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step 1 - path > derm > Flashcards

derm Flashcards

1
Q

layers of epidermis?

A 
surface to base (Californians Like Girls in String Bikinis):
Corneum (keratin)
Lucidum 
Granulosum
Spinosum (desmosomes)
Basale (stem cells)
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2
Q

zonula occludens?

A

= tight junction
apical side of epithelial cell
claudins and occludins
prevents paracellular solute movement

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3
Q

zonula adherens?

A

= adherens junction
below zonula occludens
connects actin cytoskeletons of adjacent cells with cadherins (Ca dependent)

** loss of E-cadherin –> metastasis

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4
Q

macula adherens?

A

= desmosomes
below zonula adherens
keratin interactions –> structural support

** autoAbs –> pemphigus vulgaris

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5
Q

epithelial cell gap junctions?

A

made up of connexons

allow communication

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6
Q

epithelial cell integrins?

A

at basolateral surface

proteins that bind to collagen and laminin in basement membrane

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7
Q

hemidesmosomes?

A

at basolateral surface
connect keratin of basal cells to basement membrane

** autoAbs –> bullous pemphigoid

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8
Q

increased thickness of stratum corneum?

A

hyperkeratosis

seen in psoriasis, calluses

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9
Q

hyperkeratosis with retention of nuclei in stratum corneum?

A

parakeratosis

seen in psoriasis

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10
Q

epidermal accumulation of edematous fluid in intercellular spaces?

A

spongiosis

seen in eczematous dermatitis

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11
Q

separation of epidermal cells?

A

acantholysis

seen in pemphigus vulgaris

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12
Q

epidermal hyperplasia (increased stratum spinosum)?

A

acanthosis

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13
Q

decreased melanin production, normal melanocyte number?

A

albinism
defect in tyrosinase activity or tyrosine transport; or failure of neural crest cell migration in development

** increased risk of skin cancer

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14
Q

preggo with hyperpigmented areas on face?

A

melasma (chloasma)

assoc with preg or OCP use

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15
Q

autoimmune destruction of melanocytes?

A

vitiligo

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16
Q

melanocytic nevus?

A

common mole

** intradermal nevus: papular; junctional nevus: flat

17
Q

epidermal changes in psoriasis?

A

increased stratum spinosum and stratum corneum

decreased stratum granulosum

18
Q

rhinophyma?

A

bulbous deformation of nose

from chronic inflammatory changes of rosacea

19
Q

sudden appearance of multiple seborrheic keratoses?

A

Leser Trelat sign = sign of underlying malignancy

- GI, lymphoid

20
Q

honey colored crusting?

A

impetigo
S aureus or S pyogenes
(bullous usually S aureus)

21
Q

well-defined demarcation b/w infected and normal skin?

A

erysipelas
upper dermis and superficial lymphatic involvement
S pyogenes

22
Q

MC organism in skin abscess?

A

MRSA

23
Q

bullae, purple skin, crepitus?

A

nec fasc

anaerobes or S pyogenes

24
Q

fever and generalized erythematous rash with sloughing?

A

staph scalded skin

** exotoxin destroys keratinocyte attachments in stratum granulosum ONLY

25
Q

white painless NON-scrapeable tongue plaques?

A

hairy leukoplakia

EBV

26
Q

flaccid intraepidermal bullae, oral involvement, Nikolsky +?

A

pemphigus vulgaris - potentially fatal
IgG Abs to desmoglein (anti-desmosome)
immunofluorescence: Abs in reticular pattern around epidermal cells

** bullae caused by acantholysis

27
Q

tense blisters, no oral involvement, Nikolsky -?

A

bullous pemphigoid - not as bad as vulgaris
IgG Abs to hemidesmosomes
immunofluorescence: Abs in linear pattern at epidermal/dermal junction

** blisters contain eosinophils

28
Q

pruritic papules, vesicles, bullae; often at elbows?

A

dermatitis herpetiformis
IgA deposits at tips of dermal papillae
assoc with celiac

29
Q

multiple lesion types, including target lesions?

A 
erythema multiforme
infections: mycoplasma, HSV
drugs: sulfa, beta lactams, phenytoin
cancer
autoimmune dz
30
Q

SJS/SJS-TEN/TEN?

A

SJS < 10% BSA
SJS-TEN: 10-30%
TEN > 30%

31
Q

small rough red/brown papules/plaques?

A

actinic keratosis
premalignant –> squamous cell ca
caused by sun exposure

32
Q

painful lesions on anterior shins?

A

erythema nodosum
subQ fat lesions

** assoc with sarcoid, coccidio, histo, TB, strep, leprosy, Crohn

33
Q

pruritic, purple, polygonal, planar papules and plaques?

A

lichen planus
mucosal involvement: Wickham striae (white lines)
sawtooth lymphocytic infiltrate at dermal-epidermal junction

** assoc with HCV

34
Q

UVA vs UVB?

A

UVA –> tanning, photoaging
UVB –> sunburn

UV radiation –> DNA mutation, keratinocyte apoptosis

35
Q

pink pearly nodule, rolled borders, central crusting/ulceration?

A

basal cell carcinoma
MC skin cancer
locally invasive, rare mets

** palisading nuclei

36
Q

ulcerative red lesions with frequent scale; sun-exposed areas?

A

squamous cell carcinoma
2nd MC skin cancer
locally invasive, LN spread possible, rare mets

    • keratin pearls on histo
    • assoc with arsenic exposure
37
Q

melanoma marker?

A

S-100

38
Q

melanoma mutation?

A

BRAF kinase activating mutation

** BRAF V600E - can try vemurafenib (BRAF kinase inhibitor)

step 1 - path (12 decks)

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