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Medical Screening

Pathology branch of medicine that investigates disease
Clinical Pathology pathology applied to solution of clinical problems, esp. use of lab methods in clinical diagnosis
Pathogenesis development of unhealthy conditions or disease, esp. cellular events
Dynamic process that varies with changes in interactions between person and environment
Continuum between wellness & illness; absence of disease; reflect biological, psychological, spiritual and sociologic state
Illness sickness or deviation from a healthy state; a perception or response to not being well
Disease biomedical condition that results from a malfunction of an organ or body system (can occur w/o person being aware) (pathogical)
Types of Illness Acute, Subacute & Chronic
Acute rapid onset short duration usually responds to specific tx self limiting usually return to full function
Subacute time course between acute & chronic less of a "sick" role than acute
Chronic fluctuate in intensity have aspects of permanent impairment or disability requires LT medical management
Disability the condition of being unable to perform as a consequence of physical or mental unfitness
Disability Models NAGI: sequence of "domino" events ICF: (International Classification of Functioning)
NAGI Disease/pathology Impairment Functional limits Disability
ICF (International Classification of Functioning) Describes how someone lives with and functions with their disability Components: body function/ structure; activities/ participation; environmental factors, personal factors
Cognitive Deficits decreased executive functions poor problem solving slow info processing memory deficits learning disabilities
Psych Issues denial noncompliance anxiety/stress panic disorder depression (chronic pain & geriatrics) Symptom magnification Syndrome:(matheson) Conversion hysteria (hysterical paralysis)
Integument composed of skin and its associated tissues; sweat glands, sebaceous glands, hair, and nails
Skin function serves as a barrier, prevents desiccation (drying out), regulates body temperature (thermoregulation), site of excretion, production of Vit. D, and serves as a sensory organ
Epidermis derived outer layer composed of keratinized stratified squamous epithelium
Dermis layer of dense irregular collagenous connective tissue that underlies and interdigitates with the epidermis
Hypodermis loose connective tissue containing varying amounts of adipose that underlies and supports the skin; it is the superficial fascia that covers the entire body
What are you assessing when you are looking at the skin? texture, turgor, temperature, transillumination, mobility, color, consistency, circulation, hair growth and sensation
What are you assessing when you are looking at the hand? palmar erythema (liver), tremor (liver flap), pallor of palmar creases (anemia, malabsorption), palmar xanthomas (hyperlipidemia, diabetes), turgor (dehydration) and edema
What are the structures of the nail? bed-highly vascularized plate cuticle-seals and protects space b/w proximal fold and plate
What are you assessing when you are looking at the nails? color, clubbing, nicotine stains, Leukonychia "white spots or bands," Koilonychia "spoon nails," Beau's lines, Onycholysis, Pitting, and Thinning/thickening
What do you look for when examining of mass/lesion? Follow-up questions? A-Asymetry B-Border C-Color D-Diameter Questions: How long have you had? Has it changed recently? Does it itch, burn or feel sore?
What are the causes of skin lesions? contact with agent, contact with infective organism, medication rxn, trauma, heredity, allergies, radiotherapy rxn, systemic origin, burns and neoplasm
Systems Review Questions: skin, hair and nails 1. Skin problems past 2 months? 2. Skin lumps or bumps (tumors/nodules) 3. Excessive sweating 4. Excessive itching? 5. Changes in hair? 6. Changes in nails? 7. Skin rashes, sores? 8. Any changes in moles? 9. Any other present skin problems?
What is Screening? a method for detecting disease or body dysfunction before an individual would normally seek medical attention
Why we need to Screen? medication side effects multiple comorbidities esp. with age visceral referral patterns/ pan mechainsms
What are the components of PT management? examination, evaluation, diagnosis, prognosis, intervention
What is Differential Diagnosis? determination of which of two or more disease with similar symptoms is the one from which the patient is suffering, by a systematic comparison and contrasting of the clinical finding.
What are the keys for decision making in screening? PMH (Past Medical History) Risk factor Assessment Clinical Presentation Assoc. Signs/Symptoms of Systemic Disease Review of Systems
Signs observable findings: skin color, clubbing, edema
Symptoms reported indications of disease or dysfunction which are not observable
What are the division of red flags? Past medical history Risk Factors Clinical Presentation Pain Pattern Assoc. Signs/Symptoms
What is Constitutional Sx? collection of signs and sx present when there is a systemic illness
What are the Constitutional Sx? fever, sweats, vomiting, pallor, fatigue, diaphoresis, nausea, diarrhea. dizziness or syncope, and weight loss
PT Role in Prevention Primary, Secondary & Tertiary Prevention and Health Promotion
Primary prevention stopping disease or condition development through education, rush factor reduction and general health promotion
Secondary prevention early detection of disease or illness limiting duration or severity
Tertiary prevention provision of ways to limit disability and improve function even with chronic disease
Health Promotion education and support to help patients/ clients make choices to promote health
Macule (circumscribed, flat, non palpable changes in skin color) small spot; EG freckle, petechia
Patch (circumscribed, flat, non palpable changes in skin color) larger than macule. EG vitiligo
Papule (palpable elevated solid masses) up to 0.5cm EG elevated nevus
Primary Lesions may arise from previously normal skin
Nodule (palpable elevated solid masses) larger than 0.5cm;up to 2cm. Often deeper and firmer than a papule
Plaque (palpable elevated solid masses) flat, elevated surface > 0.5cm. Often formed by coalescence of papules; nodule with rough surface.
Tumor (palpable elevated solid masses) large nodule; >2.0cm
Wheal (palpable elevated solid masses) somewhat irregular, relatively transient superficial area of localized skin edema. EG mosquito bite, hive.
Vesicle (circumscribed superficial elevations of skin formed by free fluid in a cavity w/n skin layers) up to 0.5cm filled with serous fluid. EG herpes simplex
Bulla (circumscribed superficial elevations of skin formed by free fluid in a cavity w/n skin layers) greater than 0.5cm filled with serous fluid. EG 2nd degree burn.
Pustule (circumscribed superficial elevations of skin formed by free fluid in a cavity w/n skin layers) filled with pus. EG acne, impetigo
Secondary Lesions result from changes in primary lesions
Erosion (loss of skin surface) loss of superficial epidermis; surface is moist but does not bleed. EG moist area after rupture of vesicle, as in chicken pox.
Ulcer (loss of skin surface) deeper loss of skin surface; may bleed and scar. EG stasis ulcer of venous in sufficiency; syphilitic chancre
Fissure (loss of skin surface) linear crack in the skin EG athlete's foot
Crust (material on the skin surface) dried residue of serum, pus, or blood EG impetigo
Scale (material on the skin surface) a thin flake of exfoliated epidermis EG dandruff, dry skin, psoriasis
Lichenification (miscellaneous lesions) thickening and roughening of the skin with increased visibility of normal skin furrows; EG atopic dermatitis
Atrophy (miscellaneous lesions) thinning of skin with loss of the normal skin. Skin looks shinier and more translucent than normal. EG arterial insufficiency
Excoriation (miscellaneous lesions) an abrasion or scratch mark. May be linear or rounded, as in a scratched insect bite
Scar (miscellaneous lesions) replacement of destroyed tissue by fibrous tissue. May be thick and pink (hypertrophic) or thin and white (atrophic). Does not extend beyond the injured area.
Nevus (miscellaneous lesions) mole-flat to slightly elevated, round, evenly pigmented lesion
Comedo (miscellaneous lesions) blackhead-marks plugged opening of sebaceous gland; hallmark of area
Telangiectasias dilated small vessels that look either red or bluish. Occur alone, or as parts of other lesions such as a basal cell carcinoma or radiodermatitis
Spider Angioma (vascular lesion of skin) liver disease, pregnancy, Vit B deficiency, normal in some
Spider Vein (vascular lesion of skin) often with increased pressure in superficial veins, as in varicose veins
Hemangioma or Cherry Angioma (vascular lesion of skin) normal with aging; not uncommon in newborns
Petechia (1-3mm)/Purpura (larger) (Purpuric lesions of skin) deep red or reddish purple; fade over time. possible bleeding disorder
Ecchymosis (purpuric lesions of skin) (bruise) purple or purplish bluse; fades to green, yellow, and brown with time. Often due to trauma; seen in bleeding disorders.
Basal Cell Carcinoma (skin tumors) malignant; slow growing, fair skinned > 40; face
Squamous Cell Carcinoma (skin tumors) sun exposed face or back of hand of fair skinned, >60
Malignant Melanoma (skin tumors) chance in mole: highly malignant; fair-skinned. Signs are asymmetry, irregular border, diameter >6mm, and elevated irregular surface.
Kaposi's Sarcoma in AIDS (skin tumors) malignant tumor; anywhere on body; many forms
Actinic Keratosis (skin tumors) superficial flattened papules covered by dry scale. Pink, tan or gray color on sun exposed skin of older, fair-skinned persons. Benign, but may give rise to squamous cell carcinoma. Typically found on face and hands
Seborrheic Keratosis (skin tumors) Common-bengin yellow to brown, raised lesions that feel slightly greasy and velvety or warty. Found on trunk of older people, or face and elsewhere. May be found in young black people, esp. women on cheeks and temples.
Clubbing (lesions of nails) distal phalanx of each finger is rounded and bulbous; nail plate is more convex. Proximal nail fold is spongy or floating upon palpation. Cause are many, including chronic hypoxia and lung cancer
Paronychia (lesions of nails) inflammation of the proximal and lateral nail folds. Acute or chronic, due to frequent immersion in water.
What are the signs/sx of skin disease? pruritus-itching urticaria-hives rash-eruption on skin blisters-fluid filled, elevated lesions Xeroderma-excessive dryness where skin is rough &discolored Edema Change in Pigmentation, Turgor, Texture
What might cause pruritus? candidias, DM, drug sensitivity, hyperthyroidism, intestinal parasites, anemia, kidney disease, leukemia, lymphomas, renal, liver disease, and tumor
What are the functional impact of aging on Skin? Altered permeability, decrease inflame response, decreased immune response, increase sensitivity to sun, impaired wound healing, decreased sweating, impaired sensation, increased pain threshold, hair loss and change in color
Pressure Ulcers wound/tissue destruction created by pressure
Eczema (Skin Disorder) "Dermatitis" superficial inflammation caused by irritant exposure, allergic sensitization, or genetic idiopathic factors
Contact Dermatitis (Skin Disorder) acute or chronic inflammation caused by exposure to chemical, mechanical, physical and biological agents; most common skin disease
Rosacea (Skin Disorder) chronic facial disorder; associated with H pylori bacteria; linked with migraines
Impetigo (Skin infection) superficial infection caused by staph or strep bacteria; most common > 5 yrs. and older adults
Cellulitis (Skin Infection) rapidly spreading acute inflammation with infection of skin and subcutaneous tissue
Herpes Zoster (Skin infection) "shingles" local disease caused by varicella zoster virus (same as viruses for systemic chicken pox); peak incidence 50-70 yrs. old; triggered by stress or immunocompromised state
Warts (Verrucae) (Skin Infection) Benign viral infection by HPVs; incidence highest in kids and young adults; transmit: direct contact
Ringworm (Tinea Corporis) (Skin Infection) Fungal infection; skin, hair, nails; ring shaped pigmented patches covered with vesicles or scales; transmission: contact; Tx: topical agent with oral meds; no association with worms
Athlete's Foot (Tinea Pedis) (Skin Infection) Fungal infection in between toes; Tx: anti fungal powder/cream
Scabies (Skin Infection) parasitic infection caused by mites; transmitted by direct contact with skin or contaminated objects; Tx: scabicide cream; occasional use of one dose invermectin
Pediculosis (Skin Infection) Lice; reside primarily in head, body hair, genitalia; transmission by direct contact with person or contaminated object; Tx: shampoo/soap
Nevi (Moles) (Skin Tumors-Benign) pigmented or nonpigmented lesions; symetrical edges; appearance: black, brown, flesh colored, on any part of skin, vary size/ thickness
Seborrheic Keratosis (Skin Tumor-benign) hereditary; usually occur after middle age; present as multiple lesions on face, back, chest; Appearance: waxy, smooth, raised, vary in color; Tx: Cryotherapy
Actinic Kerotosis (Skin Tumor-benign) Rxn to LT sun exposure; Appearance: well defined, crusty, sand paper; on sun exposed areas, usually in caucasian pop, can convert to squamous cell carcinoma ; Tx: topical agent, exposure to blue light, cryotherapy
Basal Cell Carcinoma (Skin Tumors-Malignant) Slow growing surface epithelial cell skin tumor; rarely mets; does not invade blood, lymph, significant local destruction, Risk: caucasian, sun exposure, outdoor occupation, can reoccur; Tx: Mohs' surgery, irradiation
Squamos Cell Carcinoma (Skin Tumor-Malignant) Second most common skin cancer; usually occurs in sun exposed areas, can become invasive, incidence greater > 60 yrs & men > women
Malignant Melanoma (Skin Tumor-Malignant) Neoplasm of skin from melanocytes; can occur anywhere on body; 70% from existing nevi; Tx: surgical excision with chemo radiation if there is spread to lymph
Kaposi's Sarcoma (Skin Tumor-Malignant) Malignancy of vascular tissue that presents as skin disorder; Tx: antiviral agents for AIDS KS; chemo
Psoriasis( Skin Disorder Assoc. with Immune Dysfunction) Chronic, inherited, recurrent; well defined, erythematous plaques covered with silvery scales; Tx: topical prep, phototherapy, immunosuppressants
Lupus (Skin Disorder Assoc. with Immune Dysfunction) chronic inflammatory disorder of connective tissue; Forms: cutaneous-skin & SLE-organs involved; Auto immune defect; Tx: topical prep
Created by: vbchicaq12
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