General Appearance, Vital Signs, Skin, Hair, Nails, Head, Neck, and Mental Status Flashcards
General review of systems
Weight loss or gain Fatigue Fever or chills Muscle weakness Night sweats
Skin
Skin changes Rashes Lumps Itching Dryness Color Change
Change in nevi (moles)
Color
Shape
New
weight gain caused by
Excess body fat Edema Ascites Endocrine disorders Medication side effects
what do you do when a patient has gained weight?
Diet?
Physical activity?
Weight loss attempts?
Psychological conditions?
Screen for endocrine disorders
Take a medication history
ALWAYS determine the time frame
for weight gain voluntary or involuntary?
Anorexia-
Loss of desire to eat, could be a sick patient w/ a terminal illness
Anorexia nervosa
Disorder marked by extremely low body weight and distorted body image.
Bulimia-
Disorder characterized by recurrent binge eating and compensatory behaviors to prevent weight gain such as excessive exercise or vomiting
weight loss follow up questions?
Has your appetite increased or decreased?
How long have you been losing weight?
How do you feel about the way you look?
What is your typical diet?
fatigue
common symptom of illness is a Lack of energy to complete tasks, exhaustion, tiredness May signify underlying medical (anemia, thyroid disorder, cardiac ischemia) or psychiatric disease (depression
Affected everyday activities? Time course? Modifying factors? Personal and social issues? was there anything else going on at this time or feel similar?
fatigue differential diagnosis
Anxiety/depression Systemic diseases Infections Cancer Medications And others!
Persistent fatigue
Chronic fatigue
Idiopathic fatigue
persists for more than 1 month
for 6 months or more
not attributed to a psychiatric or medical illness
muscle weakness
Categorized according to anatomic location causing the weakness Muscle Spinal nerve root Peripheral nerves Brain or spinal cord Upper/lower motor neurons disease
Primary muscle or neurologic disorders
Other systemic
diseases
Duration of symptoms? Evolution of symptoms? Distribution of symptoms? Associated signs and symptoms? Risk factors?
Functional weakness
- No true muscle weakness, but this interferes with completing activities of daily living.
True motor weakness
- Difficulty or inability to perform certain tasks. Example: patient that has difficulty rising from a chair.
Normal Temperature
Average oral temperature:
37°C or 98.6°F
Diurnal variation: 35.8°C (96.4°F) to 37.3°C (99.1°F)
temperature lower during sleep
Fever-
Fever of unknown origin (FUO)
Chills-
Temperature over 99 °F during the day and over 100 °F in the evening
- Temperature over 100.9 °F for 3 weeks with no clear etiology.
Involuntary muscle contractions with violent shivering and teeth chattering.
Fevers/chills caused by
Infection Malignancy (can cause night sweats) Inflammation Medications Post-op (chills after anesthesia because of changes in body temp. Endocrine disorders (hypothyroidism)
When someone has fevers/chills ask about?
Alarm symptoms- Rash, SOB (meningitis), chest pain, change in mental status.
Sick contact
Time course (how long has this been going on for)
Associated symptoms
Flushing-
Hot flashes
Hyperhydrosis
Night sweats
Acute onset of cutaneous vasodilation. ex. steroid reaction found in torso or head and can be found in periphery
- Sudden feelings of warmth, sweating. feels like flushing or may accompany it ex. menopause
- Increased sweating beyond necessary to maintain thermal homeostatis. ex. usually caused by medication
- Drenching sweating occurring during sleep requiring the patient to change clothes or bedding in absence of fever or environmental factors. Serious until proven otherwise if… New, Accompanied by Systemic Symptoms (weight loss, lymphadenopathy, cough). Clinical context is crucial! Ask about known co-morbid illnesses, travel/ exposure history.
ex. women going into menopause, red flag for undiagosed malignancy around once a week or once a month, hyperthyroidism, can be caused by medication taken at odd times
Night sweats are caused by
should be asked about?
Hormonal changes GERD Sleep disorders Medications Infection Malignancy inflammation
Alarm symptoms- Weight loss, lymphadenopathy, new symptoms in any organ system.
Bedding , night clothes, medications
Social history that might indicate TB, HIV, hepatitis
what are you looking for in general appearance?
Level of consciousness Apparent state of health Signs of distress Height (stature) and build (habitus) [weight] Skin Dress, grooming, and personal hygiene Facial Expression Odors of body and breath Posture, gait and motor activity
Level of Consciousness factors
Alert- Eyes open; responds appropriately.
Lethargic- Appears drowsy; can open eyes; makes eye contact, responds then may fall asleep.
Obtunded- Can open eyes; responds slowly but is confused; decreased interest in environment.
Stupor- Arouses from sleep only after painful stimuli is utilized; slow to no responses; lapses into unresponsiveness when stimuli is removed.
Comatose- Remains unresponsive to external stimuli.
General appearance
Well appearing Acute or chronically ill Frail Robust vigorous
signs of distress include
clutching chest (cardiac or respiratory)
guarding (indicating pain)
frazzled (anxiety/depression)
Height (stature) and build (habitus) [weight]:
Is the patient unusually short or tall? Is the build slender and lanky, muscular, or stocky? Note general body proportions and look for deformities
- short stature (turner syndrome, renal failure, achondroplastic and hypopituitary dwarfism, long limbs in proportion to trunk in hypognoadism and marfan syndrome height loss in osteoporoisis and vertebral issues; truncal fat w/ thin limbs suggests cushing syndrome
marfan syndrome
connective tissue disorder ex. causing fatal aneurysm from lack of tissues and is very lax
Cushing syndrome
C6-C7 vertebrae with fat pad buffalo hump, facial hair, lines on abdomen, osteoporosis ex-or-endogenous cortisol, when take prednisone a lot, something that develops, pituitary or adrenal adenoma. skinny arms and truncal fat
- increased adrenal cortisol production of cushing syndrome produces round moon face w/ red check w/ excessive hair growth in mustache, sideburn areas, and chin.
general appearance
Skin color and obvious lesions: Brief inspection of exposed skin. Full integument exam later. Looking for: pallor cyanosis Jaundice (icterus) rashes bruises
facial expression
Observe at rest, during conversation, during the physical exam, and during interaction with others
Note eye contact
Look for appropriate changes in facial expression (mask facies is parkinson disease symptom)
natural eye contact, sustained or unblinking, averted quickly or absent? stare of hyperthyroidism, immobile of parkinsonian, flat or sad of depression;
Posture, gait, and motor activity functions
gait steady or unsteady, unassisted? how fast are they moving, involuntary movements w/ preferred posture
posture-sit as if in pain or uncofmroatble, gait & motor activity-tremors, involuntary movement, smooth or self confidence walking w/ balance?
Gaits: spastic scissors propulsive steppage waddling
upper neuron issues after stroke for spastic and scissors
propulsive- spinal stenosis parkinson hurts to go straight
steppage- can’t dorsiflex foot usually w/ a lesion of L5
waddling- hip issue or duck gait
Palpating temperature –
better accuracy using dorsum of examiner’s hands if it is cold and clammy how does it compare to other areas
Places to get a temperature
Axillary (least accurate hold thermometer for 5-10 minutes least accurate
Oral-most commonly used
Temporal Artery- common higher than normal
Rectal Membrane- best and most accurate way to measure temperature inserting toward umbilicus
Tympanic- common higher than oral clean out wax
Hyperthermia
Hyperpyrexia-
Hypothermia-
Fever-
Elevation in body temperature due to loss of homeostatsis with inability to increase heat loss.
Extreme elevation in temperature above 106 degrees F. excessively high temperature above 106F severe illness, crush injury, malignancy, drug reactions, and immune disorders (collagen and vascular diseas)
Abnormally low temperature; below 95 degrees F when taken rectally. abnormally low temperature caused by exposure to cold, paralysis, sepsis alcohol starvation, hypothyroidism, and hypoglycemia
Elevated temperature 38 degrees C (100.4 degrees F) Rectally.
Arterial Pulse Measurement
An assessment of heart rate Radial or other locations Palpate for pattern (rhythm) Regular or irregular Palpate for intensity (strength) Weak, brisk (normal strong), or bounding If regular rhythm and normal rate count for 30 seconds and multiply by 2. If abnormal or irregular, count for a full 60 seconds. do early beats appear in a basically regular rhythm? does irregularity vary consistency w/ respiration? is is irregularly irregular Normal adult range: 60-100 beats/minute
Respiratory Rate
Count the respirations by watching the chest rise and fall. can have retractions It is more accurate if the patient does not know you are counting. expiration prolonged COPD Observe Rate: Normal 12 to 20 breaths/minute Rhythm: Regular, Irregular Depth: Shallow, Deep Effort: Gasping, Labored
Blood Pressure Cuff Measurement
Width of bladder: 40% of upper arm circumference
Length of bladder: 80% of upper arm circumference. arrows of arm width must fall in range for proper measurement.
If the cuff is too narrow, the reading will be high
If the cuff is too wide, the reading will be low on a small arm and high on a large arm
Optimal conditions for taking blood pressure
higher in first thing in the morning, do both arms, must do after multiple visits and if high double check before leaving.
Preparation is vital!
Avoid smoking, caffeine, exercise 30 minutes prior to measurement. (increases rate, cause inflammation in vessels)
Quiet examination room with comfortable temperature.
Arm free of clothing.
Ask the patient which arm they prefer. Avoid using side with a fistula, lymphedema, lymph node excision, extensive scarring or other abnormality.
Patient should sit quietly in a chair for at least 5 minutes prior; back supported and feet on the ground.
List the steps for obtaining an accurate blood pressure, and describe the consequences if proper technique is not observed.
Palpate the brachial artery (antecubital crease; medial to the biceps tendon)
Position the arm so that the brachial artery is at heart level
Rest the arm on a table a little above the patient’s waist OR support the patient’s arm with your own at their mid-chest level
Proper cuff location (2.5 cm above antecubital crease)
Secure the cuff – snug, not tight.
Palpate the radial pulse and inflate the cuff until it disappear Remember this number (systolic BP by palpation).
Deflate the cuff; wait 15-30 seconds.
Place your stethoscope lightly over the brachial artery
Hold arm at level of patient’s heart, and reinflate the cuff 30 mm Hg higher than the systolic number obtained by palpation.
Deflate the cuff at a rate of 2-3 mmHg/second
First sound = systolic blood pressure two consecutive sounds
Disappearance of sound = diastolic blood pressure except when there is an auscultatory gap
Orthostatic blood pressure
Measure blood pressure and
heart rate in two positions
1) Check BP with patient supine after resting 3-10 minutes
2) Wait three minutes
2) Check BP immediately when patient stands up patient usually gets dizzy
Normal: systolic ≤ initial ; diastolic rises slightly
Orthostasis: systolic BP drops ≥ 20 mmHg or diastolic BP drops ≥ 10 mmHg, pulse increases ≥ 20 beats/min
*In some settings it is routine to do this in 3 positions (supine, sitting, standing).
drop in systolic blood pressure of at least 10 mmHg w/in 3 minutes of standing caused by drugs, blood loss, bed rest, and ANS diseases
caused by Medications; Polypharmacy
Moderate or severe blood (or other fluid) loss dehydration
Prolonged bed rest
Autonomic and cardiovascular disorders
Types of hypertension
White Coat- Elevated BP in a clinical setting but not elsewhere. blood pressure >14090 in medical settings and mean awake home readings of 135/85 caused by stress of being in a medical environment
Masked- Normal office BP; but BP elevated when ambulating and at home. Increased risk of cardiovascular disease and organ damage. ex. if you have headache, dizziness, and other common signs of HBP have pt check home or have moving pressure. office blood pressure <140/90 elevated daytime blood pressure above 135/85 at home 10-30% of population w/ increased risk of cardiovascular disease and end organ damage
Nocturnal hypertension
Normally a physiologic dipping of BP occurs when shifting from wakefulness to sleep. With this type of HTN, a nocturnal fall of less than 10% of daytime values is associated with significant risk of cardiovascular disease and organ damage. Only identified by 24 hour monitoring. caused by vascular changes in eyes, headache, and dizziness
Blood pressure measurement
Measurement of BP in both arms at least once
Difference of pressure should be no more than 10 mm Hg per side
Diagnosis of Hypertension: Two or more properly measured BP readings taken on two or more office visits and verified in contralateral arm.
auscultatory gap
start to hear systolic pressure, disappears and then it comes back, at risk for cardiovascular instance, buildup of plague or aneurysm check doing BP while arm is raised and lower while you deflate, or have them make a fist
why do we check both arms for blood pressure?
check both sides if there is a difference of more than 10 mmhm can be caused by aneurysm or stenosis
pain is…
subjective with pain feeling different to each person. find out more by OPQRST
when did it start, at what point is it worse or better, associated sensory loss, other neurological symptoms setting in which it occurs (environmental, emotional) remitting or exacerbating factors what makes it better or worse, associated manifestations
Idiopathic
Neuropathic
Nocioceptive (somatic)
Psychogenic
– Without identifiable etiology
– Direct consequence of lesion or disease affecting somatosensory system ex. disc hernia
– Linked to tissue damage but sensory system is intact
– Associated with psychological factors
ex. if patient states 10/10 and is not in distress could be psychogenic
somatic
visceral
neuropathic
Sharp, stabbing, localized
Deep, achy, poorly localized
Burning, hot, distribution of nerve
actue pain
chronic pain
short lived
lasting at least 12 weeks
- Compare and contrast different methods of obtaining a patient’s temperature.
Oral- most commonly used and for adults correlate more closely w/ correct pulmonary artery temperature are generally lower than core body temperature and lower than core body temperature by (0.7-0.9F) higher than axillary by 1 problems caused by breathing
Rectal- most closely and more reliable because closer to core and not affected by breathing
Temporal- for adults correlate more closely w/ pulmonary artery temperature but are about 0.5C lower, using temporal artery
Axillary- take 5-10 inutes to register and are much less accurate than other measurements
Tympanic- more variable than oral or rectal, better used for children reliable but does it close to hypothalamus where temperature regulation occurs
Pain
1. Describe components of the patient history that are useful in the evaluation of pain.
LOPQRST
tolerance
dependence
addiction
reduced physiological reaction to a drug following repeated use
physical condition in which the body has adapted to the presence of the drug. withdrawal symptoms are eminent
chronic, relapsing disease marked by compulsive drug seeking and use despite harmful consequences
high vmi in men and women and assess for
if bmi greater than 35 if circumference is greater than 35in in men 40 in women.
bmi>25 assess for risk factors of hypertension, high LDL,, low HDL, high triglycerides, high BG, heart disease, cigarette an inactivity
major functions of the skin
keep the body in homeostasis Provides boundaries for body fluid Protects underlying tissues from microorganisms, harmful substances, and radiation Modulates body temperature Synthesizes vitamin D
Three Layers of Skin
Epidermis Outer Layer- Stratum Corneum Inner (cellular) Layers- Stratum Basale and Stratum Spinosum Dermis Subcutaneous tissue
Epidermis
Horny Layer (keratinized layer of dead cells aka stratum corneum) and cellular layer (stratum lucidium, stratum granulosum, stratum spinous, and stratum basal)
dermis-
contains connective tissue, sebaceous glands, hair follicle, and sweat glands and provides nourishment to the epidermis
hypodermis
contains nerves, vein, artery and mostly fat adipose cushioning
sweat glands two kinds and variety
eccrine (widely distributed, open directly onto skin surface, help control body temperature through sweat production)
apocrine (axxilary and genital open to genitals during stress providing body odor).
sebaceous glands
(found everywhere except palms soles secretes fatty, oily substance (sebum) secreted onto skin through hair follicles)
structure of nail
nail bed-tissue under nail
nail plate-fingernail
cuticle-seals space between nail fold and plate
nail root where nail grows from
structure of nail
nail bed-tissue under nail causing plate to be pink
nail plate-fingernail
cuticle-seals space between nail fold and plate or lateral nail fold
nail root where nail grows from
lunula- white area
proximal nail fold- covers nail root
clubbing more convex angle greater than 180 degrees caused by hypoxia
Concerning symptoms associated w/ skin
Hair loss (alopecia)
Rash
Moles
Nail changes
hair loss caused by
Systemic/chronic illness
Infection (systemic or local)
Medication exposure or serious illness in past 3-4 months
Psychiatric disorder
Physical stress or life-threatening psychological stress
Tight braids or “pulled-back” hairstyle – traction alopecia
Hormonal
due to systemic/chronic illness, infection (systemic or local), medication exposure or serious illness in past 3-4 months, psychiatric disorder, physical/psychological life-threatening stress, tight braids, hormones. Alopecia = Hair loss. May be diffuse or patchy, Telogen effluvium = Excessive hair shedding, Male-pattern baldness = Androgenic alopecia. Thinning crown, receding hairline. Trichotillomania = Urge to pull out one’s own hair. Can be diffuse, patchy, or total. Focal patches lost suddenly in alopecia areata w/ scarring alopecia need to refer to dermatology, sparse hair in hypothyrodism and fine silky hair inhyperthyroidism. Inspect for erythema, scaling, pustules, tenderness, bogginess, and scarring (need refferal right away). Pull on hair and if they have telogen bulbs most liekly have telogen effluvium, see if they break off
Alopecia
Telogen effluvium
Male-pattern baldness
Trichotillomania
= Hair loss. May be diffuse or patchy
= Excessive hair shedding
= Androgenic alopecia. Thinning crown, receding hairline.
= Urge to pull out one’s own hair
rash?
what is it caused by caused by
inflammatory skin eruption caused by: Drug reactions Infections (bacterial, viral, fungal)/infestations pregnancy Autoimmune (polycyhtemia vera and thyroid disease) Idiopathic Allergic Neoplastic (lymphomas and leukemia)
macule
primary lesion circumscribed, flat discoloration of only the top layer of horny epidermis of skin less than 1cm w/ a patch is more than 1cm. if a flat spot is larger than >1cm can be blue, red, or hypopigmented from a number of causesfreckle is a type of macule. can be brown, blue, red, or hypo pigmented any color can be associated w/ problems. if a flat spot is small <1cm it is a macule, can be brown, blue, red, or hypopigmented by a number of causes see powerpoint
plaque
primary lesion circumscribed palpable solid lesion 1 cm or larger often formed by confluence of papuples caused by many disease appear red, raised, and dry patchy affecting only horny layer of epidermis
raised spot >1cm psoriasis, atopic dermatisis, or rosea
papule
primary lesion a palpable lesion effecting full thickness of epidermis and dermis <1cm in diameter coloration varies from skin color, yellow, white, brown, red, blue or violaceous with variations from benign to associated w/ a disease
- lesion that is palpable above skin being raised if <1cm, color varies felsh, yellow, white, brown, red, bblue can become confluent and form plaques can be benign or cancerous
nodule/cyst
primary lesion a circumscribed often round, solid lesion larger and deeper than a papule w/ a large one referred to as tumor located completely below the epidermis fully floating in the epidermis almost always associated w/ something that needs treatment
mobile or fixed encapsulated collections of fluid or semisolid
- circumscribed, often round, solid lesion larger and deeper than papule w/ a large one being a tumor ex. BCC, wart
wheal
primary lesion. a firm edematous papule or plaque, resulting from infiltration of the dermis with fluid wheals are transient and may last a few hours to a few days. A wheal is a red, swollen mark or white that can be individual bumps or large connected areas, that is often itchy and changes shape. They usually occur in response to a stimulus like a bug bite or food allergies. causing by increased inflammation of cellularly layer in skin and redness in the horny layer.
firm edematous papule or plaque, resulting from infiltration of dermis w/ fluid transient w/ dermal edema lasting few hours to days ex. hives, urticara
vesicle
primary lesion circumscribed collection of free fluid less than 1cm in height that is located between horny and cellular layer of epidermis ranging from benign to indicator of herpes
if lesion is raised, filled w/ fluid and small <1cm it is a vesicle ex. herpes simplex or shingles
pustule
primary circumscribed collection of leukocytes and free fluid that varies in size and is located under horny layer of epidermis dividing cellular epidermis and comes in contact w/ dermis
ex. acne, chicken pox,
burrow
primary Burrows are tunnels formed in the skin that appear as linear marks. They are a result of an infestation of the skin by parasites such as scabietic mites.
small linear or semipiginous pathways in epidermis created by scabies mites
crust
secondary lesion is a collection of dried serum and cellular debris, scab caused from damage
lichenification
secondary skin has become thickened and leathery caused from continual rubbing or scratching skin caused by chronic eczema
scar
secondary an abnormal formation of connective tissue implying dermal damage after injury or surgery are initially thick and pink but become white and atrophic forming a bump in cellular layer that increases the size of the horny layer w/ no issue
keloid
secondary abnormal proliferation of scar tissue that forms at the site of cutaneous injury (eg, on the site of a surgical incision or trauma); it does not regress and grows beyond the original margins of the scar
erosion
secondary a focal loss of epidermis. do not penetrate below the dermoepidermal junction and therefore heal without scarring from inflammatory or infectious disease
excoriation
secondary lesion that is a scratch caused from ones own compulsion to pick at skin causing red raised bumps and scratches to surface.
fissure
secondary a linear loss of epidermis and dermis with sharply defined nearly vertical walls caused by chapping or eczema
ulcer
secondary focal loss of epidermis and dermis ulcers heal with scarring caused by physical trauma and infection
scale
excess dead epidermal cells of horny layer that are produced by abnormal keratinization and shedding with genetic components or some bacterial causes
moles or nevi
Most moles are harmless, but in some cases, moles may become cancerous.
Monitoring moles and other pigmented patches is an important step in detecting malignant melanoma.
Clusters of pigmented cells
Can come in a range of colors and can develop virtually anywhere on your body.
nevi use ABCDEEFG to describe and characterize could become cancer
- Describe the ABCDE method of screening for melanoma, and describe the skin findings associated with malignant melanoma.
Any two of these factors should be sent to a dermatologist for an assessment. screen anyone w/ >50 moles, and >5-10 atypical moles
A- asymmetry of one side of mole compared to other, B- border irregularity especially if ragged, notched, or blurred, C-color variations w/ more than two colors especially, blue=black, white (loss of pigment due to regression), or red (inflammatory reaction to abnormal cells except of homogenous blue color in blue nevus. the blue or black color w/in a larger pigmented lesion is especially concerning for melanoma. D- diameter >6mm normal one should be approximately the size of a pencil eraser. E- evolving or changing rapidly in size, symptoms, or morphology and is the most sensitive of these criteria. E- elevated. F-firm to palpation. G-growing progressively over several weeks
basal cell carcinoma
Comprises 80% of skin cancers
Shiny and translucent, they grow slowly and rarely metastasize. raised pearly reddish
most common cancer in world, rarely spreads to other parts of body, invdde and destroy local tissues immature cells to basal layer
squamous cell carcinoma
Comprises 16% of skin cancers
Crusted, scaly, and ulcerated, they can metastasiz. roughened hyperkeratotic lesions sun exposed areas
begn usually by acitinic keratosis feeling rough or keratotic arises form sun-damaged skin of head, neck, and dorsal arms and ahnds and can metastasize if left untreated consisting of more mature cells found on scalp, lips, and ears
melanoma
Comprises 4% of skin cancers
Tend to spread rapidly
when examining skin quality what do you look for
color (hyper or hypopigmentatioN, redness/erythema), yellow/jaundice), ecchymosis/bruising, cyanosis)
moisture (Dryness, sweating (moist), and oiliness)
temperature (Identify warmth or coolness of skin)
texture (Rough or smooth)
turgor (Lift fold of skin over back of hand
Note ease with which it lifts up (mobility) and speed with which it returns to place (turgor))
lesions
what do you do differently of people of color
Melanin may obscure changes
Therefore inspect conjunctivae, buccal mucosa, nail beds, and palms to assess color changes.
cyanosis and its location
- indicating severe lack of oxygen forcing areas like extremities to shunt oxygen elsewhere and turn blue ex. COPD exacerbation
Blue coloration of the skin and mucous membranes due to the presence of deoxygenated hemoglobin in blood vessels near the skin surface.
Central cyanosis is often due to a circulatory or ventilation problem (cardiopulmonary failure)
low oxygen levels in blood cause lips, fingers, and toes to turn blue central due to circulatory or ventilation problem (cardiopulmonary failure,
Peripheral - Peripheral cyanosis is the blue tint in fingers or extremities, due to inadequate circulation.
what do you look at in scalp
Look at distribution and quantity of hair
Look for any scalp lesions
what do you look for in nail beds
Look for color and deformity
Clubbing (mostly caused by lung issues or cancers)
lesion characteristics
Anatomic location and distribution Patterns and shapes (morphology) Type of lesion (macules, papules, nevi, vesicles) Color Size
describing a rash what do you look for?
Morphology of lesions - What is the color? Primary or secondary lesions? Are the lesions all the same or variable? Is there any exudate? Size, number? Texture?
Pattern – Shape, round, oval, annular (ring-shaped), iris (target-shaped), serpiginous (snake-like)
Anatomic distribution – localized, generalized, symmetrical, acral (hands and feet), light-exposed areas, intertriginous (skin folds), clustered, dermatomal
pityriasis rosea
Scaly, patchy rash sometimes seen in a Christmas tree pattern
Hearld Patch may appear initially then symmetric spreading
Unknown etiology but may be related to viral infection
single oval, flat-topped superficial erythematous to skin colored plaque or multiple round to oval scaling violaceous plaques contagious infection
dermatomyositis
Inflammatory myopathy Muscle weakness and rash Red/purple patches Unknown etiology, most likely autoimmune - uncommon inflammatory disease w/ rash ad muscle weakness slightly raised reddish scaly rash
athlete’s foot (tinea pedis)
Fungal infection
Usually begins between the toes, but can spread
- fungal infection beginning between toes occurs in people who feet are sweaty in tightfitting shoes scaly rash cuasing itching, stinging, and burning contagious and can be spread
tinea versicolor
Common fungal infection
Discolored patches
hypopigmented, hyperpgimented or tan round to oval macules on upper neck and back, upper chest, and arm w/ slight inducible scale on scraping
small pox
Firm
Well circumscribed vesicles or pustles
May be umbilicated
Caused by viral (variola) infection
erythema infectiosum
“Slapped cheek” rash
“Lace like” rash on extremities
Caused by Parvovirus B19
pigments of skin
melanin- brown skin tone determined by sunlight
carotene- golden yellow pigment subcutaneous fat palms and soles
hemoglobin- RBC oxygen of blood oxyhemoglobin vs. deoxyhemoglobin w/ or without oxygen (causing bluish cast cyanosis best assessed where horny layer is thinnest under fingernails, mouth and mucus membrane, and in mouth
velus hair
short fine, incosncipuous unpigmented
