1.2. General Skin and Appearance Flashcards
What are important characteristics to look for and document in a general assessment?
- Alertness
- Orientation: x3
- Apparent state of health
- Apparent age: do they look younger, older, stated age?
- Race
- Signs of acute/chronic disease
- Nutritional state, including hydration
- Gait
- Hygiene
- Cooperation: personable, conversational, distracted?
How does a primary and secondary survey differ?
Primary (seconds) and secondary (minutes)
What 4 categories could you look for when observing distress/pain?
- Affect/mood: depressed, flat affect
- Verbal tones
- Posture
- Physical findings: flushed, sweating
What is considered unsteady gait?
- Lack of coordination
- Abnormal posture
- Gait influenced by pain
- Muscle abnormalities
- Nervous system, cerebral palsy
What can cause an unsteady gait?
- inflammatory processes
- joint and bone infection
- muscle disease
- tendon disease
- trauma
- congenital disease
- footwear
What is an ataxic gait?
Unsteady with feet thrown out. Heels come down first then toes
-Occurs w/ intoxication, brain injury, side effects of anti-epileptic drugs, stroke, polyneuropathy
What is a waddling gait?
Resembles a duck
-Due to congenital hip disorder, spinal muscle atrophy, muscular dystrophy or myopathy
What is a propulsive gait?
Stooped and stuff posture w/ head and neck bent forward
-Usually seen in Parkinson’s and CO and Mg poisoning.
What is a steppage gait?
Foot hangs with toe pointing down and scraping ground while walking
-Symptom of MS, peritoneal neuropathy, lumbar slipped disc, and SC injury
What is a spastic or scissor gait?
Knee and thigh hit each other while walking in a crisscross manner
-Due to brain abscess, tumor, cerebral palsy, MS, spinal tumor, liver failure
What is an antalgic gait?
- Associated with pain, and avoid pain by changing gait
- limp where phase of gait is shortened
Parkinsonian gait (also type of propulsive gait)
- Trunk, head, neck forward and knee flexed
- wide base and small shuffling step
- tend to fall forward and increase speed (destination)
- IMPORTANT*
What to inspect on skin
- Color
- Lesion
- rash
- Scars
- Tattoos
What to palpate on skin
- Character
- temp
- moisture
- turgor (dehydration status)
- elasticity (pinch over dorsal hand/forearm)
- crepitus (crackly- bone to bone)
- pigment
- lesions/scars
What do ABCDE stand for in accessing skin lesions for melanoma?
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
What does Hirsutism mean?
Excessive hairiness, especially in women
- 5-10% of women in reproductive age
- Common cause is polycystic ovarian syndrome or hormonal disorders
What does Virilization mean?
Secondary male characteristics manifesting in females
What does alopecia mean?
balding, hair loss
What is the difference between papule and plaque on skin?
- Papules are flat and red macule (indicative of contact dermatitis or shingles)
- Plaque large, thickened skin (psoriasis)
What is an erythematous macular rash?
small red dots covering large area
-drug eruption (sulfa) and hypersensitivity rxn
What should you look for in an eye exam?
- sclera for conjunctival injection or jaundice
- note color, erythema, swelling
- look at lacrimal glands
What should you look for in a nose exam?
nostril for tumor or erosion
What should you look for in an oral cavity exam?
- mucosa surface for erosions, vesicles, white/red/brown macule, plaque
- examine teeth and gum for abnormal dentition, cavities, abscesses, periodontal disease
What should you look for in an ear exam?
- palpate for presence of rough, gritty keratitis areas
- look for ear tumors, especially post auricular areas
What are common skin issues at the flexor wrists?
dermatitis, scabies, lichen planus
What are dorsal hands a site for?
sun-related disorders such as actinic keratosis and photodermatoses (UV exposure)
What is lichen planus?
recurrent, pruritic inflammatory eruption characterized by small, discrete, flat papules that could turn into rough scaly plaque
-radiation therapy can sometimes cause this
What is onycholysis?
distal nail plate detached from nail bed
What does splinter hemorrhage at nail bed potentially indicate?
endocarditis
What is clubbed fingernail?
> 180 degree due to chronic tissue hypoxia
-important in CVD
How should you approach a patient presenting with skin complaint?
- Begin with patient seated and facing you
- Scan skin for tone and different features (variations, red, flush, color)
- Touch skin lightly (checking abnormal variations)
- Check turgor and elasticity
What area is considered “inframammary”?
between chest and breast
-important to check for yeast or intertrigo (rash from skin to skin contact)
What area is considered “infrapannicular”?
between fat fold of the skin
What area is considered “infragluteal”?
b/t butt cheeks
What are the 6 F’s that contribute to increase fat in abdomen?
- Fluid
- Flatus
- Feces
- Fetus
- Fat
- Fatal tumor
How would you approach a trunk exam?
- position pt to enhance draping privacy
- start with chest
- female: lift breast if need to check inframammary area - Examine axillae for presence/absence of hair or skin lesions, lymphadenopathy
- Back: 40% of melanomas in men are on back
How would you approach an abdominal exam?
- Pt lie down for exam
- Lift and spread skin to check in body folds (particularly in obese for yeast or intertrigo)
- Check inguinal area for signs of fungal infection or lymphadenopathy
How would you approach a leg exam?
- Examine ant and medial surface of leg
- 40% of melanomas in women are on legs, so note pigment changes - Knee and popliteal surface
- Common for psoriasis and atopic dermatitis - Lower leg: evaluate edema, stasis dermatitis (skin changes resulting from blood pooling), ulcer
- Feet: pallor and decreased temp (indicate vascular disease)
- Dorsal and posterior tibial pulses
- Check carefully in diabetic patients - Check tow webs for scales or fissures (fungal infection)
- Toenails
What is Ram’s Horn deformity?
Curling of toenail due to fungal infection
What would loss of toenails indicate?
peripheral vascular disease
What are the 9 head/neck sites of lymph nodes? IMPORTANT
- submental (under chin)
- Submandibular (under jaw)
- Jugular
- Supraclavicular: (swollen usually means malignancy)
- Poststernoclediomastoid
- Postauricular
- Preauricular
- Suboccipital
- Pretrapezius
What are the 6 lymph nodes in your upper torso?
- Supraclavicular
- Infraclavicular
- Lateral axillary
- Central (center of armpit)
- Subscapular
- Pectoral
