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7th > Chapter 105 - Skin Changes and Disease in Pregnancy > Flashcards

Chapter 105 - Skin Changes and Disease in Pregnancy Flashcards

1
Q

Chnages most commonly observed in pregnancy

A

Pigmentary disturbances

  • hyperpigmentation
  • linea nigra
  • melasma
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2
Q

Irregular blotchy facial hyperpigmentation that occurs in 70% of pregnant women

A

Melasma or chloasma

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3
Q

Melasma is aggravated by: (2)

A

Sun exposure

OCP intake

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4
Q

Significant change in nevi size is a feature of most pregnancies.
True or False

A

False, not

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5
Q

The most common structural change in pregnancy

A

Striae gravidarum
Striae distensae
Stretch marks

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6
Q

Strongest risk factors for development of striae: (3)

A

Family history
Personal history
Race

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7
Q

Most common vascular lesion to develop

A

Spider angiomata

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8
Q

Dermatoses associated with fetal risk (3)

A

Pemphigoid gestationis
Intrahepatic cholestasis of pregnancy
Pustular psoriasis of pregnancy

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9
Q

Immunologically mediated, intensely prurituc vesiculobullous eruption of mid to late pregnancy associated with fetal risk

A

Pemphigoid gestationis

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10
Q

Reversible form of cholestasis in kate pregnancy associated with biochemical abnormalities but remits within 2 to 4 weeks of delivery

A

Intrahepatic cholestasis of pregnancy

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11
Q

Rare, acute pustular eruption accompanied by fever leukocytosis and elevated ESR

A

Pustular psoriasis of pregnancy

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12
Q

Physiologic nail findings during pregnancy (5)

A 
Subungual hyperkeratosis
Distal onycholysis
Transverse grooving
Brittleness
Accelerated growth
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13
Q

Increase or decrease in pregnancy

  1. Eccrine function
  2. Sebaceous function
  3. Apocrine function
A
  1. Increased (except palms)
  2. Increased
  3. Decreased
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14
Q

Bluish discoloration of vagina and cervix

A

Jacquemier Chadwick sign

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15
Q

Cervical softening

A

Goodell sign

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16
Q

Pemphigoid gestationis is associated with: (2)

A

Increased small for gestational age births

Premature delivery

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17
Q

In PG, DIF shows (pathognomonic)

A

(+) linear band C3 with or without IgG at DEJ

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18
Q

Gold standard for diagnosis of PG

A

DIF

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19
Q

96% specific for PG

A

ELISA

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20
Q

Risk of fetal complications of PG correlates with maternal disease severity
True or False

A

True

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21
Q

__% of women with PG flares postpartum and will require treatment; with OCP intake or during menstruation

A

75

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22
Q

Treatment for pemphigoid gestationis (4)

A

Topical steroids
First gen antihistamines
Plasmapheresis
IVIg

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23
Q

PG can also occur in abnormal pregnancies (3) implicating a role for paternally derived tissues

A

Hydatidiform mole

Choriocarcinoma

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24
Q

Intraheptic cholestasis of pregnancy, rare, reversible, occurs in late pregnancy when serum concentrations of ___ reach their peak

A

Estrogen

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25
Q

Second only to viral hepatitis in causing jaundice in pregnant women

A

ICP

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26
Q

ICP is most common in

A

Scandinavia

South America

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27
Q

Only pregnancy dermatosis that presents without primary skin lesions

A

Intrahepatic cholestasis of pregnancy

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28
Q

Patients with ICP may complain of nocturnal pruritus only.

True or False

A

True

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29
Q

Pruritus precedes onset of jaundice by 1-4 weeks

True or False

A

True

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30
Q

Harmful effects of fetus by intrahepatic cholestasis of pregnancy include (3)

A

Increase in premature births
Intrapartum fetal distress
Fetal death

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31
Q

Recurrence of ICP in ___% of subsequent pregnancies

A

45 to 70%

32
Q

Genes muted in ICP include (3)

A

ABCB4
ABCB11
ATP8B1

33
Q

Single most sensitive indicator of ICP

A

Elevation in serum bile acids

34
Q

Common features of ICP

  1. Serum total bile acid concentrations greater than ___
  2. Cholic acid to chenodeoxycholic acid ratio greater than ____ or cholic acid proportion of total bile acids greater than ___%
  3. Glycine conjugates to taurine conjugates of bile acids ratio less than ___ or glycocholic acid concentration greater than __
A
  1. 11 uM (4.6 to 8.7 uM)
  2. 1.5 (0.7 to 1.5); 42%
  3. 1 (0.9 to 1.2); 2uM (0.6 to 1.5uM)
35
Q

Elevation in this liver enzyme is sensitive for ICP but is not seen in heathy pregnancies

A

ALT

36
Q

Increased or decreased in ICP

  1. Gamma glutamyl transferase
  2. Direct fractions of bulirubin
  3. Alpha 2 globulin
  4. Beta globulin
  5. Albumin
A

All are increased except for 5.

37
Q

Routine liver tests alone are sufficient for diagnosis of ICP
True or False

A

False, not

38
Q

Cutaneous biopsy aids in diagnosis of ICP

True or False

A

False, does not

39
Q

Hallmark of ICP

A

Symptoms and biochemical abnormalities resolve in 2-4 weeks of delivery

40
Q

Complications in fetus of patients with ICP are correlated to

A

Higher bile acid levels
Increase placental anoxia
Increase incidence of meconium stained amniotic fluid

41
Q

Essential to the management of ICP

A

Intense fetal monitoring

42
Q

Current treatment of choice for ICP

A

Ursodeoxycholic acid 450 mg to 1200 mg

For mild cases, bland emollients and topical anti pruritic

43
Q

Most recommend early induction of labor at __ wks of gestation or earlier for patients with ICP

A

38

44
Q

Originates in flexural areas spreading centrifugally with onycholysis sparing face, palms, and soles.

A

Pustular psoriasis of pregnancy

45
Q

Life threatening maternal complications of pemphigoid gestationis may result from (2)

A

Profound hypocalcemia and bacterial sepsis

46
Q

The most feared complications of pustular psoriasis of pregnancy

A

Placental insufficiency

Stillbirth or neonatal death

47
Q

How to distinguish pustular psoriasis of pregnancy from generalized pustular psoriasis

A

Absence of positive family history
Abrupt resolution of drug delivery
Recur only during subsequent pregnancies
Factors known to trigger psoriasis are absent

48
Q

Common lab derangements include

A 
Leukocytosis
Neutrophilia
Elevated ESR
Hypoferric anemia
Hypoalbuminemia
Decreased Ca, Phosphate, Vitamin D
49
Q

Cardinal feature of pustular psoriasis of pregnancy

A

Rapid resolution of symptoms after delivery

50
Q

Recurrences of Pustular psoriasis of pregnancy are common in subsequent pregnancies and more severe with earlier onset in gestation.
True or False

A

True

51
Q

First line therapy for pustular psoriasis of pregnancy

A

Cyclosporine 5-10mkday

Infliximab TNF alpha blocking agent

52
Q

Earlies sign of fetal hypoxemia

A

Fetal decelerations

53
Q

Dermatoses not associated with fetal risk in pregnancy

A

PUPPP

Atopic eruption of pregnancy

54
Q

Common self-limited intensely pruritic dermatoses that occurs almost exclusively in primigravidas during late pregnancy

A

Polymorphic eruption of pregnancy

55
Q

Papules surrounded by pale halo coalesce to form erythematous plaques that starts within the striae gravidarum, spread to involve buttocks and thighs, sparing the umbilicus

A

Polymorphic eruption of pregnancy

56
Q

Rule for polymorphous eruption of pregnancy

A

Spontaneous remission within days of delivery

57
Q

Management of polymorphous eruption of pregnancy

A

Topical corticosteroids

Oral antihistamines

58
Q

DIF/ IDIF studies of polymorphous eruption of pregnancy

A

DIF: granular or absent C3, IgM, or IgA deposits at DEJ or around blood vessels
IDIF: negative

59
Q

Benign pruritic condition of pregnancy characterized by eczematous and/or papular eruption in individuals with a personal and/or familial atopic background and/or serum IgE levels

A

Atopic eruption of pregnancy

60
Q

Most common pruritic disorder in pregnancy

A

AEP (50%)

61
Q

Presents earlier than other pregnancy associated dermatoses

A

AEP

62
Q

Classic eczematous eruption affecting flexural surfaces and the face occurs in 2/3 of individuals

A

AEP E type

63
Q

Discrete pruritic excoriated papules with a predilection for extensor surfaces, with truncal involvement less common

A

AEP P type

64
Q

AEP, preferential expression of ___ cytokines

A

TH2

65
Q

In a mother with AEP, there will be increased risk of AD for the infant.
True or False

A

True, for mothers with known history of atopy

66
Q

Management for AEP

A

Midpotency topical corticosteroids

Antihistamines

67
Q

Helpful for truncal, follicular lesions of AEP

A

BPO

68
Q

In severe cases of AEP, ___can be used

A

UVB phototherapy

69
Q

Duration of symptoms of polymorphic eruption in pregnancy averages

A

6 weeks

70
Q

Involvement of palms. soles, or skin above the breasts is exceptional in PUPPP.
True or False

A

True

71
Q

Linea nigra is irreversible

True or False

A

False, reversible

72
Q

Physiologic hair changes (4)

A

Hirsutism

Telogen effluvium

73
Q

Treatment for PG

A

Topical steroids and/or systemic antihistamines

74
Q

___ of ICP patients may progress to jaundice, pale stools, dark urine

A

1 in 5

75
Q

PUPPP is associated with

A

Multiple gestation

76
Q

Total serum IgE is elevated in __ patients of AEP

A

20-70%

7th (23 decks)

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