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BMS100 Clin Phys > Clin Phys 7 > Flashcards

Clin Phys 7 Flashcards

1
Q

What is the function of the skin?

A
  • protective barrier
  • key for regulating body temperature
  • provides sensory information
  • limited importance in waste removal & vitamin synthesis (vitamin D)
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2
Q

What is the skin an important barrier for?

A
  • mechanical, chemical or thermal injuries
  • barrier to infection
  • reduces heat, fluid, electrolyte loss
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3
Q

T/F: The skin is the largest & heaviest organ

A

True

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4
Q

How much does skin weigh?

A

8 lbs

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5
Q

What are the layers of the skin?

A
  • epidermis
  • dermis
  • subcutaneous/hypodermis
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6
Q

Where is skin thick? Thin?

A

thick: palms and soles (epidermis 0.4-1.4 mm)
thin: everywhere else (epidermis: 0.075-0.15)

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7
Q

What is the epidermal layers outermost to innermost?

A
  • stratum corneum
  • stratum lucidum (only in thick)
  • stratum granulosum
  • stratum spinosum
  • stratum basale
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8
Q

What epidermal layer only present in thick skin?

A

stratum lucidum

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9
Q

What is the location of the corneum?

A

most superficial layer

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10
Q

What is the layer size of the corneum?

A

15-30 cells

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11
Q

What is the function of the corneum?

A
  • most important component of the barrier
  • prevents penetration microbes
  • prevents dehydration
  • mechanical protection
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12
Q

T/F: Skill cells in corneum are dead

A

True

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13
Q

What is corneum full of?

A

keratin and flaggrin

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14
Q

What is keratin and flaggrin held together by in the corneum?

A

tight junctions, desmosomes

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15
Q

What does flaggrin help keratin do?

A

aggregate into large macrofibrils

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16
Q

Where is lucidum located?

A

immediatley below corneum

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17
Q

What is the layer size of lucidum?

A

3-5 cells

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18
Q

T/F: cells in lucidum are dead

A

true

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19
Q

What is the function of lucidum?

A

similar to corneum

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20
Q

Where is granulosum located?

A

between the corneum and spinosum

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21
Q

What is the layer size of granulosum?

A

3-5, flattened and compacted

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22
Q

What are the functions of granulosum?

A
  • Living cells that are re-organizing keratin and associating it with filaggrin and other proteins
  • Lamellar granules – lipid-rich, layered granules that help reduce water loss
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23
Q

Where is spinosum located?

A

superficial to basal

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24
Q

What is the layer size of spinosum?

A

8-10 cell layers

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25
Q

What is the thickest layer of skin?

A

spinosum

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26
Q

What is the function of spinosum?

A
  • Very busy synthesizing keratin, proto-filaggrin, and other proteins
  • Eventually keratin becomes 50% of the cell mass of keratinocytes
  • Thick bundles of keratin called tonofibrils are linked to desmosomes
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27
Q

Where is basale located?

A

deepest epidermal layer

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27
Q

What is the layer size of basale?

A

single layer

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28
Q

What are the functions of basale?

A
  • stem cells divide and give rise to all of the layers
    -melaoncytes synthesize and distribute melanin to keratinocytes
  • wide range of sensory receptors
  • resident immune cells - langerhans cells
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29
Q

Which cell layers have living cells?

A

granulosum,

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30
Q

What layer has melanocytes?

A

basale

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31
Q

What is the function of melanocytes?

A

synthesize and distribute melanin to keratinocytes

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32
Q

T/F: Keratin is a fibrous protein

A

True

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33
Q

What is the structure of keratin?

A

strong, flexible long proteins that have a relatively simple, repeating secondary structure

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34
Q

How is keratin insoluble in water?

A

due to many hydrophobic amino acid residues

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35
Q

What are the two layers of alpha-keratin?

A
  • single “strand” protein = alpha helix
  • two strands coiled around each other = “coiled coil”
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36
Q

Where do the 2 strand interact with each other in a coiled coil?

A

at amino acid residues

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37
Q

What is a protofilament of keratin?

A

long chains of 2 coiled coils

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38
Q

What is a protofibril of keratin?

A

2 long chains of protofilaments

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39
Q

What are 4 protofibrils called?

A

microfibrils or tonofibrils

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40
Q

What are macrofibrils?

A

many microfibrils

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41
Q

What helps with the formation of macrofibrils?

A

flaggrin

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42
Q

T/F: Keratin can be flexible and hard

A

true

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43
Q

What is keratin held together by?

A

H-Bonds and number of disulphide bones which cross-link individual fibres to each other

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44
Q

What does the hardness of keratin depend on?

A

number of disulphide bones

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45
Q

What are rhinoceros horns made of?

A

18% of residues are cysteines (disulphide bonds) - keratin

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46
Q

What side is alpha-helix coiled (keratin)?

A

right

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47
Q

What side is coiled-coil coiled (keratin)?

A

left

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48
Q

What does the coiling of coiled-coil on the left increase (keratin)?

A

strength

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49
Q

What does hard keratin not have?

A

filaggrin or phospholipids

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50
Q

What are examples of hard keratin?

A

hair, nails

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51
Q

What is this?

A

alpha-helix

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52
Q

What is this?

A

coiled coil

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53
Q

What is this?

A

protofilament

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54
Q

What is this?

A

filament

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55
Q

What are the dermal layers from ouermost to innermost?

A

papillary
reticular

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56
Q

T/F: dermal layer has blood vessels

A

True

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57
Q

Which layer of the dermal is the superifical 1/5?

A

papillary

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58
Q

What is papillary layer made of?

A

loose connective tissue - fine eleastic fibers, type III and type I collagen

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59
Q

What does the papillary layer do?

A

interlocks dermis and epidermis

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60
Q

What does papilla mean?

A

fingers

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61
Q

What does the papillary layer contain?

A
  • vascularization
  • sensory receptors
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62
Q

What is the reticular layer made of?

A

dense irregular connective tissue - Type I collagen and elastic fibers

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63
Q

T/F: Collagen binds to water to keep the skin hydrated

A

True

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64
Q

Which layer of the dermal is the thickest?

A

reticular

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65
Q

What does the reticular layer house?

A
  • hair follicles
  • nerves, arteries, veins, lymphatics
  • sebaceous & sudoriferous (sweat) glands
  • some adipose tissue
  • SMC
  • some sensory receptors
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66
Q

Which types of collagen are fibril-forming?

A

Type I, II, III

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67
Q

Which type of collagen forms 90% of the body’s collagen?

A

Type I

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68
Q

Which type of collagen has the most structural strength?

A

Type I

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69
Q

Which cells produce collagen?

A

many cells in the dermis - fibroblasts

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70
Q

Where does final fibril-forming of collagen occur?

A

extracellular space

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71
Q

What structure is collagen?

A

coiled coil but not alpha-helix

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72
Q

What is tropocollagen?

A

three collagen alpha-chains are coiled around each other

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73
Q

How is the tight twisting of alpha chains of collagen accomplished by?

A

unique amino acid sequence

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74
Q

What is the amino acid sequence of collagen?

A

Gly-X-Y
Often X is proline
Often Y is hydroxyproline

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75
Q

The glycine on collagen has a very small what?

A

R-group

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76
Q

What are the structures of hydroxyproline and proline and what does this provide?

A

kinked - provides twists or kinks in molecule

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77
Q

What is the hydroxylated proline in collagen ideal for?

A

covalent cross-linking

78
Q

What is crucial to collagen formation and cross-linking?

A

vitamin C

79
Q

How is collagen synthesized?

A
  • fibroblasts produce tropocollagen fibres that have some degree of hydroxylation and glycosylation that are secreted into the ECM
  • Outside of the cell, the tropocollagen molecules are assembled into fibrils and fibres
  • These fibrils and fibres are also linked to proteoglycans and glycoproteins
80
Q

What is a hair follicle?

A

an epidermal in-growth into dermis (invagination) that builds a long structure formed from hard keratin (hair)
- specialized keratinocytes

81
Q

Where are hair follicles derived from?

A

epidermis

82
Q

What areas of skin are completely without hair?

A

palms, soles, lips, genital structures

83
Q

Which area of skin has the most hair?

A

face

84
Q

How many hairs in total should a person have?

A

5 million

85
Q

What is the hair bulb?

A

bulbous part at the base of the follicle

86
Q

What does the dermal papilla do with reference to hair follicle?

A

contacts the bulb, supplying capillary network

87
Q

What does the hair bulb hold?

A

hair matrix (site of active cell division)

88
Q

What do melanocytes in the hair bulb do?

A

transfer melanosomes to jeratinocytes

89
Q

T/F: With reference to hair bulb, Keratinocytes at the papilla are very similar to the stratum granulosum and spinosum.

A

True

90
Q

What are the layers of the hair shaft?

A

medulla
cortex
cuticle

91
Q

Which layer of the hair shaft is lightly keratinized?

A

medulla

92
Q

Which layer of the hair shaft is filled w/ hard keratin?

A

cortex

93
Q

Which layer of the hair shaft looks like “tiles” or “shingles”

A

cuticle

94
Q

T/F: The reason a person has straight or curly hair is due to their cortex

A

True

95
Q

The hair shaft is not called the hair shaft until?

A

it passes beyond the epidermis

96
Q

What is arrector pili?

A

bundle of smooth muscle cells that pull the shaft into a more erect position

97
Q

What is the arrector pili innervated by?

A

sympathetic nervous system

98
Q

Why does hair need to be in a more erect position?

A

thermoregulation - when we are cold, to trap heat and regulation

99
Q

What does the hair root plexus contain?

A

very sensitive mechanoreceptors - myelinated nerves, desensitize rapidly

100
Q

Where is the arrector pili found?

A

same side of sebaceous gland

101
Q

What are the 3 phases of hair growth?

A

anagen, catagen, telogen

102
Q

What occurs during the anagen phase of hair growth?

A

longer period of mitotic activity and growth

103
Q

What occurs during the catagen phase of hair growth?

A

arrested growth and regression of the hair bulb

104
Q

What occurs during the telogen phase of hair growth?

A

cellular inactivity (hair shedding)

105
Q

What is produced at the beginning of the anagen phase?

A

progenitors

106
Q

What do progenitors give rise to?

A

matrix of new hair bulb

107
Q

When are stem cells located with reference to hair growth?

A

outer layer of follicle, external root sheath, near attchment points of the arrector pili

108
Q

How long is the anagen phase?

A

2-6 years

109
Q

How long is the catagen phase?

A

1-2 weeks

110
Q

How long is the telogen phase?

A

5-6 weeks

111
Q

What is the lower most layer of the skin?

A

hypodermis/subcutaneous tissue/superficial fascia

112
Q

What does the hypodermis/subcutaneous tissue/superficial fascia contain?

A

loose aerolar and adipose tissue

113
Q

What is hypodermis/subcutaneous tissue/superficial fascia important for?

A

stabilizing the position of the skin in relation to underlying tissues

114
Q

Prolactine/progesterone/estrogen shift hair into what phase while women are pregnant?

A

anagen

115
Q

After a women gives birth they are then shifted into what phase of hair growth? Causing what?

A

catagen and telogen causing massive hair loss

116
Q

What is the is hypodermis/subcutaneous tissue/superficial fascia a storage area for? Why?

A

fat - insulates against excessive heat loss

117
Q

What does the superifical region of the is hypodermis/subcutaneous tissue/superficial fascia contain?

A

vessels

118
Q

What are 3 components of skin colouration?

A

hemoglobin, carotene, melanin

119
Q

What is hemoglobin?

A

red blood vessels in vasculature below epidermis

120
Q

What happens to skin colour if there is deoxygenation? Why?

A

skin looks “blue” cyanosis due to hypoxia and less hemoglobin

121
Q

What is carotene?

A

yellow pigment from plants in the diet

122
Q

What is melanin?

A

pale yellow to black pigment produced by melanocytes

123
Q

What are two important things to note during a skin exam?

A

morphology & distribution

124
Q

What does morphology encompass with reference to skin exam?

A

general shape, size, color, appearance

125
Q

What does distribution encompass with reference to skin exam?

A

is there a pattern? what area of the body does it affect?

126
Q

What is a flat lesion <5mm?

A

macule

127
Q

What is a flat lesion lesion >5mm called?

A

patch

128
Q

What is flat + raised <5mm?

A

papule

129
Q

What is flat + raised lesion >5mm called?

A

plaque

130
Q

What is a solid bump (round-topped, no fluid) lesion <5mm called?

A

papule

131
Q

What is a solid bump (round-topped, no fluid) lesion >5mm called?

A

nodule

132
Q

What is a serous fluid filled lesion <5mm called?

A

vesicle

133
Q

What is a serous fluid filled lesion >5mm called?

A

bulla(e)

134
Q

What is a pus-filled lesion <5mm called?

A

pustule (cyst)

135
Q

What is a pus-filled lesion >5mm called?

A

abcess or also cyst - depend on structure (has to be epithelial lining)

136
Q

What is a cyst?

A

any pocket of fluid (infected or not lined by epithelium)

137
Q

What is an abscess?

A

pocket of purulent fluid (bigger than pustule) - NOT lined by epothelium

138
Q

What stores melanin?

A

melanosomes

139
Q

What is an ulcer?

A

a defect in the epidermis, down at least to dermis level, usually due to impairment of healing/re-epithelialization

140
Q

What is a vascular lesion?

A

include telangiectasias (dilated arterioles, venules that one can see with the naked eye) and hemangiomas (many different types of vessel-rich, red or violet growths)

141
Q

What is a scale?

A

accumulation or excess shedding of the stratum corneum – can be dry or waxy-feeling.

142
Q

How does atopic dermatitis occur?

A

Defects in the moisture barrier (filaggrin) and/or tight junctions –> antigens “getting past” the epidermal barrier over and over –> recruitment of immune cells

143
Q

How does atopic dermatitis present?

A

repetitive episodes of ithcy, erythematous, edematous macular-papular rash

144
Q

Where is atopic dermatitis found?

A

extensor surfaces, face, scalp

145
Q

What is this showing?

A

early to late atopic dermatitis (eczema) under the microscope

146
Q

What does (1), (2), and (3) reference in this image?

A

(1) edema in epidermis
(2) lymphocytes and mast cells
(3) hyperkeratotic skin (from scratching it so much)

147
Q

T/F: Psoriasis is extremely common.

A

True

148
Q

What is psoriasis?

A

chronic inflammatory condition that appears to have an autoimmune basis

149
Q

What occurs during psoriasis?

A

epidermal hyperproliferation - divide quickly
abnormal differentiation of epidermal keratinocytes

150
Q

What is this, describe its attributes?

A

psoriasis - plaque, thin epidermis, enlarged blood vessels

151
Q

What does psoriasis look like?

A

morphology: plaque - red base or silvery white scale/ well defined borders

distribution: symmetrical

152
Q

What are common sites of psoriasis?

A

scalp and extensor surfaces (elbows and knees)

153
Q

What condition is this?

A

psoriasis

154
Q

What is vitiligo?

A

disorder of skin pigmentation

155
Q

Why does vitiligo develop?

A

immune system attacks cells that produce melanin

156
Q

What do melanocytes produce?

A

melanosomes

157
Q

T/F: Melanosomes can produce their own melanin

A

True

158
Q

What condition is this?

A

vitiligo

159
Q

T/F: Abscess is typically infectious

A

True

160
Q

What does vitiligo look like?

A

morphology: patch - colourless,
distribution: symmetrical, wide spread

161
Q

What is the prevalence of alopecia areata?

A

0.1-0.2%

162
Q

What is the lifetime risk of alopecia areata?

A

1.7%

163
Q

What is the percentage of alopecia areata patients seen by dermatology?

A

0.7-3%

164
Q

What is the epidemiology of alopecia areata?

A

M:F = 1:1; affects any age

165
Q

What is the pathophysiology of alopecia?

A

NK cells & cytotoxic T-cells attack the hair follicle (adaptive immune system)

166
Q

What is ~20% of alopecia areata associated with?

A

stressful events - severe infection, trauma, severe psychologic stress

167
Q

When is alopecia areata more susceptible to inidviduals?

A

If they are genetically susceptible

168
Q

What are clinical features of alopecia areata?

A

patchy hair loss that does not scar - hair will regrow

169
Q

How long does a stressful event predate hair loss by with alopecia areata?

A

1-6 months

170
Q

T/F: 80-90% of people with alopecia areata have only 1 patch of hair loss

A

True

171
Q

What areas do alopecia areata often effect?

A

scalp, beard

172
Q

When does re-growth of alopecia areata tend to occur?

A

about a year later

173
Q

What is the prevalence of androgenetic alopecia?

A

50% of men
- at least 13% of women pre-menopause, >50% women older than 65

174
Q

At what age is androgenetic alopecia usually detectable?

A

Age 40

175
Q

What is the pathophysiology of androgenetic alopecia?

A

gradual conversion of terminal hairs to vellus hairs - inherited

176
Q

What does androgenetic alopecia development greatly depend on in men?

A

androgen exposure over time

177
Q

What are clinical features of androgenetic alopecia?

A

hair loss over the crown for both sexes
- men: posterior and lateral scalp are spared
- women: mid-frontal hair loss/vertex, temporal regions spared; often frontal hair-line preserved/ if rapid check for diseases

178
Q

Do men or women have a larger psychosocial impact due to androgenetic alopecia?

A

women

179
Q

What condition does this reflect?

A

androgenetic alopecia

180
Q

What is acute telogen effluvium?

A

nonscarring alopecia characterized by acute - subacute diffuse hair shedding

181
Q

What causes acute telogen effluvium and when does it occur?

A

caused by metabolic or hormonal stress or by medications -> hair loss occurs 2-3 months later

182
Q

T/F: The stressor causes anagen hair to enter telogen.

A

True

183
Q

What is the recovery of acute telogen effluvium?

A

spontaneous and occurs within 6 months unless background of pattern alopecia is present

184
Q

T/F: There is a chronic form of acute telogen effluvium.

A

True

185
Q

What does a positive hair pull test indicate?

A

active hair shedding and can be seen in TE and in active stages of AA or different scarring alopecias

186
Q

What is terminal hair?

A

thick hair on scalp

187
Q

What is vellus hair?

A

thin hair seen on body

188
Q

What is the procedure for the hair pull test?

A
  • select 50-60 hairs & hold the bundle close to the scalp b/w the thumb, index finger, & long finger
  • firmly pull on the bundle using slow traction as the fingers slide down the hair shaft, avoid a fast and forceful tug
  • count the pulled hairs and discard broken hairs
189
Q

T/F: 50% of hairs during hair pluck are in telogen.

A

False, 25%

190
Q

Where should a hair pull test be done on the head?

A

performed at vertex, parietal areas, and the occipital area of the scalp

191
Q

If more than 10% of the hairs in each bundle are removed from a scalp area, the hair pull test is considered?

A

positive - alopecia areata

192
Q

If fewer than 10% are removed, then the hair loss can usually be attributed to?

A

normal shedding

193
Q

If a test is positive in more than 1 scalp region, the clinician must consider?

A

telogen effluvium

BMS100 Clin Phys (8 decks)

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