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NPTE > Integumentary > Flashcards

Integumentary Flashcards

1
Q

What is the largest organ in the body?

A

Skin

15-20% of body weight

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2
Q

What are the layers of the skin?

A
  1. epidermis
  2. dermis
  3. sucutaneous tissue
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3
Q

Definition

Hair that is thick, coarse, and pigmented

A

terminal hair

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4
Q

definition

Hair that is short and fine

A

vellus hair

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5
Q

Where are sebaceous glands NOT found?

A

palms and soles

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6
Q

What is the function of sebum?

A
  1. lubricates skin
  2. protects against bacteria and fungus
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7
Q

What is the function of eccrine glands?

A

helps control body temperature

Open on the skin

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8
Q
A
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9
Q

Where are apocrine glands found? What stimulates them?

A

a. axillary and genital areas
b. stimulated by emotional stress

open into hair follicles

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10
Q

What happens to hair follicle density and metabolism as a person ages?

A

decreases

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11
Q

What causes reddening of the skin?

A

Increased blood flow with an increase in oxyhemoglobin to the skin and capillaries

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12
Q

What causes peripheral cyanosis?

A

Reduced blood flow to the skin and loss of oxygen to tissues

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13
Q

What causes central cyanosis?

A

Reduced oxygen level in the blood

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14
Q

What can central cyanosis cause?

A
  1. advanced lung disease
  2. congenital heart disease
  3. abnormal Hgb
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15
Q

What are the types of tissue union?

A
  1. primary (first intention)
  2. secondary
  3. tertiary (delayed primary)
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16
Q

Describe first intension/primary tissue healing.

A
  • no major loss of connective tissue
  • wound is not contaminated
  • closure within 3-7 days
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17
Q

Describe secondary healing.

A
  • full thickness wound
  • little epithelialization present

Chronic wounds, pressure injuries, venous ulcers, other open wounds

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18
Q

Describe tertiary healing (delayed healing).

A
  • leaving the wound open to optimize drainage and granulation… closed with sutures, staples, etc
  • used for contaminated tissue and when wound healing has to be delayed
  • closure will result in too much tension
  • closes within 5-7 days of injury
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19
Q

What type of wound usually heals without scarring?

A

epidermal wound

superficial or partial-thickness wound

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20
Q

Do dry or moist wounds epithelize quicker?

A

moist wounds

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21
Q

What are the phases of healing for dermal/full-thickness wounds?

A
  1. homeostasis
  2. inflammation
  3. granulation, proliferation, or firoblastic phase
  4. maturation and matrix formation phase
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22
Q

Describe the homeostasis phase of healing.

A
  • vasoconstriction to reduce loss and prevention of infection
  • fibrin plug is formed
  • 10-15 minutes after injury
  • occurs after growth factors are released
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23
Q

Describe the inflammation phase of healing.

A
  • 24-48 hours
  • cardinal signs of inflammation become apparent due to vasodilation of non-injured vessels to allow leukocytes and growth factors in the area of injury
  • phagocytosis and nevascularization
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24
Q

What are the cardinal signs of inflammation?

A
  • rubor (redness)
  • calor (heat)
  • tumor (swelling)
  • dolor (pain)
  • functiolaesa (loss of function)
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25
Q

What are the key cells in the inflammation phase?

A
  1. platelets
  2. leukocytes
  3. macrophages
  4. mast cells
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26
Q

What phase of the healing process can DM impair?

A

Inflammation phase

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27
Q

When does inflammation phase occur?

A

24-48 hours after injury

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28
Q

When does homeostasis phase occur?

A

10-15 minutes after injury

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29
Q

What are the 4 primary events that occur during the granulation/proliferation/fibroblastic phase?

A
  1. angiogenesis
  2. granulation formation
  3. wound contraction
  4. epithelialization
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30
Q

What are the primary cells associated with the granulation phase? What do they provide?

A
  • myofibroblasts (wound contraction)
  • fibroblasts (collagen, elastin, and glycosaminoglycan production)
  • epithelial cells (epithelialization)
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31
Q

When does the maturation/matrix formation stage occur?

A

2-4 weeks after injury

can last up to years- collagen synthesis and alignment)

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32
Q

When is a wound pink during maturation phase?

A

Weeks 6-12

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33
Q

When is a wound lavender/soft pink during maturation phase?

A

months 12-15

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34
Q

What medications can delay wound healing?

A
  1. corticosteroids
  2. chemotherapy
  3. NSAIDS
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35
Q

diagnosis

  • smooth, red, elevated patches of skin (hives)
  • indicative of allergic response
A

urticaria

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36
Q

diagnosis

excessive dryness of the skin with shedding of the epithelium

A

xeroderma

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37
Q

What can xeroderma indicate?

A
  • deficiency in thyroid function
  • DM
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38
Q

What is clubbing?

A

thickened and rounded nail end with spongy proximal fold

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39
Q

(true/false) clubbing develops over time

A

false (at birth)

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40
Q

What is clubbing indicative of?

A
  • crohn’s disease
  • cardiac-related cyanosis
  • lung cancer/hypoxia
  • ulcerative colitis
  • biliary cirrhosis
  • neoplasm
  • GI involvement
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41
Q

What is schamroth’s window test used for?

A

clubbing

Loss of diamond shape when nails from each hand are placed back-to-back

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42
Q

Changes in nails often indicate what?

A

Systemic issues unless congenital

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43
Q

Palmar erythema could indicate what?

A

liver or renal issues

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44
Q

What can pallor indicate?

A
  • anemia
  • internal hemorrhage
  • lack of sunlight exposure
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45
Q

What skin change is seen with the following:

  • arterial insufficiency
  • syncope
  • chills
  • shock
  • vasomotor instability
  • nervousness
A

pallor

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46
Q

definition

brownish yellow spots that may be due to aging, uterine and liver malignancies, or pregnancy

A

liver spots

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47
Q

Brown skin is often associated with what?

A

Venous insufficiency

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48
Q

definition

Immune disorder that causes white patches of skin to develop due to destruction of melanocytes

  • individuals are at greater risk for sunburn, skin cancer, hearing loss, and eye problems
A

vitiligo

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49
Q

Coolness of the skin can indicate what?

A
  • poor circulation
  • obstruction (vasomotor spasm, thrombosis, hypothyroidism)
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50
Q

Excessive salt intake can lead to an (increase/decrease) in skin temperature

A

increase

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51
Q

(true/false) Warmth from cellulitis and/or infection is global

A

False (local warmth)

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52
Q

Those with hypothyroidism have (thinning/thickened) hair

A

thinning hair

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53
Q

Diagnosis

Male pattern hair growth within women

A

hirsutism

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54
Q

What can hirsutism indicate?

A
  • polycystic ovary syndrome
  • cushing’s syndrome
  • tumor
  • inherited trait
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55
Q

Defintion

Flat spot that is measured up to 1 cm

A

macule

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56
Q

definition

Flat spot that is 1 cm or larger

A

patch

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57
Q

definition

Elevated mass that can e measured up to 1 cm

A

papule

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58
Q

definition

elevated mass that is 1 cm or larger

A

plaque

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59
Q

definition

raised, marble-like lesion

A

nodule

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60
Q

definition

raised, irregular, localized edemous spots

A

wheal

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61
Q

definition

elevated lesion that measures up to 1 cm and contains serous fluid

A

vesicle

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62
Q

definition

Elevated lesion that is 1 cm or larger and contains serous fluid

A

bulla, blister

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63
Q

definition

elevated lesion that contains pus

A

pustule

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64
Q

definition

ulcer that is slow to heal; not painful

A

indolent ulcer

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65
Q

definition

Skin inflammation/eczema caused by a reaction to light

A

actinic

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66
Q

definition

Describe what acute eczema looks like.

A
  • red
  • oozing
  • crusty rash
  • extensive erosions
  • exudate
  • pruritic vesicles
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67
Q

Describe what subacute eczema looks like.

A
  • erythmatous skin
  • scaling
  • plaques
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68
Q

Describe what chronic eczema looks like.

A
  • thickened skin
  • scattered scaling plaques
  • fibrotic papules
  • fibrotic nodules
  • post-inflammatory pigmentation changes
  • possible relapsing course
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69
Q

Diagnosis

superficial skin infections caused by staphylococci or streptococci

  • associated with inflamed, smal vesicles accompanied with itching
  • highly contagious
  • common in children and the elderly
A

impetigo

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70
Q

definition

  • suppurative inflammation of cellular or connective tissue in or close to the skin that tends to be poorly defined and widespread
  • caused by streptococcal or staphylococcal infection
  • can be contagious
  • skin is hot, red, edemous
A

cellulitis

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71
Q

What can cellulitis turn into if not treated?

A
  • gangrene
  • lypmhangitis
  • abscess
  • sepsis
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72
Q

What populations are at an increased risk of developing cellulitis?

A
  • DM
  • wounds
  • malnutrition
  • steroid therapy
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73
Q

What is an abscess?

A
  • cavity containing pus and surrounded by inflamed tissue
  • result of localized infection
  • commonly a staphylococcyl infection
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74
Q

diagnosis

  • itching and soreness, followed by vesicular eruption of the skin on the face or the mouth (cold sore or fever blister)
  • spread by contact
A

herpes 1 (herpes simplex)

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75
Q

What is the common cause of vesicular genital eruption?

A

herpes 2

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76
Q

How is herpes 2 spread?

A

sexual contact

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77
Q

What can herpes 2 cause in newborns?

A

meningoencephalitis or can be fatal

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78
Q

diagnosis

  • caused by varicella-zoster that causes chickenpox
  • virus is reactivated after lying dormant in the cerebral ganglia or ganglia of the posterior nerve roots
A

herpes zoster (shingles)

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79
Q

What are the s/s of herpes zoster (shingles)?

A
  • pain and tingling affecting the spinal or cranial dermatome
  • progression to red papules along distribution of affected nerve
  • red papules progress to vesicles along dermatome
  • fever/chills
  • malaise
  • GI disturance
  • pain
  • CN III and V involvement
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80
Q

What CN III symptoms are seen with herpes zoster (shingles)?

A
  • eye pain
  • corneal damage
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81
Q

What CN V symptoms are seen with herpes zoster (shingles)?

A

loss of vision

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82
Q

(true/false) there is a curative agent for herpes zoster.

A

FALSE

  • Antiviral drugs slow progression
  • symptomatic treatment for itching and pain
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83
Q

(true/false) Herpes zoster is contangious to everyone the person comes in contact with.

A

False

only those who have not had chickenpox before

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84
Q

What modalities are contraindicated for those with herpes zoster? why?

A

a. US and heat
b. can icnrease severity of symptoms

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85
Q

What population is the shingles vaccination recommended for?

A

Healthy adults > 50 y/o

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86
Q

Warts are a common, benign infection caused by what?

A

HPV

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87
Q

How is HPV transmitted?

A
  • direct contact
  • autoinoculation
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88
Q

How is ringworm transmitted?

A

contact

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89
Q

(true/false) Pain caused by shingles can least weeks, months, or years

A

true

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90
Q

What areas of the body does ringworm affect?

A

Fungal infection involving the hair, skin, and nails

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91
Q

How is ringworm treated? How long does treatment last?

A
  • topical antifungal drugs
  • oral antifungal drugs
  • treatment can last for months even with subsiding symptoms
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92
Q

What are the side effects of antifungals?

A
  • HA
  • GI disturbance
  • fatigue
  • insomnia
  • photosensitivity
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93
Q

diagnosis

Infection that is caused in skin folds due to excessive moisture

A

yeast (candidiasis)

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94
Q

What are the s/s of yeast infection?

A

Mouth:
- soreness and redness
- oral patches
- pain

Genital:
- erythema
- inflammation
- itching
- burning urination
- pain with sex
- white discharge

Topical:
- redness
- rash
- soreness

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95
Q

Diagnosis

Chronic autoimmune disease of the skin characterized by erythematous plaques covered with silver scales

  • common complaints: itching and pain
  • common on ears, scalp, knees, elbows, and genitalia
A

psoriasis

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96
Q

Diagnosis

What is lupus erythematosus?

A

chronic, progressive autoimmune inflammatory disorder of connective tissues

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97
Q

What does lupus erythematosus look like?

A

red rash with raised scaly plaques

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98
Q

What are the two types of lupus?

A
  • discoid lupus erythematosus (DLE)
  • systemic lupus erythematosus (SLE)
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99
Q

Diagnosis

  • Type of lupus that only affects the skin
  • flare-ups with sun exposure
  • lesions can cause atrophy, scarring, or pigment changes.
A

discoid lupus

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100
Q

diagnosis

  • type of lupus that affects multiple organ systems (skin, joints, kidneys, heart, nervous system, mucous membranes)
  • can be fatal
A

systemic lupus

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101
Q

What kind of lupus can be fatal?

A

systemic

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102
Q

What are the s/s of systemic lupus?

A
  • malaise
  • butterfly rash on nose
  • skin lesion/rash
  • chronic fatigue
  • arthralgia
  • arthritis
  • photosensitivity
  • anemia
  • hair loss
  • raynaud’s phenomenon
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103
Q

What diagnosis is indicated when a patient has a “butterfly rash” on the bridge of their nose?

A

systemic lupus

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104
Q

(true/false) There is a cure for all types of lupus

A

false

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105
Q

What are side effects of corticosteroids?

A
  • edema
  • weight gain
  • acne
  • HTN
  • bruising
  • purple stretch marks

Increased risk of developing cushing’s syndrome, DM, osteoporosis, myopathy

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106
Q

What usually accompanies systemic sclerosis (scleroderma)?

A

raynaud’s phenomenon

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107
Q

s/s

  • taught, firm, edematous skin that is firmly bound to subcutaneous tissue
  • fibrosis of skin, joints, blood vessels, and internal organs
A

scleroderma

108
Q

What are the differences between limited systemic sclerosis and diffuse systemic sclerosis?

A

Limited systemic sclerosis:
- symmetrical skin involvement of distal extremities and face
- late visceral and pulmonary HTN involvement
- CREST syndrome

Diffuse systemic sclerosis:
- symmetrical, widespread skin involvement of the extremities, face, and trunk
- rapid progression of skin changes
- early visceral involvement

109
Q

What immune disorder of the skin is associated with CREST syndrome?

A

Limited systemic scleroderma

110
Q

What is CREST syndrome?

A

Calcinosis
Raynaud’s phenomenon
Esophageal dysfunction
Sclerodactyly
Telangiectasias

111
Q

diagnosis

Autoimmune myopathies that are characterized by edema, inflammation, and degeneration of proximal muscles (shoulder, pelvic girdle, neck, pharynx)

A

Polymyositis (PM)

112
Q

(true/false) polymyositis has a asymmetric distribution.

A

false (symmetrical)

113
Q

What term is used if polymyositis has a characteristic skin rash?

A

dermatomyositis (DM)

  • interstitial lung disease and sclerodactyly are commonly associated with dermatomyositis
114
Q

(true/false) the onset of polymyositis and dermatomyositis is gradual.

A

FALSE

can be gradual or rapid

115
Q

(true/false) polymyositis and dermatomyositis can be fatal due to possible cardiac and/or pulmonary involvement

A

True

may cause need for ventilatory assistance and tube feeding

116
Q

What medications are used for treatment of polymyositis and dermatomyositis?

A

corticosteroids and immunosuppressants

117
Q

Benign or malignant?
Seborrheic keratosis

A

Benign

118
Q

What is seborrheic keratosis?

A

proliferation of basal cells leading to multiple raised lesions

119
Q

Who and Where commonly experiences seborrheic keratosis?

A

Multiple lesions on the trunk of older individuals

120
Q

Benign or malignant?
Actinic keratosis

A

benign

flat, round, irregular lesion with dry scale on sun-exposed skin

121
Q

(true/false) actinic keratosis can lead to squamous cell carcinoma

A

true

122
Q

What changes to a common male can indicate possible melanoma?

A
  • new swelling
  • redness
  • scaling
  • oozing
  • bleeding
123
Q

Diagnosis

slow-growing epithelial basal cell tumor that is characterized by a raised patch with ivory appearance or as a reddened area of eczema

  • rolled border with indented center
A

basal cell carcinoma

124
Q

diagnosis

malignant tumor that has poorly defined margins and presents as a flat red area, ulcer, or nodule that grows more rapidly

  • can be invasive to surrounding tissues
A

squamous cell carcinoma

125
Q

(true/false) basal cell carcinoma has a higher risk to metastasize compared to squamous cell carcinoma

A

FALSE

126
Q

Mucosal and lingual squamous cell carcinoma are often associated with what risk factors?

A

alcohol and/or tobacco use

127
Q

What is the most common type of malignant melanoma?

A

Superficial spreading melanoma

128
Q

diagnosis

tumor that arises from melanocytes
- lesions can have swelling or redness beyond the border, oozing or bleeding, or sensations of burning, itching, or pain

A

malignant melanoma

129
Q

What are the clinical signs for malignant melanoma?

A

Asymmetrical
Border: irregular, notched
Color: black/blue/red mixture
Diameter > 6 mm
Elevated- can also e flat and/or change over time

130
Q

What are the AWARE guidlines used for? What are they?

A

–> used for skin cancer prevention

A: avoid protected sun exposure
W: wear protective clothing
A: apply sunscreen
R: routine skin check
E: educate others

131
Q

Diagnosis

Lesions of a vascular endothelial cell
- red, dark purple, blue macules that progress to nodules or ulcers
- itching and pain present
- common in LEs
- angioproliferative tumor

A

kaposi’s sarcoma

132
Q

How did kaposi’s sarcoma become so prominent in the united states?

A

Human herpes virus 8

133
Q

Where is kaposi’s sarcoma more prominent?

A

LEs

134
Q

(true/false) kaposi’s sarcoma can involve internal structures producing lymphatic obstruction

A

true

135
Q

(true/false) Arterial insufficiency may coexist with venus ulcers.

A

true

136
Q

What are the following clinical features of a venous ulcer?

Area:
pulse:
pain?
Color:
Temperature:
edema
skin changes:
ulcers?
gangrene?

A

Area: LEs (commonly medial malleolus)

Pulse: normal

Pain: possible aching pain in dependent position

Color: normal or cyanotic, hemosiderin stain

temperature: normal

Edema: present

skin changes: liposclerosis or lipodermatosclerosis is possible (fibrotic); pigmentation change; atrophie blanche lesions; stasis dermatitis; gppd granulation

Ulceration: shallow and wet with large amount of exudate

gangrene: absent

137
Q

Venous ulcers are typically (shallow/deep) and (regular/irregular).

A

shallow and irregular located over bony areas

138
Q

What is venous insufficiency pain described as?

A
  • burning
  • throbbing
  • cramping
  • aching
  • fatigue
139
Q

What ABI contraindicates high compression?

A

< 0.7

140
Q

What ABI contraindicates ALL levels of compression?

A

< 0.6

+/- active DVT

141
Q

What are the following clinical features of an arterial ulcer?

Area:
pulse:
pain?
Color:
Temperature:
trophic changes:
ulcers?
gangrene?

A

Area: LE (common over toes, feet, bony areas of trauma), lateral malleolus, anterior tibia

pulse: poor or absent, intermittent claudication

pain: severe, intermittent, progressing to pain at rest, exacerated with limb elevation

Color: pale or cyanotic (with foot elevation); dusky rubor (on dependency)

temperature: cold

trophic changes: loss of hair on foot and toes, thickened nails

Ulcers: toes or feet - can be deep

Gangrene: yes - adjacent to ulcer

142
Q

(true/false) With the presence of a venous ulcer, pain is exacerbated when feet are elevated.

A

False

legs are comfortable when elevated

143
Q

(true/false) Arterial and venous ulcers have drainage

A

FALSE

only venous

144
Q

What is TcPO2? What does it measure?

A

a. Transcutaneous partial pressure of oxygen - reflects the amount of total O2 is available, closely representing PaO2

b. Used to determine which wounds have an increased chance of healing

145
Q

What TcPO2 is indicative of a good chance of healing?

A

> 40 mmHg

146
Q

What TcPO2 is indicative of a decreased chance of healing?

A

< 20 mmHg

147
Q

A doppler skin perfusion pressure of ____ mmHg is indicative that the wound is unlikely to heal.

A

< 30 mmHg

148
Q

What test is helpful to detect early sensory loss?

A

Vibration testing

149
Q

What are the scores of the wagner classification system?

A

0 - no open lesions; high risk of ulcers

1- superficial ulcer

2- tendon, capsule, or bone is exposed

3- ulcer w/ abscess, osteomyelitis, or joint infection

4- localized gangrene

5- gangrene is not localized

150
Q

What is the wagner classification system used for?

A

staging neurotrophic ulcers

151
Q

Describe a stage I pressure injury.

A
  • non-blanchable erythema of intact skin
  • may have skin changes
  • may have altered sensation
152
Q

Describe a stage II pressure injury.

A
  • partial-thickness skin loss (epidermis, dermis, or both)
  • superficial ulcer
  • presents as a blister or abrasion
153
Q

Describe a stage III pressure injury.

A
  • full-thickness skin loss
  • damage or necrosis to the subcutaneous tissue
  • may extend to top of the fascia
  • presents as a deep crater
154
Q

Describe a stage IV pressure injury.

A
  • full-thickness skin loss
  • extensive destruction, tissue necrosis, or damage to the muscle, one, or supporting structures
  • undermining or sinus tracts may be present
155
Q

Describe an unstageable pressure injury.

A

tissue depth is obscured due to slough or eschar - extent of damage cannot be determined

156
Q

What is a deep tissue injury?

A

Discolored area of tissue that is not reversible and will likely progress to a full-thickness injury.

157
Q

What are the percentages of each area of the body when following the rule of 9s?

  • head and neck
  • arms
  • anterior trunk
  • posterior trunk
  • legs
  • perineum
A

Head and neck: 9%
Arms: 9% each (18% total)
Anterior trunk: 18%
Posterior trunk: 18%
Legs: 18% each (36% total)
Perineum: 1%

158
Q

Describe the three zones of a burn.

A
  1. Zone of coagulation: cells are irreversibly injured and cell death occurs
  2. Zone of stasis: cells are injured and can die without treatment after 24-48 hours
  3. Zone of hyperemia: minimal cell injury - cells should recover
159
Q

What zone of a burn is more sensitive to infection and trauma?

A

Zone of stasis

160
Q

What TBSA classifies a burn as critical?

A

Children and older adults (one of the following):
- >10% TBSA with full-thickness burns
- >20% TBSA with partial-thickness burns

Any patient:
- >25% of TBSA
- burns to the eyes, face, ears, hands, and/or perineum
- presence of any impairment due to burn(s)

161
Q

What TBSA classifies a burn is moderate?

A

Children and older adults:
- <10% TBSA of full thickness burns and 10-20% TBSA of partial-thickness burns

Any adults:
- <15-25% TBSA with mixed partial/full-thickness burns

Burns cannot involve the hands, face, feet, genitalia, perineum, and/or major joints

162
Q

What TBSA classifies as a minor burn?

A

Children and older adults (one of the following):
- < 2% TBSA of full-thickness burns
- <10% TBSA of partial-thickness burns

Any adult:
- < 15% TBSA of partial-thickness turns

Burns cannot involve the hands, face, feet, genitalia, perineum, and/or major joints

163
Q

What are suspicious signs indicating possible smoke inhalation injury?

A
  • singed nose hairs
  • burns to face
164
Q

What pulmonary complications can occur with smoke inhalation?

A
  • pneumonia
  • pulmonary edema
  • restrictive lung disease (if involving burns to the trunk)
  • airway obstruction
165
Q

A burn victim experiences (hyper/hypo)metabolism

A

hypermetabolic state

results: decreased energy and nitrogen balance, weight loss

  • May persist for months or years after a major burn
166
Q

Those with burns greater than ____% TBSA have decreased renal perfusion and increased risk of developing AKI

A

> 30%

167
Q

How does healing occur for first degree burns?

epidermal burn

A

Spontaneous within 3-7 days
- no scarring

168
Q

How does healing occur for superficial partial-thickness burn?

second degree burn

A

spontaneous healing within 7-21 days
- minimal to no scarring; discoloration may be present

169
Q

How does healing occur for a deep partial-thickness burn?

second degree burn

A
  • slow
  • occurs through re-epithelialization and scar formation
  • excessive scarring can occur without preventive treatment
170
Q

How does healing occur for a full thickness burn?

third degree burn

A
  • removal of eschar and use of skin grafting due to the destruction of the epidermis and dermis
  • hypertrophic scarring and wound contracture are likely to develop without preventive measures
171
Q

How does healing occur for a subdermal burn?

fourth degree burn

A
  • skin grafting
  • scarring
  • extensive surgery with possible amputation
172
Q

What layers of the skin and structures are damaged in superficial partial-thickness burns?

A

epidermis and upper layers of the dermis

173
Q

What layers of the skin and structures are damaged in deep partial-thickness burns?

A
  • epidermis and dermis
  • nerve endings
  • hair follicles
  • sweat glands
174
Q

What degree of burn has little to no pain present due to nerve endings being destroyed?

A

3rd degree (full-thickness burn)

175
Q

Burn appearance

  • pink/red appearance
  • dry surface with no blistering
  • minimal edema
  • tenderness
  • delayed pain
A

first degree

176
Q

Burn appearance

  • bright pink/red appearance
  • blanching with brisk capillary refill
  • blisters present
  • moist surface and weeping
  • moderate edema
  • painful, sensitive to touch, temperature changes
A

superficial partial-thickness burn

177
Q

Burn appearance

  • mixed red and waxy white appearance
  • lanching with slow capillary refill
  • broken blisters
  • moist surface
  • marked edema
  • sensitive to pressure but insensitive to light touch
A

deep partial-thickness burn

178
Q

Burn appearance

  • Skin is white (ischemic), charred/black, and/or tan
  • no blanching is present
  • dry, leather-like surface
  • depressed area
  • little to no pain
A

full thickness burn (third degree)

179
Q

Burn appearance

  • charred appearance
  • destruction of vascular system and layers of the skin
A

subdermal burn

fourth degree

180
Q

Definition

Raised scar that stays within the boundaries of the burn would and is red, firm, and raised

A

hypertrophic scar

181
Q

definition

flat and depressed scar

A

hypotrophic scar

182
Q

What is sulfamylon used for? What does it do?

A

a. used for burn injuries
b. penetrates through eschar

antibacterial agent

  • avoid with sulfur allergies
183
Q

What is the most common topical medication for burns?

A

Silver sulfadiazine

Antibacterial agent

  • avoid at full-term pregnancy
  • do not use for infants < 2 months
  • avoid with sulfur allergies
184
Q

Type of graft

use of another human skin

A

allograft (homograft)

185
Q

Type of graft

use of skin from another species

A

xenograft (heterograft)

186
Q

Type of graft

combination of collagen and synthetic materials

A

biosynthetic graft

187
Q

Type of graft

laboratory grown from a patient’s own skin

A

cultured skin

188
Q

Type of graft

use of patient’s own skin

A

autograft

189
Q

Type of graft

graft that contains the epidermis and upper layers of the dermis from the donor site

A

split-thickness graft

190
Q

Type of graft

contains epidermis and dermis from the donor site

A

full-thickness graft

191
Q

What procedures are necessary with circumferential burns of the extremities when compression from increased edema and fluid retention occur within a confined anatomical space?

A

escharotomy and fasciotomy

192
Q

What are the 5 types of wound debridement?

A
  1. autolytic dressings
  2. surgical/sharp
  3. enzymatic
  4. biological
  5. mechanical
193
Q

What are the most common contractures seen at the following joints?

  • anterior neck
  • shoulder
  • elbow
  • hand
  • hip
  • knee ankle
A

Anterior neck: FLX

Shoulder: ADD and IR

Elbow: FLX and PRON

Hand: claw hand

Hip: FLX and ADD

Knee: FLX

Ankle: PF

194
Q

What anticontracture positioning should you put the neck in?

A

Common contracture:
FLX

anticontracture position:
- stress hyperEXT with the use of a firm cervical orthosis

195
Q

What anticontracture position should you place the shoulder in?

A

Common Contracture:
ADD and IR

Anticontracture position:
- stress ABD, EXT, and ER
- use of an airplane splint (axillary splint)

196
Q

What anticontracture position should you place the elbow in?

A

Common Contracture:
FLX and PRON

Anticontracture position:
- stress EXT and supination with the use of a posterior arm splint

197
Q

What anticontracture position should you put the hand in?

A

Common Contracture:
Claw hand

Anticontracture position:
- wrist ext (15 degrees)
- MP FLX (70 degrees)
- PIP/DIP EXT
- Thumb AD

*Place in intrinsic plus position using a resting hand splint

198
Q

What anticontracture position should you put the hip in?

A

Common Contracture:
FLX and ADD

Anticontracture position:
- stress hip EXT and ABD while in neutral rotation

199
Q

What anticontracture position should you place the knee in?

A

Common Contracture:
FLX

Anticontracture position:
- stress EXT with use of a posterior knee splint

200
Q

What anticontracture position should you place the ankle in?

A

Common Contracture:
PF

Anticontracture position:
- stress DF by placing the ankle in a neutral position with an AFO

201
Q

After placing a graft, exercise must be deferred for how long to allow healing to occur?

A

defer for 3-5 days

202
Q

What principle is used to ensure proper wound preparation? What does it stand for?

A

**“TIME”
**
Tissue (viable v. non-viable)
Infection/inflammation
Moisture balance
Edges of wound

203
Q

What are contraindications for use of negative-pressure wound therapy (vacuum-assisted closure/wound vac))?

A
  • malignancy within the wound
  • exposure nerve or vasculature structure
  • untreated osteomyelitis
  • significant eschar
204
Q

What occurs during hyperbaric oxygen therapy?

A

Patient breathes in 100% oxygen while in an elevated atmospheric pressure chamber

–> hyperoxygenation reverses tissue hypoxia and increases wound healing

205
Q

What are indications for hyperbaric wound therapy?

A
  • compromised skin grafts
  • acute ischemia
  • osteomyelitis
  • necrotizing infections
  • thermal burns
  • wounds not healing due to hypoxia
206
Q

What are contraindications for use of hyperbaric oxygen therapy?

A
  • untreated pneumothorax
  • use of anti-neoplastic medications
207
Q

What amount of pressure is recommended for wound irrigation techniques?

A

4-15 psi

208
Q

definition

Type of debridement that uses the body’s enzymes and moisture beneath a dressing making non-viable tissue become liquefied.

  • provides fast healing with less pain
A

autolytic debridement

209
Q

What dressing types are used for autolytic deridement?

A
  • hydrocolloids
  • hydrogels
  • transparent films
210
Q

definition

type of deridement that involves the application of a topical agent that chemically liquefies necrotic tissue

A

enzymatic debridement

211
Q

What type of debridement is commonly used in long-term settings due to there being less pain and the ability to apply daily?

A

enzymatic deridement

212
Q

definition

Type of debridement that involves the use of maggots grown in a sterile environment with a dressing keeping them in the area of the wound-
may stimulate granulation formation and epithelialization

A

biological debridement

213
Q

definition

Type of debridement that removes foreign material and contaminated tissue by physical forces
– involves irrigation, hydrotherapy, and wet-to-dry dressings

A

mechanical debridement

214
Q

(true/false) Do not debride heel ulcers if it is dry without the presence of edema, erythema, fluctuence, or drainage.

A

true

215
Q

What kind of deridement can be used with the following?

  • individuals on anticoagulant therapy
  • those who cannot tolerate other forms of debridement
  • necrotic wounds in medically-stable patients
A

autolytic

216
Q

What kind of deridement can be used with the following?

  • all moist necrotic wounds
  • eschar after cross-hatching
  • homebound individuals
  • people who cannot tolerate surgical deridement
A

enzymatic

217
Q

What kind of deridement can be used with the following?
- wounds with moist necrotic tissue or foreign material present

A

mechanical

218
Q

What kind of deridement can be used with the following?
- scoring and/orexcision of leathery eschar
- excision of moist necrotic tissue
- biofilm removal

A

sharp

219
Q

What kind of deridement can be used with the following?
- advancing cellulitis w/ sepsis
- immunocompromised individuals
- removal of biofilm
- excision of granulation and scar tissue

A

surgical

220
Q

What method of deridement can be used to do the following?
- selective removal of necrotic tissue and biofilm
- reducing bioburden
- increase angiogenesis
- wound bed preparation for grafting or flap closure

A

kilohertz US

221
Q

What kind of deridement can be used with the following?
- all non-healing necrotic wounds in patients who are medically stable
- for individuals who cannot tolerate other forms of deridement

A

biological

222
Q

What are the contraindications for autolytic debridement?

A
  • infection
  • immunosuppressed patient
  • dry gangrene or dry ischemic wounds
223
Q

What are the contraindications for enzymatic debridement?

A
  • ischemic wounds
  • dry gangrenee
  • clean, granulated wounds
224
Q

What are contraindications for mechanical debridement?

A

clean, granulated tissue

225
Q

What are contraindications for sharp debridement?

A
  • advancing cellulitis w/ sepsos
  • when infection threatens the individual’s life
  • use of anticoagulants and/or coagulopathy
226
Q

What is the normal range of albumin?

A

3.5-5.5

227
Q

What albumin range is indicative of malnutrition?

A

< 3.5

228
Q

Those with wounds require at least how much water per day?

A

3L

229
Q

(true/false) Those who are on air-fluidized bed require less hydration

A

False (more)

230
Q

Where are pressure injuries commonly seen on neonates?

A

head

231
Q

What measurement tool estimates the size of a burn through TBSA while also accounting for variations in age and body size?

A

Lund-browder charts

Rule of nines does NOT account for variations in age and ody size

232
Q

What is the braden score used for?

A

Risk assessment for development of scores

233
Q

What braden score is indicative of a higher risk for sores?

A

<18

score: 6-23 possible

234
Q

The walking impairment scale examines treatment effects on walking impairments and symptoms in patients with ______________ .

A

PAD with claudication

235
Q

What scale is used for pressure sore risk assessment in children 21 days - 8 y/p?

A

Braden Q scale

Braden + tissue perfusion oxygenation

236
Q

What is the AMPAC used for?

A

assesses functional outcome measures in post-acute care settings

  • measures difficulty, assistance, and limitations of ADLs

cognition is only assessed in the longer form

237
Q

Type of dressing

Bandage that is permeable to atmospheric oxygen and moisture vapor but not to water, bacteria, and environmental contaminants

A

transparent film

238
Q

Type of dressing

Adhesive wafer containing absorptive particles that interact with wound fluid to form a gelatinous mass over the wound bed

  • can be occlusive or semiocclusive
  • availale in paste form
A

hydrocolloids

239
Q

Type of dressing

Water or glycerine-based gels that are insoluble to water

A

hydrogels

240
Q

Type of dressing

semipermeale membrane that can be hydrophilic or hydrophobic.
- varies in thickness, absorptive capacity, and adhesive properties

A

foams

241
Q

Type of dressing

soft, absorbent, nonwoven dressings that react with exudate to form a viscous hydrophilic gel mass over the wound area.
- made from seaweed

A

alginates

242
Q

What is the difference between an alginate and hydrofiber?

A

Hydrofibers are composed of a polymer instead of seaweed

243
Q

Type of dressing

Type of dressing that is used when conventional approaches have failed or are unlikely to succees.

A

specialty dressings

244
Q

When do full thickness wounds show signs of healing with the use of a specialty dressing?

A

2-4 weeks

245
Q

When do partial thickness wounds show signs of healing when using a specialty dressing?

A

1-2 weeks

246
Q

Type of dressing

Indications:
- stage I and II pressure ulcers
- can be used as a secondary dressing
- autolytic debridement
- skin donor site
- covers hydrophilic powder, paste, and hydrogels

A

transparent films

247
Q

Type of dressing

Indications:
- protection for partial-thickness wounds
- autolytic deridement of necrosis or slough
- wounds with mild exudate

A

hydrocolloids

248
Q

Type of dressing

Indications:
- partial and full thickness wounds
- wounds with necrosis and slogh
- burns/tissue damage from radiation

A

hydrogel

249
Q

Type of dressing

Indications:
- moderate exudate
- secondary dressing for wounds with packing (to provide additional absorption)
- provides protection and insulation

A

foams

250
Q

Type of dressing

Indications:
- moderate to large exudate
- wounds with exudate + necrosis
- wounds that require packing and absorption
- infected and non-infected wounds that have exudate

A

alginates and hydrofibers

251
Q

Type of dressing

Indications:
- exudate
- packing wounds and dead space
- protection of clean wounds
- autolytic debridement of slough or eschar
- delivery of topicals

A

gauze

252
Q

(true/false) hydrocolloids may soften or change shape with heat or friction

A

true

252
Q

(true/false) most hydrogels require a secondary dressing.

A

true

253
Q

(true/false) transparent film can be used on wounds with fragile surrounding skin or infected wounds

A

False

254
Q

(true/false) foams can be used for wounds with no exudate

A

false

255
Q

(true/false) gauze decreases infection rates compared to semiocclusive dressings

A

false (increases)

256
Q

When should you change alginates and hydrofibers?

A

every 8 hours to 2-3 days

257
Q

When should you change hydrocolloids?

A

every 3-7 days

258
Q

When should you change hydrogels?

A

every 8-48 hours

259
Q

Why should you not tightly pack gauze into a wound bed?

A

Can compromise blood flow

260
Q

How often should you change foam dressings?

A

every 1-5 days

261
Q

What are the layers of the epidermis?

A
  1. stratum corneum
  2. stratum lucidum
  3. stratum granulosum
  4. stratum spinosum
  5. stratum basale
262
Q

(true/false) Ther epidermis contains no blood cells

A

true

263
Q

What cells do the stratum granulosum and stratum spinosum contain?

A
  1. keratinocytes
  2. langerhans cells (immunity cells)
264
Q

What forms the stratum corneum?

A

dead skin cells filled with keratin

265
Q

What parts of the body contains the stratum lucidum?

A

Palms and soles of feet only

formed from dead skin cells

NPTE (22 decks)

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