Lecture 1 - Skin ish

Question 1

Melanocytes are derived from ____ ____ cells. They produce melanin via the following process: tyrosine –> DOPA (via the enzyme _____) and then eventually to melanin. Patients with albanism are deficient in the enzyme ______, so not conversion of tyrosine to DOPA.

Answer 1

Neural Crest cells

Tyrosinase

Tyrosinase

Question 2

_____ are circumscribed flat lesions that are 5mm or smaller in diameter.

A _____ is a flat circumscribed lesion that is greater than 5mm.

______ are elevated dome-shaped or flat-topped lesions that are 5mm or smaller in diameter.

_____ are elevated dome-shaped or flat-topped lesions that are greater than 5mm in diameter.

Answer 2

Macules

Patch

Papules

Nodules

Question 3

_____ are discrete, pus-filled, raised lesions.

A ______ is an elevated flat-topped lesion (NOT dome shaped like nodules) that is greater that 5mm in diameter.

______ describes a rash consisting of small (1-2mm) red or purple macules due to minor hemorrhage.

______ describes a rash consisting of 0.3-1cm red or purple macules and patches.

Answer 3

Pustule

Plaque

Petechiae

Purpura

Question 4

_____ are small fluid-filled raised lesions that are 5mm or less in diameter. (Think herpes).

_____ are fluid filled raised lesions that are greater than 5mm in diameter.

_____ describes a transient, itchy, elevated lesion, either with or without erythema and/or dermal edema.

_____ describes dry, horny, plate-like excrescence with imperfect cornification of the stratum corneum.

Answer 4

Vesicles

Bulla

Wheal

Scale

Question 5

_______ (either basket weave or compact) is the microscopic term that describes thickening of the stratum corneum.

_______ describes keratinization of the stratum corneum with retained keratinocyte nuclei.

________ describes hyperplasia of the stratum granulosum.

Answer 5

Hyperkeratinosis

Parakeratosis

Hypergranulosis

Question 6

______ is the term that describes intercellular edema between keratinocytes in the epidermis.

______ swelling (ballooning) describes intracellular edema of keratinocytes, usually along the stratum basale.

Answer 6

Spongiosis

Hydopic swelling

Question 7

_____ is the term that describes epidermal hyperplasia with thickening of the ______ layer (the layer where keratinocytes arise from stem cells in the stratum basale). Note: keratinocytes become smaller as they move up the layers of the epidermis.

_______ is the term that describes loss of intercellular cohesion between keratinocytes (typically connected by desmosomes in the stratum spinosum.)

Answer 7

Acanthosis

Malpighian layer

Acantholysis

Question 8

______ is the term that describes premalignant proliferation of cells that are disorderly, pleiomorphic, and lack maturation.

______ is the term that describes keratinization of cells below the stratum granulosum.

Answer 8

Dysplasia

Dyskeratosis

Question 9

_______ dermatitis describes inflammation around blood vessels in the skin. It can be superficial or deep, while ______ describes inflammation of those blood vessels, themselves.

______ dermatitis describes inflammation of vesicles.

______ dermatitis describes inflammation throughout the dermis.

_______ describes inflammation of the adipose tissue of the hypodermis.

Answer 9

Perivascular dermatitis

Vascular dermatitis

Vesicular dermatits

Diffuse dermatits

Panniculitis

Question 10

Eczematous dermatits is a _______ dermatitis, which presents microscopically as intercellular edema between the keratinocytes in the epidermis. You’ll also see perivascular infiltrate.

Answer 10

Spongiotic dermatitis

Question 11

Contact dermatits can be either _____ or _____. Which of the two is characterized by a type-IV hypersensitivity reaction (so an immunologic reaction), and which of the two is characterized by exposure to physical or chemical substances that cause DIRECT damage to the skin?

Answer 11

Allergic or Irritant

Allergic –> immune response

Irritant –> direct damage

Question 12

_____ dermatitis is typically a chronic, relapsing eczematous rash, which often begins in infancy. There is a genetic component, with 75% of patients having a family history of the disease and 50% of patients have associated _____ or hay fever.

Answer 12

Atopic dermatitis

Asthma

Question 13

_______ eczema (aka pompholyx) is typically localized to the hands and feet, and it appears as fluid-filled papules.

______ dermatitis (aka nummular eczema) is not associated with ATOPY (the other eczemas are). The lower leg is a common site, and it presents typically as single coin-shaped lesions.

Answer 13

Dyshidrodtic eczema (aka pompholyx)

Discoid dermatitis (aka nummular eczema)

Question 14

_______ dermatitis is very common among newborns. It is a chronic dermatosis characterized by redness and scaling where the ______ glads are most active. It presents as an erythematous, greasy yellowish scaly rash, very often on the face. Think yellow crusty baby face.

Answer 14

Seborrheic dermatitis

Sebaceous glands

Question 15

______ multiforme is an acute, self-limiting and often relapsing mucocutaneous syndrome characterized by ____-shaped plaques, predominantly on the extremities. It is caused by a ____-mediated cytotoxic reaction.

What is the difference between the Major and Minor versions of this syndrome (major being more serious of course.)

Why is it most often seen in patients between 20-40 years of age?

Keep in mind treatment involves treating the underlying disease (hence it is a syndrome, not a disease itself).

Microscopic findings typically reveal vesicle formation or vacuolar change at the junction between the ______ and ________.

Answer 15

Erythema multiforme

Target-shaped plaques

Cell-mediated cytotoxic reaction.

Major involves the mucosa and is more serious.) Minor does not!

It is most often seen in this age range because it is associated with reccurence of herpes.

Dermis and Epidermis

Question 16

____-_____ syndrome (SJS)/ Toxic epidermal necrolysis is an acute, life-threatening skin and mucous membrane reaction characterized by extensive necrosis and sloughing off of the skin, The process for SJS and toxic epidermal necrolysis vary only in the % of the skin involved.

<10% –> _____

10-30% –> Overlap between the two

> 30% –> ______

Answer 16

Stevens-Johnson Syndrome

<10% –> SJS

10%-30% –> Overlap

> 30% –> Toxic Epidermal Necrolysis

Question 17

Lichen Planus is an interface dermatitis that can arise anywhere on the body, often with oral involvement and presents microscopically with ____-like lymphocytic infiltrate along the dermal-epidermal junction. Also look for _____ bodies, which are necrotic keratinocytes.

In long standing Lichen Planus, there’s longitudinal ridging of the _____, with distal splitting.

Pathogenesis involves possible altered external antigen stimulus eliciting a cell-mediated ______ T-cell immune response.

Answer 17

Band-like

Civatte bodies

Nails

Cytotoxic

Question 18

Psoriasis is an erythematous scaly plaque that is most often seen on the ____ and ____, though it can be seen anywhere on the body. It often presents in teens and early adult life (type I) or later in the ____ decade of life (type II). Keep in mind this is a _______ disease, so if one parent had the disease, 8% of offspring will likely get it, while if both parents had the disease, 41% of offspring are likely to get it.

The key to the pathogenesis of Psoriasis is both innate and adaptive immune responses stimulate cytokine and growth factor production that increases the proliferation of basal _______ by up to 28 x faster than normal. Microscopically, you’ll see elongation of rete ridges, suprapapillary thinning, and _____ Microabscesses (neutrophils aggregate in parakeratotic stratum corneum.)

Answer 18

Elbows and knees

Sixth decade

Polygenic

Keratinocytes

Munro’s Microabscesses