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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

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A

coin shaped eczema

23
Q

eczema herpeticum

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A

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

24
Q

eczema herpeticum presentation

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A

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

25
eczema herpeticum investigation + treatment
viral swab | treatment = acyclovir oral for mild/moderate, IV in severe
26
topical steroid ladder (weakest - most potent)
``` mild = hydrocortisone 0.5% moderate = eumovate (clobetasone butyrate 0.05%) ``` potent = betnovate (betamethsone 0.1%) very potent = dermovate (clobetasol propionate 0.05%)
27
how to use topical steroids
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
side effects of topical steroids
thinning of skin - more prone to flares, brusing, tearing stretch marks telangiectasia systemic absorption - depends where used
29
what causes icthyosis vulgaris?
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
psoriasis histology
retained nuclei beehive in dermis - inflammatory infiltrates
31
psoriasis pathophysio
skin changes due to rapid generatiion of new skin cells, resulting in abnormal build up + thickening of the skin in those areas
32
psoriasis vulgaris
commonest symmetrical sharply demarcated, scaly, erythematous plaques sites - extensors, scalp, sacrum, feet, trunk, nails
33
guttate psoriasis
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
palmoplantar pustular psoriasis
pustules on sole of foot (congregation of WBC, NOT an infection) painful can be systemically unwell
35
erythrodermic psoriasis
vv widespread, rare skin comes away in large patches resulting in raw exposed areas some pustules medical emergency - patient requires admission
36
which type of psoriasis is common in kids and oftern triggered by a throat infection?
guttate | widespread, spotty
37
signs of psoriasis
koebner phenomenon = psoriasis develops in area of skin trauma auspitz sign = removal of surface scale reveals tiny bleeding
38
systemic signs of psoriasis
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
topical therapies for psoriasis
``` vit D analogues - calcipotriol dithranol coal tar topical steroids topical calcimeurin inhibitors - tacrolimus (adults ONLY) ```
40
non topical treatment for psoriasis
phototherapy - UVB combined steroid + vit D analogue - dovobet, enstilar (adults ONLY) methotrexate cyclosporine retinoids biologic medication
41
why is acne exacerbated by puberty?
androgenic hormones increase the production of sebum --> why acne improves with anti-androgenic hormonal contraception
42
pellagra presentation triad
photosensitive dermatitis diahrrohea dementia
43
cause of pellagra
niacin (B3) deficiency
44
what causes acne?
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
topical treatment for acne
benzoyl peroxide - if inflammation topical vit A derivative (retinoid) - if no inflammation + mainly commedones topical antibiotics (clindamycin, prescribed with benzoyl peroxide)
46
action of benzoyl peroxide
reduces inflammation unblocks skin toxic to bacteria
47
action of topical vit A derivative (retinoid)
slow sebum production, dry skin, requires contraception prescribe if no immflamation + mainly commedones
48
systemic treatment of acne
oral antibiotics oral contraceptive pill isoretinoin (oral retinoid, roaccutane)
49
action of oral isoretinoin
(roaccutane) reduces inflammation reduces bacterial growth
50
side effects of oral isoretinoin (roaccutane)
dry skin + lips photosensitivity depression, anxiety, agression, suicidal ideation teratogenic, must be on contraception
51
rosacea
prominent facial flushing age 30-60 association with demodex mite chronic, periods of exacerbation + remission
52
presentation of rosacea
``` 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
treatment for rosacea
1st line = topical metronidazole if ineffective - oral tetracycline invermectin - reduces demodex avoid agrravating + topical steroids telangectasia - vascular laser rhinophyma - surgery/laser therapy

dermatology (10 decks)

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