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Dermatology - Quiz 1 includes Derm terminology FIRST AID 2010 bottom 1/2 p 383-385
Terms in this set (88)
circumscribed flat discoloration < 1 cm. If you can see it but not feel it, it's macular
circumscribed flat discoloration > 1 cm. Basically a macule bigger than 1 cm = patch. Vitiligo is a patch
superfical solid lesion up to 1 cm. Molluscum contagiosum is a papule with a small dell in the middle of the papule.
superfical elevated solid lesion > 1 cm. Psoriasis can present as a circumscribed, scaly plaque
circumscribed collection of free fluid < 0.5 cm
circumscribed collection of free fluid > 0.5 cm
vesicle containing pus (inflammatory cells)
edematous, transitory plaque
circumscribed depth implied solid lesion > 1cm
dried serum, blood, bacteria, debris, cotton from bandages. crusting often tips off the doctor that there is a secondary infection that needs to be treated.
crack or split
loss of epidermis (superficial)
loss of epidermis and dermis (deeper)
thickening with skin line accentuation, an accentuation of the normal skin lines. Patient has been rubbing the skin. It stimulates mechanoreceptors that stimulate growth factors that cause overgrowth of epidermis.
thickening, fibrous tissue
loss of substance (thinning)
How can you describe the configuration of a lesion?
Annular, Sharply marginate, Ill-defined, Discoid, Polycyclic, Arcuate, Linnear,Targetoid, Serpiginous, Reticular, Whorrled.
If a plaque is in the epidermis, a ___ is in the dermis
Vesicles and scaliness on the foot. What is the most likely diagnosis?
A large fluid-filled blister is a ___ whereas a small one is a ____
Large = Bulla
Small = Vescicle
What surface antigens are on a Pro-T cell
None. They are the double negatives.
What surface antigens are on an IMMATURE T cell
EITHER CD4 or CD8
What is scale?
Scale is dead superficial epidermis.
If you had an ulcer form in a diabetic patient with peripheral neuropathy, would it likely be primary or secondary?
Give the medical term for this common skin disorder: Warts, soft, tan-colored, cauliflower-like lesion. Epidermal hyperplasia, hyperkeratosis, koilocytosis, Verrucua vulgaris on hands and condyloma acuminatum on genitals. Caused by HPV
Give the medical term for this common skin disorder: Common mole. Benign
Give the medical term for this common skin disorder: Hives. Intensely pruritic wheals that form after mast cell degranulation
Give the medical term for this common skin disorder: Freckle. Normal number of melanocytes with increased melanin pigment
Give the medical term for this common skin disorder: Pruritic eruption, commonly on skin flextures. Often associated with other atopic diseases like asthma, allergic rhinitis
Atopic dermatitis aka eczema
Give the medical term for this common skin disorder and the type of hypersensitivity reaction that it is: Hypersensitivity rection following expsure to skin allergin. Lesions occur at site of contact
Allergic contact dermatitis. Type 4
Give the medical term for this common skin disorder: Papules and plaques with silvery scaling, especially on knees and elbows. Acanthosis with parakeratitic scaling (nuclei still in stratum corneum) Increase in stratum spinosum, Decrease in stratum granulosum. Auspitz sign (bleeding spots when scales are scraped off). Can be associated with nail pitting and arthritis
How do epidermal layers change in psoriasis?
Acanthosis with parakeratitic scaling (nuclei still in stratum corneum) Increase in stratum spinosum, Decrease in stratum granulosum.
I have psoriasis with bleeding spots that occur when scales are scraped off. What is this sign called?
Give the medical term for this common skin disorder: flat greasy pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts). Looks pasted on.
Seborrheic keratosis. A common benign neoplasm of elderly.
Where on the body do the lesions of seborrheic keratosis most commonly occur?
Head, trunk, extremities
What "sign" is related to Seborrheic keratosis?
Lesser-Trelat sign. Sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy such as GI, lymphoid
Name the pigmentation disorder: Normal melanocyte number with decreased melanin production due to decreased activity of TK. Can also be caused by failure of neural crest cell migration in development.
Name the pigmentation disorder: Irregular areas of complete depigmentation. Caused by a decrease in melanocytes
Name the pigmentation disorder: Hyperpigmentation associated with pregnancy "mask of pregnancy" or OCP use
I am a very superficial skin infection usually from Stap aureus or S pyogenes. Highly contagious. Honey colored crusting
I am an acute, painful spreading infection of dermis and subcutaneous tissues. Usually from Strep pyogenes or Staph aureus
What layers of the skin are involved in impetigo versus cellulitis?
Cellulitis, dermis and subcutaneous
I am a deep tissue injury usually from anaerobic bacteria or strep pyogenes. Results in crepitus from methane and CO2 production.
Necrotizing fasciitis. Flesh eating bacteria. Follows fascial plane.
I am a skin disease characterized by exotoxin that destroys keratinocyte attachments to stratum granulosum ONLY. Characterized by fever and generalized erythematous rash with sloughing of upper layers of epidermis. Seen in newborns and children.
Staplylococcal Scalded Skin Syndrome SSSS
I am a collection of white painless plaques on the tongue that cannot be scraped off. EBV mediated. Occurs in HIV patients
What two viruses are involved in hairy leukoplakia
HIV + EBV = white nasty plaques that you cant scrape off the mucous membranes of your mouth and tongue
A am a POTENTIALLY FATAL blistering disorder. Autoimmune IgG against desmosomes.
Where does the immunofluorescence light up in Pemphigus vulgaris?
Antibodies around cells of epidermis in retigular pattern.
What is acantholysis
Intraepidermial bullae involving skin and oral mucosa. Seen in Pemphigus vulgaris.
What is a postitive Nikolsky's sign?
Separation of epidermis and dermis upon manual stroking of skin seen in Pemphigus vulgaris
I am an autoimmune disorder with IgG against hemidesmosomes. I show linear immunofluorescence
Bullous pemphigoid. Eosinophils within the blisters. Similar but less severe than pemphigus vulgaris. Affects skin but spares oral mucosa and has a negative Nikolsky's sign
I am a skin disorder characterized by pruritic papules and vesicles. Deposits of IgA at tips of dermal papillae. Associated with celiac disease
I am a skin disorder associated with infections such as Mycoplasma pneumoniae, HSV, drugs, Cancers, and autoimmune dz that presents wtih multiple types of lesions such as macules, papules, vesicles and target lesions
What three drug types are associated with erythema multiforme?
Sulfa, beta lactams, phenytoin
I am a skin disorder characterized by fever, bulla formation, necrosis, sloughing of skin, high mortality rate. Usually associated with adverse drug reaction
What is the more severe form of Stevens-Johnson syndrome called?
Toxic epidermal necrolysis
I am a skin disorder characterized by Pruritic, Purple, Polygonal Papules. Sawtooth infiltrate of lymphocytes at dermal epidermal junction
I am a skin disorder characterized by premalignant lesions caused by sun exposure. Small, rough, erythematous or brownish papules. Cutaneous horn. Risk of carcinoma is proportional to epithelial dysplasia.
I am a skin disorder characterized by inflammatory lesions of subcutaneous fat, usually on anterior shins. Associated with coccidiomycosis, histoplasmosis, TB, leprosy, streptococcal infections, sarcoidosis
I am a skin disorder characterized by hyperplasia of stratum spinosum. Asssociated with hyperinsulinemia (cushings, diabetes) and visceral malignancy
Name some causes of acanthosis nigricans
am a skin disorder characterized by hyperplasia of stratum spinosum. Asssociated with hyperinsulinemia (cushings, diabetes) and visceral malignancy
am a skin disorder characterized a "herald patch" followed later by "christmas tree" distribution. Multiple papular eruptions. Remits spontaneously
am a skin disorder characterized by a red nodule that grows rapidly during first few weeks of life and then regresses at 5-8 years old.
I am a red skin lesion that appears in 30s to 40s and I do not regress.
What is the genetic defect in epidermolysis bullosa simplex
Mutation in keratin 5. Clinical manifestation of erosions and blisters in babies, caused by separation of epidermis from dermis. Will improve over time.a genetically heritable disease, with a mutation in one of the keratins of the basal keratinocytes, either keratin5 or keratin 14.
The result is a fragile basal layer that results in easy rupture of these cells with shear
stress, and subsequent blister formation.
What is the KOH mount Tzank test for?
Fungi and viral diseases(HSV, VZV, CMV), pemphigus vulgaris. Tzank cells are multinucleate giant cells.
What are patch tests for?
Used to determine cutaneous allergies such as nickel, etc.
What do psoriasis, atopic dermatitis, drug reaction, seborrheic dermatitis, lymphoma, mycosis fungoides have in common?,
Erythroderma aka Red Man syndrome. MCC is vancomycin
What do you do if you see a patient with erythroderma?
Red Man syndrome. These patients need to be hospitalized and monitored. They get fluid and electrolyte imbalance, thermoregulatory disturbancs, high cardiac output, tachycardia (but NOT hair loss)
If a patient has 1 hemangioma that's fine, but more than 5 and what is your concern?
If you see more than 5 hemangiomas in the skin, you need to do workup for internal hemangiomas. If they are in the internal blood vessels, they can go into high output heart failure, they can block the respiratory passages etc. Pt can die.
What is one legit reason for a kid to have multiple scars and bruises at varying stages of healing?
Ehlers danlos. Ask if family members have a history of bruising easily. Otherwise, it's probably abuse. More common cause.
What is the defect in Ehlers-Danlos?
Collagen. Type III and IV. Pts can bend and strethch their skin.
Your patient is a child with lots of erosions in her mouth and a lot of strictures in the mouth and esophagus. It also happens to her hands. She has scarred up hands that look more like mitts. Genetic disease Autosomal recessive due to defect in Type 7 collagen. What is it?
Epidermolysis Bullosa Dystrophica
Your patient has a very poor diet, delayed wound healing and dehissence of wounds. Why?
Not enough Vitamin C. Ascorbic acid is a co-factor for post-metabolic cross linking of collagen.
If you don't have enough ascorbic acid, you will have delayed wound healing and friable bleeding gums due to the microtrauma of eating.
I am a disease of elastin. Patients get emphysema at a young age, diverticulitis, ruptured bladders, etc.
What disease am I?
Cutis Laxa. Mutation of tropoelastin gene. Recall that Alveoli expand due to elastin.
What is the pathology that causes exopthalmos and pretibial myxedema in graves
Excessive deposition of mucopolysaccharide
How is cell-to-cell adhesion accomplished in the skin?
Desmosomes. Basically keratin filaments within cells attach to Cadherins in the intercytoplasmic space between cells, joining 2 cells together
How is cell-to-BM adhesion accomplished in the skin?
Two ways: Hemidesmosomes, which have alpha6beta4 integrins and BP180 protein, Focal adhesions which have integrins that interact with extracellular laminins and collagen
Explain the structure of keratin
Keratinization is the process of creating keratin, contained in a now-dead but functional cell.
Keratin has a helical structure. It is made of subunits. Each subunit has a Type 1 and Type 2 member. The pairs then pair up, eventually forming larger intermediate filaments.
I am a Histidine-rich protein that functions to aggregate keratin filaments
filaggrin Get it - fil-aggregation
What diseases are due to a defect in fillagrin?
I am an Enzyme which cross-links numerous proteins to form the tough, "cornified envelope" or
squame of the stratum corneum,
transglutaminase. This is why The cornified envelope is extremely chemically-resistant (resists boiling in detergents). This is why we dont dissolve in our own shampoo each day. The clinical
manifestation is the (autosomal recessive) disease lamellar ichthyosis.
Is the stratum corneum alive?
No. Dead. Corneocytes are devoid of
nucleus, mitochondria or other organelles. When shed in
large numbers or large clumps, clinically visible scale is seen (eg. dandruff).
What is the major structural protein of the dermis>?
Collagen. Triple helical proteins. Some are homotrimeric,
i.e. 3 identical alpha chains, (like type III collagen), others are
heterodimeric, consisting of 2 or 3 different alpha chains.
Name two genetic diseases of collagen
Ehlers Danlos, Epidermolysis bullosa
I am a Glycoprotein, dimer of molecular weight of 440 KD, found in blood (soluble form),
dermis and basement membranes (insoluble forms)
•Binding site for cell surface integrin receptors, fibrin, collagen, heparin
•Role in would healing and tissue repair, contributes to regenerative properties of the
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