38 Questions
What percentage of body weight does the skin account for?
16%
What is the main function of the sweat glands in the skin?
To regulate body temperature
What is the main purpose of the skin as a barrier?
To protect underlying tissues from microorganisms and harmful substances
What is the primary function of the sebaceous glands?
To produce a fatty substance onto the skin surface
What is the purpose of the nails?
To protect distal ends of fingers and toes
How many layers does the skin have?
Three
What type of hair is coarser and pigmented?
Terminal hair
What is the area of the skin?
1.2 – 2.3 m2
What is the primary purpose of palpating the scalp?
To detect tenderness and masses
What is the significance of assessing skin moisture?
To identify dryness, sweating, or oiliness
What is the term for decreased skin turgor?
Dehydration
What is the purpose of the ABCDE rule in dermatology?
To identify DANGER SIGNS in skin lesions
What is the significance of assessing skin color?
To identify jaundice, pallor, or cyanosis
What is the term for increased pigmentation?
Hyperpigmentation
What is the main function of eccrine glands in the human body?
To regulate body temperature
Where are apocrine glands typically found in the human body?
In the axilla and groin regions
What is the primary lesion?
A lesion that develops as a result of a disease process
What is a common symptom that may indicate a skin problem?
All of the above
What is the significance of assessing skin temperature?
To identify warmth or coolness of skin
Why is it important to inspect the skin in the same order every time?
To avoid skipping parts of the examination
What is the purpose of using a dermoscope during a skin examination?
To inspect the skin more closely
Why is it important to conduct a skin examination in a private space?
To maintain patient privacy
What should be inspected during a skin examination?
The entire skin surface, including anterior and posterior surfaces
Why is it important to use natural light or artificial light that resembles natural light during a skin examination?
To avoid distorting skin colors
What is the characteristic of a macule?
It is a flat area of change in color of the skin
What is the primary reason for pressure sores in bedbound patients?
Decreased blood flow to the skin
What is the purpose of inspecting the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels?
To identify areas susceptible to skin damage and ulceration
What is the characteristic of a papule?
It is a small, raised lesion typically 1cm in diameter
What is the purpose of recording the physical examination in phrases rather than sentences?
To make the examination more concise
What is the characteristic of a vesicle?
It is a fluid-filled lesion with a diameter of 1cm
What is the first step in conducting a physical examination of a patient's body surface?
Ask permission to expose the area to be examined
What is the primary purpose of palpating the body surface with the dorsum of the hand?
To assess the patient's temperature
What should be included in the inspection of the patient's scalp?
All of the above, including distribution and texture of hair
How should the patient be assisted during the examination?
Polite assistance should be offered to help the patient stand or sit
What should be inspected during the examination of the patient's head and neck?
All of the above, including the forehead, eyelashes, and behind the ears
When should the examiner wash their hands during the examination?
At the beginning and end of examination, and when necessary
What is the purpose of palpating the patient's skin with the finger pads?
To detect lesions or tenderness
Why should the patient be asked if they would like to have a chaperone present?
To respect the patient's privacy and comfort
Study Notes
Anatomy and Physiology of the Skin
- The skin keeps the body in homeostasis despite changes in environment.
- It provides boundaries for body fluid, protects underlying tissues from microorganisms, and modulates body temperature.
- The skin is responsible for excretion of water, salts, and urea, and synthesizes vitamin D.
- The skin accounts for 16% of body weight and has an area of 1.2-2.3 m2.
- The skin has three layers: epidermis, dermis, and superficial fascia.
- Hair, nails, and sebaceous and sweat glands are appendages of the skin.
Hair
- There are two types of hair: vellous hair (short, fine, and less pigmented) and terminal hair (coarser and pigmented).
- Vellous hair is found on the scalp, eyebrows, and other areas of the body.
Nails
- Nails protect the distal ends of fingers and toes.
Sebaceous and Sweat Glands
- Sebaceous glands are found everywhere except on the palms and soles, producing a fatty substance onto the skin surface through hair follicles.
- Sweat glands are of two types: eccrine glands (widely distributed, open directly onto the skin surface, and help control body temperature) and apocrine glands (found in the axilla and groin, stimulated by emotional stress).
The Health History
- Common symptoms to ask about during the health history include hair loss, nail changes, rash, pruritus, moles, and growths.
- Ask the patient about any changes in their skin, hair, or nails, and about any new moles or changes in existing moles.
Techniques of Examination
- Plan to examine the skin in the same order every time to avoid missing any part of the examination.
- Inspect and palpate the skin from head to toe, including the anterior and posterior surfaces of the body, behind the ears, axillary, under the breasts, inguinal regions, genitalia, and intergluteal crease.
- Inspect the palms and soles, web spaces, hair distribution, and condition, and nails.
Tips for Skin Examination
- Conduct the examination in a private space, ensuring the patient is comfortable and wearing a gown.
- Ask permission to expose the area to be examined and offer a chaperone if desired.
- Inspect and palpate the skin in good light, preferably natural light or artificial light that resembles natural light.
Techniques of Examination
- Inspect the skin for color, moisture, temperature, texture, mobility, and turgor.
- Palpate for lesions, tenderness, and temperature using the palm and finger pads.
- Inspect and palpate the hair and scalp, including the upper and lower back, shoulders, arms, and hands.
Inspection
- Inspect the skin for rashes, lesions, bruises, nevi, color changes, and scars.
- Inspect the upper and lower back, shoulders, arms, and hands, including the scalp, face, neck, and chest.
Palpation
- Palpate the scalp for contour, deformities, tenderness, and masses.
- Palpate the skin for tenderness and lesions, using the palm and finger pads.
- Assess the moisture, temperature, texture, and mobility of the skin.
Assessing Skin Turgor
- Note the quantity, distribution, and texture of the skin.
- Lift a fold of skin to assess mobility and turgor.
Techniques of Examination
- Whenever you see a skin lesion, look it up in a well-illustrated textbook of dermatology.
- Note the characteristics of the lesion, including its number, size, color, texture, shape, location, and configuration.
Skin Lesions
- Primary lesions develop as a direct result of the disease process and characterize the disease.
- Secondary lesions result from changes in primary lesions.
- Note the characteristics of primary and secondary lesions, including flat and raised lesions, macules, papules, vesicles, and nodules.
Assessing for Nail Clubbing
- Assess the nails for clubbing.
Evaluating the Bedbound Patient
- The bedbound patient is particularly susceptible to skin damage and ulceration due to pressure sores.
- Carefully inspect the skin that overlies the sacrum, buttocks, greater trochanters, knees, and heels.
Recording the Physical Examination
- Initially, use sentences to describe findings, and later use phrases.
- Examples of recording the physical examination include describing the skin color, temperature, moisture, and nail condition.
Learn about the anatomy and physiology of skin, hair, and nails, and how to perform a full-body skin examination. Identify normal and abnormal findings and relate symptoms to diagnosis.
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