Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Musculoskeletal and Skin > Blistering Disorders > Flashcards

Blistering Disorders Flashcards

1
Q

Layers of skin

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

epithelial cell junction

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the difference between a vesicle(s) and a bulla(e)?

A

Vesicles are small (<1cm) and bullae are large (>1cm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

types of bullae

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A.Vesicles or bullae?

B.Tense or flaccid?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Secondary Changes

A

Exogenous factors or temporal changes that evolve over time

  • •Erosion–Partial loss of the epidermis–Occurs after blisters break
  • Ulceration–Full thickness loss of the epidermis–May have loss of the dermis or even subcutis
  • Crust–Dried serum, blood or pus on the surface
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

describe

A

Erosions in eczema herpeticum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
A

Ulceration in pyoderma grangrenosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
A

Ulceration in pyoderma grangrenosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

67-year-old M presents with a 4-week history of this intensely pruritic eruption. He has been applying topical Benadryl without improvement. He denies oral involvement.

How would you describe the lesions?

A

•Multiple tense vesicles and bullae with erosions and crusts in the axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Diagnosis?

no oral involvement!

A

A.Bullous pemphigoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bullous Pemphigoid

A

•Most common autoimmune blistering disorder•IgG antibodies against hemidesmosomes in the epidermal basement membrane leading to subepidermal split•Usually chronic; low mortality•Elderly males•Associated disorders: malignancy, neurological disorders, drugs, autoimmune disorders•Treatment: topical and oral steroids, steroid sparing agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bullous Pemphigoid: Clinical Characteristics

A

•Pruritic, tense bullae arising on an urticarial background•Bullae rupture to leave crusts and erosions•Typically spares oral mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A previously healthy 56-year-old M presents to the Emergency Department with a 4-month history of intermittent painful oral lesions as well as lesions on the face, trunk and extremities. He reports that the oral lesions preceded the skin lesions.

How would you describe the lesions?

A

•On the neck, back, upper extremities and hard palate, there are widespread erosions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are your concerns with this much denuded or eroded skin involvement?

A

•Infection•Dehydration and electrolyte imbalance due to excess fluid loss from skin wounds•Pain•Involvement of the esophagus or other mucosal areas

17
Q

case 2

Diagnosis?

A

A.Pemphigus vulgaris

18
Q

Pemphigus Vulgaris

A

•Autoimmune blistering disorder•Autoantibodies against desmosomes in the epidermis leads to loss of connection between adjacent cells •May be fatal•M=W•Mean age between 40-60 years•More common in Jewish or Mediterranean descent

19
Q

Clinical Features: pemphigus vulgaris

A
  • All patients have painful oral erosions •May impair food/liquid intake•Other mucosal sites may be involved
  • Skin involvement in 50% of patients•Flaccid bullae and erosions•Intact blisters are rare due to fragility and easy breakage•Painful•Heals without scarring (dermis unaffected), but PIH in darker skin types•Widespread denudation may lead to death from fluid imbalance or secondary infection
20
Q

Nikolsky Sign

A

Rubbing the skin causes the epidermis (top layer) to shear away from the dermis (middle layer), leaving a moist surface

positive in pemphigus vulgaris

21
Q

Treatment Pemphigus vulgaris

A

•Oral steroids•Steroid sparing agents•Wound care

retuxlmab

22
Q

Comparison of Bullous Pemphigoid and Pemphigus Vulgaris

A
23
Q

Case 3:

A 35-year-old White M presents for a several-year history of an itchy rash on the elbows and knees that worsens after eating bread. Denies nausea, vomiting, abdominal pain, diarrhea.

How would you describe the lesions?

Diagnosis?

A

•Discrete vesicles and erythema on the knee and elbow

A.Dermatitis herpetiformis

24
Q

Dermatitis Herpetiformis

A

•Chronic, autoimmune disorder•More common in White men, rare in African Americans and Asians•Most patients (> 90%) have an associated gluten-sensitive enteropathy, but a minority (20%) have GI symptoms•Pathogenesis: IgA deposition in the papillary dermis•Increased risk of thyroid disease (Hashimoto thyroiditis) and small bowel T-cell lymphoma•Treatment: strict gluten-free diet adherence may lead to complete remission and decrease risk of lymphoma, dapsone

In predisposed individuals, oral intake of gluten induces synthesis of IgA antibodies directed against intestinal tissue transglutaminase. Cross reactivity with epidermal transglutaminase leads to cutaneous disease. The associated autoantigen is an epidermal transglutaminase, transglutaminase 3 (TG3).

For treatment, dapsone is effective for the cutaneous lesions only. Patients will notice a rapid improvement within a few days. However, it does not impact GI disease whereas a gluten free diet does. A gluten free diet may be difficult for patients to follow. It takes several months to a year to be effective, but it can improve both cutaneous and GI disease and decrease the risk of lymphoma.

25
Q

Dermatitis Herpetiformis: clinical features

A
  • Intermittent papulovesicular eruption•Lesions are often grouped (i.e, herpetiform)
  • Symmetric distribution on extensor surfaces of extremities, buttocks, and scalp
  • Extremely pruritic •Intense pruritus leads to secondary excoriations, which may be the only cutaneous finding

after eating gluten

26
Q

case 4: A 32-year-old F PMH cold sores presents for a one-day history of the following eruption on her arms and legs. She also reports painful bumps on her lips, which appeared before the eruption. She does not take any medications. Denies cough or other URI symptoms.

How would you describe the lesions?

What is the diagnosis?

A

•On the dorsal hand, there are scattered targetoid lesions

A.Erythema multiforme

27
Q

What is the most common trigger of erythema multiforme in adults?

A

A.Herpes simplex virus: A preceding HSV infection is the most common precipitating factor; occasionally, there are other preceding infections (e.g., mycoplasma) or, rarely, drug exposure

28
Q

Erythema Multiforme

A

Self-limited but potentially recurrent

▪ Abrupt onset of papular “target” lesions, majority of lesions appear within 24 hours

▪ Target lesions favor acrofacial sites

▪ Mucosal involvement and systemic symptoms may be present

29
Q

Case 5: A 28 year-old F with no significant PMH presents for a painful sunburn on her back after spending the weekend at the beach. She reports that she forgot to reapply sunscreen.

Which of the following is false regarding sunburn?

A.It is an acute inflammatory reaction due to excessive UV light exposure

B.It is a risk factor for development of basal cell carcinoma, squamous cell carcinoma and melanoma

C.It can cause DNA damage, inducing apoptosis of keratinocytes

D.UVB is dominant in sunburn

E.UVA is dominant in photoagingF.It is more common in lighter skinAll of the above are true

A

All of the above are true

30
Q

A sunburn is similar to what type of thermal burn?

A

A.First degree

31
Q

Thermal Burns

A

•Clinical presentation depends on depth of injury•First degree: superficial; limited to epidermis•Painful, no bullae, heals without scar•Second degree: partial-thickness•Superficial variant•Epidermis/superficial dermis•Painful, bullae, mild but variable scarring•Deep variant•Epidermis and most of dermis, including follicles•Painful but reduced sensation, bullae, thick scars and wound contractures•Third degree: full-thickness epidermis and dermis•Little to no pain, white, dry, charred, significant scarring

32
Q

Rule of 9s

A

•Burn severity is based on depth and body surface involvement (BSA)•BSA is estimated in adults by the “rule of nines”•Cannot be applied to infants and children due to relatively increased head:trunksurface ratio (e.g, head accounts for 19% BSA in 2-year-olds)

33
Q

A patient presents with painless burns covering the entire left leg (front and back) and the front side of the right arm. What percent body surface area is involved? Given the absence of pain, what type of burn did the patient likely sustain?

A

A.22.5% BSA, third degree:

Entire left leg = 18%

Front side of right arm = 4.5%

Total = 18+4.5 = 22.5%

Little to no pain in third degree burns

34
Q

Kodachromes

A
35
Q
A

dermatitis hermetatis

36
Q
A

bulbous imtepgo

37
Q
A

pemphigus vulgaris

desmosomes

38
Q
A

erythema multiforme

Musculoskeletal and Skin (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions