Skin

A patient in the clinic is diagnosed with dermatitis. The patient states that a previous healthcare professional diagnosed eczema. What response by the healthcare professional is best?

"Both are general terms for a specific inflammatory response in the skin."

A child has been diagnosed with ringworm and the parent asks how to get rid of this parasite. What response by the healthcare professional is most appropriate?

"Ringworm is actually a fungal infection of the skin."

A woman has developed hirsutism. What conditions should the healthcare professional assess her for

Adrenal hyperplasia Polycystic ovaries Adrenal tumor

A patient with scleroderma asks the healthcare professional how this condition was acquired. What response is best?

Autoantibodies

Lesions that usually have depressed centers with rolled borders and are frequently located on the face and neck characterize which malignancy?

Basal cell carcinoma

basal cell carcinoma

Basal cell carcinoma arises as a consequence of ultraviolet-associated mutation in only the TP53 tumor-suppressor gene leading to the loss of keratinocyte repair functions and apoptosis resistance of DNA-damaged cells. The Ras gene is involved in melanoma. The myc gene codes for a transcription factor and is involved in several cancers. The src gene is a proto-oncogene

What effects does normal aging have on the wound healing process?

Decreased cell proliferation Decreased blood supply Depressed immune responses

What changes do normal aging cause?

Decreased cell proliferation, decreased blood supply, and depressed immune responses delay wound healing in aging skin. Decreased nutrition can affect the healing process, but that is not a normal age-related change. Decreased cognitive function is not related to wound healing.

Which gland releases secretions that are important in thermoregulation and cooling of the body through evaporation?

Eccrine

Which cell is thought to be the progenitor cell of Kaposi sarcoma?

Endothelial

Which leukocytes are elevated in atopic dermatitis?

Eosinophils

What clinical manifestations do allergic contact and stasis dermatitis have in common?

Erythema and pruritus

Which cells of the dermis secrete connective tissue matrix?

Fibroblasts

A patient has an onychomycosis. Where would the healthcare professional assess this disorder?

Fingernail

Which type of dressings should the healthcare professional apply to pressure ulcers?

Flat, moisture-retaining

what is the cause of diaper rash?

Frequently the infant with diaper dermatitis has a secondary infection with C. albicans

A patient has a furuncle. Where would the healthcare professional assess the patient for this condition?

Hair follicles

What are adrenergic receptors?

Heat loss can be regulated by varying blood flow through the skin by opening and closing the arteriovenous anastomoses in conjunction with evaporative heat loss of sweat. The sympathetic nervous system regulates vasoconstriction and vasodilation through -adrenergic receptors only.

Viral infections of the skin

Herpes virus, which includes Herpes Simplex (cold sores), Herpes Zoster (shingles) and Herpes Varicella (chicken pox

The healthcare professional educates a community group that chickenpox (varicella) may be followed years later by which disorder?

Herpes zoster

Which inflammatory mediators are active in frostbite

Histamine. Prostaglandins Bradykinin Thromboxanes

why ibuprofen?

Ibuprofen is used to inhibit prostaglandins. Although ibuprofen may be administered for the other reasons stated, those applications are not related to the treatment of frostbite.

Which immunoglobulin (Ig) is elevated in atopic dermatitis?

IgE

In latex allergies, which immunoglobulin (Ig) is associated with an immediate reaction?

IgE Latex allergy can be either a type IV hypersensitivity to chemicals used in latex rubber processing or a type I immediate hypersensitivity, with IgE antibodies formed in response to latex rubber protein.

A patient is brought to the Emergency Department with cold, white, waxy fingers and toes. The patient denies pain. Which intervention does the healthcare professional provide as the priority?

Immersing in warm water

Cutaneous vasculitis develops from the deposit of which substance?

Immune complexes

A parent of a child in a crowded daycare is worried about the staff passing on a bacterial infection to the child. Which infection would be most likely?

Impetigo

what is impetigo?

Impetigo is a common bacterial skin infection in infants and children and is particularly infectious among people living in crowded conditions with poor sanitary facilities or in settings such as daycare facilities. The other options are not as infectious as impetigo

what do langerhans cells do in allergic reaction?

In allergic contact dermatitis, Langerhans cells process the antigen and carry it to T cells that then become sensitized to the antigen-releasing cytokines and chemokines, leading to leukocyte infiltration and inflammation. Merkel cells are associated with touch receptors and function as slowly adapting mechanoreceptors when stimulated by deformation of the epidermis. Keratinocytes produce keratin, a scleroprotein that provides protection from mechanical stress. Keratin is the main constituent of skin, hair, and nail cells.

Atopic Dermatitis (Eczema)

In the acute phase of atopic dermatitis, inflammation is associated with the activation of T helper 1 (Th-1) cells with an overexpression of cytokines (interleukin [IL]-4, IL-5, and IL-13) and chemokine ligand 1 (CCL1) and 18 (CCL18) with increases in IgE, eosinophils, and macrophages. IgA, IgM, and IgG are not involved in atopic dermatitis.

In the acute phase of atopic dermatitis

In the acute phase of atopic dermatitis, inflammation is associated with the activation of T helper 1 (Th-1) cells with an overexpression of cytokines (interleukin [IL]-4, IL-5, and IL13) and chemokine ligand 1 (CCL1) and 18 (CCL 18) with increases in IgE, eosinophils, and macrophages. Neutrophil refers to white blood cells and eosinophils are one component. Basophils and monocytes are not elevated in atopic dermatitis.

A patient was hospitalized with frostbite and is receiving ibuprofen. The patient asks the healthcare professional to explain the rationale for the drug. What is the best response?

Inhibiting prostaglandins

A child has atopic dermatitis. What assessment finding does the healthcare professional associate with this condition?

Itching

hallmark sign of atopic dermatitis

Itching is considered a hallmark of atopic dermatitis, and rubbing and scratching to relieve the itch are responsible for many of the clinical changes of atopic dermatitis. Atopic dermatitis is not characterized by high fever, vesicles, or papular rash.

What information does the student learn about Kaposi sarcoma?

Kaposi sarcoma is a vascular malignancy. It is associated with drug-induced immunosuppression. d Kaposi sarcoma is associated with acquired immunodeficiency syndrome (AIDS). The classic form of Kaposi sarcoma is observed on the lower legs of older men.

What term is used to identify skin lesions that are elevated, rounded, and firm with irregular clawlike margins that extend beyond the original site of injury?

Keloid

What are keloids?

Keloids typically send out clawlike projections from the margins.

Parents do not want the child to contract tinea corporis. Which animal would they limit the child's exposure to?

Kittens

In allergic contact dermatitis, which cells possess the antigens and present them to T cells?

Langerhans cells

Which component of the epidermis initiates immune responses and provides a defense against environmental antigens?

Langerhans cells

A parent reports a child has skin lesions that rupture, creating a thin, flat, honey-colored crust. What treatment does the healthcare professional educate the parent about?

Topical mupirocin

Triggers for psorasis

Triggers for psoriasis include physical injury, infection, and some medications such as betablockers and lithium

The student learns that which skin lesion is mediated by the immunoglobulin E (IgE)-stimulated release of histamine, bradykinin, or kallikrein from mast cells?

Urticaria

The student learns that the cause of molluscum contagiosum is which of these?

Virus

hirsutism

Women who develop hirsutism may be secreting hormones associated with ovarian or adrenal disease. Such women should be evaluated for polycystic ovaries, adrenal hyperplasia, or adrenal tumors. Neither Cushing nor Addison diseases are associated with hirsutism.

Which receptors of the sympathetic nervous system regulate heat loss through the skin?

a-Adrenergic

types of ezcema

allergic dermatitis, atopic dermatitis, stasis dermatitis, irritant dermatitis, or seborrheic dermatitis.

Skin Cancer

asal cell, squamous cell, or melanoma

Psoriasis

chronic, T-cell mediated, autoimmune disorder and can affect the skin and nails.

Alopecia

esponse to androgens (in both men and women) or as a sign of disease. Alopecia areata is an inflammatory response of the hair follicles that is often triggered by a stress response.

two primary forms of squamous cell carcinoma

in situ -not likely to spread invasive- mets

Fungal infections

inea pedic (athlete's foot), tinea corporis (ringworm), tinea capitis (scalp), tinea cruris (jock itch), onychomycosis (nails), and candidiasis

Scleroderma

utoimmune disorder that results in fibrosis of the skin, most commonly on the face and neck.

furuncle

A furuncle, or "boil," is used to identify an inflammation of the hair follicles (root) that may develop from a preceding folliculitis and spread through the follicular wall into the surrounding dermis.

Which information does the student learn about a nevus

A nevus is an aggregation of melanocytes. Nevi begin to form at the ages of 3 to 5 years. Nevi share a relationship with melanoma.

nevus

A nevus, or mole, is a benign pigmented or nonpigmented lesion that forms from melanocytes beginning at ages 3 to 5 years. Over time the cells move down into the dermis and the nevi become nodular and symmetrical without irregular borders. Nevi may undergo transition to malignant melanomas. Nevi repeatedly traumatized, irritated by clothing, or large lesions can be excised

basal cell carcinoma

Basal cell carcinoma lesions have depressed centers with rolled borders. Lesions are most often observed on people who live in regions with intense sunlight and on those areas of the skin most exposed—namely, the face and neck. Squamous cell lesions are firm with a granular surface that bleeds easily. Kaposi sarcoma lesions are purplish brown macules and develop into plaques and nodules and are seen most often in people with AIDS. The ABCDE rule is used as a guide for assessing malignant melanoma: Asymmetry, Border irregularity, Color variation, Diameter larger than 6 mm, and Elevation which includes raised appearance or rapid enlargement.

A patient has psoriasis. Which drug classifications does the healthcare professional advise the patient to avoid if possible

Beta-blockers Lithium

what is bullous impetigo?

Bullous impetigo is a rare variant of impetigo caused by S. aureus. The staphylococci produce a bacterial toxin called exfoliative toxin (ET), which causes a disruption in desmosomal adhesion molecules with blister formation characteristic of bullous impetigo. The other organisms are not involved in this disorder.

what is C. albicans?

C. albicans infection is a superficial fungal infection that commonly occurs in children. C. albicans is part of the normal skin flora in certain individuals and invades susceptible tissue sites if the predisposing factors are not eliminated.

A baby has diaper dermatitis. What secondary infection does the healthcare professional assess for?

Candida albicans

The healthcare professional teaches a parent group that which organism causes thrush

Candida albicans

A patient shows the healthcare professional a collection of infected hair follicles on the back of the neck is red, painful, and draining. What condition does the professional educate the patient on?

Carbuncles

A child has been diagnosed with tinea corporis. Which lesion would the healthcare professional assess for in this condition?

Circular (round or oval) lesions with erythema and scaling patche

Keloids are caused by excessive amounts of which substance in the corneum during connective tissue repair?

Collagen Abnormal wound healing with excessive fibroblast activity and collagen formation during dermal connective tissue repair cause keloids. The other substances are not associated with keloid formation.

what is a common source of tinea corporis?

Contact with kittens and puppies is considered a common source of tinea corporis.

Cutaneous vasculitis

Cutaneous vasculitis involves the deposit of immune complexes, initiating an uncontrolled inflammatory response and causing the lesions that are often polymorphic.

what are the lesions tinea corporis?

Lesions caused by tinea corporis are often erythematous, round, or oval-scaling patches that peripherally spread with clearing in the center, creating the ring appearance, which is why this disease is commonly referred to as ringworm. A pink-to-red rash is characteristic of rubella. The honey-colored crusts cover the lesions of bullous impetigo. Clusters of papules, vesicles, and pustules characterize varicella.

The healthcare professional is assessing four patients for pressure ulcer formation. What is the first change in the skin that the professional would note if a patient were developing a pressure ulcer?

Nonblanchable erythema of intact skin

where will you find blanchable erythema?

Nonblanchable erythema of intact skin, usually over bony prominences, characterizes stage 1 pressure ulcers. A blister would indicate a deep tissue pressure injury as would a reddish-purple discoloration. Blanchable erythema of intact skin would not indicate any pressure damage.

A child has white plaque in the mouth with a few shallow ulcers. What treatment does the healthcare professional educate the parent about

Nystatin oral suspension

What are fibroblasts?

Only fibroblasts secrete the connective tissue matrix and collagen. Macrophages are phagocytic cells. Mast cells release histamine and play a role in hypersensitivity reactions in the skin. Histiocytes are a type of macrophage found in loose connective tissue.

Interdermal nevus

Only intradermal nevus is characterized by a small (less than 1 cm) lesion with regular edges and bristlelike hairs with a color change that can range from skin tones to light brown. A junctional nevus is flat, dark, and up to 2 cm in size. A compound nevus is elevated and smooth. Heaped up keratinized cells describe a scale.

What are Langerhans cells?

Only mast cells release histamine and play a role in hypersensitivity reactions in the skin. Histiocytes are macrophages that reside in loose connective tissue and phagocytize pigments and the debris of inflammation. Fibroblast cells secrete collagen and connective tissue matrix. Macrophages are phagocytic.

Endothelial cell

Only the endothelial cell is thought to be the progenitor of Kaposi sarcoma, but the specific origin is elusive.

What is urticaria?

Only urticaria is mediated by the IgE-stimulated release of histamine, bradykinin, or kallikrein from mast cells or basophils, or both, which causes the endothelial cells of skin blood vessels to contract. Dermatitis is a general term for a particular type of skin inflammation. Scleroderma can be local or systemic and involves connective tissue. Cutaneous vasculitis involves the deposit of immune complexes

onychomycosis

Onychomycosis is the term used to identify a fungal or dermatophyte infection of the nail plate. The professional would assess the patient's fingernails (or toenails).

A healthcare professional assesses a patient who presents with a single lesion on the trunk that is circular, demarcated, and salmon pink. The lesion measures approximately 3 to 4 cm in diameter. What treatment option does the professional educate the patient about?

Oral erythromycin regime

Lesions on the elbows and knees that are well demarcated, thick, silvery, scaly, and erythematous characterize which type of psoriasis?

Plaque

A patient has an intradermal nevus. What assessment does the healthcare professional know is consistent with this lesion?

Regular edges with bristle-like hairs

What is scleroderma?

Scleroderma means sclerosis of the skin and is associated with immune dysregulation and several autoantibodies.

A healthcare professional assesses a patient who has elevated lesions on the face that are waxy and yellowish. What condition does the professional discuss with the patient?

Seborrheic keratosis

What is ceborrheic kertosis?

Seborrheic keratosis is a benign proliferation of cutaneous basal cells that produces smooth or warty elevated lesions. The pathogenetic origin is unknown. Seborrheic keratosis usually occurs in older people as multiple lesions on the chest, back, and face. The color varies from tan to waxy, yellow, flesh-colored, or dark brown to black. Keratoacanthoma usually arise from hair follicles. Actinic keratosis is a common premalignant condition with lesions that are rough, poorly defined, and pink or reddish

what is ring worm?

Tinea corporis (ringworm) is a fungal infection of the skin and is not actually an infestation of worms. The healthcare professional should educate the parent to this fact.

Bowen disease is a form of which type of cancer?

Squamous cell carcinoma

Squamous cell carcinoma

Squamous cell carcinoma (SCC) is a tumor of the epidermis and the second most common human cancer. Two types are characterized: (1) in situ (Bowen disease) and (2) invasive. Bowen disease is not a form of any of the other cancers.

The disruption in cellular adhesion observed in bullous impetigo is caused by an exfoliative toxin related to which organism?

Staphylococcus aureus

What are flat dressing best for?

Superficial pressure ulcers should be covered with flat, nonbulky dressings that cannot wrinkle or cause increased pressure or friction. The dressing should be moisture-retaining such as Hydrogel.

The student learns that alteration of which gene is associated with basal cell carcinoma?

TP53

What are the characteristics of plaque psoriasis?

The description provided is characteristic of only lesions observed in plaque psoriasis. These lesions are well-demarcated, thick, silvery, scaly, erythematous plaque surrounded by normal skin. Inverse psoriasis is rare and is seen in skinfolds. Guttate psoriasis small papules appear after a streptococcal infection. Erythrodermic psoriasis covers a large portion of the body with red, scaling lesions.

What are eccrine glands?

The eccrine sweat glands are distributed over the body, with the greatest numbers in the palms of the hands, soles of the feet, and forehead. These secretions are important in thermoregulation and cooling of the body through evaporation. Sebaceous glands secrete sebum which is a lipid substance that protects from drying. Apocrine glands are found in the axillae, scalp, face, abdomen, and genital area and have very limited proven function. Exocrine glands secrete substances onto the epithelial surface; an example is a sweat gland.

Mediators of frostbite?

The inflammatory mediators of frostbite are similar to burns and include prostaglandins, thromboxanes, bradykinin, and histamine. Leukotrienes are not associated with frostbite

what is the most common inflammatory skin disorder?

The most common inflammatory disorder of the skin is eczema, or dermatitis. Eczema and dermatitis are general terms that describe a particular type of inflammatory response in the skin—these terms can be used interchangeably. Yellowish scaly plaques are seen in seborrheic dermatitis. Self-limiting blisters can be seen in bullous pemphigoid.

what is poxvirus?

The poxvirus is the only organism that induces epidermal cell proliferation and blocks immune responses that would control the virus as noted with molluscum contagiosum

What is herpes zoster?

The same herpesvirus—varicella-zoster virus (VZV)—causes both herpes zoster (shingles) and varicella (chickenpox). Varicella is the primary infection, followed years later by herpes zoster, particularly among those who are immunosuppressed. Varicella-zoster virus does not produce erysipelas, cytomegalovirus, or warts.

What is a carbuncle?

The term carbuncle is used to identify a collection of infected hair follicles occurring most often on the back of the neck, the upper back, and the lateral thighs. The lesion begins in the subcutaneous tissue and lower dermis as a firm mass that evolves into an erythematous, painful, and swollen mass and drains through many openings. Erysipelas is a bacterial infection with firm red spots that coalesce together. A furuncle, or boil, is a deep, firm, red, painful nodule that changes into a fluctuant cyst

how to treat bullous impetigo?

This child has bullous impetigo, which is treated with topical mupirocin. Supportive care is used in rubella, which has a faint-pink to red, coalescing maculopapular rash develops on the face, with spread to the trunk and extremities, Oral griseofulvin would be appropriate for tinea capitis, which is found on the scalp. Corticosteroids would be useful for itchy rashes such as atopic dermatitis

treatment for thrush?

This infant has thrush, caused by Candida albicans. The treatment is an antifungal mouth rinse such as nystatin. Warm saline rinses and antiviral medications will not treat this fungal infection.

what is a herald patch?

This patient has a herald patch, seen in pityriasis rosea. Treatments include medication for itching and erythromycin and acyclovir. UV light therapy is a treatment for lichen planus. Keratolytic agents are used in psoriasis. Photoprotection is vital in acne rosacea.

Frostbite

This patient has signs of frostbite. Immersion in a warm-water bath (40C to 42C [104F to 107.6F]) until frozen tissue is thawed is the best treatment for frostbite. Rubbing or massaging the area would damage the traumatized cells. Dry heat is not used. Leaving the area uncovered would occur in order to immerse it.