exam 1 Flashcards
3 ways to describe a rash
color, morphology, size
3 morphology of primay lesion
fluid filled vs solid
color
scale or no scale
distrubution of a rash can either be ____ or ____
diffuse (all over) or localized
describe symmetrical distrubution
bilateral in the same area of the boday
acral sites on the body are where?
palms, soles of feet, no and ears
with a blister, a lesion that is <1cm
vesicle
with a blister, a lesion that is >1cm
bullae
what is Nikolsky sign?
when skin sloughs off when pressed aginst it
Dyshidrotic eczema
* Herpes simplex
* Impetigo
* Varicella/zoster
* Tinea pedis
* Scabies
* Contact dermatitis
* Hand foot and mouth
* Polymorphic light eruption
* Grover’s disease
* Arthropod assaults
* Erythema multiforme
* Dermatitis herpetiformis
* Id reaction
are all examples of
Vesicles (≤1 cm)
fluid filled lesions
- Bullous impetigo
- Bullous tinea
- Trauma/thermal
- Bullous erythema multiforme
- Staph scalded skin
- Stephens Johnson Syndrome
- Toxic epidermal necrolysis
- Autoimmune blistering disease
- Bullous drug eruption
- Lichen planus
- Porphyria cutanea tarda
- Diabetic bullae
are all examples of
Bullae (≥1 cm
fluid filled lesions
algorithm
moph. prime. lesion
(same size and shape)
usually solitary papules and dome-shaped
Monomorphic
(inflammatory lesions)
(varied size and shape),
multiple, often confluent, flat-topped
Polymorphic
(vascular reaction)
*Petechiae
*Coagulation disorders
*Leukocytoclastic vasculitis
*Henoch-Schonlein purpura
*Ecchymoses
*Meningococcemia
*Rocky Mountain Spotted
Fever
*Vascular ulcers
are all examples of
Purpuric/non-blanchable
(polymorphic/vasculr)
*Kawasaki disease
*Staph scalded skin
*Toxic shock syndrome
*Red man syndrome
*Angioedema
*Autoimmune blistering
diseases
*Erythema multiforme
*Erythema nodosum
*Drug eruption
*Urticarial vasculitis
Persistent/blanching
(polymorphic/vasculr)
*Rosacea
*Urticaria
are all exaples of
Transient
(polymorphic/vasculr)
*Furuncles
*Carbuncles
*Epidermoid cysts
*Cellulitis
*Erythema nodosum
*Acne vulgaris
*Mycosis fungoides
are all examples of
Nodules
Monomorphic
Inflammatory Lesions
Macules and papules
*Arthropod assaults
*Spider and cherry angiomas
*Scabies
*Acne
*Keratosis pilaris
*Candidiasis
*Pyogenic granulomas
*Granuloma annulare
*Viral exanthems
*Early psoriasis lesions
*Pityriasis rosea (w/o scale)
*Secondary syphilis (the
‘great imitator’)
*Pityriasis lichenoides
*Grover’s disease
are all examples of
Monomorphic
Inflammatory Lesions
red scaly lesion with epitheial disruption
Eczematous
red scaly lesion with no epitheial disruption
Papulosquamous
Atopic dermatitis
* Irritant contact dermatitis
* Allergic contact dermatitis
* Dyshidrotic eczema
* Nummular eczema
* Stasis dermatitis
* Scabies
* Secondary lesions (DH, tinea, etc.)
* Seborrheic dermatitis
* Polymorphic light eruption
* Lichen planus
* Eczematous reaction patterns
* Cutaneous T cell lymphoma
* Xerotic eczema
* Exfoliative erythroderma
are all examples of
Eczematous
Epithelial Disruption
- Psoriasis
- Tinea
- Lupus erythematosus
- Discoid lupus
erythematosus - Cutaneous T cell
lymphoma (mycosis
fungoides) - Pityriasis rubra pilaris
- Lichen planus
- Darier’s disease
- Exfoliative erythroderma
are all examples of
Prominent plaques
Papulosquamous
No Epithelial Disruption
- Pityriasis rosea
- Keratosis pilaris
- Seborrheic dermatitis
- Tinea
- Lichen planus
- Secondary syphilis
- Guttate psoriasis
- Pityriasis lichenoides
(PLC or PLEVA)
are all examples of
Papules
Papulosquamous
No Epithelial Disruption
are flat or slightly elevated with a central core, circumscribed, painful lesions with a smooth, hard surface
Corns
A superficial area of hyperkeratosis is called a
callus
They may be flat, raised, dome-shaped, smooth, rough, or hairy. Their color ranges from pink, tan, gray, blue, and shades of brown, to black.
nevi (moles)
There is a strong association between _______ and the number of nevi.
sun exposure
Atypical nevi tend to occur on heavily sun damaged skin, classically ______ in men and on the ____ in women
upper back
legs
areas of hyperpigmentation on the face and neck that are associated with pregnancy or hormonal variation
melasma
Alterations in color in dark-skinned persons are best seen in what 7 areas
the sclera
conjunctiva
buccal mucosa
tongue
lips
nail beds
palms.
Sharp, oval, or circular; depigmented halo around nevus; may undergo many morphologic changes; usually disappears and halo repigments (may take years)
Halo nevus
occurence for Halo nevus
Usually on back in young adult
Usually benign; biopsy indicated because same process can occur around melanoma
occurence for Intradermal nevus
Cells limited to dermis
No indication for removal other than cosmetic
occurence for Junction nevus
Nevus cells lining dermoepidermal junction
Should be removed if exposed to repeated trauma
occurence for Compound nevus
Nevus cells in dermis and lining dermoepidermal junction
Should be removed if exposed to repeated trauma
occurence for Blue nevus
Nevus cells in dermis
Typically benign, but should be removed if changes occur
Dome-shaped; raised; flesh to black color; may be pedunculated or hair bearing
Intradermal nevus
Flat or slightly elevated; dark brown
Junction nevus
Slightly elevated brownish papule; indistinct border
Compound nevus
May be present at birth; may cover large area; hair growth may occur after several years
Congenital nevus
Normal Nevus color
Uniformly tan or brown; all nevi on one person tend to look alike
Normal Nevus shape
Round or oval with a clearly defined border that separates the nevus from surrounding skin
Normal Nevus surface
Begins as flat, smooth spot on skin; becomes raised; forms a smooth bump
Normal Nevus size
Usually less than 6 mm (size of a pencil eraser)
Normal Nevus number
Typical adult has 10–40 nevi scattered over the body
Normal Nevus location
Usually above the waist on sun-exposed surfaces of the body; scalp, breast, and buttocks rarely have normal nevi
Atypical Nevus color
Mixture of tan, brown, black, and red/pink; nevi on one person often do not look alike
Atypical Nevus shape
Irregular borders may include notches; may fade into surrounding skin and include a flat portion level with skin
Atypical Nevus surface
May be smooth, slightly scaly, or have a rough, irregular, “pebbly” appearance
Atypical Nevus size
Often larger than 6 mm and sometimes larger than 10 mm
Atypical Nevus number
Many persons do not have increased number; however, persons severely affected may have more than 100 nevi
Bleeding into the skin results in ecchymoses (i.e., bruising); pinpoint bleeding from capillaries is called
(smaller than 0.5 cm in diameter)
petechiae
atypical nevus location
May occur anywhere on the body, but most commonly on back; may also appear below the waist and on scalp, breast, and buttocks
Bleeding into the skin results in ecchymoses (i.e., bruising); pinpoint bleeding from capillaries is called
larger than 0.5 cm in diameter)
purpura
lesion that occur as initial spontaneous manifestations of a pathologic process
primary
that result from later evolution of or external trauma to a primary lesion
secondary
Clostridium gas gangrene smells like
rotten apples
Proteus infection smell like
mousy
Pseudomonas infection (especially burns) smell like
grapelike
Tuberculous lymphadenitis (scrofula) smells like
stale beer
Anaerobic infection; scurvy smells like
putrid
Phenylketonuria smells like
mousy/ musty
A flat, circumscribed area that is a change in the color of the skin; less than 1 cm in diameter
Macule
Freckles, flat nevi, petechiae
An elevated, firm, circumscribed area; less than 1 cm in diameter
papule
A flat, nonpalpable, irregularly shaped macule greater than 1 cm in diameter
patch
Elevated, firm, and rough lesion with flat top surface greater than 1 cm in diameter
plaque
Elevated, irregular-shaped area of cutaneous edema; solid, transient, variable diameter
wheal
Elevated, firm, circumscribed lesion; deeper in dermis than a papule; 1–2 cm in diameter
nodule
Elevated and solid lesion; may or may not be clearly demarcated; deeper in dermis; greater than 2 cm in diameter
tumor
Elevated, circumscribed, superficial, not into dermis; filled with serous fluid; less than 1 cm in diameter
vesicle
Vesicle greater than 1 cm in diameter
bulla
Elevated, superficial lesion; similar to a vesicle but filled with purulent fluid**
pustule
Elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid or semisolid material
cyst
Fine, irregular, red lines produced by capillary dilation
Telangiectasia
Heaped-up, keratinized cells; flaky skin; irregular; thick or thin; dry or oily; variation in size
scale
Rough, thickened epidermis secondary to persistent rubbing, itching, or skin irritation; often involves flexor surface of extremity
Lichenification
Irregularly shaped, elevated, progressively enlarging scar; grows beyond the boundaries of the wound; caused by excessive collagen formation during healing
keloid
Loss of the epidermis; linear hollowed-out, crusted area
Excoriation
Linear crack or break from the epidermis to the dermis; may be moist or dry
fissure
Loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or bulla
erosion
Loss of epidermis and dermis; concave; varies in size
ulcer
Dried serum, blood, or purulent exudates; slightly elevated; size varies; brown, red, black, tan, or straw-colored
crust
Thinning of skin surface and loss of skin markings; skin translucent and paper-like
Atrophy
lesion arrangement that Following a nerve or segment of the body
Zosteriform (dermatomal)
lesion arrangement that is Interlocking or coalesced circles (formed by enlargement of annular lesions)
Polycyclic
lesion arrangement Pink macules with purple central papules
Iris/target lesion
lesion arrangement Snakelike or wavy line track
Serpiginous
lesion arrangement Netlike or lacy
Reticulate
lesion arrangement Measles-like: maculopapular lesions that become confluent on the face and body
Morbilliform
lesion border Well demarcated or defined, able to draw a line around it with confidence
Discrete
lesion border Poorly defined, have borders that merge into normal skin or outlying ill-defined papules
Indistinct
lesion border Margin of lesion shows greater activity than center
active
lesion border Nonsmooth or notched margin
Irregular
lesion border Center of lesion depressed compared with the edge
Border raised above
lesion boarder Expanding at margins
Advancing
Associated Changes Within Lesions
An erythematous border surrounds lighter skin
centeral clearing
Associated Changes Within Lesions
Peeling or sloughing of skin
Desquamation
Associated Changes Within Lesions
Hypertrophic stratum corneum
Keratotic
Associated Changes Within Lesions
Central umbilication or dimpling
Punctation
Associated Changes Within Lesions
Dilated blood vessels within lesion blanch completely, may be markers of systemic disease
Telangiectasias
type of arrangement
linear
lesion arrangement ** Round, active margins with central clearing**
annular
10 physical exam charachteristics of skin lesions
Size (measure all dimensions)
Shape
Color
Blanching
Texture
Elevation or depression
Attachment at base
Exudates
Configuration
Location and distribution
11 red flags in skin assessment
- Fever
- Ill appearance
- Extreme of age (young or old)
- Purpura or petichiae
- Generalized or musculoskeletal pain
- Immunocompromised
- Lymphadenopathy
- Commonly offending drugs
- Nonhealing chronic lesion
- Chronic, irregular, and evolving lesion greater than 6 mm
- Oral lesions
Most common inflammatory skin disorder
can be caused by
Irritant contact dermatitis
Allergic contact dermatitis
Atopic dermatitis
Can be more severe in Black/Hispanic population- papular and lichenification (article) can be present
Eczematous dermatitis
Deep-seated infection of the pilosebaceous unit
Staph aureus most common organism
Acute onset of tender red nodule with center filled with pus.
Furuncle (boil)
Inflammation and infection of the hair follicle and surrounding dermis
Folliculitis
Characterisitic Findings
itching
primary lesions: erythema, papules, vesicles
secondary lesions
excoriations in acute stage from scratiching
lichenification in chronic forms
dermatitis
what is this an example of
lichification
Group of noncandidal fungal infections that involve the stratum corneum, nails, or hair;
tinea
Tinea Corpus
Tine Cruris
Tine Capitus
Tinea Pedis
Chronic and recurrent disease of keratinocyte proliferation; salmon or silvery pink scaling on extensor surfaces
Psoriasis
Nonspecific reaction pattern associated with obesity, certain endocrine syndromes or malignancies, or as an inherited disorder
Acanthosis nigricans
Most common form of skin cancer
usually in elderly but getting younger
head & neck area
rarely metastasizes
pearly nodule with telangictasia
Rolled borders
basal cell carcinoma
precancerous lesions
Actinic keratosis
Squamous CellCarcinoma causes
sun, burns, chronic inflammatory disease and scars,
aging
Scaly pink/red patch
Scaling
crusting
Central ulceration/erosion
Lips mouth and ears
Papule that bleeds, scale, sore that won’t heal
can metastasize
squamous cell carcinoma
Upper back & legs
Horizontal growth
papule to plaque to nodule
variation in color
irregular border
asymmetry
>6 mm
malignent melanoma
Neoplasm of the endothelium and epithelial layer of the skin causing painless, flat or raised purple, red, or brown patch/nodules
Commonly associated with human immunodeficiency virus (HIV) infection
Kaposi sarcoma
A superficial benign neoplasm of epidermal cells that presents as a papule or plaque with a characteristic “pasted-on” appearance. These lesions are usually acquired later in life (middle age and beyond) and tend to grow slowly.
Seborrheic Keratosis ( not malignant)
Causes yellow greasy scales and erythema on the scalp- may be related to stress, fatigue, yeast
Seborrheic dermatitis ( dandruff)
Growth of terminal hair in women in the male distribution pattern on the face, body, and pubic areas
Hirsutism
Inflammation of the paronychium
Paronychia
Fungal infection of the nail
**Onychomycosis
**
Loosening of the nail plate from the nail bed that begins at the distal groove
Onycholysis
Central depression of the nail with lateral elevation of the nail plate- what are these associated with?
Koilonychia (spoon nails)
** iron deficiency anemia, syphilis, fungal dermatoses, hemochromatosis, and hypothyroidism**
Whitening of the proximal half to three-quarters of the nail bed- associated with liver disease, chf, dm and aging
White banding (Terry nails)
Benign dermatosis that usually arises in the third trimester of a first pregnancy
Polymorphic eruption of pregnancy
Caused by blocked sweat ducts and trapped sweat beneath the skin
Miliaria rubra (prickly heat)
Common, contagious superficial skin infection
Most common bacteria is staphylococcus aureus, not usually MRSA.
Can be treated with topical or oral treatment.
Impetigo
Measles virus infects by invasion of the respiratory epithelium
Measles (rubeola)
Occurs on the lower legs in some patients with venous insufficiency
Stasis dermatitis
Atypical squamous cells confined to the upper layers of epidermis
Actinic keratosis
Eczema in black skin:
thicker cohesion:
papular and lichenified areas
sometimes soft ivory in color but commonly dark brown
Keloids: a higher tendency to scar in _____ especially in darker skin
darker skin
-refers to nodes that are abnormal either in size, consistency, or number
can be localized or general
Lymphadenopathy
Generalized if lymph nodes are enlarged in __or more noncontiguous areas I.e. inguinal and occipital
localized if only one area is involved.
2
hard node suggests ____
malignancy
Warm and tender nodes may be related to ____
inflammation/infection
2 things to examine for Enlarged node-
examine regions they drain and nodes elsewhere in the chain
Examine spleen
enlarged Submandibular & submental nodes
dental problems
enlarged nodes in Preauricular
same side conjunctivitis
lymphoma
enlarged Occipital nodes
common in childhood infections
enlarged Inguinal nodes
STDs
Leg and foot infections
Pelvic malignancy
enlarged Axillary nodes
hand and arm infections
lymphoma
breast cancer
enlarged nodes
Lymphadenopathy
inflamed & enlarged nodes
Lymphadenitis:
Inflammation of one or more lymphatic vessels
nodes Draining into area
Lymphangitis:
excess accumulation of lymph fluid
Lymphedema
Congenital malformation of nodes
(transilluminates; hemangiomas do not)
Lymphangioma
Wavelike motion when nodes are palpated
Fluctuant:
Nodes feel connected and move as unit
matted
lymphadenopathy in >2 extrainguinal sites for 3 months
Kaposi’s sarcoma
CMV infection; TB
HIV infection
9 red flags with headaches
Stiff neck/fever
Abrupt onset of severe pain
Neurological deficit (AMS)
Progressively worsening headache
Vomiting
New onset in persons 50 years or older
worst headache of life
ice pick (lancinating) pain
unrelenting w/ treatment
headache that : not directly related to a specific cause**
Primary:
headaches that have an underlying cause
Cerebrovascular, menningeal irritation, facial or cervical disfunction
secondary
elongated head
prominent nose and lower jaw
heavy eyebrow ridge
coarse facial features
Acromegaly
congenitally small skull
Microcephaly:
acorn shaped head due to skull enlargement
Paget’s disease
acromegaly, Cushings syndrome, Grave’s disease, hypothyroidism
are all examples of
Endocrine facies:
Cushing’s syndrome facial 4 charachteristics
moon face
telangiectasis
hirsutism
paper thin and erythematous skin
small non-tender nodes that feel like BBs under the skin
Shotty—
exopthalmos, periorbital swelling, upper lid retraction
fine, moist skin
fine hair
staring or startled expression
goiter
Grave’s Disease
ptosis
periorbital swelling
thickening of nose and lips
prominent tongue
dull facial expression
Hypothyroidism
Paralysis of upper and lower parts of face
lax eyelid
flat nasolabial fold
drooping corner of mouth
Facial Palsy (Bell’s Palsy)
is the most common cause of bilateral or unilateral enlargement of the parotid gland in children.
Mumps
premature suture union, while brain continues to grow
Craniosyostosis: premature suture
birth trauma
bleeding into periosteum
bound by suture lines
on palpation, firm at first, later becomes softer and fluctuant
generally resolves in 2 weeks to 3 months
Cephalohematoma
subcutaneous edema
common form of birth trauma
on palpation, feels soft with poorly defined margins
resolves in days
Caput succedaneum
sutures are palpable til __ months of age
6
fontanels
closed by 2 years of age
diamond shaped
4-5 cm
anterior
fontanels
closed by 2 months of age
triangular shpaed
0.5 to 1 cm
posterior
mouth breathing
allergic shiners
Perennial Allergic Rhinitis
are tiny, bright ruby-red to dark blue/black, round papules that may become brown with time. They occur in virtually everyone older than 30 years and increase numerically with age
Cherry angiomas
- Itching is typically present.
often report allergy history (allergic rhinitis, asthma).
- For irritant or allergic contact, exposure history is important.
*
Eczematous Dermatitis
Acute phase characterized by erythematous, pruritic, weeping vesicles
- Subacute eczema characterized by erythema and scaling
- Chronic stage characterized by thick, lichenified, pruritic plaques
Eczematous Dermatitis
Self-limiting inflammation of unknown cause.
Sudden onset with occurrence of a primary (herald) oval or round plaque.
- Herald lesion is often missed.
- Eruption occurs 1–3 weeks later and lasts for several weeks.
- Pruritus may be present with the generalized eruption.
- Often occurs in young adults during the spring time.
Pityriasis Rosea
Pain, itching, or burning of the dermatome area usually precedes eruption by 4–5 days.
- After eruption resolves, there may be persistent pain called postherpetic neuralgia.
Herpes Zoster (Shingles)
Single dermatome that consists of red, swollen plaques or vesicles that become filled with purulent fluid (Fig. 9.53)
- Does not cross midline
- Can still occur in immunized patients
- Disseminated lesions in immunosuppressed or older adults
Herpes Zoster (Shingles)
- Persistent sore or lesion that has not healed
- May have crusting
- May itch
basal cell
- Pink growth with a slightly elevated rolled border and a crusted indentation in the center; as the growth slowly enlarges, tiny blood vessels may develop on the surface.
- Scar-like area that is white, yellow, or waxy and often has poorly defined borders; the skin appears shiny and taut.
basal cell
(thin-walled, contains clear lymph fluid)
- Cystic hygroma
(tends to feel spongy; appears reddish blue, with color depending on size and extent of blood vessel involvement; Valsalva maneuver may enlarge the mass)
- Hemangioma
Objective Data
- Red streaks in the skin after the course of the lymphatic collecting duct
- Appears as a tracing of rather fine lines streaking up the extremity
- Sometimes indurated and palpable to gentle touch
Acute Lymphangitis
Subjective Data
- Enlarged lymph node
- Pain, malaise, possibly fever
- Minor trauma to the skin distal to the area of
Acute Lymphangitis
Infection and inflammation of a lymph node; may affect a single or localized group of nodes
Acute Suppurative Lymphadenitis
Subjective Data
- Enlarged lymph nodes
- Pain from enlarged lymph nodes
Acute Suppurative Lymphadenitis
Objective Data
- Involved node usually firm and tender
- Overlying tissue edematous; skin appears erythematous, usually within 72 hours
- When abscess formation is extensive, nodes fluctuant
- Mycobacterial adenitis characterized by an inflammation without warmth that may or may not be slightly tender
Acute Suppurative Lymphadenitis
Subjective Data
- Painless cystic masses
- Usually manifest during the first year of life and often enlarged after an upper respiratory infection
- Asymptomatic when in the posterior triangle of the neck, but if found anteriorly, may cause airway or swallowing problems
Congenital malformation of dilated lymphatics
Objective Data
- Soft, non-tender, and easily compressible spongy fluid-containing mass without discrete margins
- Most present at birth and apparent early in life, usually in the neck or axilla, less commonly in the chest or extremities
- May be large enough to distort face and neck
- Diagnosis through physical examination and imaging studies (ultrasound, computed tomography, or magnetic resonance imaging), which show a thin-walled, multiloculated cystic mass
Congenital malformation of dilated lymphatics
Massive accumulation of lymphedema throughout the body; the most common cause of secondary lymphedema worldwide
Lymphatic Filariasis (Elephantiasis)
Subjective Data
- Swelling of limb or body area
- Travel to infected areas: Asia, Africa, the Western Pacific, India, Philippines
- Many patients are asymptomatic, but some may develop fever with lymphangitis and lymphadenitis, chronic pulmonary infection, and progressive lymphedema
Lymphatic Filariasis (Elephantiasis)
Objective Data
- Lymphedema of the entire arm or leg; the genital regions (vulva, scrotum, breasts)
- Diagnosis can be made by identification of microfilariae microscopically in blood
Lymphatic Filariasis (Elephantiasis)
Malignant neoplasm of the lymphatic system and the reticuloendothelial tissues
Non-Hodgkin Lymphoma
Subjective Data
- Painless enlarged lymph node(s)
- Fever, weight loss, night sweats, abdominal pain, or fullness
- Family history
Non-Hodgkin Lymphoma
Objective Data
- Nodes may be localized in the posterior cervical triangle or may become matted, crossing into the anterior triangle.
- Nodes usually well defined and solid
Non-Hodgkin Lymphoma
Malignant lymphoma
Hodgkin Lymphoma
Objective Data
- Clinical presentation variable
- Most commonly, painless enlargement of the cervical lymph nodes, often in the posterior triangle, that is generally asymmetric and progressive (Fig. 10.24)
- Nodes sometimes matted and firm, almost rubbery
- Usually asymmetric; may occasionally be enlarged in similar patterns on both sides of the body
- Nodal size may fluctuate
Hodgkin Lymphoma
Subjective Data
- Painless enlarged lymph nodes
- May have abdominal pain, sometimes fever
- May have history of infectious mononucleosis
Hodgkin Lymphoma
Infectious mononucleosis
Epstein-Barr Virus Mononucleosis
Subjective Data
- Malaise, fatigue, acute or prolonged (longer than 1 week) fever, headache, sore throat, nausea, abdominal pain, and myalgia
- Prodromal period may last 1–2 weeks
Epstein-Barr Virus Mononucleosis
Objective Data
- Generalized lymphadenopathy most commonly in the anterior and posterior cervical nodes and the submandibular lymph nodes and less commonly in the axillary and inguinal lymph nodes
- Epitrochlear lymphadenopathy is particularly suggestive of infectious mononucleosis
- Hepatomegaly; symptomatic hepatitis or jaundice is uncommon, but elevated liver enzymes are common.
- Splenomegaly to 2–3 cm below the costal margin is typical; massive enlargement is uncommon
- Moderate to severe pharyngitis with tonsillar enlargement, occasionally with exudates
- Petechiae at the junction of the hard and soft palate frequently seen
- Diagnosis with mononucleosis spot test
Epstein-Barr Virus Mononucleosis
Subjective Data
- No significant symptoms
- History of eating raw or rare meat or uncooked eggs
- History of direct contact with cat feces, cleaning the litter box, gardening in feces-contaminated soil
Toxoplasmosis
Zoonosis, caused by the parasite Toxoplasma gondii
Objective Data
- Single node, chronically enlarged and non-tender
- Node is usually in the posterior cervical chain
Toxoplasmosis
Subjective Data
- Fever—usually high grade and persistent over 3–4 days
- Sometimes associated with a mild respiratory illness and lymphadenopathy
Roseola Infantum (HHV-6)
Infection by human herpes virus 6
Objective Data
- Adenopathy, discrete and not tender, involves the occipital and postauricular chains and may last for some time
- When the fever diminishes, a morbilliform fine maculopapular rash occurs, spreading from the trunk to the extremities; the child begins feeling much better
Roseola Infantum (HHV-6)
Infection by human herpes virus 6
Subjective Data
- Burning, itching lesions
- May report enlarged lymph nodes
Herpes Simplex (HSV)
Infection by human herpes virus 1 (HSV-1) or human herpes virus 2 (HSV-2)
Objective Data
- Discrete labial and gingival vesicles or ulcers
- May have enlargement of the anterior cervical and submandibular nodes
- These nodes tend to be somewhat firm, quite discrete, movable, and tender; the frequency of this condition and the symptoms are generally sufficient to establish the diagnosis; a viral culture can be obtained if necessary
Herpes Simplex (HSV)
Infection by human herpes virus 1 (HSV-1) or human herpes virus 2 (HSV-2)
Subjective Data
- Enlarged lymph nodes
- Initial symptoms include severe fatigue, malaise, weakness, persistent unexplained weight loss, fevers, arthralgias, and persistent diarrhea
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS)
Viral infection that attacks the body’s immune system
Objective Data
- Generalized lymphadenopathy
- In children there may be a prolonged clinical latent period, but initial signs may include neurodevelopmental problems with loss of developmental milestones
- Progressive infection characterized by decreasing CD4+ T-lymphocyte count and increasing viral load level
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS)
Viral infection that attacks the body’s immune system
Subjective Data
- Slow-growing painless lumps, either in front of ear or under jaw
- Difficulty opening the mouth
- Tongue numbness or weakness
Salivary Gland Tumor
Tumor in any of the salivary glands, but most commonly in the parotid
Objective Data
- Benign tumors usually smooth, malignant often irregular
- Facial weakness, fixation of the lump, sensory loss, and ulceration
salivary gland tumor
Tumor in any of the salivary glands, but most commonly in the parotid
Subjective Data
- Weight gain, constipation, fatigue, and cold intolerance (Table 11.1)
Objective Data
- Normal-size thyroid, no goiter, or nodule(s)
Hypothyroidism
Subjective Data
- Weight loss
- Tachycardia
- Diarrhea
- Heat intolerance
Hyperthyroidism
Objective Data
- Normal-size thyroid, goiter, or nodule(s)
- Fine hair
- Brittle nails
- Exophthalmos
- Tachycardia
Hyperthyroidism
In hyperthyroidism
______ intolerance
weight _____
______ emotional state
______ hair
____ skin
______ nails
_____ eyes
______ neck
________ cardiac
_______ GI
_____ menstrual
_____ neuromuscular
heat intoleranece
weight loss
Nervous, easily irritated, highly energetic
Fine, with hair loss; failure to hold a permanent wave
Warm, fine, hyperpigmentation at pressure points
Thin, with tendency to break; may show onycholysis
Bilateral or unilateral exopthalmos, lid retraction, double vision
Goiter, change in shirt neck size, pain over the thyroid
Tachycardia, dysrhythmia, palpitations
Increased frequency of bowel movements; diarrhea rare
Scant flow, amenorrhea
Increasing weakness, especially of proximal muscles
In hypothyroidism
______ intolerance
weight _____
______ emotional state
______ hair
____ skin
______ nails
_____ eyes
______ neck
________ cardiac
_______ GI
_____ menstrual
_____ neuromuscular
cold intolerance
weight gain
Lethargic, complacent, disinterested
hair Coarse, with tendency to break
skin Coarse, scaling, dry
Thick fingernails
Puffiness in periorbital region
No goiter
no cardiac changes
constipation
Menorrhagia
Lethargic, but good muscular strength
subjective data
- Cognitive impairment, slowed mentation, poor concentration, decreased short-term memory, social withdrawal, psychomotor retardation, depressed mood, and apathy
- Constipation
- Muscle pains
- Hearing problems, deafness
Myxedema
Skin and tissue disorder usually due to severe prolonged hypothyroidism
Objective Data
- Coarse thick skin, thickening nose, swollen lips, puffiness around eyes
- Slow speech
- Mental dullness, lethargy, mental problems
- Weight gain
- Thin brittle hair, with bald patches
Myxedema
Subjective Data
- Palpitations
- Heat intolerance
- Weight loss
- Fatigue
- Increased appetite
- Tachycardia
Graves Disease
Overactive thyroid caused by autoimmune antibodies to thyroid-stimulating hormone receptor
Objective Data
- Diffuse thyroid enlargement; most commonly with prominent eyes (exophthalmos)
Graves Disease
Overactive thyroid caused by autoimmune antibodies to thyroid-stimulating hormone receptor
Subjective Data
- Weight gain
- Nausea
- Fatigue
Objective Data
- Enlarged nontender smooth thyroid
Hashimoto Disease
Underactive thyroid caused by autoimmune antibodies against thyroid gland
pain begins unilaterally but may become generalized and may lateralize to the opposite side and/or radiate to the face or neck.
typical onset at approximately age 6 years through adolescence.
Black people and those of Hispanic descent more affected
migraine
pain occurs in episodic clusters of attacks.
cluster headaches
mild to moderate nonthrobbing pressure or squeezing pain that can occur anywhere in the head or neck. The pain often starts slowly as a dull and aching discomfort that progresses to holocranial pain and pressure.
tenision headache
