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What is Clubbing?
Thickened and rounded nail end with spongy proximal fold
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What is clubbing indicative of? - 5
- Cardiac - cyanosis
- Lung - cancer, chronic hypoxia
- GI - Crohn's; Ulcerative colitis
- Biliary cirrhosis
- Neoplasm
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Test for clubbing - name + describe
- Schamroth’s window test
- Loss of diamond shaped space when nails from hands are placed back to back
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Splinter hemorrhages - define + what it indicates
- Small areas of bleeding under nails
- Potential cardiac or renal signs
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Cherry red skin color on palms means what?
Liver or renal issues
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Halo of erythema, warmth, and swelling may indicate what?
Infection (cellulitis)
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Trophic changes may indicate what?
Poor arterial nutrition
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Cyanosis skin color indicates what? - 4
- Cardiac - CHF
- Advanced lung disease
- Venous obstruction
- Arterial obstruction
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Temporary pallor seen w/what? - 5
- Arterial insufficiency and syncope
- Chills
- Shock
- Vasomotor instability
- Nervousness
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Yellow skin color indicates what? - 2
- Jaundice, liver disease
- Look for yellow color in sclera of eyes, lips, skin
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Brown skin color indicates what?
INC pigmentation associated w/venous insufficiency (i.e., hemosiderinosis)
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Local warmth of reddened areas may indicate what? - 2
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Hirsutism - define + seen w/what pathologies (3)?
- Male pattern hair growth in women
- Polycystic ovary syndrome
- Cushing’s
- Tumor
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What is Hidrosis?
- Moist skin (hyperhidrosis)
- INC perspiration
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Dry skin (hypohidrosis) can indicate what? - 4
- Dehydration
- Ichthyosis
- Hypothyroidism
- Seen in later stages of diabetes mellitus
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Urticaria - define + indicates what?
- HIVES - Smooth, red, elevated patches of skin
- An allergic response to drugs or infection
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Xeroderma - define + indicates what?
- Excessive dryness of skin w/shedding of epithelium
- Deficiency of thyroid function + Diabetes
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What is Ecchymosis?
BRUISE
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What is Petechiae?
Tiny red/purple hemorrhagic spots on skin
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Pruritus - define + when is it common (3)
- Itching
- Diabetes
- Drug hypersensitivity
- Hyperthyroidism
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Turgor - define + test
- Hydration status
- Lift skin on back of hands
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Macule
Flat spot up to 1 cm
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Palpable elevated solid mass - 3
- Papule = <1 cm
- Plaque = >1 cm
- Nodule = marble like
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Wheal
Irregular, localized, skin edema
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Benign tumors - 3
- Seborrheic keratosis
- Actinic keratosis
- Benign nevus
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Actinic keratosis - 2
- Flat, round, irregular lesions covered by dry scale on sun-exposed skin
- Precancerous
- Can lead to squamous cell carcinoma
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Benign nevus - 4
- Sharply defined borders
- Uniform color
- < 6mm
- Flat or raised
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Name malignant tumors - 4
- Basal cell carcinoma
- Squamous cell carcinoma
- Malignant melanoma
- Kaposi’s Sarcoma
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Basal cell carcinoma - 3
- Raised patch w/ivory appearance OR reddened area of eczema
- Rolled border
- Indented center
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Squamous cell carcinoma - 3
- Flat red area
- Poorly defined margins
- Ulcer or nodule
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ABCDEs of Malignant Melanoma
- A - asymmetry
- B - border
- C - color
- D - diameter
- E - elevation
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Diameter of malignant melanoma
> 6mm
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Kaposi’s sarcoma - define & S/S (4)
- MALIGNANT tumor d/t human herpes virus
- Red or dark purple/blue macule
- Progress to nodules or ulcers
- Itching
- Pain
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Dermatitis - acute, subacute, chronic - 3 each; avoid use of what?
- Acute - Red, oozing, crusting rash
- Subacute - erythema, scaling, scattered plaques
- Chronic - thickened skin, fibrotic nodules
- AVOID USE OF ALCOHOL
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Stasis dermatitis - results from what? looks how?
- Result of venous insufficiency
- Look - dry skin w/shallow ulcers
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Impetigo - 3
- Contagious superficial skin infection caused by staphylococci or streptococci
- Common in Children & elderly
- Look - inflammation; small pus-filled vesicles; itching
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Herpes 1 (herpes simplex) vs Herpes 2
- Both - Viral infection
- 1 - cold sore or fever blister
- 2 - genital
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Herpes 2 & newborns
May cause meningoencephalitis - can be fatal
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Herpes zoster (shingles) - 5
- Viral infection caused by varicella-zoster virus (chickenpox)
- Fever, Chills
- Malaise
- GI disturbances
- Ocular complications w/(CN) III involvement - eye pain, corneal damage, loss of vision
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Shingles - PT contraindication - 2
- Heat
- Ultrasound
- Both can INC severity of symptoms
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Management of warts - 4
- Cryotherapy
- Acids
- Electrodessication and curettage
- Over-the-counter medications
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Tinea corporis - 4
- Ringworm - Fungal infection of hair/skin/nails
- Forms ring-shaped patches w/vesicles or scales
- Itchy
- Transmission is through direct contact
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Tinea pedis - define + S/S (4)
- Athlete's foot - Fungal infection of foot, typically between toes
- Erythema
- Inflammation
- Pruritus, itching
- Pain
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Cellulitis - Describe look; Tx (3)
- Skin is hot, red, and edematous
- Antibiotics
- Elevation of part
- Cool, wet dressings
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If cellulitis goes untreated what can occur? - 4
- Lymphangitis
- Gangrene
- Abscess
- Sepsis
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Who is at INC risk for cellulitis?
- Elderly
- Individuals w/diabetes, wounds, malnutrition, or on steroid therapy
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Psoriasis - define, look, location
- Chronic autoimmune disease of skin
- Erythematous plaques covered w/silvery scale
- Location - ears, scalp, elbows, knees, genitals
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Precipitating factors for psoriasis - 8
- Trauma
- Infection
- Pregnancy
- Endocrine changes
- Cold weather
- Smoking
- Anxiety
- Stress
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Psoriasis - medical (topical & meds) & PT management - 2
- PT - Long-wave ultraviolet (UV) light
- Topical - corticosteroids, occlusive ointments, coal tar
- Meds - Immunosuppressive - methotrexate
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Systemic lupus erythematosus (SLE)? - 5
- Chronic, systemic inflammatory disorder
- Affects skin, joints, kidneys, heart, nervous system, mucous membranes
- Can be fatal
- Most affected - young women
- Red rash w/raised, red, scaly plaques
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Systemic lupus erythematosus (SLE) - S/S - 9
- Fever/Malaise
- Butterfly rash across bridge of nose
- Photosensitivity
- Skin lesions
- Chronic fatigue
- Arthralgia, arthritis
- Anemia
- Hair loss
- Raynaud's phenomenon
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What to observe for w/Systemic lupus erythematosus (SLE)?
Side effects of corticosteroids
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Side effects of corticosteroids - 6
- Edema
- Weight gain
- Acne
- Hypertension
- Bruising
- Purplish stretch marks
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What is long-term use of corticosteroids associated with? - 7
- INC susceptibility to infection (immunosuppressed patient)
- Osteoporosis
- Myopathy
- Tendon rupture
- Diabetes
- Gastric irritation
- Low potassium
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Scleroderma - 4
- Chronic, autoimmune disease of connective tissues
- Causes fibrosis of skin, joints, blood vessels, internal organs
- Symmetrical
- Skin - Taut, firm, edematous, firmly bound to subcutaneous tissues
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What is scleroderma usually accompanied by?
Raynaud's phenomenon
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Precautions w/sclerosed skin - 3
- Sensitive to P
- Acute HT may occur, stress regular BP checks/vital sign monitoring
- Pulmonary HT can lead to R sided heart failure in severe cases
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Polymyositis - 5
- Disease of connective tissues
- Onset - Rapid, severe
- Symmetrical distribution
- Proximal mms - shoulder/pelvic girdles, neck, pharynx
- Interstitial lung disease
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Polymyositis - PT - 2
- Fatigue management/conservation of energy principles
- Low level aerobic/resistance - additional mm damage w/too much exercise
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Hypothyroidism & hair
Thinning hair
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Hyperthyroidism & hair
Silky hair
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What is it?
Systemic lupus erythematosus
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What is it?
Impetigo
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What is it?
Psoraisis
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What is it?
Urticaria
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What is it?
Basal cell carcinoma
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What is it?
Kaposi’s sarcoma
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What is it?
Cellulitis
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What is it?
Scleroderma
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Induration - d/t what? causes what?
- Local edema
- Causes firmness in skin
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