Quiz 1 Flashcards
Define “Integumentary System”
- Skin, appendages, hair/hair follicles, nails, glands (apocrine sweat glands, eccrine sweat glands, sebaceous glands)
What are the 5 layers of the Epidermis and their functions?
- Stratum Corneum - (dead keratinocytes)
- Stratum Lucidum - only present in thick skin (i.e. palms and soles of the feet)
- Stratum Granulosum
- Stratum Spinosum
- Stratum Basale - host keratinocytes, Langerhans’ cells (immune), melanocytes (produce melanin), and Merkel cells (mechanoreceptors – light touch)
What are the GENERAL functions of the skin?
- First barrier against infection & foreign substances
- Retains moisture
- Provides light touch sensation
- Assists with thermoregulation (i.e. sweat & goose bumps)
- Assists with excretion (sweat)
- Assists with vitamin D production
- Contributes to cosmesis/appearance/identity
What is the Basement Membrane Zone? Purpose?
- Where the epidermis meets the dermis
- Purpose: increases surface area and reduces shear forces
About how many days does it take keratinocytes to travel from the basale layer to the lucidum layer?
28 days
What are the 2 layers of the Dermis?
- Papillary Dermis (highly vascularized)
- Reticular Dermis (Deep layer that contains appendages; 80% of dermis)
Protein fibers in the dermis contain what?
- Collagen, Elastin and Reticular
What are the functions of the Dermis?
• Supports and nourishes epidermis • Assists with infection control - Houses mast cells and macrophages • Assists with thermoregulation • Houses skin appendages • Provides sensation • Temperature regulation
What does the subcutaneous layer consist of?
- Adipose tissue, loose CT and fascia, fibrous CT
- Contains blood vessels, lymphatics, nerves, mechanoreceptors (Ruffini endings, Pacinian corpuscles)
What are the functions of the subcutaneous layer?
- Thermal insulation
- Energy/stores calories
- Cushioning
What are the stages of wound healing?
- Hemostasis
- Inflammation
- Repair
- Remodel
During hemostasis, what is the platelet plug?
Retraction and sealing off of blood vessels
During hemostasis, what is the fibrin clot?
A stable matrix of fibrinogen that serves as a structure for other cells during the wound healing process (platelets are reabsorbed into bloodstream)
What are the 5 cardinal signs of inflammation?
- Pain
- Erythema
- Swelling
- Calor (increased temperature)
- Loss of function
How long does the inflammation stage last?
4-6 days
What cells are present during the inflammation stage?
- Mast cells (histamine)
- Neutrophils – “fight infection”
- Macrophages – converted from monoctyes; perform phagocytosis
- Lymphoctyes
What happens during the repair stage?
Granulation
Wound Contraction (around day 4)
Epithelialization
When does the remodeling stage occur?
Day 8 through 1 year
Identify the positive or negative LOCAL factors that affect healing
pH (incontinence potential acidity) Local ischemia Moisture Repeated trauma Infection
Identify SYSTEMIC factors that affect healing
Age
Comorbidities
Medications
• Steroids, anticoagulants, immunosuppression
Blood flow (perfusion & oxygenation) bad for smokers!
Infection
Nutrition – need protein, vitamin C (critical for collagen cross-linkage & tensile strength), zinc, and iron
Stress
Describe the following anatomy of the normal artery: trilaminar structures, tunica intima, media and adventitia
o Tri-laminar structures
o Tunica intima – endothelial cells, which maintain blood in liquid state
o Tunica media – contribute to structural integrity
o Tunica adventitia – outermost layer, which contains collagen fibrils that contribute to the strength of an artery
Discuss the physiology of large, medium and small arteries
This is an objective, but no relevant answer persists in the slideshow
Discuss the pathophysiology of atherosclerosis
o Proliferative disease affecting cells that make up the intima
o Associated with LDLs and thrombi
o Occurs in large/midsize arteries at certain points in the arterial tree
o Now thought of as a series of progressive acute events
o Smooth muscle proliferation
What are the risk factors for PAD?
o Cigarette smoking o DM o Hypertension o Hypercholesterolemia o Hyperhomocysteinemia o Chronic kidney disease o Insulin resistance o C-reactive protein o More prevalent in men than in women
Intermittent claudication is the cardinal sign of what?
PAD
A patient with critical leg ischemia will tell you what during Hx?
- Leg pain worsens with elevation
- Paresthesia
- Sleeps with legs over the side of the bed
How do you document pulse?
0 = absent 1+ = faint 2+ = diminished 3+ = normal 4+ = bounding
An ABI below what number is indicative of MODERATE arterial disease?
0.8
Where do venous skin ulcers most commonly occur?
- malleolar area
What are some useful imaging techniques for PAD?
o Bilateral Lower Extremity Duplex Ultrasound
o MRI Angiography
What is the #1 suggestion for management of PAD?
Stop smoking, you asshole
Define DM Type 1 and 2
o Type I = typically juvenile onset; you do not produce insulin thus you HAVE to take insulin
o Type II = insulin-resistance à you MAKE insulin but you’re body doesn’t use it. NOT due to a lack of insulin
What are some prevention strategies for Typed 2 diabetes?
Physical activity Nutrition/ Diet Weight Management Control Stress AVOID USING TOBACCO (causes insulin resistance)
5 most common meds for DM
Biguanides (Metformin) Insulin secretagogues Thiazolidinediones DPPIV inhibitors α-Glucosidase inhibitors
For diagnosis of diabetes, a fasting glucose level has to be …
≥ 7.0 mM (126 mg/dL)
Describe complications of DM including: nephropathy, retinopathy & neuropathy
o Nephropathy - Renal dysfunction/renal failure
o Retinopathy - Impaired/absent vision
o Neuropathy - Impaired/absent sensation
Outline factors leading to the development of diabetic/neuropathic ulcers
o Poor sensation/neuropathy
o Poor wound healing
Discuss how exercise impacts insulin action/blood glucose concentrations
o Increases insulin sensitivity
o Stimulates glucose uptake in skeletal muscle
Discuss the interplay of mood/mental health and diabetic incidence and outcomes
Mood spectrum disorders are associated with serious endocrine/metabolic co-morbidities such as Bipolar disorder Schizophrenia Depression PTSD Anxiety
