Case Launch (M1)

Question 1

What is Sepsis?

Answer 1

• A rare, serious complication of an infection.
• Sepsis is when the body’s response to infection injures its own tissues and organs.
• It can lead to organ failure and death.

Question 2

What are the symptoms of sepsis in children, that if you see them, you should call 999?

Answer 2

• Skin is mottled, bluish or pale
• Is difficult to wake
• Feels cold to touch
• Is breathing very fast
• Has a rash that does not fade when you press it
• Has a fit or convulsion

Question 3

What is the National Early Warning Score (NEWS)?

Answer 3

• It is an early warning system for identifying acutely ill patients, including those with sepsis. in hospitals in England.
• NEWS >5 should always prompt a screen for sepsis.
• Patients are given a score on:
  
  • respiration rate
  • oxygen saturation
  • systolic blood pressure
  • pulse rate
  • level of consciousness or new confusion
  • temperature

Question 4

What are the Sepsis Six?

Answer 4

• A treatment plan for sepsis.

1. Give oxygen to keep sats (AKA O₂ sat) above 94%.
2. Take blood cultures (blood is injected into bottles with culture media/ food for micro-organisms to see if there are micro-organisms in the blood).
3. Give IV antibiotics.
4. Give a fluid challenge: the patient is given a lot of fluid in a short amount of time, to see if the patient will benefit or deteriorate from further fluid replacement.
5. Measure lactate.
6. Measure urine output.

Question 5

LO’s

Answer 5

1. Describe the normal structure of skin
2. Describe the functional role of skin

Question 6

What does ‘integument’ mean?

Answer 6

A tough outer protective layer, especially that of an animal or plant.

Question 7

If integument means tough, outer protective layer, then what is the integument of humans?

Answer 7

The skin and its accessory structures! The skin is AKA the Cutaneous Membrane and its Accessory Structures (like sweat/ exocrine glands, nails and hair).

Question 8

What are the functions of the skin?

Answer 8

1. Water-proof barrier
2. A thermo-regulator: surface area and sweat glands.
3. Protection from the environment: burns, UV rays.
4. Innate Immune System: skin has anti-bacterial petides, fatty acids and commensal bacteria.
5. Sensory Functions: touch and heat.
6. Endocrine role: hormone production and production of vitamin D.

Question 9

Describe the structure of the skin AKA the Cutaneous Membrane

Answer 9

There are two parts to the skin/ cutaneous membrane.

1. Epidermis: made of stratified (layered) squamous (flattened) epithelium.
2. Dermis: made of a variety of connective tissues.
   
   • It has a papillary layer that contains dermal papillae (these are projections of the dermis into epidermis). The dermal papillae act like the teeth of a zip.
   • It has a reticular layer: no projections of the dermis into the epidermis.

(Need to learn the attatch images, and the order of each layer).

Question 10

Describe the epidermis?

Answer 10

• There are two types:
  
  • Thin skin (skin covering most of body) where the epidermis has four distinct layers of cells. No lucidum layer.
  • Thick skin (palms and soles of feet). Epidermis has five distinct layers of cells.
• All cells layers of the epidermis are made of keratinocytes (produce a fibrous protein called keratin). So are your hair and nails, but they are more specialised.
• The epidermis is avascular: oxygen and nutrients diffuse from the dermis.

Question 11

Name the specialised cell types in the epidermis.

Answer 11

1. Melanocytes: produce pigment.
2. Langerhans cells (dendritic cells of the epidermis): these phagocytes migrate to lymph nodes when activated.
3. Merkel cells: fine touch and pressure sensing.

Question 12

Name the five layers of thick epidermis

Answer 12

1. Stratum corneum: made of dead cells/ keratonocytes
2. Stratum lucidum (thick only): cells transitioning to dead
3. Stratum granulosum
4. Stratum spinosum: has desmosomes (cell to cell juctions).
5. Stratum basale: where all the cells originate from, mitotically active.

(​Cornettos Look Great Such Bants)

• In histology each layer can be differentiated by their colour. Each layer has a slightly different colour
• Differentiation and programmed cell death takes place during this migration upwards.

Question 13

Describe the dermis

Answer 13

1. Has a papillary layer made of loose connective tissue (collagen). It projects into the stratum basale layer of the epidermis to form finger like projections upwards (caller dermal papillae). Has vasculature.
2. Underneath the papillary layer is the reticular layer made of collagen and elastin. Has vasculature.
3. It has a hypodermis layer/ subcutaneous layer under the papillary layer. Connects the skin to the underlying fascia (fibrous tissue) of the bones and muscles.

Question 14

How is ezcema often treated?

Answer 14

• Oral antibiotics for secondary bacterial infections.
• Antivirals (e.g. aciclovir) for secondary herpes infection.
• Topical (applied directly to skin) steriod cream
• Hydrocortisone steroids
• Anti- histamine tablets
• E-45 cream after drying thoroughly to prevent eczema breakout
• Use soap substitutes
• For severe cases try phototherapy and immunosuppressants (e.g. oral prednisolone, azathioprine, ciclosporin).
• Have to be really empathetic

Question 15

What is the most common type of eczema?

Answer 15

• Atopic aczema: develops in childhood.
• Accompanied by food allergies, hayfever.

Question 16

What genetic defect is thought to cause atopic eczema?

Answer 16

A primary genetic defect in skin barrier function (loss of function variants of the protein filaggrin) appears to underlie atopic eczema.

Question 17

How does eczema present?

Answer 17

Commonly present as itchy, erythematous/red dry scaly patches.

Question 18

What are the complications of eczema?

Answer 18

1. Secondary bacterial infection (crusted weepy lesions)
2. Secondary viral infection - molluscum contagiosum (pearly papules with central umbilication), viral warts and eczema herpeticum

Question 19

Describe the three causes of acne

Answer 19

• Acne results in 3 factors working in combination.
  
  1. Hyperseborrhoea: excess sebum production by the sebaceous gland.
  2. Abnormal follicular keratinization: normally, the dead cells lining the inside of the hair follicle are forced out by the growing hair. But in abnormal follicular keratinisation, they clog up the follicle.
  3. Infection of hair follicle by Propionibacterium.
• These impact on the functioning of the pilo-sebaceous unit (each hair unit is composed of a hair, a hair follicle/ root, a sebaceous gland, and erector pilli muscles).