Exam #5- Integumentary Flashcards
(113 cards)
1
Q
aging changes of the skin
A
skin becomes thinner, drier, wrinkled, changes in pigmentation
of capillary loops shorten and decreases
less melanocytes and langerhans cells
sebaceous, eccrine, and apocrine glands atrophy
temp regulation is not as good
pressure/touch receptors decrease in number and decrease sensory perception
decreased protective functions
infections increase
delayed wound healing
2
Q
neural innervation of the skin is the function of what?
A
the SYMPATHETIC nervous system by way of the ALPHA ADRENERGIC RECEPTORS
3
Q
wheal
A
primary lesion
elevated, weird shaped area of cutaneous edema
solid and transient
diameter is varied
may last for a few hours
4
Q
nodule
A
primary lesion
elevated, firm, circumscribed lesion
deeper than papule
5
Q
tumor
A
primary lesion
elevated, solid lesion
deeper in dermis
6
Q
vesicle
A
primary lesion
elevated, circumscribed, superficial lesion
does not extend into dermis
filled with SEROUS fluid (free fluid)
7
Q
bulla
A
primary lesion
vesicle that measures >1cm
8
Q
pustule
A
primary lesion
elevated, superficial lesion
like a vesicle but filled with PURULENT fluid (pus)
inflammatory cells
9
Q
cyst
A
primary lesion
elevated, circumscribed, encapsulated lesion
is in dermis/subcutaneous layer
filled with liquid or semisolid
10
Q
telangiectasia
A
primary lesion
irregular red lines
produced by capillary dilation
11
Q
scale
A
secondary lesion
heaped up, keratinized cells
flaky skin and weird shape, can be thick or thin
dry or oily
12
Q
lichenification
A
secondary lesion
rough, thickened epidermis caused by rubbing, itching, or irritation
13
Q
keloid
A
secondary lesion
weird shaped, elevated progressively enlarging scar
grows beyond wound
caused by too much collagen formed during healing
14
Q
scar
A
secondary lesion
think to thick fibrous tissue
replaces normal skin after injury/lacaration
15
Q
excoriation
A
secondary lesion
loss of epidermis
linear, hollowed out, crusted area
16
Q
fissure
A
secondary lesion
linear crack/break from epidermis to dermis
may be moist/dry
think of cracked feet
17
Q
erosion
A
secondary lesion
loss of part of epidermis
depressed, moist, glistening
happens after rupture of vesicle or bulla
18
Q
ulcer
A
secondary lesion
loss of epidermis/dermis
concave
19
Q
atrophy
A
secondary lesion
thinning of skin surface
loss of skin markings
20
Q
macule
A
circular flat discoloration <1cm
brown, blue, red or hypopigmented
21
Q
patch
A
circumscribed flat discoloration >1cm
22
Q
plaque
A
superficial elevated solid flat topped lesion >1cm
23
Q
crust
A
dried serum or exudate on skin
24
Q
pathophysiology of pressure ulcers
A
due to unrelieved pressure on skin (shearing forces, friction, moisture)
capillary blood flow occlusion
underlying tissue damage (like ischemia or necrosis)
25
decubitus ulcer
d/t lying/sitting in same position for too long on a bony prominence
26
stage 1 pressure ulcer
non-blanchable **erythema of intact skin**
intact skin with non blanchable redness of a localized area, usually over a bony prominence
the area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue
may be difficult to detect in individuals with dark skin tones
27
stage II pressure ulcer
partial-thickness skin loss
involves **epidermis or dermis**
presents as a shallow open ulcer with a red pink wound bed, without slough
may also present as an intact or open/ruptured serum-filled or serosanginous filled blister
28
stage III pressure ulcer
full-thickness skin loss
involves damage/loss of SUBQ TISSUE
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
29
stage IV pressure ulcer
full thickness skin loss with damage to MUSCLE, BONE, or SUPPORTING STRUCTURES
slough or eschar may be present
often includes undermining and tunneling
category/stage IV ulcers can extend into muscle and/or supporting structures (fascia, tendon or joint capsule)
30
what is the outermost layer of the skin?
epidermis
31
pruritus
itching
**most common s/s of primary skin disorders**
32
itch
**specific unmyelinated C nerve fibers**
**regulated by CNS**
33
neuropathic pruritus
related to pathologic condition
34
psychogenic pruritus
psych problem
35
s/s of dermatitis eczema
pruritus, lesions w/indistinct borders, epidermal changes
chronic eczema- thickened, leathery, hyperpigmented skin from recurrent irritation/scratching
36
allergic contact dermatitis
t cell mediated or delayed hypersensitivity (TYPE IV)
allergen comes in contact with skin, binds to carrier protein
sensitizing antigen is formed
LANGERHAN CELLS process antigen
carry it to T cells
sensitization
37
which cells of the skin are important in immunity?
langerhan cells
38
a skin disorder that is the result of a type IV hypersensitivity reaction is known as what?
allergic contact dermatitis
39
irritant contact dermatitis
non immunologic inflammation
due to chemical irritation from acids/prolonged exposure to irritants
40
atopic dermatitis
d/t family history of allergies, hay fever, IgE
41
stasis dermatitis
happens in legs d/t venous stasis, edema, vascular trauma
42
seborrheic dermatitis
chronic skin inflammation that involves scalp, eyebrows, eyelids, nasolabial folds, axillae, chest, and back (cradle cap in babies)
greasy, scaly, white, or yellowish plaques
43
a skin lesion that is elevated, firm, rough, and has a flat top
plaque
44
psoriasis
chronic, relapsing, proliferative skin disorders
45
pathophysiology of psoriasis
t cell AUTOIMMUNE mediated skin disease
46
s/s of psoriasis
scaly, thick, silvery, elevated lesion, usually on scalp, elbows, or knees
47
pityriasis rosea
benign, self limiting inflammatory disorder
48
pathophysiology of pityriasis rosea
d/t a VIRUS
49
s/s of pityriasis rosea
herald patch- CIRCULAR, demarcated, salmon-pink
50
systemic complications of psoriasis
arthritis and heart disease
51
an autoimmune skin disorder that results in scaly, silvery lesions with evidence of dermal and epidermal thickening
psoriasis
52
pathophysiology of lichen planus
AUTO-INFLAMMATORY disorder of SKIN and MUCUS membranes
origin is unknown, but it involves **t tubules, adhesion molecules, inflammatory cytokines, and antigen presenting cells**
53
s/s of lichen planus
lesions are non-scaling popular VIOLET-colored with itching on wrists, ankles, lower legs, and genitals
54
a benign t cell mediated auto-inflammatory skin disorder that results in violet colored lesions is what?
lichen planus
55
acne vulgaris
inflammatory disease of pilosebaceous follicles
hypertrophy of sebaceous glands and telengiectasia
common during ADOLESCENCE
56
acne rosacea
skin inflammation of MIDDLE AGED ADULTS
lesions are erythematolangiectatic, papulopustular, phymateous, and ocular
related to chronic, inappropriate vasodilation
flushing and sun sensitivity
57
lupus erythematosus
inflammatory, autoimmune, systemic disease with cutaneous s/s
types: skin (discoid) and systemic (SLE)
58
discoid (cutaneous) lupus erythematosus
acute, subacute, chronic
**restricted to skin**
59
pathophysiology of discoid lupus
altered immune response with new T and B cells formed, decreased number of regulatory T cells, and increased pro inflammatory cytokines
tissue damage d/t autoantibodies and immune complexes
60
s/s of discoid lupus
photosensitivity, butterfly pattern, can lead to SLE
61
pathophysiology of erythema multiforme
**immune complexes** formed and deposited around dermal blood vessels, basement membranes, and keratinocytes
affects mouth, air passages, esophagus, urethra, and conjunctivae
62
s/s of erythema mutliforme
"bulls eye" or target lesion, erosions/crusts form when lesions rupture
63
steven johnson syndrome
cause is unknown but involves an immune mechanisms r/t drug administration
severe blistering
64
pathophysiology of pemphigus
AUTOIMMUNE, chronic, blister forming disease of skin and oral mucous membranes
caused by circulating IgG AUTOANTIBODIES that work against surface adhesion molecules in the epidermis
65
s/s of pemphigus
blisters can be deep or superficial to the epidermis
66
folliculitis
bacterial
infection of hair follicles from a staph infection
67
furuncles
bacterial
boils (inflammation of hair follicles) that develop from folliculitis from staph infection
68
carbuncles
bacterial
collection of infected hair follicles
painful, swollen, and red with systemic s/s
69
cellulitis
bacterial
infection of dermis and SQ tissue from staph or group B strep infection
70
necrotizing fasciitis
bacterial
inflammation that spreads quickly to fascia, muscles, and SQ fat to skin
71
erysipelas
bacterial
superficial form of cellulitis
72
impetigo
bacterial
superficial lesion from staph
73
HSV-1
virus
cold sores
74
HSV-2
virus
genital
75
herpes zoster (shingles)
virus
caused by varicella zoster virus
76
varicella chickenpox
virus
77
wart
virus
benign lesions caused by HPA
78
a child presents with lesions superficially on the skin. the provider knows that this disorder is caused by staph
impetigo
79
tinea
caused by dermatophytes tinea capitis, tinea pedis, tinea corporis, tinea cruris, tinea unguium
80
candidiasis
caused by candida albicans found on skin, GI, vagina
81
s/s of candidiasis
thin walled pustule that produces a whitish yellow curd-like substance
82
pathophysiology or urticaria (hives)
type I hypersensitivity reaction
histamine release
endothelial cells of skin to contract fluid leaks from vessels
83
s/s of urticaria
itchy area of raised erythema with central pallow
wheals
welts
84
urticaria is the result of which type of hypersensitivity reaction?
type I
85
pathophysiology of scleroderma
SCLEROSIS (hardening) of skin
muscles, bones, and internal organs
T HELPER CELLS and their CYTOKINES: fibroblast proliferation and fibrosis due to multiple autoantibodies
86
s/s of scleroderma
skin is hard, hypopigmented, taut, shiny, and tightly connected to underlying tissue
87
pathophysiology of ticks
ticks embed their heads into pts skin so they can get blood
they gorge on blood and get huge
they they release their toxins/transmit microorganisms
88
pathophysiology of lyme disease
tick that spreads infection borrelia burgdorferi
89
stages of lyme disease
localized
disseminated infection
late persistent infection
90
localized lyme disease
3-32 days with erythema migrans with or without fever, fatigue, malaise, myalgia, arthralgia
91
dissmeninated infection of lyme disease
secondary erythema migrans, arthralgia, meningitis, neuritis, carditis
92
late persistent infection of lyme disease
years after
arthritis, encephalopathy, polyneuropathy, HF
93
seborrheic keratosis
benign
proliferation of cutaneous basal cells that produce smooth/warty elevated lesions
94
keratoaconthoma
benign
tumor of squamous cell that comes from hair follicles
95
actinic keratosis
benign
premalignant lesion made of aberrant proliferations of epidermal keratinocytes caused by too much UV light
96
nevi (moles)
benign
pigmented or not
lesions that form from melanocytes
can transition to malignant melanomas
97
basal cell CA
malignant
surface epithelial tumor
mutation of TP53 and PTCH1 genes
most common type of skin cancer
shiny "pearly" papule or nodule
grows slowly
usually occurs on sun-exposed areas
umbilicated center and telangiectasias
98
squamous cell cancer
malignant
tumor of epidermis: in situ or invasive
mutation of TP53 gene
more common in immunocompressed or transplant patients
hyperketatotic lesion with crusting and ulceration
can be more aggressive than basal cell cancer
usually occurs on sun-exposed areas
99
malignant melanoma
malignant
tumor of skin that comes from melanocytes
100
kaposi sarcoma
malignant
vascular malignancy
due to herpes virus
common in immunosuppressred pts (post transplant, AIDS)
101
a patient presents with a skin lesion with crusting and ulceration that is invading the epidermis. the provider would suspect which type of skin cancer?
squamous cell carcinoma
102
ABCDE rule
asymmetry
border irregularity
color variation
diameter >6mm
elevation that includes raised appearance/rapid enlargement
103
ABCD sign of melanoma
asymmetry- when half of the mole does not match the other half
border- when the border (edges) of the mole are ragged or irregular
color- when the color of the mole varies throughout
diameter- if the mole's diameter is larger than a pencil's eraser
104
cold injuries basics
injury from extreme cold that affects fingers, toes, ears, nose, cheeks
alternating cycles of vasoconstriction/vasodilation leads to burning reaction
105
s/s of cold injury
white/yellowish, waxy, firm to touch
106
partial thickness burn
**ONLY epidermis**
local pain with erythema
no blisters until 24 hours after injury
107
superficial partial thickness burn
thin walled, fluid filled blisters form minutes after injury
painful!
108
deep partial thickness burn
ENTIRE dermis
spares skin appendages like hair follicles and sweat glands
waxy, white skin
can distinguish after 7-10 days between deep partial and full when hair or skin buds reappear
109
full thickness burn
entire **epidermis, dermis, and underlying SQ are destroyed**
PAINLESS due to destroyed nerve endings
burn color is white, cherry red, or black
wound is dry or leathery
110
which type of burn is associated with injury to the epidermis and all skin barrier are intact?
partial thickness injury
111
burn shock
in immediate (acute) phase is d/t **hypovolemia, heart issues, cellular issues**
112
capillary seal
end of burn shock
113
ebb phase of burn shock
heart contractility is decreased during 1st 24 hours because blood is shunting away from liver, kidney, and gut
