Module 14 Flashcards

1
Q

Skin Lesions

A
  • Primary
    Physical changes in the skin considered to be caused directly by the disease process.
  • Secondary
    May evolve from primary lesions, or may be caused by external forces such as scratching, trauma, infection, or the healing process.

*Not always clear if lesion

  • There is a primary and secondary skin lesion
  • Secondary: you are doing something to your body
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2
Q
Primary Skin Lesions 
Macule:
Vesicle: 
Pustule:
Papule:
Nodule:
Wheal:
Telengieactasia:
A
  • Macule > small, circular, flat, different color > freckle
  • Vesicle > small raised, filled with clear fluid > if large > bullae or blister
  • Pustule > raised lesion filled with pus > acne
  • Papule > solid raised lesion > group > plaque
  • Nodule > solid lesion that is moveable to area around it > lipoma
  • Wheal > skin elevation with itching > allergic reaction
  • Telengieactasia > dilated blood vessels on surface of skin
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3
Q

Secondary Skin Lesions (Check you book for pictures!)

  • Ulcer
  • Scale
  • Crust
  • Erosion
  • Scar
  • Lichenification
  • Atrophy
A
  • Ulcer > loss of dermis and poss. Epidermis > w/ deep - crack > fissure
  • Scale > dry, scaly dead skin with flaking > psoriasis
  • Crust > dried substance > blood, pus, scab
  • Erosion > loss of epidermis > scrape
  • Scar > discolored fibrous tissue that replaces normal skin
  • Lichenification > rough epidermis > dermatitis
  • Atrophy > thin wrinkled skin > topical corticosteroid use
  • We are expected to know what these are and what they look like
  • Make sure you can apply the proper name to different diseases/symptoms
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4
Q

Acne

Comedone:

A

Comedone: A pore clogged with sebum and dead skin cells

  • Clogged up comedone (pore)
  • Can be open or closed
  • When it is clogged there is a collection of bacteria where they multiply
  • Closed comedone is a white head
  • Open comedone all of that puss gets oxidized so it is a blackhead
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5
Q

Acne

A
  • Acne Vulgaris
  • Main cause of skin disease (85% of population 12-25)
  • Whiteheads (closed comedones), blackheads (open comedones), papules, pustules
  • Nodules, cysts
  • Face, neck, chest, back – most sebaceous glands located
  • Severe forms:
    • Acne Conglobata – Large interconnected lesions
      • Most common in males 18-20
    • Acne Fulminans (Acute Febrile Ulcerative Acne – abrupt onset of acne congoblata, or after unsuccessful treatment of conglobata
      • Begins as pain and inflammation in the joint > progresses into a swelling of the lymph nodes located at the base of the neck, causing inflexibility in the neck within weeks after the nodes swell > After some time, extreme loss of weight and atrophy of the muscles
  • (Acne) Rosacea – red facial rash (adult acne)
    • Transient, recurrent, persistent (middle aged adults)
    • Possibly due to overactive facial > Triggers that cause episodes of flushing and blushing play a part in the development of rosacea (Exposure to temperature extremes, strenuous exercise, heat from sunlight, severe sunburn, stress, anxiety, cold wind, and moving to a warm or hot environment from a cold one such as heated shops and offices during the winter can each cause the face to become flushed. Certain foods and drinks can also trigger flushing (alcohol, caffeine (especially, hot tea and coffee), foods high in histamines, and spicy food)
    • Corticosteroids make it worse!
    • Rhinophyma – following slide pictures
  • Everyone gets it at some point
  • Most people just get nodules
  • Anything fulmonating is never good (acne fulminans)
  • Acne rosacea is more of a blood vessel thing
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6
Q

Acne Vulgaris

A

Acne vulgaris is thought to be caused by multiple factors. Overproduction of a normal oil on the skin, called sebum, increases under the influence of hormones. This, coupled with insufficient shedding of exfoliating dead skin cells, plugs hair follicles. The plugged follicle can become inflamed and have increased growth of normal skin bacteria, Propionibacterium acnes.

  • Cystic acne occurs across the upper chest as well as on the back.
  • Anywhere where a person has increase sebum production is where they are more likely to get this
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7
Q

Acne Vulgaris blackheads

A

Blackheads (open comedones) are collections of oil and debris that clog pores. The material is normally whitish, but as it oxidizes, the surface turns black, producing this characteristic appearance.

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8
Q

Rhinophyma

A

Rhinophyma (subtype of rosacea) is a large, bulbous, ruddy nose caused by granulomatous infiltration, commonly due to untreated rosacea. Alcoholism is mistakenly attributed as the cause of this disease, but heavy alcohol consumption does aggravate the condition. It is a slowly progressive condition due to hypertrophy of the sebaceous glands of the tip of the nose often seen in cases of long-standing acne rosacea

  • Alcoholishm is not the cause but it can aggrivate it
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9
Q

Acne Conglobata Tx

A

Healthy diet, foods high in antioxidants, fruits

- sugar is proinflammatory so cut out sugar or refined foods

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10
Q

Polycythemia Vera (1 in 200,000 in US)

A
  • Abnormal, slow, idiopathic proliferation of RBC at bone marrow (WBC and platelet counts may also be elevated)  increased risk for AML later in life
    • Primary polycythemia - neoplastic proliferation and maturation of erythroid, megakaryocytic and granulocytic elements to produce what is referred to as a panmyelosis
    • Secondary polycythemias - low serum level erythropoietin (EPO). PCV cells have a mutation in the EPO receptor, which makes them hypersensitive to EPO
  • S/S: due to increased blood volume & hyperviscosity
    • Splenomegaly, thrombi, HA, tinnitus, chorea, delirium,
    • Visual disturbances, angina, thrombosis, ischemia, infarct
    • Pruitis after warm bath/shower
    • Plethora (ruddy complexion) in the face, palms, nail beds, mucosa, and conjunctiva.
  • Testing: CBC
  • Tx:
    • Meds for bone marrow suppression
    • Phlebotomy
    • Low dose aspirin
  • Poly means multiple cyt means cell emia means blood so a lot of red blood cells
  • Two main types: primary vs. secondary
  • Neoplastic is new growth
  • Primary is a pan (everything) increase in all of the blood cell types
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11
Q

Polycythemia Vera

A

Polycythemia is a condition of increased production of red blood cells (RBCs). The percentage of RBCs in the blood may become so high that the blood ceases to flow in some smaller vessels and capillaries. In this photomicrograph, the RBCs are densely packed together.

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12
Q

Insect bites

A
  • Causes
    • Bees, wasps, fire ants, fleas (Bubonic plaque), lice, ticks (Lyme disease), mosquitoes (malaria, West Nile Virus), fly (typhoid fever, dysentery), bedbugs
    • Spiders
  • Signs and Symptoms
    • Redness, swelling, pruritis, hives, pain
    • Cellulitis
    • Anaphylaxis
    • Secondary bacterial infection
  • Testing
    • Clinical
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13
Q

Eczema

A
  • A term for a group of medical conditions that cause the skin to become inflamed or irritated.
  • Types:
    1) Atopic dermatitis: has a genetic basis and is probably most commonly called eczema. Begins early in life in those with a predisposition to inhalant allergies, but it probably does not have an allergic basis. Characteristically, rashes occur on the cheeks, neck, elbow and knee creases, and ankles.
    2) Contact Dermatitis
    • Irritant contact dermatitis: This occurs when the skin is repeatedly exposed to toxic substances (i.e. sodium lauryl sulfate)
    • Allergic contact dermatitis: After repeated exposures to the same substance, the body’s immune recognition system becomes activated at the site of the next exposure and produces eczema (i.e . poison ivy, nickel)
      3) Stasis dermatitis: It commonly occurs on the swollen lower legs of people who have poor circulation in the veins of the legs.
      4) Fungal infections: the fungus can be visualized with a scraping under the microscope or grown in culture.
      5) Scabies: infestation by the human itch mite
      6) Pompholyx (dyshidrotic eczema): common but poorly understood condition which classically affects the hands and occasionally the feet by producing an itchy rash composed of tiny blisters (vesicles) on the sides of the fingers or toes and palms or soles.
      7) Lichen simplex chronicus: It produces thickened plaques of skin commonly found on the shins and neck.
      8) Nummular eczema: This is a nonspecific term for coin–shaped plaques of scaling skin most often on the lower legs of older individuals.
      9) Xerotic (dry skin) eczema: When the skin becomes pathologically dry, it will crack and ooze.
      10) Seborrheic eczema: It produces a rash on the scalp, face, ears, and occasionally the mid-chest in adults. In infants, in can produce a weepy, oozy rash behind the ears and can be quite extensive, involving the entire body.
  • Many different types
  • Contact Dermatitis: grass, poison ivy, etch
  • Stasis: paralyzed or in bed,
  • Scabies: look for in webbing , overcrowding dirty places
  • Dyshidrotic (dry skin) eczema: nurses because they are constantly washing their hands
  • Best Tx for eczema is to identify the cause
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14
Q

Eczema
causes
s/s
testing

A
  • Causes
    • Unknown - dysfunctional interplay between the immune system and skin
    • Allergy?
    • Anything physical, mental or emotional
  • Signs and Symptoms
    • Intense itching, burning, dry flaky erythematous skin > often found in the bends of the arms or legs, face, and neck
    • Secondary bacterial infections > danger if person is immunocompromised
  • Testing
    • Clinical
    • Wound culture and sensitivity
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15
Q

Psoriasis

A
  • Causes
    • Autoimmune T-cell reaction to skin
  • Risk factors:
    • FHx, genetic predisposition, HIV, stress, obesity, smoking
  • Triggers: Alcohol, stress, infections, injury to skin, cold weather, certain meds (Lithium – for bipolar disorder)
  • Main areas: Elbows, knees and scalp
  • Signs and Symptoms
    • Red skin with silvery scales and inflammation
    • Nail involvement: pitting, onycholysis
      • Separation of nail plate
    • Psoriatic arthritis-skin disease precedes in 80%
  • Testing
    • Clinical
    • R/O RA
  • Silvery scales it hallmark SILVERY SCALES
  • Usually happens in the same place
  • If it is autoimmune a person will take humera, steroids, any immunosupressants
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16
Q

Skin Lesions Diagnosis

A
ABCDE
Asymmetry
Border
Color
Diameter
Elevation
17
Q

Tinea

A
  • Variety of organisms which cause fungal skin infections
  • Causes
    • Ringworm (tinea corporis), athlete’s foot (tinea pedis), jock itch (tinea cruris)
    • Touching, wet floors (shower), pet
  • Signs and Symptoms
    • Itching, burning, redness
  • Testing
    • Clinical
  • Generic name given to any type of fungal organisms
  • Anytype of fungal species that can cause
  • They are empicudous they are everywhere
  • Tx: Antifungal anything that ends in ASOL
18
Q

Tinea in the scalp

A

In the scalp, fungal infections often form circular, scaly, inflamed patches. Frequently, there can be temporary hair loss (hair returns when infection clears but if treatment is delayed and scarring results, permanent hair loss can be seen). This is a classical example of ringworm (tinea capitis)

19
Q

Herpes Family of Viruses

A
  • HSV 1 – cold sores
  • HSV 2 – genital sores
  • Shingles
  • Causes
    • Herpes Simplex Virus
    • Varicella Zoster Virus
  • Signs and Symptoms
    • Asymptomatic
    • Itching, pain, burning, dysuria, vesicles and ulcers  first outbreak is worst and may not have another outbreak
    • Feel “fluish”
    • Ocular > can lead to blindness
    • Herpes Encephalitis seen with HIV infection
    • Sore will heal within 3 weeks of onset
  • Testing
    • Clinical
    • Test for other STD’s
20
Q

Candidiasis

A
  • Yeast infection
  • Yeast is found in 20-50% of healthy women
  • Causes
    • Hormonal (BC pills or estrogen supplement), Obesity, Antibiotics
    • DM – mucus membranes more sugary, ↓ immune system
    • AIDS – ↓ immune system – can spread throughout body
  • Signs and Symptoms
    • Asymptomatic
    • Vaginal or Vulvar pruritis
    • Thick white discharge – ‘cottage cheese’
    • Dyspareunia
      • Painful sexual intercourse
    • Dysuria
  • Testing
    • Usually diagnose w/o tests
    • Slide > KOH prep > pseudohyphae – specific branching pattern
  • Tx
    • “Azole” medications - antifungal drugs
    • They block the manufacture of ergosterol, a crucial material of the yeast cell wall.
21
Q

Trichomonas

A
  • Protozoal infection
  • Causes
    • STD – 174 million people worldwide
  • Signs and Symptoms
    • Gray-green frothy vaginal discharge
    • Fishy odor
    • Edema and pruritis
    • Males may be asymptomatic
  • Testing
    • Slide > Mix with KOH:“Whiff test” > amines produced by trichomonads
    • Saline Wet prep > protozoa with flagella
    • Nucleic acid amplification tests (NAATs)
    • R/O Gardnerella (Main cause of Bacterial Vaginosis AKA BV)
      • disorder of the chemical and biological balance of the normal vaginal flora bacterial overgrowth
      • Main cause of BV is douching  which alters the vaginal flora. Strongly discouraged by the U.S. Department of Health and Human Services
    • R/O Candida
  • Tx:
    • Metronidazole (Flagyl)
22
Q

Other Genital Infections

  • Chlamydia
  • Gonorrhea
A
  • Chlamydia (Silent Epidemic) > Chlamydia trachomatis
    • M > asymptomatic (50%), purulent, thin white discharge from the penis with or without a burning sensation during urination
    • F > asymptomatic (75%), abd. pain, spotting, infertility due to Pelvic Inflammatory Disease (PID) > infection of the uterus, fallopian tubes, and/or ovaries. PID can cause scarring inside the reproductive organs, which can later cause serious complications, including chronic pelvic pain, difficulty becoming pregnant, ectopic (tubal) pregnancy
    • Dx: Urine sample, Swab
    • Tx: antibiotics
  • Gonorrhea (The Clap French term, ‘clapier’, which means brothel.) > Neisseria gonorrhea
    • M > burning sensation with urination and thick penile discharge
    • F > asymptomatic (50%), vaginal discharge, lower abdominal pain, or pain with intercourse
      • A mother may transmit gonorrhea to her newborn during childbirth; when affecting the infant’s eyes, it is referred to as ophthalmia neonatorum
    • Dx: Swab with PCR
    • Tx: antibiotics
23
Q

Other Genital Infections

- Genital Warts

A
  • Genital Warts > condyloma acuminata  STD due to HPV
    • Incubation period 3 weeks to 1 year (3 months average)
    • 90% of HPV infection is eliminated by the body within 2 years
    • Strains of HPV (16, 18) > cervical cancer (70%)
    • About a dozen HPV types (including types 16, 18, 31, and 45) are called “high-risk” types because they can lead to cervical cancer, as well as anal cancer, vulvar cancer, vaginal cancer, and penile cancer
  • Oral infection with HPV increased the risk of HPV-positive oropharyngeal cancer independent of tobacco and alcohol use
  • HPV types 6 and 11 can cause a rare condition known as recurrent respiratory papillomatosis  warts form on the larynx
  • Papanicolaou (Pap) Smear
  • Vaccines now available (Gardasil 6, 11, 16, 18), Cervarix (16, 18)
24
Q

Systemic Lupus Erythematosus

A
  • Inflammatory Autoimmune Disorder  can affect any/all systems
    • Systemic
    • Discoid > skin
    • Medication induced
  • Causes
    • Autoimmune
  • Signs and Symptoms
    • Incr. F, ages 20-40, remissions/exacerbations
    • Joint pain/swelling (90%), Vasculitis/rash (70-80%)
    • Renal disease (40-50%), Hematologic abnormalities (50%)
    • Cardiovascular diseases (30-50%)
    • Malar rash > sunlight
  • Testing
    • 4 out of 11 findings
    • CBC, Antinuclear antibody (ANA), Double stranded anti-DNA
    • ESR, CRP
25
Q

Common lupus symptoms

A
  • Brain: persistent and unusual headaches, memory loss, or confusion
  • Mouth and nose: sores inside the mouth and or nose
  • Lungs/heart: shortness of breath and/or pain in the chest
  • Fingers, toes, or the tip of the nose may turn white or blue with exposure to cold during stressful situations
  • Fatigue and unexplained fevers
  • Eyes: dry or puffy eyes, and increasing sensitivity to light
  • skin: a “butterfly” rash on the face usually over the cheeks and bridge of the nose or other rashes that can worsen with sun exposure
  • stomach: nausea, vomiting, recurring and persistent abdominal pain, bladder infections, and blood in urine
  • persistent pain and swelling of the legs, joints, and/or feet
26
Q

Discoid Lupus Erythematosus (DLE)

A
  • +Subset of SLE
  • Cutaneous manifestation is the only symptom
  • Causes
    • Genetic and environmental
    • AI component?
  • Signs and Symptoms
    • Incr. F, ages late 30’s - early 40’s
    • 1-2cm raised red plaque with a brownish scale
    • Alopecia, telangiectasias, urticaria (Hives), Raynaud phenomenon (white, numb and cold digits followed by cyanosis)
  • Testing
    • Skin biopsy will reveal lumpy deposits of immunoglobulins
    • Immunofluorescent observation
  • Tx
    • Topical creams
    • Avoid sunlight