Inflammatory skin, skin tumours and disease of the eye

Question 1

What are the common infections of the cornea and conjunctiva of the eye?

Answer 1

VZV - trigeminal nerve can cause scarring to the eye

Chlamydia - 2 types:
-trachoma - can cause blindness

• Types D-K - mild disease during birth (infection in genital tract: conjunctivitis)

Question 2

What conditions are associated with development of cataracts in the lens of eye?

Answer 2

Lens becoming opaque
Senile degeneration
Rubella
Downs syndrome
Diabetes mellitus

Question 3

What conditions are associated with retinal infections? What do they cause in adults/children

Answer 3

Toxoplasmosis - cat poo - congenital infection causes severe bilateral impairment, adults - focal inflammatory disease

Taxocara canis - infected dog faeces - can cause localised infection

Question 4

What are the main retinal vascular disease causes?

Answer 4

Diabetic retinopathy
Hypertensive retinopathy
Ischaemic retinopathy

Question 5

What are the two types of macular degeneration? What are they due to?

Answer 5

Dry macular degeneration - age, progressive visual impairment

Wet - new vessel growth beneath retina

Question 6

What are the two tumours that arise from the eye?

Answer 6

Retinoblastoma - loss of RB gene

Melanoma - arise from melanocytes in the eye - treat with surgery (remove eye)

Question 7

What is dermatitis commonly referred to as?

Answer 7

Eczema

Question 8

What are the 3 stages of dermatitis/eczema?

Answer 8

Acute - weeping serous exudate, red skin, small vesicles

Subacute - less exudate, red skin, ITCHY, crusting

Chronic - leathery skin secondary to scratching

Question 9

What is the main microscopic features of dermatitis?

Answer 9

• SPONGIOSIS - oedema in the epidermis

- Hyperkeratosis and hyperplasia of epidermis

Question 10

What are the different types of eczema?

Answer 10

Atopic eczema - childhood - type I hypersensitivity reaction

Contact irritant dermatitis - direct injury to skin by irritant e.g. acid

Contact allergic dermatitis - ( e.g. metals) allergens combine with epidermal proteins and become immunogenic

Unknown aetiology

Question 11

What are the clinical characteristics of psoriasis? What is the Auspitz sign?

Answer 11

Red oval plaques occurring in extensor surfaces (knees, elbows, sacrum)

• silvery sales
• Auspitz sign - removing scales will cause small bleeding points

Question 12

What is the distinct microscopic appearance of psoriasis?

Answer 12

Psiariasform hyperplasia

• regular elongated clubbed shaped rete ridges
• thinning epidermis
• Parakeratotic scales

Question 13

What is the pathogenesis of psoriasis?

Answer 13

Massive cell turnover

Question 14

What genetic/environmental factors are associated with psoriasis?

Answer 14

PSORS (genetic)

Stress, trauma, infection, drugs

Question 15

What are the characteristic features of Lupus?

Answer 15

Red scaly skin (sun exposed)

Butterfly rash

Autoimmune disease - effects connective tissues of body (particularly kidneys)

Question 16

What is the presenting feature of dermatomyositis? What systemic disease is it associated with?

Answer 16

Heliotrophic rash - peri-occular oedema and erythema

Visceral cancer

Question 17

How do dermatitis herpetiforms present? What condition are they associated with?

Answer 17

• Small itchy blister

- Associated with coeliacs disease

Question 18

What is acanthosis nigricans? What disease is it associated with?

Answer 18

Dark warty lesions under armpits

Visceral malignancy

Question 19

What is necrobiosis lipoidica? What disease is it associated with?

Answer 19

Red and yellow plaques in legs

Diabetes

Question 20

What are the clinical features of basal cell carcinoma?

Answer 20

• Most common skin tumour
• due to sun exposure (mainly)
• Rarely metastasise
• Nodule -> ulcer (rodent ulcer) (look like basement cells!!)

Question 21

What are the clinical features of squamous cell carcinoma?

Answer 21

• UV radiation/actinic - mostly occurs of face and hands
• Microscopic apprende = look like squamous cells!
• Nodules -> ulcerate
• Rarely metastasise

Question 22

What usually precede SSC?

Answer 22

acinitic keratosis

Question 23

What is the function of melanin>

Answer 23

Protect epidermal cell nuclei from UV radiation

Question 24

What are naevi?

Answer 24

moles - benign melanocytes

Question 25

What are the distinguishing features of melanomas vs naevi?

Answer 25

Asymmetrical
Borders uneven
Colour variation
Diameter >6mm

Question 26

What are the risk factors for melanoma?

Answer 26

• Sun exposure - short, intermittent
• Race - celtic red hair, blue eyed, don’t tan
• Family history
• Giant congenital naevi

Question 27

What are the prognostic factors for melanoma?

Answer 27

Breslow thickness (thicker the tumour, worse the prognosis)

Site - BANS - back, arms, neck, scalp - poorer prognosis

Question 28

What is the treatment for melanomas?

Answer 28

Excision of tumour and lymph if invaded