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Step1 > Derm > Flashcards

Derm Flashcards

1
Q

Epidermis layers (surface to base)

A

“Californians Like Girls in String Bikinis”

Stratum Corneum (keratin)
Stratum Lucidum (most prominent in palms and soles)
Stratum Granulosum
Stratum Spinosum (desmosomes)
Stratum Basale (stem cells)
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2
Q

Tight junctions

A

zona occludens

composed of claudins and occludins and prevent paravellular movement of solutes

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3
Q

Adherens junction

A

Belth desmosomes, zonula adherens

Cadherins are Ca dependent adhesion proteins

loss of cadherins –> promote metastasis

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4
Q

Desmosome

A

Spot desmosome, macula adherens

structural support via intermediate filament interactions

autoantibodies to desmoglein –> pemphigus vulgaris

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5
Q

Gap junction

A

channel proteins called connexons permit electrical and chemical communicaiton between cells

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6
Q

Integrins

A

membrane proteins that maintain integrity of basolateral membrane by binding to collagen, laminin, and fibronectin in basement membrane

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7
Q

Hemidesmosome

A

connects keratin in basal cells to underlying basement membrane

autoantibodies –> bullous pemphigoid

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8
Q

Macule

A

flat lesion with well circumscribed change in skin color

<1 cm

ex) freckle or labial macule

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9
Q

Patch

A

Macule >1 cm

ex)large birthmark (congenital nevus)

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10
Q

Papule

A

Elevated solid skin lesion <1 cm

ex) mole (nevus), acne

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11
Q

Plaque

A

Papule > 1 cm

ex) psoriasis

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12
Q

Vesicle

A

small fluid containing blister < 1cm

ex) chicken pox or shingles

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13
Q

Bulla

A

Large fluid containing blister >1 cm

ex) bullous pemphigoid

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14
Q

Pustule

A

VEsicle containing pus

ex) pustular psoriasis

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15
Q

Wheal

A

Transient smooth papule or plaque

ex) hives

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16
Q

Scale

A

Flaking off of stratum corneum

ex) eczema, psoriasis, SCC

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17
Q

Crust

A

Dry exudate

ex) impetigo

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18
Q

Hyperkeratosis

A

increased thickness of stratum corneum

ex) psoriasis, calluses

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19
Q

Parakkeratosis

A

Retention of nuclei in stratum corneum

ex)psoriasis

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20
Q

Hypergranulosis

A

Increase thickness of stratum granulosum

ex) lichen planus

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21
Q

Spongiosis

A

Epidermal accumulation of endematous fluid in intercellular spaces

ex) Eczematous dermatitis

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22
Q

Acantholysis

A

Separation of epidermal cells

ex) pemphigus vulgaris

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23
Q

Acanthosis

A

Epidermal hyperplasia (increases spinosum)

ex) acanthosis nigricans

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24
Q

Albinism has _____ melanocyte number with _____ melanin production. This is due to decreased ________ activity or defective _________

A

normal; decreased

tyrosinase activity; tyrosine transport

increased risk of skin cancer

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25
Q

This skin disorder is hyperpigmentation that occurs with pregnancy and is sometimes called the mask of pregnancy

A

melasma (chloasma)

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26
Q

This skin disorder has irregular patches of complete depigmentation caused by autoimmune destruction of melanocytes

A

Vitiligo

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27
Q

Patient presents with well demarcated plaques with greasy yellow scales in areas rich in sebaceous glands such as the scalp, face, and periocular region. What skin disorder is this? what organism is it related to? what disease is it related to? treatment?

A

This is seborrheic dermatitis

Malassezia spp.

Parkinson disease

treat with topical antifungals and corticosteroids

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28
Q

What bacteria is commonly linked to acne

A

Cutibacterium acnes (formerly known as propionibacterium acnes)

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29
Q

This skin disorder is related to an increase in IgE and mutations in filaggrin gene predispose patients.

A

Atopic dermatitis (eczema)

often on the face in infancy. In antecubital fossa in children and adults

filaggrin mutation causes a skin barrier dysfunction

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30
Q

What type of hypersensitivity reaction is Allergic contact dermatitis

A

Type IV hypersensitivity

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31
Q

Melanocytic nevus

A

common mole

benign

melanoma can arise

intradermal –> papular
Junctional –> flat

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32
Q

Facial disorder characterized by firm hyperpigmented papules and pustules that are painful and pruritic. Commonly referred to as “razor bumps”

A

Pseudofolliculitis barbae

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33
Q

Psoriasis has papules and plaques with silver scaling. Where is it commonly located and what are the histological changes?

A

Especially knees and elbow

Acanthosis with parakeratotic scaling (nuclei still in stratum corneum)

Munro microabscesses

Increase in stratum spinosum

decrease stratum granulosum

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34
Q

Psoriasis is commonly associated with the _____ sign

A

Auspitz sign - pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off.

psoriasis is also associated with nail pitting and psoriatic arthritis

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35
Q

Rosacea

A

Inflammatory facial skin disorder characterized by erythematous papules and pustules but not comedones

facial flushing occurs

phymatous rosacea can cause rhinophyma or bulbous deformation of nose

36
Q

These are flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts). What sign is associated with this condition?

A

Seborrheic keratosis

Leser Trelat sign

37
Q

Verrucae

A

Warts

epidermal hyperplasia, hyperkeratosis, koilocytosis

38
Q

Urticaria

A

Hives

Pruritic wheals that form after mast cell degranulation

characterized by superficial dermal edema and lymphatic channel dilation

39
Q

Angiosarcoma

A

BV malignancy that is very aggressive and difficult to resect due to delay in dx

elderly, sun exposed areas

associated with radiation therapy and chronic postmastectomy lymphedema

Hepatic angiosarcoma associated with vinyl chloride and arsenic exposures

40
Q

Benign skin papules found in AIDS patients. What organism causes the infection

A

Bacillary angiomatosis

Bartonella infection

41
Q

Cherry hemangioma

A

benign capillary hemangioma of the elderly
does not regress
frequency increases with age

42
Q

Cystic hygroma

A

Cavernous lymphangioma of the neck

turners syndrome

43
Q

Glomus tumor

A

Benign painful red blue tumor commonly under fingernails

from the smooth mm cells of the thermoregulatory glomus body

44
Q

Kaposi sarcoma is an endothelial malignancy that is associated with ____ and ____

A

HHV 8 and HIV

45
Q

Pyogenic granuloma

A

polypoid lobulated capillary hemangioma that can ulcerate and bleed

associated with trauma and pregnancy

46
Q

Strawberry hemangioma

A

benign capillary hemangioma of infancy

grows rapidly and regresses spontaneously by 5-8 years old

47
Q

______ is characterized by honey colored crusting and is commonly caused by what infections?

A

Impetigo

superficial skin infection from S aureus and S pyogenes

48
Q

Bullous impetigo

A

bullae

S aureus

49
Q

Erysipelas

A

infection of upper dermis and superficial lymphatics that has raised demarcation

S pyogenes

50
Q

Cellulitis

A

acute painful spreading infection of deeper demis and subq tissues

S pyogenes and S aureus

51
Q

Abscess organism is mostly

A

S aureus

52
Q

Necrotizing fasciitis

A

S pyogenes

pain out of proportion to exam findings

Bullaw and purple color to skin

crepitus from methane and CO2 production

“flesh eating bacteria”

53
Q

Scalded Skin Syndrome

A

Staph

exotoxin destroys keratinocyte attachments in stratum granulosum only

sloughing of upper layers of epidermis that heals completely

54
Q

What sign for _____ indicated seperation of epidermis upon manual stroking of skin

A

Nikolsky sign

55
Q

Herpetic witlow

A

herpes infection on finger

56
Q

Molluscum contagiosum is caused by

A

pox virus

57
Q

Hairy leukoplakia

A

irregular, white, painless plaques on lateral tongue that cannot be scraped off

EBV mediated

HIV + patients and organ transplant recipients

58
Q

Hair leukoplakia vs thrush vs leukoplakia

A

thrush can be scraped off

leukoplakia is precancerous

59
Q

Pemphigus vulgaris

A

IgG antibody against desmoglein ( component of desmosomes which connect keratinocytes in the stratum spinosum)

Flaccid epidermal bullaw caused by acantholysis (serperation of keratinocytes) “row of tomb stones”

Oral mucosa involved

+ nikolsky sign

60
Q

Pemphigus vulgaris is what type of hypersensitivity reaction

A

type II

61
Q

Pemphigus vulgaris on immunofluorescence

A

Antibodies around epidermal cells in a reticular (net-like) pattern

62
Q

Bullous pemophigoid

A

less severe than pemphigus vulgaris

IgG antibody against hemidesmosomes (epidermal basement membrane)

tense blisters containing eosinophils

spares mucosa

Nikolsky sign -

63
Q

Bullous pemphigoid is what type of hypersensitivity reaction

A

Type II

64
Q

Bullous pemphigoid on immunofluorescence

A

linear pattern at epidermal-dermal junction

65
Q

Dermatitis herpetiformis

A

deposits of IgA at tips of dermal papillae

celiac disease

treat with dapsone, gluten free diet

66
Q

Erythema multiforme

A

macules, papules, vesicles, target lesions

67
Q

fever, bullae formation and necrosis, sloughing of skin at dermal-epidermal junction

A

Steven johnson syndrome

typicall involves 2 mucous membranes

targetoid skin lesions

68
Q

More severe form of steven johnson syndrome that requires treatment in burn unit. What percentage of body has to be affected?

A

toxic epidermal necrolysis

> 30% of body

if 10-30% then its SJS-TEN

69
Q

Premalignant lesions caused by sun exposure. Risk of _____ is proportional to degree of epithelial dysplasia

A

Actinic keratosis; SCC

small rough erythematous or brownish papules or plaques

70
Q

Erythema nodosum

A

Painful, raised inflammatory lesions of subq fat (panniculitis), usually on anterior shins

71
Q

Lichen planus

A

Pruritic
Purple
Polyglobal Planar Paules
Plaques

72
Q

Characteristic of Lichen Planus when there is mucosal involvement

A

Wickham striae and hyperfranulosis

73
Q

Lichen planus is commonly associated with _____ and we see a ______ pattern on histology

A

Hep C

Sawtooth infiltrate or lymphocytes at dermal-epidermal junction

74
Q

This condition has a “herald patch” prior to other scaly erythematous plaques appearing in a _______ distribution on the trunk

A

Pityriasis rosea

Christmas tree

Multiple pink plaques with collarette scale

self resolving in 6-8 weeks

75
Q

Sun born is due to UV_ and tanning is UV_

A

UVB is for sunburn (B=burn)

UVA is for tanning and photoaging

76
Q

First degree burn

A

through epidermis

77
Q

Second degree burn

A

through epidermis and partial dermis

blistering without scaring

78
Q

Third degree burn

A

Full thickness burn through epidermis, dermis, and hypodermis

skin scares with wound healing

79
Q

Most common skin cancer

A

Basal cell carcinoma

80
Q

Waxy, pink, pearly nodules commonly with telangiectasis, rolled borders, central crusting or ulceration are a sign of

A

BCC (basal cell carcinoma)

locally invasive but rarely metastasize

can also appear as a nonhealing ulcer with infiltrating growth or as a scaling plaque (superficial BCC)

Palisading nuclei

81
Q

Second most common skin cancer

A

Squamous cell carcinoma

82
Q

Squamous cell carcinoma

A

Commonly appears on face, lower lip, ears, hands

locally invasive may spread to lymph nodes and will rarely metastasize

ulcerative red lesions with frequent scale

histopathology: keratin pearls

83
Q

Melanoma tumor marker

A

S-100

84
Q

Melanoma is often driven by activating mutation in ________ and thus might benefit from vemurafenib a ________ inhibitor

A

BRAF V600E kinase

BRAF kinase

85
Q

Melanoma risk of metastasis correlates with

A

Breslow thickness

86
Q

ABCDEs of melanoma

A 
Asymmetry
Border
Color
Diameter (>6mm)
Evolution

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