Integumentary management for physical therapists

Question 1

what are the two distinct layers of the skin?

Answer 1

epidermis
dermis

Question 2

what occurs at the dermal-epidermal junction?

Answer 2

basement membrane

Question 3

what is the layer under the distinct layers of the skin?

Answer 3

subcutaneous aka the hypodermis

Question 4

what are the layers of the skin in order?

Answer 4

epidermis
dermis
adipose tissue
muscle
bone

Question 5

what is meant by blanch able and non blanchable skin?

Answer 5

blanch able turns white after pressing on the skin

Question 6

what is the dermis?

Answer 6

Thin stratified epithelium
Range from 0.06 to 0.6mm
0.4-0.6mm over palms of hands and soles of feet
Gives rise to hard keratinized structures (nails, hair)
Cellular, avascular, water resistant
Composed of 5 layers
90% Keratinocytes (synthesize keratin)
Contains melanin

Question 7

what are the 5 layers of the epidermis?

Answer 7

stratum corner
stratum lucid
stratum granulosum
stratum spinosum
stratum basale

Question 8

what are the cells of the epidermis?

Answer 8

keratinocytes
melanocytes
langerhan cells
basal cells
eccrine unit
procaine unit
hair folicles
nails
sebaceous glands

Question 9

what are the cells of the dermis called?

Answer 9

fibroblasts
collagen
elastin
macrophages
mast cells
lymphatic glands
blood vessels
nerve fibers

Question 10

what are the cells of the epidermis?

Answer 10

adipose

Question 11

what is the function of a keratinocyte (squamous cell)

Answer 11

synthesis of keratin

Question 12

what is the function of melanocytes?

Answer 12

synthesis of melanin

Question 13

what is the function of langerhan cells

Answer 13

immune responce

Question 14

what is the function of basal cells?

Answer 14

epidermal production

Question 15

what is the function of eccrine unit?

Answer 15

thermoregulation by persiratation

Question 16

what is the function of apocrine unit

Answer 16

sweat production

Question 17

what is the function of hair follicles?

Answer 17

protection

Question 18

what is the function of nails?

Answer 18

protection

Question 19

what is the function of sebaceous glands

Answer 19

produces sebum (oil for lubrication of skin)

Question 20

what is the function of fibroblasts? where are the found?

Answer 20

collagen synthesis
dermis

Question 21

what is the function of collagen? where are the found?

Answer 21

insoluble connective tissue proteins
dermis

Question 22

what is the function of elastin? where are the found?

Answer 22

primary protein in elastic tissues
dermis

Question 23

what is the function of macrophages? where are the found?

Answer 23

phagoctosis, intimate growth and repair through growth factor production
dermis

Question 24

what is the function of mast cells? where are the found?

Answer 24

provide histamine for vasodilation
dermis

Question 25

what is the function of lymphatic glands cells? where are the found?

Answer 25

removal of microbes and intestinal waste dermis

Question 26

what is the function of blood vessels cells? where are the found?

Answer 26

thermoregulation provides metabolic skin requirements dermis

Question 27

what is the function of nerve fibers? where are the found?

Answer 27

sensory perception dermis

Question 28

what is the function of nerve fibers? where are the found?

Answer 28

protection from trauma, energy storage, thermoregulation subcutaneous

Question 29

what are the functional components of the epidermis?

Answer 29

stratum corneum keratinocytes melanocytes Merkel cells Langerhans’ cells

Question 30

what are keratins?

Answer 30

Insoluble fibrous proteins Extremely resistant to changes in pH, temperature and enzymatic digestion Two broad categories Hard Soft

Question 31

how often does the epidermis shed?

Answer 31

Sheds on average every 28-30 days Until age 60- then every 60 days

Question 32

what are the functions of the epidermis?

Answer 32

Protection: infection, shear/friction, water loss, toxic irritants Vitamin D synthesis Thermoregulation Regulation, retention, dissipation Sensation (light touch) Pigmentation (melanocytes)

Question 33

what is the importance of the epidermal-dermal junction and what lies within there?

Answer 33

basement membrane: separates the epidermis form the dermis rete pegs reduce shearing stress between the epidermis and the dermis

Question 34

what is the dermis?

Answer 34

Thickest layer of skin (2-4 mm) 20-30X thicker than epidermis Provides support and nutrition to the epidermis Responsible for giving skin its bulkiness Extra-cellular matrix (fibroblasts) Is vascularized and innervated Major proteins are collagen and elastin

Question 35

what are the functional components of the dermis?

Answer 35

Functional components hair follicles sweat glands sebaceous glands nerve endings lymph vessels capillaries collagen elastin

Question 36

what are dermal appendages?

Answer 36

Hair follicles Sebaceous glands Sweat glands Lined with epithelial cells Epithelial islands

Question 37

what are subcutaneous tissues

Answer 37

Superficial fascia Anchors skin to underlying structures Blood vessels and nerve endings Fat Insulates and “pads” underlying structures

Question 38

how are the muscles aligned in the skin organization

Answer 38

Separated from subcutaneous fat by fascia Point of contact to bony prominences Greatest oxygen demand of all tissues Most sensitive to ischemia

Question 39

Review what are the three factors the skin provides us? organs of communication and idenfification

Answer 39

provides thermoregulation sensation metabolism Organ of communication and identification Injury can result in: Functional change Physiologic change Body image change Facial skin, along with underlying muscles capable of expressions

Question 40

what are the levels of skin loss?

Answer 40

Wounds are classified by depth of tissue injury Erosion- loss of superficial epidermis, probably not bleed, redness, repair by local inflammatory response Partial thickness skin loss- loss of epidermis and part of the dermis, bleed, reepithelization for repair Full thickness skin loss- loss of epidermis, dermis extending into subcutaneous/hypodermis, secondary intention repair through scar Full thickness with muscle, tendon, bone

Question 41

what are the skin changes noticed with aging?

Answer 41

Decreased: Epidermal/Dermal thickness Decreased subcutaneous fat Collagen and elastin Size of Rete ridges/pegs Sensation and metabolism Sweat glands Circulation Reduced mast cells Epidermal regeneration Up to 4X slower healing than younger populations