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dermatology - high yield Flashcards

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Dermatology Board Prep flashcards
1
Q

what is the water proof barrier of skin

A

keratin layer

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2
Q

what does the keratin layer contain

A

corneocytes

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3
Q

what does the granular layer consist of

A

large keratinocyte granules

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4
Q

what do the large keratinocyte granules conatain

A

fillagrin and involucrin

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5
Q

what does the prickle cell layer contain

A

desmosomes that anchor cells together

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6
Q

what is the epidermal layer closest to the dermis

A

basal

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7
Q

how thick is the basal layer

A

one cell thick

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8
Q

what is the metabolically active layer of the epidermis

A

the basal layer

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9
Q

what are the 4 epidermal cells

A

keratinocytes, langerhans cells, merkel cells and melanocytes

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10
Q

what makes up 95% of the cells in the epidermis

A

keratinocytes

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11
Q

where do keratinocytes originate

A

in the basal layer

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12
Q

where do keratinocytes end up

A

in the stratum coneum

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13
Q

what do keratinocytes do

A

produce cytokines and are involved in immune response

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14
Q

where are melanocytes found

A

in the basal layer

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15
Q

what do melanocytes do

A

produce melanin that forms a protective overcap over the nucleus of cells

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16
Q

what is eumelanin

A

brown/black

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17
Q

what is phaemelanin

A

red/yellow

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18
Q

where are langerhans cells found

A

in the prickle cell layer and dermis

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19
Q

where are langerhans cells formed

A

in bone marrow

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20
Q

what are langerhans cells

A

dendrictic cells involved in the immune system

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21
Q

how to langerhans cells work

A

attach to antigen and present it in the lymph nodes

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22
Q

where are merkel cells found

A

in the basal layer

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23
Q

what are merkel cells

A

mechanoceptors sensitive to light touch

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24
Q

anagen

A

growth phase

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25
Q

how long does anagen last

A

3-7 years

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26
Q

catagen

A

involuting stage

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27
Q

how long does catagen last

A

28 days

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28
Q

what is telogen

A

resting phase

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29
Q

when does telogen occur

A

everyday

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30
Q

3 layers of the dermis

A

lamina lucida, lamina densa, sub lamina densa zone

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31
Q

what does the dermis contain

A

fibroblasts, macrophages, langerhans cells, mast cells

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32
Q

what senses vibration

A

meissners corpuscles

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33
Q

what senses pressure

A

pacinian corpuscles

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34
Q

what senses painful stimuli

A

free nerve endings

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35
Q

where are aebaceous glands found

A

everywhere - especially face, chest and upper back

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36
Q

what gland is affected in acne

A

sebaceous gland

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37
Q

what are apocrine glands part of

A

pilo sebaceous unit

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38
Q

what do sabaceous glands release

A

oil

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39
Q

what do apocrine glands produce

A

oily fluid, odorous

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40
Q

why is the oily fluid smelly in apocrine glands

A

due to decompisition by bacteria

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41
Q

where are apocrine glands found

A

armpits, groin, eyelids, ears

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42
Q

what is the function of eccrine glands

A

cool down the body

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43
Q

where are eccrine glands found

A

everywhere especially hands, feet armpits and forehead

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44
Q

what is the role of keratinocytes

A

to release chemokine and cytokine and sense pathogens via surface receptors and produce anti microbial peptides that kill pathogens

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45
Q

what are the main antigen presenting cell in skin

A

langerhan cells

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46
Q

what do langerhan cells contain

A

birbeck granule

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47
Q

what to langerhans cells do

A

present pathogens to T cells

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48
Q

what T cells are found in the epidermis

A

CD4 and CD8

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49
Q

what T cells are found in the dermis

A

CD4 T cells

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50
Q

what T cells are involved in inflammation

A

CD4 and T helper cells

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51
Q

what T cell is psoriasis associated with but dermatitis isnt

A

TH1

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52
Q

what t cell is atopic dermatitis associated with but psoriasis isnt

A

TH2

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53
Q

what t cell is associated with both psoriasis and atopic dermatitis

A

TH17

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54
Q

examples of conditions with inappropriate inflammatory responses

A

psoriasis, urticaria, skin tumours, atopic dermatitis, bullous pemphigoid and SLE

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55
Q

what are prophyrias

A

manifestations in the skin due to accumulations of porphyrins

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56
Q

what does reduced activity of the enzymes that produce heam lead to

A

increase porphyrins

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57
Q

what is prophyria cutanea tarda due to

A

reduced activity of uroprophrinogen decarboxylase

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58
Q

symptoms of prophyria cutanea tarda

A

blisters, milia, hyperpigmentation, hypertrichosis, solar urticaria

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59
Q

how to diagnose prophyria cutanea tarda

A

plasma screen and urine test (woods lap)

60
Q

what is erythropoietic protophyria caused by

A

reduced activity of ferrochelectase

61
Q

signs of erythropoueric protophyria

A

burning senstation, no physical signs, pain in sunlight, swelling and itching

62
Q

investigations of prophyrias

A

plasma screen, RBC porphyrins, transaminases

63
Q

what causes acute intermittent porphyria

A

reduced activity of PBG deaminase

64
Q

what is the lamina propia

A

a layer of loose connective tissue found in mucous membranes like the respiratory tract

65
Q

what builds up in acute intermiitent porphyrias

A

porphobillogen

66
Q

what builds up in erythropoietic protoporphyria

A

protoporphyrin

67
Q

what type of hypersensitivity is bullous pemphigoid

A

type 2

68
Q

what causes bullous pemphigoid

A

auto antibody deposition on the basement membrane

69
Q

what are the auto antibodies in bullous pemphigoid developed against

A

hemi desmosomes

70
Q

clinical features of bullous pemphigoid

A

deep tense blisters which are itchy and located around the flexures

71
Q

is the nikolsky sign in bullous pemphigoid positive

A

no

72
Q

who does bullous pemphigoid tend to affect

A

the elderly population

73
Q

how to diagnose bullous pemphigoid

A

skin biopsy and immunofluorescence

74
Q

what does immunoflourenscece in bullous pemphigoid show

A

deposition of IgG and C3 at the dermo epidermal junction

75
Q

what is the management of bullous pemphigoud

A

potent topical corticosteroids or oral corticosteroids, immunosuppressants and antibiotics

76
Q

what is pemphigus vulgaris

A

an autoimmune condition where there is deposition of IgG autoantibodies in the epidermis

77
Q

clinical features of pemphigous vulgaris

A

flaccid, superficial blisters that are painful but nt itchy

78
Q

is the nikolksy sign positive in pemphigus vulgaris

A

yes

79
Q

what is the most common presenting symptom of pemphigous vulgaris

A

oral mucosa being affected

80
Q

what has a higher mortality pemphigus vulgaris or bullous pemphigoid

A

pemphigoid vulgaris

81
Q

how to diagnose pemphigoid vulgaris

A

skin biopsy and immunofluorescence

82
Q

what does immunofluorescnce of pemphigus vulgaris show

A

deposition of IgG auto antibodies in the epidermis causing a chicken wire appearance

83
Q

what is the management of pemphigus vulgaris

A

oral corticosteroids

84
Q

what is dermatitis herpetiformis

A

an autoimmune condition caused by deposition of IgA autoantibdies in the dermis

85
Q

what is dermatitis herpetiformis strongly correlated with

A

coeliac disease

86
Q

clinical features of dermatitis herpetiformis

A

itchy, vesicular lesion on the extensor surfaces

87
Q

diagnosis of dermatitis herpetiformis

A

skin biopsy and immunofluorescence

88
Q

what does immuno fluresnce in dermatitis herpetiformis look like

A

deposition of IgA in granular pattern in the upper dermis

89
Q

what is the management dermatitis herpetiformis

A

gluten free diet - dapsone can help

90
Q

what are the antibodies against in pemphigous vulagris

A

desmoglein

91
Q

what is epidermolysis known as

A

butterfly skin

92
Q

inheritance of epidermolysis

A

autosomal dominant usually

93
Q

history of epidermolysis

A

young child with fragile skin blisters all over body rubbing skin causes painful tear

94
Q

presentation of actinic keratosis

A

scaly rash over temples and nose which has lesions red and pink in colour

95
Q

risk factors for actinic kertosis

A

outdoor occupation, pale skin, not applying suncream

96
Q

presentation of psoriasis

A

symmetrical sharply demarcated scaley erythematous plaques involving extensor surfaces, scalp, sacrum, hands, feet trunk and nails

97
Q

peak onset of psoriasis

A

15-25 or 50-60

98
Q

cause of psoriasis

A

multifactorial

99
Q

histology of psoriasis

A

epidermal acanthosis, parakeratosis, elongated rete ridges on histology

100
Q

presentation of guttate psoriasis

A

acute and spotty

101
Q

presentation of palmoplantar pustular

A

painful to walk on

102
Q

what does psoriasis demonstrate

A

koebner phenomenon and auspitz sign

103
Q

systemic disease associated wuth psoriasis

A

psoriasitic arthritis, metabolic syndrome, crohns, cancer, uveitis, depression, alcohol, smoking

104
Q

managemnet of psoriasis

A

vit d analogue, coal tar, dithranol, steroids, keratinolytics, photo therapy, immunosuppression and immune modulation

105
Q

examples of vit D analogues

A

calcitriol calcipotriol

106
Q

pathophysiology of eczema/dermatitis

A

spongiosis and inflammatory cell infiltertrate

107
Q

presentation of eczema/dermatitis

A

ill defined erythematois itchy rash

108
Q

pathogenesis of contact allergic dermatitis

A

type 4

109
Q

histology of contact allergic dermatitis

A

spongiotic dermatitis

110
Q

pathogenesis of contact irritant dermatitis

A

trauma (soap, water)

111
Q

histology of contact irritant dermatitis

A

spongiotic dermatitis

112
Q

pathogenesis of atopic dermatitis

A

genetic and environmental factors resulting in inflammation

113
Q

histology of atopic dermatitis

A

spongiotic

114
Q

pathogenesis of drug related dermatitis

A

type 1 or 4

115
Q

histology of drug related dermatitis

A

spongiotic and eosinophils

116
Q

pathogenesis of photo inficed dermatitis

A

reaction to UV light

117
Q

histology of photo induced dermatitis

A

spongiotic

118
Q

pathogenesis of lichen simplex

A

physical trauma to skin - scratching

119
Q

histology of lichen simplex

A

songiotic dermatitis and external trauma

120
Q

pathogenesis of stasis dermatitis

A

physical trauma to skin - hydrostatic pressur e

121
Q

histology of stasis dermatitis

A

spongiotic dermatitis and extravasation of RBCs

122
Q

what is Th2, IL4, 5 and 6 and filaggrin gene mutation assocated with

A

atopic dermatitis

123
Q

diagnosis of atopic dermatitis requires

A

itch plus 3 or more of the followng - visible flexural rash, history of delxural rash, history of atopy, generally dry skin, onset before the age of 2

124
Q

management of atopic dermatitis

A

irritant avoidance, soap substitution, emollient, topical steroids, photo therapy, systemic immunosuppressants, biologics

125
Q

what is acne vulgaris

A

inflammatory disease of pilosebaceous unit

126
Q

process of acne development

A

increased production of sebum, poral occlusion, cutibacterium acne colonisation, dermal inflammation

127
Q

features of acne

A

comedones, pustules, papules, cysts, nodules, erythema, sebborhoea

128
Q

secondary features of acne

A

scarring - atrophic, icepick, hypertrophic/keloid, hyperpigmentation

129
Q

what does acne mostly affect

A

face, upper back, anterior chest

130
Q

management of acne

A

avoid oily substances, benzoyl peroxed, vit A derivative, antibiotics

131
Q

systemic management of acne

A

antibiotic - tetracycline, isotretinoin

132
Q

who does rosacea typically affect

A

women aged 30-60

133
Q

features of rosacea

A

papules, pustuesm erythemia of nose chin, cheeks, forehead, facial flushing

134
Q

what can rosacea cause

A

rhinophyma, telangiectasia, conjuctivitis

135
Q

management of rosacea

A

avoidance of aggravating factors, topical antimicrobials, oral tetratcycline

136
Q

example of topical antimicrobial

A

metronidazole, ivermectin

137
Q

how can rhinophyma be treated

A

with isotrenoin, vascular laser and surgery

138
Q

who does lichen planus affect

A

middle aged

139
Q

pathophysiology of lichen planus

A

T cell mediated inflammation targeting unknown protein in skin and mucosal keratinocytes

140
Q

lichen planus features

A

violaceous flat topped shiny papules affecting volar wrists, forearms, shins, ankles, wickhams striae

141
Q

what is wickhams striase

A

longitudinal nail ridges, hyperpigmentation, hypertrophy

142
Q

management of of lichen planus

A

emollients symptomatic topical oral steroids, photo therapy

143
Q

how long does lichen planus last

A

12-18 months

144
Q

first line management of psoriasis

A

emollient, potent corticosteorid, vit D analogue

145
Q

histology of psoriasis vulgaris

A

acanthosis

dermatology (12 decks)

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