exam 2 HPA abnormalities

sinus headache

• deep, constant, throbbing headache; pressure-like pain in one specific area of the face or head; face is tender

• occurs with or after a cold, acute sinusitis, or acute febrile illness with purulent discharge from nose

• one area of the face or along eyebrow ridge and below cheekbone

• lasts until associated condition is improved

• may be moderately severe; not debilitating

• pain worse with movement of head, bending forward, lying down; in the morning or with temp change

• nasal drainage, congestion, fever, bad breath

cluster headaches

• stabbing pain; accompanied by tearing, eyelid drooping, reddened eye, and runny nose

• sudden onset; precipitated by consuming alcohol

• localized in the eye and orbit and radiating to facial and temporal regions

• typically occurs in late evening or night

• intense

• movement or walking back and forth may relieve pain

• occurs more in young males

tension headaches

• dull, tight, diffuse

• no prodromal stage; may occur with stress, anxiety, or depression

• usually located in frontal, temporal, or occipital region

• lasts up to days, months, or years

• aching

• relief may be obtained by local heat, massage, analgesics, antidepressants, and muscle relaxants

• affect women more than men

migraine headaches

• accompanied by nausea, vomiting, and sensitivity to noise or light

• may have prodromal stage (visual disturbances, vertigo, tinnitus, numbness, tingling); precipitated by emotional disturbances, anxiety, ingestion of sensitive foods

• located around eyes, temples, cheeks, forehead; can affect only one side

• lasts up to 3 days

• throbbing, severe

• rest may bring relief

• occur more often in women

tumor-related headache

• aching, steady; neurologic and mental symptoms, nausea and vomiting

• no prodromal stage; aggravated by coughing, sneezing, sudden movement of head

• varies with location of tumor

• occurs in morning and lasts for hours

• variable in intensity

• usually subsides later in the day

acromegaly

enlargement of facial features (nose, ears) and the hands and feet

cushing syndrome

may present with moon shaped face with reddened cheeks and increased facial hair

exophthalmos

seen in hyperthyroidism

scleroderma

tightened, hard face with thinning facial skin

bells palsy

begins suddenly and reaches peak within 48 hours; symptoms include twitching, weakness, paralysis, drooping eyelid or corner of mouth, drooling, dry eye, dry mouth, decreased ability to taste, eye tearing, and facial distortion

hypothyroidism/myxedema

dull, puffy face; edema around eyes; dry, course and sparse hair

parkinson disease

mask-like facial appearance, shuffling gait, rigid muscles, diminished reflexes

simple goiter

any enlargement of the thyroid gland not caused by inflammation or neoplasm

cerebrovascular accident

results in neurologic damage; symptoms depend on what part of brain was affected

tractional alopecia

hair loss caused by pulling; parts of hair falling out

alopecia totalis

complete hairloss

skin breakdown

poor circulation, poor hygiene, infrequent position changes, dermatitis, infection, traumatic wounds

stage I pressure ulcer

intact skin with localized area of non-blanchable erythema; changes in sensation, temperature, or firmness

stage II pressure ulcer

partial-thickness loss of skin with exposed dermis; wound bed is viable, pink or red, moist, and may also present an intact or ruptured serum filled blister; adipose is not visible and neither is deeper tissue; no tissue, slough, or eschar are present; commonly seen in pelvis and heel

stage III pressure ulcer

full thickness loss of skin, fat is visible in the ulcer and granulation tissue and epibole are often present; slough and eschar may be visible; depth of tissue varies on location (area with significant adiposity can develop deep wounds); undermining and tunneling may occur; if slough or eschar obscures extent of tissue loss this is unstageable pressure injury

stage IV pressure ulcer

full thickness and tissue loss with exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer; slough and/or eschar may be visible; epibole (rolled edges), undermining, and/or tunneling often occur; depth varies by anatomical position

macule and patch

small, flat, nonpalpable skin color change

papule and plaque

elevated, palpable, solid mass

nodule and tumor

elevated, solid, palpable mass that extends deeper into dermis than a papule

vesicle and bulla

circumscribed elevated, palpable, mass containing serous fluid

wheal

elevated mass with transient borders that are often irregular; size and color vary; caused by movement of serous fluid into the dermis; does not contain free fluid

pustule

pus-filled vesicle or bulla

cyst

encapsulated fluid-filled or semisolid mass that is located in subcutaneous tissue or dermis

erosion

loss of superficial dermis that does not extend to the dermis; depressed moist area

ulcer

skin loss extending past epidermis, with necrotic tissue loss; bleeding and scarring are possible

scar

skin mark left after healing of wound or lesion that represents replacement by connective tissue of the injured tissue

young are red or purple

old are white and glistening

fissure

linear crack in the skin that may extend to the dermis and may be painful

petechia

round, red, or purple macule that is 1-2 mm in size; secondary to blood extravasation and associated with bleeding tendencies

hematoma

localized collection of blood creating an elevated ecchymosis; associated with trauma

cherry angioma

popular and round, red or purple lesion found on the trunk or extremities; may blanch with pressure; normal age related skin alteration and usually not clinically significant

spider angioma

red arteriole lesion with a central body with radiating branches; usually noted on the face, neck, arms, and trunk; rare below the waist; compression of the center of the arteriole completely blanches the lesion; associated with liver disease, pregnancy, and vitamin B deficiency

telangiectasia

bluish or red lesion with varying shape (spider-like or linear) found on legs and anterior chest; does not blanch when pressure is applied; secondary to superficial dilation of venous vessels and capillaries and associated with increased venous pressure states

ABCDE

asymmetry

borders

color

diameter

elevated

linear configuration

straight line; as in scratch or streak

annular configuration

circular lesions

clustered configuration

lesions grouped together

discrete configuration

individual and distinct lesions

nummular configurations

smaller lesions run together to form larger lesions

confluent configuration

smaller lesions run together to form larger lesions

longitudinal ridging

parallel ridges running lengthwise; seen in elderly and some young with no known etiology

half and half nails

nails that are white on the upper proximal half and pink on the distal half seen in chronic renal disease

pitting

seen with psoriasis

koilonychio

spoon-shaped nails that may be seen with trauma to cuticles or nail folds or in iron deficiency anemia, or endocrine or cardiovascular disease

yellow nail syndrome

yellow nails grow slow and are curved; may be seen in AIDS and respiratory syndrome

paronychia

local infection

unilateral blindness

lesion in eye or optic nerve

bitemporal hemianopia

loss of vision of both temporal fields; lesion in optic chiasma

left superior quadrantopia

similar loss of vision in quadrant of each field; partial lesion of temporal loop (optic radiation)

right visual field loss

right homonymous hemianopia or similar loss of vision in half of each field; lesion in right optic tract or lesion in temporal loop (optic radiation)

dysfunction

abnormalities found during an assessment of extraocular muscle function

pseudostrabismus

normal in young children, the pupils will appear at the inner canthus (due to epicanthic fold)

strabismus (tropia)

a constant malignant of the eye axis; defined according to the direction toward which the eye drifts and may cause ambylopia

phoria (mild weakness)

noticeable only with cover test, less likely to cause amblyopia

• exophoria is an outward drift

• esophoria is an inward drift

paralytic strabismus

noticeable with positions test; usually the result of weakness or paralysis of one or more extraocular muscles; the nerve affected will be on the same side as the eye affected; this position in which the max deviation appears indicates the nerve involved

• 4th nerve paralysis: eye cannot look down when inward

• 6th nerve paralysis: eye cannot look to outer side

ptosis

drooping eye

ectropion

outwardly turned lower lid

conjunctivitis

generalized inflammation of the conjunctiva

exophthalmos

protruding eyeballs and retracted eyelids

chalazion

infected meibomian gland

hordeolum

stye

entropion

inwardly turned eyelid

blepharitis

staphylococcal infection of the eyelid

diffuse episcleritis

inflammation of the sclera

subconjunctival hemmorhage

bright red areas of the sclera

scleral jaundice

sclera is yellow

corneal scar

appears grayish white, may be due to inflammation or an old injury

early pterygium

thickening of bulbar conjunctiva that extends across the nasal side

nuclear cataracts

appear gray when seen with a flashlight; appear as black spots against red reflex when seen through ophthalmoscope

peripheral cataracts

look like gray spokes that point inward when seen with a flashlight; look like black spokes that point inward against red reflex when seen through an ophthalmoscope

miosis

pinpoint pupils; constricted and fixed pupils - possibly a result of narcotic drugs or brain damage

anisocoria

pupils of unequal size; some cases the condition is normal; in cases of abnormality:

• greater in bright light compared to dim light: cause maybe trauma, tonic pupil, and oculomotor nerve paralysis

• greater in dim light compared to bright light: cause may be Horner syndrome

mydriasis

dilated and fixed pupils, typically resulting from central nervous system injury, circulatory collapse, or deep anesthesia

papilledema

swollen optic disc, blurred margins, hyperemic appearance from accumulation of excess blood, visible, and numerous disc vessels, lack of visible physiologic cup

glaucoma

enlarged physiologic cup occupying more than half of the discs diameter, pale base of enlarged physiologic cup, obscured and/or displaced retinal vessels

optic atrophy

white optic disc, lack of disc vessels

constricted arteriole

narrowing of the arteriole, occurs with hypertension

copper wire arteriole

widening of the light reflex and a coppery color, occurs with hypertension

silver wire arteriole

opaque or silver appearance caused by thickening of arteriole wall, occurs with long-standing hypertension

arteriovenous nicking

AV crossing abnormality characterized by vein appearing to stop short on either side of arteriole; caused by loss of arteriole wall transparency from hypertension

arteriovenous tapering

AV crossing abnormality characterized by vein appearing to taper to a point on either side of the arteriole; caused by loss of arteriole wall transparency from hypertension

arteriovenous banking

AV crossing abnormality characterized by twisting of the vein on the arterioles distal side and formation of a dark, knuckle-like structure; caused by loss of arteriole wall transparency from hypertension

cotton wool-patches

aka soft exudates; have a fluffy cotton ball appearance, with irregular edges; appear as white or gray moderately-sized spots on retinal background, caused by arterial microinfarction, associated with diabetes mellitus and hypertension

hard exudate

solid, smooth surface and well-defined edges, creamy yellow-white, small, round spots typically clustered in circular, linear, or star pattern; associated with diabetes mellitus and hypertension

superficial (flame-shaped) retinal hemmorhages

appear as small, flame-shaped, linear red streaks on retinal background; hypertension and papilledema

deep (dot-shaped) retinal hemmorhages

appear as small, irregular red spots with blurred edges on retinal background, lie deeper in retina than superficial retinal hemorrhage, associated with diabetes mellitus

microaneurysms

round, tiny red dots with smooth edges on retinal backgrounds, localized dilations of small vessels in retina, but vessels are too small to use, associated with diabetic retinopathy

affect external ear and ear canal

• malignant lesion

• otitis externa

• buildup of cerumen in ear canal

polyp

growth on inside of ear canal due to chronic ear infections or a skin cyst inside the ear

exostosis

known as surfer’s ear, abnormal bone growth within ear canal due to chronic irritation, hereditary, or unknown reasons

microtia

congenital abnormality where the external ear does not fully develop

tophi

hard external ear nodules associated with deposits of uric acid crystals in advanced gout

acute otitis media

note the red, bulging tympanic membrane; decreased or absent light reflex

blue/dark red tympanic

indicates blood behind eardrum due to trauma

perforated tympanic membrane

perforation results from rupture caused by increased pressure, usually from untreated infection or trauma

serous otitis media

note the yellowish, bulging membrane with bubbles behind it