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Block F: Immunnology > Skin > Flashcards

Skin Flashcards

1
Q

What are Warts?

A

Warts: Benign infection with papilloma viruses

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2
Q

What is Congenital melanocytic nevus?

A

Congenital melanocytic nevus: congenital lesion, with risk of melanoma high if >20cm

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3
Q

What is epidermolysis bullosa?

A

Epidermolysis bullosa: defective epidermal cell adhesion (acantholysis)

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4
Q

Characteristics (4) of Cyst?

A 
o	Cyst:
	Raised
	Fluid filled cavity
	Encapsulated
	Lined with the epithelium
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5
Q

What causes albinism?

A

o Melanocytes: attach with hemidesmosomes to the basal membrane, makes melanin granules to provide ultraviolet barrier. Mutation in tyrosinase gene will cause albinism and make patient susceptible to cancer

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6
Q

Characteristics (2) of Crust?

A

o Crust:
 Surface change
 Hardened deposit from serum, blood, or pus

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7
Q

Characteristics (3) of Scale?

A

o Scale: (ex: tinea pedis)
 Skin surface change
 Desquamation
 Flake arising from stratum corneum

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8
Q

What is a secondary skin lesion?

A

Evolution of primary skin lesion or what the patient did themselves (like scratching)

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9
Q

Causes of Acute atopic eczema/dermatitis? (5)

A

Causes: fungus, immunosuppression, staphylococcus, psoriasis, scratching, etc

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10
Q

What is Basal cell carcinoma (BCC)?

A

Most common skin cancer with low risk of metastasis, often with pearly rolled up border

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11
Q

Clinical subtypes of melanoma: from most common to least? (3)

A
  • Superficial spreading: horizontal (flat) to vertical growth (papule)
  • Nodular: vertical growth (greater risk of metastasis)
  • Acral lentiginous: palms, soles, nails (present in darker skin phototypes)
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12
Q

What is the Atopic March?

A

Atopic March: atopic dermatitis is often followed, with age, by food allergy, then asthma, then rhinitis

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13
Q

Treatment of Non melanoma skin cancer (NMSC)? (5)

A 
o	Biopsy to classify
o	Curettage and Electrodessication
o	Cryotherapy
o	Radiotherapy
o	Topical therapy
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14
Q

Give the three benign skin lumps/bumps

A
  • Seborrheic keratosis: benign papule or plaque with a warty surface that appears in adulthood
  • Cherry angioma: benign vascular lesion that appears as form red capsule
  • Solar lentigo: benign melanocytic proliferation due to UV exposure
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15
Q

Major criteria for Acute atopic eczema/dermatitis? (5)

A 
Major criteria:
-	Pruritus
-	Typical morphology
-	Chronic
-	Personal or family history of atopy: 
o	Asthma
o	Allergic rhinitis
o	Atopic dermatitis
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16
Q

What are the clinical features of Dress Syndrome? (4)

A 
Clinical features:
o	Happens 2-6 weeks after ingestion of drug
o	Facial red swelling
o	No mucosal erosions
o	Presents with hepatitis
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17
Q

Characteristics (2) of Pustule?

A

o Pustule:
 Raised
 Fluid-filled, but with pus

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18
Q

Name the dermatologic emergencies (10)

A 
Acute purpura
Toxic shock syndrome
Necrotizing fasciitis 
Erythroderma
Stevens-Johnson syndrome/Toxic epidermal necrolysis
Dress syndrome
Acanthosis nigricans
Vasculitis
Erythema nodosum
Necroboisis lipoidica
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19
Q

o Basement membrane is connected to dermis via what? (5)

A

o Basement membrane is connected to dermis via collagen VII, collagen III, collagen I and elastin (which also requires microfibrils/fibrillin)

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20
Q

Where on the skin are melanomas most often found?

A

Melanoma sites: in men, it’s upper back. In women, it’s the legs (calves)

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21
Q

What is a primary skin lesion?

A

Lesion resulting directly from the disease process

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22
Q

Clinical features of Stevens-Johnson syndrome/Toxic epidermal necrolysis? (4)

A

o 1-3 days prodrome of skin pain and fever
o Tender dusky red or purpuric macules
o Skin detachment showing dermis
Diagnosis: Nikolsky’s sign and Asboe Hansen’s sign (can also indicate Erythema multiforme and Mycoplasma mucositis)

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23
Q

Contributing factors of Acute atopic eczema/dermatitis? (4)

A 
Contributing factors:
-	Microbial dysbiosis
-	Irritant contact dermatitis
-	Allergic sensitization:
o	Type 1: systemic, immediate  skin prick tested
o	Type 4: delayed type  patch tested
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24
Q

What is Marfan’s syndrome?

A

Marfan’s syndrome: Fibrillin-1 gene mutation leading to aortic aneurysm, lax joints and dislocation of the lens

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25
Q

Characteristics (3) of Papule?

A

o Papule: (ex: molluscum contagiosum)
 Raised
 Different color from surrounding skin (but can be the same actually)
 <0.5cm

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26
Q

What is Necrobiosis lipoidica?

A

Necrobiosis lipoidica: waxy brown atrophic yellow plaque present in diabetes

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27
Q

What is Dress Syndrome? Treatment?

A

Dress syndrome: strong, drug-specific immune reaction that triggers viral reactivation (T cell expansion causing tissue damage by CD8 lymphocytes)
Treatment: Steroids

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28
Q

What are the three types of epithelia?

A

o Ectoderm: lining of oral, nasal, cornea and skin
o Endoderm: lining of GI and respiratory tract, liver pancreas
o Mesoderm: renal tubules, reproductive tract, blood vessels

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29
Q

What is Ichthyosis?

A

Ichthyosis: abnormal keratinization or glycolipic processing/release

30
Q

Risk factors of Non melanoma skin cancer (NMSC)? (3)

A
  • Non melanoma skin cancer (NMSC): usually on head an neck (photo-exposed area)
    Risk factors:
    o Skin type I-III (super-white to well, hum, like, almost white?)
    o Previous skin cancer
    o Immunosuppressed (favors more BCC than SCC)
31
Q

Melanoma risk factors? (4)

A
  • Phenotype (skin phototype I-III, red/blood hair and freckles)
  • Sun exposure
  • Family history, previous skin cancer
  • Immunosuppressed
32
Q

Characteristics (3) of Nodule?

A

o Nodule: (ex: basal cell carcinoma)
 Raised, solid but with depth
 <0.5cm

33
Q

What is Staphylococcal scalded skin syndrome Treatment?

A

Staphylococcal scalded skin syndrome: disease of childhood where there’s a decrease renal toxin clearance and/or lack of toxin-neutralizing antibodies
Treatment: Beta-lactamase-resistant antibiotic

34
Q

Clinical features of toxic shock syndrome? (6)

A 
o	Capillary leak syndrome with fever
o	Exanthema
o	Strawberry tongue
o	Hypotension
o	Multiorgan dysfunction
o	Convalescent desquamation
35
Q

Characteristics (4) of Urticaria?

A 
o	Urticaria:
	Raised
	Any size or shape
	Last <24h
	Edema and erythema
36
Q

What is Dysplastic nevus? What is the treatment?

A

Dysplastic nevus: can come with dysplastic nevus syndrome if there’s a family history of >50nevi or size >5-6mm
Treatment: biopsy, sun protection and monthly self exam

37
Q

What is Squamous cell carcinoma? What is it called when it’s in situ?

A

Squamous cell carcinoma: 2nd most common skin cancer caused by lifetime IV light exposure, low risk of metastasis, scaly red plaque
When SCC is in situ, it is called Bowen’s disease

38
Q

What is Basal cell carcinoma?

A

Basal cell carcinoma: destructive of basal cells, but not metastatic

39
Q

What is Acquired melanocytic nevi?

A

Acquired melanocytic nevi: “mole” or beauty spot”, occur at all age, all skin types. Uniform in color and shape, and <6mm. Melanoma risk is low

40
Q

What are the two types of necrotizing fasciitis?

A

o Type 1: polymicrobial present in adulthood (immunosuppressed, diabetes, ulcers)
o Type 2: streptococcus present in children

41
Q

Characteristics (3) of Ulcer?

A

o Ulcer: (ex: diabetic ulcer)
 Lack of substance
 Non-moist circumscribed depression
 Due to loss of epidermis and all or part of dermis

42
Q

What is found Stratum basale/germinativum? (two adhesion structures and two cells)

A

Presence of cuboidal cells (keratinocytes that release lipid lamellated granules), mitoses
 Has two adhesion structures:
• Hemidesmosomes (integrins) for cell-matrix adhesion
• Desmosomes (cadherins) for cell-cell adhesion

43
Q

What is Erythema Nodosum?

A

Erythema nodosum: bruises that appear and disappear out of the blue, due to fat inflammation under the skin

44
Q

Characteristics (3) of Erosion?

A

o Erosion: (ex: pemphigus vulgaris)
 Lack of substance
 Moist circumscribed depression
 Due to loss of epidermis and all or part of dermis

45
Q

Characteristics (3) of Tumor?

A

o Tumor: (ex: basal cell carcinoma)
 Raised, solid but with depth
 >0.5cm

46
Q

What is Stevens-Johnson syndrome/Toxic epidermal necrolysis?

A

Stevens-Johnson syndrome/Toxic epidermal necrolysis: rare, acute life-threatening detachment of the skin caused by extensive keratinocyte necrosis as a reaction to drug. This can lead to sepsis, since you lose the skin barrier

47
Q

What are the three types of Acquired melanocytic nevi?

A 
o	Junctional (between dermis and epidermis): flat and dark
o	Intradermal (within the dermis): raised and lighter
o	Compound (junctional and intradermal components): slightly lighter and elevated
48
Q

What are the two subtypes of Non melanoma skin cancer (NMSC)?

A

o Basal cell carcinoma (BCC)

o Squamous cell carcinoma

49
Q

Characteristics (3) of Vesicle?

A

o Vesicle: (ex: herpes zoster)
 Raised
 Clear, fluid-filled
 <0.5cm

50
Q

What is the morphology of Acute atopic eczema/dermatitis? (5)

A

Morphology:

  • Erythematous
  • Edematous
  • Scale crust
  • Oozing/weepy
  • Ill-defined borders
51
Q

Give the epithelial layers of the skin (5)

A 
o	Stratum corneum (keratinized layer)
o	Stratum lucidum
o	Stratum granulosum
o	Stratum spinosum
o	Stratum basale/germinativum
52
Q

What is Acute atopic eczema/dermatitis?

A

Acute atopic eczema/dermatitis:
Irritation (micro-fissures) leading to decreased water binding and skin moisture, which leads to a decrease in skin surface lipids (ceramides)

53
Q

Causes of Erythroderma? (5)

A 
Causes: from most common to least common
o	Idiopathic
o	Dermatitis
o	Psoriasis
o	Drug reactions
o	Cutaneous T cell lymphoma
54
Q

Clinical features of necrotizing fasciitis? (3)

A

o Extreme pain (distinguishes it from cellulitis)
o Skin is shiny, gray-blue color
o Septic, and does not respond to antibiotics

55
Q

Risk factors (1) and drugs culprits (3) in Stevens-Johnson syndrome/Toxic epidermal necrolysis?

A 
Risk factors:
o	Immunosuppressed (HIV infection)
Common drugs culprit:
o	Allopurinol
o	Antibiotics (sulfonamides, mostly)
o	Oxicam NSAIDs
56
Q

What is the melanocyte? What does it do?

A

o Melanocytes: attach with hemidesmosomes to the basal membrane, makes melanin granules to provide ultraviolet barrier. Mutation in tyrosinase gene will cause albinism and make patient susceptible to cancer

57
Q

What are Desmosomes?

A

• Desmosomes (cadherins) for cell-cell adhesion

58
Q

Characteristics (3) of Patch?

A

o Patch: same as macule, but larger
 Flat
 Different color from surrounding skin
 >0.5cm

59
Q

Characteristics (3) of Macule?

A

o Macule:
 Flat
 Different color from surrounding skin
 <0.5cm

60
Q

What are the three types of Acanthosis nigricans?

A 
-	Acanthosis nigricans: 
Three types:
o	Malignancy associated
o	Familial
o	Acutely caused by insulin resistance (endocrinopathy): most common, with Acromegaly, Cushing, hypothyroidism, Addison’s, hypogonadism, cancer of GI tract
61
Q

Causes of toxic shock syndrome? (2)

A

o Staphylococcal

o Streptococcal

62
Q

Characteristics (3) of Bulla?

A

o Bulla: (ex: bullous pemphigoid)
 Raised
 Clear, fluid-filled
 >0.5cm

63
Q

What is Erythroderma?

A
  • Erythroderma: increased skin perfusion with exfoliation, causing protein and electrolyte loss, and high-output cardiac failure
64
Q

Characteristics (3) of Atrophy?

A

o Atrophy: (ex: striae)
 Lack of substance
 Wasting/failure of tissue to form
 Clinically thinner or depressed

65
Q

Treatment (2) for Acute atopic eczema/dermatitis

A

Treatment: traditional skin barrier care (ex: Vaseline), then, if it doesn’t work, steroids targeting Th2

66
Q

Characteristics (3) of Plaque?

A

o Plaque: (ex: Psoriasis)
 Raised
 Different color from surrounding skin (but can be the same actually)
 >0.5cm

67
Q

What are the clinical features of Staphylococcal scalded skin syndrome Treatment? (4)

A

o Periorificial crusting (hallmark)
o Disruption of the epidermis
o Bulla formation
o Painful skin tenderness

68
Q

What is Squamous cell carcinoma?

A

Squamous cell carcinoma: target the keratinocytes, and is metastatic

69
Q

What cells are found in - the connective tissue/Papillary layer of dermis? (6)

A 
o	Mesenchymal cell
o	Fibroblast/Fibrocyte
o	Adipocyte
o	Macrophage/Histiocyte
o	Mast cell
o	Plasma cell
70
Q

What are Hemidesmosomes?

A

• Hemidesmosomes (integrins) for cell-matrix adhesion

Block F: Immunnology (9 decks)

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