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Med Surge Integumentary > Pg 472 > Flashcards

Pg 472 Flashcards

1
Q

What are the three types of ultraviolet (UV) wavelengths?

A
  • Ultraviolet A (UVA)
  • Ultraviolet B (UVB)
  • Ultraviolet C (UVC)

UVA can cause elastic tissue damage, UVB contributes to skin cancer, and UVC is blocked by the atmosphere.

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2
Q

Which skin type is especially at risk for sun damage?

A

Fair-skinned persons and those with light-colored eyes

They have less melanin, providing less natural protection against UV radiation.

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3
Q

What should patients be taught to avoid the damaging effects of the sun?

A
  • Wear protective clothing
  • Use sunglasses
  • Wear a large-brimmed hat
  • Use a darker colored, long-sleeved shirt of tightly woven fabric
  • Carry an umbrella

The greatest risk is from midday sun, particularly between 10:00 a.m. and 2:00 p.m.

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4
Q

What percentage of UV rays occur during midday sun?

A

80%

This is the time when the risk of sunburn is highest.

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5
Q

What types of sunscreens are there?

A
  • Chemical sunscreens
  • Physical sunscreens

Chemical sunscreens absorb into the skin, while physical sunscreens reflect UV radiation.

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6
Q

What does SPF stand for?

A

Sun Protection Factor

SPF measures the effectiveness of a sunscreen in filtering and absorbing UV radiation.

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7
Q

What is the minimum SPF recommended for daily sunscreen use?

A

15

Products labeled as ‘broad spectrum’ must have an SPF of at least 15.

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8
Q

How often should sunscreen be reapplied?

A

Every 2 hours

Sunscreen should also be reapplied after swimming.

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9
Q

Fill in the blank: Sunscreens with an SPF of 15 or more filter _____ of the UVB rays.

A

92%

This makes sunburn unlikely when applied appropriately.

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10
Q

What are some common photosensitizing drugs?

A
  • Antidepressants: fluoxetine, paroxetine, venlafaxine
  • Antidysrhythmics: amiodarone, quinidine
  • Antihistamines: cetirizine, chlorpheniramine
  • Antimicrobials: tetracycline, azithromycin, ciprofloxacin
  • Antifungals: griseofulvin, ketoconazole
  • Antipsychotics: chlorpromazine, haloperidol
  • Cholesterol-lowering agents: atorvastatin, simvastatin
  • Diuretics: furosemide, thiazides
  • Hypoglycemics: glipizide, glyburide
  • Nonsteroidal anti-inflammatory drugs: diclofenac, ibuprofen, naproxen

These drugs can increase the skin’s sensitivity to sunlight.

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11
Q

What is the ABCDE rule for skin assessment?

A
  • Asymmetry
  • Border irregularity
  • Color change and variation
  • Diameter of 6 mm or more
  • Evolving

This rule helps assess lesions for potential skin cancer.

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12
Q

True or False: Sunscreens are considered waterproof.

A

False

Sunscreens must be reapplied after swimming, as they are not waterproof.

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13
Q

What should patients taking photosensitizing drugs do to protect their skin?

A

Use sunscreen products

They should also assess their skin monthly and seek professional assessment for hard-to-see areas.

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14
Q

What is a common side effect of certain drugs that can lead to increased sensitivity to sunlight?

A

Photosensitivity

Photosensitivity can manifest as swelling, redness, and papular, plaque-like lesions similar to sunburn.

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15
Q

Name a category of drugs that may cause photosensitivity.

A

Antidepressants

Examples include fluoxetine, paroxetine, and venlafaxine.

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16
Q

List two examples of antidysrhythmic drugs that may cause photosensitivity.

A
  • Amiodarone (Cordarone)
  • Quinidine
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17
Q

What type of drugs includes cetirizine and diphenhydramine that may cause photosensitivity?

A

Antihistamines

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18
Q

Which category of drugs includes tetracycline and azithromycin that may cause photosensitivity?

A

Antimicrobials

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19
Q

Fill in the blank: Griseofulvin and ketoconazole are examples of _______ that may cause photosensitivity.

A

[Antifungals]

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20
Q

What are two examples of antipsychotic drugs that may cause photosensitivity?

A
  • Chlorpromazine
  • Haloperidol
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21
Q

Name a category of drugs that includes atorvastatin and simvastatin that may cause photosensitivity.

A

Cholesterol-lowering agents

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22
Q

What type of drugs includes furosemide and thiazides that may cause photosensitivity?

A

Diuretics

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23
Q

List two examples of hypoglycemics that may cause photosensitivity.

A
  • Glipizide
  • Glyburide
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24
Q

Which category of drugs includes diclofenac and ibuprofen that may cause photosensitivity?

A

Nonsteroidal anti-inflammatory drugs

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25
Q

True or False: All drugs that cause photosensitivity have the same manifestations.

A

False

The manifestations can vary and may include different skin reactions.

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26
Q

What is essential for patients taking photosensitizing drugs to understand?

A

Their photosensitizing effect

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27
Q

What are the risk factors for skin cancer?

A
  • Having fair skin
  • Blond or red hair with blue eye color
  • History of outdoor sunbathing
  • Living near the equator or at high altitudes
  • Family or personal history of skin cancer
  • Having an outdoor occupation
  • Spending a lot of time in outdoor recreation activities
  • Indoor tanning

These factors increase the likelihood of developing skin cancer.

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28
Q

How does the Fitzpatrick Classification of Skin Type assist in skin cancer risk assessment?

A

It helps determine a person’s skin complexion and their risk for skin cancer.

The classification categorizes skin types based on their reaction to sunlight.

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29
Q

Why are dark-skinned persons less susceptible to skin cancer?

A

They have increased melanin, which acts like a sunscreen.

Despite this, they still face risks and should wear sunscreen.

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30
Q

Where do melanomas commonly occur in dark-skinned individuals?

A
  • Palms
  • Soles
  • Mucous membranes
  • Under the nails

These areas have less melanin, making them more susceptible to melanoma.

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31
Q

What are the two most common forms of skin cancer?

A

Nonmelanoma skin cancers, specifically basal cell and squamous cell cancers.

More than 5.4 million new cases are diagnosed each year.

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32
Q

What is the most common causative factor for nonmelanoma skin cancers?

A

Sun exposure.

Nonmelanoma skin cancers usually develop in sun-exposed areas.

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33
Q

What are the characteristics of actinic keratosis (AK)?

A
  • Most common precancerous skin lesion
  • Affects older White population
  • Appears on sun-exposed skin
  • May spontaneously resolve with reduced sun exposure

AK is also known as solar keratosis.

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34
Q

What is the typical presentation of basal cell cancers?

A

They may occur in sun-protected areas and do not follow the same pattern as squamous cell cancers.

Squamous cell cancers usually occur on the head and neck.

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35
Q

What is the Fitzpatrick Classification for skin type with the highest risk of burning?

A

Type I: White, freckles, very fair; always burns, never tans.

This classification helps in predicting skin cancer risk based on skin type.

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36
Q

True or False: Nonmelanoma skin cancers develop from melanocytes.

A

False.

Nonmelanoma skin cancers develop in the basement membrane of the skin.

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37
Q

Fill in the blank: The potential for severe local destruction, disfigurement, and disability is associated with _______.

A

nonmelanoma skin cancers.

While there are few deaths, these cancers can have serious consequences.

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38
Q

What is the incidence of skin cancer among Blacks, Asians, and Hispanics compared to other groups?

A

Lower incidence than Caucasians

Melanoma in dark-skinned persons often goes unrecognized until advanced stages.

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39
Q

What increases the risk of melanoma in dark-skinned individuals?

A

History of dysplastic nevi and lower levels of vitamin D

Less protection against UV radiation.

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40
Q

What is Actinic Keratosis (AK) characterized by?

A

Irregularly shaped, flat, slightly red papule with indistinct borders and hard keratotic scale

AK can be impossible to distinguish from squamous cell cancer.

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41
Q

How is Basal Cell Carcinoma (BCC) described?

A

Locally invasive cancer arising from epidermal basal cells, most common but least deadly skin cancer

Typically occurs in middle-aged to older adults.

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42
Q

Where do most BCCs occur?

A

Head and neck area, followed by trunk and extremities

Sun-exposed areas are most affected.

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43
Q

What are the main risk factors for Squamous Cell Carcinoma (SCC)?

A

Sun exposure, immunosuppression after organ transplant, smoking

SCC can be aggressive and has the potential to metastasize.

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44
Q

What is the significance of a biopsy in suspected SCC?

A

A biopsy should always be done when a lesion is thought to be SCC

It helps confirm the diagnosis.

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45
Q

What is the ABCDE rule used for?

A

To evaluate suspicious skin lesions for melanoma

It assesses Asymmetry, Border, Color, Diameter, and Evolving characteristics.

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46
Q

What is the cornerstone of skin assessment for melanoma?

A

Dermoscopy examination

It helps determine if a lesion should be biopsied.

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47
Q

What does the Breslow measurement assess?

A

Tumor thickness in millimeters

It is the most important prognostic factor for melanoma.

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48
Q

What is the prognosis for melanomas less than 1 mm thick?

A

Small chance of spreading

Thicker melanomas have a greater chance of metastasizing.

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49
Q

What is melanoma primarily caused by?

A

UV radiation from the sun and artificial sources

It damages the DNA in skin cells.

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50
Q

What is the initial treatment for melanoma?

A

Wide surgical excision

Additional therapy may be required if it has spread.

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51
Q

What is the 5-year survival rate for advanced melanoma?

A

Around 27%

This rate significantly worsens with deep tumors or lymph node involvement.

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52
Q

What is Actinic Keratosis?

A

A premalignant skin condition caused by sun damage, characterized by flat or elevated, dry, hyperkeratotic scaly papules, often multiple

Common in older Whites and may recur even with adequate treatment.

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53
Q

What are the clinical manifestations of Actinic Keratosis?

A

• Flat or elevated, dry, hyperkeratotic scaly papule
• Often multiple
• Rough adherent scale on red base
• Often found on sun-exposed areas

Can be rough or wart-like.

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54
Q

What treatments are available for Actinic Keratosis?

A

• Excision
• Cryosurgery
• Laser
• Chemical peel
• Topical fluorouracil
• Imiquimod
• Ingenol mebutate
• Photodynamic therapy

Recurrence is possible even with adequate treatment.

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55
Q

What are Atypical or Dysplastic Nevi?

A

Morphologically between common acquired nevi and melanoma, may be a precursor of melanoma

Often >5 mm with irregular borders and varying colors.

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56
Q

What are the characteristics of Atypical or Dysplastic Nevi?

A

• Often >5 mm
• Irregular border, possibly notched
• Varying colors within a single mole
• Central part often raised

Most common on the back but can occur in unusual sites.

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57
Q

What is Basal Cell Carcinoma?

A

A slow-growing tumor related to sun exposure, characterized by changes in basal cells with no maturation or normal keratinization

Metastasis is rare with a 90% cure rate for primary lesions.

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58
Q

What is the prognosis for Basal Cell Carcinoma?

A

Metastasis is rare, and there is a 90% cure rate with primary lesions

Early detection and treatment are crucial.

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59
Q

What is Cutaneous T-Cell Lymphoma?

A

A localized chronic skin disease possibly related to environmental toxins, with Mycosis fungoides as the most common form

Prevalence is higher in men, and the disease course is unpredictable.

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60
Q

What are the main characteristics of Melanoma?

A

Neoplastic growth of melanocytes anywhere on skin, eyes, or mucous membranes, with a correlation between survival rate and depth of invasion

Poor prognosis unless diagnosed and treated early.

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61
Q

What are the classic stages of Melanoma?

A

• Patch (early)
• Plaque
• Tumor (advanced)

Each stage indicates progression in disease severity.

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62
Q

What symptoms are associated with Melanoma?

A

• Irregular color, surface, and border
• Variegated color (red, white, blue, black, gray, brown)
• Itching
• Lymphadenopathy

Often <1 cm in size, with specific common sites differing by gender.

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63
Q

What treatments are available for Melanoma?

A

• Surgical excision
• Sentinel lymph node evaluation
• Adjuvant therapy (if lesion >1.5 mm)
• Immunotherapy
• Targeted therapy

Key adjuvant therapies include cytokines and inhibitors.

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64
Q

Fill in the blank: The most common site for Melanoma in males is the _______.

A

back

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65
Q

True or False: Melanoma can spread through local extension, regional lymphatic vessels, and bloodstream.

A

True

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66
Q

What is Squamous Cell Carcinoma (SCC)?

A

Cancer of squamous cell of epidermis.

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67
Q

Where does Squamous Cell Carcinoma often occur?

A

On previously damaged skin.

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68
Q

What are the clinical manifestations of early Squamous Cell Carcinoma?

A

Firm nodules with indistinct borders, scaling, ulceration.

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69
Q

What are the clinical manifestations of late Squamous Cell Carcinoma?

A

Covering of lesion with scale or horn from keratinization, ulceration.

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70
Q

What is the cure rate of Squamous Cell Carcinoma with early detection and treatment?

A

High cure rate.

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71
Q

What treatments are available for metastatic Squamous Cell Carcinoma?

A

Immunotherapy for metastatic lesions.

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72
Q

What is the common location for Squamous Cell Carcinoma?

A

Sun-exposed areas such as face and hands.

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73
Q

What is an Atypical or Dysplastic Nevus?

A

Larger than usual nevi with irregular borders and various shades of color.

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74
Q

What is the increased risk of developing melanoma with Dysplastic Nevi?

A

The more DN a person has, the higher the risk; 10 or more DN increases risk by 12 times.

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75
Q

What is the role of immunotherapy in melanoma treatment?

A

Enhances immune response against melanoma cells.

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76
Q

What are some anti-PD-1 agents used in melanoma treatment?

A
  • Nivolumab (Opdivo) * Pembrolizumab (Keytruda)
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77
Q

What are BRAF and MEK inhibitors used for?

A

Targeted therapy for melanoma.

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78
Q

What is the function of the BRAF gene in melanoma?

A

Signals melanoma cells to proliferate.

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79
Q

What chemotherapy drugs are used for advanced melanoma?

A
  • Dacarbazine * Temozolomide
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80
Q

True or False: Chemotherapy is highly effective for melanoma.

A

False.

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81
Q

What is the role of radiation therapy in melanoma treatment?

A

Treating lymph node and brain metastases.

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82
Q

What is the size of a Dysplastic Nevus?

A

Greater than 5 mm across.

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83
Q

What are the ABCDE characteristics in reference to moles?

A

Characteristics that may indicate melanoma.

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84
Q

What is the Breslow measurement used for?

A

To report tumor thickness.

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85
Q

What cytokines are mentioned for immunotherapy?

A
  • a-interferon * Interleukin-2
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86
Q

What is the effect of PD-1 inhibitors?

A

Boost the immune response against melanoma cells.

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87
Q

Fill in the blank: Dysplastic nevi may have the same _______ characteristics as melanoma.

A

ABCDE

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88
Q

What are the main types of bacteria that cause primary and secondary skin infections?

A

Staphylococcus aureus and group A B-hemolytic streptococci

These bacteria can lead to conditions like impetigo, erysipelas, and cellulitis.

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89
Q

What skin conditions can Staphylococcus aureus cause?

A

Impetigo, folliculitis, cellulitis, and furuncles

These conditions are common results of infections caused by this bacterium.

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90
Q

What viral infections are commonly associated with the skin?

A

Herpes simplex, herpes zoster, and warts

These are among the most common viral infections affecting the skin.

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91
Q

What are the two common types of contact dermatitis?

A

Irritant contact dermatitis and allergic contact dermatitis

These types differ in their causes and responses.

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92
Q

What is the primary cause of irritant contact dermatitis?

A

Direct chemical injury to the skin

This type occurs due to exposure to irritants.

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93
Q

What is the primary treatment for allergic dermatitis?

A

Avoid known irritants

Identifying and eliminating exposure to allergens is crucial.

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94
Q

Fill in the blank: The lesions in Stevens-Johnson syndrome (SJS) start as

A

a red, macular rash with purpuric centers.

The rash typically evolves and can lead to blisters and skin detachment.

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95
Q

What are the systemic symptoms that can precede skin findings in SJS/TEN?

A

Fever, cough, headache, anorexia, myalgia, and nausea

These symptoms may appear 1 to 3 days before skin lesions develop.

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96
Q

What are the three classifications of the severity of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)?

A

SJS, SJS-TEN overlap, and TEN

These classifications depend on the percentage of total body surface area affected.

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97
Q

True or False: Most fungal infections of the skin are harmful in healthy adults.

A

False

While they may cause embarrassment and distress, they are generally harmless.

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98
Q

What does a microscopic examination showing hyphae in a skin scraping indicate?

A

A fungal infection

Hyphae are thread-like structures characteristic of fungal infections.

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99
Q

What is a common preventive measure against insect bites?

A

Using repellents and maintaining meticulous hygiene

These practices can reduce the incidence of infestations and bites.

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100
Q

What role do allergies play in reactions to insect bites?

A

An allergy to the venom can play a key role in the reaction

This can lead to varying degrees of hypersensitivity.

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101
Q

What is the most important action in caring for a patient with SJS/TEN?

A

Identifying and stopping the offending drug(s)

This is crucial to halt the progression of the disease.

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102
Q

Fill in the blank: Fungal infections can infect the skin, hair, and _______.

A

nails

This highlights the broad impact of fungal infections.

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103
Q

What is the common treatment for skin drug reactions like SJS and TEN?

A

Supportive care, including airway management and fluid replacement

These interventions are vital for patient recovery.

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104
Q

What can prompt, routine skin inspection help prevent?

A

Tick bites and related diseases such as Lyme disease

Regular inspections are particularly important in areas at risk for tick exposure.

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105
Q

What is a carbuncle?

A

Multiple, interconnecting furuncles with many pustules in a reddened area, most common at the nape of the neck.

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106
Q

What are the clinical manifestations of cellulitis?

A

Hot, tender, red, edematous area with diffuse borders; may include chills, malaise, and fever.

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107
Q

What is the usual causative agent of cellulitis?

A

Staphylococcus aureus and streptococci.

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108
Q

What is erysipelas?

A

A superficial cellulitis mainly involving the dermis, presenting as a red, hot, sharply demarcated plaque.

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109
Q

What is the potential complication of erysipelas?

A

Bacteremia.

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110
Q

What bacteria commonly cause folliculitis?

A

Usually staphylococci.

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111
Q

Fill in the blank: Folliculitis has an increased incidence in patients with _______.

A

diabetes.

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112
Q

What are the common treatment methods for a furuncle?

A

Incision and drainage, warm moist compresses, systemic antibiotics.

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113
Q

What are the symptoms of furunculosis?

A

Lesions similar to furuncles, malaise, regional adenopathy, fever.

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114
Q

What is impetigo?

A

A contagious infection with vesiculopustular lesions that develop thick, honey-colored crust surrounded by redness.

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115
Q

What is the most common location for impetigo?

A

Face as a primary infection.

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116
Q

What are the topical treatments for impetigo?

A

Incision and drainage, warm moist compresses, antimicrobial cream, and antiseptic measures.

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117
Q

What systemic antibiotics are often used for widespread infections of impetigo?

A

Systemic antibiotics like cephalexin, doxycycline, dicloxacillin, or clindamycin.

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118
Q

Furuncles are often associated with

A

severe acne or seborrheic dermatitis.

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119
Q

What is a common characteristic of a furuncle?

A

Tender, red, painful area around hair follicle with draining pus.

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120
Q

What is the main goal of treatment for folliculitis?

A

To relieve symptoms and prevent further infection.

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121
Q

What is the typical healing outcome for folliculitis?

A

Usually heals without scarring.

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122
Q

What are the common areas affected by folliculitis?

A

Scalp, beard, and extremities in men.

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123
Q

What is the most common benign skin problem?

A

Acne

Other common benign skin problems include psoriasis and seborrheic keratoses.

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124
Q

What is psoriasis?

A

A chronic autoimmune disease affecting around 7.5 million Americans

It is fairly common and affects men and women at equal rates, with the highest occurrence in Whites.

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125
Q

At what age does psoriasis usually develop?

A

15 to 35 years old.

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126
Q

What percentage of people with psoriasis have at least one relative with the disease?

A

One-third.

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127
Q

What are some health conditions associated with psoriasis?

A
  • Metabolic syndrome
  • Heart disease
  • Type 2 diabetes
  • Psoriatic arthritis
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128
Q

What is the most common form of psoriasis?

A

Plaque psoriasis.

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129
Q

How are lesions of plaque psoriasis characterized?

A

Red, scaling papules that merge to form plaques with adherent silver scales.

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130
Q

What areas of the body are commonly affected by psoriasis plaques?

A
  • Knees
  • Elbows
  • Scalp
  • Hands
  • Feet
  • Lower back
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131
Q

What is the primary goal of psoriasis treatment?

A

Varies from improved quality of life to complete disease resolution.

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132
Q

How can psoriasis affect a person’s emotional health?

A

It erodes self-image, leading to self-consciousness, social withdrawal, and depression.

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133
Q

What is isotretinoin used for?

A

To treat acne.

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134
Q

What are the serious precautions associated with isotretinoin?

A
  • Can cause serious damage to fetus
  • Contraindicated in pregnant women or those wanting to become pregnant
  • Cannot donate blood during and for 1 month after treatment
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135
Q

What are some side effects of phototherapy?

A
  • Nausea
  • Itching
  • Redness
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136
Q

What is the role of methoxsalen in phototherapy?

A

It is combined with UVA light (PUVA) for treatment.

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137
Q

How often are phototherapy treatments generally given?

A

2 to 3 times a week.

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138
Q

True or False: Psoriasis is more physically disabling than emotionally disabling for most patients.

A

False.

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139
Q

Fill in the blank: Psoriasis is associated with _______.

A

[metabolic syndrome, heart disease, type 2 diabetes, psoriatic arthritis].

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140
Q

What are the two types of Herpes Simplex Virus (HSV)?

A

HSV-1 and HSV-2

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141
Q

How long before symptoms occur after contact with HSV?

A

Symptoms occurring 2 days to 2 weeks after contact

142
Q

What factors can worsen Herpes Simplex Virus infections?

A
  • Sunlight
  • Trauma
  • Menses
  • Stress
  • Systemic infection
143
Q

How is recurrent HSV infection characterized?

A

Recurrence in similar spot with grouped vesicles on reddened base

144
Q

What is Herpes Zoster commonly known as?

A

Shingles

145
Q

What is the primary cause of Herpes Zoster?

A

Activation of the varicella-zoster virus

146
Q

How does the incidence of Herpes Zoster change with age?

A

Incidence increases with age

147
Q

What are the common clinical manifestations of Herpes Zoster?

A
  • Grouped vesicles and pustules
  • Burning, pain, and neuralgia preceding outbreak
  • Usually unilateral
148
Q

What is the recommended treatment for Herpes Zoster?

A
  • Antiviral agents (e.g., acyclovir, famciclovir, valacyclovir)
  • Analgesia
  • Vaccine (Zostavax) for prevention
149
Q

What causes plantar warts?

A

Human papillomavirus (HPV)

150
Q

What are common treatments for plantar warts?

A
  • Topical immunotherapy (imiquimod)
  • Cryosurgery
  • Salicylic acid
  • Duct tape
151
Q

What characterizes a verruca vulgaris?

A

Caused by HPV, may disappear spontaneously in 1-2 years

152
Q

What is the common treatment for actinic keratoses?

A

Phototherapy

153
Q

Fill in the blank: The immunosuppressive effects of PUVA increase the risk for _______.

A

[SCC, BCC, and melanoma]

154
Q

What is photodynamic therapy used to treat?

A

AK and some skin cancers

155
Q

What is the mechanism of action for photodynamic therapy?

A

The drug reacts with oxygen upon light application, killing target cells

156
Q

What should patients receiving PUVA wear to protect against UV light?

A

Prescription goggles that block 100% of UV light

157
Q

True or False: Plantar warts are usually painless.

A

False

158
Q

What is a common characteristic of warts?

A

Cone shaped with black dots (thrombosed vessels) when wart removed

159
Q

What should be taught to a patient preparing for phototherapy for actinic keratoses?

A

Importance of sun protection and monitoring lesions for changes

160
Q

What are the common clinical manifestations of bedbug bites?

A

Wheal surrounded by vivid flare, firm hives transforming into persistent lesions, often grouped in threes appearing on uncovered parts of the body

Bedbugs are typically present in furniture and walls during the day and bite at night.

161
Q

Which species are referred to as Hymenoptera?

A

Bees and wasps

These insects can cause intense, burning, local pain, swelling, and itching.

162
Q

What are the types of lice mentioned in the text?

A
  • Pediculus humanus var. capitis (head lice)
  • Pediculus humanus var. corporis (body lice)
  • Phthirus pubis (pubic lice)

These parasites suck blood and lay eggs on skin and hair.

163
Q

What causes scabies?

A

Sarcoptes scabiei

The mite penetrates the stratum corneum and deposits eggs, leading to an allergic reaction.

164
Q

How is scabies transmitted?

A

By direct physical contact and sometimes by shared personal items

It is rarely seen in dark-skinned people.

165
Q

What is the causative agent of Lyme disease?

A

Borrelia burgdorferi

This spirochete is transmitted by ticks in certain endemic areas.

166
Q

What are the common symptoms of Lyme disease?

A
  • Spreading, ring-like rash
  • Flu-like symptoms
  • Possible cardiac, arthritic, and neurologic manifestations

The rash is common in groin, buttocks, axillae, trunk, and upper arms and legs.

167
Q

What is the primary treatment for Lyme disease?

A

Oral antibiotics, such as doxycycline

IV antibiotics may be necessary for arthritic, neurologic, and cardiac symptoms.

168
Q

What are the main adverse effects of radiation therapy?

A
  • Permanent hair loss (alopecia)
  • Telangiectasia
  • Atrophy
  • Changes in pigmentation
  • Ulceration
  • Hearing loss
  • Eye damage
  • Mucositis

Adverse effects depend on the location and dose of radiation delivered.

169
Q

What is total body skin radiation used to treat?

A

Cutaneous T-cell lymphoma

This treatment follows a lengthy course and causes premature skin aging.

170
Q

Fill in the blank: The __________ is used for palliative pain control in melanoma.

A

radiation therapy

171
Q

True or False: Radiation therapy requires multiple visits to a radiology department.

A

True

172
Q

What is a potential complication of radiation therapy around the eyes?

A

Lens damage

Shielding is needed to prevent this damage.

173
Q

What is Candidiasis commonly caused by?

A

Candida albicans

Candidiasis is also known as moniliasis and affects various body areas.

174
Q

What are the clinical manifestations of Candidiasis in the mouth?

A

White, cheesy plaque resembling milk curds

50% of adults are symptom-free carriers.

175
Q

What are common symptoms of vaginal Candidiasis?

A

Vaginitis with red, edematous, painful vaginal wall and white patches

Symptoms include itching and pain on urination and intercourse.

176
Q

Where does Candidiasis typically appear?

A

Warm, moist areas such as groin, oral mucosa, and submammary folds

177
Q

What is Tinea Corporis commonly known as?

A

Ringworm

178
Q

What is the typical appearance of Tinea Corporis?

A

Annular (ring-like) scaly appearance with well-defined margins

179
Q

What is Tinea Cruris commonly referred to as?

A

Jock itch

180
Q

What is Tinea Pedis commonly known as?

A

Athlete’s foot

181
Q

What are the clinical manifestations of Tinea Pedis?

A

Interdigital scaling and maceration, scaly plantar surfaces, sometimes with redness and blistering

May be itchy and painful.

182
Q

What is Tinea Unguium also known as?

A

Onychomycosis

183
Q

What are the symptoms of Tinea Unguium?

A

Scaliness under distal nail plate, brittle, thickened, broken, or crumbling nails with yellowish discoloration

184
Q

What is the incidence of Tinea Unguium related to?

A

Increases with age

185
Q

What is the main treatment for Tinea Unguium?

A

Oral antifungal (terbinafine, Lamil, traconazole)

Topical antifungal cream has minimal effectiveness if unable to tolerate systemic treatment.

186
Q

What is the role of laser technology in skin treatment?

A

Efficient treatment for many types of skin problems

187
Q

What can lasers do in surgical use?

A

Cut, coagulate, and vaporize tissue

188
Q

What is the most common type of laser used in skin treatment?

A

CO2 laser

189
Q

What does the argon laser primarily treat?

A

Vascular and other pigmented lesions

190
Q

What are some common OTC topical antibiotics?

A
  • Bacitracin-neomycin-polymyxin (Neosporin)
  • Bacitracin
  • Polymyxin B
191
Q

What is mupirocin used for?

A

Superficial Staphylococcus infections such as impetigo

192
Q

What are commonly used oral antibiotics for systemic infections?

A
  • Penicillin
  • Erythromycin
  • Doxycycline
  • Clindamycin
  • Linezolid
  • Vancomycin (drug of choice for severe infections)
193
Q

What are the effects of topical corticosteroids?

A

Local anti-inflammatory and antipruritic effects

194
Q

What should be considered before applying a corticosteroid preparation?

A

Try to diagnose a skin problem first

195
Q

What does the potency of a corticosteroid preparation depend on?

A

The concentration of the active drug

196
Q

What type of hypersensitivity is associated with Allergic Contact Dermatitis?

A

Type IV delayed hypersensitivity response

This type of hypersensitivity involves an immune response that occurs after sensitization to an antigen.

197
Q

What are the common clinical manifestations of Allergic Contact Dermatitis?

A
  • Red papules and plaques
  • Itching
  • Occasional vesicles
  • Appearance of lesions 2-7 days after contact with allergen

The lesions often take the shape of the causative agent.

198
Q

What is the main treatment approach for Atopic Dermatitis?

A
  • Topical or oral corticosteroids
  • Antihistamines
  • Skin lubrication
  • Elimination of contact allergen
  • Avoidance of irritating affected area
  • Systemic corticosteroids if sensitivity severe

Treatment may vary based on the severity and stage of the condition.

199
Q

What are the stages of Atopic Dermatitis?

A
  • Acute stage: Redness, oozing vesicles, extreme itching
  • Subacute stage: Scaly, light red to red-brown plaques with itching
  • Chronic stage: Thickened skin, lichenification, dry skin, itching

Stress reduction can help reduce flares.

200
Q

What is a common cause of Drug Reactions?

A

Any drug that acts as an antigen and causes hypersensitivity reaction

Certain drugs like penicillin are more likely to cause reactions.

201
Q

What are the characteristics of Urticaria (Hives)?

A
  • Redness and edema in upper dermis
  • Raised or irregularly shaped wheals
  • Can occur anywhere on the body
  • A single lesion usually resolves in 24 hours

Often triggered by an allergic event.

202
Q

What can be a potential side effect of long-term corticosteroid use?

A
  • Adrenal suppression
  • Skin atrophy
  • Capillary fragility
  • Rosacea
  • Acne
  • Bruising

Atrophy may not occur until the corticosteroid has been in use for 2 to 3 weeks.

203
Q

What is the most potent delivery system for a topical corticosteroid?

A

Ointment

Ointments allow for better absorption and effect compared to creams.

204
Q

What is the role of intralesional corticosteroids?

A

Injected directly into or just beneath the lesion

Provides a reservoir of medication with effects lasting several weeks to months.

205
Q

What are some common antihistamines used for treating allergic skin reactions?

A
  • Diphenhydramine
  • Loratadine (Claritin)
  • Fexofenadine (Allegra)
  • Cetirizine (Zyrtec)

Antihistamines can vary in their sedative effects and efficacy in controlling itching.

206
Q

True or False: Systemic corticosteroids are primarily used for long-term therapy in skin problems.

A

False

Systemic corticosteroids are generally reserved for short-term therapy for acute problems or severe diseases.

207
Q

Fill in the blank: Antihistamines with sedative effects, such as ________, may be better for itching.

A

diphenhydramine

Sedative effects can enhance symptom relief but may impair activities like driving.

208
Q

What is Acne Vulgaris?

A

An inflammatory disorder more common in teenagers that may begin and persist, with flares occurring with hormonal changes and before menses.

209
Q

What type of sensation may patients experience with immunomodulators?

A

Transient burning or feeling of heat at the application site.

210
Q

What is the purpose of skin scraping in dermatology?

A

To obtain a sample of surface cells for microscopic inspection and diagnosis.

211
Q

What are common tests performed on skin scrapings?

A
  • Mineral oil examination for scabies
  • 10% to 20% KOH for fungus.
212
Q

True or False: Electrodessication typically involves deeper tissue destruction than electrocoagulation.

A

False.

213
Q

What is topical fluorouracil used to treat?

A

Precancerous lesions, especially actinic keratosis (AK), and some skin cancers.

214
Q

What are common side effects of using topical fluorouracil?

A
  • Redness
  • Burning
  • Itching.
215
Q

Fill in the blank: Curettage involves the removal and scooping away of tissue using an instrument called a _______.

A

curette.

216
Q

What is the appearance of a lipoma?

A

A benign tumor that is encapsulated.

217
Q

What is punch biopsy used for?

A

To obtain a tissue sample for histologic study or to remove small lesions.

218
Q

What may occur within 1 to 3 weeks of topical fluorouracil application?

A

Painful, eroded areas over the damaged skin.

219
Q

What is the role of electrodessication and electrocoagulation in dermatology?

A

Coagulation of bleeding vessels and destruction of small vascular lesions.

220
Q

What is lentigo associated with?

A

Increased number of melanocytes in the basal layer due to aging.

221
Q

What should be done to reduce redness and itching after applying topical fluorouracil?

A

Apply a low-potency topical corticosteroid 20 minutes after dosing.

222
Q

What is the risk of minor electrosurgery on patients with pacemakers?

A

Electrical energy can affect both pacemakers and internal defibrillators.

223
Q

What types of lesions can be removed using curettage?

A
  • Warts
  • Actinic keratosis
  • Seborrheic keratosis
  • Small basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs).
224
Q

What is the typical appearance of acrochordons?

A

Common skin tags that appear on the trunk.

225
Q

What does the term ‘nevi’ refer to?

A

A group of melanocytic lesions commonly known as moles.

226
Q

What is Acne Vulgaris?

A

An inflammatory disorder of sebaceous glands

More common in teenagers and may persist into adulthood.

227
Q

What are the two types of lesions associated with Acne Vulgaris?

A
  • Noninflammatory lesions (open comedones, closed comedones)
  • Inflammatory lesions (papules, pustules)

Flare can occur with corticosteroids, androgen-dominant birth control pills, and before menses.

228
Q

Where is Acne Vulgaris most commonly found on the body?

A
  • Face
  • Neck
  • Upper back
229
Q

What is the primary treatment for Acne Vulgaris?

A
  • Topical benzoyl peroxide
  • Retinoids
  • Antimicrobials (clindamycin, minocycline, erythromycin)
  • Systemic antibiotics

Isotretinoin may provide lasting remission for severe nodulocystic acne.

230
Q

What are Acrochordons?

A

Commonly known as skin tags, small, skin-colored, soft, pedunculated papules

Common after midlife and often appear on neck, axillae, and upper trunk.

231
Q

What causes Lentigo?

A

Increased number of normal melanocytes in the basal layer of epidermis from sun exposure

Also known as ‘liver spots’ or ‘age spots’.

232
Q

What is a Lipoma?

A

A benign tumor of adipose tissue, often encapsulated

Most common in the 40- to 60-year-old age group.

233
Q

What is Psoriasis?

A

An autoimmune chronic dermatitis that involves very rapid turnover of epidermal cells

234
Q

What are the common features of Psoriasis?

A
  • Sharply demarcated silvery scaling plaques
  • Reddish skin often on scalp, elbows, knees, palms, soles, and fingernails
  • Symptoms vary in intensity

Usually develops before age 40 and has family predisposition.

235
Q

What is the goal of treating Psoriasis?

A

To reduce inflammation and suppress rapid turnover of epidermal cells

No cure, but control is possible.

236
Q

List some topical treatments for Psoriasis.

A
  • Corticosteroids
  • Tazarotene
  • Calcipotriene
  • Anthralin
  • Tacrolimus
  • Halobetasol propionate

Intralesional injection of corticosteroids may be used for chronic plaques.

237
Q

What systemic treatments are used for Psoriasis?

A
  • Natural or artificial UVB
  • PUVA (UVA with topical or systemic photosensitizer)
  • Traditional and oral therapies (methotrexate, retinoid, apremilast, cyclosporine)
  • Biologic therapies

Examples of biologic therapies include adalimumab, brodalumab, certolizumab pegol, among others.

238
Q

What is rosacea?

A

A common disorder of the central face with an unclear cause

Rosacea has four major subtypes.

239
Q

What are the four major subtypes of rosacea?

A
  • Erythematotelangiectatic (ETR)
  • Papulopustular (PPR)
  • Phymatous (PHY)
  • Ocular rosacea (OR)

Each subtype has distinct clinical manifestations.

240
Q

What are the clinical manifestations of Erythematotelangiectatic rosacea?

A
  • Telangiectasia
  • Redness
  • Flushing

Telangiectasia refers to thread-like red lines or patterns on the skin.

241
Q

What are the clinical manifestations of Papulopustular rosacea?

A
  • Redness
  • Flushing
  • Papules
  • Pustules

These symptoms can cause significant discomfort.

242
Q

What are the clinical manifestations of Phymatous rosacea?

A
  • Thickening of the skin
  • Hypertrophy of the nose

This subtype may lead to noticeable changes in facial appearance.

243
Q

What are the clinical manifestations of Ocular rosacea?

A
  • Tearing
  • Stinging
  • Itching
  • Dryness of the lids

Ocular rosacea can significantly impact eye comfort.

244
Q

What common factors can exacerbate rosacea?

A
  • Foods
  • Alcohol use
  • Smoking

Lifestyle factors often play a role in the severity of rosacea symptoms.

245
Q

What are some treatments for rosacea?

A
  • Ablative laser surgery
  • Minocycline
  • Trimethoprim/sulfamethoxazole
  • Topical treatments (e.g., sulfacetamide)

Treatment options vary depending on the severity and subtype.

246
Q

What are seborrheic keratoses?

A

Benign skin growths that usually occur after age 40, with an unknown etiology

They tend to increase in number with age.

247
Q

What is a characteristic appearance of seborrheic keratoses?

A

Well-defined shape, appearance of being ‘stuck on’

They can also increase in pigmentation over time.

248
Q

When is biopsy indicated for seborrheic keratoses?

A

If unable to distinguish from melanoma

Biopsy helps rule out more serious conditions.

249
Q

What is cryosurgery?

A

The use of subfreezing temperatures to destroy epidermal lesions

It is commonly used to treat warts, skin tags, and other lesions.

250
Q

What agent is most often used in cryosurgery?

A

Topical liquid nitrogen

It causes cell rupture during thaw, leading to cell death.

251
Q

What are some skin problems treated by laser?

A
  • Acne scars
  • Hair removal
  • Hemangiomas
  • Leg veins
  • Pigment discoloration
  • Pigmented nevi
  • Port wine stain
  • Psoriasis
  • Resurfacing of skin
  • Rosacea
  • Skin lesions
  • Tattoo removal
  • Vascular lesions
  • Warts
  • Wrinkles

Laser treatments offer a range of cosmetic and therapeutic benefits.

252
Q

What is the procedure for a punch biopsy?

A

Marking the biopsy area, anesthetizing it, rotating the punch, and removing a small cylinder of skin

Hemostasis is achieved with pressure or absorbable gelatin.

253
Q

What is Mohs surgery?

A

Microscopically controlled removal of skin cancer in thin horizontal layers

This technique helps ensure complete removal of cancerous tissue.

254
Q

What is the purpose of examining specimens in cancer treatment?

A

To see if any cancer cells remain after the first excision.

255
Q

What are the benefits of Mohs surgery?

A
  • Preserves normal tissue
  • Produces a smaller wound
  • Can completely remove cancer.
256
Q

True or False: Mohs surgery is typically performed under general anesthesia.

A

False

257
Q

What is the importance of a careful history in nursing management of skin problems?

A

It helps detect findings that could lead to identifying the cause of skin problems.

258
Q

What should patients be taught regarding the duration of skin treatment?

A

Skin problems may be slow to resolve, and they should follow package directions for OTC drugs.

259
Q

Fill in the blank: Wet compresses are often applied for _______.

A

[superficial skin problems that involve inflammation, itching, and infection]

260
Q

What are the initial steps in nursing management for skin problems?

A
  • Assess patient’s skin for acute and chronic problems
  • Assess risk factors
  • Document findings and develop a care plan.
261
Q

What should be considered when teaching patients about sun exposure?

A

Risks associated with sun exposure and methods for decreasing exposure.

262
Q

What is the recommended thickness for compress material when applying a wet compress?

A

4 to 8 layers thick.

263
Q

What type of water should be used for a wet compress?

A

Room temperature tap water, filtered, bottled, or sterile water if necessary.

264
Q

True or False: Continuous compresses can have solution added to them.

A

False

265
Q

How long should intermittent compresses be placed?

A

10-30 minutes, several times a day.

266
Q

What should be done if the skin appears macerated during treatment with compresses?

A

Stop the compresses for 2-3 days.

267
Q

What should be used to protect the mattress and linens during the application of compresses?

A

A water-resistant pad.

268
Q

What should be done with materials used repeatedly for wet compresses throughout the day?

A

Change and wash them daily.

269
Q

What types of therapies should nurses teach patients about for skin disorders?

A
  • Dressings
  • Baths
  • Oral or topical medications.
270
Q

What is crucial to evaluate after administering therapies for skin problems?

A

Treatment effectiveness and any adverse effects.

271
Q

What are common bases for topical medications?

A

Common bases include:
* Cream
* Gel
* Lotion
* Ointment
* Paste
* Powder
* Baths

Each base has specific properties that influence the effectiveness of the medication.

272
Q

What is the purpose of baths in skin treatment?

A

Baths help to decrease itching and can be relaxing for the patient.

Agents such as colloidal oatmeal and sodium bicarbonate can be added to bath water.

273
Q

Fill in the blank: To prevent increased irritation and inflammation, the patient should ______ the skin dry with a towel after a bath.

A

gently pat

274
Q

What should be applied after a bath to maintain skin hydration?

A

Cream, ointment, emollients, or other prescribed topical agents.

This helps seal moisture in the skin and increases absorption of topical agents.

275
Q

What factors influence hygienic practices?

A

The patient’s skin type, lifestyle, culture, age, and gender.

The normal acidity of the skin and perspiration protect against bacterial overgrowth.

276
Q

True or False: Most soaps are alkaline and can lead to a loss of skin protection.

A

True

277
Q

What is pruritus?

A

Pruritus is the sensation of itching.

It can be caused by various physical or chemical stimuli and is carried by nonmyelinated nerve fibers.

278
Q

What should older persons avoid to prevent skin dryness?

A

Harsh soaps and shampoos, and frequent bathing.

Older skin tends to be drier and requires gentler care.

279
Q

What is lichenification?

A

Lichenification is thickened skin marked by scratching or rubbing.

It often occurs with conditions like atopic dermatoses.

280
Q

What should be done to treat skin lesions with jewelry inserted?

A

Care for them with antibacterial soaps that do not contain sulfites.

281
Q

What is the role of wet compresses in treating pruritus?

A

Wet compresses help to decrease itching by hydrating the skin.

Apply for 30 to 60 minutes, then pat the skin dry and apply a lubricant.

282
Q

What is the main side effect of systemic antihistamines?

A

Sedation.

This can be beneficial at night when itching is often worse.

283
Q

Fill in the blank: Occlusion with a plastic wrap can increase the absorption of _______ or simple emollients.

A

topical corticosteroids

284
Q

What can trap perspiration against the outer layer of the epidermis?

A

Plastic wrap.

This helps to enhance the effectiveness of topical treatments.

285
Q

What should patients avoid to decrease the sensation of itching?

A

Anything that causes vasodilation, such as heat or rubbing.

286
Q

What is the purpose of applying topical agents in a downward motion?

A

To spread evenly in the direction of hair growth.

287
Q

What is lichenification?

A

Thickening of the skin due to chronic rubbing or scratching.

Common sites include the hands, forearms, shins, and nape of the neck.

288
Q

What are some common causes of itching that can lead to lichenification?

A

Dryness and irritation.

Preventing the cause of itching is key to preventing lichenification.

289
Q

What precautions should be taken to prevent the spread of skin infections?

A

Wear gloves when handling open wounds, practice hand washing, and dispose of dressings properly.

Most skin problems are not contagious, but precautions are still necessary.

290
Q

What are the most common contagious skin lesions?

A
  • Impetigo
  • Streptococcal infections
  • Staphylococcal infections (e.g., MRSA)
  • Fungal infections
  • Scabies
  • Pediculosis

Moist skin can increase the risk of these infections.

291
Q

What practices can minimize the risk of secondary infections in open skin lesions?

A

Meticulous hygiene, hand washing, and regular dressing changes.

Scratching can create portals for pathogens.

292
Q

What signs indicate a possible infection after a skin procedure?

A
  • Redness persisting longer than a week
  • Fever greater than 101°F
  • Increased pain
  • Pronounced swelling
  • Purulent drainage

These symptoms should be reported to the healthcare provider immediately.

293
Q

How should an oozing wound be cared for post-procedure?

A

Cleanse with saline solution twice daily and apply antibiotic ointment with a nonadherent secondary dressing.

Keeping wounds moist and covered promotes rapid healing.

294
Q

What is the typical timeline for suture removal?

A

4 to 14 days, depending on the site.

Sometimes alternating sutures are removed after the third day.

295
Q

What psychological effects can chronic skin problems have on patients?

A

Emotional stress, social and employment issues, poor self-image, and problems with sexuality.

The visibility of lesions can contribute to these issues.

296
Q

What types of cosmetics are recommended for patients with skin sensitivities?

A
  • Oil-free
  • Hypoallergenic

Rehabilitative cosmetics can help camouflage skin conditions like vitiligo and melasma.

297
Q

What are some common cosmetic procedures?

A
  • Chemical peels
  • Toxin injections
  • Fillers
  • Laser surgery
  • Breast enlargement/reduction
  • Face-lift
  • Liposuction

Transitory side effects may include mild redness, pain, and swelling.

298
Q

What are the most common reasons patients seek cosmetic procedures?

A

To improve body image and enhance self-confidence.

Economic considerations may also influence these decisions.

299
Q

What is laser surgery used to treat?

A

Congenital and acquired vascular lesions.

Examples include cherry angiomas and spider leg veins.

300
Q

What are common cosmetic topical procedures?

A
  • Chemical Peels
  • Tretinoin (Retin-A, Renova)
  • Microdermabrasion
  • A-Hydroxy Acids (e.g., Glycolic Acid, Lactic Acid)

These procedures are used to improve the appearance of the skin.

301
Q

What is the indication for Chemical Peels?

A

Improves appearance of photodamaged skin, especially fine wrinkling and reduces actinic keratoses

Chemical peels can include various acids like Jessner and TCA.

302
Q

What is the primary effect of Microdermabrasion?

A

Smooths appearance of photodamaged and wrinkled skin, acne scarring

It also improves appearance of actinic and seborrheic keratoses.

303
Q

What are the side effects of Tretinoin?

A
  • Redness
  • Swelling
  • Flaking
  • Pigmentation changes
  • Teratogenic effects
  • Increased phototoxicity with photosensitive drugs

Tretinoin is often applied at night due to light inactivation.

304
Q

What patient teaching is recommended for Tretinoin use?

A

Apply at night, use emollients, sunscreen, and avoid abrasive facial cleansers

This is important to manage severe sensitivity.

305
Q

What is the main purpose of a face-lift (rhytidectomy)?

A

The lifting and repositioning of the lower two-thirds of the face and neck to improve appearance

Indications include redundant soft tissue, asymmetric redundancy, trauma, and solar elastosis.

306
Q

What are common complications associated with cosmetic surgery?

A

Complications can occur if the person smokes or does not follow activity restrictions

Proper postoperative care is essential to minimize risks.

307
Q

What is the purpose of liposuction?

A

To remove subcutaneous fat to improve facial and body contours

It is not a substitute for diet and exercise.

308
Q

What are the contraindications for liposuction?

A
  • Use of anticoagulants
  • Uncontrolled hypertension
  • Diabetes
  • Poor cardiovascular status

Younger patients with good skin elasticity are better candidates.

309
Q

How is liposuction typically performed?

A

Under local anesthesia, a blunt-tipped cannula is inserted through a small incision to break loose fat and remove it with suction

Multiple sessions may be necessary depending on the area.

310
Q

What is the healing process after liposuction?

A

Firm pressure is applied to the wounds until drainage stops, and results may take several months to be evident

Postoperative care is crucial for optimal results.

311
Q

True or False: Antibiotics are always used after a face-lift procedure.

A

False

Antibiotics are used at the healthcare provider’s discretion.

312
Q

What is a major consideration before cosmetic surgery?

A

Informed consent and realistic expectations.

313
Q

True or False: A face-lift effectively reduces deep wrinkles on the forehead and temples.

A

False.

314
Q

What should be reviewed with patients regarding healing after surgery?

A

The timeframe for healing.

315
Q

What should patients expect regarding the final results of cosmetic procedures?

A

Healing may take up to 1 year and results are affected by age, health, and skin type.

316
Q

What is the typical pain management after cosmetic procedures?

A

Mild analgesics.

317
Q

What should patients be taught to recognize after surgery?

A

Signs and symptoms of infection.

318
Q

What indicates adequate circulation in the surgical area postoperatively?

A

Warm, pink skin that blanches on pressure.

319
Q

What are the uses of skin grafts?

A

To protect underlying structures, reconstruct areas, facilitate rapid closure, and minimize complications.

320
Q

What is the ideal healing method for wounds?

A

Healing by primary intention.

321
Q

What are the two types of traditional skin grafts?

A

Free grafts and skin flaps.

322
Q

What is an autograft?

A

A graft taken from the patient’s own body.

323
Q

What is the method of free skin grafting that uses an operating microscope?

A

Reconstructive microsurgery.

324
Q

What are skin flaps used for?

A

To cover wounds with a poor vascular bed, provide padding, and cover wounds over cartilage and bone.

325
Q

What is soft tissue expansion used for?

A

To provide skin for resurfacing defects, removal of disfiguring marks, or as a preliminary step in breast reconstruction.

326
Q

In soft tissue expansion, what is placed under the skin?

A

A subcutaneous tissue expander.

327
Q

How often can saline solution be used for expansion in soft tissue expansion?

A

Weekly.

328
Q

What is the primary tissue characteristic of the tissue expander next to a defect?

A

Color and texture.

329
Q

What are engineered skin substitutes?

A

Engineered skin substitutes are products like Apligraf, Dermagraft, and Integra that are gaining popularity, each with its own indications and benefits.

330
Q

What are the characteristics of 2-layered engineered skin substitutes?

A

They have both dermal and epidermal components.

331
Q

From what sources are skin substitutes engineered?

A

Skin substitutes are engineered from neonatal foreskins and cadavers.

332
Q

What structures do skin substitutes lack?

A

Skin substitutes do not contain structures such as Langerhans cells, macrophages, and lymphocytes.

333
Q

What are the advantages of using engineered skin substitutes?

A

Advantages include:
* Ready availability
* No donor site
* Use in outpatient settings
* Minimal scarring
* Less pain

334
Q

What is the age and profile of patient G.L.?

A

G.L. is a 48-year-old White, fair-skinned man who is a long-distance truck driver.

335
Q

What leisure activities does G.L. enjoy?

A

G.L. enjoys swimming and bicycling.

336
Q

What is G.L.’s medical history related to skin cancer?

A

He has a history of basal cell cancer (BCC) on his left ear in the last 4 years.

337
Q

What familial history does G.L. have regarding melanoma?

A

His father was treated for metastatic melanoma in the past 2 years.

338
Q

What changes did G.L. notice about his lesion?

A

He first noted the lesion 1 month ago when it started changing size.

339
Q

What are the characteristics of G.L.’s lesion?

A

The lesion is 4-mm, deep brown, scalloped with vaguely defined borders.

340
Q

How many dysplastic nevi were found on G.L.’s back?

A

5 dysplastic nevi were found on his back.

341
Q

What did the excisional biopsy confirm about G.L.’s condition?

A

The excisional biopsy confirmed superficial spreading melanoma.

342
Q

What were the results of the sentinel node biopsy?

A

The sentinel node biopsy results were negative.

343
Q

What stage is G.L.’s melanoma?

A

Melanoma stage I.

344
Q

What is one risk factor for melanoma that G.L. has?

A

G.L. has a history of basal cell cancer.

345
Q

What manifestations of melanoma are present in G.L.?

A

A changing lesion on the left arm and dysplastic nevi.

346
Q

What is the prognosis for a patient with stage I melanoma?

A

The prognosis is generally favorable.

347
Q

What treatment options are available for G.L.?

A

Options include surgical removal of the melanoma.

348
Q

What is the priority of care for G.L.?

A

To manage his anxiety regarding treatment outcomes.

349
Q

What are the priority clinical problems for G.L. based on the assessment data?

A

Anxiety and concerns about the melanoma.

350
Q

How can G.L. be helped to deal with his anxiety over treatment outcomes?

A

Providing reassurance and clear information about the treatment process.

351
Q

What should be included in G.L.’s teaching plan regarding future sun exposure?

A

Advice on protecting skin from sun damage.

352
Q

Which safe sun practices should be included in a teaching plan for a patient with photosensitivity? (select all that apply)

A
  • Wear protective clothing
  • Apply sunscreen liberally and often

Med Surge Integumentary (7 decks)

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