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USMLE Step 3 > Dermatology > Flashcards

Dermatology Flashcards

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USMLE® Step 1 flashcards
1
Q

In Pemphigus Vulgaris, antibodies are produced against antigens in the _______

A

Intercellular spaces of the epidermal cells

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2
Q

What are the causes of Pemphigus Vulgaris?

A
  • Idiopathic
  • ACE inhibitors
  • Penicillamine
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3
Q

Nikolsky’s sign is present in the following conditions:

A
  • Pemphigus vulgaris
  • Staphylococcal scalded skin syndrome
  • Toxic epidermal necrolysis
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4
Q

Lesions of Pemphigus Vulgaris are:

A

Painful, not pruritic

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5
Q

Treatment for Pemphigus Vulgaris?

A
  • Glucocorticoids (such as prednisone)

- When steroids are ineffective: Azathioprine, Mycophenolate, Cyclophosphamide

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6
Q

Can Pemphigoid be drug induced?

A

Yes, by sulfa drugs and others

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7
Q

Explain the difference in skin fractures found in Pemphigus Vulgaris and Bullous Pemphigoid

A

Vulgaris – Acts like a burn, bullae (destruction within epidermis) are relatively thin and fragile.
Pemphigoid – Blisters are relatively deep, bullae are thicker walled. Less likely to rupture

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8
Q

How do you test for Pemphigus Vulgaris?

A

Biopsy of the skin

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9
Q

How do you test for Bullous Pemphigoid?

A

Biopsy with immunofluorescent antibodies

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10
Q

Treatment for Bullous Pemphigoid

A
  • Systemic steroids, such as prednisone

- Alternatives to steroids: Tetracycline, Erythromycin w/nicotinamide

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11
Q

Describe the age range, severity, bullae, if the mouth is involved, and other features of Pemphigus Vulgaris

A
  • 30’s and 40’s
  • Life threatening
  • Thin and fragile
  • Yes
  • Nikolsky’s sign
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12
Q

Describe the age range, severity, bullae, and other features of Bullous Pemphigoid

A
  • 70’s and 80’s
  • Resolves
  • Thick and intact
  • No
  • No other features
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13
Q

Are oral lesions found in Bullous Pemphigoid?

A

Yes, but rare

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14
Q

Are oral lesions found in Pemphigus Foliaceus?

A

No

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15
Q

What is Pemphigus Foliaceus?

A

Blistering disease associated w/other autoimmune diseases OR drug induced by ACE inhibitors or NSAIDS

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16
Q

Describe the bullae in Pemphigus Foliaceus

A

Much more superficial than B. Pemphigoid and P. Vulgaris

Intact bullae are not seen because they break so easily.

17
Q

Are oral lesions found in Pemphigus Foliaceus?

A

No

18
Q

How is Pemphigus Foliaceus diagnosed and treated?

A

Same as Pemphigus Vulgaris:
- Biopsy
- Glucocorticoids (such as prednisone)
When steroids are ineffective: Azathioprine, Mycophenolate, Cyclophosphamide

19
Q

What is Porphyria Cutanea Tarda?

A

Disorder of porphyrin metabolism –> photosensitivity reaction to abnormally high accumulation of porphyrins

20
Q

List the conditions that are associated with PCT

A
  • Alcoholism
  • Liver disease
  • Chronic hepatits C
  • Oral contraceptives
  • Chronic hepatitis or hemochromatosis PCT, is associated w/increased liver iron stores
  • Diabetes (found in 25% of patients)
21
Q

What is PCT present with?

A
  • Nonhealing blisters on sun-exposed parts of body
  • Hyperpigmentation of skin
  • Hypertrichosis of face
22
Q

How do you test for PCT?

A

Test for urinary uroporphyrins

Uroporphyrins are elevated 2-5 times above coproporphyrins in PCT

23
Q

Treatment for PCT?

A
  • Stop drinking alcohol
  • Stop all estrogen use
  • Use barrier sun protection
  • Use phlebotomy to remove iron, if not possible, use Deferoxamine
  • Chloroquine increases excretion of porphyrins
24
Q

Acute urticaria is a _______ reaction

A

Hypersensitivity

25
Q

What is acute urticaria most often mediated by? What is the result?

A

IgE and mast cell activation –> Evanescent wheals and hives

More on Acute Urticaria (pg 291/292)

26
Q

Most common causes of Urticaria?

A
  • Medications
  • Insect bites
  • Foods
  • Emotions (occasionally)
  • Contact with latex

Page 292 for specifics

27
Q

What is Chronic Urticaria associated with?

A
  • Pressure on the skin - aka dermatographism
  • Cold
  • Vibration
28
Q

In Urticaria, when does the onset of wheals and hives occur? How long do they last?

A

Usually within 30 min, lasts

29
Q

How is severe, acute Urticaria treated?

A

H1 antihistamines

(diphenhydramine, hydroxyzine or cyproheptadine

30
Q

How is Urticaria treated?

A
  • H1 antihistimines
  • Systemic steroids (for life threatening reactions)
  • Chronic therapy (newer, nonsedating antihistamines)
  • Desensitization when the trigger cannot be avoided
  • Avoid

Page 292 for more info/specifics

31
Q

How does diphenhydramine work?

A

H1 receptor inverse agonist

32
Q

How does cyproheptadine work?

A

Seratonin antagonist, histamine H1 blocker

33
Q

How does hydroxyzine work?

A

Potent H1 receptor inverse antagonist

USMLE Step 3 (4 decks)

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