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Clinical Pathology > Theme 10: Skin and musculoskeletal pathology: L1 > Flashcards

Theme 10: Skin and musculoskeletal pathology: L1 Flashcards

1
Q

What is eczema/dermatitis?

A
  • very common pattern of skin disease

- varies from trivial to severe

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2
Q

What are the 3 stages of eczema and what does the skin look like in each?

A
  1. Acute dermatitis - skin is red, blistering and itchy - serous exudate
  2. Subacute dermatitis - skin is red, less exudate, more itching, crusting
  3. Chronic dermatitis
    - skin becomes thickened with a dense keratin layer
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3
Q

What is spongiosis?

A
  • presence of an irritant/ hypersensitivity process
  • there is oedema between cells causing a spongy appearance
  • inflammatory cells are also seen
  • characteristic of eczematous dermatitis
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4
Q

What are the features of atopic eczema?

A
  • usually starts in childhood, occasionally adults
  • often family history
  • often associated with asthma and hay fever
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5
Q

What type of hypersensitivity is atopic eczema?

A

type 1 hypersensitivity - reaction to allergen

IgE mediated

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6
Q

What is contact irritant dermatitis?

A

direct injury to skin by irritant e.g acid, alkali

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7
Q

What is contact allergic dermatitis?

A

nickles, rubbers, dyes

delayed type IV hypersensitivity reaction

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8
Q

What are the two morphological subtypes of dermatitis?

A
  1. seborrheic dermatitis - affect areas rich in sebaceous glands e.g scalp, forehead, upper chest
  2. nummular dermatitis - coin shaped lesions
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9
Q

What is psoriasis?

A
  • 1-2% population
  • well defined, red oval plaques on extensor surfaces (knees, elbows, sacrum)
  • fine silvery scale
  • +/- pitting nails
  • +/- sero-negative arthritis
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10
Q

What is the cellular process of psoriasis?

A
  • psoriasiform hyperplasia

- massive cell turnover

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11
Q

What is the aetiology of psoriasis?

A
  • genetic factors

- environmental triggers - infection, stress, trauma, drugs

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12
Q

What are the associated co morbidities of psoriasis?

A
  • arthropathy (any disease of joints)
  • psychosocial effects
  • cardiovascular disease
  • increased risk fo non-melanoma skin cancer
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13
Q

What is lichenoid pattern characterised by?

A

epidermal basal cell damage

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14
Q

What is lichen planus and where is oit found?

A
  • inflammatory skin condition usually in adults
  • on flexor surfaces, mucous membranes and genitals
  • usually self limiting
  • associated with viral hepatitis, HIV, drugs
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15
Q

What is lupus erythematosus?

A
  • autoimmune disorder primarily affecting connective tissues of the body
  • autoantibodies direct at various tissues
  • renal involvement is major predictor of outcome
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16
Q

What are the two types of LE?

A
  1. Discoid LE (DLE) - affects skin only

2. Systemic LE (SLE) - visceral disease

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17
Q

What is the characterstic rash of SLE?

A

Butterfly rash on cheeks and nose

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18
Q

What is dermatomyositis?

A
  • peri-ocular oedema and erythema (heliotropic rash)

- erythema in photosensitive distribution

19
Q

What is characteristic of bullous disease?

A

formation of fluid filled blisters

20
Q

What is the difference between a pemphigus and pemphigoid blister?

A

Position of blister:

  1. Pemphigus is inter-epidermal
  2. Pemphigoid is sub-epidermal
21
Q

What is pemphigus?

A

Groups of disorders characterised by loss of cohesion between keratinocytes resulting in an intraepidermal blister

22
Q

Pemphigus and pemphigoid is caused by autoantibodies. What can detect these?

A

immunofluorescence

23
Q

What is the difference between pemphigous and pemphigoid blisters?

A

Pemphigous are inter-epidermal and rupture

-pemphigoid are sub epidermal and do not rupture easily

24
Q

What is dermatitis herpetiformis?

A
  • small intensely itchy blisters on extensor surfaces
  • often young patients
  • associated with coeliac disease
25
Q

What is acanthosis nigricans and what is it associated with?

A
  • dark warty lesions in armpits

- associated with internal malignancy

26
Q

What is pretibial myxema (dermopathy around tibia) associated with?

A

graves disease

27
Q

What is the commonest malignant tumour?

A

basal cell carcinoma

28
Q

What are the risk factors for BCC?

A
  • sun exposed site, especially face
  • occasionally secondary to radiotherapy
  • pale skin that burns easily
  • immunosuppression
  • Gorlin’s syndrome (rare)
29
Q

What are the early and late clinical signs of a BCC?

A

early: nodule
late: (rodent) ulcer

30
Q

What cells do SCC arise from?

A

keratinocytes

31
Q

What is marjolins ulcer?

A

SCC arises within chronic scars/ ulcers

32
Q

What is the clinical appearance of a SCC?

A

Nodule with ulcerated, crusted surface

33
Q

What is actinic keratosis?

A
  • pre malignant disease to SCC
  • dysplasia to squamous epithelium
  • scaly lesion with erthematosus base
34
Q

What is the function of melanocytes?

A

function is to form melanin which is transferred to epidermal cells to protect the nucleus from UV radiation

35
Q

What is a benign tumour of melanocytes called?

A

naevi (moles)

36
Q

What is a malignant tumour of melanocytes called?

A

melanoma

37
Q

What are the two types of naevi?

A
  1. Superficial

2. Deep - blue naevi (mongolion spot)

38
Q

Which is the most rare, yet most dangerous skin cancer?

A

melanoma

39
Q

What are the differences in features of a naevus and a melanoma?

A 
Naevus:
Symmetrical
Borders even
Colour uniform
Diameter < 6mm 
Melanoma:
Asymmetrical
Borders uneven
Color variation
Diameter > 6mm
40
Q

What is nodular melanoma?

A

starts as pigmented nodule +/- ulceration - poor prognosis

41
Q

What is lentigo maligna?

A
  • slow growing, flat, pigmented patch

- face-elderly people

42
Q

What is acral lentigenous melanoma?

A
  • palms and soles

- occasionally subungual

43
Q

What are the prognostic factors for a melanoma?

A
  1. Breslow thickness: measure on microscope from granular layer of epidermis to base of tumour
  2. Site - BANS - back, arms, neck, scalp all poorer prognosis
  3. Ulceration
  4. Satellites
  5. Sentinel node

Clinical Pathology (57 decks)

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