Patho Exam 2

__________ is one of the greatest factors in age-related skin changes

- exposure to sunlight

Treatment for fungal infections

- nysatin mouth rinse and clotrimazole troches (throat lozenges) - Fluconazole

Treatment for Impetigo

- topical application of 2% mupirocin ointment or 1% retapamulin ointment - oral antibiotics for large area of infection or if febrile

Often, ______ infections are manifested as erythematous macules or plaques with peripheral scaling and some central clearing

Fungal Infections

Acute, painful inflammation with vesicles along the distribution of a spinal nerve (dermatome) is characteristic of a. herpes zoster. b. herpes simplex. c. human papillomavirus. d. tinea.

A. herpes zoster

After the initial infection of the herpes simplex virus, the herpesvirus persists in the latent form in the _________ and other ganglia

- Trigeminal nerve

Eruptions of shingles generally follow a _______ dermatomal distribution and most often occur on the thorax, trunk, and face

- Unilateral

- common benign papillomas caused by DNA-containing papillomaviruses - An exaggeration of normal skin composition, with the stratum corneum being irregularly thickened - They may resolve spontaneously if immunity to the virus develops - Treatment includes: surgical removal by laser, liquid nitrogen, cryotherapy or salicylic acid paint/plasters, topical blistering agents, immunomodulators, intralesional injections

- Verrucae (Warts) (these are tough to cure, can multiply, and occur spontaneously)

- a small blister (up to 5mm in diameter) - fluid collection may be subcorneal, intraepidermal, or subepidermal - Example: Herpes Simplex (early stages)

- Vesicle

Verrucae, herpes simplex, and herpes zoster are examples of _______ infections

- Viral

- An elevation in the skin, with a smooth surface, sloping borders, and (usually) light pink color - caused by acute areas of edema in the skin - may appear, disappear, or change form abruptly within minutes or hours - size ranges from 3mm to 20cm - Example: mosquito bite

- Wheal

Sebaceous glands are particularly active during puberty causing a predisposition to _______ and less active with age, causing a predisposition to ______

- acne - dry skin

- With aging, nails become __________. - Most nail changes are due to a diminished _______ supply to the nail bed

- dull, brittle, hard, and thick - vascular supply

With aging, collagen fibers become cross-linked and rearranged into thicker bundles, a condition known as ______ - Elastosis due to sunlight, given a tanned look = ______________

- elastosis - solar elastosis

Corticosteroids are commonly administered for the management of skin disorders because they a. are analgesics. b. prevent infection. c. enhance collagen production. d. reduce inflammation.

D. reduce inflammation

Which finding is characteristic of oral candidiasis? a. Silvery plaques on the skin b. Itching, oozing rash c. thickened, discolored nails d. whitish coating on the tongue

D. whitish coating on the tongue

The difference between chickenpox and measles is that chickenpox a. is caused by a virus, whereas measles is caused by a bacterium. b. causes a widespread rash, whereas measles causes a macular rash. c. is a childhood infection, but measles can evolve into shingles in adults. d. causes vesicles that scab, whereas measles remains a macular rash.

d. causes vesicles that scab, whereas measles remains a macular rash.

- Secondary Lesion - loss of outer skin layers from scratching or rubbing - Example: scratched insect bite

excoriation

Impetigo is what type of infection?

- Bacterial

What is the most common, benign form of skin cancer? a. Basal b. Squamous c. Melanoma d. Actinic keratosis

A. Basal

- It is suggested that the trait is inherited via a maternal gene located on chromosome 11

Atopic Dermatitis

Atopic dermatitis (eczema) is caused by: A. parasitic infestation of the skin B. superficial staphylococcal infection C. superficial fungal infection D. contact with skin allergens.

D. Contact with skin allergens

- Occurs above the waist - may result when external infection is spread to other parts of the body through occupational hazards that exist in professions such as dentistry and medicine and some athletics

Herpes Simplex Virus Type 1

- a spot, circumscribed, up to 1cm - not palpable - not elevated above or depressed below surrounding skin surface - hypopigmented, hyperpigmented, or erythematous - example = freckles

Macule

- Treatment of __________ is designed to cause increased peeling of the stratum corneum and loosening of the follicular plugs

acne vulgaris

- Any mass lesion - generally larger than a nodule (larger than 2cm) - may be either malignant or benign - Example = lipoma

Tumor

- secondary lesion - loss of skin through the epidermis - healing results in scar formation

Ulcer

Which type of dermatitis is associated with cradle cap in newborns? a. Irritant b. Seborrheic c. Atopic d. Stasis

B. Seborrheic

A 4-year-old is brought to the clinic for evaluation of dry, scaly, itchy patches on the face, antecubital areas, and behind the ears and knees. The skin is dry overall, and there is evidence of scratching. This is likely a case of a. impetigo. b. atopic dermatitis. c. psoriasis. d. scabies

B. atopic dermatitis

The presence of a widely distributed pruritic maculopapular rash and erythema is commonly associated with a. psoriasis. b. drug reaction. c. scleroderma. d. bedbug bites

B. drug reaction

A topical therapy that would tend to dry the skin because it is an astringent is a. lotion. b. gel. c. cream. d. ointments

B. gel

It is true that vitiligo a. occurs as a result of a genetic lack of melanin production. b. is a depigmented patch of skin. c. occurs most commonly in light-skinned individuals. d. is a warning sign for malignant melanoma

B. is a depigmented patch of skin

Scleroderma is characterized by a. large, weeping, open sores. b. thickening and decreased elasticity of the skin. c. butterfly rash on the face. d. hair loss and ulcer formation on the extremities.

B. thickening and decreased elasticity of the skin

Which finding indicates a need for further evaluation of a nevus mole? a. The presence of light pigmentation b. Variations in color within the nevus c. Very dark coloration of the mole d. Diameter less than 2 mm

B. variations in color within the nevus

_________ is the most common malignancy in the United States

- Skin Cancer

Male pattern baldness is an inherited trait that is mediated by _________

- Testosterone

- Disease of the pilosebaceous unit affecting 90% of individuals - Arises when sludging of sebaceous oils and deposition of loose epithelial cells cause an obstruction of the follicular canal - continued oil production and bacterial growth in this obstructed follicle may cause rupture of the wall or sebaceous gland and result in an inflamed lesion

- Acne Vulgaris

- Secondary lesion - diminution of epidermal surface - skin appears thinner and more translucent than normal - if occurs in the dermal layers, it may result in wasting or depression of the skin surface - Example: Arterial Insufficiency

- Atrophy

Common source of superficial skin infections

- Candida albicans

Seborrheic dermatitis is manifested as ______ in infants and ______ in adolescence and adults

- Cradle cap - Dandruff

- secondary lesion - a collection of serous exudate and debris on the surface of damaged or absent outer skin layers - Example: Impetigo

- Crust

Although seborrheic dermatitis is not _______ it may be controlled with topical medications. - The regular use of tar, zinc, selenium sulfide, or salicylic acid shampoos often clears the symptoms and signs in the scalp - mild topical corticosteroids clear lesions on the ace and ears

- Curable

- Usually seen as a white or yellow opaque discoloration that often progresses to a thickened, crumbed, or deformed nail

- Dermatohyte infection of the nail / Onychomycosis

- secondary lesion - loss of epidermis that does not extend into the dermis - example: ruptured chickenpox vesicle

- Erosion

- Secondary lesion - a split in all epidermal layers of the skin - Example: Athlete's foot

- Fissure

- Lesions usually begin with a burning or tingling sensation followed by vesicles and erythema that progress to pustules, ulcers, and crusts before healing - the lesion is most common on the lips, face, and mouth - Recurrent lesions are common and may be precipitated by stress, sunlight exposure, menses, or injury

- Herpes Simplex Virus

- an acute, localized inflammatory disease of a dermatomal segment of the skin - it is caused by the same virus that causes chickenpox (varicella zoster virus) - it results from the reactivation of the latent virus

- Herpes Zoster (Shingles)

Responsible for most infections in the genital area

- Herpex Simplex Virus Type 2

The ______________ is the subgroup that causes human warts

- Human papillomavirus

- an acute, contagious skin disease characterized by the formation of vesicles, pustules, and yellowish crusts - usually caused by staphylococci or streptococci

- Impetigo

Seborrheic dermatitis is what type of condition?

- Inflammatory condition

- Often occur in those with hypersensitivity reactions to substances in the environment - Agents ranging from viruses to insects can infect the skin

- Inflammatory/Infectious

- Secondary lesion - augmentation of scar tissue, creating a significant elevation on the skin surface after healing

- Keloid

- Secondary lesion - Epidermal thickening and roughening of the skin with increased visibility of skin surface furrows - Example: Chronic Atopic Dermatitis

- Lichenification

The cancer considered to be the most malignant is:

- Melanoma

Three genera of fungi commonly infect human skin:

- Microsporum - Trichophyton - Epidermophyton

The specific cause of psoriasis is unknown, but it appears to be a ________ condition in which minor aberrations of the immune system promote inflammation and hyperproliferation within the skin

- Multifactorial inherited condition

The bacterium of impetigo is carried in the ______ and may pass onto the skin and produce the disaese

- Nasal Canal

- A lesion similar to a papule - diameter of 5mm to 2cm - may have a significant palpable dermal component - examples - fibroma, xanthoma, intradermal nevi

- Nodule

- a bump that is palpable and circumscribed - elevated and less than 5mm in diameter - may be pigmented, erythematous, or flesh-toned - Examples: elevated nevus (mole)

- Papule

A macule that is greater than 1cm - ex: cafe au lait spots, mongolian spots

- Patch

- usually well circumscrcibed with a large surface area and slight elevation - examples: psoriasis, lichen planus

- Plaque

The most important complication in shingles in people older than 50 years is __________ that is characterized by recurring pain that lasts long after the rash and blisters of shingles disappear - eye involvement can results in permanent _____

- Postherpetic neuralgia - blindness

- an elevated, well-circumscribed lesion containing purulent exudate - Example: Acne Vulgaris

- Pustule

- Secondary Lesion - A compact portion of desquamating stratum corneum - may vary in size, thickness and consistency - Examples: Psoriasis scale (compact and thick), pityriasis rosea scale (thin and small)

- Scale

- Secondary Lesion - A collection of fibrous tissue that forms to replace lost epidermal and dermal tissue

- Scar

Appearance of lesions modified by normal progress over time or by such external agents as scratching

- Secondary lesions

- Treatment: antiviral drugs, preferably within 48 hours, vaccine, Burrow compresses o during an attack, the reactivated virus travels from ganglia to skin of corresponding dermatome

- Shingles

The clinical manifestations of ________ include the eruption of vesicles with erythematous bases that are restricted to the skin areas supplied by sensory neurons of a single or associated group of dorsal root ganglia

- Shingles

Degenerative changes of the epidermis (top layer) with aging:

- epidermis thins - there may be some thickening in sun-exposed areas - the average number of cell layers remain unchanged (With aging, cells of the epidermis reproduce more slowly and more irregular; however, exposed epidermal cells may divide more frequently than unexposed cells)

Toenails in the aging adult may have _______ and resultant thickening which is primarily caused by ________, a dermatophyte infection of the nails

- hyperkeratosis - onychomycosis

Psoriasis lesions are common on the

- knees, elbows, lower back, scalp, nails

With aging, the dermis becomes ________ because of decreased amounts of elastin and increase in the collagen-to-elastin ratio

- less elastic

Examples of primary lesions

- macules - papules - nodule - tumor - plaque - wheal - vesicle - billa - pustule

Treatment for Herpes Simplex Virus:

- no cure for herpes simplex virus is known - most treatment measures are palliative - analgesics for pain - Acyclovir, famiciclovir, valacyclovir is recommended to shorten the duration of outbreaks

Original appearance of lesions; unmodified by time and external processes

- primary lesions

- a common chronic skin disease characterized by papules and plaques with an overlying silvery scale

- psoriasis

- Tinea capitis = - Tinea barbae = - Tinea faciei = - Tinea corporis = - Tinea manus = - Tinea cruris = - Tinea pedis =

- scalp - beard - face - trunk - hands - groin - foot

Sebaceous glands show little atrophy or histologic change with age but exhibit functional decline with a decrease in ________ secretion and a decrease in the _______ of sebaceous glands. This decrease results in drier, coarser skin

- sebum - decrease in the number of sebaceous glands

Etiologically, acne involve multiple factors such as

- sex hormones, heredity, bacterial flora of the skin, stress, mechanical occlusion and cosmetic use

Sweat glands with aging generally decrease in ________, _________, and ______

- size, number, and function

Candida albicans (yeast infection) is manifested as _______ in infants, _______ in bedridden patients, and in immunocompromised individuals as the as the systemic disorder ________

- thrush - intertrigo - mucocutaneous candidiasis

With Herpes Simplex Virus, pain is common and healing takes place in ______ to _____ days

10-14 days

A major difference between a vesicle and a wheal is that vesicles a. contain fluid, but wheals are edematous tissue. b. are palpable, but a wheal is not. c. are larger than wheals. d. are smaller than wheals.

A. contain fluid, but wheals are edematous tissue - both vesicles and wheals are palpable

A post-infective painful neuralgia can occur as a complication of a. shingles. b. herpes simplex. c. impetigo. d. verrucae

A. shingles

Psoriasis is characterized by a. silvery scale on the skin. b. itching, oozing rash. c. thickened, discolored nails. d. whitish coating on the tongue.

A. silvery scale on the skin

- A blister larger than 5mm - fluid may be located at various levels - Examples: pemphigus, pemphigoid

Bulla

This is a precancerous skin condition

Actinic Keratosis

What is the most deadly form of skin cancer? a. Basal b. Squamous c. Melanoma d. Actinic keratosis

C. Melanoma

At puberty when sebaceous gland secretion increases, follicle obstruction and infection may occur, resulting in a. psoriasis. b. eczema. c. acne vulgaris. d. pemphigus.

C. acne vulgaris

Impetigo is a skin infection caused by a. fungus. b. yeast. c. bacteria. d. parasite.

C. bacteria

Shingles is caused by the same virus that causes a. measles. b. mumps. c. chickenpox. d. rubella

C. chickenpox

Deep pressure ulcers usually a. appear first as reddened areas that do not blanch. b. begin in the dermal and epidermal skin layers. c. result from thrombosis of deep vessels. d. are an unavoidable consequence of immobility

C. result from thrombosis of deep vessels

Itchy linear burrows on the hands and wrists are associated with a. tick bites. b. Rocky Mountain spotted fever. c. scabies. d. contact dermatitis

C. scabies

Manifestations of herpes zoster include a. multiple fluid-filled vesicles on the lips, tongue, and hands. b. generalized, painful maculopapular rash. c. red, itchy palms and soles of feet. d. a dermatomal distribution of lesions and pain.

D. a dermatomal distribution of lesions and pain

- A papulosquamous skin disease manifested by various degrees of scaling and erythema in areas of high oil gland concentration

Seborrheic Dermatitis

may actually be the presenting sign in an individual with a previously undiagnosed immunodeficiency disorder

Mucocutaneous candidiasis

In the aging adult, the _________ cells of the inner layer of the epidermis show greater variation in nuclear and cytoplasmic size, with a less orderly arrangement of cells

Prickle Cells

- skin disorder that includes psoriasis, seborrheic keratosis, cysts, warts, and pillomas - other benign tumors arise from other cells in the skin: nevi, lipomas, dermatofibromas, neuromas, and hemangiomas - Kaposi sarcoma is a malignant, opportunistic neoplasm that occurs in persons with preexisting immunodeficiency

Proliferative/Neoplastic

The organisms Microsporum, Trichophyton, and Epidermophyton can caused an infection termed __________ in any cutaneous area

Tinea