PATHOPHYS Flashcards
1
Q
what is the major UVB chromophore in the skin?
A
DNA
2
Q
what are the 3 main things that can happen when sunlight hits the skin?
A
- some reflected
- some absorbed in epidermis & dermis by DNA, proteins and other substances
- some penetrates deeper into tissues and is dissipated
3
Q
which spectrum of light causes an immediate tanning response?
A
UVA and visible light
4
Q
which spectrum of light causes a delayed tanning response?
A
UVB
5
Q
what are solar lentigenes?
A
age spots (from photodamage)
6
Q
How can sundamage cause immunosuppression?
A
- lymphocytes and Langerhans cells are sensitive to UV induced DNA damage
- langerhans cells disappear from skin following sun exposure strong enough to cause a mild sunburn
7
Q
what are the 2 most common causes of death in xeroderma pigmentosum?
A
metastatic skin cancer and neurologic degeneration
8
Q
which diseases are treated with UV light?
A
psoriasis
cutaneous lymphoma
eczema
9
Q
tanning beds mostly emit which type of UV light?
A
UVA
10
Q
which type of tan provides more protection against a sunburn UVA or UVB?
A
UVA induced tans provide 10 times less protection than UVB tans
11
Q
the risk of skin cancer increases by ____________% in individuals who start using tanning beds before 30.
A
75%
12
Q
what is the mechanism behind a delayed tanning response?
A
increased melanin synthesis and increased transfer of melanosomes to keratinocytes
13
Q
Name the 2 common DNA photoproducts from UV damage
A
cyclobutane dimers
6,4 photoproducts
14
Q
what are the 2 signature mutations induced by UV light?
A
C–>T
CC–>TT
15
Q
which skin cancer has a corrlation with mutation in PTCH gene?
A
basal cell carcinoma
16
Q
Name the pathology:
pearly, nodular, shiny, centrally ulcerated and studded w/ telangiectasias on gross appearance.
A
basal cell carcinoma
17
Q
Name the micropathology:
basophillic hyperchromatic cells that form nodules, often etending from the surface epidermis
-cells at the periphery of aggregations form a palisade
-tumor nodules are set in a mucinous stroma, w/ retraction from that stroma (clefting)
A
basal cell carcinoma
18
Q
what are 3 major risks for getting squamous cell cancer of the skin?
A
UV light
HPV
immunosuppression
19
Q
what are the risk factors for the ability of a squamous cell carcinoma in skin to metastasize?
A
size of tumor (larger than 2 cm clinically greater risk)
depth of invasion into dermis (greater than 4 mm depth, greater risk)
anatomic site (higher risk on lips and ears)
host immune status
20
Q
what is the most common cause of death in melanoma of the skin?
A
CNS involvement
21
Q
what is the most important prognostic factor for melanoma of skin?
A
lymph node involvement
22
Q
what are the histologic prognostic factors of melanoma?
A
breslow thickness & ulceration
23
Q
what is a keratoacanthoma?
A
neoplasm of KCs, related to SCC (possibly subtype), grows 2-6 wks
- painful
- may involute spontaneously
24
Q
what is Marjolin’s ulcer?
A
ulcerated invasive SCC arising on the background of chronic inflamm. scarring, radiation, trauma
25
what is the most common type of malignant melanoma in pts with darker skin?
acral lentiginous melanoma
26
what is a lentigo maligna?
melanoma in situ, slow growing still in radial growth phase (seen in older pts w/ sun-exposed skin)
27
melanocytes are derived from what kinds of cells?
neural crest cells
28
where is the most common site for melanocytes to develop into melanoma?
dermal-epidermal junction
29
what is the #1 organ site for metastasis in melanoma?
SKIN
30
what is breslow's thickness?
distance of involvement from the stratum granulosum to the deepest tumor cell (used for melanoma)
31
about what percent of melanomas have BRAF mutations?
50%
32
what is the name of the bug that causes american trypanosomiasis (chagas diseae)?
T. cruzi
33
what is the name of the bug that causes african trypanosomiasis?
T. brucei
34
How is T. cruzi (chagas disease) transmitted?
REDUVIID BUGS !
35
what is romana sign?
seen in american trypanosomiasis-edema of the palpebral and periocular tissue due to entry through the conjunctiva
36
which trypanosomiasis causes trypanosome chancre?
african trypanosomiasis
37
what is the other name for onchocerciasis?
river blindness
38
which derm infection can you prevent by not going to Belize?
human botfly (cutaneous myiasis)
39
The cimicids (bedbugs) have what characteristic finding on the skin?
bites come in 3's (BREAKFAST, LUNCH AND DINNER)
40
which type of hair is in the growing phase cycle?
anagen hair (1-5 yrs)
41
which type of hair is in the resting phase cycle?
telogen hair (3 months)
42
what should you do when you see pattern alopecia with male pattern distribution in a female pt?
check DHEAS and testosterone
43
what is the ultimate result of minoxidil treatment?
reverses hair loss and slows the progression of hair loss
44
who would be the ideal pt where minoxidil would work the best?
young guys
45
what is androgentic alopecia?
common baldness (gradual miniaturization of hairs w/ transformation of large terminal follicles (visible) to small vellus follicles (invisible)
46
what is the main adverse effect you have to remember with finasteride?
the sexual side effects could last even if you stop taking the drug
47
what is telogen effluvium?
an excess shed of telogen hair occurs due to a premature shunting of anagen to telogen
-results in increased shedding of 20-35% of total scalp hair
48
about how many hairs from the scalp are shed each day?
100
49
what is anagen effluvium?
acute, extreme alteration of growth of majority of anagen hair
-acute loss of 80-90% of scalp hair (b/c anagen hair makes up a greater %)
50
what is alopecia areata?
circular area of complete hairloss on a normal scalp
51
Secondary syphilis has what clinical appearance?
moth-eaten
52
what is the test for secondary syphilis?
RPR
53
will the hair grow back if you treat the secondary syphilis?
yes
54
what are the 3 labs you need to get to exclude other causes of hair loss other than secondary syphilis?
CBC (anemia)
Ferritin (normal CBC and low ferritin, treat w/ iron and get regrowth of hair)
TSH
55
How can you clinically determine if the hair loss is due to traction alopecia?
look for the peripheral fringe and broken hair
56
the proximal matrix makes the ________nail plate
dorsal
57
the distal matrix makes the ______________ nail plate
ventral
58
fingernails grow about how much each month?
Fingernails-3 mm/month
| Toenails-1 mm/month
59
lichen planus is associated with which disorder that has abnormal nail matrix function?
trachyonychia (sandpaper nails)
60
which disorder of abnormal nail matrix function has mees' lines?
true leukonychia
w/ transverse white bands that have been traditionally associated with arsenic and thallium toxicity
61
Mees' lines are associated with what abnormal nail matrix function and are associated with what kind of toxicity?
true leukonychia
| Arsenic and thallium toxicity
62
chronic paronychia is most commonly due to what?
candida infection
63
recurrent episodes of acute paronychia should raise concern for what kind of infection?
HSV infection
64
which type of onychomycosis is associated with immunosuppression/HIV?
proximal subungual (PSO)
65
what is the most frequent tumor of the nail apparatus?
squamous cell carcinoma
66
what is the main causative role of squamous cell carcinoma when it involves the nail apparatus?
HPV16
67
Hutchison's sign is found in what nail pathology?
melanoma
| hutchison's sign =extension of pigment onto the nail folds
68
How can you tell if a certain rash come from the outside?
outside origin= scaley red thickened skin, straight lines, geometric shapes, spares folds
69
how can you tell if a rash has an internal origin?
flat, doesn't spare folds, no straight lines, no sharp cutoffs
70
what kinds of things can cause an internally originating rash?
drugs
Rocky mountain spotted fever
meningococcemia
hepatitis
71
what kinds of things cause an external origin rash?
contact dermatitis
72
describe what older skin on sun exposed area looks like?
thinner, dryer, scaley, bruises more easily
73
Name the pathology:
very common benign lesion that's tan w/ pigmented waxey plaques, looks like someone threw mud against a wall (stuck on appearance)
seborrheic keratosis
74
Name the lesion: benign red papules and nodules made up of blood vessels
cherry angiomas
75
name the lesion:
| dome shaped nodule usually with a hyperpigmented border, feels like a BB under the skin
dermatofibroma
76
name the lesion:
| large blue vascular lesion on the lower lip, compressible, benign
venous lake
77
name the lesion: keratotic horn shaped projection produced by multiple causes such as warts, seborrheic keratoses, and squamous cell carcinoma, must biopsy base for diagnosis
cutaneous horn
78
name the pathology:
due to lower leg swelling the lower leg is scaley and red, diagnose pitting edema, progression from scaley red to erosionsto ulcers if no treatment
stasis dermatitis
79
term for flat discolored spot on skin not raised above the surface
macular
80
term for a small blister that contains serous fluid
vesicle
81
term for a pus filled blister
pustule
82
term for a large bump greater than 4mm
nodule
83
term for a small bump less than 4 mm
papule
84
term for a well defined elevated are of skin
plaque
85
Name the pathology:
| scaley red macules, papules or plaques commonl seen on the elbows and knees
psoriasis
86
name the pathology:
| red scaley rash found on posterior neck, popliteal and antecubital fossae
atopic dermatitis
87
name the pathology:
multiple scaley red oval plaques commonly begins with a single lesion (herald patch) and then days to wks later multiple lesion develop, lesions are in cleavage lines and have a christmas tree distribution?
pityriasis rosea
88
Name the pathology:
| scaley rough lesions on long term sun exposed skin (1/1000 turn into squamous cell carcinoma)
actinic keratosis
89
Name the pathology:
| round pearly lesions with telangiectasias due to long term sun exposure spreads wide and deep but rare to metastasize
basal cell carcinoma
90
Name the pathology:
| keratotic nodule with firm base which usually begins as an actinic keratosis and becomes a neoplasm.
squamous cell carcinoma
91
what are the ABCDs of melanoma?
asymmetry
borders (irregular)
color (variations)
diameter (greater than 6 mm)
92
what do you do if a pt comes in and says that their mole has changed?
take it off
93
increased educational status correlates with increased risk of developing what?
melanoma
94
what are the clues that let you know a rash is getting better?
redness (if redness decreases)
Desquamation (skin peels off)
Wrinkling (swelling and inflammation have gone down)
95
always examine a pt with their clothes _______
OFF
96
what would a biopsy of an outside origin rash look like?
abnormal stratum corneum, inflamm. cells, in the epidermis and sometimes blister, clinically looks like red scaley skin + blister
97
what would a biopsy of an internal origin rash look like?
scattered inflammatory cells in the dermis, clinically this looks red, the epidermis is unaffected clinically flat and smooth
98
which rash presents in a classic dermatome pattern?
herpes zoster
99
Name the pathology:
| group of blisters on a red base
herpes
100
if you have a pt who comes in with lesions on their palms and soles you should start thinking about what?
secondary syphilis
101
term for a special group of exotoxins that bind conserved portions of T cell receptors and are able to activate a large number of T lymphocytes.
superantigens
102
which 2 microbes classically make the superantigens?
Staph aureus & Strep pyogenes
103
Term for a superficial crusting epidermal skin infection that presents in bullous and nonbullous forms. Often has a honey crusted coating
impetigo
104
when you see a young honey colored crusting epidermal skin infection on a kid's face you know he has what?
impetigo
105
term that describes the superficial infection of hair follicles with pus accumulation in the epidermis.
folliculitis
106
term for the streptococcal infection of the superficial dermal lymphatics that demonstrates sharply demarcated, raised borders.
erysipelas
107
term for fungi that digest keratin as their nutrient source?
dermatophytes
108
95% of tinea pedis cases are caused by ___________
dermatophytes
109
jock itch is caused by what?
tinea cruris
110
ring worm is caused by what?
tinea corporis
| tinea facei
111
candidiasis is more common in which pts?
women (accounting for vulvovaginal candidisis, and in immunosuppressed pts)
112
Most common form is herpes infection is________________ presents as vesicular or ulcerative lesions of the oral cavity or perioral skin and mucosa (HSV-1)
herpes labialis
113
term for HSV superinfection of atopic dermatitis
eczema herpeticum
114
Name the lesion: painful grouped vesicles on an erythematous base on the border of the lip.
HSV-1 herpes labialis
115
name the pathogen: "dew drops on a rose pedal"
varicella chickenpox
116
name the pathology:
| produces a painful prodrome, followed by a dermatomal vesicular eruption
zoster rash (varicella zoster virus) aka shingles
117
Name the pathogen:
| multinucleated acantholytic keratinocyte under histopathology
herpetic viral infection
118
name the pathology:
| pearly white umbilicated papules in a child
molluscum contagiosum (caused by DNA pox virus)
119
90% of genital warts are caused by what 2 viruses?
HPV6 & HPV11
120
which 2 viruses are strongly associated with cervical cancer?
HPV16 & HPV18
121
Gardasil covers which HPV types?
6, 11, 16, 18
122
Cervarix covers which HPV types?
16, 18 (cervical cancer)
123
defects in the development of the ectoderm lead to what?
ectodermal dysplasia
124
ichythosis vulgaris is due to what kind of mutation?
filaggrin
125
what embryonic tissue forms the epidermis?
only the ectoderm
126
what embryonic tissue forms the dermis?
ectoderm and mesoderm
127
what is stasis dermatitis?
due to venous insufficiency and edema (can result in venous ulcers)
128
what are the 2 most important treatments of stasis dermatitis?
ELEVATION & COMPRESSION
129
Is there a vaccine for ParvoB19?
"NO VACCINE FOR PARVOB19"
130
what is the cause of hand-foot-mouth disease?
coxsackie virus
131
If you see a pt with eczema herpeticum in the derm clinic what do you need to do?
SEND THEM TO THE ER!
132
superficial fungal infections only hit what kind of tissue?
dead keratinous tissue
133
what is a histologic clue that there is a superficial fungal infection?
neutrophils in the stratum corneum
134
Name the pathogen:
| vacuolated superficial keratinocytes w/ pyknotic raisin-like nuclei (koilocytes)
HPV
135
name the pathogen: multinucleated keratinocytes
herpes viruses
136
name the pathology: sunburn-like erythema and sandpaper papules
TSS
137
which virus causes immunosuppression by infecting lots of monocytes?
measles
138
albinism is due to a lack of what?
melanin
139
what is the follicular occlusion tetrad?
1. acne conglobata
2. Hidradenitis suppurativa
3. Dissecting Cellulitis
4. pilonidal cyst
140
Pellagra is caused by what kind of deficiency?
niacin
141
what are the 3 D's of pellagra?
Dementia
Dermatitis
Diarrhea
142
hypohidrotic ectodermal dysplasia is dysfunction in thermoregulation with a mutation in what gene?
EDAR-ectodyplasin A receptor
- unable to regulate temp.
- results in abnormal hair follicles, sweat lands and teeth
143
stratum corneum compared to brick and mortar, what are the bricks and whats the mortar?
bricks=flattened keratinocytes filled w/ keratin & filaggrin
| mortar=lipid mixture surrounding keratinocytes (water barrier)
144
the keratins combine to form ______________filaments
intermediate
145
what is the primary cell in the dermis?
fibroblast
146
fibroblasts have what kind of origin?
mesenchymal
147
what are apocrine sweat glands?
sweat glands that are associated with a hair follicle (found in axilla and anogenital skin)
148
what are eccrine sweat glands?
sweat glands not associated hair follicle (all over body)
149
what are sunburn cells?
damaged keratinocytes that are undergoing apoptosis
150
what happens if you fail to delete the cells damaged by the sun?
could cause cancer
151
In what layer of the epidermis is profilaggrin processed into filaggrin?
stratum corneum
152
atopic dermatitis is assoicated with genetic defects in what gene?
filaggrin
153
what is a nevus?
aka mole, benign collection of melanocytes
154
what are some of the histological changes with sunburn?
```
damaged keratinocytes (sunburn cells
inflamm.
intercellular edema
perivascular edema
hyperkeratosis, acanthosis (after 72 hours)
```
155
what is chronologic aging?
smooth, pale finely wrinkled skin with benign growths
156
what is photoaging?
dry deeply wrinkled inelastic leathery atrophic, telangiectasias, irregular pigmentation
157
what another name for freckles?
ephelides
158
how do melanomas metastasize?
lymphatics
159
onycholysis (distal nail plate detachment from the nail bed) is commonly to due what 2 things?
PSORIASIS
| or onychomycosis
160
splinter hemorrhages in the nail bed are most commonly associated with what?
bacterial endocarditis
161
What is the prognosis of erythema toxicum neonatorum?
benign, up to 50% of infants, resolves spontaneously
162
when do keratinocytes present antigen?
when they are stimulated
163
pemphigus vulgaris often starts with ____________________
mucosal erosions (more likely to see erosions rather than blisters)
164
what is the prognosis for untreated pemphigus vulgaris?
high mortality (30-70%)
165
pemphis vulgars has autoantibodies against which antigen?
desmoglein 3 (PVDG3)
166
Describe the clinical presentation of bullous pemphigoid?
fairly sudden onset of very itchy wheals and tense blisters on trunk and extremities (mouth and oral mucosa affected in some)
167
which drug can cause bullous pemphigoid?
furosemide
168
In bullous pemphigoid there are autoantibodies against which antigens?
BPAg1
| BPAg2
