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Chapter 46: Structure, Function, and Disorders of the Integument

MULTIPLE CHOICE
1. Which component of the epidermis initiates immune responses and provides a defense against

environmental antigens?
a. Langerhans cells
b. Merkel cells

c. Keratinocytes
d. Melanocytes

ANS: A

Langerhans cells (a type of dendritic cell) and dermal dendritic cells initiate an immune
response by presenting processed antigen to T cells, thus providing a defense against
environmental antigens. This function is not true of the other options.
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REF: Page 1617

2. Which cells of the dermis release histamine and play a role in the hypersensitivity reactions of

the skin?
a. Histiocytes
b. Fibroblasts

c. Mast cells
d. Macrophages

ANS: C

Only mast cells release histamine and play a role in hypersensitivity reactions in the skin.
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REF: Page 1618

3. Which cells of the dermis secrete connective tissue matrix?


a. Macrophages
c. Fibroblasts
b. Mast cells
d. Histiocytes
ANS: C

Only fibroblasts secrete the connective tissue matrix and collagen.


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REF: Page 1618

4. Which gland releases secretions that are important in thermoregulation and cooling of the

body through evaporation?


a. Sebaceous
b. Apocrine

c. Eccrine
d. Exocrine

ANS: C

The eccrine sweat glands are distributed over the body, with the greatest numbers in the palms
of the hands, soles of the feet, and forehead. These secretions are important in
thermoregulation and cooling of the body through evaporation. This function is not true for
the other options.
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REF: Page 1618

5. Which receptors of the sympathetic nervous system regulate heat loss through the skin?
a. Cholinergic
c. -Adrenergic
b. -Adrenergic
d. Anticholinergic

ANS: C

Heat loss can be regulated by varying blood flow through the skin by opening and closing the
arteriovenous anastomoses in conjunction with evaporative heat loss of sweat. The
sympathetic nervous system regulates vasoconstriction and vasodilation through -adrenergic
receptors only.
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REF: Page 1619

6. What is the first change in the skin that indicates a pressure ulcer?
a. Blanchable erythema of intact skin
b. Nonblanchable erythema of intact skin
c. Blister at the site of pressure
d. Reddish-purple discoloration
ANS: B

Nonblanchable erythema of intact skin, usually over bony prominences, characterizes stage 1
pressure ulcers. This selection is the only option that accurately identifies the initial skin
change indicative of a pressure ulcer.
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REF: Page 1625

7. Which type of dressings should be applied to pressure ulcers?


a. Flat and dry
c. Bulky and dry
b. Flat and moist
d. Bulky and moist
ANS: B

Superficial pressure ulcers should be covered with flat, nonbulky dressings that cannot
wrinkle or cause increased pressure or friction. Spontaneous healing will occur more quickly
if the ulcer is kept moist with an occlusive dressing.
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REF: Page 1626

8. What term is used to identify skin lesions that are elevated, rounded, and firm with irregular

clawlike margins that extend beyond the original site of injury?


c. Acne
d. Keloid

a. Psoriasis
b. Dermatitis
ANS: D

Of the options available, only keloids typically send out clawlike prolongations.
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REF: Page 1626

9. Keloids are sharply elevated, irregularly shaped, progressively enlarging scars caused by

excessive amounts of which substance in the corneum during connective tissue repair?
c. Stroma
d. Reticular fibers

a. Elastin
b. Collagen
ANS: B

Abnormal wound healing with excessive fibroblast activity and collagen formation during
dermal connective tissue repair cause keloids. The other options are not associated with keloid
formation.

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REF: Pages 1626-1627

10. In allergic contact dermatitis, which cells possess the antigens and present them to T cells?
a. Langerhans cells
c. Keratinocytes
b. Merkel cells
d. Macrophages
ANS: A

In allergic contact dermatitis, only Langerhans cells process the antigen and carry it to T cells
that then become sensitized to the antigen-releasing cytokines and chemokines, leading to
leukocyte infiltration and inflammation.
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REF: Pages 1627-1628

11. In latex allergies, which immunoglobulin (Ig) is associated with an immediate reaction?
a. IgA
c. IgG
b. IgE
d. IgM
ANS: B

Latex allergy can be either a type IV hypersensitivity to chemicals used in latex rubber
processing or a type I immediate hypersensitivity, with IgE antibodies formed in response to
latex rubber protein. This selection is the only correct option available.
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REF: Page 1628

12. What medical term is used to identify an inflammatory disorder of the skin that is often

considered synonymous with dermatitis and characterized by pruritus with lesions that have
an indistinct border?
a. Eczema
c. Atopic dermatitis
b. Psoriasis
d. Pityriasis rosea
ANS: A

The most common inflammatory disorder of the skin is eczema, or dermatitis. Eczema and
dermatitis are general terms that describe a particular type of inflammatory response in the
skinthese terms can be used interchangeably. Pruritus, lesions with indistinct borders, and
epidermal changes generally characterize diseases that are considered eczematous. Of the
available options, only eczema is associated with these characteristics.
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REF: Page 1627

13. What clinical manifestations do allergic contact and stasis dermatitis have in common?
a. Petechiae and hyperpigmentation
c. Scaling and crusting of lesions
b. Edema and vesicular lesions
d. Erythema and pruritus
ANS: D

Only erythema and pruritus are exhibited with both conditions.


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REF: Pages 1627-1628

14. Lesions on the elbows and knees that are well demarcated, thick, silvery, scaly, and

erythematous characterize which type of psoriasis?


c. Guttate
d. Erythrodermic

a. Plaque
b. Inverse

ANS: A

The description provided is characteristic of only lesions observed in plaque psoriasis. These
lesions are well-demarcated, thick, silvery, scaly, erythematous plaque surrounded by normal
skin.
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REF: Page 1629

15. Which skin disorder begins with a single lesion that is circular, demarcated, and salmon pink,

measures approximately 3 to 4 cm in diameter, and is usually located on the trunk?


c. Psoriasis
d. Acne rosacea

a. Lichen planus
b. Pityriasis rosea
ANS: B

Of the options available, only pityriasis rosea begins as a single lesion known as a herald
patch. This lesion is circular, demarcated, and salmon pink; it measures approximately 3 to 4
cm in diameter and is usually located on the trunk.
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REF: Page 1630

16. Which immunoglobulin is found in skin biopsy with immunofluorescent observation of

people with discoid lupus erythematosus?


a. Immunoglobulin A (IgA)
b. Immunoglobulin E (IgE)

c. Immunoglobulin G (IgG)
d. Immunoglobulin M (IgM)

ANS: D

Skin biopsy with immunofluorescent observation reveals lumpy deposits of immunoglobulins,


especially IgM, in some individuals. This immunoglobulin is the only one associated with
discoid lupus erythematosus.
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REF: Page 1632

17. Which term is used to identify a collection of infected hair follicles occurring most often on

the back of the neck, the upper back, and the lateral thighs that forms a mass and evolves into
an erythematous, painful, and edematous mass and drains through many openings?
a. Erysipelas
c. Carbuncles
b. Furuncles
d. Boils
ANS: C

The term, carbuncle, is used to identify a collection of infected hair follicles occurring most
often on the back of the neck, the upper back, and the lateral thighs. The lesion begins in the
subcutaneous tissue and lower dermis as a firm mass that evolves into an erythematous,
painful, and swollen mass and drains through many openings.
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REF: Page 1635

18. Chickenpox (varicella) may be followed years later by which disorder?


a. Erysipelas
c. Warts (Verrucae)
b. Cytomegalovirus
d. Herpes zoster
ANS: D

The same herpesvirusvaricella zoster virus (VZV)causes both herpes zoster (shingles)
and varicella (chickenpox). Varicella is the primary infection, followed years later by herpes
zoster, particularly among those who are immunosuppressed. These statements are not true of
any of the other options.
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REF: Page 1636

19. What type of skin infection is tinea corporis (ringworm)?


a. Nematode
c. Viral
b. Fungal
d. Bacterial
ANS: B

Tinea corporis is a fungal infection of the skin. This selection is the only option that accurately
identifies the nature of the infection.
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REF: Page 1637

20. Cutaneous vasculitis develops from the deposit of _________________.


a. Immune complexes
c. Complement proteins
b. Immunoglobulin E (IgE)
d. T lymphocytes
ANS: A

Cutaneous vasculitis involves the deposit of immune complexes, initiating an uncontrolled


inflammatory response and causing the lesions that are often polymorphic.
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REF: Page 1638

21. Which skin lesion is mediated by the immunoglobulin E (IgE)stimulated release of

histamine, bradykinin, or kallikrein from mast cells?


c. Urticaria
d. Cutaneous vasculitis

a. Dermatitis
b. Scleroderma
ANS: C

Only urticaria is mediated by the IgE-stimulated release of histamine, bradykinin, or kallikrein


from mast cells or basophils, or both, which causes the endothelial cells of skin blood vessels
to contract.
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REF: Page 1639

22. Scleroderma is associated with _________________.


a. X-linked recessive gene
c. Virus
b. X-linked dominant gene
d. Autoantibodies
ANS: D

Scleroderma means sclerosis of the skin and is associated with immune dysregulation and
several autoantibodies. This selection is the only option associated with scleroderma.
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REF: Page 1639

23. What name is given to a benign proliferation of basal cells that produces smooth or warty

elevated lesions on the chest, back, and face that are tan or waxy, yellow, flesh-colored, or
dark brown to black?

a. Basal keratosis
b. Seborrheic keratosis

c. Keratoacanthoma
d. Actinic keratosis

ANS: B

Seborrheic keratosis is a benign proliferation of cutaneous basal cells that produces smooth or
warty elevated lesions. The pathogenetic origin is unknown. Seborrheic keratosis usually
occurs in older people as multiple lesions on the chest, back, and face. The color varies from
tan to waxy, yellow, flesh-colored, or dark brown to black. No other option exhibits these
characteristics.
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REF: Page 1640

24. Lesions that usually have depressed centers with rolled borders and are frequently located on

the face and neck characterize which malignancy?


c. Malignant melanoma
d. Basal cell carcinoma

a. Squamous cell carcinoma


b. Kaposi sarcoma
ANS: D

Of the available options, only basal cell carcinoma has depressed centers with rolled borders.
Lesions are most often observed on people who live in regions with intense sunlight and on
those areas of the skin most exposednamely, the face and neck.
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REF: Pages 1641-1642

25. The alteration of which gene is associated with basal cell carcinoma?
a. myc
c. src
b. TP53
d. Ras
ANS: B

Basal cell carcinoma arises as a consequence of ultraviolet-associated mutation in only the


TP53 tumor-suppressor gene leading to the loss of keratinocyte repair functions and apoptosis
resistance of DNA-damaged cells.
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REF: Page 1642

26. Bowen disease is a form of which type of cancer?


a. Kaposi sarcoma
c. Basal cell carcinoma
b. Malignant melanoma
d. Squamous cell carcinoma
ANS: D

Squamous cell carcinoma (SCC) is a tumor of the epidermis and the second most common
human cancer. Two types are characterized: (1) in situ (Bowen disease) and (2) invasive.
Bowen disease is not a form of any of the other options.
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REF: Pages 1642-1643

27. A small (less than 1 cm) lesion with regular edges and bristlelike hairs with a color change

that can range from skin tones to light brown characterize which form of nevus?
c. Intradermal
d. Compound

a. Junctional
b. Epidermal
ANS: C

Only intradermal nevus is characterized by a small (less than 1 cm) lesion with regular edges
and bristlelike hairs with a color change that can range from skin tones to light brown.
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REF: Page 1643 | Table 46-9

28. Which cell is thought to be the progenitor cell of Kaposi sarcoma?


a. Endothelial
c. Melanocyte
b. Keratinocyte
d. Exothelial
ANS: A

Only the endothelial cell is thought to be the progenitor of Kaposi sarcoma, but the specific
origin is elusive.
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REF: Page 1645

29. Which intervention is included in the treatment of frostbite?


a. Applying local, dry heat
c. Immersing in warm water
b. Rubbing or massaging the area
d. Leaving the area uncovered
ANS: C

Immersion in a warm-water bath (40 to 42 C [104 to 107.6 F]) until frozen tissue is
thawed is the best treatment for frostbite. Rubbing or massaging the area would damage the
traumatized cells. The remaining options have no therapeutic value for frostbite.
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REF: Page 1646

30. What is the purpose of administering ibuprofen to individuals being treated for frostbite?
a. Treating fever
c. Reducing pain
b. Preventing plate aggregation
d. Inhibiting prostaglandins
ANS: D

Ibuprophen is used to inhibit prostaglandins. Although ibuprofen may be administered for the
other reasons stated, those applications are not related to the treatment of frostbite.
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REF: Page 1646

31. What is the medical term for a fungal infection of the nail plate?
a. Paronychia
c. Tinea corporis
b. Onychomycosis
d. Tinea capitis
ANS: B

Onychomycosis is the only term used to identify a fungal or dermatophyte infection of the nail
plate that occurs in 2% to 18% of the population.
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REF: Page 1647

32. What term is used to identify an inflamed hair root?


a. Tinea
c. Furuncle
b. Verruca
d. Erysipelas
ANS: C

A furuncle, or boil, is used to identify an inflammation of the hair follicles (root) that may
develop from a preceding folliculitis and spread through the follicular wall into the
surrounding dermis.
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REF: Page 1634

MULTIPLE RESPONSE
33. What effect does normal aging have on the wound healing process? (Select all that apply.)
a. Decreased cell proliferation
b. Decreased blood supply
c. Depressed immune responses
d. Depressed appetite
e. Decreased cognitive function
ANS: A, B, C

Decreased cell proliferation, decreased blood supply, and depressed immune responses delay
wound healing in aging skin. The other options are not related to wound healing progress.
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REF: Page 1619

34. Which statements are true regarding a nevus? (Select all that apply.)
a. A nevus is an aggregation of melanocytes
b. Nevi begin to form at the ages of 3 to 5 years.
c. Nevi are characterized by irregular borders.
d. Nevi share a relationship with melanoma.
e. Nevi always warrant being removed.
ANS: A, B, D

A nevus, or mole, is a benign pigmented or nonpigmented lesions that form from melanocytes
beginning at ages 3 to 5 years. Over time the cells move down into the dermis and the nevi
become nodular and symmetrical without irregular borders. Nevi may undergo transition to
malignant melanomas. Nevi repeatedly traumatized, irritated by clothing, or large lesions can
be excised.
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REF: Page 1641

35. Which statements are true regarding Kaposi sarcoma? (Select all that apply.)
a. South America has been the site of the endemic form of Kaposi sarcoma.
b. Kaposi sarcoma is a vascular malignancy.
c. It is associated with drug-induced immunosuppression.
d. Kaposi sarcoma is associated with acquired immunodeficiency syndrome (AIDS).
e. Presentation of the classic form of Kaposi sarcoma is observed on the lower legs of

older men.
ANS: B, C, D, E

Kaposi sarcoma is a vascular malignancy with four different presentations: (1) it is associated
with drug-induced immunosuppression; (2) its endemic form has been found in equatorial
Africa, (3) the classic form appears on the lower legs of older men, and (4) it is associated
with AIDS.

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REF: Page 1645

36. Which medications may exacerbate existing psoriasis? (Select all that apply.)
a. Antibiotics
b. Calcium channel blockers
c. Nonsteroidal antiinflammatory drugs (NSAIDs)
d. Beta blockers
e. Lithium
ANS: C, D, E

Antimalarial drugs, lithium, NSAIDs, and beta-blockers tend to exacerbate existing psoriasis.
This statement is not true of the remaining options.
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REF: Page 1629

37. Which inflammatory mediators are active in frostbite? (Select all that apply.)
a. Leukotrienes
b. Histamine
c. Prostaglandins
d. Bradykinin
e. Thromboxanes
ANS: B, C, D, E

The inflammatory mediators of frostbite are similar to burns and include prostaglandins,
thromboxanes, bradykinin, and histamine. Leukotrienes are not associated with frostbite.
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REF: Page 1646

38. Women who develop hirsutism may be secreting hormones associated with which condition?

(Select all that apply.)


Adrenal hyperplasia
Cushing disease
Polycystic ovaries
Addison disease
Adrenal tumor

a.
b.
c.
d.
e.

ANS: A, C, E

Women who develop hirsutism may be secreting hormones associated with ovarian or adrenal
disease. Such women should be evaluated for polycystic ovaries, adrenal hyperplasia, or
adrenal tumors. Neither Cushing nor Addison diseases are associated with hirsutism.
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REF: Page 1647

MATCHING

Match the descriptions of the skin lesions with the disorder where it is found.
______ A. Elevated, firm circumscribed area less than 1 cm in diameter
______ B. Elevated, firm, and rough lesion with a flat top surface greater than 1 cm in
diameter
______ C. Flat circumscribed area that is less than 1 cm in diameter

______ D. Elevated irregular-shaped area of cutaneous edema; solid and transient with a
variable diameter
______ E. Elevated circumscribed, superficial lesion filled with serous fluid, less than 1
cm in diameter
39.
40.
41.
42.
43.

Urticaria, allergic reaction


Varicella (chickenpox), herpes zoster (shingles)
Wart (verruca) or lichen planus
Psoriasis or seborrheic and actinic keratoses
Nevus (flat mole)

39. ANS: D
PTS: 1
REF: Page 1621 | Table 46-3
MSC: Urticaria exhibits elevated, irregular-shaped areas of cutaneous edema. Its lesions are solid and
transient with a variable diameter.
40. ANS: E
PTS: 1
REF: Page 1621 | Table 46-3
MSC: Varicella (chickenpox) and herpes zoster (shingles) are elevated circumscribed, superficial
lesions filled with serous fluid and measure less than 1 cm in diameter.
41. ANS: A
PTS: 1
REF: Page 1620 | Table 46-3
MSC: Warts (verruca) or lichen planus are elevated, firm, circumscribed areas less than 1 cm in
diameter.
42. ANS: B
PTS: 1
REF: Page 1620 | Table 46-3
MSC: Psoriasis or seborrheic and actinic keratoses are elevated, firm, and rough lesions with flat-top
surfaces that measure greater than 1 cm in diameter.
43. ANS: C
PTS: 1
REF: Page 1620 | Table 46-3
MSC: A nevus is a flat, circumscribed area that is less than 1 cm in diameter.