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Musculoskeletal and Skin > MSS-Week 3 > Flashcards

MSS-Week 3 Flashcards

1
Q

Layers of Epidermis

A

Cornified - contains anucleate corneocytes + filaggrin and ceramides
Granular - contains flattened keratinocytes and keratohyalin and lamellargranules
Spinous - contains keratinocytes
Basal - contains stem cells and melanocytes
Basement membrane

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2
Q

Keratinization/Cornification

A

Stem cell-> keratinocyte-> separate from basement membrane-> migrate toward surface-> lose water content-> lamellar and keratinocyte granules form-> lose organelles-> corneocyte
28 days

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3
Q

Pemphigus Vulgaris

A 
autoimmune blistering dx
rare, affects elderly
autoantibody against desmoglein 1/3-> weakened desmosomes-> intraepidermal blistering
flaccid blisters --> erosions
Nikolski's sign+ (rubbing=sloughing)
can be fatal, tx w immunosuppressants
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4
Q

Ichthyosis Vulgaris

A

Common autosomal dom with wide variability
mutation in profilaggrin-> defective cornified envelope
large fish scales, esp on shins
assoc with atopic dermatitis, allergic rhinitis, allergies, asthma

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5
Q

SPF (sunscreen)

A

=MEDprotected/MEDunprotected

MED= minimal erythema dose (at 24hrs)

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6
Q

Layers of Dermis

A

Papillary - superficial, interdigitates w epidermis, more cellular, fine loose collagen
Reticular - deep, fewer cells, coarse packed collagen

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7
Q

ECM

A

Collagen - produced by fibroblasts, Col I most abundant, then Col III, more Col III during embryogenesis and healing
Elastic fibers - composed of microfibrils made of fibrillin and amorphous elastin
Ground substance - glycoproteins, proteoglycans, hyaluronic acid, water

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8
Q

Marfan Syndrome

A

Mutations in fibrillin (auto dom)
variable
tall, thin, long fingers, scoliosis, flexible, stretch marks, myopia, aortic aneurism, mitral prolapse

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9
Q

Ehlers-Danlos Syndrome

A

Inherited disorder of collagen synthesis/assembly
variable
elastic, fragile skin, flexible joints, scoliosis

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10
Q

Morphea

A

Acquired autoimmune
localized sclerosis/thickening of collagen
erythematous and indurated plaques, slowly expand, can leave scars

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11
Q

Systemic Sclerosis

A

Acquired autoimmune
generalized sclerosis
young/middle age women
Lots of sx and other systemic probs

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12
Q

Panniculitis

A

Inflammation of subcu fat

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13
Q

Erythema Nodosum

A

Acquired disorder of young women
reactive process, can be triggered by Strep infxn, medications, or other
tender, red nodules on shins

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14
Q

Structures of Basement membrane zone

A 
Hemidesmosomes (BP 230-plakin-organize cytoskeletal archetecture, BP 180-connects keratinocytes and cytoskeleton to dermal Col VII) - cell-ACM attachment
Lamina Lucida (BP 180)
Lamina Densa (Laminin 332, Col IV)- bridges BMZ
Sublamina densa (Col VII) - anchoring fibrils, epidermal-dermal adhesion
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15
Q

Bullous Pemphigoid

A

Most common autoimmune bullous dermatosis
usually elderly
tense/stable blisters with serous content
antibodies against BP230 and BP180, causes subepidermal blisters
DIF-> linear staining on epidermal side of salt-split
tx: high potency steroids

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16
Q

Mucous Membrane Pemphigoid

A

Usually elderly
recurrent blictering of mucous membranes and skin-> scars
antibody against BP 180
association with malignancies
DIF-> linear staining on dermal side of salt-split

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17
Q

Epidermolysis Bullosa Acquisita

A

Rare autoimmune against Col VII
slight trauma elicits blistering and erosions
fibrosis of hands and feet
DIF-> stining on dermal side of salt-split

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18
Q

Epidermolysis Bullosa

A

mutations in genes encoding for BMZ proteins
inherited skin fragility
slight trauma-> blistering and erosions
Epidermolysis bullosa simplex= keratins 5,14
Junctional EB= laminin 332 and BP180
Dystrophic EB= Col VII

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19
Q

Macule

A

flat, non-palpable <1cm

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20
Q

Patch

A

flat, non-palpable >1cm

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21
Q

Papule

A

elevated or depressed, palpable, <1cm

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22
Q

Plaque

A

elevated or depressed, palpable, >1cm

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23
Q

Nodule

A

palpable, >1cm, more rounded surface than plaque

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24
Q

Vesicle

A

fluid filled blister, <1cm

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25
Q

Bulla

A

fluid filled blister, >1cm

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26
Q

Pustule

A

pus filled blister

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27
Q

Wheal

A

edematous papules and plaques = hives

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28
Q

Telangiectasia

A

dilated blood vessels

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29
Q

Erosion

A

open area, loss of epidermis

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30
Q

Ulcer

A

open area, loss of dermis

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31
Q

Fissure

A

linear ulcer

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32
Q

Purpura

A

area of hemorrhage

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33
Q

Petechiae

A

pinpoint purpura

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34
Q

Scale

A

accumulation of cornified layer

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35
Q

Crust

A

dried serum, pus, blood

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36
Q

Lichenification

A

epidermal thickening, accentuated skin markings

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37
Q

Induration

A

dermal thickening, firm

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38
Q

Excoriation

A

linear erosion caused by scratching

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39
Q

Nummular

A

coin-shaped

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40
Q

Geographic

A

irregular border like continent

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41
Q

serpiginous

A

wavy lines

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42
Q

Annular

A

ring-like with central clearing

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43
Q

Arcuate

A

curved

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44
Q

Verrocous

A

looks like top of cauliflower

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45
Q

Targetoid

A

looks like bulls-eye

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46
Q

Reticulate

A

net-like

47
Q

Blaschkoid

A

follows ectodermal development lines

48
Q

Types of pilosebaceous units

A 
Lanugo= fetal
Vellus= fine
Terminal= coarse, often darker
49
Q

Components of pilosebaceous unit

A

hair follicle and associated sebaceous gland
hair bulb (inferior), isthmus (middle), infundibulum (upper)
stem cells are in matrix of hair bulb

50
Q

The hair cycle

A 
Anagen= growth, 2-6yrs
Catagen= regression, 2-3weeks
Telogen= resting, 3mo
51
Q

Telogen effluvium

A

large proportion of hair enters telogen phase simultaneously as a result of stressor
hair is shed 3mo later

52
Q

Alopecia Areata

A

autoimmune, sudden development of round smooth patches of hair loss, course unpredictable
Nail changes= pitting
Tx: topical corticosteroids

53
Q

Anagen Effluvium

A

Hair loss as result of medications (chemo)

starts 2-3weeks after admin, regrows once stopped

54
Q

Sweat glands

A

Eccrine: distributed all over, innervated by postganglionic sympathetics, ACh
Coiled thin portion in lower dermis, frains into long this duct with apical portion,, large clear cells secrete electrolytes and water, dark cells unknown function
Apocrine: function unclear, localized to specific sites, secrete oily precursors to body odor

55
Q

Acne Vulgaris

A

increase in sebum production, increased corneocytes -> plugging of hair follicles (comedo)
These comedos can rupture-> inflammation
Also P. acnes G+ rod found deep in follicle-> inflammation
Comodones: closed=whiteheads, open=blackheads
inflammatory-> pustules, nodules, cysts, papules
post-inflammatory hyperpigmentation
Tx: topical retinoids, benzoyl peroxide, topical antibiotics, systemic antibiotics, contraceptives, isotretinoin

56
Q

Acne Rosacea

A

persistent erythema, acne-like sx

Tx: similar to acne vulgaris

57
Q

Vitiligo

A

autoimmune destroys melanocytes-> depigmented patches
unpredictable course
Tx: topical corticosteroids, UV phototherapy

58
Q

Oculocutaneous albinism

A

inherited genetic disorder usually in tyrosinase, defects in melanin production
skin and hair, visual sx too, skin cancer

59
Q

Piebaldism

A

Rare autosomal dom, congenital patch of white hair and skin due to absence of melanocytes
Stable (unlike vitiligo)
speckled appearance

60
Q

Waardenburg Syndrome

A

Rare autosomal dom or res, achromia of hair, skin, congenital deafness, heterochromia irides, eyebrow hyperplasia, wide nasal root

61
Q

Melanocytic Nevi

A

benign proliferations of melanocytes
well circumscribed with regular border, uniformly pigmented
Junctional=dermal-epidermal junction, compund=also in dermis, intradermal=only in dermis (histo)
Congenital: tend larger
all have small risk of malignant transformation

62
Q

Ephelides

A

Freckles

marker of UV damage-> increased risk of melanoma

63
Q

Cafe-au-lait macules

A

CALM
well-curcumscribed, uniformly light or dark macules or patches, appear in infancy or early childhood
Multiple may be sign of neurofibromatosis

64
Q

Solar lentigines

A

tan to dark brown macule due to UV exposure

seen later in life, larger

65
Q

Dermal melanocytosis

A

blue-gray patches over lumbosacral region, larger, common in asians
“Mongolian spots”

66
Q

Acanthosis nigricans

A

commonly manifestation of insulin resistance, associated w cancer
brown velvety plaques on posteroir neck, axilla, groin

67
Q

Diabetic Dermopathy

A

seen in 30% of diabetics
brown atrophic macules on shins
marker of poor diabetes control

68
Q

Necrobiosis lipoidica diabeticorum

A

yellow-orange atrophic patches progressively expand, sometimes ulcerate
shins of diabetics

69
Q

Thyroid disease effect on skin

A

Hyperthyroidism: fine, velvety, smooth skin, warm and moist
Graves ds: pretibial myxedema- hyaluronic acid deposition, firm non-pitting shiny pink plaques
Hypothyroidism: cold dry rough skin, alopecia of lateral 1/3rd of eyebrows

70
Q

Adrenal disease effect on skin

A

Cushing’s-> skin atrophy, striae, fragility, purpura

Addison’s: hyperpigmentation

71
Q

Systemic Lupus Erythematosus

A

pink scaly rash on face (malar/butterfly)
also diffuse alopecia, ulcers, Raynaud, etc
Tx: topical steroids, systemic immunosuppressants

72
Q

Discoid Lupus Erythematosus

A

=Chronic cutaneous LE

hyperkeratotic violaceous plaques on head and neck, heal with atrophic scars

73
Q

Dermatomyositis

A

autoimmune with inflammation of skin and muscle
symmetric muscle weakness, photosensitive dermatosis
Heliotrope rash: pink-purple upper eyelids w edema
Gottron’s papules: pink-purple flat-topped papules

74
Q

Sarcoidosis

A

Noncaseating granulomas in multiple organ systems, skin in 1/4
red-brown macules and papules on face around eyes and nose
Lofgren’s syndrome

75
Q

Dermatitis Herpetiformis

A

autoimmune blistering caused by hypersensitivity to gluten

76
Q

Neurofibromatosis Type I

A

autosomal dom caused by mutations in NF1 gene
multiple cafe-au-lait macules
plexiform neurofibromas= larger plaques with bag of worms feel

77
Q

Tuberous Sclerosis

A

autosomal dom disorder causes multiple benign tumors in all organs
facial angiofibromas= telangiectatic papules on central face

78
Q

Sturge-Weber Syndrome

A

Congenital developmental disorder
capillary malformation-> port wine stain on forehead at birth
also seizures and glaucoma

79
Q

PHACE Syndrome

A

Hemangiomas of the face (large), other things too

80
Q

Psoriasis

A

Plaque= most common
Guttate= numerous smaller legions, often strep trigger
erythrodermic= generalized erythema
pustular= broad patches of erythema and pverlying pustules
often symmetric involvement of extensor elbows/knees
can have psoriatic arthritis too
Tx: topical corticosteroids

81
Q

Atopic Dermatitis

A

most common chronic inflammatory skin dx
onset in infancy, associated with allergic rhinitis and asthma
acute: edematous erythematous papules and plaques, may ooze
Subacute: erythematous and scaly, crusted, less well defined than psoriasis
Chronic: thickened with lichenification
facial predominance, dry skin, pruritis is a prob
Tx: topical corticosteroids, skin care, avoid triggers, also phototherapy and immunosuppressants and antihistamines

82
Q

Seborrheic Dermatitis

A

Mild inflammatory condition, variable
infants: greasy, yellow scale on scalp,, self-limited
adults: areas of high sebum production, pruritis, more diffuse and ill-defined than psoriasis
Tx: infants: emollients, low-potency topical steroids,, adults: topical antifungals

83
Q

Lichen Planus

A

idiopathic inflammatory common in middle-age adults
possibly autoimmune
caused by drugs, HepC, vaccines
small, polygonal, violaceous, flat-topped papules, pruritis, fine white lines (wickham’s striae),, located on flexor surfaces
can have oral involvement
Tx: eliminate trigger, topical steroids and antihistamines, sometimes phototherapy and immunosuppressants

84
Q

Seborrheic Keratosis

A

common benign lesion, middle-age and elderly
sharply delineated, round, flesh colored or brown-black warty plaques on trunk or face
Some have FGF3 mutation
Sudden appearance of multiple= Leser-Trelat sign= internal malignancy (adenocarcinoma of stomach)
Hyperkeratotic papillomatous and verrucous epidermis
Tx: nothing necessary, can remove if necessary

85
Q

Actinic Keratosis

A

=solar/senile keratosis
common lesions, dysplastic (pre-neoplasia)
result of UV exposure
Some can become malignant
rough, erythematous or yellow-brown scaly lesions
surgical or medical destruction
corneal layer is thickened w nuclei, dermis thickened blue-gray elastic fibers (solar elastosis)

86
Q

Squamous Cell Carcinoma

A

Common tumor due to sun in elderly
SCC in situ is irregular shape, erythematous and scaly or crusted plaques
Invasive tends to be nodular, variable scale, may ulcerate
5% go invasive, 30% of those metastatic
removed with surgery
full-thickness dysplasia

87
Q

Keratoacanthoma

A

A variant of SCC
solitary pink or flecsh colored dome shaped nodule with central keratin plug
grows rapidly over 2-10 week then stationary
tends to involute spontaneously, but may cause extensive local damage, so treat aggressively

88
Q

Basal Cell Carcinoma

A

Most common malignant cutaneous neoplasm
sun exposed elderly males
patched/hedgehog pathway mutations
papule with a pearly translucent edge w visible telangiectasia
most are slow growing, non-aggressive, rarely metastatic
Tx: surgery
superficial type (in epidermis) or nodular type (dermis, basophilic with peripheral palisading)

89
Q

Dysplastic Nevi

A

Some potential for malignant transformation
usually larger than acquired nevi, irregular in shape, uneven color, tend to be on non-sun exposed areas
Dysplastic nevus syndrome: multiple dysplastic nevi, increased risk of melanoma and other cancer), CDKN2A gene
Always junctional or compound (not intradermal)

90
Q

Melanoma

A

Most serious skin cancer, adults, 6th most common cancer
mostly de novo
striking variations in pigmentation, irregular/notched borders
ABCDE: asymetry, border, color, diameter, evolution
Some have germline CDKN2A mutation
BRAF or NRAS mutations are common
Tx: surgery, metastastasis=poor prognosis
Breslow thickness= depth of penetration= predicts prognosis
cells are large with abundant cytoplasm, dusty melanin, poorly formed nests, lack of maturation

91
Q

Types of Melanoma

A

Lentigo maligna: usually head and neck, in situ lesion present for years before tumor, sun damage
Superficial spreading: most common, trunk in men, legs in women
Nodular: high vertical growth rate, poor prognosis, trunk and legs
Acral lentiginous: least common in white, most common in AA, asian, hispanic, palmar, plantar, subungal, older females

92
Q

Mycosis Fungoides

A

T-cell lymphoma, most common cutaneous lymphoid malignancy
males 2:1, blacks 2:1
Patch stage: many years, ill defined patches of varying hue, fine scale, irregular in size and shape, random distribution on trunk
Plaque stage: well-demarcated lesions, annular in shape, violaceous and scaly
Tumor stage: red in color, tense shiny surface, maybe ulceration
Proliferation of CD4+ T-cells, usually CD8-

93
Q

Sezary Syndrome

A

rare variant of cutaneous T-cell lymphoma
erythroderma, blood involvement, poor prognosis
generalized exfoliative erythroderma and tumor cells in peripheral blood

94
Q

Impetigo

A 
superficial bacterial skin infxn
usually Staph aureus
small superficial vesicles, rapidly burst then thick yellowish dirty crust with margin of erythema
mouth, nose, extremities
warm, humid conditions
Tx: topical antibiotics
neutrophilic infiltrate
95
Q

Staphycoccal Scalded Skin Syndrome

A

toxin mediated exfoliative dermatitis
phage group II, type 71 S aureus, exotoxins A and B
intraepidermal splitting through granular layer, sudden onset skin tenderness, macular eruption, large easily ruptured bullae, desquamation in large sheets
good prognosis in kids, bad in adults

96
Q

Cellulitis

A

diffuse inflammation of connective tissue
expanding area of erythema, edematous and tender
marked dermal edema and lymphatic dilation, diffuse neutrophils

97
Q

Erysipelas

A

Type of cellulitis
elevated border, preads rapidly, usually old males, lower extremeties
oral antibiotics

98
Q

Warts

A

HPV infection
Verruca vulgaris: most common
Verruca plana: flat wart on face or dorsal hands
Verruca plantaris: on soles
Verruca palmaris: palms
typically spontaneously regress, or can destroy
papillomatous hyperplasia of epidermis, prominant granular layer, irregular basophilic keratohyaline granules

99
Q

Condyloma Accuminatum

A

commonly caused by HPV 6, 11
trauma accompanying intercourse (genitals)
single or multiple papular eruptions, pearly, filiform, fungating, cauliflower, plaquelike, can be smooth, verrucous, or lobulated
marked acanthosis with broad exophytic growth, surface is hyperkeratotic and parakeratotic

100
Q

Herpes Simplex Virus (HSV)

A

HSV1= herpes labialis
HSV2= herpes genitalis
Diagnosis: Tzanck smear, PCR, biopsy
usually self-resolving, can use antivirals
epidermal acantholysis with multinucleated keratinocytes with glassy intranuclear inclusions, balloning degeneration

101
Q

Variella and Herpes Zoster

A

widespread vesicular eruption, successive crops of papules, vesicles, pustules, crusted lesions, healing lesions

102
Q

Molluscum Contagiosum

A

caused by DNA poxvirus, direct skin contact
solitary or multiple dome-shaped umbilicated, waxy papules
kids, head/neck/trunk/genitals
inverted lobules, eosinophilic inclusion bodies in cytoplasm of keratinocytes above basal layer

103
Q

Scabies

A

caused by a mite
papules and burrows on hands and feet
papular eruption often excoriated, secondary bacterial infxn
Tx: topical insecticide

104
Q

Dermatophytoses (Tinea)

A

fungus
Epidermophyton: epidermal keratin
Microsporum, Trichophyton: also hair
presence of neutrophils, sandwich sign

105
Q

Tinea Versicolor

A

= pityriasis versicolor
common superficial fungal infxn, tropical climates, young adults
Malassezia
multiple irregular areas of hypo/hyperpigmentation, circular and macular
Tx: topical or oral antifungals
spaghetti and meatballs

106
Q

Urticaria

A

=hives
pink edematous papules and plaques
migratory and individual lesions last less than 24hrs
angioedema and anaphylactic shock can also occur
IgE-mediated hypersensitivity, usually caused by upper respiratory infxn
oral antihistamines

107
Q

Exanthematous Drug Erumptions

A

=morbilliform drug rashes
Type IV hypersensitivity
monomorphic macules and thin papules start on face and trunk, then extremities
pruritic, low-grade fever
onset 2-14days after drug initiation
spontaneously resolve over 2 weeks
Tx: supportative for pruritis, topical steroids and oral antihistamines

108
Q

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

A

resembles exanthematous drug eruption, but associated with fever, facial edema, enlarged lymph nodes, arthralgias
Ofen liver involvement, can be fatal
systemic corticosteroids

109
Q

Erythema Multiforme

A

Target lesions with 3+ color zones and a dusky red/purple center
arise abruptly on acral areas, last up to 2weeks
usually infectious trigger (herpes simplex)
self-resolves, can use systemic steroids if severe

110
Q

Stevens-Johnson and Toxic Epidermal Necrolysis (SJS/TEN)

A

severe, life threatening disorders
usually preceded by prodrome of fever, malaise, upper respiratory sx
painful red patches evolve rapidly to bullae and necrosis
SJS30%
mortality rate is high, esp from sepsis

111
Q

Vasculitis

A

inflammation and destruction of blood vessels, range of presentations

112
Q

Leukocytoclastic Vasculitis (LCV)

A

histologic diagnosis, multiple clinical presentations
neutrophils are predominant inflammatory cell
can be triggered by infections and drugs
palpable purpura, usually legs

113
Q

Henoch-Schonlein Purpura

A

Small vessel vasculitis, usually kids
leukocytoclastic vasculitis, but IgA immune complexes are more specific
usually triggered by infections
palpable purpura, esp buttocks and lower extremities
self-limited, resolves of 2-4weeks

Musculoskeletal and Skin (4 decks)

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