Lecture 4 from Profs

Question 1

what are age related changes in the epidermis

Answer 1

skin more fragile

altered turnover rate & DNA repair; photo-aging

Question 2

what are age related changes with the dermis?

Answer 2

loss of thickness
decrease mast cells and histamine
decrease vascular supply and collagen synthesis

Question 3

What changes with the SubQ with age?

Answer 3

decreased volume (face and hands)
increase volume in abdomen and thighs

Question 4

which level of vit d is tested for?

Answer 4

25-hydroxycholecalciferol

Question 5

where do you get Vitamin D?

Answer 5

Dairy, fish, sun

must go through a process to be used

Question 6

why does hair grey?

Answer 6

hair follicles produce less melanin

Question 7

what causes senile purpura?

Answer 7

Capillary fragility

Question 8

why is temp regulation difficult?

Answer 8

atrophy of sweat glands

Question 9

what causes pressure ulcers?

Answer 9

decreased SubQ fat

Question 10

what is dry skin?

Answer 10

xerosis

Question 11

what are purple spots in skin exposed areas? not raised or painful.

Answer 11

actinic purpura

Question 12

what is the name for age spots/ liver spots?

Answer 12

solar lentigo

Question 13

what are waxy, raised lesions?

tan, brown-black, or gray, waxy to verrucoid papules and plaques, stuck-on appearance; benign

Answer 13

seborrheic keratosis

use cryosurgery to remove

Question 14

sun exposed area, crusty, reddened, circular

Answer 14

Seborrheic keratosis

do a biopsy, or totally remove can turn into squamous cell

Question 15

reddish bump, large, a bit irregular. can have a crust on it

Answer 15

Squamous cell

Question 16

Red bump with waxy, with telangiectasia

Answer 16

Basal cell carcinoma

Question 17

what biopsy do you not do with melanoma?

Answer 17

shave

Question 18

perpendicular force to skin surface

Answer 18

Pressure

Question 19

parallel force to skin surface

Answer 19

Shearing

Question 20

4 things for pressure ulcers?

Answer 20

Pressure
Friction
Shearing force
moisture

Question 21

main symptom of arterial dz?

Answer 21

claudication

Question 22

what test do we do to check for peripheral arterial dz?

Answer 22

ABI

Question 23

cutaneous vesicular eruption & excruciating pain (burning, knifelike, deep & boring)

Answer 23

Herpes Zoster

Question 24

Tx for herpes zoster.

Answer 24

Antiretrovirals & analgesia = minimize sequelae (post-herpetic neuralgia)

Question 25

Diagnostics for anemia

Answer 25

``` CBC w/differential reticulocyte count blood smear erythrocyte indices nutritional status ```

Question 26

what might be a first sign of anemia?

Answer 26

Worsening of angina

Question 27

PE changes in anemia

Answer 27

pallor tachycardia evidence HF change in cognitive tests

Question 28

What does high MCV indicate?

Answer 28

Megaloblastic- B12 and folate deficiences

Question 29

what does normal MCV indicate?

Answer 29

Anemia of chronic dz | early Fe deficiency

Question 30

Low MCV indicates what?

Answer 30

Fe deficiency anemia of chronic dz sideroblastic

Question 31

what can cause iron deficiency?

Answer 31

Dietary or blood loss

Question 32

Will ferritin be low or high with microcytic/ hypochromic anemia?

Answer 32

Low ferritin

Question 33

How do you treat microcytic/ hypochromic anemia?

Answer 33

Ferrous sulfate 2-3 times a day

Question 34

what is a microcytic/ hypochromic anemia that is congenital and acquired. Associated w/ chronic alcohol abuse, RA, cancer, lead poisoning.

Answer 34

Sideroblastic anemia

Question 35

diagnostics for sideroblastic anemia

Answer 35

CBC- microcytic, hypocrhomic + ringed sideroblasts increased iron and transferrin saturation TIBC normal ferritin normal

Question 36

how do you treat sideroblastic anemia?

Answer 36

trial pyridoxine transfusion look for cause

Question 37

what can be a problem with transfusion w/ sideroblastic anemia

Answer 37

iron overload

Question 38

what can sideroblastic anemia turn into?

Answer 38

myeloblastic leukemia

Question 39

labs with anemia of chronic dz?

Answer 39

decrease serum iron high or normal ferritin TIBC low

Question 40

how do you manage anemia of chronic dz?

Answer 40

treat underlying dz or malignancy EPO transfusion

Question 41

Signs of B12 deficiency

Answer 41

loss of vibratory and position sense dementia neuro-psych

Question 42

how to treat b12 anemia?

Answer 42

Supplement, correct nutritional or underlying GI issue

Question 43

labs for B12 deficiency

Answer 43

CBC: macrocytic, hyperchromic, hypersegmented neutrophils; BM: megaloblasts; B12 & folate levels

Question 44

causes of folate macrocytic/ megalobalstic anemia

Answer 44

chronic alcohol abuse inadequate dietary intake drugs- anticonvulsants, triameterene

Question 45

signs of folate deficiency anemia?

Answer 45

no neuro symptoms

Question 46

who are vit d deficiency seen in lost

Answer 46

bed bound | nursing home patients

Question 47

what vitamins do you worry about ODing on?

Answer 47

A D E K

Question 48

: non-palpable ecchymotic areas, no hx anticoagulation, abuse, trauma

Answer 48

actinic purpura

Question 49

a small, sharply circumscribed, pigmented macule surrounded by normal appearing skin/melanin pigment, aka “age spot”, spots represent areas of melanin overproduction in the skin from lifetime of chronic sun exposure, benign

Answer 49

Lentigo

Question 50

tan, brown-black, or gray, waxy to verrucoid papules and plaques, stuck-on appearance; benign

Answer 50

Seborrheic keratoses

Question 51

condition of thick, scaly, or crusty patches of skin, pre-malignant lesion, progression to squamous cell CA

Answer 51

Actinic keratosis

Question 52

translucent, "pearly" or "waxy" papule; associated telangiectasia, sometimes central ulceration

Answer 52

Basal cell carcinoma

Question 53

a flesh-colored or reddish bump or patch

Answer 53

Squamous cell carcinoma

Question 54

4 stages of pressure ulcers

Answer 54

Non blanching erythema → dermis → fascia → bone