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bulla description

• 1° lesion
• A vesicle (elevated, circumscribed, superficial, not in dermis, filled with pus)
• it is > 1cm in diameter
Examples: blister, pemphigus vulgairs, lupus erythemotosus, impetigo, drug reactions

Erythema description

• superficial reddening of the skin
• usually in patches
• result of injury or irritation

excoriation description

• 2° skin lesion
• there is a loss of the epidermis
• a linear hollowed out crusted area
• cause could be C-diff → need moisture barrier
Example: abrasion, scratch, scabies, diaper rash

Nodule description

• 1° skin lesion
• an elevated, firm, circumscribed lesion.
• it is deeper into the dermis than a papule.
• 1-2 cm in diameter
Ex: dermatofibroma, erythema nodosum, lipomas, melanoma, hemangioma, neurofibroma

Papule description

• 1° skin lesion
• an elevated, firm circumscribed area
• it is < 1cm in diameter
Ex: warts, elevated moles, lichen planus, cherry angioma, skin tags

Pustule description

• 1° skin lesion
• an elevated & superficial lesion
• similar to a vesicle, but filled with purulent fluid
Ex: Impetigo, acne, folliculitis, herpes simplex

Keloid description

• 2° skin lesion
• Irregular in shape, elevated, a progressively enlarging scar
• it grows (overgrowth) beyond the boundaries of the wound
Ex: keloid following surgery

Zosteriform description

• Lesions that follow a nerve
Ex: Herpes zoster

pallor: common causes (3)

Anemia, hypotension, vascular disease

Pallor: appearance in dark-skinned people

• skin tone lighter than usual
• light skinned people may have yellowish-brown skin
• dark skinned people may be ashen
• loss of red tones of the skin

Pallor: appearance in light-skinned people

• pale skin color, may appear white

cyanosis: common causes (3)

• hypoxia
• anemia
• hypotension

cyanosis: appearance in dark-skinned people

• ashen-gray color
• found in:
- conjunctive of the eye
- oral mucous membranes
- nail beds

cyanosis: appearance in light-skinned people

• grayish blue tone, especially in nail beds, mucous membranes, palms & sole of feet

What is hypoxia?

Deficiency in the amount of oxygen reaching the tissues.

jaundice: common causes

Liver/gallbladder disease

jaundice: appearance in dark-skinned people

• yellowish green color
• found in:
- sclera of the eye (not normal yellow pigmentation)
- palms of hands & soles of feets

jaundice: appearance in light-skinned people

• yellowish color
• found in:
- skin
- sclera of eye
- palms of hands
- fingernails
- oral mucosa

petechiae description

• tiny (pinpoint size) flat, reddish purple spots
• < 0.5cm in diameter
• non-blanchable
• Cause = tiny hemorrhages in the dermal or submucosa, due to intravascular defects & infections

ecchymosis description

• a reddish purple spot of varying size
• non-blanchable
• aka Bruise
• Cause = trauma to the blood vessel resulting in bleeding under the tissue

hematoma description

a mass of blood, in a confined space
Cause = a break in a blood vessel

Edema: 1+

• slight indentation (2mm)
• normal contours
• interstitial fluid 30% above normal

Edema: 2+

• deeper pit after pressing (4mm)
• lasts longer than 1+
• fairly normal contour

Edema: 3+

• deep pit (6mm)
• remains several second after pressing
• skin swelling is obvious by observation

Edema: 4+

• deep pit (8mm)
• pit remains a long time after pressing
• frank swelling

Common variations of aging adult's skin (7)

1. thinning of the skin (dermis loses elasticity, collagen leading to more folds & wrinkles
2. skin lesions are more prevalent (liver spots, skin tags
3. stasis dermatis
4. ↓ gland activités causes dry skin & ↓ perspiration
5. fat shifts from face & extremities to abdomen & hips
6. ↓ melanin → gray hair, thinning hair
7. nails become brittle, thick, harder, yellowish & develop ridges

macule description

• flat, circumscribed area that is a change in the color of the skin
• < 1cm in diameter
Ex: freckles, flat moles, measles

papule description

• An elevated, firm, circumscribed area, raised drainage on the inside
• < 1cm in diameter
Ex: wart, elevated mole

plaque description

• Elevated, firm and rough lesion with a a flat top surface
• > 1cm in diameter
Ex: Psoriasis, eczema

nodule description

• Elevated, firm, circumscribed lesion
• deeper in the dermis than papule, almost subcutaneous
• 1-2 cm in diameter
Ex: Lipoma, hemangioma, melanoma, cyst

tumor description

• elevated and solid lesion
• may or may not be demarcated
• deeper in dermis
• > 2cm in diameter
Ex: Neoplasms

Wheal description

• Elevated, irregular shaped area of cutaneous edema, intradermal
• solid, transient
• variable diameter
Ex. insect bites, uticaria, allergic reactions, lupus, TB test

vesicle description

• elevated, circumscribed, superficial, not into dermis, filled with serous fluid
• >< 1cm in diameter
Ex: Blisters, Vericella, impetigo

pustule description

• elevated, superficial (similar to vesicle but filled with purulent fluid
Ex: Acne, serous fluid folliculitis, impetigo

Skin—three layers

1. Epidermis
- Stratum germinativum or basal cell layer
- Stratum corneum or horny cell layer
- Derivation of skin color
2. Dermis
- Connective tissue or collagen
- Elastic tissue
3. Subcutaneous layer

What are some Epidermal appendages? (4)

1. Hair
2. Sebaceous glands
3. Sweat glands
- Eccrine glands - Apocrine glands
4. Nails

Skin/structures: functions (6)

- Protection most important function
• Microbes/foreign substances, trauma
- Contains body fluid compartments
- Primary contact with outside world; sensory input
- Temperature regulation
- Production/excretion
- Express emotions/surface repair

Skin functions (9)

• Protection
• Prevents penetration
• Perception
• Temperature regulation
• Identification
• Communication
• Wound repair
• Absorption and excretion
• Production of vitamin D

What are Health history questions of the skin? (12)

• Previous history of skin disease (allergies, hives, psoriasis, or eczema)
• Change in mole
• Change in pigmentation (size or color)
• Excessive dryness or moisture
• Pruritus
• Excessive bruising
• Rash or lesion
• Medications
• Hair loss
• Change in nails
• Environmental or occupational hazards
• Self-care behaviors

Skin: what should you look for in color & what are some skin color abnormalities?

- General pigmentation
- Widespread color change
• Pallor
• Erythema
• Cyanosis = central vs. peripheral (Raynauds)
• Jaundice = liver disease, can cause itching

Where should you look for cyanosis?

• central vs. peripheral
• central = lips (note: correlate with additional clinical findings)
• Raynauds

inspect for localized color variation (2)

- Intentional: tattoos, coining patterns
- Normal localized variations
• Moles, freckles, patches, striae

What are are 2 types of skin temperature & how should you feel for temperature?

• Hypothermia = poor circulation, cold room
• Hyperthermia = infection
• back of hand

What are 2 different types of skin moisture?

• Diaphoresis = sweating, exercise, breathing heavily
• Dehydration

Inspect the skin for the following (7)

1. temperature
2. moisture
3. Texture
4. Thickness
5. Edema
6. Mobility and turgor
7. Vascularity or bruising

When is Skin turgor inaccurate?

Not accurate in elderly for detection of dehydration

What does the presence of Edema mean & what are possible causes?

sign of infection → cellulitis, renal or heart failure

Skin lesions: What characteristics should you note?

- Characteristics
• Light: color, elevation, borders
• Ruler: size (cm)

skin lesions: What should you document?

location, distribution, color, pattern or shape, edges, elevation (flat/raised), size, exudate (drainage & what does it look like)

Are primary lesions normal variations?

yes, normal variation

Are secondary lesions normal variation

some normal, some something else caused it

are vascular lesions normal?

many normal (ecchymosis, telangiectasia, angioma)

Self-examination: ABCDE

A = asymmetry (irregular)
B = border ( not intact)
C = color (different from surrounding skin)
D = diameter
E = elevation & enlargement

Inspect & Palpate: Hair, what are you looking for?

- Scalp: surface characteristic; smooth without flaking, scaling, redness, lesions;
• Hair: shiny, soft
- Quantity/distribution: balding patterns/hair loss (male patterned)
- Texture: fine/coarse
- Color
• Inspect facial/body hair
- Distribution/quantity/texture: gender differences

Inspect & Palpate: Nails, what are you looking for?

• Inspect:
- Shape: smooth/rounded; nail base angle = 160
- Contour: flat/slightly rounded
- Consistency
- Color: pink, blanch (dark skinned, yellow/brown with vertical lines)
- Thickness: smooth, uniform
- Cleanliness
• Palpate: nail base; firm/adheres to bed (anemia, iron deficiency = problems w/nail bed)

Abnormal findings: Nails (6)

- Clubbing
- Thinning/brittleness
- Inflammation
- Pitting
- Beau's lines
- Splinter hemorrhages

Abnormal findings: What is the cause of Nails/splinter hemorrhages? (3)

Onycholysis & splinter hemorrhages
• CVD could cause
• Infection on heart valve
• Endocarditis

Abnormal findings: What are the causes of Nails/Beau's lines? (3)

heart failure, anemia, B12 deficiency

Abnormal findings: What are the causes Nails/Melanotic bands? (2)

skin cancer (can be under nail bed), normal variation

Abnormal findings: What are the causes Nails/pitting? (4)

vitamin deficiency, chronic, trauma, cirrhosis

Where in the skin would you find a cyst?


What is a crust?


what is a fissure?

laceration, cut

erosion leads to ?

leads to scarring

what is an atrophic scar?


what is a hemangioma?

vascular lesions

common skin lesions: primary (1)

primary contact dermatitis

common skin lesions: secondary (6)

1. labial herpes simplex (cold sores) = staf infection
2. allergic drug reaction
3. Tinea corporis (ringworm of the body) = fungal infection
4. herpes zoster (shingles) = along nerve tract, usually unilateral
5. Psoriasis
6. Erythema Migrans of Lyme disease (target lesion)

Malignant Skin lesions (3)

1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Malignant melanoma

Infectious diseases (2)

1. anthrax
2. Small pox (variola major)

Abnormal skin findings due to DM (4)

1. ↑ infections
2. ↓ sensation (more injuries
3. pressure ulcers
4. impaired healing

abnormal skin finding Vascular disease (11)

1. clubbing
2. thinning or brittleness of the nails
3. beau's lines (grooves or transverse depressions)
4. splinter hemorrhages
5. pallor
6. cyanosis
7. non-healing wounds
8. ↓ skin temperature
9. gangrene
10. hair loss
11. edema

abnormal skin findings COPD (2)

1. clubbing
2. cyanosis

abnormal skin findings immobility (2)

1. pressure ulcer
2. excoriation

abnormal skin findings anemia (5)

1. spoon nail
2. splinter hemorrhage
3. beau's lines
4. pallor
5. cyanosis

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