COT Visual Assessment 1 — Questions and Answers
Question 1: During a visual assessment of a patient's skin, you notice a lesion that is flat, non-palpable, and less than 1 cm in diameter with a distinct color change from the surrounding skin. How is this lesion correctly classified?
- Papule
- Macule (Correct answer)
- Vesicle
- Plaque
Correct answer: Macule
A macule is defined as a flat, non-palpable skin lesion less than 1 cm in diameter that differs in color from the surrounding skin. It cannot be felt when the skin is palpated. A papule is elevated and palpable, a vesicle is a fluid-filled blister, and a plaque is a large raised flat-topped lesion.
Question 2: When performing a visual assessment of a patient's respiratory effort, which finding would MOST indicate increased work of breathing?
- Symmetric chest rise with each breath
- Use of sternocleidomastoid muscles during inhalation (Correct answer)
- Respiratory rate of 14 breaths per minute
- Pink mucous membranes
Correct answer: Use of sternocleidomastoid muscles during inhalation
Use of accessory muscles such as the sternocleidomastoid during inhalation is a classic visual sign of increased work of breathing. Normal breathing relies primarily on the diaphragm and intercostals. Symmetric chest rise, a normal respiratory rate of 14 breaths/min, and pink mucous membranes are all reassuring normal findings.
Question 3: A patient presents with yellowing of the sclera and skin. During your visual assessment, you document this finding. Which term correctly describes this observation?
- Cyanosis
- Pallor
- Jaundice (Correct answer)
- Erythema
Correct answer: Jaundice
Jaundice (icterus) is the yellow discoloration of the skin, sclera, and mucous membranes caused by elevated bilirubin levels. Cyanosis is a bluish discoloration indicating low oxygen saturation, pallor is abnormal paleness often related to anemia or vasoconstriction, and erythema refers to redness of the skin.
Question 4: During visual assessment of a wound, you observe edges that are rolled inward toward the wound bed. This characteristic finding is MOST associated with which type of wound?
- Acute surgical incision
- Chronic wound with impaired healing (Correct answer)
- Superficial abrasion
- Partial-thickness burn
Correct answer: Chronic wound with impaired healing
Rolled or epibolic wound edges (where the edges roll inward) are a hallmark of chronic wounds with impaired healing. This occurs when epithelial cells migrate downward rather than across the wound surface, preventing closure. Acute surgical incisions have clean approximated edges, abrasions have no true wound edges, and burns present differently based on depth.
Question 5: When visually assessing a patient's pupils using the PERRL mnemonic, what does the letter 'R' stand for?
- Reactive
- Round (Correct answer)
- Red reflex present
- Responsive
Correct answer: Round
In PERRL, the letters stand for: Pupils, Equal, Round, Reactive to Light. The 'R' specifically refers to Round, describing the shape of the pupils. Equal means both pupils are the same size, and Reactive to Light (the 'L' component) means they constrict appropriately when light is applied. Confusing 'Round' with 'Reactive' is a common error.
Question 6: During a visual gait assessment, you observe that a patient lifts their hip on the affected side with each step to allow their foot to clear the ground. Which gait pattern are you observing?
- Antalgic gait
- Trendelenburg gait
- Steppage gait (Correct answer)
- Circumduction gait
Correct answer: Steppage gait
Steppage gait (also called foot drop gait) involves exaggerated hip and knee flexion or hip hiking to clear a foot that cannot dorsiflex adequately. The patient must lift the entire limb higher to prevent the foot from dragging. Antalgic gait involves a shortened stance phase to minimize pain, Trendelenburg gait shows pelvic drop to the contralateral side, and circumduction involves swinging the leg outward in an arc.
COT Visual Assessment 1
During a visual assessment of a patient's skin, you notice a lesion that is flat, non-palpable, and less than 1 cm in diameter with a distinct color change from the surrounding skin.
How is this lesion correctly classified?