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DT1 Exam 2 > Derm > Flashcards

Derm Flashcards

1
Q

vitiligo

A

chronic depigmenting condition from complete loss of epidermal melanocytes
Autoantibody against melanin concentrating hormone receptor 1

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2
Q

association for vitiligo

A

pernicious anemia and Hashimoto thyroiditis

may be autoimmune

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3
Q

locations for vitiligo

A

predilection for acral areas (fingers, limbs, ears)

orifices (mouth, eyes, nose, anus)

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4
Q

description of vitiligo rash

A

asymptomatic white macules with sharp borders that gradually enlarge
hair will also lose pigment

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5
Q

treatment of vitiligo

A

topical steroids, calcineurin inhibitors (tacrolimus) and light therapy

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6
Q

histology of vitiligo

A

giant melanosome in depigmented areas

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7
Q

ephelis

A

freckle
basal layer hyperpigmentaiton
darken with sun exposure
no risk of malignancy

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8
Q

lentigo

A

hyperpigmentation of cells just above the basement membrane

do not darken with sun exposure

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9
Q

histology of lentigo

A

age or liver spot
rete ridges are elongated and appear club-shaped or tortuous
increased melanocytes in basal layer
melanophages appear in upper dermis

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10
Q

melanocytic nevi

A

tan to brown
uniformly pigmented
well defined, rounded borders

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11
Q

histology of melanocytic nevi

A

well nested at dermal-epidermal junction
melanocytes mature as they descend in dermis
no deep mitoses
no deep pigment in melanocytic nests

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12
Q

histology of junctional melanocytic nevus

A

nests at dermal-epidermal junction

restricted to the tips and sides of rete

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13
Q

compond melanocytic nevus

A

more raised and dome shaped than junctional nvus

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14
Q

histology of compound melanocytic nevus

A

intraepidermal nevus cell nests and nests and cords in underlying dermis (mature and become smaller)

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15
Q

dermal melanocytic nervus histology

A

epidermal nests are completely lost

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16
Q

spitz nevus characteristics

A

composed of spindle and/or epithelioid cells
sharply defined laterally
symmetry from left to right
clefts separating nests from keratinocytes

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17
Q

clinical characteristics of spitz nevus

A

common in children

deep red color, may be confused with hemangiomas

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18
Q

dyskeratotic melanocytes (Kamino bodies)

A

eosinophilic bodies along dermal-epidermal junction

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19
Q

histology of spitz nevus

A

nests of melanocytes within the epidermis

nests separated from epidermis by clefts

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20
Q

dysplastic melanocytic nevus characteristics

A

commonly large, oval, and multiple
irregular pigment common
fading border or fied egg appearance

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21
Q

histology of dysplastic melanocytic nevus

A

usually compound, concentric papillary dermal fibrosis
horizontally oriented nests with bridging of adjacent rete
at the tips and sides of rete
hyperchromatic, enlarged nuclei

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22
Q

melanoma characteristics

A

malignancy of pigment producing cells (derived from neural crest)
found in skin, eyes, GI tract, letpomeninges, oral and genital mucosa

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23
Q

number one cause of skin cancer deaths worldwide

A

melanoma

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24
Q

determination of tumor stage

A

vertical phase

can lead to metastasis to lymph nodes, brain, GI, bone, liver and lungs

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25
Q

common mets in melanoma

A

brain (third after lung and breast cancer)

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26
Q

risk factors for melanoma

A 
changing mole (number 1)
atypical nevi, numerous
large congenital nevi
previous melanoma or nonmelanoma
sun sensitivity
xeroderma pigmentosum
fair skin and history of blistering sunburns
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27
Q

management of suspicious lesions

A 
asymmetry
border irregularity
color variation
diameter
evolving
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28
Q

biopsy lesion

A

full thickness skin extending into subcutaneous fat with 2mm lateral margins
excision, punch or incisional if large

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29
Q

radial growth phase

A

horizontal spread within the epidermis and superficial dermis
lack ability to metastasize

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30
Q

vertical growth phase

A

invade downward into deeper dermal layers as a mass
metastatic potential
cells do not mature

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31
Q

superficial spreading melanoma

A

most common melanoma
radial growth phase of uncertain length before vertical growth phase develops
may show multiple shades-red, tan, brown, blue, black, gray and white

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32
Q

typical location of superficial spreading mel

A

back of men and lower legs of women

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33
Q

histological superficial spreading mel

A

buckshot scatter of atypical melanocytes
not symmetrical
deep mitoses
typically fails to mature from top to bottom

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34
Q

lentigo maligna

A

slow growing lesion
long radial growth phase
tan-brown macule that graudally enlarges, devlops darker, asymmetric foci

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35
Q

location for lentigo maligna

A

face of old men

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36
Q

histological features of lentigo maligna

A

junctional growth of atypical melanocytes
poorly nested and confluent melanocytes at dermal-epidermal junction
adnexa extension

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37
Q

lentigo maligna melanoma

A

lentigo maligna with vertical growth phase

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38
Q

acral lentiginous melanoma

A

least common
most common melanoma in AA and Asians
palms, soles, beneath nail plate

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39
Q

Hutchinson’s sign

A

sign of malignant melanoma on fingernail

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40
Q

nodular melanoma histology

A

vertical growth phase
no apparent radial growth
mitoses are frequent and often atypical

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41
Q

breslow measurement

A

actual measurement from skin surface

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42
Q

clark measurement

A

number of layers of skin that the tumor has penetrated

most closely correlates with survival statistics

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43
Q

sentinel node biopsy

A

radioactive tracer and gamma probe
for intermediate tumors (1-4mm) or high risk thin tumors
helpful in staging

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44
Q

seborrheic keratosis

A

most common benign tumor in older individuals
looks like melanoma
begin as light brown, flat macules-then become velvety or waxy

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45
Q

sign of Leser-Trelat

A

multiple eruptive SK with internal malignancy

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46
Q

dermatosis papulosa nigra

A

brown to black, smooth, dome shaped papules
subtype of SK in AA
liquid nitrogen can cause hypopigmentation

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47
Q

histology of SK

A

sheets of small, basaloid cells
exuberant keratin production
horn cells and loose lamellar keratin

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48
Q

horn cysts

A

keratin filled cysts

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49
Q

acanthosis nigricans

A

hyperpigmentation and hyperplasia of stratum spinosum

found in folds of neck, axilla, groin

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50
Q

acanthosis benign type

A

associated with endocrine abnormalities (DM)

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51
Q

malignant acanthosis

A

middle aged and older

associated with visceral malignancy

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52
Q

epidermal inclusion cyst

A

common on head or neck of children
may be excised if inflammed
cyst wall resembles normal epidermis, filled with strands of keratin

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53
Q

actinic keratoses

A

can develop into SCC
palpation-rough or gritty skin, feels like broken glass
slightly erythematous papule or plaque with adherent scale

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54
Q

locations of actinic keratoses

A

face, scalp, ears, posterior neck, forearms and legs

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55
Q

histology of actinic keratoses

A

parakeratosis (retained nuclei) in stratum corneum
hyperplasia and cytologic atypia of basal cells
solar elastosis in superficial dermis

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56
Q

treatment of actinic keratoses

A

isolated-cryotherapy
5FU (causes intense inflammation)
excision, electrodissection, curettage, CO2 laser, Imiquimod, photodynamic therapy

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57
Q

side effect of cryotherapy

A

mild blistering and then scab

if ulcerated or thickened-rule out SCC

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58
Q

most common cancer in the US

A

nonmelanoma skin cancer
80% BCC
20% SCC

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59
Q

SCC

A

arises in epithelium and is common in middle aged and elderly

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60
Q

risk factors for SCC

A

male, elderly, UV and ionizing radiation, fair skin, arsenic, HPV, burn scars and immunosuppression
MOST IMPORTANT IS DNA DAMAGE FROM UV LIGHT-UVB#1

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61
Q

common locations for SCC

A

scalp, dorsal upper extremities, ears

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62
Q

Bowen disease

A

sharply demarcated pink plaque and can arise on non-sun exposed skin
SCC in situ

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63
Q

erythroplasia of Queyrat

A

Bowen disease of glans penis
manifests ad one or more velvety red plaques
SCC in situ

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64
Q

Bowen histology

A

no invasion through basement membrane of dermoepidermal junction
atypical nuclei involve all layers of epidermis

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65
Q

SCC histology

A

invade basement membrane
lobules of polygonal cells, area of keratinization in well differentiated
anaplastic, necrosis, no keratin organization in poorly differentiated

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66
Q

intercellular bridges

A

SCC

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67
Q

invasive SCC

A

raised, firm, pink to flesh colored keratotic papule
metastases to regional lymph nodes
surface changes include scaling, ulceration, crusting or presence of cutaneous horn

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68
Q

diagnosis of SCC

A

requires biopsy (shave, punch, incisional, or excisional)
lymph node biopsy or FNA if lymphadenopathy is present
PET, ultrasound guided FNA and sentinel to determine nodal mets

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69
Q

treatment of SCC

A 
surgical removal (less margin than melanoma)
ED and C not recommended
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70
Q

keratoacanthoma

A

benign epithelial tumor that may progress to SCC
look alike
appear suddenly on actinically damaged skin and regress
red to flesh colored dome-shaped papule with central keratinous plug

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71
Q

histology of keratoacanthoma

A

large, red, glassy squamoid cells
mitoses uncommon
neutrophil microabscesses common
eosinophils and lymphocytes are common in surrounding infiltrate

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72
Q

BCC

A

most common
pluripotential cells in basal layer of epidermis and follicular structures
can cause local destruction and disfigurement

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73
Q

BCC risk factors

A

UV radiation, xray, arsenic, immunosuppression

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74
Q

common presentation of BCC

A

non-healing lesion that bleeds

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75
Q

common location BCC

A

face, ears, scalp, neck, upper trunk

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76
Q

nodular BCC

A

most common type
face most common site
waxy with central depression
telangiectasias over surface

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77
Q

superficial BCC

A

trunk most common site
atrophic center with fine translucent micropapules on rim
light red color

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78
Q

diagnosis of BCC

A

biopsy to confirm

shave or punch

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79
Q

histology of BCC

A

basaloid cells which palisade at border of nest
nests in fibromyxoid stroma
separation artifact-stroma separates from tumor nodules

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80
Q

treatment of BCC

A 
currettage, excision with margin examination
Mohs micrographic surgery
radiotherapy
radiation
Imiquimod
5FU
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81
Q

Mohs surgery

A

removal of tumor and thin rim
frozen section allows examination of tissue while patient is in office
best long term cure rates of any treatment modality

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82
Q

acanthosis

A

diffuse epidermal hyperplasia

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83
Q

dyskeratosis

A

premature keratinization within cells below stratum granulosum

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84
Q

hydropic swelling

A

intracellualr edema of keratinocytes

seen in viral infections

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85
Q

hypergraunulosis

A

hyperplasia of granulosum due to intense rubbing

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86
Q

hyperkeratosis

A

thickening of straum corneum due to qualitative abnormality of keratin

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87
Q

lentiginous

A

linear pattern of melanocyte proliferation within the epidermal basal cell layer

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88
Q

papillomatosis

A

surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae

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89
Q

parakeratosis

A

keratinization with retained nuclei in stratum corneum

normal in mucous membranes

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90
Q

spongiosis

A

intercellular edema of epidermis

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91
Q

dermatofibroma

A

benign fibrous histiocytoma
very common benign lesion that occurs on lower legs
display dimple sign
fibrous reaction to some past trauma to skin

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92
Q

histology of dermatofibroma

A

proliferations of fibroblasts with collagen
whirling fibroblasts with collagen bundles
overlying hyperkeratosis and hyperpigmentation-reddish brown color

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93
Q

dermatofibrosarcoma protuberans histology

A

primary fibrosarcoma of skin
extends from dermis into subcutaneous fat in honeycomb pattern
fibroblasts in pinwheel pattern

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94
Q

mycosis fungiodes

A

T cell lymphoma that presents in skin and may evolve into generalized lymphoma

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95
Q

stages of mycosis fungiodes

A

patch-scaly, red-brown
plaque-raised, indurated, irregular, red, scaly
nodule-fungating, red-brown

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96
Q

histology of mycosis fungiodes

A

T helper cells form bands in superficial dermis

invade epidermis as single cells or small clustures (Pautrier microabscesses)

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97
Q

urticaria pigmentosa

A

usually children

round to oval, red-brown papules and plaques, pruritic and may blister, appear shortly after birth

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98
Q

systemic mastocytosis

A

usually adults

skin lesions similar to urticaria pigmentosa plus multi-organ mast cell infiltration

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99
Q

organ involvement in systemic mastocytosis

A

bone marrow, liver, spleen, lymph nodes

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100
Q

darier sign

A

wheal when skin lesion is rubbed (sign of mastocytosis)

101
Q

dermatographism

A

hive occurs when normal skin is stroked with pointed instrument (sign of mastocytosis)

102
Q

cause of signs and symptoms in mastocytosis

A

histamine, heparin, other mast cell contents

103
Q

histology of matocytoma

A

metachromatic granules within dendritic mast cells
fried egg cells-central nuceli
Giemsa to visualize mast cell granules

104
Q

ichthyosis

A

disorders which impair epidermal maturation

most cases congenital

105
Q

ichthyosis vulgaris

A

associated with lymphoid and visceral malignancies

stratum granulosum thin or absent

106
Q

ichthyoses histology

A

build up of compacted stratum corneum with loss of basket weave pattern

107
Q

stratum granulosum normal to slightly thickened

A

lamellar
x-linked
congential ichthyosiform eryhtroderma

108
Q

urticaria

A

wheals

from mast cell degranulation and microvascular hyperpermeability

109
Q

pathogenesis of urticaria

A

antigen-induced mast cell degranulation through sensitization with specific IgE antibodies
follows exposure to multiple antigens-pollens, foods, drugs, insect venom

110
Q

histology of urticaria

A

perivenular infiltrate, neutrophils then mononuclear cells

collagen bundles more widely spaced due to dermal edema

111
Q

contact dermatitis

A

inflammatory reaction caused by an exogenous chemical

can be irritant or allergic

112
Q

irritant contact dermatitis

A

produced by substance that has direct toxic effects on the skin (acids detergents, alkalis, frequent hand washing)
not an immunologic condition
rash begins shortly after exposure

113
Q

allergic contact dermatitis

A

cell mediated, delayed type hypersensitivity reaction (type IV)
Ag on skin surface taken up to Langerhans cells
Migrate via dermal lymphatics to lymph nodes
Present Ag to CD4 T cells which become effector and memory cells

114
Q

sensitization allergic contact dermatitis

A

sensitization occurs 1-2 weeks after 1st exposure to allergen

115
Q

common allergens for allergic contact dermatitis

A

poison ivy, mangos, iodine, nickel, rubber, cosmetics

116
Q

poison ivy contact dermatitis

A

produce urushiol as common allergic substance

fluid contained in vesicles does not contain an allergen and cannot induce disease in others

117
Q

clinical features of contact dermatitis

A

erythematous papules and vesicles with oozing to crusting and scaling
very pruritic

118
Q

atopic dermatitis

A

prurutic
worse in winter due to decreased humidity
look for history of allergies, asthma, eczema

119
Q

baby atopic dermatitis

A

face, diaper, extensor surfaces

120
Q

adults atopi dermatitis

A

neck, face, axillae, antecubital, popliteal fossa

121
Q

linchenification

A

epidermal thickening characterized by visible and palpable skin thickening with accentuated skin lines

122
Q

nummular dermatitis

A

coin shaped red plaques
young adults
same treatment for atopic dermatitis

123
Q

asteatotic dermatitis

A

old people-cracked skin

avoid excessive bathing

124
Q

histology of acute spongiotic dermatitis

A

spongiosis

exocytosis of lymphocytes

125
Q

histology of subacute spongiotic dermatitis

A

parakeratosis
acanthosis
spongiosis
exocytosis of lymphocytes

126
Q

erythema multiforme

A

immune mediated, hypersensitivity reaction resulting in epidermal cell injury
attacked by CD8
target lesions are diagnostic

127
Q

triggers of erythrema multiforme

A

HSV, mycoplasma, sulfa drugs, penicillin, phenytoin, allopurinol, barbituates

128
Q

histology of erythema multiforme

A

perivascular lymphocytic infiltate, degenerating and necrotic keratinocytes early
later-lymphocytes into epidermis, epidermal necrosis with blister formation

129
Q

Stevens-Johnson syndrome

A

more sever than EM
children>adults
mucous membranes-mouth and conjunctiva

130
Q

frequent causes of SJS

A

sulfa drugs and anticonvulsants

131
Q

treatment SJS

A

stop medication

burn unit

132
Q

toxic epidermal necrolysis

A

dermatologic emergency

large area of epidermis detach

133
Q

Pityriasis rosea

A

subacute spongiotic dermatitis
related to HHV 7
older children and young adults, common in winter
herald patch and Christmas tree pattern

134
Q

herald patch

A

resembles ringworm

found in Pityriasis Rosea

135
Q

common sites of pityriasis rosea

A

trunk, upper arms, thighs

136
Q

venous insufficiency

A

increased hydrostatic pressure and capillary damage leading to extravasation of RBC and serum
starts as edema and hyperpigmentation and leads to pruritic erythema and stasis dermatitis

137
Q

cause of thickened, brown appearance in stasis dermatitis

A

hemosiderin

138
Q

psoriasis

A

accelerated proliferation of skin cells resulting in scaling
average age is 35
stratum basale to shedding in 3-4 days instead of 28

139
Q

rash in psoriasis

A

well demarcated, erythematous plaques and papules with silver scaling
Auspitz sign
symmetrical

140
Q

Koebner phenomenon

A

trauma to skin and stress can cause exacerbations (psoriasis)

141
Q

Auspitz’s sign

A

pinpoint bleeding on removal of scale

142
Q

histology of psoriasis

A

downward elongation of rete ridges
thinning of overlying stratum granulosum with parakeratosis abover
aggregates of neutrophils and spongiosis
capillaries in dermal papillae are brought close to surface

143
Q

Guttate psoriasis

A

post strep infection

144
Q

psoriasis on nails

A

oil spotting-focal brown discoloration of nail plate
onycholysis-distal separation of plate from bed
subungal hyperkeratosis
pitting

145
Q

psoriatic arthritis

A

pencil in cup deformity where one articular surface is eroded creating a pointed appearance

146
Q

arthritis mutilans

A

destructive form of psoriatic arthritis with periarticular bone resorption

147
Q

treatment of psoriasis

A 
corticosteroids
calcipotreiene-from vitamin D
tars-poor compliance 
DO NOT GIVE ORAL STEROIDS-REBOUND
methotrexate-folate antagonist
light therapy
acitretin-vitamin A derivative
biologics
148
Q

seborrheic dermatitis

A

chronic inflammatory process affecting areas rich in sebaceous glands
peaks in infancy and adulthood
thought to be caused by malassezia furfur
usually symmetrical distribution

149
Q

associations with seborrheic dermatitis

A

HIV and Parkinson

150
Q

histologic features of seborrheic dermatitis

A

spongiotic early and psoriasis later
parakeratosis with neutrophils and serum at ostia of hair follicles
perivascular infiltrate of lymphocytes and neutrophils

151
Q

Linchen planus

A 
idiopathic inflammatory disorders
pruritic, purple, polygonal, planar papules, plaques
most common on wrists and ankles
mucous membrane involvement is common
Koebner phenomenon
152
Q

Wickham’s striae

A

fine reticulated white lines

associated with Lichen planus

153
Q

association of lichen planus

A

hep C

154
Q

histology of lichen planus

A

dense continuous infiltrate of lymphocytes along the dermoepidermal junction
degerneation and necrosis of basal keratinocytes
dermoepidermal interface more angulated-saw tooth

155
Q

civatte bodies

A

incorporation of necrotic basal keratinocytes into infalmed papillary dermis (lichen planus)

156
Q

SLE characteristics

A

autoimmune disease involving connective tissues and blood vessels
more common in AA
female: male 9:1
may present with fatigue, fever, weight loss, malaise, arthralgias, CNS symptoms

157
Q

malar rash

A

butterfly rash eryhtematous, confluent, macular eruption with clear borders
spares nasolabial folds

158
Q

other symptoms of SLE

A

oral ulcers, renal disease, pericarditis, pneumonitis, peritonitis, hepatosplenomegaly, myopathy, neuropathy, lymphadenopathy, seizures

159
Q

false positives for SLE

A

RPR and VDRL

160
Q

histology of SLE

A

lichenoid interface dermatitis
epidermal atrophy
thickening of basal membrane

161
Q

pemphigus vulgaris

A

most common and most severe type
men and women equally
involves scalp, face, axillae, groin, trunk, points of pressure, oral ulcers

162
Q

cause of pemphigus vulgaris

A

IgG autoantibodies against desmogleins 1 and 3 in desmosomes in suprabasal deep epidermis and mucosal epithelium

163
Q

blisters in pemphigus vulgaris

A

flaccid blisters that rupture leaving erosions with crust

positive Nikolsky sign (pressure on blister causes lateral spread of lesion)

164
Q

histology of pemphigus vulgaris

A

acantholysis (lysis of intercellular adhesions connecting squamous epithelial cells)
single layer of intact basal cells forms blister base-row of tombstones

165
Q

DIF on pemphigus vulgaris

A

net like pattern of intercellular IgG deposits

166
Q

pemphigus vegetans

A

rare
large, moist, verrucous, vegetating plaques
oral lesions common

167
Q

association of pemphigus vegetans

A

ulcerative colitis

168
Q

pemphigus foliaceous

A

Brazil
Target Ag is Dsg1
subcorneal blister

169
Q

bullous pemphigoid

A

elderly individuals
oral lesions uncommon (only after cutaneous lesions)
Ags to BPAg1 and BPAg2 in hemidesmosome-only 2 causes blister

170
Q

site of blisters in bullous pemphigoid

A

inner aspects of thighs, flexor surfaces of forearms, axillae, groin and lower abdomen

171
Q

blisters in bullous pemphigoid

A

sturdy-roof is full thickness

172
Q

histology bullous pemphigoid

A

subepidermal, nonacantholytic blisters
early perivascualr infiltrate of lmyphocytes
eosinophils in blister cavity

173
Q

direct immunofluorescence in bullous pemphigoid

A

linear deposition of C3 and IgG along dermoepidermal junction

174
Q

associations in dermatitis herpetiformis

A

HLA-B8, HLA-DR, HLA-DQ

175
Q

etiology of dermatitis herpetiformis

A

IgA autoantibodies to transglutaminases bind to TG in gut and cross react with reticulin in fibrils in skin

176
Q

lesions in dermatitis herpetiformis

A

symmetrically grouped lesions

papules and plaques progress to vesicles and bullae

177
Q

common sites of dermatitis herpetiformis

A

buttocks
elbows
knees
scapular areas

178
Q

GI related to dermatitis herpetiformis

A

gluten sensitive enteropathy occurs in nearly all patients

there may be no GI symptoms

179
Q

histology of dermatitis herpetiformis

A

microabscesses at dermal papillae
subepidermal blister
neutrophil microabscesses and fibrin deposition in tips of dermal papillae
basal cells overlying tips show dermoepidermal separation

180
Q

immunofluorescence in dermatitis herpetiformis

A

discontinuous granular deposition of IgA in tips of dermal papillae

181
Q

diagnosis of dermatitis herpetiformis

A 
skin biopsy
antiendomysial antibodies (specific for TG)
endoscopy-blunting of villi in small bowel
182
Q

treatment of dermatitis herpetiformis

A

gluten-free diet (slow response)

dapsone-check G6PD, monitor methemoglobin and CBC

183
Q

epidermolysis bullosa

A

inherited defects in proteins that lend stability to skin
blisters at points of pressure, rubbing, trauma
symptoms at or soon after birth

184
Q

simplex epidermolysis bullosa

A

mutations to keratin 14 or 5

results in basal cell layer defects

185
Q

junctional type epidermolysis bullosa

A

from separation of lamina lucida

186
Q

dystrophic type epidermolysis bullosa

A

below lamina densa from defect in collagen VII

scar formation on healing

187
Q

non-herlitz junctional epidermolysis bullosa

A

defect in laminin VBeta3

188
Q

histology of epidermolysis bullosa

A

firin deposition in floor of blister

dermal fibrosis may be present

189
Q

associations of porphyria cutanea tarda

A

females on OCPs
alcohol use
Hep C

190
Q

deficiency in porphyria cutanea tarda

A

uroporphyrinogen carboxylase deficiency (UROD)

191
Q

type 1 porphyria cutanea tarda

A

exposure to drugs/chemicals

hepatic UROD is inhibited

192
Q

type 2 prophyria cutanea tarda

A

AD

deficient in RBCs and fibroblasts

193
Q

porphyria cutanea tarda

A

porphyrins make skin sensitive

may also get hypertrichosis

194
Q

exacerbations of prophyria cutanea tarda

A 
iron
alcohol
smoking 
estrogens
hep C
HIV
halogenated hydrocarbons
195
Q

diagnosis of porphyria cutanea tarda

A

test for increase in uroporphyrin in urine

fluoresce orange under Wood’s lamp

196
Q

histology of porphyria cutanea tarda

A

subepidermal vesiculation
acral skin with compact orthokeratosis
solar elastosis
festooning-protuberance of rigid dermal papillae into blister cavity
thickening of walls of superficial dermal vessels

197
Q

pathogenesis of acne vulgaris

A

obstruction of sebaceous follicles by sebum promotes proliferation of P. acnes (anaerobe)

198
Q

obstructive acne

A

closed comedones-whiteheads

open comedones-blackheads (dilated pore with keratinous material)

199
Q

inflammatory acne

A

lesions progress from papules/pustules to nodules to cysts

200
Q

risk factors for acne

A 
male 
puberty
Cushing's syndrome
oily complexion
androgen excess
201
Q

components of acne

A

keratinization of lower portion of follicular infundibulum with development of keratin plug blocking outflow of sebum to skin surface
hypertrophy of sebaceous glands with puberty
lipase syntehsizing bacteria colonize upper and midportion of hair follicle
inflammation of follicle associated with release of cytotoxic and chemotactic factors

202
Q

acne rosacea

A

chronic infalmmatory disorder tha affects blood vessels and pilosebaceous units
between 30-50 yo

203
Q

triggers of acne rosacea

A

sun exposure, alcohol, spicy foods, exercise, stress, temperature extremes

204
Q

stages of acne rosacea

A 
flushing episodes-pre rosacea
persistent erythema and telangiectasias
pustules and papules
rhinophyma
affects nose and cheeks including nasolabial folds
205
Q

rhinophyma

A

skin on nose becomes thick and greasy

hyperplasia of sebaceous glands, connective tissue and vasculature

206
Q

treatment of acne rosacea

A

topical metronidazole and oral doxycycline

207
Q

histology of acen rosacea

A

perifollicualr infiltrate of lymphocytes surrounded by dermal edema and telangiectasias

208
Q

erythema nodosum

A

inflammatory reaction of connective tissue septa separating fat lobules
most common in females 20-30

209
Q

location and appearance of erythema nodosum

A

painful, red, subcutaneous, elevated nodules-indurated and poorly circumscribed
usually on the anterior aspect of the tibia
bilateral but not symmetric

210
Q

causes of erythema nodosum

A 
idiopathic
strep
sarcoidosis
IBD
fungal infection
pregnancy
meds-OCP, sulfa, amiodarone, antibiotics
syphilis
TB
211
Q

workup for erythema nodosum

A

CXR
VDRL for syphilis
(pregnancy test first)

212
Q

treatmetn for eryhtema nodosum

A

bed rest, leg elevation, NSAIDs, heat for symptoms

steroids only when infection excluded

213
Q

histology of erythema nodosum

A

septal panniculitis
widening of septa from fibrin, edema, neutrophilic infiltrate
mononuclear cells and granulomatous inflammation of septum with fibrosis in chronic

214
Q

warts

A

benign growths caused by infection of epidermal cells with HPV
transmitted by skin to skin contact
disrupt skin lines

215
Q

intralesional brown-black dots on warts

A

thrombosed vessels

216
Q

sites of verruca vulgaris

A

elbows
knees
fingers
palms

217
Q

sites of verruca plana

A

chin
dorsum of hands
legs

218
Q

plantar warts

A

HPV1

may cause pain if on pressure areas

219
Q

cause of condyloma acuminatum

A

HPV 6 and 11

16 and 18 can lead to cervical cancers

220
Q

histology of verruca vulgaris

A

exophytic

church spire

221
Q

koilocytes

A

cells with vacuolated cytoplasm-clearing around the nucleus

222
Q

molluscum contagiosum

A

viral infection in kids and sexually active adults
caused by poxvirus
transmitted by skin to skin contact

223
Q

lesion in molluscum contagiosum

A

central umbilication
papules have cheesy core
anywhere on kids and genitals of sexually active adults

224
Q

histology of molluscum contagiosum

A 
cup-shaped lesion with scalloped border
verrucous acanthosis (epidermal hyperplasia)
molluscum bodies in cells of stratum cornum and granulosum (ovoid, homogeneous, cytoplasmic inclusion bodies)
225
Q

impetigo

A

superficial bacterial infection

painful lesions

226
Q

nonbullous impetigo

A

most common
face and extremities
papules to vesicles on eryhtematous base
honey colored crust when ruptured

227
Q

bullous impetigo

A

young children
vesicles enlarge to form flaccid bullae
trunk is more frequently affected

228
Q

histology of impetigo

A

accumulation of neutrophils beneath stratum corneum

229
Q

treatment of impetigo

A

mupirocin (bactroban) or hydrogen peroxide

oral antibiotics for bullous type

230
Q

scabies

A

infection with sarcoptes scabiei
common in school age children, nursing home patients, less developed children
incubation 1 month

231
Q

sites for scabies

A

finger webs, wrists, penis

linear burrows with dark dot-path of female mite in skin

232
Q

reaction to feces and eggs in scabies

A

delayed type IV hypersensitivity

233
Q

scabies treatment

A

permethrin or lindane lotion
oral ivermectin
treat all close contacts
itching may last for weeks but not contagious at that point

234
Q

xanthelasma

A

macrophages containing lipid droplets

always check lipids

235
Q

associations of xanthelasma

A 
familial hyperlipidemias
nephrotic syndrome
myeloma
pancreatitis
thyroid disease
primary biliary cirrhosis
236
Q

mongolian spot

A

single gray-blue lesion over lumbosacral area
more common in Asians and Native American patients
no melanomas in this lesion
melanocytes in dermis instead of epidermis may be neural crest cells interrupted in migration

237
Q

cherry angioma

A

bright red domed, vascular lesions on trunk

benign and increase with age

238
Q

hemangioma of infancy

A

most common tumor of infancy
more common in premature, Caucasian girls
tumor of hyperplastic blood vessels
blanchable bright red to deep purple lesions
grow in first year and regress by 10

239
Q

treatment of hemangioma of infancy

A

only if it ulcerates or blocks ears, larynx, eyes

propranolol, steroids, laser

240
Q

phases of hair development

A

anagen (growing)
catagen (involution)
telogen (resting-shed at end)

241
Q

angrogenetic alopeica

A

scalp 5 alpha reductase

men and women equally affected

242
Q

telogen effluvium

A

diffuse decrease in hair density due to rapid conversion of anagen to telogen
precipitated by stressful events, illness, fever, pregnancy

243
Q

alopecia areata

A

autoimmune disorder causing patchy or diffuse hair loss

244
Q

treatment for alopecia

A

areata-topical steroids

androgenetic-topcial minoxidil or finasteride (inhibits DHT), spironolactone in women

245
Q

xeroderma pigmentosum

A

AR condition
decreased ability to reapir DNA following damage by UV light due to defects in excision of abnormal nucleotides or defects in replacement of nucleotides following excision

246
Q

signs of xeroderma pigmentosum

A

eryhtema, scaling, hyperpigmentation and lentigo on light-exposed area
skin later-atrophy, telangiectasia, intermingling areas of hyper and hypopigmentaiton
SCC, BCC, and melanoma as early as 5-6 yo

247
Q

chediak-higashi syndrome

A

AR
immunodeficiency due to defect in neutrophil phagosome lysosome fusion causing giant lysosomal inclusinos visible on peripheral blood smear
pyogenic infections
albinism-abnormal melanin storage in melanocytes
nystagmus, peripheral and cranial neuropathies

248
Q

wiskott-aldrich syndrome

A 
x linked
immunodeficiency
eczema
thrombocytopenia
combined B and T lymphocyte disorder
249
Q

albinism

A

melanocytes normal in number and location but production of melanin defective due to complete absence of tyrosinase
white hair, blue eyes and pink/white skin

DT1 Exam 2 (6 decks)

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