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Integrated systems > Derm > Flashcards

Derm Flashcards

1
Q

ID the epidermis, dermis, and hypodermis

A
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2
Q

ID the layer

A

Stratum corneum

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3
Q

Epidermis is derived from [embryonic structure]
Dermis is derived from [embryonic structure]
Hypodermis is derived from [embryonic structure]

A

Epidermis is derived from ectoderm
Dermis is derived from mesoderm
Hypodermis is derived from mesoderm

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4
Q

Name the layers of the epidermis from superficial to deep

A

Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale
Basement membrane

“Come let’s get sunburnt”

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5
Q

The stem cell layer of the epidermis is the _

A

The stem cell layer of the epidermis is the stratum basale

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6
Q

The [epidermis layer] is anuclear or “dead”

A

The stratum corneum is anuclear or “dead”

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7
Q

The antigen presenting immune cells of the skin are _

A

The antigen presenting immune cells of the skin are langerhan cells

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8
Q

Merkel cells of the skin are a type of [cell]

A

Merkel cells of the skin are a type of neuroendocrine cells

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9
Q

There are two layers of the dermis, the _ and _

A

There are two layers of the dermis, the papillary dermis and reticular dermis

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10
Q

ID the layers of the epidermis

A
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11
Q

Meissner corpuscles and immune cells are found in the [layer of the dermis]

A

Meissner corpuscles and immune cells are found in the papillary dermis

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12
Q

Sebaceous glands, apocrine glands, hair follicle roots, and ruffini corpuscles are found in the [dermis layer]

A

Sebaceous glands, apocrine glands, hair follicle roots, and ruffini corpuscles are found in the reticular layer

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13
Q

The tightest of all cellular junctions are the _

A

The tightest of all cellular junctions are the tight junctions
* We find these in the BBB and blood-testis barrier
* Also called zonula occludens
* They prevent water loss

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14
Q

_ are cellular junctions which allow for cellular electrochemical communication in locations like the cardiac myocytes

A

Gap junctions are cellular junctions which allow for cellular electrochemical communication in locations like the cardiac myocytes

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15
Q

[Cellular junctions] are the structural connectors between cells

A

Desmosomes are the structural connectors between cells
* Also called macula adherens
* They attach to keratin

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16
Q

[Cellular junctions] connect epithelial cells to the basement membrane

A

Hemidesmosomes connect epithelial cells to the basement membrane

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17
Q

[Cellular junctions] connect the actin cytoskeletons of adjacent cells

A

Adherens junctions connect the actin cytoskeletons of adjacent cells
* They are found between adjacent epithelial cells

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18
Q

Claudins and occludins compose [cellular junctions]

A

Claudins and occludins compose tight junctions

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19
Q

[Cellular junctions] are composed of cadherins

A

Adherens junction are composed of cadherins
* Cadherens

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20
Q

Desmoplakin, desmocollin, desmoglein make up [cellular junctions]

A

Desmoplakin, desmocollin, desmoglein make up desmosomes

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21
Q

Hemidesmosomes are made up of [cellular component]

A

Hemidesmosomes are made up of integrins

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22
Q

Gap junctions are made up of [cellular components]

A

Gap junctions are made up of connexons

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23
Q

Hyperkeratosis is _

A

Hyperkeratosis is increased thickness of the stratum corneum
* Ex: psoriasis, verrucae, calluses

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24
Q

_ is retention of nuclei within the stratum corneum

A

Parakeratosis is retention of nuclei within the stratum corneum
* Ex: psoriasis, actinic keratosis

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25
Q

_ is a classic example of hypergranulosis with rete ridge changes

A

Lichen planus is a classic example of hypergranulosis with rete ridge changes
* (And wickham striae)
* Recall that hypergranulosis means increased thickness of the granulosum layer

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26
Q

Spongiosis refers to _

A

Spongiosis refers to accumulation of fluid within the intercellular spaces
* Ex: atopic dermatitis, allergic contact dermatitis

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27
Q

Epidermal hyperplasia of the stratum spinosum is called _

A

Epidermal hyperplasia of the stratum spinosum is called acanthosis
* Ex: acanthosis nigricans, psoriasis

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28
Q

Acantholysis refers to _

A

Acantholysis refers to separation of cells in the epidermis without basement membrane involvement
* Affects desmoglein 1
* Nikolsky positive, tombstoning, floating keratinocytes
* Ex: pemphigus vulgaris, SSS

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29
Q

A macule is a _

A

A macule is a flat discoloration < 1 cm
* Ex: freckle, solar lentigo, tinea versicolor

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30
Q

A flat discoloration > 1 cm is called a _

A

A flat discoloration > 1 cm is called a patch
* ex: large congenital nevus, port wine stain

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31
Q

An elevated skin lesion < 1 cm is called _

A

An elevated skin lesion < 1 cm is called papule
* ex: acne, molluscum contagiosum

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32
Q

A plaque is a _

A

A plaque is an elevated skin lesion > 1 cm
* ex: psoriasis, BCC

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33
Q

_ is a fluid filled blister < 1 cm

A

Vesicle is a fluid filled blister < 1 cm
* Ex: varicella zoster, herpes simplex

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34
Q

A fluid filled blister > 1 cm is called _

A

A fluid filled blister > 1 cm is called bulla
* Ex: pemphigus vulgaris, bullous pemphigoid, burns

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35
Q

A pus filled vesicle is called a _

A

A pus filled vesicle is called a pustule
* Ex: acne, folliculitis

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36
Q

_ is a raised pink papule or plaque that is transient

A

Wheal is a raised pink papule or plaque that is transient
* Ex: allergic contact dermatitis, hives, bug bites

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37
Q

_ is a thickened stratum corneum that is dry, flaky, white/silver

A

Scale is a thickened stratum corneum that is dry, flaky, white/silver
* Ex: psoriasis, eczema, actinic keratosis, SCC

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38
Q

Crust refers to exudate or secretions that have dried; common in [infectious condition]

A

Crust refers to exudate or secretions that have dried; common in impetigo

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39
Q

_ are abrasions and trauma to skin via mechanical force

A

Excoriations are abrasions and trauma to skin via mechanical force

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40
Q

Lichenification is _

A

Lichenification is thickening of skin, accentuation of skin markings
* Often result of repeated excoriation
* Lichen simplex chronicus

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41
Q

Hematomas are [blanching/ non-blanching] blood collections

A

Hematomas are non-blanching blood collections
* Ex: petechiae, ecchymosis, purpura

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42
Q

Impetigo is a bacterial skin condition of the [layer]

A

Impetigo is a bacterial skin condition of the epidermis (superficial)

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43
Q

Two types of impetigo are _ and _

A

Two types of impetigo are superficial impetigo and bullous impetigo

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44
Q

“Honey-colored” crusted skin lesions are classic for [condition]

A

“Honey-colored” crusted skin lesions are classic for superficial impetigo
* Highly contagious
* Nikolsky negative

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45
Q

Superficial impetigo is most commonly caused by [bug(s)]

A

Superficial impetigo is most commonly caused by staph aureus or strep pyogenes

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46
Q

Bullous impetigo involves fluid-filled blisters that are nikolsky sign _

A

Bullous impetigo involves fluid-filled blisters that are nikolsky sign positive

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47
Q

Bullous impetigo is most commonly caused by [bug(s)]

A

Bullous impetigo is most commonly caused by staph aureus
* Exfoliative toxin cleaves desmoglein 1 –> stratum granulosum cleavage –> blisters

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48
Q

Complications of impetigo caused by strep pyogenes include _

A

Complications of impetigo caused by strep pyogenes include rheumatic fever and PSGN

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49
Q

Impetigo should be treated with [abx]

A

Impetigo should be treated with nafcillin (penicillinase resistant penicillin)

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50
Q

Sandpaper rash that begins on the neck and then moves to the trunk and extremities is classic for _

A

Sandpaper rash that begins on the neck and then moves to the trunk and extremities is classic for scarlet fever
* Group A strep
* Pastia lines (red lines in wrist/elbow)
* Strawberry tongue

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51
Q

_ is a bacterial infection of the deep dermal and subcutaneous tissue

A

Cellulitis is a bacterial infection of the deep dermal and subcutaneous tissue
* Either strep pyogenes or staph aureus

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52
Q

_ is a bacterial infection of the superficial dermis

A

Erysipelas is a bacterial infection of the superficial dermis

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53
Q

[Erysipelas/ Cellulitis] is a deeper skin infection

A

Cellulitis is a deeper skin infection

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54
Q

[Erysipelas/ Cellulitis] has more defined borders

A

Erysipelas has more defined borders

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55
Q

Cellulitis is classic in [regions]

A

Cellulitis is classic in lower extremities
* Streaking erythema towards lymph nodes

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56
Q

Erysipelas most common occurs in [regions]

A

Erysipelas most common occurs in lower extremities and face

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57
Q

Systemic symptoms [will/ will not] be present with cellulitis and erysipelas

A

Systemic symptoms will be present with cellulitis and erysipelas

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58
Q

Non-purulent cellulitis is caused by [bacteria]

A

Non-purulent cellulitis is caused by strep pyogenes

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59
Q

Purulent cellulitis is caused by [bacteria]

A

Purulent cellulitis is caused by staph aureus

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60
Q

Erysipelas is caused by [bacteria]

A

Erysipelas is caused by strep pyogenes

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61
Q

_ is a diffuse staphylococcal infection of the epidermis which is nikolsky sign positive

A

Staphylococcal scalded skin syndrome is a diffuse staphylococcal infection of the epidermis which is nikolsky sign positive

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62
Q

Staph scalded skin syndrome damage to the epidermis is mediated by _

A

Staph scalded skin syndrome damage to the epidermis is mediated by exfoliative exotoxin
* Cleaves desmoglein 1 –> stratum granulosum cleavage –> blisters

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63
Q

Staph scalded skin syndrome is more common in babies, children, or adults with [risk factor]

A

Staph scalded skin syndrome is more common in babies, children, or adults with renal insufficiency
* Kidneys can’t efficiently filter out the toxin

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64
Q

[SJS/ SSS] can have oral involvement

A

SJS can have oral involvement
* Versus SSS will have no mucosal involvement and will heal completely without scarring (only affects the epidermis)

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65
Q

An abscess is a collection of pus in the [skin layers]

A

An abscess is a collection of pus in the dermis and epidermis

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66
Q

An abscess is almost always caused by [bacteria]

A

An abscess is almost always caused by staph aureus
* May present as a fluctuant warm fluid collection with systemic symptoms

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67
Q

Necrotizing fasciitis is an infection of the _

A

Necrotizing fasciitis is an infection of the fascia

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68
Q

How will necrotizing fasciitis present?

A
  • Crepitus from gas production by the bacteria
  • Pain out of proportion on physical exam
  • Bullae and purple discoloration of skin
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69
Q

Herpes viruses are [structure]

A

Herpes viruses are double stranded DNA viruses

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70
Q

Name some buzzwords for herpes infections

A
  • Tzanck smear
  • Multinucleated giant cells
  • Intranuclear eosinophilic cowdry A inclusions
  • “Dew drop on a rose petal”
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71
Q

Primary infection with varicella zoster virus is known as _ ; secondary infection is _

A

Primary infection with varicella zoster virus is known as chicken pox ; secondary infection is shingles

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72
Q

Shingles involves a prodrome of sx such as _ before the rash develops

A

Shingles involves a prodrome of sx such as fever, malaise, localized pain before the rash develops
* Prodrome is caused by cytokines

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73
Q

_ sign is when shingles involves the tip of the nose

A

Hutchinson sign is when shingles involves the tip of the nose

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74
Q

Ramsay Hunt syndrome is caused by VZV involvement of _

A

Ramsay Hunt syndrome is caused by VZV involvement of facial nerve
* Also called herpes zoster oticus

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75
Q

A child with chicken pox should not be given aspirin due to the risk of [complication]

A

A child with chicken pox should not be given aspirin due to the risk of Reye’s syndrome

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76
Q

Herpes simplex encephalitis primarily affects the [lobe]

A

Herpes simplex encephalitis primarily affects the temporal lobe –> language dysfunction, memory loss, behavioral changes

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77
Q

How will HSV 2 present?

A

HSV 2 presents with prodromal genital pain followed by ulcers and inguinal lymphadenopathy

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78
Q

Diagnosis?

A

HSV 1

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79
Q

[HSV-1, HSV-2, VZV] can be transmitted via airborne droplets

A

VZV can be transmitted via airborne droplets

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80
Q

HSV-1 goes dormant in the _

A

HSV-1 goes dormant in the trigeminal ganglia

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81
Q

HSV-2 goes dormant in the _

A

HSV-2 goes dormant in the sacral ganglia

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82
Q

VZV goes dormant in the _

A

VZV goes dormant in the dorsal root ganglia or trigeminal ganglia

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83
Q

The best means to prevent the spread of HSV-2 is _

A

The best means to prevent the spread of HSV-2 is consistent condom use

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84
Q

Continued pain after the shingles rash resolves is called _

A

Continued pain after the shingles rash resolves is called post herpetic neuralgia

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85
Q

Name the HSV-1 infections

A
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86
Q

Name the VZV diagnoses

A
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87
Q

Small painless papules with central umbilication describes _

A

Small painless papules with central umbilication describes molluscum contagiosum

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88
Q

Molluscum contagiosum papules will persist for [duration] but will spontaneously regress over time (no treatment needed)

A

Molluscum contagiosum papules will persist for 6-9 months but will spontaneously regress over time (no treatment needed)

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89
Q

Molluscum contagiosum is caused by [pathogen]

A

Molluscum contagiosum is caused by pox virus
* dsDNA virus

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90
Q

On histology, molluscum contagiosum will present with _

A

On histology, molluscum contagiosum will present with inclusion bodies called Henderson-Paterson bodies
* The virus replicates in the cytoplasm of cells and creates inclusion bodies filled with viral particles

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91
Q

How does this condition spread?

A

Skin to skin contact with an someone infected with molluscum contagiosum

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92
Q

Verrucae are caused by [virus] which causes the infection of the epidermis in children and immunocompromised adults

A

Verrucae are caused by HPV which causes the infection of the epidermis in children and immunocompromised adults
* The high risk HPV are 16, 18, 31, 33

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93
Q

E6 is an oncoprotein carried by HPV that [action]

A

E6 is an oncoprotein carried by HPV that inhibits p53

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94
Q

E7 is an oncoprotein carried by HPV that [action]

A

E7 is an oncoprotein carried by HPV that inhibits retinoblastoma

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95
Q

Histology of verrucae may reveal _ hyperplasia, hyperkeratosis, and [special cells]

A

Histology of verrucae may reveal epidermal hyperplasia, hyperkeratosis, and koilocytes

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96
Q

_ is the “common wart” that presents with a cauliflower texture most commonly on the hands

A

Verruca vulgaris is the “common wart” that presents with a cauliflower texture most commonly on the hands

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97
Q

Verruca vulgaris is caused by [HPV subtypes]

A

Verruca vulgaris is caused by HPV 2 and 4

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98
Q

Verruca plana are found on the [regions]

A

Verruca plana are found on the mouth and forehead
* These are flat warts

99
Q

Verruca plana are caused by [HPV subtypes]

A

Verruca plana are caused by HPV 3 and 10

100
Q

Warts that are found on the high pressure areas on sole of feet are called _

A

Warts that are found on the high pressure areas on sole of feet are called verruca plantaris
* Aka plantar warts

101
Q

Plantar warts are caused by [HPV subtype]

A

Plantar warts are caused by HPV 1

102
Q

Condylomata acuminata are sexually transmitted and caused by [HPV subtypes]

A

Condylomata acuminata are sexually transmitted and caused by HPV 6, 11

103
Q

White plaques on the tongue that cannot be scraped off are suggestive of [diagnosis] which is mediated by [pathogens]

A

White plaques on the tongue that cannot be scraped off are suggestive of hairy leukoplakia which is mediated by EBV or HPV
* Squamous hyperplasia of oral mucosa
* Common in HIV patients

104
Q

White plaques on the back of the tongue are more likely to be _ while white plaques on the lateral aspects are more likely to be _

A

White plaques on the back of the tongue are more likely to be thrush (candida) while white plaques on the lateral aspects are more likely to be hairy leukoplakia

105
Q

Candida esophagitis occurs in HIV patients with [CD4 count]

A

Candida esophagitis occurs in HIV patients with CD4 < 100

106
Q

At 20-25C, candida is in its _ form

A

At 20-25C, candida is in its pseudohyphae and budding yeast form

107
Q

At 37C, candida is in its _ form

A

At 37C, candida is in its germ tube form

108
Q

Treat oral candidiasis with _
vaginal candidiasis with _
esophageal candidiasis with _

A

Treat oral candidiasis with nystatin rinse
vaginal candidiasis with topical azole
esophageal candidiasis with IV fluconazole

109
Q

[Immune cells] are important for fending off a mucocutaneous candidiasis infection

A

T cells are important for fending off a mucocutaneous candidiasis infection
* Therefore HIV patients are prone to mucocutaneous candidiasis due to T cell destruction

110
Q

Candida albicans infection of the epidermis between the skin folds is called _ and should be treated with _

A

Candida albicans infection of the epidermis between the skin folds is called candidal intertrigo and should be treated with topical nystatin
* Skin folds and high moisture areas, common in obese, diabetic, immunocompromised

111
Q

What does tinea corporis look like?

A

Tinea corporis is erythematous, raised, pruritic with central clearing
* There are sharp borders, no satellite lesions

112
Q

Tinea corporis is caused by [pathogen]

A

Tinea corporis is caused by dermatophytes
* Trichophyton and microsporum

113
Q

Tinea corporis can be diagnosed by _ where microscopy shows _

A

Tinea corporis can be diagnosed by KOH prep where microscopy shows segmented hyphae

114
Q

Tinea corporis usually occurs in the context of _ ; therefore first choice in management is often _

A

Tinea corporis usually occurs in the context of high heat/moisture exposure ; therefore first choice in management is often better hygiene practices
* Also use topical azole or terbinafine

115
Q

Tinea capitis often presents as itchy scalp, hair loss, and [systemic sign]

A

Tinea capitis often presents as itchy scalp, hair loss, and cervical lymphadenopathy
* Breakage of the hair

116
Q

The dermatophyte that tends to affect the outer hair shaft (tinea capitis) is _

A

The dermatophyte that tends to affect the outer hair shaft (tinea capitis) is microsporum
* Ectothrix

117
Q

The dermatophyte that tends to affect the inner hair shaft (tinea capitis) is _

A

The dermatophyte that tends to affect the inner hair shaft (tinea capitis) is trichophyton
* Endothrix

118
Q

Tinea capitis is treated with [topical] or [oral medications]

A

Tinea capitis is treated with antifungal shampoo or oral griseofulvin

119
Q

Itching, burning, scaling skin; diagnosis?

A

Tinea pedis
* Treat with topical azole or topical terbinafine

120
Q

_ is a superficial fungal skin infection of the nail

A

Onychomycosis is a superficial fungal skin infection of the nail
* Treat with oral antifungal like terbinafine

121
Q

Tinea versicolor is caused by [pathogen]

A

Tinea versicolor is caused by malassezia fungal species

122
Q

KOH prep of tinea versicolor will reveal _

A

KOH prep of tinea versicolor will reveal spaghetti and meatball multiple branching hyphae and budding cells

123
Q

Malassezia causes the degradation of _ which in turn produces _ which is damaging to [enzyme], leading to decreased pigmentation

A

Malassezia causes the degradation of lipids which in turn produces acid which is damaging to tyrosinase, leading to decreased pigmentation

124
Q

Tinea versicolor is treated with _

A

Tinea versicolor is treated with selenium sulfide (topical shampoo)

125
Q

[Tinea versicolor/ vitiligo] loves the face, neck, abdomen, while [tinea versicolor/ vitiligo] loves the extremities

A

Tinea versicolor loves the face, neck, abdomen, while vitiligo loves the extremities

126
Q

Red painful papules and ulcers with pus, ascending lymphangitis is caused by [pathogen]

A

Red painful papules and ulcers with pus, ascending lymphangitis is caused by sporothrix schenckii
* Lives on vegetation; called rose gardener’s disease

127
Q

“Cigar shaped fungus” =

A

“Cigar shaped fungus” = sporothricosis

128
Q

Sporotrichosis is treated by _ or _

A

Sporotrichosis is treated by itraconazole or potassium iodide

129
Q

Necrosis of the nares and palate, black eschar, and air-fluid levels with bony destruction on CT describe [infection]

A

Necrosis of the nares and palate, black eschar, and air-fluid levels with bony destruction on CT describe mucormycosis

130
Q

Mucormycosis will present as [microbiology]

A

Mucormycosis will present as non-septate hyphae with wide angle branching (90 degree)
* Caused by mucor and rhizopus species

131
Q

Mucormycosis is most common in [population]

A

Mucormycosis is most common in diabetics in DKA!

132
Q

Mucormycosis must be treated with _ and _

A

Mucormycosis must be treated with amphotericin B and surgical debridement

133
Q

Name the disease process

A

Pemphigus vulgaris

134
Q

Name the disease process

A

Bullous pemphigoid

135
Q

Name the disease process

A

Dermatitis Herpetiformis

136
Q

[Flaccid bullae/ tense bullae] is classic in pemphigus vulgaris

A

Flaccid bullae is classic in pemphigus vulgaris
* Affects the desmosomes, more superficial

137
Q

Pemphigus vulgaris is nikolsky sign _ and [does/ does not] have oral mucosal involvement

A

Pemphigus vulgaris is nikolsky sign positive and does have oral mucosal involvement

138
Q

Histology of pemphigus vulgaris will show _

A

Histology of pemphigus vulgaris will show acantholysis, tombstoning, retigular IgG
* Attacks desmoglein 1 + 3

139
Q

Tense bullae, nikolsky sign negative, linear IgG + C3 deposition describes _

A

Tense bullae, nikolsky sign negative, linear IgG + C3 deposition describes bullous pemphigoid
* No mucosal involvement
* Lysis between BM and epidermis (goes after hemidesmosomes)

140
Q

Dermatitis herpetiformis usually affects [population]

A

Dermatitis herpetiformis usually affects celiacs (tissue transglutaminase)
* HLA-DQ2, HLA-DQ8

141
Q

Name some clinical features of dermatitis herpetiformis

A

Name some clinical features of dermatitis herpetiformis:
* Pruritic papules, vesicles, bullae
* Dorsal hands, knees, elbows, buttocks

142
Q

Which skin region is affected in dermatitis herpetiformis?

A

Dermis!
* Subepidermal inflammation
* Neutrophilic papillary microabscesses
* Granular IgA in dermal papillae

143
Q
A
144
Q

Erythema multiforme is a reactive skin response involving target lesions with a “dusky” center; commonly associated with _ or _ infection

A

Erythema multiforme is a reactive skin response involving target lesions with a “dusky” center; commonly associated with HSV-1 or mycoplasma pneumoniae infection

145
Q

Erythema multiforme can be caused by drugs, including _ , _ , _

A

Erythema multiforme can be caused by drugs, including sulfas , beta-lactams , mycoplasma pneumoniae

146
Q

Erythema nodosum is caused by inflammation of the _

A

Erythema nodosum is caused by inflammation of the subcutaneous fat
* Coccidiodomycosis, histoplasmosis, strep, leprosy, TB, sarcoidosis, IBD

147
Q

Erythema migrans is associated with [category infections]

A

Erythema migrans is associated with tic infections

148
Q

A good way to distinguish SJS from erythema multiforme is _

A

A good way to distinguish SJS from erythema multiforme is oral mucosal involvement

149
Q

Bullae and skin peeling, nikolsky sign positive following drug exposure describes _

A

Bullae and skin peeling, nikolsky sign positive following drug exposure describes steven johnson syndrome (SJS)

150
Q

Once SJS affects greater than 30% of the body surface area it is classified as _

A

Once SJS affects greater than 30% of the body surface area it is classified as toxic epidermal necrolysis (TEN)

151
Q

Common drugs that cause SJS include…

A

Common drugs that cause SJS include…
* Lamotrigine
* Sulfas
* Penicillins
* Even mycoplasma pneumoniae infection

152
Q

We treat SJS with _

A

We treat SJS with steroids

153
Q

DRESS syndrome stands for _

A

DRESS syndrome stands for Drug Reaction with Eosinophilia and Systemic Symptoms

154
Q

How does DRESS syndrome present?

A

Delayed hypersensitivity reaction involving morbilliform rash and fever after taking certain medications or following herpes viruses

155
Q

The medications usually responsible for DRESS syndrome are remembered by _

A

The medications usually responsible for DRESS syndrome are remembered by ABCs
* Allopurinol
* AntiBiotics
* AntiConvulsants
* Sulfas

156
Q

Transient pink, pruritic, raised, well-circumscribed wheals describe _ ; caused by [hypersensitivity reaction]

A

Transient pink, pruritic, raised, well-circumscribed wheals describe urticaria ; caused by type 1 HSR
* IgE mediate mast cell degranulation
* Involves superficial dermis spongiosis

157
Q

Allergic contact dermatitis is classically a [type HSR]

A

Allergic contact dermatitis is classically a type IV HSR
* Langerhan cells –> T cells –> IFN-gamma
* Increased vascular permeability –> dermal and epidermal spongiosis –> desmosomal compromise

158
Q

Describe the skin lesions caused by atopic dermatitis

A

Atopic dermatitis causes erythematous and pruritic weeping papules/ plaques
* The itch that rashes

159
Q

Babies tend to have atopic dermatitis on [body regions] while adults have it on [regions]

A

Babies tend to have atopic dermatitis on face, scalp, torso, extensor surfaces while adults have it on flexor surfaces

160
Q

Atopic dermatitis is a [T helper] response mediated by [cytokines]

A

Atopic dermatitis is a Th2 response mediated by IL-4 and IL-13
* Involves increase in serum IgE
* Mast cells and eosinophils involved

161
Q

Mutations in _ gene may be involved in atopic dermatitis

A

Mutations in filaggrin gene may be involved in atopic dermatitis

162
Q

Acne vulgaris involves the blockage of a pilosebaceous unit, called a _

A

Acne vulgaris involves the blockage of a pilosebaceous unit, called a comedone
* Also involves increased sebum production and poor keratinocyte desquamation (not shedding properly)

163
Q

_ mediates the pro-inflammatory fatty acid production involved in acne vulgaris

A

C. acnes mediates the pro-inflammatory fatty acid production involved in acne vulgaris
* Sometimes patients are given a short course of doxy to kill bacteria

164
Q

Hyperandrogenic states such as _ can lead to acne vulgaris

A

Hyperandrogenic states such as PCOS, anabolic steroids can lead to acne vulgaris

165
Q

Painful draining sinus tracts with scarring describes [condition]

A

Painful draining sinus tracts with scarring describes hidradenitis suppurativa

166
Q

Hidradenitis suppurativa is caused by occlusion of the _

A

Hidradenitis suppurativa is caused by occlusion of the apocrine glands
* Hormonal stimulation can lead to keratinocyte overgrowth causing occlusion

167
Q

Hidradenitis suppurativa affects [body regions]

A

Hidradenitis suppurativa affects axilla, medial thighs, anogenital region
* Painful, draining pustules and cysts
* Eventually scarring and fibrosis

168
Q

Risk factors of hidradenitis suppurativa include:

A

Risk factors of hidradenitis suppurativa include:
* Female
* Obesity
* AA
* FH
* Smoking
* Tight clothing

169
Q

Painful erythematous pustules that arise after hot tub use or aquatic environment describes _

A

Painful erythematous pustules that arise after hot tub use or aquatic environment describes folliculitis

170
Q

Folliculitis is most commonly caused by _ or _

A

Folliculitis is most commonly caused by staph aureus or pseudomonas

171
Q

Folliculitis is usually self limited, however can progress to _ or _

A

Folliculitis is usually self limited, however can progress to abscess or cellulitis

172
Q

Diagnosis?

A

Folliculitis

173
Q

Diagnosis?

A

Pseudofolliculitis barbae

174
Q

Pseudofolliculitis barbae is most common in [population] following [action]

A

Pseudofolliculitis barbae is most common in Black males following shaving

175
Q

The pathophysiology behind pseudofolliculitis barbae is _

A

The pathophysiology behind pseudofolliculitis barbae is coiled hair shaft trapped beneath the skin –> local inflammation –> firm, hyperpigmented papules and pustules + erythema, pain, pruritis

176
Q

Rosacea [does/ does not involve] comedones

A

Rosacea does not involve comedones
* Will see erythematous papules and pustules
* Flushing occurs in response to triggers

177
Q

Name some common triggers of rosacea

A
  • Heat
  • Spicy foods
  • Alcohol
  • Stress
  • Nicotine
178
Q

_ involves plaques and papules related to hypergranulosis in regions of trauma commonly secondary to chronic Hepatitis C

A

Lichen planus involves plaques and papules related to hypergranulosis in regions of trauma commonly secondary to chronic Hepatitis C
* Also associated with vitiligo and ulcerative colitis

179
Q

To remember the presentation of lichen planus, remember the _

A

To remember the presentation of lichen planus, remember the 6 P’s
* Pruritis
* Pink/Purple
* Planar
* Polygonal
* Papules
* Plaques

180
Q

Common sites of involvement of lichen planus include the:

A

Common sites of involvement of lichen planus include the:
* Shins
* Ankles
* Wrists
* Genitalia

Often follows lines of minor trauma (Koebner phenomenon)

181
Q

Oral mucosal involvement of lichen planus is called _

A

Oral mucosal involvement of lichen planus is called wickham striae

182
Q

Lichen planus is [immune cell]- mediated and affects the [skin layer]

A

Lichen planus is T-cell (CD8+)- mediated and affects the dermal-epidermal junction (interface dermatitis)
* Histology shows hypergranulosis
* Saw tooth rete ridges
* Lymphocytic infiltrate

183
Q

Rash with a christmas tree distribution =

A

Rash with a christmas tree distribution = pityriasis rosea
* Red/pink plaques with collarette scale

184
Q

Pityriasis rosea often presents in [population] after _

A

Pityriasis rosea often presents in children or young adults after viral infection
* It can also be idiopathic
* But often there is a prodrome + herald patch (URI, fever)

185
Q

Psoriasis is ultimately caused by _

A

Psoriasis is ultimately caused by overactivity of the stratum basale –> increasing keratinocytes
* Result of inflammatory state (TNF-alpha, IL-6, CRP, HLA B27)

186
Q

Erythematous raised papules and plaques with a silvery scale on the extensor surfaces and scalp describes _

A

Erythematous raised papules and plaques with a silvery scale on the extensor surfaces and scalp describes psoriasis

187
Q

Pin-point bleeding when picking at psoriasis scales is _ sign

A

Pin-point bleeding when picking at psoriasis scales is Auspitz sign

188
Q

When a patient presents with psoriasis, check for other involvement of the _ and _

A

When a patient presents with psoriasis, check for other involvement of the nail beds (pitting) and joints

189
Q

Psoriasis will present with [findings] on histology

A

Psoriasis will present with hyperkeratosis, parakeratosis, acanthosis on histology
* There will be thickening of the stratum spinosum, decreased stratum granulosum

190
Q

[Benign skin lesion] is a precursor to squamous cell carcinoma

A

Actinic keratosis is a precursor to squamous cell carcinoma
* Presents as sandpaper white scale –> erythematous or brown papules
* Pre-cancerous; increased dysplasia increases SCC risk

191
Q

Risk factors of actinic keratosis include _ and _

A

Risk factors of actinic keratosis include sun exposure and age

192
Q

Actinic keratosis on histology reveals _

A

Actinic keratosis on histology reveals parakeratosis and hyperkeratosis
* Manage with freezing, topical 5-FU, or surgical excision

193
Q

Squamous cell carcinoma usually presents on the face, ears, hands, and [upper/ lower lip]

A

Squamous cell carcinoma usually presents on the face, ears, hands, and lower lip

194
Q

Squamous cell carcinoma risk factors include:

A

Squamous cell carcinoma risk factors include:
* Sun exposure
* Age
* Immunosuppression
* Chronic wounds
* Burns
* Arsenic

195
Q

[SCC/ BCC] bleeds easily and is nonhealing

A

Squamous cell carcinoma bleeds easily and is nonhealing; it is painless
* Locally invasive, remove with surgical excision

196
Q

Squamous cell carcinoma will show _ on histology

A

Squamous cell carcinoma will show onion skin keratin pearls on histology
* Additionally atypical nuclei

197
Q

Basal cell carcinoma is common on the head, neck, hands, and [upper/ lower lip]

A

Basal cell carcinoma is common on the head, neck, hands, and upper lip

198
Q

Basal cell carcinoma will present as _ on biopsy/histology

A

Basal cell carcinoma will present as palisading nuclei on biopsy/histology

199
Q

Diagnosis?

A

Basal cell carcinoma
* Waxy, pink, pearly plaques
* Crusting, ulceration, scaling plaques
* Sometimes telangiectasias

200
Q

_ is the most common skin cancer

A

Basal cell carcinoma is the most common skin cancer

201
Q

_ is a dome shaped, core of keratin

A

Keratoacanthoma is a dome shaped, core of keratin
* Erythema + scale
* Rapidly growing
* Occur in the middle age and elderly
* May spontaneously regress

202
Q

Diagnosis?

A

Keratoacanthoma: rapidly growing dome with a crater in the center of keratin

203
Q

Diagnoses?

A
204
Q

The malignant cells in melanoma are dervied from [embryonic structure]

A

The malignant cells in melanoma are dervied from neural crest cells
* Recall that the ncc derivatives are MOTEL PASS
* Melanocytes, odontoblasts, tracheal cartilage, enterochromafin like cells, laryngeal cartilage, parafollicular C cells, all ganglia and adrenal medulla, schwann cells, septum (aorticopulmonary)

205
Q

Name the ABCDEs of melanoma

A

A- asymmetry
B- border
C- color
D- diameter (> 6 mm)
E- evolution

206
Q

Name some risk factors for melanoma

A

Name some risk factors for melanoma:
* Family history
* Light skin
* Sun exposure
* Sunburn
* Dysplastic nevi
* Immunosuppression
* Genetics

207
Q

Name the skin layer involved in melanoma: _

A

Name the skin layer involved in melanoma: stratum basale

208
Q

Name (4) subtypes of melanoma

A

Name (4) subtypes of melanoma
1. Superficial spreading
2. Lentigo maligna
3. Nodular
4. Acral lentiginous

209
Q

The most common subtype of melanoma is _

A

The most common subtype of melanoma is superficial spreading

210
Q

_ is a melanoma subtype that has a long radial phase

A

Lentigo maligna is a melanoma subtype that has a long radial phase
* Spreads left to right (superficial)

211
Q

_ melanoma has no radial phase and instead has deep penetration early

A

Nodular melanoma has no radial phase and instead has deep penetration early

212
Q

_ melanoma has no relation to sun exposure and happens on dark skins on the palms and soles and under the fingernails

A

Acral lentiginous melanoma has no relation to sun exposure and happens on dark skins on the palms and soles and under the fingernails

213
Q

_ is a genetic marker of neural crest cells which is positive in melanoma

A

S-100 is a genetic marker of neural crest cells which is positive in melanoma

214
Q

_ mutations are common in melanoma; they allow uncontrolled cell proliferation; _ mutations affect a tumor suppressor

A

BRAF mutations are common in melanoma; they allow uncontrolled cell proliferation; CDKN2A mutations affect a tumor suppressor

215
Q

Metastasis of melanoma is common to the _

A

Metastasis of melanoma is common to the lymph nodes, brain, bone, heart

216
Q

The most important prognostic factor with melanoma is _

A

The most important prognostic factor with melanoma is depth of invasion/ Breslow thickness

217
Q

Treatment of melanoma first begins with [biopsy] followed by [medication options]

A

Treatment of melanoma first begins with excisional biopsy with wide margins followed by BRAF inhibitors (vemurafenib), IL-2 (aldesleukin) or IFN-alpha

218
Q

Describe the burn classification

A
219
Q

_ are benign “red moles” that occur with old age

A

Cherry hemangiomas are benign “red moles” that occur with old age

220
Q

_ are benign vascular tumors that occur in the first weeks of life and disappear at 5-8 years

A

Strawberry hemangiomas are benign vascular tumors that occur in the first weeks of life and disappear at 5-8 years

221
Q

Bacillary angiomatosis must be treated with _

A

Bacillary angiomatosis must be treated with doxycycline
* Macrolides can be used for cat scratch fever but not strong enough for angiomatosis

222
Q

Bacillary angiomatosis is associated with a _ infiltrate, while Kaposi sarcoma has a _ infiltrate

A

Bacillary angiomatosis is associated with a neutrophilic infiltrate, while Kaposi sarcoma has a lymphocytic infiltrate

223
Q

Kaposi sarcoma is more common in [population] and it is caused by [infection]

A

Kaposi sarcoma is more common in eastern european males and it is caused by HHV-8

224
Q

“Stuck on” appearance =

A

“Stuck on” appearance = seborrheic keratosis
* Benign hyperpigmented plaque/papule
* Common in increasing age
* Greasy appearance

225
Q

The sudden appearance of multiple seborrheic keratosis lesions is a sign of possible _

A

The sudden appearance of multiple seborrheic keratosis lesions is a sign of possible GI adenocarcinoma
* Leser-Trelat sign

226
Q

The mechanical barrier of the skin that regulates water loss:

A

The mechanical barrier of the skin that regulates water loss: stratum corneum

227
Q

The mitotically active keratinocytes are found here:

A

The mitotically active keratinocytes are found here: stratum basale
* Think of melanoma in this layer

228
Q

Intercellular junctions of the epidermis; think this layer:

A

Intercellular junctions of the epidermis; think this layer: stratum spinosum

229
Q

Formation of the cornified cell envelop occurs in this layer:

A

Formation of the cornified cell envelop occurs in this layer: stratum granulosum
* Keratohyalin granules also found here

230
Q

Melanocytes are found in the [layer]

A

Melanocytes are found in the basal layer of the epidermis

231
Q

Abnormal premature keratinization is called _ ; squamous cell carcinoma is an example

A

Abnormal premature keratinization is called dyskeratosis ; squamous cell carcinoma is an example

232
Q

Hand-foot-mouth disease is caused by [pathogen]

A

Hand-foot-mouth disease is caused by coxsackie or other enteroviruses
* Erythematous macules on the palms, soles, mouth vesicles
* Treatment is supportive

233
Q

Erythema infectiosum is caused by [pathogen]

A

Erythema infectiosum is caused by parvovirus
* Slapped cheek

234
Q

Parvovirus is a [type virus] that is spread by respiratory secretions and common in school aged kids; can cause hydrops fetalis in pregnancy

A

Parvovirus is a ssDNA virus that is spread by respiratory secretions and common in school aged kids; can cause hydrops fetalis in pregnancy

235
Q

What is the timeline of the parvo B19 infection?

A
  1. Flu like symptoms
  2. 7-10 days later erythematous malar rash (slapped cheek)
  3. Few days after, diffuse reticular, lacy rash
236
Q

A prodrome of a very high fever in a young child followed by diffuse macular to maculopapular rash after the fever resolves describes _ ; caused by [pathogen]

A

A prodrome of a very high fever in a young child followed by diffuse macular to maculopapular rash after the fever resolves describes Roseola ; caused by HHV6 & HHV7

237
Q

A prodrome of fever, arthralgias, malaise followed by a herald patch and later multiple papules and plaques is most often caused by [pathogen]

A

A prodrome of fever, arthralgias, malaise followed by a herald patch and later multiple papules and plaques is most often caused by HHV6 or HHV7

238
Q

Itching and small papules in the webspaces likely describes _

A

Itching and small papules in the webspaces likely describes scabies
* Sarcoptes scabiei

239
Q

The pruritis mechanism for ectoparasites is _ mediated

A

The pruritis mechanism for ectoparasites is IgE mediated

240
Q

Diagnosis?

A

Pityriasis versicolor
* Recall that it can be hyper or hypopigmented

241
Q

Tinea pedis is most commonly caused by [specific dermatophyte]

A

Tinea pedis is most commonly caused by trichophyton

242
Q

Erythema with overylying greasy yellow scale in the scalp, ears, eyebros, nasolabial folds, central chest, etc describes _

A

Erythema with overylying greasy yellow scale in the scalp, ears, eyebros, nasolabial folds, central chest, etc describes seborrheic dermatitis
* Think dandruff
* Common in areas of high sebum production
* Can cause post-inflammatory hypopigmentation

243
Q

Seborrheic dermatitis is due to an inflammatory response to [pathogen]

A

Seborrheic dermatitis is due to an inflammatory response to Malassezia
* Treat with ketoconazole cream

244
Q

What cell type mediates allergic contact dermatitis?

A

Th1

Integrated systems (8 decks)

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