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Clinical Exam Test 2
LECOM OMS1
587
Medical
Professional
11/24/2011

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Cards

Term
What are the 6 ethical principles?
Definition
Autonomy, Beneficence, Nonmaleficence, Utilitarianism, Fairness and Justice, and Deontologic imeratives
Term
What does Autonomy mean?
Definition
The patient's need for self-determination: the ability to choose between alternatives.
Term
What does Beneficence mean?
Definition
Do good for the patient.
Term
What does Nonmalficence mean?
Definition
Do no harm to the patient.
Term
What does Utilitaraianism mean?
Definition
Consider appropriate use of resources with concern for the greater good of the larger community.
Term
What does Fairness and Justice mean?
Definition
Recognize balance between patient's autonomy and the interests of family and community.
Term
What does Deontologic imperatives mean?
Definition
Responsibilities for offering care are established by tradition and cultural contexts and vary by culture.
Term
What does establishing a positive patient relationship depend on?
Definition
communication, courtesy, comfort, connection, and confirmation
Term
What are 3 types of questions?
Definition
open-ended, direct, leading
Term
What is the structure of the history?
Definition
Identifiers, cheif complaint, history of present illness, past medical history, family history, personal and social history, review of symptoms.
Term
What are identifiers?
Definition
name, date, time, age, gender, race, occupation, and referral source
Term
What is the chief complaint?
Definition
direct quote from the patient explaining why they are seeking care
Term
What is the history of present illness?
Definition
the circumstances that surround the primary reason for the patient's visit.
Term
What is the past medical history?
Definition
past medical and surgical history
Term
What is the family history?
Definition
Family's health, past medical history, illnesses, deaths, genetic, social, and environmental influences of family.
Term
What is the personal and social history?
Definition
Work, family, and school relationships
Term
What is the review of symptoms?
Definition
Detailed review of possible complaints in each of the body's systems
Term
What are the 4 steps to approach a sensitive topic?
Definition
1. Introduce the topic 2. open-ended quesions 3. interpret and repeat the patient's words 4. ask relevant questions
Term
What is the CAGE questionnaire?
Definition
Cut down, Annoyance, Guilt, Eye-opener
Term
What is TACE used for?
Definition
Adults and pregnant women.
Term
What is CRAFFT used for?
Definition
Adolescents
Term
What is the TACE questionaire?
Definition
How many drinks does it take to feel high, Annoyance, Cut Down, Eye-Opener
Term
What is the CRAFFT questionnaire?
Definition
Car with impaired driver, Relax with drugs, Alone using, Forget things you did, Family/Friends told you to cut down, Trouble for using them
Term
What is the HITS questionnaire?
Definition
Hurt, Insult, Threaten, Scream
Term
What questionnaires can be used for alcohol in adults?
Definition
TACE and GAGE
Term
What questionnaire is used for substance abuse in adolescents?
Definition
CRAFFT
Term
What questionnaire is used for spirituality?
Definition
FICA
Term
What is FICA?
Definition
Faith, Importance/Influence, Community, Address how it affects health care decisions
Term
What are similar terms to describe chief complaint?
Definition
presenting problem and reason for seeking care
Term
What 4 questions give a basis of understanding of the unique experience of each patient?
Definition
Why is it happening now? How is this patient different from others? Can I assume that what is true for this patient is true for others? How does this bear on my ultimate interpretation?
Term
What are risk factors for Type II Diabetes?
Definition
Children: obesity and dyslipidemia. Adults: 1 or more second degree relatives with diabetes or CVD.
Term
What are 2 mnemonics for adolescent screening?
Definition
HEADSSS: Home, Edu/Employment, Eating, Activities/Affect/Anger, Drugs, Sexuality, Suicide, Safety. PACES: Parents/peers, Accidents/Alcohol/Drugs, Cigarettes, Emotions, School/Sexuality.
Term
What state or federal laws control the need for confidentiality in adolescents?
Definition
pregnancy, abortion, substance abuse, physical abuse.
Term
What takes on a dominant role during middle adolescence?
Definition
risky behavior, immature decisions, arguments with parents
Term
What takes on a dominant role during late adolescence?
Definition
understanding of consequences and self takes hold
Term
How frequent is postpartum depression?
Definition
1 out of 8 women after delivery
Term
What should compliment advanced directives?
Definition
The appointment of a surrogate who has legally executed durable power of attorney for healthcare.
Term
What is frailty?
Definition
Loss of physical reserve and increased risk of loss of physical function and independence
Term
What findings suggest frailty?
Definition
3 or more of the following: muscle weakness, fatigue, decline in activity, slow or unsteady gait, unintentional weight loss. OR the PT needs help with 2 or more ADLs
Term
What describes mobility disability?
Definition
Difficulty walking, climbing stairs, balance.
Term
What describes housework disability?
Definition
Heavy, light, meal preparation, shopping, medication use, money management.
Term
What describes upper extremity function disability?
Definition
Grasping, opening jars, reaching overhead.
Term
What describes ADL disability?
Definition
Bathing, dressing, toileting, moving, eating, walking in home.
Term
What is palliative care?
Definition
Comprehensive management of phys, emot, and spirit or PTs with life-limiting conditions.
Term
What are the 4 types of histories?
Definition
Complete, inventory, problem aka focuesd, interim.
Term
When is an inventory history taken?
Definition
Touches on major points without going into detail, used when the entire history will be taken in more than one session.
Term
When is a problem aka focused history taken?
Definition
During an acute possibly life threatening problem.
Term
When is an interim history taken?
Definition
Chronicles events that have occurred since your last meeting.
Term
What are standard precautions?
Definition
Hand hygeine, PPEs, cough etiquette, safe injections, masks for catheter insert/ subarachnoid puncture, contaminated surface containment.
Term
How can health care professionals minimize their vulnerability?
Definition
Follow standard precautions, minnimize latex exposure, use good body mechanics.
Term
When should hand hygiene be used?
Definition
After touching blood, body fluid, secretions, excretions, contaminated items, after removing gloves, and between patient contacts.
Term
When should gloves be used?
Definition
Touching blood, bodily fluids, secretions, excretions, contaminated items, mucous membranes, and nonintact skin.
Term
When should a gown be used?
Definition
When contact of your body is expected with blood/body fluids, secretions, and excretions.
Term
When should a mask or goggles be used?
Definition
Splashed or sprays of blood, body fluid, secretions, suctioning, or endotracheal intubation.
Term
How should needles/ sharps be handled?
Definition
Do not recap, bend, break, or hand manipulate. If recapping is required, use a 1-hand scoop technique
Term
What are 3 types of latex reactions?
Definition
Irritant contact dermatitis, Type IV dermatitis, Type I systemic reactions.
Term
What is Irritant contact dermatitis?
Definition
Chemical irritation that does not involve the immune system.
Term
What is Type IV dermatitis?
Definition
aka Delayed hypersensitivity: involves immune system, onset 24-48 hrs.
Term
What is Type I systemic reactions?
Definition
True allergic reaction caused by IgE, releasing histamine, leukotrienes, prostaglandins, and kinins.
Term
What are the symptoms of Irritant contact dermatitis?
Definition
Dry, itchy, irritated hands.
Term
What are the symptoms of Type IV dermatitis?
Definition
Resembles poison ivy and may lead to oozing skin blisters.
Term
What are the symptoms of Type I systemic reactions?
Definition
Local utricaria (wheals), generalized utricaria with angioedema, asthma, eye-nose itching, GI symptoms, anaphylaxis, chronic asthma, and permanent lung damage.
Term
What is the dorsal recumbent position used for?
Definition
Examination of genital and rectal areas.
Term
What is the lithotomy position used for?
Definition
pelvic exam
Term
Describe the Sims position.
Definition
PT in lateral recumbent rolls torso toward prone, sharply flex top leg, gently flex bottom leg: rectal exam.
Term
What odor can be detected for inborn errors of metabolism?
Definition
PAH defect: mousy, Tyrosinemia: fishy
Term
What odor can be detected for infectious diseases?
Definition
TB: stale beer, Diptheria: Sweetish
Term
What odor can be detected for poison/ intoxication?
Definition
Cyanide: bitter almond, Chloroform and Salicylates: fruity
Term
What odor can be detected for physiologic non-disease states?
Definition
Sweaty feet: cheesy
Term
What odor can be detected for foreign bodies?
Definition
lodged organic material: foul-smelling discharge.
Term
What part of your hand is used for discriminatory touch?
Definition
Palmar surface of fingers and finger pads (not fingertips)
Term
What part of your hand is used to sense vibration?
Definition
ulnar surface of hands and fingers
Term
What part of your hand is used to sense temperature?
Definition
Dorsal surface
Term
What depth yields percussion tones?
Definition
4-6cm deep
Term
What are the percussion sounds from loudest to quietest?
Definition
Tympany, hyperressonance, ressonance, dullness, and flatness
Term
How do you perform percussion?
Definition
Place distal phalynx of middle finger nondominant hand over target area, elevate other fingers. Snap wrist to bring down dominand middle finger TIP (plexor) down on target finger (pleximitor).
Term
What is the tone, intensity, pitch, duration, and quality of a gastric bubble?
Definition
tympanic, loud, high, moderate, and drumlike
Term
What is the tone, intensity, pitch, duration, and quality of emphysematous lungs?
Definition
hyperresonant, very loud, low, long, boomlike
Term
What is the tone, intensity, pitch, duration, and quality of healthy lung tissue?
Definition
resonant, loud, low, long, hollow
Term
What is the tone, intensity, pitch, duration, and quality of the liver?
Definition
dull, soft-moderate, moderate-high, moderate, thudlike
Term
What is the tone, intensity, pitch, duration, and quality of muscle?
Definition
flat, soft, high, short, very dull.
Term
How are indirect measurements of blood pressure taken?
Definition
stethoscope and either aneroid or mercury sphygmomanometer
Term
How wide should an adult blood pressure cuff be?
Definition
1/3 - 1/2 the circumference of the limb
Term
How long should the cuff bladder be?
Definition
2x the width (80% of limb circumference)
Term
How wide should a child's blood pressure cuff be?
Definition
2/3 or upper arm or thigh (40% of circumference)
Term
How much of the distance between the acromion and olecranon should the child's cuff cover?
Definition
0.7
Term
How long should a child's cuff bladder length/ width be?
Definition
80-100% of arm circumference/ 40% arm circumference
Term
What method of measuring temperature is best for children ages 2 months- 16 years?
Definition
tympanic
Term
Why does ear temperature reflect body temperature?
Definition
tympanic membrane shares blood supply with hypothalamus in the brain.
Term
Why does axillary temperature correlate well with a newborn's core temperature?
Definition
infant has small body mass and uniform skin blood flow.
Term
How is sPO2 measured?
Definition
pulse oximitry (healthy = 97-99%)
Term
What are 4 types of patient transfer?
Definition
Pivot, Cradle, 2-person, and Equipment
Term
What is the natural frequency of the diaphragm of an acoustic stethoscope?
Definition
300Hz (best for low frequency sounds)
Term
What is the bell of the acoustic stethoscope used for?
Definition
low pitches sounds with light pressure (higher with firm)
Term
What are the components of a magnetic stethoscope?
Definition
Convex single diaphragm over iron disk, compression activates air column. Dial adjusts for high, low, and full frequency sounds.
Term
What is unique about a stereophonic stethoscope?
Definition
Right and left ear can hear right and left auscultory sounds independently.
Term
How does a pulse oximiter work?
Definition
One diode sends out invisible infrared, and the other visible red. oxygenated Hb = more red light passes through to other side.
Term
How does Doppler Detect Blood Flow?
Definition
Low power high frequency wave reflects at various tissue interfaces, resulting in audible sounds.
Term
What frequency does Doppler measure?
Definition
2-10 MHz
Term
What is used to determine fetal heart rate?
Definition
A fetoscope or a Leff scope.
Term
At what age can a fetoscope or Leff scope detect HR?
Definition
17-19 weeks gestation
Term
What is the small aperture of the opthalmoscope used for?
Definition
small pupils
Term
What is the red-free filter aperture of the opthalmoscope used for?
Definition
green beam: optic pallor, minute vessel changes, retinal hemorrhages, blood appears black.
Term
What is the slit aperture of the opthalmoscope used for?
Definition
Anterior eye to determine lesion elevation.
Term
What is the grid aperture of the opthalmoscope used for?
Definition
Size of fundal lesions
Term
What is the magnification power (diopter) of an opthalmascope?
Definition
pos or neg 20 to pos or neg 140
Term
Can an opthalmoscope compensate for myopia or hyperopia?
Definition
Yes, using plus and minus lenses, HOWEVER there is no compensation for astigmatism.
Term
How should an opthalmoscope be seated in the handle?
Definition
Fit the adapter of the handle into the head receptacle and push downward while turning the head in a clockwise direction.
Term
How do you use a strabismoscope?
Definition
Have child focus on accomodative target, cover one eye with scope, watch for movement in both eyes, switch.
Term
What the the numerator and denominator of visual acuity represent?
Definition
Numerator: distance in feet between patient and chart. Denominator: distance from which a person with normal vision could read the lettering.
Term
What does a Snellen chart measure?
Definition
far vision
Term
When should the Tubling E or HOTV tests be used?
Definition
Children aged 3-5 years.
Term
What is an LH (LEA) symbols chart?
Definition
Presents 4 optotypes: circle, square, apple, house: recorded as smallest symbol/ testing distance
Term
What is a broken wheel (Landolt) test?
Definition
Child must identify broken wheel on a card. Each card has a different size card to ID different acuities.
Term
What tests are used for near vision?
Definition
Rosenbaum or Jaeger chart: series of numbers, E, X, and O in graduated sized.
Term
What is used to test macular degeneration?
Definition
Amsler grid: PT views grid one eye at a time noting line distortion or scotoma. Used when PT has retinal drusen bodies of family Hx.
Term
Which otoscope speculum is used for a tympanic membrane/ external auditory canal exam?
Definition
Largest that will comfortably fit.
Term
What otoscope speculum is used for naris?
Definition
Shortest and widest
Term
What evaluates the fluctuating capacity of the tympanic membrane?
Definition
pneumatic attachment for otoscope, apply pufs of air.
Term
What does tympanometry assess?
Definition
Functions of ossicular chain, eustachian tube, and tympanic membrane
Term
What is a nasal speculum used for?
Definition
To visualize lower and middle turbinates.
Term
What frequency tuning fork is used for auditory evaluation?
Definition
500-1000Hz (speech is 300-3000 Hz)
Term
What frequency tuning fork is used for vibratory sensation?
Definition
100-400Hz: tap against heel of hand, apply base of fork to bony prominence
Term
What are the 3 types of vaginal specula?
Definition
Graves: 3.5-5 x 0.75-1.25, Penderson: narrower and flatter blades, Pediatric: smaller in all dimesions
Term
What is a Goniometer used for?
Definition
Degree of joint flexion and extension
Term
What does a Wood's lamp do?
Definition
300nm black light that causes fungi to flouresce
Term
What does a dermatoscope measure?
Definition
(Digital) Epiluminesence microscopy examines skin lesions
Term
What do Lange and Harpenden calipers measure?
Definition
Thickness of subcutaneous tissue.
Term
What does a monofilament test?
Definition
Loss of protective sensation such as on plantar surface of foot.
Term
What is the proper way to use a monofilament?
Definition
Depress on foot until it bends (under 10 g of pressure)
Term
What is necessary equipment?
Definition
Stethoscope, opthalmoscope, BP cuff and manometer, cm ruler, tape measure, reflex hammer, auditory and vibratory tuning forks, penlight, near vision screenign chart.
Term
Which phase of heart contraction produces a pressure wave resulting in an arterial pulse?
Definition
ventricular systole
Term
How much time does it take for an impulse from ventricular systole to be felt as the dorsalis pedis pulse?
Definition
0.2 sec
Term
How long does it take for an RBC in the aorta to reach the dorsalis pedis?
Definition
2.0 sec
Term
What are the 3 factors that influence systolic pressure?
Definition
cardiac output, blood volume, and compliance of the arterial tree
Term
How is pulse affected when the aortic valve closes?
Definition
There is a small upstroke in the descending part of the pulse called the dicrotic notch
Term
What factor influences diastolic pressure?
Definition
peripheral vascular resistence
Term
systole - diastole =
Definition
pulse pressure
Term
What 4 factors contribute to the characteristics of the pulses?
Definition
stroke volume, distensibility of great vessels, blood viscosity, peripheral resistence
Term
Where are the external jugular veins most visible?
Definition
above the clavicle, close to the insertion of SCM
Term
The activity of the right side of the heart is transmitted back through the _____ as a pulse.
Definition
jugular veins
Term
What do the 3 peaks of the jugular vein pulse represent?
Definition
a- brief backflow during R atrial contraction, c- backward push during R ventricular systole, v- increasing volume and pressure on right atrium
Term
What do the 2 descending slopes of the jugular vein pulse represent?
Definition
x- passive atrial filling, y- open tricuspid ie rapid filling of right ventricle
Term
When does the ductus arteriosus close?
Definition
12-14 hours after birth
Term
In the infant, what causes blood to flow into pulmonary arteries rather than across the foramen ovale?
Definition
pulmonary resistance becomes lower than systemic resistance when the infant starts breathing
Term
What closes the foramen ovale?
Definition
pressure in the left side of the heart becomes higher than the right
Term
How is systemic vascular resistance altered in pregnant women?
Definition
systemic vascular resistance decreases causing peripheral vasodilation -> palmar erythema and spider telangietasias
Term
What changes are seen in the arterial walls of the elderly?
Definition
calcification, dilation, and tortuousity
Term
What are the risk factors for preeclampsia?
Definition
40+, 1st pregnancy, preexisting hypertension, obesity, renal Dx, or diabetes mellitus, family Hx
Term
What are the risk factors for varicose veins?
Definition
Women 4x more likely than men, Irish & German descent, sedentary, age
Term
A healthy pulse contour should be _____.
Definition
smooth, rounded, domed
Term
What is a possible cause of an alternating pulse (pulsus alternans)?
Definition
left ventricular failure
Term
What is a possible cause of a pulsus bisiferans?
Definition
aortic stenosis combined with aortic insufficiency
Term
What are possible causes of a large, bounding pulse?
Definition
exercise, anxiety, fever, hyperthyroidism, aortic rigidity or atherosclerosis
Term
What is a possible cause of a bigeminal pulse?
Definition
disorder of rhythm
Term
What are possible causes of a paradoxic pulse (pulsus paradoxus)?
Definition
premature cardiac contraction, tracheobronchial obstrction, bronchial athsma, emphysema, pericardial effusion, constrictive pericarditis
Term
What are possible causesof a Water-hammer (Corrigan) pulse?
Definition
patent ductus arteriosus, aortic regurgitation
Term
What is normal resting hear rate?
Definition
60-100 BPM
Term
What is the pule rate of tachycardia?
Definition
> 100 BPM
Term
What is the pulse rate of bradycardia?
Definition
< 60 BPM
Term
A heart rate that is irregular but that occurs in a repeated pattern may indicate:
Definition
sinus arrhythmia
Term
Lack of pulse symmetry between right and left may indicate:
Definition
impaired ciculation
Term
What arteries can be auscultated fro bruits?
Definition
temporal, carotid, subclavian, abdominal aorta, renal, iliac, and femoral
Term
What is the venous hum?
Definition
a clinically insignificant sound that can be auscultated at the medial clavicle anterior to SCM, can be confused with other pathologies
Term
What can cause carotid artery bruits?
Definition
valvular aortic stenosis, mitral valve damage, aortic regurgitation, stenosis
Term
What is claudication?
Definition
Pain brought on by exercise and relieved with rest, pain is distal to stenosis.
Term
What are the 5 P's of arterial occlusion?
Definition
Pallor, Pain, Pulselessness, Paresthesia, Paralysis
Term
Where would pain present in an obstructed superficial femoral artery?
Definition
calf muscle
Term
Where would pain present in an obstructed common femoral or external iliac artery artery?
Definition
thigh
Term
Where would pain present in an obstructed common artery or distal aorta?
Definition
aorta
Term
What sound is produced during a blood pressure reading?
Definition
Korotkoff sounds
Term
What indicates the beginning of the Korotkoff sounds?
Definition
2 consecutive systolic beats
Term
What is the term for when Korotkoff sounds appear, disappear, and reappear 10-15 mmHg lower?
Definition
auscultory gap
Term
What can cause the auscultory gap to widen?
Definition
systolic hypertension, chronic severe aortic regurgitation
Term
What can cause the auscultory gap to narrow?
Definition
pulsus paradoxis with cardiac tamponade or other cardiac constrictions
Term
Define phases 1 of Korotkoff sounds.
Definition
First 2 consecutive beats = systolic pressure
Term
Define phases 2 of Korotkoff sounds.
Definition
reappearance of sounds after auscultory gap
Term
Define phases 3 of Korotkoff sounds.
Definition
point as which sounds are first crisp
Term
Define phases 4 of Korotkoff sounds.
Definition
point at which crisp sounds become muffled: 1st diastole
Term
Define phases 5 of Korotkoff sounds.
Definition
disappearance of sound: 2nd disatole
Term
What is optimal blood pressure?
Definition
<120/80
Term
What is the range of prehypertension?
Definition
120-139/ 80-89
Term
What is the range of stage 1 hypertension?
Definition
140-159/ 90-99
Term
What is stage 2 hypertension?
Definition
> 160/100
Term
What is considered an exaggerated paradoxical pulse?
Definition
>10 mHg difference in systolic pressures between inhalation ans exhalation
Term
What can cause an exaggerated paradoxical pulse?
Definition
cardiac tamponade, pericarditis, emphysema
Term
How is postural hypertension defined?
Definition
Drop in systolic (>15mmHg) and diastolic pressures when the patients stands after being supine
Term
What can cause portal hypertension?
Definition
blood loss, drugs, ANS disease
Term
What can undermine the accuracy of blood pressure readings?
Definition
cardiac dysrhythmias, aortic regurgitation, venous congestion, valve replacement
Term
What is the expected value for jugular venous pressure?
Definition
9 cm H2O (divide by 1.3 for mmHg
Term
What is the quality and character of a jugular vs carotid pulse?
Definition
3 undulating waves / one brisk wave
Term
What is the effect of respiration of a jugular vs carotid pulse?
Definition
decreased on inspiration and increased on expiration/ no effect
Term
What is the effect of venous compression on a jugular vs carotid pulse?
Definition
easily eliminates pulse wave/ no effect
Term
What is effect of abdominal pressure on a jugular vs carotid pulse?
Definition
increased prominence/ no effect
Term
What can the hepatojugular reflex measure?
Definition
right-sided heart failure is suspected when JVP elevates after the hepatojugular reflex is tested
Term
How do you perform the hepatojugular reflex?
Definition
While measuring JVP, apply firm sustained pressure over the midepigastric region
Term
What measurement taken in the hands is equivalent to mean JVP?
Definition
elevate hand, measure from midaxillary line at nipple to the level of collapsed hand veins
Term
What are the signs of acute venous obstruction?
Definition
constant pain with swelling & tenderness, enorgement of superficial veins, erythema & cyanosis
Term
What is a Homan sign?
Definition
Flex patient's knee and dorsiflex foot. Calf pain may indicate venous thrombosis
Term
Edema with skin thickening and ulceration indicates:
Definition
deep vein thrombosis
Term
Unilateral edema indicates:
Definition
occlusion of a major vein
Term
Bilateral pitting edema indicates
Definition
congestive heart failure
Term
Nonpitting edema indicates
Definition
arterial insufficiency or lymphedema
Term
Describe Grade 1 Edema
Definition
slight pitting that disappears rapidly, can be felt not seen
Term
Describe Grade 2 Edema
Definition
deeper pit that disappears in 10-15 sec
Term
Describe Grade 3 Edema
Definition
deep pit that lasts 1 min+, the tested extremity appears swollen
Term
Describe Grade 4 Edema
Definition
very deep pit that lasts 2-5 min, tested extremity is grossly distorted
Term
How can the presence of varicose veins in the leg be tested?
Definition
Have patient stand on their toes 10 times in succession to build leg pressure. Pressure disappears in competent veins and persists in incompetent veins.
Term
How can the presence of collateral veins be tested?
Definition
Compress the vein with one hand and strip it of blood moving towards the heart with the other hand. If stripped veins fills, there are collaterals.
Term
How can the competency of venous valves be tested?
Definition
Compress the vein with one hand and strip it of blood moving towards the heart with the other hand, then release cephalad hand. If the entire column fills, the valves are incompetent.
Term
What should also be tested with blood pressure in the infant?
Definition
capillary refill
Term
What does a bounding infant pulse indicate?
Definition
patent ductus arteriosus
Term
What type of specialized sphygmomanometer can be used for infants and children?
Definition
one that includes Doppler or other oscillometric technique
Term
What is usual newborn blood pressure?
Definition
60-96/ 30-62 mmHg
Term
What can capillary refill time > 2sec in an infant or your child indicate?
Definition
dehydration or hypovolemic shock
Term
What can newborn hypertension indicate?
Definition
thromosis from umbilical catheter, stenosis, kidney disease, neuroblastoma, Wilms tumor, hydronephrosis, adrenal hyperplasia, or CNS disease
Term
Which phase of the Korotkoff sound is the appropriate measurement for diastole for ages 3-adolescence?
Definition
Phase 4, after which use phase 5
Term
In children, radial artery BP will read ____ less that brachial artery BP?
Definition
10 mmHg
Term
50% of the time, hypertension in adolescents is ___.
Definition
primary
Term
Hypertension in children younger that 10 is ______.
Definition
secondary due to kidney disease, renal artery disease, coarctation of the aorta, or pheochromocytoma
Term
Hypotension in pregnant women peaks at ____.
Definition
16-20 weeks gestation
Term
What is considered elevated blood pressure in a 2nd trimester pregnant woman?
Definition
>125/ 75 mmHg
Term
What is considered elevated blood pressure in a 3rd trimester pregnant woman?
Definition
>130/ 85 mmHg
Term
During pregnancy, a rise in ____ above the 1st trimester baseline should be monitored, and sustained pressure of _____ indicates a BP disorder.
Definition
30/ 15 mmHg, >140/ 90 mmHg or
Term
Hypertension in older adults is defined as:
Definition
> 140/ 90 mmHg
Term
What is temporal aka giant cell arteritis?
Definition
inflammatory disease of he branches of the aortic arch including temporal arteries
Term
How is an arterial aneurism defined?
Definition
1.5x the diameter of the normal artery
Term
What is peripheral artery disease?
Definition
stenosis of the extremities caused by atherosclerotic plaques
Term
What is Raynaud's Disease?
Definition
Exaggerated spasm of the digital arterioles and sometimes nose and ears due to cold exposure.
Term
What is arterial embolic disease?
Definition
atrial fibrillation that leads to clot formation within the atrium, may lead to dispersed emboli
Term
What causes venous thrombosis?
Definition
Trauma or prolonged immobilization
Term
What can hypertension cause?
Definition
stroke, renal failure, congestive heart failure
Term
How does constrictive pericarditis arise?
Definition
chronic inflammation and subsequent scarring of the pericardium
Term
Where is coarctation of the aorta most commonly seen?
Definition
stenosis is seen in descending aortic arch near the origin of the left subclavian artery and ligamentum arteriosum
Term
What is Kawasaki disease?
Definition
acute vasculitis unknown ETO affecting the young, may be due to cardiac involvement leading to aneurisms of coronary artery
Term
What is preeclampsia?
Definition
hypertesion that occurs after the 20th week of pregnancy with proteinuria
Term
What is eclampsia?
Definition
preeclampsia with seizures when no other cause for seizures can be found
Term
What causes venous ulcers?
Definition
Chronic venous insufficiency in which lack of venous flow leads to lower extremity venous hypertension
Term
What is the only useful information for ruling in DVT?
Definition
malignancy, previous DVT, recent immobilization, difference in calf diameter, and recent surgury
Term
What is useful information for ruling out DVT?
Definition
absence of calf swelling or diameter difference
Term
What is the pathophysiology of temporal arteritis?
Definition
unknown ETO, inflammatory infiltrates develop of thoracic aorta, arterial intimal thickening can affect structures in the head.
Term
What are the subjective findings of temporal arteritis?
Definition
age 50+, flu-like, headache esp temporal region, occular symptoms, ischemia of jaw and tongue
Term
What are the objective findings of temporal arteritis aka giant cell arteritis?
Definition
Area over temporal area red, swollen, tender, nodular. Temporal pulse varies.
Term
What is the pathophysiology of arterial aneurism?
Definition
result of atherosclerosis + tobacco and hypertension, 4x more common in men
Term
What are the subjective findings of arterial aneurism?
Definition
asymptomatic until dissection causes ripping pain
Term
What are the objective findings of arterial aneurism?
Definition
pulsatile swelling, thrill or bruit may be present over aneurism
Term
What is the pathophysiology of arteriovenous fistula?
Definition
congenital or caused by catheterization
Term
What are the subjective findings of arteriovenous fistula?
Definition
low extremity edema, varicose veins, claudication, high cardiac output
Term
What are the objective findings of arteriovenous fistula?
Definition
weak or absent pulses, foot or leg is painful at rest, cold and numb, and dry with poor hair growth. Ulceration, muscle atrophy, edema.
Term
What is the pathophysiology of peripheral arterial disease?
Definition
peripheral atherosclerosis, diabetes, hypertension, dyslipidemia, tobacco use, vascular trauma, radiation, vasculitis
Term
What are the subjective findings of peripheral arterial disease?
Definition
predictable anount of exercise produces pain, ache, or cramp in exercised muscle
Term
What are the objective findings of peripheral arterial disease ?
Definition
severe ischemia, leg or foot is painful at rest, cold and numb, and skin is scaling with poor hair growth. Ulceration and muscle atrophy, no edema.
Term
What is the pathophysiology of Reynaud phenomenon?
Definition
primary: young, healthy women, unknown ETO. Secondary: CT disease such as sclerodoma or systemic lupus erythematosus
Term
What are the subjective findings of Reynaud phenomenon?
Definition
Involved areas feel cold and achy, which improves when warmed. Secondary Renaud: intense pain with digital ischemia and necrosis.
Term
What are the objective findings of Reynaud phenomenon?
Definition
Primary: red white and blue extremities, vasospasm lasts < 1 hr. Secondary: fingertip ulcers or skin over digits appears smooth, shiny, tight
Term
What is the pathophysiology of arterial embolic disease?
Definition
emboli caused by atherosclerotic plaques, infectious material from fungal and bacterial endocarditis, or atrial myxomas
Term
What are the subjective findings of arterial embolic disease?
Definition
pain, parasthesias
Term
What are the objective findings of arterial embolic disease?
Definition
occlusion of small arteries and necrosis of their tissues. endocarditis leads to splinter hemmorhages in nail beds
Term
What is the pathophysiology of venous thrombosis?
Definition
prolonged immobilization, malignancy, birth control meds, trauma, or previous DVT
Term
What are the subjective findings of venous thrombosis?
Definition
tenderness along iliac vessels or femoral canal, popliteal space, or deep calf veins, pulmonary embolism may occur without warning,
Term
What are the objective findings of venous thrombosis?
Definition
difference in circumference of upper and lower legs, mininal ankle edema, high-grade fever, and tachycardia, Howman sign useful
Term
What is the pathophysiology of hypertension?
Definition
BP consistently at 140/ 90 mmHg or higher
Term
What are the subjective findings of hypertension?
Definition
Essential hypertension is asymptomatic, malignant hypertension has headache, visual symptoms, and encephalopathy
Term
What are the objective findings of hypertension?
Definition
In addition to BP, end organ damage, papilledema, or heart failure may be present
Term
What is the pathophysiology of tricuspid regurgitation?
Definition
due to conditions that lead to dilation of the right ventricle such as hypertension and pulmonary thrombosis, can also result from primary valvular disease
Term
What are the subjective findings of tricuspid regurgitation?
Definition
no symptoms if mild-medium, severe shows right-sided heart failure with ascites or peripheral edema
Term
What are the objective findings of tricuspid regurgitation?
Definition
v wave is early, prominent, and often merges with c wave, holocystolic murmur in tricuspid, pulsatile liver, peripheral edema
Term
What is the pathophysiology of atrial fibrillation?
Definition
heart disease leading to enlargement or elevated pressures
Term
What are the subjective findings of atrial fibrillation?
Definition
asymptomatic then palpations, lightheadedness, or dyspnea
Term
What are the objective findings of atrial fibrillation?
Definition
absent wave withan irregularly irregular pulse: 2 venous pulsations for each arterial pulsation, variable interval between v waves
Term
What is the pathophysiology of cardiac tamponade?
Definition
pericardial fluid from infection, malignancy, or autoimmune disease impairs cardiac ooutput
Term
What are the subjective findings of cardiac tamponade?
Definition
acute sudden onset chest pain and dyspnea or chronic heart failure symptoms
Term
What are the objective findings of cardiac tamponade?
Definition
Y-descent is abolished and JVP is elevated 15-25cm of H2O, JVP falls with inspiration, pulsus paradoxus (decrease in systolic >10mm Hg)
Term
What is the pathophysiology of constrictive pericarditis?
Definition
pericardial thickening and inelasticity, diminished cardiac filling and output
Term
What are the subjective findings of constrictive pericarditis?
Definition
progressive cardiac insufficiency such as worsening of lower extremity edema or dyspnea
Term
What are the objective findings of constrictive pericarditis?
Definition
Elevated JVP with prominent Y descent, peripheral edema and ascites due to right-sided heart failure
Term
What is the pathophysiology of coarctation of the aorta?
Definition
congenital defect of vascular wall or acquired inflammatory aortic disease or severe atherosclerosis
Term
What are the subjective findings of coarctation of the aorta?
Definition
asymptomatic unless severe hypertension or vascular insufficiency develops
Term
What are the objective findings of coarctation of the aorta?
Definition
differences in systolic BP when radial and femoral pulses are palpated simultaneously
Term
What is the pathophysiology of Kawasaki Disease?
Definition
ETO of vasculitis is unknown, immune-mediated blood vessel damage can result in both vascular stenosis and aneurism formation
Term
What are the subjective findings of Kawasaki Disease?
Definition
diffuse symptoms of varied duration, wieght loss, fatique, myalgias, or arthritis
Term
What are the objective findings of Kawasaki Disease?
Definition
Conjunctival injection, strawberry tongue, edema of hands and feet, lymphadenopathy and polymorphous nonvesicular rashes
Term
What is the pathophysiology of preeclampsia-eclampsia?
Definition
vascular and immunologic abnormalities within uteroplacental circulation
Term
What are the subjective findings of preeclampsia-eclampsia?
Definition
may be diagnosed without proteinuria if visual changes, headache, abdominal pain, and pulmonary edema are present
Term
What are the objective findings of preeclampsia-eclampsia?
Definition
sustained elevation of blood pressure > 160/ 110 mmHg
Term
What is the pathophysiology of venous ulcers?
Definition
incompetent valves, obstruction of blood flow, or loss of pumping effect of blood vessels
Term
What are the subjective findings of venous ulcers?
Definition
asymptomatic then leg heaviness and discomfort progressing to edema and ulceration
Term
What are the objective findings of venous ulcers?
Definition
ulcers on medial and lateral aspects of lower limbs, induration, edema, and hyperpigmentation
Term
How do you test CN V and VII?
Definition
Ask PT to clench teeth, squeeze eyes tightly shut, wrinkle forehead, smile, stick out tongue, puff out cheeks
Term
How do you test CN V?
Definition
Test light touch sensation on forehead, cheeks, chin, and corneal reflexes
Term
How do you test CN II?
Definition
Rosenbaum chart near vision screening and visual fields
Term
How do you test CN III, IV, and VI?
Definition
extra ocular eye movements
Term
How do you test CN VIII?
Definition
Assess hearing with whisper or ticking watch
Term
How do you test CN XII?
Definition
Inspect tongue for symmetry and movement
Term
How do you test CN IX and X?
Definition
gag and 'ah' reflex
Term
How do you test CN VII and IX?
Definition
taste test
Term
How do you test CN XI?
Definition
shoulder shrug
Term
What are Rinne and Weber tests used for?
Definition
ears
Term
What is the Romberg test used for?
Definition
Neurologic assessment
Term
What does an Apgar indicate?
Definition
information about the baby's pre, during, and post birth state
Term
What are physical signs unique to an infant aged 36 weeks or less?
Definition
<2 transverse creases on sole of foot, breast nodule is <3mm, no cartilage in ear helix, scrotum doesn't contain testis or have rugae
Term
Is apnea common in a premature infant?
Definition
yes, it may last for up to 20 sec
Term
What puts the infant at risk for diaphragmatic hernia?
Definition
If the mother has fever during or after delivery or herpetic lesions
Term
How do you assess CN IX, X, and XII in an infant?
Definition
Observe cry, tactile fremitus, facial symmetry, integrity or mouth, pharynx, and soft pallate.
Term
How do you assess CN XII in an infant?
Definition
Observe sucking and swallowing
Term
What does the Denver II test evaluate?
Definition
language, motor coordination, and social skills
Term
What are basic ADL's?
Definition
bathing, dressing, toileting, ambulation, feeding
Term
What are instrumental ADL's?
Definition
housekeeping, shopping, cooking, taking meds, communication, money management
Term
What is the traditional and essential component of critical thinking?
Definition
evidence-based practice
Term
What is CFM Saint's philosophy of medicine?
Definition
Many diagnoses can be made
Term
How is Occam's razor applied to medicine?
Definition
Plurality (of diagnoses) must not be posited without necesity.
Term
What is Bayes Theorem?
Definition
Diagnosis is based on probabilities
Term
What are prohibited abbreviations?
Definition
U, IU, QD, QOD or any variant, trailing zero (X.0), lack of leading zero, MS, MSO4, or MgSO4
Term
What is the difference between pain and tenderness?
Definition
pain is a symptom and tenderness is a sign
Term
What is objective data?
Definition
What you can see, hear, and touch
Term
What are the 6 components of POMR?
Definition
Comprehensive health history, phys exam, problem list, assessment and plan, needed lab and imaging tests, and progress notes
Term
What does the Assessment include?
Definition
Your interpretations and conclusions, their rationale, the diagnostic strategy, present and anticipated problems, and the needs of ongoing and future care.
Term
What does the Plan include?
Definition
diagnostics, therapeutics, and patient education
Term
What is included in an interval hisotry?
Definition
Subjective: status of problem, current medications and ROS, Objective: vitals, exam, results of tests since last visit, Assessment: diagnosis, Plan: 3 components
Term
What is a PAM list?
Definition
Problems, allergies, and medications
Term
What is identifying information?
Definition
Name, DOB, and assigned history number
Term
What is general patient information?
Definition
Additional identifying information
Term
What mnemonic is used for HOPI?
Definition
OLDCAARTS
Term
How many generations should a family history include?
Definition
3
Term
What obstetric information is taken for women?
Definition
Preterm pregnancies,Term Pregnancies Abortions/ Miscarriages, Living Children
Term
What is included in the general statement of the physical exam?
Definition
age, race, gender, general appearance, weight, height, BMI, and vitals
Term
Precursors in the ___ produce vitamin D
Definition
skin
Term
What are the 2 major layers of the epidermis and what is their major function?
Definition
stratum corneum- protection and water retention. cellular stratum- synthesizes keratin.
Term
What connects the epidermis to the dermis?
Definition
The basement membrane
Term
Where are melanin and keratin synthesized?
Definition
In the stratum germinativum
Term
What epidermal layer is only present in palms and soles?
Definition
stratum lucidum
Term
Epidermis and cutaneous adipose tissue are separated by _____.
Definition
Dermis
Term
What are dermal papillae?
Definition
Upward projections of dermis that provide nourishment to the epidermis.
Term
What is contained in the dermis besides blood vessels?
Definition
Elastin, collagen, reticular fibers, sensory nerve and nerves of the ANS.
Term
What connects the dermis to underlying organs?
Definition
The hypodermis which is composed loose CT and fatty cells.
Term
What is the function of eccrine glands?
Definition
regulate body temperature by secreting water directly onto the surface of the skin
Term
Where are eccrine glands found?
Definition
found throughout the body except lip margins, eardrums, nail beds, and glans penis
Term
What is the function of apocrine glands?
Definition
Secrete an odorless white fluid in response to emotional stimuli.
Term
Where are apocrine glands found?
Definition
axilla, nipples, anogenital region, eyelids, and external ears
Term
Which glands are responsible for body odor?
Definition
Body odor is created by bacterial composition of apocrine sweat.
Term
What is the function of sebaceous glands?
Definition
secrete sebum to keep hair from drying out
Term
Where are sebaceous glands found?
Definition
associated with hair
Term
What stimulates sebum production?
Definition
hormones, especially testosterone
Term
How is hair formed?
Definition
By epidermal cells that invaginate into the dermal layer
Term
What provides blood supply to the base of a hair follicle?
Definition
the papilla
Term
Name and describe the 2 types of hair found in adults.
Definition
vellus: short, fine, nonpigmented. teriminal: coarse, long, pigmented.
Term
What are the cyclic changes of hair growth?
Definition
anagen (growth), catagen (atrophy), and telogen (rest)
Term
What marks the distal end of the nail matrix?
Definition
the lunula
Term
What is the eponychium?
Definition
the cuticle- it is composed of stratum corneum
Term
What is the paronchium?
Definition
The soft tissue surrounding the nail border.
Term
What is vernix caseosa?
Definition
A mixture of sebum and cornified epidermis that covers the infant at birth.
Term
What is lanugo?
Definition
fine hairs that cover the infant- shed 10-14 days after birth
Term
What sweat glands are functioning in a 1 month old baby?
Definition
eccrine but not apocrine
Term
What happens to the skin and sweat glands of pregnant women?
Definition
They increase in number and function, respectively.
Term
What happens in the sweat glands and skin of older adults?
Definition
They decrease in function, and thickness, respectivley.
Term
What changes are seen in the hair of older adults?
Definition
Terminal scalp hair changes to vellus hair, men's nose and ear hair transitions to terminal hair, and there is an overall loss of trunk and limb hair.
Term
What confers the highest risk for melanoma?
Definition
previous melanoma, changing or atypical nevi, 1st degree relative with melanoma,
Term
What confers increased risk for melanoma?
Definition
more than 50 nondysplastic nevi, nevi greater than 15cm, immune supression, blistering sunburns, pale skin
Term
What are the risk factors for basal and squamous cell carcinoma?
Definition
age 50+, UVA UVB exposure, freckles, blistering sunbuns, repeated irritation, precancerous dermatoses, or exposure to arsenic, creosote, coal tar, petroleum, or radioactivity
Term
Name some medications for hair loss.
Definition
minoxidil, propecia, DHT inhibitors
Term
What are taxanes and anthracyclines?
Definition
chemotherapy drugs
Term
When should sunscreen be applied?
Definition
20 min before exposure as well as 2-3 hours after, and after swimming
Term
What equipment is needed for a skin exam?
Definition
ruler, flashlight, magnifying lens, woods lamp
Term
What provides the best light for color variations?
Definition
daylight
Term
What provides the best light for contour?
Definition
tangential light
Term
What are corns?
Definition
lesions often found on pressure points which are circumscribed, painful, hard, and smooth
Term
Describe a soft corn.
Definition
caused by bone against soft tissue (between 4th and 5th toes)
Term
Describe a hard corn.
Definition
aka callous, caused by bony prominence over weight bearing area, hyperkeratinized and nontender
Term
What races have pigmentary demarcation lines?
Definition
70% of blacks and 11% of whites
Term
Who are predisposed to nevi?
Definition
Caucasians aged 40-50
Term
What are nonpigmented striae?
Definition
stretch marks
Term
What are dysplastic nevi?
Definition
mole with irregular border greater than 5mm usually on the trunk
Term
What distinguishes a melanoma from a nevus?
Definition
border is more irregular, usually greater than 6mm, color variation within lesion
Term
What are the features of a halo nevus?
Definition
depigmented halo around mole
Term
What is the occurrence of a halo nevus?
Definition
back of young adult
Term
Should a halo nevus be removed?
Definition
usually benign but biopsy is indicated
Term
What are the features of a intradermal nevus?
Definition
Dome shaped with peduncles or hairs
Term
What is the occurrence of a intradermal nevus?
Definition
cells of dermis
Term
Should an intradermal nevus be removed?
Definition
no
Term
What are the features of a junction nevus?
Definition
flat or slightly elevated, dark brown
Term
What is the occurrence of a junction nevus?
Definition
nevus cells lining dermoepidermal junction
Term
Should a junction nevus be removed?
Definition
remove if exposed to repeated trauma
Term
What are the features of a compound nevus?
Definition
slightly elevated brownish papule with an indistinct border
Term
What is the occurrence of a compound nevus?
Definition
nevus cells lining dermis and dermoepidermal junction
Term
Should a compound nevus be removed?
Definition
remove if exposed to repeated trauma
Term
What is the occurrence of a hairy nevus?
Definition
may be present at birth or develop later
Term
Should a hairy nevus be removed?
Definition
should be removed if changes occur
Term
What is the color of a normal mole / dysplastic mole?
Definition
uniform tan or brown / mixture of colors
Term
What is the shape of a normal mole / dysplastic mole?
Definition
clear border / irregular border
Term
What is the surface of a normal mole / dysplastic mole?
Definition
smooth flat or raised / smooth, scaly, or pebly
Term
What is the size of a normal mole / dysplastic mole?
Definition
<6mmHg / >6mmHg
Term
What are the numbers of a normal mole / dysplastic mole?
Definition
10-40 / normal or > 100
Term
What is the location of a normal mole / dysplastic mole?
Definition
above waist on sun-exposed surfaces / anywhere but most commonly on back
Term
What is an ecchymoses?
Definition
aka bruise, caused by injury
Term
What is a petichae?
Definition
a discoloration not caused by trauma and < 0.5 cm
Term
What is a purpora
Definition
a discoloration not caused by trauma and > 0.5 cm
Term
What is a telangictasia?
Definition
name given to both capillary spiders and spider angiomas: permanenty dilated small blood vessels
Term
How do you distinguish capillary spiders from spider angiomas?
Definition
capillary spiders: when blanched refill erratically. spider angiomas: when blanched refill unformly from the center outward
Term
What can cause generalized brown skin?
Definition
pituitary, adrenal, or liver disease
Term
What can cause localized brown skin?
Definition
nevis or neurofibromatosis
Term
What can cause white skin?
Definition
albinism or vitiligo
Term
What can cause localized red skin?
Definition
inflammation
Term
What can cause generalized red skin?
Definition
fever, viral exanthem, urticaria, polycythemia
Term
What can cause increased generalized yellow skin?
Definition
liver disease
Term
What can cause increased generalized yellow skin except for sclera?
Definition
hypothyroidism, increased dietary carotene
Term
What can cause blue skin on lips, mouth, and nail beds?
Definition
CV and pulmonary diseases
Term
Give the definition and cause of purpuras.
Definition
red-purple nonblanching discoloration > 0.5cm caused by intravascular defects and infection
Term
Give the definition and cause of petichae.
Definition
red-purple nonblanching discoloration < 0.5cm caused by intravascular defects and infection
Term
Give the definition and cause of ecchymoses.
Definition
red-purple nonblanchng discoloration of variable size caused by vascular wall destruction, trauma, and vasculitis
Term
Give the definition and cause of spider angioma.
Definition
red central body with radiating spider-like legs that blanch with pressure to the central body caused by liver disease or vitamin B deficeincy
Term
Give the definition and cause of venous star.
Definition
bluish spider that does not blanch with pressure caused by increased pressure in superficial veins
Term
Give the definition and cause of telangeictasia.
Definition
Fine, irregular red lines caused by capillary dilation
Term
Give the definition and cause of capillary hemangioma.
Definition
aka nevus flammeus: red irregular macular patches caused by dilation of dermal capillaries
Term
What is the cause of a rotten apple odor?
Definition
clostridium gas gangrene
Term
What is the cause of a mousy odor?
Definition
proteus infection
Term
What is the cause of a grapelike odor?
Definition
pseudomonas infection (esp burns)
Term
What is the cause of a pungent odor?
Definition
schizophrenia
Term
What is the cause of a stale beer odor?
Definition
TB lymphadenitis (scrofula)
Term
What is the cause of a putrid odor?
Definition
anaerobic infection (scurvy)
Term
What is the cause of a feculent odor?
Definition
intestinal obstruction or peritonitis
Term
What is the cause of a mousy or musty odor?
Definition
PKU
Term
Hyperkeratosis, especially of palms and soles, may be a sign of ____.
Definition
arsenic or other toxic exposure
Term
A magnifying glass with the magnifying power of ___ is used to inspect skin lesions?
Definition
5x-10x
Term
Describe and give an example of a macule.
Definition
flat colored area < 1cm / freckles, moles, petechiae, measles, scarlet fever
Term
Describe and give an example of a papule.
Definition
elevated area < 1cm / wart aka verruca, lichen
Term
Describe and give an example of a patch.
Definition
flat, nonpalpable > 1cm / vitiligo, port-wine stains, mongolian spots, cafe-au-lait
Term
Describe and give an example of a plaque.
Definition
elevated area with flat top > 1cm / psoriasis, seborrhea, actinic keratosis
Term
Describe and give an example of a wheal.
Definition
elevated irregular area of cutaneous transitent edema / insect bites, utricaria, allergic reaction
Term
Describe and give an example of a nodule.
Definition
elevated, firm, circumscribed lesion deeper than a papule 1-2cm / erythema nodosum, lipoma
Term
Describe and give an example of a tumor.
Definition
elevated solid lesion > 2cm / neoplasms, benign tumor, lipoma
Term
Describe and give an example of a vesicle.
Definition
Elevated, circumscribed, filled with serous fluid < 1cm / varicella, herpes zoster aka shingles
Term
Describe and give an example of a bulla.
Definition
vesicle > 1cm / blister, pemphigus vulgaris
Term
Describe and give an example of a pustule.
Definition
similar to vesicle but filled with purulent fluid / impetigo, acne
Term
Describe and give an example of a cyst.
Definition
elevated, encapsulated lesion in dermis or subcutaneous layer / sebaceous cyst, cystic acne
Term
Describe and give an example of a telangeictasia.
Definition
fine, irregular red lines produced by capillary dilation / telangectasia in rosacea
Term
Describe and give an example of a scale.
Definition
heaped up keratinized cells, can be dry or oily / seborrheic dermatitis following scarlet fever or drug reaction
Term
Describe and give an example of a lichenification.
Definition
rough, thickened epidermis secondary to mechanical irritation, often on flexor surface / chronic dermatitis
Term
Describe and give an example of a keloid.
Definition
irregular, elevated, progressively-enlarging scar caused by excessive collagen formation during wound healing / keloid formation following surgery
Term
Describe and give an example of a scar.
Definition
fibrous tissue that replaces skin following laceration / healed wound or incisions
Term
Describe and give an example of a excoriation.
Definition
loss of epidermis with a linear or hollowed-out, crusted area / scratch or scabies
Term
Describe and give an example of a fissure.
Definition
linear crack or break / athlete's foot, cracks at the
Term
Describe and give an example of a erosion.
Definition
follows rupture of vesicle or bulla / varicella, variola after rupture
Term
Describe and give an example of a ulcer.
Definition
concave loss of epidermis and dermis- decubiti, stasis ulcers
Term
Describe and give an example of a crust.
Definition
Dried liquid of varied color / scab on abrasion, eczema
Term
Describe and give an example of a atrophy.
Definition
skin thinning / striae or aged skin
Term
What skin lesions are found in regional areas?
Definition
acne vulgaris, herpes zoster, psoriasis
Term
What skin lesions are found in generalized areas?
Definition
utricaria, disseminated drug erruptions
Term
What skin lesions are found in localized areas?
Definition
impetigo, herpes simplex, tinea corporis
Term
What skin lesions are round/ discoid shaped?
Definition
nummular eczema
Term
What skin lesions are oval shaped?
Definition
pitoryiasis rosacea
Term
What skin lesions are annular shaped?
Definition
tinea corporis, sarcoidosis
Term
What skin lesions are zosteriform (following a nerve) shaped?
Definition
herpes zoster
Term
What skin lesions are polycyclic shaped?
Definition
psoriases,utricaria
Term
What skin lesions are linear shaped?
Definition
contact dermatitis
Term
What skin lesions are iris/ target shaped?
Definition
erythema multiform
Term
What skin lesions are stellate shaped?
Definition
meningococcal septicemia
Term
What skin lesions are serpinginous shaped?
Definition
cutatnia larva migrans
Term
What skin lesions are reticulate shaped?
Definition
polyarteriris nodosa, lichen planus lesions of erythema infectiosum
Term
What skin lesions are morbilloform shaped?
Definition
measles, roseola, drug eruptions
Term
What lesions have a discrete border?
Definition
psoriasis
Term
What lesions have an indistinct border?
Definition
nummular eczema
Term
What lesions have a active border?
Definition
tinea eruptions
Term
What lesions have an irregular border?
Definition
malignant melanoma
Term
What lesions have a raised border?
Definition
basal cell carcinoma
Term
What lesions have a advancing border?
Definition
cellulitis
Term
What lesions show central clearing with an erythematous border?
Definition
tinea eruptions
Term
What lesions show desquamaination changes?
Definition
rash of toxic shock syndrome
Term
What lesions show keratinic changes?
Definition
aka hypertrophic stratum corneum, calluses and warts
Term
What lesions show punctuation changes?
Definition
basal cell carcinoma
Term
What lesiosn show telangectasia changes?
Definition
basal cell carcinoma, actinic keratosis
Term
What lesions show black pigmentation?
Definition
malignant melanoma
Term
What lesions show pearly-white pigmentation?
Definition
basal cell carcinoma
Term
What lesions show purple pigmentation?
Definition
purpora, kaposi syndrome
Term
What lesions show violaceous pigmentation?
Definition
erysipelas
Term
What lesions present on sun-exposed areas?
Definition
lupus erythematous, viral exanthem, and porphyria
Term
What lesions present on cloth-covered areas?
Definition
contact dermatitis and milaria
Term
What lesions present on flexor surfaces?
Definition
atopic dermatitis, intertrigo, candidiasis, and tinea cruris
Term
What lesions present on extensor surfaces?
Definition
psoriasis
Term
What lesions present on truncal areas?
Definition
pitoryiasis rosacea (Xmas tree pattern), atopic dermatitis, drug reaction
Term
What lesions present on face, surface, and back areas?
Definition
acne vulgaris, drug-induced acne, Cushing syndrome
Term
Use a broad spectrum sunscreen of SPF ____ or higher.
Definition
SPF 30
Term
The sudden appearance of pigmented white bands in nails may indicate _____.
Definition
melanoma
Term
Proximal subungal fungal nail infection is associated with _____.
Definition
HIV
Term
Diffuse darkening of nails may arise from _____.
Definition
antimalarial drugs, candidal infection, hyperbilirubinemia, or trauma
Term
Green-black nail discoloration is associated with ____.
Definition
pseudomonas infection
Term
Causes of blue nails include ____.
Definition
cyanosis, melanoma, silver poisining, medication, and Wilson disease (Cu metabolism defect)
Term
Longitudinal splinter hemorages in nails may indicate ______.
Definition
endocarditis, vasculitis, and severepsoriasis
Term
Transverse rippling of the nail plate is caused by ____.
Definition
inflammation of chronic paronychia of chronic eczema
Term
After injury of the nail matrix it takes ____ for the nail to resume normal appearance.
Definition
6 months
Term
Depressions occuring in all the nails are usually a response to ____.
Definition
Syphilis, high fever, peripheral vascular disease, or uncontrolled diabetes mellitus
Term
Nail pitting is most commonly seen with ____.
Definition
psoriasis
Term
The nail bed angle should measure _____ degrees.
Definition
160 degrees
Term
In clubbing, the angle of the nail approaches or exceedss ____ degrees.
Definition
180 degrees
Term
Nail clubbing is associated with _____.
Definition
respiratory and CV diseases, cirrhosis, colitis, and thyroid disease
Term
Separation of the nail plate from the bed is common in ____.
Definition
psoriasis, trauma, candidial or pseudomonas infections,
Term
Beau lines are ____.
Definition
transverse nail grooving
Term
Koilonychia is ____.
Definition
upward curving "spoon nail"
Term
Onycholisis is _____.
Definition
asymmetric separation of the nail bed
Term
Paronychia is ____.
Definition
soft tissue infection around a nail
Term
Anonychia is
Definition
absence of a nail
Term
Physiologic jaundice may be present to a mild degree in ____% of infants at birth.
Definition
0.5
Term
What are expected color changes of the newborn?
Definition
acrocyanosis, cutis marmorata, erythema toxicum, mongolian spots, and salmon patches
Term
What is acrocyanosis?
Definition
cyanosis of hands and feet
Term
What is cutis marmorata?
Definition
transient mottling when cold
Term
What is erythema toxicum?
Definition
pink papular rash with vesicles- appears in 1-2 days and dissapears a few days after
Term
What are mongolian spots?
Definition
irregular areas of deep blue pigmentation- seen in non White infants
Term
What are salmon patches?
Definition
aka stork bites, localized pink areas
Term
What are the risk facors for infant hyperbilirubinemia?
Definition
TSB or TcB >75%, other hemolytic disease, premature, breast-fed, Asian, male, discharged within 72 hrs.
Term
Faun tail nevus is associated with ____.
Definition
spina bifida occulta
Term
Epidermal verrucus nevi is associated with ______.
Definition
can be in wither linear or whorled pattern- skeletal, CNS, and occular abnormalities
Term
Cafe au lait macules are associated with ______.
Definition
>5mm: neurofibromatosis, pulmonary stenosis, temporal lobe dysrhythmia, tuberous sclerosis
Term
Freckling in the axillary or inguinal area is associated with ______.
Definition
neurofibromatosis
Term
Ash leaf macule is associated with ______.
Definition
white macules associates with tuberous sclerosis
Term
Facial port wine stain is associated with ______.
Definition
oclurar defects such as glaucoma, angiomatous malformation of meninges such as Sturge-Kalischer-Weber syndrome
Term
Port wine stain of limb or trunk is associated with ______.
Definition
when accompanied with varicosities and soft tissue hypertrophy, associated with orthopedic problems (Klippel-Trenaunay-Weber Syndrome)
Term
Congenital lymphedema without transient hemangiomas is associated with ______.
Definition
gonadal dysgenesis caused by ansence of X chromosome producing XO phenotype (Turner Syndrome)
Term
Supernumary nipples are associated with ______.
Definition
renal abnormalities
Term
Hair collar sign is associated with ______.
Definition
isolated cutaneous anomaly that may involve neural tube defects
Term
What is the study of crease patterns on the palms and soles?
Definition
dermatoglyphics
Term
What is cutis marmorata?
Definition
A newborn's mottled appearance is response to changing temperature.
Term
What is the NIH criteria for diagnosing Neurofibromatosis with Cafe au Lait spots?
Definition
Prepubertal: more than 6 spots >5mm / Postpubertal: more than 6 spots >15mm
Term
What are Milia?
Definition
Whitish papules on the face of a 2-3 month infant
Term
What does tenting of a newborn's abdomen for <2 seconds after pinching indicate?
Definition
<5% loss of body weight dehydration
Term
What does tenting of a newborn's abdomen for 2-3 seconds after pinching indicate?
Definition
5%-8% loss of body weight dehydration
Term
What does tenting of a newborn's abdomen for 3-4 seconds after pinching indicate?
Definition
9%-10% loss of body weight dehydration
Term
What does tenting of a newborn's abdomen for >4 seconds after pinching indicate?
Definition
>10% loss of body weight dehydration
Term
What is chloasma?
Definition
mask of pregnancy
Term
____ after delivery, the mother sheds hair which will regrow in _____.
Definition
2-4 months / 6-12 months
Term
Describe a Stage I Decubitus Ulcer
Definition
Nonblanchable erythema of intact skin
Term
Describe a Stage II Decubitus Ulcer
Definition
Partial-thickness skin loss involving epidermis or dermis
Term
Describe a Stage III Decubitus Ulcer
Definition
Full-thickness skin loss, subcutaneous tissue damaged or necrotic, fascia intact
Term
Describe a Stage IV Decubitus Ulcer
Definition
Extends into bone or muscle
Term
What are acrochordon?
Definition
pedunculated skin tags
Term
What are solar lentigines?
Definition
liver spots
Term
What is trichobezoar?
Definition
An obstructive clump of swallowed hair in the stomach
Term
Describe eczematous dermatitis.
Definition
intercellular edema and epidermal breakdown, with history of allergies.
Term
What is the objective data for the acute, subacute, and chronic stages of eczematous dermatitis, respectively?
Definition
erythematous, prutitic, weeping vesicles / erythema and scaling / thick, lichenified, pruritic plaques
Term
What is the objective data for atopic dermatitis?
Definition
lichenified plaques of childhood: lesions of flexures, nape, and dorsal limbs / of puberty onward: flexures, head and neck
Term
Describe folliculitis.
Definition
Follicular-based pustules. Risk factors include: mechanical irritation, immunosuppression, dermatitis, antibiotics, diabetes mellitus, or EGRF inhibitor meds
Term
What is the objective data for folliculitis?
Definition
pustule 1-2cm
Term
Describe a furuncle.
Definition
aka boil, commonly caused by staphylococcus aureus, acute onset, tender nodule that becomes pustular
Term
Describe cellulitis.
Definition
most cases caused by streptococcus pyogenes or staphylococcus aureus, red hot tender irregular break in skin, may have fever, lymphangitic streaks and regional lymphadenopathy
Term
Describe Tinea.
Definition
Aka dermatophytosis, infection spread by direct contact, organisms survive on dead keratin, may report pruritis.
Term
What is the objective data of tinea?
Definition
Varied, may be papular, pustular, vesicular, erythematous or scaling. Microscopic skin exam with KOH shows hyphae
Term
Describe Pitriasis Rosea.
Definition
Sudden onset of herald patch with eruption 1-3 weeks later, pruritis may be present, erythematous with fine scaling, soles and face usually not involved, truck lesions usually in christmas tree pattern
Term
Describe Psoriasis
Definition
Multifactorial with genetic component marked by increased keratin production with scale, may have pruritis, well-circumscribed, silvery scaling papules and plaqes, commonly on back, buttocks, extensor surfaces, and scalp.
Term
Describe Rosacea.
Definition
Episodes of variable duration over the course of years, never itches but has stinging pain, can be triggered by exposure, emotion, or food / alcohol.
Term
What is the objective data of rosacea?
Definition
Eruptions on forehead, cheeks and nose. Telangectasia, erythema, papules, and pustules on central face. Resembles acne but with no comedones. Rinophyma (nose hypertrophy) possible.
Term
Describe Herples SImplex.
Definition
Type I oral and Type II genital, tenderness, pain, parastheisas, grouped vesicles erupt then crust lasting 2-6 weeks
Term
Describe drug eruptions.
Definition
Immunologically mediated: IgE, cytotoxic, immune complex, cell-mediated hypersensitivity. Non-immunologically mediated: direct release of mast cell mediators. Rash appears from 1-several days after drug, pruritis, discrete of confluent erythematous macules and papules that fade in 1-3weeks
Term
Describe Acnthosis Nigricans.
Definition
Caused by insulin resistence, hyperinsulinism, malignant form results from insulin-like growth activity of TGF-alpha which stimulates keratinocyte proliferation. Youth = benign or inherited, older adult = malignant.
Term
What is the objective data of Acnthosis Nigricans?
Definition
symmetric thickening of the skin on flexural areas such as the armpit, hands or mucosal surfaces may mean malignancy
Term
Describe cutaneous anthrax.
Definition
Biological warfare with gram positive Bacillus anthracis, non-communicable, 12 incubation on previous abrasion, eventual nevrosis with lymphangitis.
Term
Describe smallpox.
Definition
Possible biological warfare with variola virus. Direct transmission by saliva, incubation 7-17 days after exposure, rash on mucosa that spreads, high fever, headache, back ache.
Term
Describe Basal Cell Carcinoma.
Definition
Most common skin cancer. May be nodular, pigmented, cyctic, sclerosing, and superficial, mostly on exposed areas, sores that are crusty and itchy.
Term
What is the objective data of basal cell carcinoma?
Definition
Shiny nodule of varied color, open sore, scar-like with poor borders
Term
Describe Squamous Cell Carcinoma.
Definition
Second most common skin cancer. Malignant tumor of epithelium. Exposed area, persistent sore or lesion, elevated, wart-like, scaly, open sore.
Term
Describe Malignant Melanoma.
Definition
Lethal cancer of melanocytes. Highly migratory, changing mole, family history, use ABCDEs.
Term
Describe Kaposi's Syndrome.
Definition
A neoplasm of the endothelium and epithelium. Caused by Herpes Virus, associated with HIV, peripheral lymphedema, cutaneous lesions soft vascular and purple, usually on skin but can involve mucosa or any organ.
Term
Describe Alopecia Areata.
Definition
Sudden rapid patchy hair loss of round areas with brittle hair. Regrowth begins in 1-3 months.
Term
Describe Paronychia.
Definition
Bacteria between nail fold and plate, acute or chronic, redness tenderness purulent drainage.
Term
Describe Onchomycosis.
Definition
Nail fungus, discomfort, hyperkeratosis and onycholysis (separation). Unlike, psoriasis, there is no pitting.
Term
Describe Subungal hematoma.
Definition
Blood eruption under nail due to trauma.
Term
Describe Leukonychia Punctata.
Definition
White spots due to trauma.
Term
Describe oncholysis.
Definition
Nail separation due to trauma, candida, pseudomonas, allergic contact dermatitis or hyperthyroidism, painless.
Term
Describe Koilonchia.
Definition
Aka spoon nails due to iron deficiency, syphillis, fungus or hyperthyroidism- nail concavity.
Term
Describe Beau Lines.
Definition
Due to coronary occlusion, hypercalcemia, or skin disease. Transverse depressions at bases of lunula that disappear when nails grow.
Term
Describe White Banding on nails.
Definition
aka Terry Nails, associated with cirrhosis, chronic congestive heart failure, adult-onset diabetes mellitus, and age: transverse white bands cover the nail except for a narrow zone at the distal tip.
Term
Describe Psoriasis on nails.
Definition
Chronic and recurrent disease of keratin synthesis marked by pitting, oncholysis, sunungal thickening, yellow scaly debris, splinter hemorrhages.
Term
Describe warts on a nail.
Definition
Aka periungal growths, occur at the nail fold and extend under the nail
Term
Describe digital mucous cysts.
Definition
Result from localized fibroblast proliferation, induce longitudinal nail groove, if found on DIP they are probably caused by herniation of tendon sheaths or joint linings related to ganglion and synovial cysts.
Term
Name 2 skin lesions of pregnant women.
Definition
PUPPP and herpes gestationis.
Term
Describe PUPPP.
Definition
aka Pruritic Utricarial Papules and Plaques of Pregnancy: a benign dermatosis that arises late 3rd trimester. Usually resolves after delivery with no recurrence in future pregnancies, marked intense puritic rash that begins on the abdomen (sparing periumbilicus) spreading to thighs, buttocks, and arms. May have white halo around papules, small vesicles only, not on palms and soles (large or on palms and soles suggests herpes)
Term
Describe herpes gestationis
Definition
aka pemgoid gestationis is an autoimmune disorder of pregnancy, mother can develop skin necrosis and kidney damage. Marked by intense unrelenting puritis, Erythematous utricarial patches and plaques progressing to vesicles and blisters found on periumbilicus, palm and soles.
Term
Describe Seborrheic Dermatitis.
Definition
In infants, chronic recurrent erythematous scaling located in areas of high sebaceous gland concentration such as scalp, back, intertrigenous and diaper areas. Most common in first 3 months of life, parent reports greasy scalp with rash, "cradle cap" is yellow, lesions elsewhere are red.
Term
Describe Miliaria Rubra.
Definition
aka prickly heat, caused by sweat duct occlusion in infants: irregular red macular rash usually on covered areas of skin.
Term
Describe Impetigo.
Definition
Common and contageous, caused by staphlococcal or other type of infection, usually on face, small erythematous macule that changes into a thin vesicle or bulla with honey-colored crust, may have regional lymphadenopathy.
Term
Describe Acne Vulgaris.
Definition
Androgens stimulate excess sebum and keratinization is disrupted by impaction of pilosebaceous canal. Noninflammatory = comedones. Inflammatory = paules or nodules.
Term
Describe Varicella.
Definition
aka chickenpox, caused by VZV (varicella zooster virus?), incubation 2-3 weeks, communicatble via droplets/ airborne, communicable window 2 days before crusting, causes fever headache sore throat malaise, maculopapular becoming vesicular. Can appear everywhere, even buccal mucosa or conjunctiva.
Term
Give possible complications of Varicella.
Definition
Secondary bacterial infection, viral pneumonia, encephalitis, aseptic meningitis, myelitis, Guillian-Barre syndrome, and Reye syndrome
Term
Describe Measles.
Definition
aka Rubeola, a virus of respiratory epithelium that spreads in leukocytes to reticuloendothelial system. Communicable from a few days before fever to 4 days after rash. Preventable by immunization. Characteristic prodromal fever, conjunctivitis, coryza, and bronchitis followed by red bloctchy rash on face that spreads.
Term
What is the objective data of Measles?
Definition
Koplik spots (discrete white macular lesions) on buccal mucosa. Rash lasts 4-7 days. Also causes infection of respiratory tract and CNS.
Term
Describe German Measles.
Definition
aka Rubeola, similar to Measles except it causes fever. Contagious 10 days before to 15 days after rash. Forschheimer spots (reddish spots) on soft palate.
Term
Describe Trichtillomania.
Definition
aka hair pulling. Hair has irregular density and border.
Term
Describe Stasis Dermatitis.
Definition
Caused by venous insufficiency in older adults, occurs on lower legs. Marked by sense of fullness or dull aching on lower legs, gradually increases erythema, itch, or pain. Appears red, scaling, weeping, or ulcerous. May be acute, subacute, chronic, or recurrent.
Term
Describe a lineal relational orientation.
Definition
Group goals are more important than individual goals, roles passed via succession i.e. father to son. Most common in Eastern Asian populations.
Term
Describe a collateral relational orientation.
Definition
Group goals are more important than individual goals, with more emphasis on relationships at one's own level. Most common in Black, Hispanic, and Native American populations.
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