Robbins CH 25 Skin Flashcards Preview

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Flashcards in Robbins CH 25 Skin Deck (96):
1

Vesicles

Fluid filled
Max size of 5mm
Easily traumatized and unroofed--leaving shallow ulcerations

2

Bullae

Fluid filled
> 0.5 cm

3

Macules

Not raised
Flat area

4

Patch

flat area > 0.5cm

5

Papules

Elevated

6

Nodule

Elevated >0.5 cm

7

Pustules

Raised and filled with leukocytes to impart a yellow color

8

A focal increase in melanocytes of the basal layer causing a brown macule whose pigmentation is not related to sun exposure...

Lentigo

9

What is seen with lentigo?

Tanning of epidermis and elongation of rate ridges

Basal melanocytic hyperplasia

10

A masklike area of facial hyperpigmenation associated with pregnancy?

Melasma

11

A collection of mast cells with light brown appearance on skin?

Urticaria pigmentosa

12

Both junctional and intradermal and shows swirling cell on microscopy?

Melancytic nevus

13

Uncommon condition with hyper pigmented areas in skin folds--may occur in association with endocrinopathies or with neoplasms?

Acanthosis nigricans

14

Occurs in sun-exposed skin of adults--the cells have darker nuclei with scant cytoplasm. The sporadic form has PTCH gene mutation?

Basal cell carcinomas

15

Raised, pigmented lesions of thickened epidermis, seen in older adults. associated with FGFR3 mutation

Seborrheic keratoses

16

Hundrends of skin lesions that have been forming since childhood. Often seen in two siblings. Dark brown pigmented lesions that occur in sun-exposed and non-sun-exposed areas?

Dysplastic nevus syndrome

17

Dysplastic nevus syndrome is a precursor of....

Malignant melanoma

18

What mutation is seen in dysplastic nevus syndrome?

Cyclin-depdendent kinase inhibitor 2 mutations (CDKN2A)

19

Associated with TSC1 mutation?

Tuberous sclerosis

20

What type of melanoma is more aggressive and more likely to metastasize?

Melanoma with nodular growth pattern

21

Exhibits an indolent radial growth phase for many years before reaching an accelerated nodular vertical growth phase. Most lesions on head and neck or older pts. Activating BRAF mutation is seen?

Lentigo maligna melanoma

22

Dilated sub epidermal blood vessels forming lesions that is associated with ATM mutations?

Ataxia-telangiectasia

23

Associated with TYP mutation?

Albinism

24

What does the TYP gene do?

Encodes the enzyme tyrosinase that is part of the initial pathway of melanin production by melanocytes

25

Defects in DNA excision repair that predisposes pt to skin cancers, such as basal cell carcinoma, squamous cell carcinoma and malignant melanoma?

Xeroderma pigmentosum

26

Flat, round pigmented sharply demarcated, non-painful, non-ulcerating lesions composed of basaloid cells that commonly occur in older individuals?

Seborrheic keratoses

27

Rough raised lesion common on hands and feet?

Verruca vulgaris (Wart)

28

Lesions in axillae and flexural areas. Not painful or pruritic..

Acanthosis nigricans

29

Involvement of the skin in children that produces reddish papillose or nodules or erythematous scaling plaques?

Langerhans cell histiocytoses

30

Acrochordon or skin tag composed of a central core of fibrovascular connective tissue covered by normal appearing squamous epithelium?

Fibroepithelial polyp

31

Forms a red nodule that is composed of vascular spaces in the upper dermis?

Hemangioma

32

Epithelial cyst that forms on the scalp?

Pilar cyst

33

Localized dermal collection of lipid-laden macrophages associated with hyperlipidemia?

Xanthoma

34

Cystic structure formed from downward growth of epithelium or expansion of a hair follicle--lined by squamous epithelium that desquamates keratinaceous debris into the center of the expanding cyst?

Epidermal inclusion cyst

35

Produces comedones--typically on face and upper trunk?

Acne

36

Form of a benign adnexal tumor--subcutatneous nodule usually seen on the head, neck, and upper trunk?

Trichoepithelioma

37

Premalignant lesions associated with sun exposure?

Actinic keratoses

38

What are the risk factors associated with squamous cell carcinoma?

UV exposure
Scarring from burn injury
Irradiation
Immunosuppression

39

What is a precursor of squamous cell carcinoma that is a disorder involving DNA repair?

Xeroderma pigmentosum

40

Hypersensitivity response to infections or drugs causing lesions that have many forms--papules, macules, vesicles, bullae?

Erythema multiforme

41

Self-limited inflammatory disorder that manifest as purple, pruritic, polygonal papules?

Lichen planus

42

Inflammatory dermatosis that can be associated with arthritis, myopathy, enteropathy, atherosclerotic heart disease?

Psoriasis

43

Inherited condition resulting from mutation in one of several XP genes--nucleotide excision repair defect--ind. can develop any of the sun-exposed skin disorders. Child presenting with squamous cell carcinoma?

Xeroderma pigmentosum

44

Arise as pearly papillose on sun-exposed areas of the skin. Slowly infiltrate surrounding tissues, and gradually enlarge?

Basal cell carcinoma

45

Premalignant lesion of the epidermis that does not invade surrounding tissue?

Actinic keratosis

46

Benign lesion of the dermis composed of cells resembling fibroblasts. Localized, dermal, spindle cell proliferation with overlying epidermal hyperplasia and downward elongation of hyper pigmented rate ridges?

Dermatofibroma

47

Malignant counterpart of dermatofibroma associated with PDGFB gene juxtaposed with the promoter region of COL1A1?

Dermatofibrosarcoma protuberans

48

What occurs as a result of PDGFB gene juxtaposed with the promoter region of COL1A1 seen withDermatofibrosarcoma protuberans?

Upregulation of a growth-promoting factor

49

FGFR3 mutations

Seboorheic keratoses

50

KIT mutations

Mast cell proliferations

51

PTCH1 mutations

Basal cell carcinoma

52

TSC1 mutations

Tuberous sclerosis

53

A localized form of mastocytosis--cutaneous lesions show the characteristic Darier sign on rubbing (more pruritic with swelling and erythema when rubbed)...

Urticaria pigmentosa

54

Point mutation in KIT oncogene involved where upper dermal infiltrates of large cell with abundant pink cytoplasm that stains an intense purple color with toluidine blue?

Urticaria pigmentosa

55

Common reaction to many skin irritants?

Aczematous dermatitis

56

Reaction to a chemical--often a drug
Has systemic effect
Lesions often begin with targetoid appearance...

Erythema multiforme

57

A hypersensitivity response to certain infections, disorders and drugs can lead to erythema multiforme. What are these infections/drugs/disorders?

Drugs--sulfonamides and penicillin

Infections--HSV, mycoplasma and fungal infections

Disorders--malignant disease and collagen vascular diseases--SLE

58

Urticaria is a ____

type I hypersensitivity

59

What is Koebner phenomenon?

Seen with psoriasis--appearance of lesion with trauma

60

What causes the skin damage seen with psoriasis?

Abnormal CD4+ and CD8+ lymphocyte activation with release of many cytokines

61

What is seen on biopsy of psoriatic lesion?

thinning of stratum granulosum with marked overlying parakeratotic scale containing micro abscesses

62

What Th cells are involved in the elaborate cytokine promotion of cell proliferation seen in psoriasis?

Th17 and Th1

63

What are the nail changes seen with psoriasis?

Yellow-brown discoloration
Pitting
Dimpling
Separation of nail plate from the nail bed (onycholysis)

64

What are disease associated with Psoriasis?

Arthritis
Myopathy
Enteropathy
Atherosclerotic heart disease

65

Autoantibodies to desmoglein--causing suprabasal blister fromation?

Pemphigus vulgaris

66

Pruritic, purple, polygonal papillose with sandlike infiltrate of lymphocytes at the dermal-epidermal junction

Lichen planus

67

What cell is involved in lichen plans?

CD8+ cells reacting to antigen in the basal layer and dermoepidermal junction

68

Where is the common spot on the body for lichen planus lesions to form?

Oral lesions

69

Caused by IgG autoantibodies directed at an intercellular cement substance called desmoglein?

Pemphigus Vulgaris lesions

70

What are the common sites of intraepidermal blisters to occur with pemphigus vulagaris?

Scalp
Axillae
Groin
Knees

71

What is seen on biopsy of pemphigus vulgarism lesions?

Epidermal acatholysis and formation of intraepidermal blister

Basal cell layer remains intact

72

Bullous pemphigoid results from what?

linear IgG deposition at the basal-cell basement membrane attachment plaques (Hemidesmososmes) containing bulls pemphigoid antigen (BPAG)

Subepidermal bullae is formed

73

Disease associated with celiac disease?

Dermatitis herpetiformis

74

What is the pathogenesis of dermatitis herpetiformis?

Reticulin--component of the anchoring fibrils that attach the epidermal basement membrane of the superficial dermis are affected by the IgA/IgG antibodies that are formed against the gliadin protein in gluten

75

What type of reaction is contact dermatitis and where does this happen on body?

Type IV hypersensitivity reaction

Seen on hands and forearms

76

What type of reaction id discoid lupus erythematous?

Type III hypersensitivity reaction--antigen-antybody complex deposition along the BM of the epidermis

77

What are the early and late lesions seen with discoid lupus erythematosus?

Early--well-demarcated scaly purple macules or papules

Later-- expansion into discoid plaques

78

What is seen on biopsy of discoid lupus erythematous?

Basal vacuolar degeneration, areas of epidermal atrophy, acanthuses, keratotic follicular plugging, BM thickening, superficial and deep perivascular lymphocytic infiltrates

79

Bullous pemphigoid lesions involve antibodies against what?

type XVII collagen as a component of hemidesmosomes

Occur at the dermal-epidermal junction

80

What is the sever form of erythemia multiforme that is mediated by cytotoxic CD8+ cells targeting epidermal basal cells?

Toxic epidermal necrolysis

81

What organism is involved in acne vulgaris?

Propionibacterium acnes organism

82

Form of panniculitis that is associated with infections, drug ingestion, inflammatory bowel disease, and malignancies. The inflammation primarily involves dermal adipose tissue?

Erythema Nodosum

83

Seen on the face and hands with crusting lesions. Caused by staphylococcus aureus and B-hemolytic streptococcal infections. Subcorneal pustules.

Impetigo

84

Firm nodules that microscopically contain pink cytoplasmic inclusions?

Molluscum contagiosum lesions--molluscum bodies are the pink inclusions

85

BRAF mutations

Present in melanocytic proliferations--dysplastic nevi

86

IgA deposition

Dermatitis herpetiformis

87

Type IV hypersensitivity reaction of the skin?

Contact dermatitis

88

Poxvirus

Molluscum contagiosum

89

Superficial infection of the skin that produces shallow erosions-- honey colored crust

Coagulase-postive staphylococcus aures or group A B-hemolytic streptococcus

Lesions are highly infections

Impetigo

90

Common disorder resulting from superficial dermatophyte infection by various fungal species --trichophyton, epidermophyton, and microsporum?

Athlete's foot--tinea pedis

91

What are the fungal species involved in athlete's foot--tinea pedis?

Trichophyton
Epidermophyton
Microsporum

92

Mites burrow through the stratum cornerum--producing linear lesions--intense pruritus?

Sarcoptes scabiei

93

Localized firm nodule caused by poxvirus?

Molluscum contagiosum

94

Superficial dermatophytic fungal infection that produces erythema and crusting--annular appearance with central clearing--Ring-worm?

Tinea corporis

95

Common condition caused by a superficial fungal infection--malassezia furfur with lesions that wax and wane. No pain/itching or bleeding involved?

Tinea versicolor

96

Cause of Hansen disease--manifest with areas of skin anesthesia that predispose to repeated trauma?

Mycobacterium leprae