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Disease and Defense > Unit 3a > Flashcards

Unit 3a Flashcards

1
Q

Functions of the skin (7)

A 
Decoration
Barrier (physical, light, immunologic)
Vitamin D synthesis
Water Homeostasis
Thermoregulation
Insulation/Calorie Reservoir
Touch/Sensation
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2
Q

How can we get vitamin D?

A

Produced in response to exposing the skin to sunlight, but also acquired in foods

From sun (D3) or diet (D3 or D2) –> calcidiol in liver –> calcitriol active form in kidneys

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3
Q

Cells present in Epidermis (3) and their basic functions

A

Keratinocytes = physical barrier, vitamin D synthesis, water homeostasis

Melanocytes = light barrier

Langerhans cells = immunologic barrier

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4
Q

Glands of the Adnexa and their function (3)

A

Eccrine glands = water homeostasis, thermoregulation

Sebaceous glands = lubrication of the skin

Apocrine glands = pheromones/body odor

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5
Q

Structures of the Dermis and their function (3)

A

Blood vessels = thermoregulation

Fibroblasts = strength and elasticity

Nerves = sensation

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6
Q

Function of the subcutaneous fat layer

A

insulation, calorie reservoir

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7
Q

Fitzpatrick skin type I:

Hair
Eyes
Skin
Freckles?
Sunburn?
Tan?
A 
red/blond hair
blue-green eyes
white skin
\+++ freckles
Always sunburn
no tan
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8
Q

Fitzpatrick Skin Type II

Hair
Eyes
Skin
Freckles?
Sunburn?
Tan?
A 
Blond/Brown hair
Light to medium eyes
Fair skin
\++ freckles
easily sunburns
minimally tans
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9
Q

Fitzpatrick Skin Type III

Hair
Eyes
Skin
Freckles?
Sunburn?
Tan?
A 
Brown hair
medium to dark eyes
light brown skin
\+ freckles
Initially sunburn
Gradually tans
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10
Q

Fitzpatrick Skin Type IV

Hair
Eyes
Skin
Freckles?
Sunburn?
Tan?
A 
Medium to dark hair
dark eyes
moderate brown skin
no freckles
minimally sunburns
tans well
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11
Q

Fitzpatrick Skin Type V

Hair
Eyes
Skin
Freckles?
Sunburn?
Tan?
A 
dark hair
dark eyes
dark brown skin
no freckles
rarely sunburns
dark tan
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12
Q

Fitzpatrick Skin Type VI

Hair
Eyes
Skin
Freckles?
Sunburn?
Tan?
A 
dark hair
dark eyes
black skin
no freckles
never sunburns
always tan
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13
Q

Skin color NOT due to ___________

A

number of melanocytes in the skin

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14
Q

Skin color due to…(2)

A

type of melanin produced

distribution of melanosomes

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15
Q

Melanin Types:

Eumelanin –> _________ pigment

Pheomelanin –> __________ pigment

A

Eumelanin → black/brown pigment

Pheomelanin → yellow/red-brown pigment (skin type I and II)

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16
Q

Distribution of Melanosomes:

Light skin –> ?

Dark skin –> ?

A

Light skin → smaller, distributed in clusters above nucleus in keratinocyte

Dark skin → larger distributed individually throughout cytoplasm of keratinocyte

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17
Q

Albinism is a defect in the ________ gene involved in ____________

A

tyrosinase

melanin production

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18
Q

Vitiligo

A

autoimmune attack of melanocyte

Acquired depigmentation - complete absence of melanocytes

Depigmented patches and macules

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19
Q

Keratinocytes

A

form barrier layer

Synthesize keratin (major intracellular fibrous protein of skin)

Involved in cycle of proliferation, differentiation, and apoptosis

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20
Q

Melanocytes

A

pigment producing cells

Arise from neural crest

Located in basal layer of epidermis, in hair follicles

1:10 ratio (melanocyte:keratinocyte)

Each melanocyte supplies melanin to 30 keratinocytes

Absence of melanocytes usually due to autoimmunity (EX-vitiligo)

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21
Q

Melanin

A

pigment derived from tyrosine

synthesized by melanoyctes, packaged in granules called melanosomes

protects DNA from UV damage

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22
Q

Langerhans Cells

A

dendritic cells, participate in cell-mediated immunity

Derived from bone marrow stem cell

Cycle back and forth between skin and lymph nodes

Found in small numbers in all the epidermal layers

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23
Q

Merkel Cells

A

small cells associated with nerve endings in epidermis

Role in light touch (?) - unknown

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24
Q

The Dermis is the… and made up of which two layers?

A

underlying CT layer (below epidermis)

Papillary layer
Reticular layer

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25
Q

Papillary layer

structure (1)
function (5)
A

(loose CT) immediately under epidermis

1) Site of attachment to epidermis
2) Important for epidermis development and differentiation
3) Contains capillary network blood supply for epidermis
4) Pathway for defense cells
5) Contain Meissner’s Corpuscles (sense delicate touch)

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26
Q

Reticular layer

structure (1)
function (4)
A

dense CT, deeper than pap layer

1) Extensive collagen and elastic fibers for strength and flexibility
2) Houses glands, hairs - major role in their development/function

3) Site of nerve tracts and major sensory receptors
4) Pacinian corpuscles sense vibration, deep pressure, and touch

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27
Q

Pacinian corpuscles are located in the ________ layer, while Meissner’s Corpuscles are located in the _________ layer

A

reticular

papillary

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28
Q

subcutaneous fat is composed of ________

A

adipocytes

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29
Q

Layers of epidermis from deep to superficial (5)

A

1) Stratum basalis
2) Stratum spinosum
3) Stratum granulosum
4) Stratum lucidum
5) Stratum corneum

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30
Q

Stratum basalis (5 characteristics)

A

Basal Cell Layer

Single layer of columnar or cuboidal cells (keratinocytes)

Basal keratinocytes = stem cells of epidermis

Contains Hemidesmosomes and Desmosomes

Deepest layer of epidermis

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31
Q

Stratum spinosum (3 characteristics)

A

“Prickly” appearance due to desmosome attachments between cells

Intracellular adhesions use tonofilament-desmosome interaction to distribute stress

Synthesis of involucrin and membrane coating granules begins here

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32
Q

Stratum granulosum

A

cell in this layer contain different types of granules

E.g. Keratohyalin granules

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33
Q

Keratohyalin granules

A

contain profilaggrin → Filaggrin which cross-links keratin tonofilaments

Important in barrier function of skin

Mutation in Filaggrin → dry skin conditions (ichthyosis, atopic dermatitis)

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34
Q

Stratum lucidum (2)

A

thin, light staining band, seen only in thick skin

Cells have no nuclei or organelles

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35
Q

Stratum corneum (3)

A

outermost layer of epidermis

Keratinocytes have lost nuclei/organelles - entire cell filled with keratin

Desmosomes still connect tightly packed adjacent cells

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36
Q

Hemidesmosomes

A

attach basal cells to basal lamina at dermal-epidermal junction

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37
Q

Ab to hemidesmosomes →

A

bullous pemphigoid

autoimmune subepidermal blistering disease

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38
Q

Genetic defect in Colagen VII –> _____________

A

Dystrophic Epidermolysis Bullosa (EB)

Extensive dystrophic scarring
blistering with skin damage

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39
Q

Genetic defect in laminin-5 –> ?

A

Junctional EB

Improves with age

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40
Q

Desmosomes

A

attach keratinocytes to each other (contain intracellular keratin)

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41
Q

Ab to desmosomes –> ?

A

autoimmune blistering disease (pemphigus vulgaris)

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42
Q

Defect in keratin filament 5 and 14 –> ?

A

Epidermolysis Bullosa Simplex

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43
Q

Tonofilaments

A

protein keratin structures that insert into desmosomes on cytoplasmic side of the plasma membrane

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44
Q

Thick skin (3)

A

hairless
found on palms and soles
has stratum lucidum

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45
Q

Raised and smooth:
less than 1cm
>1cm
>1cm+firm

A

Papule
Plaque
Nodule

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46
Q

Flat area of color change:

less than 1 cm
> 1cm

A

Macule

patch

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47
Q

Fluid filled (3)

A

Vesicle (less than 1cm)
Bulla (>1cm)
Pustule (less than 1cm, contains pus)

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48
Q

Blanchable redness due to increased blood flow =

Erythema
Erythroderma
telangiectasia

A

Erythema = localized

Erythroderma = generalized

Telangiectasia = dilation of small, superficial subcutaneous blood vessels, persistent

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49
Q

Atrophy vs. erosion vs. ulcer vs. fissure

A

Atrophy = thinning of epidermal, dermal, or subcu tissue

Erosion = localized loss of epidermal or mucosal epithelium

Ulcer = loss of epidermis and at least upper dermis

Fissure = linear crack or cleavage

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50
Q

Stasis dermatitis is present on ___________ and is associated with __________

A

Lower legs

Lower extremity efema

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51
Q

Stasis Dermatitis morphology and location of inflammation

A

Morphology: erythematous papules and thin plaques with scale

Location of inflammation: epidermis and dermis

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52
Q

Cellulitis morphology and location of inflammation

A

Morphology: warm, tender, erythematous patches or plaques

Location of inflammation: dermis and subcutaneous tissue

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53
Q

Seborrheic Dermatitis is present on ________ and is due to irritation from _________

A

scalp

Malassezia furfur (yeast) and overproduction of skin oil

54
Q

Psoriasis is typically located on _______ while atopic dermatitis is located on _______

A

extensor surfaces

flexor surfaces

55
Q

Psorasis is associated with _______ and ________ diseases

A

arthritis and cardiovascular

56
Q

Atopic dermatitis is _______, due to defect in _________. It is associated with _______ and _________

A

dry skin

filaggrin

Associated with asthma and allergic rhinitis

57
Q

Nummular dermatitis is located on __________, and is often caused by ____________

A

legs mostly, but also arms and trunk

excess use of soap and dry skin

58
Q

Irritant dermatitis caused by contact with irritating substance. Common irritants are…(7)

A

soap, water, skin products, perfumes, wool, raw foods, body secretions, friction

59
Q

Allergic contact dermatitis is caused by contact with allergen resulting in ____________.

Common allergens include (3)

A

Delayed type hypersensitivity (Type IV)

1) Nickel (#1 cause)
2) Fragrance
3) Neomycin/Bacitracin

60
Q

Diagnosis of allergic contact dermatitis is done with _________

A

patch testing

61
Q

Dermis (4)

A

tough elastic support structure

provides TENSILE strength

beneath epidermis, above subcutaneous tissue

provides ALL nutritional support to epidermis

62
Q

Dermis matrix is made up of…(3)

A

1) Collagen - forms the tensile strength
2) Elastic Fibers - allow for resilience
3) Ground substance - facilitates diffusion

63
Q

_________ makes up 85% of adult dermis and bone and provides _______ strength

A

Collagen I

tensile

64
Q

Synthesis of collagen

A

1) Procollagen synthesized intracellularly in fibroblast

Procollagen = 3 separate protein chains in a-helix structure, EXCRETED

2) Secreted and assembled into collagen fibrils EXTRACELLULARLY
3) Requires vitamin C (for cross-linking) + other cofactors for extracellular assembly

Glycine + proline + hydroxyproline

65
Q

Elastic fibers

A

provide skin with resiliency (ability to distort and return to original shape)

Thin fibers intertwined among collagen bundles

66
Q

Histology:

________ = large eosinophilic (pink)

________ = argyrophilic (silver)

A

Collagen

Elastin

67
Q

Dermis ground substance

A

Glycosaminoglycans + Fibronectins

gelatinous material between/amongst collagen bundles, elastic fibers, and appendageal structures of the dermis

68
Q

Ground substance is produced by _______ and destroyed by __________

A

fibroblasts

enzymes (hyaluronidase)

69
Q

Glycosaminoglycans (GAGs)

two kinds

A

(GAGs) proteins + sugars, absorb water, allows diffusion

1) Hyaluronic acid
2) Dermatan Sulphate

70
Q

Fibronectins act to ___________

A

glue GAGs together

71
Q

Ehlers-Danlos Syndrome (EDS)

A

disorder of COLLAGEN SYNTHESIS

  • Skin hyperextensibility
  • Joint hypermobility
  • Tissue fragility
  • Poor wound healing
  • Gorlin’s sign (touch tip of nose with tongue)
72
Q

Scurvy

A

vitamin C defect → collagen synthesis problem

73
Q

Collagen synthesis problems (2)

A

scurvy

Ehlers-Danlos Syndrome (EDS)

74
Q

Solar Elastosis

A

acquired disorder of ELASTIC FIBERS

Accumulation of significant sunlight exposure → degeneration of elastic fibers → collagen bundles dystrophic and aggregate

Sun-damaged elastic fibers = basophilic (blue) staining

Indicative that sample is from a middle-aged, older person

75
Q

Function of Blood Vessels in dermis layer

A

1) Wound healing
2) Control of homeostasis
3) Modulation of inflammation/leukocyte trafficking
4) Provides ALL blood and nutrients to epidermis

76
Q

Blood vessels are located in the _________ portion of the ___________

A

suprapapillary portion, upper portion of papillary dermis

77
Q

Blood vessels of the dermis are divided into two plexi: ________ and _________

A

superficial and deep

78
Q

Psoriasis can result in _________ after removal of a scaled area of skin

A

Auspitz sign (pinpoint bleeding)

79
Q

Verruca (warts)

A

viral neoplasms with increased blood supply

80
Q

Leukocytoclastic vasculitis

A

disease involving postcapillary venules

Caused by precipitation of immune complexes in walls of small vessels

Type III - Gell and Coombs reaction pattern

“palpable purpura” (combo of inflammation + hemorrhage)

81
Q

Examples of disorders of vascular supply (3)

A

1) Psoriasis
2) Verruca (warts
3) Leukocytoclastic vasculitis

82
Q

Function of nerve tissue

A

inform and protect

83
Q

Pacinian Corpuscle

A

Resemble and onion

Involved in pressure and vibratory sensation

Rapidly adapting, single sensory nerve fiber termination

In dermis of thin and thick skin

Large-concentric layers of flattened CT-like cells interspersed with intercellular fluid/collagen

84
Q

Meissner’s Corpuscle

A

Pine-cone structure

Located near DEJ

Involved in fine touch, tactile discrimination

High concentration in distal aspects of digits

In dermal papillae of THICK skin

85
Q

Free Nerve endings (two types)

A

Pass through upper dermis, terminate in dermoepidermal junction

Type A
Type C fibers

86
Q

Type A nerve fibers

A

myelinated, conduct rapidly

87
Q

Type C nerve fibers

A

unmyelinated, slow conducting

Convey sensation of diffuse, dull, non-localizing

Temperature and itching sensation (PURITIS)

Itch and pain are different and INDEPENDENT sensory modalities

88
Q

Disorders of innervation of the skin

A

Congenital Insensitivity to Pain + Anhidrosis (inability to sweat)

Mutation in neurotrophic tyrosine receptor kinase 1 (NTRK1) which encodes for nerve growth factor (NGFR)

89
Q

Apocrine Glands:

location
secretion composition
initiation of function

3 examples

A

specialized sweat glands

Location: axillary, pubic, and perianal regions

Secretion: Produce milky, viscid, carb-rich secretion (initially odorless → bacterial action → body odor)

Begin to function in puberty (respond to sympathetic adrenergic stimuli)

EX) Moll’s glands (eyelids), cerumen (ear wax), lactation glands (breasts)

90
Q

Structure of apocrine glands

A

coiled portion deep in dermis + straight duct (traverses dermis) + empties into hair follicle

Surrounded by contractile myoepithelial cells

91
Q

Apocrine glands use _________ secretion which is…

A

Decapitation secretion

apical portion of secretory cell cytoplasm pinches off and enters the lumen

92
Q

Eccrine glands

Location
Secretion composition
Function

A

traditional sweat glands all over body

Location: Most numerous on forehead, upper cutaneous lip, palms/soles
-NOT in lips, under nails, on glans penis/clitoris, or labia minora

Secretion: Odorless, watery sweat
-Water, enzyme-rich secretions (initially isotonic → hypotonic as Na+ is reabsorbed by the ducts)

VITAL for thermoregulation - cooling via evaporation of sweat

93
Q

Eccrine glands use __________ secretion which is…

Sweating is mediated by __________

A

Merocrine
-secrete WITHOUT apocrine blebbing or holocrine shedding

SYMPATHETIC portion of ANS - triggered by Ach secretion

94
Q

Apoeccrine Glands

A

hybrid sweat glands

In axilla (role in hyperhydrosis)

Respond to cholinergic stimuli

Long ducts open to surface

Secrete 10x as much sweat as eccrine glands

95
Q

Two types of hairs

A

Terminal Hairs:

  • large, thick, coarse, pigmented (scalp, beard, chest, back, pubic areas)
  • At/near dermal-subcutaneous junction

Vellus Hairs:
-small, fine, apigmented, diffuse on body

96
Q

Embryology of hair

A

Derived from primitive ectodermal germ (PEG)

Underlying mesenchyme (becomes dermal papillae) INDUCES formation of PEG in the overlying fetal skin

Develop in utero - down growth of epidermis forming pilosebaceous unit

97
Q

Hair embryology

Lower bulge –> ?

Middle bulge –> ?

Upper Bulge –> ?

A

Lower Bulge: attachment for arrector pili

Middle Bulge: sebaceous gland

Upper Bulge: apocrine gland

98
Q

Structure of hair (3 segments)

A

Infundibulum - upper third of hair follicle

Isthmus - middle (sebaceous duct to insertion of arrector pili)

Matrical area - lower third (bulb)

Central medulla (soft keratin) + cortex + cubicle of hard keratin

99
Q

Arrector Pili Muscle

A

smooth muscle

Contraction → hair stands on end (goose bump)

100
Q

Hair growth - 3 phases

A

Growth is intermittent (grow 2-3 years, rest several months)

Anagen (growth) - 3 yrs

Telogen (rest) - 3 mos

Catagen (involution) - 3 days

101
Q

Sebaceous glands

A

oil glands, secrete sebum (complex mix of lipids) onto hair

Develop with hair follicles

Development accelerated at puberty - sex hormones requisite to sebum secretion

In oily areas of the body (scalp, face, neck, upper chest, upper back)

102
Q

Sebaceous glands use _________ secretion which is….

A

Holocrine secretion

involves entire sebocytes being secreted

103
Q

Androgenic Alopecia

A

finer, miniaturized, hair higher in dermis

Terminal hairs → vellus hairs (miniaturization of hair follicles)

Aka “pattern baldness”, affect 50% of population

104
Q

Acne

A

disorder of pilosebacceous unit (hair follicle + oil gland)

Follicle becomes plugged, oil accumulates

Bacteria, P. acne cause follicle to rupture → inflammation

105
Q

Anhidrotic Ectodermal Dysplasia

A

Mutation in EDA gene

Aberrant eccrine development

Severely decreased sweating** → Poor temperature regulation

Other ectodermal problems (sparse hair**, abnormal teeth, etc.)

106
Q

Chromohidrosis

A

“colored sweat”

Apocrine origin, lipofuscin pigment causes colored sweat

107
Q

Hyperhidrosis

A
  • involving eccrine and/or apoeccrine glands
  • Excessive sweating
  • New treatment: botox - blocks release of Ach from nerves → block sweat production
108
Q

Seborrheic Dermatitis

1 symptom and its location?

5 associated diseases

A

severe dandruff - scalp, face, upper torso

Diseases: Parkinson’s, head trauma, HIV, chronic neurologic conditions (cerebral palsy), PTSD

109
Q

Acanthosis nigricans

A
  • new onset of soft dark areas in skin folds, hands and neck = “velvet neck”
  • Familial-AD (rare), Drugs (Rare)-nicotinic acid, systemic steroid
  • Related to obesity, DM, endocrinopathies (Cushing’s, PCOS)
  • May precede, accompany, or follow onset of cancer: rapid onset, associated weight loss
110
Q

Skin signs of diabetes (4)

A

1) yellow skin
2) brown/red patches on lower legs
3) diabetic foot ulcers (mal perforans)
4) disseminated granuloma annulare (a whole bunch)

111
Q

Ehlers-Danlos skin signs (3)

A

increased joint/skin elasticity

poor wound healing (large scars)

increased ecchymoses

112
Q

Infective Endocarditis skin signs (6) + other associated symptoms

A

1) splinter hemorrhages in nails
2) purpura
3) nail fold changes
4) Janeway lesions (acute)
5) Osler’s nodes (subacute)
6) Roth spots (eyes)

  • Fever of unknown origin, malaise, fatigue, night sweats, SOB, blood in urine and cough
  • Strep viridans from teeth
113
Q

PHACES Syndrome (peds)

A

large hemangioma of face and neck, affects cervical arteries and heart

114
Q

Marfan’s Syndrome

A

tall, skinny, decreased subcutaneous fat

115
Q

Sarcoidosis (4 signs)

A

1) hyperpigmented plaques
2) erosive/ulcerated plaques
3) granulomatous reactions in tattoos, walled off granulomas
4) Bilateral hilar lymphadenopathy

116
Q

Scleroderma (6 skin signs + other)

A

1) thickened skin over fingers and hands
2) tightening around mouth
3) “Lost smile”
4) Pain in finger tips
5) Reduced ROM with tight feeling
6) salt/pepper skin changes

Other: SOB, difficulty eating

117
Q

Lichen Planus (3)

A

1) new onset itchy rash wrists/lower legs, sores in mouth
2) Purple, polygonal pruritic papules
3) Wickman’s striae

118
Q

Porphyria Cutanea Tarda (PCT)

4 skin signs
underlying defect
treatment

A

1) blistering lesions on hands with sun exposure
2) hypertrichosis
3) atrophic white scars with milia
4) Associated with hepatitis

Due to deficiency in uroporphyrin decarboxylase

TX:
serial phlebotomy to decrease iron load

119
Q

Pyoderma Gangrenosum (PG)

A

punched out ulcers with necrotic sharply demarcated (undermined) border

Associated with Inflammatory Bowel Disease, UC, Crohns, Arthritis

Usually on lower extremities

AVOID surgery and debridement - treat with immunosuppressants and corticosteroids

120
Q

Cullen’s sign and Grey Turner

A

sign of bleeding in peritoneum

Cullen’s sign (periumbilical bruising)
Grey Turner (bruising on flanks)

Sign of blunt trauma to abdomen, acute pancreatitis

121
Q

Koilonychia

A

seen with chronic iron deficiency

Hair loss, heavy/irregular menses, nail changes (spoon)

122
Q

Lupus (4 skin signs)

A

Malar Rash
Discoid Rash
Oral Ulcers
Photosensitivity

123
Q

Acanthosis nigricans with tripe palms → ______ malignancy

A

GI malignancy

124
Q

Erythema Gyratum Repens (= ?) and Hypertrichosis lanuginosa acquisita (= ?) → _________

A

Erythema Gyratum Repens = abnormal wood-grain pattern on skin

Hypertrichosis lanuginosa acquisita = fuzzy hair on face

LUNG cancer

125
Q

Dermatomyositis (rash on upper chest = shawl + purple around eyes) –> ?

A

ovarian/female reproductive malignancy

126
Q

Sister Mary Joseph Node (near belly button) → ?

A

Pancreatic, GI cancer

127
Q

weet Syndrome (big pustules on hand/face + fever) –> ?

A

AML

128
Q

Terry’s nails

A

(distal erythema) → cirrhosis or CHF

129
Q

Linsay’s nails

A

(half and half red/white) → renal disease

Yellow nails, thickened nails, growth interruption all reflective of internal health

130
Q

Rash + fever + headache…think what?

A

ticks

Disease and Defense (11 decks)

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