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Final - Physical Assessment
Terms in this set (229)
The inferior tip of the scapula lies at the level of the ___ rib or interspace.
Which intercostal space is used for needle insertion for tension pneumothorax?
Which intercostal space is used for chest tube insertion?
Which intercostal spaces are used for thoracentesis?
Oblique (major) fissure
Runs from the T3 spinous process obliquely down and around the chest to the 6th rib at the midclavicular line
Horizontal (minor) fissure
Anteriorly, this fissure runs close to the 4th rib and meets the oblique fissure in the midaxillary line near the 5th rib
The trachea bifurcates into its mainstem bronchi at the levels of the ______ _____ anteriorly and the ___ spinous process posteriorly. This bifurcation is also called the ______.
Sternal angle; T4; carina
The right bronchus is ...
Shorter, wider, and more vertical
The right bronchus has _ secondary bronchi and __ tertiary bronchi
The left bronchus has _ secondary bronchi and _ tertiary bronchi
The left bronchus is ...
Longer, narrower, and more horizontal
Bronchiectasis is a condition in which the lungs' airways are abnormally stretched and widened. This stretching and widening is caused by mucus blockage. More and more mucus builds up in the airways, allowing bacteria to grow. This leads to infection.
Foul smelling sputum is present in ...
Anaerobic lung abscess
Tenacious sputum is present in ...
Large volumes of purulent sputum are present in ...
Bronchiectasis or lung abscess
Hemoptysis is common in ...
5 A's Model
Ask about tobacco use
Advise to quit
Assess willingness to make a quit attempt
Assist in quit attempt
Arrange follow up
Flat percussion notes
Large pleural effusion
Dull percussion notes
Resonant percussion notes
Simple chronic bronchitis
Hyperresonant percussion notes
Tympanitis percussion notes
Diaphragmatic excursion is normally between _ and ___ cm
When the eye focuses on an object (far away/near by) the ciliary muscle fibers relax causing the suspensory ligaments to be pulled tight and resulting in a thinning of the lens
When the eye focuses on an object (far away/near by) the ciliary muscle fibers contract causing the suspensory ligaments to relax and resulting in a thickening of the lens
What action does the inferior oblique muscle cause on the eyeball?
It pulls the eye up and out
What action does the superior oblique muscle cause on the eyeball?
It pulls the eye down and out
Myopia occurs when the eyeball is too _____. It is also known as what? What type of lens is used to correct it?
Short; nearsightedness; concave
Hyperopia occurs when the eyeball is too ____. It is also known as what? What type of lens is used to correct it?
Long; farsightedness; convex
What is an astigmatism?
An abnormal shape of the cornea (most common) or the lens
Red, inflamed lid margins, often with crusting present
Slightly raised, yellowish, well-circumscribed plaques that appear along the nasal portions of both eyelids. May accompany lipid disorders.
A subacute, nontender, usually painless nodule involving a blocked meibomian gland. Usually point inside the lid rather than on the lid margin. Scar tissue in the lid.
Stype. Infection of one of the meibomian glands in the lid. Usually caused by staph or strep.
Inflammation of the lacrimal sac. A swelling between the lower eyelid and nose. Usually due to bacterial infection. An acute inflammation is painful, red, and tender
conjunctival infection: diffuse dilation of conjunctival vessels with redness that tends to be maximal peripherally. Usually not painful, more irritating.
- Allergic - usually bilateral. Can cause cobblestoning (a buildup of granulation and or/lymphoid tissue from long standing or chronic allergic conjunctivitis)
- Infectious - can be bilateral or unilateral (chemosis - swollen conjunctiva)
Leakage of blood outside of the vessels, producing a homogenous, sharply demarcated, red area that resolves over 2 weeks. Often caused by frequent increased intrathoracic pressure such as from coughing or straining to have a bowel movement
of the bulbar conjunctiva that grows slowly across the outer surface of the cornea, usually from the nasal side. Commonly seen in patients who are exposed to environmental elements (UV light or dust/sand)
A harmless, yellowish triangular
in the bulbar conjunctiva on either side of the iris. Appears frequently with aging, first on the nasal and then on the temporal side
Abducens (VI) nerve palsy
Cannot abduct laterally, lateral gaze defect due to paralysis of lateral rectus. May be a cause of paralytic strabismus (dysconjugate gaze).
Oculomotor (III) nerve palsy
The eye is pulled outward by action of the abducens (VI) nerve. Upward, downward, and inward movements are impaired or lost. May be a cause of paralytic strabismus (dysconjugate gaze)
Trochlear (IV) nerve palsy
Cannot look down and out because the superior oblique is paralyzed. May be a cause of paralytic strabismus (dysconjugate gaze)
In esotropia, the corneal light reflex will be positioned _______ to center.
In exotropia, the corneal light reflex will be positioned ______ to center.
Corneal arcus senilicus
Thin, grayish white circle not quite at the edge of the cornea. Accompanies normal aging but if it occurs in young people it might suggest high calcium or lipid levels.
How can you tell the difference between a corneal abrasian and a corneal ulcer?
A corneal abrasion is transparent, only involves the epithelium and thus does not change the corneal contour. A corneal ulcer is opaque and involves the stroma so the corneal contour becomes uneven.
Pus in the anterior chamber
A superficial grayish white opacity in the cornea, secondary to an old injury or to inflammation
Opacities of the lenses visible through the pupil. Risk factors are older age, smoking, diabetes, and corticosteroid use.
Painful and the vessels around the limbus are engorged
Blood in the anterior chamber. An ocular emergency.
Increased intraocular pressure
Open angle glaucoma
Common form of glaucoma, the normal spatial relation between the anterior surface of the iris and cornea is preserved and the iris is fully lit. Has no symptoms. Can be caused by increased production of aqueous humor and/or defective draining through the trabecular meshwork.
Narrow (closed) angle glaucoma
sudden increase in intraocular pressure when drainage of the aqueous humor is blocked. Can be caused by medication or by going to see a movie. Pupil will probably not react to light due to the muscle spasm. May see a "steamy cornea" or mid-dilated fixed pupil. Patient will normally complain of deep ocular pain, an angry red cornea, and possibly a headache
Glaucoma can cause an abnormal optic cup to optic disc ratio called glaucomatous cupping. It is an indication of a significant increase in intraocular pressure
Pupils should be between _ and _ mm.
Difference in pupillary size of .4 or greater
Tonic (Adie's) pupil
Dilated pupil unilaterally. Reaction to light is severely reduced and slowed, or even absent. Near reaction, although very slow, is present. Slow accommodation causes blurred vision. Deep tendon reflexes are often decreased. Typically benign or inherited.
Oculomotor (III) nerve paralysis
The dilated pupil is fixed to light and near effort. Ptosis of the upper eyelid and lateral deviation of the eye are almost always present. Superior, inferior, and medial rectus as well as the inferior oblique muscles are paralyzed
Argyl Robertson Pupil
Small irregular pupils. Eyes accommodate with near effort but do not react to light. Seen in tertiary (CNS) syphilis
The affected pupil, though small, reacts briskly to light and near effort. Ptosis of the eyelid is present, perhaps with loss of sweating on the forehead. Also causes miosis.
Afferent pupillary defect (Marcus Gunn pupil)
Both pupils constrict less when a bright light is swung from the unaffected eye to the affected eye due to a decreased response to light
What is considered legal blindness?
A visual acuity of 20/200 or less with correction
Occulsion of a branch of the retinal artery may cause a unilateral horizontal defect (half the field of vision)
Blind right eye (right optic nerve)
A lesion of the optic nerve and of the eye itself produces unilateral blindness
Bitemporal hemianopsia (optic chiasm)
A lesion at the optic chiasm may involve only fibers crossing over to the opposite side (vertical, lateral half fields of vision)
Left homonymous hemianopsia (right optic tract)
A lesion of the optic tract, interrupts fibers originating on the same side of both eyes. Visual loss is therefore similar (homonymous) and involves half of each field
Homonymous left superior quadrantic defect (right optic radiation, partial)
A partial lesion of the optic radiation in the temporal lobe, may involve only a portion of the nerve fibers
Left homonymous hemianopsia (right optic radiation)
A complete interruption of fibers in the optic radiation, produces a visual defect similar to that produced by a lesion in the optic tract
Tiny, round, red spots commonly seen in and around the macular area. They are minute dilations of very small retinal vessels. A hallmark of diabetic retinopathy. May leak and cause hemorrhages.
Flame-shaped red streaks in the fundi, shaped by the superficial bundles of nerve fibers that radiate from the optic disc. Sometimes the hemorrhages occur in clusters. Seen in severe hypertension, papilledema, and occlusion of the retinal vein
Small, rounded, slightly irregular red spots that are sometimes called dot or blot hemorrhages. Occur in a deep layer of the retina. Diabetes is a common cause
Develops when blood escapes into the potential space between the retina and vitreous. Typically larger than retinal hemorrhages. Because it is anterior to the retina, it obscures any underlying retinal vessels. Causes include a sudden increase in intracranial pressure.
Creamy or yellowish, often bright, lesions with well-defined "hard" borders. They are small and round but may coalesce into larger irregular spots. Often occur in clusters or in circular, linear, or star-shaped patterns. Causes include diabetes and hypertension. Composed of lipids or proteins.
Cotton wool spots (soft exudates)
White or grayish, ovoid lesions with irregular "soft" borders. They are moderate in size but usually smaller than the disc. They result from infarcted nerve fibers. Seen in hypertension and many other conditions
Refers to the formation of new blood vessels. They are more numerous, more tortuous, and narrower than other blood vessels in the area and form disorderly looking red arcades. A common feature of the proliferative stage of diabetic retinopathy. The vessels may grow into the vitreous, where retinal detachment or hemorrhage may cause loss of vision. Vessels also may rupture and cause a pre-retinal hemorrhage. Differentiates background from proliferative retinopathy.
The vein appears to taper down on either side of the artery. Caused by chronic hypertension.
The vein appears to stop abruptly on either side of the artery due to the wall becoming slightly calcified or hardened. Caused by chronic hypertension.
The vein is twisted and forms a dark, wide knuckle. Caused by chronic hypertension.
Sometimes the arteries, especially those close to the disc, become full and somewhat tortuous and develop an increased light reflex with a bright coppery luster. Caused by chronic hypertension.
A portion of a narrowed artery develops such an opaque wall that no blood is visible within it
Found in severe hypertensive emergencies. Symmetric soft exudates extend from the macula.
Wet macular degeneration
Patient develops new blood vessels under the retina. This causes hemorrhage, swelling, and scar tissue
Dry macular degeneration
Much more common and characterized by drusen and loss of pigment in the retina. Results in a more gradual loss of vision
Small, yellowish deposits of undigested cellular debris that form within the layers of the retina. The areas of atrophy are usually centralized around the macula. The loss of central vision is progressive and degenerative.
Elevated intracranial pressure causes intraaxonal edema along the optic nerve, leading to engorgement and swelling of the optic disc. The opposite of glaucomatous cupping.
A patient presents with a complaint of ear pain. During the history the patient reports that they were recently diagnosed with a respiratory infection. What condition are you suspicious of given the patient's history?
Unusually soft wax, debris from inflammation or rash in the ear canal, or discharge through a perforated eardrum is present in which condition of the ear?
Otitis media (either acute or chronic)
A patient presents to the ER complaining of ear pain. During the physical exam you perform the "tug test" by moving the auricle and tragus. The patient tells you that this test produced pain in their ear. This physical exam finding increases your suspicion for _____ _______ and decreases your suspicion for _____ _____.
A patient presents to the ER complaining of ear pain. During the physical exam you perform the "tug test" by moving the auricle and tragus. The patient tells you that this test does not produce pain in their ear. You press behind the patient's hear and they tell you this is painful. These physical exam findings make you suspicious of _____ _____.
"Cauliflower ear" can result if hematomas of the _______ are not properly treated.
Which type of hearing impairment results from problems in the external or middle ear?
You are seeing a patient who is complaining of hearing loss. During the history the patient reports that noisy environments actually help their hearing. What type of hearing loss does this indicate?
Which type of hearing loss is usually reversible with treatment?
All of the following are causes of conductive hearing loss except:
a) wax buildup
b) hole in tympanic membrane
c) disruption of hair cells
d) swollen auditory canal
c) disruption of hair cells is a cause of sensorineural hearing loss
Which type of hearing impairment results from problems in the inner ear, cochlear nerve, or its central connections to the brain?
You are seeing an 80-year old patient who is complaining of hearing loss. During the history the patient reports that they particularly have trouble understanding speech. Their family member adds that they often complain about others mumbling when they are in fact speaking at a normal level. What type of hearing loss is this information indicative of?
Which type of hearing loss can be caused by prebycusis?
The Weber tuning fork test tests for what?
Lateralization in patients with unilateral hearing loss.
During the Weber test, the patient reports that the sound lateralizes to the impaired ear. This indicates what type of hearing loss?
Unilateral conductive hearing loss
During the Weber test, the patient reports that the sound lateralizes to the good ear. This indicates what type of hearing loss?
Unilateral sensorineural hearing loss
The Rinne tuning fork test tests for what? What type of hearing loss?
It compares air conduction and bone conduction.
Only tests for conductive hearing loss.
During the Rinne test, the patient reports that the sound is heard longer through bone than air. This result is (abnormal/normal).
Abnormal. This finding indicates conductive hearing loss.
A patient presents to the ER by EMS because of head trauma. Upon examining the patient you note a thin, watery discharge draining from the patient's nose. You are immediately suspicious of what?
CSF leakage into the nasal cavity
What does tenderness of the nasal tip or alae suggest?
Local infection such as a furuncle or nasal vestibulitis
What is Pott's puffy tumor?
Chronic sinusitis of the frontal sinuses
What symptom might indicate a squamous cell tumor of the maxillary sinuses?
Change in the sponginess of the skin overlying the sinuses.
What conditions are conducive to nasal polyps?
Allergic rhinitis (chronic irritation), aspirin sensitivity, asthma, chronic sinus infections, and cystic fibrosis
Which type of hearing loss can be caused by a CN VIII lesion?
In what type of vertigo does the patient feel as if they are spinning?
In what type of vertigo does the patient feel as if the room is spinning?
Nontender nodular swellings covered by normal skin deep in the ear canal suggest _________. These are nonmalignant overgrowths which may obscure the drum and are associated with swimming in cold water.
A patient presents to the ER with a complaint of ear pain. During the otoscope exam you notice a canal that is swollen, narrowed, moist, pale, and tender. Your suspicion for which condition automatically increases?
A patient presents to the ER with a complaint of ear pain and itchiness. During the otoscope exam you notice a canal that is thickened and red. Your suspicion for which condition automatically increases?
A patient presents to the ER with a complaint of ear pain. During the otoscope exam you notice a red bulging drum and you are not able to visualize the cone of light. Your suspicion for which condition automatically increases?
Acute purulent otitis media
A pediatric patient is brought to the ER by his parents. They think he has an ear infection. You perform an otoscope exam and notice that the drum has an amber color. During the history, the parents report that the patient has been teething. Your suspicion for which condition automatically increases?
Serous effusion caused by erupting molars.
During an otoscope exam you notice an unusually prominent short process and handle of the malleus. What does this suggest about the tympanic membrane?
It suggests that it is retracted.
What is the name for an inflammatory condition of the eardrum, characterized by painful fluid-filled vesicles on the tympanic membrane and the sudden onset of severe pain in the ear? This condition also often occurs with bacterial (usually mycoplasmic) otitis.
a) glomus tumor
c) serous effusion
d) bullous myringitis
e) none of the above
d) bullous myringitis
What is the name of the most common benign tumor of the middle ear? It is usually a vascular tumor may have branched off of the carotid artery?
a) glomus tumor
c) serous effusion
d) bullous myringitis
e) none of the above
a) glomus tumor
What is the name of the condition in which blood is present in the tympanic cavity of the middle ear? It may be caused by posterior epistaxis, the aspiration of blood up the Eustachian tube, or from a basilar skull fracture.
a) glomus tumor
c) serous effusion
d) bullous myringitis
e) none of the above
Normally a tympanic membrane perforation will heal on its own except for in patient's who are _______.
What is the layman's term for otitis externa?
List some medications that might affect hearing
What part of the tympanic membrane is perforated most often? Why?
Pars tensa because it has more tension than any other part of the tympanic membrane.
Above the short process of the malleulus lies a small portion of the eardrum called the ___ ________.
What is the name for a perceived sound that has no external stimulus?
How do patient's often describe this sound?
A musical ringing or a rushing or roaring noise in one or both ears.
Why might a bad ear infection lead to Bell's palsy or facial paralysis?
The ear canal is innervated by the facial nerve so if the infection affects the nerve Bell's palsy or facial paralysis might be the result.
The tympanic membrane is attached to the bony annulus except where?
At the membranous flaccida
Which ducts lie at the base of the tongue?
Wharton's ducts (ducts of the submandibular gland)
Which ducts open onto the buccal mucosa near the upper second molar?
Stenson's ducts (ducts of the parotid gland)
What does bright red edematous mucosa underneath a denture suggest?
Denture sore mouth
What is Osler-Weber-Rendu syndrome?
Multiple small red spots on the lips suggest this condition which is also known as hereditary hemorrhagic telangiectasia. It is an autosomal dominant endothelial disorder causing vascular fragility and arteriovascular malformations. Telangiectasias are also visible on the oral mucosa and fingertips.
What does asymmetric protrusion of the tongue suggest?
CN XIII lesion
What physical exam findings might you find in a patient with CN X paralysis?
The soft palate fails to rise and the uvula deviates to the opposite side after you instruct the patient to say "ah" during inspection of the pharynx.
The thyroid spans the ___ through ___ tracheal rings just below the cricoid cartilage.
Anterior cervical lymph nodes are usually enlarged in what condition?
Group A streptococcal infection
Posterior cervical lymph nodes are usually enlarged in what condition?
A complete or partial collapse of a lung or lobe of a lung — develops when the tiny air sacs (alveoli) within the lung become deflated. It is one of the most common breathing (respiratory) complications after surgery. Atelectasis is also a possible complication of other respiratory problems, including cystic fibrosis, inhaled foreign objects, lung tumors, fluid in the lung, severe asthma and chest injuries.
What is a brachial cleft cyst?
A branchial cyst is a cavity that is a congenital remnant from embryologic development. It is present at birth on one side of the neck and is located just in front of the sternomastoid muscle. The cyst may not be recognized until adolescence as it enlarges its oval shape. Such a sinus tract may either have a small dimple or skin tag at the opening. The cyst is a smooth, soft and nontender structure.
What is a thyroglossal duct cyst?
A thyroglossal duct cyst is a congenital defect. When the thyroid gland forms during embryonic development, it begins at the base of the tongue and moves down the neck through a canal called the thyroglossal duct. This duct normally disappears once the thyroid reaches its final position in the neck. Sometimes, portions of the duct remain leaving cavities or pockets called cysts. These cysts can fill with fluid or mucus, and may enlarge if they become infected. Very enlarged cysts can cause difficulty swallowing or obstruct breathing passages.
Thyroglossal duct cysts (TGDC's) are the most common congenital neck cyst. They are typically located in the midline and are the most common midline neck mass in young patients.
What conditions may cause a widened pulse pressure (>40 mmHg)?
Isolated systolic hypertension
Patent ductus arteriosus
What conditions may cause a narrowed pulse pressure (<30 mmHg)?
Severe aortic stenosis
What is Korotkoff sound phase 1?
A sharp thud that indicates the systolic pressure
What is Korotkoff sound phase 2?
Blowing or swishing sound
What is Korotkoff sound phase 3?
Softer thud than phase 1
What is Korotkoff sound phase 4?
1st diastolic. It is a softer blowing sound that disappears.
What is Korotkoff sound phase 5?
2nd diastolic. Silence.
Which two Korotkoff phases are used in calculating the blood pressure?
Phase 1 (systolic) and Phase 5 (2nd diastolic).
What conditions are associated with an auscultatory gap?
Arterial stiffness and atherosclerotic disease
If the blood pressure cuff is too small, the blood pressure will read ____.
If the blood pressure cuff is too large, the blood pressure will read ____.
What conditions may cause a small, weak pulse?
Hypovolemia, cold, aortic stenosis, CHF
What conditions may cause a large, bounding pulse?
Fever, hyperthyroidism, heart block, anemia, PDA, atherosclerosis
What is pulsus alternans?
Variation in the amplitude of the pulse from minute to minute. Often seen with left ventricular failure.
What is paradoxical pulse?
A pulse that decreases with inspiration. Seen with pericardial tamponade, obstructive lung disease, and constrictive pericarditis
What is the normal pulse rate for a newborn?
What is the normal pulse rate for a 1 year old?
What is the normal pulse rate for a 3 year old?
What is the normal pulse rate for a 6 year old?
What is the normal pulse rate for a 10 year old?
What is the normal respiratory rate for a newborn?
What is the normal respiratory rate for a 1 year old?
What is the normal respiratory rate for a 3 year old?
What is the normal respiratory rate for a 6 year old?
What is hyperpnea and what conditions may cause it?
Hyperpnea is a respiratory rate greater than 20 with inspirations that are deep. It may be caused by exercise, anxiety, or metabolic acidosis
What type of breathing is Kussmaul breathing and what condition causes it?
Kussmaul breathing is deep breathing due to metabolic acidosis. It may be fast, normal in rate, or slow.
What is Cheyne-Stokes breathing and what is it associated with?
Period of deep breathing alternate with periods of apnea. Children and aging people normally may show this pattern in sleep. Other causes include heart failure, uremia, drug-induced respiratory depression, and brain damage.
What is Biot's breathing and what is it associate with?
Ataxic breathing is also known as Biot's breathing. Ataxic breathing is characterized by unpredictable irregularity. Breaths may be shallow or deep, and stop for short periods. Causes include respiratory depression and brain damage, typically at the medullary level.
What are the normal temperature fluctuations in degrees Celsius and Farenheit?
Normal = 37 degrees C or 98.6 degrees F
Or from 36.1-37.7 degrees C or 97-99.9 degrees F
Rectal temperatures read how much higher than oral temperatures?
.4-.5 degrees C or .7-.8 degrees F
A temperature greater than 41.1 degrees C (106 degrees F)
A temperature less than 35 degrees C or 95 degrees F
What is in your differential diagnosis for a patient with a fever?
Collagen vascular disease
Infarction of any tissue
Name some physical exam findings you might notice in a patient with hypothyroidism.
Dry or rough skin, cool skin temperature, brittle and sparse hair
What is asteatosis?
Dry, thin skin
An increased concentration of _______________ in cutaneous blood vessels gives the skin a bluish cast known as cyanosis.
Deoxyhemoglobin - a darker and somewhat bluer pigment of blood after oxygen is lost from the hemoglobin molecule.
What is a cafe-au-lait spot?
A slightly but uniformly pigmented macule or patch with a somewhat irregular border, usually 0.5-1.5 cm in diameter; benign. Six or more spots, each with a diameter of >1.5 cm, however, suggest neurofibromatosis
What is tinea versicolor?
A common superficial fungal infection of the skin, causing hypo- or hyperpigmented ("versicolor"), slightly scaly macules on the trunk, neck, and upper arms.
What is vitiligo?
A condition in which depigmented macules appear on the face, hands, feet, extensor surfaces, and other regions and may coalesce into extensive areas that lack melanin. The condition may be hereditary.
How can you distinguish carotenemia from jaundice?
Carotenemia does not affect the sclera, while jaundice does. Carotenemia is caused by a diet high in carrots and other yellow vegetables or fruits
What is psoriasis?
Silvery scales or plaques, mainly on the extensor surfaces
What is a lentigo?
A freckle that is darker than others and non-fading.
What is a macule?
A small, circumscribed, non-palpable discoloration up to 1.0 cm (ex. freckle)
What is a patch?
A flat spot, 1.0 cm or larger (ex. cafe-au-lait spot)
What is a plaque?
A palpable solid lesion 1.0 cm or larger with an elevated flat top. Often formed by coalescence of papules (ex. psoriasis)
What is a papule?
An elevated, solid bump up to 1.0 cm (ex. psoriasis)
What is a nodule?
A knot-like lesion larger than 0.5 cm, deeper and firmer than a papule
What is a cyst?
A nodule filled with expressible material, either liquid or semisolid
What is a wheal?
A somewhat irregular, relatively transient, superficial area of localized skin edema (ex. urticaria).
A round or annular edematous papule or plaque that is characteristically evanescent. May be surrounded by a flare of erythema. (ex. hives)
What is a vesicle?
A circumscribed, palpable elevation up to 1.0 cm, filled with serous fluid (ex. herpes simplex and herpes zoster)
What is a bulla?
A circumscribed, palpable elevation 1.0 cm or larger, filled with serous fluid (ex. insect bite)
What is a pustule?
A palpable elevation filled with pus (yellow proteinaceous fluid filled with neutrophils) (ex. acne or small pox)
What is a burrow? What condition are they associated with?
A minute, slightly raised tunnel in the epidermis, commonly found on the finger webs and on the sides of the fingers. It looks like a short (5-15 mm), linear or curved gray line and may end in a tiny vesicle. Associated with scabies.
When are secondary skin lesions seen?
In overtreatment, excess scratching, and infection of primary lesions
What are scales?
Thin flakes of dead exfoliated epidermis (ex. dry skin).
Heaped up keratinized cells. Flaky exfoliation of varied size. Silver or white tan in color.
What is a crust?
The dried residue of skin exudates such as serum, pus, or blood
What is lichenification?
Visible and palpable thickening of the epidermis and roughening of the skin with increased visibility of the normal skin furrows (often from chronic rubbing) (ex. dermatitis)
What is a scar?
Increased connective tissue that arises from injury or disease
What is a keloid?
Hypertrophic scarring that extends beyond the borders of the initiating injury
What is an erosion?
Nonscarring loss of the superficial epidermis; surface is moist but does not bleed
What is excoriation?
Linear or puncture erosions caused by scratching (ex. cat scratches)
What is a fissure?
A linear crack in the skin, often resulting from excessive dryness (ex. athlete's foot)
What is an ulcer?
A deeper loss of epidermis and dermis; may bleed or scar (ex. stasis ulcers of venous insufficiency, syphilitic chancre)
What are the five vascular lesions of the skin?
Spider angioma, spider vein, cherry angioma, hemangioma, and telangiectasia
What is a spider angioma?
A fiery red lesion ranging from very small to 2 cm. Contains a central body, sometimes raised, surrounded by erythema and radiating legs. Pulsatility often seen in the center. Pressure on the body causes blanching. Distributed on the face, neck, arms, and upper trunk; almost never below the waist. Seen in liver disease, pregnancy, vitamin B deficiency though it occurs normally in some people.
Central arteriole with radiating thin-walled vessels. Mostly seen in young children and pregnant women.
What is a spider vein?
A bluish lesion that varies from small in size to several inches. Variable in shape. Pressure does not cause blanching. Distributed most often in the legs, near veins; also on the anterior chest. Often accompanies increased pressure in the superficial veins, as in varicose veins.
What is a cherry angioma?
A bright or ruby red lesion that may become purplish with age. Usually between 1 and 3 mm. Is round, flat or sometimes raised, and may be surrounded by a pale halo. May show partial blanching, especially if pressure is applied with edge of a pinpoint. Distributed on the trunk and extremities. Increases in size and numbers with aging.
Birthmark that most commonly appears as a rubbery, bright nodule of extra blood vessels under the skin. Grows during the first years of life then recedes over time.
Small blood vessels that have enlarged and show through skin. Often seen on the cheeks.
What are the two purpuric lesions of the skin?
Petechia/purpura and ecchymosis
What are petechia/purpura?
Deep red or reddish purple lesions that fade away over time. Petechia are between 1-3mm and purpura are larger. Usually have a rounded shape though sometimes irregular and are flat. No pulsatility or blanching. Variable distribution. Caused by blood outside the vessels; may suggest a bleeding disorder or, if petechiae, emboli to skin. Palpable purpura are seen in vasculitis.
What is ecchymosis?
A purple or purplish blue lesion, fading to green, yellow, and brown with time. Variable size, larger than petechiae (>3 mm). Rounded, oval, or irregular, may have a central subcutaneous flat nodule (hematoma). No pulsatility or blanching. Variable distribution. Caused by blood outside the vessels; often secondary to bruising or trauma; also seen in bleeding disorders.
What is actinic keratosis?
Superficial, hyperkeratonic papules. Often multiple; can be round or irregular; pink, tan, or grayish. Appear on sun-exposed skin of older, fair-skinned people. Considered to be dysplastic or precancerous; one of every 1,000 per year develop into squamous cell caricinoma.
What is seborrheic keratosis?
Common, benign, whitish-yellowish to brown raised papules that feel slightly greasy and velvety or warty and have a "stuck on" appearance. Typically multiple and symmetrically distributed on the trunk of older people, but may also appear on the face and elsewhere.
What is basal cell carcinoma?
A malignant skin tumor that grows slowly and almost never metastasizes. It is most common in fair-skinned adults 40 years or older, and usually appears on the face. An initial red macule or papule may develop a depressed center and a firm, elevated border. Telangiectatic vessels are often visible. Approximately 80% of all skin cancers.
What is squamous cell carcinoma?
Usually appears on sun-exposed skin or fair-skinned adults older than 60 years. May develop in an actinic keratosis. Usually grows more quickly than a basal cell carcinoma, is firmer, and looks redder. The face and dorsum of the hand are often affected. Approximately 16% of skin cancers with only 1% metastasizing.
What is a benign nevis?
A benign nevis or common mole, usually appears in the first few decades. Several nevi may arise at the same time, but their appearance usually remains unchanged. Typical features:
- round or oval shape
- sharply defined borders
- uniform color, especially skin-colored, tan, or brown
- diameter <6 mm but >10 mm if congenital
- flat or raised surface
What is a pressure ulcer?
Pressure (decubitus) ulcers usually develop over bony prominences subject to unrelieved pressure, resulting in ischemic damage to underlying tissue. Prevention is important: inspect the skin thoroughly for early warning signs of erythema that still blanches with pressure, especially in patients with risk factors. Pressure ulcers form most commonly over the sacrum, ischial tuberosities, greater trochanters, and heels.
What is alopecia areata?
Clearly demarcated round or oval patches of hair loss, usually affecting young adults and children. There is no visible scaling or inflammation.
What is trichotillomania (trichotillosis)?
Hair loss from pulling, plucking, or twisting hair. Hair shafts are broken and of varying lengths. More common in children, often in settings of family or psychological stress
What is tinea capitis?
Ringworm. Round scaling patches of alopecia. Hairs are broken off close to the surface of the scalp. Usually caused by fungal infection
What is paronychia?
A superficial infection of the proximal and lateral nail folds adjacent to the nail plate. The nail folds are often red, swollen, and tender. Arises from local trauma due to nail biting, manicuring, or frequent hand immersion in water.
What is clubbing of the fingers?
A bulbous swelling of the soft tissue at the nail base, with loss of the normal angle between the nail and the proximal nail fold. The angle increases to 180 degrees or more, and the nail bed feels spongy or floating. Involves vasodilation with increased blood flow to the distal portion of the digits and changes in connective tissue. Seen in congenital heart disease, interstitial lung disease and lung cancer, inflammatory bowel disease, and malignancies.
A painless separation of the whitened opaque nail plate from the pinker translucent nail bed. Starts distally and progresses proximally, enlarging the free edge of the nail. Local causes include trauma from excess manicuring, psoriasis, fungal infection (onychomycosis), and allergic reactions to nail cosmetics. Systemic causes include diabetes, anemia, photosensitive drug reactions, hyperthyroidism, peripheral ischemia, bronchiectasis, and syphilis.
Nail plate turns white with a ground-glass appearance, a distal band of reddish brown, and obliteration of the lunula. Commonly affects all fingers. Seen in liver disease, usually cirrhosis, heart failure, and diabetes.
Trauma to the nails is usually followed by nonuniform white spots that grow slowly out with the nail.
Curving transverse white bands that cross the nail parallel to the lunula. Arising from the disrupted matrix of the proximal nail, they vary in width and move more distally as the nail grows out. Seen in arsenic poisoning, heart failure, Hodgkin's disease, chemotherapy, CO poisoning, and leprosy
Transverse depressions of the nail plate, usually bilateral, resulting from temporary disruption of proximal nail growth from systemic illness. Timing of the illness may be estimated by measuring the distance from the line to the nail beds. Seen in severe illness (diabetes mellitus, psoriasis, malnutrition), trauma, and cold exposure if Raynaud's is present.
Punctuate depression of the nail plate caused by defective layering of the superficial nail plate by the proximal nail matrix. Usually associated with psoriasis but also seen in Reiter's syndrome, sarcoidosis, alopecia areata, and localized atopic or chemical dermatitis.
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