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KAPLAN FLASH CARDS > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Inheritance of Marfan syndrome

A

Autosomal Dominant

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2
Q

What is defective in Marfan syndrome?

A

Protein called fibrillin

*Located in ECM

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3
Q

Autoantibodies to adhesion proteins (ie: desmosomal or hemidesmosomal) can lead to what 2 diseases, respectively?

A

Desmosomal autoantibody:
Pemphigus vulgaris

Hemidesmosomal autoantibody:
Bullous pemphigoid

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4
Q

Another name for atopic dermatitis

A

Eczema

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5
Q

Eczema is considered which hypersensitive reaction/

A

Type 1

*Treat with topical steroids

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6
Q

Microscopy analysis of atopic dermatitis would show what?

A

Spongiosis (increasing spacing of epidermal cells due to intercellular edema)

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7
Q

What is the difference in location of the erythematous lesions in infants vs children/adults who are affected by eczema?

A

Infants: Extensors

Adults: Flexors

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8
Q

What can be in the family history of a patient who has eczema?

A

Family has hay fever, allergic rhinitis, or asthma

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9
Q

What type of sensitivity reaction is contact dermatitis?

A

Type 4

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10
Q

Cause of lichen simplex chronicus?

A

Itching & scratching

*Results in leathery thick skin

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11
Q

Differentiating factor between eczema & seborrheic dermatitis?

A

Seborrheic dermatitis is confined to head & scalp with red patchy infiltrate

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12
Q

Explain how restoration naturally of the epidermis can occur?

A

Stem cells located in the hair follicles and sweat glands within the dermis

**Because items above are derived from ectoderm too, which includes hair follicles, sebaceous glands, & sweat glands

***Dermis is derived from mesoderm

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13
Q

Where are melanocytes derived from embryonically?

A

Neural crest cells

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14
Q

Inheritance of xeroderma pigmentosum

A

Autosomal recessive

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15
Q

Characteristic of xeroderma pigmentosum

A

Extreme sensitivity to sunlight

*predisposition to malignancy –> malignant melanoma, BCC, & SCC

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16
Q

Reason for xeroderma pigmentosum

A

Defective nucleotide excision repair (NER) mechanism of UV damaged DNA, causing pyridimidine dimers

*Thymidine nucleotides form covalent bonds with each other rather than complementary bases on opposite DNA strand

**These mutations accumulate and can cause cancer

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17
Q

Explain the ABCDE rule and what is it used to identify?

A

Melanoma

  • Asymmetry of growth
  • Borders are irregular
  • Color variations
  • Diameter great than 6 mm
  • Evolution over time
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18
Q

What is the name of the ulcerative form of impetigo?

A

Ecthyma

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19
Q

2 main forms of impetigo

A

1) Non-bullous [either S. aureus or S. pyogenes]
- Lesions begin as papules & progress to vesicles
- Later become pustules

2) Bullous [only S. aureus]
- Caused by exfoliative toxin A

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20
Q

What is + Nikolsky sign suggestive of? What is it?

A

Rubbing results in skin exfoliation

Dx: Pemphigus Vulgaris (autoimmune disease)

*Caused by dysfunctional desmosomes in epidermis

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21
Q

What disease is associated with a defect in actin?

A

NONE! trick question….not a single one exists

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22
Q

Inflammation of the nasolacrimal sac & cause?

A

Dacryocystitis

*Due to obstruction of nasolacrimal duct, causing reduced tear flow & infection

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23
Q

Infant who develops generalized severe erythema and flaccid bull (+ Nikolsky sign) is indicative of what infection?

A

Scalded skin syndrome

*S. aureus

**Treat baby like burn victim

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24
Q

In scalded skin syndrome of the infant, where are symptoms especially located?

A

Around the umbilicus

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25
Q

What do exotoxins in staph infections typically target in scalded skin syndrome?

A

Desmosomes between keratinocytes in the stratum granulosum

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26
Q

What diseases demonstrate a + Nikolsky sign? (3)

A
  • Scalded skin syndrome
  • Epidermal necrolysis
  • Pemphigus vulgaris
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27
Q

Maculopapular rash that begins in the face and neck, traveling to the extremities, and sparing the palms & soles is what disease?

A

Scarlet fever

*S. Pyogenes

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28
Q

What is the severe cause of Steven-Johnson syndrome?

A

Toxic epidermal necrolysis

*Presents similar to scalded skin syndrome but patients are older, involve mucous membranes, and triggered by new medicines

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29
Q

Vitamin C is an essential cofactor for what in scurvy?

A

Necessary for hydroxylation of proline & lysine residues on pre-pro-collagen chains

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30
Q

Cause of albinism

A

Deficiency in enzyme tyrosinase (AR inheritance)

*Inability to synthesize melanin from tyrosine (aromatic amino acid)

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31
Q

Function of hemidesmosomes

A

Connect basal surface of epithelial cells to underlying basement membrane

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32
Q

In which layer are blisters formed in bullous pemphigoid?

A

Subepidermal

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33
Q

What are antibodies being made against in the disease involving hemidesmosomes?

A

Dystonin

*Bullous pemphigoid

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34
Q

Function of the desmosome

A

Connecting the lateral surfaces of two adjacent cells together

35
Q

Where are blisters located in pemphigus vulgaris

A

Intraepidermal

36
Q

Most common cause of erythema multiforme

A

Herpes simplex virus

*this rash has a target lesion

**Due to CD8 & CD4 cells targeting epithelial cells

37
Q

What are 2 diseases/conditions that can cause a rash on the palms & feet?

A

1) Erythema muliforme
2) Syphillus

38
Q

Triggers of erythema multiforme

A
  • MEDICATIONS: penicillin, sulfonamides, allopurinol
  • INFECTIONS: HSV 1 or 2; mycoplasma pneumoniae
39
Q

Describe papule found in molluscum-contagiosum virus

A

Flesh-colored, dome-shaped papules with central depression (called umbilication)

*Caused by pox virus

40
Q

Where does smallpox typically begin?

A

Rash that begins on the face and progresses to the arms, legs, hands and feet

*Vesicular or pustular lesions

41
Q

Cause of athletes foot

A

Tinea pedis

42
Q

What would be the defining factor for a carcinoma of the skin to be in situ versus invasive?

A

*Invasive = disruption of the basement membrane, involvement of the dermis, and possible invasion of lymph & blood vessels

*In situ = abnormal keratinocytes extending throughout the full thickness of the epidermis without disruption of the basement membrane

43
Q

What is squamous cell carcinoma derived from & which layer of epithelium?

A

Keratinocytes in the epidermis (stratum spinosum)

44
Q

What are premalignant lesions of SCC referred to as? What would they appear as clinically?

A

Actinic keratosis

*Associated with hyperkeratosis

**Clinically, tan-brown-red color with rough, sandpaper-like consistency & cutaneous horn formation

45
Q

If a patient presents with a port-wine stain, what should they be evaluated for?

A

Sturge-Weber disease

*Slowly progressing neurocutaneous disorder

46
Q

When biopsied, what would a port-wine stain appear like?

A

Capillary malformations

47
Q

Characteristics of Sturge-Weber disease (5)

A

1) Leukocoria (absent red-reflex)
2) Ipsilateral leptominingeal angiomatosis
3) intellectual disability
4) Seizures
5) Pheocromocytoma

48
Q

What causes scabies?

A

Sarcoptes Scabiei mite

49
Q

Signs of scabies infection

A
  • Intense pruritis
  • Burrow skin lesions over wrists, finger webs, genitals
50
Q

Hypertrophic scars are due to up regulation of what protein?

A

TGF-beta

*Controls fibroblast recruitment & collagen deposition

51
Q

What layer of the skin are warts typically found to originate in?

A

Stratum granulosum

*Due to multiple dense basophilic keratohyalin granules containing lipids to help form a waterproof barrier

52
Q

What layer of the skin is responsible for waterproofing

A

Stratum granulosum

*Due to multiple dense basophilic keratohyalin granules containing lipids to help form a waterproof barrier

53
Q

Where in the body would we find naturally a thicker layer of stratum lucidum?

A

Palms & soles of feet

54
Q

What layer of skin do squamous cell carcinomas develop in?

A

Stratum spinosum

55
Q

What layer of skin does pemphigus vulgarisms develop in?

A

Stratum spinosum

56
Q

What is the most prognostic factor in determining malignancy of melanoma?

A

DEPTH (not diameter!!)

57
Q

What would melanoma stain + for and what is its marker?

A

S-100 (stain) & HMB45 (melanoma marker)

58
Q

Why is depth the most important prognostic factor for melanoma?

A

Because the lymphatics of the superficial dermis lie only 1 mm under the skin surface

59
Q

Biopsy of a suspected lupus rash would show what?

A

IgG deposition & compliment at the derma-epidermal junction

60
Q

What is the technical term for the butterfly rash seen in lupus?

A

Malar rash

61
Q

What is the difference in antibodies between limited & systemic sclerosis?

A

LIMITED:
Increased anti-centromere antibody

SYSTEMIC:
Increased anti-Scl-70 (DNA topoisomerase 1) antibody

62
Q

What is the pathomechanism of wheal formation?

A

Mast cell degranulation causing dilation of superficial lymphatic channels & intradermal edema (causing spongiosis)

63
Q

Microabscesses in the stratum corneum can be seen in what diseases (4)

A

1) Impetigo
2) Fungal skin infections
3) Psoriasis
4) Cutaneous T cell lymphoma

64
Q

Microscopic blisters at the tips of dermal papillae is characteristic of what?

A

Dermatitis herpetiformis (celiac disease)

65
Q

What is acanthosis?

A

Stratum spinousum proliferation

*Seen in acanthosis ingrains

66
Q

What is parakeratosis?

A

Retaining nuclei in the stratum corneum

67
Q

Acanthuses nigrans can be suggestive of what?

A
  • Underlying cancer (diffuse gastric carcinoma)
  • Obese patients
  • Diabetic (type 2) patients
68
Q

What visible changes would you see to suggest a patient has stasis dermatitis?

A
  • Hyperpigmentation of skin
  • Erythematous skin ulcerations in legs
  • Chronic edema
69
Q

How does PAD look differently than venous stasis visually?

A

PAD ulcers usually occur at the tips of digits where distal arterial branches are located

*diabetic ulcers present at foot pressure points

70
Q

Which are painful and which are painless; arterial & venous ulcers

A

Arterial: PAINFUL

  • Due to ischemia
  • Ulcers at tips of toes/bony prominences (lateral malleolus & metatarsal heads)

Venous: PAINLESS

71
Q

What is the precursor lesion called of squamous cell carcinoma?

A

Actinic keratosis

*hyperplastic lesion

72
Q

What is the typical presentation of squamous cell carcinoma?

A

Scaly, red plaque with ulceration & bleeding

73
Q

Histology of squamous cell carcinoma

A
  • Keratin pearls
  • Large & hyperchromatic nuclei
74
Q

Risk factors of SCC (excluding sun obviously) - 4

A
  • Arsenic
  • 3rd degree burns
  • Xeroderma pigmentosum
  • Chronically draining ulcers
75
Q

Precursor of melanoma

A

Dysplastic nevi

76
Q

Does SCC occur on the upper or lower part of the lip?

A

Lower!!

*Upper is BCC

77
Q

What is the difference between actinic keratosis versus cheilitis?

A

Cheilitis is a precursor lesion around the lip with “cutaneous horns”

Keratosis

78
Q

What can the sudden appearance of multiple seborrheic keratoses be suggestive of?

A

Underlying GI malignancy

*Called Leser-Trélat sign!

**Always do biopsy of these seborrheic keratosis

79
Q

Histologically, what condition has pseudo-horn cysts, and what are these?

A

Seborrheic keratoses

*Small cystic spaces in the epidermis filled with keratin

80
Q

Histologically, what does dermatitis herpetiformis present as?

A

Dermal-epidermal separation with sub epidermal blisters & neutrophilic accumulation

*IgA staining in dermal papillae

81
Q

Why does derma-epidermal separation occur in celiac disease?

A

IgA cross reacts with epidermal keratinocytes transglutaminase (eTG), disrupting cell anchoring & causing separation

82
Q

Why is a blue nevus blue?

A

Tyndall effect

-Light wavelength scatters due to melanin within the dermis

83
Q

What are blue nevus?

A

Deep, intradermal nevus in which clusters of nevus cells extend into the reticular dermis & subcutaneous tissue

84
Q

Palisading nuclei are a common biopsy finding on what condition?

A

Basal cell carcinoma

*Palisade means fence like

KAPLAN FLASH CARDS (10 decks)

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