Skin, Hair, Nails

o Skin assessments: Turgor; Moisture vs Hydration; Edema; Thickness; Texture;

Vascularity/bruising
o Normal vs abnormal skin findings:
o Jaundice
o Pallor
o Erythema/rubor
o Cyanosis
o Types/classifications of skin lesions
o Shapes—examples of each
o Annular/circular; tinea corporis
o Confluent; hives
o Discrete; acne, chicken pox
o Grouped; contact dermatitis
o Target; Lyme disease
o Zosteriform; Herpes zoster

o Primary lesions:
o Macules
o Papules
o Plaques
o Nodules
o Wheals
o Vesicles/bullae
o Cysts
o Pustules
o Secondary lesions:
o Scales
o Crusts
o Fissures
o Ulcers
o Lichenification
o Excoriations
o Skin Cancer
o Malignant melanoma
ABCDE rule—assessing for skin lesions/malignancies
o Basal cell : basic presentation
o Squamous cell : basic presentation
o Nails
o Abnormalites
o Clubbing of nails—describe; what is cause
o Pitting/nicking
o Fungal infections of nails
o Capillary refill
o Hair
o Causes of hair loss/lesions to scalp
o Common changes seen in skin/hair/nails in aging
o Normal variants for different ethnicities
 o Signs of abuse

Heart and Neck Vessels

o KNOW normal blood flow through heart, including valves and lungs
o Anatomical locations for assessing heart sounds
o Understand S1, S2 and extra sounds—S3 S4
o Murmurs—what are we listening for? Where/how do we examine for murmur
o Cardiac cycle—what is systole and diastole—atrial kick
o Stroke volume, cardiac output
o Understanding of preload and afterload
o Cardiac risk factors---modifiable and non-modifiable
o Neck vessels—name and explain function
o Assessing neck vessels—what abnormals are we looking for and what do they mean? (do
not need to know how to estimate JVP—Just know what would indicate jugular
venous distention—and what that means/what causes it)
o Know pathway of electrical conduction
o Health history important to cardiovascular health
o Know normal or expected variants for aging adults, children and infants for all sections.
o Chest pain—classic signs of cardiovascular/ischemic pain vs. other causes
o Congestive Heart Failure—signs and symptoms of right sided and left sided HF
Terms and Vocab to know r/t Ch, 19
 Bruit*
 Atrial Kick
 Diastole
 Afterload
 Preload
 Systole
 CHF
 Orthopnea*
 Apical impulse
 Stroke volume
 Cardiac output
 Pericardium
 Clubbing of nails *
 Pericardial Friction Rub*
* why is this important to cardiac health

Peripheral Vascular System & Lymph

1. Mechanisms of arterial, venous and lymph circulation and why are significant for assessment
Structure or veins vs. arteries
Lymph tissue/nodes/ducts
Calf pump/peripheral heart
2. Assessment findings for peripheral venous vs. peripheral arterial insufficiency pg. 532
Risk factors for PVD/PAD
3. Assessment findings for Deep Vein Thrombosis (ACUTE venous disease) vs Superficial varicose veins
(CHRONIC venous disease)
4. Raynaud Phenomenon—assmt findings
5. Assessment techniques “normal” findings for Peripheral Vascular Assessment as we have done for
RWU, and for Head to Toe
6. Normal variants for aging and pregnant.
7. Common abnormal findings in assessment of PVS/Lymph (example—what is considered weak
or bounding pulses, what is considered edema, abnormal lymph findings etc.)
8. Vocabulary—terms to know. I will not be able to define during the test!!
a. Vascular
b. Venous
c. Arterial
d. Capillary
e. Lymphatic
f. Ischemia
g. Claudication
h. Arteriosclerosis
i. Venous stasis
j. Phlebitis/thrombophlebitis

Abdomen
o Know 4 abdominal quadrants and what organs are in each quadrant—which one’s you would
assess for and how you would assess [eg. liver is in RUQ, assess by palpating for border and
percussing for height]
o Which organs are easiest to assess posteriorly? Anteriorly? Laterally?
o What subjective information is relevant to abdominal assessment?
o Techniques/order for performing abdominal examination [inspect, auscultate, percuss, palpate—
light then deep]
o Risk factors and causes for constipation
o Assessing for splenomegaly and hepatomegaly. NOTE: palpate RLQ first, slowly palpating
diagonally into LUQ so as to not miss extremely large spleen—then assess at costal border.
o CVA tenderness
o Expected changes/findings for older adults
o Exam techniques to assess for:
o Appendicitis [iliopsoas test, rebound tenderness-Blumburg Sign, obturator]
b. Cholecystitis (gall bladder disease) [Murphy’s sign]
c. Ascites/shifting dullness [fluid wave]
 TERMS TO KNOW:
o Borborygmi
o hernia also inguinal region hernia—groin check only
o Dysphagia
o
Breast & Axilla; Male GU
o Anatomy of breasts and male genitalia
o Regional lymph nodes
o Abnormal findings—subjective and objective for breast exam
o Important components of breast exam
o Teaching pt self-breast exam
o Teaching testicular self-exam
o How to describe “lump” in breast or testicular exam
o Significant risk factors for breast and testicular cancers
o Testicular torsion—symptoms and assessment related to
o Translumination in testicular exam—what are normal/abnormal findings
o Phimosis/Paraphimosis