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INTEG > MIDTERM > Flashcards

MIDTERM Flashcards

1
Q

How many days does it take to form EPIDERMIS

A

28 days

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2
Q

What two layers form the DERMIS
Where do Meissners and Pacinian Corpuscles belong?

A

Papillary Layer = thin upper (Meissners)
Reticular = THICK lower (Pacinian)

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3
Q

Name the three phases of hair growth

A

Anagen = growth phase (2-6yrs)
Catagen = transition (2-3 weeks)
Telogen = resting (3mo)

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4
Q

What phae is hair colored in?

A

Anagen Phase = growth phase

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5
Q

EUMELANIN=

A

black/brown hair

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6
Q

Pheomelanin

A

BLONDE

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7
Q

Erythromelanin

A

RED

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8
Q

Longitudinal band of brown/black pigment stretching from matrix to nail folds

A

MELANONYCHIA
Hutchinson’s sign

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9
Q

small, discrete erythematous scaling papules on the trunk and extremities, some of which coalesce

A

GLUTTATE PSORIASIS

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10
Q

irregular and asymmetric hyperpigmented patch with striking variegation of pigmentation

A

MELANOMA

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11
Q

Primary Skin Lesions

: flat, < 1 cm

: flat >1 cm

A

Macule: flat, < 1 cm
Patch: flat >1 cm

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12
Q

Primary Skin Lesions

: Elevated < 1 cm

: Elevated > 1 cm

A

Papule: Elevated < 1 cm

Plaque: Elevated > 1 cm

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13
Q

Primary Skin Lesions

: Large palpable mass > 1 cm

: Fixed large nodule > 2 cm

A

Nodule: Large palpable mass > 1 cm

Tumor: Fixed large nodule > 2 cm

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14
Q

Secondary Skin Lesions

Do erosions scar?

A

Loss of epidermis
heals WITHOUT scarring

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15
Q

Secondary Skin lesion

Loss of tissue leading to exposure of dermis/ fat
Does it scar?

A

ULCER
heals with scarring

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16
Q

red macule due to vasodilation
blanches under pressure ( essentially vasoconstricting
it so redness stops )

A

ERYTHEMA

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17
Q

Extravasation of RBCs
* does not blanch under pressure ( RBCs are out so pressing won’t make a difference )

A

PURPURA

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18
Q

Dilated vessel i.e. spider angiomas

A

Telangiectasia

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19
Q

Thickening of stratum corneum d/t to keratinocyte proliferation

A

Lichenification

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20
Q

Yellow Red papule from fat deposition

A

XANTHOMA

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21
Q

Itchy, evanescent Hypopigmented papule/plaque d/t edema
from dermis associated with allergies

A

WHEAL

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22
Q

What is a good screening tool for susceptibility to skin cancer?

A

Fitzpatrick Skin Types

What happens after 15 min of sun exposure w/o sunscreen
Always -> never

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23
Q

Fitzpatrick Skin Types

Type I: Always burn, never tan
Type II: Usually burns, sometimes tans Type III: Sometimes burns
Type IV: Rarely burns
Type V: Very rarely burns
Type VI: Never burns, always tans

A

(Always Burns –> Never Burns)
(Never Tan –> Always Tan)

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24
Q

dead, protective layer of epidermis

A

Stratum corneum

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25
Q

layer of epidermis present in thick skin dead cells

A

Stratum lucidum

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26
Q

Are there blood vessels in the epidermis?

A

NO

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27
Q

merocrine, tubular glands that help with thermoregulation

A

SWEAT GLANDS
* Eccrine – found everywhere
* Apocrine – found in axila, pubic, perianal area

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28
Q

HOLOCRINE, associated with hair follices, nerve endings, smooth muscle

A

SEBACEOUS Glands

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29
Q

transepidermal water loss → Ca2+ gradient loss →

A

lamellar body ( lipid-containing) secretion → cytokine secretion, inflammation and keratinocyte proliferation

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30
Q

What are the two barriers to UV radiation?

A

Melanin and Protein Lipid Barrier in the stratum corneum

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31
Q

defects in lipid metabolism or the protein components of the stratum corneum are accompained by skin barrier defects

A

ICHTHYOSIS

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32
Q

Acute and Chronic eczema result in vesicular lesions that lead to ulcerations and erosions that become easily colonized and infected

A

Eczema with spongiosis

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33
Q

desquamative inflammatory dermatoses make the skin barrier function less effective

A
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34
Q

lymphocytic infiltrate with vasculitis

A

URTICARIA

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35
Q

bacterial infection
ulceration and acute inflammation

A

IMPETIGO

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36
Q

In desquamative, inflammatory dematosis, is the skin barrier intact and fully functional?

A

NO

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37
Q

What dermatological condition demonstrates HORNCYSTS?

A

Seborrheic keratosis

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38
Q

What dermatological condition results from bacterial infection?

A

IMPETIGO

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39
Q

If munroe’s microabscess is seen on a pathologiclal specimen slide, what dematological condition is present?

A

PSORIASIS

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40
Q

vitiligo, tinea, moles, freckles, sunspots, lentigenes are examples of

A

Macules and Patches

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41
Q

Acne, boils, candida, chickenpox, impetigo are examples of

A

PUSTULES

Small patch of BULGING skin filled with PUS

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42
Q

nodule with a central punctum
cheesy, yellow, keratin material
lined by flat epidermal cells, has a granular layer surrounding keratin

A

Epidermal Inclusion Cysts

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43
Q

rapid build up of epidermal cells especially over the knees and elbows
SILVERY SCALING
Histopath: Parakeratosis = cell nuclei within stratum corneum

THERE IS NO GRANULAR LAYER

CD8 is in the DERMIS / CD4 is in EPIDERMIS

A

PSORIASIS

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44
Q

Thick skin, increased keratin (stratum corneum) layer
Plantar (SOLES of Feet)
VITAMIN DEFICIENCIES (E, A, D)

A

Hyperkeratosis

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45
Q

benign neoplasms of melanocytes
grows as nests of melanocytes at the dermal-epidermal junction can extend into dermis

FLAT macule or RAISED Papule, usually < 6mm

A

NEVI

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46
Q

Dysplastic nevus is a precursor

A

MELANOMA

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47
Q

Antibodies against desmogelin 3 is seen in what bullous disease?

A

Pemphigus Vulgaris

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48
Q

Antibodies against hemidesmosmes is seen in which bullous disease?

A

Bullous phemphigod

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49
Q

If Nikolsky’s sign is positive, what bulloys disease?

A

Pemphigus Vulgaris

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50
Q

Pemphigus Vulgaris vs Bullous Phemphigoid Immunofluorescence appearance

A

Pemphigus Vulgaris – FISH NET
Bullous Phemigoid – LINEAR PATTERN

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51
Q

Autoimmune bullous disease of IgA at the tips of dermal papillae
Consists of: pruritic vesicles and bullae grouped together bullae-> filled with watery fluid, PMN’s, and eosinophils

A

Dermatitis Herpetiformis

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52
Q

What skin disease is associated with celiac disease and resolves with a gluten free diet?

Immunofluorescence: granular deposits w/in the dermal papillae

A

Dermatis Herpetiformis

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53
Q

multisystem blood vessel diseaes
* Affects: mostly men in the 4th and 5th decade of life
* Associated with Hep B in some patients
* Skin: may show gangrene, nodules purpura, rashes, ulcers, livedo reticularis

Most often on legs

A

Polyarteritis Nodosa Vasculitis

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54
Q

Hypersensitivity reaction of dermal blood vessels
* Characterized by: targeted rash and bullae of skin and mucous membranes
* Associated with herpes simplex, penicillin, SLE, steven johnson syndrome

vascular interface dermatitis w lymphocytes along dermo epiderm junction

A

Erythema Multiforme

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55
Q

What are Nevi, can they extend into the dermis?

A

Benign neoplasms of melanocytes
YES

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56
Q

What is acantholysis?

A

Seen in pemphigus vulgaris, seperation of the stratum spinosum keratinocytes. BM is connected, Nikolsky’s sign happen on skin and oral mucosae

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57
Q

What is the antibody formed in bullous pemphigod?
In celiac disease, what is the immunoglobulin?
It is also used diagnostic immunofloruensce

A

Anti-hemidesmosomes
IgA

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58
Q

Which has a histopathology that demonstrates vaculoar interface dermatitis with lymphocytes along the dermo epidermal junction?

A

erythema multiforme

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59
Q

What vasculitis shows rashes, ulcers, subQ nodules and livido reticularis?
It is likely in a 40 yo male with Heb B

A

PAN
Polyarteritis Nodosa

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60
Q

Patient presents with oral lesions and blisters that easily rupture. Immunofluorescence depicted with image on left. What does this patient most likely have?

A

Pemphigus vulgaris

immunofluorescence = FISH NET

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61
Q

A 45 year old patient presents with red lesions on the lower legs shown in picture. He also has a fever and endorses night sweats. What is this condition associated with in some patients?

A

HEP B

Polyartertis Nodosa Vasculitis

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62
Q

What Fitzpatrick Skin Type is the following person: usually burns, sometimes tans?

A

Type II

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63
Q

What are the four infection sites of Strep pyogenes and what do we see

A

Corneum – IMPETIGO
Epidermis – Ecthyma
Dermis – Erysipelas
Cellulitis – FAT

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64
Q

Patient comes in with painless, prurutic vesicular rash. When the fluid dries it forms a honey colored thick crust. What do you suspect?

A

IMPETIGO

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65
Q

What protein inhibits osponization and phagocytosis seen in strep impetigo?

A

M PROTEIN

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66
Q

Patient presents with “fiery red patch” rash you suspect ERYSIPELAS. What is a predisposing factor to this?

A

LYMPH OBSTRUCTION

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67
Q

Bacterial cause of cellulitis, infects skin abrasions upon contact with contaminated raw meat and fish

A

Erysipelothrix rhusiopathiae

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68
Q

What Induces pro-inflammatory cytokine production and Activates endothelia (rash and inflammation)

A

Streptococcal Pyrogenic Exotoxin B (SpeB)

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69
Q

What toxins damage mammalian cells, resulting in cell lysis and release of lysosomal enzymes

A

Streptolysin O and S

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70
Q

Two mechanisms involved in Necrotizing Fasciitis

A

Streptodornases and Hyaluronidase

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71
Q

Newborn presents as febrile, erythematous lesions around mouth, nose and neck. + Nikolsky sign

A

Staph Scalded Skin Syndrome

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72
Q

What toxin is involved in Staph Scalded Skin Syndrome

A

Exfoliative Toxin A and B

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73
Q

What staphylococcus virulence factors are responsible for folliculitis, furnucles and carbuncles?

A

Adhesins/Teichoic Acid
Capsules and Protein A
Toxins

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74
Q

Another major cause of folliculitis: grows in adequately chlorinated warm water (hot tubs)

A

Pseudomonas Aeruginosa

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75
Q

Another major cause of folliculitis: itchy acne-like eruption on the upper back, upper arms, chest, neck, chin and face

A

Malassezia furfur

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76
Q

How does VZV infect the skin epithelia when it is in the Lymph node?

A

VIREMIA to liver ans spleen via T cells and monocytes –> skin –> local nerve

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77
Q

What virulence factor is responsible for viral dissemintation of varicella zoster virus?

A

VZV glycoprotein C
binds to chemokine and then to chemokine receptor triggering enhanced recruitment and migratory action of monocytes, dendritic
cells, and T cells

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78
Q

Name the VIRUS

ssDNA naked virus
Transmission = inhalation of contaminated resp dropplets
Patients no longer contagious once the rash has appeared – due to immune response

A

PARVOVIRUS B19

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79
Q

Child presents to urgent care with cold like sympotoms, fever, headache and facial rash
Rash develops a lacy, reticular pattern

A

FIFTH DISEASE
erythema infectiosum

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80
Q

Which type of hypersensitivity reaction is seen in Fifth disease?

Parvovirus B19

A

Type 3

81
Q

What virus and what disease?

Patient presents with blister-like painful lesions in the mouth (herpangina) & skin rash
Oral and pharyngeal ulcers and vesicular rash of palms of hands + soles of feet

A

Coxsackievirus
Hand Foot Mouth Disease

82
Q

Patient presents with fever, cough, coryza, conjunctivitis, koplik spots, rash, diffuse blotchy erythematous maculopapular rash
Leukopenia and Serum Vit. A is DEC

Vaccine: MMR

A

MEASLES (RUBEOLA)

complication = subacute sclerosing panencephalitis

83
Q

Patient presents with Postauricular/occipital lymphadenopathy ( usually before rash)
Forschheimer spots on mucosa (pinpoint, red/purpule macules on uvula)

If congenital – Blueberry Muffin Rash + sensorineural deafness/cataract

A

Rubella GERMAN MEASLES

84
Q

patient presents with vesicles that look like dew drops on a rose petal
Vesicular rash in crops
Giant cells on Tzanck Smear

A

Varicella (Chickenpox)

reactivation as shingles

85
Q

Patient has a high fever for 3-5 days and then rash breaks out once fever subsides
non-pruritic blanching erythematous maculopapular rash starts on trunk –> spreads to out to face and extremities

A

Roseola Infantum
HHV 6

Little 6 yo Rosy has a Rash
complication - seizures

86
Q

Patient presents with skin colored pearly papules with central umbilication
Molluscum bodies (keratinocytes + eosinophilic cytoplasmic inclusion bodies)

A

Molluscum contagiousm

87
Q

Kissing Disease

Fatigue * distinct in children* , exudative pharyngitis, lymphadenopathy ( posterior cervical ) , hepatosplenomegaly,

A

Infectious Mononucleosis
EBV (HHV4)

88
Q

Patient presents with clustered vesicles on an erythematous base and eroded bullae that can leave scars
“Cold sore”/”Fever blister”

** Multinucleated Giant cells on Tzanck smear**

A

HSV

89
Q

Vesicular/ulcerative rash around the mouth
Could also present with herpetic whitlow ( vesicular lesions )

A

Herpetic Gingivostomatitis

90
Q

Round papules with rough edges ( warts ) that can occur anywhere, often hands

HPV 2 and 4

A

Verruca Vulgaris

Condyloma Acuminata (HPV 6/11) – genital warts

91
Q

This infection is seen in contact lens wearers – dont wash with tap water
Chronic Granulomatous Dermatitis

A

Acanthamoeba Infection

92
Q

Infection caused by sandfly bite
Visceral:
Mucocutaneous
DERMAL: hypopigmented macules –> diffuse nodular lesions

A

Leishmaniasis

93
Q

infection due to skin penetration by freshwater snails causing dematitis
Swimmer’s Itch
Katayama Fever, Pruritic Rash

A

Schistosmiasis

94
Q

Infection die to larvae from soil penetrates human skin –> serpiginous tunnel
Ground Itch

A

Ancylostomiasis

95
Q

Mosquito vector transmits tiny larvae with bite in human
Adult worm may form in subcutaneous nodules and subconjunctival nodules

A

Dirofilariasis

96
Q

infection due to drinking contaminated water (water flea = cyclops)
Worm migrates to skin – blisters on legs and feet

A

Dracunculosis

97
Q

infection due to bite of black fly (simulium) on subcutaneous tissue forming painless skin nodules affecting eyes

Dermatitis and Keratoconjunctivitis – river blindness

A

Onchocerciasis

98
Q

infection via bite from Mango Fly (Chrysops) –> eye –> subconjunctivia

Calabar Swelling of eye

A

Loiasis
Loa Loa = filarial nematode

99
Q

infection due to ingestion of undercooked pork – enters mucosa of intestines (striated muscle, heart, brain)
Myalgia

Tx: Albendazole

A

Trichinellosis

100
Q

Human Lice infestation

A

Pediculosis

Pediculosis ciliaris ->conjunctivitis -keratitis
Complication - impetigo

101
Q

skin infection caused by fly larvae (maggots) of dermatobia hominis (human bot fly)

Furnucular , Wound and Migratory depending on species

A

MYIASIS

102
Q

Chiggers – Scrub itch
agent = harvest mite – bite thin areas of skin
severly prutitic papules or vesicles

A

Trombidiosis

103
Q

What is the causative agent?

Patient presents with a visibly lumpy jaw; oral/fascial abscesses that that drain through sinus tracts with yellow sulfur granules

A

Ac+inomyces israelli

Bacterial Infection

104
Q

What is the causative agent

Pt. said they were scratched by a cat and now presents with bacillary angiomatosis

Tx: Erythromycin or Doxyclcline

A

BartoNellosis

105
Q

What is the causative agent?

Pt. is a butcher recently handling contaminated raw fish and meat. Presents with violaceous lesions with raised margins b.w fingers and spares

TX: Penicillin

A

ERYSIPELOID
(Erysipelothrix rhusiopathiae)

106
Q

What disease?

Patient was recently in contact with infected horses, now has ulcerated nodule with regional lymphadenopathy

A

GLANDERS

107
Q

What disease?

Child comes in petechiae on his extremities, which is progressing to ecchymotic

Tx: ICV penicillin or ceftriaxone

A

Meningococcemia

108
Q

What disease?

Pt. presents with 1-3 mm pits on plantar surface of feet

Tx: Topical erythromycin, clindamycin, or benozyl peroxide

A

Pitted Keratolysis

Kytococus Sedentarius

109
Q

What disease?

Patient presents with erythematous macules or papules and fever. Was possibliy in contact wiith rats and or contaminated food.

A

Rat bite Fever (Haverhill fever)

Streptobacillus moniliformis

110
Q

What disease

Patient presents with hypertrophic plaques on nares

Histopath shows MIKULICZ cells

A

Rhinoscleroma
(Klebsiella pneumoniae)

111
Q

S. aureus produces what?– which can produce bullous or exfoilative skin lesions?

TSS, Staph. scaled skin syndrome, bullous impetigo, scarlet fever

A

EXOTOXINS

112
Q

Enanthem vs. Exathem

A

Enanthem = rash INSIDE body : strawberry tongue/exudative pharynigitis
Exanthem = diffuse erythematous rash with sandpaper texture that starts on head and neck.spreads, circumoral pallow and pastiass lines

113
Q

What disease

Patient has yellowish brown concretions on axillary hair shafts

A

Trichomycosis Axillaris
(Corynebacterium tenuis)

114
Q

Patient presents with solitary lesion and has no sensory loss

A

Leprosy
(Mycobacterium leprae)

115
Q

Pt. comes in with bright pink, painful nodules on UE/LE and face

A

Type 2 Erythema Nodosum leprosum

Tx = Thalomide

116
Q

Hematogenous spread of mycobacteria from fulminant tuberculosis of the lung or meninges

exposure to contaminated surgical instruments

A

Miliary tuberculosis of the skin

117
Q

Swimming pool

Begins as a small papule at the site of inoculation and evolves into a nodule or granulomatous plaque

Tx: Minocycline

A

Pool/Aquarium Granuloma

118
Q

Exposure to humidity, moisture, warmth, and increased CO2 tension

sharply demarcated hyper/hypopigmented macules with slight scaling on neck, shoulders, chest, back, and abdomen

Histo: spaghetti/meatball → turns into hyphae and spore ), + Woods lamp

A

Pityriasis/tinea versicolor
(Malassezia)

119
Q

black ,firm, adherent concretions
white, soft, nonadherent small concretion.
Both found on scalp, beard, moustache, and beard areas.

A

Tinea piedras

120
Q

arthroconidia invade interior of hair shaft
black dots are remnants of brittle hair broken at the surface of the scalp

A

Endothrix - Black Dot Ringworm

121
Q

chronic infection of the scalp - begins during childhood
Yellowish cup shaped crusts made up of hyphae and keratinous debris

A

FAVUS (t. schoenleinii)

122
Q

dermatophyte infection of the nails
* AIDS Marker *

A

Onychomycosis
Tinea Ungium

123
Q

How do you treat tinea?

A

With antifungals only NOT systemic steroids

124
Q

Gardening, farming, being florist ( organism lives in soil )

fixed cutaneous = lesion without lymphatic spread, occurs with prior exposure vs. lymphocutaneous = subcutaneous macules and papules that follow the shape/flow of lymph vessels, ulceration with lymphatic spread usually on hand, forearm, and leg

“Cigar bodies/ asteroid bodies

A

Sporotrichosis ( from sporothrix schenckii

125
Q

found in Tropic of Cancer

Penetrating wound in the foot
Presents as : Subcutaneous abscesses

A

Mycetoma/ madura foot

126
Q

from soil saprophytes, decaying vegetation / Found in tropics/subtropics

Cauliflower-like tumors that can conjoin, irregular verrucous plaques, annular nodules with central clearing

Histo:“Copper pennies

A

Chromoblastomycosis/ Verrucous dermatitis

127
Q

associated with bottlenose dolphins

** Painless keloids**, nodules, ulcers, and verrucous lesions on face and UE

Biopsy: “Chain of coins”/ “brass knuckles”

A

Lacaziosis/Keloid Blastomycosis/Lobo’s Disease

128
Q

Exposure to soil with bat, bird, and/or chicken droppings
Cutaneous manifestations in AIDS = general macules, papules, nodules, ulcers, that are molluscum-like

Primary cutaneous ( rare )= chancre with lymphadenopathy

A

Histoplasmosis/Cave Disease

129
Q

Symptoms: Acts like virus causing resp disease/ cough/ fever & causes chronic pulmonary symptoms that mimic pneumonia
Gilchrist’s Disease: primary cutaneous manifestation

A

Blastomycosis ( from Blastomyces dermatitidis

130
Q

found in Southern California, Arizona, New Mexico, SW Texas

Asymptomatic, self-limited resp infection or pulmonary manifestation with flu-like symptoms
Cutaneous ( rare )= chancre-like lesion with lymphadenitis
Disseminated cocci ( rare ) = papules, pustules, nodules on face, scalp, neck

A

Coccidioidomycosis/ San Joaquin Valley Fever
from Coccidioides immitis

131
Q

found in Brazil

Skin symptoms: Papules, vesicles, crusty granulomatous lesions
Biopsy: “Mariner’s Wheel” ( large thick round cells with buddings attached to mother

A

Paracoccidioidomycosis ( from Paracoccidioides brasiliensis

132
Q

found in SE Asia

Skin symptoms:** Molloscum-like**, mucocutaneous lesions Biopsy: Intra/extracellular oval/round yeast shaped

A

Penicilliosis ( from Penicillium marneffei)

133
Q

encapsulated and found in pigeon droppings

Primary cutaneous = sentinel of disseminated disease ( to the CNS, bone, skin, lungs )
Cutaneous symptoms ( 10-15% of HIV patients )= nodules, papules ulcers, cellulitis, molluscum-like on head, neck ,mouth, and nose

A

Cryptococcosis ( Cryptococcus neoformans, gatti )

134
Q

MOST COMMON FUNGAL OPPORTUNISTIC INFECTION

increased risk if impaired epithelial cell barrier, systemic illnesses, catheters, heat, and humidity *
Skin symptoms: Thrush ( tongue ),perleche, vulvovaginitis/balanitis, folliculitis, onychomycosis
Cutaneous: papulonecrotic eschars and purpura

Biopsy: budding yeast with pseudohyphae

A

Candidiasis ( from Candida albicans

135
Q

2nd MC cause of opportunistic infection, found in leaves, grain soil

Starts in lungs usually
Cutaneous manifestations = Usually due to trauma; erythematous macules, papules, and plaques → turn into hemorrhagic bullae and ulcerations with central necrotic eschar

A

Aspergillosis

136
Q

caused by acholoric algae in stagnant water

Skin symptoms: Papules, plaques, vesicles, cellulitis, eczematoid dermatitis, verrucous nodules. 1⁄3 of cases also causes olecranon bursitis

A

Protothecosis ( from prototheca wickerhamii )

137
Q

3 Pathogenesis of ACNE

A
  1. Keratinocyte proliferation
  2. Excessive sebum production
  3. Cutibacterium acnes
138
Q

gram positive non motile rod found deep within the sebaceous follicle

A

CUTIBACTERIUM ACNES

139
Q

this acne treatment:
normalization of follicular keratinization and corneocyte cohesion which aids in the expulsion and existing comedones and prevents formation of new ones
Have anti-inflammatory properties

A

RETINOIDS

140
Q

acne treatment

potent bacteriocidal agent that reduces P. acnes within the follicle

A

Benzoyl Peroxide

141
Q

naturally occurring dicarboxylic acid that inhibits protein synthesis of P. acne
- Also aids in reversing the hyperkeratosis or the hair follicles, thus decreasing microcomedo formation

A

AZELAIC ACID

142
Q

bacteriostatic agent that inhibits folic acid synthesis by competing with para-aminobenzoic acid

A

Dapsone

143
Q

What drug can cause blue pigmentation of teeth and nails?

A

MINOCYCLINE

144
Q

analog of Vitamin A; oral therapy effective to induce long-term remission of acne; dosing = 0.5-2 mg BID; should get 120-150 mg/kg over their treatment course

Can cause teratogenicity and toxicity:

A

Isotretinoin

145
Q

tumors contains FXIIIa positive dermal dendritic cells

appear at firm tan brown papiles – often flat

A

Benign Fibrous Histiocytoma = Dermatofibroma

hyperplasia and tendency of fibroblasts to surround collagen bundles

146
Q

Pathogenesis: Molecular Hallmark

  • Translocation: gene encoding for collagen 1A1 (COL1A1) and platelet-derived growth factor-beta (PDGFB)
  • Resulting Rearrangement: Juxtaposition of COL1A1 promoter sequences and the coding region of PDGFB
  • Overexpression and increased secretion of PDGFB: drives tumor cell growth through autocrine loop
A

Dermatofibrosarcoma protuberans

147
Q

Tumor consists of flesh-colored fibrotic nodule on sectioning. Lesions often infiltrates the subcutis in a manner reminiscent of “swiss chess” to adicionades. Characteristic storiform (swirling) alignment of the spindled cells is apparent

A

Dermatofibrosarcoma protuberans

148
Q

Intracellular accumulation of cholesterol within macrophages
Foamy cell clusters: subepithelial connective tissue of skin; tendons

Depositions of yellowish cholesterol rich material

A

Xanthomas

Associated condition: cholestasis

149
Q

local dilation of a structure vs permanent dilation of preexisting small vessels

A

Ectasis v. Telangiectasia

spider telan. = arrays of dilated subcut. arteries- blanch w press

150
Q

Mutation: TGF-beta signaling pathway genes
–> dilated capilaries and veins - present at birth

A

Hereditary Hemorrhagic Telangiectasia = Osler-Weber-Rendu disease

151
Q

common tumors

Increased number of normal and abnormal vessels filled with blood

3 types: capillary, juvenile, cavernous

A

Hemangiomas

152
Q

Most common type of hemangioma
* made up of thin-walled capillaries with scant stroma
* occur in skin, subcut. tissue, mucous membranes

A

CAPILLARY Hemangioma

153
Q

Strawberry type hemangiomas of the newborn
Fade by 1-3 years of age and completely regress by age 7 in most cases

A

Juvenile Hemangioma

154
Q

What type of hemangioma

  • Rapidly growing red lesion of skin, gingiva, and/or oral mucosa
  • Bleed easily and ulcerate
  • Develop after trauma
A

Cavernous Hemangioma – Pyogenic Granulomas

155
Q

Two types of angiosarcomas
associated with carcinogenic exposure

Malignant Tumor

A

Organ associated and cutaneous form

156
Q

This type of angiosarcoma begins as multiple deceptively small nodules that become
asymptomatic red papules
- Color: fleshy masses of red-tan to gray-white tissue
- Margins blur surrounding structures
- Central areas of necrosis and hemorrhage

A

Cutaneous Angiosarcomas

157
Q

T cell lymphoma that presents in skin → Lymphoma - Characteristics:
- Erythematous plaques early in disease
- Appear on trunk, extremities, face, and scalp - Size of nodules correlates with spread

A

Mycosis Fungoides/Sezary Syndrome

158
Q

Pathology of what disease has Pautrier’s Microabscess

A

Sezary Syndrome

159
Q

a group of idiopathic disorders:
Letterer-Siwe disease
Hand Schuller Christian Syndrome
Localized Eosinophilic Granuloma

A

Langerhans Cell Histiocytosis

160
Q

this disease occurs before age 2/ocasionally adults
* Cutaneous lesions resembling a seborrheic eruption - infiltrates of LCs; front/back of the trunk, scalp - Hepatosplenomegaly
* Lymphadenopathy
* Pulmonary lesions

A

Letterer-Siwe disease
(Multifocal Multisystem)

Langerhans Cell Histiocytosis

161
Q

2nd MC tumor of sun-exposed sites in older people
- Higher incidence in M > F
- Premalignant condition: Actinic keratosis
- Invasive/metastasize

Path: UV induced DNA damage to squamous cells defect in p53/RAS

A

Squamous Cell Carcinoma

162
Q

Most common invasive cancer in human
- rarely metastasizes
- Incidence: increase in immunosuppression, increase in xeroderma pigmentosum

Present as pearly papules

A

Basal Cell Carcinoma

163
Q

Do basal cell carcinomas occur on mucosal surfaces?

A

NO – arise from the epidermis or follicular epithelium

164
Q

pathogenesis of basal cell carcinomas is due to mutations in what?

A

mutations in p53

165
Q

What is the morphological progression of melanocytic nevi ?

A

Junctional –> Compound –> Intradermal

166
Q

What’s unique about Intradermal Nevi

A

Undergo maturation = NEUROTIZATION
- Fusiform cells

167
Q

What type of NEVUS?

  • non-nesting/dermal infiltration/fibrosis
  • heavily pigmented

CLINCALLY CONFUSED WITH MELANOMA

A

BLUE NEVUS

168
Q

What type of NEVUS?

  • fascicular growth pattern
  • plump and fusiform cells with pink-blue cytoplasm

clinically confused with hemangiomas

A

SPITZ NEVUS

169
Q

MRA Drug

MEK inhibitor indicated for melanoma with BRAF mutations

A

TRAMETINIB

170
Q

MRA Drug

BRAF protein kinase inhibitor

A

Dabrafenib

171
Q

What type of basal cell carcinoma presentation?

flush with skin, erythematous , scaly +/- shallow ulcer or crusting

A

Superficial Basal Cell Carcinoma

172
Q

What type of basal cell carcinoma presentation?

“enlarging scar”, white/yellow plaque with poorly defined borders more aggressive growth , induration ( thickening/hardening of skin )

A

Morpheaform Basal Cell Carcinoma

173
Q

Surgical excision of what size lesion margins have shown 5 year cure rates exceeding 95%

A

4-5mm margins

174
Q

When is it most appropriate to use electrodesiccation and curettage?

A

low risk superficial or nodular BCCs on the trunk or extremities

175
Q

tumor suppressor gene on chrom 9

A

PTCH1

176
Q

Merkel Cell Cancer is linked to what virus?

more aggresive than melanoma

A

Polyomavirus

177
Q

Merkel cell Carcinoma – 90% involve 3 factors

AEIOU

A

Asymoptomatic
Expanding rapidly
immunosuppresive
older patients > 70 yo
UV exposure

178
Q

appearance of sqamous cell carcinoma

actinic keratosis =

A

scaly plaque

179
Q

squamous cell carcinoma mainly affects what areas?

A

ears, lips, temples, upper face and dorsum of hands

180
Q

clinical presentation of SCC

Variant that grows rapidly ( 4-6 weeks ) and then spontaneously resolves =

A

KERATOACANTHOMA

181
Q

clinical presentation of SCC

Ulcerating variant of SCC predisposed by chronic unstable burns/scars & draining osteomyelitis. Can metastasize rapidly after resection.

A

Marjolin’s Ulcer

182
Q

TNM Staging

T1 < 1mm

T2 = 1.01-2 mm

T3= 2.01-4 mm

T4 > 4 mm
a= no ulcerations b= ulcerations

A
183
Q

TNM staging

N0= no lymphatic metastases
N1= 1 lymph node involved
a= micrometastases
b= macrometastases N2
a= 2 lymph nodes involved
b= 3 lymph nodes involved N3= 4+ positive nodes

A

M= Distant metastases
M0= no distant metastases
M1=
a= metastases to distant skin, subcutaneous, and LN sites with normal LDH (LDH= sign of tissue damage ) b= lung metastases with normal LDH
c= metastases to other visceral sites with normal LDH or any metastases with
elevated LDH

183
Q

TNM staging

N0= no lymphatic metastases
N1= 1 lymph node involved
a= micrometastases
b= macrometastases N2
a= 2 lymph nodes involved
b= 3 lymph nodes involved N3= 4+ positive nodes

A

M= Distant metastases
M0= no distant metastases
M1=
a= metastases to distant skin, subcutaneous, and LN sites with normal LDH (LDH= sign of tissue damage ) b= lung metastases with normal LDH
c= metastases to other visceral sites with normal LDH or any metastases with
elevated LDH

184
Q

“itching condition”
T-cell mediated inflammatory disease
main issue = proliferation of keratinocytes

A

PSORIASIS

Keratinocyte injury/infection → increase of proinflammatory cells ( i.e. APCs ) that activate
T cells → T-cell mediated: CD4+ Th17 and Th1 cells & CD8+ T cells secrete growth
factors that cause keratinocyte hyperproliferation → leads to the formation of lesions

185
Q

Histopath of Papulosquamous Rash:

Acanthosis = epidermal thickening

Increased epidermal cell degeneration ( leading to decreased epidermal thickening) above areas
of elongated dermal papillae
- Neutrophil aggregation in superficial epidermis

A

PSORAIAS

186
Q

Auspitz’s sign

Clinical feature of psoriasis

A

pinpoint bleeding when scale is removed

187
Q

6P’s describe this skin disorder

Pruritic, purple, polygonal, planar papules, and plaques

A

Lichen Planus

188
Q

Pathology of what skin disorder?

autoimmune disorder results from CD8+ T cell mediated cytotoxic triggered against antigens in the basal keratinocyte cells and the dermo-epidermal junction –:> INFLAMMATION and necrosis

A

LICHEN PLANUS

189
Q

Clincal presentation of which skin disorder?

Wickham Striae = papules have whites dots or lines
Melanin from damaged keratinocytes gives the lesions black color
Lymphocytes infiltrate dermoepidermal junction
Zigzag Contour
Civatte bodies/Colloid bodies = annucleate, necrotic basal cells seen in inflammed paillary dermis

A

Lichen Planus

190
Q

known as balanitis xerotica obliterans (BXO) when it affects the penis

A

lichen sclerosis

191
Q

Erythematous, scaly plaques with hyperpigmentation. Can lead to scarring, dyspigmentation, and alopecia if scalp is involved

Etilology = sun exposure, smoking, MHC-II/HLA-8, DR3, DR2 genetic associations

Histopath = epidermal atrophy, effacement of rete ridges, hyperparakeratosis, follicular kertoti plugging and basement membrane thickening with vacuolar interface change

A

Discoid Lupus erythematous (DLE)

192
Q

Oval shaped erythematous, very pruritic, plaques/lesions with well-defined borders that occur on **upper and lower extremities **(drying of skins → causes lesions to recur at previously involved sites ) with scaling, oozing, and crusting

A

Nunmular Eczema = coin shaped eczema

193
Q

exanthematas skin disease characterized by diffuse, scaling papules in T-shirt distribution after a viral prodrome
seen in young pateitns esp. women
Etiology = drug induced reactions

A

Pityriasis rosea

194
Q

skin disorder primarily affects areas with sebaceous glands
- craddle cap in infants
- caused by a rxn to pityrosporum yeast on the skin

A

Seborrheic dermatitisi

195
Q

ruffled sock appearance

A

loose anagen (cuticle folded back)

196
Q

trichotillosis

A

habitual pulling and plucking of hairs

197
Q

minoxidil and finasteride can be used in treatment of what?>

A

Alopecia

INTEG (2 decks)

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