Pathology

Question 1

2 types of dermis

Answer 1

Papillary dermis - thin

Reticular dermis - thick, type I collagen

Question 2

Dermis collagen types

Answer 2

I and III

Question 3

Hyperkeratosis

Answer 3

thickening of keratin layer

Question 4

Parakeratosis

Answer 4

peristence of nuclei in keratin layer

Question 5

Acanthosis

Answer 5

thickening of epithelium

psoriasis

Question 6

Papillomatosis

Answer 6

Irregular epithelium thickening

Question 7

Spongiosis

Answer 7

Fluid between squames
Vesicles
Eczema

Question 8

Koebner phenomonen

Answer 8

Eczema at site of trauma

Question 9

Auspitz sign

Answer 9

Pinpoint bleeding in psoriasis

Question 10

Microabscesses of munro

Answer 10

Psoriasis

Question 11

Features of rosacea

Answer 11

Women
Facial flushing
Visible blood vessels
Malarerythmea
Pustules
Rhinophyma (thickening of skin)

Question 12

Treatment of rosacea

Answer 12

Tetracycline

Avoid spicy food/alcohol

Question 13

Pathology of rosacea

Answer 13

Demodex mite
Vascular ectasia
Patchy inflammation with plasma cells
Perifollicular granulomas

Question 14

Aetiology of acne

Answer 14

Increased androgens at puberty
More sebum produced
Plugging of pilosebaceous units
Infection with P acnes

Question 15

Immunobullous disorders

Answer 15

Pemphigus
Pemphigoid
Dermatitis herpetiformis

Question 16

Pemphigus

Answer 16

Middle age
IgG antibodies agaisnt desmoglein
Damage to desmosomes
Acantholysis
May affect mucosa
Blisters rupture to form shallow erosions
IgG chickenwire

Question 17

Pemphigoid

Answer 17

Elderly
No acantholysis
Damage to hemi-desmosomes
Epidermis separates from basement membrane
Linear IgG on basement membrane
Tough tense blisters

Question 18

Dermatitis herpetiformis

Answer 18

Coeliac
Symmetrical itchy lesions, elbows, knees, buttocks
Papillary dermal microabscesses
Granular IgA in dermal papillae - targets gliadin (in gluten)
Immune complexes in dermal papillae

Question 19

Melanocytes derived from:

Answer 19

Neural crest

Question 20

Melanocytes are in what layer?

Answer 20

Basal layer

Question 21

Eumelanin

Answer 21

Brown/black

Question 22

Phaeomelanin

Answer 22

Red

Question 23

MC1R protein

Answer 23

Turns phaeomelanin into eumelanin

Question 24

One defective copy of MC1R

Answer 24

Freckling

Question 25

2 defective copies of MC1R

Answer 25

Red hair and freckles

Question 26

Ephilides

Answer 26

Freckles Patchy increase in melanin pigmentation, clumpy distribution of melanocytes Fair skin, red head

Question 27

Actinic lentigines

Answer 27

Age/liver spots UV exposure Increase in melanin

Question 28

Melanocytic naevi

Answer 28

Mole | Usual/Dysplastic/Spitz/Blue

Question 29

How are simple naevi formed?

Answer 29

Melanocyte:Keratinocyte ratio breaks down

Question 30

Junctional naevus

Answer 30

Clusters of melanocytes at DEJ

Question 31

Compound naevus

Answer 31

Clusteres at DEJ and in dermis

Question 32

Intradermal naevus

Answer 32

Clusters in dermis

Question 33

Dysplastic naevi

Answer 33

Irregular border Architechtural and cellular atypia Fibrosis and inflammation Increased risk of cancer

Question 34

Halo naevi

Answer 34

Halo of depigmentation around mole = inflammatory regression

Question 35

Blue naevi

Answer 35

Dermal | Dendritic spindle cells

Question 36

Spitz naevi

Answer 36

Benign juvenile melanoma, less than 20 years old - benign Pink - vasculature Epidermal hyperplasia

Question 37

Malignant melanoma

Answer 37

Females, middle age De novo or dysplastic naevi Childhood sunburn Exposed sites

Question 38

When to suspect melanoma

Answer 38

``` Irregular border Different colours Ulceration Changes shape Bleeding New ABCDE - asymmetry, border, colour, diameter, evolution ```

Question 39

Superficial spreading melanoma

Answer 39

Commonest type | Trunk and limbs

Question 40

Acral lentiginous melanoma

Answer 40

Palms/soles

Question 41

Lentigo maligna

Answer 41

Sun damaged face/neck/scalp | Large liver spot

Question 42

Nodular melanoma

Answer 42

Trunk | VGP - more aggressive

Question 43

When can melanoma metss?

Answer 43

Vertical growth phase

Question 44

Prognosis of melanoma

Answer 44

Breslow depth and ulceration | Deepest tumour from granular layer

Question 45

What suffix indicates melanoma ulceration?

Answer 45

b | e.g. pT3b

Question 46

How does melanoma mets?

Answer 46

Local lymph - satelline deposits Regional node mets Blood to skin, liver, brain, heart, lungs, GIT

Question 47

Treatment of melanoma

Answer 47

Surgery Remove nodes Chemotherapy Immunotherapy (BRAF inhibitor)

Question 48

Sebhorreic keratosis

Answer 48

``` Ageing skin Benign proliferation of keratinocytes Face and trunk Stuck on, greasy Horn, acanthosis, hyperkaratosis ```

Question 49

Leser Trelat sign

Answer 49

Eruptive appearance of many seborrheic keratoses in short period of time = malignant

Question 50

BCC

Answer 50

Middle aged/elderly Sun exposed sites Peripheral palisading, Telangiectasia, well circumscribed, pearly, cords of basal cells Slow growing, hardly ever mets

Question 51

Precursors of SCC

Answer 51

Bowen's - legs Actinic keratosis - head/neck/back of hands Viral lesions

Question 52

Precursors of SCC show:

Answer 52

squamous dysplasia

Question 53

Bowen's disease

Answer 53

SCC in situ Elderly females, lower leg Scaly patch/plaque, irregular border, no dermal invasion

Question 54

Diagnosis of Bowen's

Answer 54

Punch biopsy

Question 55

Actinic keratosis

Answer 55

Sun exposed skin - scalp, hands, face Precursor of invasive SCC Crust, elongated rete ridges

Question 56

Viral precursors of SCC

Answer 56

Erythroplasia of Queyrat - Bowens of penis | HPV 16 = dysplasia