Pathology Part 3 Flashcards
(124 cards)
1
Q
Erythroderma
A
Refers to the clinical state of inflammation or redness of all (or nearly all) of the skin - medical emergency
2
Q
Cuases of Erythroderma
A
o Atopic eczema
o Psoriasis
o Drugs
o Idiopathic
3
Q
Drug causes of Erythroderma
A
- Sulphonamides
- Gold
- Sulfonylurea
- Penicillin
- Allopurinol
4
Q
Erythema nodosum
A
Inflammation of subcutaneous fat
5
Q
Features of Erythema nodosum
A
> Tender, erythematous, nodular lesions
Usually occurs over shins, may also occur elsewhere
Usually resolves within 6 weeks
Lesions heal without scarring
6
Q
Infection causes of Erythema nodosum
A
- streptococci
- tuberculosis
- brucellosis
7
Q
Systemic disease causes of Erythema nodosum
A
- sarcoidosis
- inflammatory bowel disease
- Behcet’s
8
Q
Drug causes of Erythema nodosum
A
penicillins
sulphonamides
combined oral contraceptive pill
9
Q
Other causes of Erythema nodosum
A
Pregnancy and malignancy
10
Q
Treatment for Erythema nodosum
A
- Symptomatic – NSAIDs
2. Light compression bandaging and bed rest
11
Q
Erythema multiforme
A
A hypersensitivity reaction which is most commonly triggered by infections. It may be divided into minor and major forms.
12
Q
Two types of Erythema multiforme
A
Erythema multiforme minor
Erythema multiforme major
13
Q
Features of Erythema multiforme
A
> Target lesions > First back of the hands/feet before spread to torso > Pruritus > Resolves in 2-4 weeks > No mucosal involvement
14
Q
Causes of Erythema multiforme
A
- Viruses: herpes simplex virus
- Idiopathic
- Bacteria: Mycoplasma, Streptococcus
- Drugs
- Erythematosus
- Sarcoidosis
- Malignancy
15
Q
Drugs that cause Erythema multiforme
A
Penicillin sulphonamides carbamazepine allopurinol NSAIDs oral contraceptive pill nevirapine
16
Q
Erythema multiforme major
A
The more severe form, erythema multiforme major is associated with mucosal involvement.
17
Q
What do the target lesions in Erythema multiforme look like?
A
Erythematous, polycyclic, annular concentric rings
18
Q
Pyoderma gangrenosum
A
A rare, non-infectious, inflammatory (neutrophilic dermatosis) disorder. It is an uncommon cause of very painful skin ulceration. It may affect any part of the skin, but the lower legs are the most common site.
19
Q
Causes of Pyoderma gangrenosum
A
> idiopathic in 50% > inflammatory bowel disease in 10-15% > rheumatoid arthritis > SLE > lymphoma > Liver disease
20
Q
Pyoderma gangrenosum features
A
Erythematous nodules or pustules that frequently ulcerate
> Bluish-black (gangrenous) edge
> May be associated pyrexia and malaise
21
Q
Treatment for Pyoderma gangrenosum
A
- Very potent topical steroids
- Immunosuppressants used in resistant cases
- Underlying cause should be treated
22
Q
Acanthosis nigricans
A
Describes symmetrical, brown, velvety plaques that are often found on the neck, axilla and groin.
23
Q
Causes of Acanthosis nigricans
A
Type 2 diabetes mellitus Gastrointestinal cancer Obesity Polycystic ovarian syndrome Acromegaly Cushing's disease Hypothyroidism Familial Prader-Willi syndrome
24
Q
Drugs that cause Acanthosis nigricans
A
- Combined oral contraceptive pill
2. Nicotinic acid
25
Scleroderma
Thickening or hardening of the skin owing to abnormal dermal collagen
26
Pathophysiology of Acanthosis nigricans
Insulin resistance → hyperinsulinemia → stimulation of keratinocytes and dermal fibroblast proliferation via interaction with insulin-like growth factor receptor-1 (IGFR1)
27
Management of acanthosis nigricans
Oral or topical retinoids
28
Dermatomyositis
A variant of polymyositis - an inflammatory disorder causing symmetrical, proximal muscle weakness and characteristic skin lesions
29
Features of dermatomyositis
1. photosensitive
2. macular rash over back and shoulder
3. heliotrope rash in the periorbital region
4. Gottron's papules
5. nail fold capillary dilatation
30
Investigations in dermatomyositis
ANA positive
anti-Jo-1
anti-SRP
anti-Mi-2 antibodies
31
Treatment for dermatomyositis
o Hydroxychloroquine
| o Immunosuppressants
32
Sarcoidosis
A multisystem disorder of unknown aetiology characterised by non-caseating granulomas. It is more common in young adults and in people of African descent
33
Sarcoidosis features
```
> Erythema nodosum,
> bilateral hilar lymphadenopathy,
> swinging fever,
> polyarthralgia
> dyspnoea,
> non-productive cough,
> malaise,
> weight loss
> Hypercalcaemia
```
34
Lofgren's syndrome
Is an acute form of sarcoidosis characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis
35
Mikulicz syndrome
There is enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma
36
Heerfordt's syndrome
There is parotid enlargement, fever and uveitis secondary to sarcoidosis
37
What are the two type of Neurofibromatosis?
NF1
| NF2
38
Neurofibromatosis
A group of autosomal dominant genetic disorders that cause tumors to form on nerve tissue. These tumors can develop anywhere in the nervous system.
39
Features of NF1
1. Café-au-lait spots (>= 6, 15 mm in diameter)
2. Axillary/groin freckles
3. Peripheral neurofibromas
4. Iris hamatomas (Lisch nodules) in > 90%
5. Scoliosis
6. Pheochromocytomas
40
Café-au-lait spot
Feature of NF1 and Tuberous sclerosis
41
Tuberous sclerosis (TS)
A genetic condition of autosomal dominant inheritance.
| Causes benign growths in many parts of the body
42
Features of cutaneous Tuberous sclerosis (TS)
1. Depigmented 'ash-leaf' spots - fluoresce under UV
2. Shagreen patches
3. adenoma sebaceum (angiofibromas)
4. Subungual fibromata
5. Café-au-lait spots* may be seen
43
Shagreen patches
An irregularly shaped, irregularly thickened, slightly elevated soft skin-colored patch, usually on the lower back, made up of excess fibrous tissue.
44
Subungual fibromata
A painless, slow-growing tumor seen in the nail apparatus
45
Adenoma sebaceum (angiofibromas)
Refers to the reddish-brown papular rash found characteristically in a “butterfly” distribution over the face.
46
Bopsy and immunoflourescene is gold standard to identify and distinguish between pemphigoid and pemphigus. What are the differences seen?
Pemphigoid: linear IgG on IF
Pemphigus: scattered IgG on IF
47
Pemphigus vulgaris
Is an autoimmune disease caused by antibodies directed against desmoglein 3, a cadherin-type epithelial cell adhesion molecule. It is more common in the Ashkenazi Jewish population.
48
Features of Pemphigus vulgaris
> Mucosal ulceration
> Flaccid, easily ruptured vesicles and bullae.
> Nikolsky's positive
> Acantholysis on biopsy
49
Nikolsky's sign
The sign is present when slight rubbing of the skin results in exfoliation of the outermost layer.
50
Acantholysis
Means loss of coherence between epidermal cells due to the breakdown of intercellular bridges.
51
Management of Pemphigus vulgaris
1. High dose oral prednisolone
| 2. Immunosuppressants
52
Bullous pemphigoid
An autoimmune condition causing sub-epidermal (basement membrane) blistering of the skin. This is secondary to the development of antibodies against hemidesmosomal proteins BP180 and BP230.
53
Features of Bullous pemphigoid
1. Itchy, tense blisters typically around flexures
2. the blisters usually heal without scarring
3. there is usually no mucosal involvement (i.e. the mouth is spared)*
4. Nikolsky negative
54
Difference in location of blisters in Pemphigus and Pemphigoid
Pemphigus - intraepidermal - Nikolsky positive
| Pemphigoid - subepidermal (Dermo-epidermal junction)
55
Dermatitis herpetiformis
An autoimmune blistering skin disorder associated with coeliac disease. It is caused by deposition of IgA in the dermis.
56
Features of Dermatitis herpetiformis
o Commoner in males
o Small intensely itchy blisters of the skin
o Appear on the elbows, extensor forearms, scalp and buttocks
57
Management of Dermatitis herpetiformis
Gluten-free diet
| Dapsone
58
Dapsone
A sulphonamide antibiotic.
It acts as an anti-inflammatory drug and has been used successfully as a treatment for several skin conditions such as dermatitis herpetiformis & pyoderma gangrenosum,
59
Biopsy features in Dermatitis herpetiformis
Show IgA in the dermal papillae and patchy granular IgA along the basement membrane
The jejunal mucosa shows a partial villous atrophy
60
Filaggrin
A protein that increases risk of eczema, hay fever and asthma
61
Porphyria cutanea tarda (PCT) type 1
Blisters, fragility, hyperpigmentation, hypertrichosis
| Manage the skin condition and underlying cause
62
Capsaicin
Antipruritic - active component of chill peppers
63
Gorlin’s syndrome
o Autosomal dominant familial cancer syndrome
o Multiple BCC
o Early onset
64
Spongiosis
Oedema between keratinocytes
65
Epidermolysis bullosa
Is where the skin blisters on minimal trauma (inherited)
66
Example of mild steroid
1% hydrocortisone
67
Example of moderate steroid
Eumovate
68
Example of potent steroid
Betnovate
69
Example of very potent steroid
Dermovate
70
Immune thrombocytopenic purpura
Immune disorder characterised by platelet-bound antibody, often with a previous history of infection.
Blood tests show a very low platelet count
71
Erythema migrans
o Bulls eye appearance
o Caused by a tick bite
o Early sign of lyme disease
o Red macule surrounded by another red circle, with non-affected skin in between
72
Herpangina
Blistering rash of the back of the mouth
Caused by enterovirus (not herpes virus)
> Coxsackie virus
> Echovirus
73
Angioma vessels
Benign localised overgrowth of blood vessels
74
Target lesion
Erythema multiforme
75
Large tense bullae that are itchy and cannot be burst
Bullous pemphigoid
76
Flaccid blisters that can be burst easily to form erythematous erosions
Pemphigus vulgaris
77
Heliotrope rash and scaly knuckles
Dermatomyositis
78
Cauliflower appearance
Plantar warts
79
Silver scales, extensor surface
Plaque psoriosis
80
Honey-colored crust
Impetigo
81
Stuck on appearance
Basal cell papilloma
82
Androgenic alopecia
o Male pattern baldness
o Positive family history
o Frontal receding with thinning of the crown
o May occur in females following menopause
83
Alopecia areata
o Immune mediated hair loss
o Patches of baldness
o Broken exclamation mark hairs
84
Hirsutism
Male pattern hair growth seen in females
85
Hypertrichosis
State of excessive hair growth at any site and occurs in both sexes
86
Neuropathic ulcers
Tend to be seen over pressure areas of the feet, such as the metatarsal heads
Most commonly seen in diabetics due to peripheral neuropathy - Painless
87
Neuropathic ulcers management
1. Keeping the ulcer clean
2. Remove pressure or trauma from the affected area
3. See a podiatrist for correctly fitting shoes
88
Arterial ulcers
```
o Present as punched-out, painful ulcers
o Higher up the leg
o “Sharp cliff-like edge”
o The leg is cold and pale
o Absent peripheral pulses
o Loss of hair may be present
```
89
Arterial ulcers management
1. Compression bandaging must NOT be used
2. Keep the ulcer clean and covered
3. Adequate analgesia and vascular reconstruction
90
Venous ulcers management
1. High compression bandaging
2. Leg elevation
3. Doppler studies should always be done before bandaging to exclude arterial disease
4. Analgesia
5. Wet/moist ulcer dressing
91
Why should doppler US studies be done before compression bandaging in venous ulcers?
Doppler studies should always be done before bandaging to exclude arterial disease
92
Venous ulcers
Result of sustained venous hypertension in the superficial veins due to incompetent valves or previous DVT
o Common later in life and cause significant
o “Shallow like a beach”
o Chronic and recurrent
o Most commonly found on the lower leg
93
Melanocytic naevi (moles)
o Benign overgrowth of melanocytes that are common in white-skinned people
o Appear in childhood and increase in number and size as you get older
o Start flat and as they proliferate they become elevated
o Even pigmentation and regular border
94
Blue naevus
Acquired symptomatic blue-looking mole
95
Basal cell papilloma (seborrhoeic wart)
o Common benign overgrowth of the basal cell layer of the epidermis
o Surface is irregular and appear ‘stuck on to the skin’
o Can be treated with cryotherapy
96
Another name for Basal cell papilloma
Seborrhoeic wart
97
Dermatofibromata
o Firm, elevated pigmented nodules that may feel like a button on the skin
o Peripheral ring of pigmentation is sometimes seen
o Often on the leg, commoner in females
A dermatofibroma is the name we give to a common and harmless knot of fibrous tissue which occurs in the skin. Dermatofibromas are firm bumps which feel like small rubbery buttons lying just under the surface of the skin.
98
Solar keratosis (actinic keratosis)
> Significant sun exposure
> Exposed skin as erythematous silvery-scaly papules or patches
> Background skin is inelastic, wrinkled with flat brown macules (solar lentigos) reflecting diffuse solar damage
99
What is the risk of Solar keratosis (actinic keratosis)
A small proportion can transform into SCC after many years
100
Another name for Solar keratosis
Actinic keratosis
101
Treatment for Solar keratosis
1. Crytotherapy
| 2. Topical 5-flourouracil cream
102
Bowen's disease
Form of intrapeidermal carcinoma-in-situ which can become invasive - Due to long-term sun exposure
Presents on exposed skin, most commonly on women’s legs, as an isolated scaly red patch or plaque looking rather like psoriasis
103
Bowen's disease management
1. Crytotherapy
| 2. Topical 5-flourouracil cream
104
Giant congenital melanocytic naevi
o Very large moles present at birth
| o Increased risk of developing malignant melanoma
105
Lentigo maligna
o Slow-growing macular area of pigmentation seen in elderly people, commonly on the face
o Border and pigmentation are often irregular
o Increased risk of developing invasive malignant melanoma
106
Risk of Lentigo maligna
Increased risk of developing invasive malignant melanoma
107
Most common malignant skin tumour
Basal cell carcinoma (rodent ulcer)
108
Basal cell carcinoma features
Can present as a slow-growing papule or nodule that may go on to ulcerate
Telangiectasia over the tumour or a skin-coloured jelly-like ‘pearly edge’ may be seen
109
Basal cell carcinoma
Most common malignant skin tumour
| Common later in life on exposed sites (although rare on the ear)
110
Basal cell carcinoma management
Surgical excision
111
What area is rare for BCC to develop?
The ear
112
Squamous cell carcinoma
o More aggressive than BCC and can metastasize
o Can arise in pre-existing bowen’s disease
o Ill-defined nodules that may ulcerate
o Grow rapidly
o Examination of regional lymph nodes is essential
o Most common on sun-exposed sites, particularly lower lip and ear
113
Risk factors for SCC
1. excessive exposure to sunlight
2. actinic keratoses and Bowen's disease
3. immunosuppression e.g. renal transplant, HIV
4. smoking
5. long-standing leg ulcers (Marjolin's ulcer)
6. genetic conditions e.g. xeroderma pigmentosum,
7. oculocutaneous albinism
114
Common sites for SCC
Lower lip & ear
115
Malignant melanoma
o Most serious form of skin cancer
| o History of childhood sun exposure and intermittent intense sun exposure appears to be necessary
116
Risk factors for Malignant melanoma
```
> Pale skin
> Multiple melanocytic naevi (>5)
> Immunosuppression
> Family history
> Lentigo maligna
```
117
Most common Malignant melanoma
Superficial spreading
118
The 4 types of malignant melanoma
Superficial spreading
Nodular
Lentigo maliga
Acral lentiginous
119
Second most common Malignant melanoma
Nodular
120
Most aggressive Malignant melanoma
Nodular
121
Superficial spreading malignant melano sites of invasion
Arms, legs, back and chest, young people
122
Nodular malignant melano sites of invasion
Sun exposed skin, middle-aged people
123
Lentigo maliga (malignant melanoma) sites of invasion
Chronically sun-exposed skin, older people
124
Acral lentiginous malignant melano sites of invasion
Nails, palms or soles, African Americans or Asians
