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NR509 - Advanced Assessment > Week 2 - Skin, Hair and Nails > Flashcards

Week 2 - Skin, Hair and Nails Flashcards

1
Q

Validity

A

Does the test accurately identify whether the patient has a disease
 Compare test against gold standard

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2
Q

Sensitivity

A

Probability that a person with the disease has a positive test (true positive rate)

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3
Q

Specificity

A

Probability that a non-diseased person has a negative test

Positive result from a test with high specificity usually indicates disease

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4
Q

Positive predictive value

A

Probability that a person with a positive test has the disease

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5
Q

Negative predictive value

A

Probability that a person with a negative test does not have the disease

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6
Q

BMI

A
  • 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.

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7
Q

Auscultatory gap

A

Silent interval between systolic and diastolic pressures – associated with arterial stiffness and atherosclerotic disease

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8
Q

Normal/abnormal BP ranges

A

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

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9
Q

Orthostatic hypotension

A

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

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10
Q

White coat hypertension

A

BP >140/90 in medical settings, less than 135/85 in ambulatory settings

Conditioned anxiety response

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11
Q

Acute pain

A

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

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12
Q

Chronic pain

A

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

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13
Q

Nociceptive (somatic) pain

A

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
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14
Q

Neuropathic pain

A

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

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15
Q

Clinically significant weight loss

A

5% or more of usual body weight over 6 months

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16
Q

Weight loss causes

A
  • Endocrine disorders
  • DM
  • Adrenal insufficiency
  • Chronic infections
  • AIDS
  • Malignancy
  • Chronic cardiac, pulmonary or renal failure
  • Depression
  • Anorexia/bulimia
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17
Q

Weight loss causes with high intake

A
  • DM
  • Hyperthyroidism
  • Malabsorption
  • Bulimia
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18
Q

Drugs associated with weight loss

A
  • Anticonvulsants
  • Antidepressants
  • Digoxin
  • Levodopa
  • Metformin
  • Thyroid medication
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19
Q

Signs of malnutrition

A
  • Weakness
  • Easily fatigued
  • Cold intolerance
  • Flaky dermatitis
  • Ankle swelling
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20
Q

Testing for aphasia

A
  • 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
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21
Q

Fluency

A

Rate, flow and melody of speech

22
Q

Circumlocutions

A

phrases or sentences are substituted for a word the person cannot think of, example “what you write” instead of “pen”

23
Q

Paraphasias

A

words are malformed – I write with a den (malformed), I write with a bar (incorrect), I write with a dar (invented)

24
Q

Broca aphasia

A

persevered comprehension with slow, nonfluent speech and receptive

25
Q

Wernicke aphasia

A

impaired comprehension with fluent speech

26
Q

Assessment of abstract thinking

A

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

27
Q

Mental Status Exam

A
  1. Orientation
  2. Attention (start at 100 and keep -7)
  3. Memory (long/short term).
  4. New learning ability (remember 3-4 words)
  5. Higher cognitive functions (calculation, abstract thinking - draw clock)
  6. Depression screening
  7. Substance abuse screening
  8. Hallucinations/illusions
28
Q

Epidermis

A

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

29
Q

Dermis

A

Dense layer of collegen and elastic fibers
- Pilosebaceous glands (oil)
- Sweat glands
- Hair follicles
- Terminals of cutaneous nerves

30
Q

Subcutaneous tissue

A
  • Carotene (yellow pigment) – lots found in palms and soles
  • Bilirubin- yellow-brown pigment caused by breakdown of heme in red blood cells -causes jaundice
31
Q

Oxyhemoglobin

A

Red

32
Q

Deoxyhemoglobin

A

Blue

33
Q

Pilosebaceous glands

A

(oil) produce fatty substance secreted onto skin from hair follicles (absent in palms and soles)

34
Q

Eccrine gland

A

Sweat gland, widely distributed, open onto skin surface, help control body temperature

35
Q

Apocrine gland

A

found in axillary and genital regions, open to hair follicles

36
Q

Vellus hair

A

short, fine, inconspicuous, relatively unpigmented

37
Q

Terminal hair

A

coarser, thicker, more conspicuous, pigmented (calp and eyebrows)

38
Q

Macule

A

circumscribed, flat area of color change in the skin less than 1cm in diameter

39
Q

Patch

A

circumscribed flat area of color change in the skin greater than 1cm in diameter

40
Q

Papule

A

small, solid elevation of the skin less than 1 centimeter in diameter

41
Q

Plaque

A

large flatter elevation of the skin sometimes formed by papules coalescing

42
Q

Nodule

A

solid elevation of skin greater than 1cm in diameter that extends into the deeper skin layers

43
Q

Pustule

A

small, circumscribed elevation of the epidermis filled with purulent fluid

44
Q

Vesicle

A

small circumscribe elevation of the epidermis containing clear fluid less than 1cm in diameter

45
Q

Bulla

A

circumscribed elevation of the epidermis containing clear fluid greater than 1cm in diameter

46
Q

Wheal

A

– 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

47
Q

Skin assessment includes

A
  • 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
48
Q

Risk factors for melanoma

A

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

49
Q

How to assess for melanoma?

A

ABCDE

A - asymmetry
B - borders irregular
C - color
D - diameter
E - evolution, is it changing?

50
Q

Herpes zoster

A
  • 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;

NR509 - Advanced Assessment (9 decks)

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