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78 Cards in this Set

  • Front
  • Back
List the 9 Functions of the Skin
1. Protection
2. Prevents penetration
3. Perception
4. Temp Regulation
5. Identification
6. Communication
7. Wound Repair
8. Absorption/Excretion
What layer is the epidermis and what does it entail?
The thin, outermost layer

-the stratum corneum (outermost or horny cell layer)
-stratum germinativum (inner or basal cell layer that contains keratin and melatonin
What is the Dermis and what layer is it?
Dense connective tissue layer forming the middle bulk of the skin. Also contains the nerves that innervate the skin.
What is in the subcutaneous layer and where does it occur?
Inner most layer

Chiefly composed of adipose (fatty connective) tissue
What determines the difference in skin color?
We all have the same number of melanocytes but the concentration of melatonin, keratin and the blood vessels that lie under the skin.
What is produced from Eccrine Sweat glands?
Dilute saline solution. Matures by the age of 2 months.
What is produces from Apocrine glands?
Sweat glands in the axila, hair, sticky solution. Active during puberty. Arises from sexual or emotional excitement. Musty Body odor.
What are Sebaceous glands?
Produce Sebum
What is most important to do when looking at the subjective history during the skin examination?
If any questions asked are answered yes then you must do PQRSTU.
Give some examples of Subjective Data for a skin exam
-Previous History of Skin Disease.
-Changes in pigmentation
-Change in mole (color or size)
-Excessive dryness or moisture
-Pruritus (itching)
-Excessive Bruising
-Rash and lesions
-Medications
-Hair loss
-Change in nails
-Self care behaviors (sunscreen)
-Environment or occupational hazards
What are some considerations for objective data during a skin exam?
-Need proper equipment.
-Color
-Moisture
-Temp
-Texture
-Mobility and Turgor
-Any lesions
What is pallor and when can it occur?
Pallor is a washing out of the skin.
-can occur because of anemia, stress, fear, or if the exam room is too cool.
-Raynaud's disorder-areas of pallor and others w/erythema (can be a rheumatological disorder)
What is erythema and when does it occur?
Temporary reddening of the skin.
-can occur from embarrasment, over heating, exercise, or localized infection.
What are some considerations for objective data during a skin exam?
-Need proper equipment.
-Color
-Moisture
-Temp
-Texture
-Mobility and Turgor
-Any lesions
What is Cyanosis and when does it occur?
When the skin turns a Blue color.
-can occur because of an decrease in O2
-poor vascular condition
-shock or heart failure
-chronic lung disease
What are Mongolian Spots and which population(s) are more susceptible to them?
Hyperpigmentation
-Bluish, black, usually on the buttocks and usually fades away after 1st year.
-Occurs primarily in Black, Mexican and Asian populations
-Only 9% occur in White
What Jaundice and when can it occur?
Yellow undertone of the skin
-Rise of bilirubin in the blood
-Can occur from Hep, Sickle Cell, cirosis of the liver. Pancreatic cancer
-Can be seen in the eyes or on the hard and soft palate of the mouth.
What skin conditions are common in older adults?
-Senile Purpura- bleeding under the skin (dark spots)
-Dry Skin (xerosis)
-Senile lentigines- liver spots from sun exposure and are not cancerous.
Describe some moisture abnormalities in the skin
Diaphoresis: profuse sweating. May be MI or excessive sweating
-Panic attacks may cause clamminess
-Dehydration- look at oral mucous membranes
What skin disorder is a sign of pre-diabetes?
Hyper pigmentation around the neck.
What skin conditions are common in older adults?
-Senile Purpura- bleeding under the skin (dark spots)
-Dry Skin (xerosis)
-Senile lentigines- liver spots from sun exposure and are not cancerous.
Describe some moisture abnormalities in the skin
Diaphoresis: profuse sweating. May be MI or excessive sweating
-Panic attacks may cause clamminess
-Dehydration- look at oral mucous membranes
List some general observations when examining skin lesions
-Distribution, configuration, Morphology
-universally spread?
-symmetrical?
-localized?
-color
-sharpness (well or ill-defined)
-surface contour (dome-like)
-geometric shape
Describe a Macule and give examples
Circumscribed, flat,Non-palpable, change in skin color.
-up to 1 cm
exs. Freckles
-fat nevi (little red spots)
-measles (flat rash)
-petechiae
-scarlet fever
Describe a patch and give some examples
-A macule larger than 1cm
-Senile lentigo (liver spots)
-Mongolian spot
-vitiligo
-cafe au lait
-spot
-measles rash
What is a Papule and what are some examples?
-A palpable, elevated, circumscribe, solid mass
-caused by superficial thickening in the epidermis
-up to 0.5cm
-Ex. Elevated nevus (mole), lichen planus, wart, molluscum
What is a Plaque lesion?
What are some examples?
-A flat, elevated surface
-Larger than 0.5cm
-Often formed by coalescence of papules
-Ex. Psoriasis, lichen planus, xanthoma, xanthelasma
What is a nodule? Give an example
-A solid, elevated, firm or solft mass less than 1-2 cm
-May be firmer and extend deeper into dermis than papule
-Ex. Fibroma intradermal nevi
What is a tumor and what are its characteristics?
-A solid elevated firm or soft mass larger than 1-2 cms
-Extending deeper into dermis
-Benign or malignant
-Lipoma, hemangioma
What type of lesion is known as a WHEAL?
Exs?
-A superficial, raised, erythemotaous, TRANSIENT lesion with irregular borders due to localized edema
-Fluid is held diffusely in the tissues
-Ex. Mosquito bite, allergic reaction
-can be a drug reaction
What is the lesion know as URTICARIA? What is an example
-Wheals that have coalesced to form and extensive rash.
-can be from scratching
-caused by intrinsic pruritic (itching)
ex. Hives
What is a vesicle? Give some examples
A circumscribed, superfical, elevated CAVITY
-contains free fluid
-Clear fluid flows if wall ruptured
-Up to 1 com in size
-Ex. Herpes simplex, chicken pox, contact dermatitis.
What is a Bullae? Give some examples
-A larger vesicle
-Usually single chambered
-Superficial in epidermis
-Thin walled so ruptures easily
-Larger than 1cm
-ex. Friction blister, pemphigus, burns, contact dermatitis
What is a Cyst?
-An encapsulated fluid or pus-filled cavity in dermis or subcutaneous layer
-Tensely elevating the skin
-Larger than 1cm
Ex, Sebaceous cyst
What are pustules?
-A circumscribed, superficial, elevated cavity
-Contains turbid fluid (pus)
-Up to 1 cm
Ex. Impetigo, acne
What is a crust?
-Thickened, dried residue of burst vesicles, pustutles or blood
-can be red-brown, honey-colored, or yellow depending of the fluid's origin
-exs. excema, impetgo, crust phase of herpes simplex
What is scaling of tinea pedis?
-Tinea: is the fungus that causes this type of scaling
-Athletes's foot
-compact desiccated flakes of skin
-Dry or greasy
-Silvery or white
-from shedding of dead excess keratin cells
-visible exfoliation of the dermis
What are fissures?
-A linear crack with adrupt edges
-Extends into the dermis
-Can be dry or moist
-ex. cheilosis, athlete's foot, anal fissure, renal failure
What is erosion? Give some examples
-A superficial circumscribed loss of epidermis
-Leaves a scopped-out but shallow depression
-Moist but no bleeding
-Heals without a scar because does not extend into the dermis
-Ex, stage 2 pressure sore
What is an Ulcer? Give some examples
-A circumscribed depression extending into the dermis
-Irregular shape
-May bleed
-Leaves a scar when it heals
-Ex stasis ulcer, pressure sore, chancre
What is excoriation? What are some examples?
-A scratch mark
-Superficial
-Can be self-inflicted abrasion secondary to intense itching
-Ex. Scratch from foreign body, insects bites, scabies, dermatitis, varicella
What is a scar?
-After open reduction of fracture
-Replacement of destroyed normal skin tissue by fibrous connective tissue
-A permanent change
What is skin atrophy?
-Depressed skin level resulting from loss of tissue
-a thinning of the epidermis with loss of normal skin furrows, resulting in shiny, translucent skin
-ex. Striae, senile skin, arterial insufficency
What is Lichenification? What are some examples?
-Thickening and roughening of the skin usually as a result of intense scratching
-Results from a tightly packed set of papules
-Causes increases visibility of the superficial skin markings
-Ex long standing eczema, atopic dermatitis
What is a keloid scar?
-Hypertrophic scar
-The resulting skin level is elevated by excess scar tissue, which is invasive beyond the site of the original injury
What is meant by annular configurations?
the lesion occurs in circular pattern
What are confluent lesions?
Lesions that run together
What is a discrete lesion?
A lesions that is individual
What are grouped lesions?
Ones that are grouped in a particular place ie contact dermatitis
What is a target configuration of a lesion?
Described as an iris ex. lime disease.
What is the gyrate shape of a lesion?
The lesion looks twisted or snake like. ie scabies
What is a linear configuration?
striped lesions ie scratches
What are polycyclic lesions?
Annular lesions that grow together
What are zosteriform lesions?
linear along a nerve route. Ex. Herpes Zoster
What the the vascular lesions?
-Petechiae
-Purpura
-Ecchymosis
-Cherry Angioma
-Spider Angioma
-Telangiectasia
-Nevus Flammeus-Port wine stain
Describe Petechiae
-Color-red
-Pin sized macules of blood in the skin
Describe a Purpura
-A large macule or papule of blood in the skin
-Such blood-filled lesions do not blanch
What is Ecchymosis?
-Larger extravasations of blood into the skin.
-bruises
What are Cherry Angiomas?
-aka Campbell de Morgan spots
-small bright red papules and of no consequence
-Benign angiomas common on the trunks of the middle-aged and elderly
What are spider Angioma?
-Satellite telangiectases that look like spiders with legs radiated from a central, often palpable feeding vessel
-if diagnosis in doubt, press the center with slide and lesion will disappear
-If many on trunk check liver function. May be normal in faces of children or erupt in pregnancy
Telangiectasia?
-Term refers to permanently dilated and visible vessels in the skin
-They can appear as linear, punctate stellate crimson-purple markings
Can be caused by nifedipine
What is Nevus Flammeus?
-Present at birth
-Caused by dilated dermal capillaries
pale, pink to purple macules
-Mostly on face and trunk
What are the Skin Cancer Warning signs?
-Asymmetry in shape: one half unlike the other half
-Border is irregular: edges are irregularly scalloped
-Color is mottled- haphazard display of color; shades of brown, black, gray, red and white
-Diameter is unusually large: greater than the tip of a pencil eraser (6mm)
-Elevations is almost always present: surface distortion is assessed by side-lighting. Melanoma in situ may be flat
Enlargement: history of an increase in the size of lesion is perhaps one of the most important signs of malignant melanoma
What is the most common skin cancer?
Basal Cell Carcinoma
Describe Basal Cell Carcinoma
-Locally invasive and destructive
-Slow growing rarely metastasized
-Almost translucent, dome-shaped papule with overlying telangiectasias
What are actinic keratosis of the Scalp?
Keratotic lesions with malignant potential
Describe Squamous cell Carcinoma
-Invasive malignancy
-Commonly found on the head, neck or hands
-May arise from actinic keratosis or de novo
What is malignant melanoma?
-The most serious of skin cancers
-whenever it is very black or raised
What are the 2 types of hair?
Vellis hair: the thin hair that is all over the body
Terminal hair: hair on the scalp, eyebrows, axila, pubic or chest
Why does hair turn white?
-Melanin in shaft gets replaced by colorless hair bubbles
What is Alopecia Areata?
-Non scarring hair loss, typically of rapid onset in a sharply defined, usually round or oval area
-The loss may be diffuse or patchy or band-like at the margins of the scalp
-Most likely immunological phenomenon
Hirsutism?
-More hair in areas that are not normal
-May be normal for heritage
or certain diseases polycystic ovarian syndrome=more hair
What is nail clubbing?
Flattening of the nail at the bed
-can be a sign of cancer of the lungs or lung disease
What is capillary refill?
-Color should return to the nail between 1-3 seconds
What is impetigo?
It is a staph or strep infection
What is paronychia?
-Acute bacterial infection of the proximal and lateral nail fold
-Rapid onset of pain and swelling
-Pus accumulates behind the cuticle
-Chronic irritant exposure
Name the structures of the nail
-Nail plate: actual nail
-Lanula: crest shaped half moon
-Lateral nail fold
-Nail matrix: where nail grows from
-Posterior nail fold
-Nail Bed
What is pitting?
Pits in the nail