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FD9 > 28 - Psoriasis > Flashcards

28 - Psoriasis Flashcards

1
Q

Types of psoriasis based on age of onset

A

Type I - onset before 40 years and HLA associated

Type II - age after 40 years

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2
Q

Also known as isomorphic response

A

Koebner phenomenon

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3
Q

Koebner reaction usually occurs

A

7-14 days after injury

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4
Q

Psoriasis vulgaris is seen approximately in _____% of patients

A

90

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5
Q

Type of psoriasis: lesions may extend laterally and become circinate because of the confluence of several plaques

A

Psoriasis gyrata

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6
Q

Type of psoriasis: partial central clearing resulting in ringlike lesions

A

Annular psoriasis

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7
Q

Type of psoriasis: usually associated with lesional clearing and portends a good prognosis

A

Annular psoriasis

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8
Q

Type of psoriasis: lesions in the shape of a cone or limpet

A

Rupioid psoriasis

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9
Q

Type of psoriasis: ringlike, hyperkeratotic concave lesion, resembling an oyster shell

A

Ostraceous psoriasis

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10
Q

Type of psoriasis: thickly scaling, large plaques, usually on the lower extremities

A

Elephantine psoriasis

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11
Q

Hypopigmented ring surrounding individual psoriatic lesions usually associated with treatment, most commonly UV radiation or topical steroids

A

Woronoff ring

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12
Q

Pathogenesis of Woronoff ring

A

Not well understood but may result from inhibition of prostaglandin synthesis

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13
Q

Guttate psoriasis has the strongest association to

A

HLA-Cw6

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14
Q

Frequently precedes or is concomitant with the onset or flare of guttate psoraisis

A

Streptococcal throat infection

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15
Q

Common adult presentation of psoriasis in Korea and other Asian countries

A

Small plaque psoriasis

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16
Q

Characterized by fever that lasts several days and a sudden generalized eruption of sterile pustules; waves of fever and pustules

A

Generalized pustular psoriasis (von Zumbusch)

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17
Q

Tends to occur after a viral infection and consists of widespread pustules with generalized plaque psoriasis

A

Exanthematic pustular psoriasis

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18
Q

Exanthematic pustular psoriasis vs von Zumbusch

A

Exanthematic pustular psoriasis - no constitutional symptoms and tends not to recur

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19
Q

Characterized by pustules on a ringlike erythema that sometimes resembles erythema annulare centrifugum

A

Annular pustular psoriasis

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20
Q

Variant of pustular psoriasis occuring in pregnancy

A

Impetigo herpetiformis

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21
Q

Impetigo herpetiformis onset

A

Early in the third trimester and persists until delivery

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22
Q

Y/N: Impetigo herpetiformis tends to develop earlier in subsequent pregnancies.

A

Yes

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23
Q

Impetigo herpetiformis is often associated with

A

Hypocalcemia

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24
Q

Rare variant of pustular psoriasis that is localized to the palms and soles

A

Palmoplantar pustular psoriasis or

Pustulosis palmaris et plantaris

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25
Q

Palmoplantar pustular psoriasis vs palmoplantar pustulosis

A

Palmoplantar pustular psoriasis - chronic plaque psoriasis is present

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26
Q

Y/N: Pustulosis palmaris et plantaris has a sex predilection

A

Yes - more common in females

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27
Q

Strongly associated with pustulosis palmaris et plantaris

A

Smoking

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28
Q

Also knows as dermatitis repens

A

Acrodermatitis continua of Hallopeau

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29
Q

Napkin psoriasis usually between the ages of

A

3 and 6 months

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30
Q

Napkin psoriasis prognosis

A

Disappear after the age of 1 year

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31
Q

May be an underlying nevus, possibly an inflammatory linear verrucous epidermal nevus

A

Linear psoriasis

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32
Q

Nail changes are found in up to _____% of patients

A

40

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33
Q

Nail finding that is considered to be nearly specific for psoriasis

A

Oil spotting

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34
Q

Nail segment involved: pitting

A

Proximal matrix

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35
Q

Nail segment involved: onychorrhexis

A

Proximal matrix

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36
Q

Nail segment involved: Beau’s lines

A

Proximal matrix

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37
Q

Nail segment involved: leukonychia

A

Intermediate matrix

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38
Q

Nail segment involved: focal onycholisis

A

Distal matrix

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40
Q

Nail segment involved: thinned nail plate

A

Distal matrix

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41
Q

Nail segment involved: erythema of the lunula

A

Distal matrix

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42
Q

Nail segment involved: “oil drop” sign or “salmon patch”

A

Nail bed

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43
Q

Nail segment involved: onycholysis

A

Nail bed

Hyponychium

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44
Q

Nail segment involved: subungual hyperkeratosis

A

Nail bed

Hyponychium

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45
Q

Nail segment involved: crumbling and destruction plus other changes secondary to the specific site

A

Nail plate

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46
Q

Nail segment involved: cutaneous psoriasis

A

Proximal and lateral nail folds

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47
Q

Y/N: Alopecia is a common observation is scalp psoriasis

A

No - not a common observation

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48
Q

Present as asymptomatic erythematous patches with serpiginous borders; idiopathic inflammatory disorder resulting in the local loss of filiform papillae

A

Geographic tongue or
Benign migratory glossitis or
Glossitis areata migrans

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49
Q

Y/N: Geographic tongue is seen in many nonpsoriatic individuals

50
Q

Psoriatic arthritis is seen in up to _____% of patients

51
Q

About _____% of basal keratinocytes are cycling in normal skin, but this value rises to _____% in lesional psoriatic skin

52
Q

Neutrophils exit from the tips of a subset of dermal capillaries

A

Squirting papillae

53
Q

Accumulation of neutrophils in the overlying parakeratotic stratum corneum

A

Munro’s micrabscesses

54
Q

Accumulation of neutrophils in the spinous layer

A

Spongiform pustules of Kogoj

55
Q

CD8+ T cells are predominantly located in the

56
Q

CD8+ T cells are predominantly located in the

A

Upper dermis

57
Q

______ are prominent in developing psoriatic lesions, with _____ appearing somewhat later

A

Macrophages

Neutrophils

58
Q

Are likely to play a major role in pustular psoriasis

A

Neutrophils

59
Q

Psoriatic keratinocytes are engaged in an alternative pathway of keratinocyte differentiation called

A

Regenerative maturation

60
Q

Major genetic signal for psoriasis in the MHC

A

HLAC*0602 - encodes HLA-Cw6 protein

61
Q

Medications that exacerbate psoriasis

A 
Antimalarials
Beta blockers
Lithium
NSAIDs
IFN- alphas and gammas
Imiquimod
ACE inhibitors
Gemfibrozil
62
Q

Elevated in up to 50% of patients and is mainly correlated with the extent of lesions and the activity of disease

A

Serum uric acid

63
Q

Y/N: Serum uric acid is persistently elevated in patients with psoriasis.

A

No - usually normalize after therapy

64
Q

Guttate psoriasis prognosis

A

Self-limited, lasting from 12-16 weeks without treatment

65
Q

_____ of patients with guttate psoriasis patients later develop the chronic plaque type

A

One-third to two thirds

66
Q

First-line therapy in mild to moderate psoriasis and in sites such as the flexures and genitalia, where other topical treatments can induce irritation

A

Corticosteroids

67
Q

Only major concern with the use of topical vitamin D preparations

A

Hypercalcemia

68
Q

Recommended weekly dose of vitamin D3 analogues

69
Q

Naturally occurring substance found in the bark of the araroba tree in South America

A

Anthralin (dithranol)

70
Q

Anthralin combined with UVB phototherapy

A

Ingram regimen

71
Q

Most common side effects of anthralin

A

ICD

Staining of clothing, skin, hair, and nails

73
Q

Nail segment involved: splinter hemorrhages

74
Q

To prevent auto-oxidation of anthralin, ______ should be added

A

Salicylic acid

75
Q

Main active ingredient in a tar

76
Q

Coal tar adverse effects

A

Folliculitis
Unwelcome smell and appearance
Staining of clothing
Carcinogenesis

77
Q

Significant proportions of patients on tazarotene develop

A

Local irritation

78
Q

UV doses should be (decreased/increased) by at least one third if tazarotene is added to phototherapy

79
Q

Macrolide antibiotic derived from the the bacteria Streptomyces tsukubaensis

A

Tacrolimus

80
Q

Main side effect of topical calcineurin inhibitors

A

Burning sensation

81
Q

Carry a US FDA “black box warning” due to anecdotal reports of lymph node or skin malignancy

A

Tacrolimus

82
Q

MOA: reduction of keratinocyte adhesion and lowering the pH of the stratum corneum, which results in reduced scaling and softening of the plaques, thereby enhancing absorption of other agents

A

Salicylic acid

83
Q

Topical salicylic acid (decreases/increases) the efficacy of UVB phototherapy

84
Q

Peak UVB erythema appears within

A

24 hours of exposure

85
Q

Objective in UVB phototherapy for psorisis

A

Minimally perceptible erythema

86
Q

Excimer laser is commonly used for patients with

A

Stable recalcitrant plaques, particularly of the elbows and knees

87
Q

Climactic therapy in psoriasis

A

Going to a sunny climate can improve psoriasis

88
Q

MOA of methotrexate

A

Inhibition of AICAR (enzyme involved in purine metabolism) which leads to accumulation of extracellular adenosine

89
Q

Therapeutic effects of methotrexate usually require _____ to become evident

90
Q

Liver biopsy in low risk patients

A

Cumulative MTX dose of 3.5-4 g

91
Q

Liver biopsy in patients with one or more risk factors

A

Baseline either before treatment or after 2-6 months of treatment
Cumulative MTX dose of 1-1.5 g

92
Q

Risk factors for liver injury

A

Current or past alcohol consumption
Persistent abnormalities of liver function enzymes
Personal or family history of liver disease
Exposure to hepatotoxic drugs or chemicals
Diabetes mellitus
Hyperlipidemia
Obesity

93
Q

Only antidote for the hematologic toxicity of MTX

A

Leucovorin calcium (folinic acid)

94
Q

Folinic acid administration

A

Immediate dose of 20 mg parenterally or orally then every 6 hours

95
Q

Clinical forms most responsive to etretinate or acitretin as monotherapy

A

Generalized pustular psoriasis

Erythrodermic psoriasis

96
Q

Dose of acitretin

A

Initial dose of 25 mg/day, with a maintenance dose of 20-50 mg/day

97
Q

Inhibitor of PDE-4 which degrades cAMP intracellularly

A

Apremilast

98
Q

Apremilast adverse effects

A 
GI symptoms (diarrhea, nausea, headaches)
Worsening of depression
99
Q

Oral Janus kinase inhibitor that has a role in downstream signaling of multiple proinflammatory cytokines

A

Tofacitinib

100
Q

Tofacitinib is only approved for

A

Rheumatoid arthritis

101
Q

Tofacitinib adverse effects

A

Changes in hemoglobin
Leukopenias
Lipid abnormalities
Increased incidences of viral infections, particularly herpes zoster

102
Q

Neutral cyclic undecapeptide derived from the fungus Tolypocladium inflatum gams

A

Cyclosporin A

103
Q

Y/N: Nephrotoxic effects of cyclosporine A are largely irreversible.

104
Q

Most common adverse effects in patients using cylosporin A for short periods of time

A

Neurologic - tremors, headache, paresthesia, hyperesthesia

105
Q

Y/N: Fumaric acid is poorly absorbed after oral intake.

A

Yes - Esters are used for treatment are almost completely absorbed in the small intestines

106
Q

Systemic steroids may have a role in the management of

A

Persistent, otherwise uncontrollable, erythroderma and fulminant generalized pustular psoriasis if other drugs are ineffective

107
Q

Inhibitor of inosine-5’-monophosphate dehydrogenase

A

Mycophenelate mofetil

108
Q

Purine analog that has been highly effective for psoriasis

A

6-thioguanine

109
Q

Antimetabolite that has been shown to be effective as monotherapy for psoriasis

A

Hydroxyurea

110
Q

Most troublesome cutaneous reaction to hydroxyurea

A

Leg ulcers

111
Q

Three types of biologics for psoriasis

A
  1. Recombinant human cytokines
  2. Fusion proteins
  3. Monoclonal autoantibodies- fully humanized, humanized or chimeric
112
Q

TNF-alpha antagonists

A 
Infliximab
Etanercept
Adalimumab
Golimumab
Certolizumab pegol
113
Q

Chimeric monoclonal antibody that has high specificity, affinity, and avidity for TNF-alpha

A

Infliximab

114
Q

Human recombinant, soluble, TNF-alpha receptor-Fc IgG fusion protein

A

Etanercept

115
Q

Fully human recombinant IgG1 monoclonal antibodies and specifically targets TNF-alpha

A

Adalimumab

Golimumab

116
Q

Polyethylene glycol Fab’ fragment of a humanized TNF inhibitor monoclonal antibody

A

Certolizumab pegol

117
Q

Human monoclonal antibody that binds the shared p40 subunit of IL-12 and IL-23

A

Ustekinumab

118
Q

Interleukin-17A antagonists

A

Secukinumab
Ixekizumab
Brodalumab

119
Q

Fully human antibody that binds and neutralizes IL-17A

A

Secukinumab

120
Q

Humanized antibody that binds and neutralizes IL-17A

A

Ixekizumab

121
Q

Fully human antibody targeting the IL-17 receptor alpha chain

A

Brodalumab

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