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2nd Year - Dermatology > Nutrition 1 and 2 - Pre-reading and SGW > Flashcards

Nutrition 1 and 2 - Pre-reading and SGW Flashcards

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1
Q

What is a food allergy in comparison to a food intolerance?

A

When symptoms are caused by an immune reaction

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2
Q

What type of antibody usually mediates a food allergy?

A

IgE (sometimes non-IgE - thought to be T cell mediated, but not well understood)

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3
Q

What is a food intolerance in comparison to a food allergy?

A

A non-immune reaction

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4
Q

What causes a lactose intolerance?

A

A lactase enzyme deficiency leading to poor breakdown of lactose in the GI tract - the excess unabsorbed lactose results in symptoms

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5
Q

What are symptoms and signs of an IGE-mediated food allergy which affect the skin? (4)

A

Pruritus
Erythema
Acute urticaria
Acute angioedema

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6
Q

What are signs and symptoms of a non-IgE mediated allergy that affects the skin? (3)

A

Pruritus
Erythema
Atopic eczema

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7
Q

What are signs and symptoms affecting the GI tract of an IGE-mediated food allergy? (6)

A 
Angioedema of the lips, tongue and palate
Oral pruritus
Nausea
Colicky abdominal pain
Vomiting
Diarrhoea
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8
Q

What are signs and symptoms of a non-IgE mediated food allergy which affect the GI tract? (10)

A 
Gastro-oesophageal reflux disease
Loos or frequent stools
Blood and/ or mucus in stools
Abdo pain
Infantile colic
Food refusal or aversion
Constipation
Perianal redness
Pallor and tiredness
Faltering growth in conjunction with at least one or more GI symptoms above
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9
Q

What are 2 groups of signs/ symptoms of an IgE mediated food allergy which affects the resp system?

A

Upper resp tract symptoms e.g. nasal itching, sneeze, rhinoorhea)
Lower rest symptoms e.g. cough, wheezing

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10
Q

What is 1 group of signs/ symptoms of an IgE mediated food allergy that affects the resp system?

A

Lower resp. symptoms e.g. cough, chest tightness

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11
Q

What type of food allergy causes signs/ symptoms of anaphylaxis or other systemic allergic reactions?

A

IgE mediated food allergies

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12
Q

A food allergy should be suspected in children and young people who’s symptoms do not respond adequately to treatment for what 3 illnesses?

A

Atopic eczema
Gastro-oesophageal regular disease
Chronic GI symptoms including chronic constipation

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13
Q

Give 3 examples of atopic diseases?

A

Atopic eczema
Asthma
Allergic rhinitis

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14
Q

In terms of acute/ non-acute and rapid/ delayed onset of symptoms, describe IgE and non-IgE mediated food allergies?

A

IgE - Rapid, acute

non-IgE - Delayed, non-acute

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15
Q

If an IgE-mediated allergy is suspected in a child/ young person, what tests should be offered to them?

A

A skin prick test and/ or blood tests

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16
Q

If a non-IgE mediated allergy is suspected, what treatment/ tests should be offered to the patient?

A

Trial elimination of the suspects allergen (normally for between 2 - 6 weeks) and reintroduce after the trial

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17
Q

What is thought to case the reduced mechanical strength of skin in obesity?

A

A failure of collagen deposition to match the increased surface area

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18
Q

Why does the skin tend to be dry in obese patients?

A

Increased trans-epidermal water loss

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19
Q

What causes irritation between skin folds in obese patients?

A

Increased activity of apocrine and eccrine sweat glands in enlarged skin folds increases moisture/ skin maceration and friction in folds

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20
Q

How does microvascular dysfunction in obese patients lead to hypertension?

A

It results in increased skin blood flow

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21
Q

What effect does obesity have on lymphatics?

A

Pressure from fat impedes lymphatic flow and causes leakage of protein rich lymphatic fluid into subcutaneous tissues

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22
Q

How can obesity lead to increased hormone production?

A

The endocrine roles of adipose tissues may be altered leading to increased hormone production e.g. testosterone

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23
Q

How does obesity affect sebaceous glands?

A

Increased androgens (male sex hormones) produced in peripheral fat stimulate sebaceous glands

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24
Q

What is the name for the velvety thickening and pigmentation of the skin folds, usually axillae?

A

Acanthosis nigricans

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25
Q

What is frequently found around the neck and axillae of obese patients?

A

Skin tags (acrochordons)

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26
Q

What 2 direct skin manifestations of obesity are associated with insulin resistance?

A 
Acanthosis nigricans
Skin tags (acrochordons)
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27
Q

What is the name for increased hair in females in male distribution due to obesity?

A

Hirsutism

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28
Q

Why do patients with obesity frequently get acne?

A

Due to increased sebaceous gland activity

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29
Q

What is the name for a chronic inflammatory disease where boils and abscesses form and scar in apocrine gland areas esp. axillae, groin)? - seen in obese patients

A

Hidradenitis suppurativa

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30
Q

What is the name for male pattern balding in men/ women? - seen in obese patients

A

Androgenetic alopecia

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31
Q

What are stretch marks? What is the proper name for this?

A

Type of warring associated with dermal connective tissue injury in response to local stretching forces
Striae distensae

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32
Q

What is the sequence of events that leads to obese patients legs becoming grossly enlarged?

A

Increased subcutaneous fat causes reduced lymphatic drainage leading to swelling
Gradually worsening swelling causes chronic inflammation leading to fibrosis
Reduced tissue oxygenation and swelling results in bacterial overgrowth
Cellulitis develops easily and leads to further lymphatic damage
A downward spiral develops if left untreated and ultimately the skin becomes thick and warty and the lower leg and foot become permanently enlarged, often grossly

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33
Q

What is the sequence of events in chronic venous insufficiency that leads in venous ulceration in obese patients?

A

Abdominal obesity resists venous return from the legs
Veins dilate and valves become incompetent, varicose veins develop
The increased hydrostatic pressure in the vessels results in red blood cell leakage into tissue resulting in swelling, haemosiderin pigmentation and inflammation (due to breakdown products)
Chronic scarring eventually occurs
The skin may ulcerate (venous stasis ulceration)

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34
Q

What are 5 skin diseases aggravated by obesity?

A 
Lymphoedema
Chronic venous insufficiency
Skin infections
Intertigo
Psoriasis
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35
Q

What is intertrigo?

A

Macerated red plaques which develop in skin folds due to high moisture levels, friction, increased pH and reduced barrier function that are prone to secondary infection

36
Q

What role does vitamin A play in terms of the skin?

A

Vital for epithelial proliferation, keratinisation and development

37
Q

What are the sources of vitamin A?

A

Animal - milk, liver, eggs, oily fish

Plant - green leafy veg, bright yellow/ orange fruit and veg

38
Q

How does a vitamin A deficiency present in terms of the skin?

A

Keratotic follicaular papules on the thighs and upper arms, dry skin

39
Q

How to diagnose a vitamin A deficiency?

A

Measure serum vitamin A

40
Q

What is vitamin K essential for?

A

Several blood coagulation factors

41
Q

What are the main sources of vitamin K?

A

Green leafy veg, liver, legumes, vegetable oils (also produced in GI tract by bacteria - therefore can be affected by prolonged antibiotics)

42
Q

Presentation of vitamin K deficiency?

A

Bleeding tendency, seen in skin as proper and easy bruising

43
Q

How to diagnose a vitamin K deficiency?

A

Measure coagulation and serum Vitamin K

44
Q

What is another name for Vitamin B2?

A

Riboflavin

45
Q

What is the role of vitamin B2 (riboflavin)?

A

Essential co-factor in numerous metabolic reactions

46
Q

What are the sources of vitamin B2 (riboflavin)?

A

Milk, liver, meat, eggs, green leafy veg

47
Q

What are the signs of a vitamin B2 (riboflavin) deficiency?

A

Lesions of the margins of the lips (chalices) and corners of the mouth (angular stomatitis)
Painful red dry tongue

48
Q

How do you diagnose a vitamin B2 (riboflavin) deficiency?

A

Measure the activity coefficient of erythrocyte glutathione reductase (EGR)

49
Q

What is another name for Vitamin B3?

A

Niacin

50
Q

What is the role of vitamin B3 (niacin)?

A

Essential co-factor in numerous metabolic reactions

51
Q

What are the sources of vitamin B3 (Niacin)?

A

Meat, fish, nuts, coffee

Also converted from dietary tryptophan (essential amino acid) in the body

52
Q

What are the symptoms/ signs of a vitamin B2 (Niacin) deficiency?

A 
Pellagra:
dermatitis (worse on sun exposed areas)
Delirium
Diarrhoea - with abdo pain, vomiting
Death - in 4-5 years if not treated
53
Q

Diagnosis of vitamin B3 deficiency?

A

Clinical diagnosis, as difficult to measure niacin levels

Nicotinamide supplementation brings rapid improvement

54
Q

What is the role of Vitamin B6?

A

Co-enzymes for many processes

55
Q

What are the source of vitamin B6?

A

Meat, cereals, milk, potatoes, banks, nuts and pulses

56
Q

Symptoms of a vitamin B6 deficiency?

A

Dermatitis of face, scalp, neck, shoulders, buttocks and perineum, tongue inflammation (glossitis)

57
Q

Diagnosis of a vitamin B6 deficiency?

A

Measure serum or urinary Vitamin B6

Trial of supplement

58
Q

What is the role of folate?

A

Critical co-enzyme

59
Q

What are the sources of folate?

A

liver, green leafy veg, beans, nuts and milk

60
Q

Symptoms/ signs of a folate deficiency?

A

Anaemia, angular stomatitis, glossitis, hair depigmentation, sin and mucous membrane pigmentation

61
Q

Diagnosis of a folate deficiency?

A

Measure serum folate

62
Q

Role of vitamin B12?

A

Critical co-enzyme

63
Q

Sources of vitamin B12?

A

Only found in foods of animal origin such as meat, milk, fish and eggs

64
Q

Signs/ symptoms of a vitamin B12 deficiency?

A

Anaemia, angular stomatitis, glossitis, hair depigmentation, sin and mucous membrane pigmentation

65
Q

Role of biotin?

A

Essential co-factor for carboxylase enzymes

66
Q

Sources of Biotin?

A

Cereals, meat, milk, eggs, pulses, nuts - also produced by GI bacteria

67
Q

Presentation of biotin deficiency?

A

Rare - facial dermatitis, glossitis, alopecia

68
Q

Diagnosis of a biotin deficiency?

A

Serum biotin

69
Q

Other name for vitamin C?

A

Ascorbic acid

70
Q

Role of vitamin C?

A

Essential co-factor in collagen formation

71
Q

Sources of vitamin c?

A

Citrus fruit, strawberries, balckcurrants, tomatoes, potatoes

72
Q

Presentation of a vitamin C deficiency?

A

hYperkeratosis around hair follicles, bent hairs, inflamed gums, poor wound healing - fatigue, malaise, muscle and bone pain

73
Q

Diagnosis of a vitamin C deficiency?

A

Clinical - supplements bring a rapid improvement

74
Q

Role of zinc?

A

Required for many metabolic pathways - required for structure and function of skin and so vital for wound healing

75
Q

Sources of zinc?

A

Meat, fish, milk, eggs, cereals, nuts and pulses

76
Q

Presentation of a Zinc deficiency?

A

Genetic = acrodermatitis enteropathica (autosomal recessive) - caused by a lack of zinc absorption = diarrhoea, alopecia dry/ brittle hair, perioral, facial and aural dermatitis
Acquired - more common, and may be due to increased elimination of zinc secondary to burns or infection - dermatitis rash of hands and feet mainly

77
Q

Diagnosis of a zinc deficiency?

A

Serum zinc measurement

78
Q

What are the 2 forms of protein energy malnutrition?

A

Mrasmus

Kwashiorkor

79
Q

What is Marasmus?

A

Blobal nutrient deficincy causing weight loss by fat breakdown

80
Q

Appearance of a child with Marasmus?

A

Very thin and muscle wasting
No oedema
Skin is dry, wrinkled and lose from subcutaneous fat and muscle loss
Hair is thin, brittle and can cause alopecia

81
Q

What is Kwashiorkor caused by?

A

Very low protein intake with reasonable carbohydrate intake

82
Q

Appearance of a child with Kwashiorkor?

A

Oedema is present and children often develop an enlarge pot bello
Skin looks irregular or patchy discolouration caused by pigmentary change
Dark, dry skin amy split when stretched revealing pale areas between the cracks (crazy, paving dermatosis)

83
Q

What is the proper name for piriton?

A

Chlorphenamine

84
Q

Is he prick test or blood tests more definitive for diagnosing an IgE mediated allergy?

A

prick tests are more definitive

85
Q

what can cause a prick test to show a false negative?

A

If the patient has ingested anti-histamines

86
Q

Is it common for food to play a role in adult eczema?

A

Very uncommon (Very common in children)

87
Q

How to insert an epipen?

A 
"Blue to sky, orange to the thigh"
Remove blue cap
Push into thigh
Hold for 10 secs
Remove and massage area

2nd Year - Dermatology (16 decks)

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