Identify the finding on the eyelids of the patient in the following image.

DSSSB October 2024

Medical Surgical Nursing

Easy

Appeared in: DSSSB October 2024

Explanation

Xanthelasma palpebrarum are yellowish, flat, or slightly elevated plaques of cholesterol deposited under the skin.
The image clearly shows these characteristic lesions on the medial aspect of the upper and lower eyelids, which is the typical location.
These lesions are often soft and painless and are a key clinical sign to recognize during a physical assessment.
While not always indicative of a problem, they are frequently associated with high levels of lipids (fats) in the blood, particularly cholesterol.

Option A: The Flag sign is characterized by alternating bands of depigmented and normal-colored hair, which is a sign of protein-energy malnutrition (Kwashiorkor). It does not involve skin lesions on the eyelids.
Option C: Corneal arcus (or arcus senilis) is a white, grey, or blue opaque ring in the corneal margin of the eye itself. The finding in the image is on the skin of the eyelid, not the cornea.
Option D: Frank's sign is a diagonal crease in the earlobe. It has no relation to any findings on or around the eyes.

Clinical Relevance

Nursing practice connection: Use the key finding related to Identification of clinical signs on physical examination to guide bedside assessment, documentation, and the next nursing action.
A key nursing assessment skill is to recognize cutaneous signs of systemic diseases. Identifying xanthelasma should prompt the nurse to inquire about the patient's history of high cholesterol and advise them to see a physician for a lipid panel.
Patient education is crucial. The nurse can explain that while the growths themselves are benign, they can be a warning sign for cardiovascular risk and that managing cholesterol through diet, exercise, and medication is important.
What if? If the patient was young (under 40) and presented with xanthelasma, it would raise a higher suspicion for familial hypercholesterolemia, a genetic disorder causing very high cholesterol levels, and would warrant a more urgent and thorough cardiovascular workup.

How to Approach the Question

First, carefully examine the image provided, paying close attention to the specific location, color, and texture of the finding.
Note the key features: The lesions are on the eyelids, they are yellowish, and they appear as slightly raised plaques.
Next, review the definitions of each option provided.
Compare your visual analysis with the definitions. 'Xanthelasma' is defined as yellowish cholesterol deposits on the eyelids, which is a direct match for the image.
Eliminate the other options by confirming they describe different signs in different locations (Flag sign in hair, Corneal arcus on the cornea, Frank's sign on the earlobe).
This systematic process of observation, definition recall, and comparison allows you to confidently select the correct answer.

Concept Tested & Keywords

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E6 Medicine Harrison 22e Part 1 p. 445-447