Cumulative Exam - Semester 2 - Block 9

Question 1

Layers of the epidermis

Answer 1

Corneum
Lucidum (only palms and soles)
Granulosum
Spinosum
Basale

Question 2

Which layer of the skin is blue on H&E? Which is pink?

Answer 2

Blue - epidermis

Pink - dermis

Question 3

Anchors the skin to the BM

Answer 3

Hemidesmosomes

Question 4

Anchores keratinocytes to one another

Answer 4

Desmosomes

Question 5

Flat skin lesion, <1 cm

Answer 5

Macule

Question 6

Flat skin lesion, >1 cm

Answer 6

Patch

Question 7

Elevated skin lesion, <1 cm

Answer 7

Papule

Question 8

Elevated skin lesion, >1 cm

Answer 8

Plaque

Question 9

Fluid-filled blister, <1 cm

Answer 9

Vesicle

Question 10

Fluid-filled blister, >1 cm

Answer 10

Bulla

Question 11

Pus-filled blister, usually <1 cm

Answer 11

Pustule

Question 12

Smooth papule or plaque, any size

Answer 12

Wheal

Question 13

Flaking of the SC

Answer 13

Scale

Question 14

Dry exudate

Answer 14

Crust

Question 15

Defective desquamatization leads to a build up of compacted scales, mostly hereditary

Answer 15

Icthyosis

Question 16

Microscopic features of icthyosis vulgaris

Answer 16

Orthokeratosis (Hyperkeratosis of anuclear keratinocytes within the stratum corneum)
Thinning or loss of granulosa

Question 17

3 benign epithelial neoplasms

Answer 17

1. Seborrheic keratosis
2. Acanthosis nigricans
3. Skin tag

Question 18

Stuck-on verrucous waxy brown papules or plaques

Answer 18

Seborrheic keratosis

Question 19

Microscopic features of seborrheic keratosis

Answer 19

Hyperkeratosis
Papillomatosis (Irregular undulation of the epidermal surface)
Epidermal acanthosis ( (thickened spinosum)
String sign (flat base)
Pseudohorn cysts

Question 20

Hyperpigmehted verrucous plaques with velvety scales, often in creases of the axilla and neck

Answer 20

Acanthosis nigricans

Question 21

Microscopic features of acanthosis nigricans

Answer 21

Hyperkeratosis
Papillomatosis
Basal layer hyperpigmentation

Question 22

Flesh-colored pedunculated papules with a smooth or folded surface

Answer 22

Acrochordon (fibroepithelial polyp, skin tag)

Question 23

Microscopic features of skin tag

Answer 23

Polypoid with loose fibrous core

Papillomatosis

Question 24

Ill-defined, scaly erythematous patch located on sun-damaged skin, precursor of SqCC

Answer 24

Actinic keratinois

Question 25

Histologic features of actinic keratosis

Answer 25

Orthokeratosis alternating with parakeratosis (Flattened, keratinocyte nuclei within the stratum corneum, where nuclei are not normally present) - flag sign Basal layer atypia

Question 26

2 types of SqCC in situ

Answer 26

1. Bowen's disease - cellular atypia at all levels of the epidermis (full thickness), no invasion into the dermis, hyperkeratosis, basal layer sparing = eyeliner sign 2. Bowenoid papulosis - similar appearance, HPV induced

Question 27

Second most common skin tumor

Answer 27

SqCC

Question 28

Scaly, sometimes ulcerated, and verrucous papules and nodules

Answer 28

SqCC

Question 29

Histology - SqCC

Answer 29

Hyperkeratotic acanthotic epidermis with papillomatosis comprised of atypical SqC, extending from epidermis, invading into dermis as islands with keratin pearls

Question 30

Pearly pink papule with overlying telangiectasis

Answer 30

Basal cell carcinoma

Question 31

Histology - BCC

Answer 31

Proliferation of basaloid cells, peripheral palisading cells, peritumoral clefting, dermal telangiectasias

Question 32

Clearish cells in the basal layer with dark nuclei (1:10, ___ to keratinocytes)

Answer 32

Melanocytes

Question 33

Well-defined, milky-white patches of skin

Answer 33

Vitiligo

Question 34

Caused by loss of melanocytes

Answer 34

Vitiligo

Question 35

Caused by loss of melanin pigment

Answer 35

Albinism

Question 36

Hyperpigmentation of skin

Answer 36

Melasma

Question 37

Small tan-red to light brown macule on sun-exposed areas Histology - increased melanin pigment within basal keratinocytes, melanocytes may be enlarged, but density is normal

Answer 37

Freckle (ephelis)

Question 38

Small, oval tan-brown Histology - non-confluent typical single cell melanocytic hyperplasia along the basal layer

Answer 38

Lentigo

Question 39

Tan to brown macules and papules Histology - hyperplastic nests of melanocytes +/- architectural atypia

Answer 39

Melanocytic nevi | Atypia = dysplastic nevi

Question 40

Confluent nests and single atypical melanocytes

Answer 40

Melanoma

Question 41

4 features of dysplastic nevi

Answer 41

Shouldering (epidermal component extends at least 3 rete ridges beyond dermal component) Bridging (confluence of rete ridge nests) Lamellar fibroplasia Cellular atypia

Question 42

ABCDE - melanoma

Answer 42

``` Asymmetrical Borders (irregular) Color (uneven) Diameter, >6mm) Evolving ```

Question 43

Confluent proliferation of single and nested atypical melanocytes with upward pagetoid spread

Answer 43

Melanoma insitu

Question 44

Most important prognostic feature for melanoma

Answer 44

Breslow thickness

Question 45

Pink-brown papule or nodule most common on lower extremities Histology - dermal proliferation of boomerang shaped fibrohistiocytes with collagen trapping and overlying rete ridge tableing and basal layer hyperpigmentation

Answer 45

Dermatofibroma

Question 46

Pruritic, purple, polygonal, papules, plaques

Answer 46

Lichen planus

Question 47

Well-demarcated plaques with adherent silver/white scale (30% have nail changes)

Answer 47

Psoriasis

Question 48

Histology of psoriasis

Answer 48

Psoriasiform hyperplasia with parakeratotic (wafer-like) scales containing nuetrophils Monroe microabscesses in SC Auspitz sign = thinning of the suprapapillary plates with dilated papillary vessels Loss of granular layer, increased epidermal mitotic figures

Question 49

Site of split - DEJ

Answer 49

TENS

Question 50

Site of split - subepithelial

Answer 50

Staph Scalded Skin Syndrome, Bullous Pemphigoid