FMS-Derm Flashcards
What accounts for approximately 20% of the body’s weight?
skin
What is the largest organ of the body?
skin
What is the primary function of the skin?
protect the body against:
- microorg. 3. loss of body fluids
- UV radiation 4. stress of mechanical forces
T/F: The skin regulates body temperature.
TRUE
The skin is involved in the production of which vitamin?
Vitamin D
What are some genetic & environmental factors that affect the integumentary system?
- skin becomes thinner, drier, wrinkled, & demonstrates changes in pigmentation
- shortening & decreasing in number of capillary loops
- fewer melanocytes & Langerhans cells
- atrophy of sebaceous, eccrine, & apocrine glands
- changes in hair color
- fewer hair follicles & growth of thinner hair
flat circumscribed area of altered color that is <1cm
macule
raised, solid lesion <5mm-1cm
papule
flat, pigmented lesion >5mm-1cm
patch
> 5mm flat-topped, raised leesion
plaque
transient swelling due to dermal edema
Wheal
solid, round circumscribed elevation of 1-2cm
nodule
elevated, solid lesion that may be clearly demarcated, deeper in the dermis & >2cm
tumor
<1cm papule containing clear fluid
vesicle
large (>5mm-1cm), circumscribed , fluid-containing elevation
Bulla
papule containing purulent fluid
pustule
encapsulated nodule containing fluid, cells, or keratin
cyst
small, dilated superficial blood vessels
telangiectasia
thick stratum corneum due to increased proliferation or keratincytes
scale
focal area of thickened skin with accentuation of skin lines due to rubbing/scratching
lichenification
irregular, elevated, enlarging scar caused by excessive collagen formation during healing, following surgery or other skin trauma
keloid
thin to thick fibrous tissue healed dermal layer or deeper, healed wound or surgical incision
scar
shallow abrasion, linear hallowed-out, crusted area
excoriation
linear, split in epidermis &/or crack in dermis (can be moist or dry)
fissure
partial loss of epidermis, heals without scarring
erosion
loss of epidermis & dermis, surface excudate &/or crusting often present; heals with scarring
ulcer
thinning of skin surface & loss of skin markings
atrophy
What are pressure ulcers a result of?
any unrelieved pressure on the skin
- pressure
- shearing forces
- friction
- moisture
What are some risk factors of pressure ulcers?
- immobilization
- incontinence
- debilitation
You are a PA doing rounds & you notice one of your elderly patients that has limited movement has not changed positions for sometime. What should you be worried about this patient developing?
pressure ulcers
T/F: chronic diseases accompanied by anemia, edema, renal failure, malnutrition, sepsis, & urinary or fecal incontinence puts patients at risk for pressure ulcers.
TRUE
T/F Coarse bed sheet used for turning patients over do not present any risk of causing pressure ulcers.
FALSE (they do!!! It produces a shearing force)
T/F Epinephrine infusion is a risk factor for pressure ulcers in the critically ill patient.
FALSE! (Norepinephrine infusion is a risk factor)
IDENTIFY THE RISK FACTORS OF PRESSURE ULCERS IN A CRITICAL ILL PATIENT:
An 76 year old elderly woman was admitted to the hospital for 2 months for treatment of her anemia, renal insufficiency, fecal incontinence, and severe burn from spilling boiling water on her while cooking for her family on Sunday morning.
Pressure ulcer risk factors for the critically ill
- Age greater than 60 years
- Anemia
- Renal insufficiency
- fecal incontinence
- length of hospital stay
T/F Individuals with darkly pigmented skin are at higher risk for pressure ulcers than white pigmented skin.
OF COURSE THEY ARE!!!!!!! ALWAYS ALWAYS ALWAYS.
***early signs of skin damage may not be clearly visible in DARK PIGMENTED PEOPLE
Non-blanchable erythema of intact skin is what stage of a pressure ulcer?
stage 1
Partial thickness skin loss involving epidermis or dermis is in what stage of a pressure ulcer?
stage 2
Full thickness skin loss involving damage or loss of subcutaneous tissue is what stage of a pressure ulcer?
stage 3
Full thickness skin loss involving damage or loss of subcutaneous tissue is what stage of a pressure ulcer?
stage 4
A patient was just checked into the ER with a pressure ulcer covered with eschar. What stage of a pressure ulcer would u describe this as?
UNSTAGEABLE!!!!!!! - the wound is cover by eschar - dead or decaying tissue
What are elevated, rounded, firm, and has claw like margins that extend beyond the original site of injury due to excessive collagen formation during dermal connective tissue repaid?
Keloids
Which type collagen is increased during the development of a Keloid?
Type III
Who are Keloids most commonly found in?
darkly pigment skin types and pt’s with burn scars
Pruritis is the most common symptom of what disorders?
primary skin disorders
What is itch carried by?
specific unmyelinated C-nerve fibers
What is itch triggered by?
a number of itch medicators-
- Histamine
- Seratonin
- Prostaglandins
- Brandykinins
- Neuropeptides
- Acetylcholine
Chronic itching leads to persistent scratching. What can result because of this?
Infections and Scarring
What are the treatments for chronic itching?
treated with antihistamines, minor tranquilizers, and topical steroids.
What can modulate the itch response?
CNS
T/F Pain stimuli at lower intensities can induce itching.
true
What is the most common inflammatory disorders?
Dermatiti or eczema
There are various types of dermatitis. What are the general characteristics of dermatitis?
pruritis, lesions with indistinct borders, and epidermal changes including erythema, papules, and scales
**KNOW THIS - see the name - be able to describe it! :)
What type of reaction is allergic contact dermatitis caused by?
hypersensitivity type 4 reaction
In allergic contact dermatitis an allergen comes into contact with the skin, binds to ______ to form _______.
binds to carrier protein to form sensitizing antigen
In contact dermatitis an allergen comes into contact with the skin, binds to the carrier protein to form sensitizing antigen. What processes the antigen? What becomes sensitized to the antigen?
Langerhans cells process the antigen, carry to T cells to become sensitized to antigen.
What are the manifestations of allergic contact dermatitis?
- Erythema
- Swelling
- Pruritis
- Vesicular Lesions
Type 1 hypersensitivity inludes activation of mast cells, eosinophils, T-lymphocytes, other inflammatory cells. What inflammatory disorder is a type 1 hypersensitive disorder?
Atopic dermatitis
What are the manifestations of Atopic dermatitis?
red, weeping crusts and chronic inflammation, lichenification
T/F Irritatnt contact dermatitis is an immunological inflammatory reaction
FALSE!!! it is a non-immunologic inflammation.
A patient comes into the ER with signs of chemical irritation from acids or prolonged exposure a substance causing irritation. What would you, a PA, diagnose this patient with?
IRRITANT CONTACT DERMATITIS!!!!!!!
What is the treatment of irritant contact dermatitis?
Removal of the stimulus
What occurs in the leg as a result of venous stasis, edema, and vascular trauma?
Stasis dermatitis
A patient comes into Mississippi College PA clinic and describes a history of erythema, followed by pruritus, then scaling, petechiae, and then finally today she is showing an ulcer on her legs after coronary artery bypass graft surgery. What would be the diagnosis of this patient?
Stasis Dermatitis
Heather comes into Enterprise Medical Clinic with red rash covering her checks and nose including her nasolabial folds. This diagnosis will develop into scaly, white, or yellowish plaques.
Seborrheic dermatitis.
T-cell immune mediated skin disease that is scaly, thick, silvery, elevated lesions, usually on scalp, elbows, knees caused by a high rate of mitosis in the basal cell layer. This describes what disorder?
Psoriasis - a papulosquamous disorder
Is Psoriasis chronic?
Yes
Is Psoriasis a relapsing, proliferative skin disorder?
yes
T/F Psoriasis is thinking of the dermis.
FALSE!! Shows evidence of dermal and epidermal thickening
What is the epidermal turnover in psoriasis?
26-30 days to 3-4 days
Why do the dermis and epidermis thicken and form the thick scaly lesions in psoriasis?
the cellos do not have time to mature or keratinize. Epidermis turn over goes from 26-30 days to 3-4 days instead.
A patient comes into the family practice clinic in Enterprise, MS complaining of having a big circular, 3-4 cm demarcated salmon pink colored lesion on her chest approximately 3 weeks ago. Shorty after a lot of smaller similar lesions appeared across her body. What would you diagnose this patient with?
Pityriasis rosea - HERALDS PATCH!!!
Pityriasis rose usually occurs during what months?
winter
T/F Pityriasis rosea is a chronic inflammatory papulosquamous disorder.
false!!!!!! benign, self limiting, inflammatory disorder
What is thought to be the cause of Pityriasis rosea?
Herpes like virus
Nonscaling violet colored, 2-4mm lesion, found on the patients wrists, ankles, lower legs, and genitalia.
Lichen planus - Papulosquamous disorder
T/F Lichen planus is a benign, inflammatory disorder of the skin and mucous membranes.
True
What is thought to be the origin of lichen planus?
Unknown origin, BUT T cells, adhesion molecules, inflammatory cytokines, and antigen presenting cells are involved
A papulosquamous disorder causing inflammation of the pilosebaceous follicle?
Acne vulgaris
Inflammation of the skin that develops in adulthood. Erythematotelengiectatic, papulopustular, phymatous, and ocular lesions.
Acne Rosacea
What is associated with chronic, inappropriate vasodilation resulting in flushing and sensitivity to the sun?
Acne Rosacea
inflammatory, autoimmune disease with cutaneous manifestations, though to be an altered immune response to an unknown antigen or response to UV wavelengths with the development of self-reactive T and B cells, decreased number of regulatory T cells and increased proinflammatory cytokines
Lupus erythematosus
Autoantibodies and immune complexes causes tissue damage
What is restricted to the skin, photosensitivity, butterfly pattern over the nose and cheeks, subtype of SLE
discoid lupus erythematosus
diseases that have different causes and clinical courses but share the common characteristic of vesicles, or blister, formation
vesiculobullous disorders
Pemphigus and Erythema multiforme
blister or bubble, rare, chronic blister-forming disease of the skin and oral mucous membranes, blisters form in deep or superficial epidermis
pemphigus
autoimmune disease caused by circulating IgG autoantibodies, the antibodies and complement act against the cell surface adhesion molecule, desmoglein in the suprabasal layer of the epidermis
pemphigus
loss of intracellular connections
acantholysis
type of pemphigus that is severe
pemphigus vulgaris
type of pemphigus that is on the face and chest, milder form
pemphigus foliaceus
type of pemphigus that is variant of pemphigus foliaceous associated with SLE
pemphigus erythematosus
more benign disease than pemphigus vulgaris, bound IgG and blistering of the subepidermal skin layer, subepidermal blistering and eosinophils distinguish pemphigoid from pemphigus
bullous pemphigold
acute recurring disorder of skin and mucous membranes, associated with allergic or toxic reactions to drugs or microorganisms
erythema multiforme
caused by immune complexes formed and deposited around the dermal blood vessels, basement membranes and keratinocytes, “bull’s eye” or target lesion
erythema multiforme
surrounded by rings of alternating edema and inflammation
erythematous regions
bullous lesions from erosions and crusts when they rupture, affects the mouth, air passages, esophagus, urethra and conjuctivae
erythema multiforme
what are the severe forms of erythema multiforme?
stevens-johnson sydrome and toxic epidermal necrolysis
infection of hair follicles, staph is the common causes
folliculitis
“boils” are an inflammation of the hair follicles, develop from preceding folliculitis; spread through follicular wall into the surrounding dermis, staph is the most common causative organism
furuncles
collection of infected hair follicles, erythematous, painful, swollen mass that drains through many openings, abscesses may develop, chills, fever, malaise
carbuncles
infection of the dermis and subcutaneous tissue, staph or strep are the common cause
cellulitis
an acute superficial infection of the upper dermis (a superficial form of cellulitis) and strep is the most common cause
erysipelas
a superficial lesion of the skin, caused by coagulase-positive staph or strep
impetigo
8 types, DNA virus
Herpes simplex virus
usually causes infection of the cornea, mouth and labia, contact with infected saliva, “cold sore” or “fever blister” the most commmon manifestation
HSV-1
HSV-1 infection of the cornea
herpes keratitis
HSV-1 infection of the mouth
gingivostomatitis
HSV-1 infection of the labia
labialis
gential infections, skin to skin mucous membrane contact during viral shedding, vertical transmission from mother to neonate is associated with significant neonatal morbidity and mortality
HSV-2
An initial infection from varicella zoster can be followed years later by ________ _______.
Herpes zoster
What virus causes these symptoms? Pain and paresthesia localized to the affected dermatome (cutaneous area innervated by a single spinal nerve) followed by vesicular eruptions along a facial, cervical, or thoracic lumbar dermatome
Herpes zoster
Warts are benign lesions caused by _______ and are diagnosed by ______.
human papilloma virus
visualization
Highly-contagious, sexually transmitted venereal warts that present as cauliflower type lesions in moist areas- along the glans of the penis, vulva and anus
Condylomata acuminata
Primary cause of cervical cancer
oncogenic HPV
Fungi causing superficial skin lesions are called
dermatophytes
Fungal disorders called mycoses caused by dermatophytes are called
tinea
Which fungal infection affects the scalp?
Tinea captitis
Which fungal infection affects the feet?
Tinea pedis
Which fungal infection causes “ringworm”?
Tinea corporis
Which fungal infection causes jock itch?
Tinea cruris
Which fungal infections affect the nails?
Tinea ungium or onychomycosis
Candidiasis is a fungal infection caused by_________ ______ that is normally found where?
Candida albicans
skin, GI tract, and vagina
What could cause Candida albicans to change from a commensal organism to a pathogen?
local environment of moisture and warmth systemic administration of antibiotics pregnancy diabetes mellitus Cushing's disease debilitated states younger than 6 months of age immunosuppresion neoplastic diseases
Results from immune complexes in the small blood vessels that develops from drugs, bacterial infections, viral infections or allergens
Cutaneous vasculitis
How do the lesions of Cutaneous vasculitis present?
palpable purpura progressing to hemorrhagic bullae with necrosis and ulceration
Due to type 1 hypersensitivity reactions to allergens; histamine release causes endothelial cells of the skin to contract and causes leakage of fluid from the vessels
Urticaria (hives)
What is the treatment of urticaria?
antihistamines and steroids
Sclerosis of the skin that can progress to internal organs- associated with several antibodies
Scleroderma
How do the lesions caused by scleroderma present themselves?
Lesions exhibit massive deposits of collagen with inflammation, vascular changes, and capillary dilation
How does the skin present when scleroderma is present?
skin is hard, hypo pigmented, taut, and tightly connected to underlying tissue
How does scleroderma affect the facial skin?
Facial skin becomes very tight
Mouth may not open completely
What are some of the side effects of scleroderma?
Facial skin becomes very tight
Fingers become tapered and flexed
Nails and fingertips can be lost from atrophy
Mouth may not open completely
50% of patients with scleroderma die within ___ years.
five years
Lyme disease and Rocky Mountain Fever can be caused by what insect?
tick
Malaria, yellow fever, dengue fever, filariasis, and St. Louis encephalitis may be caused by which insect?
mosquitoes
Bites from flies may cause what?
Painful bites
Urticaria and mild bleeding
What are four types of benign tumors found on the skin?
Seborrheic Keratosis, Keratoacanthoma, Actinic Keratosis, Nevi (moles)
Four different types of malignancies found on the skin.
Basal Cell Carcinoma, Squamous Cell Carcinoma, Malignant Melanoma, Kaposi Sarcoma
What is a skin injury due to exposure to extreme cold?
Frostbite
Which area of the hot hiker man’s body might be affected after reaching the summit of Everest?
Fingers, toes, ears, nose, cheeks
The burning reaction the hot hiker man felt on areas of his body affected by frostbite were caused by what occurring in his hot body?
Alternating cycles of vasoconstriction and vasodilation.
In this hair loss disease, there is no loss of hair on the frontal hairline.
Female-pattern alopecia
Disease caused by genetic predisposition response to androgens
male-pattern alopecia
Autoimmune T-cell–mediated inflammatory disease against hair follicles that results in baldness
Alopecia Areata
Abnormal growth and distribution of hair on the face, body, and pubic area in a male pattern that occurs in women
Hirsutism
Acute or chronic infection of the cuticle
Paronychia
Fungal or dermatophyte infection of the nail plate
Onychomycosis
