Chapter 47 - Structure, Function, and Disorders of the Integument

Cutaneous vasculitis develops from the deposit of _________________. a. Immune complexes b. Immunoglobulin E (IgE) c. Complement proteins d. T lymphocytes

ANS: A Cutaneous vasculitis involves the deposit of immune complexes, initiating an uncontrolled inflammatory response and causing the lesions that are often polymorphic. REF: Page 1638

In allergic contact dermatitis, which cells possess the antigens and present them to T cells? a. Langerhans cells b. Merkel cells c. Keratinocytes d. Macrophages

ANS: A In allergic contact dermatitis, only 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. REF: Pages 1627-1628

Which component of the epidermis initiates immune responses and provides a defense against environmental antigens? a. Langerhans cells b. Merkel cells c. Keratinocytes d. Melanocytes

ANS: A Langerhans cells (a type of dendritic cell) and dermal dendritic cells initiate an immune response by presenting processed antigen to T cells, thus providing a defense against environmental antigens. This function is not true of the other options. REF: Page 1617

Which cell is thought to be the progenitor cell of Kaposi sarcoma? a. Endothelial b. Keratinocyte c. Melanocyte d. Exothelial

ANS: A Only the endothelial cell is thought to be the progenitor of Kaposi sarcoma, but the specific origin is elusive. REF: Page 1645

Lesions on the elbows and knees that are well demarcated, thick, silvery, scaly, and erythematous characterize which type of psoriasis? a. Plaque b. Inverse c. Guttate d. Erythrodermic

ANS: A 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. REF: Page 1629

Which inflammatory mediators are active in frostbite? (Select all that apply.) a. Leukotrienes b. Histamine c. Prostaglandins d. Bradykinin e. Thromboxanes

ANS: B, C, D, E The inflammatory mediators of frostbite are similar to burns and include prostaglandins, thromboxanes, bradykinin, and histamine. Leukotrienes are not associated with frostbite. REF: Page 1646

What term is used to identify an inflamed hair root? a. Tinea b. Verruca c. Furuncle d. Erysipelas

ANS: C 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. REF: Page 1634

Which receptors of the sympathetic nervous system regulate heat loss through the skin? a. Cholinergic b. ß-Adrenergic c. D-Adrenergic d. Anticholinergic

ANS: C 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 D-adrenergic receptors only. REF: Page 1619

Which intervention is included in the treatment of frostbite? a. Applying local, dry heat b. Rubbing or massaging the area c. Immersing in warm water d. Leaving the area uncovered

ANS: C Immersion in a warm-water bath (40q to 42q C [104q to 107.6q F]) until frozen tissue is thawed is the best treatment for frostbite. Rubbing or massaging the area would damage the traumatized cells. The remaining options have no therapeutic value for frostbite. REF: Page 1646

Which cells of the dermis secrete connective tissue matrix? a. Macrophages b. Mast cells c. Fibroblasts d. Histiocytes

ANS: C Only fibroblasts secrete the connective tissue matrix and collagen. REF: Page 1618

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 characterize which form of nevus? a. Junctional b. Epidermal c. Intradermal d. Compound

ANS: C Only intradermal nevus is characterized by a small (less than 1 cm) lesion with regular edges and bristle-like hairs with a color change that can range from skin tones to light brown. REF: Page 1643 | Table 46-9

Which cells of the dermis release histamine and play a role in the hypersensitivity reactions of the skin? a. Histiocytes b. Fibroblasts c. Mast cells d. Macrophages

ANS: C Only mast cells release histamine and play a role in hypersensitivity reactions in the skin. REF: Page 1618

Which skin lesion is mediated by the immunoglobulin E (IgE)-stimulated release of histamine, bradykinin, or kallikrein from mast cells? a. Dermatitis b. Scleroderma c. Urticaria d. Cutaneous vasculitis

ANS: C 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. REF: Page 1639

Which gland releases secretions that are important in thermoregulation and cooling of the body through evaporation? a. Sebaceous b. Apocrine c. Eccrine d. Exocrine

ANS: C 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. This function is not true for the other options. REF: Page 1618

Which term 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 that forms a mass and evolves into an erythematous, painful, and edematous mass and drains through many openings? a. Erysipelas b. Furuncles c. Carbuncles d. Boils

ANS: C 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. REF: Page 1635

Which medications may exacerbate existing psoriasis? (Select all that apply.) a. Antibiotics b. Calcium channel blockers c. Nonsteroidal antiinflammatory drugs (NSAIDs) d. Beta blockers e. Lithium

ANS: C, D, E Antimalarial drugs, lithium, NSAIDs, and beta-blockers tend to exacerbate existing psoriasis. This statement is not true of the remaining options. REF: Page 1629

What is the purpose of administering ibuprofen to individuals being treated for frostbite? a. Treating fever b. Preventing plate aggregation c. Reducing pain d. Inhibiting prostaglandins

ANS: D Ibuprophen 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. REF: Page 1646

Lesions that usually have depressed centers with rolled borders and are frequently located on the face and neck characterize which malignancy? a. Squamous cell carcinoma b. Kaposi sarcoma c. Malignant melanoma d. Basal cell carcinoma

ANS: D Of the available options, only basal cell carcinoma has 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. REF: Pages 1641-1642

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? a. Psoriasis b. Dermatitis c. Acne d. Keloid

ANS: D Of the options available, only keloids typically send out claw-like prolongations. REF: Page 1626

What clinical manifestations do allergic contact and stasis dermatitis have in common? a. Petechiae and hyperpigmentation b. Edema and vesicular lesions c. Scaling and crusting of lesions d. Erythema and pruritus

ANS: D Only erythema and pruritus are exhibited with both conditions. REF: Pages 1627-1628

Scleroderma is associated with _________________. a. X-linked recessive gene b. X-linked dominant gene c. Virus d. Autoantibodies

ANS: D Scleroderma means sclerosis of the skin and is associated with immune dysregulation and several autoantibodies. This selection is the only option associated with scleroderma. REF: Page 1639

Which immunoglobulin is found in skin biopsy with immunofluorescent observation of people with discoid lupus erythematosus? a. Immunoglobulin A (IgA) b. Immunoglobulin E (IgE) c. Immunoglobulin G (IgG) d. Immunoglobulin M (IgM)

ANS: D Skin biopsy with immunofluorescent observation reveals lumpy deposits of immunoglobulins, especially IgM, in some individuals. This immunoglobulin is the only one associated with discoid lupus erythematosus. REF: Page 1632

Bowen disease is a form of which type of cancer? a. Kaposi sarcoma b. Malignant melanoma c. Basal cell carcinoma d. Squamous cell carcinoma

ANS: D 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 options. REF: Pages 1642-1643

Chickenpox (varicella) may be followed years later by which disorder? a. Erysipelas b. Cytomegalovirus c. Warts (Verrucae) d. Herpes zoster

ANS: D 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. These statements are not true of any of the other options. REF: Page 1636

Match the descriptions of the skin lesions with the disorder where it is found. ______ A. Elevated, firm circumscribed area less than 1 cm in diameter ______ B. Elevated, firm, and rough lesion with a flat top surface greater than 1 cm in diameter ______ C. Flat circumscribed area that is less than 1 cm in diameter ______ D. Elevated irregular-shaped area of cutaneous edema; solid and transient with a variable diameter ______ E. Elevated circumscribed, superficial lesion filled with serous fluid

39. ANS: D PTS: 1 REF: Page 1621 | Table 46-3 MSC: Urticaria exhibits elevated, irregular-shaped areas of cutaneous edema. Its lesions are solid and transient with a variable diameter.

Match the descriptions of the skin lesions with the disorder where it is found. ______ A. Elevated, firm circumscribed area less than 1 cm in diameter ______ B. Elevated, firm, and rough lesion with a flat top surface greater than 1 cm in diameter ______ C. Flat circumscribed area that is less than 1 cm in diameter ______ D. Elevated irregular-shaped area of cutaneous edema; solid and transient with a variable diameter ______ E. Elevated circumscribed, superficial lesion filled with serous fluid

40. ANS: E PTS: 1 REF: Page 1621 | Table 46-3 MSC: Varicella (chickenpox) and herpes zoster (shingles) are elevated circumscribed, superficial lesions filled with serous fluid and measure less than 1 cm in diameter.

Match the descriptions of the skin lesions with the disorder where it is found. ______ A. Elevated, firm circumscribed area less than 1 cm in diameter ______ B. Elevated, firm, and rough lesion with a flat top surface greater than 1 cm in diameter ______ C. Flat circumscribed area that is less than 1 cm in diameter ______ D. Elevated irregular-shaped area of cutaneous edema; solid and transient with a variable diameter ______ E. Elevated circumscribed, superficial lesion filled with serous fluid

41. ANS: A PTS: 1 REF: Page 1620 | Table 46-3 MSC: Warts (verruca) or lichen planus are elevated, firm, circumscribed areas less than 1 cm in diameter.

Match the descriptions of the skin lesions with the disorder where it is found. ______ A. Elevated, firm circumscribed area less than 1 cm in diameter ______ B. Elevated, firm, and rough lesion with a flat top surface greater than 1 cm in diameter ______ C. Flat circumscribed area that is less than 1 cm in diameter ______ D. Elevated irregular-shaped area of cutaneous edema; solid and transient with a variable diameter ______ E. Elevated circumscribed, superficial lesion filled with serous fluid

42. ANS: B PTS: 1 REF: Page 1620 | Table 46-3 MSC: Psoriasis or seborrheic and actinic keratoses are elevated, firm, and rough lesions with flat-top surfaces that measure greater than 1 cm in diameter.

Match the descriptions of the skin lesions with the disorder where it is found. ______ A. Elevated, firm circumscribed area less than 1 cm in diameter ______ B. Elevated, firm, and rough lesion with a flat top surface greater than 1 cm in diameter ______ C. Flat circumscribed area that is less than 1 cm in diameter ______ D. Elevated irregular-shaped area of cutaneous edema; solid and transient with a variable diameter ______ E. Elevated circumscribed, superficial lesion filled with serous flui

43. ANS: C PTS: 1 REF: Page 1620 | Table 46-3 MSC: A nevus is a flat, circumscribed area that is less than 1 cm in diameter

What medical term is used to identify an inflammatory disorder of the skin that is often considered synonymous with dermatitis and characterized by pruritus with lesions that have an indistinct border? a. Eczema b. Psoriasis c. Atopic dermatitis d. Pityriasis rosea

ANS: A 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. Pruritus, lesions with indistinct borders, and epidermal changes generally characterize diseases that are considered eczematous. Of the available options, only eczema is associated with these characteristics. REF: Page 1627

What effect does normal aging have on the wound healing process? (Select all that apply.) a. Decreased cell proliferation b. Decreased blood supply c. Depressed immune responses d. Depressed appetite e. Decreased cognitive function

ANS: A, B, C Decreased cell proliferation, decreased blood supply, and depressed immune responses delay wound healing in aging skin. The other options are not related to wound healing progress. REF: Page 1619

Which statements are true regarding a nevus? (Select all that apply.) a. A nevus is an aggregation of melanocytes b. Nevi begin to form at the ages of 3 to 5 years. c. Nevi are characterized by irregular borders. d. Nevi share a relationship with melanoma. e. Nevi always warrant being removed.

ANS: A, B, D A nevus, or mole, is a benign pigmented or nonpigmented lesions that form 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. REF: Page 1641

Women who develop hirsutism may be secreting hormones associated with which condition? (Select all that apply.) a. Adrenal hyperplasia b. Cushing disease c. Polycystic ovaries d. Addison disease e. Adrenal tumor

ANS: A, C, E 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. REF: Page 1647

Keloids are sharply elevated, irregularly shaped, progressively enlarging scars caused by excessive amounts of which substance in the corneum during connective tissue repair? a. Elastin b. Collagen c. Stroma d. Reticular fibers

ANS: B Abnormal wound healing with excessive fibroblast activity and collagen formation during dermal connective tissue repair cause keloids. The other options are not associated with keloid formation. REF: Pages 1626-1627

The alteration of which gene is associated with basal cell carcinoma? a. myc b. TP53 c. src d. Ras

ANS: B 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. REF: Page 1642

In latex allergies, which immunoglobulin (Ig) is associated with an immediate reaction? a. IgA b. IgE c. IgG d. IgM

ANS: B 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. This selection is the only correct option available. REF: Page 1628

What is the first change in the skin that indicates a pressure ulcer? a. Blanchable erythema of intact skin b. Nonblanchable erythema of intact skin c. Blister at the site of pressure d. Reddish-purple discoloration

ANS: B Nonblanchable erythema of intact skin, usually over bony prominences, characterizes stage 1 pressure ulcers. This selection is the only option that accurately identifies the initial skin change indicative of a pressure ulcer. REF: Page 1625

Which skin disorder begins with a single lesion that is circular, demarcated, and salmon pink, measures approximately 3 to 4 cm in diameter, and is usually located on the trunk? a. Lichen planus b. Pityriasis rosea c. Psoriasis d. Acne rosacea

ANS: B Of the options available, only pityriasis rosea begins as a single lesion known as a herald patch. This lesion is circular, demarcated, and salmon pink; it measures approximately 3 to 4 cm in diameter and is usually located on the trunk. REF: Page 1630

What is the medical term for a fungal infection of the nail plate? a. Paronychia b. Onychomycosis c. Tinea corporis d. Tinea capitis

ANS: B Onychomycosis is the only term used to identify a fungal or dermatophyte infection of the nail plate that occurs in 2% to 18% of the population. REF: Page 1647

What name is given to a benign proliferation of basal cells that produces smooth or warty elevated lesions on the chest, back, and face that are tan or waxy, yellow, flesh-colored, or dark brown to black? a. Basal keratosis b. Seborrheic keratosis c. Keratoacanthoma d. Actinic keratosis

ANS: B 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. No other option exhibits these characteristics. REF: Page 1640

Which type of dressings should be applied to pressure ulcers? a. Flat and dry b. Flat and moist c. Bulky and dry d. Bulky and moist

ANS: B Superficial pressure ulcers should be covered with flat, nonbulky dressings that cannot wrinkle or cause increased pressure or friction. Spontaneous healing will occur more quickly if the ulcer is kept moist with an occlusive dressing. REF: Page 1626

What type of skin infection is tinea corporis (ringworm)? a. Nematode b. Fungal c. Viral d. Bacterial

ANS: B Tinea corporis is a fungal infection of the skin. This selection is the only option that accurately identifies the nature of the infection. REF: Page 1637

Which statements are true regarding Kaposi sarcoma? (Select all that apply.) a. South America has been the site of the endemic form of Kaposi sarcoma. b. Kaposi sarcoma is a vascular malignancy. c. It is associated with drug-induced immunosuppression. d. Kaposi sarcoma is associated with acquired immunodeficiency syndrome (AIDS). e. Presentation of the classic form of Kaposi sarcoma is observed on the lower legs of older men.

ANS: B, C, D, E Kaposi sarcoma is a vascular malignancy with four different presentations: (1) it is associated with drug-induced immunosuppression; (2) its endemic form has been found in equatorial Africa, (3) the classic form appears on the lower legs of older men, and (4) it is associated with AIDS. REF: Page 1645