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CH 4- Physical Assessment as a Screening Tool
Terms in this set (167)
1+ pulse diminished
2+ easily palpable, normal
3+ full pulse, increased strength
4+ bounding, too strong to obliterate
how is pulse recorded
Check 2 sites on people with diabetes and older adults
pulse: diabetes and older adults
who has higher pulse rate at rest?
radial and dorsalis pedis
Don't check carotid baroreceptor can cause the patient to have syncope episode
Preferred sites to take pulse?
o Pulse strength usually increases slightly with inspiration and decreases with expiration.
how does respiration affect pulse rate?
pulse amplitude that fades with inspiration instead of strengthening, and strengthens with expiration instead of fading; should report to physician
- constrictive pericarditis
- pericardial effusion
- tension pneumothorax
- pericarditis with fluid
- pericardial tamponade
paradoxic pulse occurs in patients with (6)
Condition in which the lung collapses the space inside fills with air so now your lung cannot expand
what is tension pneumothroax?
3 min after rest
should be reported to the physician
After 60 second should recover 20 beats per minute if your fair
Good cardiovascular shape it can be more
a pulse increase with activity of more than 20bpm lasting more than how long after rest should be reported?
increased intracranial pressure
immediate medical evaluation--> RED FLAG
high pulse pressure accompanied by bradycardia is a sign of
§ Stage 1 hypertension 140-159 (systolic) 90-99 (diastolic)
Stage 2 hypertension >160 (systolic) >100 diastolic
Stage 1 and Stage 2 hypertension
§ Make sure to slowly lower pressure in the cuff (not too slow)
§ Wait at least 1 min to re-take (may cause blood vessel damage)
§ Use other arm
when assesing BP (3)
<90 mm Hg or a DBP <60 mm Hg
o Decreased BP may be an early warning sign of dementia
§ For each 10 point drop in pressure, the risk of dementia increases by 20%
o Decreased BP may be an early warning sign of what?
systolic rise up to 40-50 mmHg with intense exercise
(min-mod 20mm hg or more)
while diastolic stays the same, shouldn't increase by more than 10 mmHg
Exercise should be stopped if DBP goes above 100 mm Hg (SBP goes above 200 mm Hg)
; should return to normal 3-10 minutes following exercise
how should blood pressure react to exercise
higher in LE
BP in UE or LE should be higher?
- decrease of 20 mmHg SBP
- decrease of 10 mmHg DBP
- 10 to 20% increase in pulse rate
measure after letting person lie for 2-3 minute in supine then measure again after 3-5 min of standing?
S/S: dizziness, lightheadedness, pallor, diaphoresis, syncope
Diagnostic criteria of postural orthostatic hypotension:
- decrease of ____ mmHg of SBP
- increase of ___ mmHg DBP
- ___ to ____% increase in pulse rate
when do you measure it?
Hypothermia is less than ____ F.
Lowest - early morning
Highest - late afternoon
When is body temperature lowest? Highest?
anytime you can't identify the cause of someone's symptoms, a fever would let you know the problem is systemic
According to Max, when does he take someone's temp?
walking speed of less than __mph is a high risk of mortality
Hypo or Hyperthermia
Depression and Anxiety
Education/Socioeconomic background and communication skills
Factors affecting mental status (15)
Sudden change in mental status or a stage of confusion
Risk Factor: Surgery or hospitalization within last 24 hours
-usually temporary, can last hours to weeks
Surgery/hospitalization w/ in last 24 hours
Post TKA THA
attributed to;Older age (65 or >), Poly pharmacy, & slower metabolism
* NOTE: can be anyone not just the elderly
Delirium risk factors
come to PT the same day to start ROM
Manipulation under anesthesia
Stress, trauma, pain, infection
• Hospitalization (for hip fracture, serious illness or
trauma including surgery) or change in residence
• Older age (65 years old or older)
• Hip or knee joint replacement
• Poor cognitive function, underlying dementia, previous
• Vision or hearing deficits
• Decreased physical function
• History of alcohol abuse
• Medications (e.g., benzodiazepine, narcotics, NSAIDs,
anticholinergics prescribed for sleep, psychoactive
agents, analgesics, sedative agents for pain and anxiety
• Urinary retention, fecal impaction, diarrhea
• Sleep deprivation
• Postoperative low hemoglobin, abnormal fluid and/or
electrolytes, low oxygen saturation
• Malnutrition, vitamin B12/folate deficiency, low albumin
Risk Factors for iatrogenic or post op delirium
Antidepressant (SSRI's, and TCA's ), opioids
what medications can alter mental status?
o Confusion is not a normal change and should be documented
§ Often associated with systemic conditions (Table 4-3)
§ Can signal infection (pneumonia, UTI), electrolyte imbalance, or delirium
is confusion normal with aging?
this is no bueno
can signal infection, electrolyte imbalance, or delirium
potential causes of random confusion?
Females usually present with unusual fatigue, certain level of confusion
female MI symptoms
o Important for growth and development and recovery from infection, illness, wounds, and surgery.
o Consider medications, psychosocial factors, and economic variables
o Notify physician and/or request referral for registered dietician
important for what?
consider what? (3)
Alopecia (hair loss)
signs of under or malnutrition (9)
changes in mental status and bone density
malnourished can cause what changes?
§ Wounds: TKA poor nutrition the healing is going to be significantly delayed and puts them at great risk for infection
§ Should notify physician when this happens (delayed healing)
§ Request referral to dietician at that point
§ S and s infection fever, chills, pus , sweating send to ER
what would you do if you see delayed wound healing in a TKA?
A fruit breath may indicate....
throat or sinus infections,
Helicobacter pylori bacteria
Bad breath may indicate... (6)
o of urine, ammonia, or feces
§ A brief introduction or explanation may be helpful prior to follow-up questions
Patients who are incontinent may smell what? (3)
o Vital signs, observations, and reported associated signs and symptoms are among the best screening tools available to the therapist.
§ Many people are unaware if they have high blood pressure and are asymptomatic
o Therapists in primary care settings will especially need to know when and how to assess vital signs
o Values are compared to norms and previous values to identify significant changes
what are the best screening tools available to the therapist? (3)
PT in primary care need to know what?
Guide to Physical Therapist Practice recommends that ________________ and _________________ are measured at new patient examinations
__________________ and _____________ have the greatest utility as early screening tools for systemic illness or disease
o while pulse, blood pressure, and oxygen (O2) saturation level offer valuable information about the cardiovascular/pulmonary systems.
what offers a valuable information about the cardiovascular system? (3)
-systolic decrease during exercise
-Systolic goes above 180
-Diastolic goes up more than 10-15 Should stay the same and decrease 3-5 points. Should never go up
Over 100 not good
Red Flags with BP
-Core body temp (oral or ear)
-pain(fifth vital sign)
-walking speed(the sixth vital sign)
Name the vital signs (8)
· Anytime you don't know where the patient's symptoms are coming from
· Could be systemic problem!!!
· While they don't report fever they can still have high temperature
· Patient ovulating their temperature increases
· One degree
· Over 100 now we have concern !!!
Ask if their temperature spikes like this? Is this normal? 98.6 is generalized
Who would benefit the most from a temperature assessment?
o Minimal in patients taking beta blockers ( and calcium channel blockers- prevent the normal rise in pulse rate that occurs during exercise)
§ Use RPE
Pulse Assessment: beta blocker
around 20 bpm per mixture for someone in moderate okay shape
normal rate of HR recovery post exercise?
oxygen saturation level
(3)... offer valuable information about the cardiovascular/pulmonary systems
the radial & dorsals pedis
Pulse should be checked at ___ sites in older adults and those with diabetes
indicates circulating blood volume and strength of left ventricle ejection
pulse strength tells us...
Pulse strength usually ____________ slightly with INSPIRATION and __________________ with EXPIRATION
Any condition that restricts blood flow (including cold hands or application of an automatic blood pressure cuff)
Positioning can impact a person's ability to breathe
Nail polish and nail coverings
Irregular heart rhythms
Significant venous pulsation
Pulse Ox measurements may be altered by..
The difference between the systolic and diastolic pressure readings
Normally around 40 mm Hg
what is pulse pressure?
Index of vascular aging
· (i.e., loss of arterial compliance indication of how stiff the arteries are).
what does pulse pressure indicate?
is linked to a significantly higher risk of stroke and heart failure after the six decade
Resting pulse pressure consistently greater than 60-80 mmHg is a risk factor for new onset of...
may indicate CHF or significant blood loss such as during hypovolemic shock
decrease of the pulse pressure may indicate..
sA condition in which low blood volume, due to massive internal or external bleeding or extensive loss of body water, results in inadequate perfusion.
Differences in blood pressure between sides of the body larger than ____ mmHg may indicate vascular problems or used as a method for detecting thoracic outlet syndrome
Normally, the SBP in the legs is _______% higher than the brachial artery pressure in the arms
peripheral vascular disease
BP readings that are lower in the legs as compared with the arms are considered abnormal and should prompt a medical referral for assessment of....
-At risk for increased BP because these drugs are potential vasoconstrictors
-Monitor BP carefully and look for sacral and lower extremity edema
relationship between NSAIDS & BP
low clinic blood pressure, but elevated ambulatory/home blood pressure
loss of balance falls
Low standing blood pressure (SBP of less than 140 mmHg) is an independent predictor of _______________ and _____________ in adults over 65 years of age
Headache (usually occipital and present in the morning)
Spontaneous epistaxis (nosebleed)
Nocturnal urinary frequency
S/S of hypertension (6)
Mental or visual blurring
Sense of weakness or "rubbery" legs
S/S of hypotension
A sudden drop in BP when changing positions, usually from supine to an upright position
-Rapid change in body position causes blood to pool in the abdomen and lower extremities due to gravity
-Reduction in venous return leads to a reduced stroke volume and cardiac output and lowering of the BP
-Decreased BP leads to a lack of activation of the baroreceptors which signals for an increase in sympathetic discharge
-Individuals with either blood volume depletion or an autonomic dysfunction may not be able to adequately compensate and thus experiences feelings of light-headedness or syncope
-Older adults are more prone due to declining responses of the sympathetic nervous system
- Economic status
- living alone
- Older age
- lactose intolerance
- GI impairment
- hard time chewing/swallowing
Risk factors for poor nutrition
Level of consciousness
Orientation to time place and person
Ability to communicate
When assessing mental status look at a patient's
Should linearly increase; 20 increase with moderate exercise and 40-50 increase with intense exercise
SBP changes with age and exertion
Increases risk for CVD so this with consistently elevated BP should be advised to see physician for close monitoring and follow up
Oral contraceptive effects on BP
If SBP exceeds 200 or DBP exceeds 100
BP response to exercise that indicates reduced or stopping exercise
Brief exam of CV/pulmonary, integumentary, MSK, Neuromuscular systems and the clients ability to communicate/learn
Review of systems
Part of patient history intended to gather info that may necessitate a referral
3 & 4. Percussion and palpation (these two, order doesn't matter)
4 techniques of physical examination in order
Dimension, size, shape, and density of tissue
Percussion (tapping) is used to assess
Low pitched sounds such as heart murmurs and BP
The bell side of the stethoscope is used to eval what sounds
High pitched sounds such as normal hart sounds, bowel sounds, and friction rubs
The diaphragm side of the stethoscope is used to asses what sounds
Red/brown streaks down nails. Sign of MI, subacute bacterial endocarditis, sepsis, RA, vitamin C deficiency, or hematologists neoplasm, local trauma
Splinter hemorrhages (7)
More than 5 tan macules in clients with neurofibromatosis. Larger than 1.5 cm should raise suspicions of underlying pathology even if only one is present.
Skin rash with central pustules. Sign of drug reaction to antibiotics or precursor to abdominal cancer
chronic facial skin disorder sen most often in adults between ages of 30 and 60 years old; erythema, flushing, telangiectasia, papules, pustules; enlarged nose; progressive
Petechiae and ecchymoses in flat macular hemorrhage. Sign of thrombocytopenia (platelet levels less than 100,000 mm), blood leaking from capillaries due to old age, life long UV radiation.
Xanthelasma- benign fatty fibrous yellow plaques, nodules, or tumors that develop in the subcutaneous layer of skin, often around tendons; characterized by intracellular accumulation of cholesterol and cholesterol esters
often associated with:
- disorders of lipid metabolism
- primary biliary cirrhosis
- uncontrolled diabetes
Another type of xanthelasma (xanthomas)
Sign of poorly controlled DM, indicates need for immediate medical attention to bring glucose levels down
Sign of chronic topical steroid use
what drug is this related to?
we see this, what do we think the boy has ben doing?
white nail syndrome; characterized by dots or lines of white that progress to the free edge of the nail as the nail grows; may be congenital but most often caused by other conditions like arsenic poisoning
Yellowing around the nail bed. infection of the fold of skin at the margin of a nail; may be acute or chronic
painless loosening of the nail plate occurring from the distal edge inward; may be from dermatologic condition, medication, systemic diseases or local causes like trauma
- Graves disease (hyperthyroidism, heat intolerance,bulging eyes)
- reactive arthritis
- OCD (nail pickers)
causes of onycholysis (4)
Horizontal depression across nail plate. Sign of shock, illness, malnutrition, trauma, prolonged fever, or chemo
Koilonychia: can be congenital or hereditary
Spoon nails. Sign of anemia, iron deficiency, thyroid disease, psoriasis, poorly controlled diabetes (>15 years), chemical exposure, or nutritional deficiencies
o Hypochormic anemia
o Iron deficiency
o Poorly controlled diabetes >15 years
whats this? (3)
results from oxygen deprivation in tissue beds: COPD, congenital heart defects, cor pulmonale
can occur within 10 days in someone with an acute systemic condition such as pulmonary abscess, malignancy, polycythemia
may be the first sign of cancer--> pareneoplastic syndrome
more likely shoulder pain will be the first sign
results from what?
when can it occurs? (3)
maybe the first sign of what?
assessment of digital clubbing. but fingers together, if you can see diamond shape between nails there is no clubbing. If shape seen between nails is not diamond shaped there is clubbing
§ In early clubbing the angle straightens out to 180
degrees, and the nail base feels spongy to palpation.
what is the Schamroth method
Nail patella syndrome
absence of nail from part of nail bed or toenails becoming paper thin. associated with underdeveloped patella and other jt problems
may be sign of a silent MI or the client may have a known history of MI; can also signal other systemic conditions such as bacterial endocarditis, vasculitis or renal failure
medical term for itching
spontaneous abnormal sensation of ants or other insects running over the skin
(collagen decreases as we age so it snap backs less)
what reduces tugor
- dry mouth, dry lips
signs of mild dehydration (3)
- very dry mouth
- cracked lips
- sunken eyes
- sunken fontanel (infants)
- poor skin turgor
- postural hypotension
signs of moderate dehydration (7)
- very dry mouth
- cracked lips
- sunken eyes
- sunken fontanel (infants)
- poor skin turgor
- postural hypotension
- rapid weak pulse (more than 100 bpm)
- rapid breathing
- cold hands & feet
- unable to cry or urinate
signs of severe dehydration (7)
Exercise with a fever stresses the cardiopulmonary system, which may be further complicated by dehydration.
exercising with a fever stresses what?
Severe dehydration can occur from vomiting, diarrhea, medications (e.g., diuretics), or heat exhaustion.
severe dehydration can occur from what? (3)
§ Chronically ill or hospitalized patients should be examined frequently for signs of skin breakdown. Check all pressure points, including the ears, sacrum, scapulae, shoulders, area over the greater trochanters, heels, malleoli, and the back of the head. Document staging of any pressure ulcers
Chronically ill or hospitalized patients should be examined frequently for signs of what?
1-skin changes observable. localized area of nonblanchable erythema
2-epidermis and dermis damaged; partial thickness skin loss
3-damage to subcutaneous but not fascial
4-involvement of bone, tendon, joint capsule etc
stages of pressure ulcers
press nailbed and release, color should return before 3 seconds
how to check for capillary filling
lack of pigmentation from melanocyte destruction
occurs when small capillaries under the skin start to bleed forming tiny blood spots under the skin; does not fade under pressure
can affect skin that gets wet frequently; small itchy bumps on sides of fingers or toes and progresses to a rash
decrease in platelet levels, bleeding disorder characterized by petechiae, multiple bruises, and hemorrhage into the tissues
bone marrow failure from radiation treatment, leukemia or metastatic cancer, cytotoxic agents used in chemo and drug induced platelet reduction
most common cause of thrombocytopenia
butterfly rash over ose and cheeks
lupus erthematosus common skin condition
erythema chronicum migrans
occurs with Lyme disease; no one prominent rash but one or more rashes; appears 1 to 2 weeks following tick bite and may persist 3-5 weaks; bulls eye rash
acute skin irritation caused by radiation at time of radiation; also xray keratosis
intense painful infection of the terminal phalanx of the fingers caused by HSV
or "shingers", same virus that causes chickenpox; lies dormant in dorsal root ganglion; outbreak of a rash or blisters on skin associated with severe pain; early signs are burning or shooting pain and tingling or itching
Pain that lasts longer than a month after a shingles infection and is caused by damage to the nerve; the pain may last for months or years.
discoloration of the skin in newborn infants; congenital developmental condition exclusively involving the skin and is very common in children of Asian, African, Indian, Native American, Eskimo, Polynesian or Hispanic origins; flat dark blue or black areas
Form of skin cancer frequently seen in acquired immunodeficiency syndrome (AIDS) patients. Consists of brownish-purple papules that spread from the skin and metastasize to internal organs.
round patches of reddish brown skin with hair loss over the area; neoplasm of lymphoid tissue; most common is Hodgkin's disease and non-Hodgkin's lymphoma
What is the most common manifestation of dermatologic disease but can also be a symptom of underlying systemic disease? (Book)
A palpable enlargement of the supraclavicular lymph node in the presence of primary carcinoma is called what? (
Motor function (gross and fine, coordination, gait, and balance)
Sensory function (light touch, vibration, pain, pressure, temp)
6 general Neuro screening areas
in anyone with suspected abdominal aortic aneurysm, appendicitis, known kidney disease, who has had abdominal organ transplantation
when is abdominal percussion and palpation contraindicated (4)
- Immunocompromised diabetics or patients with history of steroid and retroviral use now presenting with red inflamed swollen nail beds or feet skin lesions
- breast changes such as unexplained nipple discharge, erythema, contour changes
- Detection of palpable, fixed, irregular mass in the breast, axilla, or elsewhere
- positive or suspicious findings during screening (inspection, palpation, or auscultation of the chest or abdomen, special tests)
- a single lump, a pale or red nodule just below the skin surface, a swelling, a dimpling of the skin, or a red rash (may be cancer)
- new-onset of SOB who is tachypneic, diaphoretic, or cyanotic;
- suspicion of anaphylaxis
- Cough with sputum production that is yellow, green, or rust colored
- Abrupt change in mental status, confusion or increasing confusion, and new onset of delirium requires medical attention
-vesicular rash associated with herpes zoster. Medical referral within 72 hours of the initial appearance of skin lesions is needed (may be postherpetic neuropathy)
guidelines for immediate physician referral
- Horners syndrome (problem with innervation of eye)
- Pancoasts lung tumor
- CN III dysfunction
Ptosis can be a sign of
fine, crackling sounds made as air moves through wet secretions in the lungs
The production of whistling sounds during expiration such as occurs in asthma and bronchiolitis.
Whistling sound heard when there is a partial obstruction of the lungs
absence of sounds or very few sounds in any or all quadrants; most common in older adult with multiple risk factors
red flag during abdomen auscultation
A change in vocal resonance in the presence of a lung consolidation condition in which the transmission of the "eee" sound becomes a nasal "ay" sound.
a whispered phrase heard through the stethoscope that sounds faint and inaudible over normal lung tissue; Whispered 123 will be muffled over normal lung but sound clear over areas of consolidation
Vibrations created by the vocal cords during phonation; look for asymmetries
Aortic-R 2nd Intercostal space, sternal margin
Pulmonary-L 2nd Intercostal space, sternal margin
Tricuspid-L 5th Intercostal space, sternal margin
Mitral-L 5th Intercostal space just medial to the midclavicular line
heart sounds.. All Physicians Take Money
the first heart sound, heard when the atrioventricular (mitral and tricuspid) valves close
the second heart sound produced by closure of the semilunar (aortic and pulmonic) valves
Occurs just after S2 as the ventricles passively fill Denotes stiff ventricle as with CHF
Occurs just in front of S1 as the atria fill the ventricles
Denotes resistance to ventricular filling, stiff ventricle, volume overload
when the examiner depresses deeply and evenly in the left lower quadrant (LLQ) and quickly withdraws the fingers, the patient reports pain in the right lower quadrant (RLQ) during LLQ pressure, suggesting appendicitis
pain with palpation of the RUQ during inspiration, indicative of cholecystitis
for cost-vertebral tenderness; used to rule out involvement of the kidney
murphy percussion ?
- Chest pain?
- difficulty breathing?
- Hx of anxiety?
- Hx of cardiac condition ?
questions to ask for systems review of cardio pulmonary
- any numbness or tingling (radicular symptoms)? where? bilateral or both UE & LE no bueno
- any weakness ?
- recent falls?
- bowel/bladder issues?
questions to ask for systems review of neuro
Begins the moment you meet the pt.
airway, breathing, circulation, disability, exposure, S/S, allergies, meds, PMHx, last meal, MOI
what is general survey ? (4)
· Capillary refill, nail beds healthy, do they have clubbing, that can clue yo lung pathologies like COPD
Acute care and trauma PT may use vital signs and ABCDE
§ Past medical history
§ Last meal
· GI screen
§ Events of injury
o Trauma unit history: SAMPLE
person, place, time, condition or injury(why here)
what 4 things is patient oriented to in AxOX4
o Level of consciousness
§ Altered mental status it could be a bunch of things shock, dehydration, diabetic event. Should check this on all patients!!
§ Diabetes haven't had any food or they had too much
A life-threatening collection of air within the pleural space; the volume and pressure have both collasped the involved lung and caused a shift of the mediastinal structures to the opposite side.
A pneumothorax that occurs when a weak area on the lung ruptures in the absence of major injury, allowing air to leak into the pleural space. Seen in tall white men
§ Severe fluid volume loss
§ Burn or trauma patients
§ Allergies (anaphylactic shock)
§ Diabetes (ketoacidosis)
Severe blood loss
Hypovolemic shock at risk population (5)
- restlessness, anxiety, hyperalert
- listless, lack of interest in play (children)
- inc RR, shallow breathing, frequent sighs
- rapid, bounding pulse
- distended neck veins
- skin warm & flushed
stage 1 shock (14)
- confusion, lack of focused eye contact (vacant look)
- abrupt changes in affect or behavior
- no crying excessive unexplained crying in infant
- cold, clammy skin, profuse sweating, chills
- weak pulses
- hypotension, dizziness, fainting
- collapsed neck veins
- weak/ absent peripheral pulses
- muscle tension
stage 2 of shock (14)
- cyanosis (blue lips, gray skin)
- dull eyes, dilated pupils
- loss of bowel or bladder control
- change in level of consciousness
stage 3 of shock (late stage) (5)
psoriasis - red patches covered by thick, dry silvery scales from excessive build up of epithelial cells
most common on extensor surfaces, bony prominences, scalp, ears, and genitals
tinea corporis, ring worm of the body
seen commonly on chest, abdomen, back of arms, face, and dorsum of feet
circular lesions with clear centers, form as one or in clusters
- dec or absent pulses
- pale skin
- cold/cool temp
- no edema
- skin is shiny, hair loss, thick nails
- sensation: pain increases with activity or leg elevations; relieved by dependent position, paresthesias
what expect to see in someone with arterial insufficiency of extremities?
- normal arterial pulses
- pink to cyanotic color; brown pigment in ankles
- warm temp
- present edema
- skin is scaly, see ulcers on ankle, toes, fingers
- pain in dependent position, relieved by elevation
what expect to see in someone with venous insufficiency of extremities?
what is being palpated?
o The hands, arms, feet, and legs can be assessed throughout the physical therapy examination for changes in texture, color, temperature, clubbing, circulation including capillary filling, and edema (Box 4-11). Abnormal texture changes include shiny, stiff, coarse, dry, or scaly skin.
The hands, arms, feet, and legs can be assessed throughout the physical therapy examination for changes (7)
abnormal texture includes what? (5)
o Skin mobility and turgor are affected by the fluid status of the client. Dehydration and aging reduce skin turgor (Fig. 4-4), and edema decreases skin mobility. The therapist should be aware of medications that cause skin to become sensitive to sunlight.
what is affected by fluid status in a client?
ABCDEs to assess skin lesions for cancer detection
o Round, symmetric skin lesions such as common moles, freckles, birthmarks are considered normal
o If an existing mole or skin lesion starts to change and a line drawn down the middle shows 2 different halves, medical eval is needed
what type of skin lesion is considered normal?
§ Uneven, notched skin
o A single lesion with more than one shade of black, brown, or blue may be a sign of malignant melanoma
Malignant melanomas (3)
o Puched out ulceration with dry, purple crusts
§ Cigarette burns
o Splash marks or scald lines from thermal burns (water)
§ Buttocks and distal extremities
§ Squeezing or shaking (mid portion of upper arms)
§ NOTE: children or elder report it right away
· Cutaneous Manifestations of Abuse (3)
THIS SET IS OFTEN IN FOLDERS WITH...
Differential Diagnosis Exam 1 Practice Questions
ch 1- Intro to screening for referral in PT
ch 2- Interviewing as a Screening Tool
Chapter 8- Screening for GI Disease
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