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XXII - The Skin Flashcards

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USMLE® Step 1 flashcards
1
Q

This term is the accumulation of edema fluid within the epidermis. Characterizes all forms of eczamatous dermatitis. SEE SLIDE 22.1

A

Spongiosis(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 839

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2
Q

An uncommon, usually self-limited disorder that seems to be a hypersensitivity response to certain infections and drugs. Patients present with an array of “multiform” lesions, including macules, papules, vesicles, and bullae, as well as the characteristic targetoid lesion consisting of a red macule or papule with a pale vesicular or eroded center. SEE SLIDE 22.2.

A

Erythema Multiforme (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 840

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3
Q

Marked epidermal thickening. SEE SLIDE 22.3.

A

Acanthosis (TOPNOTCH) Robbins Basic Pathology, 9th Ed., p854.

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4
Q

The most typical lesion is a well-demarcated, pink to salmon-colored plaque covered by loosely adherent silver-white scale. SEE SLIDE 22.4.

A

Psoriasis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 854

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5
Q

In this skin disorder, there is acanthosis and loss of the stratum granulosum with extensive overlying parakeratotic scale. There is also a regular downward elongation of rete ridges (test tubes in a rack appearance). SEE SLIDE 22.5.

A

Psoriasis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 855

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6
Q

This sign is described as bleeding upon removal of scales from the lesions of psoriasis.

A

Auspitz sign(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

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7
Q

Small aggregates of neutrophils within the parakeratotic stratum corneum in psoriasis.

A

Munro microabscesses. SEE SLIDE 22.5. (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

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8
Q

Small aggregates of neutrophils within the spongiotic superficial epidermis in psoriasis.

A

Pustules of Kogoj. SEE SLIDE 22.5. (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

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9
Q

Layer of the skin which is affected in psoriasis.

A

S. granulosum(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

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10
Q

“Pruritic, purple, polygonal, planar papules, and plaques” describes this disorder of the skin and mucosa. Also noted grossly are Wickham striae, which are white lacelike markings over the papules. SEE SLIDE 22.6.

A

Lichen Planus (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 855

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11
Q

The pattern of inflammation of this disorder is characterized by angulated, zigzag contour (“sawtoothing”) of the dermoepidermal junction. SEE SLIDE 22.7.

A

Lichen Planus (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 855

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12
Q

Anucleate, necrotic basal cells seen in the inflamed papillary dermis of patients with lichen planus.

A

Colloid bodies or Civatte bodies(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

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13
Q

Characterized to have acanthosis, hyperkeratosis, hypergranulosis, with signs of chronicity such as fibrosis of the papillary dermis and chronic dermal inflammatory infiltrate. SEE SLIDE 22.8.

A

Lichen Simplex Chronicus (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 856

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14
Q

Presents as roughening of the skin that takes on an appearance reminiscent of “lichen on a tree”. It is a response to local repetitive trauma such as continual rubbing or scratching. Lesions are similar to the normal appearance of palms and soles (naturally thick). SEE SLIDE 22.8.

A

Lichen Simplex Chronicus (TOPNOTCH)Robbins Basic Pathology, 9th ed. P.856

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15
Q

Cytoplasmic vacuolization

A

Koilocytosis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p.857

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16
Q

Histologic features include epidermal hyperplasia that is often undulant (papillomatous) in character, with associated koilocytosis. Nuclear pallor and prominent keratohyalin granules can also be seen. SEE SLIDE 22.9.

A

Verrucae (warts)(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 858

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17
Q

The most common type of wart. Occurs anywhere but are found most frequently on the hands, particularly on the dorsal surfaces and periungual areas, where they appear as gray-white to tan, flat to convex, 0.1- to 1-cm papules with a rough, pebble-like surface. SEE SLIDE 22.9.

A

Verruca vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

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18
Q

These warts are common on the face or dorsal surfaces of the hands. These warts are flat, smooth, tan macules.

A

Verruca plana/flat wart(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

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19
Q

These warts occur on the soles and palms. Described as rough, scaly lesions that may reach 1 to 2 cm in diameter, coalesce, and be confused with ordinary calluses.

A

Verruca plantaris and verruca palmaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

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20
Q

These warts occurs on the penis, female genitalia, urethra, and perianal areas.

A

Condyloma acuminatum (venereal wart) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 844

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21
Q

A rare autoimmune blistering disorder resulting from loss of integrity of normal intercellular attachments within the epidermis and mucosal epithelium. Caused by a type II hypersensitivity reaction .

A

Pemphigus (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

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22
Q

Common histologic denominator in all forms of pemphigus, described as the lysis of the intercellular adhesion sites.

A

Acantholysis. SEE SLIDE 22.10. (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

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23
Q

In this variant of pemphigus, acantholysis selectively involves the layer of cells immediately above the basal cell layer, giving rise to a suprabasal acantholytic blister. SEE SLIDE 22.11.

A

Pemphigus vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

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24
Q

There is uniform deposition of immunoglobulin and complement along the cell membranes of keratinocytes, producing a characteristic “fishnet” appearance. SEE SLIDE 22.11.

A

Pemphigus vulgaris(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

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25
Q

Grossly, the lesions appear to be superficial and FLACCID vesicles and bullae that rupture easily.

A

Pemphigus vulgaris(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 859

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26
Q

In this variant of pemphigus, acantholysis selectively involves the superficial epidermis at the level of the stratum granulosum. It often involves only the skin and not the mucus membranes.

A

Pemphigus foliaceus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845

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27
Q

Characterized by a subepidermal, nonacantholytic full-thickness epidermal blister. The lesions appear to be TENSE and fluid-filled. Intercellular junctions are intact on the blister roof. SEE SLIDE 22.12.

A

Bullous pemphigoid (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 860

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28
Q

An autoimmune disease in which the characteristic finding is linear deposition of IgG antibodies and complement in the basement membrane zone. SEE SLIDE 22.12.

A

Bullous pemphigoid (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 846

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29
Q

Associated with celiac disease. Lesions are often bilateral, symmetric and preferentially involve extensor surfaces, buttocks, elbows, and knees. SEE SLIDE 22.13.

A

Dermatitis herpetiformis (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 861

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30
Q

Fibrin and neutrophils accumulate selectively at the tips of dermal papillae, forming small microabscesses, which coalesce to form a subepidermal blister. On immunofluorescence, granular deposits of IgA are localized at the tips of dermal papillae. SEE SLIDE 22.13.

A

Dermatitis herpetiformis (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 846

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31
Q

Round, exophytic, coin-like plaques varying in diameter, with a velvety/granular surface . Tan to dark brown in color, it as a stuck-on appearance often seen in older individuals. SEE SLIDE 22.14.

A

Seborrheic keratosis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 862

32
Q

The lesions consist of an orderly proliferation of uniform, monotonous sheets of small cells (basaloid in appearance) with a tendency to form keratin microcysts (horn cysts). SEE SLIDE 22.14.

A

Seborrheic keratosis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 862

33
Q

These are rare tumors that primarily occur in the head and neck region of older individuals. They usually present as flesh-colored papules and can be a marker for an internal malignancy.

A

Sebaceous Adenoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849

34
Q

Grossly, lesions are less than 1cm, tan-brown or red in color, with sandpaper-like surface. Microscopically, there is cytologic atypia in the lower epidermis and thinning of the superficial epidermis with parakeratosis. SEE SLIDE 22.15

A

Actinic keratoses(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 862

35
Q

These lesion is usually the result of chronic exposure to sunlight. The dermis contains thickened, blue-gray elastic fibers or “solar elastosis” which is the result of chronic sun damage. SEE SLIDE 22.15

A

Actinic keratoses(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 850

36
Q

Acronym for remembering the histologic features of actinic keratoses.

A

“Sunny” SPAINS S - solar elastoses (dermal sun damage)P - parakeratosisA - atypia (keratinocytic)I - inflammationN - not full thickness atypia(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 850

37
Q

A common tumor arising on sun-exposed sites in older people, with higher incidence in women. May arise from prior actinic keratoses, then when advanced become nodular and may ulcerate.

A

Squamous cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 9th ed., p 863

38
Q

Characterized by highly anaplastic (seen on all levels of the epidermis), rounded cells with foci of necrosis and only abortive, single-cell keratinization (dyskeratosis). SEE SLIDE 22.16.

A

Squamous cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 851

39
Q

This is the most common human cancer, which is a slow-growing tumor that rarely metastasizes. Tends to occur at sites subject to chronic sun exposure and in lightly pigmented people.

A

Basal cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852

40
Q

These tumors present as pearly, smooth-surfaced papules, often containing prominent, dilated subepidermal blood vessels (telangiectasia). The cells have scant cytoplasm, small hyperchromatic nuclei, and a peripheral palisade with clefting from the stroma. SEE SLIDE 22.17.

A

Basal cell carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852

41
Q

This refers to any benign congenital or acquired neoplasm of melanocytes.

A

Melanocytic nevus(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 853

42
Q

These are large nevi and may occur as hundreds of lesions on the body surface. They are flat macules to slightly raised plaques, with a “pebbly” surface. Considered as a marker of melanoma risk.

A

Dysplastic nevi(TOPNOTCH)Robbins Basic Pathology, 8th ed., p 854

43
Q

This cancer of the skin may develop from a dysplastic nevus, and results from excessive sun exposure. Malignant cells have large nuclei with irregular contours having chromatin characteristically clumped at the periphery of the nuclear membrane and prominent eosinophilic nucleoli often described as “cherry red”. Has both radial and vertical growth phases. SEE SLIDE 22.18.

A

Melanoma (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 855

44
Q

This determines the biologic behavior of melanomas.

A

Nature and extent of the vertical growth phase (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 857

45
Q

What is the most commonly accepted exogenous cause of squamous cell carcinoma of the skin?

A

Exposure to UV light (TOPNOTCH)

46
Q

Cutaneous horns are seen in what condition?

A

Actinic Keratosis (TOPNOTCH)

47
Q

Morphology: Characterized by loss of melanocytes

A

Albinism (TOPNOTCH)

48
Q

In albinism, melanocytes are present but melanin pigment is not produced due to what enzyme deficiency or defect?

A

Tyrosinase (TOPNOTCH)

49
Q

Q: + for melanocyte-associated proteins such as tyrosinase or Melan-A or S

A

Vitiligo (TOPNOTCH)

50
Q

The early developmental stage in melanocytic nevi is called?

A

Junctional nevi (TOPNOTCH)

51
Q

Most junctional nevi grow into the underlying dermis as nests or cords of cells and are calle

A

Compound nevi (TOPNOTCH)

52
Q

When all the epidermal nests of compound nevi are lost entirely they form what

A

intradermal nevi (TOPNOTCH)

53
Q

Appears to play an important role in the development of skin malignant melanoma

A

Sunlight (TOPNOTCH)

54
Q

What are the 5 clinical warning signs of melanoma?

A
  1. enlargement of a pre-existing mle2. itching or pain in pre-existing mole3. development of a new pigment lesion during adult life4. irregularity of the borders of a pigment lesion5. variegation of color within a pigmented lesion (TOPNOTCH)
55
Q

Appears clinically as flesh-colored, dome shaped nodules with central, keratin filled plug, imparting a crater like topography. SEE SLIDE 22.19.

A

Keratoacanthoma (TOPNOTCH)

56
Q

Morphology: Central, keratin filled crater surrounded by proliferating epitheal cells that extend upward in a lip-like fashion over the sides of the crater and downward into the dermis as irregular tongues. SEE SLIDE 22.19.

A

Keratoacanthoma (TOPNOTCH)

57
Q

The most important clinical sign of malignant melanoma

A

change in color, size, or shape in a pigmented lesion (TOPNOTCH)

58
Q

In Malignant Melanoma, what type of growth indicated the tendency of a melanoma to grow horizontally within the epidermal and superficial dermal layers, often for a prolonged period of time?

A

Radial growth (TOPNOTCH)

59
Q

In Malignant Melanoma, what are the determinants of a more favorable prognosis?

A
  1. Tumor depth of less than 1.7 mm2. Absence or low numbers of mitoses3. Presence of a brisk TIL response (Tumor Infiltrating Leukocytes)4. Absence of regression 5. Female gender6. Location on extremity skin (TOPNOTCH)
60
Q

A 20 y/o male, previously known case of peanut allergy inadvertently took biscuits containing peanuts. Within a short time, he developed pink wheals on his extremities and trunk that are pruritic. Histologic findings in his lesion will include:

A

Sparse superficial perivenular infiltrate of mononuclear cells and eosinophils. (TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 1162

61
Q

Histologic hallmark of Cutaneous T-cell Lymphoma

A

Presence of Sezary-Lutzner cells. SEE SLIDE 22.20. (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1160

62
Q

Presents with small, pruritic papules to large edematous plaques, which may coalesce to form annular, linear, or arcform configurations. There is usually superficial perivenular infiltrate consisting of mononuclear cells, rare neutrophils, and eosinophils.

A

Urticaria(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1162

63
Q

Febrile form of erythema multiforme associated with extensive involvement of skin, lips and oral mucosa, conjunctiva, urethra, and genital and perianal areas, often seen in children.

A

Steven-Johnson syndrome(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1164

64
Q

It is characterized by kertinocyte injury mediated by skin-homing CD8+ band cytotoxic T lymphocytes; presenting with diverse array of lesions.

A

Erythema Multiforme (TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1164

65
Q

Process by which local trauma induce psoriatic lesions in susceptible individuals

A

Koebner phenomenon(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1165

66
Q

Presents with macules and papules on an erythematous-yellow, often greasy base, in association with extensive scaling and crusting. Histologically, mounds of parakeratosis containing neutrophils and serum are present at the ostia of hair follicles(Follicular lipping). SEE SLIDE 22.21.

A

Seborrheic dermatitis(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1166

67
Q

Group of disorders caused by inherited defects in structural proteins that lend mechanical stability to the skin; common feature is a proclivity to form blisters at sites of pressure, rubbing, or trauma, at or soon after birth

A

Epidermolysis bullosa(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1171

68
Q

Presents with urticaria and vesicles associated with scarring that are exacerbated by exposure to sunlight. The vesicles are subepidermal in location and dermis contains vessels with walls that are thickened by glassy deposits of serum proteins.

A

Porphyria(TOPNOTCH)Robbins Basic Pathology, 9th ed., p 1172

69
Q

Presents with stages of flushing, then persistent erythema and telangiectasia, followed by pustules and papules, and lastly by permanent thickening of the nasal skin by confluent erythematous papules and prominent follicles(rhinophyma). SEE SLIDE 22.22.

A

Rosacea(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1174

70
Q

Presents with multiple lesions on the skin and mucus membranes, with predilection for the trunk and anogenital areas. Lesions are firm, often pruritic, pink to skin-colored umbilicated papules, with curd-like material which can be expressed from the central umbilication. SEE SLIDE 22.23.

A

Molluscum contagiosum(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1176

71
Q

The pathogenesis of blister formation in this condition is related to bacterial production of a toxin that cleaves desmoglein 1, the protein responsible for cell-to-cell adhesion within the uppermost epidermal layers.

A

Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177

72
Q

Presents as an erythematous macule and multiple pustules. As pustules break, shallow erosions from, covered with drying serum, giving the characteristic honey-colored crust

A

Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177

73
Q

It has the characteristic microscopic feature of accumulation of neutrophils beneath the stratum corneum often producing a subcorneal pustule containing serum proteins and inflammatory cells.

A

Impetigo(TOPNOTCH)Robbins Basic Pathology, 9th ed., p. 1177

74
Q

A 25 year old male presents with well-demarcated pink plaques on his elbows, scalp, and knees that have a silvery scale. A biopsy showed acanthosis, elongated rete ridges, loss of stratum granulosum with an overlying parakeratotic scale, thinning of the epidermis overlying the dermal papillae, and neutrophil aggregates in the parakeratotic stratum corneum. The dermatologist removes one of the scales, and a pinpoint bleeding is observed. This phenomenon is due to (A) the acanthosis (B) thinning of the epidermis overlying the dermal papillae (C) neutrophil aggregates (D) elongated rete ridges

A

Thinning of the epidermis overlying the dermal papillae (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 841

75
Q

A 62 year old woman has a coin-like, dark brown plaque on her chest that appears stuck-on. She has it excised, and histopathology showed an orderly proliferation of basaloid cells, with keratin microcysts. SEE SLIDE 22.14. Some of the basaloid cells have melanin. Her lesion (A) is a tumor of malignant melanocytes (B) is common in her age group (C) will exhibit a fishnet appearance if subjected to immunofluorescence (D) is a melanocytic nevus

A

is common in her age group (seborrheic keratosis) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 845848-849

76
Q

A 33 year old female has multiple flesh-colored papules on her face, neck, trunk, and limbs. One of the papules is excised, which showed a lobular proliferation of sebocytes, some with vacuolated cytoplasm, others more basaloid in appearance. Her lesions may be a sign of underlying (A) colorectal carcinoma (B) nonHodgkin lymphoma (C) aplastic anemia (D) thalassemia

A

Colorectal carcinoma (sebaceous adenoma and Muir-Torre syndrome) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 849

77
Q

A 45 year old male has a pearly papule with prominent vessels on his eyelid. He has it excised, and the lesion showed multiple nodules of basaloid cells with scant cytoplasm and peripheral palisading. The nodules appear separated from the stroma. His lesion (A) frequently metastasizes to distant sites (B) is correlated to sun exposure (C) is associated with HPV infection (D) may arise on mucosal surfaces

A

Is correlated with sun exposure (basal cell carcinoma) (TOPNOTCH)Robbins Basic Pathology, 8th ed., p 852

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