Review Flashcards
1
Q
Exam Tool: Otoscope
A
auditory canal and TM examination
2
Q
Exam Tool: Opthalmoscope
A
interior structure of eye.
3
Q
Exam Tool: Sphygmomanometer
A
Indirect measure of BP (w/ stethoscope)
4
Q
Thermometers and Avg. Temps
A
Oral - 98.7F / 37C
Rectal - 99.6F / 37.6C
Axillary - 97.6F / 36.4C
Tympanic - 99.6F / 37.6C
5
Q
Exam Tool: Stethoscope
A
Auscultation
3 Types:
Acoustic - bell is low tones, diaphragm is high tones.
Magnetic - uses Fe disk and magnet
Electronic - converts vibrations to sound via a speaker
6
Q
Exam Tool: Snellen / Rosenbaum
A
Visual Acuity Charts
Snellen - 20’
Rosenbaum - 10-14”
7
Q
Exam Tool: Tuning Forks
A
512 Hz - near threshold hearing
128 Hz - neuro vibratory exam
8
Q
Exam Tool: Percussion Hammer
A
deep tendon reflexes
9
Q
Exam Tool: Transilluminator
A
Beam of light to differentiate between media in a cavity (air vs. fluid vs. tissue)
10
Q
Universal Precautions
A
Hand hygiene, nail care, safe injection practices, PPE (masks and goggles, gown, gloves)
11
Q
Traditions in Medicine
A
Physical exam with clean dry bare hands. gloves for mouth, genitals, open wounds. head to toe. right sided.
12
Q
Exam Technique: Inspection
A
observation through site and smell. color, texture, symmetry, size, shape.
13
Q
Exam Technique: Palation
A
Process of observation through tough.
14
Q
Exam Technique: Percussion
A
Observation through vibration.
15
Q
Exam Technique: Auscultation
A
Observation through sound. Usually obtained with stethoscope.
16
Q
Tympanic Sounds
A
High pitch, drum like.
ex) gastric bubble
17
Q
Hyperresonant Sounds
A
louder than usual low-pitched sounds.
ex) emphysematous lungs
18
Q
Resonant Sounds
A
loud, hollow, low pitched
ex) healthy lungs
19
Q
Dull Sounds
A
Soft, thud-like.
ex) liver
20
Q
Flat Sounds
A
very dull soft sound
ex) over muscle
21
Q
Sounds Best Heard with Diaphragm
A
High pitched sounds
ex) S2 in heart beat
22
Q
Sounds Best Heard with Bell
A
Low pitched sounds.
ex) Bruits
23
Q
S1
A
systole / ventricular contraction. miral and tricuspid valve closure. duller, low frequency sound
24
Q
S2
A
Diastole / ventricular relaxation. aortic and pulmonary valve closure. sharper, louder than S1. Listen with bell.
25
Heart Rate
BPM, rhythm, regularity, amplitude. 60-90.
26
Respiratory Rate
breaths per min, pattern, depth, signs of distress. 12-20
27
Blood Pressure
peripheral measure of CV function. 60, or 140/90 adults
28
Body Temperature Control
Balancing heat prod. w/ heat loss. Heat prod. by liver, brain, heart,skeletal muscle. heat loss @ skin
29
Heat Loss
how fast can heat be conducted from core to skin to surroundings. blood shunting.
30
Mechanisms of Body Heat Loss
conduction (touching cold ground), convection (wind chill), radiation (loss to environment), respiration and evaporation
31
Hypothermia
heat loss > heat production. Core temp
32
Hyperthermia
heat produced > heat loss. not the same as a fever.
33
Farenheit to Celsius conversion
```
F = (9/5)C + 32
C = (5/9)(F-32)
```
34
Pulse Deficit
Difference between apical pulse and radial pulse.
35
Pulse amplitude
force with which a bolus of blood moves through an artery. 0-4+
36
Apical Pulse
Pulse heard through stethoscope at apex of heart.
37
S1 vs. S2
S1 is closing of tricuspid / mitral valves. S2 is closing of aortic / pulmonary valves.
38
Pulse Pressure
Systolic - Diastolic. 30-50 mmHg
39
Pulsus Paradoxus
Exaggerated decrease in amplitude of pulse and systolic pressure (>10 mmHg) during inspiration and increase in amplitude during exhalation
40
Tachycardia vs. Bradycardia
```
Tachy = sympathetic response
Brady = parasympathetic response
```
41
Cheyne-Stokes Respirations
period breathing with periods of apnea
42
Kussmaul Breathing
Deep labored rapid breathing. Associated with metabolic acidosis.
43
Korotkoff Sound
sound produced by turbulent blood flow in arteries. Low pitched sounds.
44
Factors that Affect BP
stroke volume, HR, peripheral resistance, atherosclerosis, anxiety, pain, sedentary lifestyle, illicit drugs
45
Auscultatory Gap
period of silence 10-15 mmHg in between korotkoff sounds. palpate radial artery prior to measuring BP
46
Orthostatic BP
supine 5 minutes. check BP and HR. move to sitting. wait 1 minute. record BP and HR. systolic decrease of 20 or more or pulse increase of 20 or more, volume depletion.
47
Acute Pain
short duration, sudden onset, in association with injury, surgery, or acute illness
48
Chronic Pain
Several months or longer. sustained by pathological processes like joint disease, headache, or cancer
49
Subjective Nociceptive Pain
A type of time limited pain that resolves when tissue damage has healed. detected by specialized peripheral nerves called nociceptors.
50
Objective Nociceptive Pain
- Objective: well localized
somatic: Subtype involving joint, bone, muscles, and other soft tissues
visceral: Subtype involving internal organs
51
Neuropathic Pain
Damage / disease to nerves involved in somatosensation
central - CNS damage. ex) phantom limb
peripheral - PNS damage. ex) funny bond
52
Pain Scale
verified, 0-10.
| ask about #, location, intensity, and character.
53
Assessment of Physical Pain Behaviors
subjective. 0-10. OPQRST. Note non verbal cues. barriers to pain assessment in certain populations.
54
Non-Verbal Pain indicators
Protective, facial, vocalizations, body movements, changes in vitals, other: diaphoresis, pupil dilation, dry mouth, confusion or iritability.
55
General Appearance
Gender, age category, illness vs. wellness, level of toxicity, acutely ill vs chronic, appropriate affect, posture, speech
56
Tanner stage
Term to identify the progression through adolescence by using secondary sex characteristics
57
Body Habitus
Height, weight, proportionality, nutritional status
58
External Eye anatomy
eyelid/palpebra - includes skin, striated muscle, tarsal plate, meibomian glands.
Conjunctiva - clear mucous membrane covering eye (bulbar and palpebral)
Lacrimal Gland - produced tears, drain via canaliculi
Canaliculi and lacrimal sacs - drain tears to nose
Eye muscles
59
Eye muscles
inferior, superior, lateral, medial rectus
inferior and superior oblique
LR6SO4, all the rest are CNIII
60
Internal Eye
Sclera, cornea, uvea (iris, pupil, ciliary body, choroid), lens, retina,
61
Sclera
dense avascular tissue, white of the eye
62
cornea
anterior 1/6th of the globe. clear tissue with sensory innervation. avascular.
63
uvea
iris - circular, contractile, pigmented
Pupil - central iris.
Ciliary Body - produced aqueous humor
Choroid - pigmented, vascular, provides O2 to retina
64
Lens
Biconvex transparent. behind iris. supported by ciliary fibers.
65
Retina
sensory aspect of eye. transforms light into electrical impulses, travel to optic nerve to visual cortex
66
Opthalmascope Procedure
turn on, begin with diopter at 0, then adjust to focus. select aperture size and filter. red free, slit, grid, cobalt, or polarized
67
External Eye Exam
**OD = right OS = Left OU = Both** Also consider peripheral vision
The external eye – begin with outside and move inward
1. Inspect area around the eye (adnexa)
a. Eyebrow size and shape
b. Orbital and periorbital area – look for edema
c. Eyelids – look for tremors and flakiness or redness of skin. Not drooping or too widely open.
d. Palpate over lacrimal gland and palpate eyelids for nodules and intraocular pressure.
2. Inspect sclera and overlying conjunctiva with ambient light AND pen light
3. Conjunctiva – translucent. Free from erythema or exudate.
4. Cornea – examine with tangential lighting. Avascular.
5. Iris and Pupil - pupil shape should be regular. Pupils should be PERRLA (pupils equal, round and reactive to light and accomodation)
a. Pupillary response, check direct and consensual
b. Check Accommodation
6. Lens – transparent
7. Extraocular Movements
a. Gaze should be conjugate, meaning both eyes move together
b. Nystagmus = eye twitch
c. Move through cardinal directions (H or star shape)
d. Normal exam is EOMI(extraocular movements intact)
8. Assess for strabismus using cover / uncover or corneal light reflex
9. Assess anterior chamber depth with tangential lighting
a. If anterior chamber is “adequate” the entire iris will light up with tangential lighting
b. If the anterior chamber is abnormal the inner iris will be in shadow
68
Internal Eye Exam
1. Dilated pupils are easier to work with. Dim room lights if possible
2. Have patient look at a distant object
3. Right Hand Right Eye Right Eye, and vice versa
4. Ophthalmoscopy Technique
a. Hand on patient’s head, lift brow
b. Locate red reflex
c. Move close to patient
d. Focus on anything in the retina (will appear orangey)
e. View optic disc (where retina converges with optic nerve) and cup
i. Stand at 15* angle
ii. Margin should be sharp, creamy yellow
iii. cup to disc ratio of 0.5 is normal
f. View retinal arteries and veins (can be used to help locate optic disc)
g. View macula (fovea) – temporal to optic disc
69
Visual Impairment
reduction in vision that cannot be corrected to normal 20/20 with standard lenses
70
Legal Blindness
20/200.
71
Proptosis / Exopthalmos
Protrusion of the eyeball
72
Ptosis
drooping of the eyelids
73
Nystagmus
involuntary eye movement or twitching
74
strabismus
eye misalignment (esotropia, exotropia, hypertropia)
75
diplopia
double vision
76
emmetropia
normal vision
77
hyperopia
farsightedness. can't see close up.
78
myopia
nearsightedness. can't see far away.
79
astigmatism
blurred vision due to irregular corneal shape or curve of lens.
80
presbyopia
old eyes
81
mydriasis
dilation of pupil caused by disease drugs or trauma
82
miosis
constriction of pupil
83
aniscoria
one pupil more dilated than the other
84
Eye Exam Findings: Diabetes
increased vascularization near macula. vitreous hemorrhage. cotton wool spot. snowflake cataracts. cloudy shape over the lens., AV nicking
85
Eye exam findings: hypertension
cotton wool spot, which are yellowish areas caused by infarction on nerve layer. A/V nicking. decreased arteriole size. hemorrhage and papilledema.
86
Eye exam findings: thyroid disease
calcium deposit in superficial cornea, appears as horizontal grey band inferior to pupil. cataracts caused by hypoparathyroidism. vision loss, tremors, exopthalmos
87
Eye exam findings: hypercholesteremia
in limepia retinalis the peripheral fundus go from normal to salmon to white. abnormalities go away as serum triglycerides return to normal. grey coloring of cornea. exudates.
88
Bones of Cranium
Frontal, Parietal, Sphenoid, Zygomatic, Maxilla, Mandible, Temporal, Occippital
89
Facial Features (new)
Nasolabial Fold
| Palpebral Fissure
90
External Anatomy of Nose
nares, ala nasi (wing)
| air passes through vestibule into choanae. vestibules separated by septum. CN I senses smells.
91
External Anatomy of Ear
| and Ear Exam
External ear: auricle (or pinna) surrounds the external auditory canal which leads to the tympanic membrane
On physical exam inspect/palpate: auricle, mastoid, tragus (triangular part near opening), helix (top of the ear), and lobule (bottom of ear, common site for piercings), use the otoscope to visual the auditory canal and tympanic membrane
Function: protects the opening of canal and provides directional sensitivity
Function: ceruminous glands secrete cerumen adding protection by trapping debris and bacteria
Function: tympanic membrane converts sound waves into mechanical movements, also the TM is a barrier to the middle ear
92
Cotton Wool Spot
ill defined yellow areas caused by infarction of nerve layer of retina
93
Hard Exudate
Sharply defined borders, yellow, clusters near vessels, caused by lipids in capillaries
94
Soft Exudate
Dull grey spots poorly defined margins caused by infarction of nerve layer
95
Pappilledema
Central Vessels pushed forward, veins dilated, venous pulsations not present
96
Exopthalmost
bulging eyes
97
Lipemia Retinalis
blood vessels become progressively pink then white as triglycerides rise
98
Arcus Cornealis
Accumulation of cholesterol around the edges of the cornea causing a grey ring
99
Middle Ear Anatomy and Exam
contains auditory ossicles (malleus/hammer, incus/anvil, stapes/stirrup); the auditory tube drains to the nasopharynx
On physical exam visualize: umbo (projection on the INNER surface of the TM at the end of the manubrium of the malleus, this is the most depressed part of the TM) and lateral process of malleus, cone of light (reflection seen on anterior inferior quadrant)
Function: conduct vibrations to the internal ear (collecting the force applied to the tympanic membrane and focusing it one the oval window)
100
Internal Ear Anatomy and Exam
bony labyrinth (continuous with the temporal bone) is made of a membranous labyrinth of fluid-filled tubes containing endolymph
On physical exam we do not visualize the inner ear, but instead test its function by the whisper test, Weber, Rinne
Function: when the stapes contacts the round window pressure waves move through the endolymph causing distortion of the basilar membrane (in the Cochlear duct), when the basilar membrane moves hair cells are triggered to release neurotransmitters and stimulate the sensory nerve
Function: cochlea provides a sense of hearing (transmitted to the 8th nerve)
Function: semicircular ducts play a role in rotational movements, utricle and saccule provide equilibrium info (moving vs. stationary)
101
Examination of the Mouth
lips, frenulum, tongue, tonsils, uvula, hard and soft palate, gingiva, salivary glands (parotid and sumandibular), dentition, buccal mucosa, maxilla, mandible
102
Examination of the Throat
Pharynx, larynx, epiglottis, esophagus, tonsils
103
Examination of the Neck
cervical vertebrae, ligaments, SCM, trapezius, lymph nodes, trachea, thyroid
104
Glands of the Mouth
Parotid Gland - stensen ducts
Submandibular Glands - wharton ducts
Sublingual
105
Bones of the Skull
zygomatic, frontal, parietal, temporal, occipital, sphenoid, lacrimal, mastoid process, mandible, maxilla, nasal bone
106
Whisper Test
have patient plug non test ear. exhale all air. whisper 2 syllable word.
107
Weber Test
assesses unilateral hearing loss. 512 Hz fork. if sound lateralizes to 1 ear, EITHER conductive loss in that ear, or sensorineural loss in the other ear.
108
Rinne Test
determines if patient hears better by bone or air conduction. vibrating fork to mastoid bone. when pt. stops hearing sound move infront of ear. in normal ears, AC>BC. If BC>AC, sensorineural loss in that ear.
109
Conductive Hearing Loss
sound cannot pass freely into inner ear
110
Sensorineural Hearing Loss
missing / damaged sensory hair cells in cochlea or damage to CN VIII (vestibulocochlear).
111
Examination of the Head
upright, centered, normal size
palpate skull front to back
free moving scalp
inspect and palpate face for symmetry. TMJ.
Hair, assess color texture distribution. look in part and behind ears.
112
Examination of the Ears
ask about hearing aids
auricles - size, shape, symmetry, color, position.
auditory canal - discharge
mastoid - not red or raised
otoscope - discharge, scaling, erythema, cerumen, foreign bodies
TM - translucent grey.
whisper, weber, and rinne
landmarks: umbo, handle of malleus, light reflex
113
Examination of the Nose
color same as face. midlne tip. oval symmetrical nares. no d/c
nasal bridge to tip non tender. patent nares. nasoscopy - color D/C, swelling, polyps, septum
114
Examination of sinuses
inspect palpate percuss transiluminate
115
Examination of Mouth
lips, mouth and oropharynx, dental prosthesis, gingiva, buccal mucosa, fordyce spots, dentition. tongue. hard/soft palate. tonsils, uvula
116
Examination of the Neck
straight, no tracheal shift, even musculature, no JVD, no visible nodes or thyroid. palpate vertebra and musculature. Thyroid exam.
117
Lymph nodes
Occipital, post auricular, pre auricular, tonsillar, submandibular, submental, anterior cervical, posterior cervical.
118
dentition
central incisors, lateral incisors, canines, first premolar, second premolar, first molar, second molar, third molar
119
septal deviation
asymmetric size of nasal cavisites. nose does not appear symmetrical.
120
Rhinitis
inflammation of the nose, purulent discharge.
121
Effusion
loss of fluid from the blood vessels or lymphatics into the tissue or a body cavity, edema, pain and tension in area of build-up
122
Otosclerosis
chronic progressive deafness, caused by formation of spongy bone and ankylosis of stapes, diminished sound transmission through bone, Rinne Test
123
Glossitis
Smooth red slick tongue, Vit B12 defficiency
124
Gingivitis / Gingival Hyperplasia
inflammation of the gums, redness, swelling, bleeding, overgrowth of gums
125
frontal bossing
prominent, protruding forehead or eyebrow ridge, common sign of acromegaly
126
geographic tongue
“expected variant”, tongue that appears map-like, lots of lines and circles that expose papillae
127
torus palatinus
boney protuberance of the hard palate, “expected variant”
128
hairy tongue
yellow-brown to black papillae that are elongated, sometimes observed after antibiotic therapy
129
cauliflower ear
blunt trauma and necrosis of the underlying cartilage
130
nasal polyps
soft, typically painless non-cancerous (benign) growths. Seem to coincide with long term rhinitis/allergy. Large polyps may occlude nasal canal causing congestion, anosmia and headaches.
131
Otorrhea
ear discharge. most commonly benign. can result from eustachician tube infection/pathology or middle ear infection/pathology. can also occur following head trauma in which case would be treated as a medical emergency (perhaps leaking brain juice AKA cerebrospinal fluid).
132
retraction/bulging of the tympanic membrane
very conical, exaggerated loss of bony landmarks and distorted light reflex
133
torticollis
dystonia resulting from the spasmodic contraction of neck muscles causing the head to take a turned, flexed or tilted position
134
pharyngitis/ tonsillitis
inflammation of the pharynx can be caused by a number of things. viruses, bacteria, fungi, pollutants or chemicals. Tonsillitis typically is described as inflamed tonsils with presence of white spot-like exudates with absence of cough (if streptococcal). Streptococcal bacteria and various viruses = most common.
135
dental caries
tooth decay or cavities. caused by bacteria
136
goiter
thyromegaly. enlarged thyroid gland typically due to lack of iodine in diet/iodine deficiency.
137
strawberry tongue
glossitis with hyperplastic fungiform papilla (looks like the dimpling of a strawberry). Can be associated with B12 defeciency, kawasaki disease, toxic shock, scarlet fever, etc.
138
atrophic tongue
papillae shrink and disappear leaving tongue red, thin, and shiny, patches of redness and inflammation, painful, sensitivity to spicy foods, bad breath
139
presbycusis
Age related hearing loss. Typically bilateral sensorineural.
140
thyroid exam
inspection: thyroid should not be visible
palpation: Displace SCM (and examine thyroid on same side) or trachea (use one hand to displace trachea, and feel thyroid on opposite side of neck). Permits visualization of gland size, symmetry, contour.
Normal exam: small, smooth, nontender, free of nodules upon palpation. Firm yet pliable.
Abnormalities: asymmetry, nodules, tenderness, enlargement (suggests goiter or thyroiditis), course tissue or gritty sensation (suggests inflammation).
141
3 layers of the epidermis
stratum corneum
cellular stratum
basement layer
142
dermis
contains blood vessels, lymph, hair follicles, sweat glands. pain and touch receptors. held together by collagen.
143
hypodermis
network of collagen and fat
144
apocrine glands
axillae, nipples, areolae, anogenital, eyelids, external ears. larger and more deep than eccrine. secrete odorless fluid. odor arises from bacteria.
145
eccrine glands
gland open to skin surface, sweat, evaporative cooling
146
nail plate
dead keratin, protects nail bed
147
eponychium
cuticle.
148
paronychium
soft tissue surrounding nail.
149
sebaceous gland
secrete lipid rich lubricating sebum. accompanies hair follicle at isthmus.
150
hair shaft
non growing portion of hair protruding form follicle composed of dead keratinocytes
151
hair follicle
region from which hair can grow
bulb
isthmus
infundibulum
152
anagen phase
active hair follicle 3-4 years 84% of hair
153
catagen phase
atrophy of follicle 2-3 weeks
154
telogen phase
resting period for follicle lasts 3 months 10-15% of hair
155
inspecting the nails
pigment, length, symmetry, ridging, beading, pitting, peeling, spooning, clubbing
156
Hair, Skin, Nails by Age
kids: skin can be red at birth. black babies get darker in a few months. smooth skin, lanugo (fine, silky hair) at birth
Adolescent: increase apocrine glands, increase androgen and sebum, coarse terminal hair
elderly: decreased sebaceous gland activity, thinning epidermis, grey hair, hair loss. slow nail growth. brittle thicker nails.
157
Hair, Skin, Nails by Race
white- earliest onset and greatest skin wrinkling
| black - blue hue of lips and gums, pigmented nail bands. palms and soles of feet are lighter.
158
Hair, Skin, Nails by Gender
Male - more likely to have hair loss with age. pubic hair in upright triangle.
Female - accelerate sweat gland activity with pregnancy. melasma (patches of dark skin) due to hormones with age. adrenal-androgenic female alopecia in 20s-30s. coarser facial hair in old age.
159
Brown Skin lesions
```
localized = nevi, neuofibromatosis.
generalized = pituitary, adrenal, liver disease
```
160
White Skin Lesions
```
Localized = vitiglio
generalized = albinism
```
161
Red (erythmatous) skin lesions
increased cutaneous blood blow:
localized = inflammation
generalized = fever, viral exanthem, urticaria
increased vascular RBCs
generalized = polycythemia
162
Yellow Skin Lesions
Increased Bile - Jaundice, generalized, liver disease
| Increased carotene pigment, generalized, hypothyroidism, increased carotene intake
163
Blue Skin Lesions
Increased unsaturated hemoglobin secondary to hypoxia, mouth lips and nail beds, cardiovascular and pulmonary disease
164
white lesion ex.
lichen planus
165
yellow lesion ex.
lipoma
166
violaceous lesion ex.
erysipelas
167
purple lesion ex
purpura, kaposi sarcoma
168
pearly lesion ex
basal cell carcinoma
169
black lesion ex
malignant melanoma
170
brown lesion ex
most nevi, pityriasis versicolor
171
orange-pink lesion ex
psoriasis
172
erythmatous lesion ex
tinea, psoriasis
173
pink lesion ex
eczema, pityriasis rosacea
174
localized lesion ex
impetigo, herpes simplex
175
regional lesion ex
acne vulgaris, psoriasis
176
generalized lesion ex
urticaria
177
lesions on sun exposed areas
sunburn, lupus erythmateous
178
lesions in clothes-covered areas
contact dermatitis, miliaria
179
lesions on flexural aspect of extremities
atopic dermatitis (inner elbow, back of knee)
180
lesions on extensor aspect of extremities
psoriasis
181
lesions in stocking and glove pattern
atopic dermatitis
182
lesions in truncal pattern
pityriasis, drug reaction
183
lesions on face shoulders and back
acne vulgaris, cushings
184
lesions in round / discoid patter
nummular excema
185
lesions in oval shape
pityriasis rosacea
186
lesions in annular shape
round, active margins w/ central cleaing: tinea, sarcoidosis
187
lesions in zosteriform shape
dermatomal: herpes zoster
188
lesions in polycyclic pattern
psoriasis
189
lesions in linear pattern
contact dermatitis
190
lesions with iris/target shape
erythema multiforma
191
lesions with stellate shape
meningococcal septicemia
192
lesions with serpiginous shape
cutanea larva migrans
193
lesions with reticulate shape
polyarteris nodosa
194
lesions with morbilliform shape
measles, roseola, drug erruptions
195
macule
primary lesion. flat. circumscribed. less than 0.5cm
196
patch
primary. flat. circumscribed, greater than 0.5cm
197
papule
primary. elevated, firm, circumscribed, less than 0.5cm
198
plaque
primary. elevated firm circumscribed greater than 0.5cm
199
wheal
primary. hive. variable diameter.
200
nodule
primary. deeper in dermis. 1-2cm
201
tumor
primary. deeper in dermis. greater than 2 cm
202
vesicle
primary elevated circumscribed superficial blister
203
bulla
primary vesible > .5 cm
204
pusture
vesicle filled with purulent discharge
205
cyst
primary. elevated circumscribed in demis filled with fluid variable size
206
telangiectasia
fine irregular red lines (primary)
207
secondary lesions
scale, lichenification, keloid, scar, excoriation, fissue, erosion, ulcer
208
Assessment of Turgor
produced by fluid content in cells. decreased when patient is dehydrated or has edema.
209
spooning nails
concave central depression of nail
210
Pallor / rubor / cyanosis
```
pallor = unhealthy pale
rubor = skin redness
cyanosis = skin blueness
```
211
clubbing
increased curvature of nail plate, bulbous swelling at terminal phalanges
212
hirsutism
women with hair in male distribution pattern
213
beau's lines
transverse depression in nail bed
214
variscosities
varicose veins
215
onycholysis
nail plate separates from nail bed
216
alopecia
sudden, rapid patchy hair loss
217
sriae
pink linear bands of skin that look like stripes... stretch marks
218
edema
swelling due to accumulation of excess fluid
219
peau d'orange
pitted or dimpled appearance of skin, looks like orange peel
220
nail pitting
pin prick like depressions in the nail plate, may indicate psoriasis
221
koilonychia
spooning nails
222
paronychia
inflammation of the paronychium
223
leukonychia
white spots in nail plate from trauma
