Test #2 (Infectious Disease, Integumentary, some CV) Flashcards
_______ refers to a traumatic or pathologic loss of normal tissue continuity, structure, or function.
Lesions
Small flat circumscribed lesion of a different colour than the normal skin.
Macule
Small, firm, elevated lesion.
Papule
Elevated lesion larger than a papule.
Nodule
Elevated, erythematous lesion that usually contains purulent exudate (pus).
Pustule
An elevated, thin walled lesion containing clear fluid.
Veslicle
Large, slightly elevated lesion with a flat surface; often topped by scale.
Plaque
Dry, rough surface, or dried exudates, or blood.
Crust
Thick, dry, rough skin surface (leather like).
Lichenification
Raised, irregular mass of collagen resulting from excessive scar formation.
Keloid
A small, deep crack or tear in the skin
Fissure
A cavity with loss of tissue from the epidermis and dermis; often weeping or bleeding.
Ulcer
Shallow moist cavity in the epidermis.
Erosion
These are temporary eruptions of the skin. They are associated with childhood diseases, heat, irritation, allergies, or drug induced reactions. They range in size from fractions of a millimetre, to many centimetres.
Rashes
The four types of \_\_\_\_\_\_ are: Blanched (white) Erythematous (red) Hemorrhagic, or purpuric (containing blood) Pigmented (coloured)
Rashes
A vesicle of fluid filled papule (a.k.a. bulla). There is a degeneration of epidermal cells; disruptions of intercellular junctions. This causes layers of skin to separate, and fluid to accumulate.
Blisters
______ are caused by friction, or burns, and are most common on the palmar surface of the hand, or plantar surface of the foot.
Blisters
A hyperkeratotic plaque of skin due to chronic pressure or friction. There is increased cohesion between cells, and decreased skin shedding. They may be removed by filing, but will reoccur if cause is not addressed.
Callus
Small, well circumscribed, conical, keratinous thickening of the skin.
• Usually appear on the toes from rubbing or ill-fitting shoes
• Painful on the feet – usually asymptomatic on the hands
• May be surgically removed, but may reoccur if the cause is not addressed
Corns
________ (Itch)
• The itch sensation originates in free nerve endings in the skin (nociceptors)
• Ranges from mild to severe
• May be a clue for internal disorders such as chronic renal disease, and biliary disease
• Triggering factors are warmth, touch, and vibration
• Most treatment measures are non-specific
Pruritis
Scratching an itch is a ______ reflex. It may or may not relieve the itch. Repeated scratching may lead to skin irritation and lacerations/excoriation.
Spinal
_______ (Dry skin) – Caused by dehydration of the stratum corneum. It may be the primary sign on a skin disorder, or an underlying systemic disease.
• Skin appears rough, scaly, wrinkled, and lined
• Dry skin is predisposed to itching which may result in cracking and fissuring
• Commonly affected areas include extremities, the back, abdomen, and waist
• Treatment is with moisturizing agents
Xerosis
Pigmentary skin disorders – These disorders involve ____________.
Melanocytes
White patches that suddenly appear on the skin. This is due to the absence of melanocytes, a decreased number of melanocytes, or melanocytes that just don’t produce melanin. Research has found an increase in hydrogen peroxide at the lesion sites.
Vitiligo
A genetic disorder with complete or partial congenital absence of pigment in the skin, hair, and eyes.
Albanism
The most common form of albinism is the recessively inherited ___________ albinism. The patient has the normal number of melanocytes, but lacks the enzyme required for the synthesis of melanin (tyrosinase DW)
Oculocutaneous
Characterized by darkened macules on the face.
Chloasma
A relatively common fungal infection. Fungus invades dead keratinized tissue.
Tinea
T/F: Massage is safe on patients with tinea.
False: No massage onsite - contagious
Primary infections are generally _________.
Secondary infections occur in a pre-existing ______, and may be deeper.
Primary infections are generally superficial.
Secondary infections occur in a pre-existing lesion, and may be deeper.
An infection of a hair follicle which spreads to the surrounding dermis.
Furuncle
T/F: It is safe to massage over a boil.
False: It will be painful to the client, and there is the risk of spreading the infection
A collection of furuncles. They coalesce into a large infected mass, which may drain through different sinuses, or develop into an abscess.
Carbuncle
A common, superficial, infection caused by staph, or group A hemolytic strep.
Impetigo
T/F: On-site massage for impetigo is unsafe.
True
An ulcerative form of impetigo, caused by staph/strep.
Ecthyma
T/F: Fever is an absolute contraindication for massage.
True
Deep infection affecting the dermis and subcutaneous tissue. It is caused by staph and beta hemolytic strep. Often associated with fish handling, swimming, and animal bites or scratches.
Cellulitis
Common benign papillomae caused by Human Papilloma virus.
Verrucae
Stay about __ cm away from warts. If you touch one, wash your hands right away – you don’t want to spread them on your client, or to yourself!
10 cm
Type 1 Herpes– usually affects the _____.
Type 2 Herpes– usually affects the _______.
Type 1 – usually affects the mouth.
Type 2 – usually affects the genitals.
Stay __ cm away from any open lesions. Wash hands immediately if you come into contact with an open lesion.
10 cm
T/F: If you have not been immunized against chicken pox, you can get it from an open shingles lesion.
True
________ Contact Dermatitis – Caused by chemicals or environmental substances that come in contact with the skin, or by rubbing.
• Can be acute or chronic
• Skin reactions vary from mild erythema and scaling to acute necrotic burns
Irritant
________ Contact Dermatitis – A cell mediated type IV hypersensitivity due to sensitization to an allergen
• More than 200 allergens have been identified
• Lesions range from mild erythema with edema to vesicles or large bullae
• A secondary lesion from bacterial infection may occur
Allergic
______ Dermatitis/Eczema (p.44) – A Type 1 hypersensitivity reaction; often seen in those with a family HX of asthma, hay fever, and atopic dermatitis. Vesicle formation occurs with oozing, crusting, and flaking
Atopic
_______ (Hives) – Characterized by edematous plaques with intense itching. Raised pink or red areas surrounded by a paler halo; red areas blanch with pressure. Size varies from a few millimetres to centimetres.
Urticaria
A group of skin disorders characterized by scaling papules and plaques; includes psoriasis and
lichen planus.
Papulosquamous Dermatoses
A relatively common chronic, pruritic disease, causing inflammation, and papular eruptions of the skin and mucous membrane. It happens as a result of an abnormal immune response linked to Hep C infection. Also associated with medication use (antimalarials, NSAID’s, beta blockers, thiazide diuretics).
Lichen Planus
T/F: Lichen Planus is non-contagious and therefore safe for on-site treatment.
False: It’s non-contagious but no on-site treatment when in flare up.
Chronic inflammatory skin disorder caused by abnormal activation of T-cells. Characterized by circumscribed, red thickened plaques with an overlying silver scale.
Psoriasis
Which skin disorder should you use caution when treating, because topical steroids are commonly used as treatment and you could accidentally dose yourself.
Psoriasis
A disorder of the pilosebaceous unit (hair follicle and sebaceous gland). Excess sebum production can plug up the pore of a pilosebaceous unit.
Acne
Non-inflammatory lesions are called ________.
Comedones
Most common form of acne among adolescents and young adults – incidence during adolescence
is roughly 100%. Lesions from mainly on the face, and neck – to a lesser extent the back, chest, and
shoulder.
Acne Vulgaris
Type of acne that occurs later in life (post adolescence). Chronic form of acne. Inflammatory and non-inflammatory lesions usually occur on the back, buttocks, and chest – to a lesser extent on the abdomen, shoulder, neck, face, upper arm, and thighs.
Acne Congoblata
Chronic inflammatory process that occurs in adults > 40 years old. It is often confused with acne, and may occur at the same time.
Rosacea
T/F: Hot hydro applications are great for treating Rosacea.
False: They are to be avoided.
Caused by mites which burrow into the epidermis. Transmission by person to person contact (including sexual contact) and by infested sheets – can live up to 2 days on infected sheets and clothing.
Scabies
The following describes the clinical protocol for a patient with _______, and also applies to patients with _______:
Reschedule for when your patient’s infestation has resolved. If you realize after your client is already on the table, be sure to bag sheets and towels separately and wash them in very hot water and use a very hot drier. Use an insecticide to wipe down all surfaces in your treatment area.
Scabies and Pediculosis (lice).
There are 3 types of UV rays:
___ are very short and do not pass through the earth’s atmosphere
___ are responsible for nearly all of the skin effects of sunlight
___ are more commonly referred to as “sun tanning rays”
- UVC are very short and do not pass through the earth’s atmosphere
- UVB are responsible for nearly all of the skin effects of sunlight
- UVA are more commonly referred to as “sun tanning rays”
An erythematous, inflammatory reaction of the skin to excessive exposure to Ultra Violet Radiation (radiation burn)
Sunburn
T/F: Massage is a contraindication for areas that are sunburnt. Cool compresses may be applied.
True
Common, benign tumours of the skin. They may be pigmented, or non- pigmented, flat or elevated, hairy or non-hairy.
Nevi (moles)
The ABCDE rule of identifying a dysplastic nevus:
A – _________ – if you drew an imaginary line through the mole, do both halves look the same?
B – ______ – are the edges uneven, scalloped, or notched?
C – _____ – are there a variety of shades (brown, blue, red, white, black)?
D – ________ – is it greater than 6 mm (about the size of a pencil eraser)?
E – _________ – has there been any change in any of the above, change in height of the
mole, itching, crusting, or bleeding?
A – Asymmetry B – Border C – Colour D – Diameter E – Evolution
Rapidly progressing malignant tumour of melanocytes. It often arises from pre-existing nevi.
Malignant Melanoma
T/F: Risk of Malignant Melanoma is greater in fair-skinned people, or people who freckle easily.
True
The second most common malignant tumour or the outer epidermis. Associated with exposure to UVR, arsenic, coal, industrial tar, and paraffin. Men are twice as likely as women to have it. Presents with a red scaled, keratotic, slightly elevated lesion with an irregular border.
Squamous Cell Carcinoma
Neoplasm of the non-keratinizing cells of the basal layer of the epidermis. The most common skin cancer of light skinned people.
Basal Cell Carcinoma
Small red lesions that are noticed shortly after birth. Begin as vascular tumours produced by proliferation of endothelial cells. There is a period of rapid proliferation, followed by slow involution. Disappear by the age of 7 leaving no scar. More common in girls and babies that are born prematurely.
Hemangiomas of Infancy (Strawberry Hemangiomas)
A vascular birth mark. Pink or red patches usually seen on the face, but can occur anywhere on the body. Slow growing capillary malformations grow and become
darker as the child grow. Persists throughout life. Can be treated by laser therapy
Port-Wine Stains
Common skin lesions:
• ____ ____– Benign, soft, papules. Size varies from pinhead to pea. Colour may be natural skin tone, or browner.
• ________ – Horny growth of keratinocytes. May be benign (seborrheic keratosis) or a pre-cancerous lesion (actinic keratosis).
• ________ (Liver spots) – A lentigo is a well bordered, brown to black macule, usually less than 1 cm in diameter.
- Skin tags– Benign, soft, papules. Size varies from pinhead to pea. Colour may be natural skin tone, or browner.
- Keratosis – Horny growth of keratinocytes. May be benign (seborrheic keratosis) or a pre-cancerous lesion (actinic keratosis).
- Lentigines (Liver spots) – A lentigo is a well bordered, brown to black macule, usually less than 1 cm in diameter.
Vascular lesions:
• ________ are smooth, cherry red or purple papule, usually found on the trunk
• ___________ – Single dilated blood vessels, capillaries, or terminal
arteries. Seen on sun exposed areas, are non-palpable and easily blanch
• ______ _____ – Small, dark blue, slightly raised papules that have a lake like appearance – smooth and compressible
• Angiomas are smooth, cherry red or purple papule, usually found on the trunk
• Telangiectases (p.40) – Single dilated blood vessels, capillaries, or terminal
arteries. Seen on sun exposed areas, are non-palpable and easily blanch
• Venous Lakes (p.41) – Small, dark blue, slightly raised papules that have a lake like appearance – smooth and compressible
The ______ is the largest vessel in the arterial system.
Aorta
The aorta receives volumes of oxygenated blood from the ____ ________, which ejects them at high pressure.
Left Ventricle
The aorta and its branches (the _______ ____) convey blood to tissue beds throughout the body.
Arterial Tree
The aorta and large arteries have strong _______ ______, meaning that they stretch to accommodate the blood from the LV and then rebound back to normal size. As they do this, the blood is propelled forward.
Elastic recoil
The small arteries lead to the arterioles, which convey blood into the tissue beds. These smaller arterial vessels have more _______ ______.
Muscular walls
The ________ _______s, which deliver blood to supply the heart wall, are located right at the proximal end of the aortic arch.
Coronary arteries
When the LV ejects blood into the aorta, the _____ _____ flaps are pressed against the openings to the coronary arteries, covering them and preventing blood inflow.
Aortic valve
As the blood passes over the aortic arch, the last volume will not clear the arch and falls back. At this point the LV has relaxed and the aortic valve has closed, so this final blood cannot re-enter the ventricle. It flows into the _______ ________, meaning that it can perfuse the cardiomyocytes of the heart chambers when they are at rest (during diastole).
Coronary arteries
The body’s system of _____ brings blood away from the tissues after oxygen and nutrients have been exchanged at the capillary level with metabolic wastes.
Veins
From the capillaries, following along vessels that become increasingly larger (venules,veins, vena cava), this “venous return” blood enters the heart’s _____ atrium.
Right
The body’s lymph drainage joins the venous return in the __________ veins that drain into the superior vena cava.
Subclavian
The superior vena cava receives venous return from the upper half of the body, above the _________. Venous return from the lower half, below the diaphragm, flows through the inferior vena cava.
Diaphragm
The large veins also act as “blood reservoirs” or ___________ vessels, so they can help adjust or manage the percentage of total blood volume in the arterial system (and therefore blood pressure) by dilating or constricting to accommodate the desired amount of blood for that moment.
Capacitance
Made of endothelial cells and some elastin, this layer is in contact with the bloodstream. In veins that work against gravity, this layer also contains valves.
Tunica Intima/Interna
T/F: Arteries also have an internal elastic membrane outside the tunica intima.
True
This layer contains variable amounts of elastin and smooth muscle, depending on the role of the blood vessel.
Tunica Media
Large arteries have a big elastin component; large veins have a balanced mix, while smaller vessels have more ______.
Muscle
This layer of veins contains variable amounts of elastin and smooth muscle, depending on the role of the blood vessel.
Tunica Media
T/F: Large arteries have a big muscle component; large veins have a balanced mix, while smaller vessels have more elastin.
False! Large arteries have a big elastin component; large veins have a balanced mix, while smaller vessels have more muscle.
_________ are the vessels involved in shunting blood in and out of tissues according to the needs of the moment.
Arterioles
The arterioles are the entry point into the __________ – their muscular walls constrict to prevent or slow inflow into their tissue beds, or alternatively relax to create a larger lumen that encourages flow.
Capilliaries
Blood vessel smooth muscle is largely innervated by the _________ ________ _______.
Sympathetic Nervous System
This outermost layer of a blood vessel largely consists of collagen.
Tunica Adventitia/Externa
The _____ ________ (vessels of the vessels) is contained in the tunica externa—especially prominent in larger arteries and veins, this is the network of small vessels that supply the walls.
vaso vasorum
__________ walls have only one layer and a basement membrane—they are semiporous, made of endothelial cells, and just one cell thick. They are only wide enough for one red blood cell.
Capillary
Capillaries are organized into networks or “____” around which their supplied cells are arranged.
“beds”
Tiny _________ vessels are present in the tissue beds, interwoven with the capillaries. They pick up “large garbage” in the form of dead cells or bacteria, damaged structural components, etc. that are too big to fit through capillary pores (spaces between the wall cells).
Lymphatic
By removing elements that have a high osmotic draw, the lymphatics help control fluid _______ in the interstitium.
Volume
Blood shunting in and out of tissue beds is also important for ___________ control. When the body becomes overheated, or when heat is applied to the body surface, arterioles dilate and blood flow to and through the subcutaneous tissues increases.
Temperature
Simultaneous contraction of the two ventricles resulting in expulsion of the blood from the heart (from the right side to the lungs and from the left side into the systemic circulation).
Heart Beat
The number of times the heart beats in one minute.
Heart Rate
The contraction, or pumping, phase of the cardiac cycle.
Systole
The resting phase of the cardiac cycle in which the chambers refill with blood and the heart itself is supplied with nutrients.
Diastole
The period from the beginning of one heart beat to the beginning of the next.
Cardiac Cycle
One cardiac cycle is completed when the heart fills with blood and the blood is then pumped from the heart. ________ is the filling phase and ________ is the emptying phase.
Diastole is the filling phase and systole is the emptying phase.
During the diastolic phase of the cardiac cycle, all four chambers are relaxed and blood is flowing into both atria — since the AV valves are open, it also _________ moves down into the ventricles.
Passively
During the second stage, the ___ _____ fires and the atria contract (atrial systole). The ventricles are still relaxed (ventricular diastole) and about 75% filled with blood. The atrial contraction pushes in the last volume of blood before the ventricles contract.
SA node
In the third stage, the AV node fires and _________ begin to build tension in preparation for contraction. The AV valves close and the semilunar valves open.
Ventricles
In the fourth stage, the ventricles contract (ventricular systole); the RV sends blood into the _________ circulation and the LV ejects blood into the aorta. These walls contract very forcefully, with all cells working in concert.
Pulmonary
In the final stage of the cardiac cycle, the ventricular myocardial cells relax quickly and profoundly. The _________ valves close, the AV valves open, and the full heart diastolic fill phase begins again.
Semilunar
While it is fair to say that the atria and ventricles undergo systole at different times, the intervals of the cardiac cycle are typically defined based on _________ diastole and _________ systole.
Ventricular diastole and ventricular systole
The myocardial cells are themselves nourished with fresh arterial blood while they are relaxed, in other words during the _________ phase.
Diastolic
Under normal conditions the cardiac cycle is about __% diastole and __% systole at rest.
60% diastole and 40% systole
The duration of the ________ phase is largely fixed, so when the heart speeds up __________ time is reduced. This is workable for short bursts, but if the heart rate is chronically increased myocardial nutrition can become short-changed.
The duration of the systolic phase is largely fixed, so when the heart speeds up diastolic time is reduced.
Blood Pressure is a combination of _________ pressure, which is the pressure applied equally by water on the walls of its container, and __________ pressure, which is exerted as a result of the flow of blood and changes according to the contours and branching of the walls.
hydrostatic pressure: the pressure applied equally by water on the walls of its container
hemodynamic pressure: exerted as a result of the flow of blood and changes according to the contours and branching of the walls.
Although there is some amount of pressure in all parts of the cardiovascular system except the entry into the RA, ________ blood pressure is central to the delivery of perfusion into the body’s tissues.
Arterial
T/F: Blood pressure is lowest in the aorta/large arteries and becomes increasingly intense as the vessels decrease in size.
False, it’s the other way around.
The elastic stretch and recoil properties of the large arteries give rise to two _________ ______, but this becomes completely attenuated into one milder propellant flow as the blood arrives at the capillary bed level and moves through the veins.
Pressure Poles
The “________” effect of large arteries is necessary to mitigate force and move the blood through the vascular circuit, but it must be removed by the time blood is delivering nutrients in a steady stream to the body’s cells.
“bellows”
The difference between the systolic and diastolic pressures.
Pulse pressure
The pulse pressure tends to go up when the heart is working harder. Ideally is should be around __.
40
The ____ _______ _________ is the average pressure in the in the large arteries.
Mean Arterial Pressure
Mean Arterial Pressure is a calculation that represents the quality of ________.
Perfusion
______ ________ is one of the key determinants of blood pressure because the higher the volume of blood in the system, especially in the core circulation, the harder the heart and vessels have to work to pump it.
Blood Volume
The ___________ function of veins diverts blood volume from the arterial tree to help manage pressure.
Capacitance
______ _________ is the quantity of blood the heart pumps into the systemic circulation each minute.
Cardiac Output
Determinants of _________ Pressure
- LV stroke volume
- strength and velocity of blood ejection from the LV
- elasticity/compliance of the aorta
Systolic
Determinants of _________ Pressure
- condition of arteries and ability to stretch and store energy for elastic recoil
- resistance of arterioles, either because of sympathetic activation or because of their physical condition, or both,
- competence of the aortic valve
Diastolic
Blood pressure is basically an equation of cardiac output and _____ ________ _________.
Total Peripheral Resitance
BP = __ x ____
or
BP = __ x __ x ____
BP = CO x TPR
or
BP = HR x SV x TPR
Can massage influence Elasticity/stiffness of large vessels in the arterial system?
No
Can massage influence Tone (constriction state) of small arteries and arterioles?
Yes
Can massage influence the condition of capillaries?
No
Can massage influence the ease of blood clearance in filtration systems (kidneys, lungs, liver)?
No
Massage can influence Diaphragm tension level?
Yes
Can massage influence Blood viscosity?
Yes
The atrial reflex, also called the _________ reflex, is an increase in heart rate due to an increase in central venous pressure. Increased blood volume is detected by stretch receptors (baroreceptors) located in both atria at the venoatrial junctions.
Bainbridge
