03-Blistering Diseases Flashcards
1
Q
- Name two cadherins in the skin.
A
- desmoglein and desmocollin
2
Q
- Name 5 members of the Plakin family.
A
- Desmoplakin, BPAg1, Plectin, Envoplakin, Periplakin
3
Q
- Name 2 other names for laminin 5.
A
- Epilegrin and Laminin 332
4
Q
- Where are the anchoring filaments located?
A
- Lamina Lucida
5
Q
- Where are the anchoring fibrils located?
A
- Sublamina densa
6
Q
- What is the predominant collagen in the Lamina densa?
A
- Type IV collagen
7
Q
- What is collagen which attaches Type I and III collagen to the Lamina densa?
A
- Type VII collagen
8
Q
- Name the tissue used for indirect IF for Pemphigus Vulgaris (and DH).
A
- Monkey Esophagus
9
Q
- Name the tissue used for indirect IF for Paraneoplastic Pemphigus.
A
- Rat Bladder
10
Q
- Name the tissue used for indirect IF for Pemphigus Foleacius.
A
- Guinea Pig Esophagus
11
Q
- Name the medium used for transport of tissue used for DIF.
A
- Michel’s media
12
Q
- What is the sign that on slight rubbing the skin reveals the dermis?
A
- Nikolsky sign
13
Q
- What is the sign: pressure on the blister surface results in lateral spread?
A
- Asboe-Hansen sign
14
Q
- Where do blisters/erosions commonly first appear in pemphigus vulgaris?
A
- Mouth
15
Q
- HLA associated with PV?
A
- HLA DR4 and DR6 most commonly
16
Q
- The mucosal variant of PV is due to what antibody?
A
- Anti-Desmoglein 3
17
Q
- The Mucocutaneous variant of PV is due to what antibody?
A
- Anti-Desmoglein 1 & 3
18
Q
- What do you see on pathology in PV?
A
- Suprabasilar acantholysis with Tombstoning and eosinophilic spongiosis
19
Q
- What is the DIF pattern in PV?
A
- Chickenwire with IgG4
20
Q
- What are the 2 subtypes of Pemphigus Vegetans?
A
- Neuman (MC and severe), and Hallopeau (mild, pustular)
21
Q
- Does Pemphigus Foliaceus have oral lesions?
A
- NO
22
Q
- Name drugs implicated in Pemphigus Foliaceus
A
- Thiol-drugs (captopril, penicillamine, gold thiosulfate), sulfa-releasing, penicillamine, nifedipine
23
Q
- What’s the histology of PF look like?
A
- Subcorneal/ Intragranular acantholysis with “cling ons”
24
Q
- In which country is endemic pemphigus found?
A
- Brazil
25
Q
- What age population is involved in endemic pemphigus?
A
- Children and young adults
26
Q
- What arthropod bite is possibly related to Fogo Selvalgem?
A
- Simulium nigrimanum
27
Q
- What is another name for Pemphigus Erythematosus and what other disease does it share features with?
A
- Senear-Usher syndrome and Lupus
28
Q
- What is the antibody in Pemphigus Erythematosus?
A
- Anti-desmoglein 1
29
Q
- What are the antibodies in Paraneoplastic Pemphigus?
A
- Plakin, BPAg1, Desmoplakin 1 and II, Envoplakin, Periplakin, alpha-2-macroglobulin-like-1
30
Q
- Name the associated malignancies with paraneoplastic pemphigus.
A
- NHL (40%), CLL (30%), Castleman’s disease (10%), Thymoma/Sarcoma/Waldenstrom’s (6% each)
31
Q
- What is the MC malignancy in adolescents with paraneoplastic pemphigus?
A
- Castleman’s disease
32
Q
- What is the HLA associated with Paraneoplastic pemphigus?
A
- HLA-DRB1
33
Q
- What is the most consistent symptom of paraneoplastic pemphigus?
A
- Intractable Stomatitis
34
Q
- What process is associated with poor prognosis in paraneoplastic pemphigus?
A
- Bronchiolitis obliterans
35
Q
- What are the 2 types of IgA pemphigus and their antibodies?
A
- Subcorneal pustular dermatosis (desmocollin 1) and Intraepidermal neutrophilic dermatosis (?Desmoglein 1/3)
36
Q
- What are the antibodies in Bullous Pemphigoid?
A
- BPAg 1 (230kD) and 2(180kD)
37
Q
- What is the HLA assoc with BP?
A
- HLA-DQB1
38
Q
- What % of BP have oral involvement?
A
37.20%
39
Q
- What is seen on DIF in BP?
A
- Linear C3 and IgG4 at basement membrane
40
Q
- Where does the IIF localize to ?
A
- Roof
41
Q
- Where does the BPAg2 Ab attack?
A
- NC16a domain
42
Q
- What common drug is known to cause BP?
A
- Furosemide
43
Q
- What trimester does pemphigoid gestationis usually occur in?
A
- 2nd
44
Q
- What is the antibody in pemphigoid gestationis and what domain?
A
- BPAg2 and NC16a domain
45
Q
- What disease is associated with Pemphigoid gestationis and HLA association?
A
- Grave’s and HLA DR3 and DR4
46
Q
- What areas of the body are usually spared in PUPPP?
A
- Periumbiical, upper chest, face, mucous membranes, palms and soles
47
Q
- What is the risk to mother and fetus in PUPPP?
A
- None
48
Q
- What lab abnormality can Impetigo Herpetiformis be associated with?
A
- Hypocalcemia (hypoparathyroidism)
49
Q
- Pregnant women with cholestasis of pregnancy are at risk for what process postpartum and why?
A
- Postpartum hemorrhage due to low vitamin K (Fetus also at risk)
50
Q
- Cicatricial pemphigoid involves the conjunctiva and oral mucosa in what %?
A
- 66% and 90% respectively
51
Q
- Skin lesions are seen in what % in cicatricial pemphigoid?
A
50.25%
52
Q
- What is the name of cicatricial pemphigoid on the head and neck without oral involvement?
A
- Brunsting-Perry
53
Q
- What is the antibody in cicatricial pemphigoid with mucosal and skin lesions?
A
- BPAg2 (distal C-terminal)
54
Q
- Ab with ocular cicatricial pemphigoid?
A
- Beta-4 integrin
55
Q
- Ab with malignancy associated cicatricial pemphigoid?
A
- Laminin 332
56
Q
- What is the drug of choice for cicatricial pemphigoid with rapidly progressive eye disease?
A
- Cyclophosphamide
57
Q
- What drug is ineffective for cicatricial pemphigoid with severe eye involvement?
A
- Cyclosporine
58
Q
- What is the antibody against in Epidermolysis Bullosa Acquisita?
A
- Type VII collagen (NC1 domain)
59
Q
- What is another name for Dermatitis Herpetiformis?
A
- Duhring Disease
60
Q
- What areas of the body are involved in DH?
A
- Extensor elbows/knees, scalp, and nuchal areas
61
Q
- What is the HLA association in DH?
A
- HLA DQ2 and DQ8
62
Q
- What diseases are associated wit DH?
A
- Thyroid disease (38-50%), small bowel T-cell lymphoma; DM, Addison’s, hepatitis, alopecia areata, MG, sarcoidosis, scleroderma, Sjogren’s, SLE, vitiligo
63
Q
- What is the appearance of the DIF in DH?
A
- Granular IgA along DE junction
64
Q
- What are common antibodies are seen in DH?
A
- Antiendomysial Ab, Antiepidermal transglutaminase Ab, Antigliadin Ab
65
Q
- What drug is commonly known to cause Linear IgA disease?
A
- Vancomycin
66
Q
- What is the antibody seen in Linear IgA disease?
A
- 97-120kD epitope of BPAg2
67
Q
- What can flare Grover’s disease?
A
- Heat or bedrest (hospitalization)