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Year 2 Clinical Pathology > Diseases of the skin and eye > Flashcards

Diseases of the skin and eye Flashcards

1
Q

Give 2 infections which cause inflammation of cornea and conjunctiva?

A

1) Herpes varicella zoster virus - if trigeminal nerve involved can cause blindness
2) Chalmydia

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2
Q

What are the 2 forms of chlamydia which can lead to inflammation of the cornea and chlamydia and how do they differ?

A

1) Trochoma - tropical disease which infects the cornea and conjunctiva, common cause of blindness
2) Mild disease due to chlamydia types d-k, acquired during birth from infection in the genital tract

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3
Q

Give the 6 causes of cataracts?

A

1) Senile degeneration
2) Rubella
3) Down’s syndrome
4) Irradiation
5) Diabetes
6) Uveitis

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4
Q

Give 2 microorganisms which can cause retinal infections, how is each transmitted ?

A

1) Toxoplasma - cat is host and oocyte in faeces

2) Toxocara canis - from infected dog faeces, larva migrate to retina and die causing local inflammation

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5
Q

What are the 2 kinds of retinal infection caused by toxoplasma, how does the prognosis of each differ?

A

1) Congenital infection which causes severe bilateral disease
2) Acquired causes focal inflammatory disease

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6
Q

Give the 3 types of retinal vascular disease?

A

1) Ischaemia - for various reasons leading to ischemic damage to retina
2) Hypertensive retinopathy - flame shaped haemorrhages and exudates
3) Diabetic retinopathy - dot and blot haemorrhages and exudates

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7
Q

What are the 2 types of macular degeneration, which is more common?

A

1) Dry macular degeneration
2) Wet macular degeneration
Dry macular degeneration more common accounting for 90% of cases

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8
Q

What is the cause of dry macular degeneration, can it be treated?

A

Age related - affects people of 60, have progressive visual impairment. No treatment is available.

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9
Q

What is the cause of wet macular degeneration, can it be treated?

A

Due to new vessel growth beneath the retina, can be treated with drugs and lasers, drugs inhibit vessel growth and are injected straight into eye

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10
Q

Which 2 tumours can arise within the eye?

A

1) Retinoblastoma

2) Melanoma - arises from melanocytes of uveal tract

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11
Q

What is the genetics of retinoblastoma?

A

10% familial, due to deletion of long arm of chromosome 13 - loss of RB gene

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12
Q

How is retinoblastoma treated? 2

A

1) Enucleation

2) DXT

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13
Q

Where does a melanoma of the eye arise from?

A

From the melanocytes of the uveal tract - iris, ciliary body, choroid

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14
Q

What are the 2 types of uveal melanoma, how do the prognoses differ?

A

Based on genetic profiling
Type 1: Good prognosis
Type 2: poor prognosis

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15
Q

How is a uveal melanoma treated? 2

A

1) Radiotherapy and surgery

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16
Q

Which types of herpes simplex virus causes coldsores and which is an STD?

A

HSV 1 - coldsores

HSV 2 - STD, causes genital warts

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17
Q

Leprosy is caused by what microorganism?

A

Mycobacterium leprae

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18
Q

Leprosy is what kind of infection?

A

Chronic granulomatous infection which can involve nerves leading to loss of sensation

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19
Q

Fish tank granuloma is caused by direct inoculation by what mycobacterium?

A

Mycobacterium marinum

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20
Q

Which 2 mycobacteria can cause skin infections?

A

1) Mycobacterium marinum

2) Mycobacterium leprae

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21
Q

What are the 3 clinical stages of eczema (dermatitis), how does each differ?

A

1) Acute dermatitis - skin red, some exudate, some vesicles
2) Subacute dermatitis - skin is red, less exudate, more itching and crusting
3) Chronic dermatitis - skin is thick and leathery secondary to scratching

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22
Q

What 3 changes do you see on microscopy in eczema?

A

1) Spongiosis - intercellular oedema within epidermis
2) Chronic inflammation - predominantly superficial dermis
3) Epidermal hyperplasia and hyperkeratosis (worse in chronic)

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23
Q

Atopic eczema tends to present when?

A

In childhood

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24
Q

Atopic eczema is often associated with what 2 other conditions?

A

Hayfever and asthma

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25
Q

What is atopic eczema caused by?

A

A type 1 hypersensitivity reaction to allergen

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26
Q

What are the 2 types of contact dermatitis, how do they differ?

A

1) Contract irritant dermatitis - direct injury to skin by irritant eg. acid alkali etc.
2) Contact allergic dermatitis - substance acts as haptens which combine with epidermal protein to become immunogenic

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27
Q

What are the 2 types of dermatitis of unknown aetiology?

A

1) Seborrhoeic dermatitis - affects areas rich in sebaceous glands: scalp, forehead, upper chest
2) Nummular dermatitis - coin shaped lesions

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28
Q

What is psoriasis?

A

Well define, red oval plaques on extensor surfaces (knees, elbows, sacrum) get a fine silvery scale, remove of scale results in bleeding points

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29
Q

Auspitz sign is related to what skin condition?

A

Psoriasis

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30
Q

What 2 other conditions/ signs are related to psoriasis?

A

Sero-negative arthritis

Pitting nails

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31
Q

What is the pathogenic mechanism behind psoriasis?

A

Massive cell turnover

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32
Q

Which genetic factor has been implicated in psoriasis?

A

Multiple loci (PSORS) in region of major histocompatibility complex on Chr6p2 implicated - same area involved in other autoimmune disorders

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33
Q

What are the 4 possible environmental triggers for psoriasis?

A

1) Infection
2) Stress
3) Trauma
4) Drugs

34
Q

Psoriasis confers increased risk of what cancer?

A

Non-melanoma skin cancer

35
Q

What are the 3 co-morbidities associated with psoriasis?

A

1) Arthropathy
2) Psychosocial effects
3) CV disease

36
Q

What is the difference between discoid LE and systemic LE?

A

Discoid LE = skin only

Systemic LE = visceral disaease +/- skin disease

37
Q

How does discoid LE appear clinically?

A

Red scaly patches on sun exposed skin sometimes with scarring, scalp involvement can also lead to alopecia

38
Q

What is the appearance of the skin involvement in SLE?

A

Butterfly rash on cheeks and nose

39
Q

What is lupus erythematosus?

A

Autoimmune disease primarily affecting connective tissues of the body - auto Ab directed at various tissues, may affect any part of the body but importantly kidneys

40
Q

How can immunofluorescence be used to detect LE?

A

In lupus IgG is deposited in the basement membrane, using immunofluorescence - can identify that Ab to Ag on the basement membrane using a fluorescently labelled anti human Ab AbA

41
Q

What kind of rash occurs in dermatomyositis?

A

Heliotropic rash - peri-ocular oedema and erythema, erythema in photosensitive distribution

42
Q

What is the muscle component of dermatomyositis, how it be detected?

A

Proximal muscle weakness - check for creatinine kinase

43
Q

In adults what is dermatomyositis sometimes associated with?

A

Underlying visceral cancer

44
Q

What are bullous diseases?

A

Diseases involving the formation of fluid filled blisters

45
Q

What is pemphigus?

A

Group of disorders characterised by loss of cohesion between keratinocytes resulting in an intraepidermal blister - these blisters can rupture easily and can be extensive, involving mucous membranes

46
Q

What is the pathogenesis of pemphigus?

A

Autoantibodies, directed against intercellular material can be detected by immunofluorescence

47
Q

What is bullous pemphigoid?

A

Disease characterised by subepidermal blisters - elderly with large tense bullae which do not rupture easily, can be localised or extensive

48
Q

What is the pathogenesis of bullous pemphigoid?

A

AutoAb to glycoprotein in basement membrane- can be detected by immunofluorescence

49
Q

What is dermatitis herpatiformis?

A

Small intensely itch blistors on extensor surfaces often in young patients

50
Q

What condition is dermatitis herpatiformis associated with?

A

Coeliac disease

51
Q

What is the pathogenesis of dermatitis herpatiformis?

A

IgA deposition in dermal papillae

52
Q

What kind of skin condition is associated with internal malignancy?

A

Acanthosis nigricans (dark warty lesions in armpits)

53
Q

What kind of skin lesions occur in diabetes mellitus?

A

Necrobiosis lipoidica (red and yellow plaques on legs)

54
Q

Which skin condition is associated with infections elsewhere, particularly in the lungs?

A

Erythema nodosum (red, tender nodules on shins)

55
Q

Porphyria leads to what kind of skin conditions, why?

A

Blisters and scarring of the skin - build up of porphyrin compounds in the skin, these cause tissue damage when exposed to sunlight

56
Q

How can porphyria be diagnosed?

A

Look for porphyrins in the urine

57
Q

What is the commonest type of malignant tumour of the skin?

A

Basal cell carcinoma

58
Q

Do BCC metastasise?

A

Very rarely

59
Q

What are the 3 main risk factors for basal cell carcinoma?

A

1) Sun exposure and pale skin that burns easily
2) Occasionally secondary to radiotherapy
3) Immunosuppression

60
Q

Which rare syndrome is related to BCC?

A

Gorlin’s syndrome

61
Q

What are the 6 main risk factors for Squamous cell carcinoma in the skin?

A

1) UV radiation
2) Radiotherapy
3) Hydrocarbon exposure
4) Chronic scars/ ulcers
5) Immunosuppression
6) Drugs - some newer drugs for melanoma

62
Q

What paercentage of SCCs in skin metastasise?

A

5% - lip, ear, perineum

63
Q

Name a premalignant disease which can preceed SCC of skin?

A

Actinic (solar) keratosis - dysplasia to squamous epithelium, only rarely progresses to invasive disease

64
Q

What is the embryological origin of melanocytes?

A

Derived from neural crest

65
Q

What is a benign tumour of melanocytes called?

A

Naevi - moles!

66
Q

What is dysplastic naevus syndrome?

A

Families with increased incidence of melanoma with multiple clinically atypical moles

67
Q

What are the 2 main types of naevi (moles)?

A

1) Supericial - congenital or acquired

2) Deep - blue naevi

68
Q

What 4 changes to naevi may indicate malignant change to melanoma?

A

1) Assymetry
2) Borders uneven
3) Colour variation
4) Diameter >6mm

69
Q

What are the 4 main risk factors for development of melanoma?

A

1) Sun exposure
2) Race - celtic, red hair, blue eyes
3) Family history - dysplastic naevus syndrome
4) Giant congenital naevi - small risk

70
Q

What is lentigo maligna?

A

A slow growing flat pigmented patch which occurs on the faces of elderly people due to proliferation of atypical melanocytes along basal layer of epidermis, with marked sun damage

71
Q

Is lentigo maligna a malignant condition with potential to metastasize?

A

Later in disease the melanocytes may invade the dermis (lentigo maligna melanoma) with potential to metastasize

72
Q

On what part of the body does acral lentigenous melanoma form and which group is it most common in?

A

Palms and soles, most common in afro-carribbeans

73
Q

What is the commonest type of melanoma in Britain?

A

Superficial spreading melanoma

74
Q

How does a superficial spreading melanoma appear macroscopically?

A

Early on its a flat macule, later becomes a large blue/black nodule

75
Q

What are the genetics of a superficial spreading melanoma?

A

Often BRAF mutations

76
Q

By what method do atypical melanocytes in superficial spreading melanoma spread into dermis?

A

Pagetoid spread

77
Q

How does a nodular melanoma appear and what is the prognosis?

A

Starts as a pigmented nodule, with or without ulceration - poor prognosis

78
Q

What is the Breslow thickness and how is it used in prognosis in melanoma?

A

Its the measure on a microscope from granular layer of the epidermis to base of tumour - ie measure of depth of invasion of melanoma. Greater the Breslow thickeness the poorer the prognosis

79
Q

Which 4 sights show poorer prognosis for melanoma (BANS)?

A

1) Back
2) Arms
3) Neck
4) Scalp

80
Q

In additions to the BANS sights what else is an indicator or poorer prognosis?

A

Positive sentinel lymph node

81
Q

What are the 2 treatments for melanoma?

A

Surgery - excise primary and lymph nodes if sentinel node positive
BRAF inhibitors - 60% of melanomas have mutation in B-raf gene

82
Q

60% of melanomas carry what mutation?

A

BRAF mutation

Year 2 Clinical Pathology (64 decks)

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