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Human Disease And Therapeutics > Quiz 5 (test 3) > Flashcards

Quiz 5 (test 3) Flashcards

1
Q

True or false… in regards to breast disease, the older the patient the greater the likelihood that it is malignant

A

True

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2
Q

What are three common symptoms of breast disease (not specific for cancer, fibrotic growths, or cysts)?

A

Pain

Palpable masses

Nipple discharge

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3
Q

Mammography screenings should start at age ___. Why?

A

~40 years

Younger women have denser breast tissue making it difficult to identify a mass.

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4
Q

Mammography detects ___, shows ___, and identifies ___.

A

Density

Architectural distortions

Calcification

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5
Q

___% of breast cancers that are not detected by mammography can be detected by ___.

A

~10%

Palpitation

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6
Q

True or false… mammography can be used to help guide biopsy needle in order to sample a growth

A

True

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7
Q

Mammography is __-__% predictive

A

85-95%

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8
Q

What is acute mastitis? What causes it?

A

Breast abscesses and necrosis. It may be infectious or non-infectious

Can be caused by plugged ducts

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9
Q

Acute mastitis is typically associated with whom?

A

Women who are breast feeding?

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10
Q

Fat necrosis of breasts is usually associated with what?

A

Trauma (such as from a seat belt during an accident)

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11
Q

What are the fibrocystic changes that can occur in breasts?

A

Fibrosis

Cysts

Palpable changes that can make detection of breast cancer difficult

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12
Q

There is a higher risk of breast cancer in the ___ types of breast cysts

A

Aggressively proliferative

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13
Q

Breast cysts typically occurs in ___-___ olds and typically (does/does not) occur after menopause

A

20-40

Does not occur after menopause

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14
Q

True or false… breast cysts rarely calcify and can be readily distinguished from cancer on a mammogram.

A

False. It can calcify. It can look like cancer on mammogram.

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15
Q

What are the most common benign neoplasms of the breast? Describe them.

A

Fibroadenomas

Mostly CT
Well circumscribed

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16
Q

True or false.. you should always remove benign neoplasms of the breast

A

False.. dont typically remove unless uncomfortable

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17
Q

Breast carcinoma rarely occurs in women under ___ years of age.

A

25

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18
Q

Who is breast carcinoma most common in?

A

The more affluent societies have the highest incidence regardless of race; suggests mostly caused by environment

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19
Q

Breast carcinoma has a ___% incidence by 70 years of age; fatality in 1 out of ___

A

~30%

9

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20
Q

5-10% of breast carcinoma cases are inherited. What gene is involved?

A

BRCA1 and BRCA2 are the most common inherited genes. - single strong gene factor

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21
Q

Family “tendency” (__-__% risk) means what?

A

20-30%

Not a single strong gene but a pattern of occurrence in family

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22
Q

What % of breast carcinoma cases are considered sporadic, meaning no family pattern, just chance?

A

70-80%

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23
Q

There are about ___ new breast cancer cases in the US each year.

A

250,000

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24
Q

What are three risk factors for breast carcinoma?

A

Diet high in animal fat

Obesity

Delayed first pregnancy

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25
Q

What are the symptoms of breast carcinoma?

A

Pain

Masses (assessed by palpitation, mammography, ultrasound, MRI, or tissue biopsy)

Swollen, pitted surface (peau d’ orange) and enlarged axillary lymph nodes

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26
Q

What is the prognosis of breast carcinoma based on?

A

Size

Axillary node status

Distant metastasis

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27
Q

The five year survival rate of stage 0 is ___

The five year survival rate of stage 4 is ___

A

92%

13%

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28
Q

If the breast tumor expresses estrogen/progesterone receptors, what kind of treatment may be used?

A

Hormonal treatment

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29
Q

Generally, all types of breast cancer are ____, originating from ____ in the ____.

A

Adenocarcinomas

Epithelial cells

Terminal ducts

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30
Q

Invasive carcinoma makes up ___% of breast cancer cases

A

75-85%

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31
Q

Most types of breast cancer are ___ and the incidence (increases/decreases) with age and have invasive and non-invasive types

A

Ductal

Increases

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32
Q

____ are procedures that remove smaller breast masses

A

Lumpectomies

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33
Q

Benign epithelial lesions typically express ___ changes. (__% of women have microscopic cysts associated with epithelial tissue_)

A

Fibrocytic

60%

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34
Q

Cervical cancers are ___-associated. ___ neoplasms represent most cervical cancers

A

HPV

Squamous cell

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35
Q

What do you do to detect early cervical cancers?

A

Pap smear

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36
Q

What are some risk factors for developing cervical cancer?

A

Multiple sex partners

Immunosupression

Early age of first sexual contact

Oral contraceptives for over 5 years

Nicotine use

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37
Q

What are some thing that can cause abnormal bleeding of the endometrium?

A

Polyps

Endometritis

Endometrial hyperplasia

Cancers

Anovultory cycles

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38
Q

What are three causes of endometrial polyps

A

HTN

Obesity

Late menopause

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39
Q

Less than __% of endometrial polyps progress to cancer

A

2%

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40
Q

Leiomyomas are ___ neoplasms. They are ___-dependent. They cause bleeding and are painful. They may cause ___. They are (very/rarely) frequent.

A

Benign smooth muscle neoplasms

Estrogen-dependent

Infertility

Very frequent (10-15%)

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41
Q

What kind of cancer is endometrial cancer?

A

Adenocarcinoma

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42
Q

What are three risks for endometrial cancer?

A

Obesity

Diabetes

HTN

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43
Q

What is the treatment for endometrial cancer?

A

Hysterectomy-treatment of choice

Radiation/chemotherapy adjunctive

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44
Q

What is the most common cause of endometritis (infections)?

A

IUDs

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45
Q

True or false… endometrial hyperplasia can progress to cancer

A

True

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46
Q

Endometrial hyperplasia has an exaggerated response due to excessive ___.

A

Estrogen. (Excessive ovarian activity)

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47
Q

What is the treatment for endometrial hyperplasia?

A

Progesterone

Hysterectomy

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48
Q

What is preeclampsia?

A

Secondary hypertension in pregnant women of at least 20 weeks gestation.

Often associated with diabetes

Exact cause is unknown but appears to be associated with abnormal circulation in the placenta

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49
Q

Is a follicular ovarian mass a non-neoplastic cyst or a neoplastic cyst?

A

Non-neoplastic

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50
Q

Is an endometrioid ovarian mass neoplastic or non-neoplastic?

A

Neoplastic

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51
Q

Most neoplastic ovarian masses (are/are not) sporadic. Contraceptives (increase/decrease) risk. __% are hereditary due to the ___ genes. What is the treatment?

A

Are sporadic

Decrease risk

10% hereditary due to the BRCA 1&2 genes

Treatment: total hysterectomy + removal of surrounding tissue + chemotherapy

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52
Q

What are three symptoms of ovarian masses?

A

Pelvic pain

Pelvic mass

Abdominal bleeding

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53
Q

True or false.. there are effective screening techniques for ovarian masses

A

False. Unlike cervical cancer, there is no effective screening for ovarian cancer

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54
Q

Natural estrogens are ___ hormones.

Synthesized estrogens may be ___

A

Steroid

Non-steroidal

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55
Q

True or false.. Estrogens and progestins can cross cell membranes and activate estrogen receptors inside the cells, thus modulating the expression of genes.

A

True

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56
Q

What are the three stages of the menstrual cycle?

A

Menstrual stage - menses

Follicular stage - proliferative

Luteal stage - secretory

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57
Q

True or false… as populations age, they spend more time in menopause (females) or andropause (males)

A

True

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58
Q

Name and describe the three different types of natural estrogens

A

E1 - estrone - predominant during menopause

E2 - estradiol - predominant during reproductive years

E3 - estratriol - predominant during pregnancy

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59
Q

Name one steroidal synthetic estrogen and one non-steroidal synthetic estrogen

A

Steroidal - ethinyl estradiol

Non-steroidal - diethylstilbesterol

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60
Q

What are six physiological functions of estrogen?

A

Sexual maturity

Increased CNS excitability

Increased endometrial and uterine growth

Maintain skin elasticity

Reduce bone resorption

Increase blood coagubility

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61
Q

What are the clinical uses of estrogen supplementation?

A

Primary hypogonadism

Postmenopausal problems

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62
Q

What are the guidelines for clinical use of estrogens?

A

Always use the smallest dose for the shortest period of time possible

Sometimes local creams are preferred to minimize exposure

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63
Q

What are seven adverse effects to estrogen supplementation?

A

Postmenopausal bleeding

Nausea

Breast tenderness

Migraines

HTN

Hyperpigmentation

Increases some cancers (breast and endometrial)

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64
Q

What are three contraindications for the use of estrogen supplementation?

A

Liver disease (slows metabolism)

Breast/endometrial cancers

Thrombolytic disorders

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65
Q

Progestins are made from ___. They are present in males, but less than females. ___ is the most important progestin in humans

A

Cholesterol

Progesterone

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66
Q

Progesterone is the precursor to what?

A

Estrogen

Androgen

Adrenocortical steroids (cortisol)

Testosterone

Estradiol

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67
Q

What is the half life of progestins?

A

~5minutes (very short acting)

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68
Q

What are the effects of progestins?

A

Increase fat deposition

Decrease CNS excitability (antiseizure - opposite of estrogen)

Increase aldosterone - increase Na retention - increase BP - increase water retention and blood volume

Increase body temperature

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69
Q

What are three clinical uses of progestins?

A

Replacement therapy

Oral contraception

Long-term ovarian suppression (dysmenorrhea or endometriosis) - in contrast to estrogens, no problem with bleeding or clotting

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70
Q

When is the use of progesterone contraindicated?

A

Breast cancer is a risk

Severe HTN or heart disease is a risk

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71
Q

Which is more effective for contraception, combination or progestin only?

A

Combination (progesterone and estrogen). It decreases ovulation close to 100%

Progestin only decreases ovulation 50-80%

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72
Q

In addition to decreasing ovulation, what else does combination contraceptives do? What about progestin-onlys?

A

Combination - decreases ovulation, conception, implantation

Progestin only - decreases ovulation, thickens mucus and reduces sperm penetration, impairs implantation

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73
Q

What are the three different types of combinations of contraceptives?

A

Monophasic - constant doses of both estrogen and progesterone

Biphasic - dosage of one or both change one time during cycle

Triphasic - dosages change 2 times per cycle

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74
Q

What is the “minipill”?

A

Progestin only

Has fewer side effects but less effective

Usually a secondary option because of drawbacks

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75
Q

Implantable contraceptive systems can be effective for ___ years.

A

2-4 years (Norplant system)

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76
Q

In addition to oral contraceptives, what are some delivery forms for contraceptives?

A

Implantable

Injections

Intravaginal rings

IUDs (with or without estrogen/progestin)

Transdermal combinations.

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77
Q

True or false… the side effects of combination contraceptives are permanent even after discontinuation

A

False. They reverse

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78
Q

Combination contraceptives can cause (reduced/increased) ovarian function and size. (Reduced/increased) breast size and tenderness. (Reduced/increased) HR and BP. (Hyper/hypo)-pigmentation, especially around the eye. Mild ____, breakthrough ___, and ___. May interact with what drugs? (Reduce/increase) sebum production in skin.

A

Reduced ovarian function/size

Increased breast size/tenderness

Increased thrombolytic events

Increased HR and BP

Hyperpigmentation

Nausea, bleeding, headaches

Can interact with antibiotics that disrupt GI flora. (Normal absorption of contraceptives from GI system is dependent on this flora)

Reduce sebum production, causing dry skin but reduces acne

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79
Q

What are the side effects of estrogen-only replacement?

A

Increase risk of ovarian, endometrial, and breast cancer after 10 years of use.

Nausea, breast tenderness, migraines, HTN. These effects are dose dependent

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80
Q

What are the uses for progestins?

A

Oral contraception

Menstural disorders, irregularity, heavy discharge

Acne

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81
Q

Name three antagonists of progestins.

A

Tamoxifen

Mifepristone

Danazol

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82
Q

What is tamoxifen?

A

Partial antagonist

Blocks actions of estrogen in breast.

Used to treat breast cancers

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83
Q

What is mifepristone?

A

Morning after contraceptive

Blocks progesterone and glucocorticoid receptors

Prevents implantation of fetus

99% effective if used within 3 days

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84
Q

What is danazol?

A

Suppresses ovarian function

Has a masculinizing effect

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85
Q

What is clomiphene (clomid)?

A

Partial estrogen agonist

Ovulation-inducing for promoting fertilization and pregnancy

increased risk of multiple births (twins)

86
Q

True or false… testosterone is an androgen

A

True

87
Q

What are some uses of testosterone?

A

Converts to estradiol

Replacement therapy for males

Gynecological disorders (reduces breast size (gynecomastia)

Has protein anabolic effects (helps replace muscle loss)

Growth stimulation - can prematurely close growth plates in growing adolescents

Counter some age-related loss of muscle mass

88
Q

True or false… testosterone can cause masculinization effects in women. It is abused for muscle and strength building. It can cause acne, aggressiveness

A

True

89
Q

True or false… ketoconzaole can inhibit the synthesis of testosterone. It is used to treat prostate carcinoma in men

A

True

90
Q

What is oxytocin used for?

A

Induce/augment labor

91
Q

What is metoclopramide?

A

D2 antagonist that stimulates prolactin and lactation

92
Q

___% of calcium is stored in bones

A

99%

93
Q

In the adult, the ___ are the primary site of hematopoeises

A

Bones

94
Q

Bone undergoes constant remodeling. ___ bone resists compression forces. ___ bone is thick and resists bending forces

A

Medullary

Cortical

95
Q

The ____ is a tough fibrous membrane that covers bone surfaces except at joints. It is well innervated.

A

Periosteum

96
Q

Osteogenesis imperfecta is deficient or defective type ___ collagen (too little bone).

A

1

97
Q

What are the symptoms of osteogenesis imperfecta?

A 
Generalized osteopenia
  Multiple fractures and bone deformities
   Malformed teeth (dentin deficiency)

Blue sclera

98
Q

What is an achondroplastic dwarf?

A

And individual with reduced function of growth plates

99
Q

What is osteopetrosis?

A

Defective osteoclasts

Bone is brittle and too dense

100
Q

What is osteomalacia?

A

Softening bone due to vitamin D deficiency

Delayed eruption of teeth and defects in the dentin and enamel

101
Q

What is Albers-Schoenberg disease?

A

Impaired osteoclasts, reduces bone resorption. Associated with…

Anemia

Bone fractures

Blindness

Deafness

102
Q

What is is osteitis deformans?

A

Mixed stages of osteolysis and osteogenesis

103
Q

What is another term for adult rickets?

A

Osteomalacia

104
Q

True or false… GI malabsorption syndrome and/or lack of sunlight exposure can lead to acquired bone disease

A

True. Scurvy and rickets

105
Q

True or false. Hyperparathyroidism can be a form of acquired bone disease

A

True

Constantly releases Ca2+

Adenoma in parathyroid can cause it

106
Q

Who is osteoporosis common in?

A

Elderly women after menopause

107
Q

True or false.. Osteomalacia is vitamin D deficiency. Lack of normal mineralization (usually kidney related)

A

True

108
Q

What are the genetic and behavioral causes of osteoporosis?

A

Genetic: age, low estrogen, fair hair and skin, tall and thin

Behavior: inactivity, smoking/alcohol, malnutrition, medicaiton (chronic corticosteroids)

109
Q

____ people in the US have osteoporosis. ___ are women over ___ years of age and have at least one osteoportoic fracture.

A

10 million

1/3 women over 50

110
Q

What is kyphosis?

A

Abnormal forward curvature of the spine

111
Q

What is scoliosis?

A

Abnormal lateral curvature of the spine

112
Q

What are the 6 different types of fractures?

A

Complete

Closed (overlying tissue intact)

Comminuted (bone splintered/crushed)

Displaced

Open (fractured bone pierces skin)

Greenstick (bone cracks through only one side (common in children not adults)

113
Q

Osteomyelitis is inflammation of bone/marrow. What are the two ways of getting it?

A

Blood-born (hematogenous spread (pyogenic infections such as staph aureus or salmonella)

Direct (trauma from compound fractures)

114
Q

What is pott disease?

A

Granulomatous osteomyelitis associated with TB or fungi.

Common in the spine

115
Q

How is diabetes related to osteomyelitis?

A

Can cause osteomyelitis due to poor circulation in the extremities. If chronic, can form a drainage site and can even become osteosarcoma

116
Q

Osteoarthritis is a degenerative joint disease. It has loss of ____ with secondary changes in ___. It presents in some degree in most people over ___ years of age. Symptoms (worsen/are relieved) with excessive use. Its due to wear and tear. It is the most common type of joint pain. There are (no/considerable) inflammatory changes. Bones swellings are called ___.

A

Articular cartilage

Bone

65

Worsen

No inflammatory changes

Heberden nodes

117
Q

Rheumatoid arthritis is more systemic and bilateral than osteoarthritis. Most common form is of ____ disease. It has a ___% prevalence. It is most common in what race? What race is it least common in?

A

Autoimmune

1%

Caucasians

Asians

118
Q

Rheumatoid arthritis onset of age is ___. __% of cases are female. (Juvenile RA). Associated with joint swelling, pain, and tenderness that (worsens/is relieved) with use. Can cause extreme distortions of joints and surrounding bone (deforming and debilitating).

A

25-50

75% female

Is relieved by use

119
Q

RA may have systemic symptoms such as ___, ___ and ___. Other areas also affected are…

A

Fever, weakness, malaise

Ulcers

Pulmonary nodules and fibrosis

Carditis and pericarditis

Vasculitis

120
Q

What are some other inflammatory arthritities?

A

Psoriatic arthritis

Other autoimmune diseases (lupus erythematosus, scleroderma)

Post-infections (rheumatic fever)

Infections (staph/strep/TB)

Gout (cystillaized uric acid)

Lyme disease, if not treated - arthritis and neurological consequences

121
Q

What is the primary cause of gout?

A

Reduced renal excretion of purine (uric acid’s break down product)

122
Q

What is the primary treatment of gout?

A

Allopurinol. Decreases the synthesis of purines

123
Q

What are the symptoms of gout?

A

Hot, swollen, pain in joints, progressive joint destruction, gouty tophi (crystallized aggregates of uric acid)

124
Q

What is pseudo-gout?

A

Crystal deposits of calcium pyrophosphate

125
Q

Name three ways to treat gout.

A

Colchicine

Allopurinol

Indomethacine

126
Q

What are ganglion cysts?

A

A cyst resulting from CT around joints. Often painful

127
Q

What is Marfan syndrome?

A

Hereditary connective tissue disease caused by a mutated fibrillin gene with the following symptoms..

Spider-like fingers

Tall growth

Necrosis of aorta

128
Q

Malignant carcinomas spread to bone tumors most likely to come from the ___, ___, ___, ___, and ___

A

Lungs

Prostate

Breast

Thyroid

Kidneys

129
Q

Bone tumors most likely seen in maxilla or mandible are…

A

Osteomas - immature bone

Giant cell tumor - benign, but aggressive

Fibrous dysplasia - not malignant

Osteosarcoma - most often in adolescent or older patient

Ewing sarcoma - seen in 10-20 year olds. 2nd most frequent sarcoma after osteosarcoma

130
Q

How many bone sarcomas occur per year in the US?

A

8000

131
Q

What is the most frequency form of bone malignancy? Who is most likely to get it? Where is most frequent?

A

Osteosarcoma

Most likely in adolescents or geriatric patients

Usually in long bones or sometimes the mandible

132
Q

What are benign tumors of the cartilage? Do not see in the mandible or maxilla.

A

Osteocondroma

133
Q

What is chrondrosarcoma?

A

Malignancy of cartilage

134
Q

What is fibrous dysplasia?

A

Fibrous/ fibro-osseous tumor

Benign medullary bone that does not properly mature

Often in the jaws

135
Q

What is the 2nd most frequent sarcoma after osteosarcoma?

A

Ewing sarcoma

136
Q

How many soft tissue tumors are found each year in the US?

A

12,000

137
Q

Name 6 different soft tissue tumors.

A

Lipoma

Liposarcoma

Fibrous tumors

Fibrosarcoma

Rhabdomyosarcoma

Smooth muscle tumors

138
Q

Describe lipomas

A

Very common

Don’t usually require treatment

139
Q

Are liposarcomas malignant?

A

Yes

140
Q

True or false… fibrous tumors are usually reactive

A

True

141
Q

What are malignant neoplasms of fibroblasts?

A

Fibrosarcoma

142
Q

What are rhabdomyosarcomas?

A

Skeletal muscle tumors

Most frequently in head and neck region

Rare

143
Q

What are two types of smooth muscle tumors?

A

Benign leiomyomas

Leiomyosarcomas (deep soft tissue)

144
Q

True or false… muscular dystrophy is a nonifnlammatory myopathy and is the most common in duchenne muscular dystonia

A

True

145
Q

What are the symptoms of muscular dystrophy?

A

Progressive weakness of voluntary muscles and breakdown of muscle tissue

Can occur anytime and anywhere

Represents a group of genetic disease

146
Q

Congenital myopathies tend to present with congenital ___ and ___

A

Hypotonia

Weakness

147
Q

What is rhabdomyolysis?

A

Diffuse destruction of skeletal muscles

148
Q

Rhabdomyolysis may develop with ____. Can be cause by some drugs such as ___. Describe acute rhabdomyolysis.

A

Flu episode

Statins

Acute: muscles are tender and swollen

149
Q

What are some denervation diseases?

A

ALS

Polio

Typically result in muscle degeneration

150
Q

Myasthenia Gravis is an inflammatory myopathy. What are its symptoms?

A

Weakness in skeletal muscles responsible for breathing and mobility

Worsens with activity and improves with rest

Often includes other skeletal muscles such as those for eyelids, facial movement, chewing, talking, and swallowing.

151
Q

What causes myasthenia Gravis?

A

Auto-antibodies kill Ach receptors; thymus may contribute to formation

Not inherited

152
Q

What is the treatment for myasthenia Gravis? What is the prognosis?

A

Acetylcholinesterase inhibitors - pyridostigmine

Immunosuppressants - prednisone, rituximab

Prognosis is usually good with proper treatment

153
Q

Name three cell types of the skin

A

Squamous cells

Basal cells

Melanocytes

154
Q

What are the appendages of the skin?

A

Apocrine glands (sweat, milky with odors - located near hair follicles)

Eccrine glands (found widely distributed, sweat is watery for thermo control)

Sebaceous (also located near hair follicles, secrets oily sebum for lubrication and to prevent water loss)

155
Q

What is a macule?

A

Flat

Circumscribed

<5mm

156
Q

What is a papule?

A

Elevated dome or flat topped

<5mm

157
Q

What is a nodule?

A

Elevated dome

> 5mm

158
Q

What is a plaque?

A

Elevated

Flat-topped lesion

> 5mm

159
Q

What does lichenfication mean?

A

Thickened skin due to repeated rubbing

160
Q

What is a pustule?

A

Discrete, pus-filled raised lesion

161
Q

What is a scale?

A

Dry, plate-like excrescence, imperfect cornification

162
Q

What is a vesicle?

A

Fluid-filled

Raised area

<5mm

163
Q

What is acantholysis?

A

Loss of intercellular adhesion keratinocytes

Epidermis falls apart and sloughs off

164
Q

What is acanthosis?

A

Diffuse epidermal hyperplasia (thicker than normal)

165
Q

What is excoriation?

A

Traumatic breakage of the skin (for example as a result of intense scratching)

166
Q

What is a bulla?

A

Fluid-filled raised area

> 5mm

167
Q

What is dyskeratosis?

A

Abnormal keratization

Deeper in epidermis than normal

168
Q

What is hyperkeratosis?

A

Hyperplasia of stratum corneum

169
Q

What is spongiosis?

A

Intercellular edema of epidermis

170
Q

What is papillomatosis?

A

Surface elevation caused by hyperplasia

171
Q

What is a cyst?

A

Fluid filled sac lined with true epithelium

172
Q

What is a granuloma?

A

Chronic inflammatory lesion consisting of granulation tissue

173
Q

What is an abscess?

A

Acute inflammatory lesion with pus, surrounded by a fibrous wall

174
Q

What is cellulitis?

A

Acute diffuse swelling along fascial planes separating muscle bundles

175
Q

Define each of the following descriptive words

Calor

Tumor

Rubor

Dalor

Funcio laesa

Urticaria

A

Calor - warm

Tumor - swelling

Rubor - reddening

Dolor - painful

Funcio laesa - loss of function

Urticaria (hives) - associated with mast cell degrandulation and resulting swelling, redness, and itching.

176
Q

Name 4 different types of acute inflammatory skin pathologies

A

Urticaria (hives)

Eczematous dermatitis

Allergic contact dermatitis

Erythema multiforma

177
Q

Urticaria is ___ mediated by antigens and ___. Treat with ___ or ___.

A

Hypersensitivity

IgE

Antihistamine

Steroids

178
Q

Eczematous dermatitis (___ most common, delayed hypersensitivity reaction). Can be prurience, edematous or oozing plaques/vesicles. Can be caused by drugs, reaction to UV or irritating chemicals. Can be associated with ___ or ___.

A

Contact dermatitis

Asthma or allergic rhinitis

179
Q

Allergic contact dermatitis - ___ memory of the reaction so that future contacts cause an [increased/decreased] dermatitis reaction.

A

Cellular

Increased

180
Q

What is erythema multiforma?

A

Hypersensitivity to infections and drugs

Dermal edema

Can have blisters and necrosis

Wide range of expressions and severity

181
Q

What is Stevens Johnson syndrome?

A

A type of severe, life threatening reaction of erythema multiforma due to reaction to medicines such as sulfonamides and salicylates

Can also be a reaction to infections such as herpes virus or fungal infections.

Advanced can have epidermal necrosis with blisters

T-cells attacking antigen and surrounding cells (basal cells)

182
Q

What drugs cause Stevens johnsons syndrome? ___ cells attack what cells?

A

Sulfonamides

Salicylates (aspirin)

T cells attack basal cells

183
Q

Name three types of chronic inflammatory skin diseases

A

Psoriasis

Lichen planus

Systemic lupus

184
Q

What is psoriasis? What is it sometimes accompanied by? What is the treatment? What does it look like?

A

Inciting antigen, auto-rejection or environmentally induced

Can be accompanied by some increase in heart attacks and arthritis

Treatment includes NSAIDs and immunosuppressant drugs

Well-marked by pink to salmon colored plaques

Regular acanthosis in epidermis-thinning of epidermis (with increased bleeding)

185
Q

What does lichen planus look like? Who does it most commonly occur in? How long does it take to resolve? What causes it?

A

Lace-like white markings, referred to as “wickham striae”. Hyperkeratosis and epidermal hyperplasia. Occurs in extremities and oral cavity

Middle age

Resolves after 1-2 years although often persists in oral cavity

Unknown inciting mechanisms- although hyperactive T cells may be involved.

186
Q

What is systemic lupus erythematosus? What is it caused by? How do you manage it?

A

Chronic autoimmune response. Affects skin. Can cause butterfly rash on face

Caused by environmental factors/triggers such as drugs, UV radiation, viruses, stress

Manage with NSAIDs, steroid, antiimmune drugs. Can cause long-term effects such as blood clots seizures, even heart attacks

187
Q

What is impetigo?

A

Infectious dermatosis (usually caused by staph and strep infections superficial).

188
Q

What is infectious dermatosis? How do you treat it?

A

Bacterial infection on face and extremities

Contagious through contact (primarily kids)

Honey color crust, pustules, use topical antibiotics such as tetracycline

189
Q

Fungal skin infections such as tinea (ring worm) or candida) often infect ____ patients. Very common presentation is…

A

Immunocompromised

Erythematosus macules, often pruritic

190
Q

What are some viral infections of the skin?

A

Warts (HPV). Contagious by direct contact. Can auto-inoculate and spread/epidermal hyperplaisa

Papillo mitosis

191
Q

What is the prominent feature of pemphigus?

A

Bulbous blistering

Painful flaccid blister like. Deep erosions and crust after ructions. Hypersensitivity reaction.

192
Q

How do you treat dermatitis herpetiformis?

A

Use immunosuppressive treatment

Tend to be auto-immune responses

193
Q

What does herpes simplex look like?

A

Group vesicles

Epidermal acantholysis

Vesicles

Sloughing

194
Q

Herpes zoster has ____ distribution. What is the danger with that?

A

Dermatomal distribution

Can get trigeminal nerve involvement and can be very dangerous spreading to surrounding tissue such as eye or brain

195
Q

VCV can cause ___ later in life in those who experienced ___ when young. What does it look like?

A

Shingles

Chicken pox

Expresses as a band of rash that often itches, burns or throbs. It may persist for weeks to months. Usually relieved by anti-inlfammtories or opioid analgesics

In extreme cases it becomes like an intense neuralgia and does not respond to traditional analgesics

Not contagious, typically does not repeat, but can in some cases

196
Q

What is pemphigus? How do you treat it? What kind of cells are associated with it?

A

Has acanthosis

Blister formation

Autoimmune

Typically treat with steroids

Pemphigus vulgaris has tzank cells.

197
Q

Acne is infected hair follicles. What is the difference between blackheads and white heads?

A

Blackheads - opened comodones

Whiteheads - closed comodones

Causes cysts, pustules, abscesses, and scarring

198
Q

True or false… drugs such as contraceptives, steroids, and testosterone make acne worse.

A

True? I’m confused though because earlier in the study guide it says that estrogen contraceptives reduce sebum production and are used for acne. ??

199
Q

What causes acne vulgaris?

A

Hormone changes (increase of sex hormones)

Blocks hair follicle and sebaceous glands

Hair follicle have proliferation of lining cells and cellular plug and traps bacteria, cellular debris, and sebum

Gland ruptures and contents spreads to form cysts, abscesses, and scarring, area is inflamed and swollen

200
Q

What do you use to treat acne vulgaris?

A

Antibiotics (tetracycline)

Keratolytics

Drying agents

Vitamin A (topical and systemic - accutane) *do not use in pregnancy!!

UV exposure

201
Q

What is perioral dermatitis? Who is most commonly found in? What causes it?

A

Follicular papules, vesicles and pustules

Found in young women

Long-term steroid use or cosmetic use. Hormonal changes

202
Q

What is the appearance of seborrhea keratosis?

A

Coin-like plaques stuck on appearance. Tan to dark brown glandular surface. Found in the elderly or middle age

Can be generally spread

203
Q

What dos actinic keratosis look like? What causes it? Is it malignant?

A

Brown to red, rough scaly texture

UV exposure in fair-skin people

It is premalignant

204
Q

Melanocytic nevi (moles) are ___ neoplasms from ___. They are variable in appearance. They have ___-defined borders and not predisposed to cancer. Pigmented nevus.

A

Benign

Melanocytes

Well-defined borders.

205
Q

Dysplastic nevi have ___, ___ borders. They are ___. If > ___ lesions, have increased risk for melanoma.

A

Irregular, assymetric borders

Sporadic

> 10

206
Q

Most malignant skin conditions are __-induced free radicals, especially in fair skinned persons

A

UV

207
Q

What is the most common skin malignancy? Describe it. How do you remove it?

A

Basal cell carcinoma

Least aggressive. Slow growing. But can be disfiguring if not removed early and can ulcerate and bleed.

Most common worldwide

Remove with local incision. Does not metastasize

208
Q

What is the second most common skin malignancy? Describe it.

A

Squamous cell carcinoma.

Intermediate aggression. No metastasis.

Red scaling plaques - locally aggressive. Often presents as a scaling ulcerative nodule. Can have keratin pearls (islands of neoplastic skin cells)

Remove with surgery

209
Q

What is the least likely, but most aggressive skin malignancy? Describe it.

A

Melanoma

Metastasizes

Warnings: rapid enlargement of nevus; new pigmented lesion not from pre-existing nevi.

Irregular borders, irregular surface and colors

Usually is superficial and spreads

Caused by UV exposure and genetics

Poor prognosis if metastasized (common sites are lungs, liver, and brain)

210
Q

Common sites of melanoma metastasis is ___, ___, and ___. It has a [high/low] mitotic rate. Lack of immune response to slow spread especially once it hits lymph nodes. Superficial lesions are typically [good/bad] prognosis. Poor prognosis with metastatic disease, high mitotic rate and poor immune response.

A

Lungs, liver, brain

High

Good

Human Disease And Therapeutics (13 decks)

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