Untitled Quiz

Skin Lesions

• Teach patients about the ABCDEF of skin lesions: Asymmetry, Border irregularity, Color variation, Diameter greater than 6 mm, Elevated, and Feeling (e.g., firm, tender).
• Shape of Lesions:
  • Round: Circular with a smooth edge.
  • Oval: Elliptical with a smooth edge.
  • Annular: Circular with a central clearing.
  • Linear: Long and narrow, in a straight line.
• Toxic epidermal necrolysis is a serious skin reaction that is more severe than Stevens-Johnson syndrome.
  • Symptoms include:
    • Flu-like symptoms like fever and chills.
    • Skin blisters and peeling, leading to raw and painful areas.
    • Involvement of the mucous membranes.
  • Complications include:
    • Dehydration due to fluid loss from the skin.
    • Sepsis, a serious infection in the bloodstream.
    • Pneumonia, an infection of the lungs.
    • Multi-organ failure (MOF).

Primary Skin Lesions

• Macule: A flat, non-palpable lesion less than 1 cm in diameter.
• Patch: A flat, non-palpable lesion greater than 1 cm in diameter.
• Papule: A solid, raised, palpable lesion less than 1 cm in diameter.
• Plaque: A solid, raised, palpable lesion greater than 1 cm in diameter.
• Vesicle: A fluid-filled lesion less than 1 cm in diameter.
• Bulla: A fluid-filled lesion greater than 1 cm in diameter.

Eschar

• A dry, dark scab or crust formed over a wound or burn.
• It's a sign of tissue death and injury.

Herpes Zoster (Shingles)

• A reactivation of the varicella zoster virus (VZV), the same virus that causes chickenpox.
• Characterized by a painful, blistering rash that typically affects one side of the body.
• The rash usually follows a nerve pathway.
• The rash can leave behind long-term nerve pain, known as postherpetic neuralgia.

Nails

• Clubbing: A condition characterized by thickening and widening of the fingertips with a curved or rounded appearance of the nails.
• Onchomycosis: A fungal infection of the nail that can cause discoloration, thickening, and crumbling of the nail.
• Paronychia: An infection of the skin around the nail that can cause redness, swelling, and pain.
• Splinter hemorrhages: Small red or brown lines that appear under the nail.
• Beau's lines: Grooves or dents that run across the nail.
• Koilonychia: A condition characterized by spoon-shaped nails with thin, concave surfaces.

Head: Abnormality

• Auscultation for temporal bruit: A whooshing sound heard during auscultation over the temporal artery, which may indicate an aneurysm.
• Major landmarks:
  • The eyes, ears, nose, and mouth should be symmetrical.

Head: Anatomy & Physiology

• Cranial Nerves involved:
  • CN V (Trigeminal nerve): Responsible for sensory innervation to the face.
  • CN VII (Facial nerve): Responsible for motor function of the facial muscles.

Eyes: General Assessment

• Snellen chart: Used to test visual acuity.
• Geiger Chart: Used to assess near vision.
• Confrontational test: Used to identify peripheral vision field defects by comparing the patient's peripheral vision to your own.
• Fixation: The ability of the eye to focus on a stationary object.
• PERRLA: Pupils Equal, Round, Reactive to Light, and Accommodation.

Eye movement

• Six cardinal fields of gaze: These movements test the extraocular muscles and their associated cranial nerves.
• The eyes should move smoothly and symmetrically in all directions.

Cataracts

• Cataract formation:
  • Clouding of the natural lens inside the eye.
  • Typically occurs with age.
  • Can also occur as a result of injury or disease.
  • Can cause blurred vision, halos around lights, and difficulty seeing at night.

Eye Cranial Nerves

• CN II (Optic nerve): Responsible for vision.
• CN III (Oculomotor nerve): Controls pupillary constriction and eye movement.
• CN IV (Trochlear nerve): Controls eye movement downwards and inwards.
• CN VI (Abducens nerve): Controls eye movement outwards.
• Consensual constriction: When both pupils constrict at the same time when light is shone into one eye.

Ears: General Assessment

• Inspect the external ear: Note the size, shape, position, and symmetry of the ears.
• Palpate the external ear: Feel for tenderness, nodules, or masses.
• Inspect the ear canal: Look for any redness, swelling, discharge, or foreign bodies.
• Palpate the mastoid process: Feel for tenderness, which may indicate an ear infection.

Ears: Hearing Assessment

• Conductive hearing loss: When sound waves cannot pass through the outer and middle ear.
  • Partial loss: The patient can hear if the sound is loud enough.
  • May be helped by hearing aids.
• Sensorineural (perceptive) hearing loss: Occurs when there is damage to the inner ear or the auditory nerve. This is a more permanent type of hearing loss.
• Young adult hearing loss causes: Exposure to loud noises, medications, infections, genetic conditions.
• Hearing loss in aging adults: Can be caused by age-related changes to the inner ear, such as the loss of hair cells.
  • Other causes include:
    • Medications
    • Medical conditions
    • Exposure to loud noises
• Eustachian tube dysfunction: A condition that can cause problems with hearing and balance.
  • The Eustachian tube is a tube that connects the middle ear with the nasopharynx.
  • When this tube is blocked, pressure can build up in the middle ear, leading to ear pain, hearing loss, and a feeling of fullness in the ear.

Ears: Inner/Middle/External Ear

• External ear: The part of the ear that you see, and which collects sound waves.
• Middle ear: The chamber behind the eardrum.
• Inner ear: Contains the cochlea, which is responsible for converting sound waves into electrical signals that the brain can interpret.
  • The inner ear also includes the semicircular canals, which are responsible for balance.

Breath Sounds: General

• Bronchial: High-pitched sounds heard over the trachea and bronchi.
• Vesicular: Soft, breezy, and low-pitched sounds heard over the peripheral lung fields.
• Bronchovesicular: A combination of bronchial and vesicular sounds heard over the main bronchi.

Adventitious Lung Sounds

• Crackles (Rales): High-pitched, crackling sounds that can be heard during inspiration.
  • They may indicate fluid in the alveoli (tiny air sacs in the lungs).
• Wheezes: High-pitched, whistling sounds that can be heard during inspiration or expiration.
  • Usually indicate narrowing of the airways, such as in asthma or bronchitis.
• Rhonchi: Low-pitched, rattling sounds that can be heard during inspiration or expiration.
  • Often associated with mucus buildup in the airways.
• Pleural friction rub: A grating or scratching sound heard when the pleurae, the two membranes that surround the lungs, rub against each other because of inflammation.
• Stridor: A high-pitched, crowing sound that is usually heard during inspiration.
  • Indicates an obstruction in the upper airway, such as the trachea or larynx.
• Grunting: is a low-pitched sound made during exhalation.
  • It can be a sign of respiratory distress in infants.
• Stridor: A high-pitched, crowing sound that is usually heard during inspiration.
  • Indicates an obstruction in the upper airway, such as the trachea or larynx.
• Wheezes: High-pitched, whistling sounds that can be heard during inspiration or expiration.
  • Usually indicate narrowing of the airways, such as in asthma or bronchitis.
• Rhonchi: Low-pitched, rattling sounds that can be heard during inspiration or expiration.
  • Often associated with mucus buildup in the airways.
• Pleural friction rub: A grating or scratching sound heard when the pleurae, the two membranes that surround the lungs, rub against each other because of inflammation.

Oral Abnormalities

• Dental caries (cavities): Holes in the teeth caused by bacteria.
• Gingivitis: Inflammation of the gums.
• Periodontal disease: A serious gum infection that can damage the soft tissues and bones that support the teeth.
• Oral candidiasis (thrush): A fungal infection in the mouth that causes white patches on the tongue, cheeks, and roof of the mouth.
• Halitosis (bad breath): A condition caused by bacteria in the mouth that produce sulfur compounds.
• Leukoplakia: White patches on the mucous membranes of the mouth that are not easily scraped off.
• Oral cancer: Cancer of the mouth, tongue, lips, or throat.

Abnormal Findings

• Coated tongue: A white or yellow coating on the tongue, which can be a sign of dehydration, infection, or poor oral hygiene.
• Swollen tonsils: Enlarged tonsils can be a sign of infection, such as tonsillitis.
• Red, swollen gums: Gingivitis.
• Dry mouth: Xerostomia.
• Receding gums: Periodontal disease.
• Missing teeth: Can be caused by trauma, decay, or periodontal disease.
• Loose teeth: Can be a sign of periodontal disease.
• Tooth discoloration: Can be caused by smoking, certain medications, or poor oral hygiene.

Oral Assessment

• Inspect the oral cavity: Look for any abnormalities in the teeth, gums, tongue, lips, and roof of the mouth.
• Palpate the oral cavity: Feel for any lumps, bumps, or tenderness.

Nasal Abnormalities

• Epistaxis (nosebleed): Bleeding from the nose.
• Nasal polyps: Small, fleshy growths in the nose.
• Sinusitis: Inflammation of the sinuses.
• Deviated septum: When the septum, the wall that separates the nasal passages, is crooked.
• Nasal airflow obstruction: Difficulty breathing through the nose, which can be caused by polyps, a deviated septum, or swelling of the nasal mucosa.

Nasal Assessment

• Kiesselbach plexus: Located in the septum, a common site of nosebleeds.

Sinuses Assessment

• Sinusitis: An inflammation of the sinuses, which are air-filled spaces in the skull that help produce mucus and filter the air we breathe. The sinuses have narrow openings that can easily become blocked by inflammation.
• Swelling and Inflammation: Can lead to sinusitis.

Thoracic Assessment

• Inspect the chest: Examine shape, symmetry, and chest wall movement.
• Palpate the chest: Check for tenderness, lumps, and masses.
• Percuss the chest: Not done on the thyroid gland.

Lung Anatomy

• Lungs:
  • Right lung has 3 lobes, and the left lung has 2 lobes.
• Apex: The highest point in the anterior chest.
• Base: The bottom of the lungs, resting on the diaphragm.
• Pleurae: The two membranes that surround the lungs.
  • Visceral pleura: Covers the lungs.
  • Parietal pleura: Lines the chest wall.
  • The pleurae maintain a vacuum that keeps the lungs expanded.