EXAM 2 - skin, MS Flashcards
Macule
< 1 cm flat non-palpable cirucumscribed discolored
Patch
>1 cm diameter flat non-palpable irregular shape discolored
Lichenification
thickened epidermis with accentuated skin lines cause by rubbing
ex: Lichen simplex chronicus
Scar
thin or thick fibrous tissue, following dermal injury
ex: burns, acne, keloid, herpes zoster, hidradenitis
Fissure
linear break in skin through epidermis and dermis
ex: hand dermatitis, intertrigo
ulcer
loss of epidermis and dermis, size varies
ex: decubitus or stasis ulcer, factitial ulcer, pyoderma gangrenosum
Petechia
< 1 cm circumscribed deposit of blood
ex: meningococcemia, Gonococcemia
From: strangulation; bleeding, liver disease
Annular
circular or ring shape
linear
line formation
arciform
arch-sharped
–drug reaction
Grouped
occurring closely together
*Herpes zoster
Gyrate
convoluted, serpiginous shape
*creeping eruption
Gentamyocin reaction; what is typically done to tx?
25mg iv benadryl
Seborrhea
Erythematous plaques with dry or oily scales
Location: head and trunk at sites of sebaceous gland, rich skin
Psoriasis
chronic, WELL DEMARCATED erythematous plaques w/silleve scale
Rosacea
papules; pustules; no comedones
Face
Seborrheic dermatitis
greasy adherent scale on coalescing macules, papules, and patches
scalp brow paranasal, postauricular, and flexural areas
Pityriasis rosacea
single 3-4cm oval plaque at onset that is followed by numerous smaller (<1cm) plaques w/collarette scale
-following natural skin lines of trunk
Lichen planus
Pruritic, polyangular, planar, purple papules; lacy surface
*Face
Impetigo
Thin, erythematous bullous vesicles or pustules that heal with HONEY-colored crust
*face, neck, extremities
herpes simplex
Expanding erosions with pain; an active vesicular border and scalloped periphery
**orolabial, genital
herpes zoster
sequential pain; crops of erythematoous papules and plaques followed by erosive blisters
*dermatomal distribution of thoracic, cranial, trigeminal, lumbar and sacral nerves
allergic contact dermatitis
vesicles, edema, redness and extreme pruritus
*exposure site; often hands, forearms, face and tops of feet
corn
occurring over a bony prominence
-feet
basal cell carinoma
pearly white, dome shaped papule with ulcerative CRUSTED, BLEEDing center
*face, scalp, ears, neck, sun exposed areas of trunk, extremities
squamous cell carcinoma
red, poorly defined base with RAISED, NECROTIC, crusted center
*head, neck, hands, sun exposed areas of skin
Melanoma
color and appearance vary considerably; pigmented and nonpigmented lesions
Paget’s disease
red, sharply demarcaated, irregularly outlined plaque and papule
breast, extramamary
Kaposi’s Scarcom
raised, oval, poorly demarcated, RUST or purplered patch, plaque or nodule
feet and lower legs
atopic dermatitis
Pruritic rash; erythematous, confluent papules and plaques affecting extensor areas; scarring
*hx of childhood eczema, allergic rhinitis, family hx of allergic rhinitis and eczema
seborrheic keratosis
variable color
waxy surface
stuck on appearance
*can occur anywhere
mole
clusters of nevus cells arranged at various levels in the skin
*anywhere; sun-exposed areas
keloid
large, raised scar that extends into adjacent normal skin
*anterior chest, shoulders, neck
Dysplastic nevus
multiple, atypical nevi with increased incidence of melanoma
*anywhere, trunk and UE’s
scabies
severe nighttime pruritus
*highly communicable. cross antigenicity with house dust mites
Cherry angioma (senile angioma)
smooth, firm, deep red, few or hundreds, increasing with age
-located on trunk
venous lake
compression collapses lesion
- located on vermillion border of lip, ear
General
Fever, malaise
possible associated dx/do:
herpes zoster, varicella, erythema nodosum, roseola, rubeola
HEENT
s/s: red eyes, conjunctivitis, URI
possible associated dx/do:
rosacea
rubeola
erythema
Respiratory
s/s: Ashtma, allergies, cough
possible associated dx/do:
atopic dermatitis
rubeola
CV
S/s: varicosities, pedal edema
possible associated dx/do:
stasis dermatitis
GI
s/s: anorexia, abd pain
possible associated dx/do:
Roseola
cutaneous candidiasis
Caused by: candida albicans
hallmark: bright erythema with satellite papules
loc: Diapered region
tinea pedis
Hallmark: scale, inflammation, maceration
loc: soles, toe webs
organism: Trichophyton rubrum or T. mentagrophytes
tinea capitis
Hallmark: fine scale, kerion
loc: hair shaft
organism: Trichophyton tonsurans, T. schoenleinii
tinea corporis
Hallmark: arciform with advancing border
loc: non-hairy extremities, trunk
org: Trichophyton rubrum, T. mentagrophytes, Microsporum canis
tinea versicolor (pityriassis versicolor)
Hallmark: finely scaling, hypopigmented and hyperpigmented flat plaques
loc: trunk, neck, arms, shoulders
org: pityrosporum orbiculare
muscular injury is a common problem and significant source of workers compensation claims.
% of children and adults?
in 10% children
25% adults
tendons connect
muscle to bon
ligaments connect
bone to bone
synovial fluid is
thin lubricating fluid
bursa are
small pockets of synovial fluid
most common bone injury
fractures
strain
involves tendon and muscles
sprain
ligaments or capsule
use of these substances slow healing and increase risk of falls and trauma:
tobacco
alcohol
recreational drugs
*vascular injury, AMS, trip and falls
Red flags in MS assessment
hx of major trauma hot/swollen joints systemic/constituional symptoms focal or diffuse weakness neurogenic pain claudication (lack of BF or O2 to muscle) poorly localized pain/ recent surgery unrelenting nighttime pain
5 P’s of MS hx:
Pain paralysis paresthesia pallor pulses
in assessment steps; what do you add?
- ROM
- muscle strength & tone
- Ligamentous test
- MO injury - proximal and distal to pain
- DTR (1 absent - 5 hyperactive)
- side good/bad comparison
Medications with MS effects
-diuretics - (K/ Na wasting)
-statins
-erythromcins
-
Rheumatoid Arthritis:
- autoimmune
- symmetrical
- swelling of joints
- dx with > 3 joints and mostly PIP over 6 weeks
Osteoarthritis :
- degeneration of cartilage
- increased pain w/activity
- crepitus
- stiffness in AM resolves in about 1 hr.
- narrowing of joint spaces
Fibromyalgia effects
2% of population
Fibromyalgia general points
pain associated for over 3 mos
- bilater and above /below the waist
- pain on palpation on 11/18 points
Differentials for Fibromyalgia
RA
OA
Lupus
crhonic fatigue
insert Image of Lymes
Lymes disease
bacterium borrelia; burgdorfer (bite from deer tick)
can be asymptomatic, early findings solitary target lesion, followed by multiple lesions
- ELISA, IGG initial test positive
- Western Blot
Red Flags for Neck Pain:
- Hx of Trauma/Neck Strain
- Neck Stiffness (nuchal rigidity) with fever
- Unrelenting pain
- Radicular symptoms
- Chronic neck pain with weakness of upper or lower ext.
- Pain with history of malignancies
-Test: CT, MRI, EMG
Red Flags for Neck Pain:
- Hx of Trauma/Neck Strain
- Neck Stiffness (nuchal rigidity) with fever
- Unrelenting pain
- Radicular symptoms
- Chronic neck pain with weakness of upper or lower ext.
- Pain with history of malignancies
-Test: CT, MRI, EMG
Radicular pain/symptoms
affecting or relating to the root of a spinal nerve.
2nd m/c cause of PC office visits in the us are due to
low back pain
most low back pain is what kind of back pain?
lumbar — 70%
compression fractures associated with
OA
** rotator cuff tear symptoms:
- pain with weakness
- Loss of strength
- unable to ABDUCT
**muscles involved in rotator cuff syndrome
Supraspinatus,
infraspinatus,
subscapularis,
teres minor
** Rotator cuff syndrome
S/S: A/L shoulder pain ^ with
arm elevation and reaching OVERHEAD
Scoliosis is:
-s/s and development
lateral curvature of the spine
- 10 yrs of age
- greater than 10 degrees
- non painful
- gradual onset
- check shoulder and hip heights for wrinkles
Carpal Tunnel syndrome:
Nerve
symptoms
Median Nerve
- overuse, repetitive use (causes loss of space and impingement on the median nerve
- Nighttime pain severe
- Pain/paresthesia
Carpal Tunnel syndrome:
Nerve
symptoms
Median Nerve
- overuse, repetitive use (causes loss of space and impingement on the median nerve
- Nighttime pain severe
- Pain/paresthesia
A Fluid filled cyst develops adjacent to a tendon sheath is?
Ganglion cyst
-ganglia are believed to be associated
Osgood Schlatter:
Inflammation of the site where patellar tendon inserts on the tibia
from: Repetitive jumping
Increased stress in the tendons
Increased pain with activity and relieved with rest
Unilateral or bilateral
Curvature of the spine The thoracic (rib cage) portion of the spine has a normal forward curvature, called “kyphosis,” which has a normal range (20 to 50 degrees
Lordosis
This forward curvature is matched by reverse curvatures (called “lordosis” or “sway”) in the cervical spine (the neck) and the lumbar spine (the low back)
Dorsiflexion of the foot increases pain associated with
plantar fascitis
Plantar Fascitis: associated with - cause worst when tx
- Unilateral/bilateral, middle age
- Overuse, flat feet, high arches, obesity, improper shoes
-Collagen degeneration r/t micro trauma
- Worst in the AM, decreases with activity
- Dorsiflexion of the foot increases pain
-Self limiting usually in 12-18 months with rest and NSAIDS
Not actually neuroma rather fibrous tissue thickening along digital nerves, typically between the 3rd/4th intermetatarsals - this is a?
Mortons Neuroma
Achilles tendonitis
Chronic overuse- extreme stress on Achilles Tendon
Passive stretching of the tendon by dorsiflexion
Pt cant stand on ball of foot and has tenderness/ hemorrhage at rupture site
position for achilles tendon repair in or
prone
lateral
Freckles, Mongolian Spot, Vitiligo , Drug eruption, secondary syphilis, hypo Melanosis
Macule
