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Robbins concepts Flashcards

1
Q

6 requirements for describing skin lesions?

A 
Quantity #
Size 
Color 
Shape
Palpability (shadow)
Texture
Location
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2
Q

Small flat any shaped lesion?

A

Macules

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3
Q

Lesion confined to epidermis, no fluid, not raised?

A

macule

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4
Q

Flat lesion >5mm (1cm)?

A

Patch

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5
Q

> 1cm raised lesion?

A

Plaque

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6
Q

raised lesion <1cm?

A

Papule (pimple)

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7
Q

Large, deep raised lesion >1cm? Grows into dermis

A

Nodule

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8
Q

Small raised fluid filled lesions?

A

Vesicles

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9
Q

Larger >1cm blister or fluid filled lesions?

A

Bulla

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10
Q

vesicle filled w/ pus?

A

postule

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11
Q

superficial loss of epidermis>

A

Erosion

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12
Q

Erosion involving the Dermis?

A

Ulcer

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13
Q

Four layers of the skin

A 
Sup--> Deep 
Stratum Corneum 
stratum granulosum 
stratum spinulosum
stratum basale
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14
Q

Protein found within granular cell layer which retains water in keratinocytes?

A

Filaggrin

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15
Q

Autoimmune blistering disease against Ag @ basal cell layer?

A

Bullus pemphigoid

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16
Q

Causes accelerated rate of epidermal turnover?

A

psoriasis

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17
Q

Three main cell types in the epidermis?

A

Keratinocytes
Melacocytes
Langerhan cell

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18
Q

Benign collection of melanocytes?

A

Nevi (MOLE)

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19
Q

Excessive collagen deposition in response to injury?

A

Keloids

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20
Q

Use for smooth, non hairy, dry thick lesions?

A

Ointment

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21
Q

Use of acute exudative inflammation intertriginous areas?

A

Cream

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22
Q

For hairy areas?

A

Lotion

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23
Q

Six components of topical prescription?

A 
Generic name 
vehicle 
concentration 
Directions 
amount 
refills
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24
Q

Loss of intercellular adhesion of keratinocytes?

A

Acantholysis

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25
Q

Diffuse epidermal hyperplasia

A

Acanthosis

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26
Q

Consequence of contact w/ poison ivy?

A

Contact dermatitis (CD4+ T cells) Delayed type hypersensitivity (T4)

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27
Q

Pt w/ wide diversity of lesions including macules, papules, and bullae + characteristic Targetoid Lesions consisting of red macules w/ pale vesicular/ eroded center?

A

Erythema Multiform

Caused by Hypersensitivity to Drugs or Infections

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28
Q

ABCDEs of mole or melanoma?

A 
Asymmetry 
Boarder irregularity 
Color
Diameter> 6mm
Evolution
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29
Q

Most common melanoma site in MEN? Women?

A

Back (M)

Legs + back (W)

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30
Q

Immune regulation of the skin is done by?

A

Langerhan cells-> Epidermis

Lymphocytes and Dendritic cells-> Dermis

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31
Q

Thermoregulation in skin?

A

Microvasculature in the Dermis

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32
Q

Bullous Pemphogoid is caused by?

A

Auto antibodies against hemidesmosomes

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33
Q

Disease caused by Anti-desmosome Abs

(type II HS)?

A

Pemphigus vulgaris

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34
Q

Disease caused by mutation in Nucleotide excision repair mechanism?

A

Xeroderma pigmentosum

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35
Q

Hypohidrotic ectodermal dysplasia?

A

EDAR gene mutation leading to abnormal hair follicles + sweat glands + and Teeth
** Unable to thermoregulate

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36
Q

Job of Melanin?

A

Protect the skin from UV light

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37
Q

Cells making up the epidermis?

A

Keratinocytes
Langerhan cells
Melanocytes
Merkel cells

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38
Q

What is in the Dermis layer?

A

Fibroblast –> collagen
Elastic fibers
Blood vessels
Nerve Endings

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39
Q

Epidermis cell layers renew every____ and cells have a _______ rate of apoptosis?

A

28+ days

LOW

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40
Q

Basal cells adhere to the basement membrane w/?

A

hemidesmosomes

41
Q

Cells in the spinous layer are held together using?

A

Desmosomes

42
Q

At what layer to epidermal cells STOP dividing and begin differentiating?

A

Stratum Spinosum

43
Q

What do the cells in the Spinous layer develop to help with Barrier function?

A

Lipid granules–> Lamellar granules

44
Q

Granular layer cells synthesize what?

A

Profillagrin inside Keratohyaline granules

45
Q

What is secreted into the intercellular layer to form a water tight seal?

A

Lipids in Lamellar granules

46
Q

Which cells process Profillagrin into fillagrin?

A

Keratinocytes @ the Stratum coneum layer

47
Q

Function of Fillagrin?

A

Keeps water in the cells

48
Q

These two substances join to form macrofibrils for a protective layer?

A

Fillagrin + Keratin

49
Q

What makes up intermediate filaments and is the major structural protein of Keratinocytes?

50
Q

Contains large amounts of Sulfur-containing acid cysteine?

51
Q

Dendritic cells in mid-epidermis responsible to allergic rxns and tumor surveillance?

A

Langerhan cells

52
Q

Merkel cells?

A

Light touch receptor cells in the Basal layer of epidermis

53
Q

What is the primary cell in the Dermis?

A

Fibroblasts–> synthesize and degrade collagen + elastin + glycosaminoglycans

54
Q

Where in the skin are mast cells located?

55
Q

Atopic Dermatitis is associated w/ mutation of what protein?

56
Q

Epidermolysis Bullousa simplex is associated w/ what mutation?

A

Mutations in Keratin 5/14

** Blisters occur at sites of high stress

57
Q

Psoriasis is associated w/ conditions and WHY?

A

increases Risk for Heart attacks & Strokes because its a Chronic inflammatory state
**also associated w/ Arthritis

58
Q

Condition is caused by genetic (HLA polymorphisms) and environmental factors causing release of Cytokines which causes Keratinocyte hyperproliferation?

59
Q

Auspitz sing for Psoriasis?

A

Removing of scales causes multiple small bleeding points

60
Q

“Pruritic, Purple, Polygonal, Planar Papules and Plaques?”

A

Lichen Planus (6 Ps)

61
Q

Results from CD8+ mediated cytotoxic response against Basal cell layer and the Dermoepidermal junction?

A

Lichen Planus

**Often cuased by viral infections or Drug exposure

62
Q

Wickham striae?

A

White dots or lines funning though flat-topped purple polyglonal papule in LICHEN planus

63
Q

“Sawtoothing” inflammation of the desmoepidermal junction?

A

Lichen planus

64
Q

Symmetrical well developed epidermal hyperplasia + hypergranulosis and Hyperkeratosis located in extremities + elbows + glans penis + and oral mucosa?

A

Lichen Planus

65
Q

Tetrad of Cough, Coryza, Conjunctivitis, and Koplik spots?

A

Diagnostic of Measles (Rubeola)

66
Q

Tiny white or blue-gray lesions in buccal mucosa that precedes with maculopapular rash?

A

Koplik spots

67
Q

Febrile maculopapular rash that begins in the face and spreads to the trunk and extremities + postauricular LAD?

A

Rubella (Togavirus)

68
Q

Low fever, LAD, and Red-purple papular skin lesions in immunocomprimised patient with scratch marks?

A

Bacillary angiomatosis (Cat scratch fever)

69
Q

Organism most responsible for skin and soft tissue infections such as Folliculitis and abscesses?

70
Q

Superficial skin infections?

71
Q

deeper dermal abscesses most commonly caused by?

A

S. aureus

Less commonly: Strep pyogenes

72
Q

Lesion characterized by accumulation of PMNs beneath stratum corneum producing a postal?

73
Q

PAS and Gomori methanamine silver stain are helpful in identifying?

A

Fungal organisms

74
Q

Verrucae are commonly caused by?

A

Warts caused by HPV

75
Q

immunoflourescence shows uniform deposition of IgG Abs along cell membranes of keratinocytes in a “FISHNET” pattern?

A

Pemphigus vulgaris

76
Q

Acantholysis?

A

Lysis of intercellular adhesion junctions btwn neighboring squamous epithelial cells in Pemphigus

77
Q

Suprabasal acantholytic blisters?

A

Pemphigus vulgaris

78
Q

Pg: Linear deposition of igG antibodies and complement in the epidermal basement membrane?

A

Bullous pemphigoid

79
Q

Gross appearing differences btwn blisters of Pemphigus vulgaris and bullous pemphigoid?

A

Non-roofed blisters= Vulgaris

Roofed= Pemphigoid

80
Q

Pg: granular IgA deposition and on selectively localized tips of dermal papillae. Associated w/ cross reactivity of IgA to epidermal transflutaminases?

A

Dermatitis Herpetiformis

81
Q

Dermatitis Herpetifromis is associated w/ what dz? Treatment?

A

Celiac disease

** responds to Gluten free diet

82
Q

UVR that penetrates ozone layer?

A

> 300nm (UVB + UVA)

83
Q

UVB characteristics?

A

290-320nm
Filtered by glass window
Causes Sunburn
Minor cause of Photoaging

84
Q

UVA characteristics?

A 
320-400nm
Least potent 
Penetrates glass
Penetrates Deep into skin
Major cause of PHOTOaging
85
Q

Factors that modify UVR?

A

Altitude
Surface reflection (Snow= highest)
Could cover-> only scattered

86
Q

what is a chromophore?

A

Molecule that absorbs UV

87
Q

Major Chromophore in Skin?

A

DNA

*aromatic AA

88
Q

Acute effects of UVR on skin?

A 
Sunburn (acute inflammation)
Immunomodulation 
Epidermal hyperplasia
Vit D photosynthèses
DNA damage
89
Q

What causes sunburn?

A

UVB

*SPF is determined by testing erythema caused by UVB

90
Q

Immediate Suntan?

A

UVA–> redistribute or oxidize existing melanin
Not protective
short lasting (hours)

91
Q

Delayed suntan?

A

UVB–> increased melanin production
Photoprotective
Long lasting

92
Q

UVR damage on DNA?

A

Direct–> absorption by bases

Indirect–> other chromophores absorb

93
Q

Specific damage to DNA by UVR?

A

Pyrimidine Dimers
Cyclobutane dimers
6,4 photoproducts

94
Q

UV signature mutations?

A

C-> T

CC–> TT

95
Q

Defense mechanism against UVR?

A

Corneum–> reflection
Melanin–> absorption
DNA repair–> NER system
Apoptosis

96
Q

heritable disease characterized by sensitivity to UV and early onset of skin cancers?

A

Xeroderma pigmentosum

97
Q

PG of Xeroderma pigmentosum?

A

Defective NER system

98
Q

Effects of XP defect?

A

Skin cancer
Eyes: cataracts + tumors + degeneration
CNS degeneration

99
Q

What cells disappear from the skin following UV exposure?

A

Langerhan cells–> immunosuppression in the skin

Dermatology (4 decks)

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