Exam 2- Module 4 Flashcards
1
Q
Skin structure
A
Epidermis: outer layer
Dermis: inner supportive layer
Beneath these layers is subcutaneous adipose tissue
2
Q
Epidermal appendages
A
Formed by tubular invagination of epidermis down into underlying dermis
Sebaceous glands
Sweat glands : eccrine and apocrine
3
Q
Newborn: lanugo
A
Fine downy hair
4
Q
Newborn: vernix caseosa
A
Thick, cheesy substance
5
Q
Newborn: sebum
A
Holding water in skin producing milia
6
Q
What happens to children epidermis?
A
Thickens, darkens, becomes lubricated
7
Q
Adolescent developmental competence
A
Apocrine gland secretions increase
Fat deposits increase
Secondary sex characteristics
8
Q
Pregnant: Linea nigra
A
Increased pigmentation midline of abdomen
9
Q
Pregnant: chloasma
A
Discoloration changes of face
“Mask of pregnancy”
10
Q
Pregnant: striae gravidarum
A
Stretch marks
Develop over abdomen, breast, thighs
11
Q
Aging adult: elasticity
A
Skin folds and sags
12
Q
Aging adult: sweat and sebaceous glands
A
Decrease in number and function
Dry skin
13
Q
Aging adult: senile purpura
A
Discoloration due to increasing capillary fragility
14
Q
Aging adult: skin breakdown
A
Cell replacement is slower and wound healing delayed
15
Q
Aging adult: hair matrix
A
Melanocytes decrease
Gray fine hair
16
Q
Skin pigmentation
A
Pallor: pale
Jaundice: yellow
Erythema: red
Cyanosis: blue
Color change transient or due to pathology?
17
Q
Inspecting lesions
A
Color
Elevation
Pattern or shape
Size
Location
Any exudate: color or odor
Woods light: UV detects fluorescing lesions
18
Q
Hair inspection
A
Color- melanin
Texture -hair care products
Distribution
Lesions -divide hair in sections
19
Q
Inspection nails
A
Shape and contour: angle nail base 160 degrees
Consistency
Capillary refill 1-2 seconds
20
Q
*ABCDE skin assessment
A
A- Asymmetry B- border C- color D- diameter E - elevation and enlargement
21
Q
Shapes and configurations of lesions
A
Annular or circular Confluent- all over Discrete- small Grouped Gyrate- looks like worm Target or iris - spot in middle Linear Polycyclic -irregular shape but clustered Zosteriform- radiates to specific area and is grouped
22
Q
Sternomastoid
A
Enables head rotation and flexion
Divided neck into two triangles: anterior and posterior
23
Q
Trapezius muscles
A
Move shoulders
Extend and turn head
24
Q
Thyroid gland
A
Straddles trachea in middle of neck
Synthesizes and secretes T4 and T3 that stimulate cellular metabolism
25
Lymphatic system
Extensive vessel system
Major part of immune system
Detects and eliminates foreign substances from body
26
Inspection and palpation of skull
Size and shape
Should feel symmetric and smooth
Cranial normal protrusions: forehead, lateral edge of parietal bones, occipital bone, mastoid process behind ears
Palpate zygomatic bone
Palpate temporomandibular joint when person opens mouth note movement without limitation and tenderness
27
Inspection of face
Facial expression and appropriateness to behavior and mood
Facial structures symmetric
Symmetry in eyebrows, palpebral fissures, nasolabial folds, sides of mouth
Abnormalities: coarse facial features, explothalmos, skin pigmentation, any swelling
Involuntary movements?
28
Inspection and palpation of neck
Symmetry
Range of motion
Lymph nodes
Trachea
Thyroid gland -posterior, anterior, bruit (if enlarged)
29
Infant and children: skull
Measure head each visit 2 years- 6 years
Infants head and posture control
Infant: turn head side to side 2 weeks
Tonic head reflex when supine
Head control: 4 months
30
Capital succedaneum
Swelling from birth trauma
Resolves in first few days
No treatment
31
Cephalhematoma
Subperiosteal hemorrhage
Birth trauma
Appears several hours after birth and increases in size
Reabsorbed during first few weeks of life without treatment
32
Craniotabes
Softening of skulls outer layer
Do not palpate unless suspected, because other abnormal findings
Can be normal especially in premature
33
Infant and children: percussion
Directly percuss plexor finger against head surface
"Cracked pot" sound
Normal before closer of fontanels
34
Infant and children: auscultation
Bruits are common in skull 4-5 yrs or w/ anemia
Systolic or continuous; heard over temporal area
35
Infant and children: transillumination
Suspect abnormal head size of intracranial lesion
Rubber-collared flashlight firmly on infant skull
Explore regions of head
A small ring around flashlight is normal
Should not see large halo around rubber collar
36
Chloasma
2nd trimester
Blotchy, hyperpigmented area over cheeks and forehead fades after delivery
37
Hydrocephalus
Obstruction of drainage of cerebrospinal fluid
Excessive accumulation
Increasing intracranial pressure
Enlargement of head
Dilated scalp veins, frontal bossing, "setting sun" downcast eyes
Thin cranial bones, separate sutures, percussion "cracked pot" sound
38
Pager disease of bone (osteitis deformans)
Bone disease
Softens, thickens, deforms bone
39
Acromegaly
Excessive secretion of growth hormone from pituitary after puberty
Enlarged skull and thick cranial bones
Elongated head, massive face, prominent nose and lower jaw, heavy eyebrow ridge, coarse facial features
40
Torticollis (wryneck)
Hematoma in sternomastoid muscle
Injured by intrauterine malposition
Head tilt to one side and limited ROM to opposite side
Headache, limited ROM, stiffness in neck
41
Thyroid, multiple nodules
Indication of inflammation or multinodular goiter
42
Thyroid, single nodule
Solitary: benign greater risk of malignancy
Cancerous: hard and have surrounding structure
43
Pilar cyst (wen)
Smooth, firm, flucuant swelling on scalp
Pressure causes overlying skin to be shiny and taut
Benign growth
44
Parotid gland enlargement
Rapid painful inflammation
Swelling occurs with blockage of duct, abscess, tumor
Note selling anterior to lower ear lobe
45
Stenson duct obstruction
Aging adults dehydrated from diuretics or anticholinergics
46
Pediatric facial abnormalities
Fetal alcohol syndrome
Congenital hypothyroidism
Down syndrome
Atopic ( allergic)
Allergic salute and crease
47
Hyperthyroidism
Increased heart rate
Weight loss
48
Hypothyroidism
Decrease heart rate
Weight gain
49
Eyes: inspection
Fundus
Retina and vessels
Macula
Fovea centrailis
50
*Visual reflex: pupillary light reflex
Normal construction of pupils when bright light shines on retina
51
Visual reflex: fixation
Reflex direction of eye toward an object attracting attention
52
Visual reflex: accommodation
Adaption of eye for near vision
53
Developmental competence: again adults
Pupil size decreases
Lens loses elasticity becomes hard and glasslike (decrease ability to change shape for near vision) PRESBYOPIA
Age 70: transparent fibers of lens begin to thicken and yellow- beginning of cataracts
54
*Aging: cataracts
Lens opacity
Clumping of proteins in lens
55
Aging/eyes: glaucoma
Increase intraocular pressure
Chronic open-angled glaucoma is most common type
56
Aging/eyes: muscular degeneration
Breakdown of cells in masculine of retina
57
Aging: loss of central vision
Most common cause of blindness
Unable to read fine print, sew, do fine work
Can cause distress
58
Ishihara chart
Color vision
59
Equipment for eye vision test
Snellen eye chart
Hand held visual screener
Opaque card and occluder
Penlight
60
Snellen eye chart
Lines of letters decreasing in size
Eye level, 20 ft
Glasses and contact lenses should stay on, remove only reading glasses
61
*Test near vision
Handheld vision screener with various sizes of print
62
Confrontation test: vision
Peripheral vision
Persons vs yours
Come at different angles with one eye covered
63
Corneal light reflex
Hirshberg test
Assess parallel alignment of eye exes by shining a light toward persons eyes
12 in away
Cornea reflection same on both eyes
64
Cover test
Stare at nose
Opaque card cover one eye
If weakness exists: covered eye will drift into relaxed position
Uncovered eye should stare straight ahead
65
Iris and pupil
Iris is usually flat and round
Note size, shape, equality of pupils
Pupillary light reflex: darken room and ask person to gaze in distance
66
*PERRLA
Pupils
Equal
Round
React
Light
Accommodation
67
Eyes: optic disc
Color: creamy yellow- orange to pink
Shape: round or oval
Margins: distinct or sharply
Cup-disc ratio: physiologic cup is brighter yellow-white than rest of disc, width no more than half disc diameter
68
Aging/eyes: xanthelasma
Soft, raised yellow plaques occurring on lids at inner canthus
Mainly in women
69
*Tympanic membrane
Eardrum
Translucent membrane with pearly grey color
70
Middle ear
Tiny air-filled cavity inside temporal bone
Contains tiny ear bones (auditory ossicles) malleus, incus, stapes
71
Ear: Eustachian tube
Opening that connects middle ear with nasopharynx
Allows passage of air
Closed but opens with swallowing or yawning
72
3 functions of ear
Sound vibrations from outer to inner
Protects ear by reducing amplitude of loud sounds
Eustachian tube allows equalization of air pressure on each side of TM so it doesn't rupture
73
Inner ear
Holds bony labyrinth
Sensory organs for equilibrium and hearing
Coachella: central hearing apparatus
Functions can be assessed
74
Hearing
3 levels
Peripheral- ear transmits sounds and coverts to vibrations to electrical impulses to be analyzed by brain
Brain stem
Cerebral cortex
75
Hearing: amplitude
Loudness
76
Hearing: frequency
Pitch or number of cycles per second
77
Conductive hearing loss
Mechanical dysfunction of external or middle ear
Partial loss, bales to hear if sound amplitude is increased
Cause can be impact of cerumen, foreign bodies, perforated TM, pus in serum in middle ear, otoscelerosis (decreased mobility of ossicles)
78
Sensorineural hearing loss
Aka Perceptive
Inner ear, cranial nerve VIII, or auditory areas of cerebral cortex
May not be able to understand words
Can be caused by presbycusis
79
Presbycusis
Gradual nerve degeneration
Occurs with aging
Ototoxic drugs- affect hair cells in cochlea
80
Mixed hearing loss
Combination of conductive and sensorineural types in same ear
81
Otoscelerosis
Conductive hearing loss
20-40 yrs
Gradual hardening impedes transmission of sound
Progressive deafness
82
Aging: ears
Cilia lining ear canal becomes coarse and stiff
Cerumen is drier because of atrophy of apocrine glands
Pendulous earlobe with linear wrinkling because of loss of elasticity of pinna
83
Aging/ears: presbycusis
Hearing loss occurs with aging
Even in ppl in quiet environment
Gradual sensorineural loss by nerve degeneration in inner ear or auditory nerve
High-frequency tone loss
84
Tittinus
Ringing, crackling, buzzing in ear
85
Vertigo
Dizzy
86
Ear examination equipment
Otoscope with bright light
Pneumatic bulb attachment -with infant or young child
Tuning forks 512 and 1024 Hz
87
*Romberg test
Ability of vestibular apparatus in inner ear to help maintain standing balance
Intactness of cerebellum
Proprioception as part of neurological system
88
Nose, mouth, throat: pregnant women
Nasal stuffiness & Epistaxis from increased vascularity in upper respiratory tract
Gums maybe be hyperemic and softened and may bleed with normal tooth brushing
89
Nose, mouth, throat: aging adult
Loss of subcutaneous fat
Atrophic tissues ulcerated easily: leads to infection
Tooth loss
Diminished taste and smell
Mastication issues
90
Bifid uvula
Uvula split completely or partially
10% American Indian groups
91
Cleft lip and cleft palate
Most common in asians
Intermediate in white
Least common in blacks
92
*strambismus
Cross eyed vision
Person cannot align both eyes
One of eyes is turn in, out, up or down
93
Diplopia
Double vision
94
*Whispered voice test
One ear at a time
Hearing in other ear by placing finger on Travis and rapidly pushing it in and out of auditory meatus
Shield lips- person cannot lip read
Head 30-60 cm (1-2ft) from person ear
two-syllable words
95
*tuning fork test
Measures air conduction (AC)
Or bone conduction (BC) sound vibrates through cranial bones in inner ear
Hold tuning fork at stem and string me softy on back of hand
96
Jugular vein
JVD sign or central venous pressure (CVP)
Pressure in vena cava
How much blood flow into heart and how well heart can move blood to lungs and body
97
Jugular being assessment
Head at 45 degrees on side
Measure highest point pulsations can be detected in vein
Normal 6-8cm
If too high: heart failure, or high pressure in lungs backing up to R side heart
98
Palpebral fissure
Open space between eyelids
99
Othalmoscope looks at
Optic disc
Retinal vessels
General background
Macula
100
Snellen eye chart
Visual acuity
101
Cover test
Muscle weakness
102
Conjuctivitis
Reddened conjunctiva
103
Conjunctiva
Mucous membrane that covers front of eye PINK
Sclera: white
