Advanced physical assessment: Skin, Hair, Nails, Lymphatics, Head and Neck.

2 major layers of epidermis?

Stratum Corneum :protects, restricts water loss.Cellular Stratum : keratin cells synthesized

2 kinds of hair

Vellus?short, fine, soft, and nonpigmented
Terminal?coarser, longer, thicker, and usually pigmented

Stratum corneum layer of skin covering the nail root is ?

Stratum corneum layer of skin covering the nail root is the cuticle, or eponychium.

The soft tissue surrounding the nail border is called:

Soft tissue surrounding the nail border is the paronychium

Dusky blue coloring of the skin, lips and/or nail bed due to decreased oxygen level

cyanosis

Use the dorsal surface of your hands or fingers to feel ?

skin temperature

Skin Lesions - Types

Lesions : Any pathologic skin change or occurrence
Types: Primary?those that occur as initial spontaneous manifestations of a pathologic process.
Secondary?those that result from later evolution of or external trauma to a primary lesion.

Boils originate on hair follicles?

Furuncles

Furuncles involving several hair follicles ?

Carbuncles

Impetigo

bacterial skin infection characterized by isolated pustules that become crusted and rupture - honey colored crusting, highly contagious.

Stevens-Johnson Syndrome (SJS)

erythema multiforme

Acnthosis nigrans

Nonspecific reaction pattern associated with obesity, certain endocrine syndromes or malignancies, or as an inherited disorder.

Hair disorders

Alopecia areata : Sudden, rapid, patchy loss of hair, usually from the scalp or face
Scarring alopecia : Skin disorders of the scalp or follicles result in scarring and destruction of hair follicles and permanent hair
Traction alopecia : Prolonged tension

Onychomycosis (Tinea Unguium)

fungal nail infection

leukonychia punctata

White spots on nail from injury

Onycholysis

Lifting of the nail plate from the nail bed without shedding, usually beginning at the free edge and continuing toward the lunula area.

Nails: Changes Associated with Systemic Disease

Koilonychia (spoon nails):
Central depression of the nail with lateral elevation of the nail plate.
Beau lines : Transverse depression in the nail bed
White banding (Terry nails) : Transverse white bands
Psoriasis : Chronic and recurrent disease of kerati

tracheal tugging

effect of an aortic aneurysm in which the trachea is pulled downward with each heart contraction

Macewen sign

percussion of the skull near the junction will be resonant; the sign associated with increased intracranial pressure after fontanels are closed.

Tortocollis

torticollis can happen due to positioning in the womb or after a difficult childbirth. This is called infant torticollis or congenital muscular torticollis.

Piaget's disease

acorn shaped skull. enlarged skull bones

Mask-Like"face with a staring look and elevated eyebrow ?

Parkinson's disease

face

Scleroderma-"Tightened-Hard" facewith thinning of the facial skin�
Cachexic -"Sunken" face with depressed eyes and hollow cheeks�
Nephrotic Syndrome -pale, edematous face�
Hyperthyroidism-Exophthalamus�
Hypothyroidism-Myxedema

A bifid uvula may be an indication of what structural abnormality?

cleft palate

Self-limiting inflammation of unknown cause. Sudden onset with occurrence of primary (herald) oval or round plague with fine, superficial scaling. Generalized eruption 2-3 weeks later, last for several week. Appears on the trunk/extremities, usually in pa

Pityriasis Rosea:

viral (varicella) infection, usually of a single dermatome, consists of red, swollen plaques or vesicles that become filled with purulent fluid. Pain itching or burning of dermatome usually precedes eruption by 4-5 days.

Herpes Zoster

Viral infection produces tenderness, pain, paresthesia or mild burning at the infected site before onset of lesions. Grouped vesicles appear on an erythematous base & then erode, forming a crust. Lesions last 2-6 weeks. Type 1 oral, Type 2, genital, but c

Herpes Simplex

Bulla

a large blister that is usually more than 0.5 cm in diameter

vitligo

localized loss of skin pigmentation characterized by milk-white patches

spider angioma

A form of telangiectasis characterized by a central elevated red dot the size of a pinhead from which small blood vessels radiate. liver diseases

Bluish spider, linear or irregularly shaped, does not blanch with pressure. Causes increased pressure in superficial veins

venous star

ABCDEs of melanoma

Asymmetric, border irregular, color variance, diameter >0.6 cm, evolution

Chronic, recurrent, erythematous scaling eruption is localized in areas with sebaceous glands are concentrated (scalp, back, intertriginous & diaper areas). Scalp lesions are scaling, adherent, and thick, yellow & crusted ("cradle cap") & can spread over

seborrheic dermatitis

Pigmented, raised, warty lesion, usually on face or trunk. Differentiate from actinic keratoses

Seborrheic Keratoses.

Pityriasis Versicolor (Tinea Versicolor)

Malassezia furfur, dimorphic, normal flora, lipophilic -- sebaceous glands (head, trunk, upper back) will cause hyphal phase and disease. more often in warmer climates. yellow-brown to dark brown color (hyper or hypo pigmentation and failure to tan)
KOH p

Mr. McDonnel is a 29-year-old patient who presents to the office with complaints of enlarged lymph nodes just inferior to the chin. Nodes that are palpable just inferior to the chin are the ______________ nodes.
a. infraclavicular
b. submental
c. submandi

b. submental

Cells that line the lymph node sinuses perform the specific function of:
a. fat absorption.
b. fetal immunization.
c. hematopoiesis.
d. phagocytosis.

d. phagocytosis

Lymph flows faster in response to:
a. increased metabolic activity.
b. decreased blood volume.
c. decreased metabolic rate.
d. decreased permeability of the capillary walls.

a. increased metabolic activity;; massage.

Mr. Shea is a 45-year-old patient who presents to the office for multiple complaints. The examination of the upper left quadrant of the abdominal cavity is essential to the evaluation of the immune system because of the location of which organ?
a. Spleen

a. Spleen

Mrs. Farrel brings in her 6-year-old son with complaints of a sore throat and fever. As the health care provider, you are concerned about his tonsils and adenoids. Enlarged tonsils and adenoids may obstruct the:
a. thoracic duct.
b. esophagus.
c. nasophar

c. nasopharyngeal passageway.

Mrs. Sing is a 44-year-old patient who presents to the office with a complaint of enlarged lymph nodes. When enlarged, which lymph nodes are most likely to be a sign of pathology (e.g., malignancy)?
a. Occipital
b. Anterior cervical
c. Supraclavicular
d.

c. supraclavicular

As adults age, their ability to resist infection is reduced because of the lymphatic nodes becoming more:
a. fibrotic.
b. mucoid.
c. porous.
d. profuse.

a. fibrotic

Ms. Hartzel is a 33-year-old patient who presents to the office with complaints of enlarged lymph nodes in her neck. During your examination, which part of the hand is used to assess lymph node size?
a. Pads of the fingers
b. Tips of the fingers
c. Palm
d

a. pads of the fingers

Which landmark is the dividing line between the anterior and posterior cervical triangles?
a. Clavicle
b. Cervical spine
c. Sternocleidomastoid
d. Sternum

c. sternocleidomastoid

The harder and more discrete a node, the more likely that there is a(n):
a. innocent cause.
b. infection.
c. malignancy.
d. metabolic disease.

c. malignancy

Which of the following findings indicates that the examiner is assessing a blood vessel rather than a lymph node?
a. A bruit
b. Inflammation
c. Tenderness
d. Redness

a. bruit

Transillumination is performed during an examination of the lymphatic system to:
a. detect lymphatic pulsation.
b. distinguish nodes from cysts.
c. evaluate nodal contours.
d. observe erythematous lesions

b. distinguish nodes from cysts.

Nodes located over the mastoid process are the ____________ nodes.
a. preauricular
b. postauricular
c. occipital
d. epitrochlear

b. postauricular

When examining lymph nodes near a joint in the arm or leg, which of the following maneuvers is likely to facilitate the examination?
a. Extension of the extremity
b. Circumduction of the extremity
c. Flexion of the extremity
d. Rotation of the extremity

c. flexion of the extremity

To palpate the inguinal nodes, you should have the patient:
a. bend over a table and cough.
b. lie supine with knees slightly flexed.
c. lie supine with legs extended.
d. stand and cough vigorously.

b. lie supine with knees slightly flexed

Obstruction of the nasopharynx, pulmonary hypertension, and risk of sleep apnea may be associated with excessively enlarged:
a. branchial cleft cysts.
b. cystic hygromas.
c. palatine tonsils.
d. thyroglossal duct cysts.

c. palatine tonsils

Enlarged inguinal nodes are likely to be associated with:
a. genital herpes.
b. pelvic inflammatory disease.
c. uterine cancer.
d. testicular cancer

a. genital herpes

Mrs. Cousins is a 35-year-old patient who presents to your clinic. Your diagnosis is acute cervical lymphadenitis. Which of the following is the most likely etiology?
Group A beta-hemolytic strep
Pneumocystis carinii infection
Milroy disease
Infectious mo

Group A beta-hemolytic strep