dermatology 2

Question 1

lichen planus

Answer 1

immune mediated
autoimmune
can have oral presentation (white streaks lace like pattern)
skin presentation - small polygonal violaceous papule with sharp outline
nails - pitting/thinning

Question 2

pemphigus

Answer 2

autoimmune blistering disease

formation of bullae (intradermal separation)

Question 3

oral and skin presentation of pemphus

Answer 3

irregular ulcers with ragged edges
lesions fragile and breakdown rapidly

skin
- inact bullae
rupture easily
- may be susceptible to infection

Question 4

pemphigoid and types

Answer 4

autoimmune blistering disease
attack proteins at the BM causing separation of dermis from epidermis
1)	bullous pemphigoid (BP)
2)	mucous membrane pemphigoid (MMP)
3)	gestational pemphigoid

Question 5

skin presentation of pemphigoid

Answer 5

bullae
may have straw coloured fluid
may burst
IMO looks like nasty blistering burn

Question 6

dermatitis hepetiormis

Answer 6

cutaneous manifestation of ceoleic disease
IgA immunigolbulin with CT papillae

oral presentation
- vesicles affecting palatal music
keratotic patches that resemble lichen planus
frequent oral ulceration

skin
- itchy papules and vescles
lesions in clusters
flat red patches and thickened plaques

Question 7

epidermolysis bullosa

Answer 7

inherited disease
blistering disorder
fragile skin, bullae form

Question 8

subtypes of epidermolysis bullosa

Answer 8

HISTOLOGICALLY distinguished
epidermis bulls simplex (epidermis)
junctional epidermolysis bullosa(lamina Lucia w/ BM zone)
dystrophic epidermolysis bullosa (lamina dense and upper dermis)
kindler syndrome (multiple levels and beneath BM)

Question 9

systemic sclerosis

Answer 9

autoimmune

progressive fibrosis of skin and internal organs

Question 10

systemic lupus erythematous

Answer 10

autoimmune chronic inflammation disease
oral - erythematous patches and oral ulceration
skin - butterfly rash
erythematous rash

Question 11

discoid lupus erythematous

Answer 11

autoimmune chronic inflam condiditon
affect skin and mucous membranes

oral - white papules
skin
- demarcated erythematous papules
- then scar long term

Question 12

behcets disease

Answer 12

multisystem immune mediated disorder

oral - ulceration, scarring on healing
skin - erythematous nodules

Question 13

dyskeratosis congnitia

Answer 13

mucocutaneous condition
Types - X linked, autosomal dominant, recessive
increased risk of developing malignancies
oral - thick white patches
skin
- looks dirty , hyperpigmentation,

Question 14

palmoplantar kertoderma

Answer 14

hyperkeratosis of palms and soles of feet
oral - variation, high arched palate, lingual ridging and fissuring
skin
- hyperkeratosis
hyperhidrosis

Question 15

darters disease

Answer 15

congenital
disruption of calcium movement in cells, fragile adhesion of keratinocytes

oral
- asymptomatic white patches
skin
- wart like waxy hyperketatotic papulaes and patches
nails- red or white lines run length of nail

Question 16

hypersensitivity

Answer 16

either humeral or cell mediated

immune mediated antigen specific reactions

Question 17

what is an allergy

Answer 17

hyersensitibe to external agent i.e. allergen

Question 18

type 1 hypersensitivvty

Answer 18

mediated by IgE - anaphylaxis, angioedema, asthma, hayfever

Question 19

type IV

Answer 19

mediated by sensitised T lymphocytes - nickel allergy , contact dermatitis

Question 20

type IV subtype reactions

Answer 20

a - macrophage activation
bc - eosinophils
d - neutrophils
type IV - T cells

Question 21

type 1 reaction stages

Answer 21

Occurs in 2 stages

1) 1st exposure sensitisation
2) subsequent exposure – allergic reaction

Question 22

sensitisation

Answer 22

hypersensitive T cells
allergens enter the body - produced by Ag presenting cells
niave T helps -> primed TH
TH simulate B cell to produce IgE specific Ab
attach to mast cells

Question 23

second exposure in type 1

Answer 23

• Antigen binds to mast cells - mast cells degranulate - release pro inflammatory cytokines (Histamine).
• Histamine - binds to H1 receptors.
• Early phase reactions (seconds) - Smooth muscle contraction (bronchi), blood vessel dilation and permeability (oedema / swelling).
• Late phase reactions (8 - 12 hours later) - Leukotrienes attract more neutrophils / mast cess / eosinophils to site of exposure – second episode of oedema and swelling

Question 24

investigating hypersensitituy

Answer 24

blood tests - measure IgE to substances
skin prick tests - histamine measured of allergen pricked
challenge test - only if other test incolclusive

Question 25

contact allergy

Answer 25

type IV delayed
T cells mature to effector T cells on contact
effector T cells release cytokines
proinflammatory cytokines released

Question 26

signs of contact allergy

Answer 26

• oral lichenoid reaction
• contact mucosal erythema
• oral ulceration
• excematous chelitis

Question 27

type IV - ertythema multiforme

Answer 27

acute self limiting hypersensitivity condition
skin - classical target lesions
oral - blistering and erosios to musocsa, haemorrphagic crusting to lips

Question 28

type IV - fixed drug eruption

Answer 28

T cell mediated hypersenstvty reaction to a drug
-repeated exposure more pronounced reaction
oral - mucosal erythema and ulceration, white patch
skin - well defined erythematous lesions