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213 Cards in this Set

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1. Epidermis - protective barrier
DEVOID OF BLOOD SUPPLY ; AS LONG AS IT IS INTACT IT IS RELATIVELY FREE FROM INFECTION
Melanocytes –
pigmentation (FRECKLES)
) Langerhans cells
initiates immune response
Merkel cells –
sensation of touch
. Dermis –
inner supportive layer GOOD BLOOD SUPPLY, SUPPORTS EPIDERMIS. SEBATEOUS GLANDS LUBRICATE HAIR FOLLICLES
. Epidermis -
protective barrier DEVOID OF BLOOD SUPPLY ; AS LONG AS IT IS INTACT IT IS RELATIVELY FREE FROM INFECTION
a) Melanocytes – pigmentation (FRECKLES)
b) Langerhans cells – initiates immune response
c) Merkel cells – sensation of touch
Subcutaneous tissues – adipose tissue
mast cells (INITIATES HYRPERSENSITIVITY RXN)
NEED TO USE A SMALL NEEDLE WHEN GIVING SUB-Q INJECTIONS TO DEHYDRATED PATIENTS, YOU MAY NOT BE ABLE TO GET SUB-Q TISSUE; IF YOU MASSAGE THE AREA IT WILL ABSORB THE INJECTION.
vellus
fine, faint, devoid of color (body hair)
terminal
pigmented, courser (scalp hair, eyebrows)
Sebaceous glands
-produce a protective lipid rich substance which is secreted through hair follicles.
Sweat glands (Eccrine) –
regulates body temperature
a) method of examination TOUCH SKIN
b) abnormal findings SEBACEOUS GLAND ACTIVITY SLOWS AS WE AGE; OLDER PEOPLE HAVE DRIER SKIN; BE CAREFUL WHEN BATHING OLDER PEOPLE SINCE THEY MAY LOSE MOISTURE.
melatin
brown pigmentation-genetically determined
carotene
golden yellow pigment-fat
Oxyhemoglobin
bright red, vasodilation
deoxyhemoglobin
darker blue pigment – may be pathologic (CARDIOVASCULAR OR RESPIRATORY IN NATURE) or physiologic (RESPONSE)
cyanosis
CYANOSIS-IF NOT REVERSED IT WILL BE FATAL,; CYANOSIS SPREADS
Nails
Nails: Anatomy and Physiology NAILS GIVE INSIGHT TO HEALTH -STATUS AND LIVING CONDITIONS. NORMAL CAPILLARY REFILL= NAIL BED RETURNS TO PINK AFTER ~ <2 SEC AFTER PRESSURE ON NAIL. FINGER TIP IS THE LAST AREA TO GET O2 SO THIS IS A GOOD INDICATOR OF HOW MUCH O2 THE REST OF THE BODY IS GETTING. WNL IS 100%O2
Nails
1. Nail plate
2. Nail root
3. Nail bed SHOULD BE FIRM
4. Periungual tissues PRONE TO INFXN ESPECIALLY IN PEOPLE WHO BITE SKIN AROUND NAILS
impetigo
impetigo (STAPH INFXN) VERY INFECTIOUS, CAN OCCUR IN ADULTS AND RUNS/SPREADS THRU HOSPITALS VERY QUICKLY ( SO NEVER PUT A POST-OP PT IN A ROOM WITH A STAPH PT)
acne
acne INCREASED SEBACEAOUS GLAND ACTIVITY, SOMETIMES IN OLDER WOMEN NEAR TIME OF MENSES
Older adults skin
SKIN LESS ELASTIC; LOOK AT SKIN TURGOR; WATCH OUT FOR ELASTCITY AND REBOUND IN OLDER PT. “TENTING” WHEN SKIN STAYS UP. USE TERMS LIKE “BRISK” AND “QUICK” RETURN RATHER THAN “GOOD”
SKIN CAN BE DRY AND SCALY, ESPECIALLY IN LOWER EXTREMETIES. BRUISES EASILY AND IS WORSE WITH MEDS LIKE BLOOD THINNERS. MORE WRINKLING, ESPECIALLY NEAR AREAS OF HIGH SUN EXPOSURE. ABILITY TO SENSE TEMP AND PAIN DECREASES. HIGH INCIDENCE OF FROST BITE IN ELDERLY
Comedomes
SEBACEOUS GLANDS THAT HAVE DRIED OUT. USUALLY FOUND AROUND EYES, IN SKIN FOLDS. GIVE ORANGE PEEL APPERANCE.
pseudoscars
transparent skin patches LIGHTER AREAS
Liver spots (senile lentigines
liver spots (senile lentigines, brown macules) SUN EXPOSED SURFACES, USUALLY FOUND ON HANDS
.senile pruritus-
) dryness and itching B/C SEBATEAOUS GLAND ACTIVITY HAS DECREASED, PT ARE MORE AT RISK FOR INFECTION B/C OF RISK OF OPEN SKIN
seborrheic keratosis-
raised, warty lesions LOOK LIKE DRY AREAS. NO ISSUES WITH MOST OF THESE LESIONS, MAY SPONTANEOUSLY FALL OFF; SOME MAY BE PROBLEMATIC. (ACTINIC KERATOSIS IS CA RELATED) IF PROBLEMATIC, NEED TO BURNED OFFAND SEEN BY DERMATOLOGIST. USULLY R/T SUN EXPOSURE.
actinic keratosis (solar keratosis) SEE ABOVE
seborrheic keratosis-raised, warty lesions LOOK LIKE DRY AREAS. NO ISSUES WITH MOST OF THESE LESIONS, MAY SPONTANEOUSLY FALL OFF; SOME MAY BE PROBLEMATIC. (ACTINIC KERATOSIS IS CA RELATED) IF PROBLEMATIC, NEED TO BURNED OFFAND SEEN BY DERMATOLOGIST. USULLY R/T SUN EXPOSURE.
f)
skin tags (acrochordons)
skin tags (acrochordons) USUALLY FOUND IN A SKINFOLD; THESE ARE EXCESS BENIGN TISSUE; THE OLDER YOU ARE, THE MORE YOU HAVE.
sebaceous hyperplasia D
dRYING OUT. PEPPBLING APPERANCE.
Things that thicken
nails NORMALLY THICKEN WITH AGE. IN CVD NAILS WILL ALSO THICKEN. TO TELL THE DIFFERENCE (NORMAL OR NOT)-CHECK PULSE, HAIR GROWTH TO AREA, AND TEMP.
General Pigmentation/Abnormal
Findings IN EXAM LOOK FOR CHANGES IN SKIN. IN DARK SKINNED PEOPLE LOOK AT SCLERA, MOUTH, MUCOUS MEMBRANES, CONJUNCTIVA, TONGUE, LIPS, SOMETIMES NAILBEDS, PALM OF HAND, GUMS.
freckles
freckles INCREASED MELANOCYTE STIMULATING HORMONE
MOLES
moles NORMAL ADULT HAS < OR = 40 MOLES. USUALLY SIZE IS LESS THAN AN ERASER HEAD, UAULLY BROWN
Birthmarks can be different colors t or f?
birthmarks CAN BE DIFF. COLORS
Danger signs of common skin pigmentations
Danger signals of common pigmentation
a) sudden increase in size
b) change in color
c) irregular border or previously flat border that becomes raised
d) irregular color pattern
e) clumping pigment (SCATTERED IN SOME AREAS BUT GROUPED IN OTHERS)
f) change in sensation NOW PAINFUL (COULD BE CA OR INFXN)
g) change in surrounding skin LOOK FOR INFLAMMATION
h) ulceration or bleeding (IF MOLE OPENS)
Pallor-decreased oxyhemoglobin
pallor-decreased oxyhemoglobin (TO TISSUE; TAKES COLOR OF CONNECTIVE TISSUE) AT RISK FOR PALLOR W/ ANEMIA, FAINTING, PERIOD OF SHOCK. SKIN IS THE LAST ORGAN TO GET O2 WHEN STURATION IS LOW. LOOK FOR PALLOR IN NAIL BED OR SCLERA OF EYE.
peripheral cyanosis
BLUISH COLOR D/T TEMP CHANGES
central cyanosis
(PATHOLOGIC) BLUISH COLOR AROUND LIPS; THIS IS CV OR RENAL RELATED (NOT JUST TEMP)
erythema (redness)
DILATION OF ARTERIES USSUALLY D/T INFXN
polycythemia
DZ OF ABUNDANCE OF RBC’S. NOT COMMON. DANGER IS NOT COLOR OF SKIN BUT CLUMPING OF RBC’S
jaundice
(yellowing)) (ICTERIC)VERY OBVIOUS IN SCLERA. BILIRUBIN NEEDS TO BE CONJUGATED TO STOOL OUT. W/ LIVER DZ, OR TOO MUCH RBC TURNOVER, LIVER CANNOT CONJUGATE BILIRUBIN FAST ENOUGH TO BE EXCRETED. LIGHT THERAPY HELPS TO CONJUGATE. URINE MAY TURN DARK B/C OF INCREASED EXCRETION AND STOOL MAY BE CLAY COLORED.
carotenemia
SEEN IN INFANTS WHEN STARTED ON VEGGIES. R/T VIT A.
hyperbilirubinemia
hyperbilirubinemia (liver disease)
Brown tan; what disease?
brown-tan; increased deposits of melanin
- - Addison’s disease ABNORMAL STIMULATION OF MELANIN STIMULATING HORMONE. PTS ALWAYS LOOK TAN.
DM?
DM’s (Diabetes Mellitus) MAY HAVE DARK CIRCLES UNDER EYES
vascularity and bleeding
ASA, MOTRIN, IBUPROFEN CAUSE BLEEDING.
cherry angiomas
BRIGHT RED, ROUND PINPOINT AREAS ON TRUNK. HORMONE RELATED. USUALLY GO AWAY AFTER HORMONAL SURGE IS OVER. LOOK FOR INCREASE IN NUMBERS.
spider angiomas
SPREAD LIKE SPIDERS; SAME AS ABOVE BUT STAR SHAPED AND INDICATE TROUBLE CLOTTING AND CHANGE IN BLEEDING AND DECREASED PLATLETS. IF PUSH ON SKIN, REDNESS DECREASES AND RETURNS.
petechiae .
petechiae IF PUSH ON THESE, REDNESS STAYS. SAME AS ABOVE.
Purpura
purpura LARGE POOLS OF BLOOD UNDER SKIN; BODY WILL EVENTUALLY ABSORB THE BLOOD.
ecchymosis
ecchymosis SIMPLE BRUISING TO SKIN; SOMETIMES PT WILL BRUISE EXTREMELY EASY. BRUISING IS BLOOD MOVEMENT TO TISSUE.
abnormal bruising
ANY BRUISING ABOVE ELBOWS OR ABOVE KNEES OR ON TORSO. THIS IS ABNORMAL. ASK ABOUT INJURIES OR ATTACKS.
annular circular
RINGWORM
confluent-
run together
GROUPED!
grouped HERPES (VESICLES)
gyrate-
snake like
iris
like eye or target
linear
like poison ivy
polycylic
-annular lesions which grow together
) non palpable lesions
not raised
macule
macule VERY SMALL , < 1 CM :FRECKLE
patch
BIGGER THAN MACULE : STAGE i PRESSUE ULCER, DECREASED BLOOD FLOW TO AREA)
palaple: papule
papule < .5 CM :WART. WARTS ARE VIRAL(BEST WAY TO REMOVE IS TO BURN)
plaque
PSORIASIS
nodule
EXTENDS DEEP INTO DERMIS : CYST. IS MOBILE
tumor
tumor
wheal
ELEVATION OF TISSUE BECAUSE OF FLUID. NOT IN DERMIS (BUG BITES)
circumscribed elevations of the skin secondary to free fluid in the cavity of skin layers
- - vesicle ACCUMULATION OF FLUID ; USUALLY RED AROUND VESICLE : HERPES,CHXN POX
- - bulla SAME TYPE OF BLISTERING AS BURNS, SERROUS FLUID
- - pustula FLUID FIILED WITH PUS (YELLOW TO GREEN) IF TURNS GREEN SUSPECT PSUEDOMONAS (ODORY)
- - cyst ENCAPSULATED
- - vesicle
ACCUMULATION OF FLUID ; USUALLY RED AROUND VESICLE : HERPES,CHXN POX
BULLA
bulla SAME TYPE OF BLISTERING AS BURNS, SERROUS FLUID
pustula
FLUID FIILED WITH PUS (YELLOW TO GREEN) IF TURNS GREEN SUSPECT PSUEDOMONAS (ODORY)
- - cyst
- - cyst ENCAPSULATED
erosion
LOSS OF EPIDERMIS
ulcer
DEPRESSED LEGION OF EPIDERMIS PROMARY PREVENTION IS ALWAYS FREQUENT POSITION CHANGES
fissure
LINEAR CRACK (CRACKS AROUND LIPS, HANDS, FINGERS)
crust
DRY BLOOD ; IF LEAVE IT IT WILL GO AWAY, PICKING AT IT DOES MAKE WORSE
dandruff
scale DANDRUFF, TISSUE TO SCALP MORE DRY
lichenification
THICK LAYERS OF SKIN, PEOPLE TEND TO SCRATH A LOT. TREE TRINK APPEARANCE, ROUGH
scar
scar SEE AFTER AN INTERRUPTION IN SKIN ; HEALS EASY IN NON OBESE PEOPLE. BEST SCARS ARE PLANNED LIKE ‘WALK IN’ SURGERIES. SCARS NEED TO BE EXCISED WITH REPEATED SURGERIES
keloid
keloid ABUNDANCE OF CONNECTIVE TISSUE AT SCAR SITE. EVERY TIME IT IS TOUCHED IT GETS WORSE
atrophic scar
atrophic scar – thinning of the epidermis “striae” STRETCH MARKS ;THINNING OF SKIN
excoriation
excoriation ABRASIONS ; COMMON IN HOSPITALIZED PT. ‘SCRATCHERS’. ANOTHER EASON TO MOISTURIZE.
) recording/wound evaluation
TALK ABOUT APPERANCE OF WOUND. IS IT OPEN TO AIR ? DOES IT HAVE SUTURES, STAPLES, STRIPS, OR GLUE ? ANY REDNESS OR DISCOLORATION ? DRAINAGE ? ODORS ?
. Moisture
3.
1. Exam Technique EXAM SKIN FOR MOISTURE ALSO LOOK AT MUCOUS MEMBRANES
4. 2. Abnormal findings
Temperature
. Exam technique LOOK AT BILATERAL TEMP CHANGES (BOTH ARMS AT THE SAME TIME)
2. Abnormal findings
a) vasodilation (hyperthermia)
b) vasoconstriction (hypothermia
TEXTURE
. Exam technique
2. Abnormal findings (CALLOUSES ARE NORMAL ABONORMALITIES)
a) roughness HYPERTHYROID= NOT A LOT OF OIL
b) generalized, velvety smooth HYPERTHYROID= ALOT OF OILS= SMOOTH SKIN
TUGOR AND MOBILITY
. Mobility and turgor
1. Exam technique
2. Abnormal findings
a) decreased mobility; scleroderma HARD SKIN, CANNOT PINCH, CONNECTIVE TISSUE DISORDER.
b) decreased turgor; dehydration
EDEMA
Edema – fluid accumulation in the intracellular spaces
1. Exam technique
2. Abnormal findings EDEMA AS WITH CHF ; ONE WAY TO CHANGE PRESSURE IS TO MOVE PLASMA
unilateral edema
) unilateral edema LOCALIZED (AS IN ONE EXTREMETY
c) bilateral edema U
SUALLY CV OR RENAL IN NATURE (AS IF IN BOTH EXTREMETIES)
sometimes nurse measure pitting edema or measure circumferecne of calf or abd. And mark where the tape is. See if the next measurment is at the same point. This will monitor for changes in edma. If fluid gets back to heart and heart will use or absorb. This is the reason for raising the feet. But make sure if feet are elevated head is down. So pt is not shaped like a v.
COLOR
Color SOME PEOPLE MAY PREMATURELY GRAY ; MAY BE R/T NERVE DAMAGE. THE MORE DYE, THE DIFFERENCE IN NUTRITION OF HAIR.
1. Related to melanin content
2. Abnormal findings
ABNORMAL HAIR SHIT
Distribution abnormalities DZ STATES MAY CAUSE LOSS OF HAIR
1. Alopecia AREAS OF BALDNESS USUALLY R/T STRESS
2. Absence of pubic hair HORMONAL DEFICIENCY
3. Hirsutism EXCESSIVE BODY HAIR, HORMONALLY INDUCED
lesions of hair what is pediculosis capitis?
Lesions
1. Seborrhea/dandruff SCALING
2. Head lice/pediculosis capitis LICE AKA WALKING DANDRUFF, HIGHLY CONTAGIOUS
Brittle Hair?
. Brittle hair MAY BE R/T DYES OR NUTRITION
COLOR OF NAILS!!!!!!!!!!!!!!!
Color LOOK AT COLOR
1. Abnormal findings
a) yellowing
b) cyanosis
c) pallor
d) splinter hemorrhages: linear streaks in the nail bed USUALLY SEEN IN DZ. SEEN WITH BACTERIAL ENDOCRINITIS (SP ? Lining of the heart).THEY GROW OUT
e) Beau’s lines: transverse depressions in the nails R/T DZ. WILL ALSO GROW OUT. SEEN WITH IMMUNOSUPPRESSED DZ.
f) White spots: result of trauma where the nail separates from the nailbed
c) Cleanliness NAILS TELL ALOT. WASH PTS WITH WASH CLOTH. DO NOT DIG.
PUSLE O2 WILL WORK THROUGH NAIL POLISH AND FAKE NAILS.
normal shape of nail and degree?
Shape and Contour NORMAL NAIL ANGLE IS 160. YOU SHOULD SEE A WINDOW WHEN HOLDING NAILS TOGETHER.
Clubbing?
clubbing 180 ANGLE. AREA THICKENS. LACK OF O2 TO FINGER TIPS. ALSO THE NAIL IS LESS FIRM AND LOOSELY HELD IN PLACE. CAPILLARY REFILL IS SLOW.
What is spoon nails? koilonychia-seen w/ what disease?
spoon nails (koilonychia) SEEN WITH ANEMIA
SWELLING OF SURROUNDING TISSUE w/ nails?
paronychia SWELLING OF SURROUNDING TISSUE
subungual hematoma
subungual hematoma TRAUMA TO NAIL BED. BLEEDING UNDER NAIL, SHOULD BE POPPED AND SOAKED TO ELIMINATE PAIN. NEEDS TO BE DONE RIGHT AWAY.
. Consistency of the nail bed
1
. Consistency of the nail bed
1. Abnormal findings
a) thickening DECREASE IN BLOOD FLOW AND FUNGUS. FUNGUS WILL SPREAD TO ALL TOES. ANTIFUNGAL MED IS TOXIC TO LIVER.
b) spongy NOT HELD IN WELL. USUALLY FROM A NUTRTIONAL DEFICIENCY.
HEAD AND NECK OUTLINE
skull is soft when? and when do you asscess IP?
IN CHILDREN
ALWAYS ASSESS INTRACRANIAL PRESSURE BY ASSESSING COGNITIVE STATUS.
Salivary glands .........
SHOULD BE MOIST
parotid – behind the mandible ...........
OPENING TO GLAND IN UPPER CHEEK. HEN INFLAMED IT MIMICS A SORE TOOTH. LOOK LIKE BLACKHEADS
submaxillary (submandibular) –
submaxillary (submandibular) – located deep in the mandible OPENING UNDER TONGUE. ALSO LOOKS LIKE BLACKHEADS
Superficial temporal artery
where is that?
eyebrow!!!
PROTECTS FROM MICROORGANISMS BY COLECTING THEM.
eyelids
protection; lined with palpebral conjunctiva
Conjunctiva...........
protection; bulbar conjunctiva, lines scleraTHIN LAYER OF TISSUE OVER EYE THAT COVERES ENTIRE EYE,SCLERA, LIDS.
lacrimal gland –
tear productionPROVIDES LUBRICATION. SITS JUST BELOW EYEBROW.IF PLUGGED EYE WILL BE DRY AND GLAND WILL BE INFLAMED. CAN BE MASSAGED THIS WILL HELP. OLDER PEOPLE LOSE FUNCTION OF THIS GLAND. THIS GLAND IS WHAT CAUSES YOU TO BLOW NOSE WHEN THERE ARE ALOT OF TEARS.
lacrimal sac:
receptacle
lacrimal puncta:
drainage
inner canthus is what????
INNER CANTHUS IS TEAR DUCT. MAY NOT BE OPEN IN BABIES.
EYELASHES GIVE WHAT?
PROTECTION
what is the sclera?
outer fibrous layer coating the eye (opaque material that appears white)IS THE COLOR OF CONNECTIVE TISSUE. WILL CHANGE COLOR IN DZ STATES
cornea????
covers and protects the iris and pupil, light transmission, non-vascularSHOULD BE TRANSPARENT (SHINY AND CLEAR) VERY SENSITIVE
iris does what???
iris: produces eye color NOTE PTS MAY HAVE COLOR CONTACTS
pupil---------ahhahh!
pupil: controls light entering retina
tell me about retina!
retina: light waves are changed into nerve impulses. Optic disc – area in which fibers from retina converge to form the optic nerve. Macula – area of sharpest vision. W/ HTN ADVANCED PRACTITIONERS MAY SEE CHANGE IN VASCULATION.
PATHWAYS!
Visual pathways CHNAGES IN VISUAL PATHWAYS DIFFER B/T PTS.
ear
The ear: three compartment NEED TO USE OTOSCOPE. NEED TO STRETCH CANAL OUT AND UP.
external ear---do you know these?
External ear
a) auricle (pinna)
b) external auditory canal
bones of middle ear?
bones (ossicles); malleus, incus and stapes
um yeah...what is the tympanic membrane....ask me about a ross story
tympanic membrane (eardrum)NORMALLY PEARLY GRAY AND REFLECTS LIGHT. MAY SEE SHADOWS OF BONES BEYOND TYMPANIC MEMBRANE.
eustachian tube
What is that?
Inner ear?????
5. Inner ear: bony labyrinth responsible for hearing and equilibrium SO IF INFECTED, PTS MAY HAVE VERTIGO
how do you examine the nose and paranasal?
The nose and paranasal sinuses NEED TO USE OTOSCOPE. NEED TO TILT HEAD BACK.
anatomy of nose is how much part of bone?
upper 1/3 encased in bone
septal cartilage –
septal cartilage – shape, separates nares
NARES?
nares – allows for air passage SHOULD BE VERY RED. NARES DECREASE IN SIZE IF PT IS CHRONIC MOUTH BREATHER. SO PTS WHO BREATH THRU MOUTH MAY NEED MASKS FOR TREATMENTS.
Cilia in your noses do what?
cilia – cleansing hairs VERY FINE HAIRS
What do turbinates do in the nosey?
turbinates – warms, humidifies and filters YOU MAY SEE THESE.
Paranasal sinus;
frontal (palpable)JUST BELOW EYEBROW
maxillary sinus?
maxillary (palpable)JUST BELOW CHEEKBONE,
ethmoid and sphenoid
are nonpalable DUH!
how do you know if your pt has a sinus infection?
AIR FILLED POCKETS. SOMETIMES SATURATED WITH FLUID. IF INFXN IN FLUID= SINUSITIS. IF PT SHOWS RESPONSE ON PALPATATION MAY BE INFX
mouth exams?
Mouth NEED TONGUE BLADE AND LIGHT. LOOK AT CONDITION OF TEETH. (GOOD OR POOR REPAIR)
tounsils
Tonsils MAY GROW BACK. MAY BE RED D/T STRESS
ahhhhhhhhhh what deviates????
Uvula WILL DEVIATE WHEN SAYING « AAAAH »
what is papula in the mouth?
Papula ROUGHENED APPEARANCE OF TONGUE. IF MORE SMOOTH INDICATES EDEMA AND MAY INTERFERE WITH BREATHING AND SWALLOWING. ALSO IF PT CANNOT STICK OUT TONGUE THIS MAY INTEFERE WITH SWALLOWING.
know these words:
. Gums (gingivae)
10. Parotid duct (Stensen’s duct)
11. Submaxillary (submandibular) duct (Wharton’s duct)
12. Buccal mucosa
lympth nodes
Lymph nodes WHEN PALPIATATED NEED TO BE NAMING NODES ! Exp : tonsillar= jugular. THESE DRAIN ANATOMICALLY (DRAIN CLOSEST TO SITE OF INFXN)
what enlarges in men during adol?
Adolescence THYROID ENLARGES IN MEN
head and neck exam of elderly.,..........
Older adult BENIGN SENILE TWITCHING AND VISION, HEARING, TAST, SMELL ALL DULL. (DULL AND ABSENCE ARE DIFFERENT). MORE WRINKLING. INCREASED PERIODONTAL DZ.
what is normocephalic?
1. Normocephalic and symmetry NORMAL SHAPE AND SIZE
hydrocephalus????
hydrocephalus-enlargement of head, increased circumference MAY BE INCREASED FLUID OR INCREASING HEAD CIRCUMFERENCE AS IN INFANCY
acromegaly
-abnormal enlargement of skull and facial bones ABNORMAL GROWTH HORMONE
Cushing’s syndrome s/s?
FAT DEPOSITS IN “MOON ROUND FACE”/ ALSO SEEN WITH STEROID USE.
Down syndrome???
MORE ROUND APPEARANCE. LOWER EARS. SLANT EYES, ENLARGED TONGUE WHICH CAN BE PROBLEMATIC.
Graves disease????
-exopathalmus HYPERTHYROID, BULGING EYES AND ROUND FACE
hypothryoidism????
myedema
symmetry of head/neck??? what from???
Symmetry ASYMMETRY MAY BE FROM NERVE DAMAGE OR STROKE.
Bell's vs stroke
Abnormal findings BOTH IF ONE SIDE DROOPING. IN STORKE PT CAN STILL RAISE EYBROWS IN BELLS PALSY THEY CANNOT. BOTH WILL INTERFERE WITH INTAKE OF LIQUIDS AND SOLIDS. (MORE ISSUES WITH LIQUIDS FIRST)
palpate the mandible!!!!!!!!!
Palpation of the Mandible
1. TMJ-temporomandibular joint
external eyes abnorms: ptosis
DROOPING OF EYELID. MAY INTERFERE WITH LIGHT.CLASSICALLY SEEN WITH MYASTHENIS GRAVIS
idlag
CAUSES DRYNESS AND AT RISK FOR INFXN.
periorbital edema
USUALLY OCCURS AFTER TRAUMA OR IN DZ STATES. CAN BE REALLY BAD. NEED TO KEEP PTS HEAD ELEVATED
entropin
EYELID TURNING INWARD, NO LONGER PROTECTING BUT SCRATCHING
ectropin-i am getting tired girls on page 10 now!
EYELID TURNING OUTWARD; RISK FOR DRYNESS AND INFXN.
hordeolum (sty)
INFXN IN HAIR FOLLICLE. BEST TX IS BABY SHAMPOO TO RID OF MICROORGANISM. ELDERLY PRONE TO THESE D/T USING KLEENEX TO WIPE BOTH NOSE AND EYES.
chalazion
INFXN IN MEIBOMIAN (SP?) GLAND. DEVELOPS OVER WEEKS USUALLY INFLAMMED. NOTPAINFUL OR RED. WARM COMPRESS MAY HELP DRAIN OR IT CAN BE LANCED.
lacrimal apparatus – abnormal findings
- - epiphoria INCREASED TEAR PRODUCTION (HAYFEVER /ALLERGY/MS)
dacryocystitis
INFLAMMATION OF TEAR DUCT D/T OBSTRUCTION
how to find abnorms of conjuctiva and sclera?
conjunctiva and sclera – abnormal findingsPULL DOWN AND LOOK UP DOWN RIGHT AND LEFT
eye scleaa abnorms???
- - pallor
- - icteric/yellowing
conjunctivitis .
PINK EYE. WHEN PTS HAVE PINK EYE, REDNESS GOES INTO SCLERA. INFANTS AND ELDERLY COMMONLY GET. NEED ATB IN EYE.
subconjunctival hemorrhage
PRESSURE AND RUPTURE OF VESSELS. MANY TIMES OCCURS AFTER CHILD LABOR. ALSO WITH INJURY AND TRAUMA. USUALLY TURNS YELLOW BEFORE CLEARING UP.
Cornea and lens issues?
cornea and lens – abnormal findings LESS TRANSPARENT WHEN THERE ARE ISSUES
senilis (corneal arcus)
- - arcus CIRCLE WITHIN IRIS. MORE COMMON WITH OLD PEOPLE. IN YOUNGER ADULTS IT MAY INDICATE LIPID PROBLEM (ACCUMULATION)
pterygium
- - EXCESSIVE TISSUE THAT TENDS TO GROW OVER IRIS. LOOKS LIKE A TRIANGLE THAT COVERS IRIS. WHEN IT GROWS OVER THE PUPIL IT IS USUALLY CUT AND TREATED.
Cataracts---------tell me about them?
R/T VASCULAR CHANGES. LOOK HAZY AND GRAY. NEED TO BECOME ‘RIPE’ BEFORE FIXING. AFTER FIXED, WILL HAVE TROUBLE WITH NIGHT VISION. ONCE REPAIRED, EXAM WILL SHOW A ‘FLOATER’ ON EYE.
glaucoma
SAME AS CATARACTS
iris-abnormal findings
- - heterochromia irides
IRIS 2 DIFFERENT COLORS
iritis
INFX OF IRIS, HAPPENS IN IMMUNE SUPPRESSION. TENDS TO BE RECURRING. INFLAMMATION AND PRESSURE DISTORT PUPIL. CAN BLOW THE RETINA. TREATED WITH STEROID EYEDROPS. IS EMERGENT CONDITION.
pupil abnormal findings
anscoria
) - - SIZE DIFFERENCE B/T RT &LT PUPILS. IF HUGE DIFFERENCE B/T THE 2 PUPILS IT INDICATES A PROBLEM
unilateral pupil changes
1 EYE DILATES AND OTHER DOES NOT
tell me about dilated and fixed pupils???????bad? or good?
dilated and fixed EXTREME PRESSURE AND DEATH INDICATED IF BOTH PUPILS ARE DILATED AND FIXED. IS DETERMINED WITH NUERO CHECKS. INDICATES INCREASED INTRACRANIAL PRESSURE.
earwax abnor or normal?
. Exam Technique – EarsWAX IS NORMAL; ONLY A CONCERN IF IT INTERFERES WITH HEARING
acute otitis media
TYMPANIC IS RED, INFLAMMED. IF THERE IS DISCOMFORT IN SURROUNDING LYMPH= ACUTE
serous otitis media
INFXN THAT HAS BEEN PRESENT LONGER. FLUID IS NOW PUS; MEMBRANE WILL BE BULGING OUTWARD.
perforation-what is this?
perforation DARKENED AREA; SCAR TISSUE (FROM PREV RUPTURE OR TUBES)
what is this?
sebaceous cysts
shape of tymapnic membrane.....tell me about this!
shape of the TM (bulging vs retraction) IF BULGING= A LOT OF FLUID BEHIND IT. IF RETRACTED= DEEPER INNER EAR INFXN , PT WILL LIKELY HAVE DIZZINESS.,
examing the nosey!!!!!!!!!! norm vs abno
. Exam Technique – Nose
1. Method of Examination
2. Abnormal Findings NARE= MUCOUS MEMBRANES SHOULD BE REDDER THAN THE MOUTH. WILL BE EVEN MORE RED WITH COLDS AND INFXNS. WILL BE MORE PALE WITH HYPERSENSITIVITIES (ALLERGIES, HAY FEVER) WILL BE SWOLLEN WITH DRAINAGE BUT PALLOR WITH ALLLERGIES.
Patency of nose!
INHALATION IS THRU BOTH NOSTRILS. HINGS THAT INTERFERE: POLYPS, DRAINAGE. (POLYPS WILL ALSO INTERFERE WITH TASTE), DEVIATED SEPTUM.
rhinitis is norm or abn?
rhinitis INFXN
nose discharge color?
) discharge CLEAR IS NORMAL
Polps in the nosey..normal or not?
polyps EXTRA TISSUES AND CAN BE MALIGNANT AND NEED TO BE REMOVED.
what is the disease in the nose from picking your noee?
furuncle (boil) infected hair follicle USUALLY FROM PICKING
narrowing of nostrils?
narrowing of nostrils with inhalation – mouth breathers or chronic obstruction
Increased vascularity causes what?
increased vascularity (liver disease) CAUSES NOSSE BLEEDS. MAY ALSO OCCUR IN PREGNANCY D/T HORMONES.
opaque fluid vs clear in the nosey???
. Exam Technique – Sinuses
1. Method of Exam
a) transillumination IF LIGHT IS SHONE BELOW NOSE; RED GLOW INDICATES CLEAR FLUID, NOW GLOW INDICATES OPAQUE FLUID (INFX)
Can palpate for sound in the sinus t/f?
Abnormal Findings
a) sinusitis CAN PALPATE FOR SOUND
cytanosis of lips abnorm or normal?
abn
mouth angular cheilosis
CRACKING AT THE SIDDE (DROLLING AT NIGHT MAY CAUSE)
what does herpes simplex look like and s/s?
herpes simplex – fever blisters VESICLES SEROUS FLUID WITH RED ROUND BASE. VERY PAINFUL. FIRST FORM IN CHILDREN= TRENCH MOUTH-USUALLY VIRAL AND CANNOT BE TREATED
Cherry lips means????
cherry colored; carbon monoxide poisoning NEEDS TO BE REVERSED WITH O2 TANK. (VERY SECLUDED TANK IN HOSPITAL D/T RISK OF EXPLOSION.
In the buccal mucosa..is yeast normal????GROSS
buccal mucosa SOME YEAST IS NORMAL IN MOUTH/VAGINA/URINARY TRACT. CHANGE IN PH CAUSES ABNORMAL GROWTH.
Color abn of the buccal mucosa and what do you do for thrush!
color changes (pallor, cyanosis)
- - thrush (candidiasis) NEEDS TO SWISH AND SWALLOW TX TO AVOID THROAT INFX AS WELL.
Aphthous ulcer of the buccal mucosa any idea???
aphthous ulcer ALLERGY TO FOOD. REMOVE FOOD IS TX.
What is candidiasis?
tongue
- - thrush (candidiasis)
What is fissured tongue?
fissured tongue CRACKING AND DRY
What does enlarged tongue mean?
enlargement USUALLY VITAMIN DEFICINCY RELATED.
WHAT IS GINGIVITIS?
gums
- gingivitis INFLAMMATION/INFXN OF GUMS; BLEEDING. DILANTIN CAN CAUSE GINGIVITIS
What is recession of the gummies?
recession of the gums ELDERLY GUMS SHRINK AND TEETH APPEAR BIGGER. NOWADAYS THEY SUTURE TEETH IN BEFORE RESORTING TO DENTURES.
What are caries?
) teeth
- - caries/cavities
How should the pharynx look?
SHOULD APPEAR SAME COLOR AS MUCOSA IN MOUTH. IF REDDER COULD INDICATE INFXN OR IRRITATION.STREP= WHITE PATCHES. IF UNTREATED, CAN EFFECT HEART AND LEAD TO RHUMATIC FEVER. STREP SMELLS CHARACTERISTIC MONO= SILVERY APPEARANCE TO PHARYNX. NEED TO REST, RELAX, ANALGESICS. MONO CAN ENLARGE THE SPLEEN.
Palp of the neck?
Inspection and Palpation of the Neck LOOK FOR SYMMETRY.
what is torticollis...a noodle???
Torticollis LATERAL NECK DEVIATION. SOME PEOPLE W/ HX OF CA HAVE HAD MUSCLE REMOVED.
decreased ROM..why would that be?
. Decreased ROM CAUSE IS ANYTHING THAT CAUSES PAIN.
How should the trachea look?
Deviation of Trachea TRACHEA SHOULD NOT BNE MOVED OVER.
undeveloped countries have probs with what med prob?
. Thyroid goiter PROBLEM IN UNDERDEVELOPED COUNTRIES D/T LACK OF IODINE
how big should lympth nodes be?
Lymphadenopathy LYMPH NODES SHOULD BE PEA SIZED AND BARELY FELT. ONLY “ABSENT” IF THEY HAVE BEEN REMOVED