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Year 2 MBChB Dermatology > General Disease > Flashcards

General Disease Flashcards

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Dermatology Board Prep flashcards
1
Q

What is acne vulgaris + where does it usually affect?

A

Inflammation of the pilosebaceous unit

Face, back and chest

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2
Q

Explain the disease pathway of acne vulgaris.

A

Increased androgens causes increased sebum which blocks pores
Rupture causes inflammation
Increased propionibacterium furthers inflammation

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3
Q

Give examples of primary (non) + secondary (inflammatory) acne lesions?

A 
Primary = open comedones/ blackheads and closed comedones/ whiteheads
Secondary = pustules, papules and cysts
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4
Q

Treatment for mild non-inflammatory + inflammatory acne vulgaris?

A

Topical retinoid or salicylic acid

Topical retinoid + topical abx + benzoyl peroxide

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5
Q

Treatment for moderate + severe inflammatory acne vulgaris?

A

Topical retinoid + oral abx + benzoyl peroxide

Oral retinoid +/- steroids

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6
Q

What is acne rosacea + who is it more common in + 2 histological signs?

A

Inflammatory facial rash
Middle-aged women
Demodex mites and perifollicular granulomas

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7
Q

5 clinical features of acne rosacea?

A 
NO COMEDONES 
Erythema
Telangiectasia 
Rhinophyma
Eye involvement
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8
Q

4 factors which irritate acne rosacea?

A

Alcohol
Temperature change
Steroids
Spicy foods

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9
Q

Suspected pathology behind acne rosacea + target treatment?

A

Excess Demodex mites

Ivermectin

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10
Q

2 optional treatment for mild + treatment for severe acne rosacea?

A

Topical metronidazole or oral tetracycline

Isotretinoin if severe

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11
Q

What is the atopic triad?

A

Asthma
Atopic dermatitis
Hay fever/ allergic rhinitis

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12
Q

Explain the disease pathway of atopic dermatitis.

A

Mutation in filaggrin + decreased AMP from keratinocytes causes reduced skin barrier and moisture loss

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13
Q

Which 3 CD4+ cells drive inflammation in atopic dermatitis?

A

Th2, Th17 and Th22

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14
Q

What is the clinical presentation + 1 histological sign of atopic dermatitis + who is it seen more in?

A

Poorly bordered, red, itchy and flaky rash
Spongiosis
Kids

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15
Q

Which sites does atopic dermatitis present in infants and children/adults?

A 
Infants = face + extensor
Children/adults = flexural
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16
Q

Chronic atopic dermatitis (lichen simplex) presents as what 3 things?

A

Lichenification
Excoration
Plaques

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17
Q

2 infections following atopic dermatitis + organism + presentation + treatment?

A

Dermatitis herpeticum, HSV, monomorphic punched-out lesions, aciclovir
Impetigo, usually staph. aureus, golden crust and ooze, fluclox

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18
Q

Diagnosis of atopic dermatitis?

A 
Itch + 3 from:
Rash
History of atopy
Dry skin
Onset < age 2
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19
Q

Topical treatment of atopic dermatitis + adjunct therapy if not responding?

A

Topical steroid

Calcineurin inhibitor

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20
Q

2 treatments for atopic dermatitis unresponsive to previous tretment?

A

Phototherapy

Immunosuppresants

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21
Q

What is contact irritant vs allergic dermatitis? Name 3 triggers of each.

A

Non-immune response to trauma = soap, perfume, nappies

Type IV reaction to allergen = nickel, latex, ivy

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22
Q

What test is used to differenciate between irritant/allergic dermatitis + procedure + result?

A

Patch test
Apply allergens to back, remove after 48 hours and check after 72
Allergic = +ve

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23
Q

Treatment for contact allergic or irritant dermatitis?

A

Avoidance
Emollients
Topical steroids

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24
Q

Key feature which differenciates discoid eczema from psoriasis?

A 
Eczema = intense itch
Psoriasis = more pain than itch
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25
Q

Increased hydrostatic pressure causes what 3 things in stasis dermatitis?

A

Oedema
RBC extravasation
Haemosiderin deposits

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26
Q

5 features of stasis dermatitis?

A 
Inflammation
Hyperpigmentation
Varicose veins
Ulcers
Lipodermatosclerosis
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27
Q

Treatment for stasis dermatitis?

A

Compression stocking + topical steroid

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28
Q

Which 2 places does seborrhoeic dermatitis usually present?

A

Nose and hairline

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29
Q

Topical treatments for seborrhoeic dermatitis + adjunct therapy for widespread disease?

A

Topical steroid

Topical antifungal

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30
Q

Treatment for pompholyx or acute exudative eczema?

A

Potassium permanganate

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31
Q

What is erythroderma (erythrodermic psoriasis) + 2 main causes?

A

> 90% of the skin turning red and flaky

Drugs and other skin conditions

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32
Q

Is keratinocyte AMP increased/decreased in eczema vs psoriasis?

A 
Eczema = decreased
Psoriasis = increased
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33
Q

What 4 things are lost in erythroderma + what are the 3 components of treatment?

A 
Heat 
Mositure 
Protein 
Electrolyte
Stop drug (if cause) + IV fluids + emollients
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34
Q

What is psoriasis vulgaris + what 4 areas does it usually affect?

A

Autoimmune disease causing reversible plaques and inflammation
Extensor areas, back, scalp and nails

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35
Q

Name 4 triggers + 3 drugs that can cause psoriasis vulgaris?

A 
Smoking
Alcohol
Stress
Infection
Lithium, amiodarone and beta-blockers
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36
Q

In psoriasis, pDC produce IFN alpha which causes a Th.. and Th.. response with IL-… and IL-…? IL-… causes increased …, … and …?

A

Th1 and Th17
IL-17 and IL-23
IL-17
Keratinocyte proliferation, AMP and neutrophilic killing

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37
Q

Name the 4 key histological features of psoriasis vulgairs.

A

Acanthosis
Hyperkeratosis
Parakeratosis
Elongated rete ridges

38
Q

Name 4 conditions associated with psoriasis vulgaris.

A

Psoriatic arthritis (15%)
CVD
Metabolic disease
Obesity

39
Q

3 nail signs in psoriasis vulgaris?

A

Pitting
Subungual hyperkeratosis
Onycholysis

40
Q

What is the Koebner phenomenon + Auspitz sign?

A 
Koebner = psoriasis in area of skin trauma
Auspitz = skin bleeds when scratching plaque
41
Q

General treatment for psoriasis vulgaris?

A

Topical steroid + topical vit D analogue

42
Q

2 treatments for resistant psoriasis vulgaris?

A

Phototherapy

Immunosuppression

43
Q

3 treatments for scalp psoriasis?

A

Greasy ointment
Coal tar shampoo
Vitamin D analogue

44
Q

Treatment for axillary psoriasis?

A

Calcineurin inhibitor

45
Q

How does guttate psorasis present + treatment?

A

Red spots in young people after strep throat infection

Phototherapy

46
Q

Treatment for pustular psoriasis?

A

Oral retinoid + PUVA

47
Q

Percentage of children who suffer from an allergy?

A

30%

48
Q

5 clinical features of anaphylaxis?

A 
Pruritus
Urticaria
Wheeze
Angioedema 
Anaphylaxis
49
Q

Test + treatment for anaphylaxis?

A

Serum mast cell tryptase

Adrenaline 500 micrograms

50
Q

Test pathway for non-anaphylactic allergic reaction?

A

IgE RAST bloods + skin prick

Challenge test if skin prick -ve

51
Q

Skin prick and challenge testing carry risk of anaphylaxis. True or False?

A

True

52
Q

Treatment of non-anaphylactic allergic reaction + preventative measure?

A

Anti-histamine

Epi-pen (300 adults and 150 kids)

53
Q

What is a chronic leg ulcer?

A

Open ulcer that stays unhealed for at least 4 weeks

54
Q

Most common type of leg ulcer (60-80%)?

A

Venous

55
Q

4 clinical features of leg ulcers?

A

Pain
Exudate
Inflammation
Smell

56
Q

Appearance + location + cause of an arterial ulcer?

A

Punched out
Lateral leg, ankle + heel
PVD

57
Q

Appearance + location + cause of a venous ulcer?

A

Superficial wound
Medial and lateral malleoli
Reduced blood flow to the heart

58
Q

Treatment of non-infected arterial vs venous ulcers?

A

Analgesics + non-adherent dressing

Analgesics + non-adherent dressing + 4-layer compression bandage

59
Q

Life-long treatment of venous ulcers + which class is best tolerated?

A 
Emollient
Compression stockings (class 2)
60
Q

4 methods of de-sloughing?

A

Honey
Hydrogel
Surgical debridement
Maggots

61
Q

3 tests for leg ulcers?

A

ABPI
Swab (if infected)
Duplex scan

62
Q

3 ABPI values + meaning?

A

<0.8 = vascular disease
0.9-1.3 = borderline/normal
> 1.5 = calcification

63
Q

Name drugs which commonly cause drug eruptions + what commonly predisposes a drug eruption.

A 
Antibiotics
Antifungals 
Antimicrobials
Anticonvulsants
NSAIDs
Paracetamol
Phenytoin
Phenobarbital
Chemotherapy agents
Allopurinol
Azathioprine
Thiazide diuretics
Predisposed by viral infection
64
Q

2 most common types of drug eruption + type of hypersensitivity reaction?

A

Exanthematous (type IV)

Urticarial (type I)

65
Q

What is SJS/TEN + classic pre-skin symptoms + cause in kids vs. adults + key clinical sign?

A

Acute skin failure
Flu-like symptoms
Kids = viral infection (SJS) vs Adults = drugs (TEN)
Nikolskys sign +ve

66
Q

Which 2 things make SJS and TEN different from erythema multiforme?

A

Mucosal involvement

Necrosis

67
Q

Erythema multiforme clinical sign + 3 causes (+ main cause)?

A

Target lesions

HSV (main), Mycoplasma and drugs

68
Q

What is Epidermolysis Bullosa (EB) + 3 types and what molecule + layer the mutation affects?

A

AD mutation in DEJ
EB simplex = keratin = epidermis
Junctional = hemidesmosome = DEJ
Dystrophic = type VII collagen = dermis

69
Q

Patient with EB are at high risk of SCC. True or False?

A

True

70
Q

What does pemphigus vulgaris (PV) cause + antibody?

A

Autoimmune intraepidermal blisters

Anti-desmoglein III IgG

71
Q

2 main histological signs of PV + what type of bulla form + pos/negative Nikolsky’s?

A

Acantholysis + epidermal IgG
Thin
+ve

72
Q

2 other ways PV can present?

A

Erosions

Mucosal blistering

73
Q

Tests + treatment triad for PV?

A

Biopsy + immunofluorescence

Steroids + immunosuppresants + abx

74
Q

What does bullous pemphigoid (BP) cause + who is it seen in + antibody?

A

Autoimmune subepidermal blisters + plaques
Elderly people
Anti-hemidesmosome IgG

75
Q

What is the main histological sign of BP + what type of bulla form + pos/neg Nikolsky’s sign?

A

Basement membrane IgG
Thick
-ve

76
Q

Test + treatment triad for BP?

A

Biopsy + immunofluorescence

Steroids + immunosuppressants + tetracycline

77
Q

Is PV or BP more fatal if left untreated?

A

PV

78
Q

What does dermatitis herpetiformis cause + linked disease + haplotype?

A

Subepidermal blistering
Coeliac disease
HLA DQ2

79
Q

What is the dermatitis herpetiformis antibody + key histological sign?

A

Anti-gliadin IgA

Papillary dermal micro abscesses

80
Q

What are porphyrins + what causes a porphyria?

A

Building blocks of haem

Lack of an enzyme which breaks down porphyrins

81
Q

What is the most common porphyria + who does it affect + deficiency?

A

Porphyria cutanea tarda (PCT)
Older males
Uroporphyrinogen III decarboxylase

82
Q

Name 3 signs + unusual sign + 3 causes of PCT.

A 
Hyperpigmentation
Hypertrichosis (excess hair)
Blistering
Red urine
Alcoholism, viral Hep and haemochromatosis
83
Q

Name 2 tests + drug for PCT?

A

Woods lamp
Plasma fluorescence scanning
Chloroquine (anti-malarial)

84
Q

How does erythropoietic protoporphyria (EPP) present + who does it affect + deficiency?

A

Acute attacks of blistering, itch and erythema
Children
Ferrochelatase

85
Q

Name 2 tests for EPP + key value.

A

Plasma fluorescence scanning = 624nm peak

RBC porphyrins

86
Q

What is the management + prophylaxis for EPP?

A

6 monthly LFTs + RBC porphyrins

TL-01 UBV phototherapy/antioxidants/iron avoidance

87
Q

How does acute intermittent porphyria present + deficiency + treatment?

A

Acute attack with GI/cardio/resp symptoms
PGB deaminase
Hematin + heme arginate

88
Q

Name a lichenoid eruption + how it presents + key oral sign + treatment.

A

Lichen planus
Itchy, shiny, purple papules on wrists/shins
Wickham’s striae
Steroids

89
Q

Name 4 histological signs of lichen planus.

A

Acanthosis
Hypergranulosis
Dermal lymphocytes
Basal cytoid bodies

90
Q

What is tuberous sclerosis + genes and proteins affected + presenting triad + treatment?

A

AD disease causing benign tumours
TSC1 or TSC2 - tuberin and hamartin
Tumours, ash leaf macules and seizures
mTOR inhibitors

91
Q

What is NF1 + protein affected and what is controls + how does it present + treatment.

A

AD or de novo disease affecting skin, eyes and CNS
NF1 and switches off cell cycle
Cafe au lait spots, axillary freckling, optic gliomas, tumours and Lisch nodules
MEK inhibitor

92
Q

Give an example of a high penetrance Mendelian disorder.

A

Tuberose sclerosis

Year 2 MBChB Dermatology (8 decks)

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