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Pathophysiology > Exam #5- Integumentary > Flashcards

Exam #5- Integumentary Flashcards

1
Q

aging changes of the skin

A

skin becomes thinner, drier, wrinkled, changes in pigmentation

of capillary loops shorten and decreases

less melanocytes and langerhans cells

sebaceous, eccrine, and apocrine glands atrophy

temp regulation is not as good

pressure/touch receptors decrease in number and decrease sensory perception

decreased protective functions

infections increase

delayed wound healing

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2
Q

neural innervation of the skin is the function of what?

A

the SYMPATHETIC nervous system by way of the ALPHA ADRENERGIC RECEPTORS

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3
Q

wheal

A

primary lesion

elevated, weird shaped area of cutaneous edema

solid and transient

diameter is varied

may last for a few hours

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4
Q

nodule

A

primary lesion

elevated, firm, circumscribed lesion

deeper than papule

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5
Q

tumor

A

primary lesion

elevated, solid lesion

deeper in dermis

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6
Q

vesicle

A

primary lesion

elevated, circumscribed, superficial lesion

does not extend into dermis

filled with SEROUS fluid (free fluid)

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7
Q

bulla

A

primary lesion

vesicle that measures >1cm

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8
Q

pustule

A

primary lesion

elevated, superficial lesion

like a vesicle but filled with PURULENT fluid (pus)

inflammatory cells

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9
Q

cyst

A

primary lesion

elevated, circumscribed, encapsulated lesion

is in dermis/subcutaneous layer

filled with liquid or semisolid

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10
Q

telangiectasia

A

primary lesion

irregular red lines

produced by capillary dilation

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11
Q

scale

A

secondary lesion

heaped up, keratinized cells

flaky skin and weird shape, can be thick or thin

dry or oily

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12
Q

lichenification

A

secondary lesion

rough, thickened epidermis caused by rubbing, itching, or irritation

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13
Q

keloid

A

secondary lesion

weird shaped, elevated progressively enlarging scar

grows beyond wound

caused by too much collagen formed during healing

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14
Q

scar

A

secondary lesion

think to thick fibrous tissue

replaces normal skin after injury/lacaration

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15
Q

excoriation

A

secondary lesion

loss of epidermis

linear, hollowed out, crusted area

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16
Q

fissure

A

secondary lesion

linear crack/break from epidermis to dermis

may be moist/dry

think of cracked feet

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17
Q

erosion

A

secondary lesion

loss of part of epidermis

depressed, moist, glistening

happens after rupture of vesicle or bulla

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18
Q

ulcer

A

secondary lesion

loss of epidermis/dermis

concave

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19
Q

atrophy

A

secondary lesion

thinning of skin surface

loss of skin markings

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20
Q

macule

A

circular flat discoloration <1cm

brown, blue, red or hypopigmented

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21
Q

patch

A

circumscribed flat discoloration >1cm

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22
Q

plaque

A

superficial elevated solid flat topped lesion >1cm

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23
Q

crust

A

dried serum or exudate on skin

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24
Q

pathophysiology of pressure ulcers

A

due to unrelieved pressure on skin (shearing forces, friction, moisture)

capillary blood flow occlusion

underlying tissue damage (like ischemia or necrosis)

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25
Q

decubitus ulcer

A

d/t lying/sitting in same position for too long on a bony prominence

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26
Q

stage 1 pressure ulcer

A

non-blanchable erythema of intact skin

intact skin with non blanchable redness of a localized area, usually over a bony prominence

the area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue

may be difficult to detect in individuals with dark skin tones

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27
Q

stage II pressure ulcer

A

partial-thickness skin loss

involves epidermis or dermis

presents as a shallow open ulcer with a red pink wound bed, without slough

may also present as an intact or open/ruptured serum-filled or serosanginous filled blister

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28
Q

stage III pressure ulcer

A

full-thickness skin loss

involves damage/loss of SUBQ TISSUE

subcutaneous fat may be visible but bone, tendon or muscle are not exposed.

slough may be present but does not obscure the depth of tissue loss

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29
Q

stage IV pressure ulcer

A

full thickness skin loss with damage to MUSCLE, BONE, or SUPPORTING STRUCTURES

slough or eschar may be present

often includes undermining and tunneling

category/stage IV ulcers can extend into muscle and/or supporting structures (fascia, tendon or joint capsule)

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30
Q

what is the outermost layer of the skin?

A

epidermis

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31
Q

pruritus

A

itching

most common s/s of primary skin disorders

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32
Q

itch

A

specific unmyelinated C nerve fibers

regulated by CNS

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33
Q

neuropathic pruritus

A

related to pathologic condition

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34
Q

psychogenic pruritus

A

psych problem

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35
Q

s/s of dermatitis eczema

A

pruritus, lesions w/indistinct borders, epidermal changes

chronic eczema- thickened, leathery, hyperpigmented skin from recurrent irritation/scratching

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36
Q

allergic contact dermatitis

A

t cell mediated or delayed hypersensitivity (TYPE IV)

allergen comes in contact with skin, binds to carrier protein

sensitizing antigen is formed

LANGERHAN CELLS process antigen

carry it to T cells

sensitization

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37
Q

which cells of the skin are important in immunity?

A

langerhan cells

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38
Q

a skin disorder that is the result of a type IV hypersensitivity reaction is known as what?

A

allergic contact dermatitis

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39
Q

irritant contact dermatitis

A

non immunologic inflammation

due to chemical irritation from acids/prolonged exposure to irritants

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40
Q

atopic dermatitis

A

d/t family history of allergies, hay fever, IgE

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41
Q

stasis dermatitis

A

happens in legs d/t venous stasis, edema, vascular trauma

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42
Q

seborrheic dermatitis

A

chronic skin inflammation that involves scalp, eyebrows, eyelids, nasolabial folds, axillae, chest, and back (cradle cap in babies)

greasy, scaly, white, or yellowish plaques

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43
Q

a skin lesion that is elevated, firm, rough, and has a flat top

A

plaque

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44
Q

psoriasis

A

chronic, relapsing, proliferative skin disorders

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45
Q

pathophysiology of psoriasis

A

t cell AUTOIMMUNE mediated skin disease

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46
Q

s/s of psoriasis

A

scaly, thick, silvery, elevated lesion, usually on scalp, elbows, or knees

47
Q

pityriasis rosea

A

benign, self limiting inflammatory disorder

48
Q

pathophysiology of pityriasis rosea

A

d/t a VIRUS

49
Q

s/s of pityriasis rosea

A

herald patch- CIRCULAR, demarcated, salmon-pink

50
Q

systemic complications of psoriasis

A

arthritis and heart disease

51
Q

an autoimmune skin disorder that results in scaly, silvery lesions with evidence of dermal and epidermal thickening

A

psoriasis

52
Q

pathophysiology of lichen planus

A

AUTO-INFLAMMATORY disorder of SKIN and MUCUS membranes

origin is unknown, but it involves t tubules, adhesion molecules, inflammatory cytokines, and antigen presenting cells

53
Q

s/s of lichen planus

A

lesions are non-scaling popular VIOLET-colored with itching on wrists, ankles, lower legs, and genitals

54
Q

a benign t cell mediated auto-inflammatory skin disorder that results in violet colored lesions is what?

A

lichen planus

55
Q

acne vulgaris

A

inflammatory disease of pilosebaceous follicles

hypertrophy of sebaceous glands and telengiectasia

common during ADOLESCENCE

56
Q

acne rosacea

A

skin inflammation of MIDDLE AGED ADULTS

lesions are erythematolangiectatic, papulopustular, phymateous, and ocular

related to chronic, inappropriate vasodilation

flushing and sun sensitivity

57
Q

lupus erythematosus

A

inflammatory, autoimmune, systemic disease with cutaneous s/s

types: skin (discoid) and systemic (SLE)

58
Q

discoid (cutaneous) lupus erythematosus

A

acute, subacute, chronic

restricted to skin

59
Q

pathophysiology of discoid lupus

A

altered immune response with new T and B cells formed, decreased number of regulatory T cells, and increased pro inflammatory cytokines

tissue damage d/t autoantibodies and immune complexes

60
Q

s/s of discoid lupus

A

photosensitivity, butterfly pattern, can lead to SLE

61
Q

pathophysiology of erythema multiforme

A

immune complexes formed and deposited around dermal blood vessels, basement membranes, and keratinocytes

affects mouth, air passages, esophagus, urethra, and conjunctivae

62
Q

s/s of erythema mutliforme

A

“bulls eye” or target lesion, erosions/crusts form when lesions rupture

63
Q

steven johnson syndrome

A

cause is unknown but involves an immune mechanisms r/t drug administration

severe blistering

64
Q

pathophysiology of pemphigus

A

AUTOIMMUNE, chronic, blister forming disease of skin and oral mucous membranes

caused by circulating IgG AUTOANTIBODIES that work against surface adhesion molecules in the epidermis

65
Q

s/s of pemphigus

A

blisters can be deep or superficial to the epidermis

66
Q

folliculitis

A

bacterial

infection of hair follicles from a staph infection

67
Q

furuncles

A

bacterial

boils (inflammation of hair follicles) that develop from folliculitis from staph infection

68
Q

carbuncles

A

bacterial

collection of infected hair follicles

painful, swollen, and red with systemic s/s

69
Q

cellulitis

A

bacterial

infection of dermis and SQ tissue from staph or group B strep infection

70
Q

necrotizing fasciitis

A

bacterial

inflammation that spreads quickly to fascia, muscles, and SQ fat to skin

71
Q

erysipelas

A

bacterial

superficial form of cellulitis

72
Q

impetigo

A

bacterial

superficial lesion from staph

73
Q

HSV-1

A

virus

cold sores

74
Q

HSV-2

A

virus

genital

75
Q

herpes zoster (shingles)

A

virus

caused by varicella zoster virus

76
Q

varicella chickenpox

A

virus

77
Q

wart

A

virus

benign lesions caused by HPA

78
Q

a child presents with lesions superficially on the skin. the provider knows that this disorder is caused by staph

A

impetigo

79
Q

tinea

A

caused by dermatophytes tinea capitis, tinea pedis, tinea corporis, tinea cruris, tinea unguium

80
Q

candidiasis

A

caused by candida albicans found on skin, GI, vagina

81
Q

s/s of candidiasis

A

thin walled pustule that produces a whitish yellow curd-like substance

82
Q

pathophysiology or urticaria (hives)

A

type I hypersensitivity reaction

histamine release

endothelial cells of skin to contract fluid leaks from vessels

83
Q

s/s of urticaria

A

itchy area of raised erythema with central pallow

wheals

welts

84
Q

urticaria is the result of which type of hypersensitivity reaction?

A

type I

85
Q

pathophysiology of scleroderma

A

SCLEROSIS (hardening) of skin

muscles, bones, and internal organs

T HELPER CELLS and their CYTOKINES: fibroblast proliferation and fibrosis due to multiple autoantibodies

86
Q

s/s of scleroderma

A

skin is hard, hypopigmented, taut, shiny, and tightly connected to underlying tissue

87
Q

pathophysiology of ticks

A

ticks embed their heads into pts skin so they can get blood

they gorge on blood and get huge

they they release their toxins/transmit microorganisms

88
Q

pathophysiology of lyme disease

A

tick that spreads infection borrelia burgdorferi

89
Q

stages of lyme disease

A

localized

disseminated infection

late persistent infection

90
Q

localized lyme disease

A

3-32 days with erythema migrans with or without fever, fatigue, malaise, myalgia, arthralgia

91
Q

dissmeninated infection of lyme disease

A

secondary erythema migrans, arthralgia, meningitis, neuritis, carditis

92
Q

late persistent infection of lyme disease

A

years after

arthritis, encephalopathy, polyneuropathy, HF

93
Q

seborrheic keratosis

A

benign

proliferation of cutaneous basal cells that produce smooth/warty elevated lesions

94
Q

keratoaconthoma

A

benign

tumor of squamous cell that comes from hair follicles

95
Q

actinic keratosis

A

benign

premalignant lesion made of aberrant proliferations of epidermal keratinocytes caused by too much UV light

96
Q

nevi (moles)

A

benign

pigmented or not

lesions that form from melanocytes

can transition to malignant melanomas

97
Q

basal cell CA

A

malignant

surface epithelial tumor

mutation of TP53 and PTCH1 genes

most common type of skin cancer

shiny “pearly” papule or nodule

grows slowly

usually occurs on sun-exposed areas

umbilicated center and telangiectasias

98
Q

squamous cell cancer

A

malignant

tumor of epidermis: in situ or invasive

mutation of TP53 gene

more common in immunocompressed or transplant patients

hyperketatotic lesion with crusting and ulceration

can be more aggressive than basal cell cancer

usually occurs on sun-exposed areas

99
Q

malignant melanoma

A

malignant

tumor of skin that comes from melanocytes

100
Q

kaposi sarcoma

A

malignant

vascular malignancy

due to herpes virus

common in immunosuppressred pts (post transplant, AIDS)

101
Q

a patient presents with a skin lesion with crusting and ulceration that is invading the epidermis. the provider would suspect which type of skin cancer?

A

squamous cell carcinoma

102
Q

ABCDE rule

A

asymmetry

border irregularity

color variation

diameter >6mm

elevation that includes raised appearance/rapid enlargement

103
Q

ABCD sign of melanoma

A

asymmetry- when half of the mole does not match the other half

border- when the border (edges) of the mole are ragged or irregular

color- when the color of the mole varies throughout

diameter- if the mole’s diameter is larger than a pencil’s eraser

104
Q

cold injuries basics

A

injury from extreme cold that affects fingers, toes, ears, nose, cheeks

alternating cycles of vasoconstriction/vasodilation leads to burning reaction

105
Q

s/s of cold injury

A

white/yellowish, waxy, firm to touch

106
Q

partial thickness burn

A

ONLY epidermis

local pain with erythema

no blisters until 24 hours after injury

107
Q

superficial partial thickness burn

A

thin walled, fluid filled blisters form minutes after injury

painful!

108
Q

deep partial thickness burn

A

ENTIRE dermis

spares skin appendages like hair follicles and sweat glands

waxy, white skin

can distinguish after 7-10 days between deep partial and full when hair or skin buds reappear

109
Q

full thickness burn

A

entire epidermis, dermis, and underlying SQ are destroyed

PAINLESS due to destroyed nerve endings

burn color is white, cherry red, or black

wound is dry or leathery

110
Q

which type of burn is associated with injury to the epidermis and all skin barrier are intact?

A

partial thickness injury

111
Q

burn shock

A

in immediate (acute) phase is d/t hypovolemia, heart issues, cellular issues

112
Q

capillary seal

A

end of burn shock

113
Q

ebb phase of burn shock

A

heart contractility is decreased during 1st 24 hours because blood is shunting away from liver, kidney, and gut

Pathophysiology (5 decks)

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