Term
|
Definition
|
|
Term
|
Definition
| Lid margin inflammation, may be infected |
|
|
Term
| What is a Retraction or Spasm? |
|
Definition
| When the muscle in your eye causes the eyelid to pull back. Can be seen above the limbus |
|
|
Term
|
Definition
|
|
Term
|
Definition
| Painless nodule pointing inward, involves a meibomian gland |
|
|
Term
|
Definition
| Inflammation of the lacrimal sac. |
|
|
Term
|
Definition
| lower lid turned outward. |
|
|
Term
|
Definition
| Inward turning of the lid margin. |
|
|
Term
|
Definition
| Cholesterol deposits in the skin near the medial canthus. |
|
|
Term
|
Definition
| Clear mucous membrane that meets cornea at limbus. |
|
|
Term
|
Definition
| yellow elevated nodule on either side of the cornea, common over age 35. |
|
|
Term
Pterygium
What do you do for pinguecula and pterygium? |
|
Definition
triangular thickening growing across the cornea associated with exposure to wind, sun, sand, and dust.
Do upper eyelid eversion as necessary. |
|
|
Term
What is the Sclera?
What are the variations in colors of the Sclera? |
|
Definition
Fibrous, protective outer layer of the eye.
White, Muddy, Yellow (Scleral icterus), and Bluish (a normal variant in children) |
|
|
Term
| What can abnormal bluish color be a sign of? |
|
Definition
|
|
Term
| What are two names for yellowing of the sclerae? |
|
Definition
| Jaundice, and Scleral icterus |
|
|
Term
Reactions to light:
1. Direct response
2. Consensual response |
|
Definition
1. pupillary constiction of stimulated eye
2. constriction of opposite pupil. (must block light between eyes when testing) |
|
|
Term
| How do you test for accommodation/near reaction? |
|
Definition
1. focus on a distant object
2. switch focus to a near object
3. observe for constriction (cannot see accommodation) |
|
|
Term
How do you test convergence?
In what disease does there tend to be poor convergence? |
|
Definition
Move target 5-8 cm from the bridge of the nose
converging eyes normally follow the object to within 5-8 cm of the nose.
Hypothyroidism. |
|
|
Term
Pupil findings:
1. Pinpoint
2. Small and reactive
3. Mid-sized and fixed
4. Mid-sized and reactive |
|
Definition
1. opiates or pontine lesion
2. metabolic encephalopathy
3. midbrain lesion
4. metabolic lesion |
|
|
Term
Unequal pupils:
1. Dilated and unreactive
2. Small and reactive |
|
Definition
1. 3rd palsy, herniation (Central nervous system)
2. Horner's synrome |
|
|
Term
|
Definition
Unequal pupils (this could be a normal variant)
Could be:
1. Horner's syndrome
2. Arygyll-Robertson
3. CN 3/ Occulomotor nerve paralysis
4. Adie's pupil/tonic pupil
5. Blindness
6. Dilated/fixed- due to anticholinergic stimulation
7. Constricted/Fixed due to narcotics |
|
|
Term
|
Definition
| partial ptosis, meiosis(constricted pupil), anhydrosis (loss of hemifacial sweating), enophthalmos. |
|
|
Term
|
Definition
| small, irregular pupil that accommodates but does not react to light. Common causes are CNS syphilis, diabetes mellitus. |
|
|
Term
| Occulomotor nerve paralysis |
|
Definition
| affected pupil is fixed to light and accommodation, often with ptosis and lateral deviation of the eye. |
|
|
Term
|
Definition
| pupil is large, regular and usually unilateral. Slow accommodation causes blurred vision. Cause is impaired parasympathetic nerve supply to the iris. |
|
|
Term
| When does unilateral blindness not cause anisocoria? |
|
Definition
| If sympathetic and parasypathetic innervation to both irises is normal, unilateral blindness does not cause aniscocoria |
|
|
Term
| What is the most common color blindness? |
|
Definition
|
|
Term
1. Exophthalmos
2. Enophthalmos |
|
Definition
1. Bulging, eyeball protrudes forward
2. Sunken |
|
|
Term
how do you test visual acuity of central vision
Explain how the Snellen Eye chart works |
|
Definition
Use the Snellen eye chart. Light it well and position patient 20 feet from the chart. Ask patient to cover eye with a card and have them read the smallest line of print possible.
The first number indicates the distance of patient from the chart, the second is the distance at which a normal eye can read the line of letters. |
|
|
Term
| How do you test the visual fields? |
|
Definition
Screening starts in the temporal field, where most defects occur.
Ask patient to look with both eyes into your eyes.
Place your hands two feet apart, lateral to the patient's ears. Instruct patient to point to our fingers as soon as they are seen.
Repeat this in upper, middle and lower temporal quadrants.
Normal: when patient sees both at the same time. |
|
|
Term
| What do you do if you find a defect in the visual field? |
|
Definition
| Test one eye at a time by having patient cover one eye at a time. |
|
|
Term
|
Definition
| Gross deviation of either eye |
|
|
Term
1. Strabismus
2. Divergent
3. Convergent |
|
Definition
1. Eyes are not properly aligned
2. Eyes turn apart from each other
3. Eyes turn towards each other |
|
|
Term
|
Definition
Slow drift in one direction with a fast correction in the oposite direction.
Test by asking patient to follow your finger with both eyes. Hold your finger briefly in each position at the point where it can be easily seen by both eyes. |
|
|
Term
1. Superior rectus
2. inferior rectus
3. medial rectus
4. Inferior oblique
5. Superior oblique
6. Lateral rectus |
|
Definition
1-4. Oculomotor nerve
5. trochlear nerve CN 4
6. Abducens CN 6 |
|
|
Term
|
Definition
Severe, deep, aching unilateral eye pain.
Optic Disc with ciliary injection, decreased vision, and dilated, fixed pupil.
Ophthalmoscopy reveals cupping of the optic disk |
|
|
Term
|
Definition
| On funduscopic exam, optic disc is pink, hyperemic and appears swollen. Margins are blurred and physiologic cup is not seen. |
|
|
Term
Visual Field Defects
1. Monocular
2. bitemporal
3. homonymous
4. congruous |
|
Definition
1. lesion anterior to optic chiasm (one eye)
2. lesion at optic chiasm
3. Same par of visual field is affected in both yes. This is 4. a lesion behind the optic chiasm (homonymous hemianopsia)
5. lesion behid lateral geniculate bodies (field effects match exactly in both eyes. |
|
|
Term
|
Definition
|
|
Term
| Which cranial nerves are exclusively sensory? |
|
Definition
| 1, 2, and 8. (Olfactory, Optic, Vestibulocochlear) |
|
|
Term
|
Definition
Ask patient to look up and away from you.
bring cotton wool twisted to a point.
Watch both eyes close
Common mistake: conjunctiva is touched instead of cornea.
Failure of either side of the face to contract- V1 lesion
Failure of only one side- V2 lesion
Absent corneal reflex can be an early and objecive sign of sensory trigeminal lesion. |
|
|
Term
| What is homononymous emianopsia? |
|
Definition
| Visual field cut involving the same half of the visual field in each eye |
|
|
Term
| In the pathway used for vision, where is the first snapse after the retina? |
|
Definition
|
|
Term
| Where in the visual pathway would there be a lesion that causes monocular blindness? |
|
Definition
| Ipsilateral eye or optic nerve before it reaches the chiasm (prechiasmatic) |
|
|
Term
| Where in the visual pathway would there be a lesion that causes bitemporal hemianopsia? |
|
Definition
| At the optic chiasm (ex/ pituitary tumor) |
|
|
Term
| Where in the visual pathway would there be a lesion that causes right superior quadrantanopsia? |
|
Definition
| left inferior bank of the calcarine cortex. |
|
|
Term
| Where in the visual pathway would there be a lesion that causes right omonymous hemianopsia? |
|
Definition
| Left hemisphere, both inferior and superior. |
|
|
Term
| What are the techniques to examining? |
|
Definition
Appear competent and confident.
Develope a routine, from head to toe
examine from the right hand side
build repoire with your patient |
|
|
Term
|
Definition
Inspection
Palpation
Percussion
Auscultation |
|
|
Term
| Order of comprehensive physical exam |
|
Definition
general survey
vital signs
skin
HENT
Lymph nodes
neck
Thorax and Lungs
cardiovascular system
breaths
abdomen
musculoskeletal/peripheral vascular
neurological
Back
Gait
Additional exams |
|
|
Term
1. Normal BP range:
2. 3 common causes of interference in BP measurements
3. 3 common causes of abnormal blood pressure? |
|
Definition
1. <120/80
2. Caffeine, Exercise, clothing
3. Arrhythmias- irregular rythms, "white coat hypertension", Obese or very thin patient. |
|
|
Term
1. tachypnea
2. Bradypnea
3. Hyperpnea |
|
Definition
1. Abnormally fast breathing rate.
2. Abnormally slow breathing rate.
3. Deep, rapid breathing |
|
|
Term
1. Cheyne-stokes
2. Biot's or ataxic respiration
3. Kussmaul's respiration |
|
Definition
1. Oscillation between Apnea and Hyperpnea.
2. Completely irregular breathing.
3. Very deep, labored breathing, with decreased amount. |
|
|
Term
| 3 common causes of abnormal respiratory rates? |
|
Definition
|
|
Term
|
Definition
1. Apparent state of health
2. level of consciousness
3. signs of distress
4. body habitus including height and build
5. skin color and obvious lesions
6. dress, grooming, and personal hygiene, odors of body and breath
7. affect, mood, manner, facial expression
posture, gait, and motor activity |
|
|
Term
| How do you approach the ROS |
|
Definition
Start with broad, open ended questons
Try to uncover unrecognized problems related to chief complaint in efficient manner. |
|
|
Term
| What are the general symptoms to ask about during ROS? |
|
Definition
usual weight
weight change
weakness
fatigue
fever
heat/cold intolerance,
malaise/myalgia |
|
|
Term
| What are some causes of weight loss? |
|
Definition
Food intake: anorexia, dysphagia, vomiting, insufficient supplies of food.
Defective absorption of nutrients through GI tract
Increase in metabolic requirements
Increase in loss of nurients through urine, feces,or injured skin. |
|
|
Term
| What are some opening questions for wight loss? |
|
Definition
How often do you check your weight?
How has it changed in the past year?
what was the reason?
What would you like to weigh? |
|
|
Term
| What does weight loss with high food intake mean? |
|
Definition
1. diabetes mellitus, hyperthyroidism or malabsorption
2. malignancy
3. possible medication side effect
4. binge eating with bulemia |
|
|
Term
|
Definition
| relatively non specific complaint, a sense of weariness or loss of energy. consider context of situation. |
|
|
Term
|
Definition
Not synonymous with fatigue.
loss of muscle strength
weakness localized to a neuroanatomic pattern, thus suggesting disorder of the nervous system or muscles
a component of the neurological ROS. |
|
|
Term
|
Definition
Ask patient to clarify what they mean by fever.
have they taken their temp?
Sweating, chills? subjective chills, vs. shaking chills. |
|
|
Term
1. Pyrexia
2. Hyperpyrexia |
|
Definition
1. Elevated temperature.
2. Temp above 41.1 Celcius, or 106 Degrees F. |
|
|
Term
| What do you ask about fevers? |
|
Definition
Focus on timing of illness
be familiar with patterns of diseases
inquire about travel, contacts with sick people, or other exposures
ask about medications. |
|
|
Term
| What is the proper cuff size and placement when taking blood pressure? |
|
Definition
width of inflatable cuff 40 percent of upper arm circumference
length should be 80 percent of upper arm circumference
recalibrate cuff periodically
Patient should avoid smoking or caffeine for 30 minutes before.
Rest for at least 5 minutes
arms free of clothing
Support Patients arm so brachial artery is at heart level. |
|
|
Term
| Meaning of blood pressure sounds? |
|
Definition
first sound- systolic
sound muffled and disappear- diastolic pressure
listen for 10-20 mmHg after last sound, read to nearest 2mmHg. |
|
|
Term
1. What is normal blood pressure?
2. What is prehypertension?
3. What is hypertension stage 1?
4. What is hypertension stage 2? |
|
Definition
1. <120/80
2. 120-139/80-90
3. 140-159/90-99
4. >160/100 |
|
|
Term
| How do you rule out coarctation of the aorta? |
|
Definition
| Take the blood pressure in the arms and legs. If they are close then there is no coarctation. If the leg pressure is lower, then Coarctation of the aorta may exist. |
|
|
Term
| What is orthostatic hypotension? |
|
Definition
| A fall in blood pressure greater than 20 mm Hg between sitting and standing. |
|
|
Term
|
Definition
Use Radial, Carotid, or Brachial artery.
Use pads of index and middle finger, and compress artery until max impulse is felt.
Count rate for 15 seconds then multiply by 4. |
|
|
Term
|
Definition
Regular: fast- >100, Normal- 60-100, Slow- <60
Irregular: regular irregular, irregularly irregular |
|
|
Term
|
Definition
Count while patient is distracted
if rhythm is regular count for 30 seconds x 2
if rhythm is irregular count for whole minute.
Normal range is 14-20 breaths |
|
|
Term
1. Normal oral temp?
2. Rectal temp
3. Tympanic membrane temp with electronic thermometer |
|
Definition
1. 98.6 after 3-5 minutes
2. Higher by 0.7-0.9 degrees (3 minute reading)
3. ? |
|
|
Term
| How to take a skin history? |
|
Definition
* have you noticed any changes in your skin, nails, hair?
* new sores, lumps, bumps, changes in skin color? |
|
|
Term
| History of present Illness (HPI) for Derm |
|
Definition
* location: one lesion or several lesions, where on the body.
* Other symptoms: itching, scaling, crusting, weeping, bleeding, does not heal, odor, changes in size, shape, or color?
* Character: What did it lok lke when it first started? Now? Has it spread? Does it Hurt? Itch? |
|
|
Term
| Palliation/Provacation of Derm symptoms. What questions should you ask? |
|
Definition
* recent skin contat with chemical irritants, changes in topical agents such as lotion or soaps? Medications? Previous diagnosis?
Timing: sudden or gradual?, healing or spreading? Sun exposure?
Environment: When/where does the lesion come out
Severity: Pain, itching, spreading? |
|
|
Term
| Why does everyones skin need to be examined? |
|
Definition
1. 1/3 of US population has a skin disorder requiring medical RX.
2. 8% of outpatient visits are related to dermatological conditions
3. skin cancer is the most common malignancy
4. Cutaneous signs of systemic disease. |
|
|
Term
|
Definition
Subcutaneous
Epidermis
Dermis |
|
|
Term
1. What layer contains sweat glands, hair cells and sebacious glands?
2. Which one contains fat? |
|
Definition
|
|
Term
| What is the difference between eccrine glands and apocrine glands? |
|
Definition
| Both are sweat glands, but eccrine are found all over to regulate temperature, while apocrine glands are found in axillary and genital regions and emit odor during emotional stress. |
|
|
Term
Pigments:
1. Melanin
2. Carotene
3. Oxyhemoglobin
4. Deoxyhemoglobin |
|
Definition
1. Darker pigment (brown)
2. Orangy
3. Red
4. Blue- such as cyanosis. |
|
|
Term
| What skin changes occur with age? |
|
Definition
| wrinkle, lose turgor, vascularity decreases, dryness asteatosis, xerosis), common benign lesions |
|
|
Term
|
Definition
| dry skin or absence of sebum |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
<1cm/ raised and palpable (mole)
Solid lesion |
|
|
Term
|
Definition
|
|
Term
|
Definition
Large >1cm
Solid lesion, palpable (Psoriasis) |
|
|
Term
|
Definition
| Solid lesion >.5 cm, and extends below the plane of skin (epidermal cyst) |
|
|
Term
|
Definition
| Any mass or large nodule. |
|
|
Term
|
Definition
A primary lesion
<1cm
circumscribed elevation with fluid
(chicken pox, small blister) |
|
|
Term
|
Definition
Primary Lesion
Large >1cm
Circumscribed elevation with fluid
(severe sun burn, poison ivy) |
|
|
Term
|
Definition
Primary lesion
Round or flat topped elevation, pale red,
*transient
(hives) |
|
|
Term
|
Definition
Primary Lesion
Circumscribed elevation that contains purulent material. superficial
(folliculitis, acne) |
|
|
Term
|
Definition
| Primary lesion with collection of pus |
|
|
Term
|
Definition
| warm, painful. Folliculitis turns into this. |
|
|
Term
|
Definition
|
|
Term
| What are secondary lesions? |
|
Definition
| curst, scale, lichenification, atrophy, fissure, ulcer, keloid, scar, excoriation |
|
|
Term
|
Definition
Secondary lesion
Loss of superficial epidermis, surface is moist but does not bleed. (skinning your knee) |
|
|
Term
|
Definition
Secondary lesion
Deep loss of tissue surface (epidermis and dermis) |
|
|
Term
|
Definition
Secondary lesion
Linear crack in skin
(such as that caused by athletes foot) |
|
|
Term
|
Definition
secondary lesion
dried residue of serum, pus or blood
(impetigo, scab) |
|
|
Term
|
Definition
Secondary lesion
thing flake of exfoliated dermis
(dandruff, dry skin) |
|
|
Term
|
Definition
Secondary lesion
thickening of the skin and increased visibility of normal skin lines
(Chronic atopic dermatitis) |
|
|
Term
|
Definition
Secondary lesion
Replacement of destroyed tissue with fibrous tissue |
|
|
Term
|
Definition
secondary lesion
Firm, nodular hypertrophic scar tissue that extends beyond the area of injury. |
|
|
Term
|
Definition
Secondary lesion
Superficial linear or punctate marks secondary to scratching |
|
|
Term
|
Definition
Secondary lesion
thin, almost transparent epidermis
(a sign of aging) |
|
|
Term
|
Definition
Secondary lesion
decreased papillary or reticular support that results in a depression.
(stretch mark) |
|
|
Term
| What are the terms for extravagated blood into the skin? |
|
Definition
Petechia: <0.5cm
Purpura:>0.5cm
Ecchymosis: secondary to traums |
|
|
Term
1. comedone: open vs. closed
2. nevus
3. wart/verruca
4. sebaceous syst
5. miliaria |
|
Definition
1. pimple: Open is a black head, closed is a white head
2. mole
3.
4.
5. skin disease marked by small itchy rashes. |
|
|
Term
| Examining the skin: What do you look at? |
|
Definition
| color, moisture, temperature, texture, mobility and turgor, lesions, Nikolsky's sign. |
|
|
Term
|
Definition
| When pinching skin causes a blister. |
|
|
Term
| What do you look at when examining skin lesions? |
|
Definition
type of lesion
location
distribution/configuration
color |
|
|
Term
| Types of grouped lesions? |
|
Definition
| herpetiform, zosteriform, arciform, annular, reticulated, linear, sperpiginous, geographic, imbricated, target, disseminated |
|
|
Term
1. herpetiform
2. zosteriform
3. arciform
4. annular
5. reticulated
6. linear
7. serpiginous
8. geographic
9. imbricated
10. target
11. disseminated |
|
Definition
1. grouped together
2. along a dermatome (shingles)
3.
4. circular formation
5. net-shaped
6. a line
7. snakelike
8. map-like
9. regular arranged overlapping
10. shaped like a target, lighter in the middle
11. scattered discrete lesions or diffuse involvement without identifiable borders. |
|
|
Term
1. Hypomelanosis/hpopigmented
2. erythematous
3. violaceous
4. hypermelanosis/hyperpigmented |
|
Definition
1. white
2. red
3. pink
4. brown |
|
|
Term
| What can cause eczematous skin disorders? |
|
Definition
Dermatitis: Atopic, contact, seborrheic, stasis
Lichen Planus |
|
|
Term
| What can cause papulosquamous? |
|
Definition
* Tinea
* Drug eruptions
* Pityriasis Rosea
* Psoriasis |
|
|
Term
| What can cause Desquamation |
|
Definition
* Steven Johnson's
* Erythema multiforma
* Toxic epidermal necrolysis
* Pemphigus vulgaris |
|
|
Term
| What are Viral Skin disorders? |
|
Definition
| Exanthems, Molluscum Contagiosum, Herpes Simplex, Herpes Varicella/Zoster |
|
|
Term
| What are bacterial skin diseases? |
|
Definition
|
|
Term
|
Definition
Basa Cell Carcinoma
Squamous Cell carcinoma
Melanoma |
|
|
Term
|
Definition
| Hives: Usually classified as a wheal. The lesions are transient within hours. Usually due to allergic reaction. Mostly to drugs. |
|
|
Term
|
Definition
Slow growing, seldom metastasizes
Most common: fair skin, over 40, located on face.
Early characteristics: translucent nodule
Later characteristics: depressed center, firm elevated border, telangiectatic vessels visible. |
|
|
Term
|
Definition
|
|
Term
Squamous cell carcinoma:
Grows quicker than Basal cell
Sun exposed surfaces
Most common in fair skinned people over 60
Characteristics: firm, erythema, face, neck, back, tips of ears, hands |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What are the ABCDEs of moles? |
|
Definition
Asymmetry
Irregular borders
Color changes
Diameter >5mm
Elevation |
|
|
Term
| What do you do when examining the nails |
|
Definition
Look at color, shape, lesions.
Look for:
Clubbing, paronychia, psoriasis, onycomycosis, onychophagia, leukonychia, specific findings associated with acute or sever illness. |
|
|
Term
| Clubbing of fingernails is from? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Inflammation of proximal and lateral nail folds. Multiple nails are often affected |
|
|
Term
|
Definition
| Painless separation of nail plate from nail bed. Usually from fungus. |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
1. Alopecia
2. Alopecia Areata
3. alopecia totalis
4. alopecia universalis |
|
Definition
1. Hair loss
2. Round patches can be genetic or tinea.
3. total air loss (could be from chemo therapy)
4. whole body hair loss |
|
|
