Lecture 4 from Profs Flashcards
what are age related changes in the epidermis
skin more fragile
altered turnover rate & DNA repair; photo-aging
what are age related changes with the dermis?
loss of thickness
decrease mast cells and histamine
decrease vascular supply and collagen synthesis
What changes with the SubQ with age?
decreased volume (face and hands) increase volume in abdomen and thighs
which level of vit d is tested for?
25-hydroxycholecalciferol
where do you get Vitamin D?
Dairy, fish, sun
must go through a process to be used
why does hair grey?
hair follicles produce less melanin
what causes senile purpura?
Capillary fragility
why is temp regulation difficult?
atrophy of sweat glands
what causes pressure ulcers?
decreased SubQ fat
what is dry skin?
xerosis
what are purple spots in skin exposed areas? not raised or painful.
actinic purpura
what is the name for age spots/ liver spots?
solar lentigo
what are waxy, raised lesions?
tan, brown-black, or gray, waxy to verrucoid papules and plaques, stuck-on appearance; benign
seborrheic keratosis
use cryosurgery to remove
sun exposed area, crusty, reddened, circular
Seborrheic keratosis
do a biopsy, or totally remove can turn into squamous cell
reddish bump, large, a bit irregular. can have a crust on it
Squamous cell
Red bump with waxy, with telangiectasia
Basal cell carcinoma
what biopsy do you not do with melanoma?
shave
perpendicular force to skin surface
Pressure
parallel force to skin surface
Shearing
4 things for pressure ulcers?
Pressure
Friction
Shearing force
moisture
main symptom of arterial dz?
claudication
what test do we do to check for peripheral arterial dz?
ABI
cutaneous vesicular eruption & excruciating pain (burning, knifelike, deep & boring)
Herpes Zoster
Tx for herpes zoster.
Antiretrovirals & analgesia = minimize sequelae (post-herpetic neuralgia)
Diagnostics for anemia
CBC w/differential reticulocyte count blood smear erythrocyte indices nutritional status
what might be a first sign of anemia?
Worsening of angina
PE changes in anemia
pallor
tachycardia
evidence HF
change in cognitive tests
What does high MCV indicate?
Megaloblastic- B12 and folate deficiences
what does normal MCV indicate?
Anemia of chronic dz
early Fe deficiency
Low MCV indicates what?
Fe deficiency
anemia of chronic dz
sideroblastic
what can cause iron deficiency?
Dietary or blood loss
Will ferritin be low or high with microcytic/ hypochromic anemia?
Low ferritin
How do you treat microcytic/ hypochromic anemia?
Ferrous sulfate 2-3 times a day
what is a microcytic/ hypochromic anemia that is congenital and acquired. Associated w/ chronic alcohol abuse, RA, cancer, lead poisoning.
Sideroblastic anemia
diagnostics for sideroblastic anemia
CBC- microcytic, hypocrhomic + ringed sideroblasts
increased iron and transferrin saturation
TIBC normal
ferritin normal
how do you treat sideroblastic anemia?
trial pyridoxine
transfusion
look for cause
what can be a problem with transfusion w/ sideroblastic anemia
iron overload
what can sideroblastic anemia turn into?
myeloblastic leukemia
labs with anemia of chronic dz?
decrease serum iron
high or normal ferritin
TIBC low
how do you manage anemia of chronic dz?
treat underlying dz or malignancy
EPO
transfusion
Signs of B12 deficiency
loss of vibratory and position sense
dementia
neuro-psych
how to treat b12 anemia?
Supplement, correct nutritional or underlying GI issue
labs for B12 deficiency
CBC: macrocytic, hyperchromic, hypersegmented neutrophils; BM: megaloblasts; B12 & folate levels
causes of folate macrocytic/ megalobalstic anemia
chronic alcohol abuse
inadequate dietary intake
drugs- anticonvulsants, triameterene
signs of folate deficiency anemia?
no neuro symptoms
who are vit d deficiency seen in lost
bed bound
nursing home patients
what vitamins do you worry about ODing on?
A D E K
: non-palpable ecchymotic areas, no hx anticoagulation, abuse, trauma
actinic purpura
a small, sharply circumscribed, pigmented macule surrounded by normal appearing skin/melanin pigment, aka “age spot”, spots represent areas of melanin overproduction in the skin from lifetime of chronic sun exposure, benign
Lentigo
tan, brown-black, or gray, waxy to verrucoid papules and plaques, stuck-on appearance; benign
Seborrheic keratoses
condition of thick, scaly, or crusty patches of skin, pre-malignant lesion, progression to squamous cell CA
Actinic keratosis
translucent, “pearly” or “waxy” papule; associated telangiectasia, sometimes central ulceration
Basal cell carcinoma
a flesh-colored or reddish bump or patch
Squamous cell carcinoma
4 stages of pressure ulcers
Non blanching erythema → dermis → fascia → bone
