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Uworld > DERM > Flashcards

DERM Flashcards

1
Q

cleared patches on melanoma is due to?

A

cytotoxic T cell recognized tumor ag ( melan A) and induce apoptosis – melanocyte regression due to tx

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2
Q

red area of melanoma is due to?

A

vessel ectasia ( dilation) and local inflammation

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3
Q

brown or black area of melanoma is due to?

A

neoplastic melanocytes

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4
Q

what is pembrolizumab?

A

programmed cell death receptor-1 ( PD-1) inhibitor

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5
Q

how does pembrolizumab work?

A

cancer cell overexpressed PD-L1, this ligand bind to PD-1 recptor on cytotoxic T cell and suppress their ability to apoptosis.

pembrolizumab block PD-1 –> restored CD8 response –> promote tumor cell apoptosis

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6
Q

spongiosis

A

accumulation of edema fluid in the intercellular space of epidermis. found in contact dermatitis

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7
Q

acanthosis

A

thickening of stratum spinosum

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8
Q

hyperkeratosis

A

thickening of stratum corneum

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9
Q

dyskeratosis

A

premature keratinization of individual keratinocyte below stratum granulosum. found in SCC

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10
Q

hypergranulosis

A

thickening of stratum granulosum. found in lichen planus

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11
Q

ecthyma gangrenosum is associated with which microbe?

A

pseudomonase aeruginosa.

it release exotoxins, casuing vascular destruction –> infussificient blood flow to patches of skin –> edematous and necrosis

common in neutropenia, hospitalized, burn indwelling catheter pt

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12
Q

intracellular protozoa with rod-shaped kinetoplasts

A

cutaneous leishmaniasis

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13
Q

MOA of leishmania

A

bite from sandfly –> mature within host MC ( intracellular, round-oval amastigote with rod-shaped kinetoplast

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14
Q

what does terbinafine use for?

A

dermatophytosis such as toe nail infection and tinea corporis

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15
Q

MOA of terbinafine

A

block squalene epoxidase

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16
Q

what can a bluish neoplasm underneath nail bed suggest?

A
  1. glomus tumor - glomangioma

2. subungual melanoma

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17
Q

what is glomangioma?

what is glomus body

A

glomangioma is tumor of modified SM cell of a glomus body

glomus body are several small, encapsulated neurovascular organ forund in dermis of nail bed, pad of finger and toes, ear.

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18
Q

what does glomus body made up of?

A

composed of an afferent arteriole connected to a richly innervated, muscular arteriovenous anastomosis, then connect to an efferent vein . With modified SM cells arranged in layers around these vascular channel.

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19
Q

what is the function of glomus body

A

shunt blood away from skin in cold temperature.

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20
Q

mildly pruritic, polycyclic rash with a raised, scaly border and central clearing; may confluent to form “flower petal” shape. What is the cause?

A

trichophyton rubrum – tinea corporis

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21
Q

where does dermatophyte infect?

A

infect keratinized matter in stratum corneum. Does not invade dermis

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22
Q

what cause photoaging?

A

UVA. penetrate into skin and produce ROS –> activate multiple inflammatory cell-surface receptor and nuclear transcription factos –> decrease collagen fibril production + increase matrix metalloproteinase –>degrade type I and III collagen and elastin

23
Q

what can cause varicose vein?

A
  1. obstruction of venous return – pregnancy, obesity
  2. increased orthostatic pressure – prolonged standing
  3. decreased muscular compression – sedentary lifestyle
  4. damaged venous valves - DVT
24
Q

what is stasis dermatitis

A

red, indurated, fibrotic and deposition of hemosiderin ( from break down of extravasated RBC) –> redddish-brown discoloration

25
Q

what is the complication of chronic venous insufficiency

A

extravasation of fluid, plasma protein, RBC –> chronic inflammation and stasis dermatitis

poor wound healing, weeping, ulceration

26
Q

what is pellagra? and what is the cause?

A

dermatitis - rough, thick, scaly skin diarrhea - due to atrophy of columnar epithelium of GI, dementia - neuronal degeneration in brain and spinal cord ( similar to pernicious anemia).

Caused by niacin deficiency

27
Q

what is niacin?

A

vit B3.

coenzyme for NAD and NADP.

28
Q

where is the source of niacin?

A

dietary intake

endogenously synthesis from tryptophan

29
Q

where can pellagra be seen?

A

alcoholism, chronic illness, carcinoid syndrome, prolonged isoniazid therapy, Hartnup disease

30
Q

what is anabolic steroid ?

A

androgen.

ex. methyltestosterone use in athlete

31
Q

what is the role of androgen in acne?

A

promote follicular epidermal hypreprolifeartion and excessive sebum production

32
Q

what is leprosy

A

deforming infection primarily of skin and nerve. caused by mycobarterium leprae

33
Q

how dose mycobaterium leprae transmit?

A

unhygienic condition through respiratory infection or skin-to-skin contact.

34
Q

what are the two types of leprosy?

A
  1. tuberculoid leprosy – self limited. Th1 mediated

2. lepromatous leprosy – severe form. Th2 mediated

35
Q

what is xeroderma pigmentosum?

A

Autosomal recessive with nucleotide excision repair defect. Cannot fix thymine dimer due to lack of endonuclease

36
Q

what are the sx of xeroderma pigmentosum?

A

severe photosensitivity, hyperpigmentation in sun-exposed area. risk for skin cancer.

37
Q

what type of inheritance pattern is demonstrated by androgenetic alopecia?

A

polygenic inheritance.

Short arm of chromosome 20, also on X and Y chromosone. Can be X-linked recessive or autosomal dominant

38
Q

what caused nonpurulent cellulitis

A

beta-hemolytic streptococci. mostly group A.

warmth, edema, erythema with no fluctuant nodules

39
Q

what causes purulent cellulitis

A

S. aureus.

painful, fluctuant nodule in dermis/subcutaneous with or without erythema

40
Q

what does pseudomonas aeruginosa causes?

A

hot tub folliculitis

hot tub, pool water.

pruritic, papulopustular rash.

gram - rod, oxidase +, produce green pigment during culture ( pyocyanin)

41
Q

what is acne vulgaris?

A

pilosebaceous follicle disorder. hyperkeratinization and obstruction of the follicle with glandular enlargement and increased sebum production –> p. acnes growth.

androgen - stimulate sebum production

mechanical irritation - promote acne by increasing glandular occlusion and disruption of follicles.

sport participation – tight-fitting clothing

42
Q

what is the effect of oral contraceptive to acne?

A

reduce acne due to decrease synthesis of androgen

43
Q

why does isocitrate DH activity decreased due to niacin deficiency?

A

niacin is needed for NAD and NADP.

NAD involved in catabolic reaction (citric acid cycle) and cell signaling and DNA repair
- NAD is cofactor for isocitrate DH, a-ketoglutarate DH and malate DH

NADP needed for anabolic reaction –> FA and cholesterol synthesis

44
Q

how does hookworm infect people?

A

walking barefoot on a beach.

Egg- containing feces deposited into shady, warm, moist sand or soil –> egg hatch into larvae –> direct contact with human skin –> penetrate BM –> dermis –> blood–> rupture into alveoli –> cough up –> swallowed into small intestine –> mature into adult hookworm –> feed on blood from duodenal mucosa –> iron deficiency anemia

45
Q

what are some human hookworms?

A

necator americanus, A duodenale

46
Q

how does bullous impetigo present?

A

blistering skin rash with honey-colored crust.

47
Q

what caused bullous impetigo?

A

s. aureus in young children - exofoliactive toxin A (serine protease) –> target desmoglein 1

nonbullous impetigo – pustules and crusting, no blistering

48
Q

what is vitiligo?

A

partial or complete loss of melanocyte.

49
Q

how dose vitiligo present?

A

flat, well-circumscribed macule and patches

50
Q

what causes vitiligo and what does it associate with?

A

autoimmune. associated with other autoimmune disease: DM1, pernicious anemia, addison, autoimmune hepatitis, Grave’s disease, autoimmune thyroiditis

51
Q

what causes IgE-independent mast cell activation?

A

medication - opioid, radiocontrast, vancomycin.

activation of protein kinase A and PI3 kinase –> release histamine, bradykinin, heparin

52
Q

what is Ehlers-Danlos syndrome

A

inherited defective collagen synthesis. Deficiency in procollagen peptidase –> cannot cleave terminal propeptide from procollagen –> formation of soluble collagen , cannot crosslink –> joint laxity, fragile tissue with easy bruising and poor wound healing

53
Q

what are the sx of Ehlers-Danlos syndrome

A

hypermobile joint, over-elastic skin, fragile tissue, easy bruising, wounding, hemarthrosis

54
Q

xanthelasma

A

cutaneous lesion found on eyelid. Contain lipid-laden MC ( foam cell)

Associated with hyperlipidemia – due to obstructive biliary lesion and primary biliary cirrhosis

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