Integument

Question 1

What is Cellulitis?

Answer 1

• Bacterial infection of deeper dermis and subq layer

Question 2

What are the Infections common to Cellulitis

Answer 2

• Strep Pyogenes
   o Also know for causing strep throat)
   o It’s an opportunistic aerobe
• Staph Aureus 
   o Normal flora on skin and sometimes in nasal passages

Question 3

What areas are involved in initial infection and later symptoms of Cellulitis?

Answer 3

• Entry via compromised skin
o Eg wounds. Other Risk factors- elderly, immune compromised, ulcer/lesion present of skin
• Usually legs, then hands and Pinna of ear
o Erythema, warmth, edema, fever, pain
• Progresses laterally through tissue spaces
• Can affect lymphatic system

Question 4

Describe the Tx for Cellulitis

Answer 4

• Mild: oral ABx
• Severe: IV Abx (7-14days)
• Recurrence common

Question 5

What is Psoriasis?

Etiology?

Answer 5

Psoriasis
• Chronic Inflm disorder
• Variable Course
Et
• Largely idiopathic
• Genetic predisposition (~30%)
• Autoimmunity (not of the traditional type, 4 types not present)

Question 6

What is the Patho of Psoriasis?

Answer 6

• 30 days cycle of epidermal cell cycle, here the cycle is accelerated (said to be d/t automimmunity.. wed don’t know why)
• T cell autoimmune response (not destroying anything)
• Skin trauma -> T cells activated -> mediators -> abn growth of keratinocytes and blood vessels
• Influx of Inflm cells -> Inflm damage (vicious cycle set up)
• Inc epidermal cell turnover
o Cells stack instead of shedding -> scaly patches
• Pattern of remission and exacerbation
o Exacerbated by stress, trauma, infection and drugs

Question 7

MNFTS of Psoriasis

Answer 7

• Psoriatic patches
o Elbows
o Knees
o Sacral region
o Scalp
• Nail Dystrophy and pitting (related to keratinocytes)
• Psoriatic arthritis (distal joints inflm) (not r/t to infect)

Question 8

Tx of Psoriasis

Basic and Severe Cases

Answer 8

• No cure
• Topical Vit D 
    o Modulates keratinocytes and regulates T cells (not adequate alone)
• Topical steroids
• Topical retinoids (vit A)
o	Anti-inflm and modulate keratinocytes

• Severe
o Methotrexate, cyclosporine (immunosuppressive properties)
o Phototherapy (B rays used to control cell proliferation
o Biologic agents (eg TNF))

Question 9

What are 3 types of skin Cancer?

Answer 9

o basal cell carcinoma
o squamous cell carcinoma
These two make 90% of skin cancer

o malignant melanoma

Question 10

What is Actinic Keratosis?

Answer 10

Actinic Keratosis is a pre cancerous erythematous scaly lesion

NOTE:
Actinic (solar radiation)
Keratosis (actual lesion)

Question 11

Who is at Risk for skin cancer?

What is the key to good prognosis?

Answer 11

• Risk is
o Inversely proportional to melatonin
o Proportional to age

• Early detection and Tx
• 95% cure rate

Question 12

Etiology of Skin Ca

Answer 12

• INC sun exposure (UV light)

* Skin damage in cumulative

Question 13

Describe Basal Cell CA (Fig 61-32)

Answer 13

• Common Form
• Basal cell (of epidermis) in origin
• Slow progression (good prognosis)
• On exposed areas (mostly head, face and neck)
• Dome shaped / Nodular Lesion (early stages of malignancy)
• Local invasion and destruction (It will be growing)
• Usually without metastasis
• Biopsy for Diagnosis (the whole lesion will be excised)

Question 14

Describe squamous cell carcinoma

Answer 14

• Cell of origin is epidermal keratinocyte
• Exposed areas
• Faster growing (essential to find it early)
• Poorly defined (more difficult to Dx and detect)
• Variable appearance (difficult to Identify)
• May infiltrate local structures
• Mets to local lymph nodes (via lympth then blood afterwards)

Question 15

Describe Basics Malignant Melanoma

not lesion description

Answer 15

• Melanocyte in origin
• Worst form-> rapidly progressive and early metastasis
• Exposed and non exposed surfaces
• Metastasis to brain, bone, liver and lung
• Intensity of solar radiation rather then duration is most important
• Can be fatal

Question 16

What are the main features of the lesion changes in Malignant melanoma

Answer 16

• Doubling in size (~3-8mths) (or at least an INC in size)
• Color change
• Irregular Border
• Pruritus
• Bleeding
• Crusting
• Ulceration

Question 17

Pneumonic for worrysome lesion changes

Answer 17

o ABCDE (pneumonic)
• Asymmetry, Border, Color, Diameter, Elevation

Question 18

Tx for skin cancer

Answer 18

• Refers to all skin cancers
• Early detection
• Sx excision (may require radiation or chemo afterward)

Question 19

Which integument disease is treated with Tumor Necrosis Factor

Answer 19

Psyrosis

Question 20

What are nevi?

Answer 20

Nevus/Nevi are generally benign (tags and moles)

Question 21

Complications of Cellulitis

Answer 21

• Complications
   o Lymphangitis (Inflm of lymphatic vessel)
   o Gangrene
   o Sepsis
   o Abscesses