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Musculoskeletal > Skin Physiology and Pathology > Flashcards

Skin Physiology and Pathology Flashcards

1
Q

Thickened and rough skin characterized by prominent skin markings; due to repeated rubbing

A

Lichenification

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2
Q

Circumscribed lesion 5cm or smaller; characterized by flatness and color

A

Macule

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3
Q

Separation of nail plate from nail bed

A

Onycholysis

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4
Q

Elevated dome shaped/flat topped lesion that is 5mm or less

A

Papule

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5
Q

Elevated flat topped lesions greater than 5 mm

A

Plaque

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6
Q

Itchy transient elevated lesion with blanching and erythema

A

Wheal

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7
Q

Loss of intercellular cohesion between keratinocytes; commonly seen in pemphigus

A

Acantholysis

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8
Q

Diffuse epidermal hyperplasia; increase in thickness of the stratum spinosum

A

Acanthosis

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9
Q

Abnormal, premature keratinziation within cells below the stratum granulosum

A

Dyskeratosis

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10
Q

Discontinuity of the skin showing incomplete loss of the epidermis

A

Erosion

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11
Q

What are the epidermis layers from surface to base?

A

Californians Like Girls on Sweet Bikes

1) Stratum corneum
2) Stratum Lucidum
3) Stratum granulosum (spines = desmosomes)
4) Stratum spinosum
5) Stratum basale (stem cell site)

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12
Q

Thickening of the stratum corneum

A

Hyperkeratosis

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13
Q

Linear pattern of melanocyte proliferation within the basal layer

A

Lentiginous

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14
Q

Surface elevation caused by hyperplasia and enlargement of the dermal papillae

A

Papillomatosis

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15
Q

Keratiniziation with retained nuclei in the stratum corneum

A

Parakeratosis

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16
Q

Intercellular edema of the epidermis

A

Spongiosis

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17
Q

What are the five variant forms of melanocytic nevi?

A

1) Congenital nevus
2) Blue nevus
3) Spindle and epithelioid cell nevus
4) Halo nevus
5) Dysplastic nevus

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18
Q

How do you differ from compound/intradermal nevi from a melanoma?

A

1) As the compound/dermal nevi goes deeper its cells become mature becoming smaller and producing little pigment
2) Melanoma cells do not show maturation

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19
Q

What is the believed precursor to melanoma?

A

Dysplastic nevus

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20
Q

Flat macules with slightly raised plaques; may appear with a “pebbly” surface or target like lesions; variable pigmentation; occur on both sun exposed and protected surfaces; increased risk for melanoma

A

Dysplastic nevi

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21
Q

What gene mutations are associated with dysplastic nevus?

A

1) CDKN2A (chromosome 9)

2) CDK4 (chromosome 12)

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22
Q

What are the two ways melanoma grows?

A

1) Radial growth

2) Vertical growth

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23
Q

Horizontal spread of melanoma within the epidermis and superficial dermis

A

Radial growth

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24
Q

Indolent lesion on the face of older men that may remain in radial growth for decades

A

Lentigo maligna

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25
Q

Melanoma growth pattern consisting of the spread downward into deeper dermal layers as an expansile mass; indicated by the appearance of a nodule

A

Vertical growth

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26
Q

What are the differences between Vitiligo and Albinisim?

A

1) Vitiligo = acquired, loss of melanocytes

2) Albinisim = inherited autosomal recessive, impaired production of melanin; melanocytes present

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27
Q

What are the differences between a ephelis and a melasma?

A

1) Ephelis (freckle) is due to mild hyperpigmentation of basal keratinocytes that is correlated with sunlight
2) Melasma is an acquired area of darkened skin due to hormonal changes

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28
Q

How do you differentiate a solar lentigo from a lentigo maligna?

A

1) Solar lentigos occur spontaneously and have no cell atypia

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29
Q

Variant melanocytic nevi that is present at birth, identical to ordinary nevi, and has deep dermal growth around adnexa; increased risk of melanoma

A

Congenital nevus

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30
Q

Variant melanocytic nevi that consists of non-nested dermal infiltration; often associated with fibrosis; black-blue nodule

A

Blue nevus

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31
Q

Variant melanocytic nevi that consists of large, plump cells with pink/blue cytoplasm; fascicular growth; common in children; red-pink nodule

A

Spitz nevus

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32
Q

Variant melanocytic nevi that has a lymphocytic infiltration surrounding the nevus cells

A

Halo nevus

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33
Q

What should you look for in a melanoma grossly?

A

Think: ABCDs

1) Asymmetry
2) Borders are irregular
3) Color variation
4) Diameter is larger than a pencil eraser (6mm)

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34
Q

What do melanoma cells look like?

A

Large cells with enlarged nuclei that are characterized by chromatin clumping to the periphery of the nuclear membrane

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35
Q

Special presentation of radial growth melanoma that arises on the sole, palm, fingernail, or toenail bed; Has a thickened, hyperkeratotic epidermis

A

Acral lentiginous melanoma

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36
Q

What are the prognostic factors in melanoma?

A

1) Breslow’s thickness (<1.7 mm = better prognosis)
2) Number of mitoses (low = better prognosis)
3) Evidence of tumor regression (absent = better prognosis)
4) Presence and number of tumor infiltrating lymphocytes
5) Gender (Women = better prognosis)
6) Location (Extremities = better prognosis)
7) Metastasis to lymph nodes

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37
Q

What mutations are generally found in melanoma?

A

1) Mutations that diminish the activity of RB tumor suppressor (CDKN2A)
2) Increases in RAS and PI3K/AKT signaling

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38
Q

Benign epithelail tumor with round, flat, coin-like, waxy plaques with a velvety to granular surface and small pore like ostia impacted with keratin; occur in middle age

A

Seborrheic Keratoses

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39
Q

What are the histological features of Seborrheic Keratoses?

A

1) Consists of small cells that resemble basal cells
2) Hyperkeratosis at the surface
3) Presence of keratin filled cysts (Horn cysts)
4) When irritated it develops whirling foci of squamous differentiation

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40
Q

Benign epitheal tumor with basal like cells, keratin filled cysts, and development of whirling foci of squamous cell differentiation when irritated?

A

Seborrheic Keratoses

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41
Q

What are causes of Seborrheic keratoses?

A

1) Activating mutation of FGFR3 gene

2) Associated with gastric carcinoma causing Leser-Trelat sign

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42
Q

What inheritance pattern does albinism have?

A

Autosomal recessive

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43
Q

What are the mutations found in dysplastic nevi syndrome?

A

1) CDKN2A (chormosome 9)

2) CDK4 (chromsome 12)

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44
Q

Soft, flesh colored tumor attached to the skin by a stalk; consists of a fibrovascular core covered in benign squamous epithelium

A

Fibroepithelial polyp

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45
Q

Name the different adnexal tumors.

A

1) Cylindroma
2) Trichoepithelioma
3) Sebaceous adenoma
4) Pilomatrixoma
5) Appocrine carcinoma

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46
Q

Adnexal tumor composed of islands of cells resembling normal epidermla basal cell layer; commonly found on the forehead/scalp

A

Cylindroma

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47
Q

What are the histological findings of dysplastic nevi?

A

1) Compound nevi
2) Lentiginous hyperplasia
3) Cells with enlarged nuclei and hyperchromasia (cellular atypia)
4) Linear fibrosis due to release of melanin from dead nevus cells

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48
Q

What are the four types of epithelial cysts and what do their walls resemble?

A

1) Epidermal inclusion cyst- walls of cyst resemble normal epidermis
2) Pilar/Trichemmal cyst- walls resemble follicular epithelium
3) Steatocystoma simplex- walls resembling the sebaceous gland duct
4) Dermoid- walls contain multiple appendages

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49
Q

Adnexal tumor with lobular proliferation of sebocytes with increased peripheral basaloid cells

A

Sebaceous adenoma

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50
Q

Premalignant epidermal tumor that occurs in sun damaged skin; Presents with dyskeratosis, intercellular bridges between basal cells, and parakeratosis; cytoligc atypia is found in the lower layers of the epidermis; may develop into a cutaenous horn

A

Actinic keratosis

51
Q

What are associated tumors and systemic manifestations of the nevoid basal cell carcinoma syndrome?

A

1) Medulloblastomas
2) Ovarian Leiomyoma
3) Cleft lip and palate
4) Intracranial calcifications
5) Abnormal segmentation of the vertebrae

52
Q

What are epidermal inclusion cysts composed of?

A

1) Laminated strands of keratin

53
Q

What is Leser-Trelat sign associated with? Why does it occur?

A

1) Paraneoplastic neoplasm due to gastric carcinoma

2) Due to elaboration of TGF-alpha

54
Q

Adnexal tumor composed of proliferating basaloid cells that form primitive structures resembling hair follicles; associated with Cowden syndrome

A

Trichoepithelioma

55
Q

What gene mutation is observed in Nevoid basal cell carcinoma syndrome?

A

1) mutation of PTCH (chromosome 9)

2) Autosomal dominant

56
Q

Benign mass composed of spindle shaped cells; well defined, non-encapsulated in the mid-dermis; dimple inward on lateral compression; overlying epidermal hyperplasia and downward elongation of rete ridges

A

Dermatofibroma (benign fibrous histiocytoma)

57
Q

Neoplasm of the dermis composed of fibroblasts in a storiform pattern and has deep extension from the dermis into the subcutaneous fat that produces a honeycomb pattern; thin overlying skin

A

Dermatofibrosarcoma Protuberans

58
Q

What is mycosis fungoides when it has a hemotogenous spread causing erythroderma?

A

Sezary syndrome

59
Q

What is prognosis of mycosis fungoides based on?

A

The progression of lesions (patches, plaques, or nodules)

60
Q

Pearly papules often containing prominent, dilated subepidermal blood vessels; composed of nests of uniformly atypical basaloid cells within the dermis

A

Basal cell carcinoma

61
Q

Chronic proliferation of atypical cerebriform CD4 Tcells that remains localized to the skin; commonly found in 40s; Progresses from patches to plaques to nodules

A

Mycosis Fungoides (Cutaneous T cell Lymphoma)

62
Q

Chronic excessive keratin buildup that results in fish like scales

A

Ichthyosis

63
Q

Red, papulovesicular, oozing, and crusted lesions due to acanthosis and hyperplasia

A

Acute Eczematous Dermatitis

64
Q

What are the microscopic findings of urticaria?

A

1) Superfical dermal edema
2) Spaced out collagen bundles
3) Dilated lymphatic and vascular spaces

65
Q

Syndrome associated with multiple epidermal cysts, fibromas, osteomas, and intestinal polyps

A

Gardner’s syndrome

66
Q

Nests or single sezary cells that form in the epidermis during mycosis fungoides?

A

Pautrier microabscesses

67
Q

Multiple lesions of increased amount of mast cells localized to the cutaneous tissue; found in children; positive for darier sign

A

Urticaria pigmentosa

68
Q

Localized area of dermal edema and erythema that occurs when mastocytosis lesion is rubbed

A

Darier sign

69
Q

Localized mast cell degranulation and resultant dermal microvascular hyperpermeability (superficial dermal edema, spaced out collagen, dilated lymphatic and vascular spaces)

A

Urticaria

70
Q

What stimulates urticaria?

A

1) IgE antibody depedent causes (pollens, foods, drugs, insect venom)
2) IgE antibody independent causes (opiates, antibiotics, curare, and radiographic contrast media)

71
Q

What is the difference between urticaria and acute eczematous dermatitis?

A

1) Urticaria is confined to the epidermis
2) Acute eczematous dermatitis seeps into the intercellular spaces of the epidermis causing mechanical shear to cells resulting in intraepidermal vesicles

72
Q

What cell is important in the pathogenesis of acute eczematous dermatitis?

A

Dendritic Langerhans cells

73
Q

What epidermal cell layer is absent in ichthyosis?

A

Stratum granulosum

74
Q

What is the primary cause of the targetoid lesions?

A

CD8 T cells which are located centrally within the lesion

75
Q

Pink to salmon colored plaque covered by scales that are silver white in color; increased epidermal cell turnover, acanthosis, elongation of the rete ridges, and parakeratosis

A

Psoriasis Lesion

76
Q

Neutrophilic aggregates found in psoriasis located in the supefrical epidermis? in the stratum corneum found with parakeratosis?

A

1) Spongiform pustules

2) Munro microabscesses

77
Q

Induction of psoriasis by trauma

A

Koebner phenomenon

78
Q

What nail changes are observed in psoriasis?

A

1) Oncholysis
2) Yellow-brown discoloration
3) Dimpling

79
Q

Self limited, pruritic, purple, polygonal, planar papules and plaques; presence of civatte bodies and dense, band-like infiltrate of lymphocytes along the dermoepidermal junction; may have white Wickham striae; pointed rete edges (saw-tooth appearance)

A

Lichen Planus (think the 6 P’s)

80
Q

What are Civatte bodies? What disease are they associated with?

A

1) Basal cells with no nucelus

2) Associated with Lichen planus

81
Q

What are the two inflammatory blistering disorders?

A

1) Pemphigus

2) Bullous Pemphigoid

82
Q

Blistering disorder caused by autoantibodies (IgG & IgM) that microscopically has acantholysis resulting in flaccid bullae

A

Pemphigus

83
Q

Tense bullae filled with clear fluid on normal or erythematous skin; Eosinophils found below the basal cell layer causing a subepidermal vessicle, nonacantholyic blister; due to autoantibodie for the hemidesmosome

A

Bullous pemphigoid

84
Q

How do you differentiate a Pemphigus from a pemphigoid bullae?

A

1) Pemphigoid bullase have subepidermal, nonacantholyic blisters
2) Bullous pemphigoid has a linear deposition of IgG, while pemphigus has a granular deposition

85
Q

What are the autoantibodies in Bullous pemphigoid selective for?

A

1) BPAG1 and 2 (bullous pemphigoid antigen)

86
Q

Linear deposition of IgG selective for bullous pemphigoid antigen

A

Bullous pemphigoid

87
Q

Subepidermal blisters caused by the deposition of IgA selective for reticulin; accumulation of fibirn and neutrophils at the tips of dermal papillae; extremely pruritic

A

Dermatitis Herpetiformis

88
Q

What type of antibody is found in dermatitis herpetiformis? What is it selective for? What disease is it associated with?

A

1) IgA
2) Selective for reticulin
3) Celiac sprue

89
Q

Group of disorders caused by inherited defects in structural proteins of the skin that results in blisters

A

Epidermolysis bullosa

90
Q

Group of uncommon inborn or acquired disturbances of porphyrin metabolism

A

Porphyria

91
Q

What components are involved with the development of Acne vulgaris?

A

1) Changes in keratinization of the lower portion of the folicular infundibulum and development of keratin plug
2) Hypertrophy of sebaceous glands
3) Lipase synthesizing bacteria colonizing the upper/middle portion of hair follicle

92
Q

What are the microscopic findings of Rosacea?

A

1) Nonspecific perifolicular infiltrate composed of lymphocytes
2) Surrounded by dermal edema and telangectasia

93
Q

What has a high cutaneous level in Rosacea?

A

1) The anti-microbial peptide cathelicidin

94
Q

Inflammatory reaction in the subcutaneous adipose tissue

A

Panniculitis

95
Q

Large, ellipsoid, homogeneous, cytoplasmic inclusion in cells of the stratum granulosum and corneum? Forms multiple firm, flesh-colored, dome shaped papules on skin and mucous. Have umbilicated centers containing curd like material What is the infecting organism?

A

1) Molluscum body

2) Poxvirus

96
Q

What is the cause of Ichthyosis?

A

Defective desquamation

97
Q

Localized mast cell degranulation that results in microvascular hyper-permeability; Type I hypersensitivity

A

Urticaria

98
Q

Butterfly-shaped rash on the face that covers the cheeks and bridge of nose

A

Systemic lupus erythematosus

99
Q

Rupturing or extending of the blister laterally into non-involved skin with direct pressure; what is this associated with?

A

1) Niolsky’s sign

2) Pemphigous

100
Q

Common benign localized hyperplasia of melanocytes; common in children; do not darken when exposed to light; Lentiginous

A

Lentigo simplex

101
Q

Hyperplastic and closely spaced melanocytes in the basal layer that occurs spontaneously

A

Solar lentigo (liver spots)

102
Q

Nests of melanocytes

A

Melanocytic nevus

103
Q

Febrile form of erythema multiforme, found in children

A

Stevens-Johnson syndrome

104
Q

Severe erythema multiforme that results in diffuse necrosis and sloughing of cutaneous and mucosal epithelial surface

A

Toxic Epidermal necrolysis

105
Q

Minute bleeding points when scale is lifted from plaque? What is it associated with?

A

1) Auspitz sign

2) Psoriasis

106
Q

Greasy, yellow dandruf flakes

A

Seborrheic dermatitis

107
Q

Rupturing or extending of a blister laterally into non-involved skin with direct pressure? What is it associated with?

A

1) Nikolsky’s sign

2) Pemphigus

108
Q

What organism causes Tinea versicolor?

A

Malassezia furfur

109
Q

Accumulation of neutrophils below the stratum corneum?

A

Impetigo

110
Q

Array of multiform lesions found on the skin due to certain infections and drugs; type IV hypersensitivity (CD8 T cells); target lesions

A

Erythema multiforme

111
Q

Crateriform tumor with a central keratin plug; hyperkeratotic nodule; arise de novo

A

Keratoacanthoma

112
Q

Tumor like collection of foamy histiocytes with cholesterol, phospholipids, and triglycerides; associated with primary biliary cirrhosis

A

Plane Xanthoma

113
Q

Multiple blue-violet dermal plaques that appear on the feet and legs before spreading proximally

A

Kaposi sarcoma

114
Q

Koplik spots on buccal mucosa

A

Measles

115
Q

What epithelial junction prevents paracellular movement of solutes? What is it composed of?

A

1) Tight junctions

2) Claudins and occludins

116
Q

What epithelial junction is located below tight junctions and forms the belt connecting actin cytoskeletons of adjacent cells wtih Cadherins? What is this interaction dependent on? What results in the loss of Cadherin?

A

Think CADHErins

1) Adhesion junction
2) CA
3) Metastasis

117
Q

What epithelial junction provides structural support via keratin interactions? What is the result of antibodies towards this junction?

A

1) Desmosome

2) Pemphigus vulgaris (flaccid blisters)

118
Q

What epithelial junction has channel proteins called connexons that permit electrical and chemical communciation between cells

A

1) Gap junctions

119
Q

Membrane proteins that maintain integrity of basement membrane by binding to lamin in the basement membrane

A

Integrins

think: INTEGrity of basement membrane

120
Q

What connects keratin in basal cell to underlyinig basement membrane? What is the result of antibodies for this structure?

A

1) Hemidesmosome

2) Bullous pepemphigoid (tense bullae)

121
Q

Pt. presents with pain and stiffness in shoulders and hips; fever, malaise, and weight loss; does not have muscle weakness; associated with temporal arteritis

A

Polymalgia rheumatica

122
Q

What is BRAF associated with

A

Melanoma

123
Q

Treatment for psoriasis?

A

1) Calcipotriene (topical Vitamin D)

Musculoskeletal (5 decks)

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