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specific marker of Merkel cells is:
A. Cytokeratin 10
B. Cytokeratin 15
C. Cytokeratin 20
D. Loricrin
E. Envoplakin
► C
Cytokeratin 20 is a specific marker for the Merkel cell. Merkel cells are mechanoreceptors
located at body sites requiring high tactile sensitivity. Keratinocyte deformation results in a
secretion of chemokines by Merkel cells, which make synaptic connection with neurons.
2
Darier’s sign is described as:
A. When an intact epidermis shears away from the underlying dermis, leaving a
moist surface
B. Spreading bulla phenomenon with pressure on an intact bulla
C. Swollen, itchy and or red after stroking the skin
D. Central depression within a lesion when squeezed along its margins
E. Disappearance of color when the lesion is pressed
► C
Swollen, itchy and or red after stroking the skin is referred to Darier’s sign and can be seen in
systemic mastocytosis or urticaria pigmentosa. Nikolsky sign can be seen when an intact
epidermis shears away from the underlying dermis, leaving a moist surface (seen in pemphigus
vulgaris, staphylococcus scalded skin syndrome (SSSS), and toxic epidermal necrosis).
Spreading bulla phenomenon with pressure on an intact bulla is referred to as Asboe-Hansen
sign, commonly seen with pemphigus vulgaris. Central depression within a lesion when
squeezed is referred to as the dimpling sign and is seen in dermatofibromas. Disappearance of
color or blanching when the lesion is pressed is commonly found on vascular lesions
3
A salt split skin DIF is performed on a biopsy taken adjacent to the skin lesions shown. Where
would you expect staining to be seen?
A. Epidermal side B. Dermal side
C. Epidermal and Dermal sides equally
D. In the lamina densa
E. In the anchoring plaques
► A
The image shown is bullous pemphigoid. On salt split skin DIF exams, deposits are seen on the
epidermal side of the split. If dermal deposits are seen, epidermolysis bullosa acquisita or anti-
epiligrin pemphigoid are potential diagnoses.
4
What does a western blot identify?
A. Protein
B. RNA
C. DNA
D. Genes
E. Cell membranes
► A
A northern blot identifies RNA and a southern blot identifies DNA.
5
Which one of the following is responsible for maintaining a barrier to water loss in the stratum
corneum?
A. Involucrin
B. Filaggrin
C. Loricrin
D. Transglutaminase
E. Odland bodies
► E
Odland bodies, also known as lamellar granules, keratinosomes, and membrane-coating granules,
are small organelles that are discharged from granular cells into the intracellular space of the
granular layer of the epidermis. These bodies have two known functions: they mediate stratum
corneum cell cohesion and they form a barrier to water loss. Odland bodies are round to oval,
measure approximately 300 to 500 nm in diameter, and possess a trilaminar membrane and a
laminated interior. They contain neutral sugars linked to lipids and/or proteins, hydrolytic
enzymes, and free sterols. Filaggrin is a breakdown product of filaggrin precursor, a component
of keratohyaline granules, which aggregates with keratin filaments and acts as a “glue” for
keratin filaments. Involucrin is a cysteine-rich protein synthesized in the cytoplasm of spinous..

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