conditions Flashcards

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1
Q

from which cells do malignant melanomas of skin arise from?

A

melanocytes in the basal layer of the epidermis

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2
Q

what does Breslow thickness refer to?

A

the distance between the granular layer + deepest tumour cell

–> thickness is linked to prognosis

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3
Q

what enzyme is deficient in erythropoietic protoporphyria?

A

ferrochelatase

build up of protoporphyrin IX due to lack of ferrochelatase

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4
Q
where are the following dermatophyte infections - 
tinea unguium
* capitis
* corporis
* pedis
* manuum
* cruris
* barbae
A
unguium = nails
capitis = scalp
corporis = body
pedis = foot
manuum = hand
cruris = groin
barbae = beard
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5
Q

ringworm investigation

A

skin scraping for microscopy and culture + woodslight

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6
Q

impetigo investigation

A

swab of lesion sent in bacterial container for microscopy + culture

*contagious

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7
Q

shingles investigation

A

swab of lesion fluid sent in viral container for PCR

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8
Q

scabies investigation

A

skin scrapings for microscopy

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9
Q

inheritance in tuberous sclerosis

A

autosomal dominant

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10
Q

strain of HPV most common in warts/verrucas

A

types 1-4

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11
Q

first line treatment of rosacea

A

topical metronidazole

-> if ineffective - oral tetracycline

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12
Q

chemo and radiotherapy is the most effective way to treat malignant melanoma - T or F?

A

FALSE !!
most effective is early radical surgery

-> Due to their embryological origins and the high amount of melanin within them, malignant melanomas do not respond well to chemotherapy or radiotherapy even when used in combination.

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13
Q

eczema/dermatitis pathophysio

A

atopic condition caused by defects in the normal continuity if the skin barrier leading to inflammation

–> tiny gaps provide entrance for irritants, microbes + allergens - creates immune respone causing inflammation etc

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14
Q

mutation in what provides a genetic predisposition to eczema/dermatitis?

A

filaggrin production

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15
Q

eczema presentation

A

dry, red, itchy, sore
flexor surfaces - insides of elbows, knees
face + neck
flares

might resolve on holiday - warm/sun improves, away from work irritant

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16
Q

treatment of eczema/dermatitis

A

emollients + avoid irritants

topical steroids
topical tacrolimus
zinc impregnated bandages
phototherapy - UVB
systemic immunosuppressants
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17
Q

histology of atopic eczema

A

spongiotic dermatitis

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18
Q

pathogenesis of contact allergic eczema

A

type IV (delayed) hypersensitivity

langerhans process antigen + presents to Th cells in dermis
–> sensitised Th cells go to nodes via lymphatics + amplifies

next time, specifically sensitised T cells proliferate, migrate + infiltrate skin

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19
Q

seborrheic dermatitis, Mx?

A

scalp, nasolabial folds, eyebrows
(dry flaky scalp in babies = cradle cap)

treatment = baby oil, white petroleum jelly
- anti-fungal cream - clotrimazole, miconazole

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20
Q

examples of anti-fungal cream

A

clotrimazole

miconazole

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21
Q

photosensitive dermatitis

A

reaction to UV light, characteristic cut off at collar

histology = spongiotic dermatitis

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22
Q

discoid eczema

A

coin shaped eczema

23
Q

eczema herpeticum

A

eczema infested with herpes simplex virus (HSV) or varicella zoster zirus (VZV)

24
Q

eczema herpeticum presentation

A

widespread, painful, vesicular rash
systemic - fever, lethargy, irrritability
reduced oral intake
lymphadenopathy

25
Q

eczema herpeticum investigation + treatment

A

viral swab

treatment = acyclovir
oral for mild/moderate, IV in severe

26
Q

topical steroid ladder (weakest - most potent)

A
mild = hydrocortisone 0.5%
moderate = eumovate (clobetasone butyrate 0.05%)

potent = betnovate (betamethsone 0.1%)
very potent = dermovate (clobetasol propionate 0.05%)

27
Q

how to use topical steroids

A

good at settling immune activity - reducing inflammation

weakest steroid for the shortest period required to get under control
thicker skin, stronger steroid required

weakest steroids ONLY for face - NOT in kids

28
Q

side effects of topical steroids

A

thinning of skin - more prone to flares, brusing, tearing
stretch marks
telangiectasia
systemic absorption - depends where used

29
Q

what causes icthyosis vulgaris?

A

loss of function mutation in filaggrin protein gene
(filaggrin is required for binding of keratin fibres in epidermal cells to form an effective skin barrier)

xerosis/dryness results from reduced skin hydration associated with defective filaggrin
excessive scale results from inability of squames to remain hydrated as they move upward to stratum corneum

30
Q

psoriasis histology

A

retained nuclei

beehive in dermis - inflammatory infiltrates

31
Q

psoriasis pathophysio

A

skin changes due to rapid generatiion of new skin cells, resulting in abnormal build up + thickening of the skin in those areas

32
Q

psoriasis vulgaris

A

commonest
symmetrical
sharply demarcated, scaly, erythematous plaques

sites - extensors, scalp, sacrum, feet, trunk, nails

33
Q

guttate psoriasis

A

common in kids
often triggered by streptococcal throat infection, stress or medication

spotty + widespread
small raised pupules - erythematous + scaly
trunk + limbs

acute - resolves within 3-4months

34
Q

palmoplantar pustular psoriasis

A

pustules on sole of foot (congregation of WBC, NOT an infection)
painful
can be systemically unwell

35
Q

erythrodermic psoriasis

A

vv widespread, rare
skin comes away in large patches resulting in raw exposed areas
some pustules

medical emergency - patient requires admission

36
Q

which type of psoriasis is common in kids and oftern triggered by a throat infection?

A

guttate

widespread, spotty

37
Q

signs of psoriasis

A

koebner phenomenon = psoriasis develops in area of skin trauma

auspitz sign = removal of surface scale reveals tiny bleeding

38
Q

systemic signs of psoriasis

A

nail changes

  • onycholysis = extra white bit
  • nail pitting
  • subungual hypokeratosis = calcification between nail bed + top of nail

psoriatic arthritis

co-morbidities = obesity, hyperlipidaemia, hypertension, T2DM

39
Q

topical therapies for psoriasis

A
vit D analogues - calcipotriol
dithranol
coal tar
topical steroids
topical calcimeurin inhibitors - tacrolimus (adults ONLY)
40
Q

non topical treatment for psoriasis

A

phototherapy - UVB
combined steroid + vit D analogue - dovobet, enstilar (adults ONLY)

methotrexate
cyclosporine
retinoids
biologic medication

41
Q

why is acne exacerbated by puberty?

A

androgenic hormones increase the production of sebum

–> why acne improves with anti-androgenic hormonal contraception

42
Q

pellagra presentation triad

A

photosensitive dermatitis
diahrrohea
dementia

43
Q

cause of pellagra

A

niacin (B3) deficiency

44
Q

what causes acne?

A

increased production of sebum, trapping keratin (dead skin cells) + blocking the pilosebaceous unit

leads to swelling + inflammation in the pilosebaceous unit

  1. increased androgens at puberty
  2. keratin plugging of pilsebaceous units
  3. infection with anaerobic bacterium
45
Q

topical treatment for acne

A

benzoyl peroxide - if inflammation
topical vit A derivative (retinoid) - if no inflammation + mainly commedones

topical antibiotics (clindamycin, prescribed with benzoyl peroxide)

46
Q

action of benzoyl peroxide

A

reduces inflammation
unblocks skin
toxic to bacteria

47
Q

action of topical vit A derivative (retinoid)

A

slow sebum production, dry skin, requires contraception

prescribe if no immflamation + mainly commedones

48
Q

systemic treatment of acne

A

oral antibiotics
oral contraceptive pill
isoretinoin (oral retinoid, roaccutane)

49
Q

action of oral isoretinoin

A

(roaccutane)

reduces inflammation
reduces bacterial growth

50
Q

side effects of oral isoretinoin (roaccutane)

A

dry skin + lips
photosensitivity
depression, anxiety, agression, suicidal ideation

teratogenic, must be on contraception

51
Q

rosacea

A

prominent facial flushing
age 30-60
association with demodex mite
chronic, periods of exacerbation + remission

52
Q

presentation of rosacea

A
nose, chin, cheeks + forehead
flushing 
enlarged/unshapely nose = rhinophyma
telangiectasia 
papules, pustules
gritty eyes, conjuctivitis
facial oedema

exacerbated by - sudden changes in temp, alcohol, sun exposure, spicy food

53
Q

treatment for rosacea

A

1st line = topical metronidazole
if ineffective - oral tetracycline

invermectin - reduces demodex
avoid agrravating + topical steroids

telangectasia - vascular laser
rhinophyma - surgery/laser therapy