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
2
Q
Which layer of the epidermis?
Composed of orthokeratin (w/o nuclei)
A
Stratum corneum
3
Q
Which layer of the epidermis?
Thin layer that acquires large basophilic granules called keratohyalin
A
Stratum granulosum
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
5
Q
Which layer of the epidermis?
Single layer of dividing cells that give rise to all epithelial cells
A
Stratum germinativum
6
Q
Which layer of the epidermis?
Granular layer
A
Stratum granulosum
7
Q
Which layer of the epidermis?
Squamous layer
A
Stratum spinosum
8
Q
Which layer of the epidermis?
Basal layer
A
Stratum germinativum
9
Q
Epithelial projections that anchor epithelium to underlying CT
A
Rete ridges
10
Q
Which part of the dermis?
Reticulin fibers that act as a scaffold for epidermis
A
BM
11
Q
Which part of the dermis?
Loose collagen and elastin directly below rete ridges
A
Papillary dermis
12
Q
Which part of the dermis?
Dense structural collagen
A
Reticular dermis
13
Q
Found in all locations except palms and soles
A
Hair follicles
14
Q
Oil glands accompanying each hair follicle and in other locations w/o hair (mucosa)
A
Sebaceous glands
15
Q
Lubricates hair and is antibacterial
A
Sebaceous glands
16
Q
Smooth muscle that attaches to hair follicle
A
Arrector pili muscles
17
Q
Found at all locations; thermoregulators
A
Eccrine sweat glands
18
Q
Found under arms
A
Apocrine sweat glands
19
Q
Clear cells living in the basal layer
A
Epidermal melanocytes
20
Q
Spindly cells living in papillary dermis
A
Dermal melanocytes
21
Q
Dendritic histiocytic antigen processing cells living in stratum spinosum
A
Langerhans cells
22
Q
Receptors for light touch; live in the basal layer
A
Merkel cells
23
Q
2 words to describe flat lesions
A
Macule
Patch
24
Q
A flat, non-palpable change in shape or color that is ≤ 1.0 cm
A
Macule
25
A flat, non-palpable change in shape or color that is > 1.0 cm
Patch
26
Slightly elevated lesion with large area
Plaque
27
Solid, ≤ 0.5 cm
Papule
28
Solid, >0.5 cm (sessile vs. pedunculated)
Nodule
29
Non-specific for any large, solid lesion
Tumor/mass
30
Fluid-filled elevation ≤ 0.5 cm
Vesicle
31
Fluid-filled elevation > 0.5 cm
Bulla
32
Pus-filled elevation of any size (yellow fluid)
Pustule
33
Arising on a broad base
Sessile
34
Arising on a stalk or pedicle that is narrower than the lesion
Pedunculated
35
Lesion composed of multiple fronds or projections (may be sessile or pedunculated)
Papillary
36
Exophytic lesion means?
Raised lesion
37
Linear cleavage of mucosa
Fissure
38
Thinning of the mucosa (red)
Atrophy
39
Depressed lesion, incomplete loss of mucosa (red)
Erosion
40
Complete loss of mucosa (dark yellowish)
Ulcer
41
Result of injury causing mucosal atrophy or hypertrophy with increased underlying collagen
Scar
42
Thickened parakeratin
Hyperparakeratosis
43
Thickened orthokeratin
Hyperorthokeratosis
44
Thickened granular cell layer (accompanies
hyperorthokeratosis, never parakeratosis)
Hypergranulosis
45
Thickening or hyperplasia of stratum spinosum
Acanthosis
46
Loss of intercellular bridges and cohesion of cells of stratum spinosum
Acantholysis
47
Edema of stratum spinosum, widened intercellular bridges
Spongiosis
48
Hyperplasia of papillary dermis, resulting in multiple surface elevations
Papillomatosis
49
Abnormal formation of keratin below surface
Dyskeratosis
50
Infiltration of epidermis by inflammatory cells
Exocytosis
51
What are the 2 acute inflammatory dermatoses?
Urticaria (hives)
Eczema
52
What category of diseases?
Duration: several days to weeks
Acute inflammatory dermatoses
53
What category of diseases?
Histology: inflammation, edema often marked by mononuclear infiltrate instead of neutrophils
Acute inflammatory dermatoses
54
What category of diseases?
Course: may be self-limited or become chronic
Acute inflammatory dermatoses
55
Which disease?
Type I hypersensitivity reaction; localized mast cell degranulation
Urticaria (hives)
56
Which disease?
Dermal microvascular hyperpermeability resulting in erythematous, edematous, and pruritic plaques are termed wheals
Urticaria (hives)
57
Which disease?
Localized or generalized, small, pruritic papules to large erythematous plaques
Urticaria (hives)
58
Which disease?
Usually develop and fade within hours, but can persist for days to months
Urticaria (hives)
59
Which disease?
Tx: antihistamines, leukotriene antagonists (block IgE), or steroids
Urticaria (hives)
60
Which disease?
Group of conditions showing pruritic, erythematous papules, and possible vesicles which ooze and crust and later coalesce into raised scaly plaques
Eczema
61
Which disease?
Caused by allergen (delayed hypersensitivity), defect in keratinocyte barrier, drug hypersensitivity, UV light, physical/chemical irritant
Eczema
62
Which disease?
Example: allergic contact dermatitis (e.g. poison ivy)
Eczema
63
Which disease?
Environmental agent that reacts with self-
proteins creating neoantigens that sensitizes T cells
Eczema
64
Which disease?
On re-exposure, memory CD4+ T cells are
activated and release cytokines that recruit inflammatory cells and cause epidermal damage
Eczema
65
What category of diseases?
Features become most apparent over many months to years
Chronic inflammatory dermatoses
66
What category of diseases?
Skin can appear rough due to thick scale and shedding (desquamation)
Chronic inflammatory dermatoses
67
What is the 1 chronic inflammatory dermatoses?
Psoriasis
68
Which disease?
1-2% of US population is affected (common)
Psoriasis
69
Which disease?
Increased risk for heart attack and stroke and affects 10% of arthritis pts
Psoriasis
70
Which disease?
Autoimmune, T cell-mediated inflammatory disease; self and environmental antigens involved
Psoriasis
71
Which disease?
T cells secrete cytokines (TNF is a major mediator) and growth factors inducing keratinocyte hyperproliferation
Psoriasis
72
Which disease?
Well-demarcated, pink to salmon–colored plaque covered by loosely adherent silver-white scale
Psoriasis
73
Which disease?
Psoriatic arthritis is a severe complication of this disease
Psoriasis
74
Which disease?
Affects skin of the elbows, knees, scalp etc. (oral
lesions extremely rare)
Psoriasis
75
Which disease?
Diagnosed by Auspitz sign – pinpoint bleeding upon scratching scale off lesions
Psoriasis
76
Which disease?
Diagnosed by Koebnerization – creation of lesions by scratching
Psoriasis
77
Which disease?
Tx: coal tar derivatives, sunlight, TNF antagonists, Vitamin A and D derivatives, methotrexate for severe cases
Psoriasis
78
What are the 2 infectious dermatoses?
Superficial fungal infection
Impetigo
79
Name for fungal infectious dermatoses
Superficial fungal infection (dermatophytes)
80
Name for bacterial infectious dermatoses
Impetigo
81
What are the 4 types of superficial fungal infections (dermatophytes)?
Tinea capitis
Tinea barbae
Tinea corporis
Tinea pedis
82
Which type of superficial fungal infections (dermatophytes)?
Head; causes focal alopecia
Tinea capitis
83
Which type of superficial fungal infections (dermatophytes)?
Beard area of men
Tinea barbae
84
Which type of superficial fungal infections (dermatophytes)?
Body; caused by heat and humidity and exposure to animals
Tinea corporis
85
Which type of superficial fungal infections (dermatophytes)?
Example is ringworm
Tinea corporis
86
Which type of superficial fungal infections (dermatophytes)?
Athlete's foot fungus w/ superimposed bacterial infection
Tinea pedis
87
A yeast that infects intertriginous zones
Candida
88
Which disease?
Ubiquitous opportunist when resistance is low, due to local or systemic causes
Superficial fungal infections (dermatophytes)
89
What are the systemic causes of superficial fungal infections (dermatophytes)?
Steroids
ABs
Diabetes
Immunosuppression (HIV, chemo)
90
Are intertriginous zones (areas on skin that stay moist) a local or systemic cause of superficial fungal infections?
Local cause
91
Which disease?
Superficial skin infection of face or extremities with Strep pyogenes and/or Staph aureus entering broken skin
Impetigo
92
Which disease?
Common in children, crowded living conditions, poor hygiene, and hot/humid climates
Impetigo
93
Which disease?
Range from fragile vesicles to flaccid bullae that
rupture and leave an amber to “honey-colored” crust
Impetigo
94
Which disease?
May resemble exfoliative cheilitis, recurrent herpes simplex or mimic child abuse
Impetigo
95
Which disease?
Diagnosed by clinical presentation or culture
Impetigo
96
Which disease?
Isolated lesions are treated w/ topical mupirocin
Impetigo
97
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
Impetigo
98
Which disease?
Extensive lesions treated with oral ABs like cephalexin, dicloxacillin, augmentin, or clindaymycin (for pts allergic to penicillin)
Impetigo
99
What is the other dermatoses not in a category?
Acanthosis Nigricans
100
Which disease?
Acquired hyperpigmented, hyperkeratotic, velvety skin on axilla, groin, and back of neck
Acanthosis Nigricans
101
What are the 2 types of Acanthosis Nigricans?
Malignant
Benign
102
Which type of Acanthosis Nigricans?
Associated w/ GI malignancy
Malignant
103
Which type of Acanthosis Nigricans?
Associated w/ endocrinopathies (diabetes, Addison's, hypothyroidism, acromegaly) or syndromes
Benign
104
Which type of Acanthosis Nigricans?
Drug ingestion (oral contraceptives, steroids) tissues show insulin resistance
Benign
105
Which disease?
Oral lesions include:
Finely papillary lesions (not brown) of lips and tongue
Often associated with internal malignancy
Acanthosis Nigricans
106
Which disease?
Slow growing, fluctuant/rubbery nodule of the face or neck often derived from hair follicles
Epidermoid cyst
107
Which disease?
May have a yellowish to white or normal skin
appearance
Epidermoid cyst
108
Which disease?
Tx is surgical excision; good prognosis
Epidermoid cyst
109
Which disease?
Very common in people > 40 yrs old, found on skin of face and trunk
Serborrheic keratosis
110
Which disease?
Multiple tan/brown to black, well-demarcated plaques
Serborrheic keratosis
111
Which disease?
Appearance described as:
Stuck on
Dirty candle wax
Dried mud on brick wall
Serborrheic keratosis
112
Which disease?
Composed of basal cells that produce keratin inclusions
Serborrheic keratosis
113
Which disease?
No tx necessary, removed for cosmetic purposes
Serborrheic keratosis
114
Which disease?
Variant version is called dermatosis papulosa nigra
Serborrheic keratosis
115
Which disease?
Multiple small dark papules that develop in 30% of AA > 20 yrs on facial skin
Dermatosis papulosa nigra
116
Which disease?
If hundreds appear suddenly (sign of Leser-Trelat) = paraneoplastic syndrome, may have internal malignancy like GI carcinoma
Serborrheic keratosis
117
Which disease?
Premalignant skin lesion caused by chronic sun (UV light) exposure
Actinic keratosis
118
Which disease?
Common on facial skin and vermilion zone (actinic cheilosis/cheilitis) of lips in fair skinned persons > 40 yrs old
Actinic keratosis
119
Which disease?
Average person presents w/ 6-8 lesions
Actinic keratosis
120
Which disease?
Scaly plaque w/ sandpaper texture
Actinic keratosis
121
Which disease?
Hyperkeratosis, usually parakeratin
Actinic keratosis
122
Which disease?
Some degree of epithelial dysplasia
Actinic keratosis
123
Which disease?
Solar elastosis
Actinic keratosis
124
Degeneration of CT from UV damage w/ increased elastic fibers; seen in Actinic keratosis
Solar elastosis
125
Which disease?
Tx is cryotherapy, surgical excision, laser ablation, photodynamic therapy, 5-fluorouracil (Effudex), imiquimod 5% cream, diclofenac 3% gel
Actinic keratosis
126
Which disease?
1/4 may regress w/ reduced sun exposure
Actinic keratosis
127
Which disease?
8% risk of malignant progression w/ 1% over 2 yrs
Actinic keratosis
128
Which disease?
Average time to progression is 2 yrs
Actinic keratosis
129
Which disease?
Sun-induced cancer usually in existing Actinic keratosis (field effect - large exposed area causes transformation of multiple cells over time)
Squamous cell carcinoma
130
Which disease?
Slowly developing (months to years), slow growing lesion
Squamous cell carcinoma
131
Which disease?
Fleshy, firm nodule w/ a keratinized, crusty or ulcerated surface
Squamous cell carcinoma
132
Which disease?
Tx is surgery or radiation; curable if not late stage
Squamous cell carcinoma
133
Which disease?
Arises from basal cells of epidermis or germ cells in hair follicles
Basal cell carcinoma
134
What is the most common skin cancer?
Basal cell carcinoma
135
Which disease?
800,000 cases diagnosed annually in US
Basal cell carcinoma
136
Which disease?
Affected pts are usually > 40 yrs old, have a fair complexion and a history of chronic sun exposure
Basal cell carcinoma
137
Where do most basal cell carcinomas develop?
Middle 1/3 of face
138
What are the 2 main subtypes of basal cell carcinoma in the head and neck?
Noduloulcerative (most common)
Sclerosing/morpheaform
139
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
Noduloulcerative
140
Which subtype of basal cell carcinoma?
Mimics scar tissue
Sclerosing/morpheaform
141
Which disease?
Basaloid cells that appear to “drop off” of the basal cell layer of the epidermis
Basal cell carcinoma
142
Which disease?
Nodulo-ulcerative = large lobules of tumor cells are characteristic
Basal cell carcinoma
143
Which disease?
May show some similarity to ameloblastoma
Basal cell carcinoma
144
Which disease?
Tx is excision, electrodessication, curettage; Mohs surgery for planes of fusion (nasolabial fold, eye)
Basal cell carcinoma
145
Which disease?
Prognosis is excellent, rare metastasis, 95% of pts cured after first tx
Basal cell carcinoma
146
Which disease?
Larger, recurrent or tumors in embryonic planes of fusion are more aggressive and require Mohs surgery
Basal cell carcinoma
147
Which disease?
Follow up is important: 44% chance of 2nd BCC and 6% chance of SCC w/in 3 yrs
Basal cell carcinoma
148
Brown macule, increased pigment with sun
exposure but normal numbers of melanocytes
Ephelis (freckle)
149
What are the 2 benign melanocytic skin lesions?
Ephelis (freckle)
Actinic lentigo
150
Brown macule common on dorsal hand and face - shows a linear increase of melanocytes in the basal layer
Actinic lentigo
151
Any congenital skin lesion
Nevus
152
Any benign congenital or acquired neoplasm of melanocytes
Melanocytic nevus
153
Benign neoplasms caused by mutation in BRAF or RAS (oncogenes)
Acquired melanocytic nevi
154
Develop early in life (average Caucasian has about 20); rare intraorally
Acquired melanocytic nevi
155
Well defined, < 6mm in diameter
Acquired melanocytic nevi
156
Begin as flat lesions with a uniform color (dark brown or black) that elevate and fade with aging
Acquired melanocytic nevi
157
No treatment needed, unless in area of repeated trauma or cosmetic concern
Acquired melanocytic nevi
158
Prognosis is excellent, malignant transformation is extremely rare
Acquired melanocytic nevi
159
Can be sporadic or familial (familial dysplastic
nevus syndrome- strong association with
melanoma)
Dysplastic nevi
160
RAS or BRAF mutations are common
Dysplastic nevi
161
Larger than acquired nevi (>5mm) and may
have hundreds
Dysplastic nevi
162
Found on sun-exposed and not sun-exposed skin
Dysplastic nevi
163
If you have > 10+ dysplastic nevi, what do you have an increased risk for?
Melanoma
164
What is a marker for melanoma risk?
10+ dysplastic nevi
165
Macules or plaques with pebbly surface, often
variable pigmentation and irregular borders
Dysplastic nevi
166
What disease?
Malignancy of melanocytic differentiation
Melanoma
167
What disease?
Most are cutaneous; 3rd most common skin cancer; dramatic increased incidence in recent decades
Melanoma
168
What disease?
<5% of skin cancers; 75% of deaths due to skin cancer
Melanoma
169
What disease?
Caused by UV light, especially intense intermittent exposure at early age
Melanoma
170
What disease?
Non-UV variations have KIT mutations
Melanoma
171
What disease?
5-10% have hereditary predisposition
Melanoma
172
What disease?
Germ-line mutations in CDKN2A gene which encodes cyclin-dependent kinase inhibitors (inhibit cyclins)
Melanoma
173
What form of melanoma?
UV light induces RAS/BRAF mutation→ p16
inactivation (vertical growth) →p53 mutation
(metastasis)
UV induced
174
What form of melanoma?
Activated by different mutations (i.e. KIT oncogene)
Non-UV induced
175
What are the 4 types of melanoma?
Superficial spreading
Lentigo maligna
Acral lentiginous
Nodular
176
What type of melanoma?
Most common type
Superficial spreading
177
What type of melanoma?
Found on back, arms, neck, scalp (BANS)
Superficial spreading
178
What type of melanoma?
Radial phase for months to years (plaque) before vertical phase (nodule forms)
Superficial spreading
179
What type of melanoma?
Malar skin of elderly fair complexioned people with chronic sun exposure
Lentigo maligna
180
What type of melanoma?
Flat brown macule that slowly expands radially over 10-15 years before entering vertical growth stage
Lentigo maligna
181
What type of melanoma?
Unrelated to sun exposure; main type in Blacks and Asians
Acral lentiginous
182
What type of melanoma?
Very short radial growth phase before invading; poor prognosis
Acral lentiginous
183
What type of melanoma?
Most mucosal melanomas are this type (including oral)
Acral lentiginous
184
What type of melanoma?
Unrelated to sun exposure; elevated, fast-growing mass
Nodular
185
What type of melanoma?
No radial growth, starts as vertical growth; worst prognosis
Nodular
186
How do you diagnose melanomas?
ABCDE's
187
What are the "ABCDEs" of melanomas?
Asymmetry
Border irregularity
Color variegation (multiple colors)
Diameter > 6mm (size of pencil eraser)
Evolving (lesions that have changed over time)
188
What are the other warning signs of melanoma? (not part of ABCDEs)
Any new nevus after age 20
Any pigmented lesion on palms, soles, nail beds, genitalia
Itching, pain, crusting, redness, ulceration, bleeding
189
What disease?
Tx is surgery with wide margins, sentinal lymph node biopsy, histologic assessment to determine type, depth of invasion, and stage
Melanoma
190
What disease?
Treated w/ drugs that inhibit BRAF or KIT
Melanoma
191
What disease?
Metastatic forms treated with immunotherapy
Melanoma
192
What disease?
Overall 5 yr survival is 92%
Melanoma
193
What disease?
3-5% develop a 2nd one, follow-up is important!
Melanoma
194
What disease?
Breslow tumor thickness is the single most important prognostic indicator
Melanoma
