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131 Cards in this Set
- Front
- Back
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What are the four layers of epidermis?
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1. stratum basalis
2. stratum spinosum 3. stratum granulosum 4. stratum corneum |
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What cells make up the epidermis and approximately what percentage of the total number of cells are they?
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1.) Keratinocytes - 95%
2.) Melanocytes - 3% 3.) Langerhans - 2% 4.) Merkel - <1% |
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What is the function of Merkel cells?
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sensory
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How do melanocytes transfer melanosomes to keratinocytes?
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via their dendrites
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What is the difference between the papillary dermis and the reticular dermis?
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The papillary dermis is on the surface, under the epidermis and has dermal papillae that interdigitate among the epidermal rete ridges. It contains the vasculature that provide nutrients to the epidermis.
Reticular dermis is below the papillary dermis and is what leather is made of. Very strong! |
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Wheals and multiple wheals or hives (urticaria) are caused by edema of what part of the skin?
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papillary dermis
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What are urticaria?
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hives (multiple wheals)
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Which of these mediate light touch and which deep pressure and where are they located?
a.) Meissner corpuscles b.) Pacini corpuscles |
a.) Meissner - light - dermal papillae
b.) Pacini - deep - subcutaneous or deep dermis |
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What are specialized cuboidal smooth muscles in the fingertips and toes that are innervated by sympathetic nerves and involved in controlling blood flow to these areas?
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Glomus bodies
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In pemphigus vulgaris, there are circulating auto-antibodies directed against what?
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desmogleins in desmosomes disrupting keratinocyte cell-cell adhesion
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In bullous phemphigoid, there are circulating auto-antibodies directed against what?
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Proteins of hemidesmosomes, disrupting the dermo-epidermal junction
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Which blisters are more stable, pemphigus blisters or pemphigoid blisters?
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pemphigoid because blister is subepidermal instead of epidermal
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In epidermolysis bullosis acquisita, there are circulating auto-antibodies directed against what?
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anchoring fibirils (collagen 7) within the dermis.
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What is the main difference in the pathophysiology of autoimmune bullous disorders like pemphigus and pemphigoid and of hereditary epidermolysis bullosa?
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autoimmune bullous disorders are caused by circulating auto-antibodies against cutaneous molecules
the hereditary guys are caused by mutations in cutaneous proteins such as keratin and collagen |
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Which kind of hereditary epidermolysis bullosa will always present with scarring?
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dystrophic EB
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Which kind of hereditary epidermolysis bullosa can be caused by mutations to the same protein that can have auto-antibodies against it in pemphigoid?
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junctional EB (collagen 17)
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Which kind of hereditary epidermolysis bullosa has the mildest clinical phenotype with no scarring typically?
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EB simplex
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Skin biopsies from bullous impetigo (with S. aureus infection) and staphylococcal scalded skin syndrome show the same pathology as those from patients with what autoimmune bollous disorder?
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phemphigus foliaceus
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How can you differentiate pemphigoid and epidermolysis bullosis acquisita with IF?
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Split the skin at the lamina lucida & do IF - if blister roof lights up, you know it's pemphigoid.
If blister bottom lights up, you know it's epidermolysis bullosis acquisita. |
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What immunoglobulin mediates type I hypersensitivity?
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IgE
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What type of hypersensitivity can manifest as urticaria?
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type I (anaphylactic/immediate)
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What type of hypersensitivity can manifest as angioedema?
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type I (anaphylactic/immediate)
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What type of hypersensitivity can manifest as pemphigus or pemphigoid?
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type II (cytotoxic)
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What type of hypersensitivity can manifest as vasculitis?
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type III (immune-complex)
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What type of hypersensitivity can manifest as allergic contact dermatitis?
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type IV (cell mediated/delayed)
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A hypersensitivity reaction to nuts can present with what dermatological manifestations?
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urticaria or angioedema
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What kind of helper T cells do people with atopy tend to make?
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TH2
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T/F - Urticaria and angioedema are usually itchy.
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false - angioedema is not.
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How can you differentiate urticaria (hives) and vasculitis?
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press a glass slide down on the lesions. if they blanch, it's type I (hives). if they don't, it's type III (vasculitis)
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What are the major criteria for diagnosis of atopic dermatitis? How many do you need to meet for diagnosis?
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1.) pruritus
2.) typical morphology & distribution 3.) chronic or relapsing dermatitis 4.) personal or family history of atopy Need at least 3/4. |
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What is atopy?
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Personal or family history of allergic rhinitis, asthma, and/or atopic dermatitis
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T/F - Most patients affected with atopic dermatitis are less than or equal to five years old.
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True.
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Who generally has the most severe form of atopic dermatitis?
a.) 9 month old baby b.) 9 year old child c.) 39 year old adult |
a.) 9 month old baby
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Your patient has atopic dermatitis and presents with eczematous lesions on her cheeks, forehead, scalp, neck, hands, and feet. None are in her flexural areas. What phase is your patient in?
a.) infantile b.) childhood c.) adolescent/adult |
a.) infantile
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Your patient has atopic dermatitis and presents with eczematous lesions on her flexural areas. What phase(s) could your patient be in?
a.) infantile b.) childhood c.) adolescent/adult |
b.) childhood
c.) adolescent/adult |
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In acute dermatitis, what kind of immunological cells predominate in the infiltrate?
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T lymphocytes and a few macrophages.
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How would you treat dermatitis characterized only by dry skin?
How about more severe forms? |
a.) only dry skin - use moisturizers
b.) then add immunomodulation (calcineurin inhibitors) c) finally, for severe flare-ups, use corticosteroids |
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Which of these diseases will have erythema over hands sparing the DIP and PIP joints?
a.) systemic lupus erythematosus b.) dermatomyositis |
a.) systemic lupus erythematosus
dermatomyositis will present with lesions exactly over the joints |
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Which of these diseases will have a heliotrope eruption?
a.) systemic lupus erythematosus b.) dermatomyositis |
b.) dermatomyositis
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A patient presents with annular lesions. She has no heliotrope eruption. Which disease is more likely?
a.) systemic lupus erythematosus b.) dermatomyositis |
a.) systemic lupus erythematosus (subacute)
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What is the pathophysiology of vasculitis? What about etiology?
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-pathophysiology - inflammation and necrosis of blood vessel walls
-etiology - infection, drug, auto-antibodies, malignancies, or idiopathic |
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What are the characteristic cutaneous manifestations of vasculitis?
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1.) palpable purpura (raised, non-blanchable erythema)
2.) symmetric lesions 3.) often on lower limbs |
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What are the cutaneous diagnostic criteria of neurofibromatosis type I?
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1.) >2 neurofibromas in the context of other criteria (family history)
2.) 6 or more cafe-au-laut macules at least 1.5cm (also sphenoid dysplasia, Lisch nodules, axillary freckling) |
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What's the hard part of the nail called where we used to paint our sparkly nail polish? What synthesizes that?
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nail plate synthesized by the nail matrix
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What's the marker of the junction between the nail matrix and the nail bed that you can see on your thumb?
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the distal border of the lunula
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The proximal nail matrix makes the ____ of the nail plate.
a.) top b.) middle c.) bottom |
a.) top
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Nail pitting demonstrates an issue with what part of the matrix?
a.) proximal b.) middle c.) distal |
a.) proximal (makes the top of the nail plate)
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What's the word for the separation of the nail plate from the nail bed?
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onycholysis
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Most scalp hairs hang out in the anagen phase. Which phase generally has the least number of hairs hanging out?
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catagen (transient stage of reduced hair growth)
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You're in a cat fight with your worst enemy and tug at her ponytail. A few hairs fall off and their edges are ragged. What phase of hair growth were these hairs in?
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anagen.
telogen hairs will have a round terminal end resembling a club. |
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What is the difference between hypertrichosis and hirsutism?
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hypertrichosis - disease process leading to too much hair.
hirsutism - hypertrichosis occurring in androgen dependent areas |
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T/F - In most cases of androgenetic alopecia, androgen levels are not normal.
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False! They are often normal, but hair follicles have more receptors for androgens and higher activity for 5alpha-reductase.
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When does miniaturization of the hair shaft occur?
a.) androgenetic alopecia b.) telogen effluvium c.) both |
a.) androgenetic alopecia
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What is post-partum hair loss frequently caused by?
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telogen effluvium (increase in the percentage of hairs in the telogen phase)
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What is the pathophysiology of alopecia areata?
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Autoimmune disorder that forces groups of hair follicles out of anagen and inhibits them from reentering anagen.
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Cancer chemotherapy induces hair loss via what?
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anagen effluvium - hair growth tapers to a halt and the hair shaft gets skinny and breaks off
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What kind of innervation & stimulus do eccrine glands get?
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sympathetic cholinergic
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What is the major stimulus for eccrine sweating?
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ice, ice baby
no, wait. Heat. |
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What's the difference between
a.) miliaria crystallina and b.) miliaria rubra? |
a.) crystallina - heat rash from superficial obstruction of eccrine sweat gland in the stratum corneum
b.) rubra - deeper obstruction in the epidermis |
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Where can you find apocrine sweat glands?
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in all the sexy parts of your body - groin and axillae
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Which of these discharges its secretions into the hair follicle? (The other dumps its shit onto the surface of the skin)
a.) eccrine sweat gland b.) apocrine sweat gland |
b.) apocrine sweat gland - must be why our pubic hair is so sleek!
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Which are bigger, apocrine glands or eccrine glands?
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apocrine (10x greater diameter secretory coil)
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What's the neurohormonal stimulus for apocrine glands?
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sympathetic adrenergic
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How come apocrine glands make stinky sweat and eccrine glands don't?
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Apocrine gland sweat consists of water, carbs, protein, iron, steroids, and lipids. Bacteria hanging out in our underarms (and groin?) break down lipids, making the stank.
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Who is more likely to get a scabies infection, a wee little baby or a wee little ten-year-old?
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the wee little baby (p 10-1)
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Which infection takes longer to develop pruritus, the initial scabies infestation or the third scabies infestation?
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the first (reinfection only takes about 24 hours to start pruritus, whereas it can take 1-2 months for the initial infection)
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What happens after scabies sex?
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the female burrows into the stratum corneum to deposit eggs. It lays a few every day for 30 days then dies.
the male, after finishing the business with his god stick in his gf's shame cave,.. well.. he dies. |
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Your patient has severe pruritus especially at night and burrows, papules, yucky on her web spaces, wrists, palms, soles, head, and neck. What does your patient have? What kind of patient is your patient?
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your patient has scabies.
And is a baby or a kid! Scabies spares the head & neck on adults. |
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What's the first line therapy for scabies?
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permethrin
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In general, how long after an initial infestation with lice do symptoms manifest?
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one week
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What are the first and second line treatments for lice?
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1st - permethrin
2nd - malathion (flammable!) |
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NOT TO BE RACIST, but let's suppose a person has his melanosomes aggregated in membrane-bound melanosome complexes.. would you say that this person looks more like Obama's mama or Obama's papa?
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mama!
black people have larger melanosomes that are singly dispersed. |
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NOT TO BE RACIST or anything, but what is the color difference between dermal and epidermal hyperpigmentation?
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dermal - slate gray or blue
epidermal - browner |
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Long wave UV light results in ____ tanning and short wave UV light results in ____ tanning.
a.) delayed b.) immediate |
long - immediate
short - delayed |
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T/F - UV exposure related hyperpigmentation can be characterized by an increase in the number of melanocytes.
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True.
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Where are giant melanin granules (macromelanosomes) found most commonly?
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patients with neurofibromatosis
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Who typically gets melasma?
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women, pregnant or oral contraceptive users.
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A patient with Addison's disease has which, hyper or hypopigmentation? What is the pathophysiology of the pigmentation disorder?
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hyperpigmentation due to increased release of melanocyte stimulating hormone and ACTH, both of which stimulate melanin production
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What is phytophotodermatitis?
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Contact with plants like fig, parsnip, fennel, dill, lime, parsley, then subsequent sun exposure that causes a dermatitis and then hyperpigmentation
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What causes berloque dermatitis?
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furocoumarin present in some perfumes and cosmetics
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Pick out the hypopigmentation disorders that are caused by reduced number and/or loss of melanocytes.
a.) pibaldism b.) albinism c.) vitiligo d.) tinea versicolor e.) leprosy f.) idiopathic guttate hypomelanosis g.) post inflammatory hypopigmentation |
a.) pibaldism
c.) vitiligo f.) idiopathic guttate hypomelanosis g.) post inflammatory hypopigmentation |
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What awesome anti-arrhythmic drug can cause slate gray discoloration of exposed flesh?
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amiodarone
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What is the pathogen for:
a.) molluscum contagiosum b.) warts c.) eczema herpeticum d.) hand, foot and mouth disease e.) herpes zoster |
a.) molluscum contagiosum - pox virus
b.) warts - HPV c.) eczema herpeticum - HSV d.) hand, foot and mouth disease - picornavirus e.) herpes zoster - varicella zoster |
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Your HIV+ patient has multiple flesh-colored papules with central umbilications on his face. What virus is he infected with?
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mulloscum contagiosum
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Which virus presents with a doodad that can be bumpy like a cauliflower (shudder)?
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HPV - wart (on genitalia)
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What are some second line treatments for warts and molluscum that only doctors smart and pretty and talented enough to be dermatologists can administer?
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laser, bleomycin, curettage - lucky them!
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What viruses can you diagnose with Tzank smears?
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Herpes guys - HSV & varicella
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Why are some HSVs resistant to acyclovir?
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The drug needs thymidine kinase to become active, and if the virus doesn't have it, then it's resistant.
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How do you know a case of hand, foot, & mouth disease isn't herpes?
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a.) distribution
b.) negative Tzank smear |
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A subcorneal pustule that breaks open and forms a yellow crusted scale means what kind of infection?
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streptococcal impetigo! yay!
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What are two common pathogens that cause folliculitis?
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S. aureus (people who exercise) and Pseudomonas auriginosa (hot tubs, swimming pools, or whirlpools)
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Where is the infection located in limb & trunk bacterial cellulitis?
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full thickness of connective tissue, dermis, & subcutaneous fat
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What is acute paronychia?
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nasty inflammation or infection of the skin folds surrounding the nails. usually Staph aureus.
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What causes erysipelas (or St. Anthony's Fire)?
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cellulitis caused by GAS
annular lesions, rapidly advancing border. |
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What causes green nail?
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pseudomonas
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What is erythema migrans?
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the annular "bulls eye" lesion seen in Lyme disease caused by Borrelia burgdorferi rx. tetracycline.
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What organism can be demonstrated with a KOH preparation?
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fungus
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What's an effective broad spectrum oral anti-fungal medication?
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imidazole (like fluconazole)
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What causes tinea versicolor?
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yeasties
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Can you wipe candida (thrush) off your patient's tongue? (eww)
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yes.
if it doesn't wipe off, your patient has oral hair leukoplakia from his epstein-barr |
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How can you tell the difference between Tinea cruris and diaper dermatitis from candida?
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Tinea cruris is sharply demarcated.
Candida diaper rash is not. |
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What is acute HIV exanthem?
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a rash similar to other viral exanthems, including mucosal ulcers
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Which of these is more likely in an HIV+ patient than an immunocompetent patient?
a.) proximal subungual onychomycosis b.) distal subungual onychomycosis |
a.) proximal subungual onychomycosis
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What infection causes Kaposi's Sarcoma?
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HHV-8 (and also HIV, duh)
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Your patient is HIV+ and has Kaposi's Sarcoma. Is it more likely this patient acquired HIV sexually or via IVDU?
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sex!
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Patients with advanced HIV with CD4 counts below 200/mm3 can present with papular pruirtic eruption/folliculitis. What kind of leukocyte infiltrate is seen in the most common version of this?
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eosinophilic folliculitis
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Patients with advanced HIV can present with single or multiple papules or nodules caused by rickettsial organisms. What is this called?
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Bacillary or epithelioid angiomatosis
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What are papulosquamous eruptions?
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rashes that exhibit scale (shedding or accumulation of the stratum corneum in perceptible flakes -- sexy)
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What are the typical sites of involvement for psoriasis?
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scalp, elbows, knees, palms, soles
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Patient has orange-red erythema and scaling with islands of sparing. He also has orange keratoderma of the soles and palms. What disease is this?
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Pityriasis rubra pilaris
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People use Head & Shoulders for what common condition? (yes, dandruff... caused by?)
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seborrheic dermatitis
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Which band of UV light is called the "sunburn spectrum"?
A B C |
UVB
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Which band of UV light is needed for Vitamin D production?
A B C |
UVB
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Which premalignant and malignant skin cancers occur on habitually sun exposed areas and which on intermittent exposure on childhood trips to tropical lands on your family yacht?
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habitual - actinic keratoses, basal & squamous cell carcinomas, lentigo malignant melanomas
intermittent - superficial spreading and nodular melanomas |
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What is polymorphous light eruption?
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idiopathic, acquired syndrome with recurrent erythema, papules, vesicles, or plaques on light-exposed parts of the skin; "sun poisoning" or "sun allergy"
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How can you tell that an epidermal inclusion or pilar cyst aren't really tumors?
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They all have openings that you can see. You can cut and squeeze out cheesy material - no such yummy reaction from melanomas!
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What is a benign common tumor in old people found on the face, chest, back, abdomen, and proximal extremeties that has cobblestoned surface and can be darkly pigmented? It can be easiliy removed with a dermal curette.
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seborrheic keratoses
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What is the benign fibrous tissue lesion found on women who only PRETEND to be feminists and shave their legs secretly? Describe what it looks like & hallmark yucky touchy diagnostic feature.
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dermatofibromas
brown hard lesion with a fuzzy border. when squeezed, the skin dimples. |
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What is a spindle and epithelioid cell nevus? What is its other name?
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aka Spitz Nevus
It's a benign nevus that microscopically can look like malignant melanoma, but is not and can be simply excised. |
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What is the distinction between displastic nevi and regular nevi?
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1.) there are more dysplastic dudes
2.) they're larger (>1cm) 3.) they continue to appear in adult life 4.) they have high potential to turn into melanoma 5.) irregular coloring and borders |
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Actinic (solar) keratosis is a precursor lesion for ____.
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squamous cell carcinoma
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What is Bowen's disease?
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squamous cell carcinoma in situ
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T/F - almost everyone with a basal cell carcinoma will develop another one in 5-10 years.
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false - about 50%
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T/F - Basal cell carcinoma very, very rarely metastasizes.
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True that.
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Basal cell carcinoma is in general more common than squamous cell carcinoma. In certain populations, however, the reverse is true. What populations?
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black people and people with renal transplants
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What the hell is keratoacanthoma?
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a weird rapidly growing tumor that's kinda like squamous cell carcinoma. Although it's not irrevocably committed to malignancy, it can grow very rapidly (1-3cm in 1-2months) and may or may not regress by itself.
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When would you want to refer to a super smart and pretty dermatologist-surgeon to get a Mohs micrographic surgery?
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For tumors that are in functionally or cosmetically important places and for tumors that are ill-defined (morpheaform BCC) or recurrent.
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What are the most important prognostic factors for malignant melanomas?
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1.) Beslow's depth
2.) ulceration of the tumor |
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NOT TO BE RACIST or anything, but which is a whitehead and which is a blackhead?
a.) closed comedone b.) open comedone |
a.) closed - white
b.) open - black |
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What's distinctive about steroid acne?
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it's monomorphic
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What is the mechanism of action of isotretinoin?
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profoundly decreases sebaceous gland secretion
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