Miscellaneous Flashcards
1
Q
How can psychological stress trigger a skin condition
A
Activate the hypothalamus and hypophysis resulting in release of neuromediators
Can stimulate release of norepinephrine and cortisol from the adrenal glands
OR
Leukocytes into the blood stream via receptors
2
Q
Give examples of neuromediators
A
Corticotropin-releasing hormone, melanocyte stimulating hormone
3
Q
Role of dryness of skin in defence against infection
A
Desiccates microorganisms
4
Q
Role of sebum in defence against infection
A
Inhibits bacterial growth
5
Q
What is staph
A
Gram positive cocci in clusters
6
Q
Skin and soft tissue treatment options for MRSA
A
Doxycycline, co-trimoxazole, clindamycin
7
Q
Clinical relevance of staph. Saprophyticus
A
Causes UTIs in women of child bearing age
8
Q
Name 3 bacteria that may be commensals
A
Staph. Epi
Corynebacterium
Propionibacterium
9
Q
Give an example of a fungal infection
A
Candidiasis
10
Q
Clinical presentation of candidiasis
A
Infection of the skin folds - under the breasts, groin, abdominal skin folds
11
Q
Diagnosis of candidiasis
A
Swab for culture
12
Q
Management of candidiasis
A
Clotrimazole cream, oral fluconazole
13
Q
Who usually gets ringworm
A
Men
14
Q
How do we get a ringworm infection
A
Most commonly from infected humans
Animals
Soil
15
Q
Causal organisms of ringworm
A
Trichophyton rubrum, T.mentagrophytes and microsportum canis
16
Q
Pathophysiology of ringworm
A
Fungus enters
Hyphae spread to stratum corneum
Increased epidermal turnover causes scaling
Inflammatory response in the dermis
17
Q
What type of tissue can ringworm infect
A
ONLY keratinised tissue
18
Q
How does ring worm infection get its appearance
A
Lesion grows outwards and heals in the centre leaving a ring appearance
19
Q
Local management of ringworm
A
Clotrimazole cream, topical nail paint
20
Q
Management of scalp ringworm
A
Terbinafine or itraconozole orally
21
Q
Who gets scalp ringworm
A
Children
22
Q
What causes scabies
A
Sarcoptes scabiei
23
Q
Incubation period of scabies
A
Around 6 weeks
24
Q
Clinical presentation of scabies
A
Intensely itchy rash
Burrows
25
Where does scabies tend to affect
Finger webs, wrists, genital area
26
Management of scabies
Malathion lotion applied overnight and washed off the next day
27
Management of lice
Malathion
28
What are the 3 main components of a dermatology clinical examination
Distribution
Configuration
Morphology
29
Discrete configuration of lesions
Lesions are well demarcated, can be clearly seen individually
30
Coalescing configuration of lesions
Individual lesions present but starting to merge together to form larger abnormal areas
31
Confluent configuration of lesions
No normal skin visible
32
Annular configuration of lesions
Lesions in a ring-shaped pattern
33
What is pitting of the nails
Small depressions of the nail plate
34
What is oncholysis
Separation of the nail plate from bed
35
What is hypertrichosis
General excess growth of hair
36
Name some local causes of hypertrichosis
Naevi, faun tail, chronic scarring, inflammation
37
State general causes of hypertrichosis
Malnutrition, anorexia, porphyria, occult malignancy, drugs
38
Name some drugs that can cause hypertrichosis
Minoxidil
Phenytoin
Cyclosporin
39
What is hirsutism
Excess growth in a male pattern
40
What is erythema
Vascular dilatation
41
What is purpura
Extravasation of blood
42
How to differentiate between erythema and purpura
Erythema blanches on pressure
43
What is petechia
1-2 mm area of flat purpura
44
What is a macule
Localised flat colour change <1 cm
45
What is a patch
Localised flat colour change >1 cm
46
What is a papule
Localised elevated area <0.5cm
47
What is a nodule
Localised elevated area >0.5 cm
48
Describe a maculopapular rash
Has both flat and elevated components
49
What is a plaque
Raised edge and flatter surface >1 cm
50
What is a pustule
Pus filled raised lesion
51
What is a vesicle
Fluid filled raised lesion <0.5cm
52
What is a bulla
Fluid filled raised lesion >0.5 cm
53
What is a wheal
Compressible dermal swelling
54
What is a cyst
Nodule containing semi-solid material
55
What is scale
Accumulated fragments of keratin layer
56
What is crust
Dried exudate
57
What is lichenification
Thickening with increased skin markings
58
What is a scar
Area where normal tissue is replaced by fibrous tissue
59
What is a fissure
A linear split in the epidermis
60
What is an erosion
A superficial break in the epidermis
61
What is an ulcer
A deeper break into the epidermis
62
What are predisposing factors
Past factors which contribute to the development of a problem
63
What are precipitating factors
Current factors or stressors that triggered the current problem at this time
64
What are perpetuating factors
Issues that contribute to the problem continuing
65
What are heuristics
Mental shortcuts that allow people to solve problems and make judgements quickly and efficiently based on past experiences
66
What is fundamental attribution error
The tendency to be judgemental and blame people rather than examine the circumstances that might have been responsible for
67
What is hindsight bias
Knowing the outcome may influence the perception of past events and prevent a realistic appraisal of what actually occurred
68
What are the 3 main types of hair
Lanugo
Vellus
Terminal
69
What is lanugo hair
Fine long hairs covering the foetus
Shed around 1 month before birth
70
What is vellus hair
Fine, short hair covering much of the body surface
Replaces lanugo hairs
71
What is terminal hair
Long, coarse hairs
72
What influences terminal hair growth
Androgen levels
73
Where do we find terminal hair
Scalp and pubic area
74
What does Hutchinsons sign look like
Spreading pigmentation
75
What might hutchinsons sign indicate
Malignant melanoma
76
What causes beaus lines
Transient arrest in nail growth which occurs during acute stress or illness
77
Name some non-scarring alopecia
Alopecia areata
Traction alopecia
Tines capitis
78
Name some scarring causes alopecia
CDLE
lichen planus
Frontal fibrosinf alopecia
79
What are virulence factors
Factors responsible for pathology and variation in virulence within and between groups of pathogens
80
Name 5 virulence factors
Adhesin
Invasin
Impedin
Agressin
Modulin
81
How does adhesin work
Enables binding of the organism to the host tissue
82
How does invasin work
Enables the organism to invade the host cell or tissue
83
How does impedin work
Enables the organism to avoid the host defence mechanisms
84
How does agressin work
Causes damage to the host directly
85
How does modulin work
Induces damage to the host indirectly
86
What is the commonest cause of toxic shock
TSST-1
87
What causes scalded skin syndrome
Exfoliating toxins A and B from staph aureus
88
Clinical sign of scalded skin syndrome
Positive nikolsky sign
89
Where is scalded skin syndrome usually seen
Neonatal face, axilla and groin
90
What is toxic shock syndrome linked to
Tampon use
91
Diagnostic criteria for toxic shock
Fever >39
Diffuse macular erythroderma and desquamation
Hypotension
>3 organs involved
92
How does protein A act as a virulence factor
Binds to the Fc portion of antibodies, rendering them inaccessible to opsonins, impairing phagocytosis
93
How does coagulase act as a virulence factor
Protects against phagocytosis
94
What is coagulase
Protein enzyme tightly bound to the surface of staph aureus which can coat its surface with fibrin upon contact with blood
95
How does a capsule act as a virulence factor
Protects bacteria against phagocytosis
96
What is Panton-valentine leukocidin
Specific secreted proteins that form one functional complex that attacks white blood cells
97
Describe strep pyogenes
Gram positive cocci in chains, coagulase negative
98
Where in the body is strep pyogenes usually found
Pharynx
99
What most commonly causes necrotising fasciitis type 2
Strep pyogenes
100
What is the risk of an affected child if a parent has an autosomal dominant disorder
50%
101
What is haploinsufficiency
Only one copy of working gene
102
What happens in dominant negative mutations
Expression of abnormal protein interferes with the normal protein
103
What happens in a gain of function mutation
Mutant protein gains a new function affecting cell processes
104
What is the risk of an affected child if the parent is a carrier of an autosomal recessive disease
1/4
105
What are the 5 layers of the scalp
Skin
Connective tissue
Aponeurosis
Loose connective tissue
Periosteum
106
What nerve supplies motor function to the muscles of mastication
The Trigeminal nerve
107
How many divisions does the Trigeminal nerve have
3
108
Name the divisions of the Trigeminal nerve
1. Opthalamic
2. Maxillary
3. Mandibular
109
How do we test for the Trigeminal nerve
Gently brush the skin of each dermatome while the patient has their eyes closed
Get them to tell you when they feel it
Compare on both sides
110
Roles of the facial nerve (4)
Controls the facial expression muscles
Controls inner ear that moderates volume of sound
Helps make tears
Relays information about taste to the brain
111
Clinical testing of the motor function of the facial nerve
Frown, close eyes tightly, smile, puff out cheeks
112
Name the methods of local anaesthesia (4)
Topical
Local infiltration
Nerve block
Field block
113
What should be used with lignocaine as an anaesthetic
Adrenaline
114
Why is adrenaline used alongside anaesthesia
Prolongs it and reduces bleeding
115
When is electrosurgery used
Treatment of minor skin lesions
116
What happens in a snip excision
Grasp lesion with skin hook and cut across the base of the lesion
117
When is a snip excision used
Minor skin lesions
118
What is curettage
Scraping of abnormal tissue
119
What is a shave excision
Flat blade of a scalpel drawn through a raised lesion to remove it
120
What does an elliptical excision look like (to me)
An eye
121
Why do we not worry about UVC rays
They are blocked by the ozone layer
122
Which UV is our biggest concern
UVA
123
Compare the wavelengths of UVA and UVB
UVB has a shorter wavelength
124
Benefits of UVR exposure
Vitamin D synthesis
Heat
Vision
Circadian rhythms
Bactericidal and virucidal
Therapeutic and diagnostic uses
125
How can UVR cause immunosuppression (3)
Depletion of langerhans cells in the skin and reduced ability to present antigens
Generation of UV induced regulatory T cells with immune suppressive activity
Secretion of anti-inflammatory cytokines
126
How does UVB cause DNA damage
Absorbed by DNA in the nucleus of a keratinocyte
Induces covalent linkages between pyrimadines in the same DNA strand producing CPDs and 6-4 PPs
127
What are CPDs
Cyclobutane pyrimadine dimers
128
How does UVA cause mutations
Indirect oxidative damage
129
Signature mutation caused by UVB
CC - TT mutation
130
Signature mutation caused by UVA
C - A point mutation
131
What is an oncogene
Overactive form of a gene that positively regulates cell division
132
What is a tumour suppressor
A gene that negatively regulates cell division to prevent the formation of a tumour
133
Give some examples of erythematous exanthems that start on the face
Measles, rubella, erythema infectiosum
134
What causes rubella
Togavirus
135
Clinical presentation of erythema infectiosum
Slapped cheek on the face
136
Virus associated with erythema infectiosum
HSV 6
137
Give some examples of erythematous exanthems that tend to start on the trunk
Roseola
Scarlet fever
Unilateral laterothoracic exanthem
138
At what point are you no longer infectious with chicken pox
Until all lesions are crusted over
139
Management of chickenpox
Acyclovir in immunosuppressed patients
140
What causes measles
Paramyxovirus called MeV
141
How does measles spread
From person to person via respiratory droplets
142
How does measles spread through the body
Enters through the respiratory tract, spreads to regional lymph nodes and then to other organs
143
Clinical presentation of measles
Fever >39
Generalised maculopapular rash
One or more of: conjunctivitis, cough, coryza
144
Koplik spots
A sign of measles before the onset of a rash
145
Investigations for measles
PCR
serology: IgM, IgG
Viral isolation
146
Prevention of measles
Live vaccine
147
Who cannot receive a live vaccine
People who are immunosuppressed
148
Complication of measles
Increased risk of bacterial superinfection
149
Pathophysiology of HSV
Virus enters epidermis and penetrates endings of sensory and autonomic nerves
Establishes a latent infection in local ganglia
Reduction in immune function leads to reactivation
150
Clinical presentation of HSV
Localised vesicular rash
Neuropathic pain
Fever, malaise
151
Investigation for HSV
PCR
152
Management of HSV
Acyclovir
153
What is the MOA of acyclovir
Inhibits the activity of viral DNA polymerase and prevents the virus from multiplying and spreading in the body
154
Role of thyroid hormone in the skin
Promotes fibroblasts activity
Regulates epidermal differentiation
Essential for hair formation and sebum production
Effects on skin perfusion
155
Name some places in the skin you may find thyroid hormone receptors
Keratinocytes, fibroblasts, arrector pili muscle cells, sebaceous gland cells
156
What is first line for phototherapy
UVB
157
When is PUVA first choice
Mycosis fungoides, pityriasis rubra pilaris, pustular psoriasis or erythrodermic psoriasis
158
Common side effect of UVB therapy
Erythema
159
What should be done before starting any phototherapy
Minimal phototoxic dose test
160
When might UVA1 treatment be used
Atopic eczema
Granuloma annulare
