Pathology

Question 1

the dermis contains a matrix of collagen and elastic fibres. when is it lost

Answer 1

smoking
sun damage
age

Question 2

what is acanthosis

Answer 2

increased epidermal thickness

Question 3

what is parakeratosis

Answer 3

nuclei in keratin layer

Question 4

what is hyperkeratosis

Answer 4

increased thickness of keratin layer

Question 5

what is spongiosis

Answer 5

oedema between squamous cells causing increased prominence of intercellular prickles

Question 6

what is the pathogenesis of psoriasis

Answer 6

unknown
may be hereditary
may be due to epidermal hyperplasia
may be complement mediated attack on keratin layer

Question 7

what is a key diagnostic feature of psoriasis histologically

Answer 7

munro micro abscesses

Question 8

describe the psoriasis rash

Answer 8

silvery scale with raised plaque
well defined
bilateral/symmetrical on extensor
may be on chest/abdo

Question 9

true/false - psoriasis has nail changes

Answer 9

true - it can

Question 10

describe histology of psoriasis

Answer 10

elongation of rete ridges, island sections of dermis behind
munro micro abscess
lymphocytes in dermis

Question 11

describe the rash of lichen planus

Answer 11

itchy flat topped violaceous papules

might see striae in oral mucosa

Question 12

describe histology of lichen planus

Answer 12

irregular sawtooth acanthosis
hypergranulosis and orthohyperkeratosis
upper dermal infiltrate of lymphocytes
basal damage

Question 13

describe pathology of pemphigus vulgaris

Answer 13

IgG against desmoglien 3 which maintains esmosomes in prickle cell layer, immune complexes form causing acantholysis and weak blisters that rupture to form erosions

Question 14

where would you see pemphigus vulgaris

Answer 14

oral mucosa and GI tract and respiratory

scalp, trunk, face, axillae groin

Question 15

what would you see histologically in pemphigus vulgaris

Answer 15

blister epidermally due to prickle cell separation

Question 16

describe formation of bullous pemphigoid

Answer 16

Auto-IgG against hemidesmosomes binding basal cell layer to BM, so whole epidermis blisters

Question 17

what test may be useful in pemphigus vulgaris and bullous pemphigoid

Answer 17

immunofluorescence

Question 18

describe where you might see acne

Answer 18

head, face, neck, shoulders, back and chest

Question 19

describe the pathology of acne vulgaris

Answer 19

increased androgens at puberty and increased sensitivity to sebaceous glands
keratin plugs pilosebaceous unit abd infection with corynebacterium acnes, produces comodome
if ruptures then scars

Question 20

what is rosaecea and who is it more common in

Answer 20

females

recurrent facial flushing, pustules, visible blood vessels, rhinophyma

Question 21

causes of rosaecea

Answer 21

sunlight
alcohol
spicy foods
stress

Question 22

describe pathology of rosacea

Answer 22

vascular ectasia 
patchy inflammation with plasma cells 
pustules 
perifollicular granulomas
follicular demodex mites

Question 23

how would seborroheic keratosis appear on histology

Answer 23

epidermal acanthosis
hyperkeratosis
horn cysts

Question 24

what is the leser-trelat sign

Answer 24

eruptive seborrhoeic keratosis signifying internal malignancy

Question 25

what is bowens disease

Answer 25

squamous cell carcinoma in situ

scaly plaque, irregular border

Question 26

what is actinic keratosis

Answer 26

precursor of invasive SCC

Question 27

where are viral lesions and what type of virus causes and consequences

Answer 27

anogenital skin, HPV type 16

very dysplastic and often found in penile cancer

Question 28

3 types of BCC

Answer 28

nodular
superficial
infiltrative

Question 29

how does BCC appear histologically

Answer 29

epidermis originating and invasive into dermis

peripheral palisading

Question 30

does BCC metastasise

Answer 30

rarely

Question 31

sites of SCC?

Answer 31

sun damaged skin, elderly
leg ulcer
burns sites
xeroderma pigmentosum

Question 32

adverse prognostic features of SSC

Answer 32

> 4mm thick
lymphatic/vascular invasion
perineural spread
scalp, ear, nose involvement