[11.20] Approach to Patient with a Skin Disorder V2 .pdf

Skin

What is the heaviest single organ of the body?

16 percent

What percentage of body weight does the skin represent?

Epidermis, dermis, and subcutaneous tissue

What are the three layers of the skin?

Epidermis

Which skin layer is the topmost layer?

Outer horny keratinized cells and inner cellular layer

What are the two layers of the epidermis?

Inner cellular layer

In which layer of the epidermis are melanin and keratin formed?

Dermis

Which skin layer is well supplied with blood?

Connective tissues, sebaceous glands, sweat glands, and hair follicles

What four structures are contained in the dermis?

Adipose or fat

What does the subcutaneous tissue contain?

Vellus and terminal

What are the two types of hair?

Vellus

Which hair type is fine, short, and inconspicuous, like that on the face?

Terminal

Which hair type is coarse, thick, pigmented, and found on the scalp?

Vascular nail bed

To what is the nail plate firmly attached?

Nail plate

The pink color of the nail and bloodiness of surgeries is due to the vascular nature of what structure?

Lunula

What is the whitish moon portion of the nail?

Proximal nail fold

Which structure covers already 1/4th of the nail?

Lateral nail folds

Which structures cover the sides of the nail and plate?

Eccrine and apocrine

What are the two types of sweat glands?

Eccrine

Which sweat glands are widely distributed and open directly to the skin?

Help control body temperature

What is the function of eccrine sweat glands?

Apocrine

Which sweat glands open into a hair follicle?

Emotional stress

What stimulates apocrine sweat glands?

Hormones

What affects apocrine sweat glands?

Sebum

What do sebaceous glands produce?

Palms and soles

Where are sebaceous glands NOT found on the skin?

Keratinocytes

Which cells produce keratin and make up the bulk of the epidermis?

Oil gland

What is another name for a sebaceous gland?

Sweat pore

Where does a sweat gland open on the skin surface?

Hair erector muscle

What muscle is attached to the hair follicle?

Arrector Pili

What is the specific name for the hair erector muscle?

Hair bulb

What is the rounded part at the base of the hair follicle?

Hair papilla

What is the structure at the very bottom of the hair follicle?

Hyponychium

What is the area under the free edge of the nail?

Eponychium

What is another name for the cuticle?

Distal phalanx

What bone is located under the nail bed?

Collagen fibers

What fibers connect the nail bed to the bone?

Nail matrix

Where does the nail grow from?

Distal edge

What is the part of the nail plate that we cut?

OLD CARTS

Which mnemonic can be followed for the History of Present Illness in dermatology?

Physical examination

In dermatology, which is often preferred to be done first or concurrently with history?

Red herring

What might a patient report that could lead a physician away from a correct diagnosis?

Site of onset, spread, duration, and resolution

What four factors define the evolution of lesions?

Itching, burning, pain, and numbness

What are four symptoms associated with skin lesions?

Time of day

Besides relief factors, what should be asked regarding when symptoms are most severe?

Current or recent medications

What must be noted as a possible cause of skin manifestations?

Vitamins, supplements, and herbal remedies

Besides prescribed and OTC drugs, what three categories of intake should be noted?

Fever, malaise, and arthralgia

What are three associated systemic symptoms to ask about?

Melanoma, atopy, psoriasis, and acne

Which four skin conditions should specifically be asked about in family history?

Social, sexual, and travel

What three types of specific history may be relevant?

Soaps, lotions, perfumes, clothing, and bathing practices

What five things can be sources of contact allergens?

Weight, vital signs, pulses, and lymph nodes

What four factors are included in the general impression?

Pallor, jaundice, and carotenemia

Besides degree of pigmentation, what are three descriptions of skin color?

Warm, cool, or clammy

What are three descriptions for skin temperature?

Xerosis

What is the medical term for skin dryness?

Seborrhea

What is the term for excess oil or secretions coming out of the skin?

Turgor, texture, and hydration status

Besides dryness/oiliness, what are three features of the skin surface to assess?

Lentigines, actinic purpura, and rhytids

What are three signs of photoaging?

Lentigines

What is the medical term for liver spots or sunspots?

Rhytids

What is the medical term for wrinkles?

Primary lesions

What term refers to the most characteristic, representative, or native appearance of skin lesions?

Unaltered by trauma, manipulation, or natural regression

What is the status of primary lesions regarding external factors?

Macule

What is a flat area of color change with no surface elevation or depression, less than 0.5 cm?

Patch

What is a flat area of color change greater than 0.5 cm in diameter?

Freckles

What is an example of a macule?

Papule

What is a solid elevation less than 0.5 cm in diameter?

Allergic eczema

What is an example of a papule?

Nodule

What is a solid elevation between 0.5 cm and 1.0 cm that extends deeper into the dermis than a papule?

Mole

What is an example of a nodule?

Tumor

What is a solid mass greater than 1.0 cm?

Squamous Cell Carcinoma

What is an example of a tumor?

Plaque

What is an elevated flat topped surface greater than 0.5 cm often formed by coalescent papules?

Thrush and psoriatic lesions

What are two examples of plaques?

Wheal

What is a type of plaque resulting from transient edema in the dermis?

Elevated, erythematous, and swollen

What are three physical descriptions of a wheal?

24 hours

Within what time frame does a wheal usually resolve?

Intradermal skin test

What is an example of a wheal?

Vesicle

What is a small, fluid filled blister within or under the epidermis?

Herpesvirus infection

What is an example of a vesicle?

Bulla

What is a large, fluid filled blister greater than 0.5 cm?

Burn

What is an example of a bulla?

Pustule

What is a vesicle filled with pus?

Acne

What is an example of a pustule?

Cyst

What is a nodule filled with expressible liquid, curdy, or solid material?

0.5 cm

What is the minimum diameter of a cyst?

Keratoacanthoma

What condition can be classified as both a nodule and a tumor?

Pityriasis Rosea

What condition classically presents with a plaque?

Secondary lesions

What are lesions that have been altered by trauma or natural regression over time?

Scales

What are flakes of cornified skin layer that may be firmly or loosely attached?

Psoriasis

What condition is associated with thick, adherent, silvery white scales?

Crust

What refers to dried secretions on the skin, which can be hemorrhagic or serous?

Impetigo

What condition is characterized by honey colored crusting?

Fissure

What is a linear break or crack in the skin?

Athlete s foot and dry hands/feet

What are two examples of fissures?

Not caused by blunt force or sharp objects

How is a medical fissure distinguished from an injury?

Ulcer

What is an area of destruction of the entire epidermis looking like a volcano crater?

Decubitus or pressure sore

What is an example of an ulcer?

Scar

What is the result of excess collagen production after an injury?

Atrophy

What is the thinned out skin resulting from the loss of some portion of the skin?

Stretch marks and paralysis

What are two examples of atrophy?

Scleroderma

Which disease can show both atrophy and ulceration?