A-10

The patient has a stage I ulcer, which is defined as intact skin that has a change in temperature,
consistency, sensation, or color. The temperature can be warm or cool; the consistency can be
firm or boggy; the patient may experience pain or itching; the color may be red, blue, or purple.

A stage II ulcer is a partial-thickness skin loss or ulceration, which involves the epidermis, dermis,
or both layers. A stage III ulcer is a full-thickness skin loss with evidence of damage to or necrosis
of subcutaneous tissue, which may extend to, but not through, the underlying muscle. A stage IV
ulcer involves full-thickness skin loss with destruction, tissue necrosis, or damage to underlying
muscle, bone, or supporting structures.

7. The correct answer is (D) Plantar wart

Plantar warts often occur on the metatarsal area, heels, and toes, where there has been slight
trauma in the past. They cause thickened skin and can be very painful upon pressure. There are
usually characteristic black dots associated with the wart, which are thrombosed capillaries.
Corns are thickened skin, but they are caused by pressure against the foot. They occur most
commonly on the lateral side of the 5th toe and between the 4th and 5th toes. Callus formations
also occur at pressure points but at places where the skin is normally thick. Calluses are not
painful and are usually located around the heel or over the plantar surface, just proximal to the
great toe. They are not tender. Neuropathic ulcers also develop at pressure points, usually
because of a lack of sensation. Although often deep and infected, they are not painful. They are
usually red, warm, and sometimes drain serosanguinous fluid.

Chapter 5
Head and Neck

A-11

Multiple Choice

1. The correct answer is (A) Central innervation of cranial nerve VII (facial)

A review of the cranial nerves and their function support the symptoms presented. Facial muscles
are mediated by cranial nerve Vll.

2. The correct answer is (C) Cluster headache

A cluster headache produces pain around the eye, temple, forehead, and cheek; it is unilateral
and always on the same side of the head. The pain may be excruciating and can occur as often
as twice a day. This type of headache is more common in men than in women.

3. The correct answer is (B) Sternomastoid and trapezius

The major anterior neck muscles are the trapezius and sternomastoid. They form two triangles on
the side of the neck, which can be used as landmarks for lymph nodes and other vessels.

4. The correct answer is (C) Myxedema

Myxedema arises from hypothyroidism, or a deficiency of thyroid hormone. You may see a
periorbital edema, coarse facial features, dry skin, and dry coarse hair and eyebrows.

Sclerodema is a rare autoimmune disorder affecting blood vessels and connective tissue,
causing a tightening of the skin in the lower face. Cachexia refers to severe weight loss from poor