Integumentary System Flashcards

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1
Q

Functions of the skin

A

Protection, sensation, thermoregulation, metabolism, sexual signaling

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2
Q

General structure

A

Epidermis

Dermis

Subcutaneous layer

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3
Q

Epidermis

A

An epithelial layer of ectodermal origin. Includes hairs, nails, sebaceous glands, and sweat glands

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4
Q

Epidermis structure

A

Thin and Thick Skin (Epidermis)

Like all epithelia, the epidermis lacks capillaries, and the cells receive
nutrients and O2 by diffusion from the dermis.

Four (or five) layers of epidermis:

Stratum basale
Stratum spinosum
Stratum granulosum
Stratum lucidum (thick skin only)
Stratum corneum

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5
Q

Stratum corneum

A

First layer, most superficial

Epidermal layer that is the most superficial; 20-30 layers of dead, flattened, anucleate, keratin-filled keratinocytes; protects against friction and water loss.

Consists of 15-20 layers of squamous, keratinized cells
filled with filamentous keratins. These fully keratinized or cornified cells called squames are continuously shed at the epidermal surface

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6
Q

Stratum lucidum

A

Second layer

2-3 layers of anucleate, dead cells; seen only in thick skin

Found only in thick skin, consists of a thin, translucent layer of flattened keratinocytes. Nuclei and organelles have been lost, and the cytoplasm consists almost exclusively of packed keratin filaments.

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7
Q

Stratum granulosum

A

Third layer

3-5 layers of keratinocytes with distinct kerato-hyaline granules

Consists of three to five layers of flattened cells undergoing keratinization, a “terminal” process.

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8
Q

Stratum spinosum

A

Fourth layer

Several layers of keratinocytes all joined by desmosomes; Langerhans cells present

Normally the thickest layer; the cytoplasm actively synthesizes keratins, like the basal layer.

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9
Q

Stratum basale

A

Fifth layer, most deep layer

Deepest, single layer of cuboidal to low columnar cells in contact with basement membrane; mitosis occurs here; melanocytes and Merkel cells also

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10
Q

Epidermis cell types

A

Keratinocytes
Melanocytes
Merkel cells
Langerhans cells

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11
Q

Keratinocytes

A

The most common–90% of
epidermal cells. These cells produce keratin,
and form a stratified squamous keratinized
epithelium.

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12
Q

Melanocytes

A

Pigment-producing cells.

Located in the
epidermal basal layer (stratum basale) and synthesize melanin
granules and transfer them into neighboring keratinocytes. Transfer
occurs through many long,
branching melanocyte processes.

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13
Q

Langerhans cells

A

Antigen-presenting cells (APCs)

Form an important defense against pathogens and environmental damage

Develop in the bone marrow from monocytes, move into the blood, and migrate into epidermis

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14
Q

Merkel cells

A

Tactile epithelial cells.

Sensitive mechanoreceptors essential for light touch sensation. Abundant in highly sensitive skin like the fingertips.

The basolateral surfaces of
the cells contact expanded
terminal discs of unmyelinated sensory fibers
penetrating the basement
membrane. The complex of
nerve and cells is called a
Merkel disk.

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15
Q

Dermal papillae

A

Projections between the dermis and epidermis that interdigitate with epidermal ridges to strengthen adhesion

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16
Q

Subcutaneous layer or Hypodermis

A

A loose connective tissue layer with pads of adipocytes. It binds the skin loosely to the underlying tissues

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17
Q

What determines most of the physical properties of the epidermis?

A

lipid envelope and keratin-filled cells

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18
Q

Friction blisters

A

Lymph-filled spaces created between the epidermis and dermis of thick skin by excessive rubbing. This activity may produce thickening and hardening of the outer epidermal layers, seen as corns and calluses.

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19
Q

Psoriasis

A

Keratinocytes differentiate rapidly, causing thickening of the epidermis and increased keratinization and desquamation. Caused by an autoimmune reaction in the skin, which can also lead
to inflammation with redness, irritation, itching, etc.

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20
Q

Skin Cancer

A

One-third of all adult cancers originate in the skin. Most are from cells of the basal or spinous layers, producing, respectively, basal cell carcinomas and squamous cell carcinomas. Both types of tumors can be diagnosed and cut out early and are rarely lethal.

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21
Q

Burns

A

Tissue injuries caused by thermal, electrical, radioactive, or chemical agents

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22
Q

First-degree burn

A

A burn in which the damage is limited to the superficial
part of the epidermis.

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23
Q

Second-degree burn

A

A burn in which the damage extends through the
epidermis into the superficial part of the dermis. However, except
for their most superficial parts, the sweat glands and hair follicles are not damaged and can provide the source of replacement
cells for the basal layer of the epidermis.

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24
Q

Third-degree burn

A

The entire epidermis, dermis, and perhaps
underlying muscle are damaged. A minor degree of healing may occur at the edges, but the damaged portions require skin
grafting. The extent of the burn (percent of total body surface affected) is generally more significant than the degree (severity of
depth) in estimating its effect on the well-being of the victim.

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25
Q

What factors contribute to skin color?

A

Melanin content in keratinocyte

Carotene

Number of blood vessels in the dermis

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26
Q

Pigments produced by the melanocyte

A

Eumelanin and Pheomelanin

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27
Q

Eumelanin

A

Brown or black pigments produced by the melanocyte, a specialized cell of the epidermis found
among the cells of the basal layer and in hair follicles.

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28
Q

Pheomelanin

A

A second, similar, pigment in humans found in red hair.

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29
Q

Melanin Synthesis

A
  1. Tyrosinase converts the amino acid tyrosine into different forms of melanin. Melanin pigment is linked to proteins, forming granules called melanosomes.
  2. Melanosomes are transported to the tips of the cytoplasmic extensions of the melanocytes. The neighboring keratinocytes absorb and transport the melanosomes toward their nuclei, where they form
    a supranuclear cap that absorbs and scatters sunlight, protecting DNA of the living cells from the mutagenic effects of UV radiation.
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30
Q

Epidermal-melanin unit

A

On melanocyte plus its nearby keratinocytes.

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31
Q

What cells contain more pigment from melanosomes, keratinocytes or melanocytes?

A

Keratinocytes

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32
Q

Melanosome Formation

A
  1. Melanin formation
  2. Granules containing melanin mature. Mature granules are ellipsoid.
  3. Melanin granules are
    transported to the tips of
    the processes of the
    melanocyte. Then taken to the neighboring keratinocytes of the basal and spinous layers.
  4. In keratinocytes the melanin granules accumulate near the nucleus as a supranuclear cap shading the DNA against UV radiation.
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33
Q

Albinism

A

A congenital disorder producing skin hypopigmentation due to a defect in tyrosinase or
some other component of the melanin-producing
pathway.

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34
Q

Moles (benign melanocytic nevi; singular is nevus)

A
Melanocytes can normally proliferate in skin to 
produce moles (benign melanocytic nevi; singular 
is nevus) of various types.
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35
Q

Malignant melanocytes

A

Changes in the size or appearance of moles are
sometimes indicative of dysplasia that can progress
further to malignant melanoma. Malignant
melanocytes often penetrate the basal lamina, enter the dermis, and metastasize into blood and lymphatic vessels.

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36
Q

Dermis

A

Made of papillary layer and reticular layer.

Vascular

A layer of mesodermal connective tissue

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37
Q

Papillary layer

A

More superficial layer of dermis; composed of areolar connective tissue; forms dermal papillae; contains subpapillary vascular plexus.

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38
Q

Reticular layer

A

Thicker layer; Deeper layer of dermis; dense irregular connective tissue surrounding hair follicles, sebaceous glands, sweat glands, nerves, and deep plexus of blood vessels extending into subcutaneous layer.

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39
Q

Subcutaneous layer

A

Not considered part of the integument; deep to dermis; composed of areolar and adipose connective tissue.

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40
Q

Fibers of Dermis

A

Although most of the
protein fibers in dermis
are collagen, there are
also elastic fibers.

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41
Q

Subpapillary plexus

A

Between the papillary and reticular dermal layers

Capillary branches extend
into the dermal papillae and
form a nutritive capillary
network below the epidermis. A deep plexus
with larger blood and
lymphatic vessels lies near
the interface of the dermis
and the subcutaneous
layer

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42
Q

Dermis Misc.

A

Nutrients for epidermal keratinocytes diffuse into the avascular epidermis from the dermal vasculature through the basement
membrane

Both dermal regions contain a rich network of blood and lymphatic vessels. Nutritive vessels form two major plexuses, microvascular subpapillary plexus and deeper plexus

Dermal vasculature also has a thermoregulatory function.

The dermis is also highly innervated.

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43
Q

Subcutaneous Tissue

A

The subcutaneous layer
consists of loose connective tissue that binds the skin loosely to the subjacent organs, making it possible for
the skin to slide over them.

This layer, also called the
hypodermis or superficial
fascia, contains adipocytes
that vary in number and size.

Its vascular supply promotes rapid uptake of drugs injected here.

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44
Q

Tactile Sensory Receptors

A

Unencapsulated receptors:
Merkel cells, free nerve endings, and root hair plexuses

Encapsulated receptors: Meissner corpuscles, lamellated (Pacinian) corpuscles, and Ruffini corpuscles (bulbous corpuscles)

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45
Q

Free nerve endings

A

An unencapsulated tactile sensory receptor in the dermis and lower
epidermal layers, which respond primarily to high
and low temperatures, pain, tickle, itching, but also
function as tactile receptors.

46
Q

Root hair plexuses

A

An unencapsulated tactile sensory receptor that are a web of sensory fibers at
the bases of hair follicles in the dermis that detects
hair movement.

47
Q

Encapsulated receptors

A

A type of tactile sensory receptor that are referred to
collectively as low-threshold (or high-sensitivity)
mechanoreceptors because even weak mechanical stimulation of the skin induces them to produce action potentials.

48
Q

Meissner corpuscles

A

An encapsulated tactile sensory receptor that are formed by a connective tissue capsule that
comprises several lamellae of Schwann cells. They respond to minimal skin depression. Meissner’s corpuscles are the most common mechanoreceptors of glabrous (smooth, hairless) skin (e.g., fingertips).

49
Q

Lamellated (Pacinian) corpuscles

A

An encapsulated tactile sensory receptor that are large structures found deep in the reticular dermis and hypodermis (subcutaneous tissue). The Pacinian
corpuscle has an onion like capsule, with many obvious layers. They are specialized for sensing coarse touch, pressure (sustained touch), and high frequency vibrations.

50
Q

Ruffini corpuscles (bulbous corpuscles)

A

An encapsulated tactile sensory receptor that are stimulated by stretch or
twisting in the skin. They sense deep touch, grip (long-term touch), and
finger position.

51
Q

Hair

A

Hairs are elongated keratinized structures
that form within epidermal invaginations, the hair follicles

All skin has at least minimal hair except the glabrous (hairless) skin of the palms, soles, lips, and some regions of genitalia.

52
Q

Skin Glands

A

Sebaceous glands, eccrine sweat glands, and apocrine sweat glands

53
Q

Sebaceous glands

A

Embedded in the dermis over most of the body, except in the thick, glabrous skin of the palms and soles.

Branched acinar glands

Holocrine secretion

Secretes sebum

54
Q

Eccrine sweat glands

A

Merocrine

Widely distributed in the skin and are most numerous on the foot soles.

The secretory components and ducts of eccrine sweat
glands are coiled.

55
Q

Apocrine sweat glands

A

The glands are misnamed: their cells show merocrine, not apocrine, secretion.

Apocrine sweat glands are largely confined to skin of the axillary and perineal regions.

56
Q

Skin repair process

A
  1. The process begins with blood quickly clotting at the wound site, releasing platelet-derived growth
    factors and other substances.
  2. Macrophages and neutrophils enter the wound as inflammation begins, and epithelial cells from the
    cut edges of the stratum basal migrate beneath and through the blood clot.
  3. Under the influence of growth factors and hydrolytic enzymes from
    macrophages, fibroblasts proliferate and produce much new collagen to
    form “granulation tissue” containing many new, capillaries.
  4. The epidermis gradually
    reestablishes continuity over the wound site, but excessive collagen
    usually remains in the dermis as scar tissue.
57
Q

Reversed prompt

Protection, sensation, thermoregulation, metabolism, sexual signaling

A

Functions of the skin

58
Q

Reversed prompt

Epidermis

Dermis

Subcutaneous layer

A

General structure

59
Q

Reversed prompt

An epithelial layer of ectodermal origin. Includes hairs, nails, sebaceous glands, and sweat glands

A

Epidermis

60
Q

Reversed prompt

Thin and Thick Skin (Epidermis)

Like all epithelia, the epidermis lacks capillaries, and the cells receive
nutrients and O2 by diffusion from the dermis.

Four (or five) layers of epidermis:

Stratum basale
Stratum spinosum
Stratum granulosum
Stratum lucidum (thick skin only)
Stratum corneum

A

Epidermis structure

61
Q

Reversed prompt

First layer, most superficial

Epidermal layer that is the most superficial; 20-30 layers of dead, flattened, anucleate, keratin-filled keratinocytes; protects against friction and water loss.

Consists of 15-20 layers of squamous, keratinized cells
filled with filamentous keratins. These fully keratinized or cornified cells called squames are continuously shed at the epidermal surface

A

Stratum corneum

62
Q

Reversed prompt

Second layer

2-3 layers of anucleate, dead cells; seen only in thick skin

Found only in thick skin, consists of a thin, translucent layer of flattened keratinocytes. Nuclei and organelles have been lost, and the cytoplasm consists almost exclusively of packed keratin filaments.

A

Stratum lucidum

63
Q

Reversed prompt

Third layer

3-5 layers of keratinocytes with distinct kerato-hyaline granules

Consists of three to five layers of flattened cells undergoing keratinization, a “terminal” process.

A

Stratum granulosum

64
Q

Reversed prompt

Fourth layer

Several layers of keratinocytes all joined by desmosomes; Langerhans cells present

Normally the thickest layer; the cytoplasm actively synthesizes keratins, like the basal layer.

A

Stratum spinosum

65
Q

Reversed prompt

Fifth layer, most deep layer

Deepest, single layer of cuboidal to low columnar cells in contact with basement membrane; mitosis occurs here; melanocytes and Merkel cells also

A

Stratum basale

66
Q

Reversed prompt

Keratinocytes
Melanocytes
Merkel cells
Langerhans cells

A

Epidermis cell types

67
Q

Reversed prompt

The most common–90% of
epidermal cells. These cells produce keratin,
and form a stratified squamous keratinized
epithelium.

A

Keratinocytes

68
Q

Reversed prompt

Pigment-producing cells.

Located in the
epidermal basal layer (stratum basale) and synthesize melanin
granules and transfer them into neighboring keratinocytes. Transfer
occurs through many long,
branching melanocyte processes.

A

Melanocytes

69
Q

Reversed prompt

Antigen-presenting cells (APCs)

Form an important defense against pathogens and environmental damage

Develop in the bone marrow from monocytes, move into the blood, and migrate into epidermis

A

Langerhans cells

70
Q

Reversed prompt

Tactile epithelial cells.

Sensitive mechanoreceptors essential for light touch sensation. Abundant in highly sensitive skin like the fingertips.

The basolateral surfaces of
the cells contact expanded
terminal discs of unmyelinated sensory fibers
penetrating the basement
membrane. The complex of
nerve and cells is called a
Merkel disk.

A

Merkel cells

71
Q

Reversed prompt

Projections between the dermis and epidermis that interdigitate with epidermal ridges to strengthen adhesion

A

Dermal papillae

72
Q

Reversed prompt

A loose connective tissue layer with pads of adipocytes. It binds the skin loosely to the underlying tissues

A

Subcutaneous layer or Hypodermis

73
Q

Reversed prompt

lipid envelope and keratin-filled cells

A

What determines most of the physical properties of the epidermis?

74
Q

Reversed prompt

Lymph-filled spaces created between the epidermis and dermis of thick skin by excessive rubbing. This activity may produce thickening and hardening of the outer epidermal layers, seen as corns and calluses.

A

Friction blisters

75
Q

Reversed prompt

Keratinocytes differentiate rapidly, causing thickening of the epidermis and increased keratinization and desquamation. Caused by an autoimmune reaction in the skin, which can also lead
to inflammation with redness, irritation, itching, etc.

A

Psoriasis

76
Q

Reversed prompt

One-third of all adult cancers originate in the skin. Most are from cells of the basal or spinous layers, producing, respectively, basal cell carcinomas and squamous cell carcinomas. Both types of tumors can be diagnosed and cut out early and are rarely lethal.

A

Skin Cancer

77
Q

Reversed prompt

Tissue injuries caused by thermal, electrical, radioactive, or chemical agents

A

Burns

78
Q

Reversed prompt

A burn in which the damage is limited to the superficial
part of the epidermis.

A

First-degree burn

79
Q

Reversed prompt

A burn in which the damage extends through the
epidermis into the superficial part of the dermis. However, except
for their most superficial parts, the sweat glands and hair follicles are not damaged and can provide the source of replacement
cells for the basal layer of the epidermis.

A

Second-degree burn

80
Q

Reversed prompt

The entire epidermis, dermis, and perhaps
underlying muscle are damaged. A minor degree of healing may occur at the edges, but the damaged portions require skin
grafting. The extent of the burn (percent of total body surface affected) is generally more significant than the degree (severity of
depth) in estimating its effect on the well-being of the victim.

A

Third-degree burn

81
Q

Reversed prompt

Melanin content in keratinocyte

Carotene

Number of blood vessels in the dermis

A

What factors contribute to skin color?

82
Q

Reversed prompt

Eumelanin and Pheomelanin

A

Pigments produced by the melanocyte

83
Q

Reversed prompt

Brown or black pigments produced by the melanocyte, a specialized cell of the epidermis found
among the cells of the basal layer and in hair follicles.

A

Eumelanin

84
Q

Reversed prompt

A second, similar, pigment in humans found in red hair.

A

Pheomelanin

85
Q

Reversed prompt

  1. Tyrosinase converts the amino acid tyrosine into different forms of melanin. Melanin pigment is linked to proteins, forming granules called melanosomes.
  2. Melanosomes are transported to the tips of the cytoplasmic extensions of the melanocytes. The neighboring keratinocytes absorb and transport the melanosomes toward their nuclei, where they form
    a supranuclear cap that absorbs and scatters sunlight, protecting DNA of the living cells from the mutagenic effects of UV radiation.
A

Melanin Synthesis

86
Q

Reversed prompt

On melanocyte plus its nearby keratinocytes.

A

Epidermal-melanin unit

87
Q

Reversed prompt

Keratinocytes

A

What cells contain more pigment from melanosomes, keratinocytes or melanocytes?

88
Q

Reversed prompt

  1. Melanin formation
  2. Granules containing melanin mature. Mature granules are ellipsoid.
  3. Melanin granules are
    transported to the tips of
    the processes of the
    melanocyte. Then taken to the neighboring keratinocytes of the basal and spinous layers.
  4. In keratinocytes the melanin granules accumulate near the nucleus as a supranuclear cap shading the DNA against UV radiation.
A

Melanosome Formation

89
Q

Reversed prompt

A congenital disorder producing skin hypopigmentation due to a defect in tyrosinase or
some other component of the melanin-producing
pathway.

A

Albinism

90
Q

Reversed prompt

Melanocytes can normally proliferate in skin to 
produce moles (benign melanocytic nevi; singular 
is nevus) of various types.
A

Moles (benign melanocytic nevi; singular is nevus)

91
Q

Reversed prompt

Changes in the size or appearance of moles are
sometimes indicative of dysplasia that can progress
further to malignant melanoma. Malignant
melanocytes often penetrate the basal lamina, enter the dermis, and metastasize into blood and lymphatic vessels.

A

Malignant melanocytes

92
Q

Reversed prompt

Made of papillary layer and reticular layer.

Vascular

A layer of mesodermal connective tissue

A

Dermis

93
Q

Reversed prompt

More superficial layer of dermis; composed of areolar connective tissue; forms dermal papillae; contains subpapillary vascular plexus.

A

Papillary layer

94
Q

Reversed prompt

Thicker layer; Deeper layer of dermis; dense irregular connective tissue surrounding hair follicles, sebaceous glands, sweat glands, nerves, and deep plexus of blood vessels extending into subcutaneous layer.

A

Reticular layer

95
Q

Reversed prompt

Not considered part of the integument; deep to dermis; composed of areolar and adipose connective tissue.

A

Subcutaneous layer

96
Q

Reversed prompt

Although most of the
protein fibers in dermis
are collagen, there are
also elastic fibers.

A

Fibers of Dermis

97
Q

Reversed prompt

Between the papillary and reticular dermal layers

Capillary branches extend
into the dermal papillae and
form a nutritive capillary
network below the epidermis. A deep plexus
with larger blood and
lymphatic vessels lies near
the interface of the dermis
and the subcutaneous
layer

A

Subpapillary plexus

98
Q

Reversed prompt

Nutrients for epidermal keratinocytes diffuse into the avascular epidermis from the dermal vasculature through the basement
membrane

Both dermal regions contain a rich network of blood and lymphatic vessels. Nutritive vessels form two major plexuses, microvascular subpapillary plexus and deeper plexus

Dermal vasculature also has a thermoregulatory function.

The dermis is also highly innervated.

A

Dermis Misc.

99
Q

Reversed prompt

The subcutaneous layer
consists of loose connective tissue that binds the skin loosely to the subjacent organs, making it possible for
the skin to slide over them.

This layer, also called the
hypodermis or superficial
fascia, contains adipocytes
that vary in number and size.

Its vascular supply promotes rapid uptake of drugs injected here.

A

Subcutaneous Tissue

100
Q

Reversed prompt

Unencapsulated receptors:
Merkel cells, free nerve endings, and root hair plexuses

Encapsulated receptors: Meissner corpuscles, lamellated (Pacinian) corpuscles, and Ruffini corpuscles (bulbous corpuscles)

A

Tactile Sensory Receptors

101
Q

Reversed prompt

An unencapsulated tactile sensory receptor in the dermis and lower
epidermal layers, which respond primarily to high
and low temperatures, pain, tickle, itching, but also
function as tactile receptors.

A

Free nerve endings

102
Q

Reversed prompt

An unencapsulated tactile sensory receptor that are a web of sensory fibers at
the bases of hair follicles in the dermis that detects
hair movement.

A

Root hair plexuses

103
Q

Reversed prompt

A type of tactile sensory receptor that are referred to
collectively as low-threshold (or high-sensitivity)
mechanoreceptors because even weak mechanical stimulation of the skin induces them to produce action potentials.

A

Encapsulated receptors

104
Q

Reversed prompt

An encapsulated tactile sensory receptor that are formed by a connective tissue capsule that
comprises several lamellae of Schwann cells. They respond to minimal skin depression. Meissner’s corpuscles are the most common mechanoreceptors of glabrous (smooth, hairless) skin (e.g., fingertips).

A

Meissner corpuscles

105
Q

Reversed prompt

An encapsulated tactile sensory receptor that are large structures found deep in the reticular dermis and hypodermis (subcutaneous tissue). The Pacinian
corpuscle has an onion like capsule, with many obvious layers. They are specialized for sensing coarse touch, pressure (sustained touch), and high frequency vibrations.

A

Lamellated (Pacinian) corpuscles

106
Q

Reversed prompt

An encapsulated tactile sensory receptor that are stimulated by stretch or
twisting in the skin. They sense deep touch, grip (long-term touch), and
finger position.

A

Ruffini corpuscles (bulbous corpuscles)

107
Q

Reversed prompt

Hairs are elongated keratinized structures
that form within epidermal invaginations, the hair follicles

All skin has at least minimal hair except the glabrous (hairless) skin of the palms, soles, lips, and some regions of genitalia.

A

Hair

108
Q

Reversed prompt

Sebaceous glands, eccrine sweat glands, and apocrine sweat glands

A

Skin Glands

109
Q

Reversed prompt

Embedded in the dermis over most of the body, except in the thick, glabrous skin of the palms and soles.

Branched acinar glands

Holocrine secretion

Secretes sebum

A

Sebaceous glands

110
Q

Reversed prompt

Merocrine

Widely distributed in the skin and are most numerous on the foot soles.

The secretory components and ducts of eccrine sweat
glands are coiled.

A

Eccrine sweat glands

111
Q

Reversed prompt

The glands are misnamed: their cells show merocrine, not apocrine, secretion.

Apocrine sweat glands are largely confined to skin of the axillary and perineal regions.

A

Apocrine sweat glands

112
Q

Reversed prompt

  1. The process begins with blood quickly clotting at the wound site, releasing platelet-derived growth
    factors and other substances.
  2. Macrophages and neutrophils enter the wound as inflammation begins, and epithelial cells from the
    cut edges of the stratum basal migrate beneath and through the blood clot.
  3. Under the influence of growth factors and hydrolytic enzymes from
    macrophages, fibroblasts proliferate and produce much new collagen to
    form “granulation tissue” containing many new, capillaries.
  4. The epidermis gradually
    reestablishes continuity over the wound site, but excessive collagen
    usually remains in the dermis as scar tissue.
A

Skin repair process