Exam 2 Flashcards
(86 cards)
1
Q
Normal BP
A
- systolic <120
- diastolic <80
2
Q
Prehypertension
A
- systolic: 120-139
- diastolic: 80-89
3
Q
Stage 1 HTN 18-60yrs
A
- systolic: 140-159
- diastolic: 90-99
4
Q
Stage 1 HTN over 60yr
A
- systolic: 150-159
- diastolic: 90-99
5
Q
Stage 2 HTN
A
- systolic: >160
- diastolic: >100
6
Q
Temp range
A
100 F = 37.7 C
102 F = 38.8 C
7
Q
BMI
A
<17 underweight
>25 overweight
>30 obese
8
Q
Ephelides
A
- freckle
- caused by over production of melanin not menalocytes
9
Q
Nevi
A
-mole/birthmark
10
Q
Junctional nevi
A
- brown macules in epidermis
- flat
11
Q
Compound nevi
A
- brown macules in epidermis and dermis
- slightly elevated
12
Q
Intradermal nevi
A
- skin colored papules in dermis
- dome shaped
13
Q
Risk factors of Melanoma
A
- HARMM: hx of melanoma, age over 50, regular dermatologist absent, mole changing, male
- red/light hair
- solar lentigines
- freckles
- UV radiation
- tanning booths
- severe blistering sunburns
- immunosuppression
- family tx of melanoma
14
Q
Derm physical exam while seated
A
- hair and scalp
- face and neck
- arms and hands
- nails and nail beds
- back
15
Q
Derm physical exam while laying flat
A
- chest
- abdomen
- lower extremities
16
Q
Derm physical exam in left lateral position
A
- back
- gluteal cleft
- perianal area
17
Q
Physical exam skin
A
- color
- moisture
- temperature
- texture
- mobility and turgor
- lesions
18
Q
Physical exam nails
A
- color
- shape
- separation
- lesions
- clubbing
19
Q
Physical exam hair
A
- quantity
- distribution
- texture
20
Q
Abnormal findings color
A
- systemic: redness, cyanosis, jaundice, pallor
- skin: erythema, pigmentation
21
Q
Abnormal findings moisture
A
- dryness
- diaphoresis
- sweating
- oiliness
22
Q
Abnormal findings temperature
A
- fever
- cellulitis
- cooler temp
23
Q
Abnormal finding texture
A
- systemic illness
- rashes: rough and smooth
24
Q
Abnormal findings mobility/turger
A
- mobility: edema and scleroderma
- turger: dehydration
25
Physical exam lesisons
- look
- location and distribution
- arrangement
- type
- color
26
Primary lesions
- macule ... patch
- papule .. plaque .. nodule .. wheal
- vesicle ... bulla
- pustule
27
Secondary lesions
- loss of skin surface: erosion, ulcer, fissure
| - material on skin surface: crust and scale
28
Macule
- circumscribed area of change of skin color
- no elevation or depression
- not palpable
- well or ill defined
- any size or color
29
Patch
- barely elevated plaque
- fits between macule and plaque
- large macule
30
Papule
- superficial
- elevated
- solid lesion
- <0.5 cm in diameter
- palpable
31
Nodule
- palpable
- solid
- round or elliptical lesion
- larger than papule
- > 0.6 cm
32
Tumor
-large nodule
33
Plaque
- plateau like elevation
- relatively large surface area in comparison to height above skin
- well defined
- >0.5 cm
34
Wheal
-rounded or flat topped pale red papule or plaque
35
Vesicle
- <0.5 cm
- circumscribed
- elevated
- containing fluid
- dome shaped
- umbliciated
- flaccid
36
Bulla
- large vesicle
- > 0.6 cm
- circumscribed
- elevated
- containing fluid
37
Pustule
- circumscribed
- superficial cavity of skin
- purulent exudate: white, yellow, greenish, hemmorahgic
38
Erosion
- loss of epidermis
- no scarring
- sharply defined
- red
- oozes
39
Ulcer
- loss of epidermis into dermis
| - scaring
40
Fissure
-deep skin split
41
Exocriation
-liner skin erosion from scratching
42
Atrophy
- skin thinning
| - all skin layers
43
Sclerosis
-stiffening or hardening of skin
44
Scaling
-scales or flakes of stratum corneum still attached to surface
45
Crusting
scab
46
Comdeo
- open (blackhead)
- closed (whitehead)
- acne
47
Cyst
- cavity containing liquid, solid, or semisolid material
| - spherical, dome-shaped papule or nodule
48
Abscess
pus in cavity
49
Furuncule
- boil
| - infection of follicle and surrounding tissue
50
Carbuncle
-groups of hair involved
51
Milia
- tiny white bumps/cysts filled with keratin
| - eyes, nose, baby acne
52
Petechiae
- minor hemorrhage
| - small red/purple dot
53
Purpura
- 3mm to 1cm
| - no blanching
54
Echymosis
- bruise/hematoma
| - > 1 cm
55
Scar
abnormal fibrosis tissue
56
Keloid
-rubbery and firm or shiny fibrotic nodules
57
Lichenification
- well defined
| - large plaque where skin appears thickened and skin markings are accentuated
58
Wood's lamp indications
any dermatitis
patches of scalp scaling or partial hair loss
pigmentary conditions
blisters or erosions on hands and forearms
patches of scaling and altered pigmentation on skin
59
Wood's lamp will see
```
tinea capitus
tinea versicolor: golden/yelllow
erythrasma: coral/red
pseduomonas: aqua green
vitiligo: accentuates hypopigmentation
porphyria cutenea tarde: pink/orange
fluorescine: evaluate conjunctiva
```
60
KOH prep will see
Hair: tinea capitus, tinea barbae
Skin: tinea corporis, tinea, cruis, tinea pedis, tinea manuum, and candidiasis
Nails: tinea ungium and candidasis
61
KOH prep
- clean area
- collect sample
- place on slide with 20% KOH
- view under microscope
62
Positive KOH
- dermatophtes causing tinea: linear
- candida - oval budding cells
- Malassezia furfur - spaghetti and meatballs
63
Main objectives for skin bx
- maintain pt comfort and safety
- obtain appropriate tissue sample
- produce best cosmetic and function result
64
Partial thickness skin bx
- removes epidermis and some dermis
- shave
- snip
- curettage
65
Full thickness skin bx
- extends into subcutaneous fat
- punch
- incisional
- excisional
66
Partial thickness bx indications
- seborrheic keratosis
- verruca vulgaris
- molluscum contagiosum
- skin tags
- nevi
- superficial basal cell
- do NOT remove suspected melanoma this way
67
Shave bx
- prepare with alcohol
- instill location anesthesia
- excise lesion by shaving
- apply pressure, 20% aluminum chloride or cautery to stop bleeding
68
Snip bx
- clean with alcohol
- pick up skin tag and cut at base
- use 20% aluminum chloride to stop bleeding
- place antibiotic ointment and bandage
69
Curettage
- topical anestheisa if needed
- Use quick scraping motions
- 20% aluminum chloride to stop bleeding or cautery
70
Partial thickness bx aftercare
- clean and dry 24 hr
- after that clean with soap and water
- reapply bandage with antibiotic ointment
- return if signs of infection
71
Incisional punch bx
- lesion or dermatosis covers large surface area
- dx needs to be confirmed before tx
- takes part of lesion
72
Excisional punch bx
- any lesion with highly suspected malignant potential
| - anything smaller than 10mm
73
Punch bx
- smaller than 1 cm clean with alcohol
- larger than 1 cm clean for 3 min with chlorhexidine or provodone-iodine
- mark margins
- inject with lidocaine
- hold skin taut and apply downward pressure turning in on direction
- lift specimen and cut bottom
- suture and apply ointment and bandage
74
Full thickness follow up care
- clean and dry 24 hr
- after clean with soap and water
- reapply bandage
- return if signs of infection
- return in 5-21 days for suture removal
- no heavy lifting
75
Excisional bx indications
- suspected melanomas
- epidermal inclusion cysts
- lipomas
- larger basal and squamous cell
- dermal lesions over 1 cm
76
Excisional bx procedure
- scrub for 5 min with chlorhexidien or providone-iodine
- mark margins
- mark intended incision
- use tip of 15 blade to incise corner and bell to cut rest
- lift and cut bottom
- close wound
77
Cryosurgery absolute contraindications
- lesions need pathology
- compromised circulation
- lesions suspected of cancer
78
Cryosurgery relative contraindications
- lesions overlying nerves
- location of lesion
- dark skin - hypopigmentation
- cold intolerance
- autoimmune disease or immunosuprressive therapy
79
Cryosurgery complications
- Immediate: dizziness, snycope, blisters, edema, bleeding, pain
- Delayed: infection, hemorrhage, formation of granulation tissue
- Prolonged/permanent: hypo/hyper pigmentation, alopecia, atrophy, altered senstation
80
Cryosurgery f/u
- wash with soap and water x2 daily
- OTC pain meds
- do not use gauze or occulsive dressing
- blisters may form
- crust will separate in 10 days
81
Ingrown toenail indications
- ingrown toenail
- fungal infection of nail
- inflammation of nail fold
- deformed, curved nail
82
Ingrown toenail procedure
- anesthetize toe
- place touriquet
- cut nail lengthwise and loosen nail
- separate nail from nail bed to proximal nail under cuticle
- remove nail
83
Ingrown toenail f/u
- elevate food 24-36 hr w/ gradual ambulation
- change dressing in 24 hours
- soak in warm water x2 daily
- return if signs of infection
- prevent by wearing loose fitting shoes and trimming nails straight across
84
Subungual hematoma contraindications
- crushed or fx bone under nail
- suspected subungual melanoma
- artificial nails no cautery
- hematoma taking up more than 50% of nail
85
Subungual hematoma procedure
- soak in antiseptic solution then clean with alcohol
- creak a hole
- let blood drain
86
Subungual hematoma f/u
- soak in soapy water 2-3 times daily
- light dressing
- return for infection
- OTC pain meds
