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Integumentary Systems > Quiz 1: Lecture 1-4 > Flashcards

Quiz 1: Lecture 1-4 Flashcards

1
Q

List the layers of the skin from superficial to deep

A

Epidermis, dermis, subcutaneous tissue (hypodermis)

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2
Q

PT decision making consists of…

A

Refer, consult, co-manage, retain

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3
Q

What are the 5 layers within the epidermis?

A

Stratum corneum, Stratum lucidum, Stratum granulosum, Stratum spinosum, Stratum basale

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4
Q

Describe the epidermis

A
  • The tough, leathery outer surface of the skin ranging in thickness from .06 to .6mm
  • Contains 5 sub layers
  • avascular (no blood supply)
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5
Q

Which layer is found between the stratum basale (lowest layer of epidermis) and and dermis?

A

Basement membrane

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6
Q

Which of the following is not a function of the integumentary system?

  • excretion
  • production of blood cells
  • temperature regulation
  • protection
  • sensory reception
  • vitamin D production
A

Production of blood cells

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7
Q

What material gives the epidermis the ability to resist abrasion and reduce water loss?

  • keratin
  • melanin
  • carotene
  • dermal papillae
A

Keratin

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8
Q

What structures of the epidermis are responsible for detecting light touch?

  • Langerhans cells
  • Merkel cells
  • Keratinocytes
  • Melanocyte cells
A

merkel cells

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9
Q

List the correct layers of the epidermis from superficial to deep

A
  • Stratum Corneum
  • Stratum Lucidum
  • Stratum Granulosum
  • Stratum Spinosum
  • Stratum Basale
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10
Q

Having 1-2 layers of cells closest to the basement membrane and rapid mitosis is a feature of which layer of the epidermis?

A

Stratum Basale

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11
Q

Having 8-10 layers of cells filled with keratin fibers and a “prickle” appearance is a feature of the…

A

Stratum Spinosum

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12
Q

Which layer is found only in thick skin?

A

Stratum Lucidum

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13
Q

The most superficial layer of the skin, having more than 25 layers or more of dead squamous cells with keratin is called…

A

Stratum Corneum

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14
Q

Skin pigments produced by cells are called…

A

melanocytes

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15
Q

The hypodermis is primarily made of what?

A

Adipose tissue

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16
Q

What are 3 clinical reasoning processes?

A
  • Forward reasoning process (Pattern Recogntion)
  • Backward reasoning process (Hypothetico-deductive process)
  • Hypothesis oriented algorithm for clinicians
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17
Q

What are the components of PT examination

A
  • History of present illness
  • History questions
  • General demographics + subjective info
  • Systems Review (pulmonary, cardiovascular, musculoskeletal, neuromuscular, integumentary)
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18
Q

What are the 4 main purposes of a systems review

A
  • Identify referral need
  • Identify risk factors/impairments
  • Identify signs and symptoms consistent with different disease processes
  • Determine educational needs
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19
Q

What is the SMART pmnemonic?

A

S - Specific
M - Measureable
A - Attainable
R - Realistic
T - Time related

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20
Q

What are the components of a clinical summary (Eval)

A
  • tests and measures
  • Integrates the test and measures data with other information collected during the history and systems review
  • diagnosis
  • prognosis
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21
Q

Describe the skin in terms of its size and weight contribution to the body

A

The skin is the largest organ of the body, accounting for approximately 15% to 20% of total body weight.

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22
Q

How does the thickness of skin vary across different body parts?

A

Skin thickness varies from 0.5mm on the eyelids to 8mm on the soles of the feet.

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23
Q

How often are skin cells replaced?

A

Every 15-30 days

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24
Q

What are the protective functions of the skin?

A

The skin protects against trauma, prevents bacterial and viral penetration, and guards against physical and chemical damage.

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25
Q

T or F? The skin plays a crucial role in regulating body temperature

A

True

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26
Q

What types of sensory reception does the skin provide?

A

pain, touch, temperature, and pressure.

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27
Q

Which layer of the skin produces vitamin D?

A

Epidermis

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28
Q

What is the basement membrane?

A

A thin layer under epithelial cells that provide structural support

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29
Q

How thick is the epidermis and what is its vascularity?

A

The epidermis is 0.06 to 0.6 mm thick and is avascular.

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30
Q

Identify the primary cell type found in the epidermis

A

The primary cell type in the epidermis is keratinocytes, which make up 90% of the cells.

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31
Q

List the other cell types found in the epidermis besides keratinocytes.

A

Melanocytes, merkel cells, langerhan cells

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32
Q

How long does it take cells to move from stratum basale to stratum corneum

A

15 to 30 days.

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33
Q

What are the 3 phases of wound healing?

A
  • Hemostasis (not a true phase)
  • Inflammation
  • Proliferation
  • Maturation
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34
Q

Describe the dermis layer of the skin.

A
  • thickest layer of the skin (2 to 4 mm)
  • less defined layers compared to the epidermis
  • highly vascular and contains various cells such as fibroblasts, macrophages, mast cells, and white blood cells.
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35
Q

How many layers does the dermis have and what are they primarily made of?

A

2, the papillary dermis and the reticular dermis (primarily made of collagen and elastin)

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36
Q

Define the papillary and reticular layers of the dermis.

A
  • papillary dermis is the upper layer of the dermis
  • while the reticular dermis is the thick/dense lower layer (makes up 80% of the dermal thickness)
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37
Q

What types of sensory organs are housed in the dermis?

A

The dermis houses sensory organs that detect touch, pressure, vibration, and temperature.

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38
Q

List the appendages contained within the dermis.

A

The dermis contains dermal appendages such as hair follicles, sweat glands, sebaceous glands, and nails

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39
Q

What is the function of sebaceous glands in the dermis?

A

Sebaceous glands create sebum which lubricates and protects the skin

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40
Q

How does the dermis contribute to the skin’s structure?

A
  • Provides strength and elasticity through its collagen and elastin fibers
  • Houses various appendages and sensory organs
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41
Q

What types of white blood cells are found in the dermis?

A

neutrophils, basophiles, and eosinophils

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42
Q

Describe the appearance of healthy dermal tissue.

A

smooth, even texture and a consistent color (indicates good blood flow and proper function)

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43
Q

Define the primary purpose of the subcutaneous layer (hypodermis).

A

primarily for energy storage, as it is composed of loose connective tissue and fat cells.

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44
Q

What vitamins are stored in the subcutaneous layer?

A

fat-soluble vitamins A, D, E, and K.

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45
Q

How does the subcutaneous layer support the dermis?

A

The subcutaneous layer anchors the dermis, providing stability and support to the skin structure.

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46
Q

T or F? The subcutaneous layer is highly vascular

A

True

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47
Q

Do all wounds heal at the same rate?

A

The process of repair is the same for all wounds; however, healing times will vary due to certain factors.

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48
Q

What is transudate fluid and its role in hemostasis?

A

Transudate fluid decreases vessel pressure and contributes to local edema during the hemostatic response.

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49
Q

How does vasoconstriction affect blood flow during hemostasis?

A

a short-term decrease in blood flow to the affected area.

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50
Q

Define the role of platelet aggregation in hemostasis.

A

involves the clumping of platelets and the activation of clotting factors, leading to the deposition of fibrin.

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51
Q

What is the significance of fibrin?

A

Fibrin is deposited to form a clot, which helps prevent contamination and provides a mesh structure for wound healing.

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52
Q

Describe the Inflammation Phase in wound healing.

A
  • 0 to 4 days after injury
  • causes redness, heat, edema, pain, and loss of function.
  • Histamine is released by mast cells, and skin grafting is often performed during this phase.
  • platelets, PMNs, macrophages, mast cells
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53
Q

How does histamine contribute to the Inflammation Phase?

A

promotes vascular responses that lead to increased blood flow and permeability, contributing to the classic signs of inflammation.

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54
Q

Define the goals of the Inflammation Phase in wound healing.

A
  • providing hemostasis
  • bringing white blood cells (neutrophils and macrophages) into the wound
  • recruiting matrix metalloproteases (MMP) to break down debris
  • providing a clean wound site for tissue restoration.
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55
Q

What role do neutrophils and macrophages play in the Inflammation Phase?

A

Neutrophils and macrophages are white blood cells that are recruited to the wound site during the Inflammation Phase to help clear debris, fight infection, and facilitate the healing process.

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56
Q

When does skin grafting occur?

A

0 to 4 days after injury (inflammation)

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57
Q

Describe the role of platelets in the inflammatory phase.

A

Releases growth factors and signaling molecules to help initiate the inflammatory response during the hemostasis phase

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58
Q

Define polymorphonuclear neutrophils (PMNs) and their function in inflammation phase

A

a type of white blood cell that plays a crucial role in the immune response by destroying pathogens during the inflammatory phase.

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59
Q

How do macrophages contribute to the inflammatory phase?

A

Macrophages help by phagocytosing pathogens and debris, releasing cytokines to recruit other immune cells, and facilitating tissue repair.

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60
Q

What is the function of mast cells in inflammation phase?

A

release histamine and other chemicals that promote vasodilation and increase blood flow to the affected area during inflammation.

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61
Q

List the 5 cardinal signs of inflammation.

A

redness, heat, swelling, pain, and loss of function.

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62
Q

Do macrophages work similar to “pacman”?

A

Yes, macrophages are like pacman as they actively engulf and digest cellular debris and pathogens in a manner similar to how pacman consumes dots

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63
Q

Describe the function of the Dermis.

A

The Dermis supports the epidermis with nutrition and structure, assists with prevention of infection, and protects us directly from UV light.

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64
Q

What are the 4 cells of the inflammation phase? (KNOW THIS)

A
  • Platelets
  • Polymorphonuclear neutrophils (PMNs)
  • Macrophages
  • Mast cells
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65
Q

What happens if the inflammatory phase is interrupted?

A

It becomes chronic inflammation

66
Q

What are the 4 sub-phases of the proliferation phase?

A

Angiogenesis, granulation tissue formation (collagen synthesis), contraction, epithelialization

67
Q

What are the 4 types of cells of the proliferation phase?

A

Angioblasts, Fibroblasts, Myofibroblasts, Keratinocytes

68
Q

What do angioblasts do?

A

Form new blood vessels

69
Q

What do fibroblasts do?

A

contributes to the formation of connective tissue

70
Q

What do myofibroblasts do?

A

mediate wound contractions

71
Q

What do keratinocytes do?

A

Forms a protective barrier on the skin by producing keratin

72
Q

What happens during angiogenesis of the proliferation phase?

A

Formation of new blood vessels are from pre-existing vasculature

73
Q

What happens during the granulation formation subphase of the proliferation phase?

A

granulation tissue is formed (collagen synthesis)

74
Q

What happens during the contraction subphase of the proliferation phase?

A

Wound edges pull in towards the center and it begins to close

75
Q

What happens during the epithelialization subphase of the proliferation phase?

A

keratinocytes migrate and replicate to cover a defect on the surface

76
Q

what is the primary cell of the granulation subphase of the proliferation phase?

A

fibroblasts

77
Q

Describe hyper-granulation.

A

Hyper-granulation is an abnormal response characterized by tissue that resembles jelly, bleeds easily, and progresses above and beyond the level of the wound.

78
Q

T or F? Contraction is fastest when the wound is a straight line, rather than rectangular (moderate speed) or circular (slow speed) wounds

A

True

79
Q

What is the greatest amount of contraction observed in wound healing?

A

The greatest amount of contraction occurs with full-thickness wounds, resulting in approximately a 40% decrease in size.

80
Q

What environmental conditions are necessary for optimal wound contraction?

A

A warm environment with high oxygen levels and adequate nutrition is necessary for optimal wound contraction.

81
Q

List essential nutrients for wound healing.

A

Zinc, iron, copper, and vitamin C are essential nutrients for wound healing.

82
Q

Describe hypo-granulation in chronic wounds.

A

Hypo-granulation refers to the inability of the wound to fill the defect, often seen in patients with diabetes mellitus or malnutrition.

83
Q

What is epibole?

A

When a wound has round edges (often leads into a chronic wound)

84
Q

What is the significance of scar tissue in the remodeling phase?

A

Scar tissue is built to provide increased tensile strength, initially at 15-20% of the original strength, eventually reaching about 80%.

85
Q

Explain the concept of ‘second generation’ scar strength.

A

A ‘second generation’ scar refers to scar tissue that achieves approximately 64% of the original tissue strength.

86
Q

How long does the remodeling phase last after an injury?

A

The remodeling phase can last up to 2 years post-injury.

87
Q

What occurs to old collagen during the remodeling phase?

A

During the remodeling phase, old collagen is broken down as new collagen is synthesized to maintain a low scar mass.

88
Q

Describe the changes that occur in scar maturation.

A

Cellularity and Vascularity decrease, leading to a transition from pink to grey color and bulky to flat appearance

89
Q

Define the types of collagen involved in scar formation.

A

Scar formation involves the transition from immature Type III collagen to mature Type I collagen during the maturation phase.

90
Q

What happens to the cellularity of a scar as it matures?

A

as it matures, cellularity decreases from high to low, leading to a flattening of the scar.

91
Q

How much more likely are individuals with darker skin to develop keloids?

A

darker skin is 15x more likely to develop keloids compared to those with lighter skin.

92
Q

What is the difference between hypertrophic scars and keloid scars?

A

Hypertrophic Scars: raised scars that do not extend beyond the original wound

Keloid Scars: extend beyond the wound margins and can continue to grow (huge scars)

93
Q

Which layer of the skin houses sensory organs? Epidermis or Dermis

A

Dermis

94
Q

Which layer of the skin houses keratinocytes? Epidermis or Dermis

A

Epidermis

95
Q

Which layer of the skin houses 2 layers? Epidermis or Dermis

A

Dermis

96
Q

Which layer of the skin is thinner? Epidermis or Dermis

A

Epidermis

97
Q

Which layer of the skin contains hair follicles? Epidermis or Dermis

A

Dermis

98
Q

What is the purpose of the hypodermis?

A

Thermoregulation/insulation, store energy and fat soluble vitamins (A, D, E, K), anchors the dermis, supports muscles, bones, fascia

99
Q

What are the 5 classic signs of inflammation?

A

Erythema (redness), loss of function, pain, heat, edema (swelling)

100
Q

What is the first stage of wound healing? Immediate response? Time period? What is released? Important cells? Goals? Disrupted by?

A

Inflammation Phase

Immediate response: Hemostasis

Time Period: 0-4 days

What is released?: Histamine

Important cells: Platelets, PMNs, Macrophages, Mast cells

Goals: Stop bleeding + bring cells to clean the wound

Disrupted by: Vascular insufficiency

101
Q

What is the second stage of wound healing? Sub phases? Time period? Important cells? Goals? What could go wrong?

A

Proliferation Phase

Sub phases: Angiogenesis, granulation, contraction, epithelialization

Time Period: 2 days - 2+ weeks

Important cells: Angioblasts, fibroblasts, myofibroblasts, keratinocytes (blast = build)

Goals: Fill in wound with granulation tissue

What could go wrong?: Hypergranulation, hypogranulation, epibole, etc.

102
Q

What is the third phase of wound healing? Time period? What is synthesized? What could go wrong?

A

Maturation Phase

Time period: 24 days - 2 years (peaks at 6 months)

What is synthesized?: Collagen

What could go wrong?: Dehiscence, hypertrophy, keloid

103
Q

What is the tensile strength of a first generation scar? second generation?

A

1st Generation Scar: 80%

2nd Generation Scar: 64%

104
Q

Differentiate between early and late stage scars

A

Early:
- High Vascularity
- High Cellularity
- Type III Collagen
- Random Layers
- Red/Pink Coloration

Late:
- Low Vascularity
- Low cellularity
- Type I Collagen
- Organized Fibrils
- Pale White Coloration

105
Q

What is the difference between a keloid and hypertrophic scar?

A

Keloid Scar: Spans outside the borders of incision, higher in type III collagen than hypertrophic

Hypertrophic Scar: Remains within the border of incision, collagen ratio 2 (type I) : 1 (type III)

106
Q

How do you know if a scar can still be managed/changed?

A

If it is still red, puffy, blanching, usually peaking in the first 6 months

107
Q

What is the collagen ratio in normal skin?

A

(type I) 4:1 (type III)

108
Q

What is the collagen ratio in hypertrophic scars?

A

(type I) 2:1 (type III)

109
Q

Which type of scar is higher in type III collagen, Keloid or Hypertrophic?

A

Keloid scar

110
Q

What are some methods of scar management?

A

compression, massage (based on tension theory), steroids, and surgical interventions.

111
Q

Which medications affect wound healing?

A
  • NSAIDs
  • steroids
112
Q

T or F? When oxygen pressure (PO2) is <40mmHg, collagen synthesis is heavily impacted

A

True

113
Q

What is the most common cause of wound infection?

A

Decreased PO2

114
Q

What are the 3 types of wound closures?

A

1.) Primary Closure

2.) Secondary Closure

3.) Delayed Primary Closure

115
Q

What is primary wound closure (primary intention)?

A
  • Wound closes with surgical intervention (has clear edges)
  • Closes within 7 days
  • Leaves minimal to no scarring
  • Potential for dehiscence (when surgical wound re-opens)
116
Q

What is dehiscence?

A

When a surgical wound re-opens

117
Q

What is secondary closure (intention)?

A
  • Closes naturally
  • A wound that penetrates through the epidermis and into the dermis
  • Heals by contraction (and some granulation + re-epithelialization)
  • Involves scar tissue formation
118
Q

What is delayed primary closure (tertiary intention)?

A
  • A wound that begins to heal naturally (secondary intention), then finished with surgical closure (primary intention)
  • Can be kept open for 4-6 days, then closed by surgical intervention

Reasons for this?
- Large amount of tissue loss/swelling
- Contamination
- High risk of infection

119
Q

What is the “marion” wound healing scale?

A

A color wound classification system

  • Red, yellow, black
120
Q

What is the “wagner” scale?

A

Used to classify neuropathic, ischemic, and arterial ulcers on a 0-5 scale

121
Q

Why does a wound become chronic in the inflammatory phase?

A
  • lack of stimulus for repair
  • inadequate perfusion and ischemia
  • free radicals and O2 reperfusion injury
122
Q

What are the collagen ratios in normal skin, hypertrophic scars, and keloid scars?

A

Type I : Type III

Normal skin - 4:1
Hypertrophic scars - 2:1
Keloid scars: Even higher type III collagen

123
Q

Which phase may have endothelial buds?

A

Proliferation phase (angiogenesis to be exact)

124
Q

What does slough tissue look like?

A

yellow or white (strings or thick clumps)

125
Q

What does granulation tissue look like?

A
  • pink/red
  • shiny and moist
  • granular appearance
126
Q

What does epithelial tissue look like?

A
  • New pink + shiny tissue
  • grows in from the edges
127
Q

What does necrotic tissue look like?

A

Black, brown, or tan

128
Q

What is a periwound?

A

The skin located around the wound itself

129
Q

What is maceration?

A

softening of tissue from liquid

130
Q

What is anhydrous?

A

dry, cracked, or scaly skin

131
Q

What is tunneling?

A

The separation of fascial layers between the muscles under the skin

132
Q

What does it mean when the periwound is undermining?

A

An area of tissue destruction extending under the skins edges

133
Q

List the functions of the skin

A
  • excretion
  • temperature regulation
  • protection
  • sensory reception
  • vitamin D production
134
Q

T or F? Zinc, iron, copper and vitamin C are essential during the contraction phase

A

True

135
Q

What are platelets?

A

Small cells that help to stop bleeding

136
Q

What are polymorphonuclear neutrophils (PMNs)?

A

A type of white blood cell that plays a big role in the immune system by responding to infection and tissue damage through phagocytosis

137
Q

T or F? Macrophages and neutrophils are white blood cells (WBC)

A

True

138
Q

What are macrophages?

A

A type of WBC that kills microorganisms and removes dead cells

139
Q

What are mast cells?

A

A type of WBC that fights infection and regulates immune responses

140
Q

What is vitamin B12?

A

Helps with anemia, produces red blood cells

141
Q

What is vitamin A?

A

Assists with inflammation

142
Q

What is vitamin D?

A

Bone health

143
Q

What is vitamin E?

A

Fat metabolism

144
Q

What is vitamin K?

A

coagulation and heart health

145
Q

What is vitamin C?

A

Skin health

146
Q

What is Zinc?

A

Infection control

147
Q

What is iron?

A

Blood and red blood cells

148
Q

What is copper?

A

Helps with cell development

149
Q

T or F? Full thickness wounds cause a loss of dermal appendages

A

True

150
Q

During the vascular response all of the following are part of that response except

a. Decreased vessel pressure
b. Vasoconstriction
c. Inflammation
d. Platelet aggregation

A

Inflammation

151
Q

What do platelets do?

A

Help with clotting

152
Q

What do mast cells do?

A
  • Release histamine
  • Immune response
  • Help fibroblast proliferation
153
Q

What do PMNs do?

A

removes damaged tissue

154
Q

What is the primary cell in the granulation formaton subphase?

A

Fibroblast

155
Q

What type of cells must be in the would in order for epithelialization to occur correctly

a. Dry
b. Granulated
c. Non-viable
d. Necrotic

A

granulated

156
Q

T or F? An epibole is a sign of a chronic wound

A

True

157
Q

T or F? During the maturation phase, a scar starts at random layers and Type I collagen and
matures into organized fibrils with Type III collagen

A

False – the scar starts as random layers of TYPE III (immature) collagen

158
Q

What happens if collagen synthesis is impaired?

A

Impaired tensile strength and increased risk of dehiscence

159
Q

A primary wound closure should take how many days to close?

A

7

160
Q

Describe the wagner scale

A

0 – no open lesion, may have cellulites

1 – superficial ulcer/partial thickness

2 - deep ulcer to tendon or bone

3 – deep ulcer with abscess or osteomyelitis

4 – localized gangrene

5 – gangrene of the entire foot

161
Q

What does histamine (released from mast cells do?

A

signals for more inflammation

162
Q

T or F? use silver on infected wound

A

True

Integumentary Systems (10 decks)

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