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140 Cards in this Set
- Front
- Back
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describe the epidermis
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most important layer of skin; normally very thin but can thicken and form corns or callouses with constant pressure or friction; composed of keratinocytes, langerhans cells, melanocytes and merkel cells
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describe the dermis
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irregular connective tissue layer with rich blood, lymphatic and nerve supply; contains sensory receptors and special glands; composed of macrophages, mast cells and histiocytes
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describe the subcutaneous tissue
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subcutaneous tissue or superficial fascia of varying thickness that connects the overlying dermis to underlying muscle
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what are some of the effects of aging on skin
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skin becomes thinner, drier, wrinkled, demonstrates a change in pigmentation; shortening and decrease in number of capillary loops; fewer melanocytes and langerhans cells; atrophy of sebaceous, eccrine and apocrine glands; changes in hair color; fewer hair follicles and growth of thinner hair
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causes of pressure ulcers
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pressure, shearing forces; friction, moisture
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risk factors for pressure ulcers
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immobilization, debilitation, incontinence, friction/shear, neurologic disorders, anemia, edema, renal failure, malnutrition, sepsis
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stages of pressure ulcers
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suspected deep tissue injury; stage 1 = non blanchable erythema of intact skin; stage 2 = partial thickness skin loss involving epidermis or dermis; stage 3 = full thickness skin loss involving damage or loss of subcutaneous tissue; stae 4 = full thickness skin loss with damage to muscle, bone or supporting structures; unstageable
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what is pruritis
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itching
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what is the most common symptom of primary skin disorders
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itching (pruritis)
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what is xerosis
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dry rough skin
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most common inflammatory disorder of the skin
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dermatitis/eczema
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what are inflammatory disorders of the skin generally characterized by
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pruritus, lesions with indistinct borders, and epidermal changes
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what kind of skin disorder is poison ivy
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allergic contact dermatitis
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what is allergic contact dermatitis caused by
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hypersensitivity type 4 reaction
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manifestations of allergic contact dermatitis
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erythema, swelling, pruritis, vesicular lesions
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describe the process by which allergic contact dermatitis occurs
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allergen comes in contact with the skin; binds to a carrier protein to form a sensitizing antigen; langerhans cells process the antigen and carry it to T cells which become sensitized to the antigen
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describe atopic dermatitis
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type 1 hypersensitivity (activation of mast cells, eosinophils, T lymphocytes, and other inflammatory cells); red weeping crusts; chronic inflammation; lichenification
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describe irritant contact dermatitis
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nonimmunologic inflammation of the skin; chemical irritiation from acids or prolonged exposure to irritating substances; symptoms similar to allergic contact dermatitis; treatment = remove stimulus
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describe stasis dermatitis
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occurs in the legs as a result of venous stasis, edema and vascular trauma; sequence of events = erythema, pruritus, scaling, petechiae, ulcerations; results in hyperpigmentation, brawny edema
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describe seborrheic dermatitis
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inflammation of the skin involving the scalp, eyebrows, eyelids, nasolabial folds, ear canals; scaly, white or yellowish plaques
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list inflammatory disorders of the skin
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allergic contact dermatitis, atopic dermatitis, irritant contact dermatitis, stasis dermatitis, seborrheic dermatitis
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list papulosquamous disorders of the skin
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psoriasis
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describe psoriasis
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chronic relapsing proliferative skin disorder; T cell immune mediated skin disease; scaly thick silvery elevated lesions usually on the scalp elbows or knees caused by a high rate of mitosis in the basale layer
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how does epidermal turnover change with psoriasis
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goes from 26-30 days to 3-4 days
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describe the patho of psoriasis
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chronic, noninfectious T cell mediated inflammatory condition; T cell leads to cytokine release which increases the inflammatory response leading to hyperproliferation of keratinocytes leading to thick inflamed plaques
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list vesiculobullous disorders of the skin
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pemphigus, bullous pemphigoid, erythema multiform
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describe pemphigus
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rare chronic blister forming disease of the skin and oral mucous membranes; blisters form in the deep or superficial epidermis; autoimmune disease caused by circulating IgG autoantibodies
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list the types of pemphigus
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vulgaris (severe), foliaceus, and erythematosus
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describe bullous pemphigoid
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more benign than pemphigus vulgaris; bound IgG and blistering of the subepidermal skin layer; subepidermal blistering and eosinophils distinguish pemphigoid from pemphigus; generally in people over 60
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describe erythema multiforme
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acute recurring disorder of the skin and mucous membranes; associated with allergic or toxic reactions to drugs or microorganism; caused by immune complexes formed and deposited around dermal blood vessels, basement membranes, and keratinocytes; can be a drug reaction or reaction to herpes virus
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what characterizes erythema multiforme
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bulls eye or target lesion that form erosions and crustshen they rupture; affects mouth, air passages, esophagus, urethra and conjunctiva; severe forms include stevens-johnson syndrome and toxic epidermal necrolysis
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list bacterial infections of the skin
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folliculitis, furuncles, carbuncles, cellulitis, erysipelas, impetigo
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list viral infections of the skin
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herpes zoster and varicella
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what are most bacterial infections of the skin caused by
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staph or strep
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describe warts
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benign lesions caused by hpv; diagnosed by visualization; infects basal skin cells
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what are dermatophytes
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fungi causing superficial skin lesions
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what are mycoses
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fungal disorders
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what are tinea
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mycoses caused by dermatophytes
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described candidiasis
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fungal infection caused by candida albicans; normally found on the skin, in the GI tract and in the vagina
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describe cutaneous vasculitis
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results from immune complexes in the small blood vessels; develops from drugs, bacterial infections, viral infections or allergens; lesions are palpable purpura progressing to hemorrhagic bullae with necrosis and ulceration
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list vascular disorders of the skin
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cutaneous vasculitis; urticaria; scleroderma;
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describe urticaria
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caused by type 1 hypersensitivity reactions to allergens; histamine release causes endothelial cells of the skin to contract causing leakage of fluid from the vessels; treat with antihistamines and steroids
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describe scleroderma
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sclerosis of the skin that can produce to internal organs; assoc with several antibodies; lesions exhibit massive deposits of collagen with inflammation, vascular changes and capillary dilation; skin is hard hypopigmented taut and tightly connected to underlying tissue; facial skin becomes very tight; fingers become tapered and flexed; nails and fingertips can be lost from atrophy; mouth may not open completely; 50% of patients die within 5 years
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list benign tumors of the skin
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seborrheic keratosis; keratoacanthoma; actinic keratosis; nevi (moles)
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describe keratocantoma
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skin tumor that contains a central keratin mass and usually occurs on exposed skin areas and heals spontaneously but may leave a scar
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describe actinic keratosis
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highest occurrence with lightly pigmented people; premalignant for squamous cell carcinoma
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what are moles
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pigmented or nonpigmented lesions that form from melanocytes; become nodular and palpable; appear anywhere; vary in size; can become atypical and turn into malignant melanoma
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list cancers of the skin
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basal cell carcinoma, squamous cell carcinoma, malignant melanoma, kaposi sarcoma
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describe basal cell carcinoma
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can reoccur but it doesn't metastasize; pearly waxy lesion may be assoc with teleangectasia, central ulceration
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describe squamous cell carcinoma
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metastasizes and reoccurs; rough crusty look; invasive type
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describe malignant melanoma
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really bad skin cancer; can be lethal; rises from melanocytes; looks inocuous; look for asymmetry, border irregularity, color uneven, deameter greater than 6mm, elevation above ground
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risk factors for skin cancer
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sun exposure; occupational exposure to pitch, tar, creosote, arsenic, radium; pale skin
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describe kaposi sarcoma
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vascular malignancy assoc with immunodeficiencies, AIDS, transplant patients; common among middle aged black males and persons of mediterranean or jewish descent
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list the layers of the blood vessels
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lumen, tunica intima, tunica media, tunica externa (adventitia)
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list the functions of the vascular endothelium
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food and O pass into tissues; wastes and CO2 pass from tissues into blood; creates compounds that cause vasodilation or vasoconstriction; creates growth factors that can stimulate smooth muscle; forms a smooth lining of the blood vessels that resists clot formation; creates compounds to promote clot formation in injured areas
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what is blood flow regulated by
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physical properties that govern the movement of liquids in a closed rigid system - pressure, resistance, velocity, turbulent v. laminar flow and compliance ie blood pressure, resistance to flow within the vessels, blood consistency, anatomic features that may cause turbulent or laminar flow, and distensibility of the vessels
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describe Poiseuille law
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law that describes the relationship of blood flow, pressure, and resistance as the difference between pressure at the inflow end of the vessel and pressure at the outflow end divided by resistance within the vessel
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describe the renin-angiotension-aldosterone system
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renin enzymatically converts the plasma protein angiotensin to angiotensin I; angiotensin converting enzyme in the lung converts agiotensin I to angiotensin II; agiotensin II produces vasoconstriction and increases salt and water retention through direct action on the kidney and through increased aldosterone secretion by the adrenal cortex (raising vascular volume and arterial bp)
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describe chronic venous insufficiency
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inadequate venous return over a long period due to varicose veins or valvular incompetence; results in venous stasis ulcers
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describe deep vein thrombosis
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obstruction of venous flow leading to increased venous pressure; factors related include venous stasis, venous endothelial damage and hypercoagulable states
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describe orthostatic (postural) hypotension
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decrease in both systolic and diastolic blood pressure upon standing; lack of normal blood pressure compensation in response to gravitational changes on the circulation; acute and chronic
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describe hypertension
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elevated blood pressure; 120-139/80-89 - prehypertensive; 140-159/90-99 - stage 1 hypertension; >160/>100 - stage 2 hypertension
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describe primary hypertension
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essential or idiopathic hypertension; genetic and environmental factors; affects 92-95% of individuals with hypertension
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discribe secondary hypertension
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caused by a systemic disease process that raises peripheral vascular resistance or cardiac output
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describe isolated systolic hypertension
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elevations of systolic pressure are caused by increases in cardiac output, total peripheral vascular resistance or both
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describe complicated hypertension
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chronic hypertensive damage to the walls of systemic blood vessels; smooth muscle cells undergo hypertrophy and hyperplasia with fibrosis of the tunica intima and media
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describe malignant hypertension
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rapidly progressive hypertension; diastolic pressure is usually >140
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factors assoc with hypertension
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genetic predisposition, family hx, advancing age, gender, race, dietary sodium intake/low dietary intake of potassium, calcium, magnesium; glucosse intolerance, cigarette smoking, obesity, heavy alcohol intake
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describe arteriosclerosis
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chronic disease of the arterial system; abnormal thickening and hardening of the vessel walls; smooth muscle cells and collagen fibers migrate to the tunica intima
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what is coronary artery disease
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any vascular disorder that narrows or occludes the coronary arteries
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what is the most common cause of coronary artery disease
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atherosclerosis
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describe peripheral artery disease
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atherosclerotic disease of the arteries that perfuse the limbs
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describe atherosclerosis
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form of arteriosclerosis; thickening and hardening is caused by accumulation of lipid laden macrophages in the arterial wall; plaque development
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describe the progression of atherosclerosis
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inflammation of the endothelium; cellular proliferation; macrophage migration; LDL oxidation; fatty streak; fibrous plaque; complicated plaque
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risk factors for coronary artery disease
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dyslipidemia, hypertension, smoking, diabetes mellitus, obesity/sedentary lifestyle
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non traditional risk factors for coronary artery disease
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markers of inflammation and thrombosis; hyperhomocysteinemia; infection
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where are high density lipoproteins made
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in the liver
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what are the good cholesterols
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high density lipoproteins
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dietary lipids are absorbed as
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chylomicrons
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what do chylomicron remnants become
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intermediate density lipoproteins
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what do intermediate density lipoproteins turn into
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low density lipoproteins
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what are the bad cholesterols
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low density lipoproteins
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why does atherosclerosis develop
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scavenger cells encounter the fatty deposits in the artery lining and try to destroy the fats by oxidizing them which injures the endothelium, forms clots, releases growth factors resulting in smooth muscle growing over the fatty core; also tries to remove fats by eating them which turn into foam cells in the core of the plaque
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describe stable plaques
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thick fibrous caps; partially block vessels; do not tend to form clots or emboli
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describe unstable plaques
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thin fibrous caps; can rupture and cause a clot to form; may completely block the artery; clot may break free and become an embolus
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define fracture
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break in the continuity of bone
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list classifications of fractures
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complete or incomplete, comminuted, linear, oblique, spiral, transverse, greenstick, torus, bowing, pathologic, stress
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describe the process of bone healing
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bleeding at broken ends with subsequent hematoma formation; organization of hematoma into fibrous network; invasion of osteoblasts, lengthening of collagen strands and deposition of calcium; callus formation (new bone is built up as osteoclasts destroy dead bone); remodeling is accomplished as excess callus is reabsorbed and trabecular bone is laid down
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manifestations of bone fractures
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unnatural alignment, swelling, muscle spasm, tenderness, pain, impaired sensation
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define crepitus
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audible clicking sounds as in the case of a broken bone
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complications of bone fractures
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improper reduction or immobilization (nonunion, delayed union and malunion), compartment syndrome, fat embolus
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describe dislocation of bone
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temporary displacement of two bones; loss of contact between articular cartilage
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describe subluxation of bone
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contact between articular surfaces is only partially lost
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describe strain
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tear or injury to a tendon
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sprain
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tear or injury to a ligament
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avulsion
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complete separation of a tendon or ligament from its bony attachment site
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muscle strain
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general term for local muscle damage often the result of sudden,forced motion causing the muscle to become stretched beyond normal capacity
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tendonitis
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inflammation of a tendon
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tendinosis
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painful degradation of collagen fibers
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bursitis
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inflammation of a bursa caused by repeated trauma; septic bursitis is caused by a wound infection
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bursa
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a fibrous sac between certain tendons and the bones beneath them; lined with a synovial membrane that secretes synovial fluid, the bursa acts as a small cushion that allows the tendon to move over the bone as it contracts and relaxes
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epicondylitis
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inflammation of a tendon where it attachs to a bone (tennis elbow, golfers elbow)
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other causes of damage to tendons besides trauma
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reduced tissue perfusion, mechanical irritation, crystal deposits, postural misalignment, hypermobility in a joint
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rhabdomyolysis
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myoglobinuria; life threatening complication of severe muscle trauma with muscle cell loss; often secondary to malignant hyperthermia; excess of myoglobin in the urine
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osteoporosis
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metabolic bone disease, severe reduction in bone density leads to easy fx; bone is normal but insufficient; porous and poorly mineralized bone
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most common disease that affects bone
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osteoporosis
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main cause of fractures in the elderly
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osteoporosis
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potential causes of osteoporosis
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decreased levels of estrogen and testosterone; decreased activity level; inadequate levels of vitamins D, C or Mg
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types of osteoporosis
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iatrogenic, regional, postmenopausal, glucocorticoid induced, age related bone loss
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risk factors for osteoporosis
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genetic, size, hormonal, dietary, smoker, sedentary lifestyle, illnesses, drugs
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pathology of osteoporosis
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bone loss exceeds bone reformation; imbalance between osteoclasts and osteoblasts; proinflammatory cytokines control osteoclasts; imbalance between Rankl and OPG
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RANKL
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essential cytokine for formation of osteoclasts; increases bone loss
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OPG
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osteoprotegerin (glycoprotein); decreases bone loss; increased bone formation
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osteomalacia
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deficiency of vitamin D lowers the absorption of calcium from the intestines resulting in inadequate or delayed mineralization; bone formation progresses to osteoid formation but calcification does not occur resulting in soft bones
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osteomyelitis
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infection in bone
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most common cause of osteomyelitis
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staphylococcal infection from open wound or blood borne infection
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manifestations of osteomyelitis
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acute and chronic inflammation, fever, pain, necrotic bone
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treatment of osteomyelitis
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antibiotics, debridement, surgery, hyperbaric, oxygen therapy
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how if non inflammatory joint disease differentiated from inflammatory
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absence of synovial membrane inflammation, lack of systemic signs and symptoms, normal synovial fluid analysis
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inflammatory joint disease
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commonly called osteoarthritis; characterized by inflammatory damage or destruction in the synovial membrane or articular cartilage and by systemic signs of inflammation; can be infectious or noninfectious
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manifestations of osteoarthritis
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pain, stiffness, enlargement of the joint, tenderness, limited motion, deformity
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rheumatoid arthritis
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chronic inflammatory disease causes destruction of connective tissue; systemic autoimmune damage to connective tissue (primarily in the joints); similar symptoms to osteoarthritis
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what is RA distinguished by
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presence of rheumatoid factors; joint fluid presents with inflammatory exudate
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pathogenesis of RA
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CD4 T Helper cells in synovial fluid become activated and release cytokines; recruitment and retention of inflammatory cells in the joint sublining the region; cycle of altered cytokine and signal transduction pathways; possible immune complex deposition and inflammatory cytokine release; RANKL release and osteoclast activation; angiogenesis in the synovium
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in evaluating for RA what must be present
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4 of the following: morning joint stiffness lasting at least 1 hour, arthritis of 3 or more joint areas, arthritis of the hand joints, symmetric arthritis, rheumatoid nodules, abnormal amounts of serum rheumatoid factor, radiographic changes
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gout
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metabolic disorder that disrupts the body's control of uric acid production or excretion; manifests high levels of uric acid in blood and other body fluids; occurs when uric acid concentration increases to high enough levels to crystallize; crystals deposit in connective tissues throughout the body
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mechanisms for crystal deposition in gout
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lower body temps, decreased albumin or glycosominoglycan levels, changes in ion concentration and pH, and trauma
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clinical stages of gout
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asymptomatic hyperuricemia, acute gouty arthritis, tophaceous gout
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contracture
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muscle fiber shortening without an action potential; caused by failure of sarcoplasmic reticulum (calcium pump) even with available ATP
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stress induced muscle tension
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neck stiffness, back pain, clenching teeth, hand grip, headache; assoc with chronic anxiety
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disuse atrophy
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reduction in the normal size of muscle cells as a result of prolonged inactivity
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treatment for disuse atrophy
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isometric movements and passive lengthening exercises
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cancer of the osteoblast or osteocyte
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osteogenic sarcoma
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cancers of cartilage
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chondrosarcoma
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osteosarcoma
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38% of bone tumors; predominant inf adolescents and young adults; in seniors with hx of radiation therapy; located in metaphyses of long bones; contain masses of osteoids
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chondrosarcoma
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tumor of middle aged and older adults; infiltrates trabeculae in spongy bone; frequent in metaphyses or diaphysis of long bones; causes erosion of cortex and can expand into neighboring soft tissues
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fibrosarcoma
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firm fibrous mass of collagen, malignant fibroblasts, and osteoclast like cells; usually affects metaphyses of femur or tibia; metastasis to lungs is common
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myelogenic tumors
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bone tumor; giant cell tumor or myeloma
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giant cell tumor
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causes extensive bone resorption because of the osteoclastic origin of the giant cells; located in epiphyses of femur, tibia, radius, humerus; tumor has slow, relentless growth rate
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multiple myeloma
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neoplasm of B cells and mature plasma cells; characterized by multiple malignant tumor masses of plasma cells scattered throughout the skeletal system and sometimes found in soft tissue
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