Quiz 2 Flashcards
The avascular superficial layer of skin; pigment producing melanocytes in this layer provide protection from UV rays. Langerhan cells also in this layer are an important component of the immunologic barrier of the skin
Epidermis
Contains blood vessels, nerves, and appendages (sweat glands, sebaceous glands, hair follicles, nails).
Dermis
Why do the blood vessels in the dermis consist of two horizontal plexuses one on top of the other?
Allows shunting of blood either toward the skin to cool or away from the skin to stay warm
Helps insulate against the cold and serves as a reserve food source
Subcutaneous tissues
Technically a flat area of discolored skin less than a cm in diameter.
Macule
Examples of a macule.
Examples of a large macule
Macule = freckle or cherry angioma
Large macule = patches, marks, spots, plaques, nevi, age spots, vitiligo, or port wine stains
A solid elevation of skin less than 1 cm in diameter.
Papule
Examples of papules
Examples of large papules
Papules = moles, warts, or skin tags
Large papules = nodules, tumors, lipomas, cysts, other masses
Small, fluid filled elevation of the skin
Vesicle
Examples of vesicles
Examples of large vesicles
Vesicles = herpes simplex, chicken pox, or herpes zoster
Large vesicles = Bullae (blisters)
A small pus filled elevation of the skin
Pustule
Examples of pustules
Examples of large pustules
Pustule = pimples
Large pustules = abscesses, furuncles, and carbuncles
Flaky skin, keratinized cells. Ex: dandruff, seborrhea, psoriasis
Scales
Dried serum, blood or purulent exudates. Ex: weeping eczema
Crust
Rough, thickened epidermis with accentuated skin markings. Ex: chronic dermatitis
Lichenification
Fine, irregular, superficial capillary dilations. Ex: Rosacea
Telangiectasis
Linear, crusted loss of epidermis/dermis. Ex: Abrasion or scratch
Excoriation
Loss of some epidermis. Ex: Sun damaged skin
Erosion
Linear crack extending into the dermis. Ex: Athletes foot
Fissure
Skin concavity involving the epidermis and dermis. Ex: Bed sores
Ulcer
Acute skin eruption that is a new localized rash due to direct skin contact with an irritant or allergen is most likely caused by this. Ex: poison ivy, household or industrial irritants
Contact reations
Acute skin eruption that causes an often itchy, red, maculopapular skin eruptions over a large portion of the body. May be associated with prescriptions, vitamins, supplements, etc.
Adverse drug reaction
Condition that presents with a nonpruritic rash to the palms, soles, mouth, or genitals. May also see white mucus patches, flat-topped, moist genital warts, and spotty alopecia of the scalp
Secondary syphilis
The primary lesion of syphilis. Painless ulceration, difficult to heal, and usually disappears prior to the rash associated with secondary syphilis
Chancre
Skin presentations associated with tertiary syphilis
Gummas
Ulceration
Who is at the greatest risk of developing skin cancer?
Light skinned people who are outside a lot, have a family history of skin cancer, and have a history of a severe sunburn
ABCDE’s of skin cancer
A- Asymmetry B- Border C- Color D- Diameter E- Evolution
Epithelial cell tumor that begins as a papule and enlarges peripherally. Metastasis is rare and therefore the least worry some
Basal cell carcinoma
A slow growing, malignant tumor of squamous epithelium. Common to the skin and lungs, but found elsewhere.
Squamous cell carcinoma
A malignant neoplasm originating in the skin. Small percentage of all skin cancers, but by far the most severe
Melanoma
A malignant multifocal neoplasm beginning as soft brown or purplish papules on the feet. Associated with AIDS, diabetes, and malignant lymphoma
Kaposi’s Sarcoma
Typical balding pattern
Males begins as early as 20 starting in the frontotemporal and vertex areas and may end with a rim of hair remaining in the lateral and posterior scalp
Uncommon for females until 60
Idiopathic disease resulting in atypical patches of hair loss. Self limiting.
Alopecia areata
Alopecia that is less common and results in permanent hair loss on the scalp
Alopecia totalis
Very rare alopecia causes widespread loss of all body hair
Alopecia universalis
A superficial lung infection of the scalp, often seen in children. Appears as scaly, round, sometimes pustular patches with broken-off hair that leave bald spots
Tinea capitis (ringworm)
A chronic, superficial, inflammatory skin process, especially common to the scalp, eyebrows, ears, face, axilla, breast, groin, and gluteal folds. Dandruff is a milder form of this condition
Seborrheic dermatitis
Chronic seborrheic dermatitis in infants
Cradle cap
Idiopathic condition that causes excessive growth of the epidermal keratinocytes causing inflammed cells and increased angiogenesis. Appears silvery-white scale on red patches that may itch.
Psoriasis
An infestation of the blood-sucking louse whi feeds on the scalp and neck. Seen in children with poor hygiene. Intense itching is the main symptom with the presence of eggs (nits) in the hair
Pediculosis capitis (head lice)
Results when epidermal tissue invaginates the dermis and becomes encapsulated. Appears as a subcutaneous nodule with an inner, cream-colored, pasty substance
Sebaceous cyst
Symptoms of a TMJ disorder
- Chronic pain in the jaw, teeth, face, head, neck, shoulders, or back.
- Jaw clicking
- Limited jaw movement
- Can’t but 3 fingers in your mouth
Primary source and another possible source of TMJ disorder
Primary = malocclusion Other = Whiplash injuries
What conditions can cause TMJ disorders?
Rheumatoid arthritis
Osteoarthritis
Displaced TMJ cartilage
Osteoarthritis produces _______ in the TMJ with joint movement
Crepitus (crackling)
How should the salivary glands feel if unaffected?
Soft, pliable, and non tender
Salivary glands of the head
Parotid
Submandibular
Sublingual
Unilateral swollen glands usually result from:
1) Bacterial infection (Parotitis)
2) Ductal calculus (stones)
3) Cyst or tumor (painless)
Located by the 2nd upper molar
Stenson’s duct
Located on either side of the frenulum of the tongue
Wharton’s duct
Bilateral swollen glands usually result from:
1) Viral infection (mumps)
2) Drug reactions
3) Lymphomas
Superficial lymph node sites to palpate
- Head and Neck
- Axillary
- Inguinal
Produces small, mobile, tender nodes involving one or two groups of nodes, but possible more
Acute infections
Way to differentiate between a localized acute infection and a systemic acute infection using lymph nodes
1-2 nodes = localized
3 or more = systemic
Produces multiple, less tender and mobile nodes that are matted together
Chronic infections
Produces large rubbery lymph nodes
Hodgkin’s Lymphoma
Produces stony hard, non-tender nodes of variable sizes.
Metastatic cancer
Swollen node in the left supraclavicular group that lacks a typical explanation. Red flag for thoracic or abdominal cancer.
Virchow’s node
Causes of tracheal deviation
1) Head tilt/cervical rotation
2) Unilateral goiter/large lymph node
3) Pneumothorax/pleural effusion
4) Unilateral atelectasis/pulmonary fibrosis
T/F The thyroid should stay stationary during swallowing
FALSE
It should move up and down
Congenital condition associated with an iodine deficiency in children
Cretinism
1 cause of hypothyroidism in the US
Hashimoto’s disease
Severe, advanced form of adult-onset hypothyroidism
Myxedema
Most common form of hyperthyroidism. Produces exophthalmos
Grave’s disease
Nerve for the muscles of mastication. Have patient clench their teeth to test for its function
C.N. V
Lightly touching the patients brow, cheek, and chin on both sides of the face tests the functionality of this nerve
C.N. V
Asking the patient to raise their eyebrows and show their teeth tests the functionality of this nerve
C.N. VII
Placing different substances on the anterior part of the tongue and asking the patient to taste it tests the functionality of this nerve
C.N. VII
Having the patient rotate their head in both directions against resistance and shrugging their shoulders against resistance tests the functionality of this nerve
C.N. XI
May be the most commonly encountered headache in chiropractic practice
Whiplash headaches
Typical patient profile and symptoms of whiplash headaches
Patient= anybody who sustained a flexion-extension injury Symptoms = stiff neck and a new atypical headache
Physical findings of a whiplash headache
Spinal and TMJ asymmetries, abnormal ranges of motion; trigger points and/or temperature discrepancies
Diagnostic studies for a whiplash headache
Flexion-extension X-rays may show soft tissue damage. MR is definitive
Symptom associated with concussion headaches
New headache
Associated symptoms of concussion headaches
Headache, amnesia, and confusion are the most common
Physical findings of concussion headaches
Anything other than a mild injury warrants a neurological exam (memory, concentration, vision, hearing, balance, reflexes, etc.)
Management of concussion headaches
Positive neurological findings = need an immediate head CT, neurological consultation or hospital referral
Symptoms of a migraine headache
Escalating, intense, throbbing, unilateral headache lasting hour to days (maybe auras, scintillating scotomas, or tingling arms or legs which precedes the headache lasting 10-30 minutes prior to the headache)
Associated symptoms of of migraine headaches
Possible nausea, vomiting light and noise sensitivity
Symptom of a dissecting vertebral artery headache
Sudden, severe (worst ever), atypical, unilateral headaches behind one ear and occipital area
Associated symptoms of a dissecting vertebral artery headache
Dizziness, Diplopia, Difficulty walking, Dysphagia, Dysarthria, Nausea, Nystagmus, and Numbness
(5 D’s and 3 N’s)
Physical findings of a dissecting vertebral artery headache
Decreased carotid pulse and/or carotid bruit, or a + vertebrobasilar artery maneuver test raise suspicion of an ominous vascular component of the headache.
Diagnostic study of a dissecting vertebral artery headache
MRA of the head is definitive
Headache as a result of emotional or physical stress such as jaw clenching, teeth grinding, loss of sleep, missed meals, and sustained occupational head, neck, and shoulder postures
Episodic Tension Headaches
Symptoms of a episodic tension headache
Moderate feeling of persistent pressure in the neck, scalp, face, and jaw muscles and the hat band area of the head. May occur as frequently as 15 times a month and last from hours to days
Tension headaches that occur more than 15 times in a month
Chronic Tension Headaches
Pressure over the affected sinuses.
Sinusitis
Physical exam findings of sinusitis
Sensitive to digital pressure of the sinuses
