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3 Surgery 2 > Skin > Flashcards

Skin Flashcards

1
Q

The epidermis is an avascular layer, and consists primarily of continually regenerating ______

A

Keratinocytes

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2
Q

The epidermis is thinnest at the eyelids and is thickest at the ____ & ____

A

Soles and Palms

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3
Q

In stratum basale (germinative layer), ____1_____ binds keratinocytes together, while ____2____ connects to to other structures in the basement membrane.

A
  1. Desmosomes

2. Hemidesmosomes

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4
Q

This layer lines the epidermal that reside largely within the substance of the dermis and later serves as a regenerative source of epithelium in the event of partial thickness in wounds

A

Stratum Basale/Germinative layer

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5
Q

This layers is from 5-15 cells in thickness and is so named due to the spinous appearance of the intercellular desmosomal attachments

A

Stratum spinosum/Spiny Layer

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6
Q

This is responsible for the eosinophilic appearance on H&E staining

A

Production of Keratin

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7
Q

These are structures within the stratum granulosum that contains lipids and glycolipids that will eventually undergo exocytosis to produce the lipid layer around the cells

A

Lamellar Granules

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8
Q

This is the layer that is present in thick skin

A

Stratum lucidum

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9
Q

This is the layer where keratinocytes will undergo programmed cell death which will cause it to lose all cellular structures except for keratin filaments

A

Stratum granulosum

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10
Q

This is the layer that contains protein-rich keratinocytes

A

Stratum corneum

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11
Q

This is responsible for the production of the skin pigment melanin

A

Melanocytes

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12
Q

T/F. Differences in skin pigmentation are based on the activity of each individual melanocytes and not the number of melanocytes.

A

T

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13
Q

These are organelles that travel along the dendritic process to eventually become phagocytized by keratinocytes. It serves to protect nuclear material of keratinocytes from damage by radiation.

A

Tyrosinase

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14
Q

These are monocyte-derived antigen presenting cells found usually on stratum spinosum, and they represent the adaptive immunity function of the skin.

A

Langerhans Cells

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15
Q

Langerhans cells are impaired by ____

A

Ultraviolet B radiation

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16
Q

These are mechanoreceptors for light touch

A

Merkel cells/Tactile Epithelial Cells

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17
Q

Where are Merkel cells found?

A

Digits, lips, and bases of some hair follicles

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18
Q

The 2nd most common cause of skin cancer death.

A

Merkel Cell Carcinoma

- a.k.a Neuroendocrine/Trabecular Carcinoma

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19
Q

Found in the nipple-areola complex and is usually associated with Paget’s Disease of the Breast

A

Toker Cells

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20
Q

It is the main and most numerous sweat gland in humans

A

Eccrine Sweat Glands

  • It is the most effective means of temperature regulation (10L of sweat/day)
  • activated by cholinergic system
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21
Q

This consists of a secretory coil that is larger and more irregular in shape

A

Apocrine Sweat Glands

  • found in Axillary, Anogenital, Nipple regions, Eyelids, and External auditory canal
  • activated by adrenergic system
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22
Q

Sweat gland that opens directly to the skin surface that does not present until puberty

A

Apoeccrine Glands

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23
Q

Give the (4) components of Pilosebaceous Units that are responsible for the production of hair and serum

A
  1. Hair Follicle
  2. Sebaceous Gland
  3. Erector Pili Muscle
  4. Sensory Organ
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24
Q

This is responsible for nail growth and adhesion

A

Nail Matrix

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25
Q

Thermal Burn Classification that is the most common cause of hospital admission

A

Flame

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26
Q

Burns related to hot water

A

Scald Burns

  • More common in children
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27
Q

Acid burn causes:

A
  • Coagulation necrosis

- Eschar formation

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28
Q

Alkali burns cause:

A
  • Liquefactive necrosis

- Deeper burns, will make a hole-like burn

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29
Q

This is a burn that has direct effects on the body such as the heart

A

Electrical

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30
Q

This is common in high-voltage injuries in which muscles are literally destroyed –> edema –> ?

A

Compartment Syndrome with Concurrent Rhabdomyolysis (CSCR)

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31
Q

Superficial burn, only the epidermis is involved

A

1st Degree Burn

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32
Q

Partial thickness burn

A

2nd Degree Burn

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33
Q

Full thickness burn

- destruction of epidermis, dermis, and underlying subcutaneous tissue

A

3rd Degree Burn

  • Appear white, cherry red, black
  • Dry, leather texture
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34
Q

Degree of burn in which there is involvement of the underlying “soft tissue”

A

4th Degree Burn

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35
Q

burns go through the muscle to bone

A

5th Degree burn

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36
Q

Charring bone

A

6th Degree burn

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37
Q
  • Burn through the epidermis and dermis, where tactile and pain sensors are intact
A

Superficial Partial Thickness

- Blister formation

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38
Q
  • Burn through the entire dermis and most of the epidermis, leaving only the skin appendages intact.
  • Elasticity of the burned dermis is destroyed
A

Deep Partial Thickness

- Mottled appearance with waxy white injury

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39
Q

This is a mesoderm-derived tissue that houses the neurovasculature

A

Dermis

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40
Q

The dermis is thinnest at the eyelids and is thickest at the ____

A

Back

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41
Q

Enumerate the three unique components of the dermis

A
  1. Fibrous structure
  2. Ground substance
  3. Cell population
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42
Q

The Papillary Layer or Superficial layer of the dermis is composed of what kind of tissue?

A

Loose Areolar Tissue

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43
Q

These contribute to the finger prints

A

Dermal Ridges

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44
Q

Touch receptors that are also identified in the the dermis

A

Meissner’s corpuscle

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45
Q

The reticular/deep layer of the dermis is composed of what kind of tissue?

A

Dense irregular connective tissue

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46
Q

These are lines of tension or cleavage within the skin that are characteristic for each part of the body

A

Langer Lines

- defined in terms of collagen orientation

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47
Q

Cleavage lines are of particular interest to the surgeon because an incision made ______ to the lines heals with a fine scar, while an incision _____ may set up irregular tensions, that result in an unsightly scar.

A

parallel

across the lines

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48
Q

These lines are oriented perpendicular to the action of the underlying muscles.

A

Kraissl’s Lines

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49
Q

T/F. Collagen runs generally perpendicular to wrinkle lines and is laid down perpendicular to scars.

A

F - ‘parallel’ replaces both ‘perpendicular’ words

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50
Q

Atrophic linear scars that represent one of the most common connective tissue damage

A

Striae gravidarum

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51
Q

Red stretch marks are called?

A

Striae rubrae

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52
Q

White stretch marks are called?

A

Striae alba

53
Q

Fundamental cells of the dermis that is responsible for producing all the dermal fibers and ground substance

A

Fibroblast

  • spindle or stellate-shaped
54
Q

Give 2 functions of Fibroblast:

A
  1. Wound healing

2. normal mechanical resistance of the skin

55
Q

These tumors arise primarily from melanocytes at the epidermal-dermal junction

A

Melanoma

56
Q

Comprised of a variety of mesenchymal dendritic cells recognizable mainly by immunohistochemistry

A

Dermal Dendrocytes

57
Q

Give 2 functions of Dermal Dendrocytes

A
  1. Antigen uptake
  2. Processing for presentation to the immune system
  3. Orchestration of processes involved in wound healing and tissue remodeling
58
Q

Effector cells of the immune system that are responsible for immediate type I hypersensitivity reactions

A

Mast Cells

59
Q

Which collagen type predominates during wound healing?

A

TYPE III COLLAGEN becomes more prominent and important during repair process

60
Q

This collagen type is the major component of extracellular matrix in skin

A

Type I Collagen

61
Q

Melanoma is the ___ most common cancer in males, and is the ___ most common cancer in females

A

6th, 7th

62
Q

In males, melanomas are commonly found on the ___ and ____

A

neck and trunk

63
Q

Enumerate melanoma assessment/observation steps. ABCDE

A 
Asymmetry
Border
Color
Diameter
Evolution
64
Q

Tissue diagnosis confirms the type of lesion or cancer through what?

A

full-thickness biopsy of the skin

65
Q

What is done to smaller lesions?

A

Excisional biopsy/total removal

66
Q

Most cancers are staged according to this committee

A

American Joint Committee of Cancer
Tumor
Node
Metastases

67
Q

Cancer clinical staging in which there are no evidence of metastases

A

Staging I and II

68
Q

Cancer clinical staging in which there is regional (clinical or radiographic) disease

A

Staging III

69
Q

Cancer clinical staging in which there is distant metastatic disease

A

Stage IV

70
Q

A technique which identifies the first draining lymph node from the primary lesion.

A

Sentinel Lymph Node Biopsy

  • most common in breast cancer
71
Q

What is used in SLNB as pre-operative lymphoscintigraphy?

A

Technetium 99-labeled sulfur colloid

72
Q

What are the dyes used for intradermal injections for Sentinel Lymph Node Biopsy?

A

Isosulfan or methylene blue dye near the tumor

73
Q

It is a grossly visible cutaneous and/or subcutaneous metastases found within 2cm of the primary melanoma

A

Satellite metastases

74
Q

Microscopic and discontinuous cutaneous and/or subcutaneous metastases found adjacent to a primary melanoma

A

Microsatellites

75
Q

Clinically evident cutaneous and/or subcutaneous metastases, identifies at a distance greater than 2cm from the primary melanoma

A

In-Transit Metastases

76
Q

Measures the depth of penetration of the lesions from the top of the granular layer of the epidermis into the dermal layer

A

Breslow Tumor Thickness

77
Q

A growth phase in which melanoma appears as an irregular plaque

A

Radial growth phase

- cells may invade the dermis but do not form a nodule

78
Q

In this growth phase, the risk of chances of metastatic spread is higher because lymphatics are located in the reticular subcutaneous tissue

A

Vertical growth phase

79
Q

It is the most common melanoma, which arises in pre-existing nevus

A

Superficial Spreading Melanoma

  • Growth phase: Early Radial
80
Q

Most aggressive type of melanoma

A

Nodular Melanoma

  • Growth phase: Vertical growth phase (HALLMARK)
  • 5% of the lesions are amelanocytic, which may lead to delays in the diagnosis
81
Q

Usually found on the sun-exposed areas of the skin

A

Lentigo Maligna Melanoma

82
Q

Precursor lesion of lentigo maligna melanoma

A

Lentigo Maligna, Hutchinson freckle

  • Growth Phase: Radial growth phase only
83
Q

Acral Lentiginous Melanoma isa a melanoma that appears in palms, soles, and in the sublingual. What is the growth phase of this melanoma?

A

Long Radial Growth Phase

84
Q

What is the recommended margin for wide excision?

A

0.5 to 1cm

85
Q

If melanoma is at least 4mm, there should be at least __ margin from the edges of melanoma should be excised

A

2cm

86
Q

It is a surgical treatment for in-transit metastases

A

Isolated Limb Perfusion

  1. Cannulation of the main artery and vein of affected limb
  2. connecting the cannula to a cardiopulmonary bypass machine
  3. Applying tourniquet to the affected limb
87
Q

A regional technique used to treat advanced melanoma or sarcoma confined to an arm or leg

  1. Chemotherapy Medication are injected into an artery of the affected extremity
  2. The limb’s blood supply is temporarily cut off with a tourniquet
A

Isolated Limb Infusion

PURPOSE: administer high doses of chemotherapy while avoiding systemic drug toxicity

88
Q

The most common non-cutaneous site of metastasis

A

Ocular Melanoma

89
Q

Hidradenitis suppurativa is also known as?

A

acne inversa

90
Q

Treatment of Hidradenitis Suppurativa is based on?

A

Hurley staging with topical and systemic antibiotics

91
Q

Hurley Classification Stage where there is abcess formation, which can be single or multiple, without sinus tracts and cicatrization (scar formation at the site of healing)

A

Stage I

92
Q

Hurley Classification with recurrent abscess with tract formation and cicatrization, single or multiple, widely separated lesions

A

Stage II

93
Q

Hurley Classification with diffuse or near-diffuse involvement, or multiple interconnected tracts and abscess across the entire area

A

Stage III

94
Q

A rare muco-cutaneous disorder characterized by cutaneous destruction at the dermo-epithelial junction

A

Epidermal Necrolysis

95
Q

Lateral pressure on the skin causes separation of the dermis from the epidermis

A

+ Nikolsky Sign (Epidermal Necrolysis)

96
Q

Enumerate drugs causes Steven-Johnson Syndrome

A 
PCP LAPSE
Phenytoin
Carbamazepine
Phenobarbital
Lamotrigine
Allopurinol
Penicillin
Sulfa drugs
Erythromycin
97
Q

A condition where circulating autoantibodies are directed against keratinocytes

A

Toxic Epidermal Necrolysis

98
Q

This is characterized by sterile pustules that will progress to painful, ulcerating lesions with purple borders

A

Pyoderma gangrenosum

99
Q

superficial varient of Pyoderma gangrenosum that is more commonly found on the trunk as single or multiple, non-painful lesions

A

Vegetative

100
Q

A clinical form of pyoderma gangrenosum that presents with vesico-pustular lesions that do not develop into ulcers

A

Pustular

101
Q

Painful tender pustular lesions that form fistulous tracts or ulcerations spreading upwards

A

Peristomal

  • Usually presents with IBD
102
Q

Painful, open sores that have bluish overhanging borders

A

Ulcerative

103
Q

Characterized by superficial blisters

A

Bullous

104
Q

Treatment for the peristomal type Pyoderma gangrenosum

A

Calcineurin inhibitor

**Calcineurin is an enzyme that activates the T-cells of the immune system

105
Q

It is a type of peripheral vascular disease that specifically affects the arteries in the lower extremities

A

PAOD

Peripheral Arterial Occlusive Disease

106
Q

a process that causes plaque build-up, and is the usual cause of PAOD

A

Atherosclerosis

107
Q

Enumerate at least 4 symptoms of PAOD

A

✓ Claudication - pain or cramping in legs during activity that disappears at rest
✓ Skin changes - reddish-blue discoloration, or thin, shiny, brittle skin
✓ Slow/non-healing sores on toes, feet, legs
✓ Loss of hair on legs
✓ Poor toenail growth
✓ Erectile dysfunction
✓ Leg or foot that feels cool or cold to the touch compared to the other leg

108
Q

An inadequate return of venous blood from the legs to the heart

A

Venous insufficiency

  • this is due to the failure of valves in the leg to shut properly during blood’s return to the heart
109
Q

Type I to Type III collagen ratio

A

4:1

110
Q

Hypertrophic scars/immature scars collagen Type I:Type III ratio

A

2:1

111
Q

T/F. Hyperthermia is detrimental to wound healing

A

F - hypothermia

112
Q

This is a zone of burn injury that occurs at the point of maximum damage

A

Zone of Coagulation

  • there is ‘irreversible’ tissue loss due to coagulation of the constituent proteins
113
Q

This is a zone of burn injury which is characterized by decreased tissue perfusion

A

Zone of Stasis

114
Q

What is the aim of burns resuscitation?

A

To increase tissue perfusion in the zone of stasis and prevent any damage from becoming irreversible

115
Q

This is a zone of burn injury where tissue perfusion is increased, and tissues here will invariably recover

A

Zone of Hyperaemia

116
Q

Skin lesion where there are red sores in the face, around a nose and mouth, hands and feet

A

Impetigo

117
Q

A type of impetigo that causes larger blisters that occur on the trunk

A

Bullous impetigo

  • Less common form of the disorder
118
Q

more serious form of Impetigo that penetrates deeper into the skin

A

Ecthyma

  • painful fluid or pus-filled sores that turn into deep ulcers
119
Q

a cutaneous infection localized on the upper layer of the dermis

A

Erysipelas

120
Q

Which bacteria causes Erysipelas?

A

beta-hemolytic group A Streptococcus bacteria

121
Q

a deeper infection, compared to the erysipelas, affecting the deeper dermis and subcutaneous tissue

A

Cellulitis

122
Q

inflammation of the hair follicle

A

Folliculitis

123
Q

a follicle with swelling and a collection of purulent material

A

Furuncle

124
Q

Neoplasms of epidermal keratinocytes that represent a range in a spectrum of disease from sun damage to squamous cell carcinoma

A

Actinic Keratosis

125
Q

These are benign lesions of the epidermis that typically present as well-demarcated, “stuck on” appearing papules or plaques over elderly individuals

A

Seborrheic Keratosis

  • Clonal expansion of keratinocytes and melanocytes make up the substance of these lesions
126
Q

Benign vascular tumors that arise from the proliferation of endothelial cells that surround blood-filled cavities

A

Strawberry Hemangioma

127
Q

Portwine stain

A

Naevus flammeus

128
Q

Sturge-Weber Syndrome is a poradic neurocutaneous disorder with angiomas which involves what structures? (2)

A 
▪ Leptomeninges of the brain and choroid
▪ Skin of the face (affect the nerves)
   ➢ Ophthalmic (V1)
   ➢ Maxillary (V2) distribution of the
trigeminal nerve
129
Q

Hallmarks of Sturge-Weber Syndrome? (2)

A

▪ facial cutaneous venous dilation

▪ nevus flammeus or port-wine stain (PWS)

3 Surgery 2 (2 decks)

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