El valor de la ectoscopia

EL VALOR DE LA ECTOSCOPIA. FUNDAMENTOS para una INSPECCIÓN EFICAZ.

Adolfo Colinet MorenoAgosto 2010AUTOR: JOZEF ISRAEL

1

SITUÁNDONOS…

• Identificación. Anamnesis. Exploración. Pruebas complementarias. Diagnóstico. Tratamiento. Seguimiento.

• Exploración: inspección, auscultación, palpación, percusión, olfación.

• INSPECCIÓN: ojeada en conjunto “a distancia”.

“El á

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LA “CRUDA” REALIDAD…SUJETE AL NIÑO POR DIOS !!!!

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Generalidades…

• Entrando por la puerta…Edad aparente, sexo, nutrición, talla, peso, fisonomía (stándard, asténico-a, pícnico-a, atlético-a). ¿Acompañado-a?

• Anatomía…Posturas, alteraciones esqueléticas, coloración, aspecto.

• Movimientos y/o esfuerzo respiratorios (eu-taqui-bradipnea), lenguaje, diaforesis, deambulación, braceo, cambios posturales, expresión facial, temblor…

5

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Talla y proporciones…

¿Armonía?

En

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ENANISMO ARMÓNICO:racial,familiar,esporádico, genérico y hipofisario.

Enanismo Armónico Familiar

E.A. hipofisario ó ATELEIÓTICO

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http://images.google.com/imgres?imgurl=http://estaticos01.cache.el-mundo.net/elmundo/imagenes/2007/07/24/1185263755_0.jpg&imgrefurl=http://www.elmundo.es/elmundo/hemeroteca/2007/07/30/m/elsibarita.html&usg=__OV6ndSusOnr1u4YrJcx5rFbftqw=&h=307&w=300&sz=22&hl=es&start=2&itbs=1&tbnid=F9jzwi6PX-aUcM:&tbnh=117&tbnw=114&prev=/images%3Fq%3Dpigmeo%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://mondereversible.files.wordpress.com/2007/09/10nn.jpg&imgrefurl=http://mondereversible.wordpress.com/2007/09/25/kenadie-jourdin-bromley/&usg=__aG6gLxSYrJSA0i7VW1GF6i2zZCI=&h=269&w=402&sz=79&hl=es&start=8&itbs=1&tbnid=-RVATaQ7yovW6M:&tbnh=83&tbnw=124&prev=/images%3Fq%3Denanismo%26hl%3Des%26tbs%3Disch:1

http://www.parecidosrazonables.com/parecidos_razonables/288_Maurice-Tiller-y-Shrek.php

http://images.google.com/imgres?imgurl=http://www.medicinaysalud.org/wp-content/uploads/2008/11/acromegalia.jpg&imgrefurl=http://www.medicinaysalud.org/enfermedades/%25C2%25BFque-es-la-acromegalia/&usg=__vnNzTPc9ryuW4mrSAsccQFJ0hrM=&h=493&w=629&sz=117&hl=es&start=1&itbs=1&tbnid=AxhT4u_Kmssk-M:&tbnh=107&tbnw=137&prev=/images%3Fq%3Dacromegalia%26hl%3Des%26tbs%3Disch:1

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http://images.google.com/imgres?imgurl=http://2.bp.blogspot.com/_ENPBORHngNk/ScYzcjSzNXI/AAAAAAAAB-A/IzRHFk-Kwk0/s320/Enanismo.jpg&imgrefurl=http://www.elrincontecnologico.com/feeds/posts/default%3Fstart-index%3D426&usg=__VE4vFs6_6c2HjCssP56osrTVIlM=&h=320&w=241&sz=25&hl=es&start=11&itbs=1&tbnid=Lb48mHCpLm5O4M:&tbnh=118&tbnw=89&prev=/images%3Fq%3Denanismo%2Bfamiliar%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://upload.wikimedia.org/wikipedia/commons/thumb/4/4b/Velazquez-dwarf-don-sebastian-de-morra.jpg/200px-Velazquez-dwarf-don-sebastian-de-morra.jpg&imgrefurl=http://es.wikipedia.org/wiki/Enanismo&usg=__Vp9WleWsQqQF9JZ0vWo7lGVdvRU=&h=266&w=200&sz=13&hl=es&start=6&itbs=1&tbnid=5vDGFQnmMpMakM:&tbnh=113&tbnw=85&prev=/images%3Fq%3Denano%2Bhipofisario%26hl%3Des%26tbs%3Disch:1

Algunos tamaños menos armónicos…

Cretinismo: tronco largo y miembros cortos

Acondroplasia: cabeza “copa gorda”

GIG

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GIGANTISMO DISARMÓNICO ACROMEGALIA: manos y pies gigantes y prominencias faciales pronunciadas.

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http://images.google.com/imgres?imgurl=http://www.gidabilimi.com/images/kretenizm1.png&imgrefurl=http://www.thyroidtreatments.net/tag/cretinism&usg=__YRsTiR-N6GdwuftefIlkGsj2FtI=&h=567&w=477&sz=247&hl=es&start=4&itbs=1&tbnid=EE1rrvAV_vd0AM:&tbnh=134&tbnw=113&prev=/images%3Fq%3Dcretinism%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://www.whk.ac.th/whk2008/web/science/iodine/IMAGE/Cretin.jpg&imgrefurl=http://www.whk.ac.th/whk2008/web/science/iodine/chapter2/idd.html&usg=__z_kazwfE_JZ_IJNDt1tO3-L8F3s=&h=279&w=260&sz=18&hl=es&start=2&itbs=1&tbnid=PIGdGnaLUuOE8M:&tbnh=114&tbnw=106&prev=/images%3Fq%3Dcretinism%26hl%3Des%26tbs%3Disch:1

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http://images.google.com/imgres?imgurl=http://www.jornada.unam.mx/2008/05/03/fotos/a06n1cul-1.jpg&imgrefurl=http://kikka-roja.blogspot.com/2008_04_27_archive.html&usg=__nJ5ntOxPqzSd1Sd4_szhNuIOVGY=&h=333&w=500&sz=21&hl=es&start=31&itbs=1&tbnid=0MO9-6KvI5jtDM:&tbnh=87&tbnw=130&prev=/images%3Fq%3Denanismo%2Bacondroplasia%26start%3D20%26hl%3Des%26sa%3DN%26ndsp%3D20%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://www.elcomerciodigital.com/prensa/fotos/200610/10/020D2GIJ-AST-xxx-P2_1.jpg&imgrefurl=http://www.elcomerciodigital.com/prensa/20061010/asturias/personas-pediran-gijon-enanismo_20061010.html&usg=__WQHrEsBatooVeldgzrgMQXSVQnA=&h=260&w=172&sz=13&hl=es&start=23&itbs=1&tbnid=qSma0nlmqA7jkM:&tbnh=112&tbnw=74&prev=/images%3Fq%3Denanismo%2Bacondroplasia%26start%3D20%26hl%3Des%26sa%3DN%26ndsp%3D20%26tbs%3Disch:1

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http://images.google.com/imgres?imgurl=http://3.bp.blogspot.com/_UpnQxB9Fs3E/Sbj_j-N5-iI/AAAAAAAAAAk/gnNyQ07XPiI/s320/castrato-process.jpg&imgrefurl=http://elmalignodedescartes.blogspot.com/2009/03/castrati.html&usg=__lgUIOU7pLeXNTX0jKCqKSIz90fg=&h=195&w=160&sz=12&hl=es&start=3&itbs=1&tbnid=QeYzCdJmWsD7SM:&tbnh=104&tbnw=85&prev=/images%3Fq%3Dcastrati%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://www.acromegaly.org.uk/acromegaly.jpg&imgrefurl=http://www.acromegaly.org.uk/&usg=__1DByAuZBz2UJpd3Iwr1cd_-SKhE=&h=281&w=248&sz=8&hl=es&start=4&itbs=1&tbnid=x4h5Jyf8NEmsGM:&tbnh=114&tbnw=101&prev=/images%3Fq%3Dacromegaly%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://www.e-radiography.net/radpath/a/acromegaly2.jpg&imgrefurl=http://www.e-radiography.net/radpath/a/acromegaly.htm&usg=__FVVyhVPAquCZQx_QcgkxLv1cfpw=&h=500&w=375&sz=50&hl=es&start=9&itbs=1&tbnid=EycdsflAfMuKHM:&tbnh=130&tbnw=98&prev=/images%3Fq%3Dacromegaly%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://img.tfd.com/mosby/thumbs/500038-fx7.jpg&imgrefurl=http://medical-dictionary.thefreedictionary.com/iatrogenic%2Bacromegaly&usg=__3XwNxhhKauoKrB4LZol9b6shBBc=&h=377&w=250&sz=16&hl=es&start=19&itbs=1&tbnid=4qXnWceavoV94M:&tbnh=122&tbnw=81&prev=/images%3Fq%3Dacromegaly%26hl%3Des%26tbs%3Disch:1

http://www.chauvet-translation.com/figures/Figure027.jpg

http://images.google.com/imgres?imgurl=http://www.eugenicsarchive.org/images/eugenics/normal/801-850/834-Mary-Ann-Bevan-the-world-s-ugliest-woman-acromegaly.jpg&imgrefurl=http://www.eugenicsarchive.org/eugenics/image_header.pl%3Fid%3D834&usg=__tAKkrpgkvvamiOc4i3COPMa6fA4=&h=666&w=409&sz=49&hl=es&start=13&itbs=1&tbnid=pzJu20vel_IUxM:&tbnh=138&tbnw=85&prev=/images%3Fq%3Dacromegaly%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://www.eldiariomontanes.es/prensa/fotos/200707/28/092D6DMGP3_1.jpg&imgrefurl=http://www.ocioycultura.com.es/rdl/2010/02/el-vitiligo-y-otras-extranas-enfermedades-de-los-famosos/&usg=__CjbOnx10TQBjLQDJ8MAe2qSXeqs=&h=269&w=200&sz=23&hl=es&start=6&itbs=1&tbnid=6swe8fAgfop7lM:&tbnh=113&tbnw=84&prev=/images%3Fq%3Dacromegalia%2Bbaloncesto%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://siskko.files.wordpress.com/2007/01/hulk_hogan_antes_y_ahora.jpg&imgrefurl=http://hoysecumplen.com/category/pressing-catch/&usg=__KrQP-Qfu-4g8GPrzUsW-zTniMOc=&h=327&w=470&sz=36&hl=es&start=10&itbs=1&tbnid=nuRPXdJpHiAc8M:&tbnh=90&tbnw=129&prev=/images%3Fq%3DACROMEGALIA%2BCELEBRITIES%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://hoysecumplen.com/wp-content/uploads/2010/01/140909galluchadoresgiganteg.jpg&imgrefurl=http://hoysecumplen.com/2010/01/page/5/&usg=__XXd0SskbdAbyb2GqB22d1wsd6Dw=&h=375&w=500&sz=61&hl=es&start=16&itbs=1&tbnid=9XBVehLC2l1plM:&tbnh=98&tbnw=130&prev=/images%3Fq%3DACROMEGALIA%2BCELEBRITIES%26hl%3Des%26tbs%3Disch:1

Otros gigantismos disarmónicos…ARANODACTILIA

MA

RFA

N Y

HO

MO

CIS

TIN

UR

IA

8

http://images.google.com/imgres?imgurl=http://www.hilaryshepherd.com/rantsnraves/wp-content/uploads/2009/09/uncle-sam-taxes.jpg&imgrefurl=http://www.hilaryshepherd.com/rantsnraves/2009/09/24/randy-quaid-evi-quaid-arrested/&usg=__xvE0QPFWWV9ngMWJUrErSgpowzA=&h=472&w=400&sz=20&hl=es&start=17&itbs=1&tbnid=UIR5BFvZvEjPEM:&tbnh=129&tbnw=109&prev=/images%3Fq%3DMARFAN%2BCELEBRITY%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://medicina.ufm.edu/uploads/assets/Sme-Marfan.jpg&imgrefurl=http://medicina.ufm.edu/cms/es/Sindrome-de-Marfan&usg=__XEMuC0PPxkdOCJMl_1krtSesazo=&h=803&w=472&sz=95&hl=es&start=1&itbs=1&tbnid=mdV38xCGnzRglM:&tbnh=143&tbnw=84&prev=/images%3Fq%3DMARFAN%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://html.rincondelvago.com/000610614.jpg&imgrefurl=http://html.rincondelvago.com/sindrome-de-marfan.html&usg=__quwjuaqgtObM4vPMHdPJduiRbV4=&h=380&w=570&sz=37&hl=es&start=7&itbs=1&tbnid=9TX5jr_6cNrCmM:&tbnh=89&tbnw=134&prev=/images%3Fq%3Daracnodactilia%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://4.bp.blogspot.com/_SYXRr644EAA/SS1ZCFAcDRI/AAAAAAAAB7s/o5l9LatQ8ig/s400/ss.jpg&imgrefurl=http://elrincondelamedicinainterna.blogspot.com/2008/11/cual-es-el-diagnstico_26.html&usg=__Y0oyhXh5RYFslXUBWevqr7cGNkk=&h=400&w=324&sz=16&hl=es&start=17&itbs=1&tbnid=f2zW5BdXd7jIZM:&tbnh=124&tbnw=100&prev=/images%3Fq%3Daracnodactilia%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://www.bvs.sld.cu/revistas/mciego/vol9_supl2_03/pics/img13_c5v9_supl203.gif&imgrefurl=http://www.bvs.sld.cu/revistas/mciego/vol9_supl2_03/casos/c6_v9_supl203.htm&usg=__DpviBRNehTGme21E8iOBttSLpwM=&h=226&w=258&sz=21&hl=es&start=16&itbs=1&tbnid=KWv5go-3IKN-_M:&tbnh=98&tbnw=112&prev=/images%3Fq%3Daracnodactilia%26hl%3Des%26tbs%3Disch:1

http://2.bp.blogspot.com/_tsOe-FCnO1g/Sa8hNu7-BEI/AAAAAAAAByY/1fbc0mUWSkg/s400/marf%C3%A1n+manos.jpg

http://images.google.com/imgres?imgurl=http://www.cardiologiapertutti.org/Immagini/Marfan%2520-%252002.jpg&imgrefurl=http://www.taringa.net/posts/info/2736752/Los-Largos-Dedos-de-Paganini.html&usg=__lYpc0HWNWsutdLnNxx2HRHfEVjA=&h=214&w=147&sz=7&hl=es&start=15&itbs=1&tbnid=8R2npBMHprTiCM:&tbnh=106&tbnw=73&prev=/images%3Fq%3Daracnodactilia%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://farm4.static.flickr.com/3091/3201874900_7665d26194.jpg&imgrefurl=http://www.flickr.com/photos/nationalmarfanfoundation/3201874900/&usg=___BvAnh_KfYql5e02TUnIivQp5ig=&h=500&w=475&sz=144&hl=es&start=18&itbs=1&tbnid=zeYggdR1bv1W7M:&tbnh=130&tbnw=124&prev=/images%3Fq%3DMARFAN%26hl%3Des%26tbs%3Disch:1

http://haplesshermit.typepad.com/photos/uncategorized/2008/03/27/vincent_schiavelli01.gif

http://images.google.com/imgres?imgurl=http://blogs.20minutos.es/myfiles/ezcultura/IMG_1935%2Bcopia.jpg&imgrefurl=http://www.taringa.net/posts/tv-peliculas-series/2100629/Javier-Botet-(Actor)---El-Monstruo-de-REC.html&usg=__iGvTJDgD2WgFvXp-Vwo-1r3XblY=&h=400&w=300&sz=17&hl=es&start=10&itbs=1&tbnid=oZAJ8VdTCyf1FM:&tbnh=124&tbnw=93&prev=/images%3Fq%3DACTOR%2BREC%2BMARFAN%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://4.bp.blogspot.com/_pCaj1MuWrMw/S6v4et2QrPI/AAAAAAAACLU/9NdDi_GhzVo/s1600/1256839370_0.jpg&imgrefurl=http://elpaisdeargentina.blogspot.com/2010/03/saludel-hombre-que-no-puede-dejar-de.html&usg=__LetZEDo6FU3IZvlMgx1Otv8AJpQ=&h=526&w=400&sz=20&hl=es&start=2&itbs=1&tbnid=-50X9q0s8GCwJM:&tbnh=132&tbnw=100&prev=/images%3Fq%3DACTOR%2BREC%2BMARFAN%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://www.hughston.com/hha/b_16_4_4b.jpg&imgrefurl=http://www.hughston.com/hha/a_16_4_4.htm&usg=__f2FsDru4FpfEIifaSRaJA7uDO14=&h=334&w=275&sz=40&hl=es&start=1&itbs=1&tbnid=J7hnFYYyzFULyM:&tbnh=119&tbnw=98&prev=/images%3Fq%3DHEART%2BMARFAN%26hl%3Des%26tbs%3Disch:1

http://go2.wordpress.com/?id=725X1342&site=hernaturehisnurture.wordpress.com&url=http%3A%2F%2Fhernaturehisnurture.files.wordpress.com%2F2008%2F08%2Fphelps13.jpg&sref=http%3A%2F%2Fhernaturehisnurture.com%2Ftag%2Fwing-span%2F

CONSTITUCIÓN…

• FENOTIPO: estado permanente tanto anatómico como funcional del cuerpo.

• GENOTIPO: caracteres heredados.

• PARATIPO: caracteres adquiridos (de crecimiento de funciones o evolutivos y de retroceso de funciones o involutivos).

9

http://www.google.es/imgres?imgurl=http://papamamabebe.com/wp-content/uploads/2009/05/bebe.jpg&imgrefurl=http://papamamabebe.com/sitios-on-line-con-marcos-de-fotos-para-bebes/&usg=__X5XGww5e-OxgQv6OAkTaGKbsIAE=&h=500&w=500&sz=133&hl=es&start=1&um=1&itbs=1&tbnid=W7Eyiz4_Ms5kyM:&tbnh=130&tbnw=130&prev=/images%3Fq%3Dbebe%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://estaticos02.cache.el-mundo.net/magazine/num117/imagenes/alba.jpg&imgrefurl=http://www.elmundo.es/magazine/num117/textos/alba.html&usg=__q8WLpYkvrfyXBjj6LoObb6XnMXg=&h=383&w=249&sz=27&hl=es&start=3&um=1&itbs=1&tbnid=LIHXRsqXVJFkwM:&tbnh=123&tbnw=80&prev=/images%3Fq%3Dduquesa%2Bde%2Balba%2Bjoven%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://estaticos.20minutos.es/img/2006/07/06/483799_tn.jpg&imgrefurl=http://www.20minutos.es/noticia/138620/1/&usg=__dk2Zi7blgh7ka1u3KCL5QTYOdyM=&h=168&w=175&sz=6&hl=es&start=7&um=1&itbs=1&tbnid=sYBiVeuT2UrgDM:&tbnh=96&tbnw=100&prev=/images%3Fq%3Dduquesa%2Bde%2Balba%2Bjoven%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.vanitatis.com/cache/2008/05/07/76eugenia_dentro.jpg&imgrefurl=http://www.vanitatis.com/cache/2008/05/08/44_tuneado_duquesa_montoro.html&usg=__zCKz0p_aw_x0RZtDmS-OO15RmYI=&h=460&w=300&sz=45&hl=es&start=10&um=1&itbs=1&tbnid=kALnEu50f_nnnM:&tbnh=128&tbnw=83&prev=/images%3Fq%3Dduquesa%2Bde%2Balba%2Bjoven%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://hoysecumplen.com/wp-content/uploads/2010/08/duquesa-de-alba.jpg&imgrefurl=http://hoysecumplen.com/category/los-ultimos-10-anos/&usg=__7zylriR75whhFh1D5FflkgPAznY=&h=300&w=300&sz=21&hl=es&start=4&um=1&itbs=1&tbnid=7XSzrd3Q_oB8iM:&tbnh=116&tbnw=116&prev=/images%3Fq%3Dduquesa%2Bde%2Balba%2Bjoven%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

TIPOS DE CONSTITUCIÓN…FÍSICA:CLASIFICACIONES “QUIJOTESCO” IDEAL “SANCHO” DISARMONÍAS

GIOVANNI TÍSICO ATLÉTICO PLETÓRICO

SIGAUD RESPIRATORIO MUSCULAR DIGESTIVO CEREBRAL

VIOLA LONGITIPO BRAQUITIPO NORMOSPLÁCNICO

KRETSCHMER LEPTOSÓMICO ATLÉTICO PÍCNICO DISPLÁSICO

10

http://images.google.com/imgres?imgurl=http://4.bp.blogspot.com/_FShpolONDqk/S9EA2_4RRgI/AAAAAAAAAAY/SkGO5-8o-lU/s1600/don-quijote-8891.jpg&imgrefurl=http://quete-importa.blogspot.com/2010_04_01_archive.html&usg=__BB16OujMfIFKTctaC3ePATm2giw=&h=875&w=620&sz=55&hl=es&start=6&itbs=1&tbnid=8egLTGwff6foHM:&tbnh=146&tbnw=103&prev=/images%3Fq%3DQUIJOTE%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://quijotadas.iespana.es/sancho.jpg&imgrefurl=http://quijotadas.iespana.es/jquiz.htm&usg=__Xog4edJHMnMQC80H_WDQ5g-h3XE=&h=1006&w=586&sz=309&hl=es&start=17&itbs=1&tbnid=X6zbtHukVaqrFM:&tbnh=150&tbnw=87&prev=/images%3Fq%3DSANCHO%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://2.bp.blogspot.com/_PSfkStpEh1E/SpG_FX3diLI/AAAAAAAAACk/laQprvZm-e8/s320/Usain_Bolt.jpg&imgrefurl=http://kbzas-d-rata.blogspot.com/2009_08_01_archive.html&usg=__7dLORJR0vlI3aaeJN3cOci9EIRg=&h=280&w=280&sz=16&hl=es&start=15&itbs=1&tbnid=N-6_I14gz5MYfM:&tbnh=114&tbnw=114&prev=/images%3Fq%3Dusain%2Bbolt%26hl%3Des%26tbs%3Disch:1

http://images.google.com/imgres?imgurl=http://3.bp.blogspot.com/_JqpPsAadxAs/S_3mHsElRjI/AAAAAAAABjQ/ipI9XRP72mk/s1600/GRU%C3%91%C3%93N.jpg&imgrefurl=http://postbysil.blogspot.com/2010/05/blanca-nieves-y-los-seis-enanitos.html&usg=__o-CUjLCv5NDtlcvkGN2bCnm462o=&h=409&w=290&sz=21&hl=es&start=18&itbs=1&tbnid=-SqOJsxohzE9VM:&tbnh=125&tbnw=89&prev=/images%3Fq%3Denano%2Bblanca%2Bnieves%26hl%3Des%26tbs%3Disch:1

TIPOS DE OBESIDAD (grasa y/o edema)

• SUPERIOR: síndrome de Cushing

• INFERIOR: lipodistrofia de Barraquer Simmonds y otros síndromes raros.

• UNIVERSAL.• ANASARCA.

11

http://www.google.com/imgres?imgurl=http://www.socreum.sld.cu/bvrmlg_imagenes_g/vergeturas_g.jpg&imgrefurl=http://www.socreum.sld.cu/bvrmlg_pag_imagen/cushing.htm&usg=__Wo-jcGuQ7avaroKfck2NGKa5850=&h=364&w=452&sz=148&hl=es&start=5&um=1&itbs=1&tbnid=9KBLvkxU_DUOfM:&tbnh=102&tbnw=127&prev=/images%3Fq%3Dsindrome%2Bcushing%26um%3D1%26hl%3Des%26sa%3DN%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.scielo.cl/fbpe/img/rmc/v132n1/fig11-01.jpg&imgrefurl=http://www.scielo.cl/scielo.php%3Fpid%3DS0034-98872004000100012%26script%3Dsci_arttext&usg=__r9x-HzLa0hC9ESWsmmIEjGpgt44=&h=313&w=450&sz=23&hl=es&start=7&um=1&itbs=1&tbnid=KOMwKaZLIWye7M:&tbnh=88&tbnw=127&prev=/images%3Fq%3Dsindrome%2Bcushing%26um%3D1%26hl%3Des%26sa%3DN%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.hipernatural.com/images/enfermedades/enfermedad_de_cushing.jpg&imgrefurl=http://www.hipernatural.com/es/enfenfermedad_de_cushing.html&usg=__931RSeZLBrVk2pl2Qs6_EqcBP4g=&h=200&w=220&sz=8&hl=es&start=3&um=1&itbs=1&tbnid=R06jIUbvw1xg3M:&tbnh=97&tbnw=107&prev=/images%3Fq%3Dsindrome%2Bcushing%26um%3D1%26hl%3Des%26sa%3DN%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://4.bp.blogspot.com/_ZnlaXXYuggs/TB7Eqb06BpI/AAAAAAAAAeM/bc2Gq8bB4Fo/s400/lipodistrofia.JPG&imgrefurl=http://biologiademais.blogspot.com/&usg=__eERa6WULoZ4z8wiwd5zxcmplOLM=&h=291&w=400&sz=25&hl=es&start=6&um=1&itbs=1&tbnid=1Lm6hGmMciV0lM:&tbnh=90&tbnw=124&prev=/images%3Fq%3DLIPODISTROFIA%26um%3D1%26hl%3Des%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://mardelossargazos.files.wordpress.com/2007/10/dromedario1.jpg&imgrefurl=http://mardelossargazos.wordpress.com/category/curiosidades/&usg=__MTMH67cYlgZPNY6hsJGPTnK5LXI=&h=288&w=359&sz=7&hl=es&start=7&um=1&itbs=1&tbnid=jH8dZXSCcO2UdM:&tbnh=97&tbnw=121&prev=/images%3Fq%3Djoroba%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

12

HIPOTIROIDISMO

EAP

http://www.google.com/imgres?imgurl=http://int-prop.lf2.cuni.cz/foto/009/pic00061.jpg&imgrefurl=http://int-prop.lf2.cuni.cz/zof/avysetreni/apoloha.htm&usg=__4dNpp8Y_eYLdMKu6rNufDxE9blA=&h=640&w=480&sz=185&hl=es&start=8&um=1&itbs=1&tbnid=9w7Vp4dXDE2osM:&tbnh=137&tbnw=103&prev=/images%3Fq%3DANASARCA%26um%3D1%26hl%3Des%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.medwave.cl/medios/perspectivas/ACTASmedHCUCHoctNovDic2006/ParteIIHemoptisisfigura1.jpg&imgrefurl=http://www.medwave.cl/perspectivas/medicina/2006y2007/1/2.act%3Ftpl%3Dim_ficha_perspectivas_especialidades.tpl&usg=__zghTJMY_WcI04dP_O4xSBkbHCTg=&h=391&w=380&sz=90&hl=es&start=2&um=1&itbs=1&tbnid=5Mp-1iyWBT-ytM:&tbnh=123&tbnw=120&prev=/images%3Fq%3DPATIENT%2Bedema%2Bagudo%2Bde%2Bpulmon%26um%3D1%26hl%3Des%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.ctv.es/USERS/tortosa/imagenes/hipofisis/hipot.gif&imgrefurl=http://www.ctv.es/USERS/tortosa/netscape/shipotNets.htm&usg=__f12L5YaNGVLC1945Xng5W3UpcdI=&h=218&w=159&sz=9&hl=es&start=11&um=1&itbs=1&tbnid=39KFnxafcqk_eM:&tbnh=107&tbnw=78&prev=/images%3Fq%3DCOLA%2BDE%2BCEJA%2BHIPOTIROIDISMO%26um%3D1%26hl%3Des%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.infobae.com/adjuntos/imagenes/28/0172855B.jpg&imgrefurl=http://www.infobae.com/salud/461650-100935-0-Cu%25C3%25A1les-son-los-s%25C3%25ADntomas-del-hipotiroidismo&usg=__n1RWRqBFRt0cAosIxtRrOt_yfsg=&h=360&w=305&sz=25&hl=es&start=4&um=1&itbs=1&tbnid=T6_dFaNMQbpxTM:&tbnh=121&tbnw=103&prev=/images%3Fq%3DCOLA%2BDE%2BCEJA%2BHIPOTIROIDISMO%26um%3D1%26hl%3Des%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://img.youtube.com/vi/M_fXFRBThVs/0.jpg&imgrefurl=http://www.yolike.com/video/goiter/&usg=__ENLiGKdRbeztzSLPfArmx6pK_qk=&h=360&w=440&sz=11&hl=es&start=20&um=1&itbs=1&tbnid=kpfNf7WOnTZ2UM:&tbnh=104&tbnw=127&prev=/images%3Fq%3DCELEBRITY%2BWITH%2BHYPOTHYROIDISM%26um%3D1%26hl%3Des%26tbs%3Disch:1

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TIPOS DE EDEMA:• INICIO (brusco/paulatino), LOCALIZACIÓN (asimetría,

localizados/generalizados, zonas declives), INTENSIDAD (fóvea +++), SIGNOS INFLAMATORIOS, DURACIÓN Y ALIVIO.

• ESTASIS O CARDIOCIRCULATORIO: zonas acras y/o declives (región lumbar y/o sacra en encamados).

• LINFÁTICO o LINFEDEMA: por compresión, filariasis, congénitos y Trofedema.

• NEFRÍTICO: párpados, testicular y mmii.• NEFRÓTICO• INFLAMATORIO (5 signos de Hipócrates)• CARENCIAL: edemas de guerra, hambre (déficit albúmina) y cáncer (2º

hipercatabolismo proteico).• ALÉRGICO o ANGIONEURÓTICO.

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UNAS “FOTICOS” MÁS…

EDEMA EN ESCLAVINA

ANGIOEDEMAS

EDEMA PALPEBRAL ¿UNI- O BILATERAL?

FILARIASIS (de esto poco)

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http://www.doyma.es/ficheros/images/21/21v18n04/grande/21v18n04-13045829tab01.gif

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EDAD APARENTE…

• EQUIVALENTE A LA EDAD CRONOLÓGICA.• “BIEN CONSERVADOS”• JUVENILISMO• PROGERIA

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DESARROLLO MUSCULAR Y ÓSEO…

• “HUESUDOS”: climaterio, acromegalia.• GRÁCIL: esqueleto femenino normal y/o

hipogonadismo en el varón.• MUSCULOSO: factor genético, laboral,

deportistas. HERCÚLEO: enfermedad Thomsen, coartación aórtica.

• HIPOPLASIA congénita y adquirida.

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HIPOPLASIAS…

• SIMÉTRICAS: proximales (miopatías congénitas o hereditarias) y distales (miopatías neurológicas, mielopáticas y vasculares).

• ASIMÉTRICAS: poliomielitis y polineuritis.

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DEFORMIDADES GENERALES…

• RAQUITISMO• ENF. PAGET• CRETINISMO• TIPOS DE CRÁNEO:

- DOLICOCÉFALOS.- MESOCÉFALOS.- BRAQUICÉFALOS.

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PIEL (exantemas) y MUCOSAS (enantemas):• COLORACIÓN: palidez, hiperemia, ictericia, cianosis, pajizo, clorosis. ¡¡ LUZ

NATURAL !!

- Tipos de ictericia: verdínica (obst. biliar completa), flavínica (anemia hemolítica), rubínica (origen hepatocelular) y melánica (ictericia crónica obstructiva).

- Piel hiperpigmentada: racial, irradiación solar y patológica.

- Melanodermias: Addison, Cushing y hemocromatosis.

- Intoxicaciones por metales (gris pizarra): agudos (arsénico) y crónicos (argirosis y aurosis).

- Piel hipopigmentada: albinismo (pelo blanco e iris rosado).

- Piel aporcelanada: panhipopituitarismo (Sind. Seehan: pezones sin color).

19

http://www.google.com/imgres?imgurl=http://www.doyma.es/ficheros/images/2/2v118n07/grande/2v118n07-13026570tab01.gif&imgrefurl=http://www.doyma.es/revistas/ctl_servlet%3F_f%3D7064%26ip%3D66.249.65.98%26articuloid%3D13026570%26revistaid%3D2&usg=__28yrifbz9ZGvU6o6H4ZRdgtlDj8=&h=516&w=730&sz=51&hl=es&start=14&um=1&itbs=1&tbnid=Fob1ao7plX_5eM:&tbnh=100&tbnw=141&prev=/images%3Fq%3Denfermedad%2Bde%2Baddison%26um%3D1%26hl%3Des%26rlz%3D1R2GZEZ_es%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.hipernatural.com/images/enfermedades/enfermedad_de_cushing.jpg&imgrefurl=http://www.hipernatural.com/es/enfenfermedad_de_cushing.html&usg=__931RSeZLBrVk2pl2Qs6_EqcBP4g=&h=200&w=220&sz=8&hl=es&start=7&um=1&itbs=1&tbnid=R06jIUbvw1xg3M:&tbnh=97&tbnw=107&prev=/images%3Fq%3Dsindrome%2Bde%2Bcushing%26um%3D1%26hl%3Des%26sa%3DX%26rlz%3D1R2GZEZ_es%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.socreum.sld.cu/bvrmlg_imagenes_g/vergeturas_g.jpg&imgrefurl=http://www.socreum.sld.cu/bvrmlg_pag_imagen/cushing.htm&usg=__Wo-jcGuQ7avaroKfck2NGKa5850=&h=364&w=452&sz=148&hl=es&start=5&um=1&itbs=1&tbnid=9KBLvkxU_DUOfM:&tbnh=102&tbnw=127&prev=/images%3Fq%3Dsindrome%2Bde%2Bcushing%26um%3D1%26hl%3Des%26sa%3DX%26rlz%3D1R2GZEZ_es%26tbs%3Disch:1

http://www.google.com/imgres?imgurl=http://www.ritabartole.it/SCIENZE/GENETICA/Genetica%2520Immagini/Malattie%2520ereditarie/albinismo.JPG&imgrefurl=http://3moongoddess.blogspot.com/2010_03_01_archive.html&usg=__vp10fWWd4jhIU9lPyrGeDTyLO7Y=&h=304&w=289&sz=12&hl=es&start=10&um=1&itbs=1&tbnid=qlJaK7raMmJ5wM:&tbnh=116&tbnw=110&prev=/images%3Fq%3Dalbinismo%26um%3D1%26hl%3Des%26sa%3DG%26rlz%3D1R2GZEZ_es%26tbs%3Disch:1

LESIONES ELEMENTALES (ERUPCIONES CUTÁNEAS):

• MÁCULAS (“manchas” sin prominencia)• PÁPULAS• VESÍCULAS• PÚSTULAS• RONCHAS o HABONES• NÓDULOS • TUBÉRCULOS • ÚLCERAS• EROSIÓN• FISURA • COSTRA• ESCAMAS

20¿MALTRATO?

http://www.google.es/imgres?imgurl=http://i.esmas.com/image/0/000/004/888/hematomaNT_.jpg&imgrefurl=http://www.esmas.com/salud/enfermedades/notransmisibles/535257.html&usg=__kP4V8E6w7CnmrOJM58Qcc8KOCRU=&h=200&w=220&sz=8&hl=es&start=6&um=1&itbs=1&tbnid=cEnfrNEt_KWDbM:&tbnh=97&tbnw=107&prev=/images%3Fq%3Dhematoma%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

MÁC

ULA

S• PIGMENTARIAS• NO PIGMENTARIAS

(VITÍLIGO)• SANGUÍNEAS

CLOASMA EMBARAZO EFÉLIDES o PECAS

MANCHAS CAFÉ CON LECHE

NEUROFIBROMATOSIS (no es macular)

VITÍLIGO Y EL “CAMUFLAJE COSMÉTICO”

LEUCODERMA o ACROMÍA SÍFILIS 2ª

TELANGIECTASIA o ARAÑA VASCULAR

PETEQUIAS EQUIMOSIS HEMOSIDEROSIS 21

http://www.google.es/imgres?imgurl=http://www.aad.org/public/publications/pamphlets/_img/3601_000.jpg&imgrefurl=http://www.aad.org/public/publications/pamphlets/common_melasma.html&usg=__l5yejyBCy9mRsDvffa3HHBjFaKg=&h=377&w=250&sz=11&hl=es&start=2&um=1&itbs=1&tbnid=WHpK-TeUgECkVM:&tbnh=122&tbnw=81&prev=/images%3Fq%3DCHLOASMA%2BPREGNANCY%26um%3D1%26hl%3Des%26sa%3DX%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://1.bp.blogspot.com/_7f1oUL-X0aM/Sp3Rps-v-yI/AAAAAAAAAA8/ahQaZOlunac/s320/PECAS.jpg&imgrefurl=http://spanidyajaimesg.blogspot.com/2009/09/efelides.html&usg=__olcUD9FgEC0G16fOtKCN1FhhDLk=&h=150&w=200&sz=9&hl=es&start=3&um=1&itbs=1&tbnid=5p1SGlbHP3fcNM:&tbnh=78&tbnw=104&prev=/images%3Fq%3DEFELIDES%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.uv.es/~vicalegr/CLindex/CLtumb/CLtumb56.jpg&imgrefurl=http://www.uv.es/~vicalegr/CLindex/CLtumb/CLtumbe13.html&usg=__nQ9O-q8mach8BFIba1PPaVJQPqE=&h=505&w=437&sz=22&hl=es&start=3&um=1&itbs=1&tbnid=m93Qjnj5W0hp4M:&tbnh=130&tbnw=112&prev=/images%3Fq%3Dmanchas%2Bcafe%2Bcon%2Bleche%26um%3D1%26hl%3Des%26sa%3DX%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://img257.imageshack.us/img257/6453/img0bg4.jpg

http://www.google.es/imgres?imgurl=http://www.mundomedicinas.com/wp-content/uploads/2009/07/vitiligo1.jpg&imgrefurl=http://www.mundomedicinas.com/tag/vitiligo/&usg=___2JNrjLOKo949IhfSTaAAXH7nz4=&h=299&w=450&sz=22&hl=es&start=10&um=1&itbs=1&tbnid=X0n9JI7Yu6yWGM:&tbnh=84&tbnw=127&prev=/images%3Fq%3Dvitiligo%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://i6.photobucket.com/albums/y227/mitshu/vitiligo1.jpg&imgrefurl=http://childrenallergyclinic.wordpress.com/2010/05/09/correlation-vitiligo-food-allergy-and-celiac/&usg=__OE8vBtB1EZs9VeB00G6tAo5AmcM=&h=1085&w=768&sz=148&hl=es&start=6&um=1&itbs=1&tbnid=XayQ9GLOet3USM:&tbnh=150&tbnw=106&prev=/images%3Fq%3Dvitiligo%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://health.indianetzone.com/magnetic_therapy/images/Magnetic--009.jpg&imgrefurl=http://health.indianetzone.com/magnetic_therapy/1/leucoderma,_leucorrhoea.htm&usg=__mvIonzytnSkGA1lAAPsD0suZbYk=&h=146&w=210&sz=9&hl=es&start=9&um=1&itbs=1&tbnid=uMO3eqUg8FNbyM:&tbnh=74&tbnw=106&prev=/images%3Fq%3DLEUCODERMA%26um%3D1%26hl%3Des%26sa%3DX%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.clinicadam.com/graphics/images/es/1385.jpg&imgrefurl=http://www.clinicadam.com/salud/6/1385.html&usg=__1pp5_BF31c8GVZ49v_cZw48ZdD4=&h=226&w=306&sz=17&hl=es&start=1&um=1&itbs=1&tbnid=RlxIDHVdHh5kEM:&tbnh=86&tbnw=117&prev=/images%3Fq%3Dsifilis%2Bsecundaria%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.verdaderahomeopatia.com.ar/rosacea.jpg&imgrefurl=http://www.verdaderahomeopatia.com.ar/ACNE%2520ROSACEA%2520Y%2520HOMEOPAT.htm&usg=__usK2ECQUkPxH_lrkaUGNH8TTtno=&h=260&w=283&sz=18&hl=es&start=2&um=1&itbs=1&tbnid=bIq3Wj4f4CsE5M:&tbnh=105&tbnw=114&prev=/images%3Fq%3Dtelangiectasias%2BCARA%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www3.telus.net/agricola/Agricola_Web/Images_Bases/full-bottle-wine-glass-1.jpg&imgrefurl=http://www3.telus.net/agricola/Agricola_Documentos_Documentos.htm&usg=__Ykaalm4lUU8QRz-KYNUOsP4F6s4=&h=686&w=600&sz=41&hl=es&start=3&um=1&itbs=1&tbnid=85TiipExr4supM:&tbnh=139&tbnw=122&prev=/images%3Fq%3DBOTTLE%2BWINE%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://sfghed.ucsf.edu/Education/ClinicImages/Petechia.1.JPG&imgrefurl=http://www.dicciomed.es/php/diccio.php%3Fid%3D3693&usg=__8uqnjGrBtsjy8Zs03ef2kO3Of68=&h=486&w=648&sz=122&hl=es&start=3&um=1&itbs=1&tbnid=mMdQFcccOU03gM:&tbnh=103&tbnw=137&prev=/images%3Fq%3DPETEQUIA%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.clinicadam.com/graphics/images/es/2883.jpg&imgrefurl=http://www.monclovitas.com/foro/showthread.php%3Fpage%3D11%26t%3D38672&usg=__AprUxyantVz6mG3zZ_tmoWFYaPI=&h=226&w=306&sz=15&hl=es&start=6&um=1&itbs=1&tbnid=Pgjtq2n4yLBz6M:&tbnh=86&tbnw=117&prev=/images%3Fq%3DEQUIMOSIS%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.mdconsult.com/das/article/body/0/jorg%3Dclinics%26source%3D%26sp%3D22718191%26sid%3D0/N/725497/f09001102002.jpg&imgrefurl=http://www.mdconsult.com/das/clinics/view/0/N/22718191%3Fja%3D725497%26PAGE%3DIf09001102002.fig%26issn%3D0025-7125%26source%3D&usg=__VZyxoGUgubR0GIcFjMQYnAlT0Ck=&h=300&w=225&sz=25&hl=es&start=3&um=1&itbs=1&tbnid=XdnRkRJOB7qYvM:&tbnh=116&tbnw=87&prev=/images%3Fq%3DHEMOSIDEROSIS%2BLEG%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

PÁPULAS, VESÍCULAS, PÚSTULAS, HABONES, NÓDULOS, TUBÉRCULOS,

ÚLCERAS, EROSIÓN, FISURAS, COSTRA Y ESCAMAS:

XANTOMAS FLICTENA 2ª PICADURA

MOLLUSCUM CONTAGIOSUM

Y DE REPENTE…URTICARIA QUISTE SEBÁCEO LIPOMA

22

ACNÉ

PIE – MANO - BOCA

http://www.google.es/imgres?imgurl=http://www.laservision.es/img/oculoplastia_03.jpg&imgrefurl=http://www.laservision.es/parpados-xantelasma.asp&usg=__iwHImCIBMpwNPWbGIvZJqXxnrx8=&h=134&w=199&sz=47&hl=es&start=15&um=1&itbs=1&tbnid=Kiy6NHSfwSskrM:&tbnh=70&tbnw=104&prev=/images%3Fq%3DXANTOMAS%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://sisbib.unmsm.edu.pe/bvrevistas/medicina_experimental/v14_n2/Images/pag37_fig2.jpg&imgrefurl=http://sisbib.unmsm.edu.pe/bvrevistas/medicina_experimental/v14_n2/loxoscelismo.htm&usg=__dD_HFZXuevq_jMhZtKWMwEdj8rk=&h=300&w=246&sz=16&hl=es&start=7&um=1&itbs=1&tbnid=HiSBxrBWyBTmoM:&tbnh=116&tbnw=95&prev=/images%3Fq%3DFLICTENA%2BARA%25C3%2591A%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.madrimasd.org/blogs/salud_publica/wp-content/blogs.dir/97/files/1178/o_Coxsack01.jpg&imgrefurl=http://www.madrimasd.org/blogs/salud_publica/2008/05/20/92374&usg=__TInwUZ_2qAxbVCKG6mmsSTNBf5k=&h=437&w=598&sz=21&hl=es&start=6&um=1&itbs=1&tbnid=nlVUDOy_nn25mM:&tbnh=99&tbnw=135&prev=/images%3Fq%3DPIE%2BMANO%2BBOCA%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://health.kernan.org/graphics/images/es/2941.jpg&imgrefurl=http://health.kernan.org/esp_imagepages/2941.htm&usg=__2-S3fauN-Exf1ookul9H_TTqZug=&h=226&w=306&sz=12&hl=es&start=2&um=1&itbs=1&tbnid=R-A8wJq7RROliM:&tbnh=86&tbnw=117&prev=/images%3Fq%3DPIE%2BMANO%2BBOCA%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.madrimasd.org/blogs/salud_publica/wp-content/blogs.dir/97/files/1178/o_pies%2520manos%2520LENGUA.jpg&imgrefurl=http://www.madrimasd.org/blogs/salud_publica/2008/05/20/92374&usg=__M4jUmXmp3OwKxZJaKHT40D-_rvg=&h=480&w=404&sz=24&hl=es&start=1&um=1&itbs=1&tbnid=uR1N_tZOS6poBM:&tbnh=129&tbnw=109&prev=/images%3Fq%3DPIE%2BMANO%2BBOCA%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

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http://www.google.es/imgres?imgurl=http://2.bp.blogspot.com/_mKNuGPQrkJA/SxPu43vNs4I/AAAAAAAAAt0/8q0JB849b0w/s1600/QUISTE%2BSEBACEO%2BNUCA%2B1.JPG&imgrefurl=http://egresadosmedicinatijuana.blogspot.com/2009/11/quiste-sebaceo-en-nuca-abscedado.html&usg=__WqmbTiY_GcaabHlA1r0MAIeONkw=&h=1200&w=1600&sz=212&hl=es&start=11&um=1&itbs=1&tbnid=mjT2lskxVG_w_M:&tbnh=113&tbnw=150&prev=/images%3Fq%3DQUISTE%2BSEBACEO%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://medicalimages.allrefer.com/large/lipoma-arm.jpg&imgrefurl=http://health.allrefer.com/health/skin-lumps-lipoma-arm.html&usg=__ISGt5xLbEZNl5DdZMAj7CQ1yb-E=&h=226&w=306&sz=10&hl=es&start=4&um=1&itbs=1&tbnid=bV58rcw3j5pTXM:&tbnh=86&tbnw=117&prev=/images%3Fq%3DLIPOMA%26um%3D1%26hl%3Des%26sa%3DG%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

http://www.google.es/imgres?imgurl=http://www.iqb.es/dermatologia/atlas/generalidades/ampolla.jpg&imgrefurl=http://www.iqb.es/dermatologia/atlas/ped02.htm&usg=__zB4VgRdKgicnHZrAYKNKWTWdE7g=&h=400&w=500&sz=77&hl=es&start=9&um=1&itbs=1&tbnid=ROlIQwyrMT8wPM:&tbnh=104&tbnw=130&prev=/images%3Fq%3DAMPOLLA%26um%3D1%26hl%3Des%26rls%3Dcom.microsoft:es:IE-SearchBox%26rlz%3D1I7GZEZ_es%26tbs%3Disch:1

ACTITUDES Y POSTURAS (activas y pasivas)

En el domicilio…

PARALINGÜÍSTICA: -Volumen-Ritmo-Tono

POSICIÓN GENUPECTORAL (de Bleechmann)

FOWLER (lo contrario Trendelenburg)

23

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MÁS POSTURAS…• POSTURAS ANTIÁLGICAS: peritonismo,

hernia discal lumbar, meningismo.• PARKINSONISMO: deambulación.• FRACTURA DE CADERA: acortamiento

y rotación externa de extremidad inferior.• POSTURA HEMIPLÉJICA: miembro

superior en adducción y pronación, miembro inferior extendido.

• EXTRAPIRAMIDALISMO.

24

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HERNIA DISCAL

PO

LIM

IAL

GIA

RE

UM

ÁT

ICA

DISTROFIA MUSCULAR DUCHENNE

DISTROFIA MIOTÓNICA DE STEINERT

DOWN

TURNER (45 X0)

25

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MÁS FENOTIPOS…

KLINEFELTER (XXY)

ASPERGER

ANGELMAN

APERT EDWARDS

PIERRE ROBIN

PRADER WILLI WEST PROTEUS

¿ ?26

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SÍNDROMES GONADALES Y SOP

MORRIS (Sd insensibilidad androgénica)

¿HASTA EL 21 DE NOVIEMBRE?

POCS27

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PROXÉMICA Y “EL ESPACIO DEFENDIBLE”:

• DISTANCIAS: íntima (15-50 cm), personal (50-75 cm), social (1-2 m) y pública (> 2 m).

28

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OLORES…

• MELENAS• ESTEATORREA• CÁNCER DE PIEL (en laboratorio)• NECROSIS• ANAEROBIOS• “MANCHAS HIDROSOLUBLES”

29

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“SOY TODO OÍDOS”…• RINOLALIA• VOZ “PATATA CALIENTE”• TOS DE LARINGITIS • DISFONÍA• PUBERTAD• COJERAS Y ATAXIAS: Parkinson, de pato y/o

segador, tabética, steppage.

30

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A PENSAR…

31

ROSÁCEA

ESPONDILITIS ANQUILOPOYETICA

MARFAN

HORNER

LYME

ACANTOSIS NIGRICANS – NODULO HERMANA Mª JOSE

HERPES ZÓSTER

FRACTURA BASE CRÁNEO

PLIEGUE DENNIE MORGAN = ATOPIA

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32

Health & Medicine

El valor de la ectoscopia