Skin Exam 1 Questions and Answers, Exams of Medicine

Download Skin Exam 1 Questions and Answers and more Exams Medicine in PDF only on Docsity! Skin Exam 1 Questions and Answers 1. What is the largest single organ? Skin 2. What is the skin organized into? Epidermis and Dermis 3. What is the epidermis A vascular superficial layer 4. What is the dermis? Vascular under-layer 5. What is the 5 functions of the skin? Protection Sensation Maintenance of fluid Immunity Thermoregulation Cushing for underlying structures 6. What is the 5 layers of the epidermis? Stratum basale Stratum spinosum Stratum granulosum Stratum lucidum Stratum corneum 7. What is the hypodermis? Deep to dermis and comprised of subcutaneous tissue and allows dermis to move freely over internal organs 8. What part of the epidermis is home for active keratinocytes which become more flat as they move upward toward the surface (a process known as stratification). Stratum basale Skin Exam 1 Questions and Answers 9. The stratum basale has keratinocytes that attach to each other and the stratum basale by way of what? Hemidesmosomes and desmosomes 10.What layer of the epithelium contains bundles of keratinocytes that have migrated up from the stratum basale and help the skin withstand friction and shear forces. Stratum spinosum 11.What is the thickest layer of the epidermis? Stratum spinosum 12.What layer of the epidermis provides protection from water loss by having intercellular spaces comprised of lipid rich material? Stratum granulosum 13.What layer of the epidermis provides a thick protection from the environment. You can see this portion of the skin on the palms of the hands and soles of the feet? Stratum lucidum 14.What part of the epidermis is comprised by desquamation or sloughing of the skin and is the final stage of keratinocyte migration Stratum corneum 15. In the stratum corneum, what happens to the keratinocytes? They become corneocytes 16.Cells other than keratinocytes comprise the epidermis. What are the other cells? Melanocytes Langerhans Cells Merkel cells 17.What primary cell of the epidermis, gives skin its pigment and are located between stratum basale and stratum spinosum? Melanocytes 18.What primary cells in the epidermis are located in the stratum spinosum and bind to lymphocytes in order to provide an immune response? Langerhans cells Skin Exam 1 Questions and Answers 42.The signaling in wound healing involves many counterparts, such as what? Concentration and timing of signals Receptor site availability, Active forms post cleavage of cells degradation rate half life pH and enzyme presence hydrophobic/hydrophilic characteristics. 43.What are the central coordinators in the healing process? Macrophages 44.Describe phase 1 of the healing process: Homeostasis: Less than 1 hour and directed by platelet aggregation Function to stop bleeding and begin scab formation Arteriole vasoconstriction and influx of neutrophils Clinical signs of Inflammation and edema Distinguishing factor between stage 2 is clot formation occurring 45.Describe phase 2 of the healing process: Inflammation: "Scavenger phase" "Neogenesis" Cleaning the wound GOAL: Increase circulation to site of injury Phagocytes engulf debris Vasodilation Macrophage formation Autolytic debridement begins when endogenous enzymes break down necrotic tissue Clinical signs: Redness, edema, pain increased temperature 46.Describe phase 3 of the healing process: Proliferation: Injured tissue replaced by healthy cells undergoing mitosis. Formation of new ECM and epidermal cells as well as granulation tissue Proliferation of fibroblasts Angiogenesis necessary to provide nutrient to area and remove waste PG and GAG synthesis contribute to matrix deposition Granulation tissue clinically known by "BEEFY RED" appearance Healthy tissue covered and re-epithelialized 47.Describe phase 4 of the healing process: Maturation/Remodeling: Skin Exam 1 Questions and Answers Wound closure/contraction Clinical signs: Blanching Usually begins even after wound closure Fibroblast to myofibroblast conversion Melanocyte Aggregation of cells to increase strength of wound Collagen I replaces Collagen 3. New epithelial tissue provides patch to cover actual tissue replacement Resulting tissue only provides 80% tensile strength of original skin which may take 2 years to recover fully 48.What is recidivism? Recurrence of wounds in the same area due to 20% decrease in original tensile strength 49.What phase of healing has the primary goal to Increase circulation to site of injury? Phase 2 inflammation 50.What are the 3 classifications to wound healing? Healing by primary intention Healing by delayed primary intention Healing by secondary intention 51.What is the healing type of wounds that you will typically see after surgery of some kind. They usually heal very uneventfully with minimal scarring. Primary intention healing (Resolves in 2 weeks) 52.Examples of wounds that heal by primary intention are what? Those that have been surgically closed and are free from bacteria or pathogens. Healing usually occurs rapidly. 53.Category 2 is delayed primary intention whereby there is what problem with the wound? Problem inside wound causing edges to avoid approximation 54.Delayed primary intention healing, is also called what? Tertiary intention 55.Delayed primary intention is usually associated with a more marked inflammatory stage and may contain what? granulomas, or masses of granulation tissue. 56.What types of wounds progress through the stages of wound healing from inflammatory phase, granulation formation and then through reepithelialization? Skin Exam 1 Questions and Answers Secondary intention wound healing 57.Wounds seen in the clinic will be either what kind of wounds? Delayed primary intention or secondary intention 58.Myofibrils are composed of what elements? similar to smooth muscle that contract and so they can assist in wound closure by approximating the edges of the wound. 59.Myofibrils are composed of elements similar to smooth muscle that contract and so they can assist in wound closure by approximating the edges of the wound. These cells are present for how long? 10-21 days 60.Cells communicate with the extracellular matrix for what reason? Provide a better environment for wound healing 61.Plasminogen activators and MMPs (Mixed metalloproteinases) break up the wound matrix for what reason? Enhance surrounding wound bed for epithelial migration 62.Changing of various cells, namely platelets, macrophages, and fibroblasts, occurs during the wound healing process for what reason? Facilitate transition to each phase of healing 63.Metamorphosis occurs via what 3 factors? Platelets Macrophages Fibroblasts 64.What are the roles of platelets in the hemostasis phase and proliferative phase? Hemostasis phase: Jump start clotting process Proliferative phase: Stimulate angiogenesis 65.The ECM is comprised of what?> Collagen Elastin PG and GAGS 66.Majority of drainage that leaves the wound is comprised of what? Protein 67.Why should patients take in protein for wound healing? Most of drainage that leaves the wound is comprised of protein 68.The extracellular matrix is comprised of such proteins that allow for what?> Skin Exam 1 Questions and Answers 89.White blood cell count that is lower may indicate what? Delayed immune response to bacteria. Delayed wound healing 90.What is normal hemoglobin content 12-18 g/dL 91.Decrease hemoglobin content may present in what way? Pale appearance Lethargy Nausea Lightheadedness 92. If hemoglobin is under what number, we should not treat them for PT? Under 7 g/dL 93.What are the normal hematocrit values? Between 36-50% 94.What does hematocrit tell us? Ratio of RBC to total blood volume 95. Individuals with too few red blood cells may be anemic, with wounds displaying a what appearance? Pale appearance 96. Increased HCT levels may predispose individuals to what? Increase thorombus formation 97.The normal prothrombin time international normalized ratio or PT INR in the clinic is____ 2.5 98.The normal prothrombin time international normalized ratio or PT INR is a measure of what? how long it takes for blood to clot. 99.The normal prothrombin time international normalized ratio or PT INR in the clinic is 2.5. This is a measure of how long it takes for blood to clot. If the value is too high, the patient is at risk for what? If its low, the patient may have an increased risk for what? High: May bleed easily Low: May blood clot Skin Exam 1 Questions and Answers 100. HbA1C% provides what value? Blood glucose levels for previous 2 to 3 months. 101. Average Glucose readings go hand in hand with what? HbA1C levels and assist the physician in diagnosing an individual with Diabetes 102. What is the normal range of HbA1C%? The normal range for this lab value is < 5.7% High values associated with delayed wound healing 103. What is average glucose? <100 mg/dL Increased average leads to delayed wound healing 104. Increased hemoglobin would have what affect on wound healing? Wound fails to progress 105. Wound classification systems depend on what characteristics of the wound? Depth of tissue loss Type of wound Severity of wound Color of tissue 106. Different classification systems are required for what? Different types of wounds 107. Our book identifies types of wounds for use of each system, which includes what? Depth of tissue injury Red, Yellow and black Pressure ulcer staging Wagner Ulcer dyvascular classification system University of Texas diabetic classification 108. Depth of tissue loss characterized wound healing. What are the types? Superficial wounds (Erosion) Partial-thickness Full-thickness Wound healing by primary intention Wound healing by secondary intention Wound healing by delayed primary or tertiary intention 109. The type of healing may be affected by what? Nature of wound itself, such as surgical sutures to remove threat of scab formation Skin Exam 1 Questions and Answers 110. What is the Marion laboratories Red, Yellow, Black Classification system? Simple system used to describe the wound surface which correlates to specific therapy needs 111. According to the Mario Laboratories Red, Yellow, Black classification system, what does Red Indicate? Wound is clean, healing and granulating 112. According to the Mario Laboratories Red, Yellow, Black classification system, what does Yellow wounds indicate? Possible infection, need for cleaning or debridement or the presence of necrotic tissue 113. According to the Mario Laboratories Red, Yellow, Black classification system, what does Black indicate 114. Wound is necrotic and needs cleaning and debridement 115. According to the Mario Laboratories Red, Yellow, Black classification system, what does this scale serve as a purpose for? Accompanies other scales well 116. True or False: All red wounds are healthy wounds False 117. What is the National pressure Ulcer Advisor Panel Pressure Ulcer Staging System? Most widely known wound classification system for pressure ulcers 118. What is the National pressure Ulcer Advisor Panel Pressure Ulcer Staging System used for? Wound severity Organize treatment protocols Select and reimburse treatment products 119. What kind of classification system is the National pressure Ulcer Advisor Panel Pressure Ulcer Staging System Etiology 120. Describe the Wagner Ulcer Grade classification system Developed for diagnosis and treatment of the dysvascular foot Used to establish presence of depth and infection in wound (Used 6 grades 0-5) Used for assessment of diabetic foot ulcers Skin Exam 1 Questions and Answers 135. What are the 3 methods to analyze dimensions of wounds? Perpendicular Clock method Tracing/wound photography 136. What is the most commonly used method for wound dimensions? Clock Methods 137. What is the perpendicular method to analyze a dimension of a wound? Length- Longest dimension Width- Longest dimension perpendicular to length Good reliability 138. What is the Clock method to analyze a dimension of a wound? Utilizes clock face to describe dimensions of wound 12 is always toward head Must doc. pt position 139. What is the Tracing/Wound photography method to analyze a dimension of a wound? Plastic measuring guide placed over wound ruler placed in frame of wound Digital photos with planimetry 140. How do you calculate the wound measurement using the clock method? Length x Width x Depth in cm Length of wound from "head to toe" (12 to 6 oclock) Perpendicular to length is width from "9 to 3 oclock" Depth using cotton tipped applicator, probe until bottom of wound is felt 141. How is the depth of a wound obtained? Using cotton tipped applicator until bottom of wound is felt 142. What are the 2 types of subcutaneous extensions for wound measurement? Undermining: May or may not be characterized by a discolored skin around periphery of wound Documentation includes depth and migration using clock technique Tunneling: Between 2 wounds Can be within same wound at an angle 143. What are the 2 main types of extensions that can be noticed by the clock method? Undermining- Which is similar to a "pocket" or "shelf" under the skin that extends over a wide range Skin Exam 1 Questions and Answers Tunneling- doesn't span a wide range, but "tunnels" into the skin similar to a waterhose under the ground 144. What is undermining in relation to wound assessment? Disruption in the attachment of the skin to underlying structures, is often noticed as a dark/discolored tissue appearance surrounding the periwound 145. What are the different types of tissues? Eschar Slough Granulation Muscle Bone Visible periosteum Tendon Adipose tissue Hypergranulation tissue 146. What is the difference between Eschar and a Scab? The difference between a scab and eschar is that eschar is flat and shiny. 147. Describe Eschar tissue Non-viable/necrotic tissue Black/brown appearance Varies in texture (hard/dry) 148. Describe Slough Tissue Non-viable subcutaneous tissue Result of autolytic debridement Soft yellow tissue 149. Describe granulation tissue Viable tissue- we want to see "Beefy red" appearance due to angiogenesis Composed of ECM and capillaries 150. Describe muscle tissue Straited Voluntary contractions Can be non-viable or viable Viable- Red and painful to tactile sensation Non Viable- nonpainful and appears greyish doesn't contract 151. Bone exposure is often associated with what pathology? Osteomyelitis Periosteum must be moist and covered at all times Skin Exam 1 Questions and Answers 152. How can you differentiate non-viable bone from viable bone? Non-Viable- black indicates necrosis Viable- white or yellow appearance 153. Describe tendon tissue Can be viable or non-viable In full-thickness wounds Viable if it is still shiny Prevent desiccation 154. Describe adipose tissue Can be non-viable or viable Viable: Shiny globules Non-Viable: Dull yellow appearance Slow to vascularize 155. When is hypergranulation tissue usually present? Cause inability to heal and silver nitrate can help this along with corticosteroids 156. Describe hypergranulation tissue Viable Abnormal healing Unable to head as edges are not able to approximate due to too much granulation 157. What is the number 1 factor when deciding on dressing? Drainage 158. What is the "amount" for drainage labels? Scant- small remnant of drainage on dressing after removal Minimal- 25% of dressing covered Moderate- 50% dressing covered Heavy-100% dressing covered Copious- Multiple layers of dressing covered Strike through- Drainage visible through last layer of dressing (can't be contained) 159. What are the different types of drainage? Serous Sanguineous Serosanguineous Purulent Infect