Class #12 Flashcards
What does “Tinea” mean?
refers to a fungal infection
What is the formal name for ringworm?
Tinea Corpus
How is tine corpus transmitted?
puppies
kittens
other children
How might my patient with tinea corpus present to me?
- circular/oval lesions on trunk, back, buttocks
- red papule with sharp borders, central clearing
- puritis, mild burning, erythema
What fungal infection presents with red circular or oval lesions with a central clearing?
tinea corpus (ringworm)
What is tine capitis?
a fungal infection that manifests on the top of the head, usually in children
What is the difference between primary tinea capitis and inflammatory tines capitis?
Primary: gray, found hairless patches
Inflammatory: delayed hypersensitivity with pustular, scaly round patches. This can evolve to a bacterial infection
What is the formal name for athletes foot?
tinea pedis
Why might I suspect my patient has athletes foot?
inflamed, blistery lesions between toes and on the soles and sides of feet, with a specific foul odour
Who is most at risk for acquiring tinea pedis?
- men
- barefoot in swimming pools and saunas
- sharing socks with someone with the infection
- recurrence with exercise/sweating
A common yeast-like fungus is called…
Candidiasis, by candida albicans. Commonly found in GI tract, mouth and vagina, and other warm moist areas of the skin
What causes oral candidiasis?
- long term antibiotic use/oral corticosteroids
- early sign of HIV
How will my patient with candidiasis present?
red rash with well-defined borders.
- puritis, burning
- can form pustules, which indicates infection
What is impetigo?
a bacterial infection (caused by staphylococci or streptococci)
-manifests as small vesicle on the face that ruptures honey-coloured serous drainage that hardens and crusts over
What bacteria causes cellulitis?
normal skin flora that become opportunistic OR exogenous bacteria
What is cellulitis?
deeper bacterial infection of the dermis and subcutaneous tissue
How is cellulitis transmitted?
handling fish
swimming
animal bites
In morning report, I am informed that my patient has cellulitis on her lower legs bilaterally. How will I expect her to present?
- red, warm, edematous, shiny skin
- may be flaky
- pain
- possible fever
What is my concern if my patient with cellulitis is not treated properly?
septicemia
What is necrotizing fasciitis?
rare bacterial infection usually caused by streptococcal bacteria that involves DEEP skin and facial plan of subcutaneous tissue
What puts an individual at risk for acquiring necrotizing fasciitis?
- immunocompromised
- cancer
- diabetes
- recent major infection
How will my patient with necrotizing fasciitis present?
- red, swollen, painful area that expands quickly!
- signs and symptoms of inflammation/infection
- progresses to sepsis
How is necrotizing fasciitis treated?
- QUICKLY
- high doses of antibiotics
- surgical debridement
What are verrucae?
small tray-white flat papules with rough surface, Warts caused by benign HPV lesions
How are verrucae transmitted?
- direct contact via break in the skin
- sexual contact for genital warts
What does herpes simplex virus cause? How does it manifest?
cold sores
-burning, tingling pustules on face, mouth and nasal septum that crust and heal
How is herpes simplex transmitted?
- direct contact with infected saliva
- skin contact via athletics, dentistry and health care
Explain the pathophysiology of shingles
- occurs as a result of reactivation of latent varicella zoster virus infection
- virus lays dormant in dorsal root ganglia, travels up dermatome and becomes active
Who is at risk for acquiring shingles?
-history of chicken pox (varicella zoster)
-old age
-HIV or immunosuppression
-malignancies
-corticosteroid/chemo/
radiation therapy
What are the manifestations of herpes zoster?
- burning pain
- pruritis
- sensitive skin
- vesicles form on skin surface, erupt, crust, and fall off. It usually lasts around 2-6 weeks
What are the possible complications of herpes zoster?
- neuralgia 1-3 months after skin clears
- Blindness if contact with eyes
What are 2 main differences between herpes simplex and herpes zoster?
- simplex lasts 1-2 weeks whereas zoster lasts zoster lasts 2-6 weeks
- simplex is contagious to anyone via saliva or direct contact with the open sore, whereas zoster is only contagious to those who have not had chicken pox, and those individuals will only acquire chicken pox, not shingles.
3 . simplex is self-limiting with no real complications, whereas zoster can result in severe nerve pain, and even blindness
This skin disorder is caused by increased testosterone in puberty
acne vulgaris
What is the difference between inflammatory and non-inflammatory acne vulgaris?
non-inflammatory AV: is caused by sebaceous glands becoming plugged. Blackheads are caused by melanin, and whiteheads indicate fatty acid irritation
Inflammatory: pustules, nodules, cysts
What is rosacea? How does it present?
a chronic inflammatory skin disorder that causes repeated blushing episodes in the nose and cheesks that eventually remains permanently
- inflammatory facial pustules, nodules, edema
- dry, itchy eyes
- telangiectasia
- skin thickens and is sensitive to heat
What is psoriasis? How does it manifest?
autoimmune skin inflammation that occurs in the 3rd decade.
- well defined red plaques with silver scales that are flat or raised on the elbows, knees, scalp, lumbosacral/intragluteal cleft
Who is at risk for acquiring psoriasis?
- heredity
- age (30s)
What is a complication of long-term psoriasis?
hyperkeratosis, which is epidermal thickening overtime, which causes permanent damage to capillaries, and leads to bleeding points under the scales
What is the difference between UVA and UVB rays?
UVA- not absorbed by ozone, cause deep penetration that causes a tan immediately
UVB-most absorbed by ozone, causes a delayed response that is more genotoxic (burn)
Why does a sunburn increase the risk for skin cancer?
-burns cause free-radical formation and damage to cellular proteins and DNA
Explain the pathophysiology of how UV radiation causes a sunburn
UV radiation hits melanocytes
- some UV reaches lower skin layers
- immune cells and DNA are damaged
- inflammatory mediators are released
- sunburn
How does a first degree burn manifest?
- only outer epidermis
- pink, red, dry, painful
- skin can still function
- 3-10 days
How deep in the skin does a second degree burn penetrate?
epidermis and dermis
Explain the difference between a partial thickness second degree burn and a full thickness second degree burn
PARTIAL -moist blisters that weep -sensitive to touch, heat, air -intact blisters help maintain body fluids -1-2 weeks to heal FULL -epidermis and into DEEP dermis -mottled pink, red or waxy skin with flat, dry blisters, edema -loss of sensation scarring -hair follicles and sweat glands remain intact - 1 month to heal
How deep is a third degree burn?
subcutaneous tissue, muscle and bone
What are the manifestations of a 3rd degree burn?
- waxy white, yellow, or tan/brown/black
- EDEMA
- no pain in areas with 3rd degree, but they experience 1st and 2nd degree pain
How is the “rule of nines” different for kids then for adults?
- in adults, the head is 9%, in kids its 18%
- in adults, each leg is 18%, in kids, they are 13.5%
What does the “rule of nines” refer to?
a reference for measuring what percentage of the body has been affected by the burn
What are the hemodynamic complications of burns?
- injury to capillaries and surrounding tissues
- fluid loss leads to hypovolemic shock
How can smoke inhalation damage the respiratory system?
- carbon monoxide, toxins, ammonia, chlorine, sulphur dioxide poisoning
- damaged mucosa can cause bronchospasm, edema
- pneumonia, pulmonary embolism, pneumothorax
Explain the hypermetabolic response to 3rd degree burns
- catecholamine and cortisol released in response to stress
- muscle/fat wasting, glucose stores depleted
- head production is increased d/t heat losses from burned area
When a burn encircles the whole body or an entire body part, what is is called?
circumferential
What is the healing process for a circumferential burn?
healing to eschar becomes leathery, and constricts, so it must be removed by either escharotomy or fasciotomy
List some ways to treat burns
- active cooling
- fluids
- hemodynamic balance
- nutrition
- analgesia
- wound care
What are the 4 types of grafts used to treat burns?
- Autograft- from own body
- Homograft-from another person (dead or alive)
- Heterograft (from another species)
- Synthetic
Explain why shearing force can cause decubitus ulcers
shearing is when the skeleton moves but the skin doesn’t. This causes cell injury and thrombosis from the inside out
What are the 4 causes of decubitus ulcers?
- Pressure
- Shearing
- Friction
- Moisture
Why does moisture on the skin increase the risk for the development of ulcers?
weakens the cell wall by changing the pH of the skin
How does friction cause ulcers?
damages dermis/epidermis interface
Why does pressure increase the risk for ulcers?
obstructs blood flow causing ischemia to the skin
What type of nevi have the capacity to develop into a malignant melanoma?
dysplastic nevi, which present as rough, irregularly shaped moles with a pebbly surface
Who is most at risk for developing malignant melanoma?
- increased UV light exposure
- h/o blistering sunburns
- family history
- h/o dysplastic nevus syndrome
- fair hair, skin and freckles
- immunosuppression
Explain what malignant melanoma looks like
- mole that is slightly raised, with an irregular border and surface
- independent from previous nevi
- often mottled
- may have erythema, tenderness, ulceration, bleeding
Explain the 2 ways that malignant melanoma can grow
RADIAL -horizontal spread in the epidermis VERTICAL -invades deeper dermis -raised dome lesion -increased risk of metastasis
Your patient was just diagnosed with basal cell carcinoma. How can you explain this to her?
- neoplasm of the basal layer of the epidermis
- most common neoplasm
- RARELY metastasizes
- SLOW-GROWING
Describe nodular basal cell carcinoma
small, flesh coloured, or pink translucent nodule enlarging overtime
Describe superficial basal cell carcinoma
scaly erythematous patch/plaque on the surface of the skin
What is squamous cell carcinoma?
malignant tumor on sun exposed area that is confined to the epidermis for a long time and then converts to invasive stage usually in the older population
What are the risk factors to acquiring squamous cell carcinoma?
- UV exposure
- Arsenic, industrial tar, coal, paraffin
- Men, but rare if of African descent
What does squamous cell carcinoma look like?
red-scaling, slightly elevated with irregular border
- can contain shallow chronic ulcer with crust
- can metastasize if not excised early
What are the ABC’s for diagnosing malignant melanoma?
Assymmetry Border irregularity Color variation Diameter > 6mm Evolution
