Question | Answer |
Epidermis | -avascular
-inner basal cell layer: forms new cells
-horny cell layer: basal cells migrate up, flatten, become dead kerontized cells
-skin color = brown from melanin, yellow/orange from carotene, and red/purple from vascular bed |
What is the dermis primarily made of? | Collegen: resists tearing
Elastic tissue: allows skin to stretch |
What are the functions of the skin? | protection, prevent penetration, perception, product. of Vit D, absorption/excretion, communication, temp regulation, would repair, identification |
What is the difference between the 2 kinds of sweat glands? | eccrine: open directly on skin and produces sweat
appocrine: produce thick secretions and open on hair follicles, active during puberty |
Sebaceous glands | secretes sebum to lubricate skin and hair and retard H20 loss, everywhere except palms and soles |
Possible causes of pallor? | anemia, high-stress states like anxiety or shock |
Possible causes of Erythema? | polycythemia, venous statis, carbon-monoxide poisoning |
Possible causes of cyanosis? | decreased profusion, hypoxemia, heart failure, chronic bronchitis |
What are some reasons for diaphoresis? | thyrotoxicosis, anxiety, pain |
Lentigines | -"liver spots"
-small flat brown macules that appear after sun exposure
-usually on dorsum of hand and forearm
-not malignant
-normal for aging adult |
Acrochordons | -"skin tags"
-overgrowths of normal skin that are polyp-like & appear in stalks |
Sebaceous hyperplasia | raised yellow papules with central depression, more common in males, commonly on forehead, cheeks, and nose |
Vitiligo | absence of melanin |
What is the difference between primary & secondary lesions? | primary: when lesion develops on previously unaltered skin
secondary: when lesion changes over time or changes due to factors like infection/scratching |
Senile angiomas | -small, smooth slightly raised bright red dot
-can ^ in size and # with age but it's not significant |
What causes purpuic lesions? | -caused by blood leaking out of the capillaries and into the tissues
-(ie: petechiae (tiny round hemorrhages 1-3mm, ecchymosis, purpura (>3mm, extensive, flat patches of petechiae and ecchymosis) |
What is a hemangioma and give examples? | -benign proliferation of blood vessels in the dermis
-ie: port-wine stain: large flat macular patch covering scalp & face
-ie: strawberry mark: immature hemangioma
-ie: cavernous: mature hemangioma, reddish-blue irregularly shaped spongy mass |
Paronychia | inflammation of the nail folds |
Beau's Line | transverse groove across nail occuring from trauma or illness that can temporarily inhibit nail growth |
Splinter Hemorrages | red-brown linear streaks |
Pitting of the Nails | often occurs w/psoriasis |
Late clubbing of the nails | -nail bed angle >180
-can occur w/ congenital cyanotic heart disease, neoplastic or pulmonary disease |
Onycholysis | -slow fungal infection of the nails
-green/thick/crumbly nails |
Folliculitis | -superficial infection of the hair follicles
-"whiteheads" |
Pediculosis Capitis | head lice |
Hirsutism | excessive body hair |
Seborrheic Dermatitis | yellow-white greasy scales w/erythema on scalp and forehead |
Basal Cell Carcinoma | -pearly papule that can become ulcerated
-most common form of skin cancer |
Squamos Cell Carcinoma | -erythemous scaly patches
-less common but grows rapidly |
Trichotillomania | -self-induced hair loss
-can be a sign of personality disorder in adults |
Traumatic Alopecia | -hair loss (along hair line or scattered) due to trauma like hair rollers, braids, tight ponytails |
Pallor in Dark Skin | -brown skin- dull yellow-brown
-black skin- dull, ashen gray
-check areas w/least pigmentation such as conjunctiva & mucus membrane |
Cyanosis in Dark Skin | -darker, dull, lifeless
-check in conjunctiva, oral mucosa, & nail beds |
Erythema in Dark skin | -purplish tinge
-cherry color in nail beds, lips, oral mucosa |
Examples of Secondary Skin Lesions | -crust, scale, fissure, erosion, ulcer, excoriation, scar, keloid, lichenification |
Skin/Hair/Nail Changes in Aging Adult | - epidermis thins
-loss of elastin/collagen/subQ fat/muscle tone = ^ risk for shear
-decrease # of sweat & sebaceous glands
-decrease # of melanocytes-->thin, fine, white hair
-cell replacement & wound healing is slowe |
Mastalgia | breast pain |
Galactarrhea | nipple discharge |
Risk Factors for Breast Cancer | family history, high breast tissue density, obesity, hormonal therapy, having a child later in life (30 yrs+), recent oral contraceptives, never breastfeeding |
Peau d'orange | -lymphatic obstruction producing edema, thickening the skin and exaggerating hair follicles giving a pigskin or orange-peel look
-suggests cancer |
Breast Self Exam | right after the menstrual cycle or the 4th-7th day of her cycle |
Mammograms | -start at age 40
-screening purpose |
How do you palpate the breasts? | -use the pads of your first 3 fingers
-vertical stripe pattern is the recommended way
-also spokes on wheel pattern or concentric circle |
How does a decrease in estrogen & progesterone effect the breast tissue? | -decrease estrogen = loss of firmness
-decrease progesterone = shrinkage |
Incidence of breast cancer among populations | -whites have higher incidence of breast CA than blacks, but mortality rate is higher in black population due to insufficient use of screening measures or lack of access to healthcare |
What are the 3 landmarks of the spine? | -C7 and T1 = base of neck
-T7 and T8 = inferior angle of scapula
-L4 = iliac crest |
Ankylosis | stiffness or fixation of a joint |
Tendinitis | pain worse in the morning, but improves |
Osteoarthritis | pain worse later in the day |
Rheumatoid | pain worse in morning but movement decreases pain |
Action of Temporomandidibular Joint | -hinge = open-close action of jaw
-gliding = protrusion/retraction of jaw and lateral movement |
Tinel Sign | +test = burning/tingling upon percussion of median nerve = carpal tunnel |
Lasegue Test | + sciatic pain = herniated nucleus pulposus |
How do you measure leg length? | between 2 fixed points from anterior iliac spine to medial malleolus |
Epicondylitis | -"tennis elbow"-commonly occurs w/excessive supination & pronation
-pain on lateral epicondyle radiating down forearm |
Phalen Sign | - hold hands back to back w/wrists at 90 degrees
+ test numbness = carpal tunnel |
Thomas Test | -tests the hip
-normally flexion flattens the lumbar spine, but a + test occurs when there is a flexion deformity in opposite hip |
McMurray Test | +click = torn meniscus |
Osgood-Schlatter | painful swelling of the tibial tubercle, during rapid growth, more common in males |
Genu Varum | bowlegs |
Genu Valgum | knock knees |
Swan Neck Abnormality | hyper-extension of proximal interphalangeal & flexion of distal interphalangeal due to rheumatoid |
Boutonniere's Deformity | flexion of proximal interphalangeal w/hyper-extension of distal interphalangeal |
Heberden's Node | bony overgrowths at the distal interphangeal |
Musculoskeletal Changes in Aging Adult | -reabsorption or loss of bone matrix after 40-->osteoporosis
-decreased height due to thinning cartilage between vertebrae
-loss of subQ fat = bony prominences
-fat deposits in abdomen & hips
-Kyphosis: backward head tilt & flexion of hips & knees |
Hallux Valgus | -big toe deviates away
-sign of rheumatoid |
Mechanically, how do rotator cuff lesions occur? | -traumatic adduction while arm was held in abduction
-fall on shoulder
-heaving lifting |
What are the functions of the musculoskeletal system? | -support to stand erect
-movement
-encase & protect organs
-produce RBC
-storage of minerals (Ca+ & phosphorus) |
Contracture | shortening of a muscle leading to limited ROM |
Callus | hypertrophy of epithelium due to prolonged pressure |
Corns | thickening of soft tissue over bony prominences |
Bunions | inflamed bursa at a pressure point |
Where can you feel the temporomandibular joint? | depression anterior to tragus of ear |
Glenohumeral Joint | shoulder |
Location of Prostate | -in front of anterior wall of rectum
-2 cm behind the symphysis pubis
-surrounds the bladder neck and urethra |
What are the effects of decreasing levels of testosterone? | -slower, less intense sexual response
-shorter & less forceful ejaculation
-goes back to flaccidity more quickly |
How do you palpate the testes? | finger and thumb in rolling motion |
Risks of Circumcision | -sepsis
-amputation of distal edge of gland
-chance of urethrocutaneous fistula |
Location of Rectum | right above anus |
Location of Anus | outermost portion |
Contraindications to contraceptive use | -smoking
-DVT
-osteopuritis |
Chadwick's sign | -blue cervix
-2nd month of pregnancy |
Characteristics of a normal uterus | -pair shaped
-tilted forward
-freely movable
-superior to bladder |
Characteristics of normal cervix | -even, pink coloration
-1 inch in diameter
-midline |
Characteristics of a normal prostate | - heart shaped
-2.5-4cm
-smooth surface
-slightly movable
-elastic/rubbery
-non tender |
Iron meds cause what kind of stool? | black & non-tarry |
Steatorrhea | excessive fat in stool caused by malabsorption |
How do you palpate the anus? | -lubricate finger
-ask patient to cough and insert finger at an angle |
What is the average length of menopause? | 10 years |
Gravida | pregnancy |
Para | live births (for twins, it's still only considered 1 birth) |
When do pap smears start? | age 18 or when sexual activity begins
NOT diagnostic, its a SCREENING process |
reasons for red blood in stool | -hemmorrhoids
-anal fissures |
Melena | -black & tarry stools
-sign of GI bleed |
PSA | prostate specific antigen
-white men: 50 years
-black men: 45 years, more likely to be diagnosed at an advanced stage and higher mortality rate |
Definition of infertility | not conceiving of 1 yr of unprotected sex |
Clay-like stool | no bile-->pancreas or liver problem |
Reasons for hypothermia | shock, peripheral arterial insufficiency, Raynaud's |
Reasons for hyperthermia | hyperthyroidism: ^ metabolic rate causing warm, moist skin |
What is turgor and where do you assess for it? | turgor: ability of skin to return to place which reflects its elasticity
where to assess: anterior chest under clavicle |
What can cause "tenting?" | severe dehydration or extreme weight loss |
Where do you assess for edema? | Edema most evident in dependent parts of the body like feet, ankles, and sacral areas, where skin looks puffy and tight |
Differentiate unilateral vs bilateral edema. | unilateral: local or peripheral cause
bilateral: generalized over whole body (anasarca)-consider central problem like heart or kidney failure |
Describe skin texture w/hyperthyroidism and hypothyroidism. | hyperthyroid--> velvet-like
hypothyroid-->rough/dry/flaky |
What is scleroderma? | -"hard skin"
-chronic connective tissue disorder associated w/decreased mobility |
When using the Wood's light, what does a blue-green fluorescence indicate? | fungal infection like tinea capitis |
What does absent or sparse genital hair suggest? | endocrine abnormalities |
Are sudden appearance of brown linear streak across nail normal? | NO! may indicate melanoma |
What is a wheal? | -primary skin lesion that is superficial, raised, transient, and erthematous
-slightly irregular due to edema
-ie: bug bite, allergic reaction |
What is a nodule? | -primary skin lesion that is solid, hard or soft, elevated, and >1cm
-may extend deeper into dermis than a papule
-ie: fibroma, intradermal nevi |
What is a cyst? | -primary skin lesion
-encapsulated fluid-filled cavity in dermis or subQ
-ie: sebaceous cyst |
macule vs papule | -macule: color change that is flat, circumscribed and less than 1 cm (freckle, petechiae)
-papule: something you can feel, caused by superficial thickening of the epidermis (elevated nevus, lichen, wart) |
What is a vesicle? | -primary skin lesion
-elevated cavity containing free fluid, up to 1 cm
-ie: blister |
Excoriation | -secondary skin lesion
-self-inflicted abrasion
-ie: insect bites, scabies, dermatitis |
keloid | -secondary skin lesion
-hypertrophic scar |
What is associated w/Epididymitis? | -swelling of the epididymis that causes sudden severe pain, red, and enlarged scrotum
-enlarged, reddened scrotum |
Varicocele | -abnormality of scrotum that feel like *"a bag of worms" |
Spermatocele | -abnormality of the scrotum that when palpated it feels like a round, freely movable mass lying above or behind testis...and if large enough can feel like a third testis |
Orchitis | -swelling of 1 testis
-S&S: acute moderate pain, swollen testis, feeling of weight, fever, reddened area |
Scrotal hernia | -non-tender swelling of the scrotum
-signs: swelling, may have pain w/straining
-observation: doesn't transilluminate
-Palpate: soft, mushy mass |
What are hemorrhoids? | -painless, flabby papules due to varicose vein
-result from increased portal venous pressure as it occurs with straining at stool, chronic constipation, pregnancy, obesity, chronic liver disease, and low-fiber diets |
Fecal Impaction | collection of hard, desiccated feces in the rectum due to decreased bowel motility whereby more H20 is removed from the stool |
rectal carcinoma | -asymptomatic
-1/5 are malignant |
What are some signs and observations of BPH? | S: urinary frequency, urgency, hesitancy, straining to urinate, weak stream
O: symmetric non-tender enlargement, prostate feels smooth, rubbery, or firm, with median sulcus obliterated |
What are some signs and observations of Prostatitis? | S: fever, chills, malaise, urinary frequency, urgency, dysuria
O: w/acute inflammation = asymmetric enlargement , w/chronic inflammation = tender enlargement w/boggy feel to isolated firm areas to normal feeling |
When should you start and how often should you have a pap smear/cervical screening? | -begin within 3 years of first having sex or at age 21
-continue annually until age 30 and if you have 3 consecutive normal paps, then you can be screened every 2-3 years |
What is urge incontinence? | involuntary urine loss from overactive detrusor muscle in the bladder |
What is stress incontinence? | involuntary urine loss w/physical strain like sneezing, coughing, laughing, etc |
Vellus hair vs terminal hair | -vellus: fine hair that covers most of body
-terminal: thicker & darker, on scalp, eyebrows, axilla, pubic area |
Tinea pedis | athlete's foot |
Tinea corporis | ringworm |