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Clinical Pathology > 63 - Inflammatory Skin Diseases, Skin Tumours, The eye > Flashcards

63 - Inflammatory Skin Diseases, Skin Tumours, The eye Flashcards

1
Q

Herpes varicella zoster

A

If trigeminal nerve involed can cause scarring - inflames: cornea and conjunctiva

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2
Q

Chlamydia inflaming cornea and conjunctiva

A

Trachoma is a tropical disease which infects the corneum and conjunctiva which is a common cause of blindness

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3
Q

Causes of cataracts

A

affects lens

Senile degeneration
Rubella
Down's
Irradiation
DM
Uveitis
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4
Q

Retinal infections

A

Toxoplasma

Toxocara canis

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5
Q

Toxoplasma

A

Cat is host and oocyst in faeces

Congenital infection can cause severe bilateral disease

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6
Q

Toxocara canis

A

From infected dog faeces

Larva may migrate to retina and die causing localised inflammation

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7
Q

Retinal vascular disease

A

Ischaemia - atheroma, vasculitis, embolis of retinal art. Ischaemic dmg to retina.

Hypertensive retinopathy - flame shaped haemorrhage and exudates

Diabetic retinopathy - dot and blot haemorrhages

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8
Q

Macular degeneration

A

Damage to macule - central part of vision

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9
Q

dry macular degen

A 
age related
90% cases
Affects >60 yo
Progressive visual impairment 
No treatment
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10
Q

Wet macular degen

A

10% due to new vessel growth beneath retina

Treat with drugs and lasers

Drugs inhibit vessel growth injected directly into the eye

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11
Q

Eye tumours

A

RB

Melanoma

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12
Q

RB

A

Rare, 10% familial

Genetics: deletion of long arm of chromosome 13 - loss of RB gene.

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13
Q

Melanoma of eye

A

arise melanocytes of uveal tract (iris, ciliary body or choroid)

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14
Q

Common skin infections

A

Herpes varicella zoster - chickenpox, shingles

HSV 1: cold sores
HSV2: genital herpes, STD

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15
Q

Common bacterial skin infections

A

Superficial - Impetigo, staph infection usually in young children. Infection in corneal later. Clinically: crusted yellow scale with pustules

Deep - cellulitis, often strep. pyogenes. infection of dermis. Clinically: hot, red, swollen painful area. Necrotising fasciitis (flesh eating bug)

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16
Q

Abscesses are

A

deep collection of pus

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17
Q

mycobacteria are

A

fish tank granuloma, direct inoculation on hand

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18
Q

leprosy caused by

A

mycobacterium leprae

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19
Q

leprosy is a

A

chronic granulomatous infection. can involve nerves, loss of sensation

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20
Q

fungal infections

A

ring worm - tinea pedis (athlete’s foot)

tinea cruris (groins) likes hot moist areas

thrush - candida infection. warm, moist areas. vagina, nappy rash, oral.

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21
Q

Eczema/dermatitis

A

Many types. Eczema is greek for boil over.

5% of children in UK

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22
Q

3 stages of eczema

A

Acute - skin red, weeping serous exudate ± vesicles

Subacute dermatitis - skin is red, less exudate, itching ++, crusting

Chronic dermatitis - skin thick and leathery secondary to scratching

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23
Q

Microscopy of eczema

A

Spongiosis (intercellular oedema within epidermis)

Chronic inflammation - predominantly superficial dermis

Epidermal hyperplasia and hyperkeratosis

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24
Q

Contact irritant dermatitis

A

Direct injury to skin by irritant e.g. acid, alkali, strong detergent

Contact allergic dermatitis: nickel, dyes, rubber

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25
Q

Unknown aetiology dermatitis

A

Morphological subtypes - seborrhoeic dermatitis: affect areas rich in sebaceous glands: scalp, forehead, upper chest.

Nummular dermatitis - coin shaped lesions

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26
Q

Psoriasis

A

1-2% of population
Well defined red oval plaques on extensor surfaces (knees, elbows, sacrum)

Fine silvery scale. Auspitz sign. Removal of scale causes small bleeding points. ± pitting nails, ±sero–ve arthritis

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27
Q

Psoriasis microscopy

A

psoriasiform hyperplasia

Regular elongated club shaped rete ridges.

thinning of epidermis over dermal papillae.

parakeratotic (contain nuclei) scale.

Collection of neutrophils in scale (Munro microabscesses)

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28
Q

Psoriasis aetiology

A

Genetic factors
FH
PSORS loci is histocompatibility complex on chromosome 6
autoimmune disorders e.g. IBD, MS

environmental triggers

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29
Q

Psoriasis associated comorbidity

A

Arthropathy: 5-10% associated
Psychosocial effects
CVD = 2-3x risk, inflammation, drugs, stress, smoking

Cancer: increased risk of non-melanoma skin cancer, lymphoma, disease or treatment effect

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30
Q

Lupus erythematous

A

Discoid LE - skin only

SLE - visceral disease ± skin

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31
Q

LE - clinical presentation

A

Red scaly patches on sun-exposed skin ± scarring, scalp involvement, causes alopecia

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32
Q

SLE - clinical presentation on skin

A

butterfly rash on cheeks and nose

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33
Q

LE - what is it?

A

auto-immune disorder primarily affecting connective tissues of the body.

Autoantibodies directed at various tissues

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34
Q

LE - microscopically

A

Thin atrophic epidermis. Inflammation and destruction of adnexal structures.

IMF-LE band. IgG deposited in basement membrane

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35
Q

LE - diagnosis

A

Immunofluorescence

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36
Q

Dermatomyositis - clinical presentation

A

Peri-ocular oedema and erythema (Heliotropic rash)

Erythema in photosensitive distribution

Myositis: proximal muscle weakness. Can check for creatinine kinase

25% associated with underlying visceral cancer

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37
Q

Dermatomyositis - microscopy

A

Similar to LE
Often a lot of dermal mucin
Negative IMF

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38
Q

pemphigus vs pemphigoid

A

intra-epidermal bulla + IMF-intercellular = pemphigus

sub-epidermal bulla + IMF basement membrane = pemphigoid

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39
Q

Pemphigus - pathophysiology

A

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

Autoantibodies vs intercellular material

40
Q

Pemphigus - clinical presentation

A

All types cause fragile blisters/bullae which rupture easily. Can be extensive ± mucous membranes

41
Q

Pemphigus - tests

A

IMF - immunofluorescence

42
Q

Bullous pemphigoid -

A

subepidermal blisters

43
Q

Bullous pemphigoid -clinical presentation

A

elderly with large tense bullae which do not rupture easily

localised or extensive

44
Q

Bullous pemphigoid - pathogenesis

A

autoantibodies to glycoprotein in basement membrane.

detected by IMF

45
Q

Dermatitis herpetiformis - clinical presentation

A

small intensely itchy blisters on extensor surface - sub-epidermal bulla

46
Q

Bullous pemphigoid - who?

A

young, associated w/ coeliac

47
Q

Bullous pemphigoid - pathophysiology

A

IgA deposition in dermal papillae on IMF

48
Q

Bullous pemphigoid - histopathology

A

neutrophil microabscesses in dermal papillae

49
Q

Acanthosis nigricans

A

dark warty lesions in armpits linked with internal malignancy

50
Q

Necrobiosis lipoidica

A

red + yellow plaque on legs and diabetes mellitus

51
Q

Erythema nodosum

A

red tender nodules on shins associated with infections elsewhere esp. lung, drugs and other diseases

52
Q

Xanthoma’s

A

yellow plaques often eyelids and hyperlipidaemias

53
Q

Gout

A

found on tophi

54
Q

Porphyria

A

Group of disorders caused by defective synthesis of haem, part of haemoglobin

55
Q

PCT stands for

A

porphyria cutanea tarda

56
Q

PCT - aetiology

A

20% inherited A.D.
80% acquired (Hep C)
-OH can precipitate

57
Q

PCT - what is it?

A

enzyme deficiency; uroporphyrinogen decarboxylase deficiency UROD.

Leads to build up of porphyrin compounds in the skin. Cause tissue damage when exposed to sunlight.

58
Q

PCT - clinical presentation

A

Blisters and scarring of skin

59
Q

PCT - diagnosis

A

look for porphyrins in urine (goes dark on light exposure)

60
Q

Skin tumours - tumours for each level

A 
Epidermis: BCC, SCC
Melanocytes: naevi, melanoma
Merkel cell tumour: rare
Adenexal structures: sweat gland, hair follice tumours and cysts
Haemangioma, neuroa

Dermatofibroma = connective tissue

61
Q

What is the commonest malignant tumour?

A

Basal cell carcinoma

62
Q

Basal cell carcinoma - aetiology

A

sun exposed site mainly face and 2° to radiotherapy

63
Q

Basal cell carcinoma - who?

A

pale skin
immunosuppression
Rare - Gorlin’s syndrome

64
Q

BCC stands for?

A

Basal cell carcinoma

65
Q

Basal cell carcinoma - clinical presentation

A

early: nodule
late: ulcer (rodent ulcer)

Morphoeic BCC is ill defined and infiltrative

66
Q

Basal cell carcinoma - microscopically

A

tumour composed of islands of basaloid cells with peripheral palisade

67
Q

SCC stands for?

A

Squamous cell carcinoma

68
Q

SCC - cause

A 
UV radiation
Radiotherapy
Hydrocarbon exposure: tars, mineral oils, soot
Chronic scars/ulcers
Immunosuppression
Drugs
69
Q

SCC - clinically

A

nodule with ulcerated crusted surface

70
Q

SCC - microscopically

A

invasive islands and trabeculae of squamous cells showing cytological atypia

71
Q

SCC - mets and high risk features

A

mets in 5% (lip, ear, perineum)

>2cm, >4mm thick

72
Q

SCC - actinic keratosis

A

pre-malignant disease -> actinic [solar] keratosis

dysplasia to squamous epithelium

v.common on chronic sun exposed sites

73
Q

SCC - actinic keratosis clinical presentation

A

scaly lesion with erythematous base

74
Q

Melanocytes - derived from?

A

neural crest

75
Q

Melanocytes - function

A

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

76
Q

Naevi

A

are moles

local benign collections of melanocytes

77
Q

types of naevi

A

superficial - congenital or acquired

deep; blue naevi = mongolion spot

78
Q

Dysplastic naevus syndrome -

A

families with increased incidence of melanoma

multiple clinically atypical moles which are histologically atypical

79
Q

Melanoma -

A

rarer than BCC and SCC
incidence is rising rapidly

dangerous and can met widely

80
Q

naevus vs melanoma

A

melanomas are ABCD

asymmetrical
borders uneven
color variation
diameter >6mm

naevus is the opposite

81
Q

Lentigo maligna - who?

A

face, elderly people

slow growing, flat pigmented patch

82
Q

Lentigo maligna - microscopically

A

proliferation of atypical melanocytes along basal layer of epidermis

skin also shows sign of chronic sun damage

83
Q

Lentigo maligna - late stage

A

may invade dermis with potential to met

84
Q

Acral Lentigenous Melanoma -

A

palms and soles, occasionally subungual

85
Q

Acral Lentigenous Melanoma - who?

A

commonest form in afro-caribbeans.

forms enlarging pigmented patch

86
Q

Acral Lentigenous Melanoma - microscopically

A

similar to lentigo maligna except no marked sun damaged

87
Q

Superficial spreading melanoma -

A

commonest type in britain

88
Q

Superficial spreading melanoma - disease progression

A

early - flat macule

late - blue/black nodule

89
Q

Superficial spreading melanoma - microscopic

A

proliferation of atypical melanocytes which invade epidermis and dermis

90
Q

Superficial spreading melanoma - genetics

A

BRAF mutations

91
Q

Nodular melanoma -

A

starts as pigmented nodules ± ulceration

poor prognosis

92
Q

Nodular melanoma - microscopic

A

invasive atypical melanocytes invade dermis to produce nodules of tumours cells

93
Q

Prognostic factors

A

Breslow thickness.

Site - BANS - back, arms (post. upper) neck, scalp.

All poorer prognosis

Senitel node - removed and, if positive, rest of lymph nodes are removed

94
Q

Breslow thickness

A

Measure on microscope from granular layer of epidermis to base of tumours which then predicts 5 yr survival rates

95
Q

Melanoma treatment

A

Surgery - excise primary and lymph nodes if sentinel node positive

BRAF inhibitors - 60% malanomas have mutation in B-raf gene.

Clinical Pathology (65 decks)

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