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PCMI > 1.2. General Skin and Appearance > Flashcards

1.2. General Skin and Appearance Flashcards

1
Q

What are important characteristics to look for and document in a general assessment?

A
  1. Alertness
  2. Orientation: x3
  3. Apparent state of health
  4. Apparent age: do they look younger, older, stated age?
  5. Race
  6. Signs of acute/chronic disease
  7. Nutritional state, including hydration
  8. Gait
  9. Hygiene
  10. Cooperation: personable, conversational, distracted?
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2
Q

How does a primary and secondary survey differ?

A

Primary (seconds) and secondary (minutes)

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3
Q

What 4 categories could you look for when observing distress/pain?

A
  1. Affect/mood: depressed, flat affect
  2. Verbal tones
  3. Posture
  4. Physical findings: flushed, sweating
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4
Q

What is considered unsteady gait?

A
  • Lack of coordination
  • Abnormal posture
  • Gait influenced by pain
  • Muscle abnormalities
  • Nervous system, cerebral palsy
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5
Q

What can cause an unsteady gait?

A
  • inflammatory processes
  • joint and bone infection
  • muscle disease
  • tendon disease
  • trauma
  • congenital disease
  • footwear
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6
Q

What is an ataxic gait?

A

Unsteady with feet thrown out. Heels come down first then toes
-Occurs w/ intoxication, brain injury, side effects of anti-epileptic drugs, stroke, polyneuropathy

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7
Q

What is a waddling gait?

A

Resembles a duck

-Due to congenital hip disorder, spinal muscle atrophy, muscular dystrophy or myopathy

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8
Q

What is a propulsive gait?

A

Stooped and stuff posture w/ head and neck bent forward

-Usually seen in Parkinson’s and CO and Mg poisoning.

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9
Q

What is a steppage gait?

A

Foot hangs with toe pointing down and scraping ground while walking
-Symptom of MS, peritoneal neuropathy, lumbar slipped disc, and SC injury

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10
Q

What is a spastic or scissor gait?

A

Knee and thigh hit each other while walking in a crisscross manner
-Due to brain abscess, tumor, cerebral palsy, MS, spinal tumor, liver failure

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11
Q

What is an antalgic gait?

A
  • Associated with pain, and avoid pain by changing gait

- limp where phase of gait is shortened

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12
Q

Parkinsonian gait (also type of propulsive gait)

A
  • Trunk, head, neck forward and knee flexed
  • wide base and small shuffling step
  • tend to fall forward and increase speed (destination)
  • IMPORTANT*
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13
Q

What to inspect on skin

A
  • Color
  • Lesion
  • rash
  • Scars
  • Tattoos
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14
Q

What to palpate on skin

A
  • Character
  • temp
  • moisture
  • turgor (dehydration status)
  • elasticity (pinch over dorsal hand/forearm)
  • crepitus (crackly- bone to bone)
  • pigment
  • lesions/scars
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15
Q

What do ABCDE stand for in accessing skin lesions for melanoma?

A

A: Asymmetry- not homogenous
B: Border
C: Color
-Black (necrotic), blue (depth of invasion, red (inflamm)
-Important in determining metastatic potential
D: Diameter
E: Evolution

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16
Q

What does Hirsutism mean?

A

Excessive hairiness, especially in women

  • 5-10% of women in reproductive age
  • Common cause is polycystic ovarian syndrome or hormonal disorders
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17
Q

What does Virilization mean?

A

Secondary male characteristics manifesting in females

18
Q

What does alopecia mean?

A

balding, hair loss

19
Q

What is the difference between papule and plaque on skin?

A
  • Papules are flat and red macule (indicative of contact dermatitis or shingles)
  • Plaque large, thickened skin (psoriasis)
20
Q

What is an erythematous macular rash?

A

small red dots covering large area

-drug eruption (sulfa) and hypersensitivity rxn

21
Q

What should you look for in an eye exam?

A
  • sclera for conjunctival injection or jaundice
  • note color, erythema, swelling
  • look at lacrimal glands
22
Q

What should you look for in a nose exam?

A

nostril for tumor or erosion

23
Q

What should you look for in an oral cavity exam?

A
  • mucosa surface for erosions, vesicles, white/red/brown macule, plaque
  • examine teeth and gum for abnormal dentition, cavities, abscesses, periodontal disease
24
Q

What should you look for in an ear exam?

A
  • palpate for presence of rough, gritty keratitis areas

- look for ear tumors, especially post auricular areas

25
Q

What are common skin issues at the flexor wrists?

A

dermatitis, scabies, lichen planus

26
Q

What are dorsal hands a site for?

A

sun-related disorders such as actinic keratosis and photodermatoses (UV exposure)

27
Q

What is lichen planus?

A

recurrent, pruritic inflammatory eruption characterized by small, discrete, flat papules that could turn into rough scaly plaque
-radiation therapy can sometimes cause this

28
Q

What is onycholysis?

A

distal nail plate detached from nail bed

29
Q

What does splinter hemorrhage at nail bed potentially indicate?

A

endocarditis

30
Q

What is clubbed fingernail?

A

> 180 degree due to chronic tissue hypoxia

-important in CVD

31
Q

How should you approach a patient presenting with skin complaint?

A
  1. Begin with patient seated and facing you
  2. Scan skin for tone and different features (variations, red, flush, color)
  3. Touch skin lightly (checking abnormal variations)
  4. Check turgor and elasticity
32
Q

What area is considered “inframammary”?

A

between chest and breast

-important to check for yeast or intertrigo (rash from skin to skin contact)

33
Q

What area is considered “infrapannicular”?

A

between fat fold of the skin

34
Q

What area is considered “infragluteal”?

A

b/t butt cheeks

35
Q

What are the 6 F’s that contribute to increase fat in abdomen?

A
  1. Fluid
  2. Flatus
  3. Feces
  4. Fetus
  5. Fat
  6. Fatal tumor
36
Q

How would you approach a trunk exam?

A
  1. position pt to enhance draping privacy
  2. start with chest
    - female: lift breast if need to check inframammary area
  3. Examine axillae for presence/absence of hair or skin lesions, lymphadenopathy
  4. Back: 40% of melanomas in men are on back
37
Q

How would you approach an abdominal exam?

A
  1. Pt lie down for exam
  2. Lift and spread skin to check in body folds (particularly in obese for yeast or intertrigo)
  3. Check inguinal area for signs of fungal infection or lymphadenopathy
38
Q

How would you approach a leg exam?

A
  1. Examine ant and medial surface of leg
    - 40% of melanomas in women are on legs, so note pigment changes
  2. Knee and popliteal surface
    - Common for psoriasis and atopic dermatitis
  3. Lower leg: evaluate edema, stasis dermatitis (skin changes resulting from blood pooling), ulcer
  4. Feet: pallor and decreased temp (indicate vascular disease)
  5. Dorsal and posterior tibial pulses
    - Check carefully in diabetic patients
  6. Check tow webs for scales or fissures (fungal infection)
  7. Toenails
39
Q

What is Ram’s Horn deformity?

A

Curling of toenail due to fungal infection

40
Q

What would loss of toenails indicate?

A

peripheral vascular disease

41
Q

What are the 9 head/neck sites of lymph nodes? IMPORTANT

A
  1. submental (under chin)
  2. Submandibular (under jaw)
  3. Jugular
  4. Supraclavicular: (swollen usually means malignancy)
  5. Poststernoclediomastoid
  6. Postauricular
  7. Preauricular
  8. Suboccipital
  9. Pretrapezius
42
Q

What are the 6 lymph nodes in your upper torso?

A
  1. Supraclavicular
  2. Infraclavicular
  3. Lateral axillary
  4. Central (center of armpit)
  5. Subscapular
  6. Pectoral

PCMI (15 decks)

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