Skin Flashcards
Macule
Example- freckle
Flat discoloration, usually less than 1cm in diameter
Patch
Ex- vitiligo, mongolian spot, measles rash, choasma.
Flat area of skin discoloration, larger than a macule (larger than 1 cm)
Papule
Ex- raised nevus
Raised lesion, less than 1cm, may be the same ir different color than the surriunding skin
Vesicle
Ex- varicella, blister, herpes zoster,
Contact dermatitis
Fluid filled, less than 1 cm
Eccrine
Produces sweat from sweat glands
Apocrine
Secretion from axillae, anogenital area occur with emotional and sexual stimulation
Skin is (9)
Inspect and palpate skin by looking at 8 things
Color Temp Moisture Texture Thickness Edema Movikity or turgor Vascularity or bruising
If there are any lesions present note: (7)
Color Elevation Pattern or shape Size Location and distrubution on body Any exudate Use woods light to detect fluorescing
Profile sign of nail
View index finger at its profile and note angle of nail base; it should be about 160 degrees
Skin self examination A B C D E
Asymmetry Border Color Diameter Elevation and enlargement
Annular
Circular, begins in center and spreads to the periphery
Example- ringworm, tinea corporis, tinea versicor, pityriasis
Discrete
Ex- acrochordon, skin tag, or acne
Distinct, individual lesions that remain separate
Confluent
Ex- hives
Lesions run together
Gyrate
Twisted, coiled spiral, snakelike
Linear
A scratch, streak, line, or stripe
Zosteriform
Linear arrangement along a unilateral nerve route
Grouped
Ex- vesicles of contact dermatitis
Clusters of lesions
Target
Ex- erythema multiform
Iris or resembles iris of eye, concentric rings of color in lesions
Polycyclic
Ex- lichen, planus, psoriasis
Annular lesions grow together
Bulla
Ex- friction blister, burns, contact dermatitis
Larger than 1cm diameter usually single chambered; superficial in epidermis. Thinned wall and ruptures easily
Tumor
Larger than a few centimeters in diameter, firm or soft. Deeper into dermis
Wheal
Ex- mosquito bite, allergic reaction,
Superficial raised, transient, and erythematous; slightky irregular shape from edema
Urticaria (hives)
Wheal to form extensive reaction, intensely pruritic.
Patch
Macules that are larger than 1cm
Plaque
Ie- psoriasis
Papules coupled to form surface elevation wider than 1cm
Target
Or Iris
Resembles iris of eye, concentric ring of color in lesion
When would you do a comprehensive assessment?
For an annual physical and/or new patient
Discuss three levels of priority
1st- Emergent- life threatening or immediate
2nd- next in urgency
3rd- important but can be addressed later
What is emergent?
Anything life threatening
What may be included in a routine periodic ohysical assessment? (8)
Dietary intake Physical activity Tobacco/alcohol/drug use Sex Counseling Dentistry Immunizations Prophylactic medical approaches (ie- folic acid for a woman trying to get pregnant)
What are the four types of data
1-complete database
2- focused/problem centered data
3- follow up
4- emergency
Complete database
Whole history and physical
Focused/ problem cenetered data
Concerning one problem or system
Follow up
Status of problems alresdy addressed to see what changed
Emergency
Crucial info for swift diagnosis as the problem needs to be immediately addressed
Cue
Piece of information, sign, symptom, or lab. Can be object, action, personal.
When do we collect objective vs subjective data
Objective data is collected in the physical examination
Subjective is collected in the ROS
What is diagnotic reasoning?
Attending to cues, formulating hypotheses, gathering data relating to hypotheses, and evaluting each hypothesis to arrive at diagnoses
What are the components of evidence based decision makong
Utilize eveidence from research And evidence based theories, physical examination and assessment of patient, clinical expertise, and patient prefences/values.
Review of Systems
A technique used by healthcare providers for eliciting a medical history if patient. It is often structured as a component of an admission notes covering the organ systems eith the focus upon the subjective symptoms perceived by the patient
When does the pain scale get used in the HH?
In the HPI (oldcart)
What is the utility of quotes in the HH?
What person says us the reason for seeking care is recorded and enclosed in quotes to indicate pt exact words
Difference between signs and symptoms
Symptoms are subjective
And
Signs are objective
What is a genogram?
A pictorial display of a persons family relationship and medical history
Define open and closed ended questions
Open ended asks for narrative information and states the topic in general terms. Utilized when you start an interview, are introducing more questions, or a new topic is introduced. Closed is yes or no questions
Basal cell carcinoma
Most common form of skin cancer
Slow growing
Small,pink, or red papule with translucent top and overlying telangiectasia (broken blood vessels: occurs on sun exposed areas:face,ears, scalp, shoulders.
Describe squamous cell carcinoma
Erythematous scaly skin patches
Central ulcer eith surrounding erythema. Occurs on hands, head, bald scalp. Related to exposure to UV radiation. Grows rapidly, less common than basal cell ca
Describe malignant melanoma
Brown but may be tan, black, pink-red, purple, or mixed
You examine one lesion with a regular border ans one with a variation in color, it goes from red to white. Which is emergent?
The red and white is abnormal/emergent
What is seborrheic keratosis?
Appears dark, greasy, waxy, and stuck on old people generally. Most on the trunk/face/hands and on both unexposed and sun exposed areas. Nom cancerous
Patient has a bulls eye pattern, red, macular rash. What us a likely differential?
Lymes disease
Patient presents with a skin issue that has a rounded border with a central ulcer and depression. What is a good differential?
Basal Cell Carcinoma
You see an intertrigal rash with lesions, what would be the best class of antibiotics?
Antifungal- nystatin powder
An older person presents with flaky, silver skin PLAQUES. Differential?
Psoriasis
Demonstrate the simularities and differences between ulcerations, scars and fissures?
They are all breaks in continuity on the skins surface but an ulcer is a deep depression extending into dermis, a fissure is a linear crack in dermis, and a scar is what forms after a lesion like a fissure or ulcer is repaired made of collagen
Acutely infected lymph nodes are characterized by
Bilateral/ firm/enlarged/warm/tender/freely moveable
Describe lymph nodes in HIV
1 enlarged 2- firm 3- nontender 4- mobile * occipital nodules are most commonly enlarged in HIV
Describe cancerous lymph nodes (4)
Hard, larger than infected UNILATERAL, FIXED
You examine enlarged POSTERIOR lymph nodes bilaterally. What is your differential?
Mono
You examine enlarged ANTERIOR lymph nodes bilaterally. What is your differential?
Strep
What is the best way to palpate lymph nodes?
Use gentle, circular motion of finger pads. Start at the preauricular lymph nodes in front of ear and then palpate the 10 groups in a routine order
What is the best way to inspect thyroid movement?
Have the patient take a sip of water and watch the tracheal midline
You have a patient with a hard, large, UNILATERAL, FIXED, supraclavicular lymph node. What are the risks here?
Not only is it cancerous but it is very likely metastatic given the fact its a supraclavicukar lymph node
What causes bells palsy?
A lower motor neuron viral lesion. It induces a rapid onset of cranial nerve 7 (facial) paralysis- often brought on by reactivation of HSV-1
You can easily palpate a pregnant womans thyroid gland. Is this a normal finding?
Yes
Describe the visual apperance of a person with parkinsons face
Mask like, immobile, flat, expressionless with elevated eyebrows, staring gaze, oily skin, and drooling
Someone reports a past diagnosis in their interview, is it objective or subjective?
Subjective
O L D C A R T
Onset Location Duration Character Alleviate/aggravation Radiation Treatment
P Q R S T
Provocative/palliative Quality/quantity Region/radiation Severity Timing
7 elements in patient interview
Cheif complaint HPI PMH PSH ROS(only need to do one) Social history Medications Family history
HPI
Onset- when it starts Location- midsternal Duration- 2 weeks Characteristics- sharp Alleviating- rest, after eating/aggravated- exercise Radiation- left shoulder Time- lasts for 10 minutes Severity- 2/10
CAGE
1-Do you ever feel uou have to CUT down on your drinking
2-ever feel ANNOYED by critism of drinking
3- guilty about drinking
4- eye opener
Cranial nerve 1
Olfactory
Smell mint leaves/tobacco
Cranial nerve 2
Optic
Visual acuity and funduscopic
Cranial nerve 3
Oculomotor
Pupillary reaction
Cranial nerve IV
Trochlear
Pupillary reaction
Cranial nerve 5
Trigeminal
Clench teeth, open jaw, lip/chin test for light touch
Cranial nerve 6
Abducens
EOM
EYE MOVEMENT TO THE SIDE
Cranial nerve 7
Facial
Raise eyebrows/frown/ show teeth/ smile/ puff cheeks
Cranial nerve 8
Acoustic
Whisper test
Weber/Rinne tests
Cranial nerve 9
Glossopharyngeal
Hoarseness
Tongue movement
Cranial nerve 10
Vagus
Saying “ah” and note palate and uvula mive upward
Cranial nerve 11
Spinal accessory
Shrug shoulders
Cranial nerve 12
Hypoglossal
Inspect tongue for atrophy/ fasciculation