Unit 2 Pathophysiology - Chapter 47 Structure, function, and d/o of integument

Question 1

Skin has how many layers?

Answer 1

Three: dermis, epidermis, and subcutaneous layer

Question 2

Keratinocytes

Answer 2

Keratin (forms superficial layer of epidermis)
Underlying epidermis contains:
* basal and spinous layer w/
* melanocytes - creates pigment via melanin
* Langerhans cells - cutaneous immune system
* Merkel cells - sensitivity for touch, hormonal functions

Question 3

Dermis

Answer 3

Consist of:
* connective tissue
* hair follicles
* sweat glands
* sebaceous glands
* blood vessels, nerves, and lymphatic vessels

Question 4

Subcutaneous layer

Answer 4

Contains:
* macrophages
* fibroblasts (produce and maintain the ECM of connective tissue)
* fat cells
* nerves, fine muscles, blood vessels, lymphatics and hair follicle roots

Question 5

dermal appendages

Answer 5

nails, hair, sebaceous glands, eccrine (most of body, sweats and evaporates) and apocrine (mainly hair follicles, same concept)

Question 6

Papillary capillaries

Answer 6

provide major blood supply to skin, arising from deeper arterial plexuses

sympathetic nervous system regulates skin blood flow

Question 7

Arteriorvenous anastomoses

Answer 7

l/t papillary capillaries => help with heat loss and heat conservation

Single Large vein and artery together

Question 8

Older skin

Answer 8

thinner + drier w/ less collagen; fewer capillary loops and fewer changes in pigmentation

Question 9

Gray and thinner hair

Answer 9

Lack of melanocytes and hair follicles

Question 10

Skin integrity of OA

Answer 10

• more permeable
• decreased sweating
• loss of thermal regulation
• less protection

Question 11

Pressure injuries

Answer 11

D/t continuous pressure and shearing forces occluding capillary blood flow l/t ischemia and necrosis

• greatest risks bony prominences: greater trochanter, sacrum, ischia, and heels.

Question 12

Keloid

Answer 12

scars that extend beyond injury border and develop d/t abnormal fibroblast activity + excess collagen formation

Question 13

Hypertrophic scars

Answer 13

elevated erythematous (abnormal redness) fibrious lesions that do not ext beyond injury border

Question 14

Pruitus

Answer 14

Itch mediators, peripheral unmyelinated polymodal C nerve fibers, and central processes contribute to itching

Question 15

Allergic contact dermatitis

Answer 15

form of delayed hypersensitivity develops with changes in skin barrier fx and exposure to allergns - microorganisms, metals, chemical, or poison ivy

Question 16

Irritant contact dermatitis

Answer 16

inflammatory response to prolonged exposure to chemicals, acids or soaps

Question 17

atopic dermatitis or atopic eczema

Answer 17

atopic (sensitivity to allergens); family history of allergies, hay fever, elevated IgE levels, and increased histamine sensitivity; common in children

Question 18

Stasis dermatitis

Answer 18

occurs on legs; d/t venous stasis and edema

Question 19

Seborrheic dermatitis

Answer 19

scaly, yellowish, inflammatory plaques of the scalp, eyebrows, eyelids, ear canals, chest, axillae, back; associated with Malassezia yeasts, immunosuppression, and epidermal hyperproliferation.

Question 20

Papulosquamous disorders

Answer 20

papules, scales, plaques, and erythema

Question 21

Psoriasis

Answer 21

chronic autoimmune T-cell mediated inflammatory skin disease; thickened epidermis and dermis w/ scaly, erythmatous pruitic plaques

Forms
* plaque (scaly, red, can impact nails)
* inverse (skin folds => groin, armpits => smooth and shiny red patches
* guttate (torso and limbs [younger folks] tear drop shapes]
* pustular (palms and soles blotchy red pustules)
* erthrodermic

Can accompany w/ disease:
* arthritis
* nail disease
* CV disease

Question 22

Pityriasis rosea

Answer 22

self-limiting disease w/ herpes type viruses present w/ oval lesions w/ scales around edges (herald patch) at skin lines of the trunk

Question 23

Lichen planus

Answer 23

papular violet-colored autoimmune inflammatory lesion involving T cells and inflammatory cytokinesd/t severe pruitus and involve both skin and mucuos membrane lesions

Question 24

Acne vulgaris

Answer 24

nose; inflammation of pilosebaceous follicles with hypertrophy (increased growth) of sebaceous glands + telangiestasia (small, widened blood vessels on the skin)

Question 25

Hidradenitis suppurativa

Answer 25

chronic inflammatory recurring scarring disease of pilosebaceous follicular ducts at skin w/ folds, hair follicles, and aprocrine (Sweat) glands and is r/t immune and environmental factors

Question 26

Acne rosacea

Answer 26

inflammation w/ erythema, edema, papules, pustules, and telangiectasia that develops on middle 1/3 of face with hypertrophy + inflammation of sebaceous glands d/t infection or immune mediated inflammation

Question 27

Cutaneous lupus erythematosus

Answer 27

inflammatory autoimmune disease affecting only skin; inflammatory lesions usually in sun-exposed area w/ butterfly distribution over nose + cheeks

Question 28

Pemphigus

Answer 28

chronic autoimmune blistering disease begins in mouth or scalp and spreads to other parts of body => fatal outcomes * pemphigus vulgaris (most common) ## Footnote q

Question 29

Bullous pephigold

Answer 29

benign autoimmune blistering disease that resolves rapidly

Question 30

Erythema multiforme minor

Answer 30

acute inflammation of skin w/o involvement of mucous membrane; target-like with alternating rings of edema + inflammation d/t HSV (herpes simplex) or other infections; rarely drug reactions

Question 31

SJS, stevens-johnson syndrome and toxic epidermal necrolysis (TEN)

Answer 31

There is a SJS/TEN overlap syndrome are the same disease with progressive blistering d/t keratinocyte cell death via bullous epidermal detachmen, mucositis (when your mouth or gut is sore and inflamed. It's a common side effect of chemotherapy and radiotherapy), and organ involvement d/t cytotoxic t-cell drug reaction

Question 32

Folliculitis

Answer 32

bacterial infection of hair follicle

Question 33

Furuncle

Answer 33

infection of the hair follicle that extends to the surrounding tissue

Question 34

Carbuncle

Answer 34

collection of infected hair follicles that forms a draining abcess

Question 35

Cellulitis

Answer 35

diffuse infection - dermis + subq d/t staphylococcus, CA-MRSA or group B streptococci

Question 36

Erysipelas

Answer 36

superficial streptococcal infection of skin (face, ears, lower legs)

Question 37

Impetigo

Answer 37

bullous or ulcerative form d/t staphylococcus or streptococcus (common in children) contagious skin infection that causes red sores on the face.

Question 38

HSV-1

Answer 38

cold sores can infect cornea, mouth and labia

Question 39

HSV-2

Answer 39

genital lesions and spread by sexual contact

Question 40

Herpes zoster and varicella (chickenpox)

Answer 40

Same herpesvirus, herpes zoster manifesting years after intial infection

Question 41

Warts or verrucae

Answer 41

benign, rough, elevated lesions d/t papillomavirus; venereal warts (condylomata acuminata) spread via sexual contact

Question 42

Tinea skin infections

Answer 42

Fungal infections; anywhere on body and classified by location (capitis - scalp, pedis - feet, corporis - body, crusis - groin, unguium - nails)

Question 43

Candidiasis

Answer 43

yeastlike fungal infection - C. albicans [skin, mucous membranes, GI tract]

Question 44

Cutaneous vasculitis

Answer 44

immune-mediated inflammation of small skin blood vessels w/ purpura, ishcemia, and necrosis resulting from disruption of vessel wall A purpura rash occurs when small blood vessels burst, causing blood to pool under the skin.

Question 45

Utricarial lesions

Answer 45

type I hypersensitivity responses; wheals (raised itchy pruitic patch), welts, or hives

Question 46

scleroderma

Answer 46

immune-mediated schlerosis (hardening) of skin localized to skin to systemic and affect bone, bone, and other organs that invovle T helper cells, cytokines, and autoantibodies

Question 47

seborrheic keratosis

Answer 47

older adults; usually sun damaged skin; squamous cells that make elevated, smooth or warty lesions of different sizes

Question 48

keratocanthoma

Answer 48

Hair follices on sun areas; dome-shaped, crusty lesion filled with keratin resolves in 3-4 months Keratin is protein can be a hair plug

Question 49

actinic (solar) keratosis

Answer 49

pigmented scaly lesion on sun exposed person w/ fair skin; may become malignant in form of squamous cell carcinoma

Question 50

Nevi

Answer 50

melanocytes form; pigmented or fleshy pink; single or groups => transition to malignant melanoma

Question 51

Basal cell carcinoma

Answer 51

common skin cancer and occurs on sun-exposed areas with different subtypes and morphologic presentations

Question 52

Squamous cell carcinoma

Answer 52

tumor of epidermis with uncontrolled growth of kerantinocytes associated w/ sun exposure and localized or invasive

Question 53

cutnaeous melanoma

Answer 53

maligant tumor arising from melanocytes; if not excised early, metastasis occurs through lymph nodes d/t chronic sun exposure or melanocytic nevi

Question 54

KS

Answer 54

endothelial cell vascular malignancy r/t immunodeficiency states and herpesvirus 8

Question 55

cutaneous lymphomas

Answer 55

cutaneous T-cell and B-cell lymphomas that present in the skin but may develop disease in extracutaenous sites

Question 56

frostbite

Answer 56

cheeks + digits, direct injury to cell and impaired circulation

Question 57

Androcentric alopecia

Answer 57

irreversible baldness in central scalp and recession of temporofrontal hairline that occus in both men and women

Question 58

Female pattern alopecia

Answer 58

thinning of central hair of scalp for women 20-30 and d/t high levels of serum adrenal androgen dehydropiandrosterone sulfate

Question 59

Alopecia areata

Answer 59

patchy loss of hair d/t autoimmune process and stress triggers or metabolic diseases; reversible

Question 60

Hirsutism

Answer 60

male pattern of hair growth in women; normal or d/t androgenic hormone secretions

Question 61

Paronychia

Answer 61

inflammation of cuticle d/t staphylococci or streptococci

Question 62

Onychomycosis

Answer 62

fungal infection of nail plate