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43 Cards in this Set
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- Back
- 3rd side (hint)
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Patient demonstrates a loss of pigmentation in a distribution over the high friction areas of her body. What is the disease?
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Vitiligo.
Loss of pigment-producing melanocytes. The pathology is likely autoimmune-mediated: what are some other conditions that the pt might have? |
Graves
Addisions |
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2 diseases involving intact melanocytes that fail to produce melanin pigment include (include inheritance):
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Ocular albinism XLR
Oculocutaneous albinism AR Ocular only involves eyes; Oculucutaneous involves eyes, skin, and hair. It may be tyrosinase-negative (small amt of pigment from deficiency in producing DOPA from tyrosine) or tyrosinase-positive, or the total absence of pigment (red eye). Oculuocutaneous albinism predisposes one to what conditions? |
Actinic keratosis
Squamous cell carcinoma Basal cell carcinoma Malignant melanoma |
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What are the respective names for
a) a local increase in melanin pigment? b) a melanocytic hyperplasia leading to a pigmented epidermal macule? c) a cluster of melanocyte-derived cells at or below the dermal border? |
a) freckle/ephelus
b) lentigo c) melanocytic nevus (mole) What "at-risk" lesion is related to a lentigo? |
Lentigo maligna, or Hutchinson freckle is a precursor to lentigo maligna melanoma.
This lesion is an in situ melanoma of atypical melanocytes at the epidermal-dermal jxn. |
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This skin condition is present at birth. It's darker colored, benign, and composed of dendritic, very-pigmented melanocytes in the dermis.
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Blue Nevus.
What are Spitz and Halo nevi like? |
Spitz: red-hemangioma-like. kids.
Halo: de-pigmented radius around nevus from lymphocytes. benign (NOT malignant melanoma) |
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3 locations for nevi include:
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Junctional
Compound Dermal Describe a dysplastic nevus. What is the gene associated with the familial type? |
Irregular pigmentation, larger in size, possibly numerous, raised and dark center.
Dysplastic nevus syndrome: AD p16INK4a |
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Risk factors for malignant melanoma include:
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Severe sunburns in childhood
Fair skin, failure to tan Large congenital mole Dysplastic Nevus Good prognoses include: |
<1mm invasion 95% 5ys
<1.7mm good px No ulcer, no progression, female, located on extremities, low mitotic rate |
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There are two growth phases of malignant melanoma. What are they like?
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Radial: melanoma expands, out, but stays within the epidermis. Cure is likely here, if lesion is excised
Vertical. Occurs later, extends into dermis. At this point, the px depends on just how far. The lesions to not all look the same. Which one occurs on the feet and hands? Which one starts out with vertical growth? Which one is associated with a Hutchinson freckle? Which one is the most common? |
Feet: acral-lentiginous
Vertical: nodular Hutchinson's: Lentigo maligna melanoma MC: superficial spreading |
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This benign lesion is common in older persons.
It's pigmented, sharply outlined, raised, and has progressive increase in pigmentation. Usually occuring in fairer people, it has a counterpart for melanized skin called dermatosis papulosa nigra. |
Seborrhehic keratosis: basaloid proliferations and hyperkeratosis, may have pseudohorn cysts.
What might it indicate if the plaque instead is brown-red, rough, scaling, and poorly demarcated? |
Actinic keratosis, a premalignant lesion related to sun exposure.
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Thickened hyperplastic, hyperpigmented skin in flexural areas is called what?
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Acanthosis nigricans.
What are two conditions and two malignancies that its presence might indicate? |
Obesity
Endocrine disorder (diabetes) Stomach and Lung Adenocarcinoma (and breast and uterus) |
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Associations of skin tags include:
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Pregnancy, diabetes, intestinal polyposis, or just areas of friction
Describe its histology. |
Connective tissue core covered by stratified squamous epithelium
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This lesion is composed of keratinous material lined with stratified sq epithelium. It is benign and may grow in a variety of patterns.
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Wen/Epithelial cyst.
Name 1 possible complication Name 1 possible association |
Rupture
FAP-associated |
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What is an epithelial tumor on the lower eyelid called (hint: associated with eccrine gland)
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Syringoma.
What are the gene-associations with 1) Piloma/Trixoma 2) Sebaceous adenoma 3) Tricholemma 4) Trichoepithelioma |
1) Beta catenin
2) MSH MLH 3) Cowden/PTEN 4) CYLD |
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This lesion appears as a pearly papule, tends to ulcerate, has local invasion and recurs, but RARELY metastasizes. Its nuclei are "palisading". Occurs on the upper part of the face, rather than the lower.
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Basal Cell Carcinoma
What is the gene/syndrome associated? What are the risk factors? |
PTCH/Smo - Gorlin Syndrome (NBCCS)
Sun exposure |
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What is the genetic association with squamous cell carcinoma?
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No single gene.
What are the predispositions then, to sq cell carcinoma? |
HPV 5 and 8, bowens
Actinic keratosis Tobacco use Sun exposure, radiation XP chronic ulceration, old burns Osteomyelitis drainage |
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The squamous cell carcinoma probably has what distinctive histological feature?
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Keratin pearl.
Also polygonal cells with eosinophilic cytoplasm. Which dome-shaped lesion with a central "cup of keratin" may be mistaken for squamous cell carcinoma? Is it malignant? |
Keratoacanthoma. Benign. Grows fast, but usu regresses spontaneously
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Pt has mental retardation and seizures. CT shows in cerebral cortex and periventricular areas.
What might you observe on this patient's skin? |
1) hypopigmented macules (ash leaf)
2) angiofibromas (facial, acne-like) 3) Periungual fibromas 4) Connective tissue hamartomas (Shagreen patches). Gene involved? |
TSC1 hamartin , or
TSC2 tuberin |
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Pt presents with mutiple basal cell tumors in early life. Genetic analysis shows a PTCH mutation. What other conditions might this patient also have?
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Cryptorchidism
Odontogenic cysts palmar pits Ovarian fibromas medulloblastoma Basal cell carcinoma Two names for this disease are: |
Gorlin's Syndrome or
Nevoid basal cell carcinoma syndrome |
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Skin lesion begins with just local erythema, then progresses to eczema to crust to plaque to nodule. Histology shows CD4+ cells with cerebriform nuclei. What is the name of the condition and the specific lesion?
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Mycosis fungoides.
Pautrier microabscess If it metastasizes, it is given another name. What is it? |
Sezary syndrome.
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What are some causes of proptosis?
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Graves
Optic N. Tumor Lacrimal gland lesions Orbital Inflammation What is the difference between blepharitis and blepharoconjunctivitis? |
Blepharitis is any dermatitis of the eyelid; blepharoconjunctivitis is inflammation of the eyelid AND the skin.
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Chalazion. Wen. Hordeolum
Which is acute? Which is chronic? Which is cystic? |
Chalazion: chronic, granulomatous
Hordeolum: acute, prurulent Wen: cystic What is the word for a benign adnexal tumor of the lower eye? |
Syringoma.
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From most to least common, what are three possible malignant tumors of the eyelid?
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Basal cell carcinoma.
Sebaceous carcinoma Squamous cell carcinoma. Which is most commonly located on the medial canthus and can lead to vision loss? Which shows high mortality? To which nodes might these cancers metastasize? |
Basal cell.
Sebaceous cell. Parotid and submandibular glands |
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Pinguecula or Pterygium?
1Degenerating elastin and collagen 2Related to sun exposure 3Fibrovascular proliferation 4Dissects in Bowman's layer 5Yellow, located near nasal limbus 6Wedge-shaped, grows toward cornea |
1 Degenation of CT: Pinguecula
2 Sun-related: Both 3 Fibrovascular prolif: Pterygium 4 Bowman dissection: Pterygium 5 Yellow, near limbus: Pinguecula 6 Wedge-shaped: Pterygium What part of the eye do Stevens-Johnsen and trachoma affect? |
Conjunctiva.
Alkali, AI, and surgery can also cause conjunctival scarring |
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Squamous neoplasms of the conjunctiva usually have what association?
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HPV-associated
Papillomas can progress to CIN, then become invasive, though it is usually shallow and indolent, rarely metastasizing. The other neoplasm of the conjunctiva is derived from what type of cell? |
Melanocytic.
Benign conjunctival nevi or malignant melanoma. Melanomas are usually sun related, unilateral, and have a 25% mortality with mets to the parotids. |
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What is the most common cause of corneal ulcer, and what does it look like?
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Herpes Virus. Appears dendritic under fluorescence.
What are some other causes of corneal ulcer? |
Acathoemeba, fungus, immune deficiency, opportunistic infection, abrasion, syphilis (tertiary and congenital).
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Keratoconus is associated with what other conditions? (name 2)
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Marfans and Down's syndrome. Also may be idiopathic.
What is the morphology? |
Bilateral, progressive corneal thinning leads to a cone shape.
This can cause astigmatism. |
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What is the difference between Fuch's Endothelial Dystrophy and Stromal dystrophy?
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Fuch's is an autosomal dominant heriditary keratotic dystrophy caused by a pump failure
The stromal dystrophies likewise cause progressive corneal damage, but are from deposition of material on the cornea. These are usually heralded by blurred vision. What is the difference between calcific band and chronic actinic keratopathy? |
Calcific band is in Bowman's layer, and is associated with Juv RA and hypercalcemia;
Chronic actinic is yellow, and associated with UV damage |
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What is the difference between a cataract and glaucoma?
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Glaucoma is a cupping of the optic disc usually from aqueous humor flow obstruction.
Cataract is lens opacity, or cloudiness. Cataracts may lead to glaucoma. Both can lead to blindness |
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What are the symptoms of cataracts?
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Blues turn to browns
Night vision impaired Halos around lights Painless progression to LO vision What are the symptoms of glaucoma? |
Largely asymptomatic
Progressive visual field loss Often discovered on exam Painless unless closed angle, then severe |
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Environmental causes of cataracts include age, UV exposure, radiation, corticosteroids. What are some genetic/acquired disease causes?
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metabolic disease, Rubella, uveitis, glaucoma, retinitis pigmentosa, scleroderma
Cataracts are serious because they can lead to..... |
Glaucoma and or blindness
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T/F
In open angle glaucoma, the aqueous humor is restricted at its entrance; in angle closure glaucoma it is restricted at its exit. |
FALSE.
Open = restricted at exit Closed = restricted at entry What is the most common type? What population is largely affected? |
Open angle. People of African heritage tend to have a higher predisposition for primary open angle glaucoma.
Those of Asian descent more often experience primary closed angle glaucoma. |
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Secondary causes of open angle glaucoma include product closure from trauma/blood cells/pigmentation/tumor, and what hemangiomatous disorder?
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Sturge-Weber syndrome (port-wine stain, ipsilat glaucoma, convulsions, mental retardation, and retinal detachment)
What are the mechanics of closed angle glaucoma? |
Narrow anterior chamber angle due to increased intraocular pressure or pupillary dilation.
It may occur with what retinal tumor of childhood? Retinoblastoma |
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Whereas opthalmitis involves the ______________, panopthalmitis involves the _______, _________, and _________ .
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Opthalmitis: vitreous humor
Panopthalm: retina, choroid, sclera, even to the orbit. This condition can lead to what ? |
Cataracts or glaucoma
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Pain, red eys, photophobia, blurred vision and miosis are symptoms of uveitis. What structures are involved?
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Iris. Ciliary body. Choroid
If it is granulomatous, what could it be caused by? |
Sarcoidosis
Opthalmoplegia/Sympathetic opthalmitis Infectious (TB) |
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Corneal calcific bands,
"mutton fat" keratopathy, and retinal "candlewax drippings" all describe what ocular condition? |
Sarcoidosis.
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In immune-mediated granulomatous opthalmitis, what happens when the eye is penetrated in trauma?
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Uveal melanocytes release pigment antigen. This is shared by both eyes, thus an immune reaction will result in the other eye 2w post-injury, causing granulomas in both.
What can be done? |
Removal of traumatized eye.
Immunosuppression |
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Is a uveal nevus a precursor to uveal malignancy?
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NO.
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The three most common pituitary adenomas are what?
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Prolactinoma.
GH adenoma. ACTH adenoma., in that order Which one is small and basophilic? Which one is large and acidophilic? |
GH adenoma is also known as an "acidophilic" adenoma.
Acth adenomma is basophilic, small, and PAS+. |
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What is the common pathology and how is acromegaly different from gigantism?
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Both occur from increased GH from a pituitary adenoma.
If the hormonal imbalance occurs before epiphyseal closure, it leads to gigantism. If adenoma occurs post-closure, it is called acromegaly. How are they different anatomically? |
In gigantism, the pt demonstrates increase in size in trunk, arms, legs, and organs;
In acromegaly, |
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hyperglycemia, diabetes mellitus, htn, gonadal dysfunction, chf, increased risk of GI tumors, and osteoporosis are all risks of what pituitary dysfunction?
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GH adenoma.
What are lab values with this condition? |
Inc. GH
Inc. IGF-1 not suppressed with glucose tolerance test. |
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Gonadotrophic adenoma
Thyrotrophic adenoma Pituitary carcinoma: What is the incidence? Which are functional? Which may present with apoplexy? |
Thyrotrophic adenoma and carcinoma are both very rare.
Gonadotrophic adenomas tend to hyposecrete; TSH tumors are functional; Carcinomas are usu non-functional. Gonadotrophic adenomas may present with apoplexy, because they are so large. What will they stain for? |
Beta-FSH.
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Panhypopituitarism is loss of what hormones?
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The anterior pituitary hormones; posterior pitutary function usu preserved.
In what order are the cells usually lost? |
Gonadotrophs, then thyrotrophs, then corticotrophs.
Gonadotrophs-->loss of sexual maturation (kids) or libido/fertility (adults) TSH--> secondary hypothyroid sx ACTH is the last to go, because it leads to secondary adrenal failure. |
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What is a complication of pituitary enlargement in pregnancy?
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Sheehan syndrome, or postpartum panhypopituitarism from labor hemmorrhage/shock leading to vasospasm and necrosis.
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What could the sudden of symptoms hemolytic anemia, diplopia, adrenal failure, and hypothyroidism
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What labs could be performed?
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