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1182
UNIT 13
Integumentary Function
SUMMARY CONCEPTS
B. Persons with psoriasis are instructed to refrain
from rubbing or scratching the lesions. Explain
the rationale for these instructions.
C. Among the methods used in the treatment of
psoriasis are the use of topical keratolytic agents
and corticosteroid skin preparations. Explain
how these two different types of agents exert
their effect on the plaque lesions.
Some skin problems occur in specific age groups.
Common in infants are diaper rash, prickly heat,
and cradle cap. Nevi, hemangiomas, and port-
wine stains may be present at birth. Infectious
childhood diseases that are characterized by
rashes include roseola infantum, rubella, rubeola,
and varicella. Vaccines are available to protect
against rubella, rubeola, and varicella.
With aging, there is thinning of the dermis and
the epidermis, diminution in subcutaneous tissue,
loss and thickening of blood vessels, and slowing
of hair and nail growth. Dry skin is common
among the elderly, becoming worse during the
winter months. Among the skin lesions seen in
the elderly are skin tags, keratoses, lentigines,
and vascular lesions.
4. During the past several decades there has been an
alarming increase in the incidence of skin cancers,
including malignant melanoma, that has been
attributed to increased sun exposure.
A. Explain the possible mechanisms whereby
ultraviolet radiation promotes the development
of malignant skin lesions.
B. Cite two important clinical signs that aid
in distinguishing a dysplastic nevus from a
malignant melanoma.
REFERENCES
REVIEW EXERCISES
1. The mother of a 7-year-old boy notices that
he is scratching his head frequently. On close
examination she notices a grayish, round, and
roughened area where the hair has broken off.
Examination by the child's pediatrician produces a
diagnosis of tinea capitis.
A. Explain the cause of the infection and
propose
possible mechanisms for spread of this infection
in school-age children, particularly during
winter months.
B. Referring to Chapter 14, explain the preference
of the superficial mycoses (dermatophytoses) for
the skin-covered areas of the body.
C. What methods are commonly used in the
diagnosis of superficial fungal infections?
2. A 75-year-old woman presents with severe burning
pain and a vesicular rash covering a strip over the
rib cage on one side of the chest. She is diagnosed
with herpes zoster or shingles.
A. What is the source of this woman's rash and
pain?
B. Explain the dermatomal distribution of the
1. Likeness LO. Common dermatologic infections in athletes
and return-to-play guidelines. J Am Osteopath Assoc.
2011;111(6):373–379.
2. Wolff K, Johnson RA, Saavedra AP, eds. Fitzpatrick's Color
Atlas and Synopsis of Clinical Dermatology. 7th ed. Chicago, IL:
McGraw-Hill; 2013:607–610.
3. Goodheart HP. Goodheart's Photoguide to Common Skin
Disorders. Philadelphia, PA: Wolters Kluwer Health | Lippincott
Williams & Wilkins; 2009:167-187.
4. DermNet NZ. Mycology of Dermatophyte Infections. 2013.
Available at: http://www.dermnetnz.org/fungal/mycology.html.
Accessed September 25, 2013.
5. Patel GA, Schwartz RA. Tinea capatitis: still an unsolved
problem? Mycoses. 2011;51:183–188.
6. Grover C, Arora P, Manchada V. Comparative evaluation of
griseofulvin, terbenafine, and fluconazole in the treatment of
tinea capitis. Int J Dermatol. 2012;51:455–458.
7. Gonzalez U, Seaton T, Bergus G, et al. Systemic antifungal
therapy for tinea capitis in children: a summarized Cochrane
review. Clin Exp Dermatol. 2010;36:826-827.
8. Graham LVD, Elewski BE. Recent updates in oral terbenafine:
its use in onychomycosis and tinea capitis in the US. Mycoses.
2011;54:e679-e685.
9. Wolff K, Johnson RA, Saavedra AP, eds. Fitzpatrick's Color
Atlas and Synopsis of Clinical Dermatology. 7th ed. Chicago, IL:
McGraw-Hill; 2013:591.
10. Wolff K, Johnson RA, Saavedra AP, eds. Fitzpatrick's Color
Atlas and Synopsis of Clinical Dermatology. 7th ed. Chicago, IL:
McGraw-Hill; 2013:524.
11. Wolff K, Johnson RA, Saavedra AP, eds. Fitzpatrick's Color
Atlas and Synopsis of Clinical Dermatology. 7th ed. Chicago, IL:
McGraw-Hill; 2013:534.
12. Goodheart HP. Goodheart's Photoguide to Common Skin
Disorders. Philadelphia, PA: Wolters Kluwer Health | Lippincott
Williams & Wilkins; 2009:140-150.
13. Goodheart HP. Goodheart's Photoguide to Common Skin
Disorders. Philadelphia, PA: Wolters Kluwer Health | Lippincott
Williams & Wilkins; 2009:155-161.
lesions.
3. Psoriasis is a chronically recurring papulosquamous
skin disorder, characterized by circumscribed red,
thickened plaques with an overlying silvery-white
scale.
A. Explain the development of the plaques in terms
of epidermal cell turnover.
CHAPTER 38
989
nd intact vestibulo-
as little
Fonent toward the
individual
improving
be
tem
she is developing cataracts.
In an unconscious
nystagmus lasting
ement away from
function, the
tually disappears.
method is the
on one side at a
on who does not
ve blood or
fluid
Disorders of Special Sensory Function: Vision, Hearing, and Vestibular Function
The habituation effect is characterized by decreased
her distant vision, a 75-year-old woman is told that
sensitivity and duration of symptoms. It may occur in
as 2 weeks or take as long as 6 months. Balance
A. What types of visual changes occur as the result
retraining exercises consist of activities directed toward
the person's preferences and lifestyle.
abnormal. General conditioning exercises, a vital
of the rehabilitation process, are individualized to
components of balance that may
on
part
SUMMARY CONCEPTS
a motor-driven
ric testing, rota-
ear and is unre-
be
of a cataract?
B. What can the woman do to prevent the
cataracts from getting worse?
C. What treatment may she eventually need?
3. A 50-year-old woman is told by her eye doctor
that her intraocular pressure is slightly elevated
and that although there is no evidence of
damage to her eyes at this time, she is at risk for
developing glaucoma and should have regular eye
examinations.
A. Describe the physiologic mechanisms involved
in the regulation of intraocular pressure.
B. Differentiate between open-angle and angle-
closure glaucoma in terms of their pathology,
manifestations, and treatment.
C. See Figure 38-12 to relate the “optic disk
cupping" that occurs with glaucoma to the
visual field loss that occurs with the disorder.
temporal bone.
precisely
delivered in
performed in
selected light
nitored using
d is that both
con-
Receptors for the vestibular system that respond
to changes in rotational and linear acceleration of
the head are located in the fluid-filled semicircular
ducts of the inner ear.
The vestibular system has extensive
vision, hearing, balance, and autonomic nervous
interconnections with neural pathways controlling
system initiate head and eye movements to
stabilize the visual field and make adjustments in
the posture muscles that maintain balance.
Disorders of vestibular function can result
system
function. Signals from the vestibular
disorders of
ing a person
ms extended
stability can
se his or her
indicated by
arms to drift
at is severely
side.
from repeated stimulation of the vestibular
system such as during car, air, and boat travel
(motion sickness); acute infection of the
vestibular pathways (acute vestibular neuritis);
dislodgement of otoliths that participate in the
receptor function of the vestibular system (benign
paroxysmal positional vertigo); or distention of
the endolymphatic compartment of the inner ear
(Ménière disease).
4. The parents of a newborn infant have been told
that their son has congenital cataracts and will
require cataract surgery to prevent losing his
sight.
A. Explain why the infant is at risk for losing his
sight if the cataracts are not removed.
B. When should this procedure be done to prevent
loss of vision?
pharmaco-
e treatment
he illusion
nistamines
orometha-
ine, atro-
cond type
REVIEW EXERCISES
iting that
minergic
es com-
eatment
nas met
one by
rogram
palance
ioning
antage
ponse
1. The mother of a 3-year-old boy notices that
his left eye is red and watering when she picks
him up from day care. He keeps rubbing his
eye as though it itches. The next morning, she
notices that both eyes are red, swollen, and
watering. Being concerned, she takes him to the
pediatrician in the morning and is told that he
has "conjunctivitis.” She is told that the infection
should go away by itself.
A. What part of the eye is involved?
B. What type of conjunctivitis do you think this
child has (bacterial, viral, or allergic)?
C. Why didn't the pediatrician order an
antimicrobial drug?
D. Is the condition contagious? What measures
should she take to prevent its spread?
5. A mother notices that her 13-month-old child
is fussy and tugging at his ear and refuses to eat
his breakfast. When she takes his temperature,
it is 100°F. Although the child attends day care,
his mother has kept him home and made an
appointment with the child's pediatrician. In the
physician's office, his temperature is 100.2°F, he
is somewhat irritable, and he has a clear nasal
drainage. His left tympanic membrane shows
normal landmarks and motility on pneumatic
otoscopy. His right tympanic membrane is
erythematous and there is decreased motility on
pneumatic otoscopy.
A. What risk factors are present that predispose
this child to the development of acute otitis
media?
B. Are his signs and symptoms typical of otitis
media in a child of this age?
C. What are the most likely pathogens? What
treatment would be indicated?
D. Later in the week, the mother notices that
the child does not seem to hear as well as he
did before developing the infection. Is this a
common occurrence, and should the mother be
concerned about transient hearing loss in a child
7 and
light-
ected
zoves
nolds
and
I of
12. During a routine eye examination to get new
of this age?
aily.
glasses because she had been having difficulty with
989
The
her distant vision, a 75-year-old woman is told that
she is developing cataracts.
us
as long as 6 months. Balance
CHAPTER 38
Disorders of Special Sensory Function: Vision, Hearing, and Vestibular Function
as little as 2 weeks or take
ensitivity and duration of symptoms. It may occur in
habituation effect is characterized by decreased
retraining exercises consist of activities directed toward
A. What types of visual changes occur as the result
improving individual components of balance that may
the person's preferences and lifestyle.
of the rehabilitation process, are individualized to
abnormal. General conditioning exercises, a vital
nconscious
vestibulo-
lasting
ward the
way from
ction, the
sappears.
od is the
side at a
does not
be
part
eye doctor
Hor fluid
SUMMARY CONCEPTS
r-driven
ag, rota-
is unre-
al bone.
-ly con-
ered in
med in
d light
using
Receptors for the vestibular system that respond
to changes in rotational and linear acceleration of
the head are located in the fluid-filled semicircular
ducts of the inner ear.
The vestibular system has extensive
vision, hearing, balance, and autonomic nervous
interconnections with neural pathways controlling
system function. Signals from the vestibular
system initiate head and eye movements to
stabilize the visual field and make adjustments in
of a cataract?
B. What can the woman do to prevent the
cataracts from getting worse?
C. What treatment may she eventually need?
3. A 50-year-old woman is told by her
that her intraocular pressure is slightly elevated
and that although there is no evidence of
damage to her eyes at this time, she is at risk for
developing glaucoma and should have regular eye
examinations.
A. Describe the physiologic mechanisms involved
in the regulation of intraocular pressure.
B. Differentiate between open-angle and angle-
closure glaucoma in terms of their pathology,
manifestations, and treatment.
C. See Figure 38-12 to relate the "optic disk
cupping” that occurs with glaucoma to the
visual field loss that occurs with the disorder.
t both
lers of
person
ended
y can
er her
ed by
the posture muscles that maintain balance.
1 Disorders of vestibular function can result
from repeated stimulation of the vestibular
system such as during car, air, and boat travel
(motion sickness); acute infection of the
vestibular pathways (acute vestibular neuritis);
dislodgement of otoliths that participate in the
receptor function of the vestibular system (benign
paroxysmal positional vertigo); or distention of
the endolymphatic compartment of the inner ear
(Ménière disease).
4. The parents of a newborn infant have been told
that their son has congenital cataracts and will
require cataract surgery to prevent losing his
sight.
A. Explain why the infant is at risk for losing his
sight if the cataracts are not removed.
B. When should this procedure be done to prevent
loss of vision?
drift
erely
aco-
lent
ion
nes
na-
CO-
REVIEW EXERCISES
pe
at
1C
n-
at
et
V
1. The mother of a 3-year-old boy notices that
his left eye is red and watering when she picks
him
up from day care. He keeps rubbing his
eye as though it itches. The next morning, she
notices that both eyes are red, swollen, and
watering. Being concerned, she takes him to the
pediatrician in the morning and is told that he
has “conjunctivitis.” She is told that the infection
go away by itself.
A. What part of the eye is involved?
B. What type of conjunctivitis do you think this
child has (bacterial, viral, or allergic)?
C. Why didn't the pediatrician order an
antimicrobial drug?
5. A mother notices that her 13-month-old child
is fussy and tugging at his ear and refuses to eat
his breakfast. When she takes his temperature,
it is 100°F. Although the child attends day care,
his mother has kept him home and made an
appointment with the child's pediatrician. In the
physician's office, his temperature is 100.2°F, he
is somewhat irritable, and he has a clear nasal
drainage. His left tympanic membrane shows
normal landmarks and motility on pneumatic
otoscopy. His right tympanic membrane is
erythematous and there is decreased motility on
pneumatic otoscopy.
A. What risk factors are present that predispose
this child to the development of acute otitis
media?
B. Are his signs and symptoms typical of otitis
media in a child of this age?
C. What are the most likely pathogens? What
treatment would be indicated?
D. Later in the week, the mother notices that
the child does not seem to hear as well as he
did before developing the infection. Is this a
common occurrence, and should the mother be
concerned about transient hearing loss in a child
should
DOO
D. Is the condition contagious? What measures
should she take to prevent its spread?
2. During a routine eye examination to get new
glasses because she had been having difficulty with
of this age?
38. Kipp MA.
50:89-104
39. Motley W
Cunningh
Ophthalm
2011:238
40. Donahue
2007;356
41. Olitsky s
changing epidemiology, emerging disease patterns, and
UNIT 10 Nervous System
11. Pepose JS, Keadle TL, Morrison LA. Ocular herpes simplex:
potential of vaccine prevention and therapy. Am J Ophthalmol.
12. Shaikh S, Ta C. Evaluation and management of herpes zoster
13. Dart JKG, Saw VPL, Kilvington S. Acanthamoeba keratitis:
990
2006;141:547-557.
ophthalmicus. Am Fam Physician. 2002;66:1723-1732.
diagnosis and treatment update 2009. Am J Ophthalmol.
2009;148(4):487-499.
14. Stapleton F, Carnt N. Contact lens-related microbial keratitis:
how have epidemiology and genetics helped us with pathogenesis
15. Harper RA, Shock JP. Lens. In: Riordan-Eva P, Cunningham ET,
and prophylaxis. Eye (Lond). 2012;26:185–193.
and align
eds. Nels
Elsevier
42. Bradfield
43. Gunton
PEDIG
44. Wu C, 1
options
45. Americ
Ambul
examir
pediat
46. Moore
6. A granddaughter is worried that her grandfather
is “losing his hearing.” Lately, he has been staying
away from social gatherings that he always
enjoyed, saying everybody mumbles. He is defiant
in maintaining that there is nothing wrong with his
hearing. However, he does complain that his ears
have been ringing a lot lately.
A. What are common manifestations of hearing
loss in the elderly?
B. What type of evaluation would be appropriate
for determining if this man has a hearing loss,
eds. Vaughan & Asbury's General Ophthalmology. 18th ed.
and the extent of his hearing loss?
New York: McGraw-Hill Medical; 2011:174-182.
C. What are some things the granddaughter might
16. Hall JE. Guyton & Hall Textbook of Medical Physiology.
do so that her grandfather could hear her better
12th ed. Philadelphia, PA: Elsevier Saunders; 2011:557-631,
when she is talking to him?
633-644.
17. Packer M, Fine H, Hoffman RS. Refractive lens surgery.
7. A 70-year-old man complains that he gets this
Ophthalmol Clin North Am. 2006;19:77–88.
terrible feeling like the room is moving around"
18. Abraham AG, Condon NG, Gower EW. The new epidemiology
and becomes nauseated when he rolls over in
of cataract. Ophthalmol Clin North Am. 2006;19:415-425.
bed or bends over suddenly. It usually goes away
19. James ER. The etiology of steroid cataracts. ) Ocul Pharmacol
once he has been up for a while. He has been
Ther. 2007;23(5):403-420.
told that his symptoms are consistent with benign 20. Asbell PA, Dualan I, Mindel J, et al. Age-related cataract. Lancet.
paroxysmal positional vertigo.
2005;365:599-609.
21. Chan WH, Susmito B-J A, Lloyd LC. Congenital and infantile
A. What is the pathophysiology associated with
cataract: aetiology and management. Eur J Pediatr. 2012:
this man's vertigo?
171:625-630.
B. Why do the symptoms subside once he has been
up for a while?
22. Kandel ER, Schwartz JH, Jessell TM, et al. Principles of Neural
Science. 5th ed. New York: McGraw-Hill; 2013:577-60,
C. What methods are available for treatment of the 639-653, 654-711, 917-935.
disorder?
23. Fletcher EC, Chong GV, Augsburger JJ, et al. Retina. In:
Riordan-Eva P, Cunningham ET, eds. Vaughan & Asbury's
General Ophthalmology. 18th ed. New York: McGraw-Hill
Medical; 2011:271-313.
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Eva P, Cunningham ET, eds. Vaughan & Asbury's General
2011:190–221.
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5th ed
Willia
47. McC
2007
48. Lusti
McP
52nd
49. Dan
Oto
50. Lee
201
51. Ker
St.
Phi
52. Pic
39
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53. AL
of
20
54. L.
55. I
56.
57.
58.
59
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