Pathology Quiz #3&4

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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. 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