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What is the major function of skin?
homeostasis
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How does the skin protect the body?
- boundaries=BF
- against pathogens
- radiation
- harmful substances
- VD
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How much of the TBW is skin?
16%
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What are the 3 layers of the skin?
- Epidermis
- Dermis
- Subcut tissue
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What are the appendages of skin?
- hair
- nails
- sebaceous & sweat glands
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what is the most superficial layer of skin?
epidermis
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Explain the epidermis:
- thin
- NO BV
- Outer horny layer
- Inner cellular layer
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What supplies nutrition to epidermis?
dermis
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Does the dermis have a blood supply?
yes
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What type of tissue is the dermis?
connective tissue
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What type of glands are located within dermis?
sebaceous glands
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What does the dermis merge with below?
adipose tissue or subcut tissue
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What are the 2 types of hair?
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This type of hair is short, fine, less pigmentation?
vellus
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This type of hair is coarser, pigmented (scalp/eyebrows)?
terminal
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What protects distal ends of toes & fingers?
nails
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These glands are present all over except for palms/soles & produce a fatty substance onto skin surfaces via hair follicles?
sebaceous glands
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What are the 2 different types of sweat glands?
Eccrine & apocrine
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Which type of sweat glands help to control body temp?
eccrine glands
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which type of sweat glands are found in axilla & groin that is stimulated by stress?
apocrine glands
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What are some common or concerning symptoms of skin?
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What is a good question to ask for the health hx for skin?
have you noticed any changes in your skin or hair?
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What is a good question for moles?
- have you noticed any moles that have changed size, shape, color, sensation?
- Have you noticed any new moles?
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How should the clinician explain the importance of health promotion & counseling when educating patients?
- early detect=moles
- protective skin care measures
- excessive sun exp
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Where is skin cancer most prevalent?
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This type of skin cancer is most prevelant that is shiny, grows slowly & rarely metastasizes?
basal cell carcinoma
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This type of skin cancer comprises about 16% that is crusted, scaly, ulcerated & can metastasize?
squamous cell carcinoma
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this type of skin cancer can spread rapidly comprising of only 4%?
melanoma
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What are the HARRM risk factors for melanoma?
- hx=previous melanoma
- Age over 50
- Regular dermatologist absent
- Mole changing
- Male gender
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What are the additional risk factors for melanoma?
- greater than or equal 50 common moles
- greater than or equal 1-4 atypical or unusual moles=dysplastic
- red/light hair
- actinic lentigines, macular brown/tan spots
- heavy sun exp
- light eye/skin color-freckles/burn easy
- FHx melanoma
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What is the ABCDE method for screening moles for possible melanoma?
- A=asymmetry
- B=Irregular borders=ragged, notched, blurred
- C=variation or change in color=blue or black
- D=diameter greater than or equal 6mm or different from other moles=changing,itching,bleeding
- E=elevation/enlarment
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What does the american cancer society recommend skin exams as part of routine cancer screening?
- every 3yrs btwn 20-40
- yearly=over 40
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How can you as a clinician do health teaching for patients about melanoma?
- Risk factors
- avoid=sun exp
- exams
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how should you conduct your own-self skin exam?
- front to back in mirror
- bend elbows & look at forearms, upper arms, palms
- back of legs, feet, space=toes & soles
- back of neck & scalp=hand held mirror
- back & butt=hand held mirror
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when do you want to avoid sun exposure?
midday=UVB=intense most
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what type of sun screen is recommended at least?
- SPF 15-screens out 93%
- water resistant
- reapply often
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Is there an spf scale for UV-A rays that cause aging?
no
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When does the examination of the skin, hair, nails begin with?
gen sur
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should the patient wear a gown for the skin inspection?
yes
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What type of light should be used to inspect skin surface?
- natural light
- artificial light=resembles natural
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Does artificial light often distort color?
yes
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What should you look for when inspecting color of skin?
- increase/degrease pigmentation
- redness, pallor, cyanosis, yellowing
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where is red color of oxyhemoglobin best assessed?
- fingertips, lips, muc mem
- dark skin=palms & soles
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Where should you look for central cyanosis?
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where should you look for jaundice?
sclera
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What should you note when accessing moisture of skin?
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How do you test temp of skin?
back of fingertips & ID=warmth,cooliness skin
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What to note about texture of skin?
rough or smooth
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How do you test for mobility & turgor?
lift fold of skin at hand/wrist
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What to take note of with skin lesions?
- anatomic location
- type
- color
- arrangement
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What are the 8 types of primary skin lesions?
- macule
- papule
- plaque
- nodule
- pustule
- vesicle
- wheal
- bulla
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What are the 8 types of secondary skin lesions?
- scale
- erosion
- ulcer
- fissure
- crust
- excoriation
- lichenfication
- hyperpigmentation
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What are the dermatologic basics?
- flex & ext areas
- palms & soles
- fingerwebs, groin, feet
- scalp, ears, central face
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What dermatologic issue can happen in the flexural areas?
atopic dermatitis & acanthosis nigracans
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What derm issue can happen in the ext surfaces?
psoriasis
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What derm issue in palms/soles?
syphilis & hand/foot disease
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What can develop in groin, feet & fingerwebs?
scabies
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What can develop in scalp, ears, central face?
seborrhea
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What can a red color tell you?
vascular: cherry angioma, spider angioma
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What can a blue color tell you?
Blue nevus, mongolian sopt
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what can a yellow color tell you?
xanthoma
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what can a white color tell you?
vitiligo
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what can a black color tell you?
melanocytic nevus & melanoma
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what can a purple or violaeceous color tell you?
petechia/purpura
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what are some changes in melanin?
- cafe-au-lait-spot
- tinea versicolor
- vitiligo
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What are some purpuric lesions?
- petechia/purpura
- ecchymosis
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What are some skin tumors?
- actinic keratosis
- seborrheic keratosis
- BCC
- Kaposi' sarcoma
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What is described by a superficial flattened papules, covered by a dry scale with multiple round or irregular pink tan grayish that appear on sun exposed areas and are benign but may give rise to SQ CC?
actinic keratosis
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What is a common benign lesion that is yellowish to brown papules with slightly greasy or warty & typically multiple & symetrically distributed?
seborrheic keratosis
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What is a Slow growing malignancy,Seldom metastasizes,Most common in fair skinned adults over 40,Usually on face,Usually starts as translucent nodule, which spreads leaving a depressed center and a firm elevated border Often accompanied by telangiectatic vessels?
BCC
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What is usually on sun exposed areas of skin,Fair haired adults over 60
- May develop actinic keratosis,Grows more quickly than basal cell?
- squamous cell carcinoma
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Appears in AIDS,Malignant tumor has many forms,Can appear almost anywhere on body,Lesions multiple,May involve internal structures?
kaposi's sarcoma
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Why do bedbound patients get pressure sores?
sustained compression obliterates arteriolar & capillary blood flow to skin
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What are the skin lesions patterns & shapes?
- Linear
- geographic
- clustered
- serpignous
- annular,acriform
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example of linear skin lesion
linear epidermal nevus
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example of geographic skin lesion
mycosis fungoides
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example of clustered skin lesion pattern
herpes simplex
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example of serpignous skin lesion pattern
tinea corporis
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example of annular skin lesion pattern
ringworm
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small flatspot up to 1.0cm
macule
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flat spot 1.0cm or larger
patch
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example of macule
hamangioma/vitiligo
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example of patch
cafe au lait spot
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elevated superficial & 1.0cm or larger that is formed by papules
ex:psorias
plaque
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a palpable elevation that is up to 1.0cm
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a marble like deeper & firmer than papule that is greater than .5cm
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a nodule filled with a liquid or semisolid
cyst
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an irregular relatively transcient superficial localized with edema
wheal
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up to 1.0cm that is filled w/serous fluid
vesicle
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greater than 1.0cm that is filled w/serous fluid
bulla
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minute slightly raised tunnel epidermis that is in the fingerwebs & sides fingers that is 5-15mm, linear & curvy grayline
burrow (scabies)
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thin flake of dead exfoliated in the epidermis
scale
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dried residue of skin exudate that has serum, pus, blood (impetigo)
crust
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visible palpable thickening of the epidermis with rough skin (neurodermatis)
lichenification
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conn tissue that arises in injury/disease due to a hypertrophic scar from a steroid injection
scar
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hypertrophic scaring that extends beyond borders from injury in the earlobe
keloid
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nonscarring loss superficial epiderms on moist skin surface with no bleeding
erosion
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linear or punctuate erosion caused by stratching from a cat stratch
excoriation
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line or crack in skin caused by excessive dryness (athletes foo)
fissure
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deep loss epidermis & dermis that bleeds & scars
Ulcer
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3 types of vascular lesion
- spider angioma
- spider vein
- cherry angioma
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fiery red that is up to 2cm surrounded by erythema on face, neck or arms
spider angioma
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bluish with varying size & shape that appears near the veins in the legs (varicose)
spider vein
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bright or ruby red that is 1-3mm that turns brownish in time that is surrounded by a pale halo
cherry angioma
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deep red or reddish purple that fades in time that is 1-3mm
petechia
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deep red or reddish purple that fades in time that is larger than a petechia
purpura
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purple or purplish blue which fades to green yellow or brown that is larger than 3mm with round & irregular & has a central hematoma
ecchymosis
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common mole that is round/oval shape with sharp defined borders that is uniform in color with a diameter less than 6mm
benign nevus
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round oval pathches of hair loss with no visible scaling/inflammation
alopecia areata
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round scaling alopecia with hairs broken off usually caused by a fungal infection
tinea capitis/ringworm
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superficial infection in the proximal & lateral nail folds that is seen as red, swollen & tender
poronychia
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bulbous swelling in the fingers with losing the angle btwn nail & nail fold
clubbing of fingers
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separation of the opaque nail plate from the pink nail bed
onycholysis
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