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CK IM > Derma > Flashcards

Derma Flashcards

1
Q

_____ is an autoimmune disease of unclear etiology in which the body essentially becomes allergic to its own skin

A

Pemphigus vulgaris

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2
Q

Pathology of Pemphigus vulgaris

A

Antibodies are produced against antigens in the intercellular spaces of the epidermal cells. They attack the “glue” that holds the epidermal
cells together

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3
Q

Pemphigus vulgaris is most often idiopathic, but _____

can occasionally cause

A

ACE inhibitors or penicillamine

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4
Q

____occurs in patients age 30s and 40s, whereas ____

occurs in those age 70s and 80s.

A

pemphigoid Vulgaris

bullous pemphigoid

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5
Q

Which is more serious?

pemphigoid Vulgaris

bullous pemphigoid

A

Pemphigus vulgaris is a much more serious and potentially life-threatening disease than pemphigoid

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6
Q

The presence of the _____ (the easy removal of skin by just a little pressure from the examiner’s finger, pulling the skin off like a sheet) is seen in pemphigus vulgaris,
staphylococcal scalded skin syndrome, and toxic epidermal necrolysis

A

Nikolsky sign

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7
Q

The lesions of ____ are painful, not pruritic.

A

pemphigus vulgaris

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8
Q

pemphigus vulgaris

The most accurate diagnostic test is to biopsy the skin and to use immunofluorescent stains. These stains will detect _____

A

intercellular deposits of IgG and C3 in the epidermis

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9
Q

Tx of pemphigus vulgaris

A

Treatment is with systemic glucocorticoids, such as prednisone. Topical steroids will not be sufficiently strong

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10
Q

Tx of PV

For those in whom steroids are ineffective or not tolerated, you can use

A

azathioprine, mycophenolate, or cyclophosphamide.

Rituximab and IVIG are also effective.

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11
Q

_____2× as common as pemphigus vulgaris and occurs in elderly persons age 70s and 80s. It can also be drug induced with sulfa drugs, including furosemide, penicillamine, and others.

A

Bullous Pemphigoid

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12
Q

Pathology of Bullous Pemphigoid

A

The defect occurs at the dermo-epidermal junction, so the layer of skin that separates off is much thicker

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13
Q

DX of Bullous Pemphigoid

A

The most accurate diagnostic test is a biopsy with immunofluorescent antibodies at the dermo-epidermal junction (basement membrane).

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14
Q

TX of Bullous Pemphigoid

A

Systemic steroids, such as prednisone, are the standard means of treatment.

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15
Q

Alternative TX of Bullous Pemphigoid

A

Tetracycline or erythromycin combined with nicotinamide is the alternative to steroids. Use topical steroids only if no oral lesions are present

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16
Q

___ is a disorder of porphyrin metabolism. Deficiency
of the enzyme uroporphyrinogen decarboxylase results in an abnormally high accumulation
of porphyrins, which then leads to a photosensitivity reaction

A

Porphyria cutanea tarda

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17
Q

Asscn of Porphyria cutanea tarda

A

porphyria cutanea tarda is associated with increased liver iron stores. Diabetes is found in 25% of patients.

HIV, alcoholism, liver disease, chronic hepatitis C, or a woman taking oral contraceptives

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18
Q

SSx of Porphyria cutanea tarda

A

Fragile, nonhealing blisters are seen on the sun-exposed parts of the body, such as the backs of the hands and the face.

This leads to hyperpigmentation of the skin in general and hypertrichosis of the face

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19
Q

Dx of Porphyria cutanea tarda

A

The diagnostic test is a level of urinary uroporphyrins. Uroporphyrins are elevated 2–5× above the coproporphyrins in this disease

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20
Q

Tx of Porphyria cutanea tarda

A

The best initial step in management is to stop drinking alcohol (although it is unlikely to be effective) and to discontinue all estrogen use

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21
Q

PCT

The most effective therapy to use if this is insufficient
is _______

A

phlebotomy to remove iron.

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22
Q

the antimalarial drug ______increases the excretion of porphyrins

A

chloroquine

23
Q

______ is a hypersensitivity reaction most often mediated by IgE and mast cell activation, resulting in evanescent wheals and hives

A

Acute urticaria

24
Q

The most common causes of acute urticaria are:

A

allergic reactions to medications, insect bites, and foods, and occasionally, the result of emotions

25
Q

MC meds causing urticaria

A

aspirin, NSAIDs, morphine, codeine, penicillins, phenytoin, and quinolones

26
Q

MC food causing urticaria

A

The most common foods are peanuts, shellfish, tomatoes, and strawberries.

27
Q

Acute urticaria lasts____weeks in duration and two-thirds of cases are self-limited.

A

<6

28
Q

Urticaria is treated with______

A

H1 antihistamines

29
Q

What should never be used for urticaria

A

Astemizole and terfenadine should never be used
and are no longer marketed; they cause potentially fatal rhythm disturbances particularly when combined with other medications, such as macrolide antibiotics, because of their effect on the hepatic P450 system.

30
Q

What to be done when trigger cant be avoided?

A

“desensitization” when the trigger cannot be avoided, e.g., a beesting in a farmer

31
Q

______ must be stopped prior to desensitization because they inhibit epinephrine, which may be used if there is an anaphylactic reaction

A

Beta-blocker medications

32
Q

____ is a milder version of a hypersensitivity reaction compared with urticaria. This is the “typical” type of drug reaction and is lymphocyte mediated

A

A morbilliform rash

33
Q

Characteristic rash of morbiliform rash

A

It is a generalized, maculopapular eruption that blanches with pressure.

34
Q

Erythema Multiforme MCC

A

most common cause of EM is a reaction to infection

35
Q

MC characteristic feature of morbiliform rash

A

The most characteristic feature of EM is target-like lesions that occur especially on the palms and soles

36
Q

characteristic rash of morbiliform rash

A

These lesions can also be described as “iris-like.” Bullae are not uniformly found. EM of this type usually does not involve mucous membranes

37
Q

SJS usually involves ____ of the total body surface area, and the overall mortality rate is ____

A

<10 to 15%

<5 to 10%.

38
Q

Best initial Tx for SJS

A

The best initial therapy for severe disease is IV

immunoglobulins. Other therapies of unclear value are cyclophosphamide, cyclosporine, and thalidomid

39
Q

_____is the most serious version of a cutaneous

hypersensitivity reaction. Mortality may be as high as 40 to 50%.

A

Toxic epidermal necrolysis (TEN)

40
Q

TEN has certain features similar to staphylococcal scalded skin syndrome; however, TEN is drug induced
as opposed to being caused by a _____ coming from an organism.

A

toxin

41
Q

Dx test for TEN

A

The diagnosis is usually clinical. The most accurate diagnostic test is a skin biopsy,
which will reveal full thickness epidermal necrosis. A skin biopsy is usually not necessary

42
Q

MCC of death in TEN

A

Sepsis is the most common cause of death, but prophylactic systemic antibiotics are not indicated. Systemic steroids are not effective and may, in fact, decrease survival.

43
Q

_____ is a localized inflammatory condition of the skin or
panniculitis. It is secondary to recent infections or inflammatory conditions. It is also associated
with pregnancy.

A

Erythema nodosum (EN)

44
Q

MCC of Erythema nodosum (EN)

A

The most common causes of EN are recent streptococcal infections, coccidioidomycoses, histoplasmosis, sarcoidosis, inflammatory bowel disease, syphilis, TB, and
hepatitis.

45
Q

SSx of EN

A

Erythema nodosum consists of multiple painful, red, raised nodules on the anterior surface of the lower extremities

46
Q

Skin infection characterized by multiple macules (usually asymptomatic), varying in color from white to brown.

A

Tinea versicolor

47
Q

Tinea versicolor etiology

A

Pityrosporum orbiculare (Malassezia furfur).

48
Q

SSx of tinea versicolor

A

Tan, brown, or white scaling macular lesions that tend to coalesce; found on chest, neck, abdomen, or face. Lesions do not tan

49
Q

Tx of tinea versicolor

A

Topical selenium sulfide, clotrimazole, ketoconazole, or oral itraconazole.

50
Q

Describe Intertriginous Candida infection

A

Well-demarcated, erythematous, itchy, exudative patches, usually rimmed with small red-based pustules that occur in the groin, gluteal folds (diaper rash), axilla, umbilicus, and inframammary areas.

51
Q

Describe Candida vulvovaginitis

A

White or yellowish discharge with inflammation of the vaginal wall and vulva. Common in pregnant women and patients with diabetes mellitus

52
Q

TX of Candida infxn

A

Topical nystatin, clotrimazole, miconazole, ciclopirox, econazole, or terconazole

53
Q

The most common bacterial organisms to cause skin infections of any kind are ______ and _____

A

Staphylococcus

and Streptococcus

54
Q

If a patient is allergic to penicillin, but the reaction is only a rash, then _____ can be safely used

A

cephalosporins

CK IM (9 decks)

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