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146 Cards in this Set
- Front
- Back
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Groupings of lesions
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Linear
Annular Arciform Confluent Dermatonal Coalesque Discrete Generalized Zoseriform |
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Linear vs Annular
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Inline (poison ivy, shingles)
Rounded (lyme disease, ringworm) |
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Arciform vs Confluent
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Arc-like
lesions merge (exanthma) |
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Dermatonal vs Coelsque
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On nerve bands
group together (herpes simplex) |
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Discrete vs Generalized
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individual (insect bites)
scattered over body (measles) |
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Zosteriform
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linear along a nerve root (herpes zoster)
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Types of lesions
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Plaque
Papule Pustule Bulla Wheal Macule Vesicle |
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Plaque
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Elevated, flat top, rough, firm, no round borders, size > 0.5 cm
Psoriasis Sebhorreic dematitis |
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Papule
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Elevated, firm, specific circumference (circumscribed), size > 0.5 cm
Wart, mole |
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Pustule
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Elevated, superficial, filled with purulent fluid (pus)
Acne, Impetigo |
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Bulla
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Large vesicle, clear fluid, size > 1cm
Blister, burn |
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Wheal
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Elevated, irregular shape, edema, variable diameter
Insect bite, hives |
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Macule
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Flat, circumscribed change in skin color, size < 1cm
Freckle, flat mole, ptechia (tiny hem in skin in babies) |
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Vescile
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Elevated mass, fluid filled, size < 0.5
Chicken pox, scabies |
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Atrophy
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thinning of skin
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Lichenification
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thickening of skin
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Excoriation
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Loss of epidermal layers due to irritation
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Keloid
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Abnormal scar tissue
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Ulcer
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Cratered skin
Commonly seen in elderly |
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Types of secondary lesions
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Scaling
Crusting Erosion Keloid Ulcer Excoriation |
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Secondary lesions in:
Shingles Chicken pox Impetigo |
Scaling and crusting
breaking open and crusting crusting |
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ABCD's of Cancer Detection
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A - Asymmetry
B- Borders irregular C- Color variation D - Diameter > 0.5 cm |
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Types of vascular lesions
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Spider angioma
Petechia Telangiectasia Ecchymosis Port Wine Stain Mongolian Spots |
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Spider Angioma
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Spider veins
Superficial capillaries on skin surface |
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Petechia
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pinpoint sized red spots
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Telangiectasia
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stork bites in infants
Over nose and eyelids |
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Ecchymosis
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black and blue marks (bruising)
Look for swelling |
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Port Wine Stain
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Commonly found on face
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Mongolian Spots
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Black and blue spots on lower back
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Assessing Edema
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Press thumb into skin & release pressure
Should be NO edema in winter -- may be a sign of heart and circulation issues |
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Pitting Edema Scale
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0 - no pitting edema
1+ - 2 mm depression 2+ - 4mm 3+ - 6 mm 4+ - 8 mm |
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Auscultation
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Listening to body sounds
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Note when Auscultating
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Frequency
Intensity Quality Duration |
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Skin Layers
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Epidermis
Dermis Subcutaneous |
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Epidermis characteristics
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Horny Layer
Keratanized cells No blood vessels |
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Dermis characteristics
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Contains blood vessels
Contains connective tissue Contains part of hair follicle Contains sebaceous glands (eccrine and apocrine) |
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Subcutaneous characteristics
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Contains fat
Contains sweat glands Contains part of hair follicle |
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Skin History
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Chief Complaint
Allergies Exposures Medications Stressors Diet Habits for skin and nails |
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Skin Assessment Techniques
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Inspection & Palpation
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Skin Assessment Areas of Focus
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Color
Moisture Temperature Texture Mobility Turgor Lesions |
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Thickened skin found in?
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Hyperthyroidism
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Lesion Areas of Focus
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Location
Distribution Borders Type |
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Folliculitis
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Inflammation of hair follicle
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Seborrheic Dermatitis
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Blocked sebaceous gland
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Hair Assessment Techniques
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Inspect & Palpate
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Hair Assessment Focus Areas
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Location (head, eyebrows, body)
Distribution Quality Texture Color |
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Nail Assessment Focus Areas
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Shape
Curvature Adhesion Infection Surface Color Thickness |
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What in a nail assessment indicates clubbing?
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Curvature of nail base is over 160 degrees
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Common Exam Positions
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Semi Fowlers & Sitting Fowlers
Horizontal Recumbent DOrsal Recumbent Side Lying Lithotomy Knee Chest Sims Prone |
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What do you perceive with palpation
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movement, vibration, position, consistency, form and temp
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What is crepitus
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Grinding noise
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What is turgor
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pinching skin to determine hydration
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What is percussion used for?
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To detect position, size and density of underlying structures
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What indicates a more solid structure?
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A dull sound in percussion (less vibrations)
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Do you move from tympanic to dull or dull to tympanic
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Tympanic to dull/solid
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Assess sounds in percussion for?
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Intensity
Pitch Quality (dull, resonant) |
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List lymph nodes
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Posterior Auricular
Preauricular Submental Submandibular Tonsillar Superficial Cervical Deep Cervical Supraclavicular Posterior Cervical Anterior Cervical Occipital |
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Head & Neck Assessment Focus Areas
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Symmetry
Hair Skull & Scalp tenderness Lesions Mvmt of neck (flexion, extension) |
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Face Assessment Focus Areas
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Symmetry
Expression Involuntary motions Lesions Hair distribution Motion Pain sensation Temporal artery TMJ |
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Neck Assessment Focus Areas
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Masses
Thyroid Trachial deviation Lymph glands ROM Muscle strength |
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Thyroid exam steps
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Approach from posterior
Place fingers on patients neck below cricoid Displace thyroid cartilage Have patient lower chin & swallow |
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Ascultation of Thyroid Gland
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If enlarged, there will be increased blood flow to thyroid
Vibrations will be heard (BRUIT) |
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Lymphatic System
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Collection of nodes
Vascular network that drains fluid lymph from body tissue and returns to venous circulation |
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How is lymph fluid collected
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System starts peripherally as capillaries - moves centrally as vessels
Collects at ducts at root of neck Fluid collected in nodes |
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Why is lymphatic system important
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Important factor in immune system
Nodes engulf foreign bodies |
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Normal shape and size of lymph nodes
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Round, oval or bean shaped
Vary in size Most inguinal nodes 1 cm (nodes in pubic area) |
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If node is palpable describe
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Location
Size in cm Shape # of nodes smooth, irregular, nodular Soft, firm, hard Matted vs discrete Tenderness Mobility |
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Signs of infection (from lymph nodes)
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Erythema (redness), increased warmth
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Concerns with lymph nodes?
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If unilateral, fixed, hard and/or irregular
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Eye Assessment Focus Areas
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Position & Alignment
Eyebrows & Eyelashes Eyelids Lacrimal area (inner part of eye) Conjuntiva & Sclera Cornea Iris & Pupil |
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Technique for Ophthalmoscope
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Darken Room
Switch on light Start at 0 diapters Start 15 degrees away Look for red - orange reflex Find vessels and optic disk |
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Check optic disk for?
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Size
Shape Margins Color |
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What is depression in optic disk?
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Physiologic cup
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Check retinal vessels for?
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Get smaller as reach periphery
Veins = dark red Arteries = light red |
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Area of central vision?
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Macula
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How do you test visual fields?
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Snellen Chart
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How far away does patient stand?
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20 feet
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How many letters must patient read to get credit for a line?
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At least 1/2 letters
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Vision of 20/40 means?
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Person can read at 20 feet what someone with normal vision can read at 40 feet
Higher the bottom number the worst the vision |
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How do you test peripheral vision?
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Move fingers from outside field of patients vision to in
Note when patient can see fingers |
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Why do you perform an "H test"?
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To detect abnormal occular movements
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What is nystagmus?
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Involuntary, rapid movement of eyeball
normal to have 1-2 flicks |
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Examples of when you would see nystagmus?
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Brain trauma
Certain psych medications |
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Common Eye Problems
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Myopia
Presbyopia Macular degeneration Loss of night vision |
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Myopia vs Presbyopia
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Nearsighted - dont need reading glasses
Farsighted - need reading glasses |
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Macular degeneration
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loss of central vision
commonly in elderly |
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Snellen chart tests what type of vision?
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Central vision
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Visual field test is for what type of vision?
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Peripheral vision
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Floaters
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Deposits of vitreous protein
Benign Usually dont go away |
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Halos
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Halo of light around objects
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What may cause Halos?
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Excess fluid in eye due to certain meds
Glaucoma |
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What is glaucoma?
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intraoccular pressure (pressure inside eyes)
May result in nerve damage to eye |
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Curtain falling
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When you can't see the top part of field of vision
Like a "black curtain" in vision Often in nearsighted individuals |
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Curtain falling is sign/symptom of?
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Retinal detachment
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What does double vision occur
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Could be due to increased BP
Reduced blood flow to nerves in brain and eye |
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Strabismus
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Cross eyed
May be seen in younger children due to impaired eye muscle strength |
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Preeclampsia
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high blood pressure in pregnancy
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Conjuctival Hemorrhages
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Bloodshot eye
Rupture of blood vessels in eye due to coughing, vomiting, injury, birth trauma |
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Palpebral fissures
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The eye openings are not as wide as normal
Often seen in FAS or Down Synfrome |
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Ectropion vs Entropion
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Eyelid comes out (everted)
Eyelid moves in (inverted) May be due to poor nutrition |
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Ptosis
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Drooping of eyelid
Aging, trauma, nerve damage |
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Chalazion
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Infection of meibomian gland (on rim of lower eyelid near nose)
Swollen outside of eye |
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Hordeolum
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Infection of eyelashes
Sty in eye |
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Xanthelasma
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Yellow plaques in skin along nasal bridge, neck, joints, palms
May be r/t abnormal metabolism of lipids |
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Conjunctiva
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Increased number and size of vessels = imflammation
Cobble appearance = allergies |
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Pterygium
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Winglike structure extending from conjunctiva to cornea
May cover part of iris Common in elderly |
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What is clear drainage from ear a sign of?
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Potential cerebral spinal injury
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Otitus Externa Signs
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Infection in external ear canal
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Otitus Media Signs
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FILL IN
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Auricle vs. pinna
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Pinna = curved part of ear
Auricle = |
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Mastoid
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Bone behind ear
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What could low placement of ears mean?
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Genetic disorder, developmental issues
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Ears correlate with what other organ regarding health?
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Kidneys
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Ear Assessment Focus Areas
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Position
Tenderness Lesions Edema Deformities Masses |
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Why does swimmers ear occur?
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May be due to water in ear or cerumen gets wet
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Cerumen
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Ear wax
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Auditory Canal Assessment Focus Areas
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Discharge
Foreign Objects Inflammation Infection |
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Ear Assessment Procedure
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Use otoscope; both hands
Pull auricle up, back and out = Adults Pull auricle down = less than 3 yrs old |
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How do we visualize ear canal and tympanic membrane?
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Use of otoscope
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Ear Drum Assessment Focus Areas
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Color
Contour Appears concave Cone of light at umbo (down towards nose) |
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What color should ear drum be?
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Pearly gray or white
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How do we focus speculum during ear exam?
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Towards patients nose
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When will we not see cone of light?
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In case of infection
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How do we assess hearing acuity?
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Use of tuning form
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What is conductive hearing loss?
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Sound goes through ear canal
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What is sensorineural hearing loss?
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Hearing loss as a result of nerve damage
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Types of Hearing Tests
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Rinne Test
Weber Test |
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Rinne Test
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Compares air conduction vs bone conduction
Hold fork against mastoid bone; then in front of ear |
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What indicates a positive Rinne test?
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If AC > BC
+ Rinne |
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What indicates hearing loss in a Rinne test?
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If AC < BC or AC = BC
- Rinne |
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Weber Test
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Assesses for lateralization of hearing; should hear same on each side
Place on top of head or middle of forehead |
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What if you hear more in affected ear?
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Conductive loss - sound is being conducted through bone to ear
i.e. impacted cerumen, perforated typmanic membrane |
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What if you hear more in unaffected ear?
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May have nerve damage in affected ear (i.e. brain damage, congenital defects, drugs, exposure to loud noise)
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Mouth Assessment Focus Areas
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Lips
Gums Teeth (carries, odor) Buccal Mucosa Sublingual areas Parotid duct openings Hard & Soft Palate Pharnyx Tonsils |
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Halitosis
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unpleasant odor in breathing
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Buccal mucosa
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inner side of cheek
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Sublingual area is where?
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under tounge
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Parotid ducts are also called?
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Stensen's ducts
i.e. mumps, smoking, bulemia, cancer |
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Pharnx location
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top part of mouth near throat
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Hard palate vs soft palate
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right behind top teeth
behind hard palate |
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Hytrophy
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Bigger gums due to inflammation, gingivitis, medications (delantin)
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Nose Assessment Focus Areas
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Swelling
Obstruction Deviated septum Discharge Nares Mucosa Sinuses |
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How to test for obstruction
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Close one nostril, breathe through other
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Clear discharge indicates?
Purulent discharge indicates? Foul smelling? Bleeding? |
Allergies
Infection (bacterial or viral) Foreign body or sinusitis Hypertension, trauma, cocaine use, neoplasm (tumor) |
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What do pink nares and mucosa indicate?
Pale/bluish? Red/swollen |
Normal, no infection or allergies
allergies infection (bacterial or viral) |
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Technique to assess sinuses
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Direct percussion of frontal and maxillary sinuses
Start with normal side first Check for swelling |
