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N400 > Module 2 > Flashcards

Module 2 Flashcards

0
Q

Physical exam for integumentary

A

Inspect & palpate. Lift a fold of skin to check mobility (how easy it lifts) & turgor (how quickly it returns into place).
Skin: Note color: increased pigment, redness, pallor cyanosis,jaundice. Note moisture, temp, texture, mobility & turgor.
Hair: quantity, distribution, and texture
Nails: color, shape, lesions, clubbing

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1
Q

Integumentary health history

A

Have you noticed changes in skin, hair, nails?

Any rashes, sores, lumps, itching?

Any moles or growths that have changed in size, color or shape?

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2
Q

Causes of change in skin temperature

A

Fever, hyperthyroidism- warmth, hypothyroidism- cool, localized warmth with inflammation or cellulitis

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3
Q

Causes of change in skin texture

A

Hypothyroidism- roughness

Hyperthyroidism- velvety texture

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4
Q

Causes of change in skin mobility and turgor

A

Decreased mobility in edema & scleroderma

Decreased turgor in dehydration

Expect changes in older adults.

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5
Q

Edema grading scale

A

1+: slight indentation (2mm); normal contours; interstitial fluid volume 30% above normal
2+: deeper pit (4mm); pitting lasts longer; fairly normal contour
3+: deep pit (6mm); remains several seconds; obvious by general inspection
4+: deep pit (8mm); prolonged pitting; frank swelling
Brawny: no pitting; excessive accumulation; skin shiny; fluid cannot be displaced

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6
Q

Melanoma ABCD’s

A

Assymetry of shape - halves appear different
Border irregularity- such as scalloped contour
Color variation- tan,brown,black,red,white,blue
Diameter (larger than 6mm) pencil eraser size

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7
Q

Primary skin lesions

A

Initial presentation

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8
Q

Macule

A

Primary lesion

Small flat spot up to 1.0 cm

Ex. Hemangioma, vitiligo

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9
Q

Patch

A

Primary lesion

Flat spot 1.0cm or larger

Ex. Cafe au lait spot

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10
Q

Plaque

A

Primary lesion

Elevated lesion 1.0cm or larger, often formed by coalescence of papules

Ex. Psoriasis

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11
Q

Papule

A

Primary lesion

Elevated lesion up to 1.0cm

Ex. Psoriasis

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12
Q

Nodule

A

Primary lesion

Knot-like, larger than 0.5cm; deeper & firmer than papule

Ex. Dermatofibroma

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13
Q

Cyst

A

Primary lesion

Nodule filled with expressible material (liquid or semisolid)

Ex. Epidermal inclusion cyst

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14
Q

Wheal

A

Primary lesion

Somewhat irregular, transient, superficial area of localized skin edema

Ex. Urticaria

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15
Q

Vesicles

A

Primary lesion

Up to 1.0cm; filled with serous fluid

Ex. Herpes simplex, herpes zoster

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16
Q

Bulla

A

Primary lesion

1.0 cm or larger; filled with serous fluid

Ex. Insect bite

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17
Q

Pustule

A

Primary lesion

Filled with pus

Ex. Acne, smallpox

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18
Q

Burrow

A

Primary lesion

Minute slightly raised tunnel; commonly found in finger webs & sides of fingers

Ex. Scabies

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19
Q

Scale

A

Secondary lesion

Thin flake of dead exfoliated epidermis

Ex. Icthyosis vulgarisms, dry skin

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20
Q

Crust

A

Secondary lesion

Dried residue of skin exudates (sperm,pus,blood)

Ex. Impetigo

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21
Q

Lichenification

A

Secondary lesion

Visible & palpable thickening of epidermis and roughening of the skin; increased visibility of normal furrows

Ex. Neurodermatitis

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22
Q

Scars

A

Secondary lesion

Increased connective tissue

Ex. Hypertrophic scar

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23
Q

Keloid

A

Secondary lesion

Hypertrophic scarring that extends beyond the borders of the initiating injury

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24
Q

Erosion

A

Secondary lesion

Nonscarring loss of superficial epidermis; moist surface but no bleeding

Ex. Aphthous stomatitis

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25
Q

Excoriation

A

Secondary lesion

Linear or punctuate erosions

Ex. Cat scratches

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26
Q

Fissure

A

Secondary lesion

A linear crack in the skin often caused by excessive dryness

Ex. Athletes foot

27
Q

Ulcer

A

Secondary lesion

A deeper loss of epidermis and dermis; May bleed and scar

Ex. Stasis ulcer of venous insufficiency, syphilitic chancre

28
Q

Stage one pressure ulcer

A

Presence of reddened area that fails to Blanche with pressure and changes in temp

29
Q

Stage two pressure ulcer

A

Skin forms of blister or sore

partial thickness skin loss

Involves epidermis, dermis or both

30
Q

Stage III pressure ulcer

A

A crater appears in skin with full thickness skin loss

Damage to or necrosis of subcutaneous tissue that may extend to, but not through underlying muscle

31
Q

Stage four pressure ulcer

A

Deepening ulcer

full thickness skin loss

destruction, tissue necrosis or damage to underlying muscle, bone and sometimes tendons and joints

32
Q

Alopecia

A

Clearly demarcated round or oval patches of hair loss

affecting young adults and children

no visible scaling or inflammation

33
Q

Trichotillomania

A

Hair loss from pulling, plucking or twisting hair

hair shafts are broken and of varying lengths

more common in children; Often stress-induced

34
Q

Tines capitis

A

Round scaling patches of alopecia

Hair broken off close to surface of scalp

Usually caused by a fungal infection

Mimics seborrheic dermatitis

35
Q

Clubbing Of the nails

A

Bulbous swelling of soft tissue at nail base

Angle increases to 180° or more & Nailbed feels spongy or floating

Seen in congenital heart disease, interstitial lung disease and lung cancer, inflammatory bowel disease and malignancies

36
Q

Head and neck health history

A

Any headaches, changing vision, hearing loss, vertigo, nosebleed, sore throat, hoarseness, swollen glands, goiter

Ex. How is your vision? how is your hearing?

37
Q

Exam of head

A

Hair: Note quantity, distribution, texture and any pattern of loss

Scalp: Part hair in several places look for scaliness, lumps, nevi or other lesions

Skull: Notes size and contour; note any deformities, depressions, lumps or tenderness

Face: Facial expression and contours; observe for asymmetry, involuntary movements, edema and masses

38
Q

Eye exam

A 
Visual acuity
Visual fields
Conjunctiva and sclera
Cornea, lens, pupils
Extra ocular movements
Fundi, including optic disc and cup, retina, retinal vessels
39
Q

Ear exam

A

Pull ear up and back in adult to insert otoscope
Pull pinna down and back in child under three

Whispered voice test to check auditory acuity

Tuning fork test for conductive versus neurosensory hearing loss

40
Q

Meningial headache

A

Generalized

Steady or throbbing, very severe

rapid onset; usually less than 24 hours

Associated with fever, stiff neck and change in mental status

41
Q

Migraine

A

Unilateral -70%; bifrontal or global-30%

Throbbing or aching, variable severity

Fairly rapid onset, lasts 4-72hrs

Associated with nausea, vomiting, photophobia, phonophobia,aura

42
Q

Tension headache

A

Usually bilateral

Steady, pressing or tightening; non throbbing

Mild-moderate with gradual onset lasting 30min - 7 days

Nausea absent

43
Q

Cluster headache

A

Unilateral; usually behind or around eye/temple

Deep, continuous, severe

Abrupt onset, peaks within minutes. Lasts up to 3hours

Clustered - several each day for 4-8 weeks

44
Q

Visual acuity & 20/20 vision

A

To test visual acuity you place the patient 20 feet from the snellen chart.

Visual acuity is expressed as two numbers, the first indicates the distance of the patient from the chart and the second the distance at which a normal eye can read the line of letters.

45
Q

Conjunctivitis

A

1) Pattern of redness is maximal peripherally.
2) Mild discomfort.
3) Vision not affected other than mild blurring due to discharge.
4) Watery, mucoid or mucopurulent discharge.
5) Pupil unaffected and cornea clear.
6) Bacterial, viral infections; highly contagious; allergy or irritation

46
Q

Subconjunctival hemorrhage

A

1) Sharply demarcated red area that resolves over two weeks.
2) No pain
3) Vision unaffected.
4) No discharge.
5) Pupil not affected; cornea clear.
6) Often no significance; may result from trauma, bleeding disorders or sudden increasing venous pressure (cough)

47
Q

Acute iritis

A

1) Ciliary injection pattern of redness with dilation of deeper vessels that are visible as radiating vessels or reddish violet flush around the limbus.
2) Moderate aching deep pain.
3) Decreased vision with photophobia
4) No discharge.
5) Pupil is small & irregular; Cornea is clear or slightly clouded.
6) Associated with systemic infections such as herpes zoster, tuberculosis; refer promptly

48
Q

Acute glaucoma

A

1) Dilation of deeper vessels creating a reddish violet flush around the limbus.
2) Severe aching deep pain
3) No discharge
4) Pupil dilated and fixed;
5) Cornea steamy,cloudy
6) Acute increase in intraocular pressure constitutes an emergency

49
Q

Weber test

A

Test for lateralization done by placing the tuning fork firmly on top of the patients head or on the mid forehead.

50
Q

Rinne test

A

Compares air conduction and bone conduction.

Place the base of the lightly vibrating tuning fork on the mastoid bone behind the ear and level with the canal.

When the patient can no longer hear the sound quickly place the fork close to the ear canal and ascertain whether the sound can be heard again. (U of fork forward)

Normally sound is heard longer through air than through bone (ac>bc)

51
Q

Conductive hearing loss

A

External or middle ear disorder impairs sound conduction to inner ear (foreign body, otitis media, perforated eardrum, otosclerosis)

Onset up age 40

Little effect on sound, hearing improves in noisy environment, voice remain soft because inner ear and cochlear nerves are intact.

Weber test: sound lateralizes to impaired ear

Rinne test: bc>ac

52
Q

Whispered voice test

A

Test for auditory acuity

Stand 2 feet behind the seated patient so the patient cannot read your lips, occlude the non-test ear with a finger and gently rub the tragus in a circular motion to prevent transfer of sound to the non-test ear.

Whisper a combination of three numbers and letters using different combinations for each ear.

Is abnormal if four of the six possible numbers (2 attempts) and letters are incorrect; conduct further testing by audiometry.

53
Q

Sensorineural hearing loss

A

Inner ear disorder involves cochlear nerve and neuronal impulse transmission to the brain

Onset in middle or later years

Problem not visible

Higher registers are lost, sound may be distorted, hearing worsens a noisy environment, voice maybe loud because hearing is difficult

Weber test: Sound lateralizes to good to ear

Rinne test: ac>bc

54
Q

Acute Otitis media with purulent effusion

A

Symptoms: earache fever and hearing loss

Cause: bacterial, usually S pneumoniae or H. influenzae

On exam eardrum is reddened, loses its landmarks and bulges laterally

More common in children than adults

55
Q

Serous effusion

A

Usually caused by viral upper respiratory infections (otitis media with serious effusion) or by sudden changes in atmospheric pressure

Symptoms include fullness and popping sensations in the ear, mild conduction hearing loss and sometimes pain.

Amber fluid behind the eardrum is characteristic

56
Q

Perforated eardrum

A

Usually caused by purulent infections of the middle ear

maybe classified as central perforations or marginal perforations, which involve the margin

57
Q

Tympanosclerosis

A

Large chalky white patch, irregular margins

deposition of hyaline material within the layers of the tympanic membrane, may sometimes follow a severe episode of otitis media

does not impare hearing

58
Q

Health history for mouth, pharynx, nose, neck and regional lymphatics

A

Ask about:
Sore throat pharyngitis
bleeding of the gums
local lesions;any tendency to bleed/ bruise environmental allergies
acid reflux
smoking; inhalation of fumes or other irritants swollen glands or lumps in the neck
any evidence of enlarged thyroid gland
ask about temperature intolerance & sweating nasal congestion, stuffiness, nasal discharge
Tooth pain

59
Q

Exam of the nose

A

Inspect the anterior and interior surfaces of the nose

press on the tip of the nose with the thumb to widen the nostril and use the penlight or otoscope like to get a partial view of the nasal vesicle

note any asymmetry or deformity; test for nasal obstruction

60
Q

Exam of the mouth

A

Observe lip color and moisture, note any lumps, ulcers, cracking, scaliness

Inspect Mucosa for color, ulcers, white patches and nodules

Inspect hard and soft palate, tongue, trachea and teeth

61
Q

Examination of the neck

A

Palpate lymph nodes

palpate thyroid gland

Inspect trachea

62
Q

Thyroid

A

Located above the suprasternal notch

influences metabolism, growth and development, and body temperature

63
Q

Hypothyroidism

A

Symptoms: Fatigue, lethargy, modest weight gain with anorexia, dry coarse skin and cold intolerance, swelling of face hands and legs, constipation, weakness, muscle cramps, arthralgias, parathesias, impaired memory and hearing

On exam: Dry coarse cool skin, sometimes yellowish from carotene, with non-pitting edema and lost a hair
Periorbital puffiness
decreased systolic and increased diastolic blood pressures
bradycardia, and in late stages hypothermia
sometimes decreased intensity of heart sounds
Impaired memory, mixed hearing loss, somnolence, peripheral neuropathy, carpal tunnel syndrome

64
Q

Hyperthyroidism

A 
Symptoms: 
Nervousness 
weight-loss despite increased appetite
Excessive sweating & heat intolerance
Palpitations
Frequent bowel movements
Tremor and proximal muscle weakness

On exam:
Warm smooth moist skin
With Graves’ disease, Eye signs such as stare, lid lag and exopthalmos
Increased systolic and decreased diastolic blood pressures
Tachycardia or atrial fibrillation
Hyperdynamic cardiac pulsations with an accentuated s1
Tremor and proximal muscle weakness

65
Q

Transillumination of the sinuses

A

Perform in a darkened room; use a narrow light source.

1) Placed the light snugly under each brow close to the nose
2) Shine light downward from just below the inner aspect of each eye
3) look through the open mouth at the hard palate; a reddish glow indicates a normal air filled maxillary sinus

N400 (3 decks)

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