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D&D > Exam 3 - Dermatology > Flashcards

Exam 3 - Dermatology Flashcards

1
Q

Fitzpatrick Skin Types

A 
1 - Never tans, always burns
2 - Hardly tans, usually burns
3 - Average tanning, sometimes burns
4 - Easily tans, rarely burns
5 - Very easy to tan, very rarely burns
6 - Never burns
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2
Q 
Dark skin
(Melanosome distribution and melanin type)
A

Melanosomes larger
Distributed throughout cytoplasm of keratinocyte
Eumelanin: black to brown pigment

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3
Q 
Light skin 
(Melanosome distribution and melanin type)
A

Melanosomes smaller
Distributed in clusters above nucleus of keratinocyte
Pheomelanin: yellow to red/brown pigment

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4
Q

Vitiligo

A

Autoimmune attack against melanocyte
Acquired depigmentation
Absence of melanocytes

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5
Q

Hemidesmosomes

A

Keratinocyte attachment to dermal border
Dermal-epidermal junction
Dz: EB, Bullous Pemphigoid

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6
Q

Desmosomes

A

Keratinocytes attachment to other keratinocytes
Stratum spinosum (epidermis)
Dz: Pemphigus Vulgaris

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7
Q

Recessive Dystrophic Epidermolysis Bullosa

A 
Defect in collagen VII at DEJ (congenital)
Pseudosyndactyly (mitten hand deformity)
Flexion contractures
Increased risk of SCC
Infection
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8
Q

Bullous Pemphigoid

A 
Aquired blistering of DEJ
Antibodies to BP 230 and BP 180
Tense blister (hemidesmosomes)
No MM (No des3)
Often on flexor surfaces
Linear on IMF along BM
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9
Q

Pemphigus Vulgaris

A

Antibodies to desmoglein 1 (skin) and 3 (MM)
Flaccid bulla (intraepidermal blisters)
Desmosomes
Not linear on IMF (obliterated epidermis)

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10
Q

Epidermolysis Bullosa Simplex

A

Defect in keratin 5 and 14
Blisters on hands, feet, and extremities
Manage with age

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11
Q

Icthyosis Vulgaris

A

Filaggrin mutation - NMF loss
Defective skin barrier
Large white scaly appearance

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12
Q

Epithelial Zones

A

Stratum corneum
Stratum granulosum
Stratum spinosum
Stratum basalis

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13
Q

Dermal Zones

A

Papillary dermis - interlocks with epidermal rete, thin collagen bundles
Reticular dermis - visible elastic fibers, thick collagen bundles

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14
Q

Major Components of Dermis

A

Collagen - strength
Elastic fibers - resilience
Ground substance - facilitates diffusion

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15
Q

Solar elastosis

A

Acquired disorder of elastin

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16
Q

Pseudoxanthoma Elasticum

A

Congenital disorder of elastin

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17
Q

Hair phases

A

Anagen - growing (3 years)
Catagen - transition (3 weeks)
Telogen - resting (3 months)

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18
Q

Seborrheic Dermatitis

A 
cradle cap - scalp
Malassezia furfur (fungus)
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19
Q

Stasis dermatitis

A

lower extremity edema

bilateral

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20
Q

Numular Dermatitis

A

Excess use of soap and dry skin
Red scaly patches
Minimize soap, moisturize, topical steroids

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21
Q

Types of Hypersensitivity Reactions

A

Type I - Anaphylactic rxn (immediate)
Type II - Cytotoxic rxn
Type III - Immune complex rxn
Type IV - Delayed type hypersensitivity rxn

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22
Q

Type I HS

A

Immediate
IgE to antigen
Histamine release
Ex: urticaria and angioedema

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23
Q

Type II HS

A

Cytotoxic
IgG bind and lysis (activates complement)
Ex: ABO mismatch

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24
Q

Type III HS

A

Immune complex
Organ and vessel deposition
Activation of complement - inflammatory damage
Ex: serum sickness

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25
Q

Type IV HS

A

Delayed
Langerhans cells are APC
Local rxn w/out antibodies
Ex: Drug eruptions, allergic contact dermatitis

26
Q

Allergic contact dermatitis

A

Delayed type IV rxn

Dx w/ patch testing

27
Q

Psoriasis

A

Increased risk of CVD
Extensor surfaces
May include arthritis over joints

28
Q

Atopic Dermatitis

A

Filaggrin mutation - NMF loss
Defective skin barrier
Flexor surfaces
Associated with asthma and allergic rhinitis

29
Q

Erysipelas

A

aka St. Anthony’s Fire
Strep pyogenes
Common on face (cliff drop border, non-pitting, pain)
Lymphadenopathy

30
Q

Impetigo

A 
Non-bullous (80) and bullous (20)
High humidity
Cutaneous carriage
Poor hygine
Honey colored crust
31
Q

Non-bullous impetigo

A

Face followed by extremities

Strep pyogenes or staph aureus

32
Q

Bullous impetigo

A

Anywhere on body

Staph aureus ONLY

33
Q

Cellulitis

A 
Extremities (unilateral)
Painful erythemia WTT
Lymphatic streaking
Regional lymphadenopathy
Septic danger (staph a, strep p, h. flu)
34
Q

KOH Examination of skin

A

Used with fungal infections
Hyphae/arthrospores = Tinea
Pseudohyphae/yeast = Candidiasis
Short hyphae/yeast (spaghetti/meatballs) = Tinea versicolor

35
Q

Fungal culture test

A

Dermatophyte Test Medium (DTM)

Sabouraud agar

36
Q

Fungal biopsy stain

A

PAS w/ diastase

Gomori methenamine silver (GMS)

37
Q

Tinea Versicolor

A

Warm/humid, post pubertal patients
Food: follicular lipids
Hyper/hypopigmented macules/patches on chest

38
Q

Scabies

A

Webspace, flexures, waist, axillary, genital
Night, hot bath
Burrows and genital nodules

39
Q

Seborrheic Keratosis

A

“Barnacles of Life”
Stuck on appearance
Leser-Trelat sign - indication of internal malignancy

40
Q

Malignant Melanoma ABCDE

A 
Asymmetry
Border irregularity
Color variation
Diameter >6mm
Evolution
The ugly duckling
41
Q

Skin defenses against UV

A

DNA repair
Apoptosis of cells with damage
Defenses against ROS
Melanin

42
Q

Actinic keratosis

A

Common precancer
1/1000 will go on to cancer in a year
Usually becomes SCC

43
Q

Basal cell carcinoma

A

Most common (2nd in IS/IC patients)
Pearly and shiny
Not usually fatal

44
Q

Squamous cell carcinoma

A

2nd most common (1st in IS/IC patients)

More invasive than BCC

45
Q

FAMM syndrome

A

Familial atypical moles and melanoma
Malignant melanoma in 1 or more 1/2 degree relatives
Numerous atypical nevi
148x risk (biggest RF)

46
Q

UVA

A

Longer wavelength
Penetrates deeper
Dark patches, wrinkles, loose skin
DNA damage

47
Q

UVB

A 
Shorter wavelength
Penetrates more shallow
Vitamin D synthesis
Sunburns
Eye problems
DNA damage
48
Q

6 UV effects on skin

A 
Damage to DNA, RNA, lipids, proteins
Pro-inflammatory
Immunosuppressive
Induction of innate defense
Induction of apoptosis
Vitamin D synthesis
49
Q

3 Photodermatoses

A

Lupus Erythematosus
Dermatomyositis
Mixed Connective Tissue Disease

50
Q

4 dermatomyositis clinical signs

A

Heliotrope leading to periorbital edema
Samitz sign = ragged cuticles
Gottron’s papules=extensor lichenoid papules/poikiloderma
Shawl sign

51
Q

Dermatomyositis and malignancy

A

Adult onset is sign of internal malignancy (10-50%)

52
Q

Neurofibromatosis Type I criteria

A
  1. > 6 cafe au lait
  2. > 2 neurofibromas or >1 plexiform neurofibroma
  3. Crowe’s sign (axillary/inguinal freckling)
  4. Optic glioma
  5. > 2 Lisch nodules
  6. Osseous lesion, sphenoid wing dysplasia, cortex thin
  7. 1st degree relative with dz
53
Q

Tuberous Sclerosus

A

Adenoma sebaceum
Hypomelanotic macules
Shagreen patch

54
Q

Kaposi’s Sarcoma

A

Indication of immunocompromise

Triggered by HHV-8

55
Q

Pyoderma Gangrenosum

A

Neutrophil overreaction
Large skin wound - AVOID I&D = more trauma
Usually have underlying AI Dz

56
Q

Lichen Planus

A

Purple, polygonal, pruritic papules
Wickham’s striae - overlying lace like pattern
Concern for hepatitis C

57
Q

Acanthosis Nigricans signs and mech

A

Velvety dark patch
Usually neck, axillae, dorsal hands
Epid keratinocyte and D fibroblast proliferation

58
Q

Acanthosis nigricans associations

A 
Familial
Obesity
Diabetes
Endocrinopathies (Cushing's)
Drugs (rare)
Malignancy (look for weight loss)
59
Q

4 drug factors that affect skin absorption

A

Drug concentration
Molecular size
Lipophilicity
Vehicle composition

60
Q

4 patient factors that affect skin absorption

A

Barrier disruption
Anatomic location
Skin hydration (up=up)
Occlusion

61
Q

Classifications of topical steroids

A

Class 1 to Class 7

More to less potent

62
Q

Examples of topical steroids

A

Class 1: Clobetasol
Class 4: Triamcinolone
Class 7: Hydrocortizone

D&D (6 decks)

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