Dermatology

Question 1

what are the layers of the skin

Answer 1

epidermis (this is split into the stratum corneum, stratum granulosum, stratum spinosum and stratum basalt)
dermis
subcutaneous tissue

Question 2

where is the epidermis derived from

Answer 2

ectoderm

Question 3

what are the role of langerhans cells and where do they reside

Answer 3

the reside in the basal layers of the skin

specialise in antigen presentation - acquire antigens in peripheral tissues and transport them to the regional lymph nodes, present them to naive T cells and initiate the adaptive immune response

these activated T cells initiate the cytokine release cascade

have major roles in:
- antimicrobial immunity
- skin immunosurveillance
- induction hypersensitivity and pathogenesis of chronic inflammatory diseases of the skin

Question 4

what are the effects of UV on the skin

Answer 4

• direct cellular damage
• alterations in immunologic function
• direct effects include photoaging, DNA damage and carcinogenesis

Question 5

what are the effects of UV damage on the p53 tumour suppressor gene

Answer 5

these are mutated and it is implicated in the development of melanoma and non melanoma skin cancers

Question 6

what tries to protect the skin from UV damage

Answer 6

keratinocytes
melanocytes

Question 7

what does chronic exposure to UV cause in humans

Answer 7

loss of skin elasticity, fragility and abnormal pigmentation and haemorrhage of blood vessels

wrinkles and premature ageing

Question 8

draw me the vitamin D diagram

Question 9

what are the impacts of vitamin D deficiency

Answer 9

• increased risk of common cancers
• autoimmune diseases
• infectious diseases
• cardiovascular disease

Question 10

Merkel cells

Answer 10

these are at the BASE of the dermis and respond to sustained gentle and localised pressure, assess shape and edge of objects

Question 11

messier corpuscles

Answer 11

situated immediately below the dermis and are particularly well represented on the palmar surfaces of the fingers and the lipssensitive to light tough

Question 12

Ruffinis corpuscles

Answer 12

situated in the dermis and are receptors sensitive to deep pressure and stretching

Question 13

pacinian corpuscles

Answer 13

mechanoreceptors present in the deep dermis sensitive to deep touch, rapid deformation of the skin surface and around joints for position and proprioception

Question 14

pacinian corpuscles

Answer 14

mechanoreceptors present in the deep dermis sensitive to deep touch, rapid deformation of the skin surface and around joints for position and proprioception

Question 15

free nerve endings

Answer 15

pain and tempterture

Question 16

what is the aetiology of acne

Answer 16

there is keratin and sebum blockage of the sebaceous gland

androgenic increased sebum production and viscosity and this leads to proprioni bacterium inflammation

Question 17

What three features do you need to diagnose acne

Answer 17

papules
pustules
comedones (white and black heads)

Question 18

acne fulminans

Answer 18

this is a severe condition with an acute onset presenting with fever, bone pain etc.

Question 19

what are the treatment options for ACNE

Answer 19

reduce plugging - topical retinoid or topical benzoyl peroxide

reduce bacteria - topical antibiotics - oral antibiotics

reduce sebum production - hormones such as anti-androgens

Question 20

side effects to some topical agents

Answer 20

irritant, burning, peeling and bleaching

Question 21

Side effects to oral antibiotics

Answer 21

gastro upset

Question 22

what causes atopic eczema

Answer 22

high Ig-E immunoglobulin antibody levels

Question 23

how is atopic eczema managed

Answer 23

emmollients
topical steroids
manages
antihistamines
antibiotics and antiivirals
education for child and patient
avoidance of exacerbating factors

Question 24

what are the two types of contact dermatitis - exogenous agents

Answer 24

irritant - direct noxious effect of the skin barrier
allergic - type IV hypersensitivity reaction

Question 24

what are the two types of contact dermatitis - exogenous agents

Answer 24

irritant - direct noxious effect of the skin barrier
allergic - type IV hypersensitivity reaction

Question 25

presentation of seborrhoea dermatitis

Answer 25

chronic scaly inflammatory condition
looks like dandruff
caused by an overgrowth of pittosporum oval yeast

can be severe in HIV

Question 26

what is the treatment for seborrhoea dermatitis

Answer 26

scalp - anti yeast shampoo
face - anti-microbial, mild steroid and a simple moisturisers

often improves with UV/Sunlight

Question 27

venous dermatitis

Answer 27

underlying venous disease
affects the lower legs
incompetence of the Depp perforating veins that results increased hydrostatic pressure

Question 28

management of venous dermatitis

Answer 28

emollients
mild/moderate topical steroid
compression banding/stockings
consider early venous surgical intervention

Question 29

what is the definition of psoriasis

Answer 29

chronic relapsing and remitting scaling skin disease which may appear at any age and affect any part of the skin

it is caused by a t-cell mediated autoimmune disease

Question 30

what are some of the scoring systems used in psoriasis

Answer 30

DLQI - disease life quality index (patient)
PASI - Psoriasis area severity index (clinicians)
PEST - psoriasis epidemiology screening tool (5 questions survey to deem severity of the disease)

Question 31

what are some features of a basal cell carcinoma

Answer 31

• shiny
• lightening blood vessels (telangiectasia)
• often ulcerated centrally

Question 32

what is the best treatment for a basal cell carcinoma

Answer 32

surgical excision with a 3-4mm margin
- curettage and cautery
- cryotherapy

Question 33

where does squamous cell carcinomas originate from

Answer 33

keratinocytes