CMS100 Practical Exams PDF

CMS100 Practical Exams DO NOT FORGET TO SANITIZE YOUR HANDS “Hello, my name is Athena, and I am naturopathic medical student. Today I am going to be performing a series of physical exams, do I have your consent to do so?” Remain standing on the RIGHT SIDE of your patient (best for charting) Physical...

CMS100 Practical Exams DO NOT FORGET TO SANITIZE YOUR HANDS “Hello, my name is Athena, and I am naturopathic medical student. Today I am going to be performing a series of physical exams, do I have your consent to do so?” Remain standing on the RIGHT SIDE of your patient (best for charting) Physical Exam Dermatology Exam Technique What to Verbalize Inspect and palpate the skin: - First, assess the skin on the scalp, this includes assessment of: parting different sections of the hair Skin Color: look for to better visualize the skin underneath. Explore the areas from changes in pigmentation, redness, pallor, cyanosis the frontal region to the occiput, around the posterior neck and and yellowing of the skin. Pallor is seen on the neckline, as well as around and behind the ears. fingernails, lips, and mucous membranes - Next observe the skin on the face, particularly of the mouth paying attention to the areas around and palpebral conjunctiva. the eyebrows, eyes, nasolabial folds, In dark skinned and under the chin. Pull the lower individuals inspecting the lids down to observe the conjunctival palms and soles for pallor rim (as part of an assessment of might also be useful pallor in mucous membranes) if Central cyanosis is best indicated. identified in the lips, oral mucosa, and tongue. Be aware the darker skinned individuals have melanin in their lips that may simulate cyanosis. Cyanosis of the nails, hands and feet can be central or peripheral in origin. Jaundice (yellow colouring of skin) can be observed in the sclera, Pathology Practice Question: 1. Try to name at least 3 other descriptors you could add if you had more information from the image. This is a melanoma. An accurate description would include: a macule/papule, asymmetrical shape, with irregular borders, brown in colour with variation of darker brown in 1/3rd of the lesion. 2. Match the description with the image - Also examine the anterior neck, and upper shoulders to the level of the clavicles. Roll up the sleeves of the gown on both sides and expose the entire arm from the forearm to the upper arm and axillary area. Examine the dorsal and ventral surfaces of both arms, as well as the elbows, wrists, dorsal and palmar aspects of the hands, and fingers. Be careful to examine the areas between the fingers in the webs. - Note the skin around the proximal and lateral nail folds and observe the nails – shape, contour, and texture. - Then ask the patient to stand and raise their gown up to mid-thigh. This will allow you to examine most of the upper leg, and lower leg, from both anterior and posterior aspects. Be careful to examine up to the ankles (medial and lateral aspects), and behind the knees. *Note upper and lower leg examination can also be completed with the patient seated (for anterior surfaces) or lying supine and prone (for anterior and posterior surfaces) with appropriate draping palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane, and skin! Moisture: look for dryness, sweating and oiliness Temperature: use the backs of your hands to assess the temperature of the skin on the arms and legs. Note the temperature on any red areas. Texture: palpate the skin for any roughness or smoothness Mobility and turgor: lift a fold of skin on the dorsum of the hand, subclavicular fossa, or anterior thigh for 3 seconds so that it is tented and then release; observe its ability to change shape and return to normal. o In a study to assess the sensitivity and specificity of the main clinical characteristics of elderly people with hypernatremia, skin turgor was measured. Skin turgor was found to be decreased if tenting lasted > 3 seconds following 3 seconds of skin D: Multiple, hypopigmented macules and patches symmetrically distributed on the upper chest (or anterior thoracic) region, extending to upper arms, varying in size. This is a presentation of tinea versicolor. B: Multiple, raised, red and scaly patches of skin on the dorsum of the right hand, extending to the fingers. Appears to have thick silvery/white dry scale, with a rough texture. This is a typical presentation of plaque psoriasis. - Ask the patient to be seated and expose the posterior thoracic region. Be sure to be able to observe the lateral aspects of the thorax and abdomen to the mid-axillary line, and from the neck to the level of L5. Nails: Inspect and palpate the fingernails and toenails. Note their color, shape, and any lesions. Longitudinal bands of pigment may be seen in the nails of healthy, darkerskinned individuals. Here are some examples of nail signs and disorders. Try looking up some images as well for more clarity. - pinching. The researchers found that abnormal sub clavicular and anterior thigh skin turgor was significantly and independently associated with hypernatremia in patients. Skin Lesions: note their characteristics. Inspect and palpate the fingernails and toenails: note their colour and shape and whether any lesions are present. Skin lesions can be described in the following ways… macule, a flat, nonpalpable circumscribed area (up to 1 cm) of color change that's brown, red, white, or tan. patch, a flat, nonpalpable lesion with changes in skin color, 1 cm or larger. papule, an elevated, palpable, firm, circumscribed lesion up to 1 cm plaque, an elevated, flattopped, firm, rough, superficial lesion 1 cm or larger, often formed by coalescence of papules. A: Two annular lesions on forearm, appear to be about 1cm in diameter, circular with red (erythematous), raised borders that are crusty, with central clearing. This is tinea corporis (ringworm). C: Red (Erythematous), raised wheals on inner thigh and around the knee, asymmetrical distribution, regular borders, small wheals as well as one larger coalesced wheal. This is urticaria (hives). 3. Describe the image below one a piece of paper using the descriptors learned. nodule, an elevated, firm, circumscribed, palpable area larger than 0.5 cm: it's typically deeper and firmer than a papule. cyst, a nodule filled with an expressible liquid or semisolid material. vesicle, a palpable, elevated, circumscribed, superficial, fluid-filled Note the same image up close in blister up to 1 cm. different skinned individuals… bulla, a vesicle 1 cm or larger, filled with serous fluid. pustule, which is elevated and superficial, like a vesicle, but is filled with pus. wheal, a relatively transient, elevated, irregularly shaped area of localized skin edema. Most wheals are red, pale pink, or white. scale, a thin flake of dead exfoliated epidermis. crust, the dried residue of skin exudates such as serum, pus, or blood. lichenification, visible and palpable thickening of the epidermis and roughening of the skin with increased visibility of the normal skin furrows (often from chronic rubbing) excoriation, linear or Jaundice - Appearance of Yellow Sclera punctuate loss of epidermis, usually due to scratching. Cianosis Note the differences in appearance of cyanosis in individuals of different Consider the ABCD(E) method to colour of skin, as well as the areas of cyanosis on extremities (peripheral screen for melanoma in cyanosis) and lips/tongue (central describing moles… cyanosis). As a fun activity try to find A: Asymmetry images of healthy individuals to compare B: Border – irregular with these images provided. C: Colour variation D: Diameter > 6mm Image 1: Peripheral cyanosis E: Evolution/change - as part of your history/examination Image 2-4: Central cyanosis in different skinned individuals Back - Jaundice – appearance of yellow sclera Blood Pressure 1. Place deflated cuff on patient’s arm, Normal: