Week 3 Guiding Q's (Exam 1) Flashcards
Why is it important to screen the skin and nails for abnormal changes? (3)
- Changes in skin/nail bed may be 1st sign of inflammatory, infectious and immunologic disorders
- Skin lesions may be a result of integumentary problem or an integumentary response to a systemic problem
- New onset of skin lesions (especially in children) should be medically evaluated
Name the ABCDE Criteria utilized for screening suspicious skin lesions.
Asymmetry: Uneven edges, lopsided in shape, one half unlike the other half
Border: irregular, irregular edges, scalloped or poorly defined edges
Color: black, shades of brown, red, white, or occasionally blue
Diameter: larger than a pencil eraser (>6 mm)
Evolving: mole or skin lesion that looks different from the rest or is changing in size, shape, or color
What is dermatitis? What is the difference between contact dermatitis, dyshidrotic dermatitis, and atopic dermatitis?
Referred to as eczema
Skin is red, brown, or gray; sore; itchy and sometimes swollen
- Contact dermatitis=skin reacts to something it has come in contact with
- Dyshidrotic dermatitis= affects skin that gets wet frequently
- Atopic dermatitis= often accompanies asthma or hay fever
How long does a rash from Herpes Zoster (shingles) last? What does it feel like? What path does the lesion appear on?
- Rash may last 1-14 days
- Reports burning, shooting pain and tingling or itching
- Lesion appear unilaterally along the path of a spinal nerve
What is often the first sign of an underlying rheumatologic disease? What specific conditions is this common with? (6)
Skin lesion/rash often first sign of underlying rheumatic disease
Rheumatic diseases accompanied by skin lesions
◦ _**SLE
◦ Discoid lupus erythematosus
◦ Lyme disease**_
◦ Psoriatic arthritis
◦ Reactive arthritis
◦ Scleroderma
What characteristics of lymph nodes increase the suspicion of cancer?
Nodes that are hard, immovable and nontender raise suspicion of cancer (keep fingers flat and don’t push too hard to keep from flattening them out)
What happens to older adult’s nails? (3)
◦ Gradual thickening of the nail plate
◦ Appearance of longitudinal ridges
◦ Yellowish-gray discoloration
Beau’s Lines - what are they, what causes them
other associated conditions (5)
Transverse grooves across the nail plate
Caused by decreased or interrupted production of the nail by the matrix
Usually caused by acute illness or systemic insult
Other associated conditions:
- Poor peripheral circulation
- Eating disorders
- Cirrhosis
- Recent MI
- Other trauma
Splinter Hemorrhages - what are they, what might they be a sign of (4 things)
Red-brown, linear streaks
May be sign of silent MI or pt may have hx of MI
Systemic conditions:
- Bacterial endocarditis
- Vasculitis
- Renal failure
Clubbing (nails) - what causes this, when is it a cause for major concern?
Usually results from chronic O2 deprivation in tissue beds
Often observed in pts with COPD, congenital heart defects and cor pulmonale
Can occur w/in 10 days in pt with acute systemic condition (ie pulmonary abscess, malignancy or polycythemia)
_*Rapid development of clubbing over the course of 10-14 days requires immediate medical evaluation*_
What does Murphy’s sign test for? What is the procedure? Abnormal findings?
Testing for gallstones (acute cholecystitis)
Procedure:
- Patient Position: Supine in hook lying
- Examiner Position: On right side of the patient
- Ask patient to exhale
- Perform palpation below costal margin on the right at midclavicular line
- Have the patient take a deep breath in
Abnormal Findings: Patient stops breathing/winces or reports tenderness
What does McBurney’s point test for? What is the procedure? Abnormal findings?
Tests for appendicitis
Procedure:
- Patient Position: Supine
- Examiner Position: Standing to right side of pt.
- Deep palpation at a point 1/3 – 1/2 distance from the ASIS to the umbilicus
- Quickly release and assess for rebound tenderness
Abnormal Findings: Tenderness
What does Rovsing’s sign test for and how is it different than McBurney’s point?
Still tests for appendicitis but it’s on the opposite side of McBurney’s.
Procedure:
- Patient Position: Supine
- Examiner Position: Standing to right side of pt.
- Rebound tenderness testing administered at the lower left quadrant
Abnormal Findings: right lower quadrant tenderness with remote rebound testing at the left lower quarter
Where is your hand placement when palpating for an AAA? What is the procedure? What about abnormal findings?
Slightly left of the belly button and slightly superior, place hands side by side and capture pulse between the hands. Looking for pulse width greater than 3 cm’s.
Procedure:
- Patient Position: Supine, slightly raised knees necessarily
- Examiner Position: Standing to right side of pt.
- Palpate (deep palpation) for aortic pulse superior & slightly left of umbilicus using the pads of the fingers
- Place palms on abdomen with index fingers on each side of aorta
_**Abnormal Finding is pulse width > 3 cm
Provocation of symptoms including exquisite tenderness or referred pain to back is also abnormal**_
What are considered abnormal findings with AAA palpation? With AAA auscultation? What type of patient is best screened by these procedures?
Abnormal Finding for Palpation: pulse width > 3 cm
or provocation of symptoms including exquisite tenderness or referred pain to back is also abnormal
Abnormal Finding for Auscultation: would be presence of bruit (abnormal blowing or swishing sounds)
◦ Combination of palpation and auscultation for AAA improves the value of these techniques as a screening tool for thin patients with aneurysms greater than 5 cm
