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Y2 Dermatology > Pathology > Flashcards

Pathology Flashcards

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Dermatology Board Prep flashcards
1
Q

What is hyperkeratosis?

A

An increased thickness of the keratin layer

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2
Q

What is parakeratosis?

A

Persistence of the nuclei in the keratin layer

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3
Q

What is acanthosis?

A

Increased thickness of the epithelium

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4
Q

What is papillomatosis?

A

Irregular epithelial thickening

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5
Q

What is spongiosis?

A

Intercellular oedema in the epidermis

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6
Q

If severe spongiosis is present what may form?

A

Vesicles of the oedema fluid

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7
Q

What type of skin disease is eczema characteristic of?

A

Spongiotic

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8
Q

What type of skin disease is psoriasis characteristic of?

A

Psoriasiform

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9
Q

What is the key histological feature of spongiotic inflammatory skin disease?

A

Intraepidermal oedmea

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10
Q

What is the key histological feature of psoriasiform inflammatory skin disease?

A

Elongation of the rete edges

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11
Q

What type of skin disease is lichen planus characteristic of?

A

Lichenoid

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12
Q

What is the key histological feature of lichenoid inflammatory skin disease?

A

Basal layer damage

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13
Q

What type of skin disease are pemphigoid and pemphigus characteristic of?

A

Vesiculobullous

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14
Q

What is the key histological and clinical feature of vesiculobullous inflammatory skin disease?

A

Blistering

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15
Q

What are the 3 key features of psoriasis histologically?

A

Epidermal hyperplasia
Increased epidermal turnover
Microabscesses

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16
Q

What causes microabscess formation in psoriasis?

A

Compliment mediated attack on the keratin layer

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17
Q

What nail signs are associated heavily with psoriasis?

A

Nail dystrophy
Nail pitting
Oncholysis

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18
Q

What happens when a psoriasis scale is removed and what is this called?

A

Pin-point bleeding

Auspitz sign

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19
Q

What “phenomenon” is associated with psoriasis?

A

Koebner phenomenon

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20
Q

What is Auspitz sign and what is it associated with?

A

Pin-point bleeding under a removed scale

Psoriasis

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21
Q

What is Koebner phenomenon and what is it associated with?

A

New lesions can occur at the site of trauma

Psoriasis

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22
Q

Erythrodermic psoriasis refers to what?

A

Full body psoriasis

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23
Q

What is the risk associated with erythrodermic psoriasis?

A

Hypovolemic shock due to mass systemic vasodilation

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24
Q

What is the characteristic finding of lichen planus?

A

Itchy flat-topped violaceous papules

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25
Q

What are the 3 major histological findings in Lichen Planus?

A

Irregular sawtooth acanthosis
Hypergranulosis
Orthohyperkeratosis

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26
Q

Le homme rougue is the old name for what life threatening condition?

A

Erythrodermic psoriasis

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27
Q

True or false?

Pemphigus is more common in women

A

False

Pemphigus is equally common across both sexes

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28
Q

Explain pemphigus

A

A loss of the integrity of the epidermal adhesion (hemidesmosomes)

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29
Q

What is the most common type of pemphigus?

A

Pemphigus vulgaris

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30
Q

The auto-antibodies of Pemphigus vulgaris are against what?

A

Desmoglein 3

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31
Q

Explain the pathogenesis of pemphigus?

A

Auto-IgG of desmoglein 3 form immune complexes
Immune complexes lead to complement activation and protease release
These damage the hemidesmosomes

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32
Q

Which 5 areas are most commonly affected by pemphigus?

A 
Scalp
Face
Axillae
Groin
Trunk
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33
Q

What is the test for pemphigus?

A

Test for intraepidermal IgG by fluroresence

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34
Q

The auto-antibodies of bullous pemphigoid are against what?

A

Anchoring hemidesmosomes

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35
Q

How do you test for bullous pemphigoid?

A

Immunofluorescence looking for linear IgG complement deposition around the basement membrane

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36
Q

When does bullous pemphigoid mimic pemphigus vulgaris

A

Older lesions show re-epithelialisation

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37
Q

What condition is dermatitis herpetiformis associated with?

A

Coeliacs disease

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38
Q

What are the symptoms of dermatitis herpetiformis?

A

High-level pruritus

Symmetrical bilateral lesions foucsed on the elbows, knees and buttocks

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39
Q

Where are the lesions of dermatitis herpetiformis localised to?

A

Elbows
Knnes
Buttocks

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40
Q

What is the hallmark of dermatitis herpeitformis on histology?

A

Papillary dermal microabscesses

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41
Q

What is the most common form of acne?

A

Acne vulgaris

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42
Q

Where is the normal distribution of acne vulgaris?

A

Face, upper back and anterior trunk

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43
Q

What causes the typical distribution of acne?

A

Higher concentrations of sebaceous glands in these areas

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44
Q

Explain the pathogenesis of acne vulgaris

A

In puberty there is increased androgens
Androgens make the sebaceous glands more sensitive and active
Keratin plugging of the pilosebaceous units occurs
Infection of the unit occurs leading to inflamation

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45
Q

What is the common infective organism of acne vulgaris

A

Corynebacterium acnes

An anaerobe

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46
Q

Is rosacea more common in women or men?

A

Women

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47
Q

What are the symptoms of Rosacea?

A

Recurrent facial flush
Telangiectasia
Pustules
Rhinophymas (elderly more)

48
Q

What is the pathogenesis of rosacea?

A

Vascular ectasia
Pathcy plasma cell inflammation
Perifollicular granulomas and pustules

49
Q

What is the suspected allergen of rosacea

A

Demodex mites

This is only a suspision

50
Q

What cells do melanoma come from?

A

Melanocytes

51
Q

Where are melanocytes from?

A

The neural crest

52
Q

Where are the 3 normal places to find melanocytes?

A

Skin
Uveal tract
Leptomeninges

53
Q

Where do melanomas come from in reference to the skin layers?

A

Basally situated melanocytes

54
Q

What is the ratio of melanocytes to keratinocytes?

A

1:5 to 1:10

55
Q

True or false?

The density of melanocytes varies with race?

A

False

The amount and proportionate type of melanin changes in race not the density of melanocytes

56
Q

Which gene is the major factor in melanin production?

A

MC1R gene

57
Q

What is the MC1R gene responsible for?

A

Conversion of phaeomelanin to eumelanin

58
Q

What does 1 defective MC1R gene cause?

A

Freckling

59
Q

What do 2 defective MC1R genes cause?

A

Freckling

Red-hair

60
Q

Explain ephelides

A

Patchy increase in melanin pigmentation
Islands with most melanocytes tan
Pale intervening skin has fewer melanocytes

61
Q

What are the 4 names for actinic lentigines?

A

Actinic lentigines
Solar lentigines
Age spots
Liver spots

62
Q

Where do actinic lentigines occur?

A

On UV exposed skin

Face, forearms, dorsal hands

63
Q

What do actinic lentigines appear as on histology?

A

Epidermis elongated rete ridges
Increased melanin
Increased number of basal melanocytes

64
Q

What % of babies are born with a congenital naevus?

A

1%

65
Q

In what time frame are most naevus acquired?

A

1st 2 decades

66
Q

What are the size classes used for congenital naevi?

A

Small < 2cm diameter
Medium 2-20cm diameter
Giant > 20cm diameter

All from the largest point

67
Q

What sort of risk does a large naevus pose to a person?

A

10-15% risk of melanoma

68
Q

When do usual type naevi occur?

A

During infancy

69
Q

How do usual type naevi come about?

A

There is a breakdown in the keratinocyte ratio

70
Q

How many naevi does the normal person have?

A

20-30

71
Q

State the 3 stages of naevi development

A

Junctional naevus
Compound naevus
Intrademal naevus

72
Q

What is a junctional naevus?

A

A cluster of proliferative melanocytes at the dermo-epidermal junction
Occurs in childhood

73
Q

What is a compound naevus?

A

Junctional clusters + groups of cells in the dermis

Occurs in adolescence/early adulthood

74
Q

What is an intradermal naevus?

A

An entirely dermal cluster of melanocytes

Occurs in adulthood

75
Q

What are the 3 usual traits of a dysplastic naevus?

A

> 6mm in diameter
Variegated pigment
Border asymmetry

76
Q

What are the 2 forms of dysplastic naevus?

A

Sporadic

Familial

77
Q

What is a Sporadic dysplastic naevus?

A

A non-inherited form
One to several atypical naevi are present
Small increased risk of malignant melanoma

78
Q

What is a Familial dysplastic naevus?

A

An inherited form, with a strong family history of melanoma
Autosomal inheritance of high penetrance genes

Lots of atypical naevi
Up to 100% lifetime risk of melanoma

79
Q

What 2 properties must dysplastic naevi have?

A

Architectural atypia

Cellular atypia

80
Q

What is halo naevi?

A

A naevus with a peripheral halo of depigmentation

81
Q

What causes the characteristic appearance of the halo naevus?

A

Inflammatory regression

82
Q

What is the classical histological appearance of a blue naevus?

A

Pigment rich dendritic spindle cells

83
Q

What characterises Spitz naevus?

A

Usually occurring before age 20

Large spindles +/- epithelioid cells

84
Q

Are malignant melanomas more common in men or women?

A

Women

Ratio of 2:1

85
Q

What is the strongest attributed factor to malignant melanoma?

A

UV exposure

86
Q

What are the 4 main types of malignant melanoma?

A

Superficial spreading
Acral/mucosal lentiginous
Lentigo maligna
Nodular

87
Q

Where are superficial spreading melanomas most common?

A

Trunk and limbs

88
Q

Where are acral/mucosal lentiginous most common?

A

Acral and mucosal surfaces

89
Q

Where is lentigo maligna most common?

A

Sun damaged sites

90
Q

Where are nodular melanomas most common?

A

Trunk but varying

91
Q

How does nodular melanoma vary in pathogenesis from other melanomas?

A

All others grow from melanoma in situ

Nodular is always in vertical growth phase

92
Q

Once melanoma is no longer carcinoma in situ what is it in?

A

Vertical growth phase

93
Q

How is melanoma prognosis predicted?

A

Breslow depth and if it is ulcerated

94
Q

What is the spread of melanoma normally?

A

Local dermal lymphatics
Regional lymph node mets
Blood spread

95
Q

What is the management of melanoma?

A

Primary excision to give clear margins
Sentinel node biopsy in Dundee

If advanced normal cancer stuff

96
Q

Where are seborrhoeic keratosis most common?

A

In the face and trunk

97
Q

How are seborrhoeic keratosis most commonly described?

A

Stuck on

Greasy

98
Q

What is the other name for seborrhoeic keratosis?

A

Basal cell papilloma

99
Q

What are the 3 findings histologically of seborrhoeic keratosis?

A

Epidermal acanthosis
Hyperkeratosis
Horn cysts

100
Q

What is Leser-Trelat sign?

A

The eruptive apperance of many lesions

Indicative of a possible internal malignancy

101
Q

Where is the most common site for Bowen’s disease?

A

Legs

102
Q

What is Bowen’s disease?

A

Squamous cell carcinoma of the skin in situ (No dermal invasion)

103
Q

What is the appearance of Bowen’s disease?

A

Scaly patch/plaque with irregular borders

104
Q

Where do actinic keratosis normally occur?

A

Sun exposed skin

Especially on the head and scalp

105
Q

What do you see histologically in actinic keratosis?

A

Variable epidermal dysplasia

106
Q

Where do viral skin lesions normally occur?

A

Anogenital area

107
Q

Which type of HPV is associated with pre-cancerous lesions?

A

Type 16

108
Q

Which group most commonly get squamous cell carcinomas of the skin?

A

Elderly

Those with high sun exposure

109
Q

What is the general prognosis of a squamous cell carcinoma?

A

Good normally
Locally invasive
Low but definite metastatic risk

110
Q

What are the 5 things which suggest poorer prognosis in squamous cell carcinoma of the skin?

A 
Thickness > 4mm
Poor differentiation
Lymphatic/vascular spread
Perineural spread
Problematic site: scalps, ears, nose
111
Q

Where do basal cell carcinomas of the skin usually occur?

A

Sun-exposed sites

112
Q

What are the 3 types of basal cell carcinoma?

A

Nodular
Superficial
Infiltrative

113
Q

What is seen on histology of a skin BCC?

A

Basal cells of epidermis invading the dermis with peripheral palisading
Lots of mitoses and apoptosis also seen

114
Q

How can skin BCCs be dangerous?

A

Effectively never metastasise but have slow local destructive invasion

115
Q

What 3 things result in difficulty to excise clearly a skin BCC?

A

Spread along a nerve
Poor margins
Prominent desmoplastic fibrous stroma

116
Q

What type of cancer is a Merkel cell cancer?

A

Primary small cell neuroendocrine cancer

117
Q

What causes Merkel cell cancer?

A

Merkel cell polyomavirus

Y2 Dermatology (15 decks)

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