Unit 15 Chapters 51 & 52 Flashcards
what are the three distinct layers of the skin
epidermis, dermis, subcutaneous
what layer contains keratinocytes
epidermis
what do keratinocytes do
produce a fibrous protein called keratin
where are melaonocytes located
epidermis
what do melanocytes do
pigment synthesizing cells that produce melanin
melanin protects from
UV
what cells produce keratin
keratinocytes
what cells produce melanin
melanocytes
where are langerhan cells located
epidermis
where do langerhan cells arise from
bone marrow
why do langerhan cells migrate to the epidermis
to help activate the immune system
how do langerhan cells activate the immune system
binding to antigens
where do langerhan cells migrate to after they bind to the antigen
lymph
dermis is the primary source of
nutrition
does the dermis have neurons, nerves, supplying blood vessels, sweat glands, erector pili muscles
yes
if a patient comes in with severe burn and says it does not hurt that bad why?
the burn must have went to the dermis and damaged the nerves
why would someone with an epidermis burn be in more pain than someone with a dermis burn
with an epidermis burn the nerves are still intact
the main goal of langerhan cells is to gather
antigens
the number of what is the same in dark and white skin
melanosomes
black skin produces what substance more and faster
melanin
in dark skin what might be the difference compared to white skin
scars are darker, skin may be dry/ashy
what signs might be difficult to asses on black skin
erythema and skin pallor
since erythema and skin pallor are different to assess what should the clinician do?
look at eyes, mouth and feel the skin for warmth or cold
what type of pigmentation often accompany ethnic skin disorders
hypo and hyperpigmentation
absence of melanin leads to
vitiligo
albinism
increase in melanin
mongolian spots
melasma
rashes
temporary eruption of the skin
lesion
traumatic or pathologic loss of normal tissue, continuity, structure, or function
is rash permeant
no, temporary
telangiectases
dilated superficial blood vessels
Pruitis
sensation of itch
what might pruitis be caused by
organ disorder such as renal failure
central or primary skin disorder
morphine
why does morphine cause pruitis
acts on central opioid receptors to CNS
superficial mycoses live on
dead keratinized cells of the epidermis
superficial mycoses emit an enzyme that enables them to digest
keratin
Candida is a normal inhabitant of
GI tract, mouth, vagina
what predisposes someone to get a Candida infection
DM, antibiotics, pregnancy, BC, immunosuppressive disorders
where does Candida thrive
warm moist intertriginous folds
what does a candida infection look like
red rash with well defined borders along with macropapular satellite lesions
treatment for candida
niastain
who might be at risk of candida since we know it likes to thrive in intertriginous folds (skin on skin)
babies
obese people
dermatophytes require ________ for growth
keratin
dermatophytes emit an enzyme that enables them to digest keratin which results in
superficial skin scaling, nail disintegration or hair breakage
superficial fungal infections all are in the genus
Tinea
impetigo can cause _____________ within 7-12 days
glomerulonephritis
cellulitis affects
deeper layers, dermis and subcutaneous
herpes zoster is
shingles
herpes invades
dorsal root ganglia
shingles is caused when _____________ herpesvirus is reactivated
chickenpox
CDC recommends that people ___ years and older and have had chickenpox get the shingles vaccine
60
shingles comes back when the immune system is
supressed
rosacea is a chronic skin disorder of
middle aged and older
rosacea can look like
blushing to dark red erythema (purple almost)
rosacea has the _____________ vessels
telangiectatic
rosacea could lead to inflammatory
pustules and papuels
does rosacea progress to anything
no
rosacea is what kind of inflammatory
chronic inflammatory process
rosacea is a chronic inflammatory process accompanied by ____________ ________ with leakage of fluid and inflammatory mediators into the dermis
vascular instability
rosacea is accompanied by
gastrointestinal symptoms
allergic contact dermatitis results from a cell mediated type ___ hypersensitivity response
IV
irritant contact dermatitis is caused by ___________ that irritate the skin
chemicals
erythema multiforme occurs after
herpes simplex
is erythema multiforme self limiting
yes
erythema multiforme could develop into
stevens-johnson syndrome
in stevens johnson syndrome the skin
detaches from body surface
in stevens johnson syndrome what percentage of the body is affected
<10%
what race is more at risk for stevens johnson syndrome
again
stevens johnson syndrome lesions are similar-round erythematous papule resembling insect bite but what is one defining feature of stevens johnson syndrome rash
target or iris of the rash
stevens johnson syndrome could develop into
toxic epidermal necrolysis
toxic epidermal necrolysis how much of the body is affected
> 30%
mortality rate of toxic epidermal necrolysis
30-35%
skin disorders characterized by scaling papule and plaques
psoriasis
psoriasis is a complex, chronic, multifactorial, inflammatory disease that involves ________________ of the ___________ in the epidermis
hyper proliferation, keratinocytes
psoriasis has an increase in the
epidermal cell turnover rate
what factors play a role in the development of psoriasis
environmental, genetic, immunologic factors
psoriasis mainly affects
elbows, knees, scalp, lumbosacral areas, intergluteal clefts, glans penis
in 30% of psoriasis patients the ______ are also affected
joints
which of the following factors has been recognized as a trigger for psoriasis exacerbations
- hot weather
- increased exposure to sunlight
- alcohol
- pregnancy
alcohol
what are somethings that trigger exacerbations of psoriasis
stress, cold, trauma, infections, alcohol, drugs
what is beneficial for psoriasis
hot weather, sunlight, pregnancy
in psoriasis there is activated T cells which causes growth factor and then keratinocytes and blood vessels grow which leads to
papules
in psoriasis activated T cells attract neutrophils and monocyte and those cells enter the papules and then creates
inflammation
arthropod infestations
scabies
pediculosis
ticks
UVC do not pass through
Earths atmosphere
UVB are responsible for nearly all the
skin effects of sunlight
UVA rays can pass through window glass and are more commonly referred to as
sun tanning rays
which of the following is more damaging to DNA
UVB
acute effects of UV rays
erythema
pigmentation
injury to langerhan cells and keratinocytes
is the acute effects of UV rays reversible
yes
chronic effects of UV rays
directly damaging skin cells
accelerating the effects of aging on skin
producing changes that predispose to development of skin cancer
first degree burns are also called
superficial partial thickness burns
superficial partial thickness burns/first degree burns involve
only the outer layers of the epidermis
second degree partial thickness burns involve
the epidermis and various degree of the dermis
second degree full thickness burns involve
the entire epidermis and dermis
third degree full thickness burns
extend into the subcutaneous tissue and may involve muscle and bone
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
yes
what structures remain intact with a partial thickness second degree burn
hair follicles, sweat glands, pain sensors
first priority after burns
stop the burning process
ensure the patent airway
upper airway damage
when someone has burns they have increased
capillary permeability
in a burn patient since they have increased capillary permeability they will have _____________ colloid osmotic pressure
decreased
the decreased colloid osmotic pressure in a burn patent it due to _______ and _________ leaking out
albumin and protein
in a burn patent the plasma loss leads to
hypovolemia
so in a burn patient why is the intravascular space depleted
because its leaking
what are some complications of burns
HYPERMETABOLIC RESPONSE
renal insufficency
gastic ulceration
sepsis
why would a burn patient develop a gastric ulceration
stress
pressure injury is due to
pressure
shear force
friction
moisture
what is shear force
one thing moving against a non moving thing
what is friction
2 things moving at the same time
why would moisture make the skin more prone to pressure injury
moisture makes the skin softer and not as rough
braden scale categories
- sensory preception
- mositure
- acivity
- mobility
- nutriton
- friction and shear
braden scale is for detecting
pressure sore risk
sensory perception determines if the patient
can feel the sore or not
why might nutrition be on the braden scale list
improper neutron will not allow for generation of new skin cells due to lack of nutrients and protein
stage 1 pressure injury is characterized by
defined area of persistent redness in lightly pigmented skin or an area of persistent redness with blue or purple hues in darker pigmented skin
is stage 1 pressure injury blanchable
no, it is nonblanchable
stage 1 pressure injury is nonblanchable ______________ of intact skin
erythema
is a stage 1 pressur injury reversible
yes
in individuals with darker skin colors with a stage 1 pressure injury what also may be indicators
discoloration of skin, warmth, edema, induration, hardness
nevi
moles
dysplastic nevi have capacity to transform to
malignant melanoma
cumulative sun exposure increases risk of
basal cell carcinoma
squamous cell carcinoma
severe sun exposure with blistering increases risk of
malignant melanoma
what are the ABCDE of skin cancer
Asymmetry
Border irregularity
Color varieation
Diameter >.6cm
Evolving change over time
is malignant melanoma a metastatic form of cancer
yes
prognosis of skin cancer depends on
tumor thickness, anatomic site, type of lesion and levels of invasion
what are some factors that increase skin cancer/melanoma (3 of these risks increases someone 20 times)
- 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
what are the most common type of melanoma
superficial spreading
superficial spreading of melanoma
raised edges; grow horizontal and vertical
ulcerate and bleed
70%
15-30% of melanoma is
nodular
do nodular have the ABCDE
no
what do nodular melanoma look like
dome shaped, blue-black
4-10% of melanoma is
lentigo malgina
lentigo malgina are
slow growing, flat
2-4% of melanoma are
aural lentingious
aural lentingious grow on
palms, soles, nail beds, mucous membranes
most common location for melanoma for males is
back
most common location for melanoma for women is
legs (then back)
melanomas do NOT make
keratin
since we know that melanomas do not have keratin we know a melanoma will not
flake
basal cell is the most
common skin cancer
in squamous cell cancer what is more common
metastasis
what could develop with a squamous cell
ulcer
rubella is also called
3-day or German measles
what does the rubella rash look like
diffuse, punctate, macular rash
where does rubella start at
on trunk
where does rubella spread too
arms/legs
what are some other systemic disease that come with rubella
mild fever, post auricular sub occipital and cervical lymph node adenopathy
the most concerning thing about rubella is the ability to it ti transfer from pregnant women and cause what issues with baby
cataracts, microcephaly, mental retardation, deafness, PDA
actinic keratoses are the most common premalignant skin
lesion
where does actinic keratoses develop
sun exposed area
actinic keratoses presents how?
< 1cm, dry, brown scaly with reddish tinge, usually multiple
what age does actinic keratoses present
elderly
keratoses are ____________ lesions
premalignant
angiomas are associated with ______ failure
liver
