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| Question | Answer |
| Definition of hyperkeratosis | a natural response when the physiological tolerance of the skin has been exceeded |
| Name the callus cycle? | Intermittent compression triggers inflammatory response which increases keratinocyte production Quick turnaround so cells immature Diminshed desquamation so build up of skin cells on stratum corneum |
| Summarise hyperkeratosis | Normal protective response of the skin Thickening of the stratum corneum Increase in cell proliferation, decrease in shedding |
| What stress causes callus? | Intermittent compression |
| Causes of pathological callus? | Abnormal foot mechanism Joint malalignment Foot deformity Dermatological conditions |
| Define keratinisation | Process by which layers of the epidermis are formed |
| When should you consider not to debride callus? | Atrophic skin Systemic disease Poor circulation Anatomical location |
| Name aetiologies for callus formation? | Age Psoriarsis Intermittent compression High heels Narrow toe box |
| Name 5 layers of skin in the epidermis on the foot? | Stratum corneum stratum lucidum Stratum granulosum Stratum Spinosum Stratum basale |
| What are the main cells of the epidermis? | Keratinocytes Langerhans Merkel cells |
| Which layer of epidermis is only present on plantar aspect of the foot | Stratum lucidum |
| Which layer of the epidemis produces the lipid layer which acts as a protective layer | Stratum granulosum |
| What are the functions of the skin? | Protection Sensation Thermoregulation Hydroregulation Storage and synthesis Absorption Interacts with external environment Communication |
| What is the role of merkel cells | Sensitive to fine touch and pressure |
| Where are Langerhans situated and what do they do? | Situated in spinosum Destroy FB and send message to immune system re harmful substances |
| What do melanocytes do and where are they located? | Protect from UV radiation. Located in stratum basale |
| What happens in stratum basale? | Keratinocyte production |
| What does the granulosum do? | Acts as a protective barrier expels lipid components |
| What are two layers of dermis called? | Papillary Reticular |
| Name main cells of dermis? | Fibroblasts Macrophages Lymphocytes Mast cells Langerhan cells |
| Which part of the dermis do the appendages lie? | Reticular |
| Name 3 appendages | Sweat glands Sebaceous glands hair |
| Define eccrine gland | All over the body Produce odourless watery fluid, secrete onto skin surfaces Secrete in response to stress |
| Define apocrine | Located in armpit and groin, function at puberty |
| Define hypodermis? | Subcutaneous tissue ie acts as a shock absorber fatty padding |
| Where are pacinian corpuscles located and what do they do? | Mechanoreceptor In deep layer of dermis |
| Where are meissner cells located and what do they do? | Situated in papillary layer of dermis Sensitive to touch/pressure |
| What are ruffini corpuscles and where are they located? | Located in dermis Sensitive to touch and pressure |
| What is a noireceptor sensitive to? | Pain |
| Name 9 effects of aging on the skin? | Moisture content less Skin drier Skin less flexible/elastic Shock absorption less Atrophy of fatty pad Prone to fissures Increase in weigh bearing forces Higher chance of hyperkeratosis Increase in extravasated callus |
| Name 4 mechanoreceptor cells | Meissner Merkel Ruffini Panicinian |
| where are ruffini cells more abundant and what do they do? | Soles Stretching/grip |
| Name physiological stresses of skin | Burn Cold Bacterial infection Fungal infection Viral infection Systemic disorder Aging? |
| Name mechanical stresses on the skin | compression torsional tensile shearing |
| Define tensile stress and what does it cause? | same plane but in opposite directions fissures |
| Define shearing | Tissues stretched in opposite directions in different planes and one part slides across another |
| What is a cause of superficial shear | Blister |
| Name 2 causes of deep shear? | Bursae Glassy callus |
| Define torsional? | Amalgamation of all stress (twisting) |
| What can intermittent compression result in? | Callus |
| What can constant compression result in? | Necrosis |
| What is the cause of corns? | Intermittent compression |
| Define corn? | Deep concentrated mass of immature cornified cells |
| The nucleus of a hard corn is termed? | Parakeratotic |
| Heloma durum normally occur where? | Apices of the toes Plantar metatarsal heads |
| Definition of heloma millaire | Millions of stone wedges |
| Where do heloma millaire commonly occur? | calcaneal Margins of weight bearing areas |
| Define Heloma Molle and where they commonly occur? | Soft corn Interdigitally |
| Define Heloma Vasculare and where they commonly occur? | Corn with a vascular element Digital apices dorsal ipj plantar 1st mpj |
| What is a Durlacher corn? | HD lateral to 5th nail due to rotation of 5th toe |
| Name examples of preventative advice for H Molle? | Astringents Change hosiery regularly Footwear advice |
| Name some treatment options for treating corns? | enucleation footwear appraisal silicones padding and strapping redistributing insoles caustics biomechanic referral |
| Name 3 aetiologies for heloma durum? | Narrow toe box High heels intermittent compressive stress |
| What is a vesicle? | Less than 5 mm contains fluid |
| What is a bullae? | More than 5 mm fluid fluid |
| What can cause blisters/bullae? | Trauma Infection Idiopathic Genetic Immunological factors |
| Name 3 causes of trauma? | Mechanical - shear thermal - hot/burn cold/cryotherapy Chemical burn |
| Superficial raised blister occurs in which section of the skin? | Stratum corneum |
| If a bullae occurs in the spinosum, is visible raised and painful, what layer of skin is this known as? | Intra-epidermal layer. |
| What happens if a bulla is classed as being in the dermo-epidermal junction. | It is in the basale and dermis Its a firm blister. Can be blood fluid |
| Do we treat a blister if it is not painful, epidermis is intact and there is no inflammation? | No |
| What do we do if a blister is painful? | Need to dress and re-distribute pressure. |
| Name ways of recording blisters? | VAS scale Photographs Lesion charts Good written notes |
| What do you do if you suspect a blister is infected? | Need to treat as open lesion. establish drainage using the ANTT technique. Need 2 drain points in lesion (proximal and distal) Dress with appropriate dressing, redistributing pressure. |
| What is an adventitious bursae? | Arise as result of excessive shear in superficial fibrous tissue, in surfaces where the skin moves freely over bony surfaces. |
| What is a deep shear? | Tissues are stretched in opposite directions in different planes. One side slides across another causing trauma. |
| Define bursitis. | Increased shear at site of bursae causing inflammation, swelling, heat and redness. |
| Name 4 common bursitis foot locations | Posterior aspect of heel Plantar aspect of calcaneus Under HD on dorsum of Ipj Medial aspect of 1st metatarsal in HAV |
| How would you reduce shear? | Footwear advice. Pressure redistribution. Orthotic assessment. |
| How would you treat acute bursitis? | Reduce inflammation - cold compress. RICE |
| How would you treat chronic bursitis? | Apply heat (Rubefacient) to reduce blood flow to area in order to reduce fluid. |
| How would you treat infective bursitis? | Establish drainage. ? antibiotics/swab to be sent for culture. Wound care. |
| What is tenosynovitis? | Inflammation of a tendon sheath. |
| List as many types of dressings as you can and give an example | Low/non adherent - Melolin Tulle Foam Hydrocolloid Hydrofibre Alignate Antimicrobial Hydrogel |
| Name what wounds low adherent dressings are used for and what they do | Used on low exuding wounds Prevent damage to granulating/epithelialisation wound bed. |
| Name what wounds foams are used for and what they do | Mild to moderate exudate wounds Absorbant and contour to surface of wound if shallow undulations |
| What are film used for and what do they do | Non exuding wound Non absorbent but vapour permeable Flexible dressing, primary and secondary dressing |
| What type of wounds are hydrocolloids used for and what do they do | Dry, sloughy, necrotic wounds. Aid with autolytic debridement Low to medium exuding wounds Waterproof |
| Hydrogels | Suitable for dry, sloughy, necrotic wounds Promotes rapid debridement by facilitating rehydration and autolysis of dead tissue |
| What wounds are hydrofibre used for and what does it do | Forms into a gel on contact with exudate Highly absorbant Highly exudating wounds |
| What wounds are alginates used for and what do they do | Moderate to high exudating wounds Highly absorbent Encourages autolytic debridement Good for cavities Fibres swell and form a gel on contact with exudate |
| Name microbial dressings and what does a microbial do | Different types, aim to reduce microbial load to wound to enable wound healing to continue Inadine Medihoney Silver |
| What is tinea pedia? | Dermophyte infection of the skin |
| What are the 3 classic types of dermatophytes called? | (Trichophyton rubrum (red) Trichophyton mentagrophytes (between digits) Epidermophyton flocossum infection of epidermis |
| Name 5 host aetiologies for tinea pedia? | Immunosuppression Poorly controlled diabetes mellitus Obesity Age Profession |
| Try and name 7 environmental factors for tinea pedia? | Moist conditions occlusive footwear poor foot hygiene hyperhidrosis shared footwear shared towels public showering |
| Name health promotion advice for someone with tinea pedia | change hosiery regularly Foot hygiene wash and dry feet regularly Don't not share towels Wash towels over 60 degrees Important to protect feet in communal showers |
| What is simplex tinea pedia? | It is dry, can be itchy, epidermis may fissure |
| What does complex mean? | Foot can be itchy, burning and malodour Peeling macerating skin, interdigital and sub digital fissures can lead to bacterial infection Secondary ba |
| What is moccasin tinea pedia known as? | T Rubrum |
| What is pompholyx | Eczema which affects the hands and feet, causing vesicles and irritation. Differential diagnosis for tinea pedia |
| How do we diagnose tinea pedia? | Send skin scrapings for microscopy and culture |
| Name 3 different types of tinea pedia treatments and their ingredients | Canestan - cliotrimazole Daktarin - micanozole Lamisil - terbinafine Can have spray, creams and powder |
| What is an ointment? | More occlusive than cream Do not contain water Ideal for people who react to preservatives Often stiff and greasy |
| What is a cream? | Mixture of fat and water Easier to spread over sore skin Need to be used frequently Contain preservatives |
| What is a lotion? | Contain more water and less fat Spread easily and are cooling Quick absorbing Good for hairy skin Not effective for very dry skin |
| What happens in eczema? | Change in skin moisture levels, reduction in barrier fuction, increases water loss allowing for penetration of allergens and irritants which trigger eczema |
| What is a benefit of using a powder? | Soak up moisture Reduce friction between apposing skin surfaces |
| What is hypopigmentation? | Too little melonin |
| What is hyper pigmentation | too much melolin (freckles) |
| Summarise what you do when assessing wounds? | Document size - ? increase Site Onset and duration Medical/family history Surface features type of lesion/? edges like Colour Picture (consent) Lesion base ? bleeding |
| Define dermaphyte | A common label for a group of 3 types of fungus that commonly cause skin disease |
| What is pitted keratolysis? | Erosion of stratum corneum due to corneobactrium - looks nibbled |
| What is ichthyosis? | Genetic disorder - dry thick scaly skin (fish scales) |
| What is the process of deep wound healing? | Haemostasis Inflammation Granulation Epithelialisation Maturation |
| What is haemostasis? | Vascular response to minimise blood loss through platelet adhesion/aggregration |
| What is granulation? | Formation of new connective tissue and blood vessels (angiogenesis) Contraction of wound |
| What is epithelialisation? | Regrowth of keratinocytes across wound surface when granulation tissue has fully filled the wound |
| What is maturation? | Collagen bundle formation Contracture of wound maturation of scar |
| What is inflammation? | Tidy up - preparing for healing process involves heat, redness, swelling, pain and sometimes loss of function |
| Define wound? | Break in the integrity of epidermis |
| What does an alginate do and name an example? | Absorbs exudate Aims to limit maceration Sorbsan |
| What does a film do and name an example? | Opsite Protects. Good for shallow abrasions. Maintains moist wound environment |
| What does an hydrocolloid do and name example? | Hydration and autolysis of slough/eschar and necrosis Maintains a moist wound environment Granuflex Duoderm |
| What does hydrofibre do and name an example? | Absorption of exudate Protects wound borders due to vertical exudate absorption Aquacel |
| What does hydrogel do and name an example? | Hydration and autolysis of slough/eschar Medihoney |
| Name 4 antimicrobial dressings? | Inadine Silver Medihoney Bactigras |
| What does bactigras contain and what wounds would you use for? | Chlorhexidine paraffin for gram positive and negative bacteria |
| What type of dressing is inadine, and when should it not be used? | Broad spectrum antimicrobial, tulle dressing. Not to be used on pregnant, lactating mums or thyroid problems |
| What is biatain? | Its a foam dressing with hydrocolloid |
| Name a foam dressing and what type of wounds it would be used for? | Allevyn Highly absorbant mild/moderate exudate contour to surface of shallow wounds |
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