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N270: Advanced Health Assessment [Fall 2016] > For Final > Flashcards

Flashcards in For Final Deck (511):
1

The retina contains the major landmarks of the eye (4)

- Optic disc
- Retinal arteries and veins
- Macula
- Fovea centralis

2

Which of the major landmarks of the eye can you see on the fundoscopic exam?

- Optic disc
- Retinal arteries and veins
- Macula

generally need to have eye dilated to see the fovea centralis

3

Infants are born with ____ vision.

myopia - 20/200

4

Middle age adults become presbyopic due to the ___ becoming rigid and the ____ becoming weak.

lens becomes rigid

ciliary muscle becomes weak

5

Oldest adults develop changes in the macula causing ___ or ____

low vision or decrease in central vision (macular degeneration)

6

Adult visual acuity of 20/20 develops by ___
years of age.

4 to 6

7

Can hormonal changes with the onset of puberty cause vision changes?

yes, can cause a change in refraction.

8

Pregnancy vision changes - hormonal adaptations where?

Pregnancy causes hormonal adaptations in the cornea and can cause a change in refraction.

9

By age 70, functionality of the extraocular muscles ___

decreases

10

By age 70, functionality of the extraocular muscles decreases and often upward gaze is limited to ____

15 degrees from horizontal plane.

11

For oldest adults, fibers in the central region of the lens may cause ___ in the lens.

cloudiness

12

For oldest adults, pupil size ___ and pupillary reflex becomes ____

decreases

sluggish, reacting slowly to changes in light

13

RUQ of abdomen - 2 main organs

liver, gallbladder

14

LUQ of abdomen - 2 main organs

stomach, body and tail of pancreas

15

Linea alba

white line that runs midline in the superficial layer of abdominal muscles/tendons

16

Pain from stomach is usually felt where?

epigastric area

17

Duodenum is around the head of the ___, which also extends across quadrants

pancreas

18

Biliary tree refers to

all of the ducts from the gallbladder, pancreas, liver that drain into the duodenum

19

Aorta is slightly ___ of center

left

20

Which is lower: right or left kidney?

right

21

The ___ and ___ muscles are important to assess for appendicitis

iliacus and psoas

22

When dividing the abdomen up into 9 regions, the three that are most referred to are

epigastric, umbilical, and hypogastric or suprapubic

23

LLQ of abdomen main organ: sigmoid colon

sigmoid colon

24

Right Lower Quadrant of abdomen main organ

appendix

25

If stomach pain is in LLQ, think

diverticulitis

26

Diverticulitis is most commonly found in

sigmoid colon (LLQ)

27

Environments that foster low levels of physical activity coupled with dependence on calorie-rich diets have been linked to development of DM and obesity, both of which are risk factors for ____

nonalcoholic fatty liver disease.

28

Hepatitis C infection, a major cause of ____ in the U.S., is associated with low SES, drug use, and incarceration.

cirrhosis

29

Once cirrhosis is established, lower surveillance rates for hepatocellular carcinoma (HCC) are seen in patients with ___ and ___

low SES and poor insurance.

30

What other systems should you be thinking about with abdominal symptoms aside from GI/GU? (5)

- Respiratory
- Cardiovascular
- Musculoskeletal
- Hematologic
- Psych

31

Visceral abdominal pain - what is it caused by? what are the chief characteristics?

When hollow organs forcefully contract or become distended, or solid organs swell against their capsules

Gnawing, cramping or aching

Often poorly localized—points with hand

May writhe on table

32

Visceral abdominal pain examples (2)

gastroenteritis, biliary colic of gall stones (cholelithiasis) in cystic duct

33

cholelithiasis

biliary colic of gall stones

34

Parietal abdominal pain - what is it caused by? what are the chief characteristics?

When there is inflammation of the parietal peritoneum AKA peritonitis

Steady/constant

Often localized—points with finger

Likely lies still with knees up

35

peritonitis

inflammation of the parietal peritoneum

36

2 main examples of Parietal abdominal pain

appendicitis, inflammation of gall bladder (cholecystitis)

37

cholecystitis

inflammation of gall bladder

38

RUQ or epigastric visceral pain may be coming from ___ or ___

biliary tree or liver

39

epigastric visceral pain may be coming from ___ or ___ or ____

stomach, duodenum, pancreas

40

periumbilical visceral pain may be coming from what 3 organs?

small intestine, appendix, proximal colon

41

suprapubic or sacral visceral pain may be coming from the

rectum

42

Hypogastric visceral pain may be from what 3 organs?

colon, bladder, uterus

43

Referred pain from gallbladder may be felt in the ___ or ___

right shoulder and back

44

Referred pain from pancreas may be felt in the ___

mid-lower back

45

Hx of abdominal surgery is a risk factor for

obstructions

46

Order of abdominal exam

Inspection, auscultation, percussion, palpation

47

When should you examine painful areas in abdominal exam?

last

48

Signs that hernia might be strangulated (blood supply cut off)

changes in color, n/v, fever, pain, no bowel movements

49

Sign of hernia incarceration

can’t push in

50

Diastasis Recti - is this benign or not? when is it common?

When linea alba separates and some abdominal contents protrude

Benign

Common in pregnancy

51

Normal contour of infant abdomen:

round/protuberant

52

Normal contour of preschool abdomen:

lumbar lordosis

53

8 Fs of Abdominal Distention

Fat
Fetus
Flatus
Feces
Full bladder
Fibroids
Fluid
Fatal tumor

54

6 conditions where you may hear more bowel sounds

diarrhea, colic, malrotation, intussusception, early obstruction, diverticulitis

55

5 conditions where you may hear less bowel sounds

total obstruction, paralytic ileus, peritonitis, severe ascites, post-surgery

56

Spleen percussion: 2 techniques

1. Percuss for splenic dullness from border of cardiac dullness at 6th rib to anterior axillary line and down to costal margin (Traube’s space)
2. Splenic percussion sign - percuss, then have patient take deep breathe, and it’ll move - if enlarged, it’ll move into intercostal space that you’re percussing

57

Easiest to palpate organs in what patient population?

younger children

58

Why does the spleen float and liver doesn’t?

Because liver is next to diaphragm and can’t move as easily

59

What is a hernia?

Protrusion of peritoneum or intestine through weakened spot in musculature of abdominal wall

60

Hernia characteristics

Usually painless, intermittent, reducible, bulges with crying/ straining

61

Umbilical hernias in infants ___ need intervention

rarely

62

What 3 kinds of hernias are surgically corrected?

Inguinal, femoral, and most ventral hernias

63

Scaphoid contour means

markedly concave or hollowed

64

Peristalsis is often seen in what type of patient? Often indicates what?

thin

obstruction

65

Pulsations from the abdominal aorta are often seen in what type of patient? May indicate what 2 things?

thin

aneurysm or widened pulse pressure

66

Abdominal breathing normal in ___ and ___

infants and toddlers

67

Subcostal retractions may indicate ____

respiratory distress

68

___ or ____ may present with complaint of abdominal pain and altered respirations

Pneumonia or pleural effusion

69

If a patient is guarding or having pain with walking or coughing, and abdominal distention may be present, and they prefer supine position with knees flexed, what might this be?

Appendicitis/peritonitis

70

What 2 things are we auscultating the abdomen for?

- Bowel sounds
- Vascular sounds – listen for bruits over aorta, renal, iliac and femoral arteries

71

____ on abdominal auscultation may be heard with pleural inflammation or peritoneal inflammation

Friction rub

72

In appendicitis, bowel sounds may be ___ or ____

decreased OR hyperactive

73

Why do you need to auscultate right lower lobe (RLL) of lungs carefully with appendicitis pain?

to rule out lobar pneumonia with referred pain

74

Normal bowel sounds are clicks and gurgles, ___/min

5-35

75

Absence of bowel sounds established after ___ minutes

5

76

5 key points/steps of abdominal percussion

1) Start w/overview of 4 quadrants for gas, fluid or masses
2) Liver span and tenderness
3) Spleen size
4) Costovertebral angle tenderness (+ or - CVAT)
5) Pain over other areas of
inflammation - Watch facial expressions, may be too uncomfortable to perform in appendicitis

77

Tympany

High pitched sound, musical quality

Heard over air-filled structures (stomach, gas in
GI tract)

78

Dullness

Short high-pitched sound

Little resonance

Heard over solid or fluid filled organs adjacent to air containing organs (liver, spleen, distended bladder)

79

Resonance

Sustained note, moderate pitch

Heard over lung tissue primarily

80

Liver span in adult usually ___ cm and usually does not extend below right costal margin more than ___ cm

6-12 cm

2 cm

81

Liver percussion for span - how?

Start at right mid-clavicular line, below umbilicus, percuss upward until dullness, then percuss downward until dullness

82

Bimanual percussion for tenderness of liver and kidneys

Place palm of one hand over organ

Strike hand with ulnar surface of other hand

If organs are inflamed, there will be pain

83

What does light abdominal palpation assess for?

skin turgor, muscle tone, superficial lesions or masses, areas of resistance, muscular or peritoneal tenderness

84

What does moderate abdominal palpation assess for?

slow approach to deep palpation, further assessment of tender areas

85

What does deep abdominal palpation assess for?

Identify liver edges, kidneys, and masses by location, size, shape, consistency, tenderness, pulsation, mobility

86

RUQ: liver palpation

PALPATE WITH RIGHT HAND
STARTING BELOW UMBILICUS
AND MOVING UPWARD UNTIL LIVER IS PALPABLE

alternative: hooking

87

If kidney is enlarged, may be felt at ____ between opposing examining hands

inferior lateral border of ribs

88

Which kidney is more likely palpable?

right

89

how to palpate spleen

- With one hand below the left costal margin, palpate under costal margin at the anterior axillary line

- Attempt to lift spleen anteriorly by lifting with one hand and palpating with the other

- Roll client onto right side to bring spleen towards midclavicular line and examining hand

90

palpation of abdominal aorta is particularly important for what patients?

Important in adults > 50 and anyone with known or suspected cardiovascular disease

91

Note that you will __ rupture an aneurysm when palpating abdominal aorta

not

92

Concerned about abdominal aortic aneurysm (AAA) if lateral pulsations ___ cm diameter

>3

93

If newborn has if scaphoid, abdomen, think

diaphragmatic hernia

94

femoral pulses will be weak or absent in infant with

coarctation of the aorta

95

in newborns/infants, you might be able to palpate liver edge ___ cm and spleen edge ___ cm below costal margin

1-3

1-2

96

normal abdomen contour in toddlers/children is

protuberant

97

If toddler very upset, palpate abdomen when?

during inspiration between cries

98

Why should you percuss suprapubic area in older adults?

for urinary retention

99

While there is abdominal fat accumulation in older adults, there is less ___ and ___, so palpation may be
easier

less muscle mass and connective tissue

100

Positive Murphy's sign for cholecystitis

Palpate deeply at costal margin at mid-clavicular line

Patient takes deep breath, which forces liver and gall bladder down toward examining fingers

Sharp increase in tenderness is +

101

Most common cause of acute surgical abdomen in childhood

appendicitis

102

When is appendicitis most common? When is it rare?

Rare in early childhood or elderly, most common 11-20 y.o.

103

How is appendicitis diagnosed?

Diagnosed by CT or during surgery

104

Main symptoms of appendicitis

Anorexia and dull, aching, steady peri-umbilical pain that localizes to right lower quadrant after 4-6 hours. May have -

▪ nausea and vomiting starting AFTER abdominal pain
▪ diarrhea or constipation
▪ low grade fever
▪ urinary or respiratory symptoms

105

Inflammation of appendix secondary to obstruction, may suppurate and wall off or rupture, leading to

peritonitis

106

McBurney’s point

just below the middle of a line joining the umbilicus and the anterior superior iliac spine

107

Rovsing's sign

If palpation of LLQ increases the pain felt in the RLQ, the patient is said to have a positive Rovsing's sign and may have appendicitis

"referred tenderness"

108

Iliopsoas sign

passive extension and flexion of hip - positive if abdominal pain during these exercises

109

Obturator sign

Patient lies supine with right thigh flexed 90 degrees

Examiner immobilizes right ankle with right hand

Left hand rotates right hip by:
Pull right knee laterally (hip external rotation)
Pull right knee medially (hip internal rotation)
Left obturator/Pelvis examined in similar fashion

110

What 3 CN are you testing with extraocular movements?

III, VI, IV

111

Choroid

vascular layer between the retina and scleral area

112

Visual cortex does processing in the ___ area of the skull

occipital

113

When an athlete presents with concussion, what is sometimes the first symptom they have on the field?

blurred vision

because it impacts the occipital area which is the processing area for vision

114

With latino infants, you'll see thickened ___ which makes it a little more challenging to evaluate muscle balance

thickened epicanthal folds

115

Myopia more common in what 2 ethnicities?

Asian and Filipino-Americans

116

Latino and Asian - retina appears

pale

117

African American - retina appears

dark

118

European - retina appears

reddish or orange

119

what impacts eye during neonatal?

If they need resuscitation or are on oxygen

120

visual changes can be induced in last trimester by

HTN/diabetes

121

medications in older adults that can cause eye issues?

anticholinergics which dry out the eyes, long-term steroids

122

What does 20/20 mean?

You can see at 20 feet what the average person can see at 20 feet

If 20/40, you can see at 20 feet what the average person can see at 40 feet

123

Start doing visual acuity checks at what age? What result would you refer?

age 3

If they’re 20/40 or above

124

Corneal Light Reflex

tests the balance of the extra-ocular muscles.

Light should be symmetrically reflected off the cornea.

125

Cover uncover test

confirms balance of the extraocular muscles and detects unequal refraction in eyes

126

Pupillary reflex

response to light both direct and consensual

Often done in ER if you present with trauma post MVA

127

If glaucoma, they will have a significant change in the _____ of the cornea

curvature

128

Cornea examination

testing the curvature of the cornea by shining the light source obliquely (45 degree angle) - also to evaluate the clarity of the chamber and the lens

129

Red or Retinal Light Reflex (RLR)

Light illuminating from the retina and indicates the clarity of cornea, lens and chamber

130

Normal cup:disc ratio in retina is

<1:2

131

Comparing the arteries vs. veins in retina

arteries are brighter red and narrower than the veins

132

avascular area on the retina with irregular borders

macula

133

area of central vision on macula

fovea centralis

134

chronic exposure to dust/wind/sun can cause ___ which is common in migrant farm workers

pterygium

135

pooling blood in iris caused by trauma to the head

hyphema

136

Always evaluate ___ in UE complaints, and ____ in LE complaints.

neck in UE

lower back in LE

137

Always include neurovascular exam ___ and ____ to the complaint.

distal and proximal

138

What peripheral nerve is compressed/ entrapped/”pinched” in carpal tunnel syndrome?
A. Ulnar
B. Radial
C. Median

C. Median

139

No numbness, tingling, or pain into thumb, 2nd and 3rd digits bilaterally after 60 seconds. What does this mean?

negative Phalen’s bilaterally.

140

Numbness into 2nd digit at 20 seconds on right hand. What does this mean?

positive Phalen’s on right (R=20 seconds at D2)

141

Pain up into left` forearm at 30 seconds. What does this mean?

negative Phalen’s on left

142

Numbness and pain into all digits on right

positive Phalens-all digits on right (but think higher up compression)

143

Guyon’s canal is what nerve?

ulnar

144

Cubital tunnel is what nerve?

ulnar nerve

145

Tarsal tunnel is what nerve?

tibial nerve

146

Numbness, pain or tingling into thumb, 2nd and/or 3rd digits of left` hand (palmar).

– Positive Tinel’s at left carpal tunnel (into thumb)
– Negative Tinel’s at right carpal tunnel.

147

What is the name of bony osteophytes on the DIP joint?
A. Bouchard’s nodes
B. Rheumatoid nodules
C. Heberden’s nodes
D. Tophaceous gout

C. Heberden’s nodes

148

Lateral epicondylitis (AKA tennis elbow): the epicondyles are part of what bone?
A. Proximal Ulnar
B. Proximal Radius
C. Distal Humerus

C. Distal Humerus

149

the olecranon is the proximal _____

proximal ULNA

150

High yield questions in MSK presentations (5)

1. Antecedent events leading up to the symptom
(Any acute trauma? Cumulative exposures?)

2. Focus on the functional impact of the symptoms: ADL? Work? Sports? Exercise?

3. Hand dominance?

4. Trying to identify exact location of pathology: is it bone, joint space, tendon/ligament, muscle, bursa?

5. Do not forget about referred pain

151

Key PMH in MSK presentations (6)

• Osteoarthritis?
• Rheumatoid arthritis?
• Fibromyalgia?
• Osteoporosis?
• Cancer?
• Obesity/anorexia?

152

Note that Fluoroquinolone antibiotics (e.g., Ciprofloxacin) have a Black box warning for what?

tendon rupture

risk increases with age

153

Occupational History - Work (“WHACS”) (in/out of home)

W- What do they do for work? (Percent time sitting, standing, lifting, pulling, pushing? How much weight lifted, pushed, pulled?)

H - How do they do it?

A - Anyone concerned about exposures on/off the job?

C - Coworkers with similar symptoms?

S - Satisfaction with work?

154

If you were worried about acute hot red joint....search for what?

Search for port of entry for infection:
• Any STD exposure?
• IVDA?
• Dental procedures?
• Abscess/Cellulitis?
• Cystometrics (bladder testing)?

155

Example of neck problem that causes acute or chronic referred shoulder pain?

Cervical radiculopathy

156

Example of pulmonary problem that causes chronic referred shoulder pain?

Pancoast tumor of the lung (located in the superior pulmonary sulcus)

157

Example of cardiac problem that causes acute referred shoulder pain?

Angina

158

Example of dermatology problem that causes acute referred shoulder pain?

Herpes Zoster (Shingles)

159

Example of GI problem that causes acute referred shoulder pain?

Ruptured colon after colonoscopy

160

Apley Scratch Test (3 components)

External rotation and abduction (Lift and pat self on back)
Internal rotation and adduction (Touch scapula from behind with opposite arm)
Internal rotation and abduction (Scratch shoulders)

161

4 muscles of the rotator cuff

1. Supraspinatus tendon (posterior)
2. Infraspinatus tendon (posterior)
3. Teres minor tendon (posterior)
4. subscapularis (anterior)

162

Intrinsic risk factors for tendon injury (2)

• Narrowed space under the acromium
• Excessive physical training with inadequate muscle rest

163

Example of hip issue that could cause chronic referred pain to lumbar spine?

Avascular necrosis of the hip

164

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

Abdominal aorGc aneurysm

165

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

Ruptured ovarian cyst or malignancy

166

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

Acute prostatitis or prostate malignancy

167

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

Herpes Zoster (Shingles)

168

Example of hip issue that could cause acute or chronic referred pain to lumbar spine?

Pyelonephritis or polycystic kidney disease

169

Straight leg test for lumbar spine (passive)

– 30-60 degrees
– Lower 2 inches to remove hamstring factor
– Dorsiflex ankle

– If painful in lumbar area or down leg, POSITIVE

170

FABER Hip Exam

F: Flexion
AB: Abduction
ER: External Rotation

171

If patient presents with hand pain, always examine the ____

neck

172

4 point approach to the MSK PE

Inspection → Palpation → ROM → Provocative tests

173

Drawer test

pulling the tibia towards you to see if anterior cruciate is intact

if you can open the drawer, it’s positive for a sprain of the ligament which would be grade 1, 2 or 3

complete rupture would be a grade 3 spain

174

Lachman test is very similar to what other test?

Drawer test

175

Focus of the pre-sports participation exam is what?

Injury prevention

176

Carpal tunnel/median nerve compression could be caused by...?

Pregnancy/fluid retention
thyroid disorders
amyloidosis
multiple myelomas → anything that lays down deposits in confined space

Work-related: Repetitive motion, venous congestion, scar tissue

177

Median nerve primarily innervates sensory portions of which fingers?

first, second, third, and palmar ½ of third finger

178

2 provocative tests for carpal tunnel are what?

Tinel’s test
Phalen’s test

179

Tinel’s test

Percuss reflex hammer over the pillar of the palm - trying to stimulate the numbness/tingling (if they feel it, it would be positive) - positive is reproduction of their paresthesias in D1, D2, D3, or D4

180

Phalen’s test

Forced flexion of wrists (hold wrists against one another) for 60 seconds

If patients say they feel buzzing in a particular hand/digit - you time it - the EARLIER they’re feeling the symptoms, the higher the predictive value that they have carpal tunnel syndrome

If all digits, you might not think CT - maybe think diabetes or compression in brachial plexus

181

Classic symptoms of carpal tunnel:

numbness, tingling, pain, wake up in middle of night with numbness (because we curl up and flex our wrists)

182

thenar wasting/atrophy on the hand is an associated advanced finding of what?

carpal tunnel

183

osteoarthritis

usually symmetrical

common finding with aging

184

Swann neck deformities

(NOT normal but sadly common in rheumatoid arthritis) - subluxation of the joint

185

How do you treat Ganglion cyst?

Hit them with a bible - they’ll rupture and reabsorb

Sometimes they’ll spontaneously reabsorb within 9-12 months

186

Tendons vs. ligaments

Tendons are muscles to bone

Ligaments are bone-to-bone

187

Grade 3 sprain would indicate what

total rupture off the bone - worried about can that person weight-bear off that joint?

188

Remember that you’re supposed to approach a task with your arms ____

supinated

not pronated (protects the elbows)

189

Tennis elbow (Lateral epicondylitis) test

Take the wrist straight in neutral position, make them flex wrist, and have them extend and lift - examiner will apply resisted wrist flexion - if they say “ouch” at the elbow, that’s positive

This is diagnostic for Lateral epicondylitis

Same test for medial epicondylitis

190

septic joint? Think

STI

191

___ is probably most important access point of infection

IV drug use

192

Medial and Lateral Collateral Ligaments...
• A. Prevent the anterior-posterior movement of the tibia
• B. Stabilize the meniscus placement between the femur and the tibia.
• C. Stabilize the lateral motion of the tibia relative to the femur
• D. Prevent the patella from grinding between the femoral condyles.

• C. Stabilize the lateral motion of the tibia relative to the femur

193

Sperm is produced in ___, mature in ___, travel up the ____

testes

Epididymis

Vas Deferens

194

Spermatic Cord is what we examine anatomically, and it contains what 4 things?

arteries, veins, nerves, lymphatics

195

Where Glans meets penile shaft

Corona

196

Opening at tip of glans

Meatus

197

Covers the glans

foreskin

198

Connects foreskin to glans

Frenulum

199

When performing Femoral Vein venipuncture, aim ___ to pulse

medially

200

If there's a Femoral Vein DVT, you would see pain and tenderness in the ____

medial upper thigh

201

If there is an increase in testicular or penile size before age 9, would you refer?

yes, urgent referral

202

If there is an increase in pubic hair before age 9, would you refer?

non-urgent but would refer

203

Delayed puberty in boys is defined as

no increase in penile or testicular size by age 14

204

Ages 40-60 in men sees decrease in testosterone, which leads to what 6 things?

• Takes longer to achieve erection
• Erection maintained longer
• Orgasm may be less intense
• Longer refractory period
• Penile size decreases
• Scrotum more pendulous

205

If there's Dysuria in the Meatus, think

local lesion

206

If there's Dysuria in the Length of penis, think

urethritis

207

If there's Dysuria in the Suprapubic area, think

cystitis

208

What type of incontinence: Leakage w/ exertion, sneezing, coughing

Stress incontinence

209

What type of incontinence: Can’t make it to void; can’t defer urge

Urge incontinence

210

What type of incontinence: Leaks from full bladder or Nocturnal enuresis (bedwetting)

Overflow incontinence

211

Lice vs nits

Nits: stuck on hair base
Lice: move

212

Maculae Ceruleae

bluish spots where lice have fed

213

Foreskin too tight is known as

Phimosis

214

What is it called if the Foreskin is stuck in retraction? Is this an emergency?

Paraphimosis

yes, surgical emergency

215

Fordyce Spots: where are they found? Are they normal?

• From sebaceous glands. Normal. Harmless.
• Commonly on penis, scrotum, labia, lips

216

Peyronie’s Disease

painful erections

217

Herpes progression

Vesicles / Pustules -->  Ulcers -->  Crusts

218

If there is a solitary, painless, non-tender ulcer w/ raised borders, think

Primary Syphilis -- Chancre

219

Balanitis

Usually Yeast
Red; not just Smegma
***Itchy

220

Warts with “Cauliflower” appearance are called

Condylomata Acuminata (warts)

221

Pearly Penile Papules (PPP’s) are a ___ variant

normal

222

Penile Enlargement Surgery is or is not approved by Amer. Urological Assoc.

not

223

Average Flaccid Penile Length and girth

length: 9cm
girth: 10cm

224

When would you perform Transillumination of testes?

If unexplained swelling

225

Are Testes usually the same size? Average size? What testis normally hangs lower?

Yes

3.5-5.0 cm. long x 3 cm. x 3 cm.

Left

226

___ in particular is sensitive to touch on PE

Epididymis

227

Testicular Cancer has a : ____ incidence, ___ cure rate. Occurs in men: ___ y.o. 4 main risk factors:

low incidence, high cure rate

15-35 years old

Risk factors: Cryptorchidism, Down’s, Fam. Hx, HIV

228

Do any professional organizations recommend routine screening for testicular cancer?

no

229

Undescended testes/ Cryptorchidism

-- High risk of cancer
– Common in infancy; 1% of 1 y.o. boys

230

How do you treat Epididymitis-Orchitis? More common in what age?

Cultures and Antibiotics
(maybe IV)

Adults

231

How do you treat Testicular Torsion? More common in what age?

emergency surgery

Kids

232

Varicocele most commonly feels like what? Which side?

Bag of worms

Left side (right side very rare)

it's Varicose veins

usually asymptomatic, can affect fertility

233

Spermatocele

• Fluid-Filled Cyst
• Always superior to testis, posterior aspect
• Palpated as distinct from testis
• Ultrasound if necessary
• No treatment unless big and uncomfortable

234

Hydrocele

• Fluid within scrotal membranes
• Transilluminates (solid masses don’t)
• Usually develop over long period of time
• New acute onset may warrant ultrasound
• No treatment unless uncomfortable

235

If you detect Suprapubic Dullness, think

bladder distention

236

Prostate exam is part of the ___ exam

rectal

237

Perform an inguinal exam only ___

if indicated by history

238

What is the most common type of herniation

Indirect Inguinal Hernia

239

Indirect Inguinal Hernia

• Most common type
• Herniation through internal inguinal ring
• Often not visible
• Can remain in canal or pass into scrotum
• May only be felt during Valsalva

240

Findings of Incarceration or strangulation

very tender
often nausea / vomiting

241

Rectum is __ cm long and ___ to anus

12 cm long, superior to anus

242

Anus: how long? Lower vs. upper half

• 2.5-4.0 cm long (adult)

• Lower half innervated by somatic sensory nerves
• Upper half under autonomic control – Insensitive

243

internal vs external sphincter

• Internal is involuntary
– Urge to defecate when feces fill rectum
– Reflexive stimulation to relax sphincter

• External is voluntary

244

By 12 months, infants should have ___ stools per day. Control external sphincter by ___ months

1-2

18-24

245

Afferent neurons in rectal wall ___ with aging – interferes with relaxation of internal sphincter

degenerate

246

Aging leads to rectal ___ with stool

distention

– Requires increased pressure to sense stool – Leads to stool retention and constipation

247

Internal sphincter ___ tone with aging

loses

248

Minor vs major fecal incontinence

– Minor: staining w/ flatus or liquid stool
– Major: involuntary excretion of feces

249

Technique for rectal exam on kids

On back, legs lifted up and held flexed on abdomen

250

“Smooth, firm, symmetrical, sulcus palpable. No tenderness, no nodules.” -

normal prostate

251

“Sulcus palpable” =

Not Enlarged

252

Normal prostate not palpable in __ and ___

Children, Young Adolescents

253

Normal prostate size:

walnut

254

If there is tenderness from local lesion, you might think

Fissure; Perirectal abscess

255

Diffuse Rectal Tenderness -- think

Proctitis

256

Main cause of bladder cancer?

Cigarettes

257

The one orifice you can't get Chlamydia from?

the mouth

258

Highly unlikely to get HIV from __ sex

oral

259

What single question can distinguish Organic etiology (physical causes) from Psychological etiology of erectile dysfunction?

Early morning erections?

260

Retrograde ejaluation (goes back into the bladder) can be a side effect of __ meds

BPH

261

Urethral discharge indicates

STI of some sort

262

Masses of testicular cancer

Hard and fixed
non tender

263

Best patient position to examine inguinal lymphadenopathy or femoral pulse?

supine

264

Best patient position to examine hernia?

patient standing, examiner sitting

265

Which hernia is more common in women?

femoral

266

5 parts of the neuro exam

1) Mental Status
2) Cranial Nerves
3) Motor and Reflexes
4) Sensory
5) Cerebellar and Gait

267

What is consciousness?

State of awareness of self and environment

268

Wakefulness - what is it, what part of brain is it associated with?

● eye opening (spontaneous or to external stimulus)
● in cerebral hemispheres, particularly in cortex --> brainstem and thalamic reticular activating system (RAS)

269

Awareness- what is it, what part of brain is it associated with?

● cognition, affect, memory, and other mental functions
● cerebral hemispheres (with RAS)

270

coma definition - how would you test

eyes-closed state of unarousable unresponsiveness

sternal rub, nailbeds

271

To assess wakefulness, choose what tool?

Glasgow Coma Scale

272

What are the 3 parts of the GCS?

eye opening
verbal response
motor

273

Cognitive Impairment and Dementia - 5 components

• Orientation, attention, and memory
• Language impairment
• Visuospatial dysfunction
• Executive dysfunction
• Personality and behavioral changes

274

Vast majority of language impairment is in the ___ hemisphere

left - dominant

275

Visuospatial dysfunction and some forms of attention live in the ____ hemisphere

right/non-dominant

276

Executive dysfunction (ability to solve problems, not perseverate) live ____ lobes

bilaterally in frontal lobes

277

Personality/behavior is ___ distributed in the brain

diffusely distributed in the brain

278

_____ is where motor function lives (picking something up)

prefrontal gyrus in the frontal lobe

279

____ lobes have analog of sensory function (pain, temp, proprioception, light touch, etc.) - sensory association cortex

parietal lobes

280

____ lobe contains auditory processing and comprehension of language, both together important in memory

temporal lobes

281

____ lobe processes visual information that comes in from eyes (eye exam is high-yield part of neuro exam b/c the pathways)

occipital

282

Orientation becomes more fluid going from ____ to ____

eft to right (patients are rarely disoriented to person/often know at base level who they are)

Person, place, date, situation

283

4 components of orientation

Person, place, date, situation

284

How do you assess attention in the general part of the mental status exam?

Digits - 6 forward or 4 backward, serial 7s or 3s
spelling WORLD backwards and forwards

285

How do you assess memory in the general part of the mental status exam?

— 3 objects: ask patient to remember them, then ask for them at 5 minutes

- “2/3 @ 5 min without cues, 3/3 with cues”

286

___ hemisphere is dominant in nearly all right-handed, most left-handed people

Left

287

Test language carefully if ___ hemiparesis

right

288

Dysarthric

abnormality in motor articulation of speech

289

Testing the left hemisphere/dominant hemisphere for language: 3 components

naming, repetition, comprehension

Indicates lesions in various areas/lobes

“No ifs, ands, or buts about it”

290

___ hemisphere controls Neglect and Visuospatial Function

Nondominant Hemisphere -- right

291

___ hemisphere is the non-dominant hemisphere in nearly all righties, most lefties

Right

292

Test for neglect syndromes carefully if ___ sided hemiparesis

left

293

striking, memorable syndromes (3) of there being an issue in the Nondominant (right) Hemisphere relating to Neglect and Visuospatial Function

anosognosia
asomatognosia
hemispatial neglect

294

anosognosia

can’t articulate what’s wrong with them (can’t articulate that they have paralysis in one arm)

295

asomatognosia

don’t recognize their own hand

loss of recognition or awareness of part of the body

296

Hemispatial neglect

not moving left side of body, head turned to right

characterised by reduced awareness of stimuli on one side of space, even though there may be no sensory loss

297

4 points of exam of Nondominant (right) Hemisphere relating to Neglect and Visuospatial Function

- constructional apraxia (inability of patients to copy accurately drawings or three-dimensional constructions)
- agraphesthesia (can’t tell what shape being drawn in hand)
- extinction
- neglect clock

298

symptoms of Frontal lobe dysfunction (4)

disinhibited, slow, concrete, perseverative

299

Mini-Mental Status Exam -- how many points are there? Whats the cutoff score? What are the limitations?

- 30 point scale that’s a screening battery
- Typical cutoff is 24 (below that is considered cognitively impaired)
- Limitations: education level, language, NOT diagnostic
- Should not be used for anyone under 8th grade school level

300

Causes of anosmia:

- head trauma
- early Parkinson’s
- normal aging
- URI, meds, and many others

301

Is CN I (olfactory) tested in clinical?

Not really/rarely

302

How do you test CN I (olfactory)? What is the primary symptom of CN I (olfactory) dysfunction?

Test with aromatic, not noxious, compounds.

sx: anosmia
common and underrecognized consequence of traumatic brain injury

303

Note that anosmia can diminish ___ and is associated with ___

taste

weight loss in the elderly

304

CN I (olfactory) is not a peripheral nerve but a ___

CNS tract

305

CN I

olfactory

306

CN II

optic

307

CN III

oculomotor

308

CN IV

trochlear

309

CN V

trigeminal

310

CN VI

abducens

311

CN VII

facial

312

CN VIII

vestibulocochlear - auditory

313

CN IX

glossopharyngeal

314

CN X

vagus

315

CN XI

spinal accessory

316

CN XII

hypoglossal

317

CN II (optic) is not a peripheral nerve but a ____

CNS tract

318

What is the only part of the nervous system that you can directly look at

CN II optic

319

CN II is the ___ limb of the pupillary reflex

afferent

320

4 components of CN II assessment

- Check acuity: “+C” (if possible) - eye card
- Fundi
- Pupillary reflex
- Visual fields (also tests optic chiasm & optic radiations to occipital lobe)

321

Large lesions in the optic chiasm will take out the ____ fields of both eyes (bitemporal hemianopsia)

outer

322

If there's a lesion behind the optic chiasm, there will be a loss of the ___ optic fields

homonymous

323

If there's a lesion behind the ____ lobe, the patient will have difficulty with less visual field in each eye

right occipital

324

Is Binasal hemianopsia rare?

yes

325

CN 3 (oculomotor), 4 (trochlear), 6 (abducens) are the ___ to extraocular muscles

motor

326

CN ___ is levator palpebrae, pupillary sphincter

3

327

Eye muscles: Lateral rectus muscle corresponds to CN ___ = 6
Superior oblique = 4
Everything else is 3

6

328

Eye muscles: Superior oblique muscle corresponds to CN ___

4

329

CN ___ is the efferent limb of the pupillary reflex

3

330

Assessment of CN 3, 4, 6

- PERRL (pupils equal, round, reactive to light)
- ptosis
- Ask patient to track your finger in “H” shape: eyes should move smoothly & conjugately

331

Ptosis would be present if there’s a ___ palsy

3rd nerve

332

3 divisions of the trigeminal nerve

VI Ophthalmic
VII Maxillary
VIII Mandibular

333

Sx of CN 3, 4, 6

diplopia, that goes away if they close one eye

334

CN V trigeminal is ____ to the face and ___ to the temporalis muscle and other muscles of mastication

Sensory to face

motor to the muscles

335

Positive and negative CN V (trigeminal) symptoms

numbness (negative), pain or paresthesias (positive)

336

CN V (trigeminal) is the ___ part of the corneal reflex

afferent

337

How to assess CN V (trigeminal)

Touch on both sides in all 3 divisions (not easy to do in patient who isn’t cooperative)

To check motor: bite down while palpating

338

CN VII (facial) is ___ to the muscles of facial expression. It's also the ___ part of the corneal reflex.

motor

efferent

339

Symptoms of CN VII (facial) dysfunction

- weak face
- labial dysarthria (manifests as P and B sounds - they’ll get gutturals or linguals but can’t say Pa Pa Pa)
- hyperacusis
- loss of taste in anterior 2/3 of tongue

340

How to test the corneal reflex

touch cornea with cotton swab - eyes closing consensually

341

How to assess CN VII (facial)

Raise eyebrows
Close eyes tightly
Smile
Say pa-pa-pa, ba-ba-ba

note that nasolabial fold asymmetry on one side would be problematic

342

Upper vs Lower Motor Neuron Facial Weakness: Weak right face could indicate what 2 things?

Either problem with the right CN7 (aka a LMN facial weakness

OR

Problem on left mid-pons/brainstem or above the medulla (UMN facial weakness)

343

If a patient is very weak on the right side, the forehead will be

smooth

344

LMN lesions involve the upper and lower face ____, while UMN lesions tend to relatively spare the ___ part of the face

symmetrically

upper

so if a patient really can’t close their eye, that’s probably a lower motor neuron lesion -

give them eye drops and eye patch so they don’t dry out the cornea

345

Sx of CN 8 (Vestibulocochlear - Acoustic) (4)

hearing loss, tinnitus, vertigo, imbalance

346

Assessment of CN 8 (Vestibulocochlear - Acoustic)

Compare whisper or rubbed fingers side to side.

May see nystagmus when checking extraocular movements.

347

CN 9 (glossopharyngeal) and 10 (vagus) are the ____ and ____ of pharynx, with autonomic functions. Also the ___ reflex

sensory and motor

also gag reflex

(important in patients that are comatose, may help to decide if they need to be intubated)

348

Sx of CN 9 (glossopharyngeal) and 10 (vagus)

dysphagia,
palatal dysarthria (K and G sounds are sloppy)

349

How to assess CN 9 (glossopharyngeal) and 10 (vagus)

“Say ah:” uvula deviates AWAY from affected side

Say ka-ka-ka, ga-ga-ga (gag reflex)

350

CN 11: Spinal Accessory is ___ to trapezius and sternocleidomastoid

motor

351

Sx of CN 11 dysfunction:

shoulder weakness, pain

352

How to assess CN 11

Ask patient to:
Shrug
Turn head side to side against resistance

353

If there is an issue with right CN 11, the patient will ____

Raise R shoulder Turns head to L

354

CN XII Hypoglossal is ___ to the tongue muscles

motor
sx: lingual dysarthria Ask patient to:
Protrude tongue: deviates toward affected side (with atrophy if chronic)
Say la-la-la

355

Sx of CN XII Hypoglossal dysfunction

lingual dysarthria - motor speech disorder

sometimes trouble swallowing

356

How to assess CN XII Hypoglossal

Protrude tongue: deviates TOWARDS affected side (with atrophy if chronic)

Say la-la-la

357

Pupillary reflex: afferent is CN ___, efferent is CN ___

a: 2

e: 3

358

Corneal reflex: afferent is CN ___, efferent is CN ___

a: 5 (VI)

e: 7

359

Gag reflex: afferent is CN ___, efferent is CN ___

a: 9

e: 10

360

single cranial neuropathies

Bell’s

DM CN 6 palsy

(many others)

361

multiple cranial neuropathies could signal issue in the

subarachnoid space?

362

If you see multiple neuropathies, are they all in the same side, which might indicate ____ or ____?

a mass in subarachnoid space or compression in skull where nerves run together

363

If you see multiple neuropathies, are they in multiple levels on different sides, which could indicate ____?

Chronic meningitis

364

Multiple neuropathies on long tract sides, think ____

Problem in brainstem bc nuclei live here and long tracts

365

Weak in limbs and only motor impairment in cranial nerves, think ___ problem

motor

366

3 long tracts

corticospinal (motor)

spinothalamic (sensory) - carries pain and temp

dorsal column (sensory) - carries proprioception

367

If it’s UMN weakness - ___ and ___ are common early signs

stiffness and spasticity

368

When performing the motor exam and reflexes, you're assess motor system function of

corticospinal tract + motor unit (also extrapyramidal system)

369

When performing the motor exam and reflexes, can often assess ____ of weakness by history

pattern

(distal vs proximal, generalized, focal)

370

Proximal weakness complaints example

they might tell you they do ok walking on flat surface but have trouble getting upstairs, because they’re having weakness in hip girdle muscles

371

Distal weakness complaints example

buttoning buttons, zippers

372

Lower extremities weakness example

catching toe on stairs bc you can’t dorsiflex foot to clear the step

373

For EPS (extra pyramidal symptoms) ___ is key

DISTRIBUTION knowledge is key i.e. is it right side, left side, both sides? Legs, arms, both? Proximal, distal, both?

374

EPS

Slow to move (Parkinson’s)
tremor
myoclonus (jerk/twitching)
chorea (jerky movements of shoulder/hip/face)

375

Parts of the motor exam:

1. Inspect: atrophy (and fasciculations)

abnormal movements: tremor, chorea,
myoclonus vs paucity of movement

2. Palpate: tenderness

3. Examine:
- tone
- pronator drift and dexterity (finger/toe taps):
- sensitive corticospinal tract tests
- reflexes
- strength testing

376

tendon reflexes may diminish with ___, especially Achilles

age

age 65 or so - not pathological

377

pathological Babinski (toe goes up) is a ___ sign

UMN

tends to be confirmatory rather than hanging diagnosis on in isolation

378

Increased tone (hypertonia) is ____ sign

UMN

379

Decreased tone (hypotonia) is ___ sign

LMN

380

____ is a very sensitive sign of corticospinal tract dysfunction

Pronator drift (hold arms up and close eyes)

381

are there are nerve roots that don’t have reflexes that are associated with it?

yes

382

Achilles reflex may also be abnormal in patients with peripheral neuropathies, even if it’s subclinical -- examples (4)

long-standing diabetes, alcoholism, advanced HIV, neurotoxic chemotherapy

383

Documenting DTRS is a ___ grading. What grade is "normal"?

0 absent
1+ diminished
2+ normal
3+ increased
4+ transient clonus
5+ sustained clonus

384

“Breakway” weakness suggests

poor effort

385

UMN weakness

“pyramidal” (anti- gravity muscles
relatively spared)

386

UMN atrophy

miminal or absent

387

UMN fasiculations

absent

388

UMN tone

increased

389

UMN reflexes

increased

390

UMN Babinski

present

391

LMN weakness

myopathy: proximal polyneuropathy: distal focal: root, plexus, nerve

392

LMN atrophy

prominent, especially if peripheral nerve

393

LMN fasciculations

present in motor neuron disease (rarely neuropathy)

394

LMN tone

diminished or normal

395

LMN reflexes

diminished or normal

396

LMN Babinski

absent

397

MRC scale (strength):

0 no contraction
1 contraction, no movement
2 movement without gravity
3 movement against gravity
4 with resistance (4- to 4+)
5 normal

398

Spinothalamic tract - carries what?

pain, temperature

399

Dorsal column - carries what?

vibration, proprioception, Romberg

400

Cortical modalities (2)

- Graphesthesia (recognize writing on hand)
- Stereognosis (can say what the object is with eyes closed)

401

C2 and 3 are above the ___

neck

402

C3 and 4 are ___

shoulder

403

Sensory exam is best interpreted in context of ___, ___, or both

in context of sensory symptoms, motor signs, or both

404

Brown-Séquard syndrome

incomplete spinal cord lesion

patient who was, say, stabbed in the back at the thoracic level

they will have:
- Pain/temp down on contralateral side
- Diminished proprioception and weakness on ipsilateral side

405

B12 deficiency or balance issues - check ____

proprioception

406

What 3 symptoms may indicate cerebellar dysfunction?

Dysarthria, nystagmus or hypotonia

407

How to assess Cerebellar hemispheres:

finger-nose-finger, heel-knee-shin, rapid alternating movements

408

How to assess Midline cerebellum:

truncal, gait ataxia

409

signs of early gait ataxia

gait appears normal, with impaired tandem (can occur with advanced age)

410

signs of late gait ataxia

broad-based gait (think EtOH intoxication)

411

hemiparetic gait

problem with unilateral corticospinal tract

412

scissoring gait

problem with bilateral corticospinal tract

413

waddling gait

problem with proximal weakness (myopathy)

414

steppage gait

problem with distal weakness (neuropathy)

415

Considerations in assessing gait: (4)

age, pain, injury (acute or old), medications

416

___ and ___ are sensitive long tract signs

Drift and dexterity

417

High yield parts of the neuro exam: (3)

eyes, reflexes, gait

418

Good idea to check CN with ____ exam

HEENT

419

Check strength ___ tone and TRs

after

420

Arm + leg Face + arm (+/-leg): think

cord or brain

421

Face + arm (+/-leg) Hemiparesis: think

aphasia if right, neglect if left

422

Which of the following is NOT a normal finding upon ophthalmoscopic examination?

A. A cup to disk ratio of <1:2
B. Dark red veins larger than bright red arteries
C. An avascular macula with an irregular border
D. An optic disc with diffuse margins

D. An optic disc with diffuse margins

423

Pain of duodenal or pancreatic origin may be referred to the:
A. right shoulder
B. epigastric region
C. back
D. right flank

C. back

424

Your client presents with a complaint of worsening abdominal pain over the past few hours, beginning as mild and now severe. The pain is described as being in “my whole belly.” Physical examination reveals rebound tenderness upon palpation of the right lower quadrant. You suspect:
A. Acute cholecystitis
B. Acute diverticulitis
C. Appendicitis
D. Small bowel obstruction

C. Appendicitis

425

Risk factors for abdominal aortic aneurysm (AAA) include:
A. Age 65 or older
B. Smoking history
C. First-degree relative with a history of AAA repair
D. All of the above

D. All of the above

426

Which of the following is NOT a normal finding upon digital rectal examination?
A. Smooth prostate gland with palpable sulcus
B. Tarry stool on the examiner’s gloved finger
C. Walnut-sized prostate gland
D. Palpation of two sphincters within the anal complex

B. Tarry stool on the examiner’s gloved finger

427

Which of the following is a urological emergency?
A. epididymitis
B. varicocele
C. testicular torsion
D. hydrocele

C. testicular torsion

428

Impulse control is located in which lobe?
A. temporal
B. frontal
C. occipital
D. parietal

B. frontal

429

Which cranial nerve is affected in Bell’s Palsy?
A. V
B. VI
C. VII
D. VIII

C. VII

430

Upper motor neuron lesions presents with:
A. hypertonia
B. hypotonia
C. muscle atrophy
D. fasciculations

A. hypertonia

431

Significant anterior excursion of the knee (positive Lachman’s test) indicates an injury to which ligament?
A. Anterior cruciate
B. Posterior cruciate
C. Medial collateral
D. Lateral collateral

A. Anterior cruciate

432

Which type of skin cancer consists of more mature cells that usually resemble the spinous layer of the epidermis?
A. basal cell carcinoma
B. squamous cell carcinoma
C. melanoma
D. kaposi’s sarcoma

B. squamous cell carcinoma

433

Hypopigmented macules that appear on the face, hands, feet, extensor surfaces, and other regions and may coalesce into extensive areas that lack melanin suggest:
A. café-au-lait spot
B. seborrheic dermatitis
C. vitilgo
D. cyanosis

C. vitilgo

434

Where is McBurney's point? important for appendicitis

halfway between the umbilicus and the right iliac crest

435

Description of skin condition should always include what 5 points?

1. Primary lesion (i.e. papule)
2. Secondary change (i.e. scaly) or absence of Color
4. Size, shape, demarcation
5. Configuration, Distribution (rash) or location (growth/lesion)

436

Primary morphology: Smaller than 1cm + completely flat (non- palpable)

Macule

437

Primary morphology: Greater than 1cm + completely flat (non- palpable)

Patch

438

Vitiglio is an example of a

patch

439

petechiae is an example of

Macules

440

Primary morphology: Smaller than 1 cm, Raised (palpable), may be thin ("flat topped") or thick ("dome-shaped")

Papule

441

molluscum is an example of

Papules

442

Primary morphology: Greater than 1 cm, Raised (palpable)

plaque

443

psoriasis is an example of a

plaque

444

____ = smaller than 1 cm, serous or bloody fluid

Vesicle

445

____ = greater than 1cm, serous or bloody fluid

Bulla

446

____: always under 1cm, purulent fluid

Pustule

447

Zoster is an example of

vesicles

448

bullous pemphigoid is an example of

Bulla

449

pustular psoriasis is an example of

Pustules

450

When the epidermis is partially removed, this is an ___; fully removed would be an ____

erosion

ulcer

451

pyoderma gangrenosum is an example of an

ulcer

452

Primary morphology: Dome-shaped growth > 1cm, May be above or below skin surface

nodule

453

keratoacanthoma is an example of a

Nodule

454

Secondary changes are adjectives to describe the ___ of primary morphology

surface

455

Ring-shaped but clear in the center would be what?

Annular

456

Coin-shaped solid circle would be what?

Nummular

457

erythema multiform is an example of a ____ shape lesion

Targetoid

458

cutaneous larva migrans is an example of a ____ shape lesion

Serpiginous

459

lichen planus is an example of a ____ shape lesion

Polygonal

460

subacute cutaneous lupus is an example of a ____ shape lesion

Arcutate

461

Atopic dermatitis is often on the ___ parts of the body

flexural (like backs of knees)

462

Psoriasis is often on the ___ parts of the body

extensoral (backs of elbows)

463

Primary lesions of Dermatitis a.k.a Eczema are _____

Ill-defined erythematous papules/plaques of highly variable size and spacing

464

If Dermatitis a.k.a Eczema appears wet/weeping with microvesicles/round crusts or combination scale/crust, you know it's what stage?

Acute

465

If Dermatitis a.k.a Eczema appears dry, scaly and lichenified, you know it's what stage?

chronic

466

History for Dermatitis a.k.a Eczema is almost always ___

itchy

467

Tx for Dermatitis a.k.a Eczema

steroids/gentle skin care

468

Nummular eczema vs Tinea

Solid circle is more consistent with eczema

Ring (clearing in the center): Tinea - almost concentric circles (ripple-like effect)

469

a flake, a build up of stratum corneum or dead skin on the surface of the lesion

scale

470

dried fluid (serum, blood, pus)

crust

471

shiny, cigarette paper type wrinkling

atrophy

472

accentuation of the skin markings due to chronic rubbing and scratching - kind of like a callous - this is itchy

Lichenification

473

True red erythema

think neutrophils, cellulitis is an example

474

Purple erythema

lymphocytic inflammation

475

Red-brown erythema

granulomas

476

superficial (melasma) is what kind of brown

Muddy-tan brown

477

Tindle effect

more transmission of the blue tones so that’s why we see grey when we have a deeper lesion

478

Most tinia will be what shape?

annular

479

Ezcema is what shape

nummular

480

Koebner phenomenon

Papules in linear fashion - lesions pop up along the line where it was scratched

481

Koebner phenomenon

Papules in linear fashion - lesions pop up along the line where it was scratched

482

Seborrheic

hair-bearing areas of the skin: scalp, eyebrows and globella, nasal creases, beard region for men, then hair areas in chest, genitals, etc.

483

Photodistributed

accentuated where the sun hits exposed skin

484

Flexures

crooks of arms

485

Extensors

elbows and knees

486

Inverse

affect the body folds like trunk, under breast, armpits, groin

487

Is there any utility in biopsy for dermatitis?

no

488

small eczematous papules - very specific areas - finger webs, wrists, umbilicus/waist, genitals, ankles

scabies

489

honey-colored crusting or pustules superimposed on dermatitis/eczema would indicate

staph infection

490

Tinea

= dermatophyte

• Scale, erythema, omen papules at the leading edge of the plaque
• Not always annular– omen “waves” of papules expanding concentrically like ripples in a pond

491

Example of Class I topical steroid to tx dermatitis

Clobetasol

492

Example of Class II topical steroid to tx dermatitis

Fluocinonide

493

Example of Class III topical steroid to tx dermatitis

Triamcinolone 0.1%

494

Example of Class V topical steroid to tx dermatitis

Desonide

495

Example of Class VI topical steroid to tx dermatitis

Hydrocortisone 2.5%

496

Example of Class VII topical steroid to tx dermatitis

Hydrocortisone 1%

497

Topical steroids come in Class IX- VII, with Class I is ____, VII is ____

I is strongest

VII is weakest

498

Face, axillae, groin– use topical steroid class ___ or weaker

V

499

Hands, feet, elbows, knees– use topical steroid class ___ or stronger

III

500

Primary morphology of Psoriasis

well-marginated scaly papules/plaques (“papulosquamous” reaction pattern)

501

With Psoriasis, there is often no scale on ____ skin

moist intertriginous

502

Psoriasis treatment depends on what 4 things

- body sites involved
- type of psoriasis
- body surface area
- presence of arthritis

503

Treatment for dermatitis/eczema

Bathe daily with lukewarm water - no soap or very gentle soap like Dove only to armpits and groin

Follow bath with grease up in something thick - oily emollient to trap the water - Aquaphor, Vaseline, coconut oil (eucerin, cerave) - scoop out from jar rather than pump

topical steroids if necessary

504

for infant less than a year, use class ___ or lower of topical steroids

V

505

Benign: Brown/pink/white/yellow lesion, very common, warty sticker-like

Seborrheic keratosis

506

Benign: Bright red/pink/purple dilations in the skin - occur with aging

cherry angioma

507

Benign: Face/hands - “age or sun spots” - from sun damage

solar lentigines

508

As moles age, they go from flat and brown to dome-shaped, flesh toned, and lose pigment-- becoming

Benign intradermal nevis

509

4 main types of Malignant neoplasms

Melanoma
Squamous cell carcinoma
Basal cell carcinoma
Actinic keratosis - precursor to squamous cell carcinoma

510

If they’ve already had a skin cancer, are they much more likely to have another?

yes

511

classic “drug eruption” presentation

Pink macules/papules that look like measles