9: Geriatric Skin Disorders - Mahoney

Question 1

decrease in skin lipids –>

Answer 1

dryness

Question 2

decreased cell replacement –>

Answer 2

roughness, delayed healing

Question 3

decreased DNA repair –>

Answer 3

increased malignancies

Question 4

fragmentation of collagen/elastin –>

Answer 4

wrinkles, increase in ulcers

Question 5

reduced connective tissue support of blood vessels –>

Answer 5

increased purpura

Question 6

decreased sensation –>

Answer 6

increased injury

Question 7

impaired thermoregulation –>

Answer 7

vulnerable to heat and cold

Question 8

reduced function of sebaceous glands –>

Answer 8

decreased lipids

Question 9

reduced function of sweat glands –>

Answer 9

risk of overheating

Question 10

decreased langerhans cells –>

Answer 10

delayed healing and increase in infection

Question 11

reduced subq fat –>

Answer 11

increased risk of injury

Question 12

flattening of DE junction –>

Answer 12

increased risk of skin tears and blisters

Question 13

reduced linear nail growth –>

Answer 13

onychogryphosis, longitudinal striations, brittle nails

Question 14

decreased melanocytes –>

Answer 14

increase in malignancies

Question 15

extrinsic changes to skin with aging

Answer 15

pruritus
spider veins
age spots
easy bruising and skin breaks

Question 16

ulcer over bony prominences

pressure over time leads to ischemia and tissue damage

Answer 16

decubitus ulcer

Question 17

NPUAP stages I-IV

Answer 17

I: non-blanchable erythema
II: necrosis with superficial to partial thickness skin loss
III: necrosis with full-thickness skin loss to fascia
IV: extensive necrosis into m and bone

Question 18

tx decubitus ulcer

Answer 18

• change position
• better mattress
• keep ulcer dry
• nutritional consult
• infection control measure

Question 19

why xerosis?

Answer 19

due to decrease in lipids combined with impaired epidermal barrier function (greater loss of water from skin)

Question 20

asteatotic eczema =

Answer 20

xerosis

Question 21

pruritus is most commonly caused by…

Answer 21

xerosis

leads to local excoriations

Question 22

PHILL is itchy

Answer 22

polycythemia vera
HIV
iron deficiency anemia
liver and renal dysfuntion
lymphoma

Question 23

venous hypertension leads to inflammatory rxn accompanied by leukocye activation and release or red cells into tissue which break down into hemosiderin depositions

Answer 23

stasis dermatitis

Question 24

infection of subQ fat

Answer 24

cellulitis

- deeper than erysipelas and does not have a distinct border

Question 25

infection of dermis and upper subQ tissue

Answer 25

erysipelas

Question 26

diagnosis of herpes simplex

Answer 26

tzanck smear | - positive result is finding of multinucleate giant cells

Question 27

common cause of plantar xerosis in elderly, especially resistant to routine moisturization

Answer 27

tinea pedis | - diagnosis confirmed with KOH

Question 28

4 types of onychomycosis

Answer 28

- distal subungual - proximal subungual - total subungual - superficial white

Question 29

staining for onychomycosis

Answer 29

sabouraud's medium or PAS staining

Question 30

pathology of onychomycosis

Answer 30

fungus produces keratinase which destroys nail and leads to the thickening, discoloration and loosening with accumulation of subungual debris

Question 31

oral terbinafine for onychomycosis produces a complete cure ....

Answer 31

1/3 of time

Question 32

- primary manifestation is burrow found between fingers - highly pruritic and wil lhave overlapping signs of scratching which can hide diagnosis and be attributed to simply itchy skin in elderly

Answer 32

scabies - diagnosed by microscopic identification - treat with promethrin

Question 33

pt complains of intense itching and you worry about systeic cause ... what screening tests are appropriate?

Answer 33

``` CBC ALT and AST Creatinine HIV screening Check for interdigital papules or blisters ```

Question 34

nummular eczema

Answer 34

similar to all forms of eczema which will have an inflammatory phase with vesicles and oozing, followed by a dry, crusty phase

Question 35

- appears as dry, cracking skin on plantar surface of foot or toes - pts will have some type of allergic hx, usually hayfever or environmental allergens

Answer 35

atopic eczema

Question 36

in elderly, due to decreased ability to mount a delayed hypersensitivity reaction due to reduced number of langerhands cells and tcells and to diminished vascular reactivity

Answer 36

eczema contact dermatitis - shoes, nickel, fragrances, baslam of peru are common sources

Question 37

tx psychodermatological disorder

Answer 37

topical steroids and anti-anxiety medications

Question 38

FIEF drugs cause ...

Answer 38

furosemide ibuprofen enalapril flu vaccine bullous pemphigoid tx is topical steroids and tacrolimus along with DMARDs

Question 39

hyperkeratosis that looks like it has been stuck onto the skin

Answer 39

seborrheic keratosis *sudden appearance of multiple lesions may signal internal malignancy known as leser-trelat syndrome

Question 40

erythematous, dome-shaped, 1-10 cm nodule iwth keratin plug in center

Answer 40

keratoacantoma