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D2 Fall > Gen Path Exam 4 - Dermatologic Disease > Flashcards

Gen Path Exam 4 - Dermatologic Disease Flashcards

1
Q

What are the 4 layers of the epidermis?

A

Stratum corneum
Stratum granulosom
Stratum spinosum
Straum germinativum

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2
Q

Which layer of the epidermis?

Composed of orthokeratin (w/o nuclei)

A

Stratum corneum

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3
Q

Which layer of the epidermis?

Thin layer that acquires large basophilic granules called keratohyalin

A

Stratum granulosum

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4
Q

Which layer of the epidermis?

Layer of keratinocytes that mature and acquire keratin as they are pushed toward the surface

A

Stratum spinosum

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5
Q

Which layer of the epidermis?

Single layer of dividing cells that give rise to all epithelial cells

A

Stratum germinativum

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6
Q

Which layer of the epidermis?

Granular layer

A

Stratum granulosum

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7
Q

Which layer of the epidermis?

Squamous layer

A

Stratum spinosum

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8
Q

Which layer of the epidermis?

Basal layer

A

Stratum germinativum

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9
Q

Epithelial projections that anchor epithelium to underlying CT

A

Rete ridges

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10
Q

Which part of the dermis?

Reticulin fibers that act as a scaffold for epidermis

A

BM

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11
Q

Which part of the dermis?

Loose collagen and elastin directly below rete ridges

A

Papillary dermis

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12
Q

Which part of the dermis?

Dense structural collagen

A

Reticular dermis

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13
Q

Found in all locations except palms and soles

A

Hair follicles

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14
Q

Oil glands accompanying each hair follicle and in other locations w/o hair (mucosa)

A

Sebaceous glands

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15
Q

Lubricates hair and is antibacterial

A

Sebaceous glands

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16
Q

Smooth muscle that attaches to hair follicle

A

Arrector pili muscles

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17
Q

Found at all locations; thermoregulators

A

Eccrine sweat glands

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18
Q

Found under arms

A

Apocrine sweat glands

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19
Q

Clear cells living in the basal layer

A

Epidermal melanocytes

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20
Q

Spindly cells living in papillary dermis

A

Dermal melanocytes

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21
Q

Dendritic histiocytic antigen processing cells living in stratum spinosum

A

Langerhans cells

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22
Q

Receptors for light touch; live in the basal layer

A

Merkel cells

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23
Q

2 words to describe flat lesions

A

Macule
Patch

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24
Q

A flat, non-palpable change in shape or color that is ≤ 1.0 cm

A

Macule

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25
Q

A flat, non-palpable change in shape or color that is > 1.0 cm

A

Patch

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26
Q

Slightly elevated lesion with large area

A

Plaque

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27
Q

Solid, ≤ 0.5 cm

A

Papule

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28
Q

Solid, >0.5 cm (sessile vs. pedunculated)

A

Nodule

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29
Q

Non-specific for any large, solid lesion

A

Tumor/mass

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30
Q

Fluid-filled elevation ≤ 0.5 cm

A

Vesicle

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31
Q

Fluid-filled elevation > 0.5 cm

A

Bulla

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32
Q

Pus-filled elevation of any size (yellow fluid)

A

Pustule

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33
Q

Arising on a broad base

A

Sessile

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34
Q

Arising on a stalk or pedicle that is narrower than the lesion

A

Pedunculated

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35
Q

Lesion composed of multiple fronds or projections (may be sessile or pedunculated)

A

Papillary

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36
Q

Exophytic lesion means?

A

Raised lesion

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37
Q

Linear cleavage of mucosa

A

Fissure

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38
Q

Thinning of the mucosa (red)

A

Atrophy

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39
Q

Depressed lesion, incomplete loss of mucosa (red)

A

Erosion

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40
Q

Complete loss of mucosa (dark yellowish)

A

Ulcer

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41
Q

Result of injury causing mucosal atrophy or hypertrophy with increased underlying collagen

A

Scar

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42
Q

Thickened parakeratin

A

Hyperparakeratosis

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43
Q

Thickened orthokeratin

A

Hyperorthokeratosis

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44
Q

Thickened granular cell layer (accompanies
hyperorthokeratosis, never parakeratosis)

A

Hypergranulosis

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45
Q

Thickening or hyperplasia of stratum spinosum

A

Acanthosis

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46
Q

Loss of intercellular bridges and cohesion of cells of stratum spinosum

A

Acantholysis

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47
Q

Edema of stratum spinosum, widened intercellular bridges

A

Spongiosis

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48
Q

Hyperplasia of papillary dermis, resulting in multiple surface elevations

A

Papillomatosis

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49
Q

Abnormal formation of keratin below surface

A

Dyskeratosis

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50
Q

Infiltration of epidermis by inflammatory cells

A

Exocytosis

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51
Q

What are the 2 acute inflammatory dermatoses?

A

Urticaria (hives)
Eczema

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52
Q

What category of diseases?

Duration: several days to weeks

A

Acute inflammatory dermatoses

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53
Q

What category of diseases?

Histology: inflammation, edema often marked by mononuclear infiltrate instead of neutrophils

A

Acute inflammatory dermatoses

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54
Q

What category of diseases?

Course: may be self-limited or become chronic

A

Acute inflammatory dermatoses

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55
Q

Which disease?

Type I hypersensitivity reaction; localized mast cell degranulation

A

Urticaria (hives)

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56
Q

Which disease?

Dermal microvascular hyperpermeability resulting in erythematous, edematous, and pruritic plaques are termed wheals

A

Urticaria (hives)

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57
Q

Which disease?

Localized or generalized, small, pruritic papules to large erythematous plaques

A

Urticaria (hives)

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58
Q

Which disease?

Usually develop and fade within hours, but can persist for days to months

A

Urticaria (hives)

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59
Q

Which disease?

Tx: antihistamines, leukotriene antagonists (block IgE), or steroids

A

Urticaria (hives)

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60
Q

Which disease?

Group of conditions showing pruritic, erythematous papules, and possible vesicles which ooze and crust and later coalesce into raised scaly plaques

A

Eczema

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61
Q

Which disease?

Caused by allergen (delayed hypersensitivity), defect in keratinocyte barrier, drug hypersensitivity, UV light, physical/chemical irritant

A

Eczema

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62
Q

Which disease?

Example: allergic contact dermatitis (e.g. poison ivy)

A

Eczema

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63
Q

Which disease?

Environmental agent that reacts with self-
proteins creating neoantigens that sensitizes T cells

A

Eczema

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64
Q

Which disease?

On re-exposure, memory CD4+ T cells are
activated and release cytokines that recruit inflammatory cells and cause epidermal damage

A

Eczema

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65
Q

What category of diseases?

Features become most apparent over many months to years

A

Chronic inflammatory dermatoses

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66
Q

What category of diseases?

Skin can appear rough due to thick scale and shedding (desquamation)

A

Chronic inflammatory dermatoses

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67
Q

What is the 1 chronic inflammatory dermatoses?

A

Psoriasis

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68
Q

Which disease?

1-2% of US population is affected (common)

A

Psoriasis

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69
Q

Which disease?

Increased risk for heart attack and stroke and affects 10% of arthritis pts

A

Psoriasis

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70
Q

Which disease?

Autoimmune, T cell-mediated inflammatory disease; self and environmental antigens involved

A

Psoriasis

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71
Q

Which disease?

T cells secrete cytokines (TNF is a major mediator) and growth factors inducing keratinocyte hyperproliferation

A

Psoriasis

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72
Q

Which disease?

Well-demarcated, pink to salmon–colored plaque covered by loosely adherent silver-white scale

A

Psoriasis

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73
Q

Which disease?

Psoriatic arthritis is a severe complication of this disease

A

Psoriasis

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74
Q

Which disease?

Affects skin of the elbows, knees, scalp etc. (oral
lesions extremely rare)

A

Psoriasis

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75
Q

Which disease?

Diagnosed by Auspitz sign – pinpoint bleeding upon scratching scale off lesions

A

Psoriasis

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76
Q

Which disease?

Diagnosed by Koebnerization – creation of lesions by scratching

A

Psoriasis

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77
Q

Which disease?

Tx: coal tar derivatives, sunlight, TNF antagonists, Vitamin A and D derivatives, methotrexate for severe cases

A

Psoriasis

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78
Q

What are the 2 infectious dermatoses?

A

Superficial fungal infection
Impetigo

79
Q

Name for fungal infectious dermatoses

A

Superficial fungal infection (dermatophytes)

80
Q

Name for bacterial infectious dermatoses

A

Impetigo

81
Q

What are the 4 types of superficial fungal infections (dermatophytes)?

A

Tinea capitis
Tinea barbae
Tinea corporis
Tinea pedis

82
Q

Which type of superficial fungal infections (dermatophytes)?

Head; causes focal alopecia

A

Tinea capitis

83
Q

Which type of superficial fungal infections (dermatophytes)?

Beard area of men

A

Tinea barbae

84
Q

Which type of superficial fungal infections (dermatophytes)?

Body; caused by heat and humidity and exposure to animals

A

Tinea corporis

85
Q

Which type of superficial fungal infections (dermatophytes)?

Example is ringworm

A

Tinea corporis

86
Q

Which type of superficial fungal infections (dermatophytes)?

Athlete’s foot fungus w/ superimposed bacterial infection

A

Tinea pedis

87
Q

A yeast that infects intertriginous zones

A

Candida

88
Q

Which disease?

Ubiquitous opportunist when resistance is low, due to local or systemic causes

A

Superficial fungal infections (dermatophytes)

89
Q

What are the systemic causes of superficial fungal infections (dermatophytes)?

A

Steroids
ABs
Diabetes
Immunosuppression (HIV, chemo)

90
Q

Are intertriginous zones (areas on skin that stay moist) a local or systemic cause of superficial fungal infections?

A

Local cause

91
Q

Which disease?

Superficial skin infection of face or extremities with Strep pyogenes and/or Staph aureus entering broken skin

A

Impetigo

92
Q

Which disease?

Common in children, crowded living conditions, poor hygiene, and hot/humid climates

A

Impetigo

93
Q

Which disease?

Range from fragile vesicles to flaccid bullae that
rupture and leave an amber to “honey-colored” crust

A

Impetigo

94
Q

Which disease?

May resemble exfoliative cheilitis, recurrent herpes simplex or mimic child abuse

A

Impetigo

95
Q

Which disease?

Diagnosed by clinical presentation or culture

A

Impetigo

96
Q

Which disease?

Isolated lesions are treated w/ topical mupirocin

A

Impetigo

97
Q

Which disease?

Bullous or more extensive lesions are treated w/ a 1 week course of a systemic oral AB that is effective against Strep pyogenes and penicillin resistant Staph aureus

A

Impetigo

98
Q

Which disease?

Extensive lesions treated with oral ABs like cephalexin, dicloxacillin, augmentin, or clindaymycin (for pts allergic to penicillin)

A

Impetigo

99
Q

What is the other dermatoses not in a category?

A

Acanthosis Nigricans

100
Q

Which disease?

Acquired hyperpigmented, hyperkeratotic, velvety skin on axilla, groin, and back of neck

A

Acanthosis Nigricans

101
Q

What are the 2 types of Acanthosis Nigricans?

A

Malignant
Benign

102
Q

Which type of Acanthosis Nigricans?

Associated w/ GI malignancy

A

Malignant

103
Q

Which type of Acanthosis Nigricans?

Associated w/ endocrinopathies (diabetes, Addison’s, hypothyroidism, acromegaly) or syndromes

A

Benign

104
Q

Which type of Acanthosis Nigricans?

Drug ingestion (oral contraceptives, steroids) tissues show insulin resistance

A

Benign

105
Q

Which disease?

Oral lesions include:

Finely papillary lesions (not brown) of lips and tongue
Often associated with internal malignancy

A

Acanthosis Nigricans

106
Q

Which disease?

Slow growing, fluctuant/rubbery nodule of the face or neck often derived from hair follicles

A

Epidermoid cyst

107
Q

Which disease?

May have a yellowish to white or normal skin
appearance

A

Epidermoid cyst

108
Q

Which disease?

Tx is surgical excision; good prognosis

A

Epidermoid cyst

109
Q

Which disease?

Very common in people > 40 yrs old, found on skin of face and trunk

A

Serborrheic keratosis

110
Q

Which disease?

Multiple tan/brown to black, well-demarcated plaques

A

Serborrheic keratosis

111
Q

Which disease?

Appearance described as:
Stuck on
Dirty candle wax
Dried mud on brick wall

A

Serborrheic keratosis

112
Q

Which disease?

Composed of basal cells that produce keratin inclusions

A

Serborrheic keratosis

113
Q

Which disease?

No tx necessary, removed for cosmetic purposes

A

Serborrheic keratosis

114
Q

Which disease?

Variant version is called dermatosis papulosa nigra

A

Serborrheic keratosis

115
Q

Which disease?

Multiple small dark papules that develop in 30% of AA > 20 yrs on facial skin

A

Dermatosis papulosa nigra

116
Q

Which disease?

If hundreds appear suddenly (sign of Leser-Trelat) = paraneoplastic syndrome, may have internal malignancy like GI carcinoma

A

Serborrheic keratosis

117
Q

Which disease?

Premalignant skin lesion caused by chronic sun (UV light) exposure

A

Actinic keratosis

118
Q

Which disease?

Common on facial skin and vermilion zone (actinic cheilosis/cheilitis) of lips in fair skinned persons > 40 yrs old

A

Actinic keratosis

119
Q

Which disease?

Average person presents w/ 6-8 lesions

A

Actinic keratosis

120
Q

Which disease?

Scaly plaque w/ sandpaper texture

A

Actinic keratosis

121
Q

Which disease?

Hyperkeratosis, usually parakeratin

A

Actinic keratosis

122
Q

Which disease?

Some degree of epithelial dysplasia

A

Actinic keratosis

123
Q

Which disease?

Solar elastosis

A

Actinic keratosis

124
Q

Degeneration of CT from UV damage w/ increased elastic fibers; seen in Actinic keratosis

A

Solar elastosis

125
Q

Which disease?

Tx is cryotherapy, surgical excision, laser ablation, photodynamic therapy, 5-fluorouracil (Effudex), imiquimod 5% cream, diclofenac 3% gel

A

Actinic keratosis

126
Q

Which disease?

1/4 may regress w/ reduced sun exposure

A

Actinic keratosis

127
Q

Which disease?

8% risk of malignant progression w/ 1% over 2 yrs

A

Actinic keratosis

128
Q

Which disease?

Average time to progression is 2 yrs

A

Actinic keratosis

129
Q

Which disease?

Sun-induced cancer usually in existing Actinic keratosis (field effect - large exposed area causes transformation of multiple cells over time)

A

Squamous cell carcinoma

130
Q

Which disease?

Slowly developing (months to years), slow growing lesion

A

Squamous cell carcinoma

131
Q

Which disease?

Fleshy, firm nodule w/ a keratinized, crusty or ulcerated surface

A

Squamous cell carcinoma

132
Q

Which disease?

Tx is surgery or radiation; curable if not late stage

A

Squamous cell carcinoma

133
Q

Which disease?

Arises from basal cells of epidermis or germ cells in hair follicles

A

Basal cell carcinoma

134
Q

What is the most common skin cancer?

A

Basal cell carcinoma

135
Q

Which disease?

800,000 cases diagnosed annually in US

A

Basal cell carcinoma

136
Q

Which disease?

Affected pts are usually > 40 yrs old, have a fair complexion and a history of chronic sun exposure

A

Basal cell carcinoma

137
Q

Where do most basal cell carcinomas develop?

A

Middle 1/3 of face

138
Q

What are the 2 main subtypes of basal cell carcinoma in the head and neck?

A

Noduloulcerative (most common)
Sclerosing/morpheaform

139
Q

Which subtype of basal cell carcinoma?

Umbilicated papule that may show central
ulceration/hemorrhage, rolled pearly white border, lack of adnexal skin structures (hair); may be referred to as a “rodent ulcer

A

Noduloulcerative

140
Q

Which subtype of basal cell carcinoma?

Mimics scar tissue

A

Sclerosing/morpheaform

141
Q

Which disease?

Basaloid cells that appear to “drop off” of the basal cell layer of the epidermis

A

Basal cell carcinoma

142
Q

Which disease?

Nodulo-ulcerative = large lobules of tumor cells are characteristic

A

Basal cell carcinoma

143
Q

Which disease?

May show some similarity to ameloblastoma

A

Basal cell carcinoma

144
Q

Which disease?

Tx is excision, electrodessication, curettage; Mohs surgery for planes of fusion (nasolabial fold, eye)

A

Basal cell carcinoma

145
Q

Which disease?

Prognosis is excellent, rare metastasis, 95% of pts cured after first tx

A

Basal cell carcinoma

146
Q

Which disease?

Larger, recurrent or tumors in embryonic planes of fusion are more aggressive and require Mohs surgery

A

Basal cell carcinoma

147
Q

Which disease?

Follow up is important: 44% chance of 2nd BCC and 6% chance of SCC w/in 3 yrs

A

Basal cell carcinoma

148
Q

Brown macule, increased pigment with sun
exposure but normal numbers of melanocytes

A

Ephelis (freckle)

149
Q

What are the 2 benign melanocytic skin lesions?

A

Ephelis (freckle)
Actinic lentigo

150
Q

Brown macule common on dorsal hand and face - shows a linear increase of melanocytes in the basal layer

A

Actinic lentigo

151
Q

Any congenital skin lesion

A

Nevus

152
Q

Any benign congenital or acquired neoplasm of melanocytes

A

Melanocytic nevus

153
Q

Benign neoplasms caused by mutation in BRAF or RAS (oncogenes)

A

Acquired melanocytic nevi

154
Q

Develop early in life (average Caucasian has about 20); rare intraorally

A

Acquired melanocytic nevi

155
Q

Well defined, < 6mm in diameter

A

Acquired melanocytic nevi

156
Q

Begin as flat lesions with a uniform color (dark brown or black) that elevate and fade with aging

A

Acquired melanocytic nevi

157
Q

No treatment needed, unless in area of repeated trauma or cosmetic concern

A

Acquired melanocytic nevi

158
Q

Prognosis is excellent, malignant transformation is extremely rare

A

Acquired melanocytic nevi

159
Q

Can be sporadic or familial (familial dysplastic
nevus syndrome- strong association with
melanoma)

A

Dysplastic nevi

160
Q

RAS or BRAF mutations are common

A

Dysplastic nevi

161
Q

Larger than acquired nevi (>5mm) and may
have hundreds

A

Dysplastic nevi

162
Q

Found on sun-exposed and not sun-exposed skin

A

Dysplastic nevi

163
Q

If you have > 10+ dysplastic nevi, what do you have an increased risk for?

A

Melanoma

164
Q

What is a marker for melanoma risk?

A

10+ dysplastic nevi

165
Q

Macules or plaques with pebbly surface, often
variable pigmentation and irregular borders

A

Dysplastic nevi

166
Q

What disease?

Malignancy of melanocytic differentiation

A

Melanoma

167
Q

What disease?

Most are cutaneous; 3rd most common skin cancer; dramatic increased incidence in recent decades

A

Melanoma

168
Q

What disease?

<5% of skin cancers; 75% of deaths due to skin cancer

A

Melanoma

169
Q

What disease?

Caused by UV light, especially intense intermittent exposure at early age

A

Melanoma

170
Q

What disease?

Non-UV variations have KIT mutations

A

Melanoma

171
Q

What disease?

5-10% have hereditary predisposition

A

Melanoma

172
Q

What disease?

Germ-line mutations in CDKN2A gene which encodes cyclin-dependent kinase inhibitors (inhibit cyclins)

A

Melanoma

173
Q

What form of melanoma?

UV light induces RAS/BRAF mutation→ p16
inactivation (vertical growth) →p53 mutation
(metastasis)

A

UV induced

174
Q

What form of melanoma?

Activated by different mutations (i.e. KIT oncogene)

A

Non-UV induced

175
Q

What are the 4 types of melanoma?

A

Superficial spreading
Lentigo maligna
Acral lentiginous
Nodular

176
Q

What type of melanoma?

Most common type

A

Superficial spreading

177
Q

What type of melanoma?

Found on back, arms, neck, scalp (BANS)

A

Superficial spreading

178
Q

What type of melanoma?

Radial phase for months to years (plaque) before vertical phase (nodule forms)

A

Superficial spreading

179
Q

What type of melanoma?

Malar skin of elderly fair complexioned people with chronic sun exposure

A

Lentigo maligna

180
Q

What type of melanoma?

Flat brown macule that slowly expands radially over 10-15 years before entering vertical growth stage

A

Lentigo maligna

181
Q

What type of melanoma?

Unrelated to sun exposure; main type in Blacks and Asians

A

Acral lentiginous

182
Q

What type of melanoma?

Very short radial growth phase before invading; poor prognosis

A

Acral lentiginous

183
Q

What type of melanoma?

Most mucosal melanomas are this type (including oral)

A

Acral lentiginous

184
Q

What type of melanoma?

Unrelated to sun exposure; elevated, fast-growing mass

A

Nodular

185
Q

What type of melanoma?

No radial growth, starts as vertical growth; worst prognosis

A

Nodular

186
Q

How do you diagnose melanomas?

A

ABCDE’s

187
Q

What are the “ABCDEs” of melanomas?

A

Asymmetry
Border irregularity
Color variegation (multiple colors)
Diameter > 6mm (size of pencil eraser)
Evolving (lesions that have changed over time)

188
Q

What are the other warning signs of melanoma? (not part of ABCDEs)

A

Any new nevus after age 20
Any pigmented lesion on palms, soles, nail beds, genitalia
Itching, pain, crusting, redness, ulceration, bleeding

189
Q

What disease?

Tx is surgery with wide margins, sentinal lymph node biopsy, histologic assessment to determine type, depth of invasion, and stage

A

Melanoma

190
Q

What disease?

Treated w/ drugs that inhibit BRAF or KIT

A

Melanoma

191
Q

What disease?

Metastatic forms treated with immunotherapy

A

Melanoma

192
Q

What disease?

Overall 5 yr survival is 92%

A

Melanoma

193
Q

What disease?

3-5% develop a 2nd one, follow-up is important!

A

Melanoma

194
Q

What disease?

Breslow tumor thickness is the single most important prognostic indicator

A

Melanoma

D2 Fall (45 decks)

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