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Integ Patho (PTH 701) Quiz #1 > Layers of Skin and other stuff from Lecture #1 > Flashcards

Layers of Skin and other stuff from Lecture #1 Flashcards

1
Q

Which layer of skin is the first barrier against infection and foreign substances?

A

Epidermis

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2
Q

Which layer of skin retains moisture?

A

Epidermis

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3
Q

Which layer of skin nourishes and supports the epidermis?

A

Dermis

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4
Q

Which layer of skin assists with infection control?

A

Dermis (Houses mast cells and macrophages)

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5
Q

Which layer of skin assists with thermoregulation?

A

Both Dermis AND Epidermis

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6
Q

Which layer of skin houses skin appendages

A

Dermis

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7
Q

Which layer of skin provides light touch sensation?

A

Epidermis for light touch, but dermis also provides sensation

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8
Q

Which layer of skin assists with excretion (sweat)

A

Epidermis

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9
Q

Which layer of skin assists with Vitamin D production?

A

Epidermis

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10
Q

Which layer of skin contributes to cosmesis (appearance and identity)?

A

Epidermis

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11
Q

What makes up the Integumentary System?

A
  • Skin
  • Appendages
  • Hair / hair follicles
  • Nails*
  • Glands
  • -Eccrine sweat glands
  • -Apocrine sweat glands
  • -Sebaceous sweat glands
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12
Q

Skin receives how much resting cardiac output?

A

1/3

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13
Q

How much % of body weight is the skin?

A

15-20%

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14
Q

What determines the color of skin?

A

How active melanin production is (Melanocytes produce the protein pigment melanin).

Also influenced by Carotene (pigment) and oxygenated hemoglobin

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15
Q

What is the pH of our skin?

A

4-6.5

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16
Q

What is another name for the Basement Membrane Zone?

A

Rete Ridges - decreases overall shearing forces

Connects epidermis and dermis

Rete bridges lost in full-thickness burn victims and the elderly

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17
Q

What is the most plentiful of all the epidermal cells?

A

Keratinocytes

  • Produce Keratin / “horny layer”
  • Migrate from s. basale to s. corneum
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18
Q

What are Langerhans’ Cells

A

Immune cells - found in s. basale

provide antigens to T-lymphocytes

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19
Q

What are Merkel Cells?

A

Mechanoreceptors - found in s. basale

The Merkel cell is located in or near the basal layer of the epidermis and is closely associated with terminal axons.

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20
Q

Which layer of skin is known as the “true skin?”

A

Dermis - primarily connective tissues to provide structure for skin

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21
Q

What protein fibers make up the dermis?

A

Collagen, elastin, and reticular

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22
Q

What are the two layers of the dermis?

A

Papillary dermis (highly vascular) and Reticular Dermis (deepest layer, contains appendages)

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23
Q

What layer of skin is “dead but waterproof?”

A

Stratum corneum – layer of dead skin cells – contributes to thickness of skin (i.e. around the eye vs. the sole of the foot). P. 86 Sussman – “the acid mantle and stratum corneum make the skin less permeable to water & other polar compounds, and indirectly protect the skin from invasion by microorganisms.”

24
Q

What is the pH of an open wound?

A

Open wound pH 6.5 – 8.5. As resurfacing occurs 5.9

25
Q

What are the majority of epidermal cells?

A

Keratinocytes: majority of epidermal cells –form deepest sublayer - produce keratin – fibrous protein that is water insoluble

26
Q

What layer of the epidermis is only found in thick skin?

A

Stratum lucidum – only in thick skin like palms and soles of feet. Stratum corneum – dead keratinocytes

27
Q

What layer of skin gives you your fingerprint

A

Dermis - see class notes

28
Q

I am “hairy and sweaty”. What layer am I?

A

Epidermis?

29
Q

How many layers comprise the epidermis of the skin on the dorsum of your hand?

A

Only 4. No s.l. because it’s not thick

30
Q

What are the 3 Stages of Healing

A

(Hemostasis)

  1. Inflammation
  2. Repair (granulation, epithelialization, contraction)
  3. Remodeling
31
Q

What are the 5 cardinal signs of inflammation?

A 
Pain
Erhythema (redness)
Calor / incr. temp
Swelling
Loss of function
32
Q

What is hemostasis?

A

Retraction and sealing off of blood vessels

Achieved as a direct effect of formation of PLATELET plug

33
Q

What are the cells present in the highest number shortly after wounding?

A

Platelets

  • Activated by exposed collagen in the subendothelial CT of blood vessels
  • Release a number of factors into the blood
  • -Growth factors / cytokines
  • -Pro-inflammatory factors (e.g. serotonin)
34
Q

What is a fibrin clot?

A

A stable matrix of fibrinogen

Serves as structure for other cells during wound healing process

35
Q

How long does the inflammation stage last?

A

4-6 days

36
Q

What makes up the inflammation stage?

A

Leukocytes:

  • Mast Cells
  • -Histamine
  • Neutrophils
  • Marcophages
  • Lymphocytes
37
Q

Who do Neutrophils do?

A

NEUtrophils Predominate during the first 1-24 hours

Purpose is to fight infection

Pus is an accumulation of dead neutrophils that have phagocytized debris and bacteria

May not occur in asceptic wound

38
Q

What do monocytes do?

A

Convert into macrophages as they enter the wound

Predominate during 24-48 hours

39
Q

What to macrophages do?

A

Main role in inflammation is PHAGOCYTOSIS

Initially function in hypoxic environments to promote angiogenesis and transition to repair phase through cytokine secretion

40
Q

When does the Proliferation / Repair stage take place?

A

Day 4-14 (after angiogenesis)

Granulation, Wound contraction, and epilethelialization

41
Q

What is Granulation?

A

Granulation tissue is dependent on neovascularization / angiogenesis

Tissue is rich in fibroblasts & collagen

42
Q

When does Wound Contraction start?

A

Around Day 4

MYOFIBROBLASTS pull the entire wound together, thereby shrinking the defect and amount of scar tissue that will form

Wound closure – skin & mm 5-8 days
Tendon – lig 3-5 weeks

43
Q

What does Epithelialization do?

A

Creates a barrier between wound surface and environment

  • Keratinocytes
  • To decrease risk of infection
  • To prevent loss of fluid / electrolytes

Requires oxygen and moist environment

  • O2 comes from blood supply
  • It is best to cover wound
  • Different coverings available for “moisture balance”

Like a train, migrates adjacent to each other?

44
Q

When does Remodeling / Maturation take place?

A

From Day 8 onward up to 1 year (or more)

Remodeling scar / collagen reorganization:

  • To fit the tissue
  • To fit the function
  • Balance between synthesis and lysis

Keloid = mushrooms beyond margin of scar - similar but not hypertrophic

45
Q

What is the difference between regeneration and repair?

A

Regeneration = “epithelialization or new skin formation”

Repair = “wound healing that involves granulation tissue formation, wound contraction, and epithelialization

46
Q

What are some factors that determines scarring?

A
  • Depth of initial wound

- What was the healing environment

47
Q

What makes a wound chronic?

A

Gets stuck somewhere in the normal healing process
-Fail to follow normal healing

Typically has one of the following:

  • Prolonged inflammation
  • Failure to progress through the proliferative phase
  • Failure to epithelialize
48
Q

Which macronutrient is essential for wound healing?

A

PROTEIN!

49
Q

What are some factors that influence healing?

A

Wound characteristics / Local Factors
Systemic factors
Clinician induced

Local- wound environ, size-location-type of wound, infection, vascular supply, oxygen, external forces, movement
Clinician induced + / -
MEDS: steroids, anticoagulants, immunosupression drugs all -, nutrition – need protein, vit C, zinc, iron
Systemic- age, nutrition, circulation, disease, medication, immune status VITAMIN C – critical for collagen cross-linkage & tensile strength
Moffat et al. – age, nutrition, hydration, co-morbidities, immunosuppression, stress, infection, smoking

50
Q

What are some Wound / Local Factors that influence healing?

A

pH
-Incontinence

Local ischemia, moisture, infection, repeated trauma from inapprorpiate care (e.g. pressure, dressing changes)

51
Q

What are some Systemic Factors that influence healing?

A

Medications, age, comorbidities, bloodflow (perfusion and oxygenation - smokers), infection, nutrition, stress

52
Q

What are some clinician induced factors that influence healing?

A

Poor management of medications, topical agents, dressing changes

53
Q

How is the Epidermis nourished?

A

By diffusion from the dermis!

The epidermis contains no blood vessels

54
Q

How long does it take for Keratin to travel from the deepest layer (s. basale) to s. corneum?

A

28 days

55
Q

Most common stage chronic wound is stuck in?

A
  1. Proliferation / Repair

Integ Patho (PTH 701) Quiz #1 (8 decks)

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