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Phase 3 > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Where are Langerhan Cells usually found?

A

In the Stratum Basalis

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2
Q

Where and what do the Merkels cells do?

A

Base of epidermis

Gentle - localised pressure

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3
Q

Where and what do the Meissner corpuscles do?

A

Immediately below Epidermis
- heavy on palms and lips

Light touch

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4
Q

Where and what do Ruffini’s corpuscles do?

A

In the dermis

Deep pressure and stretching

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5
Q

Where and what do Pacinian corpuscles do?

A

Deep dermis

Deep touch and proprioception

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6
Q

What is a Macule:

A

Flattened area of abnormality.

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7
Q

What is a papule:

A

Raised area of skin

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8
Q

What is a Pustule:

A

Raised, full of pus

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9
Q

What is a plaque:

A

Raised large area of skin. like a papule but much larger. can often be crusted.

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10
Q

What is a Vesicle:

A

Small blister formation

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11
Q

What is a bulla:

A

Large blister formation

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12
Q

What is erythematous:

A

Red, inflamed

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13
Q

What must be present for the diagnosis of acne vulgaris?

A

At least 3/4 of the following:

  • Papules
  • Pustules
  • Erythema
  • Comedones
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14
Q

What is the gene that is thought to be associated with atopic eczema and may be associated with other atopic pathologies such as asthma?

A

Filaggrin

- chromosome 1

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15
Q

What is it called when the herpes virus infects someone (usually infant) with eczema leading to wide spread papules which are itchy and sore?

A

Eczema Herpeticum

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16
Q

What is is called when there is direct damage to the skin via a substance, involving no immune reaction? i.e. it has a direct noxious effect?

A

Irritant contact dermatitis

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17
Q

If a female comes into the clinic with acne, which much worse during particularly times of the menstrual cycle and is overweight, what should you be thinking as a possible cause?

A

Polycystic ovarian syndrome

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18
Q

What are the main types of acne?

A

Vulgaris

Fulminans
- emergancy

Steroid

Inversus

Rosacea

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19
Q

What is needed to make a diagnosis of acne?

A 
Comedones 
papules 
pustules 
and/ or 
erythema
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20
Q

What must females be placed on if taking isotretinion A?

A

Pregnancy prevention program

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21
Q

What infection may be a risk factor for developing psoriasis and what type would someone develop?

A

Strep infection.

Gluttate
- short lived

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22
Q

What are the major types of psoriasis?

A

Plaque

Gluttate

Keobner

  • occurs in place of trauma
  • usually around scars

Inverus

Palmer pustular

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23
Q

What is the genetic susceptibility in eczema?

A

Filaggrin

- chromosome 1

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24
Q

Outline the pathophysiology of atopic eczema

A

Type I Hypersensitivity reaction

edema pushes the keratinocytes apart causing pickling.

leads to itching and cracking

Lichenification occurs

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25
Q

What is it called when there is a co- infection of eczema and herpes?

A

Eczema Herpeticum

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26
Q

What are second line treatments for eczema?

A

Immunosuppressive

UV

Oral retinoids

Biological agents

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27
Q

What are the main subtypes of eczema?

A

Atopic

Contact

Seborrhoeic dermatitis

Venous

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28
Q

What is the pathogen in Seborrhoeic dermatitis?

Also what is it commonly known as in babies?

A

Pityrosporum Ovale

Cradle cap

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29
Q

What is the treatment of seborrhoeic dermatitis?

A

Ketoconazole shampoo

Antimicrobial face wash

steroid cream

moisturisers

UV

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30
Q

How does UV light increase the risk of skin cancer?

A

Immunosuppression:
Trans UCA transformed to Cis UCA

Cis UCA switches off immune cells.

Direct cellular damage:

  • free radicals
  • double stranded DNA break
  • mutations in p53
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31
Q

What are some key symptoms of a skin cancer?

A

Increase in size

Itchiness

Ulceration/ bleeding

32
Q

What gene is usually damaged in basal cell carcinoma?

A

PTCH gene

- suppressor protein as mpat of the sonic hedgehog pathway

33
Q

What’s a type of excisional surgery that can be used on cancerous cells?

A

Mohs Micrographic surgery

34
Q

Name two premalignant conditions of squamous cell carcinomas:

A

Actinic kertatosis

Bowen’s disease
- carcinoma in situ

35
Q

What measurement is used to work out prognosis of melanoma?

A

Clinical appearance

histological
- Breslow’s depth

36
Q

What are the surgical excisions for melanoma?

A

<1mm = 1cm margin

> 1mm = 2cm margin

37
Q

List the treatment options for melonoma:

A

Surgical excision

Immunotherapy
- PDLA-4 = Ipilimumab

Immune check point
- MEK inhibitors

BRAF v600E inhibitors
- Vemurafenib

Imaging for metastasis

assessment of lymph nodes

38
Q

What the most common pathogens of impetigo?

and what is the treatment?

A

S. Aureus

S. Pyogenes

**Fusidic acid

39
Q

What the classification system used for cellulitis?

A

Enron Classification

40
Q

Whats the drug choice for OPAT in cellulitis?

A

Ceftriaxone

41
Q

What are some common pathogens that are associated with bites?

What is the treatment:

A

S. aureus
S. Strep

Anaerobics

Pasteurella
Capnocytophaga
- these two are common in cats

treatment:

1st: Co-amoxiclav
2nd: doxycycline + metronidazole

Surgical debridement

Prophylactic treatment:

  • rabies
  • tetanus
42
Q

When an IV drug user comes in with an infection, what else should be done out with cultures and antibiotics?

A

chest x-ray

echocardiogram

43
Q

What is the bacteria associated with highly virulent and contagious boil formation on the skin?

A

PVL staphylococcus

PVL is an exotoxin produced by S. Aureus

44
Q

What the phases of hair growth?

A

Anagen
- nourishment

Catagen
- follicle detaches

Telogen
- follicle falls out

45
Q

What is the immune mediated type of hair loss seen? list some types of presentation with it?

and what is a poor prognostic sign?

How is it treated?

A

Alopecia Areata:
Immune development against hair follicles. associated with other immune conditions such as thyroid disease.

  • Localised alopecia areata
  • Alopecia totalis
  • Alopecia universalis

Treated:
- Clobetasol - topical steroid

  • topical immunotherapy
  • 5% minoxidil
46
Q

What the type of hair loss that occurs due to stress?

A

Telogen effluvium

47
Q

What is it called when there is a psychological problem of hair pulling?

A

Trichotillomania

48
Q

List some skin conditions seen in diabetes:

A

Necrobiosis Lipoderca
- yellow/ red patches on shins

Diabetic dermopathy
- brown spots on shins

Sceledema
- hardening and thickening of skin

Granuloma Annulare
- small papule rings that join together to form large rings

Type III Aconthosis Nigricans

49
Q

If there was an islet tumour of the pancreas, what skin disease may you see? and how does it present?

A

Necrolytic migratory erythema

  • blistering rash with scaly plaques

usually around the mouth

50
Q

If a person had lung cancer, what skin condition may you see?
how does it present and list some other cancers it is associated with:

A

Erythema Gyratum Repens

Circular, woodgrain pattern

Breast
cervical
G.I

51
Q

If a person had adenocarcinoma of G.I tract what skin condition might you see?

A

Type I acanthosis nigricans

52
Q

In B6 deficiency what skin condition may you see?

A

Pyridoxine dermatitis

- around lips and mouth

53
Q

In zinc deficiency, what skin condition may you see?

A

Acrodermatitis enteropathica

54
Q

If a person has inflammatory condition such as, Chrons or RA, or even myeloma, what skin condition may they have?

A

Pyoderma Gangrenosum

55
Q

In acute erythroderma, what is the pathology and what are the complications?

A

inflammatory reaction involving nearly the entire skin.
usually due to drug reactions.

complications include:

  • infection
  • temperature dysfunction
  • high output heart failure

significant loss of fluids

56
Q

What drug may cause venous ulceration?

A

Nicrorandil

57
Q

What investigations should be done when someone has a venous ulcer?

What are the scores?

A

Ankle brachial pressure Index.

<0.8 ratio - occlusion

> 1.1 ratio - calcification

58
Q

How does cellulitis and impetigo differ?

A

Impetigo is infection in the superficial levels
- honey crusted with discharge

where as cellulitis is deeper dermis and subcut tissue.
usually presents with fever and deep red rash

59
Q

What drug may cause Psoriasiform rash?

A

Beta Blockers

Lithium

60
Q

Name a drug that commonly causes a fixed rash?

A

Paracetamol

61
Q

What cancer is associated with PTCH gene defects?

A

Basal cell carcinoma

62
Q

Which type of blistering condition causes the entire epidermis to lift up? and how does this contrast to another blistering condition?

A

Bullous Pemphigoid

Pemphigus - affects the desmosomes - leading to intra epidermal skin splitting.

63
Q

What the biggest cause of erythema multiforme?

A

HSV

64
Q

What is the classification system used for cellulitis?

A

Enron system

65
Q

What kind of rash does a Tick bite cause and what is the bacteria implicated in it?

A

Erythema Migrans

Borrelia Burgdorferi

66
Q

Name a skin manifestation that comes about due to IBD and what are the symptoms:

A

Erythema Nodosum

Extremely painful across the shins.

Also associated Step infections

67
Q

List several histological differences you would see in palmer skin vs skin from the arm:

A

Palmer skin:

  • is thicker and contains Stratum lucidum
  • there is lack of sebaceous glands
  • Lack of hair follicles

Think skin:
- dermal papilla are much more pronounced

68
Q

List some histological findings of Psoriasis:

A

Parakeratosis - retention of nuclei at top of the skin

Increased mitotic figures in the basal layer

Infiltration of lymphocytes and macrophages

Increased/ prominent capillaries

69
Q

Describe the gross features of psoriasis:

A

Demarcated salmon pink coloured plaque with silver loose scale surrounding

  • inflamed
  • white scales
70
Q

Define plaque:

A

Elevated superficial solid skin lesion that >1cm in diameter

71
Q

What disease is associated with Telectangasia within the nails?

A

SLE

72
Q

What is the pathophysiology underlying SJS?

A

Formation of a [Maculopapular rash] and Bullae
to the epidermis coming off the papillary junction due to apoptosis of the keratinocytes - induced by CD8 Cells

T cell mediated immune reaction.

  • *this can only truly confirmed by biopsy of the skin where
  • keratinocyte apoptosis will be seen
  • peeling of the epidermis of the papillary junction
73
Q

What are some common symptoms of SJS, some causes and how is it treated?

A

Prodrome - flu like symptoms

Peeling maculopapular rash with blistering across <10% of skin.
commonly affects oral/ gum area.

Treated with:

Admit to ICU
ABC approach
- removal of drugs or causes - and restrict any sulphur containing drugs

  • Fluids IV - loss of fluid through burns
  • Dressings
  • Pain management
  • Infection control - possible use of IV IgGs
  • Special mattress protection
74
Q

What are some characteristic findings of Erythema Multiform

A

Target lesion - which has a centre of blistering - which allows it to be differentiated from other target lesions.

Due to HSR most commonly associated with HSV

75
Q

What tests would you carry out for Urticaria:

A

FBC

ESR
- checking for vasculitis

Eosinophil count

ANAs

Thyroid tests
- associated with underactive thyroid

Phase 3 (50 decks)

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