N202 Skin, Hair Nails pg 5-9

  1. If any lesions are present note....
    • Color- skin tone, white, black, blue etc..
    • Elevation- flat, raised, predunculated (stalk- such as a skin tag)
    • Configuration- shape or pattern
    • Size- metric (mm, cm)
    • Number- 1 or numerous
    • Location- (body part) & distribution (localized vers generalized)
    • Discharge or exudate ( describe color, odor)
  2. A primary lesion is....
    • A lesion that develops on previously normal structures
    • It is the initial lesion
  3. A secondary lesion is......
    • A lesion that changes over time because of a factor such as scratching or infection.
    • Results from changes in the primary lesion
  4. Name the primary lesions?
    • Flat lesions: Macule, Patch
    • Raised lesions: Papule, Plaques, Nodule, Tumor, Wheal, Urticaria
    • Fluid Filled lesions: Vesicle, Bulla, Pustule, Cyst
  5. What are the two types of Flat lesions?
    Macule: flat circumscribed, discolored, less than 1cm. (ex freckles, nevi, solar lentigens "liver spots", petechia

    Patch: flat, irregular, larger than 1cm (ex vitiligo, Mongolian spots, cafe au lait spot, measle rash)
  6. What are the 6 types of raised lesions?
    • Papule: solid, elevated, circumscribed, less than 1cm. (ex elevated nevus, wart (verrucal))
    • Plaques: coalesced papules greater than 1cm (ex psoriasis)
    • Nodule: solid, elevated, 1-2cm (lipoma = fatty growth)
    • Tumor: larger than a few cm, firm or soft (lipoma)
    • Wheal: Superficial, raised, erythematous, irregular ( allergic rxn, PPD, mosquito bite)-causes interstiial edema
    • Urticaria: (hives) wheals coalesce (or grow together) to form extensive rxn, intensive allergic rxn
  7. What are the 4 types of Fluid filled lesions?
    • Vesicle: elevated cavity with clear fluid, up to 1cm. (ex herpes simplex, varicella (chix pox), herpes zoster (shingles), contact dermatitis (posion ivy)
    • Bulla: elevated cavity with fluid, larger than 1cm (blister, burns)
    • Pustule: contains pus, filled with leukocytes (ex acne, impetigo)
    • Cyst: encapsulated fluid filled cavity in dermis or sub-q (ex sebaceous cyst), elevates skin
  8. What are the 8 secondary lesions?
    • Crust: Thickened dry exudate (dried serum/blood/pus) on top of primary lesion (scab) (ex. rupture of herpes vesicles results from crust with erythematous base, impetigo (staph & strep))
    • Scale: compact flakes of skin ( ex. psoriasis (white-silvery), seborrheic dermatitis (yellow-greasy), seborrhea (dandruff))
    • Fissure: linear crack (cheilosis (corners of mouth), callused heels, tinea pedis (athletes foot)-between toes)
    • Erosion: shallow depression, moist, no bleeding, no scar (effects epidermis, varicella rupture)
    • Ulcer: deep depression into dermis, leaves scar (stasis ulcer, pressure sore)
    • Excoriation: superficial abrasion (dermatitis) -red open sores
    • Scar: conncetive tissue replacing normal tissue (two types: atrophic & hypertrophic)
    • Lichenification: thickening of skin (eczema (atopic dermatitis), chronic sun exposure)
  9. A scar is a secondary lesion, there are two types of scars we learned about, what are they and give examples.
    • Atrophic: depressed scar - stretch marks (striae)
    • Hypertrophic: excess scar tissue secondary to increased collagen formation (keloid)
  10. What is an annular pattern?
    • Ring, clear center
    • An ex is tinea corporus (ring worm), pityriasis rosea
  11. What is a semiannular pattern?
    1/2 ring
  12. What is a discrete pattern?
  13. What is an confluent pattern?
    lesions run together (urticaria or hives)
  14. What is a grouped pattern?
    • clusters of lesions
    • ex vesicles of contact dermatitis
  15. What is a gyrate pattern?
    coiled, spiral, snake like
  16. What is a Iris or target pattern?
    • solid center, like a bulls eye
    • ex. erythema multiform
  17. What is a linear pattern?
    scratch, streak, line or stripe
  18. What is a webb pattern?
    like lace pattern (mottled appearance) ex sitting in the hot tub too long
  19. What is a zosteriform pattern?
    • Linear vesicles along a nerve route
    • ex. shingles (herpes zoster)
    • Vaccine available to prevent shingles for 60 years and older
  20. What is a Wood's light and what so you use it for?
    • An ultraviolet light filtered through a special glass
    • Use it to detect fluorescing lesions
    • Coral red color = bacterial
    • Blue/ green color = fungal
  21. What is the KOH test and what does it find?
    • It is a microscopic examination of skin scrapings, it helps diagnose superficial fungal infections.
    • Use sharp sterile blade and lightly scrape the scale from edge of the lesion
    • Place on clean slide
    • Add a drop of KOH
    • Fungal infection can be seen under microscope
  22. What is tinea corporis?
    Ringworm, It is a fungal infection
  23. What is tinea cruris?
    Jock itch - often spread from feet (put socks on before pants)
  24. What is tinea pedis?
    Athlete's foot
  25. What is tinea capitus?
    • Fungal scalp infection
    • ex cradle cap
  26. What is malignant melanoma?
    • Most deadly cancer
    • Highly metastatic
    • Grows deep, not wide
    • 1/2 rise from pre-existing nevi
    • High risk (fair skin, sun exposure)
    • Use the ABCD for characteristics
  27. What are the danger signs (abnormal characteristics of lesions ABCDE's)?
    • Asymmetry: not regularly round or oval, ragged edges or poorly defined margins
    • Border: irregularity (notching, scalloping, ragged edges or poorly defined margins)
    • Color: variations (areas of brown, tan, black, blue, red, white or combination)
    • Diameter: greater than 6mm (the size of pencil eraser)
    • Elevation and Enlargement
  28. What is basal cell cancer?
    • Also called BCC
    • Most common skin cancer
    • grows slowly, seldom metastasizes
    • usually appears on face (most common in fair skin older than 40 yrs
    • Usually starts as skin colored papule/nodule with overlying telangicetasia(small dilated blood vessels)
    • May develop a depressed center
  29. What is squamous cell cancer?
    • Also known as SCC
    • Grows rapidly
    • Usually appears on hands or head (sun exposed areas, usually older than 60 yrs
    • Erythematous scaly patch 1cm or more
    • Develops central ulcer
  30. What is actinc keratosis?
    • Also called AK
    • pink, scaly papules- may be precursor to SCC
  31. What is an open comedone?
    blackheads, very common in adolescents
  32. What is are closed comedones?
    White heads, common in adolescents
  33. What are seborrheic keratosis?
    • Raised, crusty, irregular lesions. Look "stuck on" sometimes waxy, non cancerous located on trunk, face, hands (genetic)
    • Common in the aging adult
  34. What is a leukonychia striata?
    White hairline markings from trauma or picking at cuticle (normally found)
  35. What is the normal nail angle?
    160 or less
  36. What is clubbing?
    • Nail straighten out to greater than 180 and nail bed becomes spongy
    • Related to chronic hypoxia- COPD, Lung CA, CHD
  37. What is splinter hemorrhages?
    • 4-5 reddish-brown streaks in nail
    • Indicates bacterial endo carditis, trauma
  38. What is Koilonychia?
    • Spoon nails/ concave
    • Iron deficiency anemia
  39. What is Paronychia?
    Inflammation/infection of skin around nail bed
  40. What is Onycholysis?
    Loosening of nail plate (fungal infection)
  41. If you see pitting in the nails this could be a sign of what?
  42. What is a subungual hematoma of the nail?
    • bleeding under the nail plate, painful, may need to be drained by drilling a hole to release pressure
    • ex car door slam
  43. How does one get an ingrown nail?
    • Cuts the nail at an angle
    • Diabetes patients are at risk for infection
  44. What is Habit-tic deformity?
    Picking at nail with index finger
  45. What is a normal capillary refill?
    • less that 2 sec
    • If more than 2 sec this could mean altered peripheral circulation
Card Set
N202 Skin, Hair Nails pg 5-9
N202 Skin, Hair Nails pg 5-9