Dermatology Disorders and Hormonal Impacts

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Questions and Answers

What is vitiligo primarily characterized by?

  • Appearance of tan or brown patches during pregnancy.
  • Visible veins under the skin due to inflammation.
  • Loss of pigment cells leading to discolored patches. (correct)
  • The skin produces excess pigment cells.

Which condition is commonly referred to as the 'pregnancy mask'?

  • Vitiligo.
  • Melasma. (correct)
  • Clubbing of the fingers.
  • Petechiae.

What might the presence of petechiae or ecchymosis indicate?

  • Vitamin deficiency.
  • Potential bleeding problems or blood thinner use. (correct)
  • Growth of tumors.
  • Skin infection or trauma.

What can be a possible sign of heart or respiratory problems?

<p>Clubbing of the fingers. (D)</p> Signup and view all the answers

What factor can contribute to pigmentation alteration?

<p>Recent skin infections or trauma. (A)</p> Signup and view all the answers

When might yellowing of the skin and whites of the eyes be a concern?

<p>Infant jaundice after birth. (A)</p> Signup and view all the answers

Which of the following is NOT a common cause of pigmentation change?

<p>Engaging in sports. (A)</p> Signup and view all the answers

How does melasma typically respond after pregnancy?

<p>It frequently disappears. (C)</p> Signup and view all the answers

What is the primary hormone involved in causing moon facies?

<p>Cortisol (C)</p> Signup and view all the answers

Which of the following conditions could contribute to elevated cortisol levels?

<p>Nonpituitary tumors (C)</p> Signup and view all the answers

What facial feature is commonly associated with moon facies?

<p>A round and puffy appearance (B)</p> Signup and view all the answers

Which diagnostic tests help confirm the presence of abnormal cortisol levels related to moon facies?

<p>Blood and urine tests (B)</p> Signup and view all the answers

What is the link between long-term steroid use and moon facies?

<p>Steroids can mimic symptoms of Cushing's syndrome (B)</p> Signup and view all the answers

Which hormone released by the pituitary gland prompts cortisol production?

<p>ACTH (A)</p> Signup and view all the answers

Why can diagnosing Cushing's syndrome be challenging?

<p>Sign and symptoms can overlap with other conditions (D)</p> Signup and view all the answers

Which of the following is NOT commonly associated with moon facies?

<p>Reduced fat on the face (B)</p> Signup and view all the answers

What factor primarily influences the risk of developing Cushing's signs and symptoms?

<p>Dose and duration of medication (D)</p> Signup and view all the answers

Which facial feature may indicate muscle weakness in children using steroids?

<p>Lack of expressiveness (D)</p> Signup and view all the answers

What characteristic of the nose is described in relation to children with certain steroid effects?

<p>Bulbous with a prominent bridge (C)</p> Signup and view all the answers

Which feature is common among the eyes of children showing signs related to steroid use?

<p>Small and almond-shaped (A)</p> Signup and view all the answers

What is the term used to describe flattened cheekbones in children affected by steroid use?

<p>Malar flatness (D)</p> Signup and view all the answers

What condition is indicated by a yellow coloration of the skin and eyes due to high levels of bilirubin?

<p>Jaundice (C)</p> Signup and view all the answers

What can pale skin indicate in a patient?

<p>Anemia (B)</p> Signup and view all the answers

What causes brown spots on the skin?

<p>Overproduction of melanin (C)</p> Signup and view all the answers

What skin discoloration occurs when the kidneys fail to excrete toxins properly?

<p>Uremic frost (D)</p> Signup and view all the answers

Which skin abnormality is characterized by localized benign proliferations of melanocytes?

<p>Blue nevi (A)</p> Signup and view all the answers

What is the term for the rounded, swollen facial appearance often seen in patients with obesity or Cushing's syndrome?

<p>Moon facies (D)</p> Signup and view all the answers

Which of the following can cause skin discoloration due to the retention of urochromes?

<p>Kidney dysfunction (C)</p> Signup and view all the answers

What type of blue nevi is more than 1 cm and may resemble nodular melanoma?

<p>Cellular blue nevi (D)</p> Signup and view all the answers

What aspect of the patient's appearance should be noted during the general examination?

<p>General appearance, symmetry, gait, and mobility (A)</p> Signup and view all the answers

What is a possible impact of observing a patient in a wheelchair during the examination?

<p>It could affect oral hygiene and dental treatment procedures. (D)</p> Signup and view all the answers

How should significant asymmetries be assessed in a patient?

<p>By comparing one side of the head and neck to the other while standing in front of the patient (A)</p> Signup and view all the answers

What might decreased mobility of the head and neck indicate during the examination?

<p>Potential difficulty in performing dental procedures. (B)</p> Signup and view all the answers

Which of the following is NOT a key area of examination in the extraoral assessment?

<p>Patient's dietary habits (D)</p> Signup and view all the answers

What should a clinician do if they notice facial asymmetries during the examination?

<p>Inquire if the patient knows the cause of the asymmetry. (A)</p> Signup and view all the answers

Why is it important to consider a patient’s medical history during a dental examination?

<p>It may influence necessary adjustments for dental procedures. (A)</p> Signup and view all the answers

What is the primary focus of the extraoral head and neck soft tissue examination?

<p>To determine if soft tissue is within normal limits (D)</p> Signup and view all the answers

What is a characteristic facial appearance of individuals with Down syndrome?

<p>Flattened face and upslanting palpebral fissures (D)</p> Signup and view all the answers

Which of the following features is NOT found in nearly every person with Down syndrome?

<p>High cheekbones (C)</p> Signup and view all the answers

What distinguishes kwashiorkor from marasmus?

<p>Presence of edema in kwashiorkor (A)</p> Signup and view all the answers

Malar rash is characterized by a pattern that covers which areas?

<p>Cheeks and bridge of the nose (A)</p> Signup and view all the answers

Scaly skin can result from various environmental factors; which factor is NOT commonly associated with skin desquamation?

<p>Nutritional deficiency (A)</p> Signup and view all the answers

What common condition can lead to skin desquamation accompanied by itching?

<p>Allergic reaction (C)</p> Signup and view all the answers

Red spots or rash can be caused by numerous dermatological issues; which of the following is not a cause listed?

<p>High blood pressure (C)</p> Signup and view all the answers

Which feature is characteristic of face malnutrition, particularly in acute forms?

<p>Cold and relaxed lips (B)</p> Signup and view all the answers

Flashcards

General Examination

A comprehensive evaluation of the patient's overall appearance, including gait, mobility, and any noticeable asymmetries.

Extraoral Head and Neck Soft Tissue Examination

A detailed analysis of the head and neck, examining for any signs of asymmetry, lesions, or scars.

Intraoral Soft Tissue Examination

Checking the oral cavity to ensure all soft tissues are normal and healthy.

Asymmetries

Variations in the appearance of the head and neck between the left and right sides.

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Mobility

The ability to move freely and easily. This could include mobility of the head and neck.

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Gait

The way a person walks or moves about, which may indicate underlying health conditions.

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Lesion

An abnormal mark or change in the skin, which could suggest a medical history.

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Scars

Marks left on the skin after a wound has healed.

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What is Jaundice?

A condition where the skin, whites of the eyes, and mucous membranes turn yellow due to a high level of bilirubin, a yellow-orange bile pigment.

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What is Anemia?

Anemia occurs when there is a shortage of healthy red blood cells, leading to less oxygen being delivered to the body. This can happen due to nutritional deficiencies, blood loss, or blood cancers like leukemia.

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What causes Brown Spots?

Dark spots on the skin caused by an overproduction of melanin. Melanin gives skin, hair, and eyes their color.

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How do kidney problems affect the skin?

Skin discoloration caused by the buildup of toxins when the kidneys are not functioning properly. The skin may appear grayish or metallic.

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What is Basal Cell Carcinoma?

A type of skin cancer that originates from the basal cells of the epidermis. These are slow-growing tumors that usually have an appearance of a pearly nodule.

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What are Blue Nevi?

Localized benign growths of melanocytes, the cells responsible for skin pigmentation. They can be present at birth (congenital) or develop later (acquired).

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What is Moon Facies?

A condition characterized by a rounded, swollen face. It is often associated with obesity but can also be a sign of Cushing's Syndrome.

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What causes Moon Facies?

This occurs when extra fat accumulates on the sides of the face, giving it a rounded appearance. It can be associated with Cushing's syndrome.

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Vitiligo

A condition where patches of skin lose their pigment cells, resulting in lighter areas on the skin, hair, and mucous membranes.

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Melasma

Tan or brown patches that can appear on the face, often associated with pregnancy, birth control pills, or postmenopausal estrogen.

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Pigmentation Alteration

A change in skin pigmentation caused by skin damage like infections, burns, or trauma. This often results in areas of darker or lighter skin than normal.

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Other Factors Affecting Pigmentation

Factors contributing to pigmentation changes, excluding medical conditions, include lifestyle, hormones, sun exposure, friction, and aging.

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Yellowing of the Skin and Eyes

Yellowing of the skin and whites of the eyes, a typical sign of jaundice in infants, usually appearing within a few days after birth.

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Petechiae

Tiny red or purple spots on the skin caused by bleeding under the surface, often associated with blood thinners or bleeding disorders.

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Ecchymosis

Larger areas of purplish discoloration on the skin caused by bleeding under the surface, often associated with bruising or trauma.

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Hematoma

A collection of blood that forms a bump or swelling under the skin, typically caused by injury.

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Steroid Side Effects Risk Factors

The risk of developing signs and symptoms of steroid use is dependent on the length of time it is taken and the dosage.

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Steroid-Induced Myopathy

A condition that can be caused by long-term use of steroids. It is characterized by muscle weakness, particularly in the face.

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Steroid-Induced Nose

A type of facial appearance associated with steroid use. Characterized by a prominent bridge of the nose, bulbous tip, narrow nostrils, and bulging below the glasses area.

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Steroid-Induced Eyes

Facial changes associated with steroid use can include small, almond-shaped eyes that are either sloping upwards or downwards with hooded eyelids. These eyes can also be spaced widely apart.

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Steroid-Induced Mouth

A feature of steroid use that may include a small mouth with a thin upper lip, a long groove running between the nose and mouth, and a straight top lip without a typical bow shape.

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Moon Facies

A condition causing roundness and puffiness in the face due to excessive fat deposits, especially in the cheeks and temples.

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Cortisol

A hormone produced by the adrenal glands that helps regulate metabolism, blood pressure, immune function, and stress response.

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Cushing's Syndrome

A condition caused by prolonged exposure to high levels of cortisol, leading to various symptoms like moon facies, weight gain, and muscle weakness.

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ACTH (Adrenocorticotropic Hormone)

A hormone produced by the pituitary gland that stimulates the adrenal glands to produce cortisol.

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Hypercortisolism

A condition that occurs when the adrenal glands produce too much cortisol, often due to ACTH overproduction.

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Steroid Treatment

Long-term use of steroid medications like prednisone, which can cause similar symptoms to Cushing's syndrome.

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MRI or CT Scan

Medical imaging techniques like MRI or CT scans used to assess the size and activity of the adrenal glands.

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Blood and Urine Tests

Blood and urine tests to measure cortisol levels and confirm the diagnosis of Cushing's syndrome.

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Down Syndrome Facial Features

A distinctive facial appearance often found in individuals with Down Syndrome, characterized by a flattened face, upward-slanting eyes (upslanting palpebral fissures), small ears, a short neck, and a tongue that tends to protrude out of the mouth.

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Epicanthic folds

Extra skin on the inner eyelid, giving the eyes an almond-shaped appearance. This feature is common in Down Syndrome.

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Upslanting Palpebral Fissures

Slanted eyes that are a common characteristic in people with Down Syndrome.

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Brachycephaly

A smaller head that is somewhat flattened in the back, frequently observed in individuals with Down Syndrome.

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Malar Rash

A red or purplish facial rash with a "butterfly" pattern, covering the cheeks and the bridge of the nose, but typically not the rest of the face. It can occur due to various conditions, such as sunburn or lupus.

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Acute Malnutrition

A group of linked disorders, including kwashiorkor, marasmus, and intermediate states, characterized by malnutrition and distinguished by clinical findings, including edema in kwashiorkor.

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Skin Desquamation

The detachment of large scales from the epidermis, often resembling fine dust. It may be caused by environmental factors, such as sun exposure, or medical conditions like allergies, infections, or immune system disorders.

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Red Spots on Skin

Red spots or rash on the skin, which can result from various causes like infections, heat, allergies, immune system disorders, and medications.

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Study Notes

Oral Examination of the Patient

  • A complete examination covers the head and neck, the general appearance, and extraoral head and neck soft tissue examination.

General Examination

  • Observe the patient's general appearance, symmetry, gait, and mobility as they enter the operatory and during the history taking.
  • Note any facial asymmetries, lesions, or scars.
  • A patient's wheelchair use, stroke history, or medications can affect treatment and need to be noted for proper dental care.
  • Assess for adequate oral hygiene and mobility of the head and neck for patient tolerance of dental procedures.

Extraoral Head and Neck Soft Tissue Examination

  • Focuses on the head and neck.
  • Determines if soft tissue is within normal limits (WNL).

Intraoral Soft Tissue Examination

  • Determines if the intraoral soft tissue is within normal limits (WNL).

Asymmetries

  • Observe the head and neck for asymmetries by standing in front of the patient.
  • Compare one side of the head and neck to the other.
  • Note any significant asymmetries, such as previous surgeries, nerve paralysis (e.g., CVA/stroke), tumors, or infections.

Abnormal Facial Color

  • Examine the patient's exposed skin, including the face.
  • Look for petechiae, ecchymosis, or hematomas, which may indicate bleeding disorders.
  • Yellowish skin may suggest jaundice or liver problems, while clubbing of the fingers may indicate heart or respiratory issues.
  • Other skin conditions like vitiligo, melasma (chloasma), or pigmentation alteration (post-inflammatory hyper- or hyperpigmentation) should be noted.
  • Consider the patient's medical history for possible causes of discoloration.

Facial Features - Moon Facies

  • Swollen rounded face shape, extra fat on the sides.
  • Often related to Cushing's syndrome (high cortisol levels).
  • Can be caused by increased hormone release (cortisol), specifically from the adrenal glands.
  • Associated conditions include pituitary gland problems and tumors of the lung, pancreas, or thymus; or benign tumors/cancers in the adrenal glands.

Moon Facies and Steroid Treatment

  • Long-term steroid use (like prednisone) can lead to similar symptoms as Cushing's Syndrome, including moon face due to weight gain and redistribution of fat.
  • Should consult regarding steroid use, dose, and duration.

Facial Features - Additional Aspects

  • Assess and note features such as:
    • Scaly skin (desquamation) from environmental factors, allergies, infections, or other medical conditions.
    • Red spots/rash that can stem from infections, allergens, immune system disorders, or medications.
    • Skin moles, especially if changes in size, shape, or color are noted, could be abnormal.
    • Note presence of edema, and any other unusual characteristics of the skin for possible issues.
  • Assess other facial features like eyes (size, shape, and placement), mouth (lip shape, and philtrum), nose (size, and shape).
    • Down syndrome characteristics such as flattened face with epicanthic folds, upslanting palpebral fissures and a brachycephalic (smaller) head.
    • Malar rash (butterfly rash) on the cheeks and nose.
  • Assess for any signs of malnutrition, such as a face of malnourishment which has specific observable facial characteristics

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