Derm Flashcards
1
Q
Epidermis layers (surface to base)
A
“Californians Like Girls in String Bikinis”
Stratum Corneum (keratin) Stratum Lucidum (most prominent in palms and soles) Stratum Granulosum Stratum Spinosum (desmosomes) Stratum Basale (stem cells)
2
Q
Tight junctions
A
zona occludens
composed of claudins and occludins and prevent paravellular movement of solutes
3
Q
Adherens junction
A
Belth desmosomes, zonula adherens
Cadherins are Ca dependent adhesion proteins
loss of cadherins –> promote metastasis
4
Q
Desmosome
A
Spot desmosome, macula adherens
structural support via intermediate filament interactions
autoantibodies to desmoglein –> pemphigus vulgaris
5
Q
Gap junction
A
channel proteins called connexons permit electrical and chemical communicaiton between cells
6
Q
Integrins
A
membrane proteins that maintain integrity of basolateral membrane by binding to collagen, laminin, and fibronectin in basement membrane
7
Q
Hemidesmosome
A
connects keratin in basal cells to underlying basement membrane
autoantibodies –> bullous pemphigoid
8
Q
Macule
A
flat lesion with well circumscribed change in skin color
<1 cm
ex) freckle or labial macule
9
Q
Patch
A
Macule >1 cm
ex)large birthmark (congenital nevus)
10
Q
Papule
A
Elevated solid skin lesion <1 cm
ex) mole (nevus), acne
11
Q
Plaque
A
Papule > 1 cm
ex) psoriasis
12
Q
Vesicle
A
small fluid containing blister < 1cm
ex) chicken pox or shingles
13
Q
Bulla
A
Large fluid containing blister >1 cm
ex) bullous pemphigoid
14
Q
Pustule
A
VEsicle containing pus
ex) pustular psoriasis
15
Q
Wheal
A
Transient smooth papule or plaque
ex) hives
16
Q
Scale
A
Flaking off of stratum corneum
ex) eczema, psoriasis, SCC
17
Q
Crust
A
Dry exudate
ex) impetigo
18
Q
Hyperkeratosis
A
increased thickness of stratum corneum
ex) psoriasis, calluses
19
Q
Parakkeratosis
A
Retention of nuclei in stratum corneum
ex)psoriasis
20
Q
Hypergranulosis
A
Increase thickness of stratum granulosum
ex) lichen planus
21
Q
Spongiosis
A
Epidermal accumulation of endematous fluid in intercellular spaces
ex) Eczematous dermatitis
22
Q
Acantholysis
A
Separation of epidermal cells
ex) pemphigus vulgaris
23
Q
Acanthosis
A
Epidermal hyperplasia (increases spinosum)
ex) acanthosis nigricans
24
Q
Albinism has _____ melanocyte number with _____ melanin production. This is due to decreased ________ activity or defective _________
A
normal; decreased
tyrosinase activity; tyrosine transport
increased risk of skin cancer
25
This skin disorder is hyperpigmentation that occurs with pregnancy and is sometimes called the mask of pregnancy
melasma (chloasma)
26
This skin disorder has irregular patches of complete depigmentation caused by autoimmune destruction of melanocytes
Vitiligo
27
Patient presents with well demarcated plaques with greasy yellow scales in areas rich in sebaceous glands such as the scalp, face, and periocular region. What skin disorder is this? what organism is it related to? what disease is it related to? treatment?
This is seborrheic dermatitis
Malassezia spp.
Parkinson disease
treat with topical antifungals and corticosteroids
28
What bacteria is commonly linked to acne
Cutibacterium acnes (formerly known as propionibacterium acnes)
29
This skin disorder is related to an increase in IgE and mutations in filaggrin gene predispose patients.
Atopic dermatitis (eczema)
often on the face in infancy. In antecubital fossa in children and adults
filaggrin mutation causes a skin barrier dysfunction
30
What type of hypersensitivity reaction is Allergic contact dermatitis
Type IV hypersensitivity
31
Melanocytic nevus
common mole
benign
melanoma can arise
intradermal --> papular
Junctional --> flat
32
Facial disorder characterized by firm hyperpigmented papules and pustules that are painful and pruritic. Commonly referred to as "razor bumps"
Pseudofolliculitis barbae
33
Psoriasis has papules and plaques with silver scaling. Where is it commonly located and what are the histological changes?
Especially knees and elbow
Acanthosis with parakeratotic scaling (nuclei still in stratum corneum)
Munro microabscesses
Increase in stratum spinosum
decrease stratum granulosum
34
Psoriasis is commonly associated with the _____ sign
Auspitz sign - pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off.
psoriasis is also associated with nail pitting and psoriatic arthritis
35
Rosacea
Inflammatory facial skin disorder characterized by erythematous papules and pustules but not comedones
facial flushing occurs
phymatous rosacea can cause rhinophyma or bulbous deformation of nose
36
These are flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts). What sign is associated with this condition?
Seborrheic keratosis
Leser Trelat sign
37
Verrucae
Warts
| epidermal hyperplasia, hyperkeratosis, koilocytosis
38
Urticaria
Hives
Pruritic wheals that form after mast cell degranulation
characterized by superficial dermal edema and lymphatic channel dilation
39
Angiosarcoma
BV malignancy that is very aggressive and difficult to resect due to delay in dx
elderly, sun exposed areas
associated with radiation therapy and chronic postmastectomy lymphedema
Hepatic angiosarcoma associated with vinyl chloride and arsenic exposures
40
Benign skin papules found in AIDS patients. What organism causes the infection
Bacillary angiomatosis
Bartonella infection
41
Cherry hemangioma
benign capillary hemangioma of the elderly
does not regress
frequency increases with age
42
Cystic hygroma
Cavernous lymphangioma of the neck
turners syndrome
43
Glomus tumor
Benign painful red blue tumor commonly under fingernails
from the smooth mm cells of the thermoregulatory glomus body
44
Kaposi sarcoma is an endothelial malignancy that is associated with ____ and ____
HHV 8 and HIV
45
Pyogenic granuloma
polypoid lobulated capillary hemangioma that can ulcerate and bleed
associated with trauma and pregnancy
46
Strawberry hemangioma
benign capillary hemangioma of infancy
grows rapidly and regresses spontaneously by 5-8 years old
47
______ is characterized by honey colored crusting and is commonly caused by what infections?
Impetigo
superficial skin infection from S aureus and S pyogenes
48
Bullous impetigo
bullae
S aureus
49
Erysipelas
infection of upper dermis and superficial lymphatics that has raised demarcation
S pyogenes
50
Cellulitis
acute painful spreading infection of deeper demis and subq tissues
S pyogenes and S aureus
51
Abscess organism is mostly
S aureus
52
Necrotizing fasciitis
S pyogenes
pain out of proportion to exam findings
Bullaw and purple color to skin
crepitus from methane and CO2 production
"flesh eating bacteria"
53
Scalded Skin Syndrome
Staph
exotoxin destroys keratinocyte attachments in stratum granulosum only
sloughing of upper layers of epidermis that heals completely
54
What sign for _____ indicated seperation of epidermis upon manual stroking of skin
Nikolsky sign
55
Herpetic witlow
herpes infection on finger
56
Molluscum contagiosum is caused by
pox virus
57
Hairy leukoplakia
irregular, white, painless plaques on lateral tongue that cannot be scraped off
EBV mediated
HIV + patients and organ transplant recipients
58
Hair leukoplakia vs thrush vs leukoplakia
thrush can be scraped off
| leukoplakia is precancerous
59
Pemphigus vulgaris
IgG antibody against desmoglein ( component of desmosomes which connect keratinocytes in the stratum spinosum)
Flaccid epidermal bullaw caused by acantholysis (serperation of keratinocytes) "row of tomb stones"
Oral mucosa involved
+ nikolsky sign
60
Pemphigus vulgaris is what type of hypersensitivity reaction
type II
61
Pemphigus vulgaris on immunofluorescence
Antibodies around epidermal cells in a reticular (net-like) pattern
62
Bullous pemophigoid
less severe than pemphigus vulgaris
IgG antibody against hemidesmosomes (epidermal basement membrane)
tense blisters containing eosinophils
spares mucosa
Nikolsky sign -
63
Bullous pemphigoid is what type of hypersensitivity reaction
Type II
64
Bullous pemphigoid on immunofluorescence
linear pattern at epidermal-dermal junction
65
Dermatitis herpetiformis
deposits of IgA at tips of dermal papillae
celiac disease
treat with dapsone, gluten free diet
66
Erythema multiforme
macules, papules, vesicles, target lesions
67
fever, bullae formation and necrosis, sloughing of skin at dermal-epidermal junction
Steven johnson syndrome
typicall involves 2 mucous membranes
targetoid skin lesions
68
More severe form of steven johnson syndrome that requires treatment in burn unit. What percentage of body has to be affected?
toxic epidermal necrolysis
>30% of body
if 10-30% then its SJS-TEN
69
Premalignant lesions caused by sun exposure. Risk of _____ is proportional to degree of epithelial dysplasia
Actinic keratosis; SCC
small rough erythematous or brownish papules or plaques
70
Erythema nodosum
Painful, raised inflammatory lesions of subq fat (panniculitis), usually on anterior shins
71
Lichen planus
Pruritic
Purple
Polyglobal Planar Paules
Plaques
72
Characteristic of Lichen Planus when there is mucosal involvement
Wickham striae and hyperfranulosis
73
Lichen planus is commonly associated with _____ and we see a ______ pattern on histology
Hep C
Sawtooth infiltrate or lymphocytes at dermal-epidermal junction
74
This condition has a "herald patch" prior to other scaly erythematous plaques appearing in a _______ distribution on the trunk
Pityriasis rosea
Christmas tree
Multiple pink plaques with collarette scale
self resolving in 6-8 weeks
75
Sun born is due to UV_ and tanning is UV_
UVB is for sunburn (B=burn)
UVA is for tanning and photoaging
76
First degree burn
through epidermis
77
Second degree burn
through epidermis and partial dermis
blistering without scaring
78
Third degree burn
Full thickness burn through epidermis, dermis, and hypodermis
skin scares with wound healing
79
Most common skin cancer
Basal cell carcinoma
80
Waxy, pink, pearly nodules commonly with telangiectasis, rolled borders, central crusting or ulceration are a sign of
BCC (basal cell carcinoma)
locally invasive but rarely metastasize
can also appear as a nonhealing ulcer with infiltrating growth or as a scaling plaque (superficial BCC)
Palisading nuclei
81
Second most common skin cancer
Squamous cell carcinoma
82
Squamous cell carcinoma
Commonly appears on face, lower lip, ears, hands
locally invasive may spread to lymph nodes and will rarely metastasize
ulcerative red lesions with frequent scale
histopathology: keratin pearls
83
Melanoma tumor marker
S-100
84
Melanoma is often driven by activating mutation in ________ and thus might benefit from vemurafenib a ________ inhibitor
BRAF V600E kinase
BRAF kinase
85
Melanoma risk of metastasis correlates with
Breslow thickness
86
ABCDEs of melanoma
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Asymmetry
Border
Color
Diameter (>6mm)
Evolution
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