diagnosis sxs / ddx / characteristics

Question 1

Epidermal burn / first degree burn characteristics

Answer 1

damage to epidermis only
pink or red appearance
no blistering
minimal edema 
tenderness / delayed pain

Question 2

superficial partial thickness burn / second degree burn

Answer 2

epidermis and upper layers of dermis damaged
bright pink or red appearance
blanching with brisk capillary refill
blisters, moist surface, weeping
moderate edema
painful, sensitive to touch
temperature changes

Question 3

deep partial thickness burn / second degree burn

Answer 3

severe damage to epidermis and dermis with injury to nerve endings, hair follicles, and sweat glands
mixed red or waxy white appearance
blanching with slow capillary refill
broken blisters, wet surface
marked edema
sensitive to pressure but insensitive to light touch and soft pin prick

Question 4

full thickness burn / third degree burn

Answer 4

complete destruction of epidermis, dermis, subq tissues and can extend into muscle
white, charred, tan or black appearance
no blanching, poor distal circulation
parchment like, dry leathery surface
depressed area
little pain / nerve endings destroyed

Question 5

subdermal burn / fourth degree burn

Answer 5

complete destruction of epidermis, dermis, and involvement of subq and muscle tissues
charred appearance
destruction of vascular system and may lead to additional necrosis

often from electrical burns or prolonged contact with flame

Question 6

Pressure sore / decubitus ulcers etiology

Answer 6

result of prolonged pressure, necrosis of tissues often over bony prominences

Question 7

pressure sore / decubitus ulcers risk factors

Answer 7

Primary = immobility
decreased sensation
moisture
friction / shearing forces
decreased arterial perfusion
abnormally high or low BMI

Question 8

most common places for pressure ulcers

Answer 8

heels
plantar surface of foot
malleoli
trochanters
ischial tuberosities
sacrum
scapulae

Question 9

Stage 1 pressure/ decubitus ulcer

Answer 9

intact skin
nonblanchable erythema
reversible with intervention.
discoloration, warthm, edema, induration

Question 10

stage 2 pressure /decubitus ulcer

Answer 10

partial thickness skin loss
epidermis and dermis involvement
abrasion, blister, shallow crater
red or pink wound bed
Intact or ruptured blister or shiny or dry shallow ulcer 
No slough or bruising

Question 11

stage 3 pressure/ decubitus ulcer

Answer 11

full thickness skin defect extending into fat layer but not through fascia (no bone, tendon or muscle exposure)
Slough present but not obscure depth of tissue loss
Undermining and tunneling possible

Question 12

stage 4 pressure /decubitus ulcer

Answer 12

full thickness skin defect extends beyond facia into muscle
tendon, capsule often exposed
may extend to and include bone destruction

Question 13

unstageable pressure ulcer

Answer 13

term is used if wound is covered with necrotic tissue

Question 14

arterial insufficiency ulcer etiology

Answer 14

Secondary to inadequate circulation of oxygenated blood BBC of :
arteriosclerosis obliterans
frequent in patients with diabetes

Question 15

arterial insufficiency characteristics

Answer 15

irregular but smooth edges
minimal to no granulation
deep and painful
location = lateral malleolus and toes, anterior tibial area
decreased or absent pulses
trophic skin changes
pallor on elevation, rubar on dependency
no drainage

Question 16

venous insufficiency ulcer etiology

Answer 16

valvular incompetence
venous hypertension
venous thrombosis
varicose veins

Question 17

venous insufficiency ulcer characteristics

Answer 17

painless
superficial w/ good peripheral pulses
hemosiderin stains 
location = medial side of ankle and distal lower leg
large amounts of exudate
edema
good granulation
normal temperature
no gangrene

Question 18

diabetic foot ulcer etiology

Answer 18

caused by repetitive trauma on insensitive skin secondary to diabetes progression (peripheral vascular disease and neuropathy )

Question 19

diabetic foot ulcer characteristics

Answer 19

often on plantar aspect of foot
typically not painful secondary to periph neuropathy
pulses may be present or diminished
absent ankle jerks with neuropathy

Question 20

dermatitis (eczema) causes

Answer 20

allergic or contact dermatitis - poison ivy, adhesive tapes, chemicals, etc
actinic - photosensitivity, reaction to sunlight/UV
atopic - allergic reaction, psychologic disorders, hereditary

Question 21

acute dermatitis

Answer 21

red, oozing , crusting rash

extensive erosions, exudate, pruritic vesicles

Question 22

subacute dermatitis

Answer 22

erythematous skin
scaling
scattered plaques

Question 23

chronic dermatitis

Answer 23

thickened skin
increased skin marking secondary to scratching
fibrotic papules

Question 24

cellulitis

Answer 24

inflammation of cellular or connective tissue in or close to the skin

poorly defined and widespread
common with staph and strep infection and can be contagious
skin is hot red, edematous

Question 25

herpes zoster causes

Answer 25

varicella-zoster virus (chicken pox) | reactivation of virus lying dormant in cerebral ganglia or ganglia of posterior nerve roots

Question 26

herpes zoster characteristics

Answer 26

pain and tingling in spinal or cranial dermatome red papules along distribution of affected nerve progression to vesicles accompanied by fever, chills, malaise, GI disturbances CN 8 involvement - eye pain and corneal damage CN 10 involvement- loss of vision

Question 27

Discoid lupus erythematosus characteristics

Answer 27

only skin flare ups with sun exposure lesions can cause atrophy, permanent scarring, hypopigmentation, hyperpigmentation

Question 28

lupus erythematosus

Answer 28

chronic progressive autoimmune inflammatory disorder of connective tissue red rash with raised, red, scaly plaques

Question 29

systemic lupus erythematosus characteristics

Answer 29

affects multiple organ systems including - skin - joints - kidneys - heart - nervous system - mucous membranes commonly affects young women fever, malaise, butterfly rash, skin lesions, chronic fatigue, arthralgia, arthritis, skin rash, photosensitivity, anemia, hair loss, raynauds

Question 30

slceroderma characteristics

Answer 30

chronic autoimmune disease of connective tissues causing fibrosis of skin, joints, blood vessels, internal organs often w/ Raynauds phenomenon skin is taut, firm, edematous, firmly bounds to subcutaneous tissues

Question 31

limited systemic sclerosis/scleroderma

Answer 31

symmetrical skin involvement of distal extremities and face slow progression of skin changes late visceral and pulmonary hypertension involvement

Question 32

diffuse systemic sclerosis /scleroderma

Answer 32

symmetrical widespread skin involvement of distal and proximal extremities, face, trunk, rapid progression of skin changes with early appearance of visceral involvement

Question 33

polymyositis characteristics

Answer 33

connective tissue disease - autoimmune edema, inflammation, degeneration of proximal muscles with symmetrical distribution rapid, severe onset often requiring vent support

Question 34

Complications of burn injury

Answer 34

infection shock pulmonary complications (esp if smoke inhale) - restrictive lung dis from burns on trunk or pneumonia metabolic complications cardiac and circulatory problems secondary to fluid loss (dec cardiac output) integumentary scars (keloids, etc)

Question 35

inflammatory phase characteristics of wound healing

Answer 35

days 1-10 platelet activation and clotting cascade mast cells, neutrophils, leukocytes kill bacteria

Question 36

proliferation phase of wound healing

Answer 36

days 3-21 formation of new tissue = prolif phase capillary buds and granulation tissue fill wound bed keratinocytes, endothelial cells, and fibroblasts are active to form collagen matrix

Question 37

maturation phase / remodeling phase of wound healing

Answer 37

begins at 7days up to 2 years | when granulation tissue and epithelial differentiation begin to appear in wound bed

Question 38

how age affects wound healing

Answer 38

epidermis thins and flattens making it more fragile and susceptible to injury from friction and shear decreased metabolism also correlated w/ decrease in overall rate of wound healing

Question 39

how co morbidities affects wound healing

Answer 39

cardiopulm disease, vascular conditions, diabetes delay the wound healing process often due to poor tissue perfusion limiting celluar activity required for adequate wound healing also some comorbidities suppress immune system and can alter inflammatory response and increase risk for infection

Question 40

how does edema affect wound healing

Answer 40

increased tissue pressure from excessive edema affects tissue perfusion and removal of celluar waste. this decreases available oxygen and nutrients and delays healing and inc risk for infection

Question 41

how does harsh or inappropriate wound care (ie whirlpool) affect wound healing

Answer 41

damages peripheral and granulating tissue therefore delays or reverses the process of healing

Question 42

how does infection affect wound healing

Answer 42

because the immune response now is trying to take care of the infection and not the wound therefore healing is slowed also the infection itself could cause further tissue damage secondary to toxins

Question 43

how does smoking affect wound healing

Answer 43

limits blood oxygen carrying capacity causing hypoxia nd slowing healing process could also allow for infection

Question 44

zone of coagulation

Answer 44

area of burn that received most severe injury irreversible cell damage

Question 45

zone of stasis

Answer 45

area of less severe injury that possesses reversible damage and surrounds the zone of coagulation

Question 46

zone of hyperemia

Answer 46

area surrounding zone of stasis presents with inflammation but will fully recover without any intervention or permanent damage

Question 47

Abraision

Answer 47

Combo of friction and shear forces Over rough surface resulting in scraping away the skins superficial layers

Question 48

Avulsion

Answer 48

"Degloving" Results from tension Causes skin to become detached from underlying structures

Question 49

Incisional wound

Answer 49

Created intentionally by sharp object

Question 50

Laceration

Answer 50

Wound or irregular tear of tissues associated with trauma | Result from shear, tension, or high force compression

Question 51

Penetrating wound

Answer 51

Wound that enters interior of an organ or cavity

Question 52

Puncture wound

Answer 52

Sharp object penetrates skin and underlying tissue Relatively little tissue damage beyond wound tract Risk of contamination and infection high

Question 53

Supine bony prominence often associated with ulcer formation

Answer 53

``` Occiput Spine of scapula Inf angle of scapula Spinous processes Med epicondyle humerus Post iliac crest Scrum Coccyx Heel ```

Question 54

Prone bony prom associate with ulcer

Answer 54

``` Forehead Anterior portion acromiom Anterior head of humerus Sternum Asis Patella Dorsum of foot ```

Question 55

Sidelying bony prominences assoc with ulcer

Answer 55

``` Ears Acromium Lateral humeral head Lat epicondyle of humerus Greater trochanter Head of fibula Lat/med malleolus ```

Question 56

Sitting bony prom assoc with ulcer

Answer 56

Spine of scapula Spinous process Ischial tuberosities