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NURS 6220 Health Assessment > Derm/HEENT Review > Flashcards

Derm/HEENT Review Flashcards

1
Q

SUBJECTIVE vs OBJECTIVE INFORMATION

A

Subjective: Everything the patient tells you about their health history
HPI, PMH, patient reported info etc.

Objective: Your observation or assessment. It is usually demonstrated, reproducible and reliable information
VS, physical assessment, labs/diagnostic studies

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2
Q

Implicit bias:

A

unconscious belief that leads to negative opinion about a person or group of people

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3
Q

Explicit Bias:

A

conscious and deliberate negative belief about a person or group of people

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4
Q

Sensitivity
* Good ability to detect a disease
* High sensitivity means high _____ ___ rate

A

true positive;

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5
Q

Screening tests should have high _________

A

sensitivity

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6
Q

Diagnostic tests should have high _____

A

specificity

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7
Q

Specificity
* Better ability to confirm a disease is present
* Lower number of false negatives
* More likely to confirm a true negative
* High specificity means a high ______ ________ rate

A

true negative

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8
Q

Acute vs Chronic

Acute < ___ weeks
Chronic > ___ weeks

A

12 weeks

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9
Q

OLD CHARTS

A
  • Onset- When did it start?
  • Location- Where is it located
  • Duration- How long does it last?
  • Characteristics- What does it feel like? Sharp, dull, pressure, etc
  • History- have you ever had this before?
  • Associated/Alleviating/Aggravating- what makes it better?
    Worse?
  • Radiation- Does it radiate
  • Timing- When does it occur as related to an association with
    something else?
  • Severity- Scale of 1-10
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10
Q

PROS/CONS of OPEN QUESTIONS

A

PROs: Provides baseline to start forming differential diagnosis; Helps build rapport

**CONS: **Patient decides what information to give; Patient takes control of the conversation- Time limits; Hard to get direct answers; Avoid “leading the witness”

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11
Q

PROS/CONS of CLOSED QUESTIONS

A

** PROs**:Direct answers to help develop diagnosis; Time efficient; Best only used with ROS

**CONs: **Easy to leave out information; Must ask the right questions; Too many can destroy rapport; avoid rapid fire;

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12
Q

USING TANNING BED:

A

Increases risk for:
Squamous cell carcinoma by** 58% **
basal cell carcinoma by **24%. **
Using tanning beds before age 20 can increase your chances of developing melanoma by 47%

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13
Q

Atopic dermatitis (eczema):

A
  • Located in bending areas
  • Exacerbated by heat and environmental factors
  • Associated with allergies
  • Often can co-exist with Asthma
  • Presents when children around 6 months
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14
Q

Charting Lesions:

A
  1. Identify primary lesion
  2. Size
  3. . Specify the number or qualify by surface area (i.e. R forearm)
  4. Demarcation (linear, annular, discoid, serpiginous, well/poor demarcation, bull’s eye)
  5. Color (test for blanching if RED)
  6. Secondary characteristics: crusting, fissure, erosion, cellulitis, necrosis
  7. Texture: smooth, hard, scaly, fleshy, coarse, fine
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15
Q

Superior or cranial

A

toward the head end of the body; upper (example, the hand is part of the superior extremity).

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16
Q

Inferior or caudal

A

away from the head; lower (example, the foot is part of the inferior extremity).

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17
Q

Anterior or ventral

A

front (example, the kneecap is located on the anterior side of the leg).

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18
Q

Posterior or dorsal

A

back (example, the shoulder blades are located on the posterior side of the body).

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19
Q

Medial -

A

toward the midline of the body (example, the middle toe is located at the medial side of the foot).

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20
Q

Lateral -

A

away from the midline of the body (example, the little toe is located at the lateral side of the foot).

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21
Q

Proximal -

A

toward or nearest the trunk or the point of origin of a part (example, the proximal end of the femur joins with the pelvic bone).

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22
Q

Distal -

A

away from or farthest from the trunk or the point or origin of a part

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23
Q

Coronal Plane (Frontal Plane) -

A

A vertical plane running from side to side; divides the body or any of its parts into anterior and posterior portions.

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24
Q

Sagittal Plane (Lateral Plane) -

A

A vertical plane running from front to back; divides the body or any of its parts into right and left sides.

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25
Q

Axial Plane (Transverse Plane) -

A

A horizontal plane; divides the body or any of its parts into upper and lower parts.

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26
Q

Median plane -

A

Sagittal plane through the midline of the body; divides the body or any of its parts into right and left halves.

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27
Q

Benign Skin Lesions:

Solar lentigo: skin blemishes that are caused by aging and exposure to the sun’s ultraviolet radiation

A
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28
Q

Benign Skin Lesions:

Rhytids: wrinkles or folds in the skin

A
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29
Q

Benign Skin Lesions:

Melasma: hyperpigmentation caused by an overproduction of melanin

A
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30
Q

Benign Skin Lesions:

Milia: small, white spots that appear on the skin

A
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31
Q

Benign Skin Lesions:

Angioma: benign growth of small vessels

A
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32
Q

Acanthosis Nigracans: dark, thick patches of skin

A
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33
Q

Ichthyosis Scales: dry flaky rough patches of dead skin

A
34
Q

Seborrheic Keratosis: non-cancerous skin growth appears as a raised, wart-like spot on skin

A
35
Q

Actinic Keratosis: precancerous skin condition that appears as a rough scaly patch or bump (can progress to BCC)

A
36
Q

Basal Cell Skin cancer:
Arises from basal layer of the epidermis

A
  • Low risk of metastasis
  • Most common type of skin cancer (white people)
  • 30% higher in men than women
    Risk Factors: UV light, genetic factors, chronic arsenic exposure, immunosuppression meds, radiation therapy
37
Q

Cutaneous Squamous Cell Carcinoma (cSCC):
Arises from keratinocytes of the epidermis

A
  • Typically found in areas exposed to sun (white)
  • Non sun exposed areas (black)
38
Q

Skin Cancer- Melanoma (most serious)

A

2 or more of the following
* Asymmetry
* Borders
* Color
* Diameter
* Elevation
* Firmness
* Growing

39
Q

Melanoma Red Flag Signs

A
  • Asymmetrical distribution of color
  • Blue-Black-White
  • Non-healing lesions
  • Head and neck lesions especially if showing “grey” color
  • Changing lesion
  • Ulceration without history of trauma
  • Black necrosis with spider bite suspicion
  • Streaking redness
40
Q

Differences between Psoriasis and Eczema

PSORIASIS
* Autoimmune disorder- skin cells grow too fast- onto of each other
* Scaly appearance
* Milder itching
* Improves with sunlight
* Located: scalp, elbows, knees, buttocks and face

A

Atopic Dermatitis (ECZEMA)
* Similar locations but also antecubital and behind knees
* Very itchy
* Genetic and environmental causes
* Exacerbated by dry climate, heat, etc.
* Common in Children with asthma and food allergies/Environmental allergies

41
Q

Strabismus:

A

uncoordinated eye movements

42
Q

Ptosis:

A

drooping of the eyelid

43
Q

Myosis:

A

excessive constriction of the pupil

44
Q

Amblyopia:

A

a vision disorder that occurs when the brain does not fully process information from one eye.

45
Q

Presbyopia:

A

loss of accommodation normal variation of aging - difficulty seeing up close objects

46
Q

Myopia:

A

nearsightedness - difficult to see objects that are far away

47
Q

Peripheral vision assessment

A

finger wiggle test

48
Q

Color blindness assessment - how do we detect color?

A

Rods and cones

49
Q

Causes of acquired color blindness:

A

retinal detachment, brain tumor, laser damage to eye

50
Q

Vision:
Optic Nerve: ?

A

CN II

51
Q

Eye movement:
List the nerves

A

CN III, IV, VI

52
Q

CN IV (trochlear):

A

test convergence: eyes able to cross when looking at your nose

53
Q

CN III (oculomotor):

A

test Doll’s EYE Accommodation ability to focus on a near object

54
Q

PERRLA

A

Pupils equal round and reactive to light (direct +consensual) and accommodation [convexity changes to see near objects, pupils constrict to look at a closer object (CN III);] Combined assessment of CN IV, III, II, VI

55
Q

EOMs - cover and uncover test:

A

testing for nystagmus, strabismus, amblyopia;
**Abnormal test **if covered eye moves to realign and shows covered eye was misaligned when covered

56
Q

Doll’s Eyes

A

**CN III disorder: **passive turn of head leaves the eye behind; normal in the newborn and disappears a week or two after birth.

57
Q

Corneal Light Reflex:

A

Abnormal is an eye alignment disorder

Abnormal can also suggest optic nerve damage or brainstem lesions

58
Q

AV Nicking-

A

visual sign of a small artery of the eye is compressing a vein (suggestive of HTN)

59
Q

Health of arteries and veins: normal ratio? (EYE)

A

ratio 2:4 normal

60
Q

Optic Disc - normal color?

A

pink-orange with a pale center

61
Q

RED FLAG SYMPTOMS
EYES

A
  • Eye pain with redness
  • Change in visual acuity
  • Photophobia with eye complaint
  • Potential Foreign object in eye (welder)
  • Floating spots
62
Q

Visual Acuity Assessment:

A

Visual acuity 20/20 - Snellen (20ft) - Rosenbaum (12inches)

63
Q

Cotton Wool spots (fluffy white patches) -

A

hemorrhages or lack of blood flow to retina (2/2 DMII/HTN)

64
Q

Papilledema:

A

optic disc swelling

65
Q

Sensorineural vs Conductive hearing

Conductive Heating Loss

  • Sound can not get through the ear canal to the inner ear
  • Temporary
  • Causes: ear wax, infection, fluid, Eustachian tube dysfunction,
  • Low frequency loss of hearing
  • Treatment: underlying cause
A

Sensorineural Hearing Loss

Involves the Cochlea or Inner ear**
* Permanent hearing loss; high frequency hearing loss
* Presbycusis (normal age-related hearing loss)
* Causes: age, prolonged loud noise, Meniere’s Disease, drugs
* Treatment: Hearing aids, cochlear implant

66
Q

Sensorineural vs Conductive hearing

Conductive Hearing Loss

A
  • Sound can not get through the ear canal to the inner ear
  • Temporary
  • Causes: ear wax, infection, fluid, Eustachian tube dysfunction,
  • Low frequency loss of hearing
  • Treatment: underlying cause
67
Q

Rinne Test:

A
  • AC>BC is normal
  • Written as Rinne’s positive (normal)
  • Written as Rinne abnormal AC<BC
  • Implies conductive hearing loss if AC<BC
68
Q

Weber: Looking for lateralization

A
  • Normal: sound is heard in both ears
  • If lateralizes or is “louder” in the “normal” ear: Sensorineural hearing loss
  • If lateralizes to the “abnormal” ear: Conductive hearing loss
  • Less environmental noise from air
  • Sound is trapped in abnormal ear
69
Q

Lymph nodes:

A

House lymphocytes (B and T cells)
* Filter foreign particles but DOES NOT DETOXIFY
* 2-25mm in size
* Kidney shaped
* No lymph nodes in CNS
* All meningeal lymphatic fluid drains to deep cervical chain

70
Q

Virchows node:

A

supraclavicular node suggesting cancer of the thorax esp on L side

71
Q

Red flag lymph nodes signs:

A

Not associated with acute infection >2weeks
* Painless
* Weight loss
* Night sweats
* Progressive and not responsive to antibiotic
* Fever unexplained
* Nonmobile lymphadenopathy

72
Q

(RED FLAG)

A
  • Fever greater than 38 °C.
  • Drenching sweats, especially at night.
  • Unintentional weight loss of >10% of normal body weight over a
    period of 6 months or less
73
Q

Posterior oral pharynx:

A

uvula, epiglottis, tonsils

74
Q

Throat and oral cavity red flag signs:

A

Lesions: HPV cancer risk
Dental caries
Lesions on lip → cancer concern
Lesions on vermillon → HSV1 HSV2

75
Q

Red flag for tonsillar abscess:

A

kissing tonsils → airway obstruction

76
Q

Hyperthyroidism

A

Anyone with a hyperthyroid disorder needs routine ophthalmology referrals due to the risk of an ophthalmopathy
* Symptoms: bilateral proptosis, restricted eye movement and periorbital edema.
* You have TSH receptors in other sites (orbital fibroblasts)

77
Q

Middle ear infections
Also known as otitis media, these infections affect the middle ear, which is located between the eardrum and the inner ear.

A

Symptoms include:
Ear pain
Fever
Hearing loss or changes
Fluid from the ear
Headaches
Sore throat
Redness of the eardrum

78
Q

Inner ear infections
These infections affect the cochlea and balance canals of the inner ear, which controls hearing and balance.

A

Symptoms include:
Balance problems
Vertigo
Dizziness
Hearing issues
Nausea and vomiting
Ringing in your ear (tinnitus)
Earaches

79
Q

Ear exam:

A

Canal- redness, discharge
* TM- Cone of light
* Wax build up may prohibit view
* Foreign bodies
* Ear tenderness
* Lymph node enlargement
* Tenderness (tragus, mastoid bone, etc)

80
Q

Name the lymph nodes

A

NURS 6220 Health Assessment (7 decks)

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