The ER physician has asked for a surgical consult, so that a surgeon will look at the wound and likely incise it (open it up) and drain or remove the damaged cells and other debris. A surgical resident responded to the consultation and came in to take a look at Laura's wound. He compared the left crural region with the right and noted how red and swollen the wound and surrounding tissues were. The resident then inspected the right leg closely. He explained that diabetes could cause a number of different skin problems, or dermopathies, which could increase her risk for infections. He noted that she had some hyperpigmentation, or small dark patches, on the skin around both tibial crests. Laura told the resident those patches had appeared a few years ago, before she had gotten her diabetes better controlled. The resident told her that those are caused when red blood cells leak into the deeper layers of skin and are broken down, leaving. behind the hemoglobin and iron that turn brownish-black and get trapped in phagocytes in the dermis. He then palpated the wound site, which was extremely uncomfortable for Laura. The surgical resident asked if Laura had seen an insect or spider actually bite her. He was more concerned that she may have become infected with an antibiotic-resistant form of bacteria that was quickly spreading through her tissues and could even get into her bloodstream. The resident went to discuss his findings and assessment with his attending physician, but he was sure that they would need to take Laura into the operating room (OR) for an incision and drainage (I\&D) of the wound as well as a few days of intravenous antibiotics in the hospital. The resident ordered some antibiotics and blood cultures to make sure that bacteria had not already found its way into her bloodstream. 1. The surgical resident noted that Laura had some hyperpigmented patches of skin on both of her shins, which is associated with diabetes. These patches are caused by the breakdown of hemoglobin in the dermis, which leaves behind a brownish-black pigment called hemosiderin that is similar in appearance to melanin. Which of the following statements is false with regard to melanin, melanocytes, and hemosiderin? a. Hemosiderin offers no protection from UV radiation, as this pigment is found deep to stem 'cells in the stratum basale. b. Moles represent an increase in the number of melanocytes in one location and are common. C. Melanocytes are found in the dermal papillae of the papillary layer of the dermis. d. Melanin is made continuously but can also be stimulated by UV radiation exposure. The surgical resident returned to admit Laura into their service. She was going to have her wound opened and cleaned thoroughly in the sterile environment of the OR. They would also take a small piece of tissue from the deepest region of the wound and send it to the microbiology lab, where they could culture the tissue to see if they coufd identify the organism causing Laura.

1. The ER physician has asked for a surgical consult, so that a surgeon will look at the wound and
likely incise it (open it up) and drain or remove the damaged cells and other debris. A surgical
resident responded to the consultation and came in to take a look at Laura's wound. He compared
the left crural region with the right and noted how red and swollen the wound and surrounding
tissues were. The resident then inspected the right leg closely. He explained that diabetes could
cause a number of different skin problems, or dermopathies, which could increase her risk for
infections. He noted that she had some hyperpigmentation, or small dark patches, on the skin
around both tibial crests. Laura told the resident those patches had appeared a few years ago,
before she had gotten her diabetes better controlled. The resident told her that those are caused
when red blood cells leak into the deeper layers of skin and are broken down, leaving. behind the
hemoglobin and iron that turn brownish-black and get trapped in phagocytes in the dermis. He
then palpated the wound site, which was extremely uncomfortable for Laura. The surgical
resident asked if Laura had seen an insect or spider actually bite her. He was more concerned that
she may have become infected with an antibiotic-resistant form of bacteria that was quickly
spreading through her tissues and could even get into her bloodstream. The resident went to
discuss his findings and assessment with his attending physician, but he was sure that they would
need to take Laura into the operating room (OR) for an incision and drainage (I&D) of the
wound as well as a few days of intravenous antibiotics in the hospital. The resident ordered some
antibiotics and blood cultures to make sure that bacteria had not already found its way into her
bloodstream. 1. The surgical resident noted that Laura had some hyperpigmented patches of skin
on both of her shins, which is associated with diabetes. These patches are caused by the
breakdown of hemoglobin in the dermis, which leaves behind a brownish-black pigment called
hemosiderin that is similar in appearance to melanin. Which of the following statements is false
with regard to melanin, melanocytes, and hemosiderin? a. Hemosiderin offers no protection from
UV radiation, as this pigment is found deep to stem 'cells in the stratum basale. b. Moles
represent an increase in the number of melanocytes in one location and are common. C.
Melanocytes are found in the dermal papillae of the papillary layer of the dermis. d. Melanin is
made continuously but can also be stimulated by UV radiation exposure. The surgical resident
returned to admit Laura into their service. She was going to have her wound opened and cleaned
thoroughly in the sterile environment of the OR. They would also take a small piece of tissue
from the deepest region of the wound and send it to the microbiology lab, where they could
culture the tissue to see if they coufd identify the organism causing Laura's infection. The
resident wanted to exam Laura's legs and feet a little more closely. He palpated the tops of both
feet and the medial aspect of both ankles for arteries to check Laura's blood supply to her feet.
The resident did find pulses here, although they were not as strong as he would have liked. He
noted that the skin on the right leg was very dry, and there was no hair growing on either leg or
foot. These findings occur when the small blood vessels supplying the skin and its accessories
such as hair follicles, nails, and sweat glands are damaged by diabetes. He also noted that she
had no hair on the dorsum of her toes, and that her toenails were thickened, yellowish, and
brittle, a sign of the fungal infections that are common in patients with diabetes. The surgical
resident recommended that Laura see an endocrinologist, a specialist who treats conditions
associated with the endocrine system, before she was discharged from the hospital. 1. Diabetes
can severely damage the small blood vessels and capillaries that supply the cells of sebaceous
glands. Which of the following would you expect if these glands in Laura's legs were not
functioning properly because they were not getting sufficient blood supply? a. The sebaceous
glands would not be able to synthesize and secrete as much cerumen, which could lead to dry

2. skin and hair and possibly even an increased risk of skin infections. b. The sebaceous glands
would not be able to synthesize and secrete as much sebum, which could lead to dry skin and
hair and possibly even an increased risk of skin infections. C. The sebaceous glands would be
stimulated to produce more cerumen, leading to an increased risk of infections and dry skin and
hair. d. The sebaceous glands would be stimulated to produce more sebum, leading to an
increased risk of infection and dry skin and hair.