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Pathophysiology - Diseases > Diseases and disorders of Integumentary system > Flashcards

Diseases and disorders of Integumentary system Flashcards

1
Q

purpose of integumentary system?

A
  • protects underlying tissues and organs from damage and infection
  • regulates temperature
  • senses pain
  • protects against dehydration, - aids in the excretion of urea and uric acid
  • synthesizes vitamin D
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2
Q

what is the integumentary system?

A
  • protects body w/ skin, hair, nails and associated glands
  • largest organ (17-20 sq ft)
  • 2 layers:
  • epidermis (outer layer, less than 0.1 mm to 5mm, regullary wear off)
  • dermis (above subcutaneous tissue, fibrous connective tissue, collagen = mechanical strength, elastin = elasticity and flexibilty, has sensory receptors
  • keratinocytes (produces keratin, kertain makes skin durable and prevents water loss)
  • melanin (pigment ranging from yellow to brown to black is produced by melanocytres fouind at bottom of epidermis)
  • if melanocytes r exposed to UV thamn more melanin
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3
Q

What are the other parts of the integumetnary system (not epidermis and dermis)

A
  • subcutaneous tissue (below dermis, connect skin to underlying srtucutres, adipsoe tissue = insulation)
  • sebaceous glands (all over body except palms of hands and soles of ft, secrete sebum into hair follicles and surface of skin which lubricates and moistens skin and hair and has moderate antibactetial and antifungal effects)
  • eccrine sweat glands (all over body, regulat temp)
  • apocrine sweat glands (near axilary and genital, begin function at puberty, has strong odor when accumulated on skin bc bacteria is using substance in sweat as food support)
  • hair projects (everywhere but palms, soles, lips, nipples, some area of genital, keratin, protected by hair follicle, eyebrow and eyelashes shielf eyes, nose hair filters dust, scalp hair insulates against heat and cold)
  • nail (visible part is nail body, nail bed is located under nail and appears pink bc rick blood suply
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4
Q

5 types of changes in skin color

A

cyanosis - blue tint, deficieny of O2 in blood

jaundice - yellow in skin and whites of eyes from imapires liver function (allows bile to accumulate and stain skin)

erythema - an redness from increased blood flow and dilated bv

pallor - pale skin from decrease blood flow

hematoma - bruising, bluish, black or yellow, indicated breakdown of clotted blood

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5
Q

changes in nails?

A
  • clubbing or enlargement at ends of nails r from long term O2 deficiency
  • pale nails = anemia
  • flat or concave nail = iron deficiency
  • cuanosis = O2 deficiecny
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6
Q

diagnostic procedures of integumentary system?

A
  • microscopic exam of skin scrapings
  • cultures
  • DNA testing
  • antigens
  • antibodies
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7
Q

how to diagnose hypersensitvity skin disorder/

A
  • complete medical history (prior outbreaks & loocations)
  • sensitivty testing or blood tests for antibodies
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8
Q

types of biopsies?

A
  • used to diagnose benign tumors and skin cancer
  • punch biopsy : round-shaped knife is rotated through epidermis and dermis into subcutaneous tissue (cylindrical core of tissue)
  • incisional : scalpel is used to make cut through epidermis, dermis down to subcutaneous, ellipticakl sample
  • excisional : removes entire lesion or tumor
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9
Q

What are types of skin lesions + s/s?

A
  • macule (freckle, discolored spot of skin)
  • wheal (hive, localized elevation of skin w/ itching)
  • papule (pimple, solid, elevated area of skin, nodule is large papule)
  • vesicle (blister, small, fluid-filled sac)
  • pustule (small, elevated lesion filled with pus)
  • ulcer (area of skin in which surface has eroded)
  • s/s r pruritus, edema, erythema and inflammation
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10
Q

What are epidermoid cysts?

A
  • fluid-filled sac that froms from cells in epidermis
  • old name was sebacious cyst (doesnt origincate from sebacesou glands)
  • most common on face, neck, chest and upper back
  • most common cutaneous cyst
  • mostly age 30s or 40s, men r 2x more likely, history of acne and traumatic or crushing injury to skin
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11
Q

what does epidermoid cysts look likwe?

A
  • flesh-colored to yellowish, smooth, round, easily moved lumps just beneath skin
  • asymptomatic (can be infected, leak or form in uncomfy place like genital skin fold or beside nail_
  • caused by abn cell proliferation (after injury to skin, hair follicle or sebaceous gland) (abn multipling cells from sac and produce keratin trapped inside)
  • heredity or liked to minor developmental defect
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12
Q

how to diagnose and treat epidermoid cysts?

A

diagnose - visual exam
treatment - removed surgical if needed

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13
Q

What is impetigo?

A
  • acute, highly contagious bacterial skin infeciton mostly in infants and kids
  • 1% of kids, 10% of all skin problesm in pediatric clinincs
  • etiology is staphylococcal or streptococcal bacteria
    that enter through a break in the skin.
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14
Q

risk factors for impetigo?

A
  • age (2-6)
  • direct contact w/ person with impetigo
  • contact with contaminated fomite (inanimate objects that transmit infectious agents(
  • attending school or daycare
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15
Q

s/s of impetigo?

A
  • red vesiclar or papular lesions with erythema
  • papules fill with fluid and become vesicles that rupture a few days later, forming thick honey-colored crust
  • pruritis
  • most onl egs, and less often on face, trunk and arms
  • vesicles r surrounded by a circle of reddened skin
  • ulcerations with erythema and scarring also may result from scratching or abrading of skin
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16
Q

how to diagnose and treat impetigo?

A

diagnose - visual exam and maybe culture, tzanck test and gram staining

treat - wash lesions w/ soap and water, keep dry and exposed to air + antibiotics, mupirocin ointment orcream

prevention - daily bathing, frequent handwashing, prompt attention to skin wounds

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17
Q

What is erysipelas?

A
  • superficial bacterial infection of skin
  • mild is common and self-limited infection
  • rarely pt needs to seek doc
  • etiology is staphylococcal or streptococcal bacteria
    that enter through a break in the skin
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18
Q

What is cellulitis?

A
  • deeper infection that extends to subcutaneous tissue
  • etiology is staphylococcal or streptococcal bacteria
    that enter through a break in the skin
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19
Q

risk factors of cellulitis?

A
  • impaired immunity
  • skin conditions such as eczema, athlete’s foot, shingles
  • chronic swelling of the arms or legs
  • IV drug use
  • obesity
  • a history of having cellulitis, & trauma to the skin.
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20
Q

s/s of erysipelas and cellulitis?

A
  • cellutlitis most often occurs on the lower extremeties
  • on face or legs
  • area is swollen, bright red, hot and tender
  • small vesicles
  • fever
  • chills
  • swelling of lymph nodes
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21
Q

how to diagnose and treat erysipelas and cellulitis?

A

diagnose - visual exam, culture

treatment - antibiotics if severe, cool epsom salt solution, warm compresses

prevent - cleaning and disinfecting skin wounds, keeping skin moisutirized and trimming fingernails to avoid scratchign skin

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22
Q

What is folliculitis, furuncles and carbuncles?

A

caused by S. aureus (enter skin thruogh opening of hair follicle and cause low-grade infection with epidermal)

  • folliculitis - superficial bacterial infection of hair follicles (pruritis, red, bumpy papules or pustules, usualy on thighs and buttocks)
  • furuncles (aka boils) - deeper infection of hair follicle (painful pustules that form in hair follicles)
  • carbuncles (larger, cluster of furuncles (painful pustules that form in hair follicles)
  • cause of these infections is usually the gram-positive bacterium Staphylococcus aureus
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23
Q

risk factors for folliculitis, furuncles and carbuncles

A
  • during long-term antibiotic therapy for acne
  • several conditions that promote growth of bacteria in the hair follicles. (bacterial growth in the hair follicles takes advantage of impaired
    immunity, skin abrasions, cuts, and bruises.
  • obesity (Bacteria also grow excessively in the skin folds of obese people)
  • topical corticosteroid therapy
  • wearing clothing that can trap heat and moisture close to the skin (waders, high boots).
  • Hot water in hot tubs, heated pools, and whirlpools can traumatize the skin and introduce bacteria to the hair follicles
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24
Q

how to diagnose and prevent follicultisi, furuncles and carbuncles?

A

diagnose w/ visual exam for presence of hairs within the pustular lesions (if recurring, blood and urine analyses)

prevent by shaving with care, keeping skin moist and well hydrated, avoiding unsanitary hot tubs and pools and regular face and handwashign

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25
Q

how to treat follicultitis, furuncles and carbuncles

A

folliculitis - antiseptic cleanser and antibiotics

furuncles and carbuncles - application of moist heat (hot compresses), antisepctic skin cleansing and antibiotics (if large than may need incision and drainainge)

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26
Q

What is oral herpes?

A
  • comon viral skin infection
  • 65% of US population is exposed to Herpes simplex type 1 by 40
  • HSV is etiology agent of skin infections known as cold osres or fever blisters
  • no cure, just inactive in nerve cells until something triggers it (like cold, flu, fever, sun exposure, stress, trauma to skin, impaired immunity
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27
Q

risk factors for oral herpes?

A
  • sharing utensils, food, and drinks with an infected person
  • kissing an infected person
  • having oral-to-genital contact with an infected person
  • virus usually affects the lips, mouth, and face, but it can cause genital herpes if transmitted during oral–genital sex
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28
Q

s/s of herpes?

A
  • clusters of painful fluid-filled vesicles on skin
  • burning or tingling sensation that preces appearance of vesicles
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29
Q

how to diagnose and treat oral herpes?

A

diagnose - visual observation of herpetic vesicles, HSV-1 antigen or antibody testing, culture and testing for HSV 1 DNA

treatment - outbreaks r usually self-limiting, antiviral drugs can decrease severity and duration of outbreak

prevented by eliminating risk factors and avoid triggers

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30
Q

What are warts?

A
  • aka verucca vulgaris
  • small, benign griwths on skin that result from hyperplasia
  • less than 1% of population
  • warts r caused by infection with human papillomavirus (HPV)
  • msot common at sites of trauma like hands and feet and probably result from inoculation of virus into damaged areas of epitehlium
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31
Q

risk factors of warts/

A
  • impaired immunity
  • age (children, young adults),
  • walking barefoot on wet surfaces
  • sharing personal items w/ someone with warts
  • physical contact with warts
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32
Q

How do warts occur?

A

causes keratinocytes to form benign neoplasm / rough, keratinized surface
- caused by viruses and r spread by touch or contact with skin shed from a wart

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33
Q

What are the types of warts?

A
  • common: (70% of all warts) small, hard, white or pink lump with a cauliflowerlike surface with small, clotted bv that resemble splinters, rough, dome-shaped, & gray-brown in color
  • plantar: grow inward on soles of the feet, forming hard, thick patches on skin with dark specks
  • flat: occur on face, arms or legs resemble small pencil erasers with flat tops and can be pink, light brwon or light yellow
  • filiform: form around mouth, nose or beard area (same color as skin with growths that look like threads sticking out of them)
  • periungual: grow under and around the toenails and fingernails and affect nail
    growth; they appear as rough bumps with an uneven surface and border
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34
Q

how to diagnose, treat and prevent warts?

A

diagnose - visual exam

treat - remove with meds that erode toughened tussye, electrocautery (heated needle or loop), cryosurgery, electrodesiccation

prevent - avoid touching warts, war sandals when walking on warm moist surfaces, treat skin, abrasians and burns

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35
Q

What are fungal skin infections?

A
  • caused by microscopic yeast and mold living on skin, hair or nails
  • one of most common skin diseases (affecting million of ppl throughout world)
  • lifetime risk is 10-20%
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36
Q

risk factors of fungal skin infections?

A
  • risk is related to fators that reduce immunity or promote the growth of fungi
  • prolonged use of antibiotics or corticosteroids
  • chronic disease such as
    diabetes or cancer
  • immune deficiency
  • exposure to damp shoes,
    clothes, communal showers or
    locker rooms
  • inherited susceptibility
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37
Q

How are fungi transmitted>

A
  • direct contact w infected persons, animals, soil, or fomites.
  • Fungi usually reside on moist areas of the body where skin surfaces touch, such as the skin folds of the breast, groin, and toes.
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38
Q

What is tinea?

A
  • aka ringworm and dermatophytosis
  • superficial fungal infection of skin and nail
  • classified by location on body
  • all r characteriaed by an active border and r marked by scalign with cetnral clearing
  • usually caused by Trichophyton rubrum or Trichophyton tonsuran
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39
Q

What is tinea corporis?

A
  • aka r body ringworm
  • can occurs in anyone with skin contact with infected doemstic animals (esp cats)
  • more common in rural settings w/ hot and humid climate
  • affects smooth areas of skin on the arms, legs, and body
  • characterized by a rash that
    begins as a small area of red, raised spots and papules
  • The rash slowly becomes ringshaped, with a red-colored, raised border and a clearer center
  • The border may look
    scaly
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40
Q

wHAT IS TINEA PEDIS?

A
  • aka athlete’s foot
  • most common of tinea
  • scales and fissures on soles of feet and between toes (intense burning and stinging pruritis)
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41
Q

What is tinea cruris?

A
  • aka jock itch
  • generally affects groin and upper and inner thighs
  • fungi cause red, ringlike areas with vesicles
  • developes more frequently during warm weather
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42
Q

What is tinea capitis?

A
  • scalp ringworm
  • highly contagious and most common in children
  • s/s include single or multiple patches of hair hat may have a black dot pattern, inflammation, scaling, pustules and pruritis
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43
Q

What is tinea unguium?

A
  • aka nail fungus
  • typically affects toenails and rarely affects fingernails
  • difficult to treat bc it resides under nails
  • begins at nails, causing white pathces and eventually turns nail brown
  • nail thickens and cracks
  • if left untreated fungi may destroy entire nail and tends to spread to other nails
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44
Q

What is tinea barbae?

A
  • barber’s itch
  • affects bearded areas of face and neck
  • deep, inflammatory pustules and crusting around hair
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45
Q

How to diagnose, treat and prevent tinea?

A

diagnose - visual exam and may include microscopic exam of skin scrapings

treat - cleaning and drying affected area and using antifungal meds

prevent - wear absorbent, breathable fabrics like cotton, keep skin clean and dry, wear sandals or shoes in gyms, locker room and pools

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46
Q

What is seborrheic dermatitis?

A
  • aka dandruff
  • on of the most common skin disorders (inflammatory condiiton of sebaceous glands)
  • chronic inflammatory skin disorder generally affecting head and trunk where sebaceous glands r prominent
  • in children it’s known as cradle cap
  • world wide preavblence is realtively low,a bt 3-5%
  • etiology is idiopathic but may be caused by yeastlike organism Pityrosporum
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47
Q

risk factors of sebhorrheic dermaititis?

A
  • oily skin or hair
  • hereditary component
  • parkinson’s disease
  • reduced immunty
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48
Q

s/s of seborrheic dermatitis?

A
  • dry or greasy scaling of scalp
  • pruritis
  • reddened and covered by yellowish, greasy appearing scales in scaplp, eyebrows, eyelids, side of nose, area behind ear and middle of chest
  • in infants, thick, yellow-crusted scalp lesions
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49
Q

etiology of seborrheic dermatitis?

A
  • etiology is unknown but yeast Malessizia or other fungi may play role (inflammatory response)
  • genetics
  • voerproduction of sebum
  • environemental factors
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50
Q

how to diagnose and treat seborrheic dermatitis/

A

diagnose - visual exam of scalp or skin, skin biopsy if not responding to treatment

treat - no cure, controlled with frequently cleaning affected area with soap, medicated shampoo, antifungal med, corticosteroids, low strength cortisone or hydrocortisone

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51
Q

What is candidiasis?

A

0 infection caused by yeast Candida albicans
- infect mouth, vagina, skin, stomach urinary tract and cause systemic infection
- Up to 14% of immunocompromised patients develop systemic candidiasis
- occurs when overgrowth of Candida from reduced immunity or disrupt normal flora

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52
Q

risk factors of candidiasis?

A
  • long term treatment with antibiotics and corticosteroids
  • illness due to immune deficiency and diabetes
  • chemotherapy
  • hormonal changes so oral conceptive use and pregnacny `
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53
Q

About ___% of women are
likely to have at least one vaginal Candida infection, and up to ___% have two or more

A

75

45

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54
Q

s/s of vaginal candidiasis?

A
  • white cottage cheese-like discharge from vagina
  • burning
  • pruritus
  • erythema
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55
Q

What is thrush?

A
  • creamy white patches on tongue or side of mouth
  • painful and easily scraped off
  • common in young healthy children, immunocompromised adults and diabetics
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56
Q

What areas does Candida cause skin infections (cutaneous candidiasis)?

A
  • areas of skin that receive little ventilation and are unusually
    moist.
  • diaper area
  • hands of people who routinely wear rubber
    gloves
  • the rim of skin at the base of the fingernail
  • groin
  • in the crease of the buttocks
  • skin folds under large breasts
  • causes patches of red, moist, weepy skin, sometimes with small pustules nearby
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57
Q

How to diagnose, treat and prevent candidiasis?

A

diagnose - visual and microscopic exam + culture

treatment -antifungal meds

prevent - keep skin clean and dry, using antibiotics correctly and eating a healthy diet (Diabetics should keep
their blood sugar under control because blood pH and sugar can promote growth of Candida)

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58
Q

What is pediculosis?

A
  • infestation of lice, external parasites that feed on blood
  • Lice have claws on their legs that are adapted for feeding
    and clinging to hair or clothing,
  • they are transmitted from person to person by close physical contact or by sharing combs, clothes, hats, or bed linens
  • three types of lice :
  • Pediculus humanus capitis (head louse)
  • Pediculus humanus corporis (body louse)
  • Pthirus pubis (pubic louse).
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59
Q

s/s of pediculosis?

A
  • pruritisu from saliva of lice as they feed on human blood
  • statching makes skin vulnerable to infeciton by other microorganisms
  • multiple eryrematousi papules
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60
Q

What is thrush?

A
  • creamy white patches on tongue or side of mouth
  • painful and easily scraped off
  • common in young healthy children, immunocompromised adults and diabeticsWha
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61
Q

Pediculosis is extremely common, affecting
more than ___ million people in the United States
each year.

A

12 `

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62
Q

What is pediculus humanus captitis?

A
  • head lice
  • common among schoolchildren
  • 12-24 M days of school r lost each yr in US due to head lice
  • difficult to see bc nits A(eggs) can be located on hair shaft
  • demale head louse lays as many as 10 eggs per 24 hrs, usually at night
  • avg lifespan of head lice in 30 days (rely on human blood so female louse cant surve more than 3 days off human head)
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63
Q

What is pthirus pubis?

A
  • pubic lice
  • infests pubic hair of both men and women
  • sopread by sexual contact
  • nickname crab from shorter, broade rbody and large front claws which allow then to grasp coarser pubic hairs
  • female pubic louse only have 1-2 eggs daily
  • average life cycle is 35 days, w/o host 1 day
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64
Q

What is pediculus humanus corporis?

A
  • body lice
  • can spread serioud disease (vector of typhus, trench fever and relapsing fever)
  • live in human clothing
  • crawl onto body only to feed, usually at night
  • lay 10-15 eggs per day on fibers of clothing, aminly clpose to seams
  • can survive10 days from host
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65
Q

How to diagnose, treat and prevent pediculosis

A

diagnose- finding live specimens of lice or viable nit

treatment - use of pediculicide meds, washing fomites in temp over 131 F for 5+ min to kill nits and lice (if not possible dry-cleaned or sealed in plastic bag for 5 days)

prevent - proper hygience and avoiding contact with infected individuals

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66
Q

How to diagnose, treat and prevent pediculosis

A

diagnose- finding live specimens of lice or viable nit

treatment - use of pediculicide meds, washing fomites in temp over 131 F for 5+ min to kill nits and lice (if not possible dry-cleaned or sealed in plastic bag for 5 days)

prevent - proper hygience and avoiding contact with infected individuals

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67
Q

What is scabies?

A
  • the itch
  • caused by contagious parasitic mite called Sarcoptes scabiei
  • poor living conditions
  • common, affects 300 M ppl annually (mostly homeless and in over-crowded conditions)
  • transmitted any close physical, direct skin to skin contact or indirect contact through fomites
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68
Q

How does scabies work?

A
  • Scabies mites can survive up to 4 days off the human body.
  • When it contacts skin, the female mite burrows into skin folds in the groin, under
    the breasts, and between fingers and toes.
  • As she burrows, she lays eggs in the tunnels, the
    eggs hatch, and the cycle starts again.
  • Intense pruritus is caused by a type IV hypersensitivity reaction to the mite.
  • Vesicles and pustules develop, and the tunnels in the skin appear as grayish lines
  • Scratching opens the lesions to secondary bacterial infection.
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69
Q

how to diagnose, treat, and prevent scabies?

A

diagnose - visal exam, icroscopic exam of skin scrapings

treat - scabicidal meds, pruritus may persists

prevent - washing clothes and bedding at temps 11+ for 5+ min orr seal items in plastic bag for 5 days + good hygiene and avoiding contact with infected individuals.

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70
Q

What is urticaria??

A

aka hives
-results from vascular reaction of skin to allergen 9acute hypersensitivity and release of histamines = local inflammation and vasodialtion of capillaries)
- common skin conditio nthat affects up to 20% of population at some point
- allergy or family member with urticaria increases risk of developing urticaria

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71
Q

s/s of urticaria?

A
  • lesions are smooth, slightly elevated wheals (patches), with red edges and pale centers that appear suddenly .
  • Wheals usually appear first on the covered areas of the skin such as the trunk and upper parts of the arms
    and legs and appear in batches.
  • Each wheal may last from a few minutes up to 6 hours.
  • Urticaria is accompanied by intense pruritus
  • when in deeper tissues it’s called angioedema and is more serious
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72
Q

MOST COMMON TRIGGERS OF URTICARIA?

A
  • Allergies to food, medications, cosmetics, soap, & detergent
  • Viral infections
  • Insect stings and bites
  • Transfusion of blood or blood products
  • Emotional and physical stress
  • Physical agents such as sunlight, heat, cold, water, and pressure
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73
Q

how to diagnose, treat and prevent urticaria?

A

diagnose - visual exam, medical history permit diagnosis, identification of possible causes

treat - reducing inflammation and s/s, coritcosteroids decrease inflammation, antihistamines control pruriti, topically applied calamine lotion (injection of epinephrine in more sever cases)

prevent - avoid allergen and reducing emotional and physcial stressmore

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74
Q

What is dermatitis?

A
  • different disorders characterized by rash accompanied by pruritus and erythema
  • likelihood of getting it increases if family history or prior allergic reactions to plants, chemicals, cleaners and metals
  • s/s r erythema, rash (can appear 1-2 days after exposure), burning and pruritis
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75
Q

What causes dermatitis?

A
  • initial exposure to allergen sensitizes skin so that it will react to next exposure
  • allergic reaction is usually confined to area where allergen touched skin
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76
Q

allergens for allergic dermatitis?

A
  • Poison ivy, poison oak, and poison sumac
  • Hair products
  • Metal nickel (jewelry and belt buckles)
  • Tanning agents in leather
  • Latex
  • Citrus fruit peel
  • Fragrances in soaps, shampoos, lotions,
    perfumes, and cosmetics
  • Topical medications
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77
Q

how to diagnose, treat, and prevent allergic contact dermatitis?

A
  • visual observation of skin rash, patch test to identify specifici irritant or allergen

treatment - reducing inflammation (corticosteroids) and relieving ssymptoms(antihistamines decrease pruritis)

prevent - avoiding contact with allergen and if contact occurs, wash it off with soap and water (gloves and protctive clothing), barrier creams can block certain substances such as poison ivy from contactgn skin

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78
Q

What is atopic dermatitis?

A
  • most common type of eczema
  • chronic skin disease that is frequently associated with other allergic conditions like asthma and hay fever and in pt with family history of allergic conditions
  • affects 10-15% of population in US
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79
Q

risk factor for atopic dermatitis?

A
  • ppl w/ family or personal history of allergic disease
  • infants
  • young chlidren
  • ppl exposed to skin iritants and extremes in temp
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80
Q

s/s of atopic dermatitis?

A
  • irritated, red, dry, crusted patches on skin
  • pruritus
  • if skin becmes infected affected ateas may ooze fluid
  • scratching cuases more irritation and increases risk of ifection
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81
Q

parts of body affected by atopic dermatitis

A
  • in babies: face, neck, ears, torso, tops of feet, outside of elbow
  • in teen, older children, adults: skin inside creases of inward bend of the elbow, knee, ankle or wrist joints, hands and upper eyelids
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82
Q

etiology of atopic dermatitis?

A
  • idiopathic
  • ppl who have it usually have many allergic disorders, particularly asthma, hay fever, food allergies
    Worsens it:
  • emotional stress
  • changes in temp or humidity
  • bacterial skin infections
  • contact with irritating clothing.
  • In some infants, food allergies may provoke atopic dermatitis
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83
Q

how to diagnose and treat atopic dermatitis?

A
  • visual exam of skin reaction, family history, occasional skin testing for specific allergies

treatment - no cure so reduce inflammation with corticosteroids and immunomodulators to decrease T-cell activation, skin moisturiziers, sunlight therapy, vitamin D or calcipotriene, NSAIDS, injectibles to blcok IL-4 and IL-3, antihistamines, tranquilizerrs, and other sedatives

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84
Q

What is rosacea?

A
  • inflammatory skin disorder that causes facial erythema
  • affects over 16M ppl in US
  • at risk ppl r middle-aged, fair skin, family history of rosacea (women r at higher risk but men get more severe)
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85
Q

s/s of rosacea?

A
  • flushing
  • persistent erythema
  • papules and pustules
  • telangiectasias (tiny bv dilate and become more visible through skin)
  • worsens if left untreated
  • cyclic (alternate btwn mild and severe)
  • severe: nose may swell and bumpy from excess tissue (rhinophyma - more in men)
86
Q

What is ocular rosacea?

A
  • affects 60% of ppl with rosacea
  • burning and grittiness and watery, itchy, bloodshot eyes
  • if not treated rosacea keratitis can damage cornea and impair vision
87
Q

etiology of rosacea

A
  • idiopathic
  • number of factors can trigger or aggravate rosacea by increasing blood flow to surface of skin
  • hot foods or beverages
  • spicy foods
  • alcohol
  • temp extremes
  • sunlight
  • stress
  • anger or embarrassment
  • strenuous exercise
  • wind
  • hot baths or saunas
  • skin care products
  • drugs that dilate bvH
88
Q

How to diagnose and treat roascea?

A

diagnose - visual exam

treat - incurable, avoid triggers, reduce inflammation w/ antibiotics and vitamin A derivatives (treat Telangiectasias can be treated with laser surgery), azelaic acid, metronidazole cream and lifestyle changes, mild cleansers and moisturizers w/o alchoohl or dryign agents, use of suncreen, topical gel, antiobiotics

89
Q

What is psoriasis?

A
  • chronic skin disease characterized by thick, flaky, red patches of various sizes, covered with carhacteristic white, sivlery sclaes and inflammation
  • affects 7.5 M ppl in US
  • risk factors include family history of psoriasis, stress, smoking, obesity, HIV infection and recurring streptococcal infection
90
Q

plaque psoriasis

A
  • 80% of all psoriasis cases
  • elbows, knees, scalp, and lower back
  • raised, inflamed, red lesions covered by silvery white scale
  • worsen, improve and worsen
  • etiology is idiopathic, involves genetics, immune system, environmentla triggers (stress, anxiety, injury to skin, cold and dry climate and meds like nonsteroidal anti-inflammaotry meds, beta blockers and lithium)
91
Q

How to diagnose and treat psoriasis?

A

diagnose - visual exam + biopsy

treat - incurable,
- salicylic acid (sloughing of dead, scaling skin cells)
- Corticosteroids (reduce inflammation and pruritus)
- anti-proliferatives decrease mitosis)
- phototherapy (decrease mitosis, scaling and inflammation)
- systemic treatment:
- vitamin A derivatives - decrease mitosis
- immunosuppressants - decrease T-cell activation and proliferation
- immunomodulators - reduce inflammation
- monoclonal antibodies - reduce inflammation and genetically engineered immunosuppressive drugs that decreases activity and number of T cells

92
Q

What is a nevus?

A
  • aka mole
  • small, dark skin growth that develops from melanocytes growing in cluster
  • most adults have btwn 10-40
  • unknown why they develop and risk factors
  • typical is plain, brown spot, diff colors, shapes and sizes r possible
  • can become malignant
93
Q

What is a dysplastic nevus?

A
  • atypical mole
  • generally larger than common nevi and has an irregular border
  • more likley to develop into melanoma but most arents malignat
94
Q

When should nevi be examined?

A
  • painful
  • itching
  • burning
  • oozing
  • bleeding
  • inflammed
  • scaly or crusty
  • suddenly different in size, shape, color or elevation
95
Q

how to diagnose, treat and prevent nevi?

A

diagnose - visual exam and maybe biopsy

treat - excision or cryosurgery

prevent - no way to prevent, just catch potential problems early by being familiar with location and pattern

96
Q

What is hemangioma?

A
  • benign tumor made of small bv that form red or purple birthmark
  • present in 4-5% of newborns
  • risk factors r being female, low birth wt, Caucasian
97
Q

Of hemangiomas, about __% are visible
at birth and the rest become visible within 1–4
weeks of birth. More than __% of hemangiomas
occur on the head or neck.

A

30

80

98
Q

What is a port-wine stain?

A
  • dark red to purple birthmark that occurs in 3 of every 1000 infants
  • visible at birth
  • flat or slightly raise
  • usually permanent
  • appear anywhere on body but usually on face, neck, scalp, arms or legs
99
Q

What is strawberry hemangioma?

A
  • streawberry red, rough, protruding lesion of face, neck or trunk
  • 0.5% of infants
  • most common hemangioma (65%)
  • present at birth or few weeks after birth
  • usually row, start to fade and turn gray usually disappearig btwn 5-10
100
Q

What is a cherry hemangioma?

A
  • small, red, dome-shapped tumor
  • appears most after 40 (70+% of ppl 70+)
  • anywhere on skin but mostly torso, abt size of pinhead (some growth to 1/4 in or more and becoe spongy and dome-shaped
101
Q

Treatment for hemangiomas?

A
  • most cases dont need treatment
  • laser therapy to reduce color and improve skin texture
  • corticosteroids to control or stop growth
  • surgical excision
  • not preventable
102
Q

What is skin cancer + risk factors?

A
  • most common of all cancers (1 in 5 ppl in US)
  • risk factors: UV radiation exposure, having skin that burns easily, severe blistering sunburns, lifetime sun exposure, tanning, exposure to artifical UV (tanning booths, sunlamps), personal or family istory of skin cancer, certain meds that increase sensitivty to UV radiation (some antibiotics, hormones, antidepressants), genetic disorders such as basal cell nevus, actinic keratosis
103
Q

What is nonmelanoma skin cancer?

A
  • 2.2M cases of nonmelanoma skin cancer and 2000 ppl will die from nonmelanoma skin cancer
  • main risk facors r sun exposure, having old scars, burns, ulcers or areas of inflammation on skin, exposure to arsenic and radiation therapy
  • cause is UV radiation damage to DNA
104
Q

WHat is basal cell carcinoma (BCC)

A
  • most common skin cancer (8/10 skin cancers r BBC)
  • slow-growing and generally non-metastasizing tumor
  • begin in lowest layer of epidermis and usually develop on UV adiation exposed areas like head and heck
  • lesion begins as pearly nodule with rolled edges taht may bleed or form a crust
  • Ulceration occurs and
    size increases if BCC is not treated
105
Q

What is Squamous cell carcinoma (SCC)?

A
  • second most common skin cancer
  • devlops in any squamous epithelium of body (including skin or mucous membranes lining natural body opening)
  • most common in areas frequently exposed to UV radiation like rim of ear, lower lip, face, bald scalp, neck, hands, arms and legs)
  • risk factors are having actinitc keratosis, infection with certain strains of human papillomavirus
  • lesion is a crusted nodule that ulcerates and bleeds (crusted or scaly area with red, inflamed base; as a grwoing tumor; as a nonhealing ulcer; or as a raised firm papule)
106
Q

how to diagnose and treat nonmelanoma skin cancer?

A

diagnose - visual exam and skin biopsy, lymph node exam. CT. MRI, PET

treat - surgical removal of tumor, radiation therapy and photodynamic therapy (photosyntheszigin agent is applied to tmor and is taken by cancer cells which destroys them when the med gets activated by light), electrodesiccation (tissue destruction bu heat), curettage, chemo, topical therapy of 5-fluorouracil or imiquimod and immunomodulators

  • new drugs blocks defective bioloical signaling pathway that results in abn cell growth

prevent - limit exposure to UV and examine skin on regular basis

107
Q

What is melanoma?

A
  • cancer that begins in melanocytes (tumors r often brown or black bc melanocytes produce melanin)
  • avg age of diagnosis is 60
  • risk factors r having atypical mole, more than 50 common nevi
  • s/s r change in shape, color, size or feel of existing mole or new mole, elevation, surface, surrounding skin, sensation, and consistency
  • in more advanced melanoma texture of mole may change and skin of suface may look scraped, and surface may ooze or bleed (itchy, tender or painful)
108
Q

The ACS estimates that in 2013 approximately
______ cases of melanoma will be diagnosed
and ____ people will die from melanoma in the
United States.

According to the World Health Organization (WHO), in 2008, _______ people were diagnosed with melanoma and _______
died of melanoma worldwide.

A

76,690 and 9,480

101,807 and 25,860

109
Q

ABCDE of melanoma?

A
  • Asymmetry: The shape of one half does not
    match the other half.
  • Border that is irregular: edges are often ragged, notched, or blurred in outline (pigment may spread into the surrounding skin)
  • Color: uneven, shades of black, brown, and tan may be present. (Areas of white, gray, red, pink, or blue may also be seen)
  • Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch).
  • Evolving: The mole has changed over the
    past few weeks or months.
110
Q

How to diagnose and treat melanoma?

A

diagnose - visual exam, history, biopsy of tumor, imaging tests to stage, full phyiscal exam, chest radiography, liver function tests, and serum lactate ehydrogenase (LDH), CT, MRI, and PET

treat - complete exciison of cancerous lesion with wide margins surgery, chemo, radiation, immunotherapy and targeted therapy

111
Q

The 5-year survival by stage of disease are localized disease, ____-%; regional disease, ____%; and metastatic disease, ___%.

A

98.1
61.4
15.3

112
Q

What is acne?

A
  • skin disorder that consists of pimples, cysts, nodules and plugged pores that occur on face, neck, chest, back, shoulder and upper arms
  • most common skin disorder in US (4050M ppl)
  • risk factors r family history, hormonal changes during adolescence, pregnancy and menstruation, use of corticosteroids, androgens and lithium
113
Q

What is acne?

A
  • skin disorder that consists of pimples, cysts, nodules and plugged pores that occur on face, neck, chest, back, shoulder and upper arms
  • most common skin disorder in US (4050M ppl)
  • risk factors r family history, hormonal changes during adolescence, pregnancy and menstruation, use of corticosteroids, androgens and lithium
  • 2 types: inflammatory and noninflammatory
114
Q

What is acne?

A
  • skin disorder that consists of pimples, cysts, nodules and plugged pores that occur on face, neck, chest, back, shoulder and upper arms
  • most common skin disorder in US (4050M ppl)
  • risk factors r family history, hormonal changes during adolescence, pregnancy and menstruation, use of corticosteroids, androgens and lithium
  • 2 types: inflammatory and noninflammatoryc
115
Q

cause of acne?

A
  • overproduction of sebum
  • blockage of hair follicles that release glands
  • growth of Propionibacterium acnes within hair follicle
  • old skin cells are not shed and clump, forming a plug (comedo) that traps oil and bacteria inside the hair follicle
  • Noninflammatory acne includes closed comedones (whiteheads) and open comedones (blackheads).
  • break in the follicle wall (forming a
    papule), inflammation is triggered and inflammatory acne develops.
  • Pustules form as white blood cells make their way to the surface of the skin.
  • If the hair follicle totally collapses, a nodule
    is formed.
  • Severe chronic acne can lead to disfiguring and scarring
116
Q

how to diagnose and treat acne?

A

diagnose - visual inspection

treatment :
- vitamin A derivatives to unclog pores and decrease inflammatons
- antibiotics kill bacteria and reduce inflammation
- benzoyl peroxide is an antibacterial oxidizing agent that ingibits growth of P. acnes
-Hormone therapy (oral contraceptives) may be used as an anti-androgen to decrease sebum production
- vitamin isotretinoin is used to treat severe acne (associated with severe birth defects if pregnancy occurs during the course of treatment or within several weeks of concluding treatment)

no preventable, just avoid overcleaningsing skin , not using harsh scrubs, avoiding products with high alc concentrations, using skin care products and makeup that is noncomedogenic and keeping hands away from face

117
Q

How do pigment disorders occur?

A
  • melanin is interspersed among other cells in epidermis and gives skin color based on number of melanocytes
  • melanin production increases with exposure to UV radiation = tanning
  • Hypopigmentation: abnormal low amount or absence of melanin. (pale white to various shades of pink due to blood vessels beneath the skin)
    Hyperpigmentation is caused by an abnormally high amount of melanin.
118
Q

What is albinism?

A
  • heredity disorder
  • absence of melanin
  • ppl of all races
  • 1 in 17,000 ppl have some albinism
  • 1 in 70 have albinism genese
  • risk factors is being child of parent w/ albinism or carrier of albinism
119
Q

s/s of albinism?

A
  • lack of melanin
  • visual abnormalities
  • rapid eye movements
  • eyes that do not track properly
  • photophobia
  • decreased visual acuity
  • functional blindness
120
Q

What is ocular albinism?

A
  • affects only eyes
  • normal or slightly lighter than normal skin
  • no pignemnt n retina
  • x-linked recessive
121
Q

What is oculocutaneous albinism?

A
  • both skin and eyes
  • absence of pigment from hair, skin or irises
  • autosomal recessive
122
Q

how to diagnose and treat albinism?

A

diagnose - appearance of skin, hiar and eyes and genetic testing

treatment - improving vision, protecting eyes from bright light, protecting skin and eyes from sun

123
Q

What is vitiligo?

A
  • loss of melanin resulting in white patches of skin
  • rare condition that occurs in 0.5-1% of population
  • affects men and women of all race but more noticeable in ppl with darker skin
  • most depigmentation in sun-exposed areas of skin
  • small areas of pigment loss that spread and become larger with time
  • white paches r usually well demarcated and may cover larger parts of body
  • often follows stressful incident
124
Q

risk factors of vitiligo?

A
  • family history of vitiligo
  • premature graying of the hair, age (10–30)
  • having certain autoimmune diseases (Addison’s disease, hyperthyroidism, pernicious anemia)
125
Q

how to diagnoe and treat vitiligo?

A

diagnose - visual inspection of skin

treatment - cause is idiopathic and no cure, small areas may be covered with tinted makeup, sunscreen should always be applied to skin to prevent sunburn
treatment options:
- repigmentation agents
- ultraviolet light therapy
- depigmentation agents
- surgery to transplant the patient’s normal
melanocytes into areas of vitiligo

126
Q

What is ephelides?

A
  • aka macule or freckles that occurs most often in people with light complexions.
  • predominately found on the face, although they
    may appear on any skin exposed to the sun.
  • flat spots that are red or light brown
  • genetic and are related to the presence of the melanocortin-1 receptor gene variant, which is dominant.
  • can be triggered by long exposure to UV radiation
  • Treatment is not necessary and freckles
    certainly cannot be prevented.
  • The regular use of sunscreen helps suppress the appearance ofephelides.
127
Q

What is ephelides?

A
  • aka macule or freckles that occurs most often in people with light complexions.
  • predominately found on the face, although they
    may appear on any skin exposed to the sun.
  • flat spots that are red or light brown
  • genetic and are related to the presence of the melanocortin-1 receptor gene variant, which is dominant.
  • can be triggered by long exposure to UV radiation
  • Treatment is not necessary and freckles
    certainly cannot be prevented.
  • The regular use of sunscreen helps suppress the appearance of ephelides.
128
Q

What are lentigines?

A
  • type of freckle that develop in older adults and are often called liver spots or age spots.
  • only known risk factor for lentigines is exposure to the sun.
  • Lentigines are small, brown lesions occurring on the face, neck, and back of the hands
  • not due to aging but are due to excessive sun
    exposure.
  • benign so treatment is not necessary.
  • If a patient requires treatment because the age spots are disfiguring or embarrassing, treatment may include depigmentation agents, vitamin A derivatives, chemical peels, cryosurgery, and laser treatment. Protecting the skin from sunlight is the best way to prevent lentigines.
129
Q

What is melasma?

A
  • aka chloasma or pregnancy mask
  • patches of darker skin on the face, esp over cheeks
  • 5-6M women in US
  • etiology is idiopathic, believed to be from increase in production of melanin (cause of trigger is unknown)
  • possible triggers include hormones, prolonged sun exposure, use of oral contraceptives, certain meds (tetracycline, antimalarial drugs)
  • treats include corticosteroids, depigmentation agents, vitamin A derivatives, chemical peels or laser treatments (protecting skin from sun)
130
Q

What are pressure ulcers?

A
  • aka bed sore and decubitus ulcer
  • area of skin that breaks down when constant pressure is placed against it
  • form in area of unrelived pressure (usually over bony prominence) which reduces blood supply to area that causes death of cells and tissue
  • 2/3 of pressure ulcer occur in pt older than 70
  • affects immobile ppl of all ages, chronically ill, neurologically impiares and is direct cause of death in 7-8% of all paraplegics
  • most common area is buttock (70%)
  • next common is lower extremities (15%)
131
Q

The prevalence in nursing homes is estimated to be ___-___%

A

17–28

132
Q

What are the risk factors for pressure ulcers?

A
  • impaired mobility,
  • age
  • reduced sensory perception
  • weight loss
  • poor nutrition and dehydration
  • urinary or fecal incontinence,
  • excessive moisture or dryness of the skin
  • medical conditions that decrease circulation
  • smoking
  • decreased mental awareness
  • muscle spasms
133
Q

At-risk patients can develop a pressure sore within ____ hour of the onset of pressure

A

2–6

134
Q

6 stage system to categorize pressure ulcers?

A

Suspected deep tissue injury - Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue.

Stage I - Intact skin with nonblanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

Stage II - Partial-thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed without slough. May also present as an intact or open/ruptured serum-filled blister.

Stage III - Full-thickness tissue loss. Subcutaneous fat may be visible but bone, tendon, or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.

Stage IV - Full-thickness tissue loss with exposed bone, tendon, or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling.

Unstageable - Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed.

135
Q

how to diagnose, treat, and prevent pressure ulcers?

A

diagnose - visual exam, culture and blood tests to assess nutritional status and overall health

treat - (if not treated will result in osteomyelitis and/or gangrene) eliminating pressure using specialized support surfaces and pressure reduction devices, turning and repositioning the pt every 2 hrs, wound debridement, antibiotics, pain management, healthy diet, muscle spasm relief, meticulous wound care, absorable geletiain spognes, granulated sugar, karaya gum patches, antiseptic irrigation, and antibiotics

prevent - repositioning, protecting and monitoring the condition of skin proper nutrition and not using tobacco

136
Q

What are corns and calluses?

A
  • areas of skin that have grown thick in response to repeated pressure and friction and form to protect skin
  • bunions, hammertoes or other foot deformities and mnual labor increase risk
  • callus (tyloma) is thickening of skin w/o distinctive border on feet (ball of foot) or hands (palm of hand) over bony prominence, cooring from white to gray-yellow, brown or red, painless or tender, throb or burn
  • When a callus develops a mass of dead cells in its center (glassy core), it becomes a corn (heloma).
  • corns have glassy core, small (les than 1/5 of inch), distncit borders and usually form on toes (hard or soft and r usually painful)
137
Q

cause of calluses and corns?

A
  • illfitting shoes or socks
  • not wearing shoes or socks
  • manual labor
  • bony prominences on ft
  • biomechanical or gait abnormailties
138
Q

How to diagnose and treat corns and calluses?

A

diagnose - visual exam, x-ray to determine underlying bone deformities

treatment - shaving or cutting off hardened area, removing it by med or surgery, surgically removing areas of protruding bone, chemical agents to soten and loosen corns, pumic stone to rub off dead skin

prevent by wearing gloves to protect hands, making sure shoes and socks fit properly, surgically correcting bondy abnormalities and keeping hands and feet moisturized

139
Q

What are burns?

A
  • damage to body’s tissue caused by heat. chemicals, electricity, sunlight or radiation
  • theraml (heat-caused) burns r the most commo
  • in response to a burn, fluid leaks out of blood vessels into tissue, causing edema and pain
  • can easily infected
140
Q

risk factors of burns?

A
  • careless smoking
    -absent or nonfunctioning smoke detectors
  • age (children under 4)
  • gender (males are 2x as likely to suffer burn injuries)
  • use of wood stoves
  • exposed heating sources or electrical cords
  • unsafe storage of flammable or caustic
    materials
  • water heaters set above 120°F
  • substandard or older housing
  • substance abuse
141
Q

The American Burn Association
estimates each year in the United States ________ people seek medical attention for burns, and burns lead to ____ hospitalizations and ______ deaths.

A

450,000

45,000

3,500

142
Q

What is a first degree and second degree burns?

A
  • First-degree or superficial burns: affect epidermis (epidermis is red, swollen and painful) (heal in 1 wk and dont scar)
  • Second-degree burns (epidermis and portions of dermis)(epidermis is extremely red and blistered and area is v painfule (heal in few weeks, some scarring and depigmentation, treat w/ antibiotic cream and apin relievers)
143
Q

What is a fourth-degree burns?

A
  • affects the epidermis, dermis, subcutaneous tissue, and structures below the skin (tendons, bone, ligaments, muscles)
  • black and charred with eschar
  • nerve endigns r destroyed so burned area isn’t painful
  • surgery or grafting to close wound, amputation, permantent disabilty, length rehab
144
Q

What is a third-degree burn?

A
  • Third-degree burns (epidermis, dermis and subcutaneous tissue)(white or brown with a dry, leathery appearance, nerve endings r destroyed so bruned area isn’t painful - edges r still painful [ fluid loss = shock)(treatment is antibiotics, IV fluids, pain relievers, surgical debridement and grafting, extendise scarrring)
145
Q

how to prevent burns?

A
  • avoiding exposure to excessive heat
  • radiation
  • sunlight
  • chemicals
  • electricity
146
Q

How to determine severity of burn?

A
  • percent of body’s surface that has been burned
  • adults use rule of nines (divie all of body into sections of 9% or 18%) and if more than 90% of body surface (60% in older person) than fatal
  • in children chart is used to adjust based on kid’s age
147
Q

What is hypothermia?

A

aka frostbite
- abnormally low body temp (below 95)
- prolonged exposure to cold air or water
- occurs when more heat escapes body than body can produce
- approx 700 ppl in US die each yr of hypothermia

148
Q

risk factors of hypothermia?

A
  • age (young children & older adults have highest risk)
  • impaired mental status
  • substance abuse
  • certain medical conditions that affect the body’s ability to regulate temperature (hypothyroidism, poor nutrition, dehydration, stroke, severe arthritis, spinal cord injuries, Parkinson’s disease)
  • some medications (certain antidepressants,
    antipsychotics, and sedatives)
149
Q

s/s of hypothermia?

A
  • shivering
  • cold and pale skin (blue)
  • lack of coordination
  • disorientation
  • decreased heart rate, respiration and bp
  • loss of consciousness
  • death
  • dilated pupils
  • stupor, unconsciousness
150
Q

How to diagnose and treat hypothermia?

A

diagnose - based on body temp

treat - rewarming

prevent - dressing appropriate to weather by wearing dry, loos-fitting, layered clothing that wicks moisture away from skin, replace wet clothes w/ dry and warm, wear hat bc 30-50% o body heat is lost through head, avoid alc b it causes bc in skin to dilate and lose heat to environment

151
Q

What is frostbite & risk factors?

A
  • damage to skin caused by freezing from prolonged exposure to cold conditions
  • risk includes medical conditions that affect sensation or the ability to respond to cold (dehydration, exhaustion, diabetes, peripheral neuropathy, circulatory problems), substance abuse, smoking, impaired mental status, previous frostbite or cold injury, and age (infant, older adult).
152
Q

s/s of superifical frostibte?

A
  • if superficial than burning, numbness, tingling, itching, cold sensation, white and frozen but retain resilience
153
Q

how to diagnose, treat, prevent frostbite?

A

diagnose - visual inspection of affected area and by taking history + imaging techniques

treat - rewarming, pain med, IV fluids, wound debridement, amputation, med to reduce clotting, tetanus vaccine booster, anti-inflammatory med, hydrotherapy to remove dead tissue (never give alcohol or rubbing affected area)

prevent - dressing adequately for the weather by wearing loose-fitting, layered clothing, keeping clothes dry, refraining from smoking, and avoiding drugs and alcohol

154
Q

s/s of deep frostbite?

A
  • if deep than intial decrease in sensation that is eventually completely lost, swelling and blood-filled blisters that r noted over white or yellowih, waxy skin that turns purplish blue as erwarmed, area is hard, no resilience and may appear blackened and dead (Freezing causes formation of ice crystals within cells, rupturing and destroying the cells)
155
Q

What happened to skin as aging?

A
  • skin loses elasticity and becomes wrinkled and saggy
  • touch sensation is decreased, increasing likelihood of frostibte and burns
  • stem cell production declines with age, causing slowerepidermal cell reproduction and thiiner, more translucent skin that is more prone to injury and infection and retain less water
  • migration of cells to top of epidermis slows
  • skin heals more slowly = more likely for secondary infecitons
156
Q

vascular and gland changes occuring in skin with age?

A
  • vascularity and circualtion decrease in subcutaneous tissue, ausing drugs to administer in this manner to be absorbed slowly
  • slowed growth
  • dull, brittle, hard and thick nails (difficult to trim)
  • decrease in the blood supply to the dermis and a decrease in sweat production lead to impaired thermoregulation, placing older adults at an increased risk for hypothermia or overheating
157
Q

immunity and melanocyte changes with aging?

A
  • less resistant to infections as numer of macrophages and other immune cells decrease
  • melanocyte number ad activtiy decline with age = skin becmes paler and hair turns gray or white
  • increased susceptibilty to sunburn and skin cancer (some melaanocyres icnrease production = lentigines)
158
Q

What is seborrheic keratosis?

A
  • benign overgrwoth of epithelial cells
  • most common benign tumor in older indiviuals (most ppl get at least 1)
  • risk factors include being over 50, family history of seborrheic keratoses
  • cause is idiopathic, maybe genetics
159
Q

s/s of seborrheic keratosis?

A
  • looksed pasted on, on head, neck or trunk
  • color from light tan to black, round to oval, flat or slightly elevated w/ scaly surface
  • v. small to more than 2 In across
  • pruritius
160
Q

how to diagnsoe and treat seborrheic keratoses?

A

diagnose - visual exam and biopsy

treatment - not necessary, can be removed by cryosurgery, curettage, laser or electrocautery

161
Q

What is actinic keratosis?

A

aka solar keratosisis
- precancerous skin condition
- 58M ppl in US have it
- higher risk for light-skinned ppl
- develops on areas exposed to sun (face, arms and legs)
- small (<1/4 in), wartlike lesions that may be pink-red or flesh-colored that later forms a yellowish brown, adherent crust
- chronic sun exposure is cause

162
Q

risk factors of actnic keratosis?

A
  • over age 50
  • impaired immunity
  • living in a sunny climate
  • having a history of frequent or intense sun exposure or sunburn
  • having a personal history of actinic keratosis or skin cancer
163
Q

If actinic keratosis is not treated, __-__%
may develop into squamous cell carcinoma.

A

10–15

164
Q

how to diagnose and treat actinic keratonosis?

A

diagnose - visual exam and biopsy

treatment - chemical peels, laser therapy, cryosurgery, photodynamic therapy,opical meds (chemotherapy agents to inhibit DNA synthesis, immune respnose modifiers to increase immune responses, nonsteroidal anti-inflammatories ot decrease prostaglandins & meds to indic ecell death

prevent by limiting exposure UV radiation

165
Q

what is contact dermatitis?

A
  • acute inflammation response of skin triggeredby exogenous chemical or substance
  • caused by action of irritants on skin’s surface or by contact with a substance that causes an allergic response incliding erythema, edema and small vesicles
166
Q

what is contact dermatitis?

A
  • acute inflammation response of skin triggeredby exogenous chemical or substance
  • caused by action of irritants on skin’s surface or by contact with a substance that causes an allergic response incliding erythema, edema and small vesicles
167
Q

s/s of psoriasis

A
  • dry plaques that progress to pustules
  • typcially dont cause discomfort but might cause slight itch or soreness
  • affected skin typically appears dry, cracked and encrusted
  • commonly in scalp, outer sides of arms and legs, especially elbows and knees and trunk of body
  • may spread to nail beds
  • can also develop in areas of physical trauma (Koebnerphenomenon)
168
Q

s/s of psoriasis

A
  • dry plaques that progress to pustules
  • typcially dont cause discomfort but might cause slight itch or soreness
  • affected skin typically appears dry, cracked and encrusted
  • commonly in scalp, outer sides of arms and legs, especially elbows and knees and trunk of body
  • may spread to nail beds
  • can also develop in areas of physical trauma (Koebnerphenomenon)
169
Q

s/s of psoriasis

A
  • dry plaques that progress to pustules
  • typcially dont cause discomfort but might cause slight itch or soreness
  • affected skin typically appears dry, cracked and encrusted
  • commonly in scalp, outer sides of arms and legs, especially elbows and knees and trunk of body
  • may spread to nail beds
  • can also develop in areas of physical trauma (Koebnerphenomenon)
170
Q

what is acne vulgaris?

A
  • inflammatory disease of the sebaceous glands and hair follicles
  • papules, pustules and comedones r usually present
  • etiology is unknown but linked to hormonal changes of adolescence (hereditarty tendencies, food llergies, endocrine disorders, psychological facotrs, fatigue and use of steroid, cause overproduction of sebum which cause a faster sheeding skin cells which stick together to form a plug)
171
Q

how to diagnose and treat acne vulgaris?

A

diagnose - characteristic lesions and pt history

treatment - topical or systemic antibiotics, keratolytic agents, vitamin A to reduce nature oil and promote drying and peeling of acne lesions, benzoyl peroxide, isotretin (Accutane - for severe acne), estrogen

172
Q

s/s of acne vulgaris?

A
  • papules, pustules, comedones
  • deeper, boil-like lesions called nodules
  • scars if chronic irritation and inflammation
  • most often on face but can also occur on neck, shoulders, chest back
  • most common in adolescets (in girls btwn 14 and 17, in boys in late teens)
173
Q

What is dermatofibroma?

A

benign and asymptomatic and an be found no any part of body, particulary on front of lower leg
- most often seen in young adults are more common in women
- thought to be fibrous reactions to viral infections or a reaction to insect bites and trauma
- scaly, hard growths that are slightly raised and pinkish

174
Q

What is keratocanthoma?

A
  • beingn epithelial growth that may be caused by a virus and generally is seen in ppl in their 60s
  • smooth, red, dome-shaped papule with central crust that usually appears singly but may occur in multiple numbers
  • can dispappera spontaneously but scarring is common
175
Q

What are keloids and hypertrophic scars?

A
  • occur secondary to trauma or surgery
  • keloid first appears normal but after several months it becomes noticeably larger and thicker
  • harmless but can cause pruritus and someitmes deformities
  • more common in dark-skinned ppl
  • extend beyond woun dsite and do not regress spontaneously
  • hypertrophic scars do not extend but stay confined and regress over time
  • keloids can be addressed surfgically
176
Q

What is acrochordon (skin tag)

A
  • common benign skin growth or tags
  • painless and usually caused by friction
  • found mailny in axilla on neck and on inguinal areas
  • brown or skin colored, flat or slightly elevated and r attacked to body by short stalk
177
Q

s/s of BCC lesions?

A
  • most common sites r sun-exposed (face, scalp, ears, back, chest, arms and back of hands)
  • 70% of BCC lesion occur on face (25-30% on nose)
  • shiny bump or nodule that is perly white, pink, red or translucent. bv may be on surface -
  • sore that bleeds, heals and recurs (associated with ulceration and crustin)
  • reddish, irritated area, usually on back, shoulders, extremitie or chest (may or may not be painful or cause pruritus)
  • smooth growth with an indented center and elevated, rolled edge or border
  • scarlike area, often with poorly defined edges, that is white, yellow ro waxy in appearance
178
Q

risk for melanoma?

A
  • sun-sensitive skin type (fair skin, light-colored hair and eyes, and skin that burns easliy)
  • history of sever sunburn
  • geographic location closer to equator
  • use of tanning beds
  • intermittent, intense exposures to UV light
  • family history of malignant melanoma
  • previous case of melanoma or nonmelanoma skin cancer
  • having many atypical moles
  • xeroderma pigmentosum, genetic disorder associated iwth defect in DNA repair
179
Q

What is pityriasis?

A

0 fungal infection that causes patches of flaky, light or dark sin to develop on trunk of body
-uncommon condition

180
Q

What is an abnormal suntain?

A
  • unspecifed adverse effect result from a proper drug, medicinal or biologic substance propelry administerd
  • some drugs and certain diseases such as Addison disease, can produce suntan even without exposure to sunlight
  • diagnose with visual exam and biopsy (to rule out malignancy)
  • treat with nonprescription depigmenting cream
181
Q

What is alopecia?

A
  • loss or absnece of hair, esp on scalp
  • can be temp or permanent, gradule or all at once in pathy areas
  • most cases its bc aging process or heredity, can be oconsequence of certain systemic illnesses such as thyroid disease, iron deficieny anemia, syphilis, or an disease, dermatitis, chemo and radiation and othe meds
  • in men it’s called androgenic alopecia (male pattern baldness) wihich is when front hairline reced e and hair at top of head thins, leaving hair on sides of head
  • alopecia areta is loss of hair in oval pathces w/o signs of inflammation
182
Q

how to diagnose and treat alopecia?

A

diagnose - visual exam, may need blood and thyroid stdues to rule out thyroid disease and anemia

treatment - cure underlyinf disease, to treat male-pattenrn baldness, minoxidial preparations in cream and spray, finasteride, toupee or wig, hair transplant

183
Q

What are deformed or discolored nails?

A
  • nails with any unusual thickening, shape or color that deviates from normal
  • can be caused y injury to the nailbed, diseases such as psoriasis, lichen planus, and chronic paronychia allow bacteria to enter end of nail to separe from underlying, congenital heart disorders and lung caner, anemia, chronic hepatic disease, small, black, splinterlike areas appear under nail with infections of cardiac vaves, systemic lupus erythematosus, and dermatomyositis, vitamin or mineral deficiency
184
Q

how to treat deformed or discolored nails 1

A
  • treat underlying conditions (if damaged by injury usually grow back)
  • several self-help measures (wearing loose-fitting shoes, keep area clean and dry to preent infection,cutting nails straight across top)
  • surgically remove ingrowing edge of nail and apply chemical t ede to releve discomfort and prevent edge from growing in again
185
Q

What is paronychia?

A
  • infection of skin anround nail
  • s/s r cuticle or nail fold becomes edamtous, red, painful, purulent material (when naul fold is affected, blister of pus called a whitlow develops beside the nail)
  • chronic infections produce similar symptoms and often several nails r affected
  • may be caused by bacteria (acute) or fungi (chronic) occurs particularly in ppl who have their hands in water for long periods)
  • diagnose with physical exam, history of s/s, culture for bacteria or fungal
186
Q

What are abrasions

A

aka scrapes, wearing away of upper layer of skin by friction, leaving red, raw, and painful injuries with minimal bleedings
- treat w/ gentle washing and irrigation of the areas w/ germicidal sopa and water, remove foreign particles, prophylaxis w/ Tdap inhection

187
Q

What are lacerations?

A
  • cuts in skin from shrap objects
188
Q

What are punctures?

A

pointed object piercing or penetrating skin w/ minimal bleeding (maybe tetanus bc anaerobic environment prefered by tetanus bacteria, need sutures or glue)
diagnosed w/ visual exam, history, radiographic studies (MRI if small)

189
Q

What are contiusions?

A

aka bruises, blood vessels r damaged or broken as result of blow to skin (blood leaks out of damaged vessels into tissues and purplish, flat bruise when blood leaks out into top layer of skin known as ecchymosis)

190
Q

What are avulsions?

A

portion of skin has been torn away or is barely attached

191
Q

What are avulsion injuries?

A

a portion of the skin has been torn away or is barely attached
usually occurs when affected body part becomes entangled in machinery, clohing, or some other means of entrapment
- treat by controlling bleeding, cleansing, surgically repairing tissue, cleansing and surigcally repairing if amputation, antibiotics, revascularization if skin graft, pain meds

192
Q

What are crushing injuries?

A
  • when a body part is subjected to a high degree of force or pressure, usually after being squeezed between two heavy objects.
  • Hemorrhage, contusions, lacerations, and fractures
    are possible complications of a crushing injury.
  • caused by finger shut in doors, hand or fingers caught in presses, heavy objects beign dropped on feet or toes, compression of any body part from MVA, loose building parts
193
Q

diagnose burns?

A

diagnose - visual exam, history, respiratory state, status of eyebrows, eyeashes and nasal hair (any singeing = pt inhaled flame = danger to respiraotory system)

194
Q

what are partial-thcikness burns and full-thickness burns?

A

partial-thickness burns ; involve all layers of skin, produce blisters and r quite painful

full-thickness burns : involve both the skin and underlying subcutanesou tissue, destrcution of nerve endings

195
Q

treat burns

A

depends on source of burns
- heat burns should be cooled with cool water and covered with dry sterile dressing
- sunburns should be treat w/ applications of cool water, antiseptic, analgesic, OTC meds, cool compress,
- chemical (other than lime) then flushed with cool water for atl east 15 min, sterile dressing
- electrical should be examined for points of entry (rings, belts, necklaces) and exit (knees, fingers, toes) and cover those areas w/ dry sterile dressing
- analgesics, antibacterial, surgical debridment and skin grafts
- burn center if severe (respirastory status, fluid and electrolye balance, vital signs, narcotics analgesics, antibiotics, skin grafting)

196
Q

What are electrical shocks?

A
  • injury that occurs as the result of exposure to or contact with electricity
  • ppl who experience electrical shock may be in cardiac or respiraotry failure
  • visible burn at enterance or exit wound
  • pain
  • caused by electricity in body causing muscle ctractions and may create cardiac dysrhythmias
  • treat based on cardiac and respirartyo status. CPR, neurologic status and vascular status, treat fractures, lacerations, head injuries, debrided and dressed with sterile dressing, narcotic analgesics, tetanus prophylaxis, antibiotics
197
Q

What are lightning injuries?

A
  • occurs when an indv is struck directly or indirectly (splash effect0 by lightning
  • classified by severtiy of injury or by type of strike the person receives, clothing may be blown off, apnea, burns in area where moisture is normally found, motor and sensory disutrances r noted, ruptured tympani membranes, altered level of consciousness and skin burns, confusion, amnesion, hearing or visual difficulties
198
Q

types of lightening strikes?

A

1) direct strike
2) contact strike (touching something that was hit by lightening)
3) side flash (lightning strikes obect, travels distance then jumps through air and strikes persion)
4) stride potential (current enters the leg of the person, travels through lower part of body and exits out the other elg)
5) ground current (lightening bolt hits ground and travels to person)

199
Q

diagnose and treat lightning strike?

A

diagnose - visual exam, histroy, neurologic asessment, examination (fernlike pattern of burns), retinal, optic nerve, occipital lobe damage, baseline visual acuity must be measured bc cataracts, conrenal ulcers or hemorrhage may occur, ruptured tymapnic membranes

treat - should enter EMS without delay, if apneic no cardiac function so cardiac monitoring, treat fractures, lacs, burns, tetanus prophylaxis, eye exams, treat ruptured tympanic membranes

200
Q

What is hyperthermia?

A
  • when indv core body temp is much highter than normal 98.6
  • acccidently occuring is consequence of prolonged exposure to extreme environmenta heat
  • occurs when body overheats and is unable to cope with exposure to seere external heat sources
  • result of salt or water depletion
201
Q

s/s of hyperthermia?

A
  • heat stroke is when temp over 105
  • has dry mouth
  • headache
  • n&v
  • dizziness and weakess
  • SOB
  • pulse is rapid and strong at onset tjem slowly decreases
  • bp decrease
  • pupiils r contrstricted
  • anxirty
  • metntal confusion
  • irritabiltiy,
  • aggression
  • hysterica bejavior
  • collapse
  • altered consciousless
  • seizures
  • sweating
  • fatigue
  • possible heat or muscle cramps
  • skin is pale, cool, moist
202
Q

diagnose and treat heat stroke?

A

diagnose - high temp, humidity, altered level of comsciousness, moist, pale skin, normal or below normal body tep

treat - coolign body down, move person to cooler environment, remove what clothign is possible, cool body by pouring cool water over it, sokaing it with a cool wet cloth, person begins to shiver, bring core temp of body below 100

203
Q

What are insect bites?

A
  • puncture of skin by bite or sting of any insect or arhtropod, may include the injection of venom into the tisssue of individual
  • fleas, mosquitos, lice, horseflies, fire ants, mites, bees, wasps, hornets, spiders
  • s/s r sharp, stining pain, itching, rednes, swelling, if systemic itching oon hands, feet, neck or groin or generalized, generalzied edema, dyspnea, wekaness, nausea, shock, unconsciousness
204
Q

diagnose and treat insect bites?

A

diagnose - visual exam, pt ihstory

treat - determine whether the stingers is still present in the bite wound, best to remove is scarping across the site ofthe sting with a plasti card or fingernail, cleansing with sopa and water,d ry dressing, cold packs, anesthetic sprays, observe for allergic reaction

205
Q

What are animal bites/ human bites?

A
  • bite inflicted on an individual by another animal
  • s/s r broekn skin with ecidence of teeth marks, possible tearing, bleeding, flesh may be bitten away, brusing, pain
  • typically occuts whenanimal is agitating, frightened, threatened or angry, domestic or wild
206
Q

diagnose and treat animal/huan bites?

A

diagnose - hisotry and physical exam, pattern of teeth marks

treat - cleansing wound, cautery or suturing to control bleeding, could be rabies if infected animal (if infected or rabies vaccinatiosn hadn been done then series of injectiosn that confer immunity against rabies), sterile dressing, tetanus prophylaxis, antibiotics

207
Q

What are snakebites?

A
  • penetrating tissue wound made by fangs or teeth of a snake
  • pt may not have actually seen snake that gave the bite, still will have noticeable bite skin or possibly only slight skin discoloration, burning pain, swelling, pulse rate becomes rapid, weakness, visual difficulty, N&V, may take 30 min to several hrs for s/s
  • poisoning usually takes 1 to 2 days t odevelop unless person is allergic to foreing poritein of venom
208
Q

cora snakes s/s

A

extremely poisnois
- leave smal chew type of teeth mark rather than 2 disticnt fang marks made by oter poisonous snakes

209
Q

Types of poisonous snakes r known to inhabit the US?

A
  • rattlesnakes (greatest)
  • copperheads
  • water moccasins
  • coral snakes
210
Q

diagnose and treat snake bites?

A

diagnose - history and visual exam (2 fangs = poinsouus), some physicians request snake head be brought

treat - first aid, removing personfrom injury sie, EMS, cleanse area with soap and water, immobilize extremity below level of heart, transort to nearest emergencyt facility, suctioning he bite with equipment, no cold, dont cut wound, no tourniquiets, no electrical shock

Pathophysiology - Diseases (22 decks)

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