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Clinical Assessment
PE, Skin, Vital Signs
57
Medical
Graduate
10/03/2009

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Cards

Term
Pulse Characteristics
Definition
RRAC: rate, rhythm, amplitude contour
Term
Weak/Thready (1+)
Definition
• ↓SV or ↑PR - HF, hypovolemic, aortic stenosis
• ↑PR - cold, CHF
Term
Bounding (3+
Definition
• ↑SV or ↓PR - fever, anemia, hypothyroid, aortic regurgitation
• ↑SV due to ↓HR – complete heart block
• ↓ compliance/ ↑ stiffness of aortic walls – aging or atherosclerosis
Term
Bisferiens
Definition
: increased pulse with double systolic peak
• Aortic stenosis or regurgitation
Term
Pulsus Alternans
Definition
alternates in amplitude - regular rhythm
• Left ventricular failure, often with left S3
Term
Bigeminal Pulse
Definition
normal beat alternates w/ premature contraction/↓SV
Term
Paradoxical Pulse
Definition
diminished pulse amplitude with inspiration
• Pericardial tamponade, obstructive lung disease
Term
Respiration characteristics
Definition
rate, regularity
Term
Normal respiration
Definition
14-20 breaths/ minute
Term
Bradypnea
Definition
drug-induced respiratory depression, diabetic coma or ICP
Term
Tachypnea
Definition
rapid & shallow) restrictive lung disease, elevated diaphragm, pleuritic chest pain
Term
Hyperpnea
Definition
rapid & deep) exercise, asthma, metabolic acidosis
Term
Sighing
Definition
hyperventilation syndrome – common causes of dizziness & dyspnea
Term
Cheyne Stokes
Definition
hyperpnea punctuated with apnea – heart failure, brain damage, drug induced respiratory depression
Term
Ataxic (Biot’s
Definition
unpredictable irregularity – respiratory depression or brain damage
Term
Obstructive:
Definition
prolonged expiration – asthma, bronchitis, COPD
Term
Temperature
Definition
Highest to lowest: Aural, Rectal, Oral
Term
Normal BP
Definition
<120/80
Term
Prehypertension
Definition
120-139/80-89
Term
Stage 1 hypertension
Definition
140-159/90-99
Term
Stage 2 hypertension
Definition
>160/>100
Term
Skin Evaluation
Definition
7 characteristics: color, moisture, temperature, texture, mobility, turgor, lesions
Term
Lesion characters
Definition
5: type, color, shape, arrangement, distribution (extent, pattern)
Term
macule
Definition
discolored flat spot <1 cm; hemangioma, vitiligo
Term
patch
Definition
discolored flat spot >1 cm; cafe-au-lait
Term
Purpura
Definition
red or purple discolorations on the skin, caused by bleeding underneath the skin
Term
Plaque
Definition
solid, elevated area, >1 cm (often formed by coalescence of papules); psoriasis
Term
papule
Definition
red, solid, elevated area, <1 cm – ex. Psoriasis
Term
nodule
Definition
marble-like legion, larger than .5 cm, often deeper & firmer than papule; dematofibroma
Term
cyst
Definition
nodule filled with expressible material (liquid or semisolid); epidermal inclusion cyst
Term
wheal
Definition
superficial, irregular & transient area of localized edema
i. accompanied by itching – seen in Uticaria
Term
vesicle
Definition
< 1 cm, filled with serous fluid; blister-like elevation (herpes simplex, varicella, zoster)
Term
bulla
Definition
blister > 1 cm; insect bite
Term
pustule
Definition
raised and filled with lymph or purulent fluid – ex. Acne
Term
burrow
Definition
raised tunnel in the epidermis; scabies
Term
scale
Definition
thin dead flake of exfoliated epidermis; ichthyosis vulgaris
Term
crust
Definition
dried residue of skin exudates such as serum, pus or blood; impetigo
Term
lichenification
Definition
visible thickening/roughening of the skin, ↑visibility of normal folds – rubbing; neurodermatitis
Term
scar
Definition
CT arising from injury or disease
Term
keloid
Definition
hypertrophic scarring that extends beyond area of initiating injury; ear lobe
Term
erosion
Definition
non-scarring loss of superficial epidermis – surface is moist but doesn’t bleed
i. ex. After rupture of a vesicle in chickenpox
Term
excoriation
Definition
linear erosions caused by scratching
Term
fissure
Definition
linear crack in the skin, often resulting from excessive dryness
Term
ulcer
Definition
deeper loss of epidermis & dermis – may bleed & scar
Term
Acne vulgaris
Definition
Primary lesion: mild acne, moderate acne, severe cystic acne; Secondary lesions: acne with pitting and scarring
Term
Vascular lesions
Definition
spider angioma, spider vein, cherry angioma
Term
petechiae
Definition
tiny, red/purplish, discrete hemorrhagic spots, 1-3mm, (will not blanch)
Term
ecchymosis
Definition
(bruise) large macule, purple fading to blue/green – blood not in vessels
Term
Actinic Keratosis
Definition
pre-cancerous legion
• superficial flattened papules covered by dry scale – may be pink, tan or grayish
Term
seborrheic keratosis
Definition
common, benign, yellowish to brown raised lesions; appear stuck-on; older people
Term
basal cell carcinoma
Definition
though malignant, it grows slowly
• initial translucent nodule spreads, leaving depressed center & firm elevated border
Term
squamous cell carcinoma
Definition
less common but more dangerous than basal cell
• usually redder than basal cell and more eroded
Term
benign nevus
Definition
normal mole – usually round, sharply defined borders & uniform in color
Term
malignant melanoma
Definition
ABCDEs
• asymmetry, irregular borders, variegated in color, diameter > 6mm, often elevated
Term
Shape of Lesions
Definition
round, oval, polygonal, polycyclic, annular, iris, serpiginous, umbilicated
Term
arrangement of lesions
Definition
disseminated (scattered, diffuse), grouped (herpetiform, linear, serpigionous, reticulated, zosteriform)
Term
distribution of lesions
Definition
extent (isolated, localized, regional, generalized), pattern (symmetrical, sites of pressure, exposed areas, intertriginous, follicular)
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