Patho- Skin Flashcards
1
Q
macule
A
small (<10mm)
brown, tan
circumscribed/flat
2
Q
patch
A
large macule
3
Q
papule
A
small (<10mm)
varying shapes (flat top/dome)
not fluid filled
4
Q
nodule
A
large papule
dome/round
5
Q
plaque
A
large papule
flat top
6
Q
blister
A
fluid filled (either vesicle or bulla)
7
Q
vesicle
A
small, fluid filled
8
Q
bulla
A
large, fluid filled
9
Q
pustule
A
pus filled vesicle (raised lesion)
pus –> PMN, dead cells, bacteria
can lyse and get huge
10
Q
wheal
A
transient (rapid, within minutes)
elevated: d/t edema
erythema
blanching
11
Q
scales
A
tiny elevations (horn like) d/t excessive cornification
12
Q
lichenification
A
thickened skin d/t rubbing (prominent skin markings)
usually no problem
13
Q
excoriation
A
linear lesion
bad b/c break epidermis (skin is not sterile), b/c holds out bacteria
14
Q
hyperkeratosis
A
abnormal thinking of S. corneum
15
Q
keratin
A
structural protein
retards water loss
problem with burn patients
16
Q
parakeratosis
A
abnormal retention of nuclei in S. corneum
normal in mucous membranes
17
Q
hypergranulosis
A
abnormal growth of S. granulosum
load up on keratin at expense of other organelles
d/t rubbing: irritation–>phys contact of cells–>stimulates mechano receptors–>mitosis
18
Q
aconthosis
A
diffuse epidermal hyperplasia
19
Q
papillomatosis
A
enlargement or hyperplasia of dermal papilla
20
Q
dyskeratosis
A
accumulation of granulation too deep in the skin
(norm= S. granulosum, not S. spinosum)
similar to MD, looks normal but doesn’t function well
21
Q
spongiosus
A
intercellular edema of the epidermis
22
Q
ballooning
A
intracellular edema of keratinocyte (skin cell)
osmotic pressure problem
23
Q
exocytosis
A
blood cells in the epidermis (any blood cell)
aka infiltration of inflammatory cells
don’t want because epidermis= dead
24
Q
erosion
A
partial loss of epidermis
usu d/t trauma
not problematic
25
ulceration
complete loss of epidermis
| reveal dermis/SQ
26
vaculoization
formation of large vacuoles within or outside of cells
| normal in plants
27
lentiginous growth
linear pattern of melanocyte proliferation within the epidermal basal cell layer
may be problem- Dx. melanoma
28
vitiligo
| appearance, location, symptoms, cause, diagnosis
appearance: smooth, white on skin
location: cm on feet/hands
symptoms: asymptomatic, only cosmetic
cause: autoimmune/ neurohormonal (but hormones= usu systemic) nn -->detrimental to melanocytes
Dx. verify loss of melanocytes/w immunoassay
29
difference between abino and vitiligo
abino= systemic & melanocytes present, but not functioning well
30
freckles
| ocurrence, location, color, patho
common in young
small & universal in location
sensitive to light (fade in winter vs lentigo)
color: brown/tan NOT red/blue/black
patho: localized increase in melanin production
31
melasma
```
"mask like" pigmentation of face
patho: hormones, common during pregnancy/ OC
excessive hormones-->stim melanocytes
steroids-->stim growth of melanocytes
(when remove hor stim, goes away)
```
Cause (dx. black light): epidermal (increase melanin deposition) -->tx. bleach
dermal: MO pago melanin from epidermis and acc in dermis (can't bleach)
32
melanocytic nevus color, size, appearance/location, patho
diverse group of lesions
color: brown or tan
size: papule (raised), @interface b/w epidermis & dermis
patho: increase activity of melanocytes -->grow in aggregates-->uniform intense color
(cells differentiate approp)
33
dysplastic nevus location, color, size, appearance
aka: BK moles
location: could have hundreds, may/not be in sunexposed areas, could-->melanoma
color: striking variability in color (red/blue/tan), likely to change
size: >6mm
appearance: macule/plaque/bull's eye
34
why skin is more prone to cancer than other areas of body
high rate of mitosis
| inevidally exposed to carcinogens
35
malgnant melanoma, risk fac, symp, size, appearance, growth
cancerous neoplasm from cells that make melanin (exponentially increasing in US)
Risk factors: UV rad & light skin
Symp: usu asymp, maybe pruritis
Size: >1cm at diagnosis (unique to this)
Appearance: irregular borders, change size, shape, color
Growth: Radial-->cells spread longitudinally within a layer of the skin (sometime basement mem = good barrier for metas)
deep/vertical growth: cells spread into dermis/epidermis
+correlation/w metas
36
Seborrheic keratosis
seborrheic- may/not have to d/w etiology
common on trunk of older people (can be on limbs)
round, waxy plaque, can peel off w/o pain/bleeding b/c coin like/w layers of skin
37
acanthosis nigricans
| appearance, patho, prog
Appearance: hyperpigmentation in skin folds (ex. pits/groin)
velvet like
unique linear component
Patho: hyperplasia of S. spinosum (lager-han/dendritic cells can facilitate adhesion)
Prog: ben--> 3/4 and usu in young adults
mal-->when man in adulthood
38
fibroepithelial polyps
aka acrocordons
CT/collagen skin, grape like
can pick off if annoying
39
epithelial cyst
```
aka wen
tumor contains keratin/sebum/fat
could be dermis/SQ
maleable (can palpate and not fixed)
not problem, just annoying
```
40
"adnexal" tumor
appendages of skin (sweat gland/ follicles)
| highly dependent on which appendage is involved
41
keratoacanthoma
```
fast growing fumor
especially in old white men >50 yo
> or equal to 1cm
usu on sun exposed area
flesh colored & dome shaped, but cells are differentiated
mimics SCC
usu cures itself
```
42
actinic keratosis
"cutaneous horn"
get huge keratin growth
usu SCC
43
SCC,
| patho, appearance, prog, tx
patho: UV light-->mutations-->DNA repair mech
"in situ" carcinoma: in it's normal location, contained in jxn b/w dermis & epidermis, basement mem = barrier
Appearance: sharply defined, red, scaling plaques-->nodules-->ulcerates (cells/w nuclei, enlarged & hyperchromatic)
Prog: usu caught in US
<5% metas
Tx. excision
44
BCC,
| where, associated with, appearance, prog
most invasive cancer in US (NK cells can kill tumors)
Where: different layer than SCC, in basal cell layer
Assoc: sun exposure, light skin, immunosuppression
Appearance: papule/w prominent surface
subepideral vessels thru it
ulcerates
+/- pigmentation
org look norm-->multifocal growths (epidermis) OR nodules (dermis) (surrounded by: fibroblasts make collagen & elastin; WBC recogn prob)
Prog: rarely metas, but may bone, ex. skull sinuses
45
urticaria
| age, cause, patho, prog
usu 20-40 yo
Patho: degran of mast cells-->hist release-->increase perm of vessels-->wheals (can -->papule/plaque)
Cause: detergent/IgE sensitive to antigen
Prog: very acute, dissipate within hrs
can get again w/o re-exposure
46
Eczema
| greek word, appearance, classifications (multifac), patho
"boiling over" (fluid acc & boils over)
Appearance: red papulovesicular -->ooze & crust-->become raised, scaly plaques
Classification: Primary irritant, allergy related, photo induced, drug related, atrophic dermatitis
Patho: Ant presentation (dendritic cells)-->CD4 Tcells in lymph node-->mem cells-->inflam at exposure site
47
Seborrheic dermatosis
| appearance, location, cause
Appearance: dandruff & greasy skin
+/- macules & papules
Location: areas/w large # of sebac glands: scalp/glabella
Cause: yeast?
48
Acne Vulgaris
| age, patho, subtypes
Age: universal in teens (M>F)
Patho: hor & abrupt changes in follicular dev
49
inflammatory acne vulgaris
"white heads"
pustule formation of follicle
does not have keratin plug
50
non-inflammatory acne vulgaris
"black head"/ open comedomes
| follicular plug of keratin-->oxidized melanin (hor increase melanin locally)
51
Psoriasis
| ocurrence, appearance, location, patho, associated with
1-2% pop (usu mild)
cm assoc/w arthritis, 1/3 have nail issues (yellow/brown)
Appearance: pink, scaly plaque-->while over time
Location: diff from eczema, target extensor: elbows, knees, glands, penis, lower back
Patho: decrease function of S. granulosum-->decrease water retention
Assoc: inflam & angiogenesis
52
what type of scale seen in psorasis
parakeratotic scale (because decrease function of S. granulosum)
53
Verruca vulgaris
| location, cause, spread, prog
Location: usu on hand
Cause: papilloma (150+ types of DNA viruses)
Spread: contact
Prog: 6 mo-->2 yrs spontaneously disappear
54
Cerebral edema
| types
(brain parenchymal edema)
vasogenic edema
cytotoxic edema
55
cause of cerebral edema
secondary to a lot of causes, consequence of starling forces
56
vasogenic edema
| cause
type of cerebral edema
disruption of BBB & increase perm of cap in CNS
loc (inflam/tumor) or gen
57
cytotoxic edema
| cause, appearance, prog
Cause: secondary to neural, glial, endothelial cell membrance injury (d/t hypoxia/ metab dam)
Appearance: widened gyri, narrow sulci
prog: could-->herniation
58
Hydrocephalus
| cause, presentation, types, tx
acc of excessive CSF within the ventricular sys
Cause: drainage prob (rarely tumor --> increases CSF prod)
in neonatals-->alien head, if after sutures close, DEAD.
types: non-communicating: a portion of ventricular sys enlarged, ex d/t tumor
communicating: enlargment of entire ventricular sys
Tx: Sx to restore dam
59
CSF pressure that will cause problems
what prob?
types
>20 cmH20 in recumbent patient
hernia thru falx cerebri/ten cerebelli
localized vs. generalized
60
types of cerebral hernias
subfalcine
transtentorial
tonsillar
61
subfalcine hernia
| cause, effect
d/t expansion of a cerebral hemisphere displaces cingulate gyrus pushing against falx cerebri (may compress Ant cerebral a. )
62
transtentorial hernia
| cause, effect
Cause: medial aspects of temp lob push against tent. cerebelli
Effect: usu bigger prob than subfalcine hernia b/c vasc on surface of pans (basilar/circle of Willis)
63
tonsillar hernia
| cause, effect
Cause: bulge of cerebellum into f. magnum
Effect: very prob b/c interfere/w medulla & pons -->CV/respir control
64
norm amount of CSF made QD
2-3 L QD
65
BBB anatomic mech?
yes
66
BBB made up of?
endothelial cells
| astrocytes= fence
67
brain good at draining?
no
68
why increase in perm of BBB bad?
neurotransmitters can cause uncontrolled stim of brain
69
neural tube defects
most cm CNS malformation
70
when does the neural tube close?
1 mo. (28 d gestation)
| aka 1st trimester
71
composition of neural tube
CNS=
ANT-->brain
POST-->SC
(encased in bone)
72
consequences of neural tube not closing
miscarriage or
| change in fxn after birth
73
neural tube re-opening?
yes, less cm
74
anencephalos
| ocurrence, cause, appearance
fairly rare: 1-5/1,000 births (F>M)
no brain or may get rest of CNS ok, but forebrain= smaller than cerebellum
gross changes in calvaria (skull cap, what immediate covers forebrain)
Cause: forebrain doesn't dev d/t defect in ANT neural tube- maybe d/t hor/genetics? (multifac)
Appearance: poorly differentiated mass of neurons/glial cells
75
spina bifida
| ocurrence, mech, appearance, cause, prog
most cm type of neural tube defect in POST end
Mech: no closure of neural tube during dev
Appearance: teratogenic (monster)
outgrowths of tissue from vertical canal, vert gap, mylomeningeocele
Cause: not well known; genetic/environ or folate levels-->correlation, NOT cause/effect
Prog: can be asymp
usu big deal- usu lumbar/sacral regions (parasymp -->groin (bladder, bowel), & LE s/m of pelvic appendages)
76
myelomeningocele
only meningeal extrusion b/w vertebrae
77
vertebral gap
shooting bodies b/w adjacent vertebrae
78
Contusion of brain
lesion assoc/ w direct parenchymal injury thru transmission of kinetic energy
79
laceration of brain
lesion assoc /w penetration/ tearing of tissue
| laceration can cause contusion
80
mechanism of contusion of brain
associated with anatomic morphology
ex. gyri most suseptible b/c where direct force is the greatest
frontal lobe along orbital lobe/temporal lobe b/c overly rough surface of skull
not usu occ lobe/brainstem
81
coup injury
injury at site of impact
82
contrecoup injury
injury opposite site of impact
83
do neurons regenerate?
no except hippocmapl/olfactory
84
shape of contusions
wedge shaped, with broad base lying along the surface
85
trauma of CNS
| cause, appearance, considerations, severity
```
Cause: blunt force
Appearance: wedged shaped & brown/yellow
Considerations:
+/- penetrating/blunt
+/- open/closed
```
+/- skull frac
parenchymal tissue
vasc (sever vv)
movement of head at time of injury (stationary = worse)
Severity: small lesions: mm3-cm3 (cortex may be silent)
(brainstem lethal) (SC severe impairment of s/m)
86
Concussion
| cause, mech, symp
```
Cause:
usu force to skull (can be force to body)
Mech: 1)change RMP (dep) d/t release of excitatory AA
2)mit decrease ATP prod
3)increase vasc perm
Symp: transient alternation in LOC
amnesia of event
temporary respir arrest
decrease reflexes
```
87
Contusion of brain
| process
```
hemorr & edema in area/inflam/w WBC
usu 1 d dam to soma of neuron
increase eosinophils
axonal swelling
PMN, then MO invade
```
88
Contusion of brain
| Patho
blood clot>fibroblasts invade>sec collagen/prot fibers>scaffolding networks around clot (may need to remove if lasts for a while)
89
epidural hematoma
| cause, patho, tx.
pocket of blood in space b/w dura mater (2 layers) &periosteum
Cause: menin. a. leak
Patho: increase space b/w skull&brain (normally fused)
Tx. if sever>Sx.
90
periosteum
sheet of fibrous CT that covers bone
91
subdural hematoma
| mech, Tx
bleeding in the arachnoid space (norm CSF collects here)
Mech: arach not very malleable, bridge vv fixed in this space b/c venous sinuses are fixed- brain shifts and tears vv
Tx. high rate of recurrence +/- Sx
92
path of bridging vv
travel from cerebral hemisphere>subarach sapce>subdural space>sup sagittal sinus
93
2 most cm hematomas
epidural & subdural
94
are hematomas always obvious?
no, b/c could have internal bleeding
95
Cerebrovasc dz.
| ocurrence
```
any neurologic dz. caused by vasc pathology
#3 killer in US (heart dz, than ca)
```
96
Cerebrovasc dz.
| cause
Cause: thrombosis (clot)
hemorr
emobolism (clot/fat/tumor/air- iatrogenic)
all 3 = stroke
>>>can be global (carotid/circle of willis) or focal (sm region of brain)
97
Cerebrovasc dz.
| mech
Mech: hypoxia (brain norm gets 15% of CO), if lg area>DEAD
isch: decrease Q to area>decrease metab>decrease cell fxn (global-cardiac arrest, shock, hypoten/focal-thrombus, embolus, vasculitis)
infarct: spec area of dam, usu not repairable
98
cells most affected by isch/infarct
| fxn of oligodendrocytes & astrocytes
neurons > glial cells
| (oligodendrocytes >prod myelin & astrocytes> around vessle & neurons, reg Q & brain fxn)> also sensitive
99
hypoxia
decrease in partial press of O2
100
isch
decrease in a tissue's use of O2 d/t occlu of Q
101
Meningitis- bact
| cause, appearance, symp, CSF, prog
aka pyogenic
inflam of the meninges (not brain)
Cause: E. Coli, S. Pneumo, others
Appearance: pocket of pus on brainstem floor
Symp: photophobia, increase irritability, stiff neck, neuro impairments (reflexes)
CSF: increase prot, decrease glc, no change WBC
prog: acute & life threatening
102
Meningitis- viral
| cause, symp, CSF, tx, prog
aka aseptic
Cause: may be bact that can't find, usu d/t enterovirus, ex. echovirus
symp: slower onset
CSF: slight increase prot, no change glc, increase WBC
Tx. symp, b/c IS fights virus
103
Cerebral Palsy
| cause, symp, Dx
non-progressive motor deficit condition/w strong neurologic component
Cause: exogenous insult during prenatal/perinatal period (ex. brain hemorr)
Symp: ataxia, dystonia (mm partially & constantly contracting), partial paralysis (momentary mm weakness)
Dx. may not be dx right away, but will recogn soon b/c have prob during dev
