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Pathophysiology > Unit 15 Chapters 51 & 52 > Flashcards

Unit 15 Chapters 51 & 52 Flashcards

1
Q

what are the three distinct layers of the skin

A

epidermis, dermis, subcutaneous

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2
Q

what layer contains keratinocytes

A

epidermis

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3
Q

what do keratinocytes do

A

produce a fibrous protein called keratin

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4
Q

where are melaonocytes located

A

epidermis

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5
Q

what do melanocytes do

A

pigment synthesizing cells that produce melanin

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6
Q

melanin protects from

A

UV

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7
Q

what cells produce keratin

A

keratinocytes

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8
Q

what cells produce melanin

A

melanocytes

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9
Q

where are langerhan cells located

A

epidermis

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10
Q

where do langerhan cells arise from

A

bone marrow

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11
Q

why do langerhan cells migrate to the epidermis

A

to help activate the immune system

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12
Q

how do langerhan cells activate the immune system

A

binding to antigens

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13
Q

where do langerhan cells migrate to after they bind to the antigen

A

lymph

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14
Q

dermis is the primary source of

A

nutrition

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15
Q

does the dermis have neurons, nerves, supplying blood vessels, sweat glands, erector pili muscles

A

yes

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16
Q

if a patient comes in with severe burn and says it does not hurt that bad why?

A

the burn must have went to the dermis and damaged the nerves

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17
Q

why would someone with an epidermis burn be in more pain than someone with a dermis burn

A

with an epidermis burn the nerves are still intact

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18
Q

the main goal of langerhan cells is to gather

A

antigens

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19
Q

the number of what is the same in dark and white skin

A

melanosomes

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20
Q

black skin produces what substance more and faster

A

melanin

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21
Q

in dark skin what might be the difference compared to white skin

A

scars are darker, skin may be dry/ashy

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22
Q

what signs might be difficult to asses on black skin

A

erythema and skin pallor

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23
Q

since erythema and skin pallor are different to assess what should the clinician do?

A

look at eyes, mouth and feel the skin for warmth or cold

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24
Q

what type of pigmentation often accompany ethnic skin disorders

A

hypo and hyperpigmentation

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25
Q

absence of melanin leads to

A

vitiligo
albinism

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26
Q

increase in melanin

A

mongolian spots
melasma

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27
Q

rashes

A

temporary eruption of the skin

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28
Q

lesion

A

traumatic or pathologic loss of normal tissue, continuity, structure, or function

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29
Q

is rash permeant

A

no, temporary

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30
Q

telangiectases

A

dilated superficial blood vessels

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31
Q

Pruitis

A

sensation of itch

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32
Q

what might pruitis be caused by

A

organ disorder such as renal failure
central or primary skin disorder
morphine

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33
Q

why does morphine cause pruitis

A

acts on central opioid receptors to CNS

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34
Q

superficial mycoses live on

A

dead keratinized cells of the epidermis

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35
Q

superficial mycoses emit an enzyme that enables them to digest

A

keratin

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36
Q

Candida is a normal inhabitant of

A

GI tract, mouth, vagina

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37
Q

what predisposes someone to get a Candida infection

A

DM, antibiotics, pregnancy, BC, immunosuppressive disorders

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38
Q

where does Candida thrive

A

warm moist intertriginous folds

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39
Q

what does a candida infection look like

A

red rash with well defined borders along with macropapular satellite lesions

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40
Q

treatment for candida

A

niastain

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41
Q

who might be at risk of candida since we know it likes to thrive in intertriginous folds (skin on skin)

A

babies
obese people

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42
Q

dermatophytes require ________ for growth

A

keratin

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43
Q

dermatophytes emit an enzyme that enables them to digest keratin which results in

A

superficial skin scaling, nail disintegration or hair breakage

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44
Q

superficial fungal infections all are in the genus

A

Tinea

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45
Q

impetigo can cause _____________ within 7-12 days

A

glomerulonephritis

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46
Q

cellulitis affects

A

deeper layers, dermis and subcutaneous

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47
Q

herpes zoster is

A

shingles

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48
Q

herpes invades

A

dorsal root ganglia

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49
Q

shingles is caused when _____________ herpesvirus is reactivated

A

chickenpox

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50
Q

CDC recommends that people ___ years and older and have had chickenpox get the shingles vaccine

A

60

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51
Q

shingles comes back when the immune system is

A

supressed

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52
Q

rosacea is a chronic skin disorder of

A

middle aged and older

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53
Q

rosacea can look like

A

blushing to dark red erythema (purple almost)

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54
Q

rosacea has the _____________ vessels

A

telangiectatic

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55
Q

rosacea could lead to inflammatory

A

pustules and papuels

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56
Q

does rosacea progress to anything

A

no

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57
Q

rosacea is what kind of inflammatory

A

chronic inflammatory process

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58
Q

rosacea is a chronic inflammatory process accompanied by ____________ ________ with leakage of fluid and inflammatory mediators into the dermis

A

vascular instability

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59
Q

rosacea is accompanied by

A

gastrointestinal symptoms

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60
Q

allergic contact dermatitis results from a cell mediated type ___ hypersensitivity response

A

IV

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61
Q

irritant contact dermatitis is caused by ___________ that irritate the skin

A

chemicals

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62
Q

erythema multiforme occurs after

A

herpes simplex

63
Q

is erythema multiforme self limiting

A

yes

64
Q

erythema multiforme could develop into

A

stevens-johnson syndrome

65
Q

in stevens johnson syndrome the skin

A

detaches from body surface

66
Q

in stevens johnson syndrome what percentage of the body is affected

A

<10%

67
Q

what race is more at risk for stevens johnson syndrome

A

again

68
Q

stevens johnson syndrome lesions are similar-round erythematous papule resembling insect bite but what is one defining feature of stevens johnson syndrome rash

A

target or iris of the rash

69
Q

stevens johnson syndrome could develop into

A

toxic epidermal necrolysis

70
Q

toxic epidermal necrolysis how much of the body is affected

A

> 30%

71
Q

mortality rate of toxic epidermal necrolysis

A

30-35%

72
Q

skin disorders characterized by scaling papule and plaques

A

psoriasis

73
Q

psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves ________________ of the ___________ in the epidermis

A

hyper proliferation, keratinocytes

74
Q

psoriasis has an increase in the

A

epidermal cell turnover rate

75
Q

what factors play a role in the development of psoriasis

A

environmental, genetic, immunologic factors

76
Q

psoriasis mainly affects

A

elbows, knees, scalp, lumbosacral areas, intergluteal clefts, glans penis

77
Q

in 30% of psoriasis patients the ______ are also affected

A

joints

78
Q

which of the following factors has been recognized as a trigger for psoriasis exacerbations
- hot weather
- increased exposure to sunlight
- alcohol
- pregnancy

A

alcohol

79
Q

what are somethings that trigger exacerbations of psoriasis

A

stress, cold, trauma, infections, alcohol, drugs

80
Q

what is beneficial for psoriasis

A

hot weather, sunlight, pregnancy

81
Q

in psoriasis there is activated T cells which causes growth factor and then keratinocytes and blood vessels grow which leads to

A

papules

82
Q

in psoriasis activated T cells attract neutrophils and monocyte and those cells enter the papules and then creates

A

inflammation

83
Q

arthropod infestations

A

scabies
pediculosis
ticks

84
Q

UVC do not pass through

A

Earths atmosphere

85
Q

UVB are responsible for nearly all the

A

skin effects of sunlight

86
Q

UVA rays can pass through window glass and are more commonly referred to as

A

sun tanning rays

87
Q

which of the following is more damaging to DNA

A

UVB

88
Q

acute effects of UV rays

A

erythema
pigmentation
injury to langerhan cells and keratinocytes

89
Q

is the acute effects of UV rays reversible

A

yes

90
Q

chronic effects of UV rays

A

directly damaging skin cells
accelerating the effects of aging on skin
producing changes that predispose to development of skin cancer

91
Q

first degree burns are also called

A

superficial partial thickness burns

92
Q

superficial partial thickness burns/first degree burns involve

A

only the outer layers of the epidermis

93
Q

second degree partial thickness burns involve

A

the epidermis and various degree of the dermis

94
Q

second degree full thickness burns involve

A

the entire epidermis and dermis

95
Q

third degree full thickness burns

A

extend into the subcutaneous tissue and may involve muscle and bone

96
Q

with a partial thickness second degree do the structures that originate in the subcutaneous layer (hair follicles and sweat glands and pain sensors) remain intact

A

yes

97
Q

what structures remain intact with a partial thickness second degree burn

A

hair follicles, sweat glands, pain sensors

98
Q

first priority after burns

A

stop the burning process
ensure the patent airway
upper airway damage

99
Q

when someone has burns they have increased

A

capillary permeability

100
Q

in a burn patient since they have increased capillary permeability they will have _____________ colloid osmotic pressure

A

decreased

101
Q

the decreased colloid osmotic pressure in a burn patent it due to _______ and _________ leaking out

A

albumin and protein

102
Q

in a burn patent the plasma loss leads to

A

hypovolemia

103
Q

so in a burn patient why is the intravascular space depleted

A

because its leaking

104
Q

what are some complications of burns

A

HYPERMETABOLIC RESPONSE
renal insufficency
gastic ulceration
sepsis

105
Q

why would a burn patient develop a gastric ulceration

A

stress

106
Q

pressure injury is due to

A

pressure
shear force
friction
moisture

107
Q

what is shear force

A

one thing moving against a non moving thing

108
Q

what is friction

A

2 things moving at the same time

109
Q

why would moisture make the skin more prone to pressure injury

A

moisture makes the skin softer and not as rough

110
Q

braden scale categories

A
  • sensory preception
  • mositure
  • acivity
  • mobility
  • nutriton
  • friction and shear
111
Q

braden scale is for detecting

A

pressure sore risk

112
Q

sensory perception determines if the patient

A

can feel the sore or not

113
Q

why might nutrition be on the braden scale list

A

improper neutron will not allow for generation of new skin cells due to lack of nutrients and protein

114
Q

stage 1 pressure injury is characterized by

A

defined area of persistent redness in lightly pigmented skin or an area of persistent redness with blue or purple hues in darker pigmented skin

115
Q

is stage 1 pressure injury blanchable

A

no, it is nonblanchable

116
Q

stage 1 pressure injury is nonblanchable ______________ of intact skin

A

erythema

117
Q

is a stage 1 pressur injury reversible

A

yes

118
Q

in individuals with darker skin colors with a stage 1 pressure injury what also may be indicators

A

discoloration of skin, warmth, edema, induration, hardness

119
Q

nevi

A

moles

120
Q

dysplastic nevi have capacity to transform to

A

malignant melanoma

121
Q

cumulative sun exposure increases risk of

A

basal cell carcinoma
squamous cell carcinoma

122
Q

severe sun exposure with blistering increases risk of

A

malignant melanoma

123
Q

what are the ABCDE of skin cancer

A

Asymmetry
Border irregularity
Color varieation
Diameter >.6cm
Evolving change over time

124
Q

is malignant melanoma a metastatic form of cancer

A

yes

125
Q

prognosis of skin cancer depends on

A

tumor thickness, anatomic site, type of lesion and levels of invasion

126
Q

what are some factors that increase skin cancer/melanoma (3 of these risks increases someone 20 times)

A
  • family history
  • blonde or red hair
  • presence of marked freckling on upper back
    -history of 3 or more blistering sunburns before 20
    -history of 3 or more years of an outdoor job as a teenager
  • presence of actinic keratosis
127
Q

what are the most common type of melanoma

A

superficial spreading

128
Q

superficial spreading of melanoma

A

raised edges; grow horizontal and vertical
ulcerate and bleed
70%

129
Q

15-30% of melanoma is

A

nodular

130
Q

do nodular have the ABCDE

A

no

131
Q

what do nodular melanoma look like

A

dome shaped, blue-black

132
Q

4-10% of melanoma is

A

lentigo malgina

133
Q

lentigo malgina are

A

slow growing, flat

134
Q

2-4% of melanoma are

A

aural lentingious

135
Q

aural lentingious grow on

A

palms, soles, nail beds, mucous membranes

136
Q

most common location for melanoma for males is

A

back

137
Q

most common location for melanoma for women is

A

legs (then back)

138
Q

melanomas do NOT make

A

keratin

139
Q

since we know that melanomas do not have keratin we know a melanoma will not

A

flake

140
Q

basal cell is the most

A

common skin cancer

141
Q

in squamous cell cancer what is more common

A

metastasis

142
Q

what could develop with a squamous cell

A

ulcer

143
Q

rubella is also called

A

3-day or German measles

144
Q

what does the rubella rash look like

A

diffuse, punctate, macular rash

145
Q

where does rubella start at

A

on trunk

146
Q

where does rubella spread too

A

arms/legs

147
Q

what are some other systemic disease that come with rubella

A

mild fever, post auricular sub occipital and cervical lymph node adenopathy

148
Q

the most concerning thing about rubella is the ability to it ti transfer from pregnant women and cause what issues with baby

A

cataracts, microcephaly, mental retardation, deafness, PDA

149
Q

actinic keratoses are the most common premalignant skin

A

lesion

150
Q

where does actinic keratoses develop

A

sun exposed area

151
Q

actinic keratoses presents how?

A

< 1cm, dry, brown scaly with reddish tinge, usually multiple

152
Q

what age does actinic keratoses present

A

elderly

153
Q

keratoses are ____________ lesions

A

premalignant

154
Q

angiomas are associated with ______ failure

A

liver

Pathophysiology (44 decks)

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