Skin, Nails, Hair, Lymph Nodes, Head, And Neck
Content
PHYSICAL EXAMINATION PERFORMANCE CHECKLIST Student Comments/Questions Skin, Hair, & Nails – Chapter 7
I. Inspection of the skin (. )olor *. +niformit$ ). ,hickness -. .$mmetr$ /. 0$giene 1. 2esions (si%e, shape, location, !istri"ution) 1. configuration #. color 3. "lanching 4. te5ture 6. elevation &!epression 7. pe!unculation 8. presence of e5u!ates 9. :!ors II. ;alpate skin surfaces (. <oisture *. ,emperature ). ,e5ture -. ,urgor /. <o"ilit$ III. Inspection of the hair (. )olor *. -istri"ution ). 'uantit$ IA. ;alpation of the hair for te5ture A. Inspection of the nails (. Inspect 1. ;igmentation of nails an! "e!s #. 2ength 3. .$mmetr$ 4. Ci!ging, "ea!ing, pitting *. <easure nail "ase angle (clu""ingE) ). Inspect ? palpate pro5 ? lateral nail fol!s for 1. Ce!ness #. .welling 3. ;ain 4. /5u!ate 6. >arts, c$sts, tumors AI. ;alpate nail plate for 1. ,e5ture #. 1irmness 3. ,hickness 4. +niformit$ 6. (!herence to nail "e!
Macule: <10 mm (freckles, scarlet fever, measles) Papule: >10 mm (wart) Patch: irregular macule > 1 cm (vitiligo, port-wine stains, cafe au lait) Plaque: elevate!, rough, > 1cm (psoriasis, actinic keratoses) Wheel : e!ema, elevate! (insect "ites, urticaria) Nodule: elevate!, 1-# cm (er$thema no!osum) umor: ># cm !esicle : not into !ermis, < 1 cm (varicella, herpes %oster) "ulla: vesicle > 1cm ("lister) Pustule: vesicle w&purulent flui!, an$ si%e (impetigo, acne) C#st: in !ermis or su"' (se"aceous c$st, c$stic acne) $%coriation: loss of epi!ermis (a"rasion, sca"ies) &issure: "reak to !ermis (athlete s foot) $rosion: follows rupture of vesicle or "ulla (varicella after rupture) 'lcer : loss of epi!ermis an! !ermis (!ecu"iti, ulcers) Crust (ec%ema, sca")
-r$ = h$poth$roi!ism >arm = h$perth$roi!ism )oarse, scaling - h$poth$roi!ism ur(or & mo)ilit#: pinch small section of skin on forearm or sternal area ? release. ,urgor altere! if !eh$!rate! or w&e!ema (@ in !eh$!rate!: skin fails to spring "ack after release!). .ome con tissue path (sclero!erma) affect mo"ilit$
0air loss on feet or toes ma$ in!icate poor circulation or nutrional !eficit. 0air loss = h$perth$roi!ism 1ine = h$perth$roi!ism, )oarse - h$poth$roi!ism
Bellow = psoriasis, fungal infection, chronic respirator$ !isease
.plinter hemorrhages = severe psoriasis, minor inDur$ ;itting = psoriasis (ngle shoul! "e 170 !egrees (clu""ing =angle F, ma$ e5cee! 1G0 !egrees) )lu""ing = respirator$ an! car!iovasc !iseases, cirrhosis, colitis, th$roi! erms: ,ransverse grooving (*eau lines) = repeate! inDur$ .poon nail (kiolon$chia) = iron !eficienc$ ;aron$chia = inflammation of nail fol! :n$chol$sis = separation of nail from un!erl$ing skin
,hin, on$chol$sis = h$perth$roi!ism, ,hick = h$poth$roi!ism
PHYSICAL EXAMINATION PERFORMANCE CHECKLIST Student Comments/Questions *#mphatic S#stem – Chapter +
I. Inspection of visi"le no!es (. /!ema *. /r$thema ). Ce! streaks II. Inspect an! palpate superficial l$mph no!es (.ets - hea! 5 7 ? neck 5 4 p. #34H a5illae, epitrochlear, popliteal, femoral) (. .i%e *. )onsistenc$ ). <o"ilit$ -. 2ocation /. -iscreet "or!ers or matte! 1. ,en!erness 9. >armth
Head: 1) occipital = "ase of skull, #) postauricular = over mastoi! process, 3) preauricular = front of ear, 4) paroti! ? tonsillar = angle of man!i"le, 6) su"man!i"ular = halfwa$ "etween angle an! tip of man!i"le, 7) su"mental Neck: 1) superficial cervical = at .)<, #) posterior cervical = anterior "or!er of trape%ius, 3) !eep cervical = !eep to .)<, 4) supraclavicular
Head ,nd Neck = Chapter I. :"serve head position II. Inspect an! the skull an! scalp (. .i%e *. .hape ). .$mmetr$ -. 2esions III. Inspect facial features (. .$mmetr$ *. .hape ). +nusual features -. ,ics /. )haracteristic facies IA. ;alpate the hea! an! scalp (. .$mmetr$ *. ,en!erness (esp. frontal ? ma5illar$ sinuses) ). .calp movement A. ;alpate temporal arteries (. ,hickness *. 0ar!ness ). ,en!erness AI. (uscultate temporal arter$ for "ruits AII. Inspect an! palpate the salivar$ glan!s AIII. Inspection of the neck (. .$mmetr$ *. (lignment of trachea ). 1ullness -. <asses, we""ing, an! skin fol!s /. Iugular vein !istention 1. )aroti! arter$ prominence IJ. ;alpate the neck (. ,rachea position *. ,racheal tug ). <ovement of h$oi! ? cartilage when swallowing J. ;alpate the th$roi! glan! (. .i%e *. .hape ). )onfiguration -. )onsistenc$ /. ,en!erness 1. Mo!ules (if enlarge! auscultate for "ruits) JI /valuate range of motion of the neck
Student Comments/Questions
,hickening, har!ness, ten!erness temporal arteritis
0ave pt fle5e! slightl$ forwar! an! laterall$ towar! si!e "eing e5amine! K4 cm, right lo"e often #6L larger
I. Inspection of the skin (. )olor *. +niformit$ ). ,hickness -. .$mmetr$ /. 0$giene 1. 2esions (si%e, shape, location, !istri"ution) 1. configuration #. color 3. "lanching 4. te5ture 6. elevation &!epression 7. pe!unculation 8. presence of e5u!ates 9. :!ors II. ;alpate skin surfaces (. <oisture *. ,emperature ). ,e5ture -. ,urgor /. <o"ilit$ III. Inspection of the hair (. )olor *. -istri"ution ). 'uantit$ IA. ;alpation of the hair for te5ture A. Inspection of the nails (. Inspect 1. ;igmentation of nails an! "e!s #. 2ength 3. .$mmetr$ 4. Ci!ging, "ea!ing, pitting *. <easure nail "ase angle (clu""ingE) ). Inspect ? palpate pro5 ? lateral nail fol!s for 1. Ce!ness #. .welling 3. ;ain 4. /5u!ate 6. >arts, c$sts, tumors AI. ;alpate nail plate for 1. ,e5ture #. 1irmness 3. ,hickness 4. +niformit$ 6. (!herence to nail "e!
Macule: <10 mm (freckles, scarlet fever, measles) Papule: >10 mm (wart) Patch: irregular macule > 1 cm (vitiligo, port-wine stains, cafe au lait) Plaque: elevate!, rough, > 1cm (psoriasis, actinic keratoses) Wheel : e!ema, elevate! (insect "ites, urticaria) Nodule: elevate!, 1-# cm (er$thema no!osum) umor: ># cm !esicle : not into !ermis, < 1 cm (varicella, herpes %oster) "ulla: vesicle > 1cm ("lister) Pustule: vesicle w&purulent flui!, an$ si%e (impetigo, acne) C#st: in !ermis or su"' (se"aceous c$st, c$stic acne) $%coriation: loss of epi!ermis (a"rasion, sca"ies) &issure: "reak to !ermis (athlete s foot) $rosion: follows rupture of vesicle or "ulla (varicella after rupture) 'lcer : loss of epi!ermis an! !ermis (!ecu"iti, ulcers) Crust (ec%ema, sca")
-r$ = h$poth$roi!ism >arm = h$perth$roi!ism )oarse, scaling - h$poth$roi!ism ur(or & mo)ilit#: pinch small section of skin on forearm or sternal area ? release. ,urgor altere! if !eh$!rate! or w&e!ema (@ in !eh$!rate!: skin fails to spring "ack after release!). .ome con tissue path (sclero!erma) affect mo"ilit$
0air loss on feet or toes ma$ in!icate poor circulation or nutrional !eficit. 0air loss = h$perth$roi!ism 1ine = h$perth$roi!ism, )oarse - h$poth$roi!ism
Bellow = psoriasis, fungal infection, chronic respirator$ !isease
.plinter hemorrhages = severe psoriasis, minor inDur$ ;itting = psoriasis (ngle shoul! "e 170 !egrees (clu""ing =angle F, ma$ e5cee! 1G0 !egrees) )lu""ing = respirator$ an! car!iovasc !iseases, cirrhosis, colitis, th$roi! erms: ,ransverse grooving (*eau lines) = repeate! inDur$ .poon nail (kiolon$chia) = iron !eficienc$ ;aron$chia = inflammation of nail fol! :n$chol$sis = separation of nail from un!erl$ing skin
,hin, on$chol$sis = h$perth$roi!ism, ,hick = h$poth$roi!ism
PHYSICAL EXAMINATION PERFORMANCE CHECKLIST Student Comments/Questions *#mphatic S#stem – Chapter +
I. Inspection of visi"le no!es (. /!ema *. /r$thema ). Ce! streaks II. Inspect an! palpate superficial l$mph no!es (.ets - hea! 5 7 ? neck 5 4 p. #34H a5illae, epitrochlear, popliteal, femoral) (. .i%e *. )onsistenc$ ). <o"ilit$ -. 2ocation /. -iscreet "or!ers or matte! 1. ,en!erness 9. >armth
Head: 1) occipital = "ase of skull, #) postauricular = over mastoi! process, 3) preauricular = front of ear, 4) paroti! ? tonsillar = angle of man!i"le, 6) su"man!i"ular = halfwa$ "etween angle an! tip of man!i"le, 7) su"mental Neck: 1) superficial cervical = at .)<, #) posterior cervical = anterior "or!er of trape%ius, 3) !eep cervical = !eep to .)<, 4) supraclavicular
Head ,nd Neck = Chapter I. :"serve head position II. Inspect an! the skull an! scalp (. .i%e *. .hape ). .$mmetr$ -. 2esions III. Inspect facial features (. .$mmetr$ *. .hape ). +nusual features -. ,ics /. )haracteristic facies IA. ;alpate the hea! an! scalp (. .$mmetr$ *. ,en!erness (esp. frontal ? ma5illar$ sinuses) ). .calp movement A. ;alpate temporal arteries (. ,hickness *. 0ar!ness ). ,en!erness AI. (uscultate temporal arter$ for "ruits AII. Inspect an! palpate the salivar$ glan!s AIII. Inspection of the neck (. .$mmetr$ *. (lignment of trachea ). 1ullness -. <asses, we""ing, an! skin fol!s /. Iugular vein !istention 1. )aroti! arter$ prominence IJ. ;alpate the neck (. ,rachea position *. ,racheal tug ). <ovement of h$oi! ? cartilage when swallowing J. ;alpate the th$roi! glan! (. .i%e *. .hape ). )onfiguration -. )onsistenc$ /. ,en!erness 1. Mo!ules (if enlarge! auscultate for "ruits) JI /valuate range of motion of the neck
Student Comments/Questions
,hickening, har!ness, ten!erness temporal arteritis
0ave pt fle5e! slightl$ forwar! an! laterall$ towar! si!e "eing e5amine! K4 cm, right lo"e often #6L larger
