Robbins concepts Flashcards
1
Q
6 requirements for describing skin lesions?
A
Quantity # Size Color Shape Palpability (shadow) Texture Location
2
Q
Small flat any shaped lesion?
A
Macules
3
Q
Lesion confined to epidermis, no fluid, not raised?
A
macule
4
Q
Flat lesion >5mm (1cm)?
A
Patch
5
Q
> 1cm raised lesion?
A
Plaque
6
Q
raised lesion <1cm?
A
Papule (pimple)
7
Q
Large, deep raised lesion >1cm? Grows into dermis
A
Nodule
8
Q
Small raised fluid filled lesions?
A
Vesicles
9
Q
Larger >1cm blister or fluid filled lesions?
A
Bulla
10
Q
vesicle filled w/ pus?
A
postule
11
Q
superficial loss of epidermis>
A
Erosion
12
Q
Erosion involving the Dermis?
A
Ulcer
13
Q
Four layers of the skin
A
Sup--> Deep Stratum Corneum stratum granulosum stratum spinulosum stratum basale
14
Q
Protein found within granular cell layer which retains water in keratinocytes?
A
Filaggrin
15
Q
Autoimmune blistering disease against Ag @ basal cell layer?
A
Bullus pemphigoid
16
Q
Causes accelerated rate of epidermal turnover?
A
psoriasis
17
Q
Three main cell types in the epidermis?
A
Keratinocytes
Melacocytes
Langerhan cell
18
Q
Benign collection of melanocytes?
A
Nevi (MOLE)
19
Q
Excessive collagen deposition in response to injury?
A
Keloids
20
Q
Use for smooth, non hairy, dry thick lesions?
A
Ointment
21
Q
Use of acute exudative inflammation intertriginous areas?
A
Cream
22
Q
For hairy areas?
A
Lotion
23
Q
Six components of topical prescription?
A
Generic name vehicle concentration Directions amount refills
24
Q
Loss of intercellular adhesion of keratinocytes?
A
Acantholysis
25
Diffuse epidermal hyperplasia
Acanthosis
26
Consequence of contact w/ poison ivy?
Contact dermatitis (CD4+ T cells) Delayed type hypersensitivity (T4)
27
Pt w/ wide diversity of lesions including macules, papules, and bullae + characteristic Targetoid Lesions consisting of red macules w/ pale vesicular/ eroded center?
Erythema Multiform
| Caused by Hypersensitivity to Drugs or Infections
28
ABCDEs of mole or melanoma?
```
Asymmetry
Boarder irregularity
Color
Diameter> 6mm
Evolution
```
29
Most common melanoma site in MEN? Women?
Back (M)
| Legs + back (W)
30
Immune regulation of the skin is done by?
Langerhan cells-> Epidermis
| Lymphocytes and Dendritic cells-> Dermis
31
Thermoregulation in skin?
Microvasculature in the Dermis
32
Bullous Pemphogoid is caused by?
Auto antibodies against hemidesmosomes
33
Disease caused by Anti-desmosome Abs
| (type II HS)?
Pemphigus vulgaris
34
Disease caused by mutation in Nucleotide excision repair mechanism?
Xeroderma pigmentosum
35
Hypohidrotic ectodermal dysplasia?
EDAR gene mutation leading to abnormal hair follicles + sweat glands + and Teeth
** Unable to thermoregulate
36
Job of Melanin?
Protect the skin from UV light
37
Cells making up the epidermis?
Keratinocytes
Langerhan cells
Melanocytes
Merkel cells
38
What is in the Dermis layer?
Fibroblast --> collagen
Elastic fibers
Blood vessels
Nerve Endings
39
Epidermis cell layers renew every____ and cells have a _______ rate of apoptosis?
28+ days
| LOW
40
Basal cells adhere to the basement membrane w/?
hemidesmosomes
41
Cells in the spinous layer are held together using?
Desmosomes
42
At what layer to epidermal cells STOP dividing and begin differentiating?
Stratum Spinosum
43
What do the cells in the Spinous layer develop to help with Barrier function?
Lipid granules--> Lamellar granules
44
Granular layer cells synthesize what?
Profillagrin inside Keratohyaline granules
45
What is secreted into the intercellular layer to form a water tight seal?
Lipids in Lamellar granules
46
Which cells process Profillagrin into fillagrin?
Keratinocytes @ the Stratum coneum layer
47
Function of Fillagrin?
Keeps water in the cells
48
These two substances join to form macrofibrils for a protective layer?
Fillagrin + Keratin
49
What makes up intermediate filaments and is the major structural protein of Keratinocytes?
Keratin
50
Contains large amounts of Sulfur-containing acid cysteine?
Keratin
51
Dendritic cells in mid-epidermis responsible to allergic rxns and tumor surveillance?
Langerhan cells
52
Merkel cells?
Light touch receptor cells in the Basal layer of epidermis
53
What is the primary cell in the Dermis?
Fibroblasts--> synthesize and degrade collagen + elastin + glycosaminoglycans
54
Where in the skin are mast cells located?
Dermis
55
Atopic Dermatitis is associated w/ mutation of what protein?
Fillagrin
56
Epidermolysis Bullousa simplex is associated w/ what mutation?
Mutations in Keratin 5/14
| ** Blisters occur at sites of high stress
57
Psoriasis is associated w/ conditions and WHY?
increases Risk for Heart attacks & Strokes because its a Chronic inflammatory state
**also associated w/ Arthritis
58
Condition is caused by genetic (HLA polymorphisms) and environmental factors causing release of Cytokines which causes Keratinocyte hyperproliferation?
Psoriasis
59
Auspitz sing for Psoriasis?
Removing of scales causes multiple small bleeding points
60
"Pruritic, Purple, Polygonal, Planar Papules and Plaques?"
Lichen Planus (6 Ps)
61
Results from CD8+ mediated cytotoxic response against Basal cell layer and the Dermoepidermal junction?
Lichen Planus
| **Often cuased by viral infections or Drug exposure
62
Wickham striae?
White dots or lines funning though flat-topped purple polyglonal papule in LICHEN planus
63
"Sawtoothing" inflammation of the desmoepidermal junction?
Lichen planus
64
Symmetrical well developed epidermal hyperplasia + hypergranulosis and Hyperkeratosis located in extremities + elbows + glans penis + and oral mucosa?
Lichen Planus
65
Tetrad of Cough, Coryza, Conjunctivitis, and Koplik spots?
Diagnostic of Measles (Rubeola)
66
Tiny white or blue-gray lesions in buccal mucosa that precedes with maculopapular rash?
Koplik spots
67
Febrile maculopapular rash that begins in the face and spreads to the trunk and extremities + postauricular LAD?
Rubella (Togavirus)
68
Low fever, LAD, and Red-purple papular skin lesions in immunocomprimised patient with scratch marks?
Bacillary angiomatosis (Cat scratch fever)
69
Organism most responsible for skin and soft tissue infections such as Folliculitis and abscesses?
S. aureus
70
Superficial skin infections?
Impetigo
71
deeper dermal abscesses most commonly caused by?
S. aureus
| Less commonly: Strep pyogenes
72
Lesion characterized by accumulation of PMNs beneath stratum corneum producing a postal?
Impetigo
73
PAS and Gomori methanamine silver stain are helpful in identifying?
Fungal organisms
74
Verrucae are commonly caused by?
Warts caused by HPV
75
immunoflourescence shows uniform deposition of IgG Abs along cell membranes of keratinocytes in a "FISHNET" pattern?
Pemphigus vulgaris
76
Acantholysis?
Lysis of intercellular adhesion junctions btwn neighboring squamous epithelial cells in Pemphigus
77
Suprabasal acantholytic blisters?
Pemphigus vulgaris
78
Pg: Linear deposition of igG antibodies and complement in the epidermal basement membrane?
Bullous pemphigoid
79
Gross appearing differences btwn blisters of Pemphigus vulgaris and bullous pemphigoid?
Non-roofed blisters= Vulgaris
| Roofed= Pemphigoid
80
Pg: granular IgA deposition and on selectively localized tips of dermal papillae. Associated w/ cross reactivity of IgA to epidermal transflutaminases?
Dermatitis Herpetiformis
81
Dermatitis Herpetifromis is associated w/ what dz? Treatment?
Celiac disease
| ** responds to Gluten free diet
82
UVR that penetrates ozone layer?
>300nm (UVB + UVA)
83
UVB characteristics?
290-320nm
Filtered by glass window
Causes Sunburn
Minor cause of Photoaging
84
UVA characteristics?
```
320-400nm
Least potent
Penetrates glass
Penetrates Deep into skin
Major cause of PHOTOaging
```
85
Factors that modify UVR?
Altitude
Surface reflection (Snow= highest)
Could cover-> only scattered
86
what is a chromophore?
Molecule that absorbs UV
87
Major Chromophore in Skin?
DNA
| *aromatic AA
88
Acute effects of UVR on skin?
```
Sunburn (acute inflammation)
Immunomodulation
Epidermal hyperplasia
Vit D photosynthèses
DNA damage
```
89
What causes sunburn?
UVB
| *SPF is determined by testing erythema caused by UVB
90
Immediate Suntan?
UVA--> redistribute or oxidize existing melanin
Not protective
short lasting (hours)
91
Delayed suntan?
UVB--> increased melanin production
Photoprotective
Long lasting
92
UVR damage on DNA?
Direct--> absorption by bases
| Indirect--> other chromophores absorb
93
Specific damage to DNA by UVR?
Pyrimidine Dimers
Cyclobutane dimers
6,4 photoproducts
94
UV signature mutations?
C-> T
| CC--> TT
95
Defense mechanism against UVR?
Corneum--> reflection
Melanin--> absorption
DNA repair--> NER system
Apoptosis
96
heritable disease characterized by sensitivity to UV and early onset of skin cancers?
Xeroderma pigmentosum
97
PG of Xeroderma pigmentosum?
Defective NER system
98
Effects of XP defect?
Skin cancer
Eyes: cataracts + tumors + degeneration
CNS degeneration
99
What cells disappear from the skin following UV exposure?
Langerhan cells--> immunosuppression in the skin
