Integumentary Disorders

Question 1

What is Cellulitis?

Answer 1

Cellulitis is a bacterial infection of the deeper dermis and subqutaneous layer of the skin.

Question 2

What causes Cellulitis?

Answer 2

Strep Pyrgenes or Staph Aureus

Question 3

How do microbes gain entry into the integumentary system?

Answer 3

Via compromised skin like wounds. This usually occurs on the legs, then hands and pinna.

Question 4

What are the characteristics and manifestations of cellulitis?

Answer 4

Erythema. Warmth. Edema. Fever. Pain.

Question 5

How does bacteria spread through tissue? What else can it affect?

Answer 5

It spreads through tissue spaces. It can also affect the lymphatic system.

Question 6

What is treatment for mild and severe cases of cellulitis?

Answer 6

Mild: Oral Abx. Severe: IV Abx (7-14 days).

Question 7

What can occur if Cellulitis is not treated?

Answer 7

There can be severe complications. Lymphangitis (infl of lymp system), Gangrene, Absessess, Sepsis.

Question 8

What are the three populations or high risk groups when discussing cellulitis

Answer 8

The elderly. Immunocompromised. Patients with ulcers and leisions.

Question 9

What is Psoriasis?

Answer 9

Psoriasis is a chronic inflammation disorder. It has a very variable course.

Question 10

What is the etiology of psoriasis?

Answer 10

Largely idiopathic. There is a genetic component (30%). Autoimmunity.

Question 11

What is the pathophysiology of Psoriasis? (not sequential)

Answer 11

T-cell autoimmune response. Skin trauma which activated the T-cells. Mediators are released and there is an abnormal growth of keratinocytes and blood vessels. There is an influx of inflammatory cells resulting in inflammatory damage. Epidermal cells turnover at an excellerated rate and stack instead of shedding resulting in scaly patches. Exacerbations of psoriasis occure during times of stress, trauma, infection or from drugs. There is a patter of remission and exacerbations.

Question 12

What are the manifestations of Psoriasis?

Answer 12

Psoriatic patches on elbows, knees, sacral region, scalp. Nail dystrophy and pitting. Psoriatic arthritis in the distal joints.

Question 13

What is the treatment for Psoriasis?

Answer 13

No cure. Topical vitamin D help modulate keotinocytes and regulates T-cells. Topical steroids. Topical retinoids help as anti-inflammatories and modulate keratinocytes. For severe psoriasis methotrexate and cyclosporine which are immunosuppressants and cytotoxic and suppresses cell division. Phototherapy. Biological agents (TNF).

Question 14

What are the three common types of skin cancer?

Answer 14

Basal Cell Carcinoma. Squamous Cell Carcinoma. Malignant Melanoma

Question 15

What is actinic keratosis?

Answer 15

Pre-CA lesion. It has a 95% cure rate. Lesion from radiation from sun.

Question 16

What is the etiology of Skin Cancer?

Answer 16

Excessive sun exposure or UV light. Skin damage is cumulative. Prevelence is proportional to age, and inversely proportional to amount of melatonin.

Question 17

What is basal cell carcinoma?

Answer 17

It is a common form of skin cancer. Basal cell origin (epidermis). Slow, appearing on exposed areas (head, face, neck). It is characterized by a dome shape and nodular lesion. There is local invasion and destruction. It usually does not metastasis. Biopsy is required for Dx.

Question 18

What is squamous cell carcinoma?

Answer 18

Origin in the epidermis keratinocytes and present in exposed areas. It is faster growing than basal cell and characterized by poorly defined and variable appearance (nodule, papule, mass, ulceration). It may infiltrate local structures and metastasize to local lymph nodes and enter the blood.

Question 19

What is malignant melanoma?

Answer 19

Cancer of melanocyte origin. This is the worst form, very progessive and metastsis. Appears on exposed and non-exposed surfaces. The main features are: Doubling in size (3-8 mths). Change in color. Irregular border. Pruritus. Bleeding. Crusting. Ulceration. Mets to brain, bone, lung, liver. Can be fatal

Question 20

What is the ABCDE of cancer characteristics?

Answer 20

Asymetry, Boarder, Color Change, Diameter, Elevation.

Question 21

What is treatment for skin cancer?

Answer 21

Early detection. Surgical excision. More advanced cancers may require radiation/chemotherapy.