Disorders of Skin Integrity

Disorders of Skin Integrity

Disorders of Skin Integrity

Disorders of Skin Integrity and Function

Leonard works in the agriculture industry and raises beef cattle. At 60 years of age, he has spent most of his life working outdoors harvesting hay and tending to his herds. His wife was the first to notice a change in his skin. One day, after taking off his shirt, she noticed a significant change in the mole he had on his right shoulder. It not only was darker but was moist and appeared to have been bleeding at one point. Surrounding the mole, his skin was red. His wife remembered hearing stories of Leonard working on his father’s farm, spending long hours out in the hot sun even though his father had gone into the barn to work during the hottest part of the day. She insisted him go to the family physician to have it examined.

1. Leonard’s physician performed a biopsy on the lesion and told Leonard he suspected the growth may be malignant melanoma. What cells are affected in this form of skin cancer? How might his childhood exposures to the sun predispose him to this form of cancer?
2. How do UVA and UVB rays contribute to the process of oncogenesis in skin cells?
3. The mole on Leonard’s shoulder was a nevocellular nevus. What are the cellular composition and appearance of this type of mole before it underwent malignant change?

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Disorders of Musculoskeletal Function: Rheumatic Disorders

Rick is a 27-year-old who works in an accounting firm. He had started to experience lower back pain and stiffness that he thought were a result of the long hours he spent at his desk. More recently, however, he began to have sleep difficulties. He found that he often woke up during the night feeling hot and sometimes sweaty. Furthermore, his back pain disrupted his sleep, particularly when it radiated around his pelvis and into his thighs. When his lack of sleep began to interfere with his work, he went to an osteopath to see what was wrong. She listened to his case history carefully. Upon physical examination, she noted a slight decrease in his lumbar lordosis and a reduced range of movement in his lumbar spine. His blood tests revealed the presence of HLA-B27, an elevated ESR, and absence of RH. His radiograph showed evidence of sacroiliitis.

1. What is the likely diagnosis Rick received? What are the common clinical presentation and manifestations of the disease?
2. Why is osteoarthritis of the hips a potential secondary complication of this disease? What are the structural changes that occur in the articular cartilage of an osteoarthritic joint?
3. What is the effect of advanced ankylosing spondylitis on lung function?

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