Integument

Question 1

what is cellulitis?

Answer 1

bacterial infection of deeper dermis and subsequent layer

Question 2

what bacteria is common in cellulitis?

Answer 2

strep pyogenes or staph aureus

Question 3

what is strep pyogenes ? staph aureus?

Answer 3

strep pyogenes is an aerobic bacteria and opportunistic (proliferates early)

staph aureus appears in low # on the skin. it is normal flora in nasal passages

Question 4

what is the transmission of cellulitis?

Answer 4

through compromised skin (wound)

usually legs, then hands and pinna

Question 5

what are some manifestations of cellulitis?

Answer 5

erythema, warmth, edema fever, and pain

Question 6

how else can bacteria from cellulitis spread?

Answer 6

through tissue spaces and can affect lymphatic system

Question 7

what are 3 risks of cellulitis?

Answer 7

compromised physical barrier, immunocompromised, elderlly

Question 8

treatment for cellulitis?

complications?

Answer 8

mild: oral abx
severe: IV abx
recurrence

lymphangitis (inflame of lymphatic vessels) can become systemic (septicaemia, bacteria), gangrene

Question 9

what is psoriasis?

Answer 9

chronic inflm disorder where the basal cells haven’t divded normally and instead of shedding, they stack on the surface and form scaly patches.

Question 10

Et of psoriasis?

Answer 10

idiopathic
genetic component of 30%
autoimmunity (HLA, MHC)

Question 11

what is the patho of psoriasis?

Answer 11

its a t cell autoimmune response
skin trauma –> t cells activated –>mediators (might be why accelerated epidermal cell cycle) abnormal growth of keratinocytes and blood vessels (mediators also alter growth of blood vessels)

influx of inflm cells

incease epidermal cell turnover (3-4 days)
patterns of remissions and exacerbations

Question 12

what exacerbates psoriasis?

Answer 12

stress, trauma, infection, drugs

Question 13

manifestations of psoriasis?

Answer 13

psoriatic patches (scaly)

• elbows,
• knees
• scalp
• sacral region

nail dystrophy and pitting (related to the keratin- 30-50% of pt have this)
psoriatic arthritis (distal joints) swelling and deformity of distal joints

Question 14

what is the treatment for psoriasis?

think severe as well.

Answer 14

no cure

Topical Vit D
o Modulates keratinocytes & regulates T cells
topical steroids
topical retinoids (anti inflm and modulates keratoniocutes

severe:

methotrexate, cyclosporine (immunosuppressive)
Phototherapy (controlled exposure to ultra violet rays - suppress the cell cycle and reduce divans of the cells)
-topical application of TAR
-biologic agents - tumor necrosis factor (brings apoptosis

Question 15

how much of canada has skin cancer?

Answer 15

1/3

Question 16

what are the 3 types of skin cancer?

Answer 16

basal cell carcinoma 90%
squamous cell carcinoma 90%
malignant melanoma

Question 17

what is the name for a pre cancerous lesion

Answer 17

actinic keratosis (actinic is radiation and keratosis is the lesion from radiation)

Question 18

what is the cure rate for skin cancer?

Answer 18

95%

Question 19

Et of skin cancer?

Answer 19

inc sun exposure
skin damage is cumulative
nevus and plural is nevi - skin tags
age
inversely proportional to the melatonin in the skin

Question 20

basal cell carcinoma

common?
area?
fast or slow?
lesion shape?
mets or invasion?
dx?

Answer 20

common form
basal cell origin (lower layers of epidermis
slow
on exposed areas (mostly head, face, neck)
dome shaped/nodular lesion
local invasion and destr 
no mets usually 
no pain
biopsy for dx

Question 21

squamous cell carcinoma?
originate where?
slow or fast?
lesion?
infiltrate or invade anywhere?
mets?

Answer 21

• Origin in epid keratinocytes
• Exposed areas
• Faster growing
• Poorly defined (lesion)
• Variable appearance (ulers, nodules, papulars)
• May infiltrate local strs (deeper layers of skin and subq affected muscles, nerves, bvessels, adipose, etx)
• Mets to local lymph node

Question 22

what is melaginant melanoma?

origin?
area?
manifestations?

Answer 22

•	Melanocyte origin (melanin –produce pigment of skin)
•	Worst form
o	Inc progressive
o	Mets
•	Exposed & non exposed surfaces 
•	Main features
o	Lesion changes (month)
•	Doubling in size (3-8 mth)
•	Color change 
•	Irregular border 
•	Pruritus 
•	Bleeding 
•	Crusting
•	Ulceration 
mets to bone, brain, lung, liver

Question 23

tx for skin cancer?

Answer 23

early detection

sx excision