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T&D 1 exam 2 > Skin > Flashcards

Skin Flashcards

1
Q

Benign epithelial tumors

A

Seborrheic ketatosis
acanthosis nigricans
epidermal cyst

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2
Q

Seborrheic ketatosis

A

loos like melanoma

older indiv

light brow/flat - pale brown w/ pink tones to dark brown/black
velvety or waxy to finely verrucous surface

looks stuck on, Crumbles with scraping

Leser trelat - eruptive, multiple assoc w/ internal malignancy

Subtype in African americans: dermatosis papulosa nigra

Histo:

  • exophytic
  • basaloid cells
  • pigmented
  • exuberant keratin production
    • HORN CYSTS (keratin filled)**
  • loose lamellar “shredded-wheat” or “onion-skin” keratin
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3
Q

Dermatosis papulosa nigra

A

-

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4
Q

acnathosis nigricans

Benign vs malignant

A
  • hyperpigmentation
  • hyperplasia - spinosum layer – thick and velvety
  • folds - neck axilla groin

Benign - childhood/puberty - endocrine abnormality (DM)
Malignant - middle-age/older - visceral malignancy (cancer)

indication of underlying disorder

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5
Q

Epidermal cyst

A

-

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6
Q

Melanoma

A 
Superficial spreading
Lentigo maligna
Nodular
Acral
Amelanotic
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7
Q

Superficial spreading

A

a

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8
Q

Lentigo maligna

A

a

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9
Q

Nodular

A

a

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10
Q

Acral

A

a

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11
Q

Amelanotic

A

a

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12
Q

Disorders of pigmentation and melanocytes

A

Hypopigmentation

Hyperpigmentation

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13
Q

Hypopigmentation

A

a

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14
Q

Vitiligo

A

a

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15
Q

Hyperpigmentation

A 
Freckle
Lentigo
Melanocytic nevi
spitz nevus
Dysplastic melanocytic nevus
melanoma
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16
Q

Freckle

A

a

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17
Q

Lentigo

A

a

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18
Q

Melanocytic nevi

A

a

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19
Q

spitz nevus

A

a

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20
Q

Dysplastic melanocytic nevus

A

large, oval, multiple
irregular pigment
Fading border “fried egg” - central papule with surrounding macule

Histo: compound, concentric papillary dermal fibrosis

Horizontally oriented nests w/ bridging of adj rete
nests are at tips/sides of rete

cytologic atypia: hyperchromatic, enlarged nuclei

potential precursor for melanoma

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21
Q

Premalignant and malignant epidermal tumors

A

Actinitic keratosis

nonmelanoma skin cancer

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22
Q

Actinic keratosis

A

Premalignant lesion assoc w/ sun exposure

earliest identifiable lesion that can develop into SCC (60%) - patient will follow up in 2-3 mo with ulcerated/thickened lesion

palpation key to diagnosis

Rough or “gritty” skin, discrete, scaly, feels like “broken glass” - surface lesion

found on sun exposed areas - face, scalp, ears, posterior neck, forearms, legs

Histo:

  • parakeratosis in corneum
  • hyperplasia and cytologic atypia of basal layer
  • solar elastosis in superficial dermis

must BIOPSY to distinguish between AK and SCC

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23
Q

Nonmelanoma skin cancer

A

Squamous cell carcinoma
Keratoacanthoma
Basal cell carcinoma

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24
Q

Squamous cell carcinoma

A

Oral

Verrucous

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25
Q

Keratoacanthoma

A

benign epithelial tumor
looks like SCC

sudden on actinically-damaged skin
rapid growth
spontaneosly regresses in few months

Red to flesh colored, dome-shaped papule w/ central crater filled w/ keratin plug

Histo

  • large, red, glassy squamoid cells
  • neutrophil microabscess common
  • eosinophils and lymphocytes in surrounding infiltrate

cant transform into SCC

Mohs micrographic surgery - remove tumor and thin rim of normal appearing skin around the diefect – sectioned and labeled, frozen so examine while patient is in the office. Best long- term cure rate of any treatment modality

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26
Q

Basal cell carcinoma

A

Nodular
Superficial
Morpheaform

Most common malignancy

pluripotent cells in basal layer or follicular structures
slow growing. rarely metastasize
local destruction if neglected
excellent prognosis
non-healing lesion that bleeds

UV radiation imp risk factor

Histo:

  • nests of basaloid cells that palisade at the border of the nest
  • nests in fibromyxoid stroma
  • nodules attach to undersurface of the epiderpis
  • STROMA SEPERATES FROM TUMOR NODULES
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27
Q

Nodular BCC

A

MC - 60%
Face

Waxy w/ central depression
Pearly
erosion, ulceration, or crusting
bleeding w/ minor trauma
rolled border
translucency 
Telangiectasia
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28
Q

Superficial BCC

A

Trunk
scaly
light red color
atrophic center with fine translucent micropapules on rim

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29
Q

Tumors of the dermis

A

Dermatofibroma

Dermatofibrosarcoma protuberans

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30
Q

Dermatofibroma aka

A

Benign fibrous hisiticytoma

Very common
lower legs
slow growing

flesh colored-pigmented

“Dimple-sign”
pruritic
past trauma

Fibroblasts with collagen , hyperkeratosis and hyperpigmentation - reddish brown color

dermatofibrosarcoma protuberans
- primary fibrosarcoma of skin

  • locally aggressive but rarely metastasize
  • Hypercellular
  • thinned epidermis
  • into subcut fat “honeycomb” pattern
  • fibroblasts in pinwheel pattern
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31
Q

Tumors of cellular migrants to the skin

A

Mycosis fungoides

Mastocytosis

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32
Q

Mycosis fungoides

A

T-cell lymphoma
trunk

3 stages
3rd - nodule - tumor w/ systemic spread. deep into dermis

Histo:
sezary-lutzner cells - bands in superficial DERMIS (cd4+)

Pautrier microabscess - single/small cluster of invading cells in epidermis

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33
Q

Mastocytosis

A

Urticaria pigmentosa
Systemic mastocytosis

  • Darier sign: wheal when lesion is rubbed
  • Dermatographism: hive when normal skin is stroked

Sx - due to release of histamine, heparin, other mast cell contents

Mastocytoma: histo-

  • metachromatic granules w/in dendritic mast cells
  • monomorphous dermal infiltrate
  • NO epidermotropism
  • “Fried egg cells”
  • Giemsa stain: purplish mast cells in dermis - the granules are purple
34
Q

Urticaria pigmentosa

A

Children usually

> 50% of mastocytosis
- multiple mastocytoma - round to oval, red-brown papules and plaques, pruritic, blister. shortly after birth

35
Q

systemic mastocytosis

A

Adults usually
only abt 10% of of mastocytosis

similar to urticaria pigmentosa PLUS multi-organ mast cell infiltration: BM, liver, spleen, LN

Pruritis and flushing due to certain foods, drugs, EtOH, temp changes

36
Q

Disorders of epidermal maturation

A

Icthyosis

37
Q

Ictyosis

A

impair epidermal maturation
thick corneum w/ loss of basket weave
thick granular layer

except with icthyosis vulgaris - no granular layer

Congenital
Acquired

38
Q

Congenital icthyosis

A

a

39
Q

Acquired icthyosis

A

a

40
Q

Acute inflammatory dermatoses

A

Urticaria
Acute eczematous dermatitis (aka spongiotic dermatitis)
Erythema multiforme (SJ, TEN, pitryiasis rosea)
Stasis dermatitis

41
Q

Urticaria

A

Histo

  • perivenular infiltrate - neuts then mononuclear cells
  • Collagen bundles more widely spaced bc of edema fluid
  • Dilated lymphatics
  • no epidermal changes
42
Q

Spongiotic dermatitis

A

Contact dermatitis

  • irritant: direct toxic effect. not immunogenic. crust
  • allergic: cell mediated. Type IV. produce urushiol. nickel. papule and scale

Atopic dermatitis - worse in winter. Very itchy. dry with oozing. diaper area, face. CHRONIC - lichenification - epidermal thickening and skin lines
begins at 1st yr of life. babies, children, adults - just different areas

Nummular dermatitis
- coin shaped, red plaques, young adults

Asteatotic dermatitis

  • “winter itch”
  • older people in winter. dry and cracked, itchy

Histo:

  • spongiosis - intERcellular edema
  • Exocytosis of lymphocytes in epidermis
43
Q

Erythema multiforme

A

CD8+ attack
early -
superficial perivascular lymph infiltrate
dermal edema
lymphocytes at dermo-epi junction w/ degenerating and necrotic keratinocyte

later-
lymph migrate into epidermis, necrosis of epi and blister forms

target lesions

44
Q

Stevens johnson

A

involves mucous membrane, mouth and conjunctiva
children > adults

fever, renal failure, sepsis, difficulty eating
sulfa, anticonvulsant

45
Q

TEN

A

necrotic epidermis lifts off dermis - supepidermal bulla

macules

w/ or w.o target lesions

46
Q

Pitryiasis rosea

A

HHV-7
herald patch - resembles ringworm
christmas tree pattern

patient feels well
not on face
trunk,upperarms, thigh
ithcy

spongiosis w/ erythrocyte extravasation

spontaneously remits - 6wks

47
Q

Stasis dermatitis

A
  • venous incompetence

inc hydrostatic pressure and extravasation of rbc
middle aged, older

incomp valves in lower legs
hyperpigmentation, edema, itchy, scaly, infl

ulceration above medial malleolus

Histo:

  • chronic intercellular epidermal edema
  • rbc extrav – hemosiderin to collect –> thickened rough brown appearance
48
Q

Chronic inflammatory dermatoses

A

Psoriasis
Seborrheic dermatitis
Lichen planus
SLE

49
Q

Psoriasis

A

Auspitz sign - pinpoint bleeding
symmetrical
Koebner phenomenon-trauma and stress cause exacerbation
thin granulosum layer and parakeratosis in corneum

  • nail involvement. oil spotting - brown, onycholysis - distal separation. also pitting and subungual hyperkeratosis
  • arthritis

pencil in cup

50
Q

Seborrheic dermatitis

A

cradle cap
dandruff

yellow, scaly, greasy patch w. erythema

common in parkinsons, hiv

parakeratosis near follicles

51
Q

Lichen planus

A

5 Ps: pruritic PURPLE polygonal planar papules plaques

wrists/ankles/mucous membrane

Wickham’s striae: fine, reticulated white lines

Koebner phenomenon

Hep C assoc

Histo:

  • interface dermatitis - dense infiltrate of lymphocytes along dermoepidermal junction. the junction is more angulated zigzag (saw toothing)
  • degeneration/necrosis of basal keratinocytes (Civatte bodies - incorporation into inflamed papillary dermis)

Self-limited.
mucous mem inv - longer course

52
Q

SLE

A

african americans
females
30-40
sun, weightloss, cns, arthralgia

Malar rash - “butterfly” - macular eruptions w/ clear borders

multi sys involvmnt

SPARES nasolabial folds

immune complex deposit

False pos - RPR and VDRL

lichenoid interface dermatitis,
epidermal atrophy with thickened basal membrane

53
Q

Blistering disease

A

Inflammatory

Non inflammatory

54
Q

Inflammatory blistering disease

A

Pemphigus vulgaris
Bullous Pemphigoid
Dermatitis herpetiformis

55
Q

Pemphigus vulgaris

A

IgG

56
Q

Bullous pemphigoid

A

IgG

57
Q

Dermatitis herpetiformis

A

IgA

58
Q

Noninflammatory blistering disease

A

Epidermolysis bullosa

Porphyria cutanea tarda

59
Q

Epidermolysis bullosa

A

a

60
Q

Porphyria cutanea tarda

A

a

61
Q

Disorders of epidermal appendages

A

Acne vulgaris

Acne rosacea

62
Q

Acne vulgaris

A

a

63
Q

Acne rosacea

A

a

64
Q

Panniculitis

A

Erythema nodosum

65
Q

Erythema nodosum

A

a

66
Q

Infection

A

Verrucae

Molluscum contagiosum:
self-limited, spontaneously remits in a few months. skin-skin, h. contagious. flesh colored/translucent. Cheesy core. anywhere in kids/genitals sexually active adults. Histo: cup-shaped, verrucous acanthosis - epidermal hyperplasia, molluscum bodies in corneum and granulosum - ovoid, homogenous, cytoplasmic inclusion bodies

Impetigo
Scabies

67
Q

Verrucae

A

Vulgaris
plana
plantaris
condyloma acuminatum

68
Q

Verruca vulgaris

A

a

69
Q

Verruca plana

A

a

70
Q

Verruca plantaris

A

a

71
Q

Condyloma acuminatum

A

anogenital wart

72
Q

Xanthelasma

A

a

73
Q

Mongolian spot

A

a

74
Q

Chediak-higashi syndrome

A

a

75
Q

Cherry angioma

A

a

76
Q

Hemangioma of infancy

A

a

77
Q

Wiskott-Aldrich syndrome

A

a

78
Q

Alopecia

A

a

79
Q

Albinism

A

a

80
Q

Xeroderma pigmentosum

A

a

T&D 1 exam 2 (10 decks)

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