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Derm Flashcards

1
Q

What does the keratin layer consist of

A

keratinocytes -> corneocytes which are then shed off

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2
Q

what is included in the keratin layer include

A

involucrin, filaggrin, keratin

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3
Q

filaggrin is what

A

skin barrier gene - filament aggregating protein

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4
Q

what do keratinocytes do

A

sense pathogens and mediate immune system

produce AMPs, cytokines, chemokines

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5
Q

T cells in epidermis T cells in dermis

A 
CD8 in epidermis 
CD4 and CD8 in dermis 
CD4 - Th1 - psoriasis 
Th2 - atopic dermis 
Th17 - psoriasis, atopic derm
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6
Q

two types of dendritic cells

A 
dendritic DCs - AG presentation and secrete chemo and cytokines
plasmacytoid DC (pDC) releases IFM gamma and is found in diseased skin
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7
Q 
chromosome 6 class 1
chromosome 6 class 2
A 
class 1 - present on all cells, presents to CD8 cells, endogenous AG
Class 2 - present on only APCs, presents to D4 cells, exogenous AG
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8
Q

immunologically mediated drug reactions - allergic or non allergic - dose dependant or not?
non immunologically mediated drug reactions - allergic or non allergic - dose dependant or not?

A

allergic. not dose dependant

non allergic, can be dose dependent

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9
Q

types(4) of allergic drug reactions

A

type 1 - direct - urticaria
type 2 - cytotoxic - phemphigoid/phemphigous
type 3 - immune complex mediated - purpura/rash
type 4 - T cell mediated

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10
Q

AGEP
SJS
TEN
DRESS

A

acute generalised exanthematous pustules - rare
steven johnson syndrome - minor form of toxic epidermal necrolysis
TEN - >30% of epidermal detachment
DRESS - drug reaction with eosinophilia and systemic symptoms

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11
Q

clingfilm helps what

A

topical drug absorption

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12
Q

investigation for PCT

A

woods lamp

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13
Q

drug causes of bullous pemphigoid

A

furosemide, ACEI, penicillin

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14
Q

linear IgA disease drug cause

A

vancomycin

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15
Q

fixed drug eruption causes

A

tetracycline, doxycycline, paracetamol, NSAIDs, carbamazapene

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16
Q

causes of itch

A

pruriceptive - something on skin - asthma
neuropathic - damage to CNS fibres - shingles
neurogenic - no damage to CNS fibres but affect on them - thyroid disease, bile duct disease, liver disease
psychogenic

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17
Q

Type 1 allergy - how can you catch it
stages
investigation

A

skin contact, injection, ingestion, inhalation
urticaria, angiooedema, asthma/wheezing, anaphylaxis
skin prick if negative - challenge test

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18
Q

Type 4 allergy - how

ix

A

airborne, skin contact, injection

patch testing - 48 hours then check after 96 hours

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19
Q

psoriasis phototherapy treatment

A

narrowband UVB and PUVA

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20
Q

what do retinoids do

A

decrease skin turnover

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21
Q

open comedones

closed comedones

A

open - blackheads

closed - whiteheads

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22
Q

demadox mite

A

rosacea

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23
Q

pompholyx eczema

A

spongiotic vesicles

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24
Q

Tuberose sclerosis - autosomal what

symptoms/signs

A

dominant
infantile seizures, ash leaf macule, depigmented macule, preiungual fibromas, facial angiofibromas, haemartomas, bone cysts, shagreen patches, enamel pitting

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25
Epidermolysis bullosa types
simplex - epidermis junctional dystrophic - dermis
26
cafe au lait macules
asymp coffee colours flat macule 1-2 are normal >5 - NF?
27
NF1
cafe au lait, neurofibromas (soft neural tumours), plexiform neuroma, axillary or inguinal freckling, 2 or more lisch nodules, bony lesions
28
what do you need derm protection for
group a strep MRSA scabies
29
what is acicilovir an analogue of
guanine
30
what is the melanocyte: basal keratinocyte ratio
1:5 - 1:10
31
breslow - how is it measured | melanoma - 5 year survival
from granular layer to deepest point of invasion
32
different skin types
``` type 1 always burns, never tans 2 usually burns, can tans 3 can burn, usually tans 4 never burns, always tans 5 brown 6 black ```
33
what does a childhood skin burn lead to
a 4x increased likelyhoood of melanoma
34
what are the three genetic conditions that lead to an increase risk for skin cancer
xeroderma pigmentosum albinism nevoid basal cell carcinoma (gorlins syndrome)
35
what is xeroderma pigmentosum median age onset defect in what
photosensitivity, skin cancer on UV exposed sites 8 one of 7 nucleotides neurological degeneration
36
what autosomal is gorlins syndrome
dominant
37
what UV is more damaging than the other
UVC most UVB UVA least damaging
38
what type of melanin is better at absorbing UV light
eumelanin is better than phaemelanin
39
layers of SCALP
``` skin connective tissue aponeurosis loose connective tissue periosteum ```
40
Functions of the skin
thermoregulation, immune, UV protection, endocrine function (UV -> vit D), sensory, barrier, fluid and electrolyte balance
41
what kind of epithelium does skin have
stratified keratinising squamous epithelium
42
what type of collagen is in the dermis | what are the 2 layers of the dermis
type 1 and 2 papillary - thin and beneath epidermis reticular - thicker bundles of type 1 collagen - contained appendages
43
inflame skin diseases (4)
spongiotic - intraepidermal oedema - eczema psoriaform - elongation of rate ridges - psoriasis lichenoid - basal layer damage - lichen planus vesicolubullous - blistering - pemphigoid
44
immunflurescnce of bullous pemphigoid shows what
linear IgA
45
what AB is in derm herpeitform and what HLA
IgA AB target is gliadin | HLA DQ2 haplotype
46
dome shaped vascular papule
spitz naeuvus
47
``` phytotoxic drug reactions: amiodarone thiazides CCBs psoralen and UV halo dixic acid ```
immediate prickling with delayed erythema exaggerated sunburn exposed telengectasia delayed (3-5days) erythema and pigmentation increased skin fragility
48
What happens in UV induced immunosuppression
dendritic cells lose the ability to present antigens | T cells switch from helper to suppressor
49
what antibodies does pemphigoid and phemphigois have
goid hemidesmosome ABs | gous desmoglein 3 (more serious)
50
HSV 16+18 6+11 1-4
cervical cancer genital warts warts/verucas
51
gardisil vaccination | cervarix vaccination
16, 18, 6 +11 | only 16 +18 - only cervical cancer
52
what is arthus reaction
skin testing testing in type 3 hypersensitivity | slower than type 1 but faster than type 4
53
what are gene changed in tuberose sclerosis and what inhibitor partially corrects it
TSC1 or TSC2 | MTOR inhibitors
54
what is NF1 responsible for
switching off cell cycle
55
what are auispitz signs
in psoriasis | bleeding sports where psoriatic scales have been scraped off
56
what is the signature DNA mutation in UV light
pyrimidine dimer mutation
57
list the precursors of SSC | and the treatment
bowens actinic keratosis viral - HPV cryotherapy, sola raze, 5 FV, imiquiomod, resurfacing
58
Treatment for SCC and BCC
surgery | 5% imiquimod cream
59
ulcer that has a shallow edge and is around the malleolus high cliff like edges and that is punched out and is on pressure points
venous arterial
60
non adherent dressing for venus ulcers
absorption - hydrocollides | anti bacterial - silver nitrate/manuka honey
61
where is latina melanoma derived from and where does it occur
lentigo maligna | chronically sun damaged skin
62
pigmented lesions on an elderly persons palms/soles/nails | pigment extends into his nails
acralantigous melanoma
63
what does an amelanotic melanoma look like
decreased or no pigment
64
what may lead to a dermatofibroma and what do they look like
insect bites | firm, increased pigment around rim, deep (dermal), brown/grey
65
why do naevi happen
due to melanocytes that have failed to migrate or unigrate in utero
66
peripheral halo of depigmentation and overrun by lymphocytes
halo naevi
67
dermal naevi. blue
blue naevus
68
large spindle and or epithelial cells
spitz naevus
69
plaque - stuck on appearance - greasy - brown/black - on trunk what is it and the cause
seborreohiec keratosis | bengin proliferation of epidermal keratinocytes
70
bulli that burst to form erosions | bulli that burst to form raw marks
pemphigoid | pemphigus
71
bulli either in one area or widespread over his trunk and prox limbs bulli on scalp, axilla and groin bulli on elbows and knees symmetrical and they itch
pemphigoid pemphigus dermatitis herpetiformis
72
itchy rash in fingerwebs, wrists and genital area
scabies
73
thick crusted skin in elderly or immunocompromised
Norwegian scabies
74
red moist skin with ragged peeling edge and papule/pustules/erythema on the edges
candida
75
where does candida intertigro occur
in skin folds where area is warm and moist
76
bulls eye target lesions
erythema multiforme
77
child | fresh firm umbiilcated nod that is 1-2 mm in dm
mallocusum contagious can be sexually transmitted self limiting liquid nitrogen
78
blistering rash at the back of the mouth
herpengioma enterocci swab. stool sample self limiting
79
what is hand foot and mouth disease caused by
enterovirus
80
``` primary syphilis secondary tertiary ix rx ```
``` painless ulcer rash all over body - snail track ulcers CNS, CVS etc. blood test, swab of ulcer injections of penicillin ```

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