Download Dermatological Lesion Identification and Classification and more Exams Nursing in PDF only on Docsity!
Macule - Primary lesion; color change, flat, <1.5cm Eg: freckles, petechiae, purpura Papule - Primary lesion; raised, solid, <1cm Eg: nevus, wart Patch - Primary Lesion; flat, >1.5cm Eg: cafe au lait, Mongolian spot Plaque - Primary lesion; slightly raised, disk shapes, >1cm, scaling Eg: psoriasis, lichen Nodule - Primary lesion; palpable, solid, elevated, >1cm Eg: nevi, basal cell carcinoma Tumor - Primary lesion; large papule/nodule, fixed, >1cm, firm/soft, deep in dermis Eg: basal cell, squamous cell carcinoma Wheal - Primary lesion; pink/red, superficial, raised, swelling, slightly irregular shape, fluid-filled, pruritic, lasts <24hours Eg: Mosquito bite, allergic rxn Pustule - Primary lesion; raised lesion, <0.5cm, contains yellow cloudy fluid Eg: folliculitis, acne Urticaria - Primary lesion; intensely pruritic Eg: Hives Cyst - Primary lesion; elevated, semi-solid, varies in size Eg: Sebaceous cyst Vesicle - Primary lesion; elevated cavity containing clear fluid Eg: herpes, varicella, contact dermatitis Bulla - Primary lesion; vesicle >0.5cm, superficial Eg: Blister Crust - Secondary lesion; thickened, dried out lesion, yellow, brown or honey-colored Eg: Impetigo, herpes zoster Scale - Secondary lesion; flakes, dry or greasy, silvery or white, shedding Eg. psoriasis Fissure - Secondary lesion; linear crack w/abrupt edges Eg: angular chelitis, eczema Erosion - Secondary lesion; partial break in epidermis Eg: Herpes simplex/zoster Ulcer - Secondary lesion; deeper depression extending into dermis Excoriation - Secondary lesion; self-inflicted abrasion, superficial, crusted Eg: Contact dermatitis Scar - Secondary lesion; permanent fibrotic change, replaced w/collagen Atrophic scar - Secondary lesion; skin level depressed w/loss of tissue Lichenification - Secondary lesion; prolonged intense scratching thickens skin Eg: Eczema Keloid - Secondary lesion; hypertrophic scar, results in elevated scar tissue
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Localized Lesion Distribution - Appears in one small area Eg: tinea corporis, impetigo, herpes simplex Regional Lesion Distribution - Involves specific region of the body Eg: Acne vulgaris, herpes zoster, psoriasis Generalized Lesion Distribution - Appears widely distributed in numerous areas Eg: Urticaria, disseminated drug eruptions Round/Discoid Lesion - Coin or ring-shaped Eg: Nummular eczema Oval Lesion - Oval shaped Eg: pityriasis rosacea Annular Lesion - Round, active margins w/central clearing Eg: tinea corporis Zosteriform Lesion - Following nerve/segment of the body Eg: Herpes zoster Polycyclic Lesion - Interlocking or coalesced circles Eg: psoriasis, urticaria Linear Lesion - In a line Eg: contact dermatitis Iris/Target Lesion - Pink macules w/purple central papules Eg: erythema multiform Stellate Lesion - Star-shaped Eg: meningococcal septicemia Serpiginous Lesion - Snake-like or wavy Eg: cutaneous larva migrans Reticulate Lesion - Net-like or lacy Eg: lichen planus Morbilliform Lesion - Confluent, salmon-colored E.g: rubeola Discrete Margins - Well-demarcated or defined Psoriasis Indistinct Margins - Poorly defined, having borders that merge into normal skin Nummular eczema Active Margins - Margin/lesion shows greater activity than center Tinea species eruptions Irregular Margins - Non-smooth Malignant melanoma Umbilicated Margins - Border raised above center w/center of lesion depressed Basal cell Advancing Margins - Expanding at margins Cellulitis Central Clearing - Lighter skin in center w/erythematous borders Tinea corporis Desquamation - Peeling/sloughing of skin Rash associated w/TSS Keratonic - Hypertrophic stratum corneum, hardening Calluses, warts
Bronchophony - "99" normal is muffled Pectoriloquy - "1,2,3" normal is indistinct Egophony - If "ee" sounds like "aa" this is abnormal Tactile fremitus - "99" with palms of hands on back; increased w/consolidation (PNA), decreased w/obstruction (emphysema, pneumothorax) Symmetric Expansion - Both hands placed w/thumbs at T9-10 level, deep breath AP Diameter - Normal is 1:2, COPD developes 1:1 (Barrel Chest) Respiratory Changes d/t Aging - Less mobile thorax, resp. muscle strength declines, Decreased elasticity of lungs, More rigid lung structure (harder to inflate) Cranial Bones - Frontal, parietal, temporal, occipital Sinuses - Can only palpate frontal, maxillary (others include ethmoid, sphenoid) Nose - Turbinates normally pink, pale and boggy w/chronic rhinitis TMJ - Place fingers in front of tragus, have pt open/close mouth and assess for clicking/snapping/crepitus/pain/tenderness over TMJ O.D. - Right Eye O.S. - Left Eye Optic Disc - Creamy yellow orange-pink, round/oval, distinct/sharply demarcated margins, cup to disc ration compares diameter of cup portion to total diameter of optic disc Retinal Vessels - Arteries brighter than veins, arteries 2:3 (artery: vein width) Macula - Small yellow central portion of retina; Fovea centralis located @center, ~5.5cm in diameter 20/20 Vision - Pt sees at 20ft what a normal person sees at 20 feet Eye Changes in Aging - Lacrimal glands involute, pupil size decreases, cataract formation, IOP (glaucoma), macular degeneration (loss of central) Lymph Nodes - Pre and post-auricular, Submandibular, tonsilar, submental, anterior cervical, deep cervical, posterior cervical, supraclavicular, infraclavicular, occipital, epitrochlear
- Axillary for breast exam Ear - Inspect (adults) pull up and back; inspect (pedi), pull down and back TM should be pearly gray w/cone of light, no perforations/bulging Pars Flaccida - Upper part of TM small and slack Pars Tensa - Lower portion of TM thicker and taut Inner Ear - Labyrinth, Vestibule, Semicircular Canals, Cochlea, Auditory Ossicles (Malleus, Incus, Stapes) Otitis Media (OM) vs. Otitis Externa (OE) - OM- Inner ear infection, TM bulges OE- "Swimmer's Ear" erythema of canal, discharge, usually no TM involvment Conductive vs. Sensorineural Hearing Loss - Conductive: Something external causes hearing loss (e.g. cerumen build-up) Sensorineural: Auditory Nerve VIII affected Weber Test - Assesses conductivity, test for unilateral deafness
- Conductive hearing loss: sound perceived greater on diseased side
- Sensorineural hearing loss: Sound is louder in good ear Rinne Test - Compares Air Conduction (AC) to Bone Conduction (BC). Normally, AC>BC. Abnormal in conductive hearing loss. Tonsil Grading - 1+ (visible)-4+ (touching each other)
Pharyngitis - Sore throat, fever, HA, malaise, tender nodes, ear pain Mononucleosis - Triad of Fever, Pharyngitis and Posterior Cervical Adenopathy Right Upper Quadrant - Liver, gallbladder, duodenum, head of pancreas Right Lower Quadrant - Cecum, Appendix Left Lower Quadrant - Sigmoid colon Left Upper Quadrant - Stomach, spleen, body of pancreas Abdominal Midline - Aorta, Uterus, Bladder Solid Viscera - Liver, pancreas, spleen, adrenal glands, kidneys, ovaries, uterus Hollow Viscera - Stomach, gallbladder, small intestine, colon, bladder Abdominal Pain, Visceral vs. Somatic - Visceral: nerve fibers in hollow organs; vague, poorly localized Somatic: sharper, more localized, follows dermatomes PE Findings of Appendicitis - Starts as epigastric pain, moves to RLQ Iliopsas, Obturator tests PE Findings of Cholecystitis - Positive Murphy's Sign RUQ pain, radiates to shoulder Ligaments - Bone to bone attachment Tendons - Muscle to bone attachment Rheumatoid Arthritis - Bilateral chronic inflammatory condition, insidious onset over weeks-months. Fatigue, malaise, morning stiffness of over an hour. Specialist needed. Osteoarthritis - Unilateral, degeneration of articular cartilage, pain worsens with exercise, morning stiffness/immobility, Herbedon's nodes. Treatable in primary care. Carpal Tunnel Syndrome - Any conditions that exerts pressure on median nerve at the wrist, including obesity, pregnancy, hypothyroidism, arthritis, trauma, diabetes, overuse. Tendon inflammation resulting from repetitive use. Tinel's Sign: Tap median nerve Phalen's Sign: Back of hands together causes tingling/numbness 33 Vertebrae - 7 Cervical 12 Thoracic 5 Lumbar 5 Sacral 3 - 4 Coccygeal Cranial Nerves I-XII - I. Olfactory: Sense of Smell II. Optic: Visual acuity, Snellen Chart, Confrontation Test III. Oculomotor: EOM, PERRLA, raise eyelids IV. Trochlear: Down and inward eye movement V. Trigeminal: Mastication, Teeth clench, Temporal muscles, Sensory (Forehead, Cheeks, Chin) VI. Abducens: Lateral eye movement VII. Facial: Facial muscles, close eyes, taste, smile, frown, close eyes, lift eyebrows, show teeth, puff out cheeks VIII. Acoustic: Hearing, Equilibrium IX. Glossalpharyngeal: Pharynx, gag
