Alterations in the Integumentary System

Question 1

what are primary and secondary lesions?

Answer 1

Primary: Retain original appearance

Secondary: Appearance is modified by normal progress over time or by external agents, such as scratching; may look dissimilar to the original lesion

Lesion Descriptions
Features of lesion should be noted:
-Size
-Symmetry
-Color
-Shape
-Number
-Distribution

Question 2

Rubella versus rubeola?

Answer 2

Rubella
-Diffuse Macular rash
-Mild febrile state
-Cold-like symptoms
-Incubation 14-21 days
-Severe teratogenic effects in unborn fetus
-Immunization for prevention

Rubeola
-Morbillivirus
-Incubation 7-20 days
-Macular, blotchy rash
-Fever of >100°F
-Koplik spots on buccal mucosa
-photosensitivity

Question 3

what is chicken pox

Answer 3

-Caused by varicella zoster virus
-3 stages of lesions: macule, vesicle, granular scab
-Rash starts on trunk & spreads to limbs
-Pruritus, cold-like symptoms
-Tx: antipyretic drugs, lukewarm baths, antihistamines, topical antipruritics
-Vaccination currently recommended

Question 4

what is Scarlet fever?

Answer 4

-Systemic reaction to toxins produced by group A beta-hemolytic streptococci
-Pink skin rash on neck, chest, axillae, groin, & thighs
-Flushed face with circumoral pallor, fever, N/V, strawberry tongue
-Complications can develop
-PCN is treatment of choice

Question 5

what is strawberry tongue?

Answer 5

Swollen, red, bumpy appearance.

Question 6

what is verrucae (warts)?

Answer 6

-Common benign papillomas caused by HPV
-Exaggeration & irregular thickening of normal skin composition
-May resolve spontaneously if immunity develops
-Current tx: surgical removal by laser, liquid nitrogen, cryotherapy or salicylic acid paint/plaster

Question 7

what is herpes simplex virus?

Answer 7

Two types of herpes virus infect the skin
1. HSV-1: Lesions common on lips, face, & mouth
2. HSV-2: Lesions in genital area
-Begin with burning or tingling sensation followed by vesicles, fever blisters, progress to pustules, ulcers, crusts & erythema
-Analgesics tx pain; antivirals shorten duration of outbreaks

Question 8

what is herpes zoster (shingles)?

Answer 8

-Acute localized inflammatory dse of dermatome segment of skin caused by varicella zoster (chickenpox)
-Results from reactivation of the latent virus
-Extremely painful
-Eruption of vesicles unilaterally on erythematous base
-Systemic antiviral tx ASAP, preferably within 48 hrs
-Clears in 2-3 wks

Question 9

what is impetigo?

Answer 9

-Acute contagious skin disease (bacteria) characterized by vesicles, pustules & yellowish crusts
-Etiology: Usually staphylococci or streptococci
-Tx: Topical application of 2% mupirocin ointment
-Oral abx used for those with large area of infxn & febrile

Question 10

what is leprosy (hansen’s disease)?

Answer 10

-Chronic infectious dse caused by Mycobacterium leprae
-Dx is made with skin biopsy
-Effects skin, nerves, mucous membranes, causes disfigurement
-Can take 2 to 10yrs for symptoms to present
-Usually responsive to sulfone drugs

Question 11

what is syphilis?

Answer 11

-STI caused by Treponema pallidum
-Primary syphilis: single chancre on genitalia
-Secondary syphilis: Disseminated rash
-Serum antibodies & exam of pustules for spirochete required for dx
-PCN is very effective tx

Question 12

what are yeast infections? etiology? tx?

Answer 12

Etiology: most common Candida albicans

Tx: Topical antifungals or systemic tx may be used

Thrush
-White lesions with milky discharge, found in mouth
-Often d/t eradication of normal flora
-Tx: nystatin mouth rinse & clotrimazole troches

Intertrigo
-Irritant dermatitis on skin
-Infants & bedridden pts

Question 13

what are scabies?

Answer 13

-parasitic infection
-Small erythematous papules overlying dry scaly crust
-Caused by a burrowing mite (Prefers finger webs, wrists, umbilicus, groin)
-Causes intense itching
-Hatch into larve in 3-4 days

Question 14

what is rocky mountain spotted fever?

Answer 14

-Caused by tick that carries Rickettsia rickettsii; most states have reported cases
-Initial bite appears as papule or macule with or without central punctate area
-HA, fever, N/V, & muscle aches occur within 4-8days
-Tx requires hospitalization & abx therapy

Question 15

what is lyme disease?

Answer 15

-Etiology: Bite of tick carrying spirochete B. burgdorferi
-Symptoms: Multiple, affecting skin, nervous system, heart, & musculoskeletal system
-Single or multiple erythematous papules that itch, burn, or sting; flulike symptoms, bulls eye rash pattern
-Abx therapy required

Question 16

what are fleas?

Answer 16

-Bites appear as small erythematous macules, erythematous papules, wheals, or vesicle
-Diethyltoluamide or pyrethrin insect repellents effective in preventing infestation
-Managed with soothing shake lotions or topical steroids

Question 17

what is lice?

Answer 17

-parasitic infection
Phthirus pubis (crab lice), Pediculus capitis (head lice) & Pediculus corporis (body lice) most common in humans
-Surface dwelling, usually readily seen
-Eradication possible with permethrin cream rinse or pyrethrin & piperonyl butoxide liquid, gel, or shampoo

Question 18

what is chiggers?

Answer 18

-Mites that reside in grass or bushes (common in south)
-Puncture of skin produces pruritic papules; secondary lesions are excoriations from scratching, may become infected by bacteria
-Tx is palliative; insect repellent encouraged for prevention

Question 19

what are bedbugs?

Answer 19

-Cimex lectularius is reddish brown insect that turns purple after feeding on human blood; nocturnal feeders
-Produces painless, pruritic oval or oblong wheal with small hemorrhagic punctum at center; multiple lesions
-Topical antipruritics are used for treatment
-Professional extermination is advised

Question 20

what are mosquito bites?

Answer 20

-raised, itching red lesion; usually occurring 8-12 hrs after bite
-Severe skin reactions are rare
-Insect repellents recommended for prevention, local antipruritics used for tx

Question 21

what is acne vulgaris? etiology? tx?

Answer 21

-Disease of pilosebaceous unit
-Etiologies: Sex hormones, heredity, bacterial flora of skin, occlusion
-Pathogenesis: Sludging of oils, loose skin cells deposited which cause an obstruction of the follicular canal.
-Tx aimed at causing peeling of the stratum corneum

Question 22

what is seborrheic dermatitis?

Answer 22

-Scaling & erythema (redness) in areas of oil gland concentration
-Cradle cap in newborns
-Dandruff in adults
-Controlled with topical medications

Question 23

what is psoriasis? Etiology? Patho? CM?

Answer 23

Chronic, relapsing, proliferative skin disease.
Etiology is unknown, possibly auto immune
Pathogenesis
-Dermis & epidermis thicken
-Cellular proliferation & inflammation
Manifestations
-Silvery plaques, redness

Question 24

what are the types of allergic skin responses? atopic dermatitis? Contact dermatitis? Drug eruptions?

Answer 24

Atopic dermatitis (eczema)
-Highest incidence children: Oozing, crusting, itching
-In adults: Dry scaling

Contact dermatitis
Cutaneous rxn to topical irritant, hypersensitivity to specific antigen
-Poison Ivy
-erythema, swelling, itching

Drug eruptions

occur within 1 wk of drug exposure
-Maculopapular rash
-Women>men
-Rxs implicated; -cillins & cephalosporins

Question 25

what is sunburn and photosensitivity?

Answer 25

-Extremely harmful due to short UV wavelength
-Manifestations: erythema, pain, heat, blistering, edema & tenderness
-Severe: chills, fever, nausea, generalized discomfort
-Prevention: limit exposure, sunscreen, protective clothing
-Tx: Cold water baths/compresses, topical steroids

Effects of Sunlight
-Produces direct local effects on skin in form of elastotic syndromes, keratoacanthomas, premalignant dses, basal cell epitheliomas, and squamous cell epitheliomas
-Indirect and direct sunlight can produce malignant melanomas

Question 26

what is vitiligo? Tx?

Answer 26

-Pigment disappears from patch of skin; sudden onset; may be associated with pernicious anemia, diabetes & hyperthyroidism

-Tx may consist of topical immunomodulating agents as well as use of various types of ultraviolet light

Question 27

what is albinism?

Answer 27

-Lack of melanin/pigmentation in skin/hair d/t inborn error in metabolism
-Eyes may show nystagmus & lack of pigment of fundi
-Sunscreens & protective clothing used to prevent UV damage

Question 28

what are pressure ulcers? RF? what are the stages?

Answer 28

-Most common in bedridden or elderly patients
-Skin: small vessels occluded-> ischemia-> cell necrosis
-Tx: Reinforce preventative measures, nutrition, infection control, wound care

Risk factors:
Immobility
-Friction
Malnutrition
Excessive moisture
Neurological factors
Peripheral vascular impairment
Age
Fever/infection
Medications
Extrinsic factors
-Pressure
-Shear
-Foreign objects in bed

Stages:
Stage 1: Reddening of skin. Does not disappear when pressure relieved
Stage 2: Superficial circulatory & tissue damage. May appear as blister
Stage 3: Destruction of subcutaneous layers
Stage 4: Destruction of subcutaneous capillaries, muscle mass & possibly bone

Question 29

what is burn injury? causes? how are the depths classified?

Answer 29

Causes
Heat (dry or moist), Electricity, Chemicals, Friction, Radiant or electromagnet energy

Integument Effects of Burn Injury
2 phases
1st is immediate–direct cellular injury
2nd is delayed–progressive dermal ischemia

Superficial (1st degree)
-Involves epidermis; reddened, blister formation

Superficial partial thickness (2nd degree)
-Epidermis to level of dermis
-Blistered, red to pale ivory, very painful

Deep Partial thickness (deep 2nd degree)
-Involves entire dermis, hair follicles intact
-Mottled appearance
-Tactile & pain sensors absent or diminished

Full thickness (3rd degree)
-Entire epidermis, dermis & underlying subcutaneous tissue
-White, dry, hard, leathery
-Painless
-May require skin grafting

4th degree
-Involved muscle, bone or both
-High voltage electricity, prolonged exposure to intense heat