Skin

Question 1

Histology with spongiosis accumulation of fluid in upper epidermis and dermal inflammation?

Answer 1

Atopic eczema

Question 2

Which inflammatory cells are seen in atopic eczema?

Answer 2

Lymphocytes with occasional mast cells

Question 3

Define acanthosis

Answer 3

Epithelial hyperplasia

Question 4

Histology of acanthosis, hyperkeratosis, chronic inflammation of dermis?

Answer 4

Chronic plaque psoriasis

Question 5

Disease associated with HSV and targetoid lesions

Answer 5

Erythema multiforme

Question 6

What cells are seen in drug reactions?

Answer 6

EOSINOPHILS

Question 7

Band-like chronic inflammatory cell infiltrate along dermal-epidermal junction

Answer 7

Lichen planus

Question 8

What is lichen sclerosis called?

Answer 8

BXO- balantis xerotica obliterans

Question 9

Histology: Band of hyalinisation in the superficial dermis

Answer 9

Lichen sclerosis

Question 10

True/false: Lupus and dermatomyosits have similar histology

Answer 10

True, chronic inflammation along dermal-epidermal junction

Question 11

Which autoantibodies are seen with pemphigus vulgaris?

Answer 11

Anti-desmosome

Question 12

Where does IgG immunofluorescene positivity appear in pemphigus vulgaris?

Answer 12

On epithelial cell surface, chicken wire pattern

Question 13

Which autoantibodies are present in bullous pemphigoid?

Answer 13

Anti-basement membrane

Question 14

Where does IgG immunofluorescene positivity appear in bullous pemphigus?

Answer 14

Basement membrane

Question 15

Which disease is associated with dermatitis herpetiformis?

Answer 15

Coeliac

Question 16

Antibodies in dermatisis herpetiformis? (hint:coeliac)

Answer 16

IgA TTG (tissue transglutaminase)

IgA anti EMA (endomysial antibodies)

Question 17

Categorise the following into intra or sub-epidermal blisters:
Pemphigus vulgaris, bullous pemphigoid, dermatitis herpetiformis

Answer 17

Pemphigus vulgaris: Intra-epidermal

Bullous pemphigoid and d. herpetiformis: Sub-epidermal

Question 18

Presentation of cutaneous sarcoidosis

Answer 18

Papules and plaques anywhere on body

Question 19

Histology: non-caseating granulomatous inflammation and special stains for fungus and mycobacterium are -ve

Answer 19

Cutaneous sarcoidosis

Question 20

Difference between granuloma annulare and necrobiosis lipoidica symptoms?

Answer 20

Granuloma annulare: annulare round pink-purple batches on BONY anatomical sites

Necrobiosis lipoidica: tender, yellow brown patches on lower legs

Question 21

True/false: grannuloma annulare and necrobiosis lipodica have a similar histology

Answer 21

True

Both have necrobiotic granulomatous inflammtion: Zones of degenerate collagen surrounded by rim of histiocytes or macrophages

Question 22

Histology: Intra-epidermal blister with intracellular viral inclusions

Answer 22

HSV

Question 23

Histology for molluscum contagiosum?

Answer 23

Rarely needed, but will show intracellular viral inclusions at higher magnification

Question 24

Disease associated with mycobacterium marinum?

Answer 24

Fish tank granuloma

Granulomatous inflammation and POSITIVE ziehl-neelsen (because of mycobacteria)

Question 25

Which stain is used for fungal infections?

Answer 25

PAS stain (periodic acid-Schiff)

Question 26

Anatomy of cutaneous cyst?

Answer 26

Epithelial lining containing ceratin

Question 27

Most common type of cyst? Epidermal inclusion cyst or pilar?

Answer 27

Epidermal inclusion cyst Pilar is on scalp

Question 28

What is Leser Trelat?

Answer 28

Multiple rapidly appearing seborrhoeic keratoses, sign of malignancy

Question 29

Another name for fibroepithelial polyp?

Answer 29

SKin tag

Question 30

What is a papilloma?

Answer 30

Benign epithelial tumour usually on squamous epithelium Also in breast, nasal cavity, larynx

Question 31

Another name for benign glandular tumours?

Answer 31

Adenoma

Question 32

Histology: Fibroblastic proliferation within the dermis

Answer 32

Dermatofibroma

Question 33

Histology: Loss of epidermis, and granulation tissue with mix of new BVs and inflammatory cells

Answer 33

Ulcer

Question 34

What is a pyogenic granuloma?

Answer 34

BENIGN vascular tumour. Polypoid proliferation of small blood vessels. Bleeds easy. Misnomer- not infectious or granulomatous

Question 35

Histology: fragmented hair shaft material within a sinus tract in the dermis, surrounded by inflammatory cells and fibrous scar tissue

Answer 35

Pilonidal sinus

Question 36

Where do pilonidal sinuses occur? Which occupation is at risk?

Answer 36

Sacral area/cleft of buttocks of obese or hairy men. Hairdressers at risk

Question 37

Histology of freckle?

Answer 37

Increase in basal pigmentation but NO increase in melanocytes

Question 38

Histology of solar lentigo?

Answer 38

Increase in basal pigmentation Increase in basal melanocytes with NO nuclear atypia

Question 39

Histology: Large number of melanocytes, nuclear polymorphism and atypia, mitotic figues and pagetoid spread

Answer 39

Lentigo maligna Pagetoid=upward spread

Question 40

Junctional naevus

Answer 40

Nests of benign melanocytes within epidermis

Question 41

Intradermal naevus

Answer 41

Nests of benign melanocytes in dermis

Question 42

Compound naevus

Answer 42

Features of junctional naevus and intradermal

Question 43

Halo naevus

Answer 43

Melanocytic lesion with surrounding LYMPHOCYTES due to immune-mediated naevus regression

Question 44

Blue naevus

Answer 44

Intradermal naevus which looks blue Very heavily pigmented melanocytes with a spindle shape

Question 45

Spitz naevus

Answer 45

Looks like a melanoma in children but acts benign

Question 46

Dysplasia

Question 47

Risk factors for dysplasia (AK, Bowen's)

Answer 47

Sunlight, immunosuppression, previous irradiation, chemical carcinogens

Question 48

Risk factos for skin cancer in groin?

Answer 48

HPV

Question 49

Dysplastic naevus

Answer 49

Melanocytic lesion with dysplasia but no invasion Can run in families or be sporadic

Question 50

Melanoma in situ

Answer 50

Severe dysplasia of melanocytes WITHIN dermis Also called lentigo maligna

Question 51

Paget's disease of nipple

Answer 51

Atypical GLANDULAR proliferations in epidermis. Pagetoid spread Migration from underlying DCIS through lactiferous duct Confirmed to be glandular with IHC stains

Question 52

Extramammary Paget's

Answer 52

Seen in hairy parts of body like groin or axilla Same histology Rare to have underlying adenocarcinoma

Question 53

Most common skin cancer?

Answer 53

BCC

Question 54

Does BCC metastasise?

Answer 54

Almost never

Question 55

Does SCC metastasise?

Answer 55

Potentially, more aggressive than BCC

Question 56

WHat is upward spread of malignant melanoma called?

Answer 56

Pagetoid

Question 57

Another term for horizontal spread

Answer 57

Radial

Question 58

Define Breslow depth

Answer 58

Distance between granular layer of epidermis and the deepest malignant cell Most important prognostic factor

Question 59

What is a BRAF mutation related to?

Answer 59

Malignant melanoma, 40% of cases have this oncogene Patients can be treated with vermurafenib

Question 60

What are mycosis fungiodes and Sezay syndrome examples of?

Answer 60

Cutaneous T cell lymphoma

Question 61

Describe Mycosis fungiodes

Answer 61

NOT a fungal infection Cutaneous T cell lymphoma involving epidermis and dermis Low grade malignancy and resembles eczema

Question 62

What is sezary syndome?

Answer 62

When tumour cells of mycosis fungiodes enters the circulation

Question 63

Which HSV causes Kaposi sarcoma?

Answer 63

HSV 8