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Derm > Derm Path & Definitions > Flashcards

Derm Path & Definitions Flashcards

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Dermatology Board Prep flashcards
1
Q

Freckle (ephelis)

A

Inc melanin pigmentation along basal layer of epidermis (stratum basalis)

NO acanthosis (thickening) of epidermis
NO melanocytic nest formation
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2
Q

Lentigo

A

Inc melanin pigmentation along basal layer of epidermis (basalis)

WITH acanthosis (thickening) of epidermis
WITH elongation of rete ridges
INC melanin pigmentation at base of rete ridges
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3
Q

Vitiligo

A

Hypopigmented patched skin - auto-immune
ABSENCE of melanocytes

Rule out tinea versicolor (M. furfur)

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4
Q

Junctional Melanocytic Nevus (benign mole)

A

Nests of melanocytes at derma-epidermal junction only

New in adults = worrisome

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5
Q

Intradermal Melanocytic Nevus (benign mole)

A

Nests of melanocytes in dermis only

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6
Q

Compound Melanocytic Nevus (benign mole)

A

Nests of melanocytes at BOTH derma-epidermal junction and in dermis

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7
Q

Blue Melanocytic Nevus (benign mole)

A

Spindle-shaped melanocytes usually w/ lots of melanin pigmentation usually in dermis

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8
Q

Dysplastic Melanocytic Nevus (benign mole)

A

Nests of melanocytes at dermo-epidermal junction stretching from rete ridge to adjoining rete ridge, surrounding lamellar fibrosis and peri-vascular chronic inflammation

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9
Q

Halo Melanocytic Nevus (benign mole)

A

Halo around nevus
Mod–> severe infiltration of lymphocytes that are attacking the melanocytes = auto-immune

Possibly malignant

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10
Q

Most malignant melanomas arise…

A

de novo

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11
Q

Dysplastic nevus syndrome

A

Multiple pigmented lesion of trunk, chets abdomen

All a little bit irregular

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12
Q

Hyperkeratosis

A

Orthokeratotic thickening of stratum corneum

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13
Q

Orthokeratosis

A

Normal state of keratinocytes in most superficial layer of epidermis = NO NUCLEI IN KERATINOCYTES

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14
Q

Acanthosis

A

Thickening of all 4-5 layers of the epidermis

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15
Q

Exocytosis

A

Extension of any leukocyte inflammatory cells into epidermis

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16
Q

Malignant melanoma

A

Malignant neoplasm of cells showing melanocytic differentiation
S-100+
HMB-45+

Begins de novo w/ atypical nested proliferation at D-E junction w/ PAGETOID GROWTH –> dermis

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17
Q

Most important factor determining melanoma mets

A

Thickness/depth of invasion

Must be <0.76mm to be unlikely to met

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18
Q

Breslow’s Level

A

Greatest neoplastic depth of invasion in millimeters from granular layer of epidermis

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19
Q

Clark’s Level

A

I - in situ (epidermis only, should not met)
II - invading but not filling papillary dermis
III - invading and filling papillary dermis
IV - invading into reticular dermis
V - invading into adipose tissue of cubcutis

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20
Q

Superficial spreading malignant melanoma

A

Horizontal growth

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21
Q

Nodular malignant melanoma

A

Vertical growth

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22
Q

Aral-Lentiginous malignant melanoma

A

Occurs on acral skin (hands/feet)

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23
Q

Neurotopic

A

Spindle cell differentiation - malignant form of blue melanocyitc nevus - usually does not show epidermal involvement

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24
Q

Seborrheic Keratosis

A

Benign proliferations of keratinocytes

“Stuck-on” lesions

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25
Q

Spongiosis

A

Edema fluid separating keratinocytes from each other in epidermis

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26
Q

Acantholysis

A

Breakdown of normal desmosomal attachments b/w keratinocytes in epidermis

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27
Q

Parakeratosis

A

Abnormal state of keratinocytes having nuclei in stratum corneum - ALWAYS ABNORMAL IN KERATINIZING SKIN

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28
Q

Hypergranulosis

A

Thickening of stratum granulosum

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29
Q

Koilocytosis

A

Peri-nuclear clearing around nulei in keratinocytes - usually indicative of HPV

30
Q

Skin vs. squamous mucosa

A

No nuclei in stratum corneum in skin vs. keratinocytes ALWAYS having nuclei in non-keratinizing squamous mucosa

31
Q

Dyskeratosis

A

Abnormal kerainization of keratinocytes usually individually below the layer of the stratum granulosum

32
Q

Lentigo malinga/Hutchinson’s freckle

A

Elderly, sun-exposed area

33
Q

1 place for melanoma metastasis

A

Liver

34
Q

MOA of corticosteroids

A

Inc lipocortins –> Inhibits phospholipase A2 –> Less arachadonic acid

anti-inflammatory, less edema, less erythema, less pruritis, less plaque

35
Q

Corticosteroid abs

A

Minimal percutaneous

  • LT occlusion inc
  • Inflammation inc
  • Genitals abs 30%!!!
36
Q

Low potency corticosteroids*

A 
Low (VII)
- hydro
- dexa
- methylprednisolone, prednisolone
Tx - atopic, seborrheic, psoriasis

Intermediate
- Fluticasone

37
Q

High potency corticosteroids*

A 
High (class I)
- Betamethasone
- Clobetasol
- Halobestasol
Tx - Pemphigus, vitiligo, keloids, hypertrophic scars, acne cysts
38
Q

Corticosteroids toxicity

A
  1. Suppression of Pituitary-adrenal axis –> Cushing
  2. Growth retardation in kids

Topical

  • atrophy
  • rosacea
  • telangectasia
  • striae
39
Q

DOC for psoriasis*

A
  • Topical steroids 2x/d*

- hands - more potent, less continuous (5-10%)

40
Q

Psoriasis causes & epidemiology*

A

SMOKING, climate, stress
20-30 & 50-60
Whites > Blacks
KNUCKLES, elbows, knees, scalp

Drug causes

  • Lithium
  • BBs
  • anti-malarials
  • SYSTEMIC steroids
41
Q

Tazarotene MOA

A

Modulates differentiation and proliferation of epithelial cells –> antiinflammatory and anti-proliferative

42
Q

Tazarotene SE*

A

NOT IN PREGNANCY

43
Q

Calcipotriene

A

D3 derivative

Extremely effective - 1-2wks

44
Q

Coal Tar

A

ONLY in-combination w/ other therapies for psoriasis - UVB therapy

45
Q

Acitretin*

A

Vit A retinoid - pustular psoriasis
Tx 3-6mo

NOT IN PREGNANCY or 3 YEARS AFTER

46
Q

Etanercept

A

Dimeric fusion protein Binds TNF receptor
SubQ a couple times a month

SE - life-threatening infections & sepsis

47
Q

Adalimumab

A

Human IgG1 TNF Ab –> downreg of MO & T-cell fxn

Psoriatic arthritis

SE - latent TB, opportunistic infections

48
Q

Infliximab

A

Chimeric IgG1 TNF Ab –> downreg of MO & T-cell fxn

SE - demyelinating = CI in MS

49
Q

PUVA (Psoralens and UVA)

A

Psoralens - makes them more light sensitive (320-400nm)

50
Q

Methorexate MOA

A

Mod-severe psoriasis

Inhibits dihydrofolate reductase –> inhibits DNA synthesis

51
Q

MTX dosing & SE

A

Oral triple-dose - q12hrs for 26hrs

BM SUPPRESSION –> agranulocytosis/pancytopenia

  • Dec dose for several months at a time
  • Rescue = LEUCOVORIN
52
Q

MTX toxicities*

A

CI - pregnancy, hepatic

TMP-SMX, Probenecid, salicylates, NSAIDs

53
Q

Anti-trichogenic

A

Inhibits ornithine decarboxylase

54
Q

Repigmentation - tx of vitiligo

A

Trioxsalen & Methoxsalen (Psoralens + UVA)

55
Q

Penicillin Rxn

A

Utricarial - exanthematous –> stop, tx w/ anti-histamine, steroids

56
Q

OCs & sulfa rxns

A

Erythema nodosum - tender, subq nodules, PRE-TIBIAL

Self-limiting - STOP offending agent

57
Q

Anti-convulsants, Barbs, sulfa rxns

A

Erythema multiforme - Maculopapular, bullous, “target lesions”

#1 = HSV
TEN or SJ syndrome
58
Q

Acral Skin

A

Normal thick skin of palms and soles w/ all five layers

59
Q

Skin other than acral

A

Other than palm and soles w/ 4 layers - NO stratum lucidum

60
Q

Vesicles

A

Cystic area in epidermis b/c spongiosis and/or acantholysis in epidermis (intradermal vs. subdermal)

61
Q

Intraepidermal bulla

A

At least the stratum basal is remains attached to the basement membrane and dermis

62
Q

Subepidermal bulla

A

ENTIRE epidermis is detached from dermis

63
Q

Erosion

A

complete loss of epidermis

64
Q

Exfoliative dermatosis/dermatitis

A

Some particular skin disease whose major feature is loss of epidermis from dermis either locally or systemically

65
Q

Apoptotic necrosis of keratinocytes

A

Focal necrosis of individual keratinocytes in epidermis usually seen in the classic differential diagnosis:

  1. Erythema multiforme
  2. TEN
  3. Fixed Drug Eruption
  4. Phototoxic Dermatitis
  5. GVHD
66
Q

Pemphigus vulgaris

A 
Pemphigus = intraepidermal
Cytotoxic Abs (Type II HS)
LINEAR deposition of IgG on desmosomes = acantholysis
FLACCID bulla
Eosionphils
67
Q

Bollous pemphigoid

A

Pemphigoid = SUBepidermal
LINEAR IgG to BM/hemidemisomes
TENSE bulla
Eosinophils

68
Q

Dermatitis Herpetiformis

A

Celiac disease
IgA deposition in papillary dermis
Neutrophils in papillary dermis

69
Q

Porphyria

A

Porphyria cutanea tarda

Inc porphrin excretion - illuminated w/ woods lamp

70
Q

Epidermolysis bullosa

A

Congenital abnormalities w/ BM - epidermis cleaves from dermis w/ little trauma

71
Q

Psoriasis

A

Neutrophils in paraketatotic scale

Derm (1 decks)

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