.lesson-duration-container {
background-color: #f0f4f8; /* Szarawe tło dopasowane do reszty strony */
padding: 8px 15px; /* Wewnętrzny odstęp */
border-radius: 8px; /* Zaokrąglone rogi */
font-family: ‘Roboto’, Arial, sans-serif; /* Czcionka Roboto, jeśli dostępna */
font-size: 16px; /* Rozmiar tekstu */
color: #6c757d; /* Ciemny szary kolor tekstu */
display: inline-block; /* Wyświetlanie jako element blokowy */
margin-bottom: 20px; /* Odstęp na dole */
border: none; /* Bez obramowania */
}
.lesson-duration-label {
font-weight: 700; /* Pogrubienie dla etykiety */
color: #6c757d; /* Ciemny szary kolor dla etykiety */
margin-right: 5px; /* Odstęp od wartości */
}
.lesson-duration-value {
color: #6c757d; /* Ciemny szary kolor dla wartości */
font-weight: 700; /* Pogrubienie dla wartości */
}Podświetlanie tekstu z notatkami
body {
margin: 0;
padding: 0;
font-family: Arial, sans-serif;
}
.highlight {
background-color: #cce7ff; /* Kolor podświetlenia bez notatki */
position: relative;
display: inline;
}
.highlight.with-note {
background-color: #ffeb3b; /* Kolor podświetlenia z notatką */
}
.note-box {
position: absolute;
background-color: #f9f9f9;
color: #333;
font-size: 14px;
line-height: 1.6;
padding: 10px 15px;
border: 1px solid #ddd;
border-radius: 5px;
box-shadow: 0 2px 5px rgba(0, 0, 0, 0.2);
max-width: 250px;
z-index: 1000;
white-space: normal;
text-align: left;
display: none; /* Domyślnie ukryta */
}
.note-controls {
position: absolute;
top: -30px;
right: -30px;
display: flex;
gap: 10px;
z-index: 10;
opacity: 0;
pointer-events: none;
transition: opacity 0.3s;
}
.note-controls.visible {
opacity: 1;
pointer-events: all;
}
.note-controls span {
cursor: pointer;
background-color: gray;
color: white;
padding: 5px 10px;
border-radius: 5px;
font-size: 16px;
font-weight: bold;
}
.note-controls span:hover {
background-color: darkgray;
}
document.addEventListener(“DOMContentLoaded”, () => {
/**
* Funkcja do sprawdzania, czy element jest nagłówkiem.
*/
const isHeaderElement = (node) => {
while (node) {
if (node.nodeType === 1 && node.tagName.match(/^H[1-5]$/)) {
return true;
}
node = node.parentNode;
}
return false;
};
/**
* Funkcja do sprawdzania, czy element należy do tabeli.
*/
const isInsideTable = (node) => {
while (node) {
if (node.tagName === “TD” || node.tagName === “TH”) {
return node;
}
node = node.parentNode;
}
return null;
};
/**
* Funkcja do walidacji zaznaczenia.
* Blokuje zaznaczenie tekstu z różnych komórek tabeli oraz nagłówków z tekstem.
*/
const isSelectionValid = (selection) => {
if (selection.rangeCount === 0) return false;
const range = selection.getRangeAt(0);
const startContainer = range.startContainer;
const endContainer = range.endContainer;
const startInHeader = isHeaderElement(startContainer);
const endInHeader = isHeaderElement(endContainer);
// Blokowanie zaznaczenia nagłówków z tekstem
if (startInHeader !== endInHeader) {
return false;
}
const startCell = isInsideTable(startContainer);
const endCell = isInsideTable(endContainer);
// Blokuj zaznaczenie, jeśli obejmuje różne komórki tabeli
if (startCell && endCell && startCell !== endCell) {
return false;
}
return true;
};
/**
* Funkcja do podświetlania zaznaczonego tekstu.
*/
const wrapTextWithHighlight = (range) => {
const fragment = range.extractContents();
const highlight = document.createElement(“span”);
highlight.className = “highlight”;
highlight.appendChild(fragment);
range.insertNode(highlight);
const noteControls = document.createElement(“div”);
noteControls.className = “note-controls visible”;
const editNote = document.createElement(“span”);
editNote.textContent = “✎”;
editNote.title = “Edytuj notatkę”;
noteControls.appendChild(editNote);
const removeHighlight = document.createElement(“span”);
removeHighlight.textContent = “x”;
removeHighlight.title = “Usuń podświetlenie”;
noteControls.appendChild(removeHighlight);
highlight.style.position = “relative”;
highlight.appendChild(noteControls);
let noteBox = null;
const updateNotePosition = () => {
const rect = highlight.getBoundingClientRect();
if (noteBox) {
noteBox.style.top = `${rect.height}px`;
noteBox.style.left = `${rect.width / 2}px`;
}
};
const hideControlsAndNoteAfterDelay = () => {
setTimeout(() => {
noteControls.classList.remove(“visible”);
if (noteBox) noteBox.style.display = “none”;
}, 3000);
};
// Wyświetl przyciski na 3 sekundy po podświetleniu
hideControlsAndNoteAfterDelay();
highlight.addEventListener(“click”, () => {
noteControls.classList.add(“visible”);
if (noteBox) noteBox.style.display = “block”;
hideControlsAndNoteAfterDelay();
});
editNote.addEventListener(“click”, () => {
const noteText = prompt(“Dodaj lub edytuj notatkę:”, noteBox?.textContent || “”);
if (noteText) {
if (!noteBox) {
noteBox = document.createElement(“div”);
noteBox.className = “note-box”;
highlight.appendChild(noteBox);
}
noteBox.textContent = noteText;
noteBox.style.display = “block”;
highlight.classList.add(“with-note”);
updateNotePosition();
hideControlsAndNoteAfterDelay();
}
});
removeHighlight.addEventListener(“click”, () => {
const parent = highlight.parentNode;
while (highlight.firstChild) {
parent.insertBefore(highlight.firstChild, highlight);
}
parent.removeChild(highlight);
if (noteBox) noteBox.remove();
});
};
/**
* Obsługa zdarzenia `mouseup` – walidacja zaznaczenia.
*/
document.body.addEventListener(“mouseup”, () => {
const selection = window.getSelection();
if (selection.rangeCount > 0 && selection.toString().trim()) {
if (!isSelectionValid(selection)) {
alert(“Nie można zaznaczać tekstu z różnych komórek tabeli lub nagłówków z tekstem!”);
selection.removeAllRanges();
return;
}
const range = selection.getRangeAt(0);
wrapTextWithHighlight(range);
selection.removeAllRanges();
}
});
});
Inspection
Inspection is a critical first step in examining the integumentary system, providing essential visual cues that can guide the rest of the physical examination. It allows the clinician to assess the condition of the skin, hair, and nails, as well as to detect signs of systemic diseases, infections, or localized trauma.
Systematic Approach:
Perform a systematic, head-to-toe examination to ensure all regions are assessed.
Scalp and Hairline
Face and Neck
Chest and Abdomen
Back and Buttocks
Upper and Lower Extremities
Palms, Soles, and Nail Beds
Specific Areas of Focus
Scalp and Hair: Part the hair to inspect the scalp for erythema, scaling, lesions, or alopecia. Note the texture, distribution, and condition of the hair.
Nails: Check the nail beds for color, shape, and texture. Clubbing, pitting, or changes in nail color may indicate systemic diseases, such as lung disease, psoriasis, or cardiac issues.
Mucosal Surfaces: Examine the oral mucosa, lips, and tongue. Look for ulcerations, pigmentary changes, or lesions, as these can offer clues to systemic conditions like anemia or vitamin deficiencies.
Skin Inspection
Changes in skin tone or pigmentation can be indicative of local or systemic pathology.
Hyperpigmentation: Darkened patches of skin, seen in conditions like Addison’s disease or post-inflammatory hyperpigmentation.
Hypopigmentation: Areas of skin that have lost pigment, common in conditions like vitiligo or post-inflammatory hypopigmentation.
Jaundice: Yellowing of the skin and eyes due to elevated bilirubin levels, typically seen in liver disease.
Cyanosis: A bluish tint to the skin, often seen in areas with poor circulation or oxygenation, such as in severe respiratory or cardiovascular conditions.
Skin Conditions
Skin observation provides valuable information about both local and systemic health. Conditions affecting the skin can be manifestations of underlying systemic diseases, allergic reactions, or infections.
Erythema (Redness): Redness of the skin often indicates inflammation, infection, or trauma. Erythema is seen in conditions such as cellulitis, lupus, and dermatitis. In autoimmune diseases like lupus, erythema can be widespread, particularly over sun-exposed areas.
Ecchymosis (Bruising): Bruises indicate bleeding under the skin, often due to trauma or a bleeding disorder. For example, extensive bruising could suggest clotting abnormalities or anticoagulant use, while localized bruising near joints may suggest trauma or injury, such as a ligament tear.
Ulceration and Rash: Open sores or rashes may point to systemic conditions such as diabetes, which impairs circulation and delays healing. Rashes can also indicate infection (e.g., impetigo), autoimmune conditions (e.g., psoriasis), or allergic reactions.
Skin Atrophy and Sclerosis: Thinning of the skin may be due to aging, chronic disuse, or systemic diseases like corticosteroid overuse. Sclerosis (skin hardening) is often seen in conditions like scleroderma, which affects the skin, connective tissues, and musculoskeletal system.
Lesions and Skin Abnormalities
Skin lesions come in various forms, each indicative of specific dermatologic conditions or systemic diseases. Careful observation and description of these abnormalities are crucial for diagnosis.
Evaluation of Skin Lesions
When assessing skin lesions, the ABCDE criteria are used to evaluate the characteristics of pigmented lesions such as moles, which can indicate malignant changes (e.g., melanoma).
A – Asymmetry: One half of the lesion differs from the other.
B – Border: Irregular, notched, or blurred edges.
C – Color: Variations in color, including tan, brown, black, red, white, or blue.
D – Diameter: Lesions larger than 6 mm (about the size of a pencil eraser).
E – Evolution: Changes in size, shape, color, or symptoms (e.g., itching, bleeding).
Note: Patients with high-risk profiles, such as those with fair skin, a history of sunburns, or a family history of melanoma, should undergo regular skin cancer screenings.
Types of Skin Lesions
Skin lesions can be broadly categorized into primary and secondary types based on their origin. Primary lesions arise from previously normal skin, while secondary lesions develop over time, often as a result of the evolution of primary lesions or from external factors such as scratching or infection. Below, we will explore each category in detail.
Primary Lesions
Primary lesions are the initial, visible alterations in the skin that occur due to a pathological process. These can be the first indicators of a dermatological condition and include a range of lesion types based on their size, texture, and content (fluid-filled or solid).
Primary Lesion Type
Description
Examples/Conditions
Macules
Flat, non-palpable changes in skin color, smaller than 1 cm
Freckles, vitiligo
Patches
Flat, non-palpable color changes larger than 1 cm
Vitiligo, large birthmarks
Papules
Raised, solid lesions smaller than 1 cm
Psoriasis, warts
Plaques
Raised, solid lesions larger than 1 cm
Psoriasis, eczema
Nodules
Larger, deeper solid lesions that can extend into the dermis or subcutaneous tissue
Lipomas, rheumatoid nodules
Vesicles
Fluid-filled lesions smaller than 1 cm
Chickenpox, herpes simplex
Bullae
Fluid-filled lesions larger than 1 cm
Bullous pemphigoid, second-degree burns
Pustules
Small, pus-filled lesions
Acne, impetigo
Wheals
Transient, raised, erythematous areas due to dermal edema
Hives (urticaria), insect bites
Secondary Lesions
Secondary lesions develop from primary lesions as a result of external factors such as scratching, infection, or changes in the healing process. These lesions often indicate the progression or complication of a skin condition and include scars, ulcers, and scales.
Secondary Lesion Type
Description
Examples/Conditions
Scales
Flakes or plates representing excess dead epidermal cells
Psoriasis, seborrheic dermatitis
Crusts
Dried serum, blood, or pus on the skin surface
Impetigo, scab after abrasion
Scars
Fibrous tissue replacing normal tissue after injury
Keloid, post-surgical scars
Ulcers
Loss of skin extending into the dermis or deeper tissues
Diabetic foot ulcer, venous stasis ulcer
Fissures
Linear cracks in the skin extending into the dermis
Athlete’s foot, cheilosis (cracks in the corners of the mouth)
Erosions
Loss of superficial epidermis that does not extend into the dermis
After rupture of a vesicle or bulla, abrasions
Nail and Hair Abnormalities
Observing changes in nails and hair can provide insight into systemic diseases, nutrient deficiencies, and dermatologic disorders.
Nail Changes:
Clubbing: Rounded, bulbous enlargement of the nail beds associated with chronic hypoxia or lung diseases.
Koilonychia (Spoon Nails): Thin, concave nails seen in iron deficiency anemia.
Pitting: Small depressions on the nail surface, often seen in psoriasis.
Onycholysis: Separation of the nail from the nail bed, observed in fungal infections or trauma.
Hair Changes:
Alopecia: Hair loss can be diffuse or patchy. Diffuse hair thinning may be due to systemic issues like thyroid dysfunction or malnutrition, while patchy hair loss (alopecia areata) suggests an autoimmune process.
Hirsutism: Excessive hair growth in women, often due to hormonal imbalances (e.g., polycystic ovary syndrome).
Nail or Hair Condition
Description
Associated Conditions
Clubbing
Bulbous enlargement of nail beds
Chronic hypoxia, lung disease
Koilonychia
Spoon-shaped nails
Iron deficiency anemia
Pitting
Small depressions on nail surface
Psoriasis
Onycholysis
Separation of nail from nail bed
Fungal infections, trauma
Alopecia
Hair loss (diffuse or patchy)
Autoimmune disorders, thyroid disease
Hirsutism
Excessive hair growth in women
Polycystic ovary syndrome, Cushing’s
Palpation
Palpation of the skin and underlying structures can provide additional information on the nature of skin abnormalities. It allows for the detection of tenderness, warmth, texture, and swelling.
Tenderness: Tender areas suggest inflammation, infection, or trauma. Localized tenderness can indicate cellulitis, while diffuse tenderness may be associated with systemic conditions like lupus or vasculitis.
Temperature: Palpating the skin to detect warmth can indicate infection or inflammation, such as in cellulitis, whereas cool skin may suggest vascular insufficiency.
Texture: Assessing whether the skin feels thickened (as in scleroderma) or thin (as in chronic corticosteroid use) provides clues to systemic diseases.
Swelling and Edema: Edema can indicate fluid retention due to systemic conditions such as heart failure or localized trauma. Palpation of non-pitting vs. pitting edema helps differentiate the underlying cause.
Abnormal Findings in Skin and Structure
Abnormal findings to be aware of during physical examination include:
Skin Atrophy: Thinning or wasting of the skin, common in chronic vascular insufficiency or aging.
Scarring: Assess for hypertrophic or keloid scarring, which can indicate abnormal healing processes.
Lymphadenopathy: Enlarged lymph nodes near areas of infection or malignancy.
Rashes with Specific Patterns: Rashes that follow specific anatomical patterns can be highly diagnostic, such as the butterfly rash across the cheeks in lupus or the dermatome distribution of a herpes zoster rash.
Skin Atrophy: Thinning or wasting of the skin, common in chronic vascular insufficiency or aging.
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