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2nd year > Dermatology > Flashcards

Dermatology Flashcards

1
Q

Which skin condition can be precipitated or exacerbated by beta blockers?

A

Psoriasis

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2
Q

Which embryological cell type forms the epidermis?

A

Ectoderm

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3
Q

Which embryological cell type forms the dermis?

A

Mesoderm

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4
Q

Embryological origin of melanocytes

A

Neural crest

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5
Q

What type of epithelium does the epidermis have?

A

Stratified squamous

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6
Q

Layers of epidermis

A

Keratin
Granular
Prickle cell
Basal

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7
Q

Composition of basal layer of epidermis

A

One layer of small cuboidal cells, with filaments of keratin

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8
Q

Composition of prickle cell layer of epidermis

A

Large polyhedral cells with large numbers of desmosomes, connected to intermediate filaments

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9
Q

Composition of granular layer of epidermis

A

2-3 layers of flattened cells with large keratohyalin granules and lamellar bodies. High lipid content

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10
Q

Composition of keratin layer of epidermis

A

Corneocytes, overlapping cell remnants which form an insoluble cornified envelope.

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11
Q

Which layer of the epidermis is a tight waterproof barrier?

A

Keratin layer

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12
Q

Which layer of the epidermis has a high lipid content?

A

Granular layer

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13
Q

Which type of cells makes up 95% of epidermal cells?

A

Keratinocytes

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14
Q

What is the function of melanosomes, which are found in melanocytes?

A

Convert tyrosine to eumelanin and phaeomelanin

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15
Q

Types of melanin pigment

A

Eumelanin (brown, black)

Phaeomelanin (red, yellow)

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16
Q

Which type of cells found in the epidermis has a mesenchymal origin in the bone marrow?

A

Langerhans cells

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17
Q

Hair growth phases

A

Anagen (growing)
Catagen (involuting)
Telogen (resting)

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18
Q

Which hair growth phase is reduced postpartum, resulting in shedding?

A

Anagen

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19
Q

What type of hypersensitivity reaction is bullous pemphigoid?

A

II

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20
Q

Which antibodies are formed in bullous pemphigoid?

A

Anti-hemidesmosome

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21
Q

At what layer of the skin do blisters form in bullous pemphigoid?

A

Dermo-epidermal junction

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22
Q

At what layer of the skin do blisters form in junctional EB?

A

Lamina lucida of the basement membrane at DEJ

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23
Q

Types of cells found in dermis

A

Fibroblasts, macrophages, mast cells, lymphocytes, Langerhans cells

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24
Q

Where are apocrine sweat glands found?

A

Axillae and perineum

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25
Q

Where are sebaceous glands found?

A

Widely distributed, but largest on face and chest

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26
Q

Where are eccrine sweat glands found?

A

All over, but particularly palms, soles, axillae.

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27
Q

Which enzyme is deficient in X-linked ichthyosis?

A

Steroid sulfatase (STS)

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28
Q

In what form is vitamin D stored in the liver?

A

Hydroxycholecalciferol

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29
Q

Which types of skin nerve endings are slowly adapting?

A

Merkel’s receptors, Ruffini’s corpuscles

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30
Q

Which types of skin nerve endings are rapidly adapting?

A

Meissner’s corpuscles, Pacinian corpuscles

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31
Q

What are Birbeck granules?

A

Characteristic feature seen in Langerhans cells

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32
Q

Which T lymphocytes are found in the epidermis?

A

CD8+

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33
Q

Which T lymphocytes are found in the dermis?

A

CD4+, CD8+

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34
Q

Function of CD4+ cells

A

Helper T cells.
TH1 activate macrophages
TH2 help B cells to produce antibodies

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35
Q

Function of CD8+ cells

A

Cytotoxic T cells - kill infected cells directly

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36
Q

What is the Koebner phenomenon?

A

Tendency of psoriatic lesions to occur at sites of skin trauma

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37
Q

Enzyme deficiency in porphyria cutanea tarda

A

Uroporphyrinogen decarboxylase

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38
Q

Type of porphyria with blisters and fragility as main features

A

Porphyria cutanea tarda

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39
Q

Urine findings in porphyria cutanea tarda

A

Uroporphyrinogenuria.

Woods lamp shows pink colouring

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40
Q

Enzyme deficiency in erythropoietic protoporphyria

A

Ferrochelatase

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41
Q

Presentation of erythropoietic protoporphyria

A

Presents in childhood with acute photosensitivity leading to pruritus, erythema, and pain

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42
Q

Function of ferrochelatase

A

Converts protoporphyrin to haem

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43
Q

Inheritance of acute intermittent porphyria

A

Autosomal dominant

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44
Q

Enzyme deficiency in acute intermittent porphyria

A

Porphobilinogen deaminase

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45
Q

Presentation of acute intermittent porphyria

A

Typically asymptomatic, with 10% of gene carriers having a syndrome with acute attacks - abdo pain, tachycardia, back and leg pain, psychiatric features

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46
Q

Virulence factors of staph aureus

A 
Fibrinogen binding protein
Haemolysin
Coagulase
Leucocidin
TSST-1 toxin
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47
Q

Diagnostic criteria for toxic shock syndrome

A

Fever of 39 or above
Diffuse macular rash
Hypotension <90
>=3 organ systems involved

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48
Q

Toxin found in some staph aureus strains associated with recurrent furunculosis and necrotising fasciitis

A

Panton-Valentine leucocidin (PVL)

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49
Q

Causative organisms for impetigo

A 
Staph aureus (~80%)
Strep pyogenes
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50
Q

Type I hypersensitivity

A

IgE-mediated, immediate reaction. Anaphylaxis

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51
Q

Type II hypersensitivity

A

IgG-mediated, cell destruction via complement activation. Seen in transfusion rections

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52
Q

Type III hypersensitivity

A

Immune complex mediated. Seen in RA, SLE

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53
Q

Type IV hypersensitivity

A

T-cell mediated, release of cytokines. Contact dermatitis, graft rejection, T1DM. Delayed reaction

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54
Q

EpiPen doses

A

300ug adults, 150ug children

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55
Q

Which law describes rate of absorption of topical drugs?

A

Fick’s Law:
J = KpCv

(Kp - permeability coefficient of drug, Cv concentration of drug in vehicle)

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56
Q

Extent of skin absorption of lipophilic dug in lipophilic base

A

Soluble in both vehicle and skin; partitions between the two

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57
Q

Extent of skin absorption of lipophilic drug in hydrophilic base

A

More soluble in skin, partitions preferentially into it

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58
Q

Extent of skin absorption of hydrophilic drug in lipophilic base

A

Limited solubility in both vehicle and skin; partitions into skin to a limited extent

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59
Q

Extent of skin absorption of hydrophilic drug in a hydrophilic base

A

Soluble in vehicle but not skin; remains on surface of skin.

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60
Q

Properties of drugs suitable for transdermal delivery

A

Low molecular weight, moderately lipophilic, potent, short half-life

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61
Q

Three stages of wound healing

A

Inflammation
Proliferation
Tissue remodelling

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62
Q

Skin manifestations of obesity

A 
Acanthosis nigricans
Skin tags
Hirsutism
Acne
Hidradenitis suppurativa
Androgenic alopecia
Stretch marks
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63
Q

Intertrigo

A

Red plaques develop in skin folds - usually in obesity

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64
Q

Skin manifestations of vit A deficiency

A

Keratotic follicular papules, dry skin

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65
Q

Skin manifestations of vit K deficiency

A

Purpura, bruising

66
Q

Skin manifestations of vit B2 (riboflavin) deficiency

A

Cheilosis, angular stomatitis, painful red tongue

67
Q

Skin manifestations of vit B3 (niacin) deficiency

A

Dermatitis - symmetrical red rash on sun exposed areas. Tongue and lip inflammation

(Pellagra - Dermatitis, Delirium, Diarrhoea, Death)

68
Q

Skin manifestations of vit B6 deficiency

A

Dermatitis of face, scalp, neck, shoulders, perineum.

Glossitis

69
Q

Skin manifestations of folate deficiency

A

Angular stomatitis, glossitis, skin and mucous membrane pigmentation

70
Q

Skin manifestations of vit B12 deficiency

A

Angular stomatitis, glossitis, skin and mucous membrane pigmentation

71
Q

Skin manifestations of biotin deficiency

A

(Rare)

Facial dermatitis, glossitis, alopecia

72
Q

Skin manifestations of vit C deficiency

A

Hyperkeratosis around hair follicles, bent hairs, inflamed gums, impaired wound healing

73
Q

Skin manifestations of zinc deficiency

A

Dermatitis of hands and feet, alopecia. Facial dermatitis in genetic congenital deficiency.

74
Q

Skin changes in Kwashiorkor

A

Irregular/patchy discolouration. Dry skin may split when stretched, revealing pale areas between cracks - ‘crazy paving dermatosis’.

75
Q

Most common food allergies

A

Cow’s milk, eggs, shellfish, fish, soya, peanuts, wheat, tree nuts

76
Q

How much emollient should be used in asthma?

A

300-500g weekly

77
Q

Example of mild steroid

A

Hydrocortisone 1%

78
Q

Examples of moderate steroids

A

Modrasone
Clobetasone butyrate
(0.05%)

79
Q

Examples of potent steroids

A 
Mometasone
Betmaetasone valerate (0.1%)
80
Q

Example of very potent steroid

A

Clobetasol proprionate 0.05%

81
Q

How much topical corticosteroid is needed for full body application (adult)?

A

20-30g

82
Q

Examples of calcineurin inhibitors

A

Tacrolimus, pimecrolimus

83
Q

Use of calcineurin inhibitors

A

Atopic eczema

84
Q

Treatment of dermatophytes

A

Clotrimazole or terbinafine

85
Q

Treatment of pityriasis versicolor

A

Ketoconazole

86
Q

Parakeratosis

A

Persistence of nuclei in the keratin layer of skin

87
Q

Hyperkeratosis

A

Thickening of keratin layer

88
Q

Acanthosis

A

Increased thickness of epithelium

89
Q

Spongiosis

A

Oedema between squamous cells

90
Q

Histology of lichen planus

A

Sawtooth acanthosis, hypergranulosis, orthohyperkeratosis

91
Q

Antibodies in pemphigus vulgaris

A

IgG against desmoglein 3

92
Q

Antibodies in bullous pemphigoid

A

IgG against hemidesmosome antigens

93
Q

Dermatitis herpetiformis HLA association

A

HLA-DQ2

94
Q

Antibodies in dermatitis herpetiformis

A

IgA targeting gliadin, cross-reacting with connective tissue matrix proteins

95
Q

Which common skin condition is thought to be related to demodex mites?

A

Rosacea

96
Q

Common coagulase-positive staph

A

Staph aureus

97
Q

Common coagulase-negative staph

A

Staph epidermidis

98
Q

a-haemolytic strep species

A

Strep pneumoniae

Strep viridans

99
Q

Antibiotic of choice for staph aureus

A

Flucloxacillin

100
Q

Antibiotics for MRSA

A

Doxycycline, cotrimoxazole, clindamycin, vancomycin

101
Q

Antibiotic for strep pyogenes

A

Penicillin (or fluclox)

102
Q

Organism in type 1 necrotising fasciitis

A

Mixed anaerobes and coliforms

103
Q

Organism in type 2 necrotising fasciitis

A

Group A strep

104
Q

Scabies treatment

A

Malathion lotion and benzyl benzoate

105
Q

Ramsay Hunt syndrome is caused by reactivation of VZW in which ganglion?

A

Geniculate ganglion of CV VII

106
Q

What age is shingles vaccine given at?

A

70

107
Q

Which type of HSV is the main cause of oral lesions?

A

HSV1

108
Q

How does aciclovir work?

A

Selectively incorporated into viral DNA and inhibits replication

109
Q

Which virus causes hand, foot and mouth disease?

A

Enterovirus, particularly Coxzackie

110
Q

What virus causes erythema infectiosum/slapped cheek?

A

Parvovirus B19

111
Q

Test for slapped cheek

A

Parvovirus B19 IgM

112
Q

Treatment of Lyme disease

A

Doxycycline, amoxicillin

113
Q

Auspitz sign

A

Feature of psoriatic lesions where removal of surface scale reveals small bleeding points

114
Q

Exacerbating factors in rosacea

A

Changes in temperature, alcohol, spicy food, UV light

115
Q

What is rhinophyma?

A

Enlarged/malformed nose sometimes seen in rosacea

116
Q

What are Wickham’s striae?

A

Fine lace-like patterns on areas of lichen planus

117
Q

Prognosis of lichen planus

A

Generally resolves after 12-18 months

118
Q

Level of split in bullous pemphigoid

A

DEJ

119
Q

Level of split in pemphigus

A

Intra-epidermal

120
Q

What is Nikolsky’s sign?

A

Top layers of skin slip away from lower layers when rubbed - indicative of cleavage at epidermis as in pemphigus

121
Q

Which bullous disorder has a high mortality if left untreated?

A

Pemphigus

122
Q

Which type of hypersensitivity reaction is contact dermatitis?

A

Type 4

123
Q

Presentation of eczema herpeticum

A

Monomorphic ‘punched-out’ lesions

124
Q

Diagnostic criteria for atopic eczema

A 
Itching plus 3 or more of:
Visible flexural rash
Personal history atopy (or 1st degree rel if <4 years)
Generally dry skin
Onset before age 2
125
Q

Cutaneous signs of tuberous sclerosis

A 
Ash-leaf macules (depigmented)
Periungual fibromas
Facial angiofibromas
Shagreen patches
Longitudinal ridging of nails
126
Q

Tuberous sclerosis genetics

A

Autosomal dominant

TSC1 and TSC2 mutations - tuberin and hamartin

127
Q

NF1 presentation

A 
Cafe au lait
Neurofibromas
Plexiform neuromas
Axillary/inguinal freckling
Optic glioma
Lisch nodules
128
Q

Drugs causing drug induced bullous pemphigoid

A

ACE inhibitors
Penicillin
Furosemide

129
Q

Drugs causing SJS/TEN

A 
Sulphonamides
Cephalosporins
Carbamazepine
Phenytoin
NSAIDs
Nevirapine
Lamotrigine
Sertraline
Tramadol
130
Q

Chemical mediators of itch

A 
Histamine
PGE2
ACh
Serotonin
Kallikrein
Interleukin 2
Substance P tryptase
131
Q

Most common skin cancer

A

BCC

132
Q

BCC presentation

A

Slow growing lump or non-healing ulcer, may be pearly or translucent
Central ulceration common - ‘rodent ulcer’.

133
Q

SCC presentation

A

Warty or crusted lump or ulcer, often on sun-damaged skin.

134
Q

Precursors of SCC

A

Actinic keratoses

Bowen’s disease

135
Q

Which skin cancer is massively increased in organ recipients?

A

SCC

136
Q

Which Fitzpatrick skin types can burn?

A

I-III

137
Q

Risk of which skin cancer is associated with lifetime cumulative UV exposure?

A

SCC

138
Q

Which protein converts phaeomelanin to eumelanin?

A

MC1R

139
Q

Which melanin causes red hair?

A

Phaeomelanin

140
Q

Melanoma staging

A 
pTis - in situ
pT1 - <1mm thick
pT2 - 1-2mm
pT3 - 2-4mm
pT4 - >4mm
141
Q

Appearance of seborrheic keratosis

A

Brown, ‘stuck-on’ appearance

142
Q

SCC precursors

A

Bowen’s disease (SCC insitu), actinic keratosis

143
Q

Most common type of chronic leg ulcer

A

Venous

144
Q

Appearance of venous ulcer

A

Shallow with irregular borders and granulating base

Common over medial malleolus

145
Q

ABPI restrictions on compression of ulcers

A

Must be >0.6

146
Q

Appearance of arterial ulcer

A

Small deep lesions with well-defined borders and necrotic base, found distally at sites of trauma and pressure areas

147
Q

Appearance of neuropathic ulcer

A

‘Punched out’, found on sites of pressure on feet. Painless.

148
Q

Management of nBCC

A

Usually excision

149
Q

Management of sBCC

A

Imiquimod, PDT, cryotherapy

150
Q

Management of SCC precursors

A

Cryotherapy, topical 5-FU, imiquimod, photodynamic therapy

151
Q

Management of seborrheic keratosis/basal cell papilloma

A

Cryotherapy or curettage

152
Q

Treatment of animal/human bite

A

Co-amoxiclav

153
Q

When is chickenpox no longer considered contagious?

A

When lesions have crusted over ~5 days after appearing

154
Q

Which age group is shingles vaccine given routinely to?

A

70-79

155
Q

Antibiotic used in impetigo

A

Fluclox - only if extensive infection

156
Q

Most common organism in cellulitis

A

Strep pyogenes

157
Q

1st line antibiotic in cellulitis

A

Flucloxacillin

158
Q

Which type of virus causes molluscum contagiosum

A

Poxvirus

159
Q

Diagnosis of pityriasis versicolor

A

Mainly clinical - if uncertain Woods lamp and/or skin scraping can be useful

160
Q

Which common childhood rash can result in hydrops foetalis if a pregnant woman is exposed?

A

Parvovirus B19/Fifths/slapped cheek

161
Q

Viruses causing hand foot and mouth

A

Coxsackie A16 and A10, enterovirus 71

162
Q

Treatment of lice

A

malathion lotion

2nd year (6 decks)

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