Exam 1 Study Guide Flashcards
ABCDE
Testing Skin Lesions for Melanoma A - Asymmetry B - Borders C - Color D - Diameter (6mm-1/4inch) E - Evolution/Elevation
SOAPE Parts
S - Subjective O - Objective A - Assessment P - Planning E - Evaluation
Primary Lesions
Associated with specific causes on previously unaltered skin.
Macule - Color change and flat Papule - Can feel, slightly elevated Nodule - Solid large lump extended into dermis Wheal - Slightly raised, allergic reaction Bulla - Larger fluid filled bump Vesicle - Smaller fluid filled bump Cyst - Large fluid filled lump Pustule - Large pus filled lump
Secondary Lesions
Modification of primary lesion either by patient themselves of other
Crust - Thickened dried out skin that can be brown, honey, or yellow. (Impetigo, scab)
Scale - Compact flakes of skin.
Fissure - linear crack in skin. (Cheilosis corners of mouth)
Erosion - Scooped out shallow depression. No bleeding, heals without scar.
Ulcer - Deep depression extending into dermis. Irregular shape, bleeds, leaves scar.
Excoriation - due to scratching or self inflicted abrasion
Secondary Lesion (Cont)
Scar - Skin lesion after it is repaired. Normal tissue replaced with collagen
Atrophic Scar - Skin level is depressed with loss of tissue and thinning of epidermis (Striae)
Lichenification - Prolonged intense scratching that thickens skin. Looks moss like.
Keloid - Benign excess scar tissue. Looks claw like
Assessment of Skin
- Color
- Temperature/moisture
- Texture, Edema, Turgor, Vascularity (Bruising)
- Lesions
- Hair and Nails
Assessment of Skin Color
Yellow - Jaundice (Liver Disease)
Pallor - Pale and ashen (Vasoconstriction, cold weather, smoking)
Blue - Cyanosis (hypoxia and cardiac arrest)
Redness - Erythema (Excess blood in capillaries, allergic reaction, fever, venous stasis, carbon monoxide poisoning)
Skin Temperature
Hypothermia - Cardiac Arrest, Shock, Raynaud’s Disease
Hyperthermia - Increased metabolism, fever, hyperthyroidism
Diaphoresis - Profuse sweating, heart attack, anxiety, pain
Dehydration - Skin feels dry and flaky, dry mucosa, dry membranes, dry and cracked lips
ABC Assessment
During Emergency Assessments use ABC
A - Airway
B - Breathing
C - Circulation
Medical Instruments
Ophthalmoscope - Visualizes Eye
Otoscope - Examines Ear
Snellen Chart - Screens distant vision
Nasal Speculum - Visualize turbinate’s of nose
Vaginal Speculum - Examine Vagina
Tuning Fork - Auditory
Percussion Hammer - Tests deep tendons and determines tissue density
Order of Assessment
Inspection - size, color, shape, position, symmetry
Palpation - temperature, turgor, texture, moisture, vibrations, shape, locate masses
Percussion
Auscultation - Assess sound pitch, loudness, quality, duration
Percussion
Flat - Over fatty tissue and bones (Thigh)
Dull - Over Masses and Dense Orders (Liver)
Resonance - Loud sound over air filled sacks (Lungs)
Hyperresonance - Very loud (Air trapped in lungs emphysema)
Tympani - Loud sound over abdominal area. Hollow sound
Order of Physical Assessment
Integumentary Head and Neck Thorax and Lungs Cardiovascular and Peripheral Vascular Breasts and Axillae Abdomen Female and Male Genitalia Anus, Rectum, Prostate Musculoskeletal Neurological
PEARRLA
Pupils Equal - In size and shape Round Reactive to Light - Eyes get smaller when light is shined Accommodation - Ability to change focus
General Survey
First initial impression with patient Physical Appearance Body Structure Mobility Behavior
OLDCART
Assessment of Pain O - Onset L - Location D - Duration C - Characteristics A - Aggravating Factors R - Relieving Factors T - Time
Order of measuring Children Vital Signs
Respiration - Watch abdomen for movement
Pulse - Apical Pulse, after 2 use radial/brachial
Temperature - Rectal higher in infants
Blood Pressure - Check 3 and older y/o.
- Cuff must be 2/3 width of arm
- Height is more correlated with BP than age
Measuring Vitals for aging adults
Temperature - Greater risk for hypothermia, less reliable
Pulse - Rhythm may be irregular
Respirations - Decrease in rate and depth
Blood Pressure - Systolic pressure increases leading to wider pulse pressure
ROS for Skin (Subjective)
History (Allergies, Hives, Eczema) Changes (Skin color, mole size, excessive hair (Hirsutism)) Irritation/Injury Medications Environmental/Occupational Hazards Self-Care Habits
Aging Adult Skin
- History of pruritis (dry skin or systemic disease)
- Changes you’ve noticed in skin past few years
- Delay in wound healing
- Changes in feet
- Falls resulting in bruises or trauma
- History of diabetes or peripheral vascular disease (extremities)
Clubbing of Nails
Nails appear like clubs and are 180 degrees with profile skin test.
- Caused by interrupted pulmonary condition such as COPD and emphysema.
Review of Systems for Head
-Headaches/Migraines
- Head Injury (loss of consciousness)
- Dizziness or Vertigo
Room spinning (Neurological Problem)
- Neck Pain (Limitations to ROM)
- History of lumps/swelling/surgeries
Assessing Head
- Check for size. (normocephalic, macrocephalic, microcephalic)
- Palpation of temporal artery.
Assessing Face
- Appropriate expression on face
- Symmetrical Features
- TMJ Disorder (Temporomandibular joint) crepitus or cracking over joint. Tenderness or limited ROM.
Assessing Face
Pilar Cyst - Swelling in the scalp
Hydrocephalus - Obstruction of drainage from cerebral spinal fluid.
Acromegaly - Excessive secretion of growth hormone from pituitary gland. Elongated head, massive face.
Fontanels
- Measured each visit up to 2 years old
- Measured yearly up to 6 years old
- Triangular posterior fontanel 1-2 Months
- Diamond shaped anterior Fontanel 9 months - 2 years.
- Delayed closure or larger than normal fontanels occur with hydrocephalus, down syndrome, hypothyroidism, or rickets.
- Depressed fontanels indicate malnutrition/dehydration
- Bulging indicates increased intracranial pressure
Assessing Pallor/Tonic Neck Reflex
- Look at children’s hands to assess pallor
- Tonic Neck Reflex is assessed with child supine, head turned to 1 side. Reflex should disappear at 3-4 months. 5 months indicates birth defect.
Physical Assessment Order
Step 1 - Inspect (Head)
Lumps/Lesions/Deformities/Hair Pattern/ Size of Skull/Symmetry/Anxiety/
Step 2 - Inspect (Neck)
Symmetry of Trachea
Step 3 - Palpate (Head)
Deformities/Patterned Hair loss/Lymph nodes
Step 4 - Palpate Thyroid Gland (Neck)
Place hands on sides of neck and ask to swallow
Step 5 - Osculate Thyroid
Notice any bruiting sound (whooshing)
Lymph nodes
Preauricular - In front of ear Postauricular - Behind Ear Occipital - Base of skull near back of neck/head Parotid - Next to ear near cheek Submandibular - Base of mandible Submental - Under the chin Superficial Cervical Chain - Upper Neck Deep Cervical Chain - Under Upper Neck Posterior Cervical Chain - Behind Neck Supraclavicular - By clavicle Tonsillar - Under Parotid Near base of mandible
Review of systems (Nose)
Discharge from nose Suffer from frequent colds/sinusitis History of trauma or recreational drug Epistaxis (nose bleeds) Allergies History of altered smell
Review of Systems (nose/throat)
History of sores/lesions/bleeding gums/toothaches
- Smoke/Alcohol
- Brush, floss, dentist regularly
Physical Assessment of Nose
Step 1 - Outer - Symmetric, midline, proportional - Deformities, inflammation, lesions - Palpate for any pain - Have patient breathe in through each nostril Step 2 - Nasal Cavity - Color/texture of mucosa (pinkish red) - Swelling/discharge - Deviated Septum - Color of discharge (red/yellow - rhinitis or sinusitis) (Gray or pale mucosa - allergies)
Physical Assessment Sinuses
- Palpate Sinuses with thumbs
Tenderness/pressure may indicate sinusitis or allergies
Assessing Mouth
- Use Tongue Blade
- Assess color/texture (moisture or lesions)
- Mucosa should be pink
(Cyanosis - Hypoxia, Cherry-lips - Carbon monoxide poisoning or ketoacidosis, Pallor - Shock/Anemia)
= Teeth Color, Gums, Tongue (Pink)
Assessing Buccal Mucosa
Inner Cheeks/Lips
- Should be Pink
Leukoedema - Grey/bluish area
Koplik Spots - Small white spots (measles)
Candidiasis - Yeast cottage cheese looking
Fordyce granules - Small isolated white/yellow papules on cheek/tongue/lips.
Assessing Palates
- Assess Hard Palate should appear white
- Assess Soft Palate - Should be pink
- Observe uvula. When patient says ahh uvula and soft palate should rise in midline.
Assessing Tonsils
- Color and texture should be pink with indentations/crypts.
- White spots/exudates show infection.
- White membrane over tonsils may be mononucleosis or leukemia
Tonsil Grading
0 - 0% of oropharynx 1 - less than 25% 2 - 26-50% 3 - 51-75% 4 - 75%
Nose/Mouth/Throat Assessment Order
Nose
- Check for symmetry.
- Use Speculum and check for deviations
- Look for boils and obstructions in nose
- Pallor should be pink and smooth
Lips
- Dryness/Color (Pink) Pallor means dehydration/anemia
- Red Lips (Erythema) (Carbon Monoxide Poisoning)
- Blue Lips (Cyanosis) (Hypoxia)
- Pallor Lips (White) (Anemia/Dehydration)
Nose/Mouth/Throat Assessment (cont)
- Check mouth color with penlight (pink)
- Check Teeth for cavities/yellow/brown
Yellow - Caffeine/Smoking
Brown - Too much fluoride in toothpaste - Gums should be pink
Grey - Chronic Allergies - Assess Tonsils
(White streaks may mean Fungal Infection) - Assess tongue
Cranial Nerve 12 - Moving tongue side to side - Smoothness of tongue B12 Deficiency
ROS Ears
History of Otalgia - Ear Pain Discharge - Ear infection or Perforated Eardrum Presbycusis - Hearing Loss Tinnitus - Ringing in Ear Vertigo History of working in loud environments Self Care Habits
Physical Assessment of External Ear
Microtia - Small Ears
Macrotia - Large Ears
Palpate for tenderness
Edema/Redness in outer ear
Physical Assessment Middle Ear
Use otoscope to look at middle ear.
- Age over 3 pullup pinna
Temporal Membrane should be shiny, translucent, and pearly grey with some earwax.
Cone of Light from otoscope should be 5 o’clock in right ear and 7 o’clock in left ear. (Variations abnormality)
Rinne and Webber Test
Rinne Test - Place tuning fork at base of skull, then once they cannot feel it, move it to the ear until they stop hearing it. Air conduction is longer than bone conduction.
Weber Test - Place fork on top of head, patient should hear the sound equally in both ears.
Ears Assessment Order
- Inspection (Symmetry, size, shape)
- Note for lesions or lumps
- Palpate for tenderness
- Watery Drainage from ear (skull fracture)
- Blood (Trauma or Ear Infection)
- First do Weber Test
- Next do Rinne Test
- Next do whisper voice test
- Next inspect inner ear
(5 o clock right side, 7 o clock left side)
ROS Eyes
Difficulty seeing Pain, redness, swelling in eyes Allergies affect eyes History of glaucoma History of surgery Use of glasses/contacts Date of most recent vision test Smoking
ROS Eyes
Strabismus - Cross Eyed Diplopia - Double Vision Photophobia - Intolerance to Light Conjunctivitis - Redness in eyes Glaucoma - Floaters or halos around lights Cataracts - Caused by smoking
Snellen Eye Chart
Assess visual acuity
- The larger the denominator the worse the patients vision is.
20/40
You can read from 20 feet what everyone else can read from 40 feet
Confrontation Test/Abnormalities
Confrontation Test - Tests peripheral vision
Presbyopia - Decrease in accommodation with aging
Peripheral Loss - First sign of glaucoma, retinal disease, and stroke
Corneal Light Reflex
- Shining light into patients eyes. Light should reflect in the same place in both eyes.
Cover Test
Cover 1 eye test. Esotropia - Inward turning of eye Exotropia - Outward turning of eye Phoria - Mild weakness Tropia - Severe weakness
Cardinal Gaze Test
Also known as diagnostic position test
- Assess muscles of cranial nerves
- Have patient follow finger with their eyes. Eyes should be parallel while following your finger
ABNORMAL
Oscillations in the iris (nystagmus), possible multiple sclerosis or brain lesions.
External Structures of Eyes
Periorbital Edema - Puffing or swelling of eyelids. Heart failure, renal failure, allergies
Ptosis - Droopy eyelids, neuromuscular weakness
Exophthalmos - Protruding Eyes
Enothalmos - Sunken Eyes
Scleral Icterus - Yellowing of sclera
PERRLA
P - Pupils E - Equal R - Round R - Reactive to L - Light A - Accommodation
Red Reflex
Eyes make a red glow when light passes through pupil and is reflected back off the retina
Inspect Ocular Fundus
- Look for creamy yellow-orange to pink and a round or oval shape
Retinal Vessels
Look for macula and a general background color of light red to dark brown/red
- Used with ophthalmoscope
Eye Diseases
Hemorrhage - Occurs with macular degeneration
