Week 2 - Skin, Hair and Nails Flashcards
Validity
Does the test accurately identify whether the patient has a disease
Compare test against gold standard
Sensitivity
Probability that a person with the disease has a positive test (true positive rate)
Specificity
Probability that a non-diseased person has a negative test
Positive result from a test with high specificity usually indicates disease
Positive predictive value
Probability that a person with a positive test has the disease
Negative predictive value
Probability that a person with a negative test does not have the disease
BMI
- Underweight <18.5
- Normal 18.5–24.9
- Overweight 25.0–29.9
- Obesity I 30.0–34.9
- Obesity II 35.0–39.9
- Extreme obesity ≥40
If the BMI is above 25 kg/m2, assess the patient for additional risk factors for heart disease and other obesity-related diseases: hypertension, high low-density lipoprotein (LDL) cholesterol, low high-density lipoprotein (HDL) cholesterol, high triglycerides, high blood glucose, family history of premature heart disease, physical inactivity, and cigarette smoking.
Auscultatory gap
Silent interval between systolic and diastolic pressures – associated with arterial stiffness and atherosclerotic disease
Normal/abnormal BP ranges
BP 120–129/<80 mm Hg - Elevated
130–139/80–89 mm Hg -stage 1 hypertension
≥140/90 mm Hg stage 2 hypertension
Choose the higher category for patients with SBP and DPB in two categories
Orthostatic hypotension
Occurs when SBP is 20mmHg or DBP at least 10mmHg lower than supine
Caused by drugs, severe blood loss, prolonged bed rest, diseases of the ANS
White coat hypertension
BP >140/90 in medical settings, less than 135/85 in ambulatory settings
Conditioned anxiety response
Acute pain
normal, predicted psychological response to an adverse chemical, thermal or mechanical stimulus that lasts less than 3-6 months and is commonly associated with surgery, trauma or acute illness
Chronic pain
pain not associated with cancer or other medical conditions that persist for more than 3-6 months, pain lasting more than 1 month beyond the course of an acute illness or injury or pain recurring a intervals of months or years
Nociceptive (somatic) pain
Linked to tissue damage to the skin, musculoskeletal system or viscera (visceral pain) but sensory nervous system is intact (arthritis or spinal stenosis)
- Dull, pressing, pulling, throbbing, spasmodic, colicky
Neuropathic pain
Consequence of lesion or disease affecting the somatosensory system – damage to the CNS from stroke or trauma, nerve entrapment, pressure on spinal or peripheral nevers, referred pain
Clinically significant weight loss
5% or more of usual body weight over 6 months
Weight loss causes
- Endocrine disorders
- DM
- Adrenal insufficiency
- Chronic infections
- AIDS
- Malignancy
- Chronic cardiac, pulmonary or renal failure
- Depression
- Anorexia/bulimia
Weight loss causes with high intake
- DM
- Hyperthyroidism
- Malabsorption
- Bulimia
Drugs associated with weight loss
- Anticonvulsants
- Antidepressants
- Digoxin
- Levodopa
- Metformin
- Thyroid medication
Signs of malnutrition
- Weakness
- Easily fatigued
- Cold intolerance
- Flaky dermatitis
- Ankle swelling
Testing for aphasia
- Word comprehension – one or two stage command (point to your nose)
- Repetition – repeat a phrase of one syllable words
- Naming – ask the patient to name parts of a watch
- Reading
comprehension – read a paragraph out loud - Writing – write a sentence
Fluency
Rate, flow and melody of speech
Circumlocutions
phrases or sentences are substituted for a word the person cannot think of, example “what you write” instead of “pen”
Paraphasias
words are malformed – I write with a den (malformed), I write with a bar (incorrect), I write with a dar (invented)
Broca aphasia
persevered comprehension with slow, nonfluent speech and receptive
Wernicke aphasia
impaired comprehension with fluent speech
Assessment of abstract thinking
Thought process – logic, organization, coherence, relevance of patient’s thought
Thought content – what the patient things about, level of insight and judgment
Perceptions – sensory awareness of objects in the environment and their interrelationships
Insight – awareness of abnormal behaviors
Judgement – process of comparing and evaluating alternatives when deciding on a course of action
Mental Status Exam
- Orientation
- Attention (start at 100 and keep -7)
- Memory (long/short term).
- New learning ability (remember 3-4 words)
- Higher cognitive functions (calculation, abstract thinking - draw clock)
- Depression screening
- Substance abuse screening
- Hallucinations/illusions
Epidermis
thin, avascular keratinized epithelium
o Outer horny layer (dead keratinized cells0
o Stratum Basale and stratum spinosum – inner cellular layer where melanin and keratin are formed
Dermis
Dense layer of collegen and elastic fibers
- Pilosebaceous glands (oil)
- Sweat glands
- Hair follicles
- Terminals of cutaneous nerves
Subcutaneous tissue
- Carotene (yellow pigment) – lots found in palms and soles
- Bilirubin- yellow-brown pigment caused by breakdown of heme in red blood cells -causes jaundice
Oxyhemoglobin
Red
Deoxyhemoglobin
Blue
Pilosebaceous glands
(oil) produce fatty substance secreted onto skin from hair follicles (absent in palms and soles)
Eccrine gland
Sweat gland, widely distributed, open onto skin surface, help control body temperature
Apocrine gland
found in axillary and genital regions, open to hair follicles
Vellus hair
short, fine, inconspicuous, relatively unpigmented
Terminal hair
coarser, thicker, more conspicuous, pigmented (calp and eyebrows)
Macule
circumscribed, flat area of color change in the skin less than 1cm in diameter
Patch
circumscribed flat area of color change in the skin greater than 1cm in diameter
Papule
small, solid elevation of the skin less than 1 centimeter in diameter
Plaque
large flatter elevation of the skin sometimes formed by papules coalescing
Nodule
solid elevation of skin greater than 1cm in diameter that extends into the deeper skin layers
Pustule
small, circumscribed elevation of the epidermis filled with purulent fluid
Vesicle
small circumscribe elevation of the epidermis containing clear fluid less than 1cm in diameter
Bulla
circumscribed elevation of the epidermis containing clear fluid greater than 1cm in diameter
Wheal
– circumscribed raised lesion consisting of dermal edema, aka hives or urticaria. Last less than 24 hours typically
Common manifestation of hypersensitivity to drugs, stings, bites, autoimmunity, physical stimuli including temp, pressure and sunlight
Skin assessment includes
- Size
- Number
- Distribution – how they are scattered or spread out
- Configuration – shape of single lesions and arrangement of group lesions
- Texture – smooth, fleshy, verrucous or warty, scaly
- Color – blanchable, non-blanchable
- Black, orange, yellow, purple, blue, silver, gray
- Check cap refill
- Black, orange, yellow, purple, blue, silver, gray
Risk factors for melanoma
o Personal or family history of previous melanoma
o ≥50 common moles
o Atypical or large moles, especially if dysplastic (abnormal cells)
o Red or light hair
o Solar lentigines (acquired brown macules on sun-exposed areas)
o Freckles (inherited brown macules)
o Ultraviolet radiation from heavy sun exposure, sunlamps, or tanning booths
o Light eye or skin color, especially skin that freckles or burns easily
o Severe blistering sunburns in childhood
o Immunosuppression from human immunodeficiency virus (HIV) or from chemotherapy
o Personal history of nonmelanoma skin cancer
How to assess for melanoma?
ABCDE
A - asymmetry
B - borders irregular
C - color
D - diameter
E - evolution, is it changing?
Herpes zoster
- with unilateral and dermatomal vesicles
- vesicles on erythematous base on left upper abdomen and trunk in a dermatomal distribution that does not cross the midline;
