1 Flashcards

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1
Q

epidermis and dermis come from where in embryo

A

ectoderm

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2
Q

melanocytes come from where in embryo

A

neural crest

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3
Q

2 types of melanin pigment

A

phaemelanin (red, yellow)

eumelanin (brown, black)

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4
Q

melanin is made from

A

tyrosine

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5
Q

layers of skin from most deep to superficial

A

dermis > basal layer > prickle layer > granular layer > keratin layer

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6
Q

epidermis is made up of

A

90% keratinocytes

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7
Q

how many layers in epidermis

A

4

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8
Q

what cells are found in epidermis

A

melanocytes
langerhans
merkel cells

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9
Q

how many days for keratinocytes to migrate from basement to top

A

28 days

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10
Q

basal layer facts (3)

A

highly metabolic
single layer
cuboidal

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11
Q

prickle cell layer features (3)

A

large polyhedral cells
desmosomes
intermediate filaments

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12
Q

which layers has no nuclei

A

granular and keratin

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13
Q

which layer has odland bodies (lamellar bodies)

A

granular

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14
Q

granular layer has which features (5)

A
flatter cells 
large ketatohyaline granules (containg filagrin)
odland bodies 
high lipid content 
nuclei lost
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15
Q

cells in keratin layer

A

corneocytes

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16
Q

keratin layer made up of what components

A

80% keratin and filaggrin

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17
Q

condition where too much melanin producing hormone by pituitary

A

nelsons syndrome

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18
Q

where will you find langerhan cells

A

prickle later
dermis
lymph nodes

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19
Q

langerhan cells have organelle called ____ that looks like a _____

A

birbeck granule, looks like tennis racket

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20
Q

merkel cell is

A

mechanoreceptor found between keratinocytes and nerve fibres

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21
Q

what can trigger merkel cell cancer

A

virus

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22
Q

phases of hair growth

A
anagen = growing 
catagen = involution (groth stops/resting begins)
telogen = resting
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23
Q

nails are made up of

A

keratin

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24
Q

parts of nail

A

top: cuticle > lunula > nail plate
under: matrix > nail bed > hyponchium

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25
Q

acquired (autoimmune) diseases that affect dermo-epidermal junction (3)

A
Bullous pemphighigouS (s-for shallow)
Bullous pemphigoiD (d-deep)
dermatitis herpetiformis
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26
Q

what can be found in dermis (8)

A
fibroblasts 
macrophages 
mast cell 
langerhans 
lymphocytes
ground substances 
blood vessel 
nerves
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27
Q

buzzword: port wine stain

A

angioma

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28
Q

what is an angioma

A

benign tumour derived from vascular or lymphatic vessels

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29
Q

pacinian receptor senses

A

pressure (P for pressure) in dermis

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30
Q

meissners receptor senses

A

vibration (in sub-cutaneous)

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31
Q

3 types of skin glands

A

sebaceous
eccrine
apocrine

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32
Q

sebaceous gland does what

A

prevents moisture loss, produces sebum, anti-microbial

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33
Q

eccrine does what

A

cooling

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34
Q

apocrine does what

A

scent

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35
Q

apocrine glands are found where

A

axilla and perineum

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36
Q

eccrine glands found where

A

all over body

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37
Q

sebaceous glands found where

A

everywhere but palms of hands and soles of feet

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38
Q

what 2 things get metabolised in skin

A

vit D and thyroid hormone (T4>T3)

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39
Q

Buzzword: cafe au lait macules and axillary or inguinal freckles

A

neurofibromatosis

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40
Q

Buzzword: ash-leaf macule under woods lamp

A

tuberous sclerosis

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41
Q

4 genetic skin diseases

A

tuberous sclerosis
neurofibromatosis type 1 (most common)
atopic eczema
epidermolysis bullosa

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42
Q

what if defective in atopic aczema

A

filagrin (skin barrier gene)

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43
Q

types of epidermolysis bullosa (EB) (3)

A

simplex (epidermal)
junctional (DEJ)
dystropic (dermis)

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44
Q

keratin layer is also called

A

stratum corneum

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45
Q

what forms keratin layer

A

differentiation of keratinocytes > corneocytes

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46
Q

type of T cell found in epidermis

A

CD8+

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47
Q

type of T cell found in dermis

A

both CD8+ and CD4+

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48
Q

Th1 response associated with

A

psoriasis

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49
Q

Th2 response associated with

A

atopic dermatitis

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50
Q

Th17 response associated with

A

both psoriasis and atopic dermatitis

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51
Q

Th2 response involves what immune components

A

b cells
IL4
IL5
IL16

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52
Q

Th1 response involves what immune components

A

macrophages
IL2
IFN gamma

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53
Q

types of dendritic cells found in dermis

A

dermal DCs

plasmocytoid DCs

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54
Q

plasmocytoid DCs produce

A

IFN gamma

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55
Q

which skin conditions are due to type 4 hypersensitivity

A
tuberculin reaction (skin test)
contact dermatitis 

**takes 24-48hrs

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56
Q

which skin feature are due to type 1 hypersensitivity

A

wheel and flare (rapid)

cellular infiltrate or nodule (late)

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57
Q

allergic contact dermatitis due to

A

multiple sub-threshold exposures to allergen (called afferentor sensitising stage, leading to efferent phase)

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58
Q

treatment for allergic contact dermatits

A

avoidance
topical steroids
oral antihistamine

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59
Q

autoimmune skin conditions

A

psoriasis
vitiligo
SLE

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60
Q

what is koebner phenomenon

A

skin lesions appearing in lines of trauma

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61
Q

which conditions show the koebner phenomenon

A

psoriasis
vitiligo
SLE * the autoimmune ones*

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62
Q

T cells mediate autoimmune skin conditions (psoriasis, vitiligo, SLE) by secreting what

A

IL17A
IL17F
IL22

these all cause keratin cell proliferation

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63
Q

impedin allows pathogen to

A

avoid host defences

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64
Q

aggressin allows pathogen to

A

cause damage directly

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65
Q

modulin allows pathogen to

A

cause damage indirecty

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66
Q

cytotoxin associated with S.aureus virulence

A

panton-valentine leukocin (PVL)

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67
Q

PVL is toxic to

A

leucocytes

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68
Q

what causes necrotising pneumonia

A

CA-MRSA - community associated MRSA

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69
Q

what causes gas gangrene

A

?? clostridium perfringens
group A strep
B-haemolysis (strep pyogenes)

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70
Q

B-haemolysis (strep pyogenes) can cause

A

cellulitis
impetigo
nec fasciitis

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71
Q

epidermis made up of which layers

A
stratum corneum (20 cells deep)
stratum lucidum (only palms/soles)
stratum granulosum (lose nuclei)
stratum spinosum 
stratum basale
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72
Q

atopic treatments in order of thinnest to thickest consistency

A

lotions>creams>ointments>gels> pastes>powders

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73
Q

what is secreted by kertinocytes to make waterproof barrier

A

reticular bodies

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74
Q

steroid pathway

A

diffuses (because lipophilic) > bind receptors in cytoplasm > conformational change exposing DNA-binding site > receptor+steroid complex moves to nucleus and binds steroid response element in DNA > transcription of specific genes either switched on or off

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75
Q

number of skin conditions known

A

2000

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76
Q

what % of GP appointments for skin

A

19%

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77
Q

when in gestation do sweat glands develop

A

6 months

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78
Q

nuclei loss starts and finishes where

A

starts granular layer, finishes keratin layer

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79
Q

granular layer is ___ cells thick

A

3

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80
Q

what is only found in DEJ

A

hemidesmosomes

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81
Q

what is most common sweat gland on face

A

eccrine

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82
Q

creams are

A

oil in water - preservatives

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83
Q

ointments contain

A

paraffin - no preservatives

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84
Q

where will you use a cream

A

hair bearing area

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85
Q

lotions contain

A

alcohol

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86
Q

roles of steroids

A

vasoconstriction
anti-inflam
anti-proliferative

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87
Q

steroids: most mild is

A

hydrocortisone (1%)

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88
Q

what do you use topical steroids to treat

A

eczema (dermatitis)
psoriasis
non-infective anti inflam issues
keloid scars

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89
Q

how much topical steroid/cream etc to cover whole body

A

20-30g

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90
Q

one finger tip is how much topical steroid

A

half gram = covers 2 hand areas

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91
Q

side effects of steroids (6)

A
  • thinning of skin
  • purpura (red/purple that does not blanche - bleeding under skin)
  • stretch marks
  • rosacea
  • telangiectasia
  • periorbital dermatitis (around mouth)
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92
Q

treatment for acne

A

clindamycin
erythromycin
tetracycline

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93
Q

treatment for rosacea

A

topical metronidazole

94
Q

treatment for impetigo

A

mupiricin

fusidic acid

95
Q

what type of antiviral for herpex simplex

A

topical

96
Q

what type of antiviral for herpex zoster

A

oral

97
Q

what do you treat warts/hyperkeratotic eczema/psoriasis with

A

keratolytics - salicylic acid

98
Q

what do you treat psoriasis with

A

emolients (coal tar/vit D alalogues/ steroids/dithranol)

99
Q

tuberous sclerosis is inherited how

A

autosomal dominant

100
Q

antibody associated with type 2 and 3 hypersensitivity

A

IgG and IgM

101
Q

what are porphyrias

A

inherited or acquired disorders of enzymes that produce porphyrins (that absorb light) and heme

102
Q

3 types of porphyrias

A

porphyria cutanea tarda
erythropoetic protorphyria
acute intermittent porphyria

103
Q

type of porphyria in young + sun exposure

A

erythropoetic protorphyria

104
Q

porphyria: most common, older, blisters, excess hair, hands/arms

A

porphyria cutanea tarda

105
Q

porphyria cutanea tarda enzyme

A

5th step, europorphyrinogen decarboxylase

106
Q

erythropoetic protorphyria enzyme

A

last enzyme, ferrochelatase

107
Q

acute intermittent porphyria enzyme

A

porphobilinogen deaminase

108
Q

eczema also called

A

dermatitis

109
Q

types of eczema (4)

A

atopic
contact allergic
irritant
photosensitive

110
Q

what is parakeratosis

A

persistence of nuclei in keratin layer

111
Q

what is acanthosis

A

inc thickening of whole epidermis

112
Q

what is papillomatosis

A

irregular epithelial thickening

113
Q

what is spongiosis

A

oedema between keratinocytes

114
Q

nappy rash is an example of

A

irritant contact dermatitis

115
Q

flexor surface, ill defined, scaly, lichenification, excoriation

A

atopic eczema

116
Q

Buzzword: monomorphic punched out lesions

A

eczema herpeticum (herpes simplex virus)

117
Q

eczema treatment

A
emollients 
avoid irritant
topical steroids
infection treatment 
phototherapy
118
Q

most common cutaneous drug reaction

A

exanthematous 90% of cases

119
Q

exanthematous features

A
mucosal sparing 
widespread
mild fever 
4-21 days post taking drug
type 4 reaction
120
Q

urticaria is what type of hypersensitivity

A

IgE

121
Q

what drug usually cause urticaria

A

beta lactam antibiotic (2nd exposure)

122
Q

2 types of staphylococcus

A

staph aureus

coagulative neg staph (epidermidis)

123
Q

what microbe is coagulative positive

A

staph aureus

124
Q

colony colours for:
staph aureus
co-ag neg

A

staph aureus: gold

co-ag neg: white

125
Q

both strep and staph grow in what environments

A

aerobic/facultative aerobics

126
Q

3 types of streptococcus

A
  • b haemolytic
  • alpha haemolytic
  • gamma haemolytic
127
Q

which strep is complete haemolytic

A

beta

128
Q

which strep is partial haemolytic

A

alpha

129
Q

which strep is non-heamolytic

A

gamma

130
Q

other name for boil

A

furuncle

131
Q

drug against strep pyogenes

A

penicillin

132
Q

tinea barbae

A

beard

133
Q

tinea corporis

A

body (think corpse)

134
Q

tinea manuum

A

hand (think high five man!)

135
Q

tinea unguium

A

nails (think UNder nails)

136
Q

tinea gruris

A

groin (think g for groin)

137
Q

treatment for fungal infection

A

clotrimazole

138
Q

treatment for candida

A

clotrimazole cream + oral fluconazole

139
Q

itching in finger webs, wrists, groin

A

scabies

140
Q

treatment for lice

A

malathion

141
Q

chicken pox affects what

A

nerve root (body wide rash)

142
Q

chicken pox skin lesion progression

A

macules > papules > vesicles > scabs

143
Q

which herpes simplex virus causes oral lesions

A

type 1

144
Q

which herpes simplex virus causes genital herpes

A

type 2

145
Q

what do you treat HSV and varicela zoster with

A

aciclovir

146
Q

how does aciclovir work (viral treatment)

A

is analogue of guanisine, incorporated into DNA and inhibits replication

147
Q

buzzword: target lesions

A

erythema multiform

148
Q

Buzzword: purlescent nodules, ubilicated

A

molluscum contagiosum

149
Q

what HPV causes warts/verucas

A

1-4

150
Q

what HPV causes genital warts

A

6 & 11

151
Q

what HPV causes cervical cancers

A

16 & 18

152
Q

types of HPV vaccines

A

gardasil (6,11,16,18)

cervarix (16, 18)

153
Q

blistering rash at back of throat

A

herpangioma

154
Q

slapped cheek disease also called

A

erythema infectiosum

155
Q

what causes slapped cheek/erythema infectiosum

A

parvovirus B19

156
Q

rash on feet and palms

A

syphilis

157
Q

types of collagen in dermis

A

type 1 and 2

158
Q

what can make rosacea worse

A

sunlight, alcohol, spicy food, stress

159
Q

4 types of pemphigus, which is most common

A

pempigus vulgaris (most common)

160
Q

antibody in pemphigus and to what

A

IgG against desmoglien 3

161
Q

what is desmoglien 3

A

maintains desmosomes and attachments

162
Q

pathophysiology in pemphigus

A

immune complex formation> compliment activation> protease release > disruption of desmosomes > acanthosis > bullae and erosions

163
Q

name for popped blisters

A

erosions

164
Q

bullous pemphigoid location

A

sub-epidermal

165
Q

antibody for pemphigoid

A

IgG to hemidesmosomes that anchor basal cells to basement membrane

166
Q

dermatitis herpetiformis associated with

A

coeliacs & HLA-DQ2

167
Q

itchy symetrical lesions on elbows, knees & buttocks

A

dermatitis herpetiformis

168
Q

dermatitis herpetiformis due to

A

IgA against gliadin component of gluten but cross react with connective tissue matrix proteins

169
Q

most common type of psoriasis

A

psoriasis vulgaris

170
Q

areas affected by psoriasis

A

extensors, posterior scalp, sacrum, nails

171
Q

buzzwords: onycholysis, nail pitting, sharply demarcated

A

psoriasis

172
Q

treatment for acne

A

benzoyl peroxide, topical vit A, topical antibiotics

173
Q

treatment in severe acne

A

oral isotretinoin (affects sebaceous activity, initially aggravates acne)

174
Q

what anti biotic can you give in bullous pemphigoid

A

tetracycline

175
Q

pruritis is

A

itch

176
Q

history of itch in mouth the blistering

A

pullous pemphigoid

177
Q

of pemphigoid and pemphigus which affects mucosal surfaces

A

pemphigus

178
Q
A: 
B:
C: 
D: 
E; 
of describing skin lesions
A
A: asymmetry
B: borders 
C: colour
D: diameter
E; evolution, everything else
179
Q

which skin cancer is most common

A

basal cell

180
Q

pearly, rolled border, central ulcer

A

basal cell

181
Q

“rodent ulcer”

A

basal cell

182
Q

which cancer rarely metastasises

A

basal cell

183
Q

type of light that causes cancer

A

ultra violet

184
Q

actinic keratosis becomes

A

bowens disease

185
Q

bowens disease becomes

A

squamous cell carcinoma

186
Q

crusted fast growing lesion

A

squamous cell

187
Q
skin types:
1:
2:
3:
4:
5:
6:
A

1: burn/never tan
2: usually burn/can tan
3: can burn/usually tan
4: always tans/never burn
5: brown skin
6: black

188
Q

site you get squamous cell

A

sun exposed areas: head, neck, hands, forearms

189
Q

basal cell and melanoma distribution

A

less sun exposed areas

190
Q

xeroderma pigmentosa is

A

genteic disorder, cant repair sun damaged DNA

191
Q

what cancer do those with xeroderma pigmentosa get

A

SSC and melanoma

192
Q

2 types of melanoma

A

cutaneous

ocular/mucosal

193
Q

which type of UV is not absorbed by ozone

A

UVA

194
Q

most common cancers to metastasise

A

malanoma and merkel cell

195
Q

most common sites for melanoma

A

face, neck, back

196
Q

drug given to those having PUVA

A

psoralen

197
Q

gene that determines pigment of skin

A

melanocortin 1 receptor (MC1R)

1 defective copy = freckles
2 defective copies = freckles & red hair

198
Q

fancy name for freckle

A

ephilides

199
Q

fancy name for liver spots

A

actinic lentigines

200
Q

fancy name for mole

A

melanocytic naevi

201
Q

congenital naevi size categorisation according to size

A

small 2cm but 20cm

202
Q

what is a dyspastic naevi

A

unusual looking mole that grow larger than others (>6mm) - looks like melanoma but isn’t one

203
Q

4 different types of malignant melanoma

A

superficial spreading
acral/mucosal lentigous
lentigo maligna
nodular

204
Q

which 3 types of malignant melanoma invade dermis

A

superficial spreading
acral/mucosal lentigous
lentigo maligna

** this is vertical growth faze (VGP), only VGP can metastasise **

205
Q

which malignant melanoma does not invade dermis

A

nodular (no VGP - cant metastasise)

206
Q

RGP is

A

rapid growth phase

207
Q

what indicates poor prognosis in melanomas

A

ulceration, high mitotic rate, lymphovascular invasion, satelites, sentinel lymphnode invasion

208
Q

what is a satelite

A

new mole that grows near an existing mole

209
Q

common areas malignant melanoma spreads to

A

liver, breast, lung, GI, brain

210
Q

scoring system for melanoma (breslow thickness)

A

pTis: melanoma in-situ 100% survival
pT1: 4mm 20%

in-situ means in epidermis

211
Q

how do you treat in-situ melanoma

A

cut out with 5mm clearance

212
Q

if invasive by <1mm treat how

A

cut out with 1cm clearance

213
Q

if invasive by >1mm treat how

A

cut out with 2cm clearance

214
Q

mutation that increases risk of melanomas

A

BRAF gene mutation

215
Q

how do you treat someone with BRAF mutation

A

give BRAF inhibitor

216
Q

rik factors for SSC (5)

A
renal transplant
sunbeds for 5yrs
life long outdoor occupation 
skin type
immunosupresion
217
Q

what is breslow thickness

A

depth from the dermo-epidermal junction to the deepest

malanoma cells - it is a prognostic indicator

218
Q

long standing scaly area/painful nodule

A

SSC

219
Q

itchy, gradually bigger with darker area

A

superficial spreading malignant melanoma

220
Q

bleeds/veins

A

basal cell

221
Q

slightly pigmented/itchy

A

dermatofibroma (benign)

222
Q

scaly plaque on calf growing gradually

A

bowens disease (can look like psoriasis)

223
Q

UVB causes ?

A

direct DNA damage

224
Q

UVA causes ?

A

indirect DNA damage

225
Q

least life threatening cancer

A

basal cell

226
Q

best aestetic result when cutting out a mole is

A

elliptical excision, scalpel cutting at 90 degrees to skin

227
Q

where do you get venous ulcers

A

medial and lateral malleolus

228
Q

where do you get arterial ulcers

A

foot or mid-shin

229
Q

where do you get pressure ulcers

A

sacrum, heels, ischia, greater trochanter

230
Q

compression ulcers should NOT be used on

A

arterial ulcers