Disorders, Drug Reactions, Cancer Flashcards

Question

Intradermal nevi

Answer 1

Very deep; only in the dermis. Form only pure cords and produce minimal melanin and are very small. THis is the oldest form of nevus.

Answer 2

T cell lymphoma, generally CD4 1. Male dominant 2. African American dominant 3. 30-40 years old Epidermotrophism, with T cells transiting to lymph node, undergoing antigenic stimulation, and forming plaques and patches and tumors in the epidermis. Form an infiltrate of mycosis cells and form intraepidermal vesicles known as Pautrier microabscesses. The cells themselves will initially be irregular, convoluted... as they transform more will lose their epidermotropism Variable prognosis

Answer 3

Patch phase: many years. First stage, and may be perceived as nonspecific dermatitis. Lower trunk and buttocks. Irregular size and random distribution. Plaque phase: Well-demarcated lesions, annular and violaceous. May or may not be scaly. Can be de novo or from patches. Get more widespread with disease progression Tumor stage: From pre-existing lesions. Red, tense and shiny. Ulceration may occur. Over 1 cm diameter.

Answer 4

Irregular shape Erythematous Scaly, crusted plaques

Answer 5

Skin infection, highly infectious. 1. Children or immunocompromised adults 2. Staph usually, sometimes strep 3. Superficial vesicles that rapidly burst and replaced with thick yellowish dirty crust and erthema margin (honey-colored crust). Mouth, nose, extremities Warm, humid conditions Can form bullous, usually group II staph Can mimic autoimmune blistering. Treat with topical antibiotics or orals if severe.

Answer 6

1. SCC variation 2. Solitary, pink/flesh colored dome shaped nodule 3. Keratin plug in the middle (exophytic or endophytic lesions) 4. Sun exposure 5. Elderly people Can involute (curl up) spontaneously, but may persist Can cause local tissue destruction, so treat even though they are not metastatic Well formed collarette around keratin-filled crater with glassy eosinophilic cytoplasm

Answer 7

1. Cutaneous malignant neoplasm 2. Elderly males 3. Sun-exposed skin, face usually 4. PTCH1 mutations (patched/hedgehog) 5. Papule 6. Pearly, translucent edge with telangiectasia Grow slow, rarely become aggressive Nodular lesions that grow downward into the dermis, basophilic

Answer 8

Well circumscribed, regular bordered uniformly pigmented areas Superficial nevus cells larger, pigmented, grow in nests Deeper nevus cells smaller/mature, less/no pigment, grow in cords

Answer 9

Nuclei are round, little mitosis. Nests in dermal/epidermal junction

Answer 10

Nevi in dermis and epidermis/dermis junction. Form cords or nests of cells

Answer 11

Very deep; only in the dermis. Form only pure cords and produce minimal melanin and are very small. THis is the oldest form of nevus.

Answer 12

1. Dysplastic condition 2. Can regress, small percentage become malignant 3. UV-induced 4. Rough, erythematous, yellow brown and scaly 5. Middle Aged or elderly 6. Men at risk 7. Fair skin at risk Destroy with surgery

Answer 13

Common tumor 1. Elderly 2. UV-induced usually 3. Ulcers, burns, arsenic, radiation, HPV, carcinogens can contribute Note that UV-induced SCC tends to be less aggressive

Answer 14

Irregular shape Erythematous Scaly, crusted plaques

Answer 15

Papillomatous hyperplasia Prominent granular layer. Clumping of large irregular keratohyaline granules

Answer 16

1. SCC variation 2. Solitary, pink/flesh colored dome shaped nodule 3. Keratin plug in the middle (exophytic or endophytic lesions) 4. Sun exposure 5. Elderly people Can involute (curl up) spontaneously, but may persist Can cause local tissue destruction, so treat even though they are not metastatic Well formed collarette around keratin-filled crater with glassy eosinophilic cytoplasm

Answer 17

1. Cutaneous malignant neoplasm 2. Elderly males 3. Sun-exposed skin, face usually 4. PTCH1 mutations (patched/hedgehog) 5. Papule 6. Pearly, translucent edge with telangiectasia Grow slow, rarely become aggressive Nodular lesions that grow downward into the dermis, basophilic

Answer 18

Well circumscribed, regular bordered uniformly pigmented areas Superficial nevus cells larger, pigmented, grow in nests Deeper nevus cells smaller/mature, less/no pigment, grow in cords

Answer 19

Nuclei are round, little mitosis. Nests in dermal/epidermal junction

Answer 20

Nevi in dermis and epidermis/dermis junction. Form cords or nests of cells

Answer 21

Very deep; only in the dermis. Form only pure cords and produce minimal melanin and are very small. THis is the oldest form of nevus.

Answer 22

1. Dysplastic condition 2. Can regress, small percentage become malignant 3. UV-induced 4. Rough, erythematous, yellow brown and scaly 5. Middle Aged or elderly 6. Men at risk 7. Fair skin at risk Destroy with surgery

Answer 23

Common tumor 1. Elderly 2. UV-induced usually 3. Ulcers, burns, arsenic, radiation, HPV, carcinogens can contribute Note that UV-induced SCC tends to be less aggressive

Answer 24

Irregular shape Erythematous Scaly, crusted plaques

Answer 25

Nodular Variable scaling May ulcerate Risk factors for metastasis: thickness of the lesion, degree of subcutis penetration Can be well differentiated orderly lobules with keratinization zones, but can also be highly anaplastic with only abortive single-cell keratinization or anaplastic.

Answer 26

1. SCC variation 2. Solitary, pink/flesh colored dome shaped nodule 3. Keratin plug in the middle (exophytic or endophytic lesions) 4. Sun exposure 5. Elderly people Can involute (curl up) spontaneously, but may persist Can cause local tissue destruction, so treat even though they are not metastatic Well formed collarette around keratin-filled crater with glassy eosinophilic cytoplasm

Answer 27

1. Cutaneous malignant neoplasm 2. Elderly males 3. Sun-exposed skin, face usually 4. PTCH1 mutations (patched/hedgehog) 5. Papule 6. Pearly, translucent edge with telangiectasia Grow slow, rarely become aggressive Nodular lesions that grow downward into the dermis, basophilic

Answer 28

Well circumscribed, regular bordered uniformly pigmented areas Superficial nevus cells larger, pigmented, grow in nests Deeper nevus cells smaller/mature, less/no pigment, grow in cords

Answer 29

Nuclei are round, little mitosis. Nests in dermal/epidermal junction

Answer 30

Nevi in dermis and epidermis/dermis junction. Form cords or nests of cells

Answer 31

Very deep; only in the dermis. Form only pure cords and produce minimal melanin and are very small. THis is the oldest form of nevus.

Answer 32

``` Familial or sporadic. 80 or more dysplastic nevi Autosomal dominant (incomplete penetration) with mutations of CDKN2A. ``` High risk for melanoma and pancreatic cancer

Answer 33

Most dangerous skin cancer Adults 1. UV exposure biggest risk factor, also consider sunburns, fair complexion, dysplastic nevi, family history, old age. 2. Xeroderma pigmentosum, familial dysplastic nevus syndrome, immunosuppression are also risks 1, Most cases are de novo 2. Most important clinic sign: CHANGE IN COLOR OR SIGN OF A PIGMENTED LESION 3. Striking color variation within a lesion

Answer 34

``` Asymmetry (dangerous) Border (irregularity is dangerous) Color (variation is dangerous) Diameter (larger is dangerous) Evolution (changing phenotype is dangerous) ```

Answer 35

CDKN2A mutations or oncogene BRAF (V600E activating mutation) BRAF mutations correspond to poor prognosis.

Answer 36

Vemurafenib

Answer 37

Epidermis in situ. Can be prolonged in this stage. Cannot metastasize

Answer 38

Can expand into deeper layers of tissue. Will initially spread via lymphatics, but can later spread hematogenously. Depth of invasion (Breslow Thickness) from the nodule is the STRONGEST prognostic indicator! (lymph invasion, mitotic rate and overlying ulceration all are also somewhat prognostic)

Answer 39

Sun damaged areas in elderly. | 10-15 years before tumor development. In situ during this period

Answer 40

Most common type of melanoma Found in trunk in men and legs in women

Answer 41

Very high growth phase, no radial growth phase. Bad prognosis. Male more than women. Trunk and legs common

Answer 42

Not common in caucasians, but common in people of color. Palmar, plantar, sublingual, and even mucosal surface melanomas. Older women most susceptible.

Answer 43

Asymmetric population in epidermis. Clusters throughout all levels of epidermis, and known as pagetoid cells Large cytoplasm, with dusty melanin

Answer 44

Poorly formed nests in the dermis

Answer 45

T cell lymphoma 1. Male dominant 2. African American dominant 3. 30-40 years old Epidermotrophism, with T cells transiting to lymph node, undergoing antigenic stimulation, and forming plaques and patches and tumors in the epidermis. Form an infiltrate of mycosis cells and form intraepidermal vesicles known as Pautrier microabscesses

Answer 46

Patch phase: many years. First stage, and may be perceived as nonspecific dermatitis. Lower trunk and buttocks. Irregular size and random distribution. Plaque phase: Well-demarcated lesions, annular and violaceous. May or may not be scaly. Can be de novo or from patches. Get more widespread with disease progression Tumor stage: From pre-existing lesions. Red, tense and shiny. Ulceration may occur. Over 1 cm diameter.

Answer 47

Rare variant of T cell lymphoma 1. Erythroderma 2. Blood Involvement 3. Poor Prognosis Generalized exfoliative erythroderma Tumor cells (Sezary cells) in the peripheral blood. 1-3 median survival

Answer 48

Skin infection, highly infectious. 1. Children or immunocompromised adults 2. Staph usually, sometimes strep 3. Superficial vesicles that rapidly burst and replaced with thick yellowish dirty crust and erthema margin (honey-colored crust) Warm, humid conditions Can form bullous, usually group II staph Can mimic autoimmune blistering. Treat with topical antibiotics or orals if severe.

Answer 49

Exfoliative dermatitis. Epidermolytic toxins A and B (ET-A, ET-B) from group II staph, type 71. Cause splitting at the granular layer in children and infants. Sudden skin tenderness, then macular eruption, then easily rupturable, flaccid bullae. This is followed with desquamation of the skin in sheets. Face, neck, trunk, axillae, groins. Can also hit mucus membranes In renal insufficient adults, can also see this (Can't clear ET-A or ET-B)

Answer 50

Diffuse inflammation of connective tissue and deep tissues. Expanding Erythema, edematous and tender Beta-hemolytic strep or coagulase positive staph (staph aureus)

Answer 51

Distinctive cellulitis with an elevated border and rapid spreading. Men over 65, commonly in lower extremities. Treat with oral or IV antibiotics

Answer 52

6 months to 2-3 years. Self limited

Answer 53

Most common wart type. On the hands.

Answer 54

Flat warts. Face and dorsal hand

Answer 55

Wart of foot

Answer 56

Wart of palm

Answer 57

TLR7 activator in immune cells. Boosts response to warts

Answer 58

Papillomatous hyperplasia Prominent granular layer. Clumping of large irregular keratohyaline granules

Answer 59

HPV 6 and 11 most common causes of condylomata High risk cancer HPV is 16, 18, 31, 33 Cauliflower, plaquelike. Can be pearly Smooth, verrucous, lobulated Treat liek oher warts Ecophytic growths that are hyperkeratotic or parakeratotic Contain vacuolated keratinocytes

Answer 60

Prodrome includes painful tingling and vescle clusters and erosions after rupture Travel along sensory nerves. Can cause recurrent disease in sensory ganglia due to UV light, trauma, fever, HIV, menstruation, stress Best diagnosed by PCR Self resolve, but you got it forever

Answer 61

11-20 day incubation Success crops of pocks at different stages Because asynchronous, will see vesicles, pustules, crusted lesions, healing all simultaneousl Children more than adults

Answer 62

Girdle like vesicular eruptions in thoraacic or lumbar distributions. May be facial at Trigeminal nerve. Parasethsia and pain precede it in the same dermatome Sequlae can be avoided with early antivirals Less inflammatory than herpes

Answer 63

``` Cutaneous infection Poxvirus Skin contact Solitary or dome-shaped, small waxy papules (resemble skin tags) Adults, think sexual transmission. Usually in kids ``` Spontaneous resolution Eosinophilic inclusion bodies

Answer 64

Contagious, close personal or sexual contact Hands and feet Papules and burrows between fingers and sides of fingers Papular eruption that is excoriated, potentially infected Treat with permethrin Decomantimate home For burrows, deposit eggs in stratum corneum

Answer 65

Dermatophyte that only acts on epidermal keratin

Answer 66

Dermatophyte that acts on skin and hair

Answer 67

Dermatophyte that acts on skin and hair

Answer 68

Sandwich sign, with hyphae sandwiched betwweeen basket weave of normal corneal layer Variable appearance, often annular rings (tinea or ring worm) Manuum is on the hand, pedis is on the foot Cruris is on genitals Corporis is on body

Answer 69

Patches of hypo or hyperpigmentation Think young adults and usually female Warm climates Malassezia globosa, but also m fur fur Circular and macular spots Spaghetti and meatballs on his to

Answer 70

Hives Pink, edematous papules or plaques They can move Last less than 24 hours Sometimes, rarely, associated with Angioedema IgE mediated hypersensitivity (worry about anaphylaxis) Treat with oral antihistamines Topical Steroids ineffective

Answer 71

Type 4 Sensitivty Most common cutaneous drug eruption Monomorphic macule and papule lesions All over body, itchy. 2-14 days after the drug was started. Even if the drug was discontinued already! 1-2 week resolution, even if still on drug usually Corticosteroids or antihistamines help with itching

Answer 72

Resembles morbilliform, but also is associated with facial edema, lymphadenapathy, fever and hepatic enzyme elevation Arthralgia also common. Eosinophilia not always present, but does not exclude diagnosis if absent. Can get other itis's (nephritis, myocarditis, thyroiditis, brain involvement) Can be fatal. Important to discontinue drug, find the source. Put on systemic corticosteroids

Answer 73

Common hands and feet. 3 or more color zones (targetoid lesions) Acral areas. Center is usually red or purple. 2 week before resolution. Triggered by infection mostly (herpes virus), but sometimes drugs. Self-resolves in a few weaks, and treat with corticosteroids if severe, otherwise just treat itchiness with antihistamines Giving antivirals will not help; the herpes has likely already resolved by the time this sequelae appears

Answer 74

SJS is less severe (10% body coverage) than TEN (30%+ body coverage) Starts with painful rash (rashes are usually itchy, not painful!) that has pretty generalized coverage, accompanied with fever, malaise, respiratory symptoms. Patches become bullae and necrotic, and epidermal detachment will occur Commonly induced by medications: Allopurinol, NSAIDs, Sulfa drugs, Anticonvulsants, Antibiotics Can cause sepsis, blindness with ocular involvement. Also has lip involvement commonly Remove the causal drug! IVIG acts to prevent apoptosis in these patients by blocking Fas ligand.

Answer 75

Histologic diagnosis Small vessel vasculitis, neutrophil mediated 50% idiopathic Can be caused by infection (strep, Hep B or C, HIV) Can be a hypersentivitiy (antibiotics usually) Palpable purpora are a hallmark, especially on the legs. Urticarial lesions also possible, but not truly utricaria as they last for over 24 hours Nodules, ulceration and livedo reticularis are common (purple, lacy net-pattern on legs)

Answer 76

Small vessel vasculitis In children more common IgA mediated DIF is used to diagnosse Triggered by strep infection or other respiratory infections Palpable purpura Buttocks and lower extremity Arthritis, abdominal pain, GI bleed, nephritis. Resolves 2-4 weeks.

Disorders, Drug Reactions, Cancer Flashcards

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