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JL Dermatology > Week 1 > Flashcards

Week 1 Flashcards

1
Q

What is the outer layer of skin and what is its cell type?

A

Epidermis

Stratified cellular epithelium

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2
Q

What layer is beneath the epidermis and what cell type is it?

A

Dermis

Connective tissue

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3
Q

What skin layer is described - Ectoderm cells form single layer periderm, gradual increase in layers of cells and periderm cells cast off?

A

Epidermis

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4
Q

What is the dermis formed from?

A

Mesoderm below the ectoderm

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5
Q

What are pigment producing cells from neural crest?

A

Melanocytes

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6
Q

What are developmental growth patterns of skin - not following vessels, nerves or lymphatics?

A

Blaschko’s lines

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7
Q

Name four skin appendages?

A
  1. Nail
  2. Hair
  3. Glands
  4. Mucosae
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8
Q

What makes up skin and is predominantly fat?

A

Sub-cutis

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9
Q

Does the skin consist of dermo-epidermal junctions?

A

Yes

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10
Q

What is stratified squamosu epithelium, 1.5mm thick?

A

Epidermis

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11
Q

What is 95% of the epidermis?

A

Keratinocytes

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12
Q

What do keratinocytes contain?

A

Structural keratins

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13
Q

What are three other cell types in the epidermis?

A 
Melanocytes (basal and suprabasal)
Langerhans cells (suprabasal)
Merkel cells (basal)
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14
Q

What are the four epidermal cell layers?

A
  1. Keratin layer
  2. Granular layer
  3. Prickle cell layer
  4. Basal layer
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15
Q

What three factors control regulation of epidermal turnover?

A

Growth factors
Cell death
Hormones

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16
Q

Name two situations where regulation of epidermal turnover is lost?

A

Skin cancer and psoriasis

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17
Q

What takes 28 days and involves keratinocytes migrating from basement membrane as well as continuous regeneration of epidermis?

A

Differentiation

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18
Q

What layer is usually one cell thick and small cuboidal?

A

Basal layer

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19
Q

The basal layer is highly metabolically active and has lots of what substance?

A

Intermediate filaments (keratin)

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20
Q

What layer has larger polyhedral cells?

A

Prickle cell layer

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21
Q

In the prickle cell layer there are lots of desmosomes - what connects to them?

A

Intermediate filaments

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22
Q

What layers does the granular layer consist of?

A

2-3 layers of flatter cells

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23
Q

What layer contains large keratohyalin granules?

A

Granular layer

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24
Q

What contains structural filaggrin and involucrin proteins and is present in the granular layer?

A

Large keratohyalin granules

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25
Q

What layer has odland bodies, high lipid content, cell nuclei lost and is the origin of “cornified envelope”?

A

Granular layer

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26
Q

What are overlapping non-nucleated cell remnants called and what layer do they occur in?

A

Corneocytes

Keratin layer

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27
Q

What makes up 80% of the keratin layer?

A

Keratin and filaggrin

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28
Q

What do lamellar granules release in the keratin layer?

A

Lipids

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29
Q

What layer is a tight waterproof barrier?

A

Keratin layer

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30
Q

What mucosa is present in lacrimal glands, eye lashes and sebaceous glands?

A

Ocular mucosa

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31
Q

Where do melanocytes migrate to in the first 3 months of foetal development?

A

From the epidermis to neural crest

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32
Q

What are pigment producing dendritic cells?

A

Melanocytes

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33
Q

What are the organelles in melanocytes called?

A

Melanosomes

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34
Q

What are the two types of melanin pigment made from tyrosine by melanocytes?

A
  1. Eumelanin (brown or black)

2. Phaeomelanin (red or yellow)

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35
Q

Does melanin absorb light?

A

Yes - neutral density filter

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36
Q

How are full melanosomes transferred to adjacent keratinocytes?

A

Via desmosomes

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37
Q

What do melanocytes form a protective cap over?

A

Nucleus

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38
Q

What represents an autoimmune disease with loss of melanocytes?

A

Vitiligo

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39
Q

In what disorder is there a genetic partial loss of pigment production?

A

Albinism

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40
Q

What disorder involves melanin stimulating hormone produced in excess by the pituitary gland?

A

Neslons Syndrome

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41
Q

What is a tumour of the melanocyte cell line?

A

Malignant melanoma

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42
Q

What cells come from mesenchymal origin - bone marrow?

A

Langerhans cells

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43
Q

What level are Langerhans cells found in?

A

Prickle cell level in epidermis - also found in dermis and lymph nodes

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44
Q

What cells found in the prickle cell level are antigen presenting cells?

A

Langerhans cells

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45
Q

What cells are basal, between keratinocytes and nerve fibres and act as mechanoreceptors?

A

Merkel cells

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46
Q

What type of infection is merkel cell cancer caused by?

A

Viral

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47
Q

What appendages have adjacent sebaceous glands?

A

Hair follicles

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48
Q

Hair pigmentation occurs via what?

A

Melanocytes above dermal papilla

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49
Q

What are the three phases of hair follicles growth?

A

Anagen - growing
Catagen - involuting
Telogen - resting

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50
Q

Name a hormone that influences hair growth?

A

Thyroxine

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51
Q

What are the three types of hair follicles?

A

Lanugo (in utero), vellus, terminal

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52
Q

What phase of hair follicles growth is the shedding phase?

A

Telogen

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53
Q

In humans what is the telogen phase?

A

Asynchronus

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54
Q

What is the interface between the epidermis and dermis called? It also has a key role in epithelial-mesenchymal interactions including support, anchorage, adhesion, growth and differentiation of epidermal cells. Also semi-permeable membrane acting as a barrier and filter.

A

Dermo-epidermal junction

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55
Q

What are inherited skin fragility diseases of the DEJ due to?

A

Mutation in one of the proteins in the DEJ.

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56
Q

Name three acquired (auto-antibodies to proteins in DEJ) diseases of the DEJ.

A
  1. Pemphigus
  2. Pemphigoid
  3. Dermatitis herpetiformis
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57
Q

Name two inherited skin fragility.

A

Epidermolysis Bullosa simplex

Epidermolysis Bullosa dystrophica

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58
Q

Name an acquired blistering disorder?

A

Bullous pemphigoid

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59
Q

What are these cells components of: mainly fibroblasts, macrophages, mast cells, lymphocytes, Langerhans cells?

A

Dermis

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60
Q

What two fibres make up the dermis?

A

Collagen and elastin

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61
Q

Is ground substance present in the dermis?

A

Yes

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62
Q

What do fibroblasts secrete?

A

Collagen

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63
Q

Name some cells in the dermis which antigen present?

A

Langerhans cells

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64
Q

Name the cells in the dermis which are chemical messengers?

A

Mast cells

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65
Q

What substance do mucopolysaccharides and glycosaminoglycans make up in the dermis?

A

Ground substance

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66
Q

Are the blood vessels in horizontal or vertical plexi?

A

Horizontal

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67
Q

Name a condition caused by localised overgrowth of blood vessels?

A

Port wine stain “stone marks” (capillary or cavernous haemangiomas)

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68
Q

What do smaller non-contractile lymphatic vessels lead to?

A

Larger contractile lymphatic trunks

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69
Q

What gives continuous drainage of plasma proteins, extravasated cells and excess interstitial fluid?

A

Lymphatic vessels

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70
Q

What do the special receptors pacinian and Meissners corpuscles detect?

A

Pressure and vibration

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71
Q

What are the three types of skin glands?

A
  1. Eccrine gland
  2. Sebaceous gland
  3. Apocrine gland
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72
Q

Where are the largest sebaceous glands present?

A

On the face and chest

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73
Q

What four things make up sebum?

A

Squalene, wax esters, triglycerides and free fatty acids

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74
Q

What produces sebum?

A

Sebaceous glands

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75
Q

Give two functions of sebaceous glands?

A

Controls moisture loss and protects against bacterial and fungal infection

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76
Q

What occurs as a result of increased sebum, blocked ducts and bacterial activity?

A

Acne

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77
Q

What do apocrine sweat glands develop as a part of?

A

Pilosebaceous unit

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78
Q

In what two locations are apocrine sweat glands found?

A

Axillae and perineum

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79
Q

What type of sweat glands are androgen dependent?

A

Apocrine

80
Q

Where are eccrine sweat glands found?

A

On the whole skin surface (palms, soles and axillae in particular)

81
Q

What is the nerve supply to the eccrine sweat glands?

A

Sympathetic cholinergic nerve supply - mental, thermal and gustatory stimulation

82
Q

Give a function of eccrine sweat glands?

A

Cooling by evaporation

83
Q

Name an acute skin failure?

A

Toxic epidermal necrolysis

84
Q

What skin failure involves red skin all over?

A

Erythroderma

85
Q

What can protein loss lead to?

A

Hypoalbuminaemia

86
Q

What absorbs UV rays to protect DNA in the cells nuclei?

A

Melanin

87
Q

Give two metabolism processes that take place in the skin?

A

Vitamin D metabolism

Thyroid hormone metabolism

88
Q

In vitamin D metabolism: what is cholecalciferol (7-dehydrocholesterol) converted to by UV?

A

Vitamin D3

89
Q

What is vitamin D3 stored as in the liver and what is it then converted to in the kidney?

A

Hydroxycholecalciferol

1,25-dihydroxycholecaliferol

90
Q

During metabolism of thyroid hormone: what is thyroxine (T4) converted to?

A

Triiodothyronine (T3)

91
Q

Where does the majority of T4 to T3 conversion take place?

A

20% in thyroid gland and 80% in peripheral tissues including skin

92
Q

What is the term for disseminated herpes simplex virus?

A

Eczema herpeticum

93
Q

What type of disease is chronic discoid lupus erythematosus?

A

An autoimmune disease

94
Q

Name four chemical signals/molecules that influence cell behaviour or help target pathogens?

A
  1. Cytokines
  2. Chemokines
  3. Eicosanoids
  4. Antimicrobial peptides
95
Q

What is usually a protein/peptide or polysaccharide thast elicits an immune response?

A

Antigen

96
Q

Are Langerhans cells an example of adaptive or innate immunity?

A

Innate

97
Q

What is formed by terminal differentiation of keratinocytes to corneocytes?

A

Keratin layer

98
Q

Name 3 important structural proteins in the keratin layer and epidermis?

A
  1. Filaggrin
  2. Involucrin
  3. Keratin
99
Q

What is the Stratum Corneum?

A

Keratin layer

100
Q

What are the structural and functional cells of the epidermis?

A

Keratinocytes

101
Q

What can keratinocytes be activated by?

A

UV light and sensitisers - e.g. allergic contact dermatitis

102
Q

Give three immunological abilities of keratinocytes?

A
  1. Sense pathogens via cell surface receptors
  2. Produce antimicrobial peptides
  3. Produce cytokines and chemokines
103
Q

What is the type of dendritic cell that intersperses with keratinocytes in the epidermis?

A

Langerhans cels

104
Q

Name antigen presenting cells characterised by the Birbeck granule (tennis racket)?

A

Langerhans cells

105
Q

What do langerhans cells act as in the epidermis?

A

Sentinels

106
Q

What does healthy skin contain a large number of in both the epidermis and dermis?

A

T cells

107
Q

What T cells are mainly found in the epidermis?

A

CD8+

108
Q

What T cells are found in the dermis?

A

CD4+ and CD8+

109
Q

What CD4 cells associated with inflammation are related to psoriasis?

A

TH1

110
Q

What CD4 cells associated with inflammation are related to atopic dermatitis?

A

TH2

111
Q

Where are T cells produced?

A

Bone marrow

112
Q

Where are T cells sensitised?

A

Thymus

113
Q

What are TH1, IL2 and IFNg?

A

CD4 helper T cells

114
Q

What two dendritic cells are found in the dermis?

A

Dermal - involved in Ag presenting and secretng cyto/chemokines
Plasmacytoid - produce IFNa (found in diseased skin)

115
Q

What chromosome is related to MHC?

A

6

116
Q

What do psoriasis, atopic dermatitis, bullous pemphigoid, contact dermatitis, morphea/systemic sclerosis, urticaria nad systemic lupus erythematosus all have in common?

A

Skin conditions associated inappropriate immune response/inflammation.

117
Q

How is psoriasis triggered?

A

By environmental factors in genetically susceptible individuals

118
Q

Psoriasis: immunopathogenesis - when keratinocytes are under stress what do they release?

A

Factors that stimulate pDC to produce IFNa and they release IL-1B/IL-6 and TNF

119
Q

Psoriasis: immunopathogenesis - once chemical signals activate DC, which migrate to skin draining lymph node to present to and activate T cells, what T cells are affected?

A

TH1 and TH17

120
Q

Psoriasis:immunopathogenesis - when T cells are attracted to the dermis by chemokines what do they secrete?

A

IL-17A/17F/22

121
Q

Psoriasis: immunopathogenesis - what does secretion of IL-17A/17F/22 stimulate?

A

Keratinocyte proliferation, antimicrobial peptide release and neutrophil attracting chemokines

122
Q

When dermal fibroblasts become involved in psoriasis immunopathogenesis - hwat to the release?

A

Keratinocytes and epidermal growth factors

123
Q

Is atopic eczema histologically different from psoriasis?

A

Yes

124
Q

Give two examples of impairment of skin barrier function in atopic eczema?

A
  1. Mutations in fillagrin gene associated with severe onset disease
  2. Decreased antimicrobial peptides in skin
125
Q

What T cells along with dendritic cells, keratinocytes, macrophages and mast cells are involved in the lesions in atopic eczema?

A

TH2

126
Q

What antibody is involved in type I immediate hypersensitvity?

A

IgE

127
Q

What antibodies mediate type II and III hypersensitivity?

A

IgG and IgM

128
Q

What does skin testing in type III hypersensitivity lead to?

A

Arthus reaction

129
Q

What cells mediate type IV hypersensitivity?

A

TH1

130
Q

Name the non-immune cells in the epidermis?

A

Keratinocytes

131
Q

Name the immune cells in the epidermis?

A

Langerhans cells and T cells

132
Q

Name the 4 dermis immune cells?

A
  1. Dendritic cells
  2. Macrophages
  3. T cells
  4. NK cells
133
Q

What is a common target for idiosyncratic drug reactions?

A

Skin

134
Q

Name a type I anaphylactic reaction to the skin?

A

Urticaria

135
Q

Name two type II cytotoxic reactions to the skin?

A

Pemphigus and pemphigoid

136
Q

Name a type III immune-complex mediated reaction?

A

Purpura/rash

137
Q

Name a type IV cell-mediated delayed hypersensitivity reaction?

A

T-cell mediated erythema/rash

138
Q

Which can be dose dependent - non-immunologically mediated reactions or immunologically mediated reactions?

A

Non-immunologically mediated reactions

139
Q

What type of reactions are eczema, drug-induced alopecia, phototoxicity, skin erosion or atrophy from topically applied 5-fluorouracil or steroids, psoriasis, pigmentation and cheilitis/xerosis?

A

Non-immunologically mediated reactions

140
Q

What are the three most common morphologies for skin reactions?

A

Exanthematous
Morbilliform
Maculopapular

141
Q

Which are more likely to develop drug eruptions - females or males?

A

Females

142
Q

Name a concomitant disease for development of drug eruptions>

A

Cystic fibrosis

143
Q

Name two chemical risk factors for drugs involved in eruptions?

A
  1. B-lactam compounds, NSAIDS

2. High molecular weight/hapten-forming drugs

144
Q

Name the most common, idiosyncratic, T-cell mediated delayed type hypersensitivity type IV reaction?

A

Exanthematous drug eruptions

145
Q

What is usually seen with an exanthematous drug eruption?

A

Widespread symmetrically distributed rash - mucous membranes usually spared

146
Q

With an exanthematous drug eruption: what are involvement of mucous membrane and face, facial oedema & erythema, confluent erythema, fever, blisters, purpura, necrosis, lympjadenopathy, arthralgia and shortness of breath all indicators of?

A

A potential severe reaction

147
Q

What are penicillins, sulphonamide antibiotics, erythromycin, streptomycin, allopurinol, anti-epileptics: carbamazepine, NSAIDs, phenytoin and chloramphenicol all associated with?

A

Exanthematous drug eruptions

148
Q

What is the usual type of urticarial drug reaction called?

A

IgE mediated hypersensitivity type I (carbazepine)

149
Q

Give two examples of pustular/bullous drug eruptions?

A
  1. Acne

2. Acute generalised exanthematous pustulosis (AGEP)

150
Q

Give four drugs that can cause acne?

A
  1. Glucocorticoids
  2. Androgens
  3. Lithium
  4. Isoniazid
151
Q

Give three drugs that can cause AGEP?

A
  1. Antibiotics
  2. Calcium channel blockers
  3. Antimalarials
152
Q

What pustular/bullous drug eruption can be caused by ACE inhibitors, penicillin and furosemide?

A

Drug-induced bullous pemphigoid

153
Q

What drug can trigger linear IgA disease?

A

Vancomycin

154
Q

What kind of drug eruption causes well demarcated round/ovoid plaques, red and painful that occur on hands, genitalia, lips and oral mucosa?

A

Fixed

155
Q

Name four drugs associated with fixed drug eruptions?

A
  1. Tetracycline, doxycycline
  2. Paracetamol
  3. NSAIDS
  4. Carbamazepine
156
Q

Give four examples of severe cutaneous adverse reactions?

A
  1. Stevens-Johnson syndrome
  2. Toxic epidermal necrolysis
  3. Drug reaction with eosinophilia and systemic symptoms (DRESS)
  4. Acute generalised exanthematous pustulosis (AGEP)
157
Q

What severe cutaneous adverse reactions can tramadol, pantoprazole, phenytoin, carbamazepine, cephalosporins and sulfonamide antibiotics cause?

A

SJS

TEN

158
Q

What type of reaction is skin toxicity, systemic toxicity and photodegradation?

A

Acute phototoxic drug reactions

159
Q

Give three chronic phototoxic drug reactions?

A

Pigmentation, photoageing and photocarcinogenesis

160
Q

Give the definition of phototoxic cutaneous drug reactions

A

Non-immunological mediated skin reaction which will arise in any individual providing there is enough photo-reactive drug and the appropriate wavelength of light.

161
Q

Can immunosuppression cause increased sensitivity to light?

A

Yes

162
Q

What are the major patterns of cutaneous phototoxicity caused by chlorpromazine and amiodarone?

A

Immediate prickling with delayed erythema and pigmentation.

163
Q

What are the major patterns of cutaneous phototoxicity caused by quinine, thiazides and DCMT?

A

Exaggerated sunburn

164
Q

What are the major patterns of cutaneous phototoxicity caused by calcium channel antagonists?

A

Exposed telangiectasia

165
Q

What are the major patterns of cutaneous phototoxicity caused by psoralens?

A

Delayed 3-5 days erythema and pigmentation

166
Q

What are the major patterns of cutaneous phototoxicity caused by nalidixic acid, tetracycline naproxen and amiodarone?

A

Increased skin fragility

167
Q

What is skin testing not indicated for?

A

Serum sickness reactions (type III) or for T-cell mediated reactions (type IV) and can potentially trigger SJS, TEN and DRESS.

168
Q

What are two hardening methods for photosensitivity?

A

Phototherapy and PUVA

169
Q

What can chromophore removal be used for?

A

Treating photosensitivity

170
Q

Give the normal metabolite pathway for pophyrias?

A

Glycine + Succinyl coA forms ALA > PBG > HMB > URO > COPRO > PROTO > HAEM

171
Q

Give the four main groups of porphyrias?

A
  1. Phototoxic skin porphyrias (such as erythropoietic protoporphyria)
  2. Blsitering and fragility skin porphyrias
  3. Acute attack porphyria
  4. Severe congenital porphyrias
172
Q

List the three most common skin porphyrias in Scotland?

A
  1. Porphyria cutanea tarda
  2. Erythropoietic protoporphyria
  3. Variegate porphyria
173
Q

What enzyme is involved in porphyria cutanea tarda?

A

Uroporphyrinogen decarboxylase

174
Q

Where is porphyria cutanea tarda blisters most commonly seen?

A

Backs of hands

175
Q

Give four presentations of porphyria cutanea tarda other than fragility and blisters?

A
  1. Hyperpigmentation
  2. Hypertrichosis
  3. Solar urticaria
  4. Morphoea
176
Q

What are four possible underlying causes of Porphyria cutanea tardas?

A
  1. Alcohol
  2. Viral hepatitis
  3. Oestrogens
  4. Haemochromatosis
177
Q

What is the enzyme involved in erythropoietic protoporphyria?

A

Ferrochelatase

178
Q

What are quantative RBC porphyrins, fluorocytes, transaminases, red cell indices all investiagtions for?

A

Erythropoietic protoporphyria

179
Q

Give three management options other than behavioural for erythropoietic protoporphyria?

A
  1. Prophylactic TL-01 phototherapy
  2. Anti-oxidants
  3. Avoid iron
180
Q

What is the enzyme affected for acute intermittent porphyria?

A

PB deaminase

181
Q

What are the five virulence factors?

A
  1. Adhesin
  2. Invasin
  3. Impedin
  4. Aggressin
  5. Modulin
182
Q

What is the virulence factor that enables binding of the organism to host tissue?

A

Adhesin

183
Q

What is the virulence factor that enables the organism to invade a host cell?

A

Invasin

184
Q

What is the virulence factor that enables the organism to avoid host defence mechanisms?

A

Impedin

185
Q

What is the virulence factor that causes damage to the host directly?

A

Aggressin

186
Q

What is the virulence factor that induces damage to the host indirectly?

A

Modulin

187
Q

What are the most important adhesins in Staph aureus?

A

Fibrinogen-binding

Collagen binding

188
Q

Name a toxin in Staph aureus that has specific toxicity for leukocytes?

A

Panton-Valentine Leukocidin

189
Q

What two severe skin infections is PVL associated with?

A

Recurrent furunculosis

Necrotising fascilitis

190
Q

What - linked with PVL and alpha toxin is responsible for necrotising pneumonia and contagious severe skin infections?

A

CA-MRSA

191
Q

What are the four diagnostic criteria for necrotising pneumonia?

A
  1. Fever - 39
  2. Diffuse macular rash and desquamation
  3. Hypotension
  4. > 3 organ systems involved
192
Q

Name three skin infections caused by Streptococcus pyogenes?

A
  1. Impetigo
  2. Cellulitis
  3. Necrotising fascilitis
193
Q

Name a way Strep pyogenes adheres?

A

Hyaluronic acid capsule

194
Q

Is impetigo contagious?

A

Yes

195
Q

Name an important S.pyogenes disease that involves pyrogenic exotoxins?

A

Toxic shock like syndrome

JL Dermatology (6 decks)

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