail pink color
-soft tissue surrounding nail border is paronychium

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5
Q

how does skin repair surface wounds?

A

by exaggerating normal process of cell replacement

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6
Q

true or false: you can obtain an allergy at any age

A

true

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7
Q

how is a skin exam done?

A

performed by inspection and palpation

  • most important tools are eyes and observation
  • adequate lighting is essential
  • inspect head/toe, get patient into gown, and look everywhere
  • when gross inspection is uncertain, use magnifying glass or dermatoscope
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8
Q

what is skin exam equipment?

A
  1. centimeter ruler (flexible and clear, to measure each lesion)
  2. wood’s lamp (to see vluorescing lesions like fungal infections)
  3. flashlight/transilluminator
  4. handheld magnifying lens (optional)
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9
Q

what should you look for in physical exam inspection

A
  1. lesion type/distribution
  2. secondary characteristics
  3. shape of individual lesions
  4. arrangement of multiple lesions - grouped lesions or individual lesions (may have appeared at different times)
  5. color
  6. consistency and feel
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10
Q

what should you look for in physical exam palpation?

A
  1. moisture (minimal perspiration/oiliness should be present)
  2. temperature (use dorsal surface of hands/fingers)
  3. texture (smooth, soft, even)
  4. turgor (altered if substantially dehydrated or edema present)
  5. mobility (move easily when pinched, and return to place when released)
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11
Q

a freckle is an example of what kind of lesion and its description?

A

primary lesion: macule; non-palpable, skin color change, <1 cm

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12
Q

an elevated nevi is an example of what kind of lesion and its description?

A

primary lesion: papule; palpable, circumscribed, <0.5 cm

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13
Q

a wart is an example of what kind of lesion and its description?

A

primary lesion: nodule/tumor; palpable, circumscribed, >0.5 cm

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14
Q

a blinster is an example of what kind of lesion and its description?

A

primary lesion: vesicle; serous fluid-filled, <1 cm

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15
Q

acne is an example of what kind of lesion and its description?

A

primary lesion: pustule; pus-filled

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16
Q

mosquito bite is an example of what kind of lesion and its description?

A

primary lesion: wheal; palpale, irregular borders

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17
Q

psoriasis is an example of what kind of lesion and its description?

A

primary lesion: plaques; large, measure greater than 5 mm, often formed by confluence of papules

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18
Q

a sebaceous cyst is an example of what kind of lesion and its description?

A

primary lesion: cysts; enclosed cavities with a lining that contains a liquid or semisolid material
-once it becomes a cyst, it has to be cut out; if infected, it must be lanced

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19
Q

what is a telangiectasia?

A

dilated superficial blood vessel that blanches if pushed in

-in obesity and chronic liver disease; how many they have is a signal of how advanced their disease is

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20
Q

a pemphigus is an example of what kind of lesion and its description?

A

primary lesion: bullae; large (equal or greater than 6 mm) vesicles
-clearly have serous fluid, not pus

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21
Q

what are secondary lesions?

A

evolved changes from primary skin disorder

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22
Q

what is excoriation?

A

secondary lesion: superficial skin erosion caused by scratching

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23
Q

what is lichenification?

A

secondary lesion: increased skin markings and thickening secondary to chronic inflammation caused by scratching or other irritation
-treatment usually no longer works

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24
Q

what is a scale?

A

secondary lesion: superficial epidermal cells that are dead and cast off from the skin

25
Q

is edema a primary or secondary lesion?

A

secondary

26
Q

what is a crust?

A

secondary lesion: dried exudate (scab)

27
Q

what is a fissure?

A

secondary lesion: deep skin split extending to dermis

28
Q

what is erosion?

A

secondary lesion: superficial focal loss of part of epidermis

29
Q

what is ulceration?

A

secondary lesion: a focal loss of epidermis extending into dermis
-can come from scratching too much

30
Q

what is atrophy?

A

secondary lesion: decreased skin thickness due to skin thinning

31
Q

what is a scar?

A

secondary lesion: abnormal fibrous tissue that replaces normal tissue after skin injury

32
Q

are changes in pigmentation a primary or secondary lesion?

A

secondary (hypo, hyper, and de)

33
Q

what does ABCDE for skin cancer mean?

A

Asymmetry: one half does not match the other
Border: irregular, ragged, notched, blurred
Color: uniform or heterogenous (multiple colors is generally worse)
Diameter: greater than 6 mm
Evolution: the more rapidly it changes, the more concerning it is

34
Q

explain what basal cell carcinoma is

A

most common form of skin cancer, usually in sun damaged skin

  • can cause a lot of local damage, but doesn’t metastasize
  • smooth, round, pearly borders with central pallor/ulcer
  • recurrent bleeding, failure to heal (when shaving, will bleed, and never goes away)
35
Q

explain what squamous cell cancer is?

A

second most common form of skin cancer in sun-exposed areas

  • ulceration, scabbed over, recurrent bleeding
  • becomes deeper and ulcerated over time
  • some people try to cut it out themselves
36
Q

explain what malignant melanoma is

A

lethal form of skin cancer that develops from melanocytes

-often in non-sun exposed areas, and places that aren’t easily seen (so must look at back, shoulder, etc.)

37
Q

how often should one go to a dermatologist if you have ever gotten a skin disease?

A

once a year, at least

38
Q

explain Kaposi’s sarcoma

A

neoplasm of endothelium and epithelium layer of the skin caused by Kaposi sarcoma herpes virus 8

  • commonly associated with HIV infection
  • can be all over skin, but usually only one or two lesions
39
Q

explain ezcematous dermatitis

A

very common dry, cracked skin

  • rule out fungal infection
  • caused by irritant or allergic contact dermatitis and atopic dermatitis
  • TRT: topical steroidal cream and removing offending agent
40
Q

explain folliculitis

A

common infection

  • inflammation of hair follicle, infected with bacteria, usually staphylococcus
  • pustle with hair caught inside
  • treat topically and ensure washing well
41
Q

explain cellulitis

A

clear, serous fluid (classic staph infection) that will spread quickly, so mark area with pen

42
Q

explain psoriasis

A

common and runs in families (2-3% of US population, don’t develop until late teens, early 20s)

  • caused by errors in immune system function
  • triggered by emotional stress, skin injury, infection, and certain medications
  • plaques improve with sun exposure
  • thick red, silver-gray patches on extensor surfaces that feel very hard
  • nail pitting and onycholysis (but w/o trauma)
43
Q

explain rosacea

A

chronic inflammatory skin disorder

  • very ruddy in appearance, and usually treat with anti-acne unless unresponsive
  • more flat and confluent than lupus
44
Q

explain SLE

A

autoimmune chronic inflammatory disease that affects nearly any part of the body

  • more common in women, especially 15-45 yo
  • UV light, stress, medications, antibiotics, and hormonal changes trigger flare (so sunlight worsens)
  • classic butterfly (malar) rash
  • more raised and angry than rosacea
45
Q

how does SLE compare to psoriasis?

A

SLE is worsened by sunlight while psoriasis is improved

46
Q

how is SLE different from rosacea?

A

SLE is more raised and angry than the flat and confluent rosacea

47
Q

explain acanthosis nigricans

A

nonspecific reaction pattern associated with obesity, certain endocrine syndromes (diabetes, glucose intolerance), PCOS, malignancies, or inherited disorder

  • velvet, leathery thickening of skin, primarily affecting skin folds
  • becoming more common due to diabetes
48
Q

explain Herpes Zoster/Shingles

DEFINITELY ON THE EXAM

A

grouped vesicles on an erythematous base, following a sensory dermatome

  • Varicella virus
  • elderly (over age of 70) and immunosuppressed are 15x more likely to get it
  • postherptic neuralgia - 40% of elderly who get Shingles b/c not treated in time with creams
49
Q

explain Vitiligo

A

autoimmune disorder attacking pigmented cells (absence of pigment)

50
Q

explain alopecia areata

A

sudden, rapid, patchy loss of hair, usually from scalp or face
-treatments are available

51
Q

explain cherry hemangiomas and angiomata

A

“little red blood blisters”

  • do not blanch when pressed on
  • perfectly benign and runs in family
52
Q

difference between cherry hemangiomas/angiomata and teleangectasia?

A

cherry hemangioma do not blanch when pressed on, but telangectasia do

53
Q

explain seborrheic keratoses

A

papular, waxy, stuck-on looking brown spot that can be peeled off (but never go away)
-increase with age

54
Q

explain chronic venous stasis

A
  • blood not returning fast enough to heart
  • brown staining edema, get small ulcers from poor venous return, and hard to heal
  • uncomfortable, but not painful
  • classic treatment is compression (stockings) to ensure not backed up
55
Q

explain plantar warts

A

warts on feet that have red spots that used to be blood vessels

56
Q

paronychia

A

staph infection from biting nails

  • if not inflammed, can just use cream, but if not then need oral antibiotics
  • if spreads to hand, needs IV antibiotics
57
Q

onychomycosis

A

fungal infection when nail is lifted up from finger

  • this is recurrent, and happens especially if immunosuppressed
  • need to use nail file instead of cutters
58
Q

explain Tinea Cruris and TInea Versicolor

A

both are fungal infections
TC: red, circular-ish rash
TV: pale skin spots, but NOT viteligo (not absence of pigment, just less pigment)
-treat topically

MSII Practice of Medicine (13 decks)

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