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143 Cards in this Set

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What are the 5 types of pigmented nevi (moles)?
1. Halo nevus
2. Intradermal nevus
3. Junction nevus
4. Compound nevus
5. Hairy nevus
What are the features of a halo nevus? Where does it usually occur?
-Sharp, oval or circular depigmented halo around a mole

-Usually on back in young adult
Features of a Intradermal nevus? Occurrence?
-Dome shaped, raised, flesh to black color, may be pedunculated or hair bearing

-Cells limited to dermis
Features of a Junction nevus?
Occurrence?
-Flat or slightly elevated, dark brown

-Nevus cells lining dermoepidermal junction
Features of Compound nevus? Occurrence?
-Slightly elevated brownish papulae; indistinct border

-Nevus cells in dermis and lining dermoepidermal junction
Features of Hairy nevus?
May be present at birth, may cover larger area; hair growth may occur after several years
What are typical features of normal moles?
-Color
-Shape
-Size
-Number
-Location
-Uniformly tan or brown; all moles look alike on same person
-Round/oval clear border
-Smooth flat spot or bump
-Less than 6 mm
-10 to 40 moles scattered over body
-Above waist on sun exposed body surfaces
What are typical features of dysplastic moles?
-Color
-Shape
-Size
-Number
-Location
-Mixture of different colored moles that don't look alike
-Irregular borders may include notches; fade into surrounding skin and include a flat portion
-Smooth, slightly scaly or rough pebbly appearance
-Larger than 6 mm
-May or may not have increased number
-Anywhere on body, most commonly on back; may also appear below waist on scalp, breast and buttocks
Brown cutaneous color change
-Cause?
-Conditions leading to generalized and localized distributions?
Cause: Darkening of melanin pigment

Generalized: Pituitary, adrenal, liver disease

Localized: Nevi, neurofibromatosis
White cutaneous color change
-Cause?
-Generalized and localized conditions?
Cause: Absence of melanin

Generalized: Albinism

Localized: Vitiligo
Red cutaneous color change
-Causes (2)?
-Generalized and localized conditions?
Causes: Increased cutaneous blood flow or increased intravascular red blood cells

Localized: Inflammation

Generalized: Fever, viral exanthem, uticaria, polycythemia
Yellow cutaneous color change
-2 generalized causes?
-Generalized conditions for each cause?

Which cause affects sclera?
Causes: Increased bile pigmentation (jaundice) or increased carotene pigmentation

Conditions for jaunice: Liver disease.

Conditions for carotene pigmentation: Hypothyroidism, increased intake of vegetables with carotene.

Jaundice will affect sclera, carotene pigmentation will not
Blue cutaneous color change
-Cause?
-Distribution?
-2 conditions?
Cause: Increased unsaturated hemoglobin secondary to hypoxia

Distribution: Lips, mouth, nail beds

Conditions: Cardiovascular and pulmonary disease
Purpura
-Description
-Causes (2)
Red-purple nonblanchable discoloration greater than 0.5 cm diameter

Cause: Intravascular defects, infection
Petechia
-Description
-Causes (2)
Red-purple nonblanchable discoloration less than 0.5 cm diameter

Causes: Intravascular defects and infection
Ecchymoses
-Description
-Cause (3)
Red-purple, nonblanchable, variable size

Causes: Vascular wall destruction, trauma, vasculitis
Spider angioma
-Description
-Cause (3)
Red central body with radiating spiderlike legs that blanch with pressure to central body

Causes: Liver disease, vitamin B deficiency, idiopathic
Venous star
-Description
-Cause (1)
Bluish spider, linear or irregularly shaped, does not blanch with pressure

Cause: Increased pressure in superficial veins
Telangiectasia
-Description
-Cause (1)
Fine, irregular red line

Cause: Dilation of capillaries
Capillary hemangioma
-Description
-Cause (1)
Red irregular macular patches

Cause: Dilation of dermal capillaries
Rotten apples odor
Clostridium gas gangrene
Mousy odor
Proteus infection
Grapelike odor
Pseudomonas infection (especially burns)
Pungent odor
Schizophrenia
Stale beer
Tuberculous lymphadenitis (scrofula)
Putrid odor
Anaerobic infection; scurvy
Feculent odor
Intestinal obstruction, peritonitis
Mousy, musty odor
Phenylketonuria
Macule description
Flat, circumscribed area that is a different color, less than 1 cm in diameter
Papule description
Elevated, firm, circumscribed area; less than 1 cm in diameter
Patch description
Flat, nonpalpable, irregular shaped macule greater than 1 cm in diameter
Plaque
Elevated firm, and rough lesion with flat top surface greater than 1 cm in diameter
Wheal
Elevated, irregular shaped area of cutaneous edema; solid, transient, variable diameter
Nodule
Elevated, firm, circumscribed lesion; deeper in dermis than a papule; 1 to 2 cm in diameter
Tumor
Elevated and solid lesion; may or may not be clearly demarcated; deeper in dermis; greater than 2 cm in diameter
Vesicle
Elevated, circumscribed, superficial, not into dermis; filled with serous fluid, less than 1 cm in diameter
Bulla
Vesicle greater than 1 cm in diameter
Pustule
Elevated, superficial lesion; similar to a vesicle but filled with purulent fluid
Cyst
Elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid or semisolid material
Telangiectasia
Fine, irregular, red lines produced by capillary dilation
SECONDARY LESIONS
Result from later evolution of or external trauma to a primary lesion
Scale
Heaped-up, keratinized cells; flaky skin; irregular; thick or thin; dry or oily; variation in size
Lichenification
Rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation; often involves flexor surface of extremity
Keloid
Irregular-shaped, elevated, progressively enlarging scar; grows beyond the boundaries of the wound; caused by excessive collagen formation during healing
Scar
Thin to thick fibrous tissue that replaces normal skin following injury or laceration to the dermis
Excoriation
Loss of the epidermis; linear hollowed out, crusted area
Fissure
Linear crack or break from the epidermis to the dermis; may be moist or dry
Erosion
Loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla
Ulcer
Loss of epidermis and dermis; concave; varies in size
Crust
Dried serum, blood, or purulent exudates; slightly elevated; size varies; brown, red, black, tan, or straw-colored
Atrophy
Thinning of skin surface and loss of skin markings; skin translucent and paper-like
MORPHOLOGIC CHARACTERISTICS OF SKIN LESIONS
Distribution
Shape/Arrangement
Border/Margin
Associated Changes w/in Lesion
Pigmentation
3 types of skin lesion distributions and their descriptions
1. Localized: Lesion appears in one small area

2. Regional: Involves a specific region of the body

3. Generalized: Widely distributed or in numerous areas simultaneously
Shape/Arrangement
Round/discoid
Oval
Annular
Zosteriform
Polycyclic
Linear
Iris/target lesion
Stellate
Serpinginous
Reticulate
Morbilliform
Round/discoid
Coin shaped (no central clearing)
Nummular eczema
Oval
Ovoid Shape
Pityriasis rosea
Annular
Round, active margins w central clearing
Tinea corporis, sarcoidosis
Zosteriform (dermatomal)
Following a nerve or segment of the body
Herpes zoster
Polycyclic
Interlocking or coalesced circles (formed by enlargement of annular lesion)
Psoriases, uticaria
Linear
In a line
Contact dermatitis
Iris/target lesion
Pink macules with purple central papules
Erythema, multiforme
Stellate
Star shaped
Meningococcal septicemia
Serpiginous
Snakelike or wavy like track
Cutanea larva migrans
Retciulate
Netlike or lacy
Polyarteritis nodosa, lichen planus lesions of erythema infectiosum
Morbilliform
Measles like: maculopapular lesions that become confluent on the face or body
Measles, roseola, drug eruption
Border/Margin
Discrete
Indistinct
Active
Irregular
Border raised above
Advancing
Discrete
Well demarcated or defined, able to draw a line around it with confidence
Psoriasis
Indistinct
Poorly defined, have borders that merge into normal skin or outlying ill-defined papules
Nummular eczema
Active
Margine of lesion shows greater activity than center
Tinea eruptions
Irregular
Non-smooth or notched margin
Malignant melanoma
Border raised above
Center of lesion is depressed compared ot the edge
Basal cell carcinoma center
Advancing
Expanding at margins
Cellulitis
Associated changes w/in lesions
Central clearing
Desquamation
Keratotic
Punctation
Telangiectasias
Central clearing
An erythematous border surrounds lighter skin
Tinea eruptions
Desquamation
Peeling or slouthing of skin
Rash of toxic shock system
Keratotic
Hypertrophic stratum corneum
Punctation
Central umbilication or dimpling
Telangiectasias
Dilated blood vessels within lesion blanch completely, may be markers of systemic disease
Pigmentation
Flesh
Pink
Erythematous
Salmon
Tan-brown
Black
Pearly
Purple
Violaceous
Yellow
White
Flesh
Same tone as surrounding skin
Neruofibroma, some nevi
Pink
Light red undertones
Eczema, pityriasis rosea
Erythematous
Dark pink to red
Tinea eruptions, psoriasis
Salmon
Orange=pink
Psoriasis
Tan-brown
Light to dark brown
Most nevi, pityriasis versicolor
Black
Black for blue-black
Malignant melanoma
Pearly
Shiny white, almost iridescent
basal cell carcinoma
Purple
Dark red-blue-violet
Purpura, Kaposi sarcoma
Violaceous
Light violet
Erysipelas
Yellow
Waxy
Lipoma
White
Absent of color
Lichen planus
4 lesions in sun exposed areas
1. Sunburn
2. Lupus erythematosus
3. Viral exathem
4. Porphyria
2 lesions in clothed areas
1. Contact dermatitis
2. Miliaria
4 lesions in flexor aspects of extremities
1. Atopic dermatitis
2. Intertrigo
3. Candidiasis
4. Tina cruris
Lesion in extensor aspect of extremities
Psoriasis
3 lesions in stocking/glove areas
1. Viral exanthem/atopic dermatitis
2. Tinea pedis
3. Poststreptococcal infection
3 lesions in truncal area
1. Pityriasis rosea
2. Atopic dermatitis
3. Drug reaction
3 lesions in face, shoulder, and back
1. Acne vulgaris
2. Drug-induced acne
3. Cushing syndrome
Vellus hair is ________.

Distribution?
Fine

Covers the body
Terminal hair is ________.

Distribution?
Coarse

Covers scalp, pubic, axillary areas, arms/legs, and beards
Yellow nail discoloration (3)
Psoriasis
Fungal infection
Chronic respiratory distress
Proximal subungual fungal infection (1)
HIV infection
Diffuse darkening of nail (4)
Antimalarial drug therapy
Candidal infection
Hyperbilirubinemia
Chronic trauma
Green-black nail discoloration
Pseudomonas infection
-painless
Generalized (multiple) blue nails
Cyanosis
White spots on nails
Cuticle manipulation (mild trauma)
Longitudinal white streaks/transverse white bands
Systemic disorder
Single nail distress?

Multiple nail distress?
Injury

Systemic disease
Clubbing is associated with what 2 kinds of disease?
Respiratory and cardiovascular
3 causes of thickening of nails
Tight fitting shoes
Chronic trauma
Fungal infection
5 causes for separation of nail plate from nail bed
1. Psoriasis
2. Trauma
3. Candidal infection
4. Pseudomonas infection
5. Medication
Jaundice is a result of?

How long may it persist in a newborn?

Where should the physician check?
Hyperbilirubinemia secondary to liver disease or infection

May persist for 3-4 weeks

Check oral mucosa and sclera
EXPECTED COLOR CHANGES IN NEWBORNS
Pg. 178
Acrocyanosis
Cyanosis of hands and feet
Cutis marmorata
Transient mottling is exposed to decreased temperature
Erythema toxicum
Pink papular rash with vesicles superimposed on thorax, back, buttocks and abdomen. Appears 24-48 hrs and resolves after several days
Mongolian spots
Irregular areas of deep blue pigmentation. Usually in sacral and gluteal regions
Salmon patches (Stork bites)
Flat, deep, pink localized areas usually seen on the mid-forehead, eyelids, upper lip and back of neck
SKIN LESIONS: EXTERNAL CUES TO INTERNAL PROBLEMS
PG. 179
Faun tail nevus
Tuft of hair overlying spinal column at birth. Usually in lumbosacral area.
Spina bifida occulta
Epidermal verrucous nevi
Warty lesions in a linear or whorled pattern that maybe pigmented or skin colored.
Skeletal, central nervous system, and ocular abnormalities
Cafe au lait macules
Flat, evenly pigmented spiots varying from light to dark brown color Larger than 5 mm in diamter
Neurofibromatosis
Freckling in axillary or inguinal area
Multiple flat pigment macules
Neurofibromatosis
Ash leaf macule
White macules
Tuberous sclerosis
Facial port-wine stain associations (2)
Opthalmic division of trigeminal nerve is associated with ocular defects or angiomatous malformation of the meninges
Limb/trunk port-wine stain association
Orthopedic problems
Congenital lymphedema with or w/o transient hemangiomas association
Gonadal dysgenesis (defective development)
Hair collar sign
Ring of long, dark coarse hair surrounding a midline scalp nodule in infants
Neural tube closure defect of the scalp
Transient puffiness in a newborn should disappear after how long?
2-3 days
What is mottling?
Discolored, uneven patches/spots
Criteria for diagnosing neurofibromatosis in prepubescent?

After puberty?
6 or more cafe au lait macules more than 5 mm in greatest diameter

6 or more cafe au lait macules more than 15 mm in greatest diameter
What are milia?

When are they found?
Small whitish, discrete papules on the face

First 2-3 months of life
Turgor in children is a good indicator of ?
Hydration and nutrition
-skin will tent if neglected in either of these regards
What glands function in newborns?

What glands mature in adolescents?
Sebaceous

Apocrine
What are decubitus ulcers?

What contributes to their association to older adults?
Pressure sores

Immobility and decreased peripheral vascular circulation
Skin of older adults usually appears?
More transparent, paler
What is purpura?
Where is commonly found?
What contributes to it?
Purple blood hemmorhage lying under skin

Dorsal surfaces of hands and lower arm

Seen in older adults on aspirin therapy
TYPES OF LESIONS THAT OCCUR IN HEALTHY OLDER ADULTS
PG. 185
Cherry angiomas
Tiny, bright red, round papules that may become brown with time
Seborrheic keratoses

Location?

Must be distinguished from?
Pigmented, raised, warty lesions, appearing on the face or trunk.

Must be distinguished from actinic keratoses
Sebaceous hyperplasia
Yellow, flattened papule with central depression
Cutaneous tags (acrochordon)

Location?
Small, soft tags of skin, pedunculated

Appear on neck and upper chest
Cutaneous horns

Location?
Small, hard projections of the epidermis

Forehead and face
Solar lentigines

Location?
Irregular, round, gray-brown macules with a rough surface

Sun exposed areas