Chapter 23: Med Surg

Question 1

epidermis

Answer 1

thin, superficial layer of skin; 0.05-0.1 mm thickness and nourished by blood vessels in dermis; regenerates every 28 days

Question 2

melanocytes

Answer 2

contained in deep basal layer (germinativum) of the epidermis; contain melanin (gives skin and hair color) and protects from UV

Question 3

keratinocytes

Answer 3

synthesized from epidermal cells in basal layer, they move to surface of epidermis to die and form corneum (horny cell layer); protective barrier

Question 4

dermis

Answer 4

1-4 mm thickness, 2 layers: papillae forms fingerprints and footprints and reticular layer forms collagen

Question 5

collagen

Answer 5

forms the greatest part of the dermis and responsible for strength; composed of fibroblasts which are important for wound healing

Question 6

subcutaneous tissue

Answer 6

not part of skin, provides insulation, provides shock absorption

Question 7

sebaceous glands

Answer 7

prevent skin and hair from drying; abundant on face, scalp, upper chest, and back, not palms and soles

Question 8

apocrine sweat glands

Answer 8

located in the axillae, breast, tummy, external auditory canals, and eyelids; thick milky substance and become odorous at puberty

Question 9

eccrine sweat glands

Answer 9

widely distributed except on lips; cools the body from evaporation and excretes waste products through the pores of the skin

Question 10

insensible perspiration

Answer 10

600-900 mL/day lost and helps maintain homeostasis through fluid and electrolyte balance

Question 11

gerontologic differences with skin

Answer 11

decreased extracellular water and sebaceous glands, increased capillary fragility which causes bruising, increased melanocytes in basal layer which cause solar lentigines, decreased estrogen causing baldness, increased keratin causing longitudinal ridging of nails

Question 12

actinic keratoses

Answer 12

areas of chronic sun exposure, increased risk for BCC & SCC

Question 13

normal nails

Answer 13

160 degrees

Question 14

intertriginous

Answer 14

skin surfaces overlap and rub on each other

Question 15

primary skin lesions

Answer 15

occur on previously unaltered skin

Question 16

secondary skin lesions

Answer 16

change with time or occur because of factors such as scratching or infection

Question 17

macule

Answer 17

circumscribed, flat discoloration < 0.5 cm: freckles, petechiae

Question 18

papule

Answer 18

elevated solid lesion up to 0.5 cm: wart, BCC

Question 19

vesicle

Answer 19

defined collection of (serous or free fluid up to 0.5 cm: chicken pox, 2nd degree burn

Question 20

plaque

Answer 20

circumscribed, elevated solid lesion formed by confluence of papules: psoriasis and keratoses

Question 21

wheal

Answer 21

firm plaque caused by fluid in dermis: insect bite

Question 22

pustule

Answer 22

circumscribed collection of leukocytes and free (purulent) fluid: acne, impetigo

Question 23

fissure

Answer 23

linear loss of epidermis to dermis: athlete’s foot or cracks at corner of mouth

Question 24

scale

Answer 24

excess dead epidermal cells: flaking of skin

Question 25

scar

Answer 25

abnormal formation of connective tissue that replaces normal skin

Question 26

ulcer

Answer 26

irregular, crater-like loss of the epidermis and dermis: pressure ulcer and chancre

Question 27

atrophy

Answer 27

depression in skin resulting from thinning of the epidermis or dermis: aged skin, striae

Question 28

excoriation

Answer 28

epidermis is missing and exposed dermis: abrasion or scratch

Question 29

angioma

Answer 29

benign tumor of blood or lymph vessels: increased with age, liver disease, pregnancy

Question 30

ecchymosis for dark skin

Answer 30

purple to brownish black

Question 31

erythema for dark skin

Answer 31

deeper brown to purple with increased skin temperature

Question 32

pallor for dark skin

Answer 32

underlying red tone in brown or black is absent, light African americans have yellowish brown skin, dark skinned may have ashen gray

Question 33

petechiae

Answer 33

small, reddish pinpoints best observed on tummy and butt < 1-2 mm in extravascular tissue

Question 34

petechiae for dark skin

Answer 34

difficult to see, may be evident in the buccal mucosa of mouth or conjunctiva of eye

Question 35

rash for dark skin

Answer 35

feel!! aka palpate

Question 36

purpura

Answer 36

bleeding disorder caused by ecchymosis or petechiae

Question 37

if a lesion blances and then refills, redness is r/t

Answer 37

dilated blood vessels

Question 38

if the lesion does not blanch and remains discolors it's r/t

Answer 38

subq or intradermal bleeding or nonvascular lesion

Question 39

asymmetric lesion

Answer 39

unilateral distribution

Question 40

confluent lesion

Answer 40

merges together

Question 41

diffuse lesion

Answer 41

wide distribution

Question 42

discrete lesion

Answer 42

separate from other lesions

Question 43

symmetric lesion

Answer 43

bilateral distribution

Question 44

zosteriform lesion

Answer 44

bandlike distribution along a dermatome area

Question 45

increased localized temperature

Answer 45

seen with burns and local inflammation

Question 46

increased generalized temperature

Answer 46

fever

Question 47

carotenemia

Answer 47

yellow discoloration of skin, not eyes, most visible on palms and soles: veggies containing carotene can cause this (carrots, squash)

Question 48

comedo

Answer 48

acne

Question 49

cyst

Answer 49

sac containing fluid or semisolid material: caused by obstruction of duct or parasitic infection

Question 50

hematoma

Answer 50

extravasation of blood: trauma and bleeding disorders

Question 51

hirtuism

Answer 51

excess hair: abnormality of adrenal glands, decrease in estrogen

Question 52

lichenification

Answer 52

thickening of skin: caused by excessive scratching rubbing or irritation

Question 53

mole

Answer 53

nevus aka overgrowth of melanocytes

Question 54

telangiectasia

Answer 54

visibly dilated, superficial, cutaneous small blood vessels, found on face and thighs: aging acne, alcoholism, liver failure, radiation, sun exposure

Question 55

vitiligo

Answer 55

complete absence of melanin: autoimmune, thyroid disease

Question 56

punch biopsy

Answer 56

use a punch instrument to obtain dermis and some fat for full thickness diagnostic purposes; place in Michel's fixative not formalin

Question 57

excisional biopsy

Answer 57

entire lesion removed with good cosmetic results, closed with sutures

Question 58

incisional biopsy

Answer 58

wedge-shaped incision made, used when excisional or punch is not an option due to large specimen needed

Question 59

shave biopsy

Answer 59

single-edged razor blade used to shave off superficial lesion, thin specimen

Question 60

potassium hydroxide (KOH)

Answer 60

hair, scales, or nails examined for superficial fungal infection

Question 61

Tzanck test (Wright's and Giemsa's stain)

Answer 61

fluid and cells from vesicles examined; used for herpes; sterile

Question 62

fungi culture

Answer 62

scraping or swab of skin performed

Question 63

bacteria culture

Answer 63

material obtained from intact pustules, bullae, or abcesses

Question 64

virus culture

Answer 64

vesicle/bulla and exudate taken from base of lesion

Question 65

mineral oil slides

Answer 65

checks for infestations, scrapings are placed on slide with mineral

Question 66

immunofluorescent studies

Answer 66

skin tissue and serum examined due to some diseases having specific, abnormal antibody proteins

Question 67

wood's lamp (black light)

Answer 67

identifies pseudomonas organisms, fungal infections, and vitiligo

Question 68

patch test

Answer 68

determines what patient is allergic to by applying potential allergen on back; instruct patient to return in 48-72 hrs to remove allergens and evaluation @ 96 hr