FTM 58 - Clinical Consideration - Integument

Question 1

How long does it take for skin cells to turnover?

Answer 1

2-4 weeks

Question 2

How do transdermal patches work?

Answer 2

They’re simply a patch that sticks to the skin well and contains a reservoir of lipid soluble drug that can be absorbed through the skin

Question 3

What are the two types of skin wounds?

Answer 3

Question 4

Describe the process of epidermal wound healing

Answer 4

Question 5

What are the phases of deep wound healing?

Answer 5

Question 6

Describe what occurs during the inflammatory phase of deep wound healing

Answer 6

Question 7

What are mesenchymal cells?

Answer 7

Stem cells that can differentiate into the different skin cell types

Question 8

Describe what occurs during the migratory phase of deep wound healing

Answer 8

Question 9

Describe what occurs during the proliferative phase of deep wound healing

Answer 9

Question 10

Describe what occurs during the maturation phase of deep wound healing.

Answer 10

Question 11

List the types of scars that can result from wound healing

Answer 11

Fibrosis - regular scar composed of an increased amount of connective tissue

Hypertrophic scar - a raised scar that remains within the original wound boundary

Keloid Scar - a hypertrophic scar that has extended past the boundaries of the original wound

Question 12

Define the following terms: hyperkeratosis, parakeratosis, acantholysis, acanthosis, complement system

Answer 12

Question 13

What is Psoriasis and what causes it? How and where does it present?

Answer 13

Psoriasis is a chronic inflammatory and proliferative disorder of the skin. It is caused by an increased rate of proliferation of the mitotic cells, therby leading to a thickened epidermis (acanthosis). This leads to constant shedding of the epidermis which presents as well-circumscribed (well defined borders), erythematous (red colored) plaques covered with silvery scales. These plaques are especially prevalent in the extensor aspects of the limbs, trunk, and lumbosacral region.

Question 14

What is Bullous Pemphigoid and what causes it? How and where does it present?

Answer 14

Bullous Pemphigoid is a chronic autoimmune blistering disease. It is caused by a separation of the epidermis from the dermis which is caused by the presence of hemidesmosome specific IgG antibodies in the skin. These autoantibodies bind to the basement membrane and stimulate leukocytic infiltration. The leukocytes (esoinophils in this case) will then release proteases that degrage hemidesmosomes causing the the basement membrane of the epidermis to separate from the dermis. Fluid accumulation occurs in the resulting cavity presenting as a blister in the skin or mucous membrane.

Question 15

What is Pemphigus Vulgaris? What causes it? How and where does it present?

Answer 15

Pemphigus Vulgaris is a rare autoimmune disorder affecting the epidermis and mucosal epithelium. In this condition the immune system targets and attacks desmosomes (specifically cadherins and desmoplakins) in the skin causing a separation of the cells of the S. Spinosum and atrophy of the prickle cell layer (S. Spinosum). This leads to blisters on the skin that easily rupture.

Question 16

What causes albinism? How does it inherit? How does it present? What are some of the long term implications of living with albinism?

Answer 16

Albinism is caused by an autosomal recessive mutation of the TYR gene which codes for tyrosinase. In the skin, tyrosinase converts tyrosine to DOPA which melanocytes will then convert into melanin. This decreased amount or absence of pigment leads to characteristic appearance of albinism. Ocular albinism occurs only in the eyes while Oculocutaneous occurs in the eyes and skin. Albinism places a person at higher risk to develop skin cancers and have reduced visual acuity/photophobia.

Question 17

What is Vitiligo? What causes it? How does it present? How is it treated?

Answer 17

Vitiligo is an autoimmune disorder resulting in destruction of melanocytes and the subsequent depigmentation of the skin. It is most evidently seen in darker skinned individuals who begin to develop white patches on their skin. It can be medically treated with topical steroid, psolaren photochemotherapy, and depigmentation. It can be surgically treated with skin grafts, micropigmentation, and melanocyte transplants.

Question 18

Answer 18

Question 19

What is a carcinoma? List the different types found in skin.

Answer 19

Question 20

What is a squamous cell carcinoma? What typically causes it? Describe the histology of the disorder.

Answer 20

Squamous Cell Carcinomas are malignant tumors of the keratinocytes. They are most often caused by DNA damage from UV exposure causing an inactivation of the P53 gene. These cell lose all order in their maturation and begin to vary in size and shape leading to hyperkeratosis and parakeratosis. The infiltrative type of Squamous Cell Carcinoma infilitrates into the dermis as squamous pearls or swirls surrounded by sheets of malignant squamous cells.

Question 21

In which populations are squamous cell carcinomas most prevalent and what are some prdisposing factor for the disease?

Answer 21

Question 22

What is basal cell carcinoma? What causes it? How does it present both histologically and superficially?

Answer 22

Basal cell carcinoma is a cancer of the S. Basale cells typically caused by exposure to UV light. Hisologically it presents as a single arrangement of basal cells organized like a fence around a group of tumor cells. Superficially it appears as a raised area of skin with rolled out margins.

Question 23

What is malignant melanoma? What causes it? How does it present histologically and superficially?

Answer 23

Malignant melanoma is a malignant transformation of melanocytes typically caused by overexposure to sunlight. Histologically it presents as an increased number of melanocytes with large atypical morphologies arranged at the dermo-epidermal junction. Superficially it appears as a large raised brown area of skin

Question 24

What makes malignant melanoma so dangerous? In which populations is it most prevalent?

Answer 24

It can invade the dermis and metastasize. It is the highest cause of skin cancer related deaths in the US. It is most commonly seen in whites especially in Australia and S. Africa.

Question 25

What is the mnemonic to aid in diagnosing malignant melanoma.

Answer 25

Question 26

T/F - neurofibromatosis is a skin lesion

Answer 26

false