H&P

Spring 2014 OMS I Exam 1 H&P Exam IDermatology Primary lesions are the first to appear and are due to the disease or abnormal state. Flat lesions: 1cm (5mm) patchSuperficial raised (epidermal and/or superficial dermal location): 1cm (5mm) plaqueDeep raised (deep dermal and/or subcutaneous location): 1cm (5mm) tumorSerum filled: 1cm bullaHemorrhagic: 3mm purpura/ecchymosisVascular: TelangiectasiaTransient well defined erythema and edema: wheal/urticaria/hiveCyst fluid or semisolid filled sacComedone: plug of sebaceous & keratinous material in the opening of the hair follicle [open black head, closed white head]

Dermatology Secondary lesions develop as a result of manipulation of the primary lesions, or they develop as part of the natural progression of primary lesionsEpidermal accumulations: Discrete keratinocyte accumulation scale Same as scale with RBCs,WBCs, serum crust Epidermal thickening with accentuated skin lines- lichenification Shedding of sheets of keratinocytes - desquamationSkin Thickness changes: Decreased epidermal, dermal and/or subcutaneous thickness- atrophyAbnormally thick scar that stays within the boundary of the lesion hypertrophic scarAbnormally thick scar that extends beyond the boundary of the lesion keloidLinear atrophy with fragmented collagen/elastin fibers stria

3Dermatology Break in Skin Surface: Linear break in skin fissureWider defect with partial epidermal loss erosion Trauma induced by scratching or picking, either linear or papular - excoriationWider defect with full thickness epidermal loss ulcer Pus accumulations: Superficial pustule ; deep abscess

Shape & Distribution Annular (ring) , nummular (circular or oval) Polycyclic or arcuate (curved like a bow) Linear or reticular Serpiginous (creeping) , targetoid (bulls-eye like) Grouped or scattered

Dermatology

Dematology Exam Be sure to offer full skin exam, need proper lighting, can incorporate into other parts of PEHair inspection: quality, distribution palpation of hair & scalpHair Pull Test: AC)

ENT Exam Mouth/Throat Outside firstBuccal area anterior posterior Palpate for masses within the skin of cheek, floor of mouth Remember which finger you used so you dont place that wet finger on patients face when switching sides !! Teeth upper then lower Hard palate, soft palate Uvula CN X lesion uvula deviates to OPPOSITE side of lesion Tonsils Pharynx Gag reflex : sensory stimluation via CN IX, motor response via CN XTongue top & under CN XII lesion tongue deviates to SAME side as lesion Gums

** Always say please & thank you! ** Vitals Review BP: