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patho II > Skin I (a) > Flashcards

Skin I (a) Flashcards

1
Q

Causes of Urticaria

A

Pollens, foods, drugs, and insect venom

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2
Q

Epi of Urticaria

A

20-40 yrs of age

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3
Q

Patho of Urticaria

A

Immediate (type 1) hypersensitivity reaction -> corss-linkage of IgE on mast cells which cause degranualtion

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4
Q

Microscopic Findings:
* Superficial perivenular infiltrate of mononuclear cells (Lymphatic vessel dilatation)
* Superficial dermal oedema, creating more widely spaced collagen bundles
* Degranulation of mast cells,

features of?

A

Urticaria

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5
Q

Degranulation of mast cells in Urticaria can highlighted using ——– stain

A

Giemsa stain

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6
Q

CP of Urticaria

A

Erythematous, oedematous, and Pruritic wheals(form after the degranulation of mast cells)

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7
Q

Tx of Urticaria

A

Antihistamines, systemic steroids

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8
Q

pressure Urticaria are lesions found only in areas exposed to ——–?

A

pressure

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9
Q

Heriditray Angioedema is caused by what type of deficiency?

A

C1 esterase inhibitor

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10
Q

Hereditary Angioedema affects?

A

1) lips,
2) throat,
3) eyelids,
4) genitals, and
5) distal extremities

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11
Q

CP of Acute Eczematous Dermatitis (Eczema)

A

Oozing/ crusted Red papules, often with overlying vesicles

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12
Q

Causes of Acute Eczematous Dermatitis (Eczema)

A

1. Allergic Contact Dermatitis (most common): Topical exposure to allergen
2. Atopic Dermatitis: Allergen exposure or defects in keratinocyte barrier function
3.Drug-related Eczematous Dermatitis: Hypersensitivity reaction to a drug

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13
Q

cause of Allergic Contact Dermatitis

A

Type IV hypersensitivity reaction secondary to contact allergens (e.g, poison ivy, nickel)

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14
Q

patho of Allergic Contact Dermatitis

A

Contact of allergen (poisin ivy) w/ skin –>

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15
Q

CP of allergic contact dermatitis

A

localized pruritic (itchy) skin lesions, blisters w/ clear fluid

* bullae: blisters w/ clear fluid

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16
Q

Microscopic Findings:
* Spongiosis (epidermal odema)
* Intercellular bridges are stretched
* Superficial perivascular lymphocytic infiltrate
* Oedema of dermal papillae
* Mast cell degranulation

features of?

A

Allergic Contact Dermatitis

*note very similar micro features of Urticaria

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17
Q

Cause of Erythema Multiforme

A

Hypersensitivity response to:
* Infections(Herpes Simplex Virus and Mycoplasma)
* Drugs (Sulfonamides, Penicillin, Salicylates, Hydantoins, Antimalarials)

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18
Q

*pathophysio

In Erythema Multiforme Skin-homing Cytotoxic T-cells attack the ———- of the skin and the ————, which may display antigens that cross-react with the inciting drug or microbe

A

Basal cells, mucosa

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19
Q

CP of Erythema Multiforme

A

Target- like papules
(consisting of red macules or papules with pale vesicular or eroded centers)

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20
Q

**

Macroscopic features:
* pathces have pale, vesicular, or eroded centers (Target-like papules)

Microscopic Findings:
* Dermal oedema
* lesions w/ degenerating (apoptotic) keratinocytes w/ lymphocytic infiltrates

A

Erythema Multiforme

*keratinocytes: the major cell type of the epidermis

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21
Q

2 severe forms of Erythema Multiforme

A

Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

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22
Q

cause of Psoriasis

* chronic skin inflammatory disorder

A

Multifactorial immunologic disease, in which both genetic (e.g. Human Leukocyte Antigen [HLA] types) and environmental factors contribute to risk

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23
Q

Patho of Psoriasis

A

Sensitised populations of T cells secrete cytokines and growth factors that induce keratinocyte hyper- proliferation

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24
Q

CP of Psoriasis

A

pink to salmon-coloured palques w/ silvery scaling

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25
Q

Microscopic Findings:
* Epidermal thickening (acanthosis), w/ parakeratotic (nuclei still in stratum corneum)
* loss of the stratum granulosum and parakeratotic scale (due to lack of maturation)
* Regular elongation of the rete ridges
* Thinning of the epidermal cell layer overlying the tips of dermal papillae

Features of?

A

Psoriasis

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26
Q

patho of Linchen PLanus

* chronic inflammatory skin disorder

A

CD8+ T cell-mediated cytotoxic immune response against antigens in the basal cell layer and the dermo-epidermal junction

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27
Q

Epi of Lichen Planus

A

Uncommon disorder; Middle-aged adults

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28
Q

**

CP of Lichen Planus

A

6 P’s
1) Pruritic, purple, polygonal, planar papules, and plaques of skin and squamous mucosa
2) Mucosal involvement –> Wickham striae

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29
Q

**

Microscopic Findings:
* The lymphocytes are intimately associated with basal keratinocytes, which often atrophy or become necrotic
* “zig-zag” contour/”saw-tooth” infiltrate of lymphocytes at Dermo-epidermal interface (junction)
* Presence of anucleate, necrotic basal cells (colloid bodies or Civatte bodies)

features of?

A

Lichen Planus

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30
Q

cause of Lichen simplex Chronicus

A

Response to local repetitive trauma, such as continual rubbing or scratching

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31
Q

CP of Lichen Simplex Chronicus

A

Raised, erythematous, and scaly lesions

32
Q

Microscopic Findings:
* Acanthosis (epi thickening)
* Hyperkeratosis
* Hypergranulosis ( ↑ thickness of the stratum granulosum)
* Solar elastosis
* Elongation of the rete ridges
* Fibrosis of the papillary dermis
* Dermal chronic inflammatory infiltrate

features of?

A

Linchen Simplex Chronicus

33
Q

cause of Impetigo

* superficial bacterial infection

A

Staphylococcus aureus, Streptococcus pyogenes

34
Q

Epi of Impetigo

A
  • Most common bacterial infections of the skin
  • Primarily in children
35
Q

CP of Impetigo

A

lesions w/ Honey-coloured crusting

36
Q

Microscopic Findings:
* Accumulation of neutrophils beneath the stratum corneum that often produces a sub-corneal pustule
* Superficial dermal inflammation accompany these findings
* Bacterial cocci in the superficial epidermis (demonstrated by Gram stain)

features of?

37
Q

obv+ skin condition

A

Skin condition: Superficial dermal fungal infection caused by Candida albicans
Obv: Satelite lesions

38
Q

Microscopic Findings:
*Neutrophilic infiltrate in the epidermis
*Psoriasiform hyperplasia

A

Candidiasis of the Skin

Psoriasiform hyperplasia-> Candida

39
Q

Stain used for Candida causing superfical Dermal fungal infection

40
Q

Obv+ skin disorder

A

Condition: Deep dermal fungal infection caused by Apergillus
Obv: A- Erythematous subcutaneous nodule
B- Focally haemorrhagic lesion

41
Q

Deep Dermal fungal infection caused by Aspergillus is due to Tissue damage and often —————– Response

A

granulomatous

42
Q

Histochemistry for Deep Dermal fungal infection caused by Aspergillus

A

1) PAS- Periodic Acid-Schiff
2) Gomori methenamine silver stains

*identify fungal organisms

43
Q

cause of Verrucae (Warts)

* viral infection

A

Human Papilloma Virus (HPV)

44
Q

patho of Verrucae (Wrats)

A

Viral E6 and E7 onco-proteins lead to dysregulated epidermal cell growth and increased survival

45
Q

Microscopic Findings:
* Epidermal hyperplasia
* Cytoplasmic vacuolisation [koilocytosis] (preferentially of the more superficial epidermal layers) –> Halos of pallor surrounding infected nuclei
* Infected cells with prominent kerato-hyalin granules and jagged eosinophilic intracytoplasmic protein aggregates (result of impaired maturation)

features of?

A

Verrucae (Warts)

46
Q

the 4 types of Verrucae (Wrats)

A
  1. Verruca Vulgaris
  2. Verruca Plana (Flat Wart)
  3. Verruca Plantaris/Palmaris
  4. Condyloma Acuminatum (Venereal Wart)
47
Q

most common type of Verrucae (Wrats)

A

Verruca Vulgaris

48
Q

loc of Verruca Vulgaris

A

dorsum of the hand

49
Q

CP of Verruca Vulgaris

A

Gray-white to tan, flat to convex, 0.1-1 cm papule with a rough, pebble-like surface

50
Q

Loc of Verruca Plana (Flat Wart)

51
Q

CP of Verruca Plana (Flat Wart)

A

Flat, smooth, tan macules

52
Q

Verucca Vulgaris presents w/ Rough, ————–to ————— skin coloured papule/plaque Macroscopically

A

hyperkeratotic to papillomatous

Hyperkeratotic –> thickening of the outer layer of the skin

53
Q

Macroscopic features:
- Rough, hyperkeratotic to papillomatous skin coloured papule/plaque

microscopic features :
- Papillomatous hyperplasia
- Prominent granular layer
- Inward bending of rete
- Koilocytosis

features of ?

A

Veruuca Vulgaris

54
Q

**

what type of Verruca (Wrats) has the following microscopic features:
- Multiple “bird’s eye” nuclei in the granular cell layer

A

Verruca Plana

55
Q

loc of Verruca Plantaris/Palmaris

A

Soles and palms

56
Q

CP of Verucca PLantaris/ Palmaris

A

Rough, scaly lesions

57
Q

Loc of Condyloma Acumuinatum (Venereal Wrat)

A

Penis, female genitalia, and perianal areas

58
Q

Macroscopic features:
- Warty cauliflower-like lesion w/ papillary or polypoid fronds

Microscopic features :
- Papillomatous mammillated epithelial hyperplasia
- Koilocytic changes
- Hyperkeratosis

features of?

A

Condyloma Acuminatum (Venereal Wart)

59
Q

cause of Pemphigus

A

Autoimmune disorder

60
Q

patho of Pemphigus

A
  • Antibody-mediated (type II) hypersensitivity reactions
  • IgG auto-antibodies that bind to intercellular desmosomal proteins (Desmoglein types 1 and 3) of skin and mucous membranes
61
Q

Epi of Pemphigus

A

Rare; Elderly women

62
Q

Clinical presentation of Pemphigus

A

Superficial flaccid vesicles and bullae that rupture easily

63
Q

Microscopic Findings:
* Acantholysis: Lysis of the intercellular adhesive junctions between neighbouring squamous epithelial cells that results in the rounding up of detached cells
* Superficial dermal infiltrates comprised of lymphocytes, macrophages, and eosinophils

features of?

64
Q

Direct Immuno-Fluorescence of Pemphigus

A

Fishnet-like pattern of intercellular IgG deposits

65
Q
  • Acantholysis selectively involves the layer of cells immediately above the basal cell layer, giving rise to a supra-basal acantholytic blister

what type of Pemphigus is this?

A

Pemphigus Vulgaris

66
Q

**

microscopic features;
- Acantholysis in the granular cell layer with “missing” stratum corneum
- Neutrophils in the granular cell layer
- Separation of the corneum from the rest of the epidermis

features of?

A

Pemphigus Foliaceus

67
Q

Cause of Bullous Pemphigoid

A

Autoimmune disorder

68
Q

Patho of Bullous Pemphigoid

A
  • Antibody mediated (type II) hypersensitivity reactions
    • Linear deposition of IgG antibodies and complement in the epidermal basement membrane
69
Q

CP of Bullous Pemphigoid

A

Multiple fluid filled blisters

70
Q

Microscopic Findings:
* Perivascular infiltrate of lymphocytes and variable numbers of eosinophils, occasional neutrophils
* Superficial dermal oedema
* Associated basal cell layer vacuolisation; The vacuolated basal cell layer eventually gives rise to a fluid-filled sub-epidermal non-acantholytic blister

features of?

A

Bullous Pemphigoid

71
Q

Direct Immuno-Fluorescence of Bullous Pemphigoid

A

Linear deposition of IgG antibodies and complement in the epidermal basement membrane

72
Q

cause of Dermatitis Herpetiformis

A

Autoimmune disorder

73
Q

Epi of Dermatitis Herpetiformis

A
  • Males
  • 80% occurs is ass. w/ Coeliac disease
74
Q

patho of Dermatiis Herpetiformis

A

Genetically predisposed persons develop:
* IgA antibodies to dietary Gluten (derived from the wheat protein Gliadin) and
*IgA auto-antibodies that cross-react with epidermal transglutaminase , expressed by keratinocytes

75
Q

**

CP of Dermatitis Herpetiformis

A

Pruritic urticaria and grouped vesicles

76
Q

**

Microscopic Findings:
* Neutrophils accumulate selectively at the tips of dermal papillae, forming small micro-abscesses- “Papillary Abscess”
* The basal cells overlying these micro-abscesses show vacuolisation and focal dermo-epidermal separation that ultimately coalesce to form subepidermal blisters

features of?

A

Dermatitis Herpetiformis

77
Q

**

Direct immunofluorescence of Dermatitis Herpetiformis

A

Discontinuous, granular deposits of IgA localised in the tips of dermal papillae

patho II (29 decks)

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