503 exam 2

• 1) Supply O2 to body for energy production
• 2) Remove CO2 as waste product of energy reactions
• 3) Maintain homeostasis of arterial blood (acid-base balance)
• 4) Maintain heat exchange

Involuntary control of respirations in brainstem

active vs passive

• Graves’ Disease
• ◦hyperthyroidism, goiter, exophthamlus

• hyperthyroidism
• Symptoms: nervousness, fatigue, muscle cramps, heat intolerance, diarrhea
• ◦Signs: weight loss, tachycardia, SOB, excessive sweating, fine tremor

• Symptoms: depression, cold intolerance, fatigue, constipation, dry skin/nails
• Signs: goiter, weight gain, bradycardia, muscle weakness and cramps,  hair loss
• –Mixedema: edema (peri-orbital, pre-tibial)

• Virchow’s Node:
• left supraclavicular node
• May indicate neoplasm of chest

circular shape to skin lesion

• larger than a vesicle
• blister
• >1cm

• skin lesions that run together
• urticaria (confluent wheals)

scooped-out, shallow depression in skin

red

self-inflicted abrasion on skin due to scratching

boil, in-grown hair

• lesion
• benign proliferation of blood vessels in the dermis

target shape of skin lesion

hypertrophic scar, elevated beyond site of original injury

• thickened papules
• caused by scratching

benign fatty tumor

softening of tissue by soaking

• >1cm flat discoloration
• ex: mangolian spot
• solar lentigo
• measles rash

• <1cm flat discoloration
• freckles 
• flat nevi
• hypopigmentation
• petechiae
• measles
• scarlet fever

birthmark

elevated nevus

• >1cm
• bigger than papule
• smaller than tumor

pale

• <1cm
• elevated nevus (mole)
• wart
• lichen planus

psoriasis

itching

red purple skin lesions due to blood in tissue from break in blood vessels

flakey skin

permanently and visibly enlarged and dilated blood vessels

sloughing of necrotic inflammatory tissue that causes a deep depression in skin, extending into dermis

• smaller than a bulla
• herpes zoster

• confluent
• hives

• discrete
• mosquito bite

linear shape of skin along a nerve route

• epidermis
• dermis
• subcutaneous layer

leukonychia

patch

• NEONATAL
• NORMAL
• caused by increased melanin pigment in basal cell layer

• NEONATAL
• "flea bite rash"
• appears first 3-4 days of life
• NO Tx NECESSARY

• NEONATAL
• NORMAL: cyanotic dx
• bluish color

• NEONATAL
• ABNORMAL: cyanotic (heart dx)
• transient bluish mottling in response to cooler room temperature

• NEONATAL
• NORMAL
• tiny white papules
• TELL PARENTS NOT TO SQUEEZE

• ADULT-GERO
• solar lentigo (sun spots)
• senile lentigines

• ADULT GERO
• NORMAL
• hyperpigmentation in hands
• looks dark, greasy, "stuck on"

• ADULT GERO
• NORMAL
• hyperpigmentation
• may develop into squamous cell carcinoma

• ADULT GERO
• ABNORMAL 
• skin tags

• ADULT GERO
• ABNORMAL
• raised yellow papules

• petechiae
• bruise
• hematoma

blowing, swooshing sound heard through the stethoscope over an area of abnormal blood flow

difficulty in swallowing

swollen lymph nodes

head tilt due to shortening or spasm of one sternomastoid muscle

a space between the bones of the skull in an infant or fetus, where ossification is not complete and the sutures not fully formed. The main one is between the frontal and parietal bones.

2 x 1

• 1 x 1
• hyperinflation

S curve

hunch back

extra sweaty

• ABNORMAL
• vascular lesion
• nevus flammeus
• "port-wine stain"

• NORMAL
• vascular birthmark
• "salmon patch"

• NEONATAL ABNORMAL
• scaly crusted scalp
• "cradle cap"

yellow-orange color in light-skinned persons who have consumed excess beta-carotene

stretch marks

brownish black patch down the midline of pregnant belly

vascular spider common during pregnancy

• ADULT-GERO
• red-tan scaly patches

a purplish patch resulting from extravasation of blood into the skin >3mm in diameter

• NEONATAL
• candidiasis

• acquired discoloration
• absence of melanin in patchy areas

• NEONATAL
• highly contagious bacterial infection of skin 
• moist vesicles with thin red base
• rupture to form thick crusts

drooping eyelid

pupils equal, round, reactive to light and accommodation

ability of eye to adjust to variations in distance

• -ask client to stand with feet at comfortable distance apart, arms at sides, and eyes closed
• -expected finding: client should be able to stand with minimal swaying for at least 5 seconds

normal finding

• 0 absent
• 1+ weak
• 2+ normal 
• 3+ full, bounding

patency of radial & ulnar arteries by compressing one artery site and observing return of skin color as evidence of patency of other artery

defect or sac formed by dilation in artery wall due to atherosclerosis, trauma, or congental defect

variation of hearts normal rhythm

thickening and loss of elasticity of the arterial walls

fatty plaque deposit in intima arteries

form in inner layer

<50 bpm

• blowing, swooshing sound
• artery is partially occluded

deficiency of arterial blood flow to a specific body

small oval clumps of lymphatic tissue located at grouped intervals along lymphatic vessels

• swelling of extremity due to obstructed lymph channel
• non-pitting

indentation left after examiner depresses the skin over swollen edematous tissue

viewing the finger from the side to detect early clubbing

• irregular force
• alternating beats of larges and small amplitude

• irregular rhythm 
• every other beat is premature

• amplitude  
• weaker inspiration
• stronger expiration

inflammation of the vein associated with thrombus formation

blood clot

open skin lesion extended into dermis

dilated tortuous veins with incompetent valves

• functional units of the lung
• thin-walled chambers 
• network of capillaries
• site of gas exchange

cessation of breathing

• allergic hypersensitivity 
• bronchospasm
• wheezing
• dyspnea

• rales
• fine crackles

collapsed alveoli

• spoken voice sound
• soft, muffled over normal lung tissue

• normal breath sound
• @ major bronchi
• moderate pitch
• equal duration of inspiration/expiration

lining the tracheobronchial tree

solidification of the lung tissue as it fills up with infectious exdudate

coarse

• rales
• discontinuous 
• adventitious lung sounds

• crackle
• discontinuous adventitious lung sound

• course, crackling sensation 
• palpable over the skin
• air enters the subcutaneous tissue

• fxn = transport
• not available for gas exchange

• COPD 
• enlargement of alveoli distal to terminal bronchioles

normal crack dividing lobes

• palpable vibration
• from spoken voice
• felt over chest wall

• abnormal lung sound
• heard when the pleurae are inflamed

• (hypercarbia)
• increased levels of CO2  in the blood

• increased RR
• increased depth

decreased levels of O2 in the blood

• hyperventilation
• diabetic ketoacidosis

ability to breathe easily only in an upright position

sudden awakening from sleeping, with shortness of breath

strikes used to assess size of underlying organ

fluid between pleura

• low-pitched wheeze
• continuous adventitious lung sound

• high-pitched wheeze
• continuous adventitious lung sound

low-pitched normal breath sounds

head tilt due to shortening or spasm of SCM

adaptation of the eye for near vision by increasing the curvature of the lens

inflammation of the glands along margin of eyelids

• opacity of the lens
• obstructs vision

unit of strength of the lens settings on the opthalamoscope

protruding eyeballs

• nearsighted
• see better nearby

involuntary rapid movement of the eyeball

pallor of the optic disc due to death of optic nerve

• stasis of blood flow out of the ocular fundus
• sign of intercranial pressure

• decrease in power of accommodation 
• adult-gero

red glow fills pupil w/ opthalmoscope

• squint, crossed eye
• disparity of eye axis

loss of ability to express thoughts in writing

loss of pain sensation

loss of comprehension of spoken or written language

inability to perform coordinated movements

impaired articulation of speech

impaired articulation of speech

disappearance of conditioned response

twitching

read number traced on skin

one-sided paralysis

recognize object in hand

involuntary contraction of two opposing muscle groups

ability to distinguish between two simultaneous pinpricks on skin

nails

• body’s circulation
• nutritional status
• signs of systemic diseases

the white outer layer of the eyeball

• hematoma
• pattern injury 
• contusion

retraction

barrel chest

unequal lung expansion

guarded expansion

decreased tactile fremitus

decreased tactile fremitus

absent tactile fremitus

increased tactile fremitus b/c consolidation

resonant

hyperresonant w emphysema

• hyperresonant in affected area
• decreased diaphragmatic excursion

dullness in affected area

wheeze

absent sounds

absent sounds

• bronchophony
• egophony
• whispered peteriloquy d/t consolidation

• 1. Skeletal muscle contraction
• 2. Pressure gradient caused by breathing
• 3. Competent valves
• 4. Patent lumen

pressure gradient caused by breathing that moves blood in veins

• Dependent rubor- deep blue/red
• 15 sec refill

• reaches adult size, surpasses at puberty, then slowly atrophies
• can feel nodes on healthy child/adolescent

• Normal:1.0-1.4
• Abnormal: <0.9 = PAD

• —1) Sores on the legs (often on toes)
• 2) Well defined wound edges, dry, deep
• 3) Hairlessness on legs, shiny skin, thickened nails
• 4) Prolonged capillary refill (>2 sec.)
• 5) 6 P’s: —pain, pallor, pulselessness, polikothermia (coldness), paralysis]

• Claudication
• Pain

• onset of cramping pain, numbness, and/or tingling in the lower legs and feet with exertion
• (walking 2-3 blocks)
• relieved with rest

• aggravated with elevation
• relieved with dependency

• 1) Post thrombotic leg syndrome
• 2) Ulcers (often on the ankles)
• 3) granulation tissue present, highly exuding, uneven or irregular wound edges, shallow, wet
• 4) Edema (upside down champagne bottle)
• 5) Hemosiderin staining

Varicose veins

• Increases at end of day
• “Aching,” “tiredness”
• Relieved with elevation
• NO symptoms of claudication pain

• 1) Calf muscle contraction insufficient
• 2) Incompetent valves
• 3) Occluded lumens

DVT; medical emergency