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Pathology Pathoma + FA > Skin > Flashcards

Skin Flashcards

1
Q

Flat lesion with well circumscribed change in skin color that is LESS than 5mm

A

Macule

Ex) freckle

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2
Q

A flat lesion with well circumscribed change in skin color that is GREATER than 5mm

A

Patch

Ex) large birthmark

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3
Q

Elevated solid skin lesion LESS than 5mm

A

Papule

mole, acne

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4
Q

Elevated solid skin lesion GREATER than 5mm

A

Plaque

psoriasis

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5
Q

Small fluid containing blister less than 5mm and greater than 5mm (2 answers)

A

Vesicle (lesser)

Bulla (greater)

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6
Q

A vesicle that contains pus

A

Pustule

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7
Q

Transient smooth papule or plaque

A

Wheal

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8
Q

Flaking off of stratum corneum

A

Scale

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9
Q

Dry exudate

A

Crust

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10
Q

What is hyperkeratosis?

A

Increased thickness of stratum corneum (outermost layer to the epidermis)

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11
Q

What is parakeratosis?

A

Hyperkeratosis with RETENTION OF NUCLEI in the stratum corneum

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12
Q

What is acantholysis?

A

Separation of epidermal cells

Ex) pemphigus vulgaris

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13
Q

What is acanthosis?

A

Epidermal hyperplasia –> increased spinosum

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14
Q

What is dermatitis?

A

Inflammation of the skin

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15
Q

Albinism has a __ melanocyte number with __ melanin production, due to a __ in ___ activity.

A

normal
decreased
tyrosinase

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16
Q

Albinism can be caused by a failure of ______

A

neural crest cell migration during development

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17
Q

What is hyperpigmentation that is associated with pregnancy or OC use?

A

Melasma (aka Chloasma)

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18
Q

Unlike albinism, this disorder has a decreased melanocyte number. It also involves irregular areas of complete depigmentation (like Dr. Makoske’s hands)

A

Vitiligo

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19
Q

Acne vulgaris can involve what types of lesions?

A

Comedones (whiteheads, blackheads)
Pustules (pimples)
Nodules (can lead to scarring)

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20
Q

What is the technical definition of acne vulgaris?

A

chronic inflammation of hair follicles and sebaceous glands

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21
Q

Sebaceous glands produce ___

A

Sebum

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22
Q

A hormone related increase in sebum can lead to formation of a ____

A

comedone

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23
Q

_____ infection often leads to inflammation, pustules, nodules, etc. related to acne

A

propionibacterium acnes

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24
Q

TX for acne?

A

Benzoyl peroxide

Vit A derivatives

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25
Q

What are melanocytes?

A

Cells responsible for skin pigmentation
Reside in basal layer of epidermis
Derived from neural crest
Synthesize melanin in melanosomes

(normal in albinism - decreased in vitiligo)

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26
Q

These are warts caused by HPV. They are soft, tan colored, cauliflower like papules. Morphology includes koilocytosis, hyperkeratosis, and epidermal hyperplasia. Condylome acuminatum on genitals.

A

Verrucae

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27
Q

What is a melanocytic nevus, and is it malignant or benign?

A

Common mole - benign, but melanoma can arise in congenital or atypical moles

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28
Q

What is urticaria?

A

Hives - pruritic wheals that form after mast cell degranulation

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29
Q

What is ephelis? There is a ___ melanocyte number and ___ melanin pigment.

A

normal melanocyte - increased melanin pigment

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30
Q

Atopic dermatitis typically shows up on the ____ surfaces?

A

Skin FLEXURES

“flex-cema” –> eczema on flexure surfaces

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31
Q

Atopic dermatitis is commonly associated with _____ because it is a ______ reaction.

A

Asthma, allergic rhinitis

Type I hypersensitivity

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32
Q

Pruritic eruption that usually starts in the face in infancy and spreads to antecubital fossa thereafter

A

eczema (atopic dermatitis)

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33
Q

Allergic contact dermatitis - everything you know about it - GO!

A

Type IV hypersensitivity
Follows exposure to allergen (nickel, poison ivy, neomycin, penicillin)
Lesions occur at site of contact
TX: remove offending agent

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34
Q

What are some major causes of allergic contact dermatitis?

A

poison ivy
penicillin
neomycin
nickel

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35
Q

Salmon colored plaques and papules and silvery scales

A

Psoriasis

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36
Q

What is Auspitz Sign?

A

IN PSORIASIS - Pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off

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37
Q

Psoriasis involves acanthosis with _______

A

parakeratinocyte scaling

^nuclei still in stratum corneum

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38
Q

How does Psoriasis affect different layers of the epidermis?

A

increase stratum spinosum

decrease stratum granulosum

39
Q

Nail pitting and arthritis are associated with ___

A

Psoriasis

40
Q

Seborrheic keratosis as a general picture - what is it?

A

Looks like a “stuck on” lesion - flat, pigmented, greasy - on head, trunk, extremities

41
Q

What type of cell proliferation is seborrheic keratosis?

A

squamous epithelial prolif with keratin-filled cysts

= horn cysts

42
Q

An older patient presents with a small benign neoplasm on the trunk and extremities. She has a positive Leser-Trelat sign. What is this sign and what does the patient most likely have?

A

Leser-Trelat = sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (GI?)

Seborrheic keratosis w underlying malignancy

43
Q

List the major blistering skin disorders

A 
Pemphigus Vulgaris
Bullous Pemphigoid
Dermatitis Herpetiformis 
Erythema Multiforme
Stevens-Johnson Syndrome
44
Q

Pemphigus Vulgaris

A

Potentially fatal autoimmune disorder with IgG antibody against DESMOGLEIN 3 = destruction of desmosomes

If desmosomes can’t hold together, then you get a separation between stratum basal and rest of epidermis = BLISTER
+ Nikolsky sign

Immunofluorescence shows FISHNET pattern

Acantholysis
Picture the image of the gross boobs in First Aid = multiple crusty, weeping lesions of broken blisters

45
Q

Bullous Pemphigoid

A

Autoimmune IgG antibody against hemidesmosomes

Blister between epidermis and dermis (subepidermal)…eosinophils within tense blisters

Affects skin but spares oral mucosa

– Nikolsky sign

Bottom line: similar to pemphigus vulgaris, but blisters don’t really rupture and this is less severe (compare desmosome and hemidesmosome, and nikolsky)

46
Q

Dermatitis Herpetiformis

A

Associated with Celiac Disease, so no surprise that this involves IgA deposition at the tips of dermal papillae

Appearance: pruritic papules, vesicles, and bullae (classically seen on elbows)

TX: …avoid gluten

47
Q

Erythema Multiforme

A 
Associated with:
Infections
Drugs
Cancers
Autoimmune Disease

Multiple types of lesions, especially TARGET LESIONS =
targets with multiple rings and dusky center showing epithelial disruption

48
Q

What infections and drugs are associated with Erythema multiforme?

A 
Mycoplasma penumoniae
HSV
Sulfa drugs (sulfonamides)
B lactams
Phenytoin
49
Q

Stevens Johnson Syndrome is characterized by what?

A 
Fever
Bulla formation
Necrosis
Skin Sloughing
High Mortality
50
Q

What parts of body are involved with Stevens Johnson Syndrome and what do some of these lesions resemble?

A

2 Mucous membranes (think eye and lip)
Skin lesions
–> target appearance may mimic erythema multiforme

51
Q

What is the more severe form of Stevens Johnson Syndrome?

A

Toxic Epidermal Necrolysis -
over 30% body surface involved.
Diffuse skin sloughing that resembles a large burn
May be due to adverse drug reaction

52
Q

Epidermal hyperplasia causing symmetrical, hyperpigmented, velvety thickening of the skin = ______.

1) Where does it appear especially?
2) What other diseases is this associated with?

A

Acanthosis nigricans

Neck, axilla, groin

Hyperinsulinemia (diabetes, cushing, obesity)
Visceral malignancy (gastric carcinoma)
53
Q

Premalignant lesions caused by sun exposure. Appear as small, rough, erythematous brownish plaques. The risk of squamous cell carcinoma is proportional to ___________

A

Actinic keratosis

Risk of squamous cell carcinoma is proportional to degree of epithelial dysplasia

54
Q

What is erythema nodosum?

A

Inflammatory lesions of subQ fat. Typically on anterior shins.

55
Q

Which other diseases are associated with erythema nodosum?

A 
Crohn disease
Sarcoidosis
Coccidioiodmycosis
Histoplasmosis
TB
Strep Infxns
Leprosy
56
Q

What are the 6 Ps of Lichen Planus?

A

Pruritic
Purple
Polygonal Planar Papules
Plaques

57
Q

What do you see at the dermal-epidermal junction in Lichen Planus?

A

Sawtooth infiltrate of lymphocytes

58
Q

What virus is Lichen Planus associated with?

A

Hep C

59
Q

What are Wickham Straie and in what disease do you see these?

A

Reticular white lines on the surface

Lichen PLanus

60
Q

What disease classically begins with a singular, sometimes hidden, “herald patch” before spreading to more diffuse, multiple patches across the ribs of chest and back? TX?

A

Pityriasis Rosea

Herald patch –> Christmas tree distribution

Self resolves in 6-8 weeks

61
Q

Which UV is dominant in tanning and photoaging? Sun burn?

A

UVA
UVB

B for Burn

62
Q

UV irradiation causes DNA mutations, inducing apoptosis of ______.

A

Keratinocytes

63
Q

Sunburn can lead to skin cancers and ___

A

impetigo

64
Q

Very superficial, highly contagious skin infection that leads to crusting –> erythematous macules –> pustules. Caused by ____ and _____.

A

Impetigo
“honey crusted lesions”
Step pyogenes and staph aureus

65
Q

What is bullous impetigo? Causative agent?

A

Fluid containing lesions of impetigo

staph aureus

66
Q

What is the major difference between cellulitis and impetigo?

A

Impetigo is very superficial and cellulitis is a spreading infxn of the dermis and subQ tissues

67
Q

Causative agents of cellulitis? Often starts due to what inciting event? May progress to …?

A

Strep pyogenes
Staph aureus

Break in skin from trauma or another infection

Necrotizing faciitis - medical emergency!

68
Q

What does Necrotizing faciitis cause and what is the causative agent?

A

Crepitus, gassy methan and CO2 production - flesh eating bacteria - bullae and purple color to skin

staph aureus or anaerobic bacteria

69
Q

Scalded Skin Syndrome

A

Staph aureus – A, B exotoxin destroys keratinocyte attachments in the STRATUM GRANULOSUM ONLY

Fever, sloughing of upper layers of epidermis, heals completely

Seen in newborns and children

70
Q

EBV mediated white painless plaques on the tongue that CANNOT be scraped off

A

Hairy leukoplakia (common in HIV pts)

compare to scraped-off candidiasis

71
Q

Molluscum contagiosum is seen with ____ virus

A

Pox

72
Q

What is the most common skin cancer?

A

Basal cell carcinoma

73
Q

Risks for Basal cell carcinoma?

A

Sunlight (UVB)
Albinism
Xeroderma pigmentosum

74
Q

Basal cell carcinoma classically appears on ______.

A

the upper lip

75
Q

Basal cell carcinoma’s pink pearly nodules commonly include:
1.
2.
3.

A

Telangiectasias
Rolled borders
Central crusting/ulceration

76
Q

Is basal cell carcinoma invasive? How do you treat?

A

Invasive, but very rarely metastasizes

TX: excision

77
Q

What are the risks factors predisposing to squamous cell carcinoma?

A 
Albinism
UVB
xeroderma pigmentosum
immuno suppression therapy
arsenic
chronic inflamm (burn scar?)
78
Q

Which skin cancer typically appears on the bottom lip? Upper lip?

A

Squamous cell on bottom

Basal on top

79
Q

Which skin cancer is associated with chronic draining sinuses?

A

Squamous cell

80
Q

What is prognosis for squamous cell carcinoma? Is it invasive?

A

Excellent prognosis

Locally invasive, may spread to lymph nodes, rarely metastastizes

81
Q

Actinic keratosis predisposes you to ___

A

squamous cell carcinoma

82
Q

Keratocarcinoma

A

Variant of squamous cell carcinoma that grows rapidly (4-6 weeks) and may even regress spontaneously

Grows FAST, leaves FAST

83
Q

Keratin pearls are seen in which type of skin cancer?

A

Squamous cell carcinoma

84
Q

What is the MCC of death by skin cancer?

A

Melanoma

85
Q

Risks for developing melanoma?

A 
Albinism
UVB
Xeroderma pigmentosum
Light skin color
Dysplastic nevi syndrome
86
Q

What are the two growth phases of melanoma?

A
  1. Radial growth - horizonal across epidermis and dermis

2. Vertical growth - down into the deep dermis

87
Q

What are the four major types of melanoma?

A

Superficial spreading melanoma
Nodular Melanoma
Lentigo Maligna Melanoma
Acrolentiginous melanoma

88
Q

Which is the MC melanoma variant?

A

Superficial spreading melanoma

has a dominant early horizontal/radial phase –> good prognosis

89
Q

Which form of melanoma is unrelated to UVB? Where is it found?

A

Acrolentinginous melanoma

dark skinned individuals; palms, soles

90
Q

Which melanoma has a poor prognosis and why?

A

Nodular melanoma

early vertical phase…burrows down in there…

91
Q

Melanoma is often driven by activating mutation in _______?

A

BRAF kinase

92
Q

Melanoma - depth of tumor correlates with ____?

A

risk of metastasis

93
Q

If excision does not work well for pts with melanoma, what BRAF kinase inhibitor drug can be used?

A

vemurafenib

Pathology Pathoma + FA (1 decks)

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