Medical Screening
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| Pathology | branch of medicine that investigates disease
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| Clinical Pathology | pathology applied to solution of clinical problems, esp. use of lab methods in clinical diagnosis
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| Pathogenesis | development of unhealthy conditions or disease, esp. cellular events
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| Dynamic | process that varies with changes in interactions between person and environment
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| Continuum | between wellness & illness; absence of disease; reflect biological, psychological, spiritual and sociologic state
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| Illness | sickness or deviation from a healthy state; a perception or response to not being well
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| Disease | biomedical condition that results from a malfunction of an organ or body system (can occur w/o person being aware) (pathogical)
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| Types of Illness | Acute, Subacute & Chronic
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| Acute | rapid onset
short duration
usually responds to specific tx
self limiting
usually return to full function
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| Subacute | time course between acute & chronic
less of a "sick" role than acute
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| Chronic | fluctuate in intensity
have aspects of permanent impairment or disability
requires LT medical management
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| Disability | the condition of being unable to perform as a consequence of physical or mental unfitness
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| Disability Models | NAGI: sequence of "domino" events
ICF: (International Classification of Functioning)
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| NAGI | Disease/pathology
Impairment
Functional limits
Disability
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| 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
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| Cognitive Deficits | decreased executive functions
poor problem solving
slow info processing
memory deficits
learning disabilities
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| Psych Issues | denial
noncompliance
anxiety/stress
panic disorder
depression (chronic pain & geriatrics)
Symptom magnification Syndrome:(matheson)
Conversion hysteria (hysterical paralysis)
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| Integument | composed of skin and its associated tissues; sweat glands, sebaceous glands, hair, and nails
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| 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
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| Epidermis | derived outer layer composed of keratinized stratified squamous epithelium
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| Dermis | layer of dense irregular collagenous connective tissue that underlies and interdigitates with the epidermis
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| 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
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| What are you assessing when you are looking at the skin? | texture, turgor, temperature, transillumination, mobility, color, consistency, circulation, hair growth and sensation
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| 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
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| What are the structures of the nail? | bed-highly vascularized
plate
cuticle-seals and protects space b/w proximal fold and plate
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| 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
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| 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?
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| 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
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| 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?
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| What is Screening? | a method for detecting disease or body dysfunction before an individual would normally seek medical attention
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| Why we need to Screen? | medication side effects
multiple comorbidities esp. with age
visceral referral patterns/ pan mechainsms
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| What are the components of PT management? | examination, evaluation, diagnosis, prognosis, intervention
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| 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.
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| 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
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| Signs | observable findings: skin color, clubbing, edema
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| Symptoms | reported indications of disease or dysfunction which are not observable
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| What are the division of red flags? | Past medical history
Risk Factors
Clinical Presentation
Pain Pattern Assoc. Signs/Symptoms
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| What is Constitutional Sx? | collection of signs and sx present when there is a systemic illness
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| What are the Constitutional Sx? | fever, sweats, vomiting, pallor, fatigue, diaphoresis, nausea, diarrhea. dizziness or syncope, and weight loss
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| PT Role in Prevention | Primary, Secondary & Tertiary Prevention and Health Promotion
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| Primary prevention | stopping disease or condition development through education, rush factor reduction and general health promotion
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| Secondary prevention | early detection of disease or illness limiting duration or severity
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| Tertiary prevention | provision of ways to limit disability and improve function even with chronic disease
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| Health Promotion | education and support to help patients/ clients make choices to promote health
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| Macule (circumscribed, flat, non palpable changes in skin color) | small spot; EG freckle, petechia
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| Patch (circumscribed, flat, non palpable changes in skin color) | larger than macule. EG vitiligo
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| Papule (palpable elevated solid masses) | up to 0.5cm EG elevated nevus
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| Primary Lesions | may arise from previously normal skin
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| Nodule (palpable elevated solid masses) | larger than 0.5cm;up to 2cm. Often deeper and firmer than a papule
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| Plaque (palpable elevated solid masses) | flat, elevated surface > 0.5cm. Often formed by coalescence of papules; nodule with rough surface.
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| Tumor (palpable elevated solid masses) | large nodule; >2.0cm
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| Wheal (palpable elevated solid masses) | somewhat irregular, relatively transient superficial area of localized skin edema. EG mosquito bite, hive.
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| 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
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| 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.
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| Pustule (circumscribed superficial elevations of skin formed by free fluid in a cavity w/n skin layers) | filled with pus. EG acne, impetigo
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| Secondary Lesions | result from changes in primary lesions
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| 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.
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| Ulcer (loss of skin surface) | deeper loss of skin surface; may bleed and scar. EG stasis ulcer of venous in sufficiency; syphilitic chancre
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| Fissure (loss of skin surface) | linear crack in the skin EG athlete's foot
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| Crust (material on the skin surface) | dried residue of serum, pus, or blood EG impetigo
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| Scale (material on the skin surface) | a thin flake of exfoliated epidermis EG dandruff, dry skin, psoriasis
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| Lichenification (miscellaneous lesions) | thickening and roughening of the skin with increased visibility of normal skin furrows; EG atopic dermatitis
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| Atrophy (miscellaneous lesions) | thinning of skin with loss of the normal skin. Skin looks shinier and more translucent than normal. EG arterial insufficiency
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| Excoriation (miscellaneous lesions) | an abrasion or scratch mark. May be linear or rounded, as in a scratched insect bite
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| 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.
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| Nevus (miscellaneous lesions) | mole-flat to slightly elevated, round, evenly pigmented lesion
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| Comedo (miscellaneous lesions) | blackhead-marks plugged opening of sebaceous gland; hallmark of area
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| 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
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| Spider Angioma (vascular lesion of skin) | liver disease, pregnancy, Vit B deficiency, normal in some
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| Spider Vein (vascular lesion of skin) | often with increased pressure in superficial veins, as in varicose veins
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| Hemangioma or Cherry Angioma (vascular lesion of skin) | normal with aging; not uncommon in newborns
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| Petechia (1-3mm)/Purpura (larger) (Purpuric lesions of skin) | deep red or reddish purple; fade over time. possible bleeding disorder
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| 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.
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| Basal Cell Carcinoma (skin tumors) | malignant; slow growing, fair skinned > 40; face
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| Squamous Cell Carcinoma (skin tumors) | sun exposed face or back of hand of fair skinned, >60
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| Malignant Melanoma (skin tumors) | chance in mole: highly malignant; fair-skinned. Signs are asymmetry, irregular border, diameter >6mm, and elevated irregular surface.
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| Kaposi's Sarcoma in AIDS (skin tumors) | malignant tumor; anywhere on body; many forms
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| 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
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| 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.
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| 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
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| Paronychia (lesions of nails) | inflammation of the proximal and lateral nail folds. Acute or chronic, due to frequent immersion in water.
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| 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
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| What might cause pruritus? | candidias, DM, drug sensitivity, hyperthyroidism, intestinal parasites, anemia, kidney disease, leukemia, lymphomas, renal, liver disease, and tumor
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| 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
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| Pressure Ulcers | wound/tissue destruction created by pressure
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| Eczema (Skin Disorder) | "Dermatitis" superficial inflammation caused by irritant exposure, allergic sensitization, or genetic idiopathic factors
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| Contact Dermatitis (Skin Disorder) | acute or chronic inflammation caused by exposure to chemical, mechanical, physical and biological agents; most common skin disease
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| Rosacea (Skin Disorder) | chronic facial disorder; associated with H pylori bacteria; linked with migraines
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| Impetigo (Skin infection) | superficial infection caused by staph or strep bacteria; most common > 5 yrs. and older adults
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| Cellulitis (Skin Infection) | rapidly spreading acute inflammation with infection of skin and subcutaneous tissue
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| 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
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| Warts (Verrucae) (Skin Infection) | Benign viral infection by HPVs; incidence highest in kids and young adults; transmit: direct contact
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| 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
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| Athlete's Foot (Tinea Pedis) (Skin Infection) | Fungal infection in between toes; Tx: anti fungal powder/cream
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| 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
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| Pediculosis (Skin Infection) | Lice; reside primarily in head, body hair, genitalia; transmission by direct contact with person or contaminated object; Tx: shampoo/soap
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| Nevi (Moles) (Skin Tumors-Benign) | pigmented or nonpigmented lesions; symetrical edges; appearance: black, brown, flesh colored, on any part of skin, vary size/ thickness
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| 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
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| 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
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| 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
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| 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
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| 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
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| Kaposi's Sarcoma (Skin Tumor-Malignant) | Malignancy of vascular tissue that presents as skin disorder; Tx: antiviral agents for AIDS KS; chemo
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| Psoriasis( Skin Disorder Assoc. with Immune Dysfunction) | Chronic, inherited, recurrent; well defined, erythematous plaques covered with silvery scales; Tx: topical prep, phototherapy, immunosuppressants
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| 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
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