Renal/Integumentary Flashcards
_____-Related Changes in the Renal System:
• Decreased kidney size – around age 30. You can actually lose up to 25% of the mass
• Decreased Renal Blood Flow (RBF) and Glomerular Filtration Rate (GFR)
o d/t renal vascular perfusion changes
• Decreased number of nephrons
• Decreased tubular transport response
• Decreased elimination of drugs
• Increased sclerotic glomerular capillaries
• Increased excretion of glucose
• Increased bladder symptoms
o Urgency, frequency, nocturia
Age
this test is for a waste product that is continuously produced during normal muscle breakdown. What your kidneys do is filter that waste product from the blood into the urine where it is then excreted. This process allows for almost no reabsorption. So when you look at this test it tells you simply the amount of blood the kidneys can make creatinine-free each minute. As renal function declines, patient’s ability to clear creatinine will go down.
plasma creatinine concentration
Normal creatinine value is ______ mg/dl
0.7 to 1.2
Test used in glomerular nephritis
creatinine concentration
a protein mainly used to assess kidney function. It also filters out of the blood by the glomeruli and is excreted out. Used when creatinine clearance could be misleading (cirrhosis, obese, malnourished, vegetarians) – individuals may not have the muscle mass to adequately assess their kidney function thru creatinine clearance.
Plasma Cystatin C Concentration
plasma protein that is freely filtered at the glomerulus.
cystatin C
two renal tests used to measure progressive renal dysfunction
creatinine + cystatin C
waste product that kidneys move from blood out of body thru urine
end product of protein metabolism
varies as a result of altered protein intake and protein catabolism
blood urea nitrogen (BUN)
test for hydration status (increases in dehydration and kidney failure)
BUN
normal range for BUN: _____ mg/dL
10-20
test: blood in the body continuously & hundreds of times throughout the day flow thru kidneys – they will push that liquid part of our body thru these tiny filters (nephrons) & the majority of the body’s fluid will be filtered thru nephrons and reabsorbed back into body. If not reabsorbed, it will then become urine
glomerular filtration rate (GFR)
rate of blood flow through the kidneys
glomerular filtration rate (GFR)
test that determines level of kidney function
glomerular filtration rate (GFR)
normal pH of urine
5-6.5
measures solute concentration of urine has a normal value of 1.016- 1.022
specific gravity
measures RBC in urine (there should be none)
sediment
measures accumulations of cellular precipitates in the urine
They are an indication of the type of disease the kidney is experiencing
casts
renal infection (pyelonephritis) will result in ____ casts
WBC
inflammation of the glomerulus (glomerulonephritis) will results in _____ casts
RBC
urine ______ indicate inflammation, infection, or metabolic disorder
crystals
urine test that shows if there is an infection
WBC
urine \_\_\_\_\_\_\_\_\_ tests: • Glucose • Bilirubin • Urobilinogen • Leukocyte esterase • Nitrates • Ketones • Proteins • Hemoglobin and myoglobin
reagent strips
test with flat plain film (one picture of abdomen AP [anterior posterior view])
->targets the kidney, ureter, and bladder (not that great of a diagnostic tool for urinary system – typically just use it when assessing for constipation)
x-ray “KUB”
renal diagnostic test that uses iodine that contain a radiopaque dye that is injected into a vein to circulate throughout the kidney and then excrete in the urine. As it is excreted in the urine a rapid series of x-rays catches the dye as it is being excreted.
o This will give us a good idea of the urinary tract and if there are any underlying complications.
o The dye is nephrotoxic and hydration is recommended prior to the IVP
Intravenous Urography/Pyelography (IVP)
non-invasive, no exposure to radiation, test that allows visualization of the kidneys – measure kidneys, see shape/location, see if there’s kidney stones, tumors, cysts, abscess, etc. [often used in pediatrics for detection of causes of reflux etc]
ultrasound
minimally invasive test that is done under fluoroscopy- an x-ray done in “real time” (allows radiologist to see urinary tract & bladder)
–>will identify if there is any bladder backup to the kidneys [reflux] also if they have reflux and have had surgery, they may repeat to see if surgery was successful. Also if they are suspicious of a blockage in urethra, this test will identify that
o Shows how the lower urinary tract is functioning
o Child is usually catheterized, and the radiopaque material is passed via catheter to the bladder. And when the bladder is full the child is asked to urinate or may do so on his/her own. The fluoroscope pictures are being made as the bladder fills and the child voids
o Used to evaluate bladder size, if there is vesicoureteral reflux and what grade the reflux is
Voiding Cystourethrogram (VCUG)
Masses of crystals or other substances that occur in the kidney and cause obstruction
• Most are made of calcium crystals – calcium oxalate and calcium phosphate
**made of minerals & salts but calcium most common
Nephrolithiasis (“Kidney Stones”)
CM of _____:
• VERY PAINFUL
• Nausea/vomiting
• Diaphoresis
• Pain radiating from flank to lower abdomen or groin
• Pain can come in waves w/fluctuating intensity.
• Pain can occur w/urination
Urine can be red, pink, or even brown in color
Nephrolithiasis (“Kidney Stones”)
Patho of ________:
• Caused by inflammation of the urinary epithelium after invasion and colonization by some pathogen in the urinary tract
• There is a positive retrograde movement of bacteria into the urethra and bladder
• Most of the time, if bacteria enters the urinary tract, our body’s immune system can get rid of the bacteria on its own by protective mechanisms. If body’s natural immune system doesn’t protect us, the bacteria will enter thru urethra, lead to an inflammation of epithelium, and multiply.
• Leading pathogen: E-coli (85% of all UTIs)
Urinary Tract Infection (UTI)
Protective _______ ________:
• Bacteria is washed out of the urethra during micturition
• Low pH & high osmolality of urea, the presence of Tamm-Horsfall proteins, and secretions from the uroepithelium which all provide a bactericidal effect.
• The ureterovesical junction (UVJ) closes during bladder contraction preventing reflux of urine to the ureters and kidneys
• Length of the male urethra is protective
• Common pathogens
• Most common pathogens are Escherichia coli & Staphylococcus
Urinary Mechanisms
Causes of \_\_\_\_\_: Mostly coliforms (e.coli, klebsiella, proteus, pseudomonas)
Acute Cystitis (Bladder Infection)
Risk Factors for \_\_\_\_\_\_\_: Premature infant female gender (including school aged girls) sexually active women [can develop from sexual intercourse] pregnant women women recently treated with antibiotics spermicide use estrogen deficiency in women persons with catheters Diabetes Mellitus bladder dysfunction
Acute Cystitis (Bladder Infection)
CM of \_\_\_\_\_\_\_: Varies w/ age Urinary urgency burning blood in urine voiding small amounts urinary frequency foul urinary odor pelvic discomfort low-grade fever adults dysuria low back pain **May be asymptomatic especially during pregnancy or in the elderly. Symptoms different in children and older sometimes suprapubic pain **In the elderly they may manifest differently: lethargy, anorexia, confusion, anxiety
Acute Cystitis (Bladder Infection)
Evaluation of ____:
• Urine dip or UA with microorganism count of 10,000 mls or more
Acute Cystitis (Bladder Infection)
Chronic bladder inflammation w/ acute cystitis-like symptoms of pelvic pain w/no evidence of bacteria in urine.
***Can be caused by autoimmune reaction, drug-induced, radiation, chemicals (spermicides, bubble baths, lubricants, etc.)
Interstitial Cystitis/Bladder Pain Syndrome [Noninfectious Cystitis]
Causes of _______:
Nonbacterial infection
noninfectious cystitis- radiation, chemical
interstitial cystitis- hypersensitivity
Hunner Ulcers- autoimmune derangement of the bladder mucosa with ulcers
scaring
decreased bladder capacity
Interstitial Cystitis/Bladder Pain Syndrome [Noninfectious Cystitis]
Acute infection of the ureter, renal pelvis, and/or renal parenchyma (most cases occur among women) in which bacteria has continued to travel past the bladder, thru ureters, and into the kidneys to wreak havoc
**Primary organism- E.Coli and other coliforms are the usual infectious agents (e.coli, klebsiella, proteus, pseudomonas
Acute Pyelonephritis (Kidney Infection)
Risk Factors for _______:
female gender
urinary tract blockage (like man w/large prostate)
weakened immune system
spinal cord or nerve damage around bladder
foreign bodies- catheter
”list goes on.”
Acute Pyelonephritis (Kidney Infection)
Cause of \_\_\_\_\_\_: ascending infection (from the lower urinary tract) or sepsis (blood born infection)
Acute Pyelonephritis (Kidney Infection)
CM of \_\_\_\_\_\_\_: very sick flank pain fevers chills costovertebral tenderness purulent urine anorexia dehydration UTI symptoms [urgency, frequency, burning, blood in urine, foul-smelling urine, n/v]
Acute Pyelonephritis (Kidney Infection)
Evaluation for ______:
UA ill show WBC casts- indicating pyelonephritis
Acute Pyelonephritis (Kidney Infection)
Chronic syndrome caused by an overactive detrusor muscle that contracts involuntarily even w/ a low volume of urine in bladder creating urgent need to void
***Symptom syndrome- urgency with/without urge incontinence, urinary frequency and nocturia
Overactive Bladder
Diagnosis of _____:
good medical hx
physical exam
negative urinalysis (may want to send off to lab to make sure urine doesn’t grow anything w/culture)
Overactive Bladder
sudden, intense urge to urinate followed by loss of urine (maybe urinary frequency & nocturia as well)
urge incontinence
urine leaks w/exerted pressure (coughing, sneezing, laughing, exercise)
stress incontinence
frequent or constant dribbling of urine because bladder doesn’t empty completely
overflow incontinence
physical or mental impairment that prevents making it to the toilet on time (dementia, bed-bound that requires assistance to bathroom).
functional incontinence
urine formation and excretion begins in fetus in the ___ month of gestation
3rd
the key to all stages of kidney development & maintenance of kidney function
Wilms Tumor 1 (WT1) gene
Urethral meatus is located on the ventral side or undersurface of the penis
hypospadias
rare malformation of penis but can also develop in famles as well.
o Males: Urethral opening is on the dorsal surface of the penis
o Females: Cleft along the ventral urethra usually extends to the bladder neck
o 2x as many boys are affected as girls
epispadias
absence of one or both kidneys in fetus
o If unilateral (occurs in 1 in 1000 live births) usually the left kidney is absent and the remaining kidney hypertrophies which can lead to a normal/healthy life
renal agenesis
kidneys are absent bilaterally (incompatible with uterine life and is a rare genetic disorder) resulting in low amniotic fluid
**more often in males
Associated with a group of facial anomalies:
• agenesis or hypoplasia
• wide set eyes,
• low set ears,
• receding chin,
• flattened nose with downward turned nasal tip
Potter Syndrome
Autosomal Dominant disorder (each child has 50% chance) that is a mutation of two genes:
• PKD1 on chromosome 16
• PKD2 on chromosome 4
Occurs in 1 in 1000 live births
• Cyst formation and obstruction, accompanied by destruction of renal parenchyma, interstitial fibrosis, and loss of functional nephrons
• Most common form, accounts for 90% of all polycystic disease
• Causes symptoms later in life around 30-40
• Affects both genders and all races
• Cysts will develop in clusters on kidneys, leading to hypertrophy & loss of function over a period of time
Polycystic Kidney Disease (PKD)
CM of \_\_\_\_: HTN flank pain bloating kidney stones kidney failure
Polycystic Kidney Disease (PKD)
Autosomal Recessive disorder (both parents must carry the abnormal gene to pass on, each child will have 25% chance of getting disease, 50% carrier, 25% non-carrier)
that occurs due to gene mutation on chromosome 6 p
• Cystic changes of the kidney and liver are evident at birth
• Renal replacement therapy is typically needed and required during childhood or adolescence.
• Enlarged kidneys with cysts
• Systemic hypertension
• Liver problems
Polycystic Kidney Disease (PKD)
inflammation of tiny filters in kidneys
o Etiology: It is a renal disorder in which proliferation and inflammation of the glomeruli are secondary to an immune mechanism. There will be a sudden onset of hematuria with red blood cell casts and proteinuria
Acute Post Streptococcal Glomerulonephritis
Patho of ______:
The most common acute glomerulonephritis that occurs after a throat (i.e., pharyngitis) or skin infection (i.e., impetigo) with certain strains of group A α-hemolytic streptococci. This occurs because antigen-antibody complexes and complement are deposited in the glomerulus. Immune complexes then initiate inflammation and glomerular injury. This form primarily occurs in children 5 to 15 years of age.
[In English: Usually takes 1-2 weeks after recovering from either strep throat or impetigo to develop this. Immune response that occurs when body produces too many antibodies and extra settle in glomeruli, leading to inflammation]
Acute Post Streptococcal Glomerulonephritis
CM of ______:
• Pink or cola colored urine [from RBCs in urine],
• foamy urine d/t excess protein,
• HTN,
• Water retention,
• edema [face, hands, feet, abdomen], and,
• In severe cases- azotemia will be present [aka increase in BUN,Creatinine]
Acute Post Streptococcal Glomerulonephritis
o Etiology: Unknown
o Pathophysiology: IgA deposited in kidneys, trapped in glomeruli
o The most common form of glomerulonephritis in children and young adults and occurs more in males than females.
o It is characterized by deposition primarily of IgA and complement proteins in the glomerulus
o Most children recover completely. 20-40% may have recurrent symptoms or even renal failure
Glomerulonephritis – Immunoglobulin A (IgA) Nephropathy (Burger’s Disease)
CM of \_\_\_\_\_\_: • Hematuria (may or may not be visible – can be dark-brown cola looking) • Proteinuria • Urinating less • Edema
Glomerulonephritis – Immunoglobulin A (IgA) Nephropathy (Burger’s Disease)
It is common to see recurrent gross hematuria with a concurrent URI (i.e., tonsillitis) or gastroenteritis in __________. Most children continue to have microscopic hematuria between the attacks of gross hematuria and have mild proteinuria. In severe cases, proteinuria, edema and HTN can occur and must be treated swiftly to prevent loss of kidney function
Glomerulonephritis – Immunoglobulin A (IgA) Nephropathy (Burger’s Disease)
Care is supportive for _______ and _________.
Glomerulonephritis – Immunoglobulin A (IgA) Nephropathy (Burger’s Disease)
Acute Post Streptococcal Glomerulonephritis
abnormal immune response in which the immune system makes IgA to protect the body from antigens & chose antigens (bacterial or viral)…typically preceded by infection…Antibodies attack blood …majority occurs in people that have recently had an URI. It can also be associated w/other types of exposures such as meds, foods, insect bites.
Henoch-Schonlein Purpura (HSP)
CM of _______:
hematuria
proteinuria
HTN
can lead to renal failure
Rash (purpura-type) Reddish-purple spots that look like bruises on buttocks, legs, feet – can also appear on arms, face, trunk
Swollen/painful joints
GI symptoms – abdominal pain, n/v, blood in stools
In children:
kidney involvement is usually transient and kidney function returns to normal. Small % have long-term problems, even smaller % have kidney failure
In adults:
more likely to have chronic kidney disease that will eventually lead to kidney failure.
Henoch-Schonlein Purpura (HSP)
____ is a small vessel IgA mediated vasculitis
Henoch-Schonlein Purpura (HSP)
Henoch-Schonlein Purpura (HSP) often results in elevated _____ and _____.
BUN and creatinine
embryonal tumor of the kidney
o Most common kidney cancer in children (nearly all cases are diagnosed before age 10 but majority are diagnosed between birth and age 5)
o Affects 1 in 10,000 children
o Associated w/mutation of WT1 gene – also the CTNNB1 and AMER1 gene are also associated
o Arises from proliferation of abnormal renal stem cells
o Most common solid tumor of childhood
o Ranks 5th among most frequently occurring childhood cancers
o Both inherited and sporadic forms
• Wilms tumor suppresses genes WT1 and WT2 on chromosome 11
Nephroblastoma (Wilms Tumor)
CM of \_\_\_\_\_: Palpable abdominal mass Abdominal Swelling Abdominal Pain Fever hematuria n/v constipation loss of appetite High BP
Nephroblastoma (Wilms Tumor)
CM of \_\_\_\_\_ in Children: --Infants: Vomiting diarrhea jaundice fever abdominal painp oor growth foul-swelling urine bloating weight loss irritability --Toddlers and young children: Fever frequency, urgency Enuresis or incontinence in a previously dry child Abdominal, flank, or back pain, pubic bone pain Foul-smelling urine and sometimes associated hematuria Chills Fatigue
UTI
Most common pathogen in UTI and pyelo in children
E.Coli
CM of ______ in Children:
Newborns: poor feeding, vomiting
Children under 2 – fever (not always), poor appetite, vomiting, diarrhea
Children over 2 – fever, appetite changes, stomach or low back pain, urinary urgency/frequency, pain w/urination. Previously potty-trained children may have accidents at night or day. Foul-smelling urine. Blood in urine.
Chills, fever
Flank or abdominal pain along with enlarged kidney(s) caused by edema
Pyelonephritis
Reflux of urine from the bladder, to the ureters and kidneys. Reflux encourages infected urine in the bladder to be swept up into the ureters and kidneys causing frequent pyelonephritis.
Vesicoureteral Reflux
Etiology of ____:
Congenital abnormalities, having parents/siblings with VUR, neural tube defects (spina bifida)
***Caused by a congenital abnormality in the valvular mechanism at the ureter bladder junction or ectopic insertion of the ureter into the bladder
Vesicoureteral Reflux
Diagnosis of ______:
- **Renal US (1st choice – non-invasive & will determine size/shape of kidneys – can not prove reflux is present but can show you the stretch of the kidneys that reflux can produce and will show you scarring that can be caused by the reflux)
- Voiding cystourethrogram (VCUG) – x-ray – catheter is placed and bladder is filled with liquid dye. X-rays are taken as the bladder fills & empties. Will identify any backwards flow of urine.
- intravenous pyelogram (IVP)
Vesicoureteral Reflux
atopic dermatitis is associated with:
increase in serum levels of IgE, interleukins and eosinophils
basal cell carcinoma starts as a ______
pearly/ivory nodule
most common type of skin cancer
basal cell carcinoma
multiple vesicular lesions around nares with yellow crust…most likely cause?
staph
aging causes _____ in the skin
decrease in cell proliferation
scabies looks like:
papules and vesicles that look like tunnels
psoriasis lesions arise from:
hyperproliferation of the skin
etiology of pityriasis rosea:
virus (likely herpes)
What will pityriasis rosea initially look like?
herald lesion then xmas tree pattern on trunk
greasy, scaling lesions in the nasolabial folds and sometimes behind the ears
seborrhic skin condition
clinical manifestations of this skin disorder include a slightly rough, pink or flesh-colored lesion in sun-exposed skin
actinic keratosis
actinic keratosis can develop into _______
squamos cell legion
antibodies found in Acute Post Streptococcal Glomerulonephritis (ASPNG)
IgG
seen in urine analysis in pyelonephritis
WBC
hormone that affects strength of pelvic muscles
estrogen
main problem with urge incontinence
relaces detressor muscle
typically see mixed incontinence in:
older adults
overflow incontinence in mean is usually due to:
(Benign Prostrate Hyperplasia) BPH
hemmorhagic ulcers in the bladder wall seen in interstitial cystitis
Hunner ulcers
Skin Changes with \_\_\_\_\_: Thinner Dryer Less elasticity Decreased melanocytes Decreased SQ fat Decreased vasculature Decreased lymphatic drainage Decreased # fibroblasts Decreased cell proliferation Decreased blood supply Decreased Langerhans cells Decreased pressure/touch receptors and free nerve endings Decreased sensory perception Decreased protective function Changes in hair color & distributions Changes in pigmentation Shortened capillary loops Atrophy of sebaceous, ecrine and apocrine glands Compromised temperature regulation Increased infections Delayed wound healing ***90% geriatric persons have some kind of skin d/o EX: keratosis, psoriasis, angiomas, liver spots and skin tags are common Cancerous and precancerous lesions are common
Aging
Highly contagious childhood skin disorder that is transmitted by skin-to-skin contact and autoinoculation (little bumps on skin – when they rupture, the juice inside makes more bumps)
o Most common in children, can also occur in adults (esp. sexually active young adults – if found in genital area – considered an STI)
o Etiology: Poxvirus
Molluscum Contagiosum
CM of ______:
Waxy, pink globules seen on face/trunk/extremities
Small, raised, round & flesh colored bumps
Little indentation (dot) or umbilication at the top
May be itchy
May become inflamed
Clears in 6-9 months
Molluscum Contagiosum
most common and effective treatment option for Molluscum Contagiosum
Cantharidin
Three day measles (3-5 days) characterized by diffuse punctate macular rash that begins on the trunk and spreads to the arms and legs and a mild febrile state might be present
If contracted during first trimester of pregnancy it can cause severe teratogenic effects in the fetus.
Less aggressive
Look for in kids not vaccinated with MMR
Rubella (German Measles)
CM of \_\_\_\_\_\_: Enlarged and tender occipital and periauricular nodes Pinkish reddish Maculopapular rash that starts on face then spread to rest of body a few days later low-grade fever mild pink eye headache general discomfort swollen lymph nodes runny nose cough
Rubella (German Measles)
Communicable viral disease– Most contagious of all infectious diseases: it can remain infectious up to 2 hours in the air after an infected person leaves an area (infects very easily!)
Rubeola (Red Measles)
Rubeola etiology
Morbillivirus - single stranded RNA virus
Rubeola Route of Transmission
droplet/air
Rubeola Incubation Period
7-12 days
Rubella Etiology
Rubivirus – a positive strand of RNA virus
Rubella Transmission
direct/droplet
Rubella Incubation
: 14-21 days
CM of \_\_\_\_\_\_\_: High fever Runny nose Cough Conjunctivitis Photosensitivity Kolpik spots (Pin point whites spot, surrounded by erythematous ring in the mouth) 1-3 day purple/reddish brown, macular and blotchy rash that begins along hairline and spread downward
Rubeola (6th Disease)
etiology of Roseola
HSV 6 or 7
transmission of Roseola
droplet
incubation period of Roseola
5-15 days
CM of \_\_\_\_\_: High fever (starts suddenly – when they are most contagious) Pink, non-pruritis macular rash Irritability Swollen glands Ear pain Decreased appetite
Roseola
transmission of chicken pox
touch/droplet
incubation period of chicken pox
14 days
Reactivation of latent varicella virus that hides in the ganglia
Shingles
transmission of pityriasis rosea
unknown
incubation of pityriasis rosea
unknown
CM of _____:
URI symptoms
fever
headache
salmon-pink herald patch (2 in. raised patch) that is usually on the trunk
early lesions are macular and papular followed by expanding rose-colored oval lesions that are bilateral and symmetrically distributed on the trunk and upper extremities resembling drooping Christmas tree
multiple smaller pink spots that are dry and scaly
***typically lasts 2-3 months
Pityriasis Rosea
cold sores arising from the trigeminal nerve root with initial outbreak causing a flu-like prodrome w/ a burning and tingling sensation followed by vesicles and erythema as the virus replicates
• as the viral vesicles rupture ulcers form
• followed by crusting before healing
• Recurrence- the virus hides in the ganglia and will erupt again when the immune system is challenged
HSV Type 1
transmission of HSV Type 1
oral secretions
herpes on genitalia that arise from the sacral nerve root that cause cluster of blisters that will rupture & leak leaving area tender
HSV Type 2
transmission of HSV Type 2
contact
transmission of genital warts
direct contact
CM of ____:
small, fleshy bumps, rough w/black centers (small clotted blood vessels) that resolve spontaneously
genital warts
Common benign papilloma caused by DNA containing papilloma viruses that causes an exaggeration of normal skin composition stratum corneum that becomes irregular and thickened
genital warts
etiology of impetigo
Staph
transmission of impetigo
Contact or touching articles/toys of infected individual
CM of ____:
Sores around the nose or mouth (red sores rupture & ooze, & ooze will dry)
Form yellowish brown crust
sores around mouth but can spread to fingers as well
Impetigo
etiology of Folliculitis, Furuncles, Carbuncles (all have to do w/hair follicles)
Staph
inflammation of the hair follicle (looks like small yellow pustules that are confined to hair follicle)
folliculitis
boils (more extensive, involved sebaceous glands)
furuncles
infected hair follicles (multiple furuncles that go deeper w/in layers of skin)
carbuncles
Fungal- Scaly, pruritic scalp w/bald areas; hair breaks easily
Tinea capitis (scalp)
Fungal- Circular, clearly circumscribed, mildly erythematous scaly patches with a slightly elevated ring-like border; some forms are dry & macular, & other forms are moist/vesicular
Tinea corporis (skin areas, excluding scalp, face, hands, feet, groin)
Fungal- Small erythematous and scaling vesicular patches w/a well-defined border that spreads over the inner and upper surfaces of the thighs; occurs w/heat & high humidity
Tinea cruris (groin, jock itch)
Fungal- Occurs between the toes & may spread to the soles of the feet, nails, & skin of toes; slight scaling, macerated painful skin, occasionally with fissures and vesiculation
Tinea pedis (athlete’s foot)
Fungal- Dry, scaly, erythematous lesions, or moist vesicular lesions that begin w/clusters of intensely itching, clear vesicles; often associate w/fungal infection of the feet
Tinea manus (hand)
A superficial or deep inflammation of the nail that develops yellow-brown accumulations of brittle keratin over all or portions of the nail
Tinea unguium or onychomycosis (nails)
CM of _____:
• Itchy red scaly circular rash.
• Scalp - may not be red but may see circular patches of hair loss.
• Nails - thickening discolored nail that will crumble and fall off.
• Groin/feet - may just be red, itchy irritated skin
Fungal Infections of the Skin
Risk Factors for \_\_\_\_\_\_: warm moist environment DM antibiotics immunosuppression pregnancy
Candidiasis
Risk Factors for \_\_\_\_\_\_ : Heat Moisture Occlusive clothing Pregnancy Systemic ATB therapy DM Sexual intercourse w/infected male
Vaginal (vulvovaginitis)
Risk Factors for _______ Candidiasis:
Uncircumcised
Sexual intercourse w/ infected female
Penis (balanitis)
Risk Factors for _______ Candidiasis:
DM
Immunosuppressive therapy
Inhaled steroids
Mouth
Risk Factors for _______ Candidiasis:
Heat & Moisture
DM
Immunosuppressive therapy
Skinfolds
CM of \_\_\_\_\_\_\_: Vaginal itching white, watery, or creamy discharge Red & swollen vaginal & labial membranes w/erosions Lesions may spread to anus and groin
Vaginal Candidiasis
CM of _____:
Pinpoint, red, tender papules & pustules on glans and shaft of penis
Penis (balanitis) Candidiasis
CM of ______:
Red, swollen, painful tongue & oral mucous membranes
Localized erosions & plaques appear w/chronic infection
Mouth Candidiasis
CM of ______:
Pruritic red rash progressing to vesicles and papules that enlarge and rupture
Skinfold Candidiasis
CM of ______:
• Dry, itchy, scaly erythema (can show up anywhere)
• Creases of elbows/knees, face, hands, scalp, trunk
• Location very individualized
Atopic Dermatitis
Skin disorder that is a Type 1 hypersensitivity that increases IgE, eosinophils, & interleukins
Atopic Dermatitis
Allergic, Irritant Type 4 Hypersensitivity (cell-mediated) or Non-allergic reaction skin disorder
contact dermatitis
skin reaction due to chemicals, metals, or plants such as poison ivy, poison oak, sumac which is a delayed acquired hypersensitivity – Type 4 – to a specific antigen/allergen (***cell-mediated)
contact dermatitis
CM of \_\_\_\_\_\_: Red skin erythematous where irritant came in contact with skin, blisters (ooze & crust over) swelling burning tenderness at site may c/o itching
contact dermatitis
a papulosquamous inflammatory skin diseases whose etiology is unknown that is manifested by various degrees of greasy, scaling, erythema, in areas of high oil gland concentration of the face and scalp
o Common inflammatory skin disorder that mainly affects the scalp, causing scaly, itchy, red skin and stubborn dandruff
Seborrheic Dermatitis
seborrheic dermatitis of the scalp is known as ______
cradle cap
skin disorder with papules and plaques with overlying silvery scale that is an inflammatory inherited condition with immune system involvement (exacerbations and remissions)
o Lesions will be on the knees, elbows, lower back, scalp, nails
psoriasis
CM of \_\_\_\_\_\_: red patches covered w/thick silvery scales Dry, cracked skin that is itchy Nail changes (thickness, rigid) swollen/stiff joints
psoriasis
CM of _____:
facial redness
swollen red papules
pustules
Rosacea
Risk Factors for \_\_\_\_: women fair skin age smoking family hx
Rosacea
Disease of pilosebaceous unit triggered by increased production of androgen that arises when sludging of sebaceous oils and deposition of loose epithelial cells cause an obstruction of the follicular canal…associated with increase production of sex hormones, especially testosterone.
o Comedones and pustules distributed over the face, upper back, upper chest
Vulgaris Acne
Genetic; IgE mediated skin disorder most common in children that will improve with age in some persons
• Commonly found on the face, antecubital regions, behind the ears, wrists
• Thickening of the skin or lichenification occurs d/t scratching
Excema
Clinical manifestations of ______:
pruritic lesions
oozing
crusting
Eczema
skin disorder that is a Type 1 hypersensitivity caused by sunlight, chronic illness, or temp changes, drugs (antibiotics), foods (shellfish, peanuts), systemic disease (lupus) or physical agents (cold, heat)
o Most lesions (hives/welts) resolve spontaneously in <24 hours
o Antihistamines, corticosteroids and B-adrenergic agonists are treatment options
Urticaria (Hives)
Clinical Manifestations of _______:
red/skin-colored wheals
itchy painful swelling (angioedema)
Urticaria (Hives)
In glomerulonephritis, what damages the epithelial cells resulting in hematuria and proteinuria?
immune injury
Which cells of the inflammatory process are found in acute poststreptococcal glomerulonephritis?
immune complexes
When does an individual have their full complement of renal nephrons?
at birth
Which of the following reactivates with stress, sun exposure, or menses?
Herpes Simplex
