quiz 4 SHN, breast lymph

vitiligo

absence of melanin pigment in patchy areas (more common in people with dark skin)

freckles/ephelides

small, flat, brown macules

Pigmented nevi (moles)

inspect for changes

pallor

white or lighter coloration; ashen gray with brown/black skin

Erythema

flushed appearance

Cyanosis

bluish, grayish): due to decreased perfusion of tissues (tissue hypoxia)

Central cyanosis

2o to cardiopulmonary problems (inspect lips, tongue, oral

mucosa, and conjunctiva)

■ Dark skin may appear blue, dull

Peripheral cyanosis

d/t vasoconstriction

Jaundice

yellow, icteric

● Bilirubin is a by product of RBC breakdown & is normally excreted through the GI tract.

● Jaundice results from rising amounts of bilirubin in the blood with reabsorption into the skin.

Hypothermia

d/t to decreased circulation)

● generalized [shock]

● localized [peripheral arterial insufficiency]

Hyperthermia

• Generalized (increased metabolic rate) - hyperthyroidism, fever, heavy exercise

● Localized (inflammation, infection, dvt)

Perspiration

normal sweating

Diaphoresis

profuse sweating

Cherry angiomas

• genetic bright red papular lesion, 1-5 mm

• located on trunk, upper chest, extremities

• increases with age Benign

Telangiectasia

• dilated superficial arteriole blood vessels

• spider like shape or linear

• legs or anterior chest

• Does not blanch with pressure

• Secondary to superficial dilatation of venous vessels and capillaries

• associated with increased venous pressure states similar to varicosities

Spider angioma

• central arteriole with capillary radiations; blanches (turns white) with pressure

• located on face, neck, arms, upper trunk; usually not below waist

• compression of the center completely blanches the lesion

• seen w/ liver disease, pregnancy, Vit B deficiency, estrogen excess. A few may be normal

Venous star

• bluish spider angioma; non blanching with pressure

• associated with increased venous pressure (seen with varicose veins) -

• primarily located on legs

Petechiae

• 1 - 3 mm round purple or red macule

• results from superficial capillary bleeding / blood

• extravasation

• caused by bacteremia, bleeding disorders (thrombocytopenia or emboli to the skin)

• Does not blanch with pressure

Ecchymosis

• larger patch of capillary bleeding

• r/t trauma, bleeding disorders or liver dysfunction

• Purple/purplish-blue fading to green, yellow, brown over time

Hematoma

localized collection of blood (raised bruise)

characteristics of skin lesions

• color

• elevation

• configuration

• size

• number

• location and distribution

• discharge or exudate

primary lesion

initial lesion

secondary lesion

results from changes in the primary lesion such as scratching, infection, scarring

example of flat lesion

macule, patch

macule

flat, circumscribed, discolored, <1 cm (ephelides, solar

lentigines, flat nevi, petechiae)

patch

flat, irregular, >1 cm (vitiligo)

example of raised lesion

papule, plaque, nodule, tumor, wheal, urticaria, vescile, bulla, pustule, cyst

papule

solid, elevated, circumscribed, < 1 cm (raised nevus, wart

[verruca])

plaques

coalesced papules, > 1 cm (psoriasis)

nodule

solid, elevated, 1-2 cm (lipoma = fatty growth)

tumor

larger than a few centimeters, firm or soft (lipoma)

wheal

superficial, raised, erythematous, irregular (allergic

reaction, PPD, mosquito bite) - causes interstitial edema

urticaria (hives)

wheals coalesce to form extensive reaction; intensely pruritic

example of fluid flled lesions

vesicle, bulla, pustule, cyst

vesicle

elevated cavity with clear fluid, <1 cm (herpes simplex, varicella [chickenpox], herpes zoster [shingles], contact dermatitis [e.g., poison ivy])

bulla

elevated cavity with fluid, >1 cm (blister, burns)

pustule

contains pus; filled with leukocytes, not

necessarily infected (acne)

cyst

encapsulated fluid filled cavity in dermis or sub-q (sebaceous cyst) If deep, may be hard to differentiate from a nodule or tumor (e.g., breast cyst versus tumor)

malignant melanoma

• Highly Metastatic

● Grows Deep, not wide

● Increased Risk: Fair skin, Sun Exposure

● Characteristics: ABCD: Asymmetry, Border is

Irregular, Color: Varied, Diameter > 6 mm

Vernix Caseosa

white coating at birth

Lanugo

fine downy hair darker than Vellus hair. Can be present at birth or shed in utero

puberty

• Increased secretion of apocrine glands - results in body odor

• Increased secretion of eccrine sweat glands – increased perspiration

• Increased secretion of sebaceous glands (oily skin/acne)

• Open comedones (blackheads)

• Closed comedones (white heads)

Solar Lentigines

flat or slightly raised, well-demarcated dark spots on the skin caused by cumulative ultraviolet (UV) light exposure

Actinic Keratosis

common, precancerous skin condition caused by long-term damage from ultraviolet (UV) light

Seborrheic Keratosis

Waxy, rough, scaly, or slightly raised bumps that look like they were "stuck on" the skin

Koilonychia

(spoon nails/concave) - iron deficiency anemia

Paronychia

inflammation/infection of skin around nail bed

Onycholysis

loosening of nail plate (fungal infection)

Leukonychia:

white hairline markings from trauma or picking at cuticle (normal)

Clubbing

nail angle straightens out to ≥ 180 degrees & nail bed becomes spongy

r/t chronic hypoxia - COPD, lung CA, Chronic Cardiopulmonary problems

stage 1 pressure ulcer

non-blanchable erythema of intact skin

stage 2 pressure ulcer

partial–thickness loss of skin with exposed dermis. Pink bed of skin, top layer of skin may look like it peeled off.

stage 3 presure ulcer

full thickness skin loss-adipose is visible

stage 4 pressure ulcer

full thickness skin and tissue loss with exposed fascia, muscle, tendon, ligament, or bone

Unstageable

full thickness skin and tissue loss, obscured by

slough or eschar.

breast review

most cancer in upper outer quadrant and axillary tail of spence

subjective data for breast pain

• localized or general

• CA can cause pain but not all breast CA is painful

• character

• cyclic or constant

• trauma

• associated factor

• fibrocystic:

  • cyclical changes

  • caffeine intake may worsen sypmtoms

• associated skin changes

objective clinical breast exam: inspection

CBE indicated if pt C/O lump on SBE

inspect:

• expose both breasts for comparison

• note size nad shape

• slight asymmetry may be normal for patient

• retraction maneuvers

inspect skin:

• smooth, even color

• localized area of redness, bulging, dimpling, edema

  • redness w heat

  • peau d orange

peau d orange

caused by blocked lymph ducts, common in CA, edema may exaggerate hair follicles causing ubmpy textue like orange peel

objective data: examination

Nipples are normally symmetric and on same plane

• Deviation could indicate CA

• May be everted, flat, or inverted

Inverted nipples: suspicion for CA (if recent change & unilateral)

Note any dry scaling, fissures, ulcerations, or bleeding

Supernumerary nipple – 2 nipples along the mammary ridge at MCL

how to feel pectoral nodes

grasp the anterior axillary fold between your thumb and fingers and with your fingers palpate the inside border of the pectoral muscle

where are epitrochlear nodes

along the upper part of arm

breast lump characteristics

• Location

● Size

● Shape

● Consistency

● Tenderness

● Borders

● Retraction/dimpling

● Mobility

● Cancer characteristics: painless lump, ulcerations, retractions, nipple d/c

pregnnacy related changes

montgomery glands and mastitis