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PCM2 > Exam 9 > Flashcards

Exam 9 Flashcards

1
Q

List 6 examples of color to look for in a skin examination.

A
  1. Hyperpigmentation
  2. Hypopigmentation
  3. Redness
  4. Pallor
  5. Cyanosis
  6. Jaundice
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2
Q

How are skin lesions initially classified (2 categories)?

A
  1. Primary

2. Secondary

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3
Q

How are primary skin lesions initially classified (2 categories)?

A
  1. Small

2. Large

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4
Q

What are the other features of primary skin lesions (6)?

A
  1. Flat
  2. Raised - solid, rounded
  3. Raised - fluid filled
  4. Raised - pus filled
  5. Raised - mesa-like
  6. Special category
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5
Q

List the 6 SMALL primary skin lesions according to the following categories:

  1. Flat
  2. Raised - solid, rounded
  3. Raised - fluid filled
  4. Raised - pus filled
  5. Raised - mesa-like
  6. Special category
A
  1. Macula
  2. Papule
  3. Vesicle
  4. Pustule
  5. Plaque
  6. Wheal
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6
Q

List the 6 LARGE primary skin lesions according to the following categories:

  1. Flat
  2. Raised - solid, rounded
  3. Raised - fluid filled
  4. Raised - pus filled
  5. Raised - mesa-like
  6. Special category
A
  1. Patch
  2. Nodule
  3. Bulla
  4. [Abscess]
  5. Plaque
  6. Wheal
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7
Q

What is a macule?

A

Primary small skin lesion

Flat (lacks elevation or depression), different color from surrounding skin

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8
Q

What is a patch?

A

Primary large skin lesion

Flat skin discoloration

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9
Q

What is a plaque?

A

Primary small or large skin lesion

Mesa-like elevation that occupies a large surface area in comparison to its height (raised and flat)

> 1.0cm

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10
Q

What is a papule?

A

Primary small skin lesion

Solid, raised lesion
Generally <0.5 cm in diameter

“Papules pop up”

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11
Q

What is a nodule?

A

Primary large skin lesion

Palpable, deeper than a papule
>0.5 cm in diameter

Feels like a marble in the skin

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12
Q

What is a pustule?

A

Primary small skin lesion

Raised lesion that contains a purulent exudate

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13
Q

What is a vesicle?

A

Primary small skin lesion

Elevated lesion that contains (clear) fluid; the wall is thin and the lesion appears translucent

<0.5 cm in diameter

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14
Q

What is a bulla?

A

Primary large skin lesion

Vesicle >0.5 cm in diameter

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15
Q

What is a wheal?

A

Primary large or small skin lesion

Firm, edematous plaque that is evanescent (comes and goes) and pruritic

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16
Q

What is another name for a wheal?

A

Hive

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17
Q

What are secondary skin lesions?

A

Lesions that are created by scratching, scrubbing, or infection

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18
Q

List the secondary skin lesions (8).

A
  1. Ulcer
  2. Scar
  3. Atrophy
  4. Scale
  5. Crusts
  6. Fissure
  7. Erosion
  8. Excoriation
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19
Q

What is an ulcer?

A

“Hole in the skin”

Destruction of the epidermis and upper dermis; will heal with scarring

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20
Q

What is a scar?

A

Healed wound or ulcer

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21
Q

What is a keloid scar?

A

An abnormal formation of connective tissue

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22
Q

What is atrophy?

A

Thinning of the epidermis and dermis

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23
Q

What is a scale?

A

Abnormal shedding or accumulation of stratum corneum in perceptible flakes

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24
Q

What is a crust?

A

Hardened deposit that results when serum, blood, or purulent exudate dries on the skin surface

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25
Q

What is another name for a crust?

A

Scab

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26
Q

What is a fissure?

A

Linear cleavage or cack in the skin; may be painful

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27
Q

What is an erosion?

A

Partial loss of skin surface; superficial (compared to an ulcer, which is deep)

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28
Q

What is an excoriation?

A

Linear erosion induced by scratching

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29
Q

List 5 other miscellaneous skin lesions.

A
  1. Burrows
  2. Lichenification
  3. Telangiectasias
  4. Petechiae
  5. Purpura
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30
Q

What is a burrow?

A

Elevated channel in the superficial epidermis produced by a parasite such as scabies or worms

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31
Q

What is a lichenification?

A

Focal area of thickened skin produced by chronic scratching or rubbing; skin lines are exaggerated or accentuated

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32
Q

What is a telangiectasia?

A

Small, dilated superficial blood vessels (capillaries, arterioles, or venules) that blanch with pressure

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33
Q

What are 4 causes of telangiectasias?

A
  1. UV radiation
  2. Topical steroid use
  3. Collagen vascular disorders
  4. Certain tumors
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34
Q

What are petechiae?

A

Tiny red macules that result from the extravasation of RBCs into the dermis; do NOT blanch with pressure, usually <5mm in diameter

35
Q

What are purpura?

A

Larger patches of extravasated RBCs; do NOT blanch with pressure

36
Q

List some skin lesion configurations (6).

A
  1. Annular
  2. Arcuate/polycyclic
  3. Gyrate
  4. Target
  5. Dermatomal
  6. Linear
  7. Serpiginous
37
Q

What is an annular skin lesion?

A

Ring-shaped

38
Q

What is an arcuate/polycyclic skin lesion?

A

Incomplete circular

39
Q

What is a gyrate skin lesion?

A

Wood-grain pattern (rare)

“To turn around in a circle”

40
Q

What is a target lesion?

A 
Consists of three zones:
1. Dark or blistered center
2. Center surrounded by a pale zone
3. Rim of erythema
Looks like a bullseye
41
Q

What is a dermatomal skin lesion?

A

Follows neurocutaneous dermatomes

42
Q

What is a serpiginous skin lesion?

A

Snakelike, winding eruption

43
Q

List and define arrangements of skin lesions (6).

A
  1. Discrete - isolated
  2. Clustered - small group
  3. Confluent - joined together
  4. Dermatomal
  5. Reticular - fishnet/lacy
  6. Morbilliform - measles-like
44
Q

List and define distribution of skin lesions (4).

A
  1. Intertrigenous - under skin folds
  2. Photodistributive - sun-exposed areas
  3. Symmetric
  4. Widespread
45
Q

What are the ABCDEs of melanoma?

A
  1. Asymmetry
  2. Borders are irregular
  3. Color varies
  4. Diameter >6mm
  5. Elevation
46
Q

What are the 2 superficial secondary lesions above the skin?

A
  1. Erosions

2. Excoriations

47
Q

What are the 3 superficial secondary lesions below the skin?

A
  1. Scales
  2. Scars (sometimes)
  3. Crusts
48
Q

What are the 2 deep secondary lesions?

A
  1. Fissure

2. Ulceration

49
Q

What does a scale indicate (what histologic process)?

A

Hyperkeratosis

50
Q

___ are shown by the patient to you but are covering for the underlying deeper issue which is the core pain or process.

A

Seed resistances

51
Q

What are examples of core pains?

A 
Fear of the unknown
Fear of physical pain
Loss of hope
Loss of internal control
Loss of external control
Feeling wronged
Loss of meaning
Self-loathing
Fear of death
Loneliness
52
Q

What is content discussion?

A

Deals with the actual question directly or meets the patient’s style of resistance by remaining focused on the facts of the situation at hand; authoritarian; may lead to debates or impasses

53
Q

What is process discussion?

A

Comment or ask about the underlying emotion or frustration; empathize; leads to better compliance

54
Q

What is side stepping?

A

Find a less threatening topic and go there temporarily

55
Q

Personality type - a patient who asks many questions, doesn’t want you to leave the room, calls you frequently, fears you won’t find them worth treating, fears you will abandon them

A

Dependent

56
Q

How can you help a patient who has a dependent personality?

A

Regular, brief sessions; set tactful limits; say to them you will come back later and briefly do

57
Q

Personality type - patients are insistent, detailed, want all of the information; may be angry when they are not in control

A

Obsessive

58
Q

How can you help a patient who has an obsessive personality?

A

Give detailed explanations, provide choices when possible, try to use the patient input in a collaborative way

59
Q

Personality type - self-centered, criticize others, believe that no one is qualified to care for them; fearful, threatened, and vulnerable, but cannot admit this

A

Narcissistic

60
Q

How can you help a patient who has a narcissistic personality?

A

Avoid confrontation, emphasize that they deserve the best the staff can give, be sure staff are all on the same page

61
Q

Personality type - always symptoms, always wants attention, may not follow through with plan; possible secondary gain, views illness and its treatment as punishments, but keeps coming back for more

A

Suffering victim

62
Q

How can you help a patient who has a suffering victim personality?

A

Regular visits, no matter how variable the complaints are

63
Q

Personality type - do not trust doctors, refuse to participate in treatment, may leave AMA, always feels that others are taking advantage of them/neglecting/harming them

A

Paranoid

64
Q

How can you help a patient who has a paranoid personality?

A

Stay calm, don’t argue, offer understanding of the patient’s position, provide clear recommendations

65
Q

Personality type - very lonely, isolative, tend to avoid medical care, have a tough time around people, feel that their privacy or space is being invaded

A

Schizoid

66
Q

How can you help a patient who has a schizoid personality?

A

Engage patient in making the medical decisions, don’t feel that you have to have a great rapport

67
Q

What are the 6 steps for delivering bad medical news?

A
  1. Schedule the meeting (have enough time)
  2. Determine if the patient understands the seriousness of the illness
  3. Does the patient want to know more?
  4. Deliver the news, then listen
  5. Ask how the patient feels, offer support
  6. Move forward
68
Q

SPIKES - pneumonic

A 
Setting
Patient's perception of condition
Invitation from patient to give information
Knowledge (explain the facts)
Explore emotions; empathize
Strategy/summary
69
Q

What technique is indicated when there is pain on rotation of the head, unilateral or bilateral trapezius pain, suboccipital pain or headache, or radicular pain in the distribution of C1-8?

A

Anterior and posterior flexion of the neck, anterior flexion against resistance; rotate head “like in the exorcist”

70
Q

What is normal for neck flexion/extension/rotation?

A

Touch chin to chest
Extended >30 degrees
Rotate 75-90 degrees

71
Q

If neck flexion/extension/rotation is abnormal, what is on the DDX?

A

C-spine DJD or inflammatory arthritis, disc disease

72
Q

What technique is indicated with trapezius pain, retro-occipital headache, or cervical nerve radicular pain?

A

Lateral flexion of head (touch ear to shoulder)

73
Q

What is normal for lateral flexion of the head?

A

At least 30 degrees toward shoulder

74
Q

If neck lateral flexion is abnormal, what is on the DDX?

A

No pain - DJD, inflammatory C-spine disease

Ipsilateral decreased or normal flexion with pain - nerve impingement

Contralateral trapezius pain - paracervical muscle spasm secondary to C-spine DJD

75
Q

What technique is indicated if there is pain on abducting >90 degrees or rotating the shoulder?

A

Arm abduction, external rotation, resist pushing arm down; flex elbow, supinate against resistance (normal if abduct past 90 degrees without pain)

76
Q

What is on the DDX if the above test is abnormal?

A

Gleno-humeral arthritis (pain in the AP passive movement)

Rotator cuff disease (abduction and resistance)

Bicepital tendonitis (supination)

77
Q

Pain on flexion and extension of the elbow indicates ___.

A

Intra-articular disease

78
Q

No pain on flexion/extension of the elbow but large effusion with or without signs of inflammation indidcates ___

A

Olecranon bursitis

79
Q

Thickened ulnar groove bilaterally indicates ___

A

Systemic inflammatory arthritis

80
Q

Nodules on the proximal posterior forearm indicate ___.

A

RA

81
Q

Hard or bony swellings that can develop in the distal interphalangeal joints

A

Heberden’s nodes

82
Q

Hard, bony outgrowths or gelatinous cysts on the proximal interphalangeal joints

A

Bouchard’s nodes

83
Q

What causes arthritis mutlians?

A

Untreated psoriasis

84
Q

Knee pain at night might indicate what?

A

Anserine bursa (location of insertion of gracilius, sartorius, semitendonosus)

PCM2 (16 decks)

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