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Health Assessment > WEEK 3: Skin, hair, nails, lymphatic, PVS Clinical Reasoning & Evaluating Clinical Evidence > Flashcards

WEEK 3: Skin, hair, nails, lymphatic, PVS Clinical Reasoning & Evaluating Clinical Evidence Flashcards

1
Q

Skin hair and nails assessment, what are the order?

A

Inspection: a thorough visual “look” at the part of the body you are examining- notice bilateral differences/symmetry
Good lighting, pen light, expose the body, instruments

Palpation: using your hands and fingers to touch the client (wash hands, warm hands- consider when to use gloves)
Pressure from light to deep
Get your hands on the area of concern: temp, edema, tenderness, texture

Auscultation: listening with your stethoscope
Bell: low pitched sounds
Diaphragm: high pitched sounds

Percussion: tapping with your finger on the joint of a finger of the opposite hand to elicit a sound

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2
Q

What are the 2 types of sweat glands

A

Eccrine glands – widely distributed, open directly onto skin surface, help control body temperature

Apocrine glands – found in axilla and groin, stimulated by emotional stress

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3
Q

What are the ABCDE for skin assessment

A

Melanoma Feature Risks
A for asymmetry

B for irregular borders, especially ragged, notched, or blurred

C for variation or change in color, especially blue or black

D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding

E for elevation or enlargement or evolution

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4
Q

What is a macule?

A

flat, small <1cm

e.g. freckles, flat mole, port wine stains, rickettisial rash, rubella, measles

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5
Q

What is Patches?

A

flat, large >1cm

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6
Q

What is plaque?

A

raised, elevated, palpatiable, solid , formed by coalesced papules, larger than 1cm

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7
Q

What is nodules?

A

> 1cm, extends deeper into skin

e.g cysts, lipomas, fibromas

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8
Q

What is Pustule

A

fluid filled, purluent fluid

e.g. bacterial infection, folliculitis

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9
Q

What is vesicles?

A

<1cm, clear fluid

e.g. herpes, allergic contact dermatitis, dermatitis herpetiformis

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10
Q

What is Bulla?

A

fluid filled, >1cm clear fluid

e.g. pemphigus vulgaris, bullous pemphigoid

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11
Q

What is pustule?

A

small palpable collection of neutrophils or keratin that appears white

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12
Q

What is Furuncle?

A

inflamed hair follicle, multiple furuncle together form a carbuncle

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13
Q

What is Wheal?

A

area of localized dermal edema that evanesces (comes and goes) within a period of 1-2 days. this is primary lesion of urticaria

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14
Q

What is Burrow?

A

small linear or serpiginous pathways in the epidermis created by the scabies mite

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15
Q

What is a Keloid

A

A raised scar after an injury has healed.
A keloid is caused by an excess protein (collagen) in the skin during healing
The scar rises after an injury or condition has healed, such as a surgical incision or acne. grows more than hypertrophic scar

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16
Q

what is Hypertrophic Scar

A

a thick raised scar that’s an abnormal response to wound healing. They more commonly occur in taut skin areas following skin trauma, burns or surgical incisions.

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17
Q

What are the different percussion scan

A

Resonant

Hyperresonant

Tympany

Dull

Flat

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18
Q

Flat sound

A

soft, high pitch, short, large pleural effusion

high pitched & short, soft
Typically over solid structures such as bone (spine, scapulae, sternum)
Pleural effusion

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19
Q

Dull

A

medium, medium pitch, medium duration, e.g. lobar pna
when fluid or solid tissue (mass) replaces air containing lung or pleural space
Pneumonia- alveoli filled with fluid, blood cells
Pleural effusion- pleura filled with serous solution
Hemothorax- pleura filled with blood
Empyema- pleura filled with pus
Tumor or fibrous tissue

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20
Q

Resonant

A

loud, low pitch, long duration,

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21
Q

Hyperresonant

A

very loud, lower pitch, longer duration, e.g. COPD, PNA

when lungs are hyperinflated
Loud, lower & longer than resonance
More common in children & very thin adults
COPD
ASTHMA (may be resonant to hyperresonant)
Unilateral: air-filled bulla
Air in lung

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22
Q

tympanitic

A

loud, high pitch, longer duration, large pnx

loud and high pitched- drum like, longer duration
Excessive air such as pneumothorax
Normal over abdomen; abnormal over chest

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23
Q

What is vellus hair type

A

Vellus hair – short, fine, less pigmentation

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24
Q

What is terminal hair?

A

Terminal hair – coarser, pigmented (scalp/eyebrows)

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25
Q

Risk factor for melanoma

A

Mole changing
Male gender
Hx of melanoma
≥ 50 moles or atypical or unusual moles (dysplastic)
Red or light hair
Actinic lentigines, macular brown (frickles) or tan spots (usually on sun exposed areas)
Heavy sun exposure (especially severe childhood sunburns)
Light eye or skin color (especially freckles/burns easily)
Family history of melanoma

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26
Q

Total body skin inspection should include

A 
Color
Moisture
Temperature
Texture
Mobility and turgor
Lesions
Hair
Nails
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27
Q

What is a nevi

A

the medical term for a mole. Nevi are very common. Most people have between 10 and 40. Common nevi are harmless collections of colored cells. They typically appear as small brown, tan, or pink spots.M

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28
Q

what is a papules

A

raised area of skin tissue that’s less than 1 centimeter around.

29
Q

SKIN: Descriptors of Rash/Lesions

A

SKIN: Descriptors of Rash/Lesions
Annular: circular lesion
Confluent:looks like its all molding together, all coming together,so many lesion you cannot tell one from another
Discrete:you can see 3 discrete lesion, see a certain amount
Gyrate/Serpiginous: in line, like snake like
Grouped: grouped lesion
Linear: a line lesion
Target: look likes targets

30
Q

Annular:

A

Annular: circular lesion

31
Q

Confluent

A

Confluent:looks like its all molding together, all coming together,so many lesion you cannot tell one from another

32
Q

Discrete

A

Discrete:you can see 3 discrete lesion, see a certain amount

33
Q

Gyrate/Serpiginous:

A

Gyrate/Serpiginous: in line, like snake like

34
Q

Herpetiform or Dermatomal

A

Herpetiform or Dermatomal (shingles like, lives in derm and nerve route):

35
Q

crust:

A

ezcema scratching

36
Q

Lichenification

A

prolonged scratching, rough skin

37
Q

fissure

A

dry skin, skin breakdown from dry skin

38
Q

ulceration

A

moist skin breakdown

39
Q

scaling

A

burn

40
Q

Milia

A

tiny white bumps on skin

41
Q

Open Comedones

A

black and white heads

42
Q

Senile Purpura-

A

Senile Purpura- superficial bleeding into the skin, happens in elder adults, generally on blood thinner.

43
Q

Ecchymosis

A

bruises

44
Q

What is Alopecia

A

Alopecia - happen in young adults, round discrete area of hair loss

45
Q

What is Trichotillomania

A

Trichotillomania- hair pulling, need behavior therpay or treat OCD need to pick

46
Q

Traction Alopecia-

A

Traction Alopecia- happens when certain hair style are pulled too tight

47
Q

Onychomycosis (& tinea pedis)-

A

Onychomycosis (& tinea pedis)- fungus/athelet’s feet

48
Q

what is mongolian spot

A

Mongolian spot: darker patch on sacrum/buttock
Darker skinned infants/children- Asian, black, Hispanic or native American
Often mistaken for “bruising” or abuse

49
Q

what is mongolian spot

A

Mongolian spot: darker patch on sacrum/buttock
Darker skinned infants/children- Asian, black, Hispanic or native American
Often mistaken for “bruising” or abuse

50
Q

what is seborrheic dermatits

A

Seborrheic Dermatitis “Cradle Cap” scaly, crusty, yellow/white
Oil, skin cells
Apply baby shampoo and coconut oil

51
Q

what is Strawberry hemangioma

A

Strawberry hemangioma: vascular nevus- collection of blood vessels
Often stays for rest of the life and style with baby, completely normal

52
Q

What is Striae Gravidarum

A

Striae Gravidarum “stretch marks”: atrophy of the skin due to rapid growth and stretching of the skin
Abdomen, breasts & thighs . . . Itching may occur
If mom have it, the daughter will most likely have it

53
Q

What is Melasma?

A

“Mask of pregnancy” Melasma: 70% of women; hyperpigmentation of skin- forehead, cheeks or nose (usually resolves after pregnancy)

54
Q

Linea nigra:

A

Linea nigra: darkened vertical line in center of abdomen

pregnancy occurance

55
Q

What is Actinic Keratoses

A

Actinic Keratoses (AK); precancerous (pre cancerous - want to freeze it off krotosis it off - )» SCC (squamous cell carcinoma)

56
Q

What is Seborrheic Keratoses

A

Seborrheic Keratoses (SK); benign

57
Q

Acrochordons

A

Acrochordons (skin tags); benign

58
Q

Solar lentigo

A

Solar lentigo (used to call these “liver spots”); benign

59
Q

Lymph node palpation characteristics to look for/into

A

Palpation
Location: where are they? If cervical- be specific
Size: estimate the size <1cm, >1cm?
Consistency: firm, rubbery, soft, matted, irregular
Mobility: mobile, fixed
Tenderness: tender, non-tender

60
Q

Lymphangitis, Lymphadenitis, vs Lymphedema

A

Lymphangitis
Inflammation or infection of the lymphatic vessels
Commonly develops after cutaneous inoculation of microorganisms into the lymphatic vessels

Lymphadenitis
Inflammation or infection of one or more lymph nodes
Pain and tenderness distinguish it from lymphadenopathy

Lymphedema
Edema or enlargement due to localized lymphatic fluid retention
Primary: Congenital malformation or dysfunction
Secondary: Acquired condition due to injury, removal, or damage to the lymphatic vessels

61
Q

Risk factors for Aortic Aneurysm

A 
Risk factors for Aortic Aneurysm
Smoking
Male gender
Advancing age
Caucasian race
Atherosclerosis
HTN
Family history of AAA
Other arterial aneurysms (eg, iliac, femoral, popliteal, intracranial)
Connective tissue disorder (eg, Marfan, Ehlers-Danlos, Loeys-Dietz syndromes) or family history
Prior history of aortic dissection
Prior history of aortic surgery or instrumentation
62
Q

PAD Risk Factors

A 
PAD Risk Factors
Age 70 years or older
DM
Smoking
Dyslipidemia
HTN
Known Atherosclerotic disease
Abnormal LE pulses
Leg symptoms with exertion or ischemic rest pain
63
Q

Ankle Brachial Index

A

higher right ankle pressure divide by higher arm pressure ;

higher left ankle pressure / higher arm pressure

<0.9 needs attention (smaller the number the more serious)

64
Q

DVT Risk: Virchow’s Triad

A

Stasis, Vessel wall injury, hypercoagulability

65
Q

Homan sign

A

Homan’s Sign: pain in calf with extreme dorsiflexion of foot

66
Q

Venous vs. Arterial Ulcers/Wounds

A 
Venous
Edema
Thickened skin
Jagged edges
Painful
Brownish appearing if chronic
Medial portion of ankle
No gangrene
Present pulses, maybe increase
Arterial
Shiny, atrophic skin
Hair loss of feet/toes
Rarely edema- mild
Round
Intermittent claudication
Pale on elevation
Red on dependency
Involves toes or points of trauma
Gangrene may develop
Pulseless or weak
67
Q

Raynauds Phenomenon

A

Raynauds Phenomenon

Vasomotor dysfunction that affects distal arterial circulation of fingers, toes, earlobes, face, nipples, or nose

68
Q

What is sensitvity vs specificity

what is high sensitivity

A

Sensitivity: the likelihood of a test to detect or “sense” a certain condition (true positive rate)
Highly sensitive: very few cases will be missed, if this test is done

Specificity: likelihood that the test will correctly identify those without the condition (true negative rate)
High specificity: very few false positives

Health Assessment (9 decks)

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