155 Week 4

Front 1

Three layers of skin, and their content (epidermis)

Back 1

epidermis: inner stratum germinativum (basal cell layer) forms new skin cells. Major ingredient is keratin. Stratum corneum is the outer horny cell layer consist of dead keratinized cells. Contains melanocytes which produce melanin

Front 2

Three layers of skin, and their content (dermis)

Back 2

-supportive layer
-consist of connective tissue or collagen--a tough, fibrous protein enables skin to resist tearing
-resilient elastic tissue allows skin to strech
-nerves, sensory receptors, blood vessles, and lymphatics
-hair follicles, sebaceous glands, sweat glands

Front 3

Three layers of skin, and their content (subcutaneous layer)

Back 3

-adipose tissue, made up of fat cells
-store fat for energy, temperature control, aids in protection
-increase skin mobility

Front 4

Define two types of human hair

Back 4

Vellus hair: fine, faint, covers most of the body
Terminal hair: darker, thicker, grows on scalp and eyebrows, axillae, pubic area, face and chest(male)

Front 5

Differentiate between sebaceous, eccrine, and apocrine glands

Back 5

sebaceous glands: produce sebum which oils and lubricates the skin and hair, retards water loss from skin, everywhere except palms and soles
Eccrine glands: open directly onto skin surface, produce sweat, widely distributed on body
Apocrine glands:produce thick , milky secretion, open into hair follicles. Locate in axillae, anogenital area, nipples, navel

Front 6

skin function list

Back 6

-protection
-prevents penetration
-perception
-temperature regulation
-identification
-communication
-wound repair
-absorption and excretion
-production of Vit D

Front 7

List variables that are external to the skin itself that can influence skin color

Back 7

Emotions: fear, anger-peripheral vasoconstriction-false pallor
embarrassment-flushing-false erythema
Environment:hot room -vasodilatation-false erythema
chilly room -vasoconstriction-false pallor,coolness
cigarette smoking
-vasoconstriction-false pallor
Physical:prolonged elevation-decreased arterial perfusion-pallor,coolness
dependent position-venous pooling-redness,warmth,distended veins
immobilization-slowed circulation-pallor coolness, nail beds pale, prolonged capillary filling time

Front 8

Describe the appearance of pallor, erythema, cyanosis, and jaundice, both in light-skinned and dark-skinned persons. State common cause of each (pallor)

Back 8

Pallor:in light-skinned persons, the red-pink tone are lost, mostly white. For brown-skinned, it's yellowish brown. For black-skinned, it's ashen or gray. Caused by high-stress states as anxiety or fear, exposure to cold and cigarette smoking, edema, anemia, shock, arterial insufficiency

Front 9

Describe the appearance of pallor, erythema, cyanosis, and jaundice, both in light-skinned and dark-skinned persons. State common cause of each (erythema)

Back 9

erythema:light-skinned persons-intense redness, dark-skinned persons-need to palpate the skin for increased warmth, taut(紧绷), tightly pulled surfaces indicative of edema, hardening of deep tissues, blood vessels
Caused by excessive blood in dilated superficial capillaries, such as fever, inflammation and blushing, polycythemia, venous stasis, CO poisoning, extravasular presence of RBC

Front 10

Describe the appearance of pallor, erythema, cyanosis, and jaundice, both in light-skinned and dark-skinned persons. State common cause of each (cyanosis)

Back 10

Cyanosis: light-skinned persons-bluish, mottled discoloration. Dark-skinned persons-difficult to observe, look at changes in level of consciousness and signs of respiratory distress. Cause:indicates tissues are not adequately perfused with oxygenated blood, such as hypoxemia,shock, heart failure, chronic bronchitis, congenital heart disease

Front 11

Describe the appearance of pallor, erythema, cyanosis, and jaundice, both in light-skinned and dark-skinned persons. State common cause of each(jaundice)

Back 11

Jaundice: For light-skinned persons, a yellow color first noted in the junction of the hard and soft palates in the mouth and in the sclera. For dark-skinned persons, they have normal yellow subconjunctival fatty deposits that are common in the outer sclera, dont confuse it with sclera jaundice. Cause: rise of bilirubin in blood, such as hepatitis, cirrhosis(肝硬化), sickle-cell disease, transfusion reaction, hemolytic disease of newborn

Front 12

list causes of changes in skin temperature

Back 12

Temperature:
hypothermia--General hypothermia accompanies central circulatory problem such as shock.
-Localized hypothermia occurs in peripheral arterial insufficiency, raynaud's disease,immobilized extremity
Hyperthermia:
-generalized hyperthermia, increased metabolic rate, such as in fever or after heavy exercise, hyperthyroidism
-localized hyperthermia with trauma, infection, sunburn

Front 13

list causes of changes in skin texture

Back 13

Hyperthyroidism--smoother and softer skin, like velvet
Hypothyroidism--rough, dry and flaky skin

Front 14

list causes of changes in skin moisture

Back 14

Diaphoresis--thyrotoxicosis (thyro甲状腺), stimulation of the nervous system with anxiety or pain
Dehydration--mucous membrane look dry, lips look parched and cracked

Front 15

list causes of changes in skin mobility and turgor

Back 15

edema, scleroderma--decrease skin mobility
poor turgor--severe dehydration or extreme weight loss

Front 16

Describe each grade on the four-point grading scale for pitting edema

Back 16

--1+ mild pitting, slight indentation, no perceptible swelling of the leg
--2+ moderate pitting, indentation subsides rapidly
--3+ deep pitting, indentation remains for a short time, leg looks swollen
--4+ very deep pitting, indentation lasts for long, leg is very swollen

Front 17

Distinguish the terms primary versus secondary in reference to skin lesions

Back 17

primary lesions: immediate/specific cause
develops on previously unaltered skin
secondary lesions:results from a change in a primary lesion over time and/or trauma

Front 18

the white linear markings that normally are visible through the nail and on the pink nail bed

Back 18

leukonychia striata

Front 19

Mongolian spot

Back 19

Mongolian spot: common hyperpigmentation in newborns of aboriginal, african, east indian, hispanic. Blue-black to purple macular area at the sacrum or buttocks, can occur on the abdomen, thighs, shoulders, or arms, due to deep dermal melanocytes. Fades during the first year

Front 20

Cafe au lait spot

Back 20

large round or oval patch of light brown pigmentation present at birth, usually normal

Front 21

erythema toxicum

Back 21

common rash appears in the first 3-4 days of life also called flea bite. Consist of tiny, punctate, red macules and papules. cheek, trunk, chest, back and buttocks

Front 22

cutis marmorata

Back 22

Cutis marmorata:transient mottling in the trunk and extremities in response to cooler room temperatures, reticulated red or blue pattern over skin

Front 23

physiological jaundice

Back 23

a yellowing of the skin, sclera, and mucous membranes developed after 3rd or 4th day of life, common, because of the increased number of red blood cells hemolyze after birth

Front 24

milia

Back 24

milia: tiny while papules on the cheeks, forehead, and across the nose and chin caused by sebum occludes the opening of follicles. Milia resolve spontaneously within a few weeks

Front 25

Lentigines(elderly people)

Back 25

lentigines: liver spots, small, flat, brown macules.They are clusters of melanocytes that appear after extensive sun exposure

Front 26

seborrheic keratosis (Aging adult)

Back 26

Lesions that look dark, greasy, and “stuck on”. They develop mostly on the trunk but also on the face and hands and on unexposed as well as on sun-exposed areas. Not cancerous

Front 27

Actinic keratosis (aging adult)

Back 27

-lesions, red-tan scaly plaques that increase over the years to become raised and roughened. -may have a silvery-white scale, related to sun exposure
-may develop into carcinoma

Front 28

Acrochordons (skin tags)

Back 28

-Overgrowths of normal skin that form a stalk and are polyplike.
-They occur frequently on eyelids, cheecks, and neck, and axillae and trunk.

Front 29

sebaceous hyperplasia (aging adult)

Back 29

-Raised yellow papules with central depression.
-common in men
-occurring over the forehead, nose, or cheeks.

Front 30

differentiate between these purpuric lesions: petechiae, ecchymosis, hematoma

Back 30

Petechiae: Tiny punctuate hemorrhages, 1 to 3 mm, round and discrete, dark red, purple or brown, in color. Caused by bleeding from superficial capillaries.
Ecchymosis:skin discoloration caused by the escape of blood into the tissues from ruptured blood vessels.
Hematoma: It is a bruise you can feel. It elevates the skin and is seen as swelling.

Front 31

Differentiate between the appearance of the skin rash of these childhood illness: measles, german measles, chickenpox

Back 31

Measles (rubeola): Red-purple maculopapular blotchy rash appears on third or fourth day of illness.Start from behind ears, Koplik's spots present.
German Measles (rubella): Pink papular rash, first appears on face, then spreads, no koplik's spots, presence of neck lymphadenopathy
Chickenpox (varicella): Small tight vesicles first appear on trunk, and then spread to face, arms and legs.

Front 32

List and describe three skin lesions associated with AIDS

Back 32

Epidemic Kaposi’s Sarcoma:
a) Patch Stage: Multiple patch-stage early lesions are faint pink on the temple and beard area.Could easily be mistaken for bruises or nevi and be ignored.
b) Advanced disease: Widely disseminated lesions involving skin, mucous membranes, and visceral organs. may observe violet-colored tumors over the nose and face, cherry-red tumor nodule
c) Plaque Stage: Evolving lesions develop into raised papules or thickened plaques. oval in shape and vary in color from red to brown.

Front 33

Contrast a furuncle with an abscess

Back 33

Red, swollen, hard, tender, pus-filled lesion caused by acute localized bacterial infection.
Furuncle: caused by the infection of hair follicles,
Abscess: due to traumatic introduction of bacteria into the skin. Usually larger and deeper than furuncles

Front 34

Describe the appearance of these conditions of the nails:koilonychia, paronychia, beau's line, splinter hemorrhages, onycholysis, clubbing(koilonychia, paronychia, beau's line)

Back 34

Koilonychia:Thin, depressed nails with several lateral edges tilted up, forming a concave凹profile.
Paronychia:Red, swollen, tender inflammation of the nail folds. Acute-baterial infection, chronic-fungal infection
Beau’s line: Transverse furrow or groove.A depression across the nail that extends down to the nail bed.

Front 35

Describe the appearance of these conditions of the nails:koilonychia, paronychia, beau's line, splinter hemorrhages, onycholysis, clubbing(splinter hemorrhages,onycholysis, clubbing)

Back 35

Splinter hemorrhages:Red-brown linear streaks, embolic lesions. Occur with bacterial endocarditis or minor trauma.
Onycholysis:slow, persistent fungal infection, change in color(green), texture, thickness, with nail crumblingor breaking and loosening of nail plate
clubbing: Proximal edge of nail elevates; angle is greater than 180 degrees. Distal phalange(指骨) looks rounder and wider.

Front 36

Define and give an example of the following primary skin lesions:macule, papule, plaque, nodule, tumour, wheal, vesicle, pustule

Back 36

macule: Solely a color change, flat and circumscribed, of less than 1 cm.
Examples: Freckles, flat nevi, hypopigmentation, petechiae, measles, scarlet fever

Front 37

papule

Back 37

Papule: Something you can feel (solid, elevated, circumscribed, less than 1 cm, diameter) caused by superficial thickening in the epidermis.
Examples: Wart, elevated nevus(mole), lichen planus, molluscum

Front 38

plaque, nodule

Back 38

plaque:surface elevation wider than 1 cm. A plateaulike, disk-shaped lesion. Examples: psoriasis and lichen planus

nodule: Nodule: Solid, elevated, hard or soft, larger than 1 cm. May extend deeper into dermis than papule. Examples: xanthoma, fibroma, intradermal nevi

Front 39

tumour, wheal,

Back 39

Tumor:Larger than a few centimeters in diameter, firm or soft, deeper into dermis. Benign or malignant
Examples: Lipoma, hemangioma
Wheal: Superficial, raised, transient, and erythematous; slightly irregular shape due to edema. Examples: Mosquito bites, allergic reaction, dermographism

Front 40

vesicle, pustule

Back 40

Vesicle: Elevated cavity containing free fluid, up to 1 cm; a “blister.” Clear serum flows if wall is ruptured. Examples: Herpes simplex., chicken pox, herpes zoster, contact dermatitis

Pustule:Turbid fluid (pus) in the cavity. Circumscribed and elevated. Example: Impetigo.acne

Front 41

Secondary skin lesions (crust, scale, fissure, erosion, ulcer, excoriation, scar, atrophic scar, lichenification, keloid)

Back 41

See book 254

Front 42

crust

Back 42

Crust: The thickened, dried-out exudate left when vesicles/ pustules burst or dry up. Color can be red brown, honey or yellow depending on the fluids ingredient (blood, serum, pus). Examples: Scab after abrasion, impetigo, etc.

Front 43

scale

Back 43

Scale: Compact, desiccated flakes of skin dry or greasy, silvery or white, from shedding of dead excess keratin cells. Examples: Dry skin.

Front 44

fissure

Back 44

Fissure: Linear crack with abrupt edges. Extends into dermis, dry or moist. Examples: Cheilosis. athlete's foot

Front 45

erosion

Back 45

Scooped out with shallow depression. Superficial; epidermis lost; moist but not bleeding; heels without scar because erosion does not extend into dermis.

Front 46

ulcer

Back 46

Ulcer: Deeper depression extending into dermis; irregular shape; may bleed; leave scar when heels. Examples: Pressure sore.

Front 47

excoriation

Back 47

Excoriation: Self-inflicted abrasion; superficial; sometimes crusted; scratches from intense itching. Examples: Insects bite.

Front 48

scar

Back 48

Scar: After a skin lesion is repaired, normal tissue is lost and replaced with connective tissue (collagen). This is a permanent fibrotic change. Examples: Acne.

Front 49

atrophic scar

Back 49

Atrophic scar: Resulting skin level depressed with loss of tissue; a thinning of the epidermis. Examples: Striae.

Front 50

lichenification

Back 50

Lichenification: Prolonged intense scratching eventually thickens the skin and produces tightly packed sets of papules; looks like surface of moss (lichen)

Front 51

Keloid

Back 51

Keloid: Hypertrophic scar. skin level is elevated by excess scar tissue, which is invasive beyond the sites of original injury. May increase long after healing occurs. Looks smooth, rubbery, “clawlike”, and has a higher incidence among blacks.