cultural final

What are common skin conditions?

Acne, eczema, psoriasis, tinea infections, and pressure injuries.

What are medication side effects that affect the skin?

Antibiotics (rash, Stevens-Johnson Syndrome), chemotherapy (hair loss, nail brittleness), and NSAIDs (photosensitivity).

What is DRESS syndrome?

A drug rash accompanied by fever and potential organ damage, sometimes caused by antiepileptics.

Define key primary skin lesions

Macule (flat spot), papule (solid bump), and vesicle (fluid-filled).

Meconium Definition

The first stool passed by a newborn, composed of amniotic fluid, mucus, bile, and epithelial cells.

Clinical Significance of Meconium

• Anal Patency: Confirms that the gastrointestinal tract is open and functional.
• Delayed Passage (>48 hours): May indicate imperforate anus, Hirschsprung’s disease, or cystic fibrosis.

Anal Region Abnormalities

• Pilonidal Cyst/Sinus: Presentation: Midline cyst or dimple near coccyx, often with hair tuft.
• Anal Fissure: Presentation: Tear in anal mucosa (posterior midline).
• Hemorrhoids: External: Thrombosed (painful, blue-purple) or skin tags.
• Fecal Impaction: Symptoms: Constipation, overflow diarrhea, abdominal distension.
• Rectal Prolapse: Presentation: Mucosa protrudes through anus ("doughnut-shaped").

Subjective Assessment for Anus, Rectum, and Prostate System

• Bowel Habits: Frequency, consistency (hard/loose), straining.
• Rectal Symptoms: Bleeding, pain, itching, mucus discharge.
• Medications: Laxatives, iron, opioids.
• Family History: Colorectal cancer, polyps, hemorrhoids.

Colorectal Cancer Risk Factors

• Non-Modifiable: Age (>45), family history, Lynch syndrome.
• Modifiable: Low-fiber diet, obesity, smoking, alcohol.

STI Health History Questions

• Sexual Activity: "Are you sexually active? If yes, with men, women, or both?"
  "How many partners in the past year? Do you use protection (condoms)?"
• Symptoms: "Any genital sores, discharge, or pain during urination/sex?"
• STI Exposure: "Have you or your partner(s) ever been diagnosed with an STI (e.g., HPV, chlamydia, herpes)?"
• Prevention: "Do you get regular STI testing? Are you vaccinated against HPV?"

Documenting Subjective Obstetric History

• Gravida (G): Total pregnancies.
  Para (P): Live births.
  Abortions (Ab): Miscarriages or elective terminations.
• Complications: "Any history of preterm labor, gestational diabetes, or preeclampsia?"
• LMP: Date of last menstrual period.

Subjective Data: Urinary Symptoms in Aging Women

"Do you leak urine with coughing/sneezing (stress incontinence)?"
"Do you feel sudden urges to urinate (urge incontinence)?"
"Any pain or burning during urination?"

HPV Vaccine & Prevention

• HPV Link to Cancer: Causes 90% of cervical cancers.
  Vaccine Recommendations:
  Ages 9–26: 2-dose series if started before 15; 3 doses if after 15.
  Catch-Up: Up to age 45.
  Screening:
  Pap + HPV co-testing every 5 years (ages 25–65).

Health Promotion: Adolescent Girls & Tanner Staging

Tanner Stages (Pubic Hair Development):
Stage 1 (Prepubertal): No hair.
Stage 2: Sparse, fine hair on labia.
Stage 3: Darker, coarser hair spreading to mons.
Stage 4: Adult-like hair, no thigh spread.
Stage 5: Full triangle with medial thigh hair.

Objective Data: Heart Assessment

• Inspection:
  Observe precordium for pulsations, lifts, or heaves.
  Note apical impulse (normally at 5th ICS, MCL).
  Palpation:
  Apical impulse: Locate and characterize (size, duration).
  Thrills: Palpate for vibrations (indicative of murmurs).
  Auscultation:
  Areas: Aortic, Pulmonic, Erb’s point, Tricuspid, Mitral (APE To Man).
  Sounds:
  S1 (closure of mitral/tricuspid valves) and S2 (aortic/pulmonic).
  S3 (ventricular gallop) or S4 (atrial gallop) if present.

Health History Components

• Biographic Data: Name, age, gender, occupation.
  Reason for Visit: Chief complaint (e.g., "chest pain x 2 days").
  History of Present Illness (HPI): OLDCARTS (Onset, Location, Duration, Characteristics, Aggravating/Alleviating, Related symptoms, Timing, Severity).
  Past Medical History: Chronic illnesses, surgeries, allergies.
  Family History: Focus on hereditary conditions (e.g., CAD, diabetes).
  Social History: Smoking, alcohol, drug use, living situation.
  Review of Systems (ROS): Head-to-toe symptom screening.

Moro Reflex

Sudden head extension or loud noise causes symmetric abduction/extension of arms, fanning fingers, then adduction/flexion (like embracing). Absence suggests CNS depression; asymmetry may indicate brachial plexus injury or clavicle fracture.

APGAR Scoring

Scored at 1 and 5 minutes post-birth (extended to 10 minutes if ≤7 at 5 mins).
Parameters (0–2 points each):
Appearance (Color): 2 = pink body/extremities; 1 = pink body/blue extremities; 0 = cyanotic/pale.
Pulse (HR): 2 = >100 bpm; 1 = <100 bpm; 0 = absent.
Grimace (Reflex Irritability): 2 = vigorous cry; 1 = grimace; 0 = no response.
Activity (Muscle Tone): 2 = active flexion; 1 = some flexion; 0 = limp.
Respiratory Effort: 2 = strong cry; 1 = irregular/weak; 0 = absent.

Assessment of the Adolescent

Psychosocial Focus: Identity formation; respect privacy (use drapes, allow street clothes during non-invasive exams).
Physical Exam:
General Appearance: Tanner staging (SMR), posture, hygiene, signs of risky behavior (e.g., track marks, excessive thinness).
Vitals: BP (compare to age percentiles), HR, respiratory rate.
HEENT: Acne, thyroid enlargement, cervical lymph nodes.
Cardiac: Auscultate for murmurs (common in puberty due to rapid growth).
Breasts: Gynecomastia in males (normal transient finding).
Genitalia: Inspect for STI lesions (e.g., vesicles, warts); testicular exam for masses.
Neurologic: Assess judgment, abstract thinking, school performance.
Confidentiality: Discuss sensitive topics (sex, drugs, mental health) privately; follow state laws on disclosure.

Assessment Position for the Young Child

• Infant: Supine on warming table; parent may hold for otoscopic/reflex exams.
  Toddler/Preschooler:
  Sitting on Parent’s Lap: For ear/throat exam (distract with toys).
  Knee-to-Knee Position: For throat exam (examiner and parent face each other, child’s legs straddle parent’s lap).
  Supine: For abdominal/hip exams; flex knees to relax abdomen.
  Prone: Assess spine/gluteal folds.
  School-Age Child:
  Cooperative on Exam Table: Use games (e.g., “blow out the pinwheel” for lung sounds).
  Modesty: Leave underwear on until genital exam.

Patient Initial Assessment

1. Hand Hygiene & Preparation: Wash hands upon entering; verify isolation/allergy alerts at door; review chart for IV/epidural/diet orders.
2. Introduction: Identify yourself; confirm patient identity via name/DOB/wristband; check for fall/DNR bands.
3. Pain Assessment: Ask current pain level (0–10 scale); note last medication dose/time; assess need for intervention.
4. General Survey:
   Facial Expression/Position: Tense (pain) vs. relaxed.
   LOC: Alert/oriented vs. confused.
   Skin Color: Consistent with heritage; pallor/cyanosis.
   Speech/Hearing: Clear articulation; appropriate responses.
   Hygiene: Ability to self-care (e.g., brushing teeth).

SBAR Communication

Situation: "This is [Name] on [Unit]. Calling about [Patient] in [Room]. [Issue] started at [Time]."
Background: Admitting Dx, relevant VS, meds, labs.
Assessment: "I suspect [Problem] due to [Findings]."
Recommendation: "Request [Intervention]."

Assessment Finding Requiring Immediate Action

• VS Alerts:
  BP:

Acne, eczema, psoriasis, tinea infections, and pressure injuries.

What are common skin conditions?

Antibiotics (rash, Stevens-Johnson Syndrome), chemotherapy (hair loss, nail brittleness), and NSAIDs (photosensitivity).

What are medication side effects that affect the skin?

A drug rash accompanied by fever and potential organ damage, sometimes caused by antiepileptics.

What is DRESS syndrome?

Macule (flat spot), papule (solid bump), and vesicle (fluid-filled).

Define key primary skin lesions

Crust (dried exudate), ulcer (deep erosion), and lichenification (thickened skin).

Define key secondary skin lesions

Annular (ring-like), linear (straight line), and zosteriform (follows nerves).

Describe lesion shapes

Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving, and Funny (ugly duckling lesion).

What is the ABCDEF rule for skin cancer?

Basal cell (pearly papule), squamous cell (scaly patch → ulcer), and melanoma (most deadly; irregular borders).

Name types of skin cancer

Infants: milia (tiny white bumps) and erythema toxicum (newborn rash). Aging adults: actinic keratosis (precancerous sun spots) and xerosis (dry skin).

Note skin conditions specific to infants and aging adults

"Any new/changing moles?" and "Non-healing sores?"

What questions should be asked during clinical assessment of the skin?

Inspect for color and lesions; palpate for temperature and turgor.

What are key inspection and palpation assessments for the skin?

Wood’s lamp (detects fungal infections) and dermatoscope (checks melanoma).

Give examples of tools used in skin assessment

Skin cancer requires ABCDEF screening, drug reactions range from rash to life-threatening SJS, and aging thins skin leading to fragility and slower healing.

What are key takeaways from Chapter 13?

Tanner staging (Stages 1-5, observing breast development), common asymmetry during growth, and palpation revealing firm, rubbery glandular tissue.

Summarize normal findings in adolescent breast exam

Dimpling/puckering, nipple retraction, and peau d’orange (skin edema).

What are key signs of breast retraction?

Atrophy (glandular tissue replaced by fibrous tissue), flattened nipples, and skin thinning.

Describe postmenopausal breast changes

Location, size, shape, consistency, mobility, nipple/skin changes, and lymphadenopathy.

Explain the 7-Point Checklist

Malignant: hard, immobile, irregular borders, associated retraction. Benign: smooth, rubbery, mobile.

What features characterize malignant vs benign breast lumps?

Adolescents: temporary, unilateral/bilateral disk. Adults: caused by medications, cirrhosis, or testosterone deficiency.

Describe gynecomastia

Central axillary (most common metastatic site), pectoral (anterior), and subscapular (posterior).

List key axillary node groups

Start at 40–44 years (optional); annual at 45–54; biennial after 55. Include BSE steps.

Summarize Mammography Guidelines

Physiologic: Bilateral, milky. Pathologic: Unilateral, bloody/spontaneous.

Differentiate between pathologic and physiologic nipple discharge

Hard, irregular, fixed mass + retraction/lymphadenopathy.

Give cancer red flags for breast assessment

Definition: The extent of movement a joint can achieve, measured in degrees.

Describe what ROM Testing is

• Active ROM: Patient moves joint independently.
• Passive ROM: Examiner moves joint for the patient (if limitations exist).

Active vs Passive ROM

• Joints: Pain, stiffness, swelling, heat, redness, limited movement.

• Muscles: Weakness, cramps, atrophy.

• Bones: Trauma (fractures, sprains), deformities.

Questions you should assess during the patient Musculoskeletal System assessment

Grading Strength (0–5 Scale):

• 5/5: Full resistance (normal).

• 4/5: Some weakness but moves against resistance.

• 3/5: Can move against gravity but not resistance.

• 2/5: Movement with gravity eliminated (passive motion).

• 1/5: Flicker of contraction.

• 0/5: No movement (paralysis).

What are the grades in the Muscle Testing Scale?

• Genital Herpes (HSV-2):

• Syphilitic Chancre (Primary Syphilis):

• Genital Warts (HPV):

• Carcinoma (Squamous Cell):

What are common lesions and causes for Male Genital Lesions?

• Painless lump/nodule (most common sign of cancer).

• Testicular enlargement/shrinkage.

• Heaviness/dull ache in scrotum/abdomen.

• Sudden hydrocele (fluid collection).

What are warning signs a patient should look out for in a TSE

• Phimosis: Non-retractable foreskin (normal in infants; pathologic if persistent).

• Paraphimosis: Retracted foreskin trapped behind glans (medical emergency).

• Hypospadias/Epispadias: Urethral meatus opens ventrally/dorsally (congenital).

• Peyronie’s Disease: Fibrotic plaques causing painful, curved erections.

• Priapism: Prolonged erection without stimulation (sickle cell/medication-induced).

What are common conditions in Penis Abnormalities

Stages (I

What are the stages of the Tanner’s Sexual Maturity Rating?

VS Alerts:

Assessment Findings Requiring Immediate Action

BP:

Assessment Findings Requiring Immediate Action

Temp:

Assessment Findings Requiring Immediate Action

HR:

Assessment Findings Requiring Immediate Action

RR:

Assessment Findings Requiring Immediate Action

O2 sat: ≤92%.

Assessment Findings Requiring Immediate Action

Urine output <30mL/hr or dark/bloody.

Assessment Findings Requiring Immediate Action

Uncontrolled pain (e.g., chest pain).

Assessment Findings Requiring Immediate Action

Altered LOC/acute confusion.

Assessment Findings Requiring Immediate Action

Active bleeding/post-op vomiting.

Assessment Findings Requiring Immediate Action

Tidal Volume

Amount of air moved into and out of the lungs during each breath

Residual Volume

amount of air that remains in a person's lungs after fully exhaling

What are the accessory muscles?

Sternocleidomastoid, scalenes, pectoralis minor, and serratus anterior

What is the tactile fremitus assessment in the posterior thorax

Palpate the chest wall and assess it while the patient says '99'

Pursed lip breathing is primarily used in which patient population?

COPD

What is the tripod positon?

Typically seen in COPD patients as sitting forward with arms braced on their knees or another surface

What position should a patient be in for a respiratory assessment?

Sitting position

What is eupnea?

What is Residual Volume (RV)?

The volume remaining in the lungs after a maximal exhalation, which cannot be directly measured by spirometry.

What is Vital Capacity (VC)?

The maximum amount of air that can be exhaled after a maximal inhalation.

What is Total Lung Capacity (TLC)?

The total volume of air in the lungs after a maximal inhalation. It is the sum of vital capacity and residual volume.

What is Tidal Volume (TV)?

The volume of air inspired or expired during normal breathing.

What is Inspiratory Reserve Volume (IRV)?

The additional amount of air that can be inhaled after a normal tidal inhalation.

What is Expiratory Reserve Volume (ERV)?

The additional amount of air that can be exhaled after a normal tidal exhalation.

What is Functional Residual Capacity (FRC)?

The volume of air remaining in the lungs after a normal tidal exhalation. It includes the expiratory reserve volume and the residual volume.

What is Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 second (FEV1)?

The amount of air forcefully exhaled either from the point of maximal inspiration, or after 1 second.

What is Chronic Obstructive Pulmonary Disease (COPD)?

A group of lung diseases that block airflow as the air moves out of the lungs, which includes chronic bronchitis and emphysema. Characterized by a decreased FEV1/FVC ratio (<0.7).

What is Restrictive Lung Disease?

Disease that involves reduced expansion of lung tissue, with decreased Total Lung Capacity. The FEV1/FVC ratio is normal or increased

How the conditions of the respiratory system may change the auscultory sounds present in the thorax?

Decreased breath sounds may indicate consolidation, obstruction, or shallow breathing due to pain or weakness, while increased breath sounds can be a sign of emphysema.

What are Wheezes?

A high-pitched whistling sound caused by narrowed airways, commonly associated with asthma or COPD.

What are Rhonchi?

A continuous rattling sound resembling snoring, caused by secretions in the large airways.

What are Crackles (Rales)?

An abnormal rattling or crackling sound caused by fluid in the small airways or alveoli.

A coarse, grating

What are common skin conditions?

Acne, eczema, psoriasis, tinea infections, and pressure injuries.

What are medication side effects that affect the skin?

Antibiotics (rash, Stevens-Johnson Syndrome), chemotherapy (hair loss, nail brittleness), and NSAIDs (photosensitivity).

What is DRESS syndrome?

A drug rash accompanied by fever and potential organ damage, sometimes caused by antiepileptics.

Define key primary skin lesions

Macule (flat spot), papule (solid bump), and vesicle (fluid-filled).

Define key secondary skin lesions

Crust (dried exudate), ulcer (deep erosion), and lichenification (thickened skin).

Describe lesion shapes

Annular (ring-like), linear (straight line), and zosteriform (follows nerves).

What is the ABCDEF rule for skin cancer?

Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving, and Funny (ugly duckling lesion).

Name types of skin cancer

Basal cell (pearly papule), squamous cell (scaly patch → ulcer), and melanoma (most deadly; irregular borders).

Note skin conditions specific to infants and aging adults

Infants: milia (tiny white bumps) and erythema toxicum (newborn rash). Aging adults: actinic keratosis (precancerous sun spots) and xerosis (dry skin).

What questions should be asked during clinical assessment of the skin?

"Any new/changing moles?" and "Non-healing sores?"

What are key inspection and palpation assessments for the skin?

Inspect for color and lesions; palpate for temperature and turgor.

Give examples of tools used in skin assessment

Wood’s lamp (detects fungal infections) and dermatoscope (checks melanoma).