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Clinical Skills > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Normal BP

A
  • systolic <120

- diastolic <80

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2
Q

Prehypertension

A
  • systolic: 120-139

- diastolic: 80-89

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3
Q

Stage 1 HTN 18-60yrs

A
  • systolic: 140-159

- diastolic: 90-99

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4
Q

Stage 1 HTN over 60yr

A
  • systolic: 150-159

- diastolic: 90-99

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5
Q

Stage 2 HTN

A
  • systolic: >160

- diastolic: >100

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6
Q

Temp range

A

100 F = 37.7 C

102 F = 38.8 C

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7
Q

BMI

A

<17 underweight
>25 overweight
>30 obese

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8
Q

Ephelides

A
  • freckle

- caused by over production of melanin not menalocytes

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9
Q

Nevi

A

-mole/birthmark

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10
Q

Junctional nevi

A
  • brown macules in epidermis

- flat

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11
Q

Compound nevi

A
  • brown macules in epidermis and dermis

- slightly elevated

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12
Q

Intradermal nevi

A
  • skin colored papules in dermis

- dome shaped

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13
Q

Risk factors of Melanoma

A
  • HARMM: hx of melanoma, age over 50, regular dermatologist absent, mole changing, male
  • red/light hair
  • solar lentigines
  • freckles
  • UV radiation
  • tanning booths
  • severe blistering sunburns
  • immunosuppression
  • family tx of melanoma
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14
Q

Derm physical exam while seated

A
  • hair and scalp
  • face and neck
  • arms and hands
  • nails and nail beds
  • back
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15
Q

Derm physical exam while laying flat

A
  • chest
  • abdomen
  • lower extremities
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16
Q

Derm physical exam in left lateral position

A
  • back
  • gluteal cleft
  • perianal area
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17
Q

Physical exam skin

A
  • color
  • moisture
  • temperature
  • texture
  • mobility and turgor
  • lesions
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18
Q

Physical exam nails

A
  • color
  • shape
  • separation
  • lesions
  • clubbing
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19
Q

Physical exam hair

A
  • quantity
  • distribution
  • texture
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20
Q

Abnormal findings color

A
  • systemic: redness, cyanosis, jaundice, pallor

- skin: erythema, pigmentation

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21
Q

Abnormal findings moisture

A
  • dryness
  • diaphoresis
  • sweating
  • oiliness
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22
Q

Abnormal findings temperature

A
  • fever
  • cellulitis
  • cooler temp
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23
Q

Abnormal finding texture

A
  • systemic illness

- rashes: rough and smooth

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24
Q

Abnormal findings mobility/turger

A
  • mobility: edema and scleroderma

- turger: dehydration

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25
Q

Physical exam lesisons

A
  • look
  • location and distribution
  • arrangement
  • type
  • color
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26
Q

Primary lesions

A
  • macule … patch
  • papule .. plaque .. nodule .. wheal
  • vesicle … bulla
  • pustule
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27
Q

Secondary lesions

A
  • loss of skin surface: erosion, ulcer, fissure

- material on skin surface: crust and scale

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28
Q

Macule

A
  • circumscribed area of change of skin color
  • no elevation or depression
  • not palpable
  • well or ill defined
  • any size or color
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29
Q

Patch

A
  • barely elevated plaque
  • fits between macule and plaque
  • large macule
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30
Q

Papule

A
  • superficial
  • elevated
  • solid lesion
  • <0.5 cm in diameter
  • palpable
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31
Q

Nodule

A
  • palpable
  • solid
  • round or elliptical lesion
  • larger than papule
  • > 0.6 cm
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32
Q

Tumor

A

-large nodule

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33
Q

Plaque

A
  • plateau like elevation
  • relatively large surface area in comparison to height above skin
  • well defined
  • > 0.5 cm
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34
Q

Wheal

A

-rounded or flat topped pale red papule or plaque

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35
Q

Vesicle

A
  • <0.5 cm
  • circumscribed
  • elevated
  • containing fluid
  • dome shaped
  • umbliciated
  • flaccid
36
Q

Bulla

A
  • large vesicle
  • > 0.6 cm
  • circumscribed
  • elevated
  • containing fluid
37
Q

Pustule

A
  • circumscribed
  • superficial cavity of skin
  • purulent exudate: white, yellow, greenish, hemmorahgic
38
Q

Erosion

A
  • loss of epidermis
  • no scarring
  • sharply defined
  • red
  • oozes
39
Q

Ulcer

A
  • loss of epidermis into dermis

- scaring

40
Q

Fissure

A

-deep skin split

41
Q

Exocriation

A

-liner skin erosion from scratching

42
Q

Atrophy

A
  • skin thinning

- all skin layers

43
Q

Sclerosis

A

-stiffening or hardening of skin

44
Q

Scaling

A

-scales or flakes of stratum corneum still attached to surface

45
Q

Crusting

A

scab

46
Q

Comdeo

A
  • open (blackhead)
  • closed (whitehead)
  • acne
47
Q

Cyst

A
  • cavity containing liquid, solid, or semisolid material

- spherical, dome-shaped papule or nodule

48
Q

Abscess

A

pus in cavity

49
Q

Furuncule

A
  • boil

- infection of follicle and surrounding tissue

50
Q

Carbuncle

A

-groups of hair involved

51
Q

Milia

A
  • tiny white bumps/cysts filled with keratin

- eyes, nose, baby acne

52
Q

Petechiae

A
  • minor hemorrhage

- small red/purple dot

53
Q

Purpura

A
  • 3mm to 1cm

- no blanching

54
Q

Echymosis

A
  • bruise/hematoma

- > 1 cm

55
Q

Scar

A

abnormal fibrosis tissue

56
Q

Keloid

A

-rubbery and firm or shiny fibrotic nodules

57
Q

Lichenification

A
  • well defined

- large plaque where skin appears thickened and skin markings are accentuated

58
Q

Wood’s lamp indications

A

any dermatitis
patches of scalp scaling or partial hair loss
pigmentary conditions
blisters or erosions on hands and forearms
patches of scaling and altered pigmentation on skin

59
Q

Wood’s lamp will see

A 
tinea capitus
tinea versicolor: golden/yelllow
erythrasma: coral/red
pseduomonas: aqua green
vitiligo: accentuates hypopigmentation
porphyria cutenea tarde: pink/orange
fluorescine: evaluate conjunctiva
60
Q

KOH prep will see

A

Hair: tinea capitus, tinea barbae
Skin: tinea corporis, tinea, cruis, tinea pedis, tinea manuum, and candidiasis
Nails: tinea ungium and candidasis

61
Q

KOH prep

A
  • clean area
  • collect sample
  • place on slide with 20% KOH
  • view under microscope
62
Q

Positive KOH

A
  • dermatophtes causing tinea: linear
  • candida - oval budding cells
  • Malassezia furfur - spaghetti and meatballs
63
Q

Main objectives for skin bx

A
  • maintain pt comfort and safety
  • obtain appropriate tissue sample
  • produce best cosmetic and function result
64
Q

Partial thickness skin bx

A
  • removes epidermis and some dermis
  • shave
  • snip
  • curettage
65
Q

Full thickness skin bx

A
  • extends into subcutaneous fat
  • punch
  • incisional
  • excisional
66
Q

Partial thickness bx indications

A
  • seborrheic keratosis
  • verruca vulgaris
  • molluscum contagiosum
  • skin tags
  • nevi
  • superficial basal cell
  • do NOT remove suspected melanoma this way
67
Q

Shave bx

A
  • prepare with alcohol
  • instill location anesthesia
  • excise lesion by shaving
  • apply pressure, 20% aluminum chloride or cautery to stop bleeding
68
Q

Snip bx

A
  • clean with alcohol
  • pick up skin tag and cut at base
  • use 20% aluminum chloride to stop bleeding
  • place antibiotic ointment and bandage
69
Q

Curettage

A
  • topical anestheisa if needed
  • Use quick scraping motions
  • 20% aluminum chloride to stop bleeding or cautery
70
Q

Partial thickness bx aftercare

A
  • clean and dry 24 hr
  • after that clean with soap and water
  • reapply bandage with antibiotic ointment
  • return if signs of infection
71
Q

Incisional punch bx

A
  • lesion or dermatosis covers large surface area
  • dx needs to be confirmed before tx
  • takes part of lesion
72
Q

Excisional punch bx

A
  • any lesion with highly suspected malignant potential

- anything smaller than 10mm

73
Q

Punch bx

A
  • smaller than 1 cm clean with alcohol
  • larger than 1 cm clean for 3 min with chlorhexidine or provodone-iodine
  • mark margins
  • inject with lidocaine
  • hold skin taut and apply downward pressure turning in on direction
  • lift specimen and cut bottom
  • suture and apply ointment and bandage
74
Q

Full thickness follow up care

A
  • clean and dry 24 hr
  • after clean with soap and water
  • reapply bandage
  • return if signs of infection
  • return in 5-21 days for suture removal
  • no heavy lifting
75
Q

Excisional bx indications

A
  • suspected melanomas
  • epidermal inclusion cysts
  • lipomas
  • larger basal and squamous cell
  • dermal lesions over 1 cm
76
Q

Excisional bx procedure

A
  • scrub for 5 min with chlorhexidien or providone-iodine
  • mark margins
  • mark intended incision
  • use tip of 15 blade to incise corner and bell to cut rest
  • lift and cut bottom
  • close wound
77
Q

Cryosurgery absolute contraindications

A
  • lesions need pathology
  • compromised circulation
  • lesions suspected of cancer
78
Q

Cryosurgery relative contraindications

A
  • lesions overlying nerves
  • location of lesion
  • dark skin - hypopigmentation
  • cold intolerance
  • autoimmune disease or immunosuprressive therapy
79
Q

Cryosurgery complications

A
  • Immediate: dizziness, snycope, blisters, edema, bleeding, pain
  • Delayed: infection, hemorrhage, formation of granulation tissue
  • Prolonged/permanent: hypo/hyper pigmentation, alopecia, atrophy, altered senstation
80
Q

Cryosurgery f/u

A
  • wash with soap and water x2 daily
  • OTC pain meds
  • do not use gauze or occulsive dressing
  • blisters may form
  • crust will separate in 10 days
81
Q

Ingrown toenail indications

A
  • ingrown toenail
  • fungal infection of nail
  • inflammation of nail fold
  • deformed, curved nail
82
Q

Ingrown toenail procedure

A
  • anesthetize toe
  • place touriquet
  • cut nail lengthwise and loosen nail
  • separate nail from nail bed to proximal nail under cuticle
  • remove nail
83
Q

Ingrown toenail f/u

A
  • elevate food 24-36 hr w/ gradual ambulation
  • change dressing in 24 hours
  • soak in warm water x2 daily
  • return if signs of infection
  • prevent by wearing loose fitting shoes and trimming nails straight across
84
Q

Subungual hematoma contraindications

A
  • crushed or fx bone under nail
  • suspected subungual melanoma
  • artificial nails no cautery
  • hematoma taking up more than 50% of nail
85
Q

Subungual hematoma procedure

A
  • soak in antiseptic solution then clean with alcohol
  • creak a hole
  • let blood drain
86
Q

Subungual hematoma f/u

A
  • soak in soapy water 2-3 times daily
  • light dressing
  • return for infection
  • OTC pain meds

Clinical Skills (2 decks)

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