SKin Changes Flashcards
6 Ps of acute limb ischemia
Parasthesia
perishing cold
pulselessness
pain
paralysis
pallor
superficial varicosities and edema indicate ____
poor venous return due to incompetent valves in the veins
describe how varicosities form
the valves in the veins don’t close properly which causes backflow and dilation of the vessel
describe stasis dermatitis and what causes it
reddish/purplish/brownish discoloration in the skin that develops over time
due to hemosiderin deposits staining the skin from red cell breakdown due to decreased blood flow or “stasis” of venous circulation
describe advanced stasis dermatitis
thickened skin, firm to the touch
“brawny edema” term often used to describe if swollen
describe cellulitis and its presenting symptoms
inflammation of the skin and subcutaneous tissue from an infection
- marked erythema
- increased warmth
- increased swelling
- sometimes skin weeping w/o any apparent open sores
describe the appearance and cause of janeway lesions
bacterial endocarditis
- irregular macules on the soles and palms that are non-tender, last days to weeks
describe the appearance and cause of osler nodes
bacterial endocarditis
- tender nodules 1mm-1cm on the fingers and toes and thenar and hypothenar eminences, last hours to days
describe the appearance and cause of splinter hemorrhages
bacterial endocarditis
- microemboli in the periphery of the nail bed produced from valvular pathology
*more likely due to nail trauma if isolated or minimal involement
describe the appearance and cause of xanthelasmas
hyperlipidemia
- lipid laden deposits on the eyelids
describe the appearance and cause of eruptive xanthomas on the shoulder
hyperlipidemia
- umbilicated lesions (dent in the center of a papule) that can look like molluscum contagiosum (viral infection)
do all patient who have hyperlipidemia present with xanthomas
nope
cause of clubbing
chronic pulmonary disease
- lung dz most common
- platelet and endothelial growth factors may contribute to the process
- peripheral hypoxia may be the trigger
compare (between vascular or neurogenic) the symptoms suggesting claudication:
factor: after a pt walking
vascular: unchanged
neurogenic: increased weakness
compare (between vascular or neurogenic) the symptoms suggesting claudication:
factor: palliative factors
vascular: stopping activity
neurogenic: bending over, sitting, or general leaning forward takes pressure off nerves
compare (between vascular or neurogenic) the symptoms suggesting claudication:
factor: provocative factors
vascular: walking uphill, increased metabolic demand neurogenic: walking downhill, increased lordosis
compare (between vascular or neurogenic) the symptoms suggesting claudication:
factor: pulses
vascular: absent neurogenic: present
list notable sx of chronic bronchitis (i know we’ve learned this a million times but just look over so you don’t forget)
“blue bloater”
- chronic, productive cough
- purulent sputum
- hemoptysis
- mild dyspnea
- cyanosis
- crackles
- obese
list notable sx of emphysema (i know we’ve learned this a million times but just look over so you don’t forget)
“pink puffer”
- dyspnea
- minimal cough
- pink skin
- pursed lip breathing
- accessory muscle use
- cachexia
complications of chronic bronchitis
- secondary polycythemia due to hypoxemia
- pulm. HTN due to reactive vasoconstriction from hypoxia
- cor pulmonale from chronic pulm. HTN
complications of COPD
- pneumothorax due to bullae (cyst)
- weight loss due to work of breathing
compare peripheral and central vascular disease
peripheral: sx seen in the extremities
central: affecting aorta, IVC, major organ vessels
describe the proper diet to reduce risk for peripheral and central vascular dz
low salt
low fat
high fiber
how does alcohol contribute to peripheral and central vascular dz
it contributes to cardiomyopathy and mitochondrial endothelial dysfunction also the dehydrating effects causes sludging or congestion/impairment of optimum blood flow
what is the plan to implement therapeutic lifestyle changes (TLC) to modify sx and slow progression of vascular dz
- stop smoking
- exercise/weight loss
- compressing/support stockings
- psychosocial support
- follow up regularly
how to prioritize a step-wise behavior modification to optimize pts success
- work w/ pt to decide which TLC is most manageable
- maybe include meds
- consider social service, physical therapy, occupational therapy, counseling, dietary education
- set realistic goals :)
what diagnostic tests would you use to evaluate underlying risk factors for cardiopulmonary dz
- CBC (check for anemia)
- lipid panel
- fasting blood sugar (check for DM)
- EKG
- CXR
- ankle/brachial index
- venous/arterial doppler US
- interventional radiology or cardiology
what causes this physical exam finding
(varicosities and edema)
pour venous return due to incompetent valves
what causes this physical exam finding
usually infection
(cellulitis)
what causes this physical exam finding
(janeway lesion)
bacterial endocarditis
what causes this physical exam finding
(oslers nodes)
bacterial endocarditis
what causes this physical exam finding
(splinter hemorrhages)
bacterial endocarditis
what causes this physical exam finding
(eruptive xanthomas)
hyperlipidemia
what causes this physical exam finding
(clubbing)
chronic lung dz
what causes this
(stasis dermatitis)
- Due to hemosiderin deposits staining the skin from red cell breakdown
- Occurs with decrease flow or “stasis” on venous side of circulation
what is this
advanced stasis dermatitis
“brawny edema”
