Clinical Skills Exam 1: Pathologies of HEENT, Skin, Hair, Nails

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o Excessive growth hormone
o Benign tumor or pituitary adenoma
o Generalized expansion of skull
o Pronounced brow and lower jaw protrusion
o Macroglossia and tooth gapping
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Terms in this set (143)
o Non-bacterial o "Serious otitis media" o Due to middle ear effusion, usually from eustachian tube dysfunction o Fluid seen around TMOtitis Media with EffusionImpacted cerumen (earwax)Ceruminouso Bacterial infection of EAC o "Swimmer's ear" o Tragal tenderness and pain with auricle movement o Pre/post auricular lymphadenopathy o +/- purulent d/c (staph or pseudomonas) o If extends into surrounding tissue or mastoid becomes malignant (more common with DM and elderly)Otitis ExternaScarring and thickening of TM due to recurrent infection, surgery or injuryTympanosclerosiso Extension of infection into mastoid process o Air filled pockets o Can lead to hearing loss or VII nerve palsy o Can spread to meninges and brainMastoiditiso Discoloration of mastoid process o Sign of basilar skill fractureBattle's SignSound is louder in BETTER hearing ear during Weber TestSensorineuronal hearing lossSound lateralizes to WORSE hearing ear during Weber TestConductive Hearing lossWhich part of the nose is involved in epistaxis?Kisselbach's areaPale or blue-tinged mucosa in nostrilAllergic RhinitisRed mucosa in nostrilURIIn nostril; associated with asthma and ASA allergyNasal polypsHerpes LabialisCold soreSuperficial staph or strep that presents with "honey color crusts"Impetigoo Rounded, bony growths that vary in size and lobulation in mouth o Common, benign, harmlessTorus palatinus/torus mandibulariso Bright red mucosal erythema with white plaques/chunks in mouth o Scraping plaques causes bleedingOral Candidiasis (Thrush)A finding that may suggest mediastinal mass, atelectasis or pneumothoraxTracheal deviationHead tilted toward affected muscle Contracted SCM muscle Chin pointed away from contract muscle Can be congential or spasmodicTorticollisChronic enlargement of thyroid glandGoiterHyperthyroidism, exophthalmos and a goiter are indicators of what disease?Grave's DiseaseWhat skin color is consistent with cardiac or pulmonary diseaseCentral cyanosisWhat skin color may be seen w/ cold temps or anxietyPeripheral cyanosisWhat is icterus-conjunctivae a sign ofJaundiceo freckles, petechiae, melasma o < 1 cm diameter o Flat, non-palpable o Variable colorMaculeo Café au lait spots, vitiligo (depigmentation) o > 1 cm diameter o Flat, non-palpable o Irregular shapePatcho molluscum contagiosum, warts, nevi o < 1 cm diameter o Palpable and firm o Flesh, red, brown o Circumscribed borders o Confluent and form plaquesPapuleo Psoriasis o> 1 cm diameter o Elevated but flat-ish, firm, rough o CircumscribedPlaqueo Palpable and solid skin lesion o lipoma, some skin cancers (basil cell carcinoma) o > 1 cm BUT < 2 cm o Deeper and firmer than a papule o RoundNoduleo Palpable and solid skin lesion o lipoma, hemangioma, tumors o > 2 cm o Larger noduleTumoro Palpable skin lesion o urticaria (hives), mosquito bites, allergic reaction o Histamine response causes pruritis, swelling, erythema and warmthWhealo Herpes simplex/zoster o < 1 cm o Well circumscribed o Filled with serous fluidVesicle"Fluid filled vesicles with serous fluid on an erythematous base" most of the time indicatesSkin lesion from the Herpes familyWhat is an example of a dermatomal skin lesion that follows a nerve segment?Herpes Zostero blisters, 2nd degree burns o > 1 cm o Well circumscribed o Filled with serous fluidBullao Acne o Well circumscribed o Elevated, superficial, epidermal o Filled with pusPustuleo Nodule filled with liquid (usually pus) or semisolid materialCysto ruptured vesicles, atopic dermatitis o Loss of superficial epidermis o Surface is moist but doesn't bleed o Heals WITHOUT scarringErosiono Deeper loss of epidermis and dermis o Heels WITH scarringUlcero atopic dermatitis, tinea pedis, angular cheilitis o Linear crack or break from epidermis to dermisFissureo seborrhea, psoriasis o Thick flake of exfoliated epidermisScaleo Impetigo o Dried residue of serum, pus or bloodCrusto scabies, atopic dermatitis, dry skin o Abrasion or scratch mark o Linear or rounded o ScratchingExcoriationo atopic dermatitis, chronic dermatitis o Thickening and roughening of the skin o Increased visibility of skin markingsLichenificationo stretch marks o Thinning of skin with loss of normal markings o Skin is shinier and translucentAtrophyo Hypertrophic scarring o Extends beyond borders of initial injuryKeloido Do NOT Blanch o infections and bleeding disorders o .1-.3 cm o Blood outside of a vessel o Round or irregular o Variable distribution o Deep red or purple redPetechiao Do NOT Blanch o .3- 1 cm o Same as petechiae but largerPurpurao Do NOT blanch o bruise o > 1 cm o Blood outside of vessel d/t trauma or bleeding disorder o Round, oval, irregular borders o Purple, green yellow lesions, variable sizeEcchymosiso Do NOT blanch o associated with aging o 1-3 mm o Flat or raised o Red o Non-pulsatile o Seen on trunkCherry angiomao Blanch o liver disease, pregnancy o Very small, up to 2 cm o Central body with surrounding erythema and radiating legs o Face, neck, arms, upper trunk o TelangiectasiaSpider angiomao Blanch o varicose veins o Very small o Variable shape, linear or irregular o On legs o Blanch with diffuse pressure onlySpider Veino Blanch o spider veins o Irregular lines secondary to dilations of capillaries o Red o Basil cell skin cancers, sun damage, rosaceaTelangiectasiao Blanch o Irregular lesion secondary to dilation of dermal capillaries o Red o Starts as macule, can progress to plaque or noduleHemangiomao Viral exanthems o Drug eruptionsMaculopapular Lesionso Papules with plaques and scales o Psoriasis o Lichen planus o Pityriasis roseaPapulosquamous Lesionso Vesicles and bullae o Herpes simplex o Herpes zoster o Pemphigus vulgarisVesiculobullous Lesionso Autoimmune disease affecting skin and mucous membranes o Positive Nikolsky's sign (rubbing of skin results in exfoliation of outermost layer)Pemphigus vulgarisDistribution of Acne Vulgarisface, chest, back of neck/shouldersDistribution of Atopic Dermatitisflexor surfaces (elbows and back of knees)Distribution of Photosensitive Eruptionsfront and back of arms, face, back of neckDistribution of Pityriasis Roseafront and back of trunk onlyDistribution of Psoriasisextensor surfaces (front of knees, back of elbows, lumbar, head)Distribution of Seborrheic Dermatitisface and heado Partial or total hair loss o No scaling or inflammationAlopeciao Pulling or plucking o Psychotic componentTrichotillomaniao Round and scaling scalp o Hairs broken off at surfaceTinea Capitiso Pulling back from front o Androgenic AlopeciaMale Pattern Baldnesso Starts at scalp o Androgenic AlopeciaFemale Pattern Baldnesso Male pattern hair growth on a woman o HypercortisolismHirsutismo Hair is dry and brittle o Hair lossHypothryroidismYellow, scaley scalpeSeborrheic DermatitisHead LicePediculosis CapitisAutoimmune disorder that results in unpredictable, patchy hair lossAlopecia AreataYellowing of nailsOnycholysisWhite spots on nailsLeukonychiaIndentation of nails d/t iron deficiency anemiaKoilonychia/SpooningNails indication of pulmonary diseaseDigital clubbingDark linear line under nail could indicate melanomaHutchinson's SignAbsent Lunula on nailTerry's NailsPeeling and flaking at free edge of nailDelaminationNail indicating psoriasisPittingHorizontal lines in nail bedBeau's LinesNail inflammation from trauma, irritation, or infection Bony tuft susceptible to osteonecrosisParonychiaSign of CN III paralysisPtosisWhat does pallor conjunctivae indicateAnemiaWhat does injection/erythema in the eye indicateInfection, injury, autoimmuneyellowish growth on sclera adjacent to corneaPingueculumwedge or wing shape growth that may grow into corneaPterygiumRing around cornea Deposition of lipids Common in elderlyArcus SenilisOpacity of the lens Visible through pupil Clouding through pupil onlyCataractConstriction of pupilMiosisDilation of pupilMydriasisWhat does a crescent shadow on medical aspect of iris indicateBowing of iris could indicate glaucomaWhat does abnormal asymmetric corneal light reflection indicate?Strabismus or imbalance of EOM tone or EOM paralysisConvergent strabismusEsotropiaDivergent strabismusExotropiao Cyst of inner eyelid d/t inflamed or blocked meobomian gland o Chronic o Painless and inward pointingChalazaiono "stye" o d/t infection of a Zeiss (sebaceous) glands at margin of eyelid o Painful!Hordeolumo Sharply demarcated yellowish deposit of cholesterol underneath skin around eyelid o Hereditary component o Familial hypercholesterolemiaXanthelasmao Infection of eyelid tissues o Infection anterior to orbital septumPeriorbital Cellulitis (Pre-septal)o Medical emergency! o Proptosis or bulging eye o Limited movement o Pain with movement o Loss of visionOrbital Cellulitiso Protrusion of eyes o Rim of sclera between upper lid and iris visible o Characteristic stare o Grave's Disease (Hyperthyroidism, lid lag)Exopthalmos (Proptosis)o Ptosis o Anhidrosis (absent sweating on affected side) o Miosis (pupillary constriction) o Anisocoria (unequal pupil size) o Sympathetic nervous system dysfunction o Congenital or associated with Pancoast tumorHorner's Syndromeo Affected pupil is larger o Reduced reaction to light (mydriasis) o Reduced near reaction o Parasympathetic nervous system dysfunction o Most common in young womenTonic (Adie's) Pupilo Brownish-yellow ring around corneo-scleral junction o Copper deposition o Sign of Wilson's DiseaseKaiser Fleischer Ringo Conjunctival erythema and injection with exudate (thick, ropey, yellow/green d/c) o Crusting o Starts unilateral o BacterialPink eyeo Conjunctival erythema and injection with increased tearing o Usually starts bilateral o Usually allergic or viralOther symptoms of Conjunctivitiso Episclera is between conjunctiva and sclera o Abrupt onset o Segmental (vs diffuse erythema of conjunctivitis)Episcleritiso Gradual onset, darker color (purple) o More severe, pain, decrease vision, photophobia o Nodular, diffuse or necrotizing o Systemic autoimmune/inflammatory diseaseScleritiso Inflammation of uveal tract (iris, ciliary body and choroid) o Painful, pain with consensual pupillary light reflex of affected eye o Limbic flush = inflammation around iris o Blurred vision o Systemic autoimmune/inflammatory diseaseUveitiso Painless, small blood vessel breaks o Can occur with injury o Increase pressure (increase BP, cough, sneeze) o Blood thinnersSubconjunctival Hemorrhageo Bleeding in anterior chamber due to trauma o Lower part of sclera "pooling" with bloodHyphemao Infection of cornea o Decrease visual acuity, photophobia o Viral, fungal or bacterial o Overnight contact use o Mucopurulent d/c o Corneal opacity-ophthalmic emergency! o Herpetic form can show dendritic lesionsKeratitiso Optic disc swelling associated with increased intracranial pressurePapilledemao Leading cause of vision loss o Smoking, genetics, Caucasian o Drusen: yellow deposits under retinaMacular Degenerationo Narrowing of arteries o Copper wiring (increase light reflex, copper color) o Silver wiring (opaque aa wall o AV nicking o Dry retina o Few hemorrhages, few exudates multiple cotton wool spotsHypertensive Retinopathyo Wet retina o Multiple hemorrhages, multiple exudates, few cotton wool spots o Neovascularization (proliferative retinopathy)Diabetic Retinopathyo" Blood and Thunder" o Variable vision loss o +/- floatersCentral Retinal Vein Occlusiono "Cherry Red Spot" o Sudden o Painless o Profound monocular vision loss o Transient loss- Amaurosis Fugax (curtain then resolves) o Pale retinal tissueCentral Retinal Artery Occlusiono Lead to retinal detachment o Increase in floaters or flashes o Shadow/curtain in visual fieldRetinal Tearso Sign of early oral cancer o Red patch or plaque that can ulcerateErythroplakiao Pre-malignant oral lesion o White patch or plaque that can ulcerateLeukoplakiao Chronic plaque exposure leads to deep inflammation of gums, ligaments and bony structures o Leading cause of tooth loss o Smoking, diabetes, HIV, pregnancy, poor hygiene o Associated with PAD and CVDPeriodontal Diseaseo Mild gum swelling o Tenderness o Erythema o Bleeding gums o Due to plaque buildup, foreign bodiesGingivitiso Cause: oral bacteria metabolize dietary carbohydrates into acids and acids demineralize tooth enamel o Root caries o Pain with eating, temp o Cellulitis o AbscessDental CariesMay present as dry, scaly or ulcerated non-healing lesion on lips or around mouthSquamous Cell Carcinoma of the LipCreasing of facial skin at corner of lips d/t tooth loss or poor denture fittingAngular Cheilitiso Exposed roots o Erythema o Inflammation o BleedingGum DiseaseTeeth wearing down with ageAttritionErythema of palate with cobblestoning of mucosa AsymptomaticDenture StomatisisPoor glycemic control in patients with diabetes increases the risk of whatPeriodontal DiseaseWhat autoimmune disease can lead to decreased salivary output leading to xerostomia and cariesRAo Medications are typical cause o Other causes are RA, radiation therapy o Lack of salivation o Dry mouth, burning sensation, changes in tastes, difficulty swallowing and speechXerostomia