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Dermatology > Pathology Part 3 > Flashcards

Pathology Part 3 Flashcards

1
Q

Erythroderma

A

Refers to the clinical state of inflammation or redness of all (or nearly all) of the skin - medical emergency

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2
Q

Cuases of Erythroderma

A

o Atopic eczema
o Psoriasis
o Drugs
o Idiopathic

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3
Q

Drug causes of Erythroderma

A
  1. Sulphonamides
  2. Gold
  3. Sulfonylurea
  4. Penicillin
  5. Allopurinol
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4
Q

Erythema nodosum

A

Inflammation of subcutaneous fat

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5
Q

Features of Erythema nodosum

A

> Tender, erythematous, nodular lesions
Usually occurs over shins, may also occur elsewhere
Usually resolves within 6 weeks
Lesions heal without scarring

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6
Q

Infection causes of Erythema nodosum

A
  1. streptococci
  2. tuberculosis
  3. brucellosis
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7
Q

Systemic disease causes of Erythema nodosum

A
  1. sarcoidosis
  2. inflammatory bowel disease
  3. Behcet’s
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8
Q

Drug causes of Erythema nodosum

A

penicillins
sulphonamides
combined oral contraceptive pill

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9
Q

Other causes of Erythema nodosum

A

Pregnancy and malignancy

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10
Q

Treatment for Erythema nodosum

A
  1. Symptomatic – NSAIDs

2. Light compression bandaging and bed rest

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11
Q

Erythema multiforme

A

A hypersensitivity reaction which is most commonly triggered by infections. It may be divided into minor and major forms.

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12
Q

Two types of Erythema multiforme

A

Erythema multiforme minor

Erythema multiforme major

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13
Q

Features of Erythema multiforme

A 
>   Target lesions
>   First back of the hands/feet before spread to torso
>   Pruritus 
>   Resolves in 2-4 weeks
>   No mucosal involvement
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14
Q

Causes of Erythema multiforme

A
  1. Viruses: herpes simplex virus
  2. Idiopathic
  3. Bacteria: Mycoplasma, Streptococcus
  4. Drugs
  5. Erythematosus
  6. Sarcoidosis
  7. Malignancy
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15
Q

Drugs that cause Erythema multiforme

A 
Penicillin
sulphonamides
carbamazepine
allopurinol
NSAIDs
oral contraceptive pill
nevirapine
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16
Q

Erythema multiforme major

A

The more severe form, erythema multiforme major is associated with mucosal involvement.

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17
Q

What do the target lesions in Erythema multiforme look like?

A

Erythematous, polycyclic, annular concentric rings

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18
Q

Pyoderma gangrenosum

A

A rare, non-infectious, inflammatory (neutrophilic dermatosis) disorder. It is an uncommon cause of very painful skin ulceration. It may affect any part of the skin, but the lower legs are the most common site.

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19
Q

Causes of Pyoderma gangrenosum

A 
>   idiopathic in 50%
>   inflammatory bowel disease in 10-15%
>   rheumatoid arthritis
>   SLE
>   lymphoma
>   Liver disease
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20
Q

Pyoderma gangrenosum features

A

Erythematous nodules or pustules that frequently ulcerate
> Bluish-black (gangrenous) edge
> May be associated pyrexia and malaise

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21
Q

Treatment for Pyoderma gangrenosum

A
  1. Very potent topical steroids
  2. Immunosuppressants used in resistant cases
  3. Underlying cause should be treated
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22
Q

Acanthosis nigricans

A

Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin.

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23
Q

Causes of Acanthosis nigricans

A 
Type 2 diabetes mellitus
Gastrointestinal cancer
Obesity
Polycystic ovarian syndrome
Acromegaly
Cushing's disease
Hypothyroidism
Familial
Prader-Willi syndrome
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24
Q

Drugs that cause Acanthosis nigricans

A
  1. Combined oral contraceptive pill

2. Nicotinic acid

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25
Q

Scleroderma

A

Thickening or hardening of the skin owing to abnormal dermal collagen

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26
Q

Pathophysiology of Acanthosis nigricans

A

Insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)

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27
Q

Management of acanthosis nigricans

A

Oral or topical retinoids

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28
Q

Dermatomyositis

A

A variant of polymyositis - an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions

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29
Q

Features of dermatomyositis

A
  1. photosensitive
  2. macular rash over back and shoulder
  3. heliotrope rash in the periorbital region
  4. Gottron’s papules
  5. nail fold capillary dilatation
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30
Q

Investigations in dermatomyositis

A

ANA positive
anti-Jo-1
anti-SRP
anti-Mi-2 antibodies

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31
Q

Treatment for dermatomyositis

A

o Hydroxychloroquine

o Immunosuppressants

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32
Q

Sarcoidosis

A

A multisystem disorder of unknown aetiology characterised by non-caseating granulomas. It is more common in young adults and in people of African descent

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33
Q

Sarcoidosis features

A 
>   Erythema nodosum, 
>   bilateral hilar lymphadenopathy, 
>   swinging fever, 
>   polyarthralgia
>   dyspnoea, 
>   non-productive cough, 
>   malaise, 
>   weight loss
>   Hypercalcaemia
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34
Q

Lofgren’s syndrome

A

Is an acute form of sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis

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35
Q

Mikulicz syndrome

A

There is enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma

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36
Q

Heerfordt’s syndrome

A

There is parotid enlargement, fever and uveitis secondary to sarcoidosis

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37
Q

What are the two type of Neurofibromatosis?

A

NF1

NF2

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38
Q

Neurofibromatosis

A

A group of autosomal dominant genetic disorders that cause tumors to form on nerve tissue. These tumors can develop anywhere in the nervous system.

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39
Q

Features of NF1

A
  1. Café-au-lait spots (>= 6, 15 mm in diameter)
  2. Axillary/groin freckles
  3. Peripheral neurofibromas
  4. Iris hamatomas (Lisch nodules) in > 90%
  5. Scoliosis
  6. Pheochromocytomas
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40
Q

Café-au-lait spot

A

Feature of NF1 and Tuberous sclerosis

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41
Q

Tuberous sclerosis (TS)

A

A genetic condition of autosomal dominant inheritance.

Causes benign growths in many parts of the body

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42
Q

Features of cutaneous Tuberous sclerosis (TS)

A
  1. Depigmented ‘ash-leaf’ spots - fluoresce under UV
  2. Shagreen patches
  3. adenoma sebaceum (angiofibromas)
  4. Subungual fibromata
  5. Café-au-lait spots* may be seen
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43
Q

Shagreen patches

A

An irregularly shaped, irregularly thickened, slightly elevated soft skin-colored patch, usually on the lower back, made up of excess fibrous tissue.

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44
Q

Subungual fibromata

A

A painless, slow-growing tumor seen in the nail apparatus

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45
Q

Adenoma sebaceum (angiofibromas)

A

Refers to the reddish-brown papular rash found characteristically in a “butterfly” distribution over the face.

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46
Q

Bopsy and immunoflourescene is gold standard to identify and distinguish between pemphigoid and pemphigus. What are the differences seen?

A

Pemphigoid: linear IgG on IF
Pemphigus: scattered IgG on IF

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47
Q

Pemphigus vulgaris

A

Is an autoimmune disease caused by antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule. It is more common in the Ashkenazi Jewish population.

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48
Q

Features of Pemphigus vulgaris

A

> Mucosal ulceration
Flaccid, easily ruptured vesicles and bullae.
Nikolsky’s positive
Acantholysis on biopsy

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49
Q

Nikolsky’s sign

A

The sign is present when slight rubbing of the skin results in exfoliation of the outermost layer.

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50
Q

Acantholysis

A

Means loss of coherence between epidermal cells due to the breakdown of intercellular bridges.

51
Q

Management of Pemphigus vulgaris

A
  1. High dose oral prednisolone

2. Immunosuppressants

52
Q

Bullous pemphigoid

A

An autoimmune condition causing sub-epidermal (basement membrane) blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230.

53
Q

Features of Bullous pemphigoid

A
  1. Itchy, tense blisters typically around flexures
  2. the blisters usually heal without scarring
  3. there is usually no mucosal involvement (i.e. the mouth is spared)*
  4. Nikolsky negative
54
Q

Difference in location of blisters in Pemphigus and Pemphigoid

A

Pemphigus - intraepidermal - Nikolsky positive

Pemphigoid - subepidermal (Dermo-epidermal junction)

55
Q

Dermatitis herpetiformis

A

An autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.

56
Q

Features of Dermatitis herpetiformis

A

o Commoner in males
o Small intensely itchy blisters of the skin
o Appear on the elbows, extensor forearms, scalp and buttocks

57
Q

Management of Dermatitis herpetiformis

A

Gluten-free diet

Dapsone

58
Q

Dapsone

A

A sulphonamide antibiotic.

It acts as an anti-inflammatory drug and has been used successfully as a treatment for several skin conditions such as dermatitis herpetiformis & pyoderma gangrenosum,

59
Q

Biopsy features in Dermatitis herpetiformis

A

Show IgA in the dermal papillae and patchy granular IgA along the basement membrane

The jejunal mucosa shows a partial villous atrophy

60
Q

Filaggrin

A

A protein that increases risk of eczema, hay fever and asthma

61
Q

Porphyria cutanea tarda (PCT) type 1

A

Blisters, fragility, hyperpigmentation, hypertrichosis

Manage the skin condition and underlying cause

62
Q

Capsaicin

A

Antipruritic - active component of chill peppers

63
Q

Gorlin’s syndrome

A

o Autosomal dominant familial cancer syndrome
o Multiple BCC
o Early onset

64
Q

Spongiosis

A

Oedema between keratinocytes

65
Q

Epidermolysis bullosa

A

Is where the skin blisters on minimal trauma (inherited)

66
Q

Example of mild steroid

A

1% hydrocortisone

67
Q

Example of moderate steroid

A

Eumovate

68
Q

Example of potent steroid

A

Betnovate

69
Q

Example of very potent steroid

A

Dermovate

70
Q

Immune thrombocytopenic purpura

A

Immune disorder characterised by platelet-bound antibody, often with a previous history of infection.

Blood tests show a very low platelet count

71
Q

Erythema migrans

A

o Bulls eye appearance
o Caused by a tick bite
o Early sign of lyme disease
o Red macule surrounded by another red circle, with non-affected skin in between

72
Q

Herpangina

A

Blistering rash of the back of the mouth
Caused by enterovirus (not herpes virus)
> Coxsackie virus
> Echovirus

73
Q

Angioma vessels

A

Benign localised overgrowth of blood vessels

74
Q

Target lesion

A

Erythema multiforme

75
Q

Large tense bullae that are itchy and cannot be burst

A

Bullous pemphigoid

76
Q

Flaccid blisters that can be burst easily to form erythematous erosions

A

Pemphigus vulgaris

77
Q

Heliotrope rash and scaly knuckles

A

Dermatomyositis

78
Q

Cauliflower appearance

A

Plantar warts

79
Q

Silver scales, extensor surface

A

Plaque psoriosis

80
Q

Honey-colored crust

A

Impetigo

81
Q

Stuck on appearance

A

Basal cell papilloma

82
Q

Androgenic alopecia

A

o Male pattern baldness
o Positive family history
o Frontal receding with thinning of the crown
o May occur in females following menopause

83
Q

Alopecia areata

A

o Immune mediated hair loss
o Patches of baldness
o Broken exclamation mark hairs

84
Q

Hirsutism

A

Male pattern hair growth seen in females

85
Q

Hypertrichosis

A

State of excessive hair growth at any site and occurs in both sexes

86
Q

Neuropathic ulcers

A

Tend to be seen over pressure areas of the feet, such as the metatarsal heads
Most commonly seen in diabetics due to peripheral neuropathy - Painless

87
Q

Neuropathic ulcers management

A
  1. Keeping the ulcer clean
  2. Remove pressure or trauma from the affected area
  3. See a podiatrist for correctly fitting shoes
88
Q

Arterial ulcers

A 
o	Present as punched-out, painful ulcers
o	Higher up the leg 
o	“Sharp cliff-like edge”
o	The leg is cold and pale
o	Absent peripheral pulses 
o	Loss of hair may be present
89
Q

Arterial ulcers management

A
  1. Compression bandaging must NOT be used
  2. Keep the ulcer clean and covered
  3. Adequate analgesia and vascular reconstruction
90
Q

Venous ulcers management

A
  1. High compression bandaging
  2. Leg elevation
  3. Doppler studies should always be done before bandaging to exclude arterial disease
  4. Analgesia
  5. Wet/moist ulcer dressing
91
Q

Why should doppler US studies be done before compression bandaging in venous ulcers?

A

Doppler studies should always be done before bandaging to exclude arterial disease

92
Q

Venous ulcers

A

Result of sustained venous hypertension in the superficial veins due to incompetent valves or previous DVT
o Common later in life and cause significant
o “Shallow like a beach”
o Chronic and recurrent
o Most commonly found on the lower leg

93
Q

Melanocytic naevi (moles)

A

o Benign overgrowth of melanocytes that are common in white-skinned people
o Appear in childhood and increase in number and size as you get older
o Start flat and as they proliferate they become elevated
o Even pigmentation and regular border

94
Q

Blue naevus

A

Acquired symptomatic blue-looking mole

95
Q

Basal cell papilloma (seborrhoeic wart)

A

o Common benign overgrowth of the basal cell layer of the epidermis
o Surface is irregular and appear ‘stuck on to the skin’
o Can be treated with cryotherapy

96
Q

Another name for Basal cell papilloma

A

Seborrhoeic wart

97
Q

Dermatofibromata

A

o Firm, elevated pigmented nodules that may feel like a button on the skin
o Peripheral ring of pigmentation is sometimes seen
o Often on the leg, commoner in females

A dermatofibroma is the name we give to a common and harmless knot of fibrous tissue which occurs in the skin. Dermatofibromas are firm bumps which feel like small rubbery buttons lying just under the surface of the skin.

98
Q

Solar keratosis (actinic keratosis)

A

> Significant sun exposure
Exposed skin as erythematous silvery-scaly papules or patches
Background skin is inelastic, wrinkled with flat brown macules (solar lentigos) reflecting diffuse solar damage

99
Q

What is the risk of Solar keratosis (actinic keratosis)

A

A small proportion can transform into SCC after many years

100
Q

Another name for Solar keratosis

A

Actinic keratosis

101
Q

Treatment for Solar keratosis

A
  1. Crytotherapy

2. Topical 5-flourouracil cream

102
Q

Bowen’s disease

A

Form of intrapeidermal carcinoma-in-situ which can become invasive - Due to long-term sun exposure

Presents on exposed skin, most commonly on women’s legs, as an isolated scaly red patch or plaque looking rather like psoriasis

103
Q

Bowen’s disease management

A
  1. Crytotherapy

2. Topical 5-flourouracil cream

104
Q

Giant congenital melanocytic naevi

A

o Very large moles present at birth

o Increased risk of developing malignant melanoma

105
Q

Lentigo maligna

A

o Slow-growing macular area of pigmentation seen in elderly people, commonly on the face
o Border and pigmentation are often irregular
o Increased risk of developing invasive malignant melanoma

106
Q

Risk of Lentigo maligna

A

Increased risk of developing invasive malignant melanoma

107
Q

Most common malignant skin tumour

A

Basal cell carcinoma (rodent ulcer)

108
Q

Basal cell carcinoma features

A

Can present as a slow-growing papule or nodule that may go on to ulcerate

Telangiectasia over the tumour or a skin-coloured jelly-like ‘pearly edge’ may be seen

109
Q

Basal cell carcinoma

A

Most common malignant skin tumour

Common later in life on exposed sites (although rare on the ear)

110
Q

Basal cell carcinoma management

A

Surgical excision

111
Q

What area is rare for BCC to develop?

A

The ear

112
Q

Squamous cell carcinoma

A

o More aggressive than BCC and can metastasize
o Can arise in pre-existing bowen’s disease
o Ill-defined nodules that may ulcerate
o Grow rapidly
o Examination of regional lymph nodes is essential
o Most common on sun-exposed sites, particularly lower lip and ear

113
Q

Risk factors for SCC

A
  1. excessive exposure to sunlight
  2. actinic keratoses and Bowen’s disease
  3. immunosuppression e.g. renal transplant, HIV
  4. smoking
  5. long-standing leg ulcers (Marjolin’s ulcer)
  6. genetic conditions e.g. xeroderma pigmentosum,
  7. oculocutaneous albinism
114
Q

Common sites for SCC

A

Lower lip & ear

115
Q

Malignant melanoma

A

o Most serious form of skin cancer

o History of childhood sun exposure and intermittent intense sun exposure appears to be necessary

116
Q

Risk factors for Malignant melanoma

A 
>	Pale skin
>	Multiple melanocytic naevi (>5)
>	Immunosuppression 
>	Family history 
>	Lentigo maligna
117
Q

Most common Malignant melanoma

A

Superficial spreading

118
Q

The 4 types of malignant melanoma

A

Superficial spreading
Nodular
Lentigo maliga
Acral lentiginous

119
Q

Second most common Malignant melanoma

A

Nodular

120
Q

Most aggressive Malignant melanoma

A

Nodular

121
Q

Superficial spreading malignant melano sites of invasion

A

Arms, legs, back and chest, young people

122
Q

Nodular malignant melano sites of invasion

A

Sun exposed skin, middle-aged people

123
Q

Lentigo maliga (malignant melanoma) sites of invasion

A

Chronically sun-exposed skin, older people

124
Q

Acral lentiginous malignant melano sites of invasion

A

Nails, palms or soles, African Americans or Asians

Dermatology (4 decks)

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