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Physical Diagnosis II > Final-Breast/Venipuncture/Hair/Skin/Nails > Flashcards

Final-Breast/Venipuncture/Hair/Skin/Nails Flashcards

1
Q

What are the risk factors for breast CA? lifestyle

A 
2 or more alcoholic drinks/day
Overweight
Sedentary lifestyle
Nulliparous
Not breastfeeding
Birth control
Hormones (estrogen) after menopause  
Breast implants
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2
Q

Risk factors for breast CA you cannot change

A 
Woman
55+
5-10% BRCA1/BRCA2
Family history of breast CA
Personal history of breast BA
AA under 45, or white over 45
Dense breast tissue 
Early menstruation
Menopause after 55
Radiation to your chest
Exposure to DES
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3
Q

How often should females perform examinations

A

Monthly

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4
Q

3 patterns of breast palpation

A

Concentric circles: out-> in

Vertical strip pattern: outer edge—> in

Wedge pattern: nipple outward like spokes of a wheel

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5
Q

The D’Souza associated with potentially pathological breast changes

A 
Discharge
Depresssion/retraction
Discoloration
Dermatological changes
Deviation to one side
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6
Q

Where is tourniquet placed

A

3-4 inches above site

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7
Q

Angle needle goes in during venipuncture

A

15-30 degrees

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8
Q

Where is needle inserted to in the vein

A

The lumen

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9
Q

When remove tourniquet

A

When last tube is filling

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10
Q

Layers of epidermis

A

Stratum corneum: protection and restrict water loss

Cellular stratum: synth of keratin

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11
Q

What layer of skin is avascular

A

Epidermis-outermost

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12
Q

What connects epidermis to dermis

A

BM

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13
Q

Very vascular layer of skin

A

Dermis

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14
Q

What separates epidermis from cutaneous adipose

A

Dermis

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15
Q

Functions of dermis

A

Resilience, strength, stability, sensory nerve fibers= sensation of pain, touch and temp

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16
Q

What layer of skin contains sensory nerve fibers and autonomic motor nerve (innervate BV, glands, are to pills)

A

Dermis

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17
Q

What layer of skin connects dermis to underlying organs

A

Hypodermics

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18
Q

What is the subcutaneous fat layer of skin

A

Hypodermis

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19
Q

Function of hypodermis

A

Heat
Insulation
Shock abs portion
Calorie reserve

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20
Q

Eccrine sweat glands

A

Open directly to skin surface to regulate body temp through water secretion

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21
Q

Where are eccrine glands absent

A

Lip margins, eardrums, nailbeds, inner prepuce and glans/penis

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22
Q

Apocrine sweat glands

A

White Odorless secretions due to emotional stimuli containing protein, carbs and more

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23
Q

Body odor produced when

A

Bacterial decomposition of apocrine sweat

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24
Q

Where are apocrine glands found

A

Axilla, nipples, aureoles, anogenital, eyelids, external ears

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25
Q

Sebaceous glands

A

Secrete sebum that’s lipids rich and prevents hair and skin from drying out

Stimulated by sex hormones (testosterones)

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26
Q

Vellus hair

A

Short, fine, soft, nonpigmented

“Peach fuz”

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27
Q

Terminal hair

A

Coarser, longer, thick pigmented

Ex: head

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28
Q

Hair formed by _____ cells that invaginate into _____ layers

A

Epidermal

Dermal

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29
Q

Nails created by ______ cells converted to ____ ____ of _____

A

Epidermal

Hard plates of keratin

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30
Q

What forms the cuticle

A

Stratum corneum layer covering root

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31
Q

Cuticle aka

A

Eponychium

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32
Q

Name of soft tissue surrounding nail boarder

A

Paronychium

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33
Q

What covers infant at birth

A

Vernix caseosa

Mixture of sebum and cornfield epidermis

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34
Q

Why are babies predisposed to hypothermia at birth

A

Subcutaneous fat poorly distributed

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35
Q

______ of stratum corneum may be present at birth of infant

Aka peeking

A

Desquamation

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36
Q

Lanugo

A

Fine, silky hair covering newborn—shoulders and back

Shed within 10-14 days

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37
Q

When is infant hair shed

A

2-3months of age

Replaced my new hair with diff color/text

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38
Q

Eccrine glands function after in infants?

A

1 month

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39
Q

Do apocrine glands function in infants?

A

No

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40
Q

When do apocrine glands enlarge and become active

A

Adolescent

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41
Q

Apocrine gland changes in adolescent

A

Increased sebum production due to hormones—androgen

Oily appearance and acne

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42
Q

Glands in pregnancy

A

Increased blood flow to skin due to increased capillaries and 40-50% increase in blood vol.

Increase in sweat and sebaceous glands (reduce heat due to increase metabolism)

Vascular spiders/hemangioma increase in size

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43
Q

Skin/CT changes in pregnancy

A

Skin thickens
+ fat in subdermal
CT fragile= separation —> striae
Skin darkening—> cholasma/Malasma “mask of pregnancy)
-nipples, umbilicals, aureoles axillae darken 90%

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44
Q

Cholasma/malasma

A

Mask of pregnancy due to darkening of skin

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45
Q

Older adults gland/skin changes

A

Sebaceous/sweat gland decrease
Epidermis thins-“parchment” appearance
Dermis less elastic—wrinkled

*lifetime of sun damage and Caucasian’s= early onset

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46
Q

Tissue in adults

A

Subcutaneous tissue decreases = “bony”

Hollow in thoracic, axillary, supraclavicular

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47
Q

Gray hair due to

A

Decreased melanocytes

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48
Q

Terminal scalp hair progressively transistors into vellus hair in who?

A

Elderly

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49
Q

In elderly hair changes

A

Terminal scalp hair goes to vellus hair

Balding

And vellus to terminal in nares and Travis of men

(CRAZY THICK ASS SHIT)

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50
Q

What is a nevus

A

Mole

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51
Q

Mc areas for nevus (mole)

A

Upper back: M

Legs: F

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52
Q

Turgor

A

Elasticity

Altered if dehydrated or edema

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53
Q

Fluid-filled lesions will transilluminate with what? Solid lesions with what?

A

Fluid filled= red glow

Solid=none

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54
Q

Hirsutism

A

Growth of terminal hair in a male distribution pattern on face, body, pubic

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55
Q

What may indicate poor circulation or nutritional deficit in regards to hair

A

Feet and toes for hair loss

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56
Q

MC inflammatory skin disorder

A

Eczematous dermatitis

57
Q

Forms of eczematous dermatitis

A

Irritant contact dermatitis
Allergic contact dermatitis
Atopic dermatitis

58
Q

Patients with what often report history of allergy

A

Atopic dermatitis

59
Q

3 phases of eczematous dermatitis

A

Acute: erythematous pruritic (itchy), weeping vesicles

Subacute: erythema and scaling

Chronic: thick, lichenified, pruritic plaques

60
Q

Atopic dermatitis in childhood

A

Lesions involve flexures, nape and dorsal aspects of limbs

61
Q

Atopic dermatitis in adolescence and adulthood

A

Lichenfied plaques in flexures, head and neck

62
Q

Folliculitis

A

Inflammation and infection of the hair follicle and surrounding dermis

63
Q

S/s of folliculitis

A

Acute onset of Paulsen and pustules associated with pruritus(itch) or pain with deep folliculitis

64
Q

Pyretic
Pyroretic
Pruritic

A

Hot/warm
Pus
Itch

65
Q

Risk factors for folliculitis

A 
Frequent shaving
Immunosuppression
Hot tubs without chlorine
Long term antibiotics
Occlusive clothing
Hot/humid
DM
Obesity
Use of EGFR inhibitors (epithelial growth factor receptor)
66
Q

Primary lesion of folliculitis

A

Small pustule 1-2cm
Located over pilosebaceous orifice and may be perforated with hair

Any hair hearing site affected

67
Q

Furuncle aka?

A

Boil

68
Q

Furunle

A

Deep infection of pilosebaceous unit

Staph MC organism

Start as small abcess and then spread to surrounding dermis and subcutaneous tissue

69
Q

What forms when many adjacent furuncles?

A

Coalescing purulent mass

Carbuncle!!

70
Q

S/s furuncle

A

Tender, red, hot nodule—> pustular

Center fills with pus and forms a core

Face neck arms axillae breast thighs butt MC spots

71
Q

Cellulitis due to what organism

A

Strep pyogenes or staph A

72
Q

Cellulitis

A

Break in the skin allows bacteria in and causes a diffuse skin infection

73
Q

S/s of cellulitis

A 
Pain and swelling at site
Fever
Red, hot, tender
Boarders not well demarcated
Lymphatic streaks!! bad
Regional lymphadenopathy
74
Q

Tinea (dermatophytosis)

A

Fungal infections that involved stratum corneum, nails, hair

Through direct contact of infected humans

75
Q 
Tinea: corporis/ringworm
Cruruis
Capitals
Pedis
Unguium
A

Corporis-body
Cruris: groin/inner thigh
Unguium: nails

76
Q

S/s of dermatophytosis/tinea

A

Pruritus
Pustular, vesicular, red, 2 infection present
Nails yellow and thick and separate

77
Q

Pityriasis rosea

A

Self-limiting, idiopathic, not contagious

“Herald” patch/lesion, sudden onset with round/oval plaque over trunk/body

78
Q

Pityriasis rosea s/s (lesions)

A

Pale, red, fine scaling

Lesions on extremities and trunk

**palms/soles/face: NO

Christmas tree pattern

79
Q

Psoriasis

A

Chronic/recurrent disease of keratin synthesis.

Abnormal differentiation of keratin expression, more stem cells and turnover. Leads to thick skin

80
Q

S/s psoriasis

A

Dry, silver scales and pitted nails
MC on back, butt, extensor surfaces of extremities and scalp

30% psoriatic arthritis

81
Q

Rosacea triggers

A 
Sun
Cold weather
Emotion
Hot beverages
Spicy food
Alcohol
Caffeine
82
Q

Rosacea s/s

A

Itching
Stinging pain and flushing episodes
Appears like acne with no comedomes
Tissue hypertrophy of nose-rhinphyma

83
Q

Herpes zoster and s/s

A

Varicella-zoster viral infection
Dormant in poster spinal gangia

Pain, itching, dermatome area
Red swollen plaques filled with fluid

84
Q

Herpes simplex s/s

A

HHV1/2

Tenderness, pain, Paresthesia BEFORE onset of lesions
Vesicles then erode and crust
2-6 weeks

85
Q

Lyme disease 3 stages

A

Tick borne-borrelia burgdorferi

Early localized 
-singly central clearing; 5+ cm
Early disseminated
-multiple skin lesions and neurologic and carditis symptoms: facial palsy, meningitis, encephalitis, lightheaded, dyspnea, syncope, chest pain
Late disease:
-arthritis atrophicans
86
Q

Acanthosis nigricans

A

Nonspecific reaction associated with obesity, endocrine or inherited disorders

Symmetric, brown thickening of skin

87
Q

S/s of acanthosis nigricans

A

Symmetric, brown thickening of skin with plaques

MC: axillae, also flex. Of neck, Groupon and arms

88
Q

Where affected may indicated malignant association of acanthosis nigricans

A

Dorsal/palmar hands or mucosal surfaces

89
Q

Anthrax

A

Spore-forming bacillus anthracis

Central necrosis developed with painless ulcer covered by black Escher

90
Q

Small pox

A

Variola virus via saliva droplets

91
Q

Smallpox s/s

A

Rash on mucosa, pharynx, face and forearms.
Lesions become vesicular then pustular then crust

S/s: high fever, fatigue, HA, backache

92
Q

Mc form of skin CA

A

Basal cell carcinoma

93
Q

Where does basal cell carcinoma mc occur

A

Exposed parts of body-face, ears, neck, scalp, shoulders

94
Q

Squamous cell carcinoma

A

2nd MC skin CA

95
Q

Squamous cell carcinoma mc occurs where

A

Sun-exposed: scalp, back of hands, LOWER LIP and EAR

Wart-like growth with central depression

96
Q

Malignant melanoma

A

Lethal develops from melanocytes

ABCDE changes in moles

New or pre-existing mole that has changed/changing

97
Q

Kaposi sarcoma

A

HHV8 associated with HIV infection

Bluish/purple painless skin lesions

Skin or mucosa, viscera and lymph

98
Q

Alopecia areata

A

Sudden rapid, patchy loss of hair in sharply defined round areas

Regrowth begins 1-3 months

99
Q

Scarring alopecia

A

Scarring and destruction of hair follicles and permanent hair loss

Seen with concurrent skin disorders

PATCHY hair loss
Hair follicles may be pustular or plugged

100
Q

Traction alopecia

A

Reversible due to loss due to traction

History of wearing certain hairstyles

Patchy hair loss corresponding to ares of stress

101
Q

Hirsutism due to

A

High androgen levels of hair follicles more sensitive to normal androgen levels

102
Q

Paronychia

A

Inflammation of paronychium due to bacteria between nail fold and nail plate

Acute: trauma
Chronic: repeated moisture exposure

103
Q

S/s paronychia

A

Redness, swelling, tender at lateral and proximal nail folds

-purulent drainage under cuticle

104
Q

Onychomycosis

A

Fungus grows in nail plate causing it to crumble

Distal nail plate turns yellow

105
Q

Subungual hematoma

A

Trauma causes bleeding/bruising under nail. Remains until nail grows out

106
Q

Onycholysis

A

Loosening of nail plate with separation from nail bed

Non-adherent portion of nail white, yellow or green tinge

107
Q

Koilonychia

A

Spoon nails
Central depression of nail with lateral elevation of nail plate

Associated with iron deficient anemia, syphilis and hypothyroidism

108
Q

Koilonychia associated with?

A

Iron deficiency anemia

Spoon appearance of nails

109
Q

Beau Lines

A

Transverse white depression in nail bed due to temporary interruption of nail formation due to systemic disorder

Assoc: coronary occlusion, hypercalcemia, skin disease

110
Q

Beau lines associated with?

A

Coronary occlusion, hypercalcemia and skin disease

111
Q

White banding/terry nails

A

Transverse white bands with NO GROOVES

Associated with cirrhosis, CHF, adult onset-DM and age

Looks like many white streaks over entire nail

112
Q

White banding associated with

A

Cirrhosis, CHF, adult-onset DM and age

113
Q

Warts

A

Epidermal neoplasm due to HPV

@ nail folds

114
Q

Digital mucous cysts

A

Longitudinal nail groove from cysts located at proximal nail fold

Cyst contain clear jelly-like substance

115
Q

Pruritic urticaria Papuans and plaques of pregnancy (PUPPP)

A

Benign usually late in 3rd trimester of 1st pregnancy

-eruption after delivery and doesn’t return with later pregnancies

116
Q

S/s PUPPP

A

Intense pruritus rash beginning on abdomen with periumbilical area spared

No lesions on face, palms or soles

Often halos of blanching surrounding Papules

117
Q

Herpes gestationis-aka pemphigoid gestationis

A

NOT RELATED TO HERPES VIRUS INFECTION

Rare autoimmune disorder or pregnancy

Complications: necrosis of infected skin and kidney damage

118
Q

S/s of herpes gestationis/pemphigoid gestationis

A

Urticaria patches (hives) that are periumbilical

Lesions become vesicles/blisters

PALMS AND SOLES AFFECTED

Infants may be born with but clears

119
Q

Seborrheic dermatitis

A

Chronic, recurrent scaling eruption where sebaceous glands are concentrated (scalp, back, diaper area)

Mc first 3 months

120
Q

S/s seborrheic dermatitis

A

Scalp lesions are scaling, adherent, thick, yellow and crusted

**cradle cap

121
Q

Miliaria

A

Occlusion of sweat ducts during heat/humidity

Irregular, red rash on covered areas of skin

122
Q

Impetigo

A

Staphylococcal or streptococcal

Usually face

Honey/amber color crusts
Regional lymphadenopathy

123
Q

Acne vulgaris

A

Impaction and obstruction of outflow of sebum

Adolescents

Comedones

“Icepick scarring” from previous lesions

124
Q

Ice pick scarring present from previous lesions from what

A

Acne vulgaris

125
Q

Chickenpox (varicella)

A

VZV
Remains dormant in sensory nerve roots for life

Maculopapular and vesicular lesions on truck, extremities, face, buccal mucosa, palate or conjunctivae

126
Q

Complications from Varicella

A

Chicken pox

Secondary bacterial infection
Viral pneumonia
Encephalitis
Meningitis
Myelitis
G-B syndrome
Reye syndrome
127
Q

Measles aka

A

Rubeola

128
Q

Measles

A

Rubeola
Invasion of respiratory epithelium

Fever, rash first on face then spread to trunks and extremities (4-7 days)

**KOPLIK spots (white macular lesion on buccal mucosa)

Complications: infection of Respiratory. Tract and CNS

129
Q

German measles AKA

A

Rubella

130
Q

German Measules

A

Rubella

Mild, fever, reddish spots on soft palate during prodrome or on first day of rash (forschheimer spots)

Starts as cold s/s then rash in UE/LE

131
Q

Forscheimer spots seen with?

A

German measles (Rubella)

132
Q

Infection during first trimester of pregnancy may lead to congenital rubella syndrome

A

German measles

133
Q

Trichotillomania

A

Loss of hair due to manipulation, twisting, pulling

irregular boarder (recall alopecia has reg. Boarder) but site is not bald fully

134
Q

Irregular boarder of hair loss bit not all hair is lost

A

Trichotillomania

135
Q

S/s of infant/children abuse

A
  • Bruising on soft tissue, or any on child not mobile ye
  • lacerations of lips/frenulum = forced feeding
  • Burns: hands/feet, cigarette, or immersion
  • hair loss: patchy
136
Q

Stasis dermatitis

A

Venous insufficiency in lower legs

Fullness, aching of lower legs
Gradual increase in pigmentation/redness
Bad: scaling, weeping, ulceration

137
Q

Solar keratosis (actinic keratosis) may lead to what?

A

Squamous cell carcinoma

138
Q

Solar keratosis (actinic keratosis)

A

May lead to squamous cell car income

Secondary to C. Sun damage
Increase # with age
Slightly raised, less than one cm with irregular round surface

Dorsal surfaces of hand, arm, neck, face

139
Q

Abuse in elderly

A
  • bruising in hidden areas: axilla, inner thighs, soles/palms
  • determine mental status of patient—self harm and not know

Physical Diagnosis II (6 decks)

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