Skin Flashcards
1
Q
The epidermis is an avascular layer, and consists primarily of continually regenerating ______
A
Keratinocytes
2
Q
The epidermis is thinnest at the eyelids and is thickest at the ____ & ____
A
Soles and Palms
3
Q
In stratum basale (germinative layer), ____1_____ binds keratinocytes together, while ____2____ connects to to other structures in the basement membrane.
A
- Desmosomes
2. Hemidesmosomes
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
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
6
Q
This is responsible for the eosinophilic appearance on H&E staining
A
Production of Keratin
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
8
Q
This is the layer that is present in thick skin
A
Stratum lucidum
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
10
Q
This is the layer that contains protein-rich keratinocytes
A
Stratum corneum
11
Q
This is responsible for the production of the skin pigment melanin
A
Melanocytes
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
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
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
15
Q
Langerhans cells are impaired by ____
A
Ultraviolet B radiation
16
Q
These are mechanoreceptors for light touch
A
Merkel cells/Tactile Epithelial Cells
17
Q
Where are Merkel cells found?
A
Digits, lips, and bases of some hair follicles
18
Q
The 2nd most common cause of skin cancer death.
A
Merkel Cell Carcinoma
- a.k.a Neuroendocrine/Trabecular Carcinoma
19
Q
Found in the nipple-areola complex and is usually associated with Paget’s Disease of the Breast
A
Toker Cells
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
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
22
Q
Sweat gland that opens directly to the skin surface that does not present until puberty
A
Apoeccrine Glands
23
Q
Give the (4) components of Pilosebaceous Units that are responsible for the production of hair and serum
A
- Hair Follicle
- Sebaceous Gland
- Erector Pili Muscle
- Sensory Organ
24
Q
This is responsible for nail growth and adhesion
A
Nail Matrix
25
Thermal Burn Classification that is the most common cause of hospital admission
Flame
26
Burns related to hot water
Scald Burns
- More common in children
27
Acid burn causes:
- Coagulation necrosis
| - Eschar formation
28
Alkali burns cause:
- Liquefactive necrosis
| - Deeper burns, will make a hole-like burn
29
This is a burn that has direct effects on the body such as the heart
Electrical
30
This is common in high-voltage injuries in which muscles are literally destroyed --> edema --> ?
Compartment Syndrome with Concurrent Rhabdomyolysis (CSCR)
31
Superficial burn, only the epidermis is involved
1st Degree Burn
32
Partial thickness burn
2nd Degree Burn
33
Full thickness burn
| - destruction of epidermis, dermis, and underlying subcutaneous tissue
3rd Degree Burn
- Appear white, cherry red, black
- Dry, leather texture
34
Degree of burn in which there is involvement of the underlying "soft tissue"
4th Degree Burn
35
burns go through the muscle to bone
5th Degree burn
36
Charring bone
6th Degree burn
37
- Burn through the epidermis and dermis, where tactile and pain sensors are intact
Superficial Partial Thickness
| - Blister formation
38
- Burn through the entire dermis and most of the epidermis, leaving only the skin appendages intact.
- Elasticity of the burned dermis is destroyed
Deep Partial Thickness
| - Mottled appearance with waxy white injury
39
This is a mesoderm-derived tissue that houses the neurovasculature
Dermis
40
The dermis is thinnest at the eyelids and is thickest at the ____
Back
41
Enumerate the three unique components of the dermis
1. Fibrous structure
2. Ground substance
3. Cell population
42
The Papillary Layer or Superficial layer of the dermis is composed of what kind of tissue?
Loose Areolar Tissue
43
These contribute to the finger prints
Dermal Ridges
44
Touch receptors that are also identified in the the dermis
Meissner's corpuscle
45
The reticular/deep layer of the dermis is composed of what kind of tissue?
Dense irregular connective tissue
46
These are lines of tension or cleavage within the skin that are characteristic for each part of the body
Langer Lines
| - defined in terms of collagen orientation
47
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.
parallel
across the lines
48
These lines are oriented perpendicular to the action of the underlying muscles.
Kraissl's Lines
49
T/F. Collagen runs generally perpendicular to wrinkle lines and is laid down perpendicular to scars.
F - 'parallel' replaces both 'perpendicular' words
50
Atrophic linear scars that represent one of the most common connective tissue damage
Striae gravidarum
51
Red stretch marks are called?
Striae rubrae
52
White stretch marks are called?
Striae alba
53
Fundamental cells of the dermis that is responsible for producing all the dermal fibers and ground substance
Fibroblast
- spindle or stellate-shaped
54
Give 2 functions of Fibroblast:
1. Wound healing
| 2. normal mechanical resistance of the skin
55
These tumors arise primarily from melanocytes at the epidermal-dermal junction
Melanoma
56
Comprised of a variety of mesenchymal dendritic cells recognizable mainly by immunohistochemistry
Dermal Dendrocytes
57
Give 2 functions of Dermal Dendrocytes
1. Antigen uptake
2. Processing for presentation to the immune system
3. Orchestration of processes involved in wound healing and tissue remodeling
58
Effector cells of the immune system that are responsible for immediate type I hypersensitivity reactions
Mast Cells
59
Which collagen type predominates during wound healing?
TYPE III COLLAGEN becomes more prominent and important during repair process
60
This collagen type is the major component of extracellular matrix in skin
Type I Collagen
61
Melanoma is the ___ most common cancer in males, and is the ___ most common cancer in females
6th, 7th
62
In males, melanomas are commonly found on the ___ and ____
neck and trunk
63
Enumerate melanoma assessment/observation steps. ABCDE
```
Asymmetry
Border
Color
Diameter
Evolution
```
64
Tissue diagnosis confirms the type of lesion or cancer through what?
full-thickness biopsy of the skin
65
What is done to smaller lesions?
Excisional biopsy/total removal
66
Most cancers are staged according to this committee
American Joint Committee of Cancer
Tumor
Node
Metastases
67
Cancer clinical staging in which there are no evidence of metastases
Staging I and II
68
Cancer clinical staging in which there is regional (clinical or radiographic) disease
Staging III
69
Cancer clinical staging in which there is distant metastatic disease
Stage IV
70
A technique which identifies the first draining lymph node from the primary lesion.
Sentinel Lymph Node Biopsy
- most common in breast cancer
71
What is used in SLNB as pre-operative lymphoscintigraphy?
Technetium 99-labeled sulfur colloid
72
What are the dyes used for intradermal injections for Sentinel Lymph Node Biopsy?
Isosulfan or methylene blue dye near the tumor
73
It is a grossly visible cutaneous and/or subcutaneous metastases found within 2cm of the primary melanoma
Satellite metastases
74
Microscopic and discontinuous cutaneous and/or subcutaneous metastases found adjacent to a primary melanoma
Microsatellites
75
Clinically evident cutaneous and/or subcutaneous metastases, identifies at a distance greater than 2cm from the primary melanoma
In-Transit Metastases
76
Measures the depth of penetration of the lesions from the top of the granular layer of the epidermis into the dermal layer
Breslow Tumor Thickness
77
A growth phase in which melanoma appears as an irregular plaque
Radial growth phase
| - cells may invade the dermis but do not form a nodule
78
In this growth phase, the risk of chances of metastatic spread is higher because lymphatics are located in the reticular subcutaneous tissue
Vertical growth phase
79
It is the most common melanoma, which arises in pre-existing nevus
Superficial Spreading Melanoma
- Growth phase: Early Radial
80
Most aggressive type of melanoma
Nodular Melanoma
- Growth phase: Vertical growth phase (HALLMARK)
- 5% of the lesions are amelanocytic, which may lead to delays in the diagnosis
81
Usually found on the sun-exposed areas of the skin
Lentigo Maligna Melanoma
82
Precursor lesion of lentigo maligna melanoma
Lentigo Maligna, Hutchinson freckle
- Growth Phase: Radial growth phase only
83
Acral Lentiginous Melanoma isa a melanoma that appears in palms, soles, and in the sublingual. What is the growth phase of this melanoma?
Long Radial Growth Phase
84
What is the recommended margin for wide excision?
0.5 to 1cm
85
If melanoma is at least 4mm, there should be at least __ margin from the edges of melanoma should be excised
2cm
86
It is a surgical treatment for in-transit metastases
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
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
Isolated Limb Infusion
PURPOSE: administer high doses of chemotherapy while avoiding systemic drug toxicity
88
The most common non-cutaneous site of metastasis
Ocular Melanoma
89
Hidradenitis suppurativa is also known as?
acne inversa
90
Treatment of Hidradenitis Suppurativa is based on?
Hurley staging with topical and systemic antibiotics
91
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)
Stage I
92
Hurley Classification with recurrent abscess with tract formation and cicatrization, single or multiple, widely separated lesions
Stage II
93
Hurley Classification with diffuse or near-diffuse involvement, or multiple interconnected tracts and abscess across the entire area
Stage III
94
A rare muco-cutaneous disorder characterized by cutaneous destruction at the dermo-epithelial junction
Epidermal Necrolysis
95
Lateral pressure on the skin causes separation of the dermis from the epidermis
+ Nikolsky Sign (Epidermal Necrolysis)
96
Enumerate drugs causes Steven-Johnson Syndrome
```
PCP LAPSE
Phenytoin
Carbamazepine
Phenobarbital
Lamotrigine
Allopurinol
Penicillin
Sulfa drugs
Erythromycin
```
97
A condition where circulating autoantibodies are directed against keratinocytes
Toxic Epidermal Necrolysis
98
This is characterized by sterile pustules that will progress to painful, ulcerating lesions with purple borders
Pyoderma gangrenosum
99
superficial varient of Pyoderma gangrenosum that is more commonly found on the trunk as single or multiple, non-painful lesions
Vegetative
100
A clinical form of pyoderma gangrenosum that presents with vesico-pustular lesions that do not develop into ulcers
Pustular
101
Painful tender pustular lesions that form fistulous tracts or ulcerations spreading upwards
Peristomal
- Usually presents with IBD
102
Painful, open sores that have bluish overhanging borders
Ulcerative
103
Characterized by superficial blisters
Bullous
104
Treatment for the peristomal type Pyoderma gangrenosum
Calcineurin inhibitor
**Calcineurin is an enzyme that activates the T-cells of the immune system
105
It is a type of peripheral vascular disease that specifically affects the arteries in the lower extremities
PAOD
Peripheral Arterial Occlusive Disease
106
a process that causes plaque build-up, and is the usual cause of PAOD
Atherosclerosis
107
Enumerate at least 4 symptoms of PAOD
✓ 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
An inadequate return of venous blood from the legs to the heart
Venous insufficiency
- this is due to the failure of valves in the leg to shut properly during blood's return to the heart
109
Type I to Type III collagen ratio
4:1
110
Hypertrophic scars/immature scars collagen Type I:Type III ratio
2:1
111
T/F. Hyperthermia is detrimental to wound healing
F - hypothermia
112
This is a zone of burn injury that occurs at the point of maximum damage
Zone of Coagulation
- there is 'irreversible' tissue loss due to coagulation of the constituent proteins
113
This is a zone of burn injury which is characterized by decreased tissue perfusion
Zone of Stasis
114
What is the aim of burns resuscitation?
To increase tissue perfusion in the zone of stasis and prevent any damage from becoming irreversible
115
This is a zone of burn injury where tissue perfusion is increased, and tissues here will invariably recover
Zone of Hyperaemia
116
Skin lesion where there are red sores in the face, around a nose and mouth, hands and feet
Impetigo
117
A type of impetigo that causes larger blisters that occur on the trunk
Bullous impetigo
- Less common form of the disorder
118
more serious form of Impetigo that penetrates deeper into the skin
Ecthyma
- painful fluid or pus-filled sores that turn into deep ulcers
119
a cutaneous infection localized on the upper layer of the dermis
Erysipelas
120
Which bacteria causes Erysipelas?
beta-hemolytic group A Streptococcus bacteria
121
a deeper infection, compared to the erysipelas, affecting the deeper dermis and subcutaneous tissue
Cellulitis
122
inflammation of the hair follicle
Folliculitis
123
a follicle with swelling and a collection of purulent material
Furuncle
124
Neoplasms of epidermal keratinocytes that represent a range in a spectrum of disease from sun damage to squamous cell carcinoma
Actinic Keratosis
125
These are benign lesions of the epidermis that typically present as well-demarcated, “stuck on” appearing papules or plaques over elderly individuals
Seborrheic Keratosis
- Clonal expansion of keratinocytes and melanocytes make up the substance of these lesions
126
Benign vascular tumors that arise from the proliferation of endothelial cells that surround blood-filled cavities
Strawberry Hemangioma
127
Portwine stain
Naevus flammeus
128
Sturge-Weber Syndrome is a poradic neurocutaneous disorder with angiomas which involves what structures? (2)
```
▪ Leptomeninges of the brain and choroid
▪ Skin of the face (affect the nerves)
➢ Ophthalmic (V1)
➢ Maxillary (V2) distribution of the
trigeminal nerve
```
129
Hallmarks of Sturge-Weber Syndrome? (2)
▪ facial cutaneous venous dilation
| ▪ nevus flammeus or port-wine stain (PWS)
