Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Dermatology > Troublesome rash > Flashcards

Troublesome rash Flashcards

You may prefer our related Brainscape-certified flashcards:
Dermatology Board Prep flashcards
1
Q

What are the 4 features of psoriatic nails?

A
  1. Periungal erythema
  2. Pitting
  3. Subungal hyperkeratosis
  4. Onycholysis (nail plate separates from the nailbed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How to psoriasis patients typically present clinically?

A

They present with plaques on the;

  • Elbows
  • Knees
  • Scalp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the common shape of a lesion on the trunk in a psoriasis patient?

A

Annular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Koebner’s phenomenon?

A

When areas of the skin become lesions where the skin should not normally be raised (e.g. when someone scratches their skin and an immediate lesion appears)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Guttate psoriasis?

A

Widespread small plaques scattered on the trunk and the limbs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Palmo-plantar pustular psoriasis (PPPP)?

A

Multiple sterile pustules appear on the palms and soles. They first look yellowish monomorphic lesions then become brown over time.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which patients are typically affected by palmo-plantar pustular psoriasis?

A

Smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is generalised pustular psoriasis (GPP)?

A

Acutely erythematous skin which is very tender. There are skeets of monomorphic, sterile pustules which can develop over hours/days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does GPP generally indicate?

A

It usually indicates a very severe and unstable psoriasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is acropustulosis?

A

It is a very rare variant of psoriasis where there are pustules on the nails and fingertips associated with inflammation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Who most commonly develops acropustulosis?

A

Young children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is flexural psoriasis?

A

Well-defines erythematous areas in the axillae, groin, natal cleft, beneath the breasts and in skin folds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is erythrodermic psoriasis?

A

This is a serious, even life-threatening condition, with confluent erythema affecting nearly all of the skin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the triggers for the life-threatening erythrodermis psoriasis?

A
  1. Withdrawing from systemic steroids
  2. Infection
  3. Excessive alcohol intake
  4. Antimalarials
  5. Lithium
  6. Hypocalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the systemic complications of erythrodermis psoriasis?

A
  1. Heart failure
  2. Hypothermia
  3. Dehydration
  4. Low protein
  5. Oedema
  6. Secondary infection (encephalitis etc)
  7. Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the pathophysiology of erythrodermic psoriasis?

A

Increased cutaneous blood flow and therefore excessive (insensible) fluid losses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Chronic Plaque psoriasis (CPP)?

A

Extensive plaques are present over the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the common areas of the body that are affected by Chronic plaque psoriasis?

A
  1. Ears
  2. umbilicus
  3. Genitals
  4. Knees
  5. Toe nails
  6. Finger nails
  7. Scalp
  8. Elbows
  9. Natal cleft
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What percentage of psoriasis is chronic plaque psoriasis?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When does guttate psoriasis commonly occur?

A

After a streptococcal sore throat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What proportion of patients with guttate psoriasis go on to develop chronic plaque psoriasis?

A

1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a joint complication of psoriasis?

A

Psoriatic arthropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What percentage of patients with psoriasis develop psoriatic athropathy?

A

5-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What percentage of patients with psoriatic arthropathy see that joint changes preceed the skin changes?

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the 5 subtypes of arthropathy patterns?

A
  1. Distal interphalangeal alone (DIP)
  2. Symmetrical polyarthritis (most common)
  3. Asymmetrical oligoarthritis
  4. Arthritis mutilans
  5. Spondyloarthropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What percentage of patients with DIP arthropathy have nail changes too?

A

80%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe asymmetrical oligoarthropathy

A

Hands and feet become very swollen and the fingers and toes become sausage shaped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What joints are affected in symmetrical polyarthtritis?

A

Hands, wrists and ankles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What happens to the skin of a patient who has arthritis mutilans?

A

The skin ‘telescopes’ as it becomes redundant when the bone of the digits becomes resorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the common cause of psoriatic arthritis?

A

A genetic predisposition and an environmental trigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What percentage of patients who have psoriatic arthritis have a family history of psoriasis?

A

40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the common triggers for psoriasis?

A
  1. Psychological stress
  2. Alcohol intake
  3. Iatrogenic - medications such as antimalarials, NSAIDs, B-Blockers, Lithium, Terbinafine
  4. Inherited
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is type 1 psoriasis?

A

75% of patients are type 1
They present when they are <40
There is a genetic link with HLA-CW6 (gene on chromosome 6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is type 2 psoriasis?

A

25% of patients are type 2
First presentation between 55 and 60
No genetic link

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What must all psoriasis patients be prescribed as first line treatment for their condition?

A

Emollient use is a must

36
Q

What is the most appropriate first line treatment (drug, dosage, route etc.) for psoriasis affecting the following area; Palmoplantar?

A

Potent topical steroid ointment OD for 4 weeks

37
Q

What is the most appropriate first line treatment (drug, dosage, route etc.) for psoriasis affecting the following area; Trunk and limbs (<10% BSA)?

A

Potent topical steroid ointment - AM OD
Vitamin D analogue - PM OD

Both for 8 weeks

38
Q

What is the most appropriate first line treatment (drug, dosage, route etc.) for psoriasis affecting the following area; mild scalp involvement?

A

Tar based shampoo

39
Q

What is the most appropriate first line treatment (drug, dosage, route etc.) for psoriasis affecting the following area; Moderate scalp involvement?

A

Potent corticosteroid topically applied OD for 4 weeks

40
Q

What is the most appropriate first line treatment (drug, dosage, route etc.) for psoriasis affecting the following area; Severe scalp involvement?

A

Descale with salicylic acid/emollient or oils for 1 week

Potent corticosteroid OD for 4 weeks

41
Q

What is the most appropriate first line treatment (drug, dosage, route etc.) for psoriasis affecting the following area; Flexural genitalia/face/hairline?

A

Initially try a mild potency topical steroid (max. BD)

If not irritated use vitamin D analogue

42
Q

What would be a good initial management plan for someone with chronic plaque psoriasis over the body?

A
  1. Use emollient every 12 hours
  2. Use a soap substitute for the bath/shower
  3. Topically treat with vitamin D analogue for the trunk and limbs
  4. Use a mild topical steroid ointment for the face and flexures
43
Q

What are the 3 steps to psoriasis treatment?

A
  1. Topical therapy
  2. Phototherapy
  3. Systemic medication
44
Q

What are the 2 validated tools we an use to determine the severity of psoriasis?

A
  1. Psoriasis Area Severity Index (PASI)

2. Dermatology of Life Quality Index (DLQI)

45
Q

Who completed the PASI score?

A

The clinician

46
Q

What is the PASI scored out of?

A

72

47
Q

What does the following score on the PASI mean; 0-5?

A

Mild disease

48
Q

What does the following score on the PASI mean; 5-12?

A

Moderate disease

49
Q

What does the following score on the PASI mean; 12-20?

A

Severe disease

50
Q

What does the following score on the PASI mean; >20?

A

Very severe disease

51
Q

Who completes the DLQI?

A

The patient

52
Q

What does the following score on the DLQI mean; 0-1?

A

Psoriasis has no effect at all on the patient’s life

53
Q

What does the following score on the DLQI mean; 2-5?

A

Psoriasis has a small effect on the patient’s life

54
Q

What does the following score on the DLQI mean; 6-10

A

psoriasis has a moderate effect on the patient’s life

55
Q

What does the following score on the DLQI mean; 11-20?

A

Psoriasis has a very large effect on the patient’s life

56
Q

What does the following score on the DLQI mean; 21-30?

A

Psoriasis has an extremely large effect on the patient’s life

57
Q

What is another scoring tool that we can use to assess the severity of psoriatic arthritis?

A

The Psoriasis Epidemiology Screening Tool (PEST)

58
Q

In patients with psoriatic arthritis, what other medical speciality should be involved in their care?

A

Rheumatology

59
Q

What is the aim of phototherapy in relation to psoriasis?

A

This is used to slow down the excessive growth of keratinocytes and is believed to be partly immunosuppressive

60
Q

How many phototherapy sessions are usually delivered weekly and for how many weeks?

A

2-3 times per week for 10 weeks

61
Q

How many sessions of PUVA is an individual restricted to in their lifetime and why?

A

100 sessions due to the risk of developing skin cancer

62
Q

What treatment option is next available for those who have a poor response to phototherapy or for those who are not eligible to try phototherapy?

A

Systemic treatment of the skin

63
Q

What is ciclosporin?

A

An immunosuppressant that inhibits T-cells.

64
Q

How often is ciclosporin taken in someone being treated for psoriasis?

A

BD

65
Q

When do we normally see a response from patients who take ciclosporin for their psoriasis?

A

Within 4-6 weeks

66
Q

What are the common side effects of ciclosporin?

A
  1. Hypertension
  2. Renal impairment
  3. Lymphopenia (immune dysfunction)
  4. Hypertrichosis (increased hair growth)
  5. Gum hypertrophy
67
Q

What is the maximum amount of time someone can spend being treated with ciclosporin?

A

12 months

68
Q

How long does it take for methotrexate to reach its maximal efficacy in patients with psoriasis?

A

4-6 months

69
Q

How does methotrexate work when thinking about psoriasis?

A

It is an anti-inflammatory and reduces the number of cutaneous T-cells

70
Q

What are the common side-effects of taking methotrexate?

A
  1. Haematological toxicities (anaemia, lymphopenia, thrombocytopenia)
  2. Liver fibrosis
71
Q

Which patients are contraindicated to taking methotrexate for psoriasis?

A
  1. Those who are trying to conceive
  2. Those who are taking trimethoprim
  3. Those who have pre-existing liver conditions
72
Q

What is Acitretin?

A

An oral retinoid (Vitamin A derivative)

73
Q

How often is acitretin taken?

A

OD

74
Q

How does acitretin work?

A

It inhibits keratinocyte proliferation in the epidermis

75
Q

How long before wanting to conceive should acitretin be discontinued and why?

A

This drug has a very long half-life and should be discontinued 2 years before wanting to conceive due to its teratogenicity

76
Q

50% of patients who take acitretin will see a response within how many weeks?

A

12

77
Q

How do Fumaric acid esters (FAEs) work?

A

They shift T-helper 1 phenotype cells into T-helper 2 phenotype cells. As psoriasis is a T-helper 1 mediated condition, this shift will prevent/reduce the psoriasis effect.

78
Q

What type of drug is a Fumaric acid ester (FAE)?

A

An oral immunomodulatory drug

79
Q

What are the common side effects of Fumaric acid esters (FAEs)?

A
  1. Nausea
  2. Diarrhoea
  3. Lymphopenia (<0.7 lymphocyte count)
80
Q

Which patients should be started on Apremilast first?

A

Those with co-morbidities that need to be considered. This is because it causes minimal toxicities.

81
Q

When systemic therapies do not help to improve psoriasis, what treatments should be considered next?

A

Biological therapy

82
Q

Which patients are eligible for biological therapy due to the expensive nature of the monoclonal antibody treatment?

A

These patients must have;

  1. Tried 2 or more systemic agents without success
  2. Have a PASI and DLQI score of 10 or more
83
Q

Give 2 examples of Tumour Necrosis Factor (TNF) inhibitors

A
  1. Etanercept
  2. Infliximab
  3. Adalimumab
  4. Certolizumab
84
Q

Adalimumab is the most common TNF inhibitor given, how is it administered and how often?

A

SC injection

Every 2 weeks

85
Q

Name the 3 families of drugs that we can use as a biological therapy for psoriasis

A
  1. TNF inhibitor
  2. IL-12/23 inhibitor
  3. IL-17 inhibitor
86
Q

What chronic and acute health conditions are patients with psoriasis at increased risk of developing?

A
  1. MI
  2. T2DM
  3. Hyperlipidaemia
  4. Metabolic syndrome

Dermatology (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions