1 Flashcards
1
Q
epidermis and dermis come from where in embryo
A
ectoderm
2
Q
melanocytes come from where in embryo
A
neural crest
3
Q
2 types of melanin pigment
A
phaemelanin (red, yellow)
eumelanin (brown, black)
4
Q
melanin is made from
A
tyrosine
5
Q
layers of skin from most deep to superficial
A
dermis > basal layer > prickle layer > granular layer > keratin layer
6
Q
epidermis is made up of
A
90% keratinocytes
7
Q
how many layers in epidermis
A
4
8
Q
what cells are found in epidermis
A
melanocytes
langerhans
merkel cells
9
Q
how many days for keratinocytes to migrate from basement to top
A
28 days
10
Q
basal layer facts (3)
A
highly metabolic
single layer
cuboidal
11
Q
prickle cell layer features (3)
A
large polyhedral cells
desmosomes
intermediate filaments
12
Q
which layers has no nuclei
A
granular and keratin
13
Q
which layer has odland bodies (lamellar bodies)
A
granular
14
Q
granular layer has which features (5)
A
flatter cells large ketatohyaline granules (containg filagrin) odland bodies high lipid content nuclei lost
15
Q
cells in keratin layer
A
corneocytes
16
Q
keratin layer made up of what components
A
80% keratin and filaggrin
17
Q
condition where too much melanin producing hormone by pituitary
A
nelsons syndrome
18
Q
where will you find langerhan cells
A
prickle later
dermis
lymph nodes
19
Q
langerhan cells have organelle called ____ that looks like a _____
A
birbeck granule, looks like tennis racket
20
Q
merkel cell is
A
mechanoreceptor found between keratinocytes and nerve fibres
21
Q
what can trigger merkel cell cancer
A
virus
22
Q
phases of hair growth
A
anagen = growing catagen = involution (groth stops/resting begins) telogen = resting
23
Q
nails are made up of
A
keratin
24
Q
parts of nail
A
top: cuticle > lunula > nail plate
under: matrix > nail bed > hyponchium
25
acquired (autoimmune) diseases that affect dermo-epidermal junction (3)
```
Bullous pemphighigouS (s-for shallow)
Bullous pemphigoiD (d-deep)
dermatitis herpetiformis
```
26
what can be found in dermis (8)
```
fibroblasts
macrophages
mast cell
langerhans
lymphocytes
ground substances
blood vessel
nerves
```
27
buzzword: port wine stain
angioma
28
what is an angioma
benign tumour derived from vascular or lymphatic vessels
29
pacinian receptor senses
pressure (P for pressure) in dermis
30
meissners receptor senses
vibration (in sub-cutaneous)
31
3 types of skin glands
sebaceous
eccrine
apocrine
32
sebaceous gland does what
prevents moisture loss, produces sebum, anti-microbial
33
eccrine does what
cooling
34
apocrine does what
scent
35
apocrine glands are found where
axilla and perineum
36
eccrine glands found where
all over body
37
sebaceous glands found where
everywhere but palms of hands and soles of feet
38
what 2 things get metabolised in skin
vit D and thyroid hormone (T4>T3)
39
Buzzword: cafe au lait macules and axillary or inguinal freckles
neurofibromatosis
40
Buzzword: ash-leaf macule under woods lamp
tuberous sclerosis
41
4 genetic skin diseases
tuberous sclerosis
neurofibromatosis type 1 (most common)
atopic eczema
epidermolysis bullosa
42
what if defective in atopic aczema
filagrin (skin barrier gene)
43
types of epidermolysis bullosa (EB) (3)
simplex (epidermal)
junctional (DEJ)
dystropic (dermis)
44
keratin layer is also called
stratum corneum
45
what forms keratin layer
differentiation of keratinocytes > corneocytes
46
type of T cell found in epidermis
CD8+
47
type of T cell found in dermis
both CD8+ and CD4+
48
Th1 response associated with
psoriasis
49
Th2 response associated with
atopic dermatitis
50
Th17 response associated with
both psoriasis and atopic dermatitis
51
Th2 response involves what immune components
b cells
IL4
IL5
IL16
52
Th1 response involves what immune components
macrophages
IL2
IFN gamma
53
types of dendritic cells found in dermis
dermal DCs
| plasmocytoid DCs
54
plasmocytoid DCs produce
IFN gamma
55
which skin conditions are due to type 4 hypersensitivity
```
tuberculin reaction (skin test)
contact dermatitis
```
**takes 24-48hrs
56
which skin feature are due to type 1 hypersensitivity
wheel and flare (rapid)
| cellular infiltrate or nodule (late)
57
allergic contact dermatitis due to
multiple sub-threshold exposures to allergen (called afferentor sensitising stage, leading to efferent phase)
58
treatment for allergic contact dermatits
avoidance
topical steroids
oral antihistamine
59
autoimmune skin conditions
psoriasis
vitiligo
SLE
60
what is koebner phenomenon
skin lesions appearing in lines of trauma
61
which conditions show the koebner phenomenon
psoriasis
vitiligo
SLE * the autoimmune ones*
62
T cells mediate autoimmune skin conditions (psoriasis, vitiligo, SLE) by secreting what
IL17A
IL17F
IL22
these all cause keratin cell proliferation
63
impedin allows pathogen to
avoid host defences
64
aggressin allows pathogen to
cause damage directly
65
modulin allows pathogen to
cause damage indirecty
66
cytotoxin associated with S.aureus virulence
panton-valentine leukocin (PVL)
67
PVL is toxic to
leucocytes
68
what causes necrotising pneumonia
CA-MRSA - community associated MRSA
69
what causes gas gangrene
?? clostridium perfringens
group A strep
B-haemolysis (strep pyogenes)
70
B-haemolysis (strep pyogenes) can cause
cellulitis
impetigo
nec fasciitis
71
epidermis made up of which layers
```
stratum corneum (20 cells deep)
stratum lucidum (only palms/soles)
stratum granulosum (lose nuclei)
stratum spinosum
stratum basale
```
72
atopic treatments in order of thinnest to thickest consistency
lotions>creams>ointments>gels> pastes>powders
73
what is secreted by kertinocytes to make waterproof barrier
reticular bodies
74
steroid pathway
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
75
number of skin conditions known
2000
76
what % of GP appointments for skin
19%
77
when in gestation do sweat glands develop
6 months
78
nuclei loss starts and finishes where
starts granular layer, finishes keratin layer
79
granular layer is ___ cells thick
3
80
what is only found in DEJ
hemidesmosomes
81
what is most common sweat gland on face
eccrine
82
creams are
oil in water - preservatives
83
ointments contain
paraffin - no preservatives
84
where will you use a cream
hair bearing area
85
lotions contain
alcohol
86
roles of steroids
vasoconstriction
anti-inflam
anti-proliferative
87
steroids: most mild is
hydrocortisone (1%)
88
what do you use topical steroids to treat
eczema (dermatitis)
psoriasis
non-infective anti inflam issues
keloid scars
89
how much topical steroid/cream etc to cover whole body
20-30g
90
one finger tip is how much topical steroid
half gram = covers 2 hand areas
91
side effects of steroids (6)
- thinning of skin
- purpura (red/purple that does not blanche - bleeding under skin)
- stretch marks
- rosacea
- telangiectasia
- periorbital dermatitis (around mouth)
92
treatment for acne
clindamycin
erythromycin
tetracycline
93
treatment for rosacea
topical metronidazole
94
treatment for impetigo
mupiricin
| fusidic acid
95
what type of antiviral for herpex simplex
topical
96
what type of antiviral for herpex zoster
oral
97
what do you treat warts/hyperkeratotic eczema/psoriasis with
keratolytics - salicylic acid
98
what do you treat psoriasis with
emolients (coal tar/vit D alalogues/ steroids/dithranol)
99
tuberous sclerosis is inherited how
autosomal dominant
100
antibody associated with type 2 and 3 hypersensitivity
IgG and IgM
101
what are porphyrias
inherited or acquired disorders of enzymes that produce porphyrins (that absorb light) and heme
102
3 types of porphyrias
porphyria cutanea tarda
erythropoetic protorphyria
acute intermittent porphyria
103
type of porphyria in young + sun exposure
erythropoetic protorphyria
104
porphyria: most common, older, blisters, excess hair, hands/arms
porphyria cutanea tarda
105
porphyria cutanea tarda enzyme
5th step, europorphyrinogen decarboxylase
106
erythropoetic protorphyria enzyme
last enzyme, ferrochelatase
107
acute intermittent porphyria enzyme
porphobilinogen deaminase
108
eczema also called
dermatitis
109
types of eczema (4)
atopic
contact allergic
irritant
photosensitive
110
what is parakeratosis
persistence of nuclei in keratin layer
111
what is acanthosis
inc thickening of whole epidermis
112
what is papillomatosis
irregular epithelial thickening
113
what is spongiosis
oedema between keratinocytes
114
nappy rash is an example of
irritant contact dermatitis
115
flexor surface, ill defined, scaly, lichenification, excoriation
atopic eczema
116
Buzzword: monomorphic punched out lesions
eczema herpeticum (herpes simplex virus)
117
eczema treatment
```
emollients
avoid irritant
topical steroids
infection treatment
phototherapy
```
118
most common cutaneous drug reaction
exanthematous 90% of cases
119
exanthematous features
```
mucosal sparing
widespread
mild fever
4-21 days post taking drug
type 4 reaction
```
120
urticaria is what type of hypersensitivity
IgE
121
what drug usually cause urticaria
beta lactam antibiotic (2nd exposure)
122
2 types of staphylococcus
staph aureus
| coagulative neg staph (epidermidis)
123
what microbe is coagulative positive
staph aureus
124
colony colours for:
staph aureus
co-ag neg
staph aureus: gold
| co-ag neg: white
125
both strep and staph grow in what environments
aerobic/facultative aerobics
126
3 types of streptococcus
- b haemolytic
- alpha haemolytic
- gamma haemolytic
127
which strep is complete haemolytic
beta
128
which strep is partial haemolytic
alpha
129
which strep is non-heamolytic
gamma
130
other name for boil
furuncle
131
drug against strep pyogenes
penicillin
132
tinea barbae
beard
133
tinea corporis
body (think corpse)
134
tinea manuum
hand (think high five man!)
135
tinea unguium
nails (think UNder nails)
136
tinea gruris
groin (think g for groin)
137
treatment for fungal infection
clotrimazole
138
treatment for candida
clotrimazole cream + oral fluconazole
139
itching in finger webs, wrists, groin
scabies
140
treatment for lice
malathion
141
chicken pox affects what
nerve root (body wide rash)
142
chicken pox skin lesion progression
macules > papules > vesicles > scabs
143
which herpes simplex virus causes oral lesions
type 1
144
which herpes simplex virus causes genital herpes
type 2
145
what do you treat HSV and varicela zoster with
aciclovir
146
how does aciclovir work (viral treatment)
is analogue of guanisine, incorporated into DNA and inhibits replication
147
buzzword: target lesions
erythema multiform
148
Buzzword: purlescent nodules, ubilicated
molluscum contagiosum
149
what HPV causes warts/verucas
1-4
150
what HPV causes genital warts
6 & 11
151
what HPV causes cervical cancers
16 & 18
152
types of HPV vaccines
gardasil (6,11,16,18)
| cervarix (16, 18)
153
blistering rash at back of throat
herpangioma
154
slapped cheek disease also called
erythema infectiosum
155
what causes slapped cheek/erythema infectiosum
parvovirus B19
156
rash on feet and palms
syphilis
157
types of collagen in dermis
type 1 and 2
158
what can make rosacea worse
sunlight, alcohol, spicy food, stress
159
4 types of pemphigus, which is most common
pempigus vulgaris (most common)
160
antibody in pemphigus and to what
IgG against desmoglien 3
161
what is desmoglien 3
maintains desmosomes and attachments
162
pathophysiology in pemphigus
immune complex formation> compliment activation> protease release > disruption of desmosomes > acanthosis > bullae and erosions
163
name for popped blisters
erosions
164
bullous pemphigoid location
sub-epidermal
165
antibody for pemphigoid
IgG to hemidesmosomes that anchor basal cells to basement membrane
166
dermatitis herpetiformis associated with
coeliacs & HLA-DQ2
167
itchy symetrical lesions on elbows, knees & buttocks
dermatitis herpetiformis
168
dermatitis herpetiformis due to
IgA against gliadin component of gluten but cross react with connective tissue matrix proteins
169
most common type of psoriasis
psoriasis vulgaris
170
areas affected by psoriasis
extensors, posterior scalp, sacrum, nails
171
buzzwords: onycholysis, nail pitting, sharply demarcated
psoriasis
172
treatment for acne
benzoyl peroxide, topical vit A, topical antibiotics
173
treatment in severe acne
oral isotretinoin (affects sebaceous activity, initially aggravates acne)
174
what anti biotic can you give in bullous pemphigoid
tetracycline
175
pruritis is
itch
176
history of itch in mouth the blistering
pullous pemphigoid
177
of pemphigoid and pemphigus which affects mucosal surfaces
pemphigus
178
```
A:
B:
C:
D:
E;
of describing skin lesions
```
```
A: asymmetry
B: borders
C: colour
D: diameter
E; evolution, everything else
```
179
which skin cancer is most common
basal cell
180
pearly, rolled border, central ulcer
basal cell
181
"rodent ulcer"
basal cell
182
which cancer rarely metastasises
basal cell
183
type of light that causes cancer
ultra violet
184
actinic keratosis becomes
bowens disease
185
bowens disease becomes
squamous cell carcinoma
186
crusted fast growing lesion
squamous cell
187
```
skin types:
1:
2:
3:
4:
5:
6:
```
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
site you get squamous cell
sun exposed areas: head, neck, hands, forearms
189
basal cell and melanoma distribution
less sun exposed areas
190
xeroderma pigmentosa is
genteic disorder, cant repair sun damaged DNA
191
what cancer do those with xeroderma pigmentosa get
SSC and melanoma
192
2 types of melanoma
cutaneous
| ocular/mucosal
193
which type of UV is not absorbed by ozone
UVA
194
most common cancers to metastasise
malanoma and merkel cell
195
most common sites for melanoma
face, neck, back
196
drug given to those having PUVA
psoralen
197
gene that determines pigment of skin
melanocortin 1 receptor (MC1R)
1 defective copy = freckles
2 defective copies = freckles & red hair
198
fancy name for freckle
ephilides
199
fancy name for liver spots
actinic lentigines
200
fancy name for mole
melanocytic naevi
201
congenital naevi size categorisation according to size
small 2cm but 20cm
202
what is a dyspastic naevi
unusual looking mole that grow larger than others (>6mm) - looks like melanoma but isn't one
203
4 different types of malignant melanoma
superficial spreading
acral/mucosal lentigous
lentigo maligna
nodular
204
which 3 types of malignant melanoma invade dermis
superficial spreading
acral/mucosal lentigous
lentigo maligna
** this is vertical growth faze (VGP), only VGP can metastasise **
205
which malignant melanoma does not invade dermis
nodular (no VGP - cant metastasise)
206
RGP is
rapid growth phase
207
what indicates poor prognosis in melanomas
ulceration, high mitotic rate, lymphovascular invasion, satelites, sentinel lymphnode invasion
208
what is a satelite
new mole that grows near an existing mole
209
common areas malignant melanoma spreads to
liver, breast, lung, GI, brain
210
scoring system for melanoma (breslow thickness)
pTis: melanoma in-situ 100% survival
pT1: 4mm 20%
**in-situ means in epidermis**
211
how do you treat in-situ melanoma
cut out with 5mm clearance
212
if invasive by <1mm treat how
cut out with 1cm clearance
213
if invasive by >1mm treat how
cut out with 2cm clearance
214
mutation that increases risk of melanomas
BRAF gene mutation
215
how do you treat someone with BRAF mutation
give BRAF inhibitor
216
rik factors for SSC (5)
```
renal transplant
sunbeds for 5yrs
life long outdoor occupation
skin type
immunosupresion
```
217
what is breslow thickness
depth from the dermo-epidermal junction to the deepest
| malanoma cells - it is a prognostic indicator
218
long standing scaly area/painful nodule
SSC
219
itchy, gradually bigger with darker area
superficial spreading malignant melanoma
220
bleeds/veins
basal cell
221
slightly pigmented/itchy
dermatofibroma (benign)
222
scaly plaque on calf growing gradually
bowens disease (can look like psoriasis)
223
UVB causes ?
direct DNA damage
224
UVA causes ?
indirect DNA damage
225
least life threatening cancer
basal cell
226
best aestetic result when cutting out a mole is
elliptical excision, scalpel cutting at 90 degrees to skin
227
where do you get venous ulcers
medial and lateral malleolus
228
where do you get arterial ulcers
foot or mid-shin
229
where do you get pressure ulcers
sacrum, heels, ischia, greater trochanter
230
compression ulcers should NOT be used on
arterial ulcers
