1
Q
The retina contains the major landmarks of the eye (4)
A
- Optic disc
- Retinal arteries and veins
- Macula
- Fovea centralis
2
Q
Which of the major landmarks of the eye can you see on the fundoscopic exam?
A
- Optic disc
- Retinal arteries and veins
- Macula
generally need to have eye dilated to see the fovea centralis
3
Q
Infants are born with ____ vision.
A
myopia - 20/200
4
Q
Middle age adults become presbyopic due to the ___ becoming rigid and the ____ becoming weak.
A
lens becomes rigid
ciliary muscle becomes weak
5
Q
Oldest adults develop changes in the macula causing ___ or ____
A
low vision or decrease in central vision (macular degeneration)
6
Q
Adult visual acuity of 20/20 develops by ___
years of age.
A
4 to 6
7
Q
Can hormonal changes with the onset of puberty cause vision changes?
A
yes, can cause a change in refraction.
8
Q
Pregnancy vision changes - hormonal adaptations where?
A
Pregnancy causes hormonal adaptations in the cornea and can cause a change in refraction.
9
Q
By age 70, functionality of the extraocular muscles ___
A
decreases
10
Q
By age 70, functionality of the extraocular muscles decreases and often upward gaze is limited to ____
A
15 degrees from horizontal plane.
11
Q
For oldest adults, fibers in the central region of the lens may cause ___ in the lens.
A
cloudiness
12
Q
For oldest adults, pupil size ___ and pupillary reflex becomes ____
A
decreases
sluggish, reacting slowly to changes in light
13
Q
RUQ of abdomen - 2 main organs
A
liver, gallbladder
14
Q
LUQ of abdomen - 2 main organs
A
stomach, body and tail of pancreas
15
Q
Linea alba
A
white line that runs midline in the superficial layer of abdominal muscles/tendons
16
Q
Pain from stomach is usually felt where?
A
epigastric area
17
Q
Duodenum is around the head of the ___, which also extends across quadrants
A
pancreas
18
Q
Biliary tree refers to
A
all of the ducts from the gallbladder, pancreas, liver that drain into the duodenum
19
Q
Aorta is slightly ___ of center
A
left
20
Q
Which is lower: right or left kidney?
A
right
21
Q
The ___ and ___ muscles are important to assess for appendicitis
A
iliacus and psoas
22
Q
When dividing the abdomen up into 9 regions, the three that are most referred to are
A
epigastric, umbilical, and hypogastric or suprapubic
23
Q
LLQ of abdomen main organ: sigmoid colon
A
sigmoid colon
24
Q
Right Lower Quadrant of abdomen main organ
A
appendix
25
If stomach pain is in LLQ, think
diverticulitis
26
Diverticulitis is most commonly found in
sigmoid colon (LLQ)
27
Environments that foster low levels of physical activity coupled with dependence on calorie-rich diets have been linked to development of DM and obesity, both of which are risk factors for ____
nonalcoholic fatty liver disease.
28
Hepatitis C infection, a major cause of ____ in the U.S., is associated with low SES, drug use, and incarceration.
cirrhosis
29
Once cirrhosis is established, lower surveillance rates for hepatocellular carcinoma (HCC) are seen in patients with ___ and ___
low SES and poor insurance.
30
What other systems should you be thinking about with abdominal symptoms aside from GI/GU? (5)
- Respiratory
- Cardiovascular
- Musculoskeletal
- Hematologic
- Psych
31
Visceral abdominal pain - what is it caused by? what are the chief characteristics?
When hollow organs forcefully contract or become distended, or solid organs swell against their capsules
Gnawing, cramping or aching
Often poorly localized—points with hand
May writhe on table
32
Visceral abdominal pain examples (2)
gastroenteritis, biliary colic of gall stones (cholelithiasis) in cystic duct
33
cholelithiasis
biliary colic of gall stones
34
Parietal abdominal pain - what is it caused by? what are the chief characteristics?
When there is inflammation of the parietal peritoneum AKA peritonitis
Steady/constant
Often localized—points with finger
Likely lies still with knees up
35
peritonitis
inflammation of the parietal peritoneum
36
2 main examples of Parietal abdominal pain
appendicitis, inflammation of gall bladder (cholecystitis)
37
cholecystitis
inflammation of gall bladder
38
RUQ or epigastric visceral pain may be coming from ___ or ___
biliary tree or liver
39
epigastric visceral pain may be coming from ___ or ___ or ____
stomach, duodenum, pancreas
40
periumbilical visceral pain may be coming from what 3 organs?
small intestine, appendix, proximal colon
41
suprapubic or sacral visceral pain may be coming from the
rectum
42
Hypogastric visceral pain may be from what 3 organs?
colon, bladder, uterus
43
Referred pain from gallbladder may be felt in the ___ or ___
right shoulder and back
44
Referred pain from pancreas may be felt in the ___
mid-lower back
45
Hx of abdominal surgery is a risk factor for
obstructions
46
Order of abdominal exam
Inspection, auscultation, percussion, palpation
47
When should you examine painful areas in abdominal exam?
last
48
Signs that hernia might be strangulated (blood supply cut off)
changes in color, n/v, fever, pain, no bowel movements
49
Sign of hernia incarceration
can’t push in
50
Diastasis Recti - is this benign or not? when is it common?
When linea alba separates and some abdominal contents protrude
Benign
Common in pregnancy
51
Normal contour of infant abdomen:
round/protuberant
52
Normal contour of preschool abdomen:
lumbar lordosis
53
8 Fs of Abdominal Distention
```
Fat
Fetus
Flatus
Feces
Full bladder
Fibroids
Fluid
Fatal tumor
```
54
6 conditions where you may hear more bowel sounds
diarrhea, colic, malrotation, intussusception, early obstruction, diverticulitis
55
5 conditions where you may hear less bowel sounds
total obstruction, paralytic ileus, peritonitis, severe ascites, post-surgery
56
Spleen percussion: 2 techniques
1. Percuss for splenic dullness from border of cardiac dullness at 6th rib to anterior axillary line and down to costal margin (Traube’s space)
2. Splenic percussion sign - percuss, then have patient take deep breathe, and it’ll move - if enlarged, it’ll move into intercostal space that you’re percussing
57
Easiest to palpate organs in what patient population?
younger children
58
Why does the spleen float and liver doesn’t?
Because liver is next to diaphragm and can’t move as easily
59
What is a hernia?
Protrusion of peritoneum or intestine through weakened spot in musculature of abdominal wall
60
Hernia characteristics
Usually painless, intermittent, reducible, bulges with crying/ straining
61
Umbilical hernias in infants ___ need intervention
rarely
62
What 3 kinds of hernias are surgically corrected?
Inguinal, femoral, and most ventral hernias
63
Scaphoid contour means
markedly concave or hollowed
64
Peristalsis is often seen in what type of patient? Often indicates what?
thin
obstruction
65
Pulsations from the abdominal aorta are often seen in what type of patient? May indicate what 2 things?
thin
aneurysm or widened pulse pressure
66
Abdominal breathing normal in ___ and ___
infants and toddlers
67
Subcostal retractions may indicate ____
respiratory distress
68
___ or ____ may present with complaint of abdominal pain and altered respirations
Pneumonia or pleural effusion
69
If a patient is guarding or having pain with walking or coughing, and abdominal distention may be present, and they prefer supine position with knees flexed, what might this be?
Appendicitis/peritonitis
70
What 2 things are we auscultating the abdomen for?
- Bowel sounds
| - Vascular sounds – listen for bruits over aorta, renal, iliac and femoral arteries
71
____ on abdominal auscultation may be heard with pleural inflammation or peritoneal inflammation
Friction rub
72
In appendicitis, bowel sounds may be ___ or ____
decreased OR hyperactive
73
Why do you need to auscultate right lower lobe (RLL) of lungs carefully with appendicitis pain?
to rule out lobar pneumonia with referred pain
74
Normal bowel sounds are clicks and gurgles, ___/min
5-35
75
Absence of bowel sounds established after ___ minutes
5
76
5 key points/steps of abdominal percussion
1) Start w/overview of 4 quadrants for gas, fluid or masses
2) Liver span and tenderness
3) Spleen size
4) Costovertebral angle tenderness (+ or - CVAT)
5) Pain over other areas of
inflammation - Watch facial expressions, may be too uncomfortable to perform in appendicitis
77
Tympany
High pitched sound, musical quality
Heard over air-filled structures (stomach, gas in
GI tract)
78
Dullness
Short high-pitched sound
Little resonance
Heard over solid or fluid filled organs adjacent to air containing organs (liver, spleen, distended bladder)
79
Resonance
Sustained note, moderate pitch
Heard over lung tissue primarily
80
Liver span in adult usually ___ cm and usually does not extend below right costal margin more than ___ cm
6-12 cm
2 cm
81
Liver percussion for span - how?
Start at right mid-clavicular line, below umbilicus, percuss upward until dullness, then percuss downward until dullness
82
Bimanual percussion for tenderness of liver and kidneys
Place palm of one hand over organ
Strike hand with ulnar surface of other hand
If organs are inflamed, there will be pain
83
What does light abdominal palpation assess for?
skin turgor, muscle tone, superficial lesions or masses, areas of resistance, muscular or peritoneal tenderness
84
What does moderate abdominal palpation assess for?
slow approach to deep palpation, further assessment of tender areas
85
What does deep abdominal palpation assess for?
Identify liver edges, kidneys, and masses by location, size, shape, consistency, tenderness, pulsation, mobility
86
RUQ: liver palpation
PALPATE WITH RIGHT HAND
STARTING BELOW UMBILICUS
AND MOVING UPWARD UNTIL LIVER IS PALPABLE
alternative: hooking
87
If kidney is enlarged, may be felt at ____ between opposing examining hands
inferior lateral border of ribs
88
Which kidney is more likely palpable?
right
89
how to palpate spleen
- With one hand below the left costal margin, palpate under costal margin at the anterior axillary line
- Attempt to lift spleen anteriorly by lifting with one hand and palpating with the other
- Roll client onto right side to bring spleen towards midclavicular line and examining hand
90
palpation of abdominal aorta is particularly important for what patients?
Important in adults > 50 and anyone with known or suspected cardiovascular disease
91
Note that you will __ rupture an aneurysm when palpating abdominal aorta
not
92
Concerned about abdominal aortic aneurysm (AAA) if lateral pulsations ___ cm diameter
>3
93
If newborn has if scaphoid, abdomen, think
diaphragmatic hernia
94
femoral pulses will be weak or absent in infant with
coarctation of the aorta
95
in newborns/infants, you might be able to palpate liver edge ___ cm and spleen edge ___ cm below costal margin
1-3
1-2
96
normal abdomen contour in toddlers/children is
protuberant
97
If toddler very upset, palpate abdomen when?
during inspiration between cries
98
Why should you percuss suprapubic area in older adults?
for urinary retention
99
While there is abdominal fat accumulation in older adults, there is less ___ and ___, so palpation may be
easier
less muscle mass and connective tissue
100
Positive Murphy's sign for cholecystitis
Palpate deeply at costal margin at mid-clavicular line
Patient takes deep breath, which forces liver and gall bladder down toward examining fingers
Sharp increase in tenderness is +
101
Most common cause of acute surgical abdomen in childhood
appendicitis
102
When is appendicitis most common? When is it rare?
Rare in early childhood or elderly, most common 11-20 y.o.
103
How is appendicitis diagnosed?
Diagnosed by CT or during surgery
104
Main symptoms of appendicitis
Anorexia and dull, aching, steady peri-umbilical pain that localizes to right lower quadrant after 4-6 hours. May have -
▪ nausea and vomiting starting AFTER abdominal pain
▪ diarrhea or constipation
▪ low grade fever
▪ urinary or respiratory symptoms
105
Inflammation of appendix secondary to obstruction, may suppurate and wall off or rupture, leading to
peritonitis
106
McBurney’s point
just below the middle of a line joining the umbilicus and the anterior superior iliac spine
107
Rovsing's sign
If palpation of LLQ increases the pain felt in the RLQ, the patient is said to have a positive Rovsing's sign and may have appendicitis
"referred tenderness"
108
Iliopsoas sign
passive extension and flexion of hip - positive if abdominal pain during these exercises
109
Obturator sign
Patient lies supine with right thigh flexed 90 degrees
Examiner immobilizes right ankle with right hand
Left hand rotates right hip by:
Pull right knee laterally (hip external rotation)
Pull right knee medially (hip internal rotation)
Left obturator/Pelvis examined in similar fashion
110
What 3 CN are you testing with extraocular movements?
III, VI, IV
111
Choroid
vascular layer between the retina and scleral area
112
Visual cortex does processing in the ___ area of the skull
occipital
113
When an athlete presents with concussion, what is sometimes the first symptom they have on the field?
blurred vision
because it impacts the occipital area which is the processing area for vision
114
With latino infants, you'll see thickened ___ which makes it a little more challenging to evaluate muscle balance
thickened epicanthal folds
115
Myopia more common in what 2 ethnicities?
Asian and Filipino-Americans
116
Latino and Asian - retina appears
pale
117
African American - retina appears
dark
118
European - retina appears
reddish or orange
119
what impacts eye during neonatal?
If they need resuscitation or are on oxygen
120
visual changes can be induced in last trimester by
HTN/diabetes
121
medications in older adults that can cause eye issues?
anticholinergics which dry out the eyes, long-term steroids
122
What does 20/20 mean?
You can see at 20 feet what the average person can see at 20 feet
If 20/40, you can see at 20 feet what the average person can see at 40 feet
123
Start doing visual acuity checks at what age? What result would you refer?
age 3
If they’re 20/40 or above
124
Corneal Light Reflex
tests the balance of the extra-ocular muscles.
Light should be symmetrically reflected off the cornea.
125
Cover uncover test
confirms balance of the extraocular muscles and detects unequal refraction in eyes
126
Pupillary reflex
response to light both direct and consensual
Often done in ER if you present with trauma post MVA
127
If glaucoma, they will have a significant change in the _____ of the cornea
curvature
128
Cornea examination
testing the curvature of the cornea by shining the light source obliquely (45 degree angle) - also to evaluate the clarity of the chamber and the lens
129
Red or Retinal Light Reflex (RLR)
Light illuminating from the retina and indicates the clarity of cornea, lens and chamber
130
Normal cup:disc ratio in retina is
<1:2
131
Comparing the arteries vs. veins in retina
arteries are brighter red and narrower than the veins
132
avascular area on the retina with irregular borders
macula
133
area of central vision on macula
fovea centralis
134
chronic exposure to dust/wind/sun can cause ___ which is common in migrant farm workers
pterygium
135
pooling blood in iris caused by trauma to the head
hyphema
136
Always evaluate ___ in UE complaints, and ____ in LE complaints.
neck in UE
lower back in LE
137
Always include neurovascular exam ___ and ____ to the complaint.
distal and proximal
138
What peripheral nerve is compressed/ entrapped/”pinched” in carpal tunnel syndrome?
A. Ulnar
B. Radial
C. Median
C. Median
139
No numbness, tingling, or pain into thumb, 2nd and 3rd digits bilaterally after 60 seconds. What does this mean?
negative Phalen’s bilaterally.
140
Numbness into 2nd digit at 20 seconds on right hand. What does this mean?
positive Phalen’s on right (R=20 seconds at D2)
141
Pain up into left` forearm at 30 seconds. What does this mean?
negative Phalen’s on left
142
Numbness and pain into all digits on right
positive Phalens-all digits on right (but think higher up compression)
143
Guyon’s canal is what nerve?
ulnar
144
Cubital tunnel is what nerve?
ulnar nerve
145
Tarsal tunnel is what nerve?
tibial nerve
146
Numbness, pain or tingling into thumb, 2nd and/or 3rd digits of left` hand (palmar).
– Positive Tinel’s at left carpal tunnel (into thumb)
| – Negative Tinel’s at right carpal tunnel.
147
```
What is the name of bony osteophytes on the DIP joint?
A. Bouchard’s nodes
B. Rheumatoid nodules
C. Heberden’s nodes
D. Tophaceous gout
```
C. Heberden’s nodes
148
Lateral epicondylitis (AKA tennis elbow): the epicondyles are part of what bone?
A. Proximal Ulnar
B. Proximal Radius
C. Distal Humerus
C. Distal Humerus
149
the olecranon is the proximal _____
proximal ULNA
150
High yield questions in MSK presentations (5)
1. Antecedent events leading up to the symptom
(Any acute trauma? Cumulative exposures?)
2. Focus on the functional impact of the symptoms: ADL? Work? Sports? Exercise?
3. Hand dominance?
4. Trying to identify exact location of pathology: is it bone, joint space, tendon/ligament, muscle, bursa?
5. Do not forget about referred pain
151
Key PMH in MSK presentations (6)
* Osteoarthritis?
* Rheumatoid arthritis?
* Fibromyalgia?
* Osteoporosis?
* Cancer?
* Obesity/anorexia?
152
Note that Fluoroquinolone antibiotics (e.g., Ciprofloxacin) have a Black box warning for what?
tendon rupture
risk increases with age
153
Occupational History - Work (“WHACS”) (in/out of home)
W- What do they do for work? (Percent time sitting, standing, lifting, pulling, pushing? How much weight lifted, pushed, pulled?)
H - How do they do it?
A - Anyone concerned about exposures on/off the job?
C - Coworkers with similar symptoms?
S - Satisfaction with work?
154
If you were worried about acute hot red joint....search for what?
```
Search for port of entry for infection:
• Any STD exposure?
• IVDA?
• Dental procedures?
• Abscess/Cellulitis?
• Cystometrics (bladder testing)?
```
155
Example of neck problem that causes acute or chronic referred shoulder pain?
Cervical radiculopathy
156
Example of pulmonary problem that causes chronic referred shoulder pain?
Pancoast tumor of the lung (located in the superior pulmonary sulcus)
157
Example of cardiac problem that causes acute referred shoulder pain?
Angina
158
Example of dermatology problem that causes acute referred shoulder pain?
Herpes Zoster (Shingles)
159
Example of GI problem that causes acute referred shoulder pain?
Ruptured colon after colonoscopy
160
Apley Scratch Test (3 components)
External rotation and abduction (Lift and pat self on back)
Internal rotation and adduction (Touch scapula from behind with opposite arm)
Internal rotation and abduction (Scratch shoulders)
161
4 muscles of the rotator cuff
1. Supraspinatus tendon (posterior)
2. Infraspinatus tendon (posterior)
3. Teres minor tendon (posterior)
4. subscapularis (anterior)
162
Intrinsic risk factors for tendon injury (2)
* Narrowed space under the acromium
| * Excessive physical training with inadequate muscle rest
163
Example of hip issue that could cause chronic referred pain to lumbar spine?
Avascular necrosis of the hip
164
Example of hip issue that could cause acute or chronic referred pain to lumbar spine?
Abdominal aorGc aneurysm
165
Example of hip issue that could cause acute or chronic referred pain to lumbar spine?
Ruptured ovarian cyst or malignancy
166
Example of hip issue that could cause acute or chronic referred pain to lumbar spine?
Acute prostatitis or prostate malignancy
167
Example of hip issue that could cause acute or chronic referred pain to lumbar spine?
Herpes Zoster (Shingles)
168
Example of hip issue that could cause acute or chronic referred pain to lumbar spine?
Pyelonephritis or polycystic kidney disease
169
Straight leg test for lumbar spine (passive)
– 30-60 degrees
– Lower 2 inches to remove hamstring factor
– Dorsiflex ankle
– If painful in lumbar area or down leg, POSITIVE
170
FABER Hip Exam
F: Flexion
AB: Abduction
ER: External Rotation
171
If patient presents with hand pain, always examine the ____
neck
172
4 point approach to the MSK PE
Inspection → Palpation → ROM → Provocative tests
173
Drawer test
pulling the tibia towards you to see if anterior cruciate is intact
if you can open the drawer, it’s positive for a sprain of the ligament which would be grade 1, 2 or 3
complete rupture would be a grade 3 spain
174
Lachman test is very similar to what other test?
Drawer test
175
Focus of the pre-sports participation exam is what?
Injury prevention
176
Carpal tunnel/median nerve compression could be caused by...?
Pregnancy/fluid retention
thyroid disorders
amyloidosis
multiple myelomas → anything that lays down deposits in confined space
Work-related: Repetitive motion, venous congestion, scar tissue
177
Median nerve primarily innervates sensory portions of which fingers?
first, second, third, and palmar ½ of third finger
178
2 provocative tests for carpal tunnel are what?
Tinel’s test
| Phalen’s test
179
Tinel’s test
Percuss reflex hammer over the pillar of the palm - trying to stimulate the numbness/tingling (if they feel it, it would be positive) - positive is reproduction of their paresthesias in D1, D2, D3, or D4
180
Phalen’s test
Forced flexion of wrists (hold wrists against one another) for 60 seconds
If patients say they feel buzzing in a particular hand/digit - you time it - the EARLIER they’re feeling the symptoms, the higher the predictive value that they have carpal tunnel syndrome
If all digits, you might not think CT - maybe think diabetes or compression in brachial plexus
181
Classic symptoms of carpal tunnel:
numbness, tingling, pain, wake up in middle of night with numbness (because we curl up and flex our wrists)
182
thenar wasting/atrophy on the hand is an associated advanced finding of what?
carpal tunnel
183
osteoarthritis
usually symmetrical
common finding with aging
184
Swann neck deformities
(NOT normal but sadly common in rheumatoid arthritis) - subluxation of the joint
185
How do you treat Ganglion cyst?
Hit them with a bible - they’ll rupture and reabsorb
Sometimes they’ll spontaneously reabsorb within 9-12 months
186
Tendons vs. ligaments
Tendons are muscles to bone
Ligaments are bone-to-bone
187
Grade 3 sprain would indicate what
total rupture off the bone - worried about can that person weight-bear off that joint?
188
Remember that you’re supposed to approach a task with your arms ____
supinated
not pronated (protects the elbows)
189
Tennis elbow (Lateral epicondylitis) test
Take the wrist straight in neutral position, make them flex wrist, and have them extend and lift - examiner will apply resisted wrist flexion - if they say “ouch” at the elbow, that’s positive
This is diagnostic for Lateral epicondylitis
Same test for medial epicondylitis
190
septic joint? Think
STI
191
___ is probably most important access point of infection
IV drug use
192
Medial and Lateral Collateral Ligaments...
• A. Prevent the anterior-posterior movement of the tibia
• B. Stabilize the meniscus placement between the femur and the tibia.
• C. Stabilize the lateral motion of the tibia relative to the femur
• D. Prevent the patella from grinding between the femoral condyles.
• C. Stabilize the lateral motion of the tibia relative to the femur
193
Sperm is produced in ___, mature in ___, travel up the ____
testes
Epididymis
Vas Deferens
194
Spermatic Cord is what we examine anatomically, and it contains what 4 things?
arteries, veins, nerves, lymphatics
195
Where Glans meets penile shaft
Corona
196
Opening at tip of glans
Meatus
197
Covers the glans
foreskin
198
Connects foreskin to glans
Frenulum
199
When performing Femoral Vein venipuncture, aim ___ to pulse
medially
200
If there's a Femoral Vein DVT, you would see pain and tenderness in the ____
medial upper thigh
201
If there is an increase in testicular or penile size before age 9, would you refer?
yes, urgent referral
202
If there is an increase in pubic hair before age 9, would you refer?
non-urgent but would refer
203
Delayed puberty in boys is defined as
no increase in penile or testicular size by age 14
204
Ages 40-60 in men sees decrease in testosterone, which leads to what 6 things?
* Takes longer to achieve erection
* Erection maintained longer
* Orgasm may be less intense
* Longer refractory period
* Penile size decreases
* Scrotum more pendulous
205
If there's Dysuria in the Meatus, think
local lesion
206
If there's Dysuria in the Length of penis, think
urethritis
207
If there's Dysuria in the Suprapubic area, think
cystitis
208
What type of incontinence: Leakage w/ exertion, sneezing, coughing
Stress incontinence
209
What type of incontinence: Can’t make it to void; can’t defer urge
Urge incontinence
210
What type of incontinence: Leaks from full bladder or Nocturnal enuresis (bedwetting)
Overflow incontinence
211
Lice vs nits
Nits: stuck on hair base
Lice: move
212
Maculae Ceruleae
bluish spots where lice have fed
213
Foreskin too tight is known as
Phimosis
214
What is it called if the Foreskin is stuck in retraction? Is this an emergency?
Paraphimosis
yes, surgical emergency
215
Fordyce Spots: where are they found? Are they normal?
* From sebaceous glands. Normal. Harmless.
| * Commonly on penis, scrotum, labia, lips
216
Peyronie’s Disease
painful erections
217
Herpes progression
Vesicles / Pustules --> Ulcers --> Crusts
218
If there is a solitary, painless, non-tender ulcer w/ raised borders, think
Primary Syphilis -- Chancre
219
Balanitis
Usually Yeast
Red; not just Smegma
***Itchy
220
Warts with “Cauliflower” appearance are called
Condylomata Acuminata (warts)
221
Pearly Penile Papules (PPP’s) are a ___ variant
normal
222
Penile Enlargement Surgery is or is not approved by Amer. Urological Assoc.
not
223
Average Flaccid Penile Length and girth
length: 9cm
girth: 10cm
224
When would you perform Transillumination of testes?
If unexplained swelling
225
Are Testes usually the same size? Average size? What testis normally hangs lower?
Yes
3.5-5.0 cm. long x 3 cm. x 3 cm.
Left
226
___ in particular is sensitive to touch on PE
Epididymis
227
Testicular Cancer has a : ____ incidence, ___ cure rate. Occurs in men: ___ y.o. 4 main risk factors:
low incidence, high cure rate
15-35 years old
Risk factors: Cryptorchidism, Down’s, Fam. Hx, HIV
228
Do any professional organizations recommend routine screening for testicular cancer?
no
229
Undescended testes/ Cryptorchidism
-- High risk of cancer
| – Common in infancy; 1% of 1 y.o. boys
230
How do you treat Epididymitis-Orchitis? More common in what age?
Cultures and Antibiotics
(maybe IV)
Adults
231
How do you treat Testicular Torsion? More common in what age?
emergency surgery
Kids
232
Varicocele most commonly feels like what? Which side?
Bag of worms
Left side (right side very rare)
it's Varicose veins
usually asymptomatic, can affect fertility
233
Spermatocele
* Fluid-Filled Cyst
* Always superior to testis, posterior aspect
* Palpated as distinct from testis
* Ultrasound if necessary
* No treatment unless big and uncomfortable
234
Hydrocele
* Fluid within scrotal membranes
* Transilluminates (solid masses don’t)
* Usually develop over long period of time
* New acute onset may warrant ultrasound
* No treatment unless uncomfortable
235
If you detect Suprapubic Dullness, think
bladder distention
236
Prostate exam is part of the ___ exam
rectal
237
Perform an inguinal exam only ___
if indicated by history
238
What is the most common type of herniation
Indirect Inguinal Hernia
239
Indirect Inguinal Hernia
* Most common type
* Herniation through internal inguinal ring
* Often not visible
* Can remain in canal or pass into scrotum
* May only be felt during Valsalva
240
Findings of Incarceration or strangulation
very tender
| often nausea / vomiting
241
Rectum is __ cm long and ___ to anus
12 cm long, superior to anus
242
Anus: how long? Lower vs. upper half
• 2.5-4.0 cm long (adult)
* Lower half innervated by somatic sensory nerves
* Upper half under autonomic control – Insensitive
243
internal vs external sphincter
• Internal is involuntary
– Urge to defecate when feces fill rectum
– Reflexive stimulation to relax sphincter
• External is voluntary
244
By 12 months, infants should have ___ stools per day. Control external sphincter by ___ months
1-2
18-24
245
Afferent neurons in rectal wall ___ with aging – interferes with relaxation of internal sphincter
degenerate
246
Aging leads to rectal ___ with stool
distention
– Requires increased pressure to sense stool – Leads to stool retention and constipation
247
Internal sphincter ___ tone with aging
loses
248
Minor vs major fecal incontinence
– Minor: staining w/ flatus or liquid stool
| – Major: involuntary excretion of feces
249
Technique for rectal exam on kids
On back, legs lifted up and held flexed on abdomen
250
“Smooth, firm, symmetrical, sulcus palpable. No tenderness, no nodules.” -
normal prostate
251
“Sulcus palpable” =
Not Enlarged
252
Normal prostate not palpable in __ and ___
Children, Young Adolescents
253
Normal prostate size:
walnut
254
If there is tenderness from local lesion, you might think
Fissure; Perirectal abscess
255
Diffuse Rectal Tenderness -- think
Proctitis
256
Main cause of bladder cancer?
Cigarettes
257
The one orifice you can't get Chlamydia from?
the mouth
258
Highly unlikely to get HIV from __ sex
oral
259
What single question can distinguish Organic etiology (physical causes) from Psychological etiology of erectile dysfunction?
Early morning erections?
260
Retrograde ejaluation (goes back into the bladder) can be a side effect of __ meds
BPH
261
Urethral discharge indicates
STI of some sort
262
Masses of testicular cancer
Hard and fixed
| non tender
263
Best patient position to examine inguinal lymphadenopathy or femoral pulse?
supine
264
Best patient position to examine hernia?
patient standing, examiner sitting
265
Which hernia is more common in women?
femoral
266
5 parts of the neuro exam
1) Mental Status
2) Cranial Nerves
3) Motor and Reflexes
4) Sensory
5) Cerebellar and Gait
267
What is consciousness?
State of awareness of self and environment
268
Wakefulness - what is it, what part of brain is it associated with?
● eye opening (spontaneous or to external stimulus)
| ● in cerebral hemispheres, particularly in cortex --> brainstem and thalamic reticular activating system (RAS)
269
Awareness- what is it, what part of brain is it associated with?
● cognition, affect, memory, and other mental functions
| ● cerebral hemispheres (with RAS)
270
coma definition - how would you test
eyes-closed state of unarousable unresponsiveness
sternal rub, nailbeds
271
To assess wakefulness, choose what tool?
Glasgow Coma Scale
272
What are the 3 parts of the GCS?
eye opening
verbal response
motor
273
Cognitive Impairment and Dementia - 5 components
* Orientation, attention, and memory
* Language impairment
* Visuospatial dysfunction
* Executive dysfunction
* Personality and behavioral changes
274
Vast majority of language impairment is in the ___ hemisphere
left - dominant
275
Visuospatial dysfunction and some forms of attention live in the ____ hemisphere
right/non-dominant
276
Executive dysfunction (ability to solve problems, not perseverate) live ____ lobes
bilaterally in frontal lobes
277
Personality/behavior is ___ distributed in the brain
diffusely distributed in the brain
278
_____ is where motor function lives (picking something up)
prefrontal gyrus in the frontal lobe
279
____ lobes have analog of sensory function (pain, temp, proprioception, light touch, etc.) - sensory association cortex
parietal lobes
280
____ lobe contains auditory processing and comprehension of language, both together important in memory
temporal lobes
281
____ lobe processes visual information that comes in from eyes (eye exam is high-yield part of neuro exam b/c the pathways)
occipital
282
Orientation becomes more fluid going from ____ to ____
eft to right (patients are rarely disoriented to person/often know at base level who they are)
Person, place, date, situation
283
4 components of orientation
Person, place, date, situation
284
How do you assess attention in the general part of the mental status exam?
Digits - 6 forward or 4 backward, serial 7s or 3s
| spelling WORLD backwards and forwards
285
How do you assess memory in the general part of the mental status exam?
— 3 objects: ask patient to remember them, then ask for them at 5 minutes
- “2/3 @ 5 min without cues, 3/3 with cues”
286
___ hemisphere is dominant in nearly all right-handed, most left-handed people
Left
287
Test language carefully if ___ hemiparesis
right
288
Dysarthric
abnormality in motor articulation of speech
289
Testing the left hemisphere/dominant hemisphere for language: 3 components
naming, repetition, comprehension
Indicates lesions in various areas/lobes
“No ifs, ands, or buts about it”
290
___ hemisphere controls Neglect and Visuospatial Function
Nondominant Hemisphere -- right
291
___ hemisphere is the non-dominant hemisphere in nearly all righties, most lefties
Right
292
Test for neglect syndromes carefully if ___ sided hemiparesis
left
293
striking, memorable syndromes (3) of there being an issue in the Nondominant (right) Hemisphere relating to Neglect and Visuospatial Function
anosognosia
asomatognosia
hemispatial neglect
294
anosognosia
can’t articulate what’s wrong with them (can’t articulate that they have paralysis in one arm)
295
asomatognosia
don’t recognize their own hand
loss of recognition or awareness of part of the body
296
Hemispatial neglect
not moving left side of body, head turned to right
characterised by reduced awareness of stimuli on one side of space, even though there may be no sensory loss
297
4 points of exam of Nondominant (right) Hemisphere relating to Neglect and Visuospatial Function
- constructional apraxia (inability of patients to copy accurately drawings or three-dimensional constructions)
- agraphesthesia (can’t tell what shape being drawn in hand)
- extinction
- neglect clock
298
symptoms of Frontal lobe dysfunction (4)
disinhibited, slow, concrete, perseverative
299
Mini-Mental Status Exam -- how many points are there? Whats the cutoff score? What are the limitations?
- 30 point scale that’s a screening battery
- Typical cutoff is 24 (below that is considered cognitively impaired)
- Limitations: education level, language, NOT diagnostic
- Should not be used for anyone under 8th grade school level
300
Causes of anosmia:
- head trauma
- early Parkinson’s
- normal aging
- URI, meds, and many others
301
Is CN I (olfactory) tested in clinical?
Not really/rarely
302
How do you test CN I (olfactory)? What is the primary symptom of CN I (olfactory) dysfunction?
Test with aromatic, not noxious, compounds.
sx: anosmia
common and underrecognized consequence of traumatic brain injury
303
Note that anosmia can diminish ___ and is associated with ___
taste
weight loss in the elderly
304
CN I (olfactory) is not a peripheral nerve but a ___
CNS tract
305
CN I
olfactory
306
CN II
optic
307
CN III
oculomotor
308
CN IV
trochlear
309
CN V
trigeminal
310
CN VI
abducens
311
CN VII
facial
312
CN VIII
vestibulocochlear - auditory
313
CN IX
glossopharyngeal
314
CN X
vagus
315
CN XI
spinal accessory
316
CN XII
hypoglossal
317
CN II (optic) is not a peripheral nerve but a ____
CNS tract
318
What is the only part of the nervous system that you can directly look at
CN II optic
319
CN II is the ___ limb of the pupillary reflex
afferent
320
4 components of CN II assessment
- Check acuity: “+C” (if possible) - eye card
- Fundi
- Pupillary reflex
- Visual fields (also tests optic chiasm & optic radiations to occipital lobe)
321
Large lesions in the optic chiasm will take out the ____ fields of both eyes (bitemporal hemianopsia)
outer
322
If there's a lesion behind the optic chiasm, there will be a loss of the ___ optic fields
homonymous
323
If there's a lesion behind the ____ lobe, the patient will have difficulty with less visual field in each eye
right occipital
324
Is Binasal hemianopsia rare?
yes
325
CN 3 (oculomotor), 4 (trochlear), 6 (abducens) are the ___ to extraocular muscles
motor
326
CN ___ is levator palpebrae, pupillary sphincter
3
327
Eye muscles: Lateral rectus muscle corresponds to CN ___ = 6
Superior oblique = 4
Everything else is 3
6
328
Eye muscles: Superior oblique muscle corresponds to CN ___
4
329
CN ___ is the efferent limb of the pupillary reflex
3
330
Assessment of CN 3, 4, 6
- PERRL (pupils equal, round, reactive to light)
- ptosis
- Ask patient to track your finger in “H” shape: eyes should move smoothly & conjugately
331
Ptosis would be present if there’s a ___ palsy
3rd nerve
332
3 divisions of the trigeminal nerve
VI Ophthalmic
VII Maxillary
VIII Mandibular
333
Sx of CN 3, 4, 6
diplopia, that goes away if they close one eye
334
CN V trigeminal is ____ to the face and ___ to the temporalis muscle and other muscles of mastication
Sensory to face
motor to the muscles
335
Positive and negative CN V (trigeminal) symptoms
numbness (negative), pain or paresthesias (positive)
336
CN V (trigeminal) is the ___ part of the corneal reflex
afferent
337
How to assess CN V (trigeminal)
Touch on both sides in all 3 divisions (not easy to do in patient who isn’t cooperative)
To check motor: bite down while palpating
338
CN VII (facial) is ___ to the muscles of facial expression. It's also the ___ part of the corneal reflex.
motor
efferent
339
Symptoms of CN VII (facial) dysfunction
- weak face
- labial dysarthria (manifests as P and B sounds - they’ll get gutturals or linguals but can’t say Pa Pa Pa)
- hyperacusis
- loss of taste in anterior 2/3 of tongue
340
How to test the corneal reflex
touch cornea with cotton swab - eyes closing consensually
341
How to assess CN VII (facial)
Raise eyebrows
Close eyes tightly
Smile
Say pa-pa-pa, ba-ba-ba
note that nasolabial fold asymmetry on one side would be problematic
342
Upper vs Lower Motor Neuron Facial Weakness: Weak right face could indicate what 2 things?
Either problem with the right CN7 (aka a LMN facial weakness
OR
Problem on left mid-pons/brainstem or above the medulla (UMN facial weakness)
343
If a patient is very weak on the right side, the forehead will be
smooth
344
LMN lesions involve the upper and lower face ____, while UMN lesions tend to relatively spare the ___ part of the face
symmetrically
upper
so if a patient really can’t close their eye, that’s probably a lower motor neuron lesion -
give them eye drops and eye patch so they don’t dry out the cornea
345
Sx of CN 8 (Vestibulocochlear - Acoustic) (4)
hearing loss, tinnitus, vertigo, imbalance
346
Assessment of CN 8 (Vestibulocochlear - Acoustic)
Compare whisper or rubbed fingers side to side.
May see nystagmus when checking extraocular movements.
347
CN 9 (glossopharyngeal) and 10 (vagus) are the ____ and ____ of pharynx, with autonomic functions. Also the ___ reflex
sensory and motor
also gag reflex
(important in patients that are comatose, may help to decide if they need to be intubated)
348
Sx of CN 9 (glossopharyngeal) and 10 (vagus)
```
dysphagia,
palatal dysarthria (K and G sounds are sloppy)
```
349
How to assess CN 9 (glossopharyngeal) and 10 (vagus)
“Say ah:” uvula deviates AWAY from affected side
Say ka-ka-ka, ga-ga-ga (gag reflex)
350
CN 11: Spinal Accessory is ___ to trapezius and sternocleidomastoid
motor
351
Sx of CN 11 dysfunction:
shoulder weakness, pain
352
How to assess CN 11
Ask patient to:
Shrug
Turn head side to side against resistance
353
If there is an issue with right CN 11, the patient will ____
Raise R shoulder Turns head to L
354
CN XII Hypoglossal is ___ to the tongue muscles
motor
sx: lingual dysarthria Ask patient to:
Protrude tongue: deviates toward affected side (with atrophy if chronic)
Say la-la-la
355
Sx of CN XII Hypoglossal dysfunction
lingual dysarthria - motor speech disorder
sometimes trouble swallowing
356
How to assess CN XII Hypoglossal
Protrude tongue: deviates TOWARDS affected side (with atrophy if chronic)
Say la-la-la
357
Pupillary reflex: afferent is CN ___, efferent is CN ___
a: 2
e: 3
358
Corneal reflex: afferent is CN ___, efferent is CN ___
a: 5 (VI)
e: 7
359
Gag reflex: afferent is CN ___, efferent is CN ___
a: 9
e: 10
360
single cranial neuropathies
Bell’s
DM CN 6 palsy
(many others)
361
multiple cranial neuropathies could signal issue in the
subarachnoid space?
362
If you see multiple neuropathies, are they all in the same side, which might indicate ____ or ____?
a mass in subarachnoid space or compression in skull where nerves run together
363
If you see multiple neuropathies, are they in multiple levels on different sides, which could indicate ____?
Chronic meningitis
364
Multiple neuropathies on long tract sides, think ____
Problem in brainstem bc nuclei live here and long tracts
365
Weak in limbs and only motor impairment in cranial nerves, think ___ problem
motor
366
3 long tracts
corticospinal (motor)
spinothalamic (sensory) - carries pain and temp
dorsal column (sensory) - carries proprioception
367
If it’s UMN weakness - ___ and ___ are common early signs
stiffness and spasticity
368
When performing the motor exam and reflexes, you're assess motor system function of
corticospinal tract + motor unit (also extrapyramidal system)
369
When performing the motor exam and reflexes, can often assess ____ of weakness by history
pattern
| distal vs proximal, generalized, focal
370
Proximal weakness complaints example
they might tell you they do ok walking on flat surface but have trouble getting upstairs, because they’re having weakness in hip girdle muscles
371
Distal weakness complaints example
buttoning buttons, zippers
372
Lower extremities weakness example
catching toe on stairs bc you can’t dorsiflex foot to clear the step
373
For EPS (extra pyramidal symptoms) ___ is key
DISTRIBUTION knowledge is key i.e. is it right side, left side, both sides? Legs, arms, both? Proximal, distal, both?
374
EPS
Slow to move (Parkinson’s)
tremor
myoclonus (jerk/twitching)
chorea (jerky movements of shoulder/hip/face)
375
Parts of the motor exam:
1. Inspect: atrophy (and fasciculations)
abnormal movements: tremor, chorea,
myoclonus vs paucity of movement
2. Palpate: tenderness
3. Examine:
- tone
- pronator drift and dexterity (finger/toe taps):
- sensitive corticospinal tract tests
- reflexes
- strength testing
376
tendon reflexes may diminish with ___, especially Achilles
age
age 65 or so - not pathological
377
pathological Babinski (toe goes up) is a ___ sign
UMN
tends to be confirmatory rather than hanging diagnosis on in isolation
378
Increased tone (hypertonia) is ____ sign
UMN
379
Decreased tone (hypotonia) is ___ sign
LMN
380
____ is a very sensitive sign of corticospinal tract dysfunction
Pronator drift (hold arms up and close eyes)
381
are there are nerve roots that don’t have reflexes that are associated with it?
yes
382
Achilles reflex may also be abnormal in patients with peripheral neuropathies, even if it’s subclinical -- examples (4)
long-standing diabetes, alcoholism, advanced HIV, neurotoxic chemotherapy
383
Documenting DTRS is a ___ grading. What grade is "normal"?
```
0 absent
1+ diminished
2+ normal
3+ increased
4+ transient clonus
5+ sustained clonus
```
384
“Breakway” weakness suggests
poor effort
385
UMN weakness
“pyramidal” (anti- gravity muscles
| relatively spared)
386
UMN atrophy
miminal or absent
387
UMN fasiculations
absent
388
UMN tone
increased
389
UMN reflexes
increased
390
UMN Babinski
present
391
LMN weakness
myopathy: proximal polyneuropathy: distal focal: root, plexus, nerve
392
LMN atrophy
prominent, especially if peripheral nerve
393
LMN fasciculations
present in motor neuron disease (rarely neuropathy)
394
LMN tone
diminished or normal
395
LMN reflexes
diminished or normal
396
LMN Babinski
absent
397
MRC scale (strength):
```
0 no contraction
1 contraction, no movement
2 movement without gravity
3 movement against gravity
4 with resistance (4- to 4+)
5 normal
```
398
Spinothalamic tract - carries what?
pain, temperature
399
Dorsal column - carries what?
vibration, proprioception, Romberg
400
Cortical modalities (2)
- Graphesthesia (recognize writing on hand)
| - Stereognosis (can say what the object is with eyes closed)
401
C2 and 3 are above the ___
neck
402
C3 and 4 are ___
shoulder
403
Sensory exam is best interpreted in context of ___, ___, or both
in context of sensory symptoms, motor signs, or both
404
Brown-Séquard syndrome
incomplete spinal cord lesion
patient who was, say, stabbed in the back at the thoracic level
they will have:
- Pain/temp down on contralateral side
- Diminished proprioception and weakness on ipsilateral side
405
B12 deficiency or balance issues - check ____
proprioception
406
What 3 symptoms may indicate cerebellar dysfunction?
Dysarthria, nystagmus or hypotonia
407
How to assess Cerebellar hemispheres:
finger-nose-finger, heel-knee-shin, rapid alternating movements
408
How to assess Midline cerebellum:
truncal, gait ataxia
409
signs of early gait ataxia
gait appears normal, with impaired tandem (can occur with advanced age)
410
signs of late gait ataxia
broad-based gait (think EtOH intoxication)
411
hemiparetic gait
problem with unilateral corticospinal tract
412
scissoring gait
problem with bilateral corticospinal tract
413
waddling gait
problem with proximal weakness (myopathy)
414
steppage gait
problem with distal weakness (neuropathy)
415
Considerations in assessing gait: (4)
age, pain, injury (acute or old), medications
416
___ and ___ are sensitive long tract signs
Drift and dexterity
417
High yield parts of the neuro exam: (3)
eyes, reflexes, gait
418
Good idea to check CN with ____ exam
HEENT
419
Check strength ___ tone and TRs
after
420
Arm + leg Face + arm (+/-leg): think
cord or brain
421
Face + arm (+/-leg) Hemiparesis: think
aphasia if right, neglect if left
422
Which of the following is NOT a normal finding upon ophthalmoscopic examination?
A. A cup to disk ratio of <1:2
B. Dark red veins larger than bright red arteries
C. An avascular macula with an irregular border
D. An optic disc with diffuse margins
D. An optic disc with diffuse margins
423
```
Pain of duodenal or pancreatic origin may be referred to the:
A. right shoulder
B. epigastric region
C. back
D. right flank
```
C. back
424
```
Your client presents with a complaint of worsening abdominal pain over the past few hours, beginning as mild and now severe. The pain is described as being in “my whole belly.” Physical examination reveals rebound tenderness upon palpation of the right lower quadrant. You suspect:
A. Acute cholecystitis
B. Acute diverticulitis
C. Appendicitis
D. Small bowel obstruction
```
C. Appendicitis
425
Risk factors for abdominal aortic aneurysm (AAA) include:
A. Age 65 or older
B. Smoking history
C. First-degree relative with a history of AAA repair
D. All of the above
D. All of the above
426
Which of the following is NOT a normal finding upon digital rectal examination?
A. Smooth prostate gland with palpable sulcus
B. Tarry stool on the examiner’s gloved finger
C. Walnut-sized prostate gland
D. Palpation of two sphincters within the anal complex
B. Tarry stool on the examiner’s gloved finger
427
```
Which of the following is a urological emergency?
A. epididymitis
B. varicocele
C. testicular torsion
D. hydrocele
```
C. testicular torsion
428
```
Impulse control is located in which lobe?
A. temporal
B. frontal
C. occipital
D. parietal
```
B. frontal
429
```
Which cranial nerve is affected in Bell’s Palsy?
A. V
B. VI
C. VII
D. VIII
```
C. VII
430
```
Upper motor neuron lesions presents with:
A. hypertonia
B. hypotonia
C. muscle atrophy
D. fasciculations
```
A. hypertonia
431
```
Significant anterior excursion of the knee (positive Lachman’s test) indicates an injury to which ligament?
A. Anterior cruciate
B. Posterior cruciate
C. Medial collateral
D. Lateral collateral
```
A. Anterior cruciate
432
```
Which type of skin cancer consists of more mature cells that usually resemble the spinous layer of the epidermis?
A. basal cell carcinoma
B. squamous cell carcinoma
C. melanoma
D. kaposi’s sarcoma
```
B. squamous cell carcinoma
433
```
Hypopigmented macules that appear on the face, hands, feet, extensor surfaces, and other regions and may coalesce into extensive areas that lack melanin suggest:
A. café-au-lait spot
B. seborrheic dermatitis
C. vitilgo
D. cyanosis
```
C. vitilgo
434
Where is McBurney's point? important for appendicitis
halfway between the umbilicus and the right iliac crest
435
Description of skin condition should always include what 5 points?
1. Primary lesion (i.e. papule)
2. Secondary change (i.e. scaly) or absence of Color
4. Size, shape, demarcation
5. Configuration, Distribution (rash) or location (growth/lesion)
436
Primary morphology: Smaller than 1cm + completely flat (non- palpable)
Macule
437
Primary morphology: Greater than 1cm + completely flat (non- palpable)
Patch
438
Vitiglio is an example of a
patch
439
petechiae is an example of
Macules
440
Primary morphology: Smaller than 1 cm, Raised (palpable), may be thin ("flat topped") or thick ("dome-shaped")
Papule
441
molluscum is an example of
Papules
442
Primary morphology: Greater than 1 cm, Raised (palpable)
plaque
443
psoriasis is an example of a
plaque
444
____ = smaller than 1 cm, serous or bloody fluid
Vesicle
445
____ = greater than 1cm, serous or bloody fluid
Bulla
446
____: always under 1cm, purulent fluid
Pustule
447
Zoster is an example of
vesicles
448
bullous pemphigoid is an example of
Bulla
449
pustular psoriasis is an example of
Pustules
450
When the epidermis is partially removed, this is an ___; fully removed would be an ____
erosion
ulcer
451
pyoderma gangrenosum is an example of an
ulcer
452
Primary morphology: Dome-shaped growth > 1cm, May be above or below skin surface
nodule
453
keratoacanthoma is an example of a
Nodule
454
Secondary changes are adjectives to describe the ___ of primary morphology
surface
455
Ring-shaped but clear in the center would be what?
Annular
456
Coin-shaped solid circle would be what?
Nummular
457
erythema multiform is an example of a ____ shape lesion
Targetoid
458
cutaneous larva migrans is an example of a ____ shape lesion
Serpiginous
459
lichen planus is an example of a ____ shape lesion
Polygonal
460
subacute cutaneous lupus is an example of a ____ shape lesion
Arcutate
461
Atopic dermatitis is often on the ___ parts of the body
flexural (like backs of knees)
462
Psoriasis is often on the ___ parts of the body
extensoral (backs of elbows)
463
Primary lesions of Dermatitis a.k.a Eczema are _____
Ill-defined erythematous papules/plaques of highly variable size and spacing
464
If Dermatitis a.k.a Eczema appears wet/weeping with microvesicles/round crusts or combination scale/crust, you know it's what stage?
Acute
465
If Dermatitis a.k.a Eczema appears dry, scaly and lichenified, you know it's what stage?
chronic
466
History for Dermatitis a.k.a Eczema is almost always ___
itchy
467
Tx for Dermatitis a.k.a Eczema
steroids/gentle skin care
468
Nummular eczema vs Tinea
Solid circle is more consistent with eczema
Ring (clearing in the center): Tinea - almost concentric circles (ripple-like effect)
469
a flake, a build up of stratum corneum or dead skin on the surface of the lesion
scale
470
dried fluid (serum, blood, pus)
crust
471
shiny, cigarette paper type wrinkling
atrophy
472
accentuation of the skin markings due to chronic rubbing and scratching - kind of like a callous - this is itchy
Lichenification
473
True red erythema
think neutrophils, cellulitis is an example
474
Purple erythema
lymphocytic inflammation
475
Red-brown erythema
granulomas
476
superficial (melasma) is what kind of brown
Muddy-tan brown
477
Tindle effect
more transmission of the blue tones so that’s why we see grey when we have a deeper lesion
478
Most tinia will be what shape?
annular
479
Ezcema is what shape
nummular
480
Koebner phenomenon
Papules in linear fashion - lesions pop up along the line where it was scratched
481
Koebner phenomenon
Papules in linear fashion - lesions pop up along the line where it was scratched
482
Seborrheic
hair-bearing areas of the skin: scalp, eyebrows and globella, nasal creases, beard region for men, then hair areas in chest, genitals, etc.
483
Photodistributed
accentuated where the sun hits exposed skin
484
Flexures
crooks of arms
485
Extensors
elbows and knees
486
Inverse
affect the body folds like trunk, under breast, armpits, groin
487
Is there any utility in biopsy for dermatitis?
no
488
small eczematous papules - very specific areas - finger webs, wrists, umbilicus/waist, genitals, ankles
scabies
489
honey-colored crusting or pustules superimposed on dermatitis/eczema would indicate
staph infection
490
Tinea
= dermatophyte
* Scale, erythema, omen papules at the leading edge of the plaque
* Not always annular– omen “waves” of papules expanding concentrically like ripples in a pond
491
Example of Class I topical steroid to tx dermatitis
Clobetasol
492
Example of Class II topical steroid to tx dermatitis
Fluocinonide
493
Example of Class III topical steroid to tx dermatitis
Triamcinolone 0.1%
494
Example of Class V topical steroid to tx dermatitis
Desonide
495
Example of Class VI topical steroid to tx dermatitis
Hydrocortisone 2.5%
496
Example of Class VII topical steroid to tx dermatitis
Hydrocortisone 1%
497
Topical steroids come in Class IX- VII, with Class I is ____, VII is ____
I is strongest
VII is weakest
498
Face, axillae, groin– use topical steroid class ___ or weaker
V
499
Hands, feet, elbows, knees– use topical steroid class ___ or stronger
III
500
Primary morphology of Psoriasis
well-marginated scaly papules/plaques (“papulosquamous” reaction pattern)
501
With Psoriasis, there is often no scale on ____ skin
moist intertriginous
502
Psoriasis treatment depends on what 4 things
- body sites involved
- type of psoriasis
- body surface area
- presence of arthritis
503
Treatment for dermatitis/eczema
Bathe daily with lukewarm water - no soap or very gentle soap like Dove only to armpits and groin
Follow bath with grease up in something thick - oily emollient to trap the water - Aquaphor, Vaseline, coconut oil (eucerin, cerave) - scoop out from jar rather than pump
topical steroids if necessary
504
for infant less than a year, use class ___ or lower of topical steroids
V
505
Benign: Brown/pink/white/yellow lesion, very common, warty sticker-like
Seborrheic keratosis
506
Benign: Bright red/pink/purple dilations in the skin - occur with aging
cherry angioma
507
Benign: Face/hands - “age or sun spots” - from sun damage
solar lentigines
508
As moles age, they go from flat and brown to dome-shaped, flesh toned, and lose pigment-- becoming
Benign intradermal nevis
509
4 main types of Malignant neoplasms
Melanoma
Squamous cell carcinoma
Basal cell carcinoma
Actinic keratosis - precursor to squamous cell carcinoma
510
If they’ve already had a skin cancer, are they much more likely to have another?
yes
511
classic “drug eruption” presentation
Pink macules/papules that look like measles
N270: Advanced Health Assessment [Fall 2016]
flashcards
Decks in class (2)
# Cards
