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Pathophysiology > Ch. 13: Integumentary Function > Flashcards

Ch. 13: Integumentary Function Flashcards

1
Q

what are the structures of the integumentary system?

A

skin, hair, nails, mucous membranes, and glands

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2
Q

what are the disorders that can occur with the integumentary system?

A

congenital defects, advancing age, inflammation, infections, and cancers

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3
Q

what is the hypodermis made of?

A

soft fatty tissue as well as blood vessels, nerves, and immune cells

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4
Q

what is the dermis made of?

A

dense irregular connective tissue and very little fat tissue. contains nerves, hair follicles, smooth muscle, glands, blood vessels, and lymphatic vessels

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5
Q

secrete sweat through skin pores in response to the sympathetic nervous system

A

eccrine glands or merocrine glands

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6
Q

sweat glands that open into hair follicles in the axillae, scalp, face, and external genitalia

A

apocrine glands

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7
Q

skin anomalies that are present at birth or shortly after. most are harmless and may even shrink or disappear with age

A

birth marks

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8
Q

what are the ways in which birthmarks may appear?

A

may be flat or raised, have regular or irregular borders, and have different shades of coloring including black, tan, brown, pale blue, pink, red, or purple

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9
Q

birthmarks that arise from blood vessels that have not formed correctly. what color are these most likely to be?

A

vascular birthmarks are usually red

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10
Q

what are the different types of vascular birthmarks?

A

macular stains, port-wine stains, hemangiomas

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11
Q

most common type of vascular birthmark. faint red marks that usually occur on forehead, eyelids, posterior neck, nose, upper lip, or posterior head

A

macular stains

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12
Q

when may macular stains be more noticeable?

A

when the child is crying

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13
Q

by what age are most macular stains gone?

A

most often fade on their own by 2 years of age, but they may last into adulthood

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14
Q

what are macular stains also known as?

A

salmon patches, angel kisses, and stork bites

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15
Q

birthmarks that appear as a bright red patch or a nodule of extra blood vessels in the skin

A

hemangioma or strawberry

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16
Q

what color with deep hemangiomas be? why?

A

bluish because they involve deeper blood vessels

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17
Q

when do hemangiomas grow?

A

grow during the first year of life and then usually recede over time

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18
Q

where are many hemangiomas found?

A

on the head and neck, but they can be anywhere

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19
Q

when will hemangiomas cause complications?

A

when their location interferes with sight, feeding, breathing, or other bodily functions

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20
Q

discolorations that look like wine was spilled on an area of the body

A

port-wine stains

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21
Q

where do port-wine stains most often occur?

A

face, neck, arms, and legs

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22
Q

how do port-wine stains change over time?

A

can be any size, but only grow as the child grows. tend to darken over time and can thicken and have a cobblestone texture in mid adulthood unless treated

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23
Q

will port-wine stains resolve on their own? when should they be assessed for complications?

A

no, they will not resolve spontaneously. those occuring near the eye should be assessed for possible complications

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24
Q

birthmarks made of clusters of pigmented cells, which cause color in skin

A

pigmented birthmarks

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25
Q

what colors are pigmented birthmarks?

A

can be many different colors from tan to brown, gray to black, or even blue

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26
Q

what are the most common pigmented birthmarks?

A

cafe au lai spots, mongolian spots, and moles

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27
Q

very common birthmarks that are the color of coffee

A

cafe au lait spots

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28
Q

when should a child with cafe au lait spots be evaluated?

A

if he or she has several spots larger than a quarter - this can be a sign of neurofibromatosis

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29
Q

flat, bluish-gray patches often found on the lower back or buttocks and are more common in individuals with darker complexions

A

mongolian spots

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30
Q

do mongolian spots usually fade?

A

yes, they usually fade often without treatment by school age

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31
Q

general term for brown nevi

A

mole

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32
Q

when present at birth, what is a mole called

A

a congenital nevus and will last a life time

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33
Q

how may a mole appear?

A

may be tan brown, or black; can be flat or raised; may have hair growth

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34
Q

what can disorders involving melanin result in?

A

alterations in skin coloring. can leave skin vulnerable to the harmful effects of UV light.

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35
Q

what the disorders involving melanin?

A

albinism and vitiligo

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36
Q

recessive condition that results in little or no melanin production

A

albinism

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37
Q

why do all forms of albinism cause problems with eye development and function?

A

melanin plays a role in the development of certain optical nerves

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38
Q

what are the two major types of albinism and how are they different?

A

type I - caused by defects that affect melanin production

type II - caused by a defect in the P gene; have slight coloring at birth

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39
Q

what is the most severe form of albinism? what do people with this condition look like?

A

oculocutaneous albinism. have white or pink hair, skin, and iris color and vision problems

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40
Q

type of albinism that affects only the eyes. the affected person’s skin and eye colors are usually normal but there is no coloring of the retina

A

ocular albinism type I

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41
Q

type of albinism caused by a single gene; it can occur with a bleeding disorder as well as with lung and bowel diseases

A

Hermansky-Pudlak syndrome

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42
Q

type of albinism that causes a lack of coloring all over the skin, but not complete

A

Chediak-Higashi syndrome

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43
Q

type of localized albinism that causes small areas without skin coloring

A

Tuberous sclerosist

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44
Q

type of localized albinism where often a lock of hair that grows on the forehead is affected, or no coloring is present in one or both irises

A

Waardenburg’s syndrome

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45
Q

what are the clinical manifestations of albinism?

A

skin changes - many result in milky white skin, but skin pigmentation can range from white to nearly the same as relatives without albinism.
hair changes - hair can range from very white to brown. may also have hair that is reddish, yellow, or brown
eye changes - eye color ranges from very light blue to brown and may change with age. somewhat translucent. can appear to be red because of red reflex.
vision changes - nystagmus, strabismus, extreme nearsightedness or farsightedness, photobia, astigmatism, functional blindness

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46
Q

will a person’s skin always stay the same color with they have albinism?

A

no, melanin production may begin or increase during childhood and adolescence, resulting in slight increases in pigmentation; hair color may also change by early adulthood

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47
Q

does albinism impair intellectual development?

A

no, but people with albinism often experience feelings of social isolation and may experience descrimination. visual issues may become an educational challenge

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48
Q

rare condition characterized by small patchy areas of hypopigmentation

A

vitiligo

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49
Q

when does vitiligo occur?

A

when the cells that produce melanin die or no longer form melanin, causing slowly enlarging white patches of irregular shapes on the skin

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50
Q

what races does vitiligo affect?

A

affects all races, but is more easily seen in people with darker pigmented skin

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51
Q

what are potential causes of vitiligo?

A

autoimmune conditions, genetic influences, sunburn, and emotional stress. has also been associated with perinicious anemia, hypothyroidism, and Addison’s disease

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52
Q

where does depigmentation of vitiligo usually develop first?

A

on sun exposed areas

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53
Q

when does vitiligo usually first appear?

A

between 10 and 30 years of age

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54
Q

vitiligo usually appears in one of three patterns. what are these patterns?

A

focal - depigmentation is limited to one or a few areas of the body
segmental - depigmentation occurs on only one side of the body
generalized - depigmentation is widely spread across many parts of the body, often symmetrically

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55
Q

what are the clinical manifestations of vitiligo?

A

patchy skin depigmentation, depigmentation of the hair, mucous membranes, and retina

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56
Q

what changes in sensation occur with aging?

A

pain, vibration, cold, heat, pressure, and touch sensations usually decrease. this may be related to decreased blood flow

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57
Q

what things can influence age related changes to the skin?

A

environmental factors, genetic makeup, and nutrition contribute to changes, but the greatest single contributing factor is sun exposure

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58
Q

who are more likely to show aging skin changes?

A

blue-eyed, fair-skinned people are more likely to show these changes than people with darker, more heavily pigmented skin

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59
Q

what happens to the epidermis with aging?

A

it thins, but the number of cell layers remain unchanged. the number of melanocytes decreases, but the remaining melanocytes increase in size

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60
Q

what do age related changes in the connective tissue cause?

A

reduced skin strength and elasticity, especially in sun exposed areas of the skin

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61
Q

what happens to the blood vessels in the dermis with aging?

A

they become fragile, which can lead to bruising, cherry angiomas, and other similar conditions

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62
Q

what age related changes occur in the sebaceous glands?

A

decreased production of sebum which can lead to difficulty maintaining skin moisture resulting in dryness and itching

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63
Q

what age related changes occur in the subcutaneous layer? what can these cause?

A

thins with age. increases risk of skin injury and reduces the ability to maintain body temperature. this layer also absorbs some medications, so loss of this layer changes the actions of these medications

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64
Q

what age related changes occur with sweat glands? what can this cause?

A

produce less sweat. causes difficulty controlling body temperature

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65
Q

benign, soft brown or flesh colored masses that usually occur on the neck and are more common in obese people or those who have diabetes mellitus

A

skin tags

66
Q

are inflammatory integumentary disorders contagious?

A

no

67
Q

acute inflammatory reaction triggered by direct exposure to an irritant or allergen-producing substance. not contagious or life-threatening

A

contact dermatitis

68
Q

what does contact dermatitis vary in severity depending on?

A

the substance, the area affected, exposure extent, and individual sensitivity

69
Q

what things can cause irritant contact dermatitis?

A

chemicals, acids, rubber gloves, and soaps

70
Q

does irritant contact dermatitis involve the immune system?

A

no, just the inflammatory response

71
Q

what are the manifestations of irritant contact dermatitis?

A

reaction similar to a burn, typically includes erythema and edema but may also include pain, pruruitis, and vesicles (blisters)

72
Q

what things does allergic contact dermatitis result from?

A

metals, chemicals, adhesives, cosmetics, and plants. sensitization occurs on the first exposure to the substance, and subsequent exposures to the substance produce manifestations

73
Q

what type of response is allergic contact dermatitis?

A

type IV cell-mediated hypersensitivity reaction

74
Q

when do manifestations of allergic contact dermatitis usually appear? what are they?

A

24-48 hours after exposure. pruritis, erythema, and edema at the site, but small vesicles may also be present

75
Q

chronic inflammatory condition that follows an inherited tendency and may be accompanied by asthma and allergic rhinitis. typically affects infants and usually resolves by early adulthood. characterized by remissions and exacerbations.

A

atropic eczema

76
Q

what might be the cause of atopic eczema?

A

may result from an immune system malfunction, similar to hypersensitivity. Not caused by allergens!

77
Q

what complications may occur with atopic eczema?

A

secondary bacterial infection, neurodermatitis (permanent scarring and discoloration from constant scratching), and eye problems

78
Q

what does the pattern of atopic eczema tend to rely on?

A

tends to be age specific

79
Q

where are skin lesions the most common with atopic eczema?

A

face, scalp, hands, or feet in young children and the knees and elbows of older children and adults

80
Q

what may make the clinical manifestations of atopic eczema worse/

A

allergens, cold and dry air, upper respiratory infections, contact with irritants, dry skin, emotional stress, and extreme temps

81
Q

what are the clinical manifestations of atopic eczema?

A

red to brownish-gray colored skin patches, pruritus which may be severe (especially at night), vesicles, thickened, cracked, or scaly skin, irritated sensitive skin from scratching.

82
Q

raised, erythematous skin lesions that are the result of a type I hypersensitivity reaction usually caused by food or medicine ingestion

A

urticaria or hives

83
Q

what may urticaria result from?

A

aside from food and medication ingestion, it may also result from emotional stress, excessive perspiration, diseases, and infections

84
Q

when can urticaria become a problem?

A

when the swelling occurs around the face, impairing breathing. it also may progress to an anaphylactic reaction and shock

85
Q

will the welts that occur with urticaria blanch?

A

yes

86
Q

common chronic inflammatory condition that affects the life cycle of the skin cells. cellular proliferation is significantly increased, causing cells to build up too rapidly on the skin’s surface. new cells grow faster than the old ones can be shed.

A

psoriasis

87
Q

what is the cause of psoriasis?

A

the exact cause is unknown, but it has a familial tendency. it is thought to be a result of an autoimmune process in which the body mistakes normal sin cells as foreign and cytokines are released, which stimulate keratinocyte proliferation

88
Q

when is the onset of psoriasis most common?

A

between the ages of 15 and 30. may be sudden and severe and the person will experience remissions and exacerbations

89
Q

what are factors that may trigger exacerbations of psoriasis?

A

bacterial or viral infections of any location, dry air or dry skin, skin injuries, certain medications, stress, too little or too much sunlight, excessive alcohol consumption

90
Q

what condition is common along with psoriasis?

A

arthritis - known as psoriatic arthritis. as many as 30% of persons with psoriasis have this condition

91
Q

how do psoriatic lesions develop?

A

begin as a small red papule that enlarges

92
Q

where to psoriatic lesions most often occur?

A

on elbox, knees, and trunk, but they can appear anywhere on the body

93
Q

what are the types of psoriatic lesions?

A

erythrodermic, guttate, inverse, plaque, pustular

94
Q

psoriatic lesions that have intense erythema and cover a large area

A

erythrodermic

95
Q

psoriatic lesions that are small, pink-red spots

A

guttate

96
Q

psoriatic lesions that have erythema and irritation and occur in the armpits, groin, and skin folds

A

inverse

97
Q

psoriatic lesions that are thick, red patches covered by flaky, silver-white scales - most common types

A

plaque

98
Q

psoriatic lesions that are white blisters surrounded by erythema

A

pustular

99
Q

what are the manifestations (other than skin lesions) that occur with psoriasis?

A

pruritus, genital lesions in males, joint pain or aching, nail changes such as thickening, yellow-brown spots, dents on the nail surface, and separation of the nail from the base, severe dandruff on the scalp

100
Q

what bacteria most commonly causes bacterial skin infections?

A

staphylococcus and streptococcus genra

101
Q

bacterial infections involving the hair follicles characterized by tender swollen areas that form around hair follicles, often on the neck, breasts, buttocks, and face

A

folliculitis

102
Q

bacterial infection that begins in the hair follicles and then spreads to the surrounding dermis that most commonly occurs on the face, neck, axillae, groin, buttocks, and back

A

furuncle or boil

103
Q

how does a furuncle lesion start?

A

as a firm, red, painful nodule that develops into a large, painful mass, which frequently drains large amounts of purulent exudate

104
Q

clusters of furuncles

A

carbuncles

105
Q

common, highly contagious skin infection that typically arises from a break in the skin and spreads easily to others by direct contact with skin or contaminated objects

A

impetigo

106
Q

how do lesions of impetigo usually begin?

A

as small vesicles that enlarge and rupture, forming he characteristic honey colored crust. these lesions can spread throughout the body through self-transfer of the exudate

107
Q

what usually causes impetigo?

A

staphylococcal infections

108
Q

what happens in impetigo caused by staphylococcus bacteria?

A

the bacteria produce a toxin that causes impetigo to spread to nearby skin this causes the skin to spread to nearby skin. the toxin attacks collagen, a protein that helps bind skin cells together. once this protein is damaged, bacteria can spread quickly.

109
Q

what manifestations are common with impetigo?

A

pruritus is common, and lymphadenopathy can occur near the lesions

110
Q

bacterial infection deep in the dermis and subcutaneous tissue. usually resulting from a direct invasion through a break in the skin or spreads from an existing wound infection

A

cellulitis

111
Q

how does cellulitis usually appear?

A

as a swollen, warm, tender area of erythema. systemic manifestations of infection are usually present

112
Q

if untreated, what can cellulitis lead to?

A

necrotizing fasciitis, septicemia, and septic shock

113
Q

rare, serious bacterial infection that can aggressively destroy skin, fat, muscle, and other tissue that is typically the result of a highly virulent strain of gram positive beta-hemolytic, group A streptococcus that invades through a minor cut or scrape

A

necrotizing fasciitis

114
Q

how does necrotizing fasciitis progress?

A

the bacteria begin to grow and release harmful toxins that directly destroy the tissue, disrupt blood flow, and break down mineral in the tissue. the first sign of infection may be a smalle, reddish, painful area on the skin. this area quickly changes to a painful bronze or purple colored patch that grows rapidly. the center of the lesion may become black and necrotic.

115
Q

what are systemic manifestations that occur with necrotizing fasciitis?

A

fever, confusion, tachycardia, hypotension, and confusion

116
Q

what are the complications of necrotizing fasciitis?

A

gangrene, multisystem organ failure, shock

117
Q

viral infection typically affecting the lips, mouth, and face that can involve the eyes and result in conjunctivitis and can result in meningoencephalitis

A

herpes simplex type 1

118
Q

how is the herpes simplex type I virus transmitted?

A

through contact with infected saliva

119
Q

how does herpes simplex type I progress?

A

the primary infection may be asymptomatic, then the virus remains dormant in the sensory nerve ganglion to the trigeminal nerve until it is reactivated which may be a result of an infection stress, or sun exposure

120
Q

what are the clinical manifestations of herpes simplex type I?

A

painful blisters or ulcerations that are preceded by a burning or tingling sensation. they will resolve spontaneously within three weeks, but healing can be accelerated with oral or topical antiviral agents.

121
Q

condition that appears in the adulthood years after a primary infection of varicella in childhood. caused by the varicella-zoster virus

A

herpes zoster

122
Q

how does herpes zoster progress?

A

there is an infection of varicella in the childhood years and the virus lies dormant on a cranial nerve or a spinal nerve dermatome until it becomes activated years later. virus only affects nerves.

123
Q

what are the clinical manifestations of herpes zoster?

A

typically unilateral. pain, paresthesia, and a vesicular rash that develops in a line over the area innervated by the affected nerve. skin becomes extremely sensitive and pruritus may be present

124
Q

what is the appearance of the rash associated with herpes zoster?

A

may appear red or silvery and occurs on one side of the head or torso depending on the nerve affected. neuralgia or pain may continue long after the rash disappears.

125
Q

what are verrucae (warts) caused by?

A

a number of the human papillomaviruses

126
Q

how are verrucae transmitted?

A

through direct skin contact between people or with the same person

127
Q

what causes the warts to develop with the human papillomaviruses? what can the lesions look like?

A

the virus replicates in the skin cells, causing irregular thickening. lesions can appear, varying in color, shape, and texture depending on the type

128
Q

causes several types of fungal infections that usually grow in warm, moist places and typically manifest as a circular, erythematous rash which is usually associated with pruritus and burning

A

tinea

129
Q

what are the manifestations of tinea?

A

circular, erythematous rash which is usually associated with pruritus and burning; hair loss at the site is common

130
Q

tinea infection of the body

A

tinea corpis or ringworm

131
Q

tinea infection that involves the feet, especially the toes

A

tinea pedis, or athlete’s foot

132
Q

tinea infection that involves the nails, typically the toenails

A

tinea unguium

133
Q

how does the infection of tinea unguium progress?

A

begins at the tip of one or two nails and then usually spreads to the other nails. the nail initially turns white and then brown, causing it to thicken and crack

134
Q

mite infection of the body that triggers the inflammatory process

A

scabies

135
Q

what is the life cycle of the scabies mites?

A

the male mites fertalize the females and then die. the females burrow into the epidermis, laying eggs over a period of several weeks through tracks. after laying the eggs, the female mites die. the larvae then hatch from the eggs and then migrate to the skin surface where they burrow into the skin in search of nutrients and mature to repeat the cycle. the burrowing and fecal matter left by the mites triggers the inflammatory process leading to erythema and pruritus

136
Q

how does the burrowing of scabies appear?

A

as small brown streaks on the skin

137
Q

how is scabies transmitted and why?

A

usually through close contact because the mites can survive or only short periods without a host

138
Q

lice infestation

A

pediculosis

139
Q

what are the three forms that a lice infestation can take?

A

pediculus humanus corpus - body louse
pediculus pubic - pubic louse
pediculus humanus capitis - head louse

140
Q

what is the life cycle of the louse?

A

the female lice lay eggs on the hair shaft close to the scalp. the nits appear as small white, iridescent shells on the hair. after hatching, the lice bite and suck the blood; in turn, the site of the bite develops a highly pruritic macule or papule

141
Q

how are lice transmitted?

A

through close contact

142
Q

skin injury that can result from thermal or nonthermal sources

A

burn

143
Q

what are sources of burns?

A

dry heat, we head, radiation, friction, heated objects, natural or artificial UV light, electricity, and chemicals

144
Q

what happens during a burn?

A

the injury triggers the inflammatory reaction and results in tissue distruction

145
Q

what does the severity of a burn depend on?

A

the location, extent, and nature of the injury

146
Q

what are the three different severities of a burn?

A

first-degree burns - affect only the epidermis. these cause pain, erythema, and edema
second-degree burns - affect the epidermis and the dermis. these cause pain, erythema, edema, and blistering
third-degree burns - extend into deeper tissues these cause white or blackened, charred skin that may be numb

147
Q

what are complications that may develop with a burn?

A

local infection - particularly staphylococcus, sepsis, hypovolemia due to damaged blood vessels and plasma proteins, shock from sepsis or hypovolemia, hypothermia because heat is lost through large injuries, respiratory problems from inhaling hot air or smoke that can burn airways causing inflammation, scarring, contractures

148
Q

skin condition commonly affecting adolescents where the skin’s pores become clogged with oil, debris, and bacteria. the pores can become inflamed, developing into a pustule, nodule, or cyst

A

acne vulgaris

149
Q

what happens if the pustule in acne vulgaris ruptures?

A

the material inside can spread to the surrounding area and cause an inflammatory reaction

150
Q

where does acne vulgaris appear?

A

commonly appears on the face and shoulders, but may also occur on the trunk, arms, legs, and buttocks

151
Q

what are risk factors for the development of acne vulgaris?

A

family history, hormonal changes, use of oily cosmetic and hair products, certain medications, high levels of humidity and sweating

152
Q

chronic inflammatory skin condition that typically affects the face and is prevalent in people who are fair skinned, bruise easily, and women

A

rosacea

153
Q

how may rosacea present?

A

as erythema, prominent spiderlike blood vessels, swelling, or acne-like eruptions. a thickening of the skin on the nose (rhinophyma), a burning or stinging sensation, and red, watery eyes

154
Q

how does rosacea progress?

A

it is a progressive condition characterized by remissions and exacerbations

155
Q

what are some exacerbation triggers with rosacea?

A

they are specific to the individual, but include sun or wind exposure, sweating, stress, spicy food, alcohol, hot beverages, hot baths, and cold weather

156
Q

who are skin cancer rates most common in?

A

men, caucasians, persons with fair complexions, and those with a family history

157
Q

what is the most significant risk factor for the development of skin cancer?

A

sun exposure

158
Q

what are the three types of skin cancer and how are they different

A

basal cell carcinoma - most common. develops from abnormal growth of the cells in the lowest layer of the epidermis
squamous cell carcinoma - changes in the squamous cells, found in the middle layer of the epidermis
melanoma - develops in the melanocytes. least common but most serious. often metastasize to other skin areas

159
Q

how may skin cancers appear?

A

may be shiny, small, waxy, scaly, rough, firm, red, crusty, bleeding, and so on

160
Q

what are the warning signs of suspicious skin lesions?

A

asymmetry, border irregularity, color variation, diameter greater than 6 mm, any skin growth that bleeds or will not heal, any skin growth that changes in appearance over time

161
Q

what are the functions of the integumentary system?

A

protects the body from pathogen invasions, regulates temperature, senses environmental changes, and maintains water balance

Pathophysiology (11 decks)

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