Week 3: Derm Flashcards Preview

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Flashcards in Week 3: Derm Deck (54)
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1

What are the best practices for performing a skin exam? (8) 

  1. Integrate skin exam in general exam
  2. Document what is present
  3. Ensure proper lighting
  4. Measuring tape/ruler
  5. Dermoscope
  6. Have patient in underwear in gown
  7. Ungloved hands if possible
  8. Scalp to toes

2

What are the eight characteristics that the FNP should describe of every skin lesion? 

  1. Number
  2. Size
  3. Color
  4. Shape
  5. Texture
  6. Primary Lesion
  7. Location
  8. Configuration

3

define lesion

any single area of altered skin - may be singular or multiple

4

How do you record the following characteristics: Number and size

Number: if multiple, record how many, estimate if numerous

Size: length and width in mm or cm

5

What are some ways to describe color? (3)

  1. skin colored = same shade as patient's skin
  2. blanching = red lesion that becomes white when pressure is applied, suggests inflammation
  3. non-blanching = bright red or violaceous that stays red when pressure is applied, suggests vascular involvement

6

What are some ways to describe configuration? (4)

  1. unilateral
  2. dermatomal
  3. grouped
  4. linear

7

What is this primary lesion?

Macule: flat and <1cm

Photo is an example of morbilliform drug eruption

 

8

What is this primary lesion?

Patch: flat, >1cm

Photo is an example of seborrheic dermatitis

9

What is this primary lesion?

Papule: raised <1cm

Photo is an example of basal cell carcinoma

10

What is this primary lesion?

Plaques: raised >1cm, can be lichenified

Photo is an example of plaque psoriasis

11

What is this primary lesion?

Vesicle: raised, clear fluid-filled, <1cm

Photo is an example of herpes zoster

12

What is this primary lesion?

Bulla: raised, clear fluid-filled >1cm

Photo is an example of inherited skin fragility disorder

13

What is this primary lesion?

Pusutle: small palpable collection of neutrophils or keratin that appears white

Photo is an example of bacterial folliculitis

14

What is this primary lesion?

Furuncle: inflamed hair follicle, multiple furuncles combine to form a carbuncle

Photo is an example of both furuncles and a carbuncle

15

What is this primary lesion?

Nodule: larger, deeper under the layer of the skin than a papule

Photo is an example of a keloid

16

What is this primary lesion?

Subcutaneous mass vs. cyst: masses are typically a well defined area of abnormal growth, where cysts are a distinct collection of fluid

Photo on the left: excised cyst

Photo on the right: lipoma or subcutaneous mass

17

What is this primary lesion?

Wheal: localized dermal edema

Photo is an example of urticaria

18

What is this primary lesion?

Burrow: small linear pathways in the epidermis

Photo is an example of scabies

19

What are some terms used to refer to the shape of a lesion? (5)

  1. Circular
  2. oval
  3. Annular: ring like with central clearing
  4. Nummular: ring like with no central clearing
  5. polygonal

20

What are some terms used to refer to the texture of a lesion? (4) 

  1. smooth
  2. fleshy
  3. verrucous/warty
  4. scaly (fine, keratotic, greasy)

21

What is this condition? What are the classic characteristics?

Actinic Keratosis

  • Easier to feel than see
  • Superficial keratotic papules come and go on sun damaged skin
  • Precursor to SCC

22

What is this condition and what does it mimic?

Superficial xerosis or sebhorreic dermatitis 

  • Mimics actinic keratosis

23

What is this condition and what are it's characteristics? (hint there are 3 types)

  1. Superficial basal cell carcinoma: Pink patch that does not heal
  2. Nodular basal cell carcinoma: Pink papule often with translucent or pearly appearance and overlying telangiectasias, may have focal pigmentation
  3. Ulcerated basal cell carcinoma: nonhealing ulcer, resulting in rolled border

24

What mimics basal cell carcinoma? (4)

  1. Actinic keratosis
  2. Sebaceous hyperplasia
  3. Fibrous papule
  4. Squamous cell carcinoma: smooth but firm border

25

What exam findings are concerning for malignant melanoma?

ABCDE(EFG): if two or more are present, consider biopsy and referral to dermatologist

  1. Asymmetry
  2. Irregular Border
  3. Color - within the mole but also within surrounding moles
  4. Diameter greater than 6mm
  5. Evolving or changing
  6. EFG: elevated, firm to palpation, growing rapidly over several weeks

26

What is this? What are it's characteristics (color and size, shape, pulsatility/effect of pressure, distribution, significance)

Spider Angioma

  • Color and size: firey red, from very small to 2cm
  • Shape: central body, sometimes raised, surrounded by erythema and radiating legs
  • Pulsatility/effect of pressure: often seen in the center of the spider when pressure with a glass slide is applied, pressure on the body causes blanching of the spider
  • Distribution: face, neck, arms, upper trunk
  • Significance: normal and common on the face and chest, seen in pregnancy and liver disease

27

What is this? What are it's characteristics? (color and size, shape, pulsatility/effect of pressure, distribution, significance)

Spider Vein

  • Color and size: bluish, size variable, from very small to several inches
  • Shape: variable, may resemble a spider or be linear, irregular, cascading
  • Pulsatility and effect of pressure: absent, pressure over the center does not cause blanching, but diffuse pressure blanches the veins
  • Distribution: most often on the legs, near veins, also on the anterior chest
  • Significance: often accompanies increased pressure in the superficial veins as in varicose veins

28

What is this? What are it's characteristics? (color and size, shape, pulsatility/effect of pressure, distribution, significance)

Cherry Angioma

  • Color and size: Bright or ruby red, may become purplish with age, 1-3mm
  • Shape: round, flat or sometimes raised, may be surrounded by a pale halo
  • Pulsatility and effect of pressure: absent, may show partial blanching especially if pressure applied with edge of a pinpoint
  • Distribution: trunk, also extremities
  • Significance: none, increases in size and numbers with aging

29

What are examples of sun damage? (6)

  1. Solar lentigo: bilaterally symmetric brown macules located on sun-exposed skin, including the face, shoulder and arms and hands (left picture)
  2. Actinic purpura: ecchymoses limited to the dorsal forearms and hands but not extending above the shirt sleeve line on the upper arm (right picture)
  3. Wrinkles: increased sun damage and tanning leads to deeper wrinkles at an earlier age
  4. Solar elastosis: yellowish white macules or papules in sun-exposed skin especially on forehead
  5. Poikiloderma: red patches in sun-damaged areas, especially the V of the neck and lateral neck, with fine telangiectasias, both hyper and hypopigmentation
  6. Cutis rhomboidalis nuchae: deep wrinkles on the posterior neck that crisscross

30

What are some abnormal nail findings? (7)

  1. Onychomycosis: fungal infection
  2. Onchyolysis: painless separation of the whitened opaque nail plate from the pinker translucent nail bed
  3. habit tic deformity: pushing on nails/picking at cuticles, looks like a christmas tree
  4. melanonychia : increased pigmentation in the nail matrix
  5. Nail biting: can cause trauma to the nail
  6. Paronychia: superficial nail infection
  7. Clubbing: bulbous swelling of the soft tissue at the nail base