Skin Lesions Overview and Classification

Skin Lesions

• ABCDEF Skin Lesions: A - Asymmetry, B - Border, C - Color, D - Diameter, E - Elevation, F - Feeling.
• Shape of Lesions:
  • Circular: Round with a defined edge.
  • Oval: Elongated and rounded.
• Photophobia: Sensitivity to light.
• Toxic Epidermal Necrolysis: More severe than Steven Johnson Syndrome.
  • Symptoms: Flu like, fever, after initial symptoms: skin blisters and peels.
  • Complications: Dehydration, sepsis, pneumonia, multi-organ failure.

Primary Lesions

• Macule: Flat, level with the surface of the skin, less than 1cm.
• Patch: Flat, level with the surface of the skin, greater than 1cm.
• Papule: Solid, elevated lesion, less than 1cm.
• Plaque: Solid, elevated lesion, greater than 1cm.
• Vesicle: Blister containing fluid or blood, less than 1cm.
• Bulla: Blister containing fluid or blood, greater than 1cm.

Eschar

• A dry, dark scab or crust that forms over a wound.
• Can be a sign of burns, infection, or other skin injuries.

Herpes Zoster

• Also known as shingles.
• It is a viral infection caused by Varicella-zoster virus.
• Symptoms: Painful rash that appears in a specific area of the body.
• Complications: Postherpetic neuralgia - persistent pain after the rash clears.

Nails

• Changes in nail appearance can indicate underlying health conditions.
• Normal nail: Smooth, pink, with a firm consistency.
• Abnormal Nails:
  • Clubbing: Bulging of the ends of the fingers and toes.
  • Beau's Lines: Horizontal grooves or ridges across the nail.
  • Splinter Hemorrhages: Small red streaks under the nail.
  • Onycholysis: Separation of the nail from the nail bed.
  • Paronychia: Inflammation of the skin around the nail.

Head Abnormalities

• Auscultation for temporal bruit: Auscultating (listening with a stethoscope) over the temporal artery to detect a pulsating sound.
• Temporal Bruit: Indicates blockage or narrowing of the temporal artery.

Head Anatomy and Physiology

• Major Landmarks:
  • Temporal Artery: Located on both sides of the head,
  • Occipital Artery: Located at the back of the head.
• Symmetry of landmarks is important for assessing nerve function.
• Cranial Nerves: Nerves that originate from the brain.
  • Cranial Nerve VII: Facial nerve.
  • Cranial Nerve VIII: Vestibulocochlear nerve.

Eyes: General Assessment

• Snellen Chart: Used to test visual acuity.
• Geiger Chart: Used to assess near vision.
• Confrontational Test: Used to test peripheral vision.
• Fixation: The ability of the eyes to focus on a single point.
• PERRLA: Pupil, Equal, Reactive, Round, Light, Accommodation.
  • Pupils: The black circles in the center of the eyes.
  • Equal: Pupils should be the same size.
  • Reactive: Pupils should constrict in response to light.
  • Round: Pupils should be round.
  • Light: Pupils should constrict in response to light.
  • Accommodation: Pupils should focus on a nearby object and then a distant object.

Eye Movement

• Six Cardinal Directions of Gaze:
  • Up and right, Up and left, Down and right, Down and left, Right, Left.
• Nystagmus: Involuntary, rapid, rhythmic movements of the eyes.

Cataracts

• Cataract Formation: Clouding of the lens of the eye.
  • Can occur with age or as a result of injury.
  • Can also be caused by diabetes or other medical conditions.

Eye Cranial Nerves

• Cranial Nerve II: Optic nerve. Responsible for vision.
• Cranial Nerve III: Oculomotor nerve. Controls eye movement, pupil constriction, and eyelid opening.
• Cranial Nerve IV: Trochlear nerve. Controls the superior oblique muscle of the eye.
• Cranial Nerve VI: Abducens nerve. Controls the lateral rectus muscle of the eye.
• Consensual Constriciton: Both pupils constrict at the same time when light is shone in one eye.

Ears: General Assessment

• External Ear: Outermost part of the ear.
  • Examined for size, shape, and any deformities.
• Middle Ear: Located inside the ear.
  • Examined for signs of inflammation, fluid, or infection.
• Inner Ear: Located deep inside the ear.
  • Examined for signs of damage or disease.

Ears Hearing

• Conductive Hearing Loss: Sound waves cannot pass through the outer and middle ear.
  • Hearing aids can help with conductive hearing loss.
• Sensorineural Hearing Loss: Damaged hair cells in the inner ear.
• Presbycusis: Age-related hearing loss.
  • Caused by changes in the inner ear or auditory nerve.
• Eustachian Tube Dysfunction:
  • The Eustachian tube is a tube that connects the middle ear to the back of the nose.
  • Dysfunction can cause fluid buildup in the middle ear, leading to ear infections or hearing loss.

Ears - Inner, Middle, and External

• Inner Ear:
  • Contains the cochlea (responsible for hearing) and the vestibular system (responsible for balance).
• Middle Ear:
  • Contains the three small bones (ossicles) that transmit sound vibrations.
  • Connected to the inner ear by the oval window.
• External Ear:
  • Composed of the auricle and ear canal.
  • Acts as a funnel to collect sound waves.

Breath Sounds: General

• Bronchial: Loud, high-pitched sounds typically heard over the trachea and major bronchi.
• Vesicular: Soft, low-pitched sounds heard over most of the lung fields.
• Bronchovesicular: Intermediate sounds heard between the scapula and over the main bronchi.

Adventitious Lung Sounds

• Wheezes: High-pitched, whistling sounds heard during expiration.
• Rales: Crackling or popping sounds heard during inspiration.
• Rhonchi: Low-pitched, rumbling sounds heard during inspiration or expiration.
• Pleural Friction Rub: Grating or squeaking sound heard during inspiration or expiration.

Oral Abnormalities

• Halitosis: Bad breath.
• Dryness: Excessive dryness of the mouth.
• Dental Caries: Tooth decay.
• Periodontal Disease: Gum disease.
• Gingivitis: Inflammation of the gums.
• Stomatitis: Inflammation of the mouth.

Oral Abnormal Findings

• Leukoplakia: White patches on the mucous membranes of the mouth.
• Candidiasis: Yeast infection of the mouth.
• Aphthous Ulcers: Small painful sores in the mouth.
• Herpes Simplex Virus: Cold sores or fever blisters.

Oral Assessment

• Tongue - The tongue should be pink, moist, and smooth.
• Lips - The lips should be pink and moist and show no signs of cracking or swelling.

Nasal Abnormalities

• Epistaxis: Nosebleed.
• Rhinorrhea: Runny nose.
• Sinusitis: Inflammation of the sinuses.
• Nasal Polyps: Soft, fleshy growths in the nose.
• Nasal Obstruction: Difficulty breathing through the nose.

Nasal Assessment

• Kiesselbach Plexus: A network of blood vessels located in the septum of the nose. A common site of nosebleeds.

Sinuses Assessment

• Sinusitis: Inflammation of the sinuses, which are air-filled spaces in the skull.
  • Sinuses openings are narrow and easily occluded.

Thoracic Assessment

• Inspect the chest for symmetry, shape, and any deformities.
• Percussion: Tapping on the chest to assess the density of the underlying tissue.
  • Percussion is not performed over the thyroid gland.

Lung Anatomy

• Right Lung: Has 3 lobes (upper, middle, and lower).
• Left Lung: Has 2 lobes (upper and lower).
• Apex: Highest point in the lung.
• Base: Lowest point in the lung.
• Pleura: Two thin layers of tissue that surround the lungs.
  • Visceral Pleura: Covers the lungs.
  • Parietal Pleura: Lines the chest wall.