| abnormal alignment of one or both eyes; cross eye, squint eye | strabismus |
| condition where the eyelid is rolled inward against the eyeball | entropion |
| condition where eyelid is rolled outward away from eyeball; occurs with aging | ectropion |
| a small sebaceous cyst of the eyelid resulting when a gland is blocked | chalazion |
| an infection of the sebaceous gland of the eyelid; "stye" | hordeolum |
| bacterial infection/inflammation of the conjunctiva of the eye; "pink eye" | conjunctivitis |
| border between the cornea and sclera | limbus |
| nearsightedness; eyesight abnormality resulting from the eye's faulty refractive ability | myopia |
| involuntary fine oscillating eye movement, best seen around the iris; abnormal in all cases except with extreme lateral gaze | nystagmus |
| the upper eyelid should always cover the top portion of the iris, even when looking down, you should not see a white rim of sclera between the lid and the iris; can be seen with hyperthyroidism | lid lag |
| drooping of the upper eyelid caused by muscle paralysis and weakness; myasthenia travis can cause or CN3 damage | ptosis |
| the simultaneous inward movement of both eyes toward each other, usually in an effort to maintain single binocular vision when viewing an object | convergence |
| appear as opaque black areas against the red reflex; slowly obstructs vision | cataract |
| red patch on the sclera, looks like a spot of paint; caused by increased intraocular pressure via coughing, vomiting, trauma, etc; looks alarming but not serious | subconjunctival hemorrhage |
| inflammation of the eyelids characterized by redness and swelling and dried crusts; usually on lash line, usually bacterial | blepharitis |
| a slightly yellowish elevated elastic tissue deposit in the conjunctiva that may extend to the cornea but does not cover it; caused by prolonged exposure to sun, wind, dust | pinguecula |
| opaque wing either of two thickened triangular layers of conjunctiva extending from the nasal edge of the eye to the cornea; it arises from irritation of the a deposit; may obstruct vision | pterygium |
| Cataracts; corneal opacity; retinal blastoma | 3 conditions that obstruct the Red Reflex |
| gradual onset over years, bilateral, mostly high-frequency loss of hearing, worse in loud environments | presbycusis |
| small painless nodule at helix; congenital; not significant | Darwin's tubercule |
| behind lobule in post auricular fold; filled with waxy sebaceous material, painful if infected | sebaceous cyst on ear |
| small, whitish yellow, hard, contender nodules in or near helix contain greasy, chalk material of uric acid crystals; sign of gout | tophi |
| painful nodules develop on rim of helix as a result of repetitive mechanical pressure or environmental trauma; small, indurated, dull red, poorly defined, very painful | chondrodermatitis nodularis helicus |
| raised pinkish scar tissue at the site of an injury; results from excessive tissue repair | keloid |
| ulcerated, crusted nodule with indurated based that fails to heal; bleeds intermittently; needs immediate biopsy; usually from chronic sun exposure | carcinoma on ear |
| single, stony, hard, rounded nodule that obscures the drum; non-tender; overlying skin appears normal; benign but refer for removal | osteoma |
| small bony hard rounded nodules of hypertrophic bone, covered with normal epithelium; arise near drum but do not obstruct view of drum; usual multiple and bilateral can be with cold water swimmers; need to treatment but may cause accumulation of cerumen which can block ear canal | exostosis |
| exquisitely painful reddened, infected hair follicle | furuncle ear |
| arises in canal from granulomatous or mucosal tissue; redder than surround skin and bleeds easily; baths in foul purulent discharge; indicates chronic ear disease; benign but refer for excision | ear polyp |
| inflammation of the external ear (including auricle and ear canal); severe swelling to 1/4 of normal ear canal size | otitis externa |
| serum or pus; otitis media with effusion (OME) or chronic otitis media; may also see air or fluid or ai bubbles | TM: yellow-amber |
| retraction of drum; vacuum in middle ear from obstructed Eustachian tube, caused by negative pressure | TM: prominent landmarks |
| acute otitis media (AOM) | TM: absent or distorted light reflex |
| blood behind drum, trauma or skull fracture | TM: blue or dark red |
| dark, round or oval areas | TM: perforation |
| scarring; sequalae of infections | TM: white dense areas |
| diminished or absent landmarks; thickened drum | chronic otitis media |
| black or white dots on drum or canal; colony of growth | fungal ear infection |
| overgrowth of epidermal tissue in the middle ear or temporal bone may result over the years after marginal TM perforation; pearly white, cheesy appearance; can erode bone and produce hearing loss; early signs include otorrhea, otalgia, unilateral conductive hearing loss, tinnitus | cholesteatoma ear |
| hyperpigmentation on sacrum or buttocks but can be anywhere; caused by dermal melanocytes | mongolian spot |
| large round or oval patch of light brown pigmentation present at birth; if 6 or more are present it is diagnostic of neurofibromatosis | cafe au lait spot |
| common rash appears first 3-4 days of life; sometimes called "flea bite rash" consists of tiny punctate red macule and pupules on cheeks, trunk, chest, back, and buttocks; no treatment needed | erythema toxicum |
| transient mottling in the trunk and extremities in the response to cooler room temperatures; it forms reticulated red or blue pattern over the skin | cutis marmorata |
| normal physiologic variance in about half of all newborns, occurs day 3 or 4 of life; not normal day 1 (hemolytic disease) or after 2 weeks (biliary tract obstruction) | physiologic jaundice |
| Seborrheic Keratosis | dark, greasy, and "stuck on" raise area of hyperpigmentation |
| Actinic (Senile) Keratosis | red-tan scaly plaques that increase over the years to become raised and roughened |
| Acrochordons | "skin tags" overgrowths of normal skin that form a stalk and are polyp-like |
| Sebaceous hyperplasia | raised yellow papules with a central depression |
| petechiae | tiny punctate hemorrahages 1 to 3mm, round and discrete, dark red, purple or brown in color |
| purpura | confluent extensive patch of petechiae and ecchymoses >3mm, flat, red to puruple, macular hemorrhage |
| ecchymosis | purplish patch resulting form extravasation of blood into the skin >3mm in diameter |
| contusion | bruise |
| measles (rubeola) | red-purple maculopapular blotchy rash on third or fourth day of illness; +Koplik spots (white grains of salt on buccal mucosa) |
| German measles (rubella) | Paler pink, papular rash, first appears on face then spreads; +lymphadenopathy and absence of Koplik spots |
| chickenpox (varicella) | small, tight vesicles first appear on trunk and spread to face, arms, legs (not palms or soles) |
| macule | solely a color change, flat and circumcised of <1cm |
| papule | something you can feel, caused by a superficial thickening in epidermis <1 cm |
| patch | macules larger than 1cm |
| plaque | papules coalesce to form surface elevation greater than 1cm |
| nodule | solid, elevated, hard or soft, larger than 1cm, may extend deeper into dermis than papule |
| tumor | larger than a few centimeters, firm or soft, deeper into dermis, may be benign or malignant |
| wheal | superficial, raised, transient and erythematous; irregular shape from edema |
| urticaria (hives) | wheals coalesce to form extensive reaction, intensely pruritic |
| vesicle | elevated cavity containing free fluid, up to 1 cm |
| bulla | larger than 1 cm fluid filled single chambered |
| cyst | encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin |
| pustule | turbid fluid (pus) in the cavity, circumscribed, elevated |
| crust (secondary) | thickened, dried out exudate left when vesicles/pustules burst or dry up |
| scale (secondary) | compact, desiccated flakes of skin, dry or greasy, silvery or white, from shedding of dead excess keratin cells |
| fissure (secondary) | linear crack with abrupt edges |
| erosion (secondary) | scooped out but shallow depression |
| ulcer (secondary) | deeper depression extending into dermis, irregular shape, may bleed, leaves scar when it heals |
| excoriation (secondary) | self-inflicted abrasion, superficial |
| scar (secondary) | after a skin lesion is repairs, normal tissue is lost and replaced with connective tissue (Collagen) |
| atrophic scar | resulting skin level depressed with loss of tissue |
| lichenification | prolonged, intense scratching eventually thickens skin and produces tightly packed set of papules |
| nevus flammeus (port-wine stain) | large, flat, macular patch covering face or scalp frequently along distribution of cranial nerve V |
| strawberry mark (immature hemangioma) | raised bright red area of well defined borders about 2-3cml does not blanch, consists of imamture capillaries, usually disappears by age 5-7 |
| cavernous hemangioma (mature) | reddish-blue, irregularly shaped, solid, and spongy mass of blood vessels |
| telangiectasia | caused by vascular dilation; permanently enlarged and dilated blood vessels visible on skin surface |
| spider or star angioma | fiery red star-shaped marking with solid circular center |
| venous lake | blue-purple dilation of venules and capillaries in a star-shaped, linear or flaring pattern |
| diaper dermatitis | red, moist, maculopapular patch with poorly defined boarders in perineal area along inguinal and gluteal folds |
| intertrigo | scalding red, moist patches with sharply demarcated borders, some loose scales; +candidiasis |
| impetigo | moist, thin-roofed vesicles with thin, erythematous base; rupture to form erosions and thick, honey-colored crusts; highly contagious bacterial infection can easily spread |
| atopic dermatitis (eczema) | chronic inflammatory skin lesion caused by overstimulated immune system, genetic changes in skin, and environmental triggers |
| primary contact dermatitis | local inflammatory reaction to an irritant in the environment of an allergy |
| allergic drug reaction | erythematous and symmetric rash, usually generalized |
| tinea corporis | "ringworm of body," scales hyperpigmented in whites, depigmented in dark-skinned people |
| tinea pedis | "ringworm of foot" or "athlete's foot," fungal infection, first appears as small vesicles between toes, on sides of feet, and on soles, grows scaly and hard |
| herpes zoster (shingles) | small, grouped vesicles emerge along route of cutaneous sensory nerve, then pustules then crusts |
| basal cell carcinoma | usually starts as small, pink or red papule with pearly translucent top overlying a telangiectasia (broken blood vessel) then develops rounded pearly borders with central red ulcer |
| squamous cell carcinoma | erythematous scaly patch with sharp margins, 1 cm or more, develops central ulcer and surrounding erythema, usually on hands or head, areas exposed to UV radiating |
| malignant melanoma | usually brown, tan, black, pink-red, purple or mixed pigmentation |
| paronychia | red, swollen, tender inflammation fo the nail folds |
| beau line | transverse furrow or groove, depression across the nail that extends down to the nail bed |
| harlequin color change | baby is in a side lying position and lower half of body turns red and upper half blanches with a distinct demarcation line down the midline |
| angular cheilitis | erythema, scaling, shallow and painful fissues at corners of mouth, occur with excessive salivation |
| herpes simplex virus (HSV) | cold sores; clear vesicles with surrounding indurated eythematous base evolving into pustules which rupture and weep and crust; highly contagious and spread by direct contact |
| candidiasis (oral) | thrush in a newborn; white "cheesy" curdlike patches that scratch off, leaving a raw, red surface |
| leukoplakia | chalky white patches that don't scrape off; precancerous |
| tonsillitis | bright red throat with white or yellow exudate on tonsils and pharynx, swollen uvula and enlarged lymph nodes |
| thyroid nodule/nodes | consider them to be abnormal until proven otherwise |
| simple goiter | typically seen in third world counties where deficient in iodine |
| Graves Disease (hyperthyroid) | goiter, exophthalmos, eyelid retraction, nervousness, fatigue, weight loss, muscle cramps |
| acute rhinitis | turbinates are dark red and swollen; nonallergic; clear, watery discharge, rhinorrhea, later purulent with sneezing, nasal itching, inflamed mucosa |
| allergic rhinitis | turbinates are pale, smooth, and glistening; abnormal immune response from repeated exposure to antigens with rhinorrhea, itching of nose, eyes, lacrimation, nasal congestion, sneezing |
| polyps (nasal) | smooth, pale gray nodules, overgrowths of mucosa; commonly caused by chronic allergic rhinitis; symptoms are absence of smell and a valve that moves when person breathes |
| perforated septum | if hole is present when you shine light in one nare the light goes into the other |
| optic atrophy | white or gray color of the disc as a result of parrtial or complete death of the nerve |
| papilledema | increased intracranial pressure causes venous stasis in the globe; increased ICP causes it; visual acuity not affected; can be caused by hemorrhages |
| hemorrhages (retinal) | pailledema, severe nonproliferative diabetic retinopahty |
| A-V nicking | sign of chronic hypertension |
| A-V narrowing | generalized disease in arteriole diameter |
| CN I | Olfactory- test using familiar scents |
| CN II | Optic- visual acuity and visual fields by controntation |
| CN III | Oculomotor- cardinal positions of gaze, PERRLA, nystagmus testing |
| CN IV | Trochlear- have pt follow your finger towards their nose |
| CN V | Trigeminal- "does this feel like this" using cotton or fingers on all 3 sections of face |
| CN VI | Abducens- looking left to right, follow finger with eyes |
| CN VII | Facial- raise eyebrows, frown, smile, close eyes tightly, show teeth, puff cheeks (push on cheeks) |
| CN VIII | Vestibulocochlear- whispered test or rub fingers next to ears |
| CN IX | Glosspharyngeal- say ahh, uvula should rise midline and tonsillar pillars medially |
| CN X | Vagus- same tests as CN IX- say ahh, touch posterior pharyngeal with cotton swab, uvula should be midline |
| CN XI | Spinal Accessory- shrug shoulders and push face into hand |
| CN XII | Hypoglossal- stick out tongue (no wiggling) "say light tight dynamite" |
| What are consititutional symptoms? | fevers, fatigue, chills, lethargy, weakness, weight changes |
| Weber Test with Conductive Hearing Loss | sound lateralizes to poorer ear because that ear is not distracted by background noise |
| Weber Test with sensorineural loss | sound lateralizes to better/unaffected ear because the ear with nerve loss cannot perceive sound |
| Weber Test with Conductive Hearing Loss | sound lateralizes to poorer ear because that ear is not distracted by background noise |
| Rinne Test with conductive loss | person hears equally long bone and air conduction AC=BC or AC<BC |
| Rinne Test with sensoriuneural loss | normal ration of AC>BC but reduced overall, person hears poorly both ways |
| Bullous Myringitis (Bullous TM) | small vesicles containing blood are on eardrum |
| Rinne Test with sensoriuneural loss | normal ration of AC>BC but reduced overall, person hears poorly both ways |
