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Disease and Defense III > Derm Review > Flashcards

Derm Review Flashcards

1
Q

Never tans, always burn

A

I

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2
Q

Very easy to tan, very rarely burn

A

V

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3
Q

Average tanning, sometimes burns

A

III

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4
Q

Easily tans, rarely burns

A

IV

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5
Q

Tans with difficulty, usually burns

A

II

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6
Q

Never burns

A

VI

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7
Q

Acquired autoimmune disorder against melanocyte

A

vitiligo

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8
Q

Microscopic finding in vitiligo

A

complete absence of melanocyte

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9
Q

Vitiligo common location

A

periorificial

acral

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10
Q

Recessive dystrophic epidermolysis bullosa = genetic defect in

A

collage VII

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11
Q

Recessive dystrophic EB

clinical?

A

extensive dystrophic scarring can produce pseudosyndactyly

flexion contractures

Increased risk of SCC

Infection complications

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12
Q

Anitbodies to BP230 or BP180 in hemidesmosomes cause?

A

bullous pemphigoid

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13
Q

autoantibodies to desmoglein 1 and 3 cause?

A

pemphigus vulgaris

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14
Q

primary skin lesion in pemphigus vulgaris

A

flaccid bulla

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15
Q

pathology of pemphigus vulgaris?

A

intraepidermal blisters

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16
Q

Epidermolysis bullosa simplex = genetic defect in?

A

genetic defects in keratin 5 and 14

lacking proteins within desmosomes

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17
Q

EB simplex

- clinical

A

generalized onset of blisters occuring shortly after birth

hands, feet, and extremities are the most common involvement

improves with age

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18
Q

icthyosis vulgaris / atopic dermatitis are caused by?

A

defective skin barrier function due to loss-of function filaggrin mutations

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19
Q

what happens when patients have mutated filaggrin?

A

they have significantly redcued levels of NMF in (natural moisturizing factor) in the SC and exhibit increased transepidermal water loss

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20
Q

Papillary dermis

  • composition
  • interlocks with
  • function (2)
A 
upper layer
thin collagen bundles
interlocks with epidermal rete
increases strength
increases surface area
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21
Q

Reticular dermis

- composition

A

Reticular dermis
deeper layer
thick collagen bundles
visible elastic fibers

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22
Q

Major consituents of dermis (3)

A

collagen - tensile
elastin - resilience
ground substance - diffusion

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23
Q

acquired disorder of elastin

A

solar elastosis

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24
Q

congenital disorder of elastin

A

pseudoxanthoma elasticum

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25
Q

acquired blistering disorder of DEJ

A

Bullous pemphigoid

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26
Q

congenital blistering disorder of DEJ

A

Epidermolysis bullosa

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27
Q

Proximal sunungual white onychomycosis associated with?

due to?

A

HIV

Trichophyton rubrum

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28
Q

Growing hair?

A

anagen

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29
Q

Involuting hair?

A

catagen

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30
Q

Resting hair?

A

telogen

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31
Q

Anagen effluvium =

A

Loss of growing hairs - often due to chemo

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32
Q

Telogen effluvium =

A

Hairs go into resing cycle

- may be due to medication / post partum

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33
Q

Dermititis synonym =

A

eczema

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34
Q

Seborrheic dermatitis = in bambinos

A

cradle cap

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35
Q

Irritant dermititis synonym

A

intertrigo

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36
Q

when you see reddening / dermatitis in the extensor area think of a defect in ?

A

filaggrin

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37
Q

Lower extremity edema = associated with

A

stasis dermatitis

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38
Q

Malassezia furfur = associated with

A

seborrheic dermatitis

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39
Q

defective filaggrin = associated with

A

atopic dermatitis

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40
Q

common irritants = associated with

A

irritant dermatitis

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41
Q

common allergens = associated wtih

A

allergic contact dermatitis

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42
Q

_____________appears as red, inflamed skin covered by greasy or dry scales that may be white, yellowish, or gray. It can effect the scalp, eyebrows, forehead, face, folds around the nose and ears, the chest, armpits (axilla), and groin. Dandruff and cradle cap are mild forms and appear as fine white scales without inflammation.

A

Seborrheic dermatitis

43
Q

__________ frequently affects the flexural areas? - e.g. elbows

44
Q

rash consequence of new fragrance likely dx?

A

allergic contact dermatitis

45
Q

Type I immune reactions

A

Immediate hypersensitivity (anaphylactic - IgE mediated)

46
Q

Pathophysiology of Type I immune reactions

A

Plasma cells produce IgE ab specific to antigen

IgE bind mast cells causing degranulation and release of histamine, which causes vasodilation and smooth muscle contriction (bronchospasm)

47
Q

Example (derm) of Type I

A

Urticaria

angioedema

48
Q

Type II immune reactions -

A

Cytotoxic reactions

49
Q

Type II immune reactions - pathophysiology

A

IgG binds antigenic cell and lysis cell

Involved activation of complement

50
Q

Examples of Type II immune reactions

A

Transfusion reactions due to incompatible blood type

51
Q

Type III immune reaction

A

Immune complex
Involves reactions to circulating antigens

Antibodies bind antigen and form immune complexes which deposit in organs

These immune complexes activate complement and cause damage due to inflammatory cascade

52
Q

Type III example?

A

serum sickness

53
Q

Type IV immune reaction?

A

delayed hypersensitivity

54
Q

Type IV immune reaction - pathophysiology

A

langerhaans cells are the antigen presenting cell

memory T cells then become sensitized to locally deposited antigen

local reaction occurs and this does not involve antibodies

55
Q

Derm example of type IV

A

Morbiliform drug eruption

allergic contact dermatitis

56
Q

____________ cells produce interferon gamma, IL-2, TNF-beta, and evoke cell mediated immunity and phagocyte dependent inflammation

57
Q

_________ cells produce IL4, 5, 6, 9, 10, and 13 and evoke strong Ab responses (IgE) with eosinophil accumulation

58
Q

Atopic dermatitis is associated wtih?

A

asthma and allergic rhinitis

59
Q

Allergic contact dermatitis is an example of which type of reaction?

A

Delayed hypersensitivity (type IV)

60
Q

Allergic contact dermatitis confirmed with?

A

patch testing

61
Q

___________ may be associated wtih increased risk of CV disease

62
Q

stasis dermatitis location

A

lower legs

63
Q

seborrheic dermatitis location

64
Q

atopic dermatitis location

A

flexor surfaces

65
Q

psoriasis location

A

extensor surfaces

66
Q

When you see hypo/hyper pigmented patches with spaghetti and meatball culture - think?

A

tinea veriscolor

67
Q

Barnacles of life =

A

seborrheic keratosis

68
Q 
color white to gray to tan to balck 
exophytic papule - stuck on appearance 
smooth to verrucous 
often friable
surface often studded with small pits
A

Seborrheic keratosis

primary lesion

69
Q

Skin defenses against UV? (4)

A

DNA Repair

  • Apoptosis of Cells with DNA Damage
  • Defenses Against Reactive Oxygen
  • Melanin
70
Q

Biggest risk factor for melanoma?

A

FAMMM syndrome

71
Q
  • Damage to DNA, RNA, lipids, proteins
  • Pro-inflammatory effects
  • Immunosuppressive effects
  • Induction of innate defenses
  • Induction of apoptosis
  • Vitamin D synthesis
A

UVR effects on skin

72
Q

What are photodermatoses?

A

Connective tissue disease

73
Q

Photodermatoses associated conditions

A

SLE
Dermatomyositis
Mixed Connective Tissue Disase = Sharp’s syndrome

74
Q

Photodistributed, violaceous poikiloderma
Favors scalp, periocular and extensor skin sites
Heliotrope = Eruption on the upper eyelids +/- periorbital edema

What are you thinking

A

Dermatomyositis

75
Q

Samitz sign = ragged cuticles

what are you thinking

A

Dermatomyositis

76
Q

Gottron’s papules =

A

lichenoid papules overlying knuckles, elbows, knees

77
Q

Gottron’s papules - what are you thinking

A

dermatomyositis

78
Q

Gottron’s sign =

A

poikiloderma over the knuckles, elbows, knees

79
Q

Gottron’s sign - what are you thinking ?

A

Dermatomyositis

80
Q

Shawl sign =

A

poikiloderma across the back and shoulders

sign of dermatomyositis

81
Q

What do we worry about when we see dermatomyositis?

A

internal malignancy
about 10%-50%
varies

82
Q

do we worry about malignancy in juvenile dermatomyositis?

83
Q

average age for adults to develop dermatomyositis?

84
Q

average age for children to develop dermatomyositis?

85
Q

sex ratio

adult dermatomyositis?

86
Q

sex ratio

child dermatomyositis?

87
Q

Dermatomyositis

Age appropriate malignancy screen including:

A

mammogram, CXR, colonoscopy, PAP smear, PSA, CBC

repeat screen every 6-12 months for at least the first 2 years

88
Q

Dermatomyositis

does risk of malignancy increase or decrease with time?

A

declines after first 2 years and reaches baseline at 5

89
Q

Neurofibromatosis Type I

Dx requires?

A

Diagnosis requires 2 or more of the following criteria

Six or more café au lait macules more than 1.5 cm in diameter (more than 0.5 cm diameter in children)

Two or more neurofibromas, or 1 plexiform neurofibroma

Axillary or inguinal freckling (Crowe’s sign)

Optic glioma

Two or more Lisch nodules

Distinctive osseous lesion, such as sphenoid wing dysplasia or thinning of the long bone cortex

A first degree relative (parent, sibling or child) with the disorder

90
Q

Adenoma sebaceum

A

angiofibromas that begin in childhood (generally present between 2–5 years of age) and appear clinically as red papules on the face especially on the nasolabial folds, cheek and chin[1]:195 mostly thought to be acne not responding to treatment. Adenoma sebaceum may at times be associated with tuberous sclerosis

91
Q

Hypomelanotic macules and Shagreen patches are associated with?

A

Tuberous sclerosis

92
Q

Shagreen patch?

A

Flesh coloured orange-peel connective tissue naevi of varying sizes, usually on the lower back

93
Q

What do you not do with pyoderma gangranosum?

94
Q

How should you treat pyoderma gangrenosum

A

conservative wound care

oral and topical anti-inflammatory agents such as steroids

95
Q

a rare condition that causes large, painful sores (ulcers) to develop on your skin, most often on your legs.

No one knows exactly what causes _ but it appears to be a disorder of the immune system. People who have certain underlying conditions, such as inflammatory bowel disease or rheumatoid arthritis, are at higher risk of __

The ulcers of __ can develop quickly. They usually clear up with treatment, but scarring and recurrences are common.

A

pyoderma grangranosum

96
Q

Pyoderma gangranosum associated conditions

A

IBD (20-30%)
Arthritis (seronegative)(RA) (20%)
Monoclonal gammopathy IgA 15%
Other hematologic disorders

97
Q

Purple, polygonal, pruritic papules

Wickham’s striae: an overlying lace-like pattern of white lines on the surface

A

Lichen Planus

98
Q

Lichen planus is associated wtih

A

hepatitis C

2-13.5 x higher in patients with LP than controls

99
Q

Velvety hyperpigmentation of the intertriginous surfaces and, less often, the extensor surfaces
The areas most often affected are the neck, axillae, and dorsal hands
Due to factors stimulating epidermal keratinocyte and dermal fibroblast proliferation

A

Acanthosis nigricans

100
Q 
Associations 
Familial:  AD, rare, onset in childhood
Obesity
Diabetes mellitus:  Insulin Resistance
Endocrinopathies
Hyperandrogenemia, Cushing’s syndrome, polycystic ovary syndrome, total lipodystrophy
Drugs (rare)
Nicotinic acid, systemic steroids
A

Acanthosis nigricans

101
Q

malignancy associations
May precede (18%), accompany (60%) or follow (22%) the onset of internal cancer
Malignancies include adenocarcinoma of the stomach (60%), lung and breast cancer, and less often other types of cancer
Rapid onset An associated with weight loss

A

Acanthosis nigricans

102
Q

Acanthosis nigricans treatment

A

underlying disorder

keratolytics such as ammonium lactate or urea cream

103
Q

To lubricate how often must creams be applied vs ointment

A

creams every 2 hours

ointments every 12 hours

104
Q

drawback of creams with irritation?

A

many required preservative which can cause irritation or allergy

Disease and Defense III (11 decks)

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