Phys Di 2 final exam with book questions

What are we looking for with skin inspection?

Adequate lighting (daylight) and tangential (oblique- countour) is best

1. Moisture- minimal perspiration or oilness should be present

2. Temperature- use the dorsal surface of hands/fingers

3. Texture- smooth, soft, and even

4. Turgor- ALTERED IF PATIENT IS SUBSTANTIALLY DEHYDRATED OR IF EDEMA IS PRESENT

5. Mobility- move easily when pinched, and return to place immediately when released

6. Body sweep

7. Color

8. Thickness

What is the difference between higher and lower turgidity?

Higher turgidity- stay peaked (dehydrated)

Lower turgidity- can’t pinch (edema)

What are we looking for with difference of thickness in skin?

Thick skin (1.5mm)- no hair follicles, sebaceous glands, erector pilli muscles

• Extra layer- stratum lucindum

• Palms of hands and soles of feet

Thin skin (.07-1.5mm)- hair follicles, sweat glands, sebaceous glands, erector pilli muscles PRESENT

Where is skin thickest and thinnest?

Thickest→ upper back

Thinnest→ eyelids

When looking at a skin lesion, what are we evaluating?

size, shape, color, texture, elevation/depression, attachment at base (pedunculated/stalked, sessile/non-stalked)

Location and distribution- generalized/localized, region of body, pattern

Configuration- grouped/clustered, linear, annular, arciform/bow shaped

Exudates- color, odor, amount, consistency

What are the two types of skin lesions?

Primary- initial spontaneous manifestations of pathological process (flat, elevated, solid mass or fluid filled)

Secondary- evolution of or external trauma to a primary lesion (tissue loss, extra tissue)

What are the 2 major discriminating factors in naming the lesions?

size and elevation

What are the examination tools for a skin evaluation?

1. small, clear, flexible ruler

2. Use of light for closer inspection

3. Transillumination- determine presence of fluid in cysts and masses

4. Darkened room- fluid filled lesions transilluminate with cherry red glow

5. Wood lamp (black light)- used to evaluate epidermal hypopigmented or hyperpigmented lesions to distinguish fluorescing lesions

What is a macule?

primary skin lesion

flat

less than 1 cm

example→ freckles, flat moles, rashes, petechiae, measles

What is a papule?

primary skin lesion

elevated

less than 1 cm

firm

examples→ warts, elevated moles (nevi), lichen planus

What are examples of maculopappular lesions?

rubella, rubeola

What is a patch?

primary skin lesion

flat

greater than 1 cm

What are examples of patches?

vitiligo

port wine stains

cafe au lait patches

chloasma/melasma

lupus

acanthosis nigrans

erythema migrans/lymes disease (annular patch)

Erythema migrans/lymes disease is an example of a _

annular patch

What is a plaque?

primary skin lesion

elevated

greater than 1 cm

What are an example of plaques?

psoriasis

acinic keratosis

What is a wheal?

elevated

variable diameter/size

poorly defined margins/edematous

What are examples of wheals?

bug bite

allergic reactions (hives)

dermographic urticaria

What is a nodule?

elevated

1-2 cm

more deeply seated in dermis

What are examples of nodules?

erythema nodosum

lipoma

How does a nodule differ from a papule and a plaque?

origin is deeper in the dermis

What is a tumor?

elevated

greater than 2 cm

firm and deeply seated

What are examples of tumors?

neoplasms

lipomas

hemangioma

What are the MC things seen in practice with skin lesions?

Sebaceous cysts

lipomas

What is a vesicle?

elevated

less than 1 cm

fluid filled and superficial

“blister”

What are examples of vesicles?

varicella (chicken pox)

Herpes zoster (shingles)

What is a bulla?

elevated

greater than 1 cm

large fluid filled blister filled with serous fluid

What are examples of bulla?

blister (burn)

pemphigus vulgaris

What is a cyst?

elevated

size is variable

well encapsulated

found in subcutaneous or dermal layer

How does a cyst differ from a vesicle and a pustule?

cyst is well encapsulated

Sebaceous cyst and cystic acne is an example of a _

cyst

What is a pustule?

elevated

less than 1 cm

filled with purulent fluid

What is the difference between a pustule and a vesicle?

Pustule- purulent fluid

Vesicle- serous fluid

Acne and impetigo are examples of _

pustule

A sebaceous cyst is commonly found _

above the eyebrow

What are prominent veins associated with venous insufficiency that are flat, irregular size, and red lines from capillary dilation? (spider veins)

Telangiectasia

Rosacea is an example of a _

rosacea

What is elevated keratinized cells that are known as flakes of hardened skin secondary to plaques?

Scale

Seborrheic dermatitis, cradle cap, dry skin, dandruff, and psoriasis are all examples of _

scales

Pityriasis roasea and herald patch are examples of _

scales

What is herald patch?

1-2 weeks prior to the eruption of the fern-like pattern of fine scales mostly on torso

What is Ichthyosis vulgaris?

1-4 years

xeroderma→ dry skin with fine white scaling: normal skin color but fish scale pattern

follicular keratosis

increased number of creased in palms and soles

diffuse involvement, especially shins, arms, back

Hydration plus emollients and urea containing lotions are good treatments for _

ichthyosis vulgaris

Who is seborrheic dermatitis common in?

offered as a differential for eczema and psoriasis

between 20-50 years old

MC in males

What is seborrheic dermatitis symptoms?

white or yellowish-red often greasy scaling macules and papules of varying size

weeping is common with ear and scalp

scalp, beard, face, trunk, body folds

What are the differentials for seborrheic dermatitis?

1. Eczema

2. Psoriasis

3. Candidiasis

T/F Seborrheic dermatitis lesions disappear with age

true

What is the treatment for seborrheic dermatitis?

Scalp→ shampoo with selenium sulfide and zinc pyrithione

Face→ hydrocortisone cream

Who is psoriasis common in?

hereditary disorder

1/3 of patients before the age of 20 usually female

caused by inflammatory changes in dermis “trigger” keratogenous changes in epidermis (KOEBNER’S PHENOMENON)

What are the symptoms of psoriasis?

Skin→ pruritis, fever, “acute illness”

silvery-white scaling, pustules, erythema

salmon pink skin

Nails→ pitting, onycholysis ( lifting of nailbed)

“oil spots”→ yellow spot under the nail plate

Arthritis occurs 1-2% of the time with _

Psoriasis

What are the two types of psoriasis?

1. Seronegative and without subcutaneous nodules→ terminal interphalangeal joints of hands and feet

2. Mutilating psoriatic arthritis with bone erosions and osteolysis and ultimately, ankylosis, especially involving the sacroiliac, hip, and cervical areas

What are the differentials for psoriasis?

1. Seborrheic dermatitis

2. Lichenification

3. Candidiasis

4. Drug eruptions

5. Glucagonoma syndrome→ malignant tumor of pancreatic islet cells

What is the treatment for psoriasis?

1. Avoid rubbing or scratching lesions

2. UVA/UVB phototherapy

3. Topical corticosteroids

4. CAVEAT→ developing tolerance to treatment can lead to skin atrophy and telangioectasia

What is lichenification?

elevated (thickened)

response to itch-scratch-rash-itch

Koebner’s phenomenon

Psoriasis and eczema are both examples of _

lichenification

Trauma and surgery can cause _

scars

What is a keloid?

scar→ elevated

progressively enlarging scar

grows larger than the original wound

What is excoriation?

divot

loss of the epidermis only

Scratches and scabies can cause _

excoriation→ divot

What is a fissure?

deeper divot from epidermis into dermis

linear

may be dry or weeping

Athlete’s foot, dry heels, and cracks at corner of mouth are examples of _

Fissures

What is asteoatotic dermatitis?

eczema craqueleoccurs in winter and in older persons on legs, arms, and hands

dry “cracked” fissured skin

over 40 years old

MC in males

asteatosis→ loss of lipids can occur with over bathing, aging

Dry, “cracked” skin with red fissures and slight scaling and sometimes lichenification can all be associated with _

Asteatotic dermatitis→ legs, hands, and forearms

What are treatments for asteatotic dermatitis?

increase ambient humidity

tepid water baths

wool fabrics should be avoided

What is an erosion?

depression of epidermis

does not extend to dermis

moist, weeping

Ruptured varicella and early basal cell carcinoma are examples of _

Erosions

What is an ulcer?

loss of tissue into dermis

deeper than erosions

Decubitus ulcers and later basal cell carcinomas are examples of _

ulcers

Dried serum, blood, or other exudates form an elevation called _

Crust

What is atrophy?

thinning of skin

loss of skin markings

Striae and aged skin can cause _

Atrophy

What are common melanocytic nevocellular nevi?

moles

appear in early childhood and reach a maximum in young adulthood

primarily in Caucasians

What are symptoms of CMNN moles?

small circumscribed, acquired pigmented macules or papules comprised of groups of melanocytes

asymptomatic→ if tender or pruritic, it can indicate malignant changes

What are the classifications of moles?

1. Junctional melanocyte→ at dermal epidermal junction, above the basement membrane

2. Dermal melanocyte→ exclusively in dermis

3. Compound melanocyte→ combination of junctional and dermal

What are the differentials for moles?

1. Hemangioma

2. Melanoma

3. Seborrheic keratosis

What are the ABCDS for moles?

asymmetry

border

color

diameter

symptoms

What are some indications for removal of moles?

Sites→ scalp, soles, mucous membranes, anogenital area or any area exposed to trauma

Color→ variegated

Border→ irregular borders present

symptoms→ itching, bleeding, or tenderness of lesion

Who is halo nevus (sutton’s leukoderma acquistion centrifugum) found in?

before 30

in patients with vitiligo

What are halo nevus symptoms?

brown nevus with halo of sharply-marginated hypomelanosis

What are the differentials for halo nevus?

Melanoma with leukoderma

Neurofibroma

What is the course of halo nevus?

1. Development (months) of halo around existing nevus

2. Disappearance (months to years) of nevus

3. Repigmentation (months to years) of halo

Who is seborrheic keratosis seen in?

before age 30

uncommon in people of color

slightly MC in males

autosomal dominant trait

What is the most common type of benign skin lesion? TQ

Seborrheic keratosis

What are the symptoms are seborrheic keratosis?

early→ small papule or plaque with or without pigmentation “thimble”

later→ plaque with warty surface and “stuck on “ appearance

scattered over face, trunk, upper extremity

What are the differentials for seborrheic keratosis?

Solar lenitgo

basal cell carcinoma

malignant melanoma

What are the treatments for seborrheic keratosis?

cryotherapy

electocautery

curettage

laser treatment

dermabrasion

Who is solar lentigo found in?

over 40 years

MC in caucasians

corelated with skin types 1 and 2

What are solar lentigo symptoms?

light yellow, light brown, or dark brown macule 1-5 cm

not uniform in color

round or oval with slightly irregular border

found on exposed areas→ face, nose, dorsa of hands and forearms

What are solar lentigo differentails?

Seborrheic keratosis in early stages

Lentigo maligna→ pre malignant dark brown lesion with flecks of black

Who is solar keratosis seen in? (actinic keratosis)

middle age (under 40)

Caucasian skin types 1 and 2

MC in males and outdoor workers

prolonged exposure to UVB rays leads to damage to keratinocytes

SQUAMOUS CELL CARCINOMA CONFINED TO EPIDERMIS

What are the symptoms of solar keratosis?

single or multiple, dry, rough, adherent scaly lesions on sun exposed skin

scales are removed with difficulty and pain

scales are skin colored or yellow-brown

How is solar keratosis treated?

may spontaneously disappear

UVB sunscreens applied daily to face, ears and any exposed skin

What is the MC form of skin cancer?

Basal cell carcinoma

Who is basal cell carcinoma found in?

Over age 40

MC in skin types 1 and 2

Caucasians with prolonged intensive insolation (amount of solar energy reaching)

What are the symptoms of basal cell carcinoma?

asymptomatic papule or nodule

ulceration can lead to frequent bleeding “rodent ulcer”

lesions usually pink or red

An ulcer that does not heal in one month should be _

suspected of malignancy until proven otherwise by biopsy

What are the differentials for basal cell carcinoma?

Dermal melanocytic nevi

nodular malignant melanoma