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Derm Mine > Pathology > Flashcards

Pathology Flashcards

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Dermatology Board Prep flashcards
1
Q

Name an anaphylactic (Type I) cutaneous drug eruption

A

Urticaria

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2
Q

Name 2 cytotoxic (Type II) cutaneous drug eruptions

A

Pemphigus

Pemphigoid

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3
Q

Name an immune-complex mediated (Type III) cutaneous drug eruption

A

Purpura/rash

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4
Q

Name a T cell mediated delayed (Type IV) cutaneous drug eruption

A

Erythema/rash

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5
Q

Are immunologically-mediated drug reactions dose-dependent?

A

No

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6
Q

Give examples of dose dependent cutaneous reactions

A

Those that are “non-allergic”

e.g. eczema, psoriasis, pigmentation, cheilitis

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7
Q

How do majority of cutaneous drug eruptions present?

A

Exanthematous (maculopapular) 75-95%

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8
Q

What are other morphologies of cutaneous drug eruptions presentation?

A 
Urticarial (5-10%)
Pustular/bullous
Pigmentation
Itch/pain
Photosensitivity
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9
Q

When do we consider drug eruptions?

A

Patient on meds
Develops sudden skin signs
Symmetric appearance

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10
Q

What affects the clearance of the reaction after drug withdrawal?

A

Half life of drug
Accumulation of drug in cells
Cross reaction with other substances

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11
Q

What age group is most affected?

A

Young adults

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12
Q

Which sex is most affected?

A

Females

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13
Q

Name 3 drugs associated with exanthematous drug eruptions

A

Penicillins
Sulphonamide antibiotics
Erythromycin
(+6)

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14
Q

Which drugs can cause an acne eruption?

A 
Glucocorticoids
Therapeutic androgens
Lithium
Isoniazid
Phenytoin
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15
Q

Which drugs can cause acute generalised exanthematous pustulosis?

A
  • this is rare
    Antibiotics
    CCBs
    Antimalarials
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16
Q

Which drugs can cause bullous pemphigoid?

A

ACE inhibitors
Penicillin
Furosemide

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17
Q

What are fixed drug eruptions?

A

Present as well demarcated round plaques
Red and painful
Affects hands, genitalia, lips

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18
Q

Which drugs can cause fixed drug eruptions?

A

Tetra/doxycycline
Paracetamol
NSAIDs
Carbamazepine

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19
Q

Give 2 examples of severe cutaneous drug eruptions

A

Steven Johnson’s Syndrome
Toxic Epidermal Necrolysis
Drug rxn with eosinophilia and systemic symptoms (DRESS)
Acute generalised exanthematous pustulosis (AGEP)

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20
Q

Give 3 examples of ACUTE phototoxic drug reactions

A

Skin toxicity
Systemic toxicity
Photodegradation

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21
Q

Give 3 examples of CHRONIC phototoxic drug reactions

A

Pigmentation
Photoageing
Photocarcinogenesis

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22
Q

What are phototoxic cutaneous drug reactions?

A

Non-immunological

Happens in anybody with enough photo-reactive drug+wavelength of light

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23
Q

Which wavelengths of light are usually implicated in phototoxic cutaneous drug reactions?

A

UVA

Visible light

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24
Q

Which 2 drugs can cause Immediate prickling with delayed erythema and pigmentation?

A

Chlorpromazine

Amiodarone

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25
Q

Which 2 drugs can cause exaggerated sunburn?

A

Thiazides

Quinine

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26
Q

Which drug can cause exposed telangectasia?

A

Calcium channel blockers

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27
Q

Which 3 drugs can cause increased skin fragility?

A

Naproxen
Amiodarone
Tetracycline

28
Q

Which 4 investigations can be used to determine the cause of a cutaneous drug eruption?

A

Phototesting
Biopsy
Patch/photopatch tests
Skin prick with specific drugs

29
Q

What is the most common porphyria?

A

Porphyria cutanea tarda (PCT)

30
Q

Which enzyme is faulty in people with porphyria cutanea tarda?

A

Uroporphyrinogen decarboxylase

31
Q

What is the typical presentation of PCT?

A

Blistering
Skin fragility
Hypertrichosis
Morphoea

32
Q

How do you investigate for PCT?

A

Woods lamp

33
Q

Which enzyme is faulty in people with erythropoietic protoporphyria (EPP)?

A

Ferrochelatase

34
Q

Which porphyrin accumulates people with erythropoietic protoporphyria?

A

Protoporphyrin IX

35
Q

Describe the presentation of EPP

A

Swelling

Burning/itching

36
Q

What are the investigations for EPP?

A

Quantitative RBC porphyrins
Fluorocytes
Transaminases

37
Q

What sort of radiation do people with EPP need protection against?

A

Visible light

38
Q

How does acute intermittent porphyria present?

A

GI upset:

  • nausea, vomitting
  • constipation
39
Q

What is hyperkeratosis?

A

Increased thickness of keratin layer

40
Q

What is parakeratosis?

A

Persistence of nuclei in the keratin

41
Q

What is acanthosis?

A

Increased thickness of epidermis

42
Q

What is papillomatosis?

A

Irregular epithelial thickening

43
Q

What is spongiosis?

A

Oedema between keratinocytes

44
Q

Give 4 features of atopic eczema

A

Pruritus
General erythema and scaling
FLEXURAL distribution
Other atopic diseases - asthma, etc

45
Q

List 3 features of chronic atopic eczema

A

Lichenification
Excoriation
Secondary infection (usu S. aureus)

46
Q

Describe the presentation of eczema herpeticum

A

Monomorphic punched out lesions

Very painful

47
Q

Describe the features of acne vulgaris

A

Open and closed comedones
Pustules/papules
Onset at puberty
Affects regions with sebaceous glands

48
Q

Describe the features of rosacea

A 
Recurrent facial flushing
Visible blood vessels
NO comedones 
Pustules seen
Thickening of the skin (rhinophyma on nose)
49
Q

Name 4 factors that trigger rosacea

A
  • sunlight
  • alcohol
  • spicy food
  • stress
50
Q

Name 3 immunobullous diseases

A

Pemphigus
Bullous pemphigoid
Dermatitis herpetiformis

51
Q

Describe the general features of pemphigus

A

Affects middle-ages
Desmosomes between keratinocytes lost
Responds to steroids
Majority - pemphigus vulgaris

52
Q

What is desmoglein 3?

A

“DesmoGLUEin”
Maintains desmosomal attachments
So keeps keratinocytes together

53
Q

Give 5 features of pemphigus vulgaris

A 
Autoimmune
May affect mucosa
IgG antibodies attack desmoglein 3
Immune complex forms on cell surface
Leads to ACANTHOLYSIS
54
Q

What is acantholysis?

A

Lysis of intercellular adhesion sites

- common to all forms of pemphigus

55
Q

What is the more common presentation of pemphigus vulgaris?

A

Erosions

- the vesicles burst very easily

56
Q

How is pemphigus vulgaris diagnosed?

A

Biopsy of fresh blisters

57
Q

Give 5 features of bullous pemphigoid

A 
Subepidermal blister
Tense blisters
NO acantholysis
IgG attack hemidesmosomes between basal cells and basement membrane
Old lesions resemble pemphigus vulgaris
58
Q

How is bullous pemphigoid diagnosed?

A

Biopsy of EARLY LESIONS

59
Q

What is the immunofluorescent pattern of IgG in the immunobullous diseases

A

Pemphigus vulgaris: Intraepidermal

Bullous pemphigus: along the basement membrane

60
Q

Give features of dermatitis herpetiformis

A

Autoimmune - mediated by IgA
INTENSE itch
Associated with coeliac disease
and HLA-DQ2 haplotype

61
Q

What is the hallmark feature of dermatitis herpetiformis?

A

Papillary dermal microabscesses

62
Q

What does IgA target?

A

Gliadin in gluten

- but crossreact with connective tissue proteins

63
Q

On mucosal surfaces, how does lichen planus present?

A

Reticular white lines

64
Q

On skin, how does lichen planus present? [6Ps]

A

Purple
Pruritic
Polygonal
Planar Papules and Plaques

65
Q

What is the most common viral cause of erythema multiforme?

A

Herpes Simplex Virus

66
Q

What causes molluscum contagiosum

A

Poxvirus

Derm Mine (7 decks)

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