Pathologies

Question 1

Primary Lymphedema

Answer 1

A congenital disorder, or at puberty, or after 35 years old due to genetic mutation. Unilateral foot or calf affected. Mostly women affected. Patho is caused by dysplasia of the lymphatic system. Or other vascular abnormalities.

Question 2

Secondary Lymphedema

Answer 2

Results from insult, injury, or obstruction to the lymphatic system. An excessive accumulation of fluid in tissue spaces from trauma, infection, radiation, or surgery. Seen usually from removing axillary inguinal or iliac nodes for metastatic tumor. Filariasis, tumors, breast cancer (1/5 women with b.c. will develop it) S/S: Swelling in one arm/leg, heavy and achy limbs, altered sensation, stages Stages: 0-3 Stage 0- No visible changes Stage 1- Reversible swelling, pitting edema Stage 2- Irreversible swelling, non-Pitting edema in late stages, stemmer’s sign + (you cannot lift and pinch the skin) Stage 3- Severe swelling, skin permanently damaged, large skin folds, BRAWNY

Question 3

Differentiate Normal to Pathological Lymph Nodes

Answer 3

Normal Lymph Nodes- Supple, Non-tender, Mobile Infected or Inflamed Lymph Nodes- Firm and Enlarged , Tender, WARM, MOBILE Malignant Lymph Nodes- Firm and grow in size, Non-tender, immobile

Question 4

Dermatitis vs Cellulitis

Answer 4

Derm is general skin rash. Swelling is not typical with dermatitis and does not have associated rash

Cellulitis is bacterial skin infection

Question 5

If lymph nodes are tender to touch, but mobile at exam, what is the next course of action?

Answer 5

REFER THE PATIENT TO PHYSICIAN! Asking a person about fever is not best, because it’s redundant. Also, according to NPTE, do not refer to specialist. Refer to PCP.

Question 6

Diff Dx Lipedema vs Lymphedema

Answer 6

Lipedema is excessive accumulation of fatty deposits. Found in UE and LE, bilaterally and symmetrical. Typically due to hormonal imbalances such as pregnancy and pub erty. NEGATIVE stemmer’s. SWELLING DOES NOT GO PAST ANKLES/WRISTS

Question 7

Precautions for BP?

Answer 7

Do not take BP in affected arm.

Question 8

What is Lymphangitis?

Answer 8

Inflammation of lymph vessels beneath skin. Caused by an infection leaked to lymph vessels and spreads to lymphatic system. S/S include red streaks, tenderness, muscle aches, swollen or tender lymph nodes. Treated by antibiotics or antifungals or antivirals, as well as elevation.

Question 9

What is Lymphadenitis?

Answer 9

Enlargement of one or 2 lymph nodes due to infection.

Nodes that increase in size

Nodes that are painful to touch

Nodes that are soft or matted together

Redness or red streaking of the skin over nodes

Nodes that are filled with pus (an abscess)

Fluid that drains from the nodes to the skin

Physician will perform tests to determine what kind of infection is present. As well as medicines to reduce swelling

Question 10

What is Peripheral Vascular Disease?

Answer 10

Any disorder that interferes with the arterial or venous blood flow of the extremities. It is a lack of adequate blood flow to region or regions of the body.

Question 11

What is arterial insufficiency?

Answer 11

It is caused by: Smoking, obesity, sedentarianism, cardiac disease, diabetes, HTN, renal disease, high cholesterol.

Two types of AI: Atherosclerosis (damage to lining of vessels with plaque) and arteriosclerosis (thickening or hardening of walls)

S/S include: Pale and cool skin, abnormal nail growth, little leg and foot hair, LATERAL MALLEOLAR WOUNDS, dry and shiny skin, intermittent claud and pain at rest.

Decreased pulses, pallor on leg elevation, rubor when dependent.

Question 12

Arterial Wounds Presentation?

Answer 12

Lateral Malleoli, Dorsum of the Foot, Toes

Wound base is necrotic and pale, lacks granulation

Dry gangrene

Deep

Dry wound bed

Wounds are painful

Defined borders

Question 13

Venous Insufficiency

Answer 13

Venous Insufficiency is inadequate draining of venous blood to heart. Results in edema/ulcerations

Caused by aging, lack of exercise, pregnancy, long hours of standing, restrictive clothing.

S/S: edema, heaviness, fatigue, HEMOSIDERIN STAINING, fibrosis, increased skin temp

Question 14

Characteristics of Venous Wounds:

Answer 14

Medial malleoli, edematous, heavy drainage, mildy painful, shallow, uneven borders, hemosiderin staining

Question 15

What is a neuropathic ulcer?

Answer 15

PAD is primary cause of impairment as well as diabetes. Typically shows up on the soles of the feet!

Could lead to charcot foot (deformation, inflammation)

Check lifestyle, dorsalis pedis pulse, venous refill, 10 gram monofilament, achilles tendon reflex

*WAGNER SCALE IS USED FOR NEUROPATHIC ULCERS

Question 16

Pathophysiology of Pressure Injuries/Ulcers?

Answer 16

A pressure ulcer is caused by unrelieved pressure causing damage in underlying tissue. Usually occurs over bony prominences. Caused by xternal pressure, friction, shearing forces, maceration, dehydration, malnutrition, decreased circulation

Intrinsic factors include decreased sensation, impaired mobility or activity levels, incontinence, diaphoresis, impaired nutritional status, altered levels of conciousness

Wounds CANNOT be back staged. IT WILL ALWAYS REMAIN THE SAME FOR DOCUMENTATION. (ex. Stage 2 HEALING ulcer)

Question 17

What are the Pressure Stages of ulcers?

Answer 17

Stage 1- Skin intact, observable changes in temperature (warmth/coolness), texture (firm or boggy feel), color (red, blue, purple), sensation (pain or itching). NON BLANCHABLE

Stage 2- Partial-thickness skin loss. Involves the epidermis and dermis or both. It is superficial and looks like a blister or shallow crater or abrasion

Stage 3- Full-thickness. Deep crater. Damage or necrosis to subcutaneous tissue, which extends down to fascia. Fascia not affected

Stage 4-Sinus tracts present, necrosis and damage extends all the way to joint/muscle/bone

Unstageable- The depth of a wound with eschar or more with 50% necrotic tissue once debrided. They are covered in necrotic tissue

Question 18

Position changes?

Answer 18

If able to move by themselves, every 15 min

If lying down, every 2 hours

If sitting, every hour

Question 19

What is Psoriasis?

Answer 19

Hereditary, chronic, recurrent inflammatory but noninfectious dermatosis characterized by well defined erythematous plaques covered with a silvery scale. Quickly replicating keratinocytes

Flare ups occur in cold weather, severe anxiety, and emotional stress.

Normal skin cells 26-28 days. Psoriatic skin is 3-4 days.

Flare-ups are more

common in the winter as a result of dry skin and lack of

sunlight

(1) topical preparations, (2)

phototherapy, (3) antimetabolites, (4) oral retinoid

therapy, and ( 5 ) immunosuppressants.

Staph occurence is high on plaques

Diff dx: Rh Arthritis has more frequent involvement of the distal interphalangeal joints, asymmetrical distribution of affected joints. Joints are less tender in PA

Question 20

What is melanoma?

Answer 20

Neoplasm of skin from melanocytes

Question 21

What is sarcoidosis?

Answer 21

*Felix had this

Inflammatory cells all over the body. Triggered by immune system reaction from unknown etiology. Can affect skin, heart, lungs, and lymph nodes.

S/S depend on which area is affected.

Question 22

What is a DTI?

Answer 22

A suspected deep tissue injury (DTI) is a purple or maroon local area of discolored skin that is due to damage of underlying soft tissue. The DTI may have a softer feel or a difference in temperature in comparison to the surrounding tissue. In patients with a spinal cord injury, a DTI is often caused by shear or pressure that occurs on the ischial tuberosities as a result of inadequate weight shifting or positioning

*USUALLY PURPLE OR MAROON AND SOFTER THAN SURROUNDING TISSUE

Question 23

What is a Superficial Thickness Burn?

Answer 23

Affects only the epidermis layer of the skin The wound is typically dry, erythematous, and painful Skin typically heals within 2-5 days.

From sunburn, exposure to hot liquids

Question 24

What is a Partial Thickness Burn (2nd degree)?

Answer 24

A burn that destroys the epidermis and the dermis.

*THIS IS SEPARATED INTO SUPERFICIAL PARTIAL THICKNESS AND DEEP PARTIAL THICKNESS

Question 25

What is a superficial partial thickness burn?

Answer 25

Destruction of the epidermis and damage to papillary layer.

• Presence of blisters can be seen, which these can be broken leaving the wound surface moist, red, and very PAINFUL (Sensate)
• 7-14 days to heal and should heal normally without scarring

Blanches with normal capillary refill

Question 26

What is a deep partial thickness burn?

Answer 26

• Destruction of the epidermis, the papillary layer of the dermis, and into the RETICULAR LAYER of the dermis - These ones are typically moist, painful, edematous and red. (can be white if very deep) - 21-35 or more days to heal. INCREASED LIKELIHOOD TO SCAR

Blanches with delay capillary refill…WAXY

Question 27

What is a Full Thickness Burn?

Answer 27

Goes UP TO SUB Q (fat). Does not damage muscle or tendon. Dry, firm, leathery eschar, edematous, insensate

*REQUIRES SKIN GRAFTING AND WILL SCAR. MONTHS TO HEAL

No blanching or capillary refill

Question 28

What is a Subdermal Thickness Burn?

Answer 28

Destroys all levels of skin. Charred (caused by flame) - Gray or brown (caused by chemical) - Edema is present in all subdermal burns - Pain is related to inflammation of the adjacent tissues but not IN THE WOUND

No natural healing. WILL NEED GRAFTING. SCARRING PRESENT.

Question 29

Apply the Rule of 9s to a body?

Answer 29

• Rule of Nines - 11 different regions each 9% - 1% given to the genitalia

“Serious burns include involvement of the hands, feet, face, genitalia, perineum, or major joints” (anything that affects a patient’s function)

Lunden and Browder chart show that the head percentage change for a developing child

Question 30

What is a Major Burn?

Answer 30

>30%

Question 31

What is the Pathophysiology of burns?

Answer 31

Cell Lysis occurs, potassium enters into the blood. So hyperkalemia occurs.

Increased capillary permeability- the capillaries feed a bunch of fluid into the skin. Creating edema. Hyponutremia occurs. Deep-partial thickness, full thickness, and subdermal burns.

Diminished blood volume due to decreased blood pressure, decreased cardiac output, decreased tissue perfusion.

Question 32

What is the bodies response to burn shock?

Answer 32

• Increased Sympathetic response - Tachycardia - Peripheral vasoconstriction - Hyperglycemia (corticoid hormones) - Increased Metabolism: Response to bacterial load and injury Infection: Loss of the skin barrier increases risk

Pulmonary Complications: Pulmonary edema (capillary fluid shift) - Inhalation injury - Damage to airways - Gas transport cells

Question 33

What is Systemic Lupus Erythemateous?

Answer 33

Chronic Inflammatory Autoimmune Disorder, Hereditary Component and Women mostly.

Positive ANA

Question 34

What is Herpes Zoster?

Answer 34

Question 35

What is a Nevus?

Answer 35

Another word for Mole