Inspection Exam Flashcards
BMI values
below 18.5 - underweight
18.5-24.9 - normal
25-29.9 - overweight
above 30 - obese
what is endomorph body type
large obese round
what is mesomorph body type
middle built muscle
what is ectomorph body type
small thin skinny
what is the characteristics of metabolic syndrome
large waist or central obesity
increase triglycerides
decrease HDL
increase blood pressure
elevating fasting blood sugar or insulin resistance
what is a flat lesion less than 1 cm
what is a flat lesion greater than 1 cm
macule
patch
ex. freckles, measles, flat moles
what is a solid raised lesion that is less than 1 cm
what is a solid raised lesion that is larger than 1 cm
papule
plaque
ex. lichen planus, warts, scabies
what is a solid lesion that is deeply root that is 1-2 cm
what is a solid lesion that is deeply rooted that is greater than 2 cm
nodule
tumor
ex. lipomas
what is a raised lesion that is filled with clear fluid that is less than 1 cm?
what is a raised lesion that is filled with clear fluid that is greater than 1 cm?
what is a raised lesion that is filled with pus?
vesicle
ex. herpes zoster, ckickenpox
bullae
ex. blister
pustule
ex. acne
what is edema in the upper epidermis referred as?
wheal
ex. insect bite or allergic reaction
what is permanent dilatation of superficial blood vessels in the skin called
telangiectasia
ex. crest syndrome
what are flakes or plates of the skin made up of desquamated layers of the stratum corneum
scales
ex. seborrheic dermatitis
what is drying of the plasma or exudate on the skin called
crust
ex. scab, abrasion, eczema
what are open areas of the skin where all the epidermis is lost
erosions
ex. varicella after rupture
what is thickening of the epidermis seen with exaggeration of normal skin lines due to chronic rubbing or scratching leading to thick leather skin
lichenification
ex. chronic dermatitis
what is traumatized skin that extends into the epidermis called
excoriations
ex. abrasions, scratches
what are linear cleavages of skin which extend into the dermis called
fissues
ex. athletes foot, cracks in corner of mouth
what is permanent fibrotic changes following damage to the dermis
scars
ex. healed wounds, surgical incision
what is exaggerated connective tissue response of injured skin that extends beyond the edges of the original wound
keloid
ex. surgery
what is chloasma
abnormal shaped brown spots or spot on the face
what presents as dark sports over the buccal mucosa, skin folds, and stretch marks
addisons disease
- hypocortisolism
what presents with purple stria on belly and extremities
cushings disease
- hypercortisolism
what is a condition is characterized by the skins destruction of pigment cells aka melanocytes which results in irregular white patches
vitilligo
- affects all races
- 10-30 years old
what flat macules are hyperpigmented and can have varying border shapes
cafe au lait spots
ex. mcune albright syndrome, fibrous dysplasia, neurofibromatosis (vonreckinghausens dz)
adrenal anatomy review each layer
cortex (endocrine) go fuck rob zona granulosa- salt zona fasiculata - sugar zona reticularis - secx
salt - mineral corticoids
ex. aldosterone
sugar - glucocorticoids
ex. cortisol
sex - hormone precursors
ex. DHEA and pregnenolone
medulla (neuroendocrine)
ex. adrenaline/epinephrine
what are features of hyperadrenalism
CUSHINGS DZ
weight gain truncal obesity moon face buffalo hump hypertension dysglycemia frequent infections decrease immunity affects T4-->T3 conversion purple stria hirsuitism - face, back head baldness depression
what are the features of hypoadrenalism
ADDISONS DZ
low blood pressure dizziness weight loss no appetite hypoglycemia dehydration intolerance to cold fatigue and weakness pigmentation of skin
what is the function of DHEA
- sex hormone precursor
- takes of estrogen production after menopause
- anabolic hormone for proteins and fats
- immune enhancer
- improves insulin sensitivity
- improves sleep
ANTI - AGING HORMONE
what is the neuroendocrine function of the adrenals
fight and flight
norepinephrine
epinephrine/adrenaline
sympathetics increased BP, pulse increase blood glucose dilates eyes dilates bronchioles reduce GI secretions
what is general adaption syndrome
hans selye - 3 stages
arousal - response to stress - fight or flight
- rapid increase catecholamines
- slow increase corticosteroids
adaption or resistance - continued release of corticosteroids - allows system to adapt to stress long after initial fight or flight response
- glucose tolerance
- increase BP, thyroid hormone, and sex hormone
exhaustion - burned out adrenals
what is pregnenolone steal
adrenal hormones are produced from cholesterol
cholesterol –> pregnenolone is the first step in making hormones
STRESS HORMONES (CORTISOL) ARE PRODUCED AT EXPENSE OF SEX HORMONES
results in adrenal exhaustion
what is stage 1 and stage 3 of adrenal exhaustion or fatigue
stage 1
- increase ACTH
- increase cortisol stim.
- increase cortisol
- pregnenolone steal
- decrease DHEA
- increase night time cortisol
stage 3
- increase ACTH
- increase cortisol stim.
- decrease cortisol
- pregnenolone steal
- decrease DHEA
- decrease night time cortisol
what condition is vitligo associated with
pernicious anemia
graves - hyperthyroidism
addisons - low cortisol
what condition is cafe au lait spots associated with
mccune albright syndrome (fibrous dysplasia)
neurofibromatosis (von reckinghausens disease)
what is the difference in clinical presentation of mccune albright syndrome and von reckinghausens disease
mccune albright
- fibrous dysplasia
- cafe au lait sponts - irregular borders - coast of maine
- precocious puberty
von reckinghausens disease
- neurofibromatosis
- cafe au lait spots - regular borders - coast of california
- systemic nodules
what does cyanosis or acrocyanosis suggest
CHF
pneumonia
acrocyanosis - lips, nose, hands, feet
what are the features of acromegaly
excess GH pituitary tumor MC weight gain hirsuitism enlargement of hands, feet, and facial bones thickening of skin joint pains
describe the varying types of tremors
rhythmic oscillations
- fine - 6 or more per sec
- coarse - less than 6
- static - resting
- intention - action
what are essential involuntary movements
hands, head, voice
increase with action or intention
hereditary, drugs, alcohol
describe choreiform and the different types
rapid jerking motions
restlessness appearance
repetitive, jerky, dancelike, uncontrolled
ex. syndenhams or huntingtons chorea
describe athetosis involuntary movement
slow, writhing, snake like motions
what is koilonychia
seen in what condition
spoon shaped nails
concave nails
plummer vinson syndrome, IDA, hemochromatosis
what is clubbing
seen in what condition
convexity nails
Lung cancer, hypertrophic pulmonary osteoarthropathy, cardiac failure, hepatic cirrhosis
what is schamroths sign
seen in what condition
pushing dorsal side of two fingers together - nails should touch and have small window
indicates clubbing
- lung or heart failure
what are lindsays nails
seen in what condition
half and half nails
proximal portion white
distal portion pink
renal failure
what are mees lines
transverse white bands
parallel to lunula
single or multiple on each nail
same position on each nail
arsenic poisoning
renal failure
hodgkins
pneumonia
what are terry nails
seen in what condition
white bands
lunula covered by white band up to 1 -2 mm from the distal border of the nail
hepatic cirrhosis
CHF
rheumatoid arthritis
what are beau lines
seen in what condition
transverse depression across nail plate
severe infection myocardial infarction hypotension shock immunosuppresive therapy severe zinc deficiency
what is oncholysis
seen in what condition
separation of the distal nail
psoraiasis
trauma
thyroid disorders
pitting nails are seen in what condition
psoriasis - MC
eczema
alopecia areata
splinter hemorrhages are seen in what condition
subacute bacterial endocarditis
trauma
SLE
rheumatoid
what is paronychia
seen in what condition
infection of the cuticle
trauma is initial event
what is antalgic gait
gait performed to avoid or minimize pain in the back, hip, or limb
what is ataxic sensory gait
what is it also called
tabetic gait
broad base stance
watches the ground
slaps feet down
what is hemiplegic gait
what is it also called
circumduction gait
leg extened
foot movement from pelvic tilting
arm adducted
what is propulsion gait
what is it also called
festination gait
torso flexed forward, arms rigid, no arm swing, bent at the hips
small steps
hesitation on starting and stopping
PARKINSONS
what is steppage gait
throws foot forward from hip and slaps foot down
anterior crural muscle deficit
cant dorsiflex the foot
POLIOMYELITIS
what kind of gait is seen in parkinsons
propulsion gait
festination gait
what kind of gait is seen in poliomyelitis
steppage gait
what is staggering gait
what is it also called
reeling gait
cerebellar ataxia
MS and alcohol
what is scissors gait
what is it also called
spastic gait
spastic paralysis to adductors excessive adduction of leg in swing plantar flexion of ankle flexion of the knee adduction and IR at the hip
MS
what type of gait is seen in MS
staggering (reeling)
and
scissors (spastic)
what is waddling gait
weak pelvic muscles
pregnancy and muscular dystrophy
what is tredelenburg gait
hip drops during gait
weak gluteus or hip pathology
