Chapter 24: Med Surg Flashcards
UVA light
responsible for tanning, elastic tissue damage and actinic skin damage
UVB light
responsible for sunburn, major developer of skin cancer
tanning
skin’s response to injury and increased melanin
chemical sunscreen
light creams and lotions designed to absorb or filter UV light, resulting in diminished UV light penetration
physical sunscreen
thick and opaque heavy creams that reflect UV radiation
PABA
blocks UVB rays
Parsol
blocks UVA
benzophenones
block both UVB and UVA
what was treated with radiation 30 years ago?
acne and hirtuism causing increased carcinoma in present middle aged patients
Vitamin A
essential for epithelial cell structure and normal wound healing
Vitamin B
essential for complex metabolic functions; deficiencies can cause erythema
Vitamin C
essential for connective tissue and normal wound healing; absence can cause scurvy or petechiae
Vitamin D
essential for bones
Unsaturated fatty acids
essential for cellular and subcellular membranes in tissue metabolism
biotin
water-soluble B complex prevents rashes and alopecia; e.g. liver, cauliflower, salmon, carrots, bananas
acanthosis nigricans
velvety dark skin of neck and body folds
ABCDE
cornerstone rule of self-skin examination; asymmetry, border, color, diameter >6 mm, and evolution
risk factors for developing skin cancer
fair skin (blonde or red hair and green or blue eyes), chronic sun exposure, family history, chemicals
nonmelanoma cancer
do not develop from melanocytes, instead develop in epidermis on sun exposed areas (face, head, neck, back of hands, and arms)
actinic keratosis
flat or elevated hyperkeratotic papules and plaques on sun exposed portions of body; greatly effect the elderly, most common of all precancerous lesions
basal cell carcinoma
well defined, locally invasive, epidermal basal cells, most common and least deadly and almost never spread beyond skin; some mistaken for melanoma because of curled borders and opaque appearance
squamous cell carcinoma
keratinizing cells, sun exposed or previously damaged skin, scaly appearance, less common but more aggressive, has potential to metastasize, biopsy should ALWAYS be performed when suspected
malignant melanoma
most deadly skin cancer and can metastasize to any organ
where does malignant melanoma frequently occur for women?
lower legs and back
where does malignant melanoma frequently occur for men?
trunk, head, and neck
cutenaeous melanoma
when melanoma begins in the skin
all suspected melanoma should be biopsied how?
excisional biopsy
what is the most important prognostic factor?
tumor thickness at time of diagnosis
Breslow measurement
depth of tumor in millimeters
Clark level
depth of invasion of the tumor; the higher the number, the deeper the tumor
dysplastic nevi
atypical moles at increased risk for melanoma, >5 mm across, irregular borders, and various colors
impetigo
associated with poor hygiene and very contagious; thick, honey crusts surrounded by erythema; tx: penicillin
folliculitis
small pustule at hair follicle opening with erythema and some crusting; tx: antistaphylococcal soap and usually cures w/o scarring
furuncle
deep infection with staphylococci around hair follicle, tender, draining pus and painful; tx: incision and drainage, warm compress
carbuncle
multiple furuncles, heal slowly with scarring tx same as furuncle
cellulitis
inflammation of subq tissue, hot and tender, edema; tx: moist heat, immobilization and elevation
erysipelas
superficial cellulitis primary involving dermis, red and hot plaque that is painful, most common on face and extremities; tx: penicillin and usually hospitilize
herpes simplex
transmission from respiratory droplets or virus containing fluid (saliva or cervical secretions), painful at first and usually recurrent in same spot; tx: moist compress, Acyclovir but no vaccine available for HSV1 & 2
herpes zoster
activation of the varicella-zoster virus, linear distribution of vesicles, painful; tx: Acyclovir within 72 hours to prevent postherpetic neuralgia
Verruca vulgaris
caused by HPV, spontaneous disappearance within 1-2 yrs, greater in youth and immunosuppressed, circumscribed flesh colored papule and painful; tx: surgery, liquid nitrogen therapy
plantar warts
caused by HPV, grows inward, painful when pressure applied, cone shaped with black dots (thrombosed vessels) present when wart is removed
candidiasis
present in warm, moist areas, white, painful, papular, erythmatous rash; tx: antifungals, keep area clean and dry, powder
tinea corporis
ringworm, angular, scaly appearance; tx: cool compress and antifungal
tinea cruris
jock itch, well-defined scaly plaque in groin area and does not affect mucous membranes; tx: topical antifungal cream
tinea pedis
athlete’s foot, interdigital scaling and maceration; tx: topical antifungal cream, gel, spray, powder
tinea unguium
affects the toenails and sometimes nails, scaliness, brittle, thickened; tx: antifungal
bedbugs
wheal surrounded by vivid flare, severe puritis, often grouped in threes; tx: antihistamines or topical corticosteroids
pediculosis
head lice, parasites that suck blood and leave excretement and eggs on skin and hair, lesions are red and noninflammatory; tx: Benzene-hexachloride or pyrethrins
scabies
mite penetrates and deposits eggs and allergic reaction occurs, transmission via direct contact, rarely seen in dark skined people, severe itching especially at night
allergic contact dermatitis
delayed hypersensitivity, sensitization after one or more exposures, appearance of lesions 2-7 days after contact with allergen, manifested by red papules and plaques, pruritic
urticaria
allergic phenomenon, erythema and edema in upper dermis, occurs spontaneously, raised multiple wheals
drug reaction
can occur as late as 14 days after cessation of drug
atropic dermatitis
genetically influenced, chronic, relapsing disease, most severe in childhood, acute- bright erythema, extreme itching, subacute- scaly, light red plaques, chronic- lichenification
acne vulgaris
inflammatory disorder of sebacceous glands, noninflammatory lesions, open comedones (blackheads) and closed comedones (white heads)
nevi
moles, grouping of normal cells derived from melanocyte-like precursor cells
psoriasis
autoimmune chronic dermatitis, excessive turnover of epidermal cells, develops before age 40, silvery scaling plaques on reddened skin
seborrheic keratoses
benign, familial, usually occur after 40 years of age, irregularly round or oval, well defined, increase in pigmentation over time
acrochordons
skin tags, common after midlife, small and skin colored, soft, pedunculated papules
lipoma
benign tumor of adipose tissue, encapsulated, rubbery, compressible
lentigo
increased number of normal melanocytes in basal layer of epidermis related to sun exposure and aging, hyperpigmented, brown to black macule or patch on sun exposed areas
total-body skin irradiation
body is bombarded with high energy electrons, treatment for cutaneous T-cell lymphoma, lengthy and causes premature aging of skin
curettage
removal and scooping away of tissue using an instrument with a circular cutting edge attached to a handle
excision
considered when cut to be made involdes the dermis
Moh’s surgery
microscopically controlled removal of a cutaneous malignancy, sections the surgical speciment horizontally,removed in thin layers, preserves normal tissues, produces smallest wound possible, and complete removal of the cancer before surgical closure
face-lift
repositions the lower 2/3 of the face and neck
free graft
provides blood supply to the grafted skin
reconstructive microsurgery
circulation is immediately established in the free flap by anastomosis of the blood vessels from the skin flap to the vessels in the recipient site
skin flap
moving a section of skin and subq from one part of the body to another without terminating the vascular attachment (pedicle), used for wounds with poor vasulcar bed or over cartilage and bone
soft tissue expansion
resurfaces a defect, removes a disfiguring mark or a preliminary step in breast reconstruction; subq tissue expander placed under skin, expand with saline, repeated until skin reaches size of repair, old incision is then opened, expander removed, and soft tissue used for advancement flap
