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JL Dermatology > Week 2 > Flashcards

Week 2 Flashcards

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Dermatology Board Prep flashcards
1
Q

Give two advantages of topical treatments?

A
  1. Direct application

2. Reduced systemic effects

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2
Q

Give three disadvantages of topical treatments

A
  1. Time consuming
  2. Correct dosage can be difficult
  3. Messy to use
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3
Q

What is a cream?

A

Semisolid emulsion of oil in water containing emulsifier and preservative

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4
Q

What is the term for a semisolid grease/oil (soft paraffin) containing no preservative?

A

Ointments

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5
Q

What do ointments restrict?

A

Transepidermal water loss

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6
Q

What is the term for a suspension or solution of medication in water, alcohol or other liquids - used to treat scalp and hair-bearing areas?

A

Lotions

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7
Q

What is another term for “thickened aqueous lotion”?

A

Gels

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8
Q

What is in a gel?

A

Semi-solids, containing high molecular weight polymers e.g. methylcellulose

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9
Q

What do emollients enhance and name a condition they are used for?

A

Rehydration of epidermis and used for all dry/scaly conditions such as eczema

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10
Q

How much emollient is prescribed weekly for patients?

A

300 - 500G

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11
Q

What is wet wrap therapy used for?

A

Very dry (xerotic) skin

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12
Q

Give the three mode of action points for topical corticosteroids?

A
  1. Vasoconstrictive
  2. Anti-inflammatory
  3. Anti-proliferative
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13
Q

Name a mild topical steroid?

A

Hydrocortisone

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14
Q

Name a moderate topical steroid?

A

Modrasone
Clobetasone
Butyrate

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15
Q

Name a potent topical steroid?

A

Mometasone
Betamethasone
Valerate

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16
Q

Name a very potent topical steroid?

A

Clobetasol

Proprionate

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17
Q

What could be used to treat eczema, psoriasis, lichen planus and keloid scars?

A

Topical corticosteroids

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18
Q

Give three side effects of topical steroids?

A

Thinning of the skin, purpura and stretch marks

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19
Q

What are fixed telangectasia, steroid rosacea and perioral dermatitis all side effects of?

A

Topical steroids

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20
Q

What antiseptic is used in acute exudative eczema, pompholyx?

A

Potassium permanganate rinse/soak/bath

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21
Q

Name three topical antibiotics used for acne?

A

Clindamycin
Erythromycin
Tetracycline

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22
Q

Name a topical antibiotic used for rosacea?

A

Metronidazole

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23
Q

Name two topical antibiotics used for impetigo?

A

Mupirocin

fusidic acid

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24
Q

Name a disease where a topical antiviral would be used?

A

Herpes simplex

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25
Q

Name two conditions where oral antivirals would be used?

A

Eczema herpeticum

Herpes Zoster

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26
Q

Name two treatments for candida?

A

Nystatin

Clotrimazole

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27
Q

Name two treatments for dermatophytes (ringworm)

A

Clotrimazole

Terbinafine cream

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28
Q

Name a treatment for pityriasis versicolor?

A

Ketoconazole

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29
Q

What is menthol?

A

An antipruritic

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30
Q

What do keratolytics do?

A

Soften keratin

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31
Q

What drug type would be used for viral warts, hyperkeratotic eczema & psoriasis, corns and calluses and to remove keratin plaques in scalp?

A

Keratolytics

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32
Q

What is used to treat genital warts?

A

Podophyllin

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33
Q

What are formaldehyde, glutaraldehyde and silver nitrate all used for?

A

Treatment of warts

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34
Q

Give 5 options for topical psoriasis treatment?

A 
Coal tar
Vitamin D analogue
Keratolytic
Topical steroid
Dithranol
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35
Q

What drug is an immune response modulator, ehances innate and cell-mediated immunity and has anti-viral/anti-tumour effects?

A

Imiquimod

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36
Q

What (trade name Aldara cream) is used for genital warts, superficial BCC and also solar keratoses, lentigo maligna, Bowen’s disease and verrucae?

A

Imiquimod

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37
Q

What do calicneurin inhibitors do?

A

Suppress lymphocyte activation

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38
Q

Give two examples of calicneurin inhibitors and a condition they are used for?

A

Tacrolimus
Pimecrolimus
Atopic eczema

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39
Q

What is increased thickness of keratin called?

A

Hyperkeratosis

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40
Q

What is parakeratosis?

A

Persistence of nuclei in the keratin layer

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41
Q

What is acanthosis?

A

Increased thickness of epidermis

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42
Q

What is papillomatosis?

A

Irregular epithelial thickening

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43
Q

What is spongiosis?

A

Oedema between keratinocytes

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44
Q

What cells are involved in inflammatory cell infiltrate?

A

Lymphocytes and/or neutrophils

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45
Q

Give four features in the acute phase of eczema?

A
  1. Papulovesicular
  2. Red erthematous lesions
  3. Oedema (spongiosis)
  4. Ooze or scaling and crusting
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46
Q

Give three features of the chronic phase of eczema?

A
  1. thickening (lichenification)
  2. Elevated plaques
  3. Increased scaling
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47
Q

What is itchy, ill-defined, erythematous and scaly?

A

Eczema

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48
Q

What is the pathogenesis and histology of contact allergic dermatitis?

A

Delayed type 4

Spongiotic dermatitis

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49
Q

What is the pathogenesis and histology of contact irritant dermatitis ?

A

Trauma e.g. soap

Spongiotic dermatitis

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50
Q

What is the pathogenesis and histology of atopic dermatitis?

A

Genetic and environmental factors resulting in inflammation

Spongiotic dermatitis

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51
Q

What is the pathogenesis and histology of drug-related dermatitis?

A

Type 1 or 4 hypersensitivity reaction

Spongiotic dermatitis and eosinophils

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52
Q

What is the pathogenesis and histology of photo-induced or photosensitive dermatitis?

A

Reaction to UV light

Spongiotic dermatitis

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53
Q

What is the pathogenesis and histology for lichen simplex dermatitis?

A

Physical trauma to skin - scratching

Spongiotic dermatitis and external trauma

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54
Q

What is the pathogenesis and histology of stasis dermatitis?

A

Physical trauma to skin - hydrostatic pressure

Spongiotic dermatitis and extravasation of RBCs

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55
Q

What type of dermatitis can a button on jeans cause?

A

Nickel contact allergic dermatitis

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56
Q

In the immunopathology of contact allergic dermatitis - what do Langerhans cells in the epidermis do?

A

Process antigen (increased immunogenicity)

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57
Q

In the immunopathology of contact allergic dermatitis - what happens after the Langerhan cell has processed the antigen?

A

It is presented to the Th cells in the dermis

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58
Q

In the immunopathology of contact allergic dermatitis - what happens after the processed antgen has been presented to the Th cells in the dermis?

A

Sensitised Th cells migrate into lymphatics and then to regional nodes where antigen presentation is amplified

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59
Q

In the immunopathology of contact dermatitis - what happens after subsequent antigen challenge?

A

Specifically sensitised T cells proliferate nad migrate to and infiltrate skin causing dermatitis

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60
Q

What can be used to test contact dermatitis?

A

Patch testing

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61
Q

What type of dermatitis is a non-specific physical irritation rather than a specific allergic reaction?

A

Irritant dermatitis

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62
Q

What is nappy rash?

A

Irritant contact dermatitis to urine - sparing of flexures

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63
Q

What type of eczema involves pruritis, ill-defined erythema and scaling, generalised dry skin, flexural distribution and is associated with asthma?

A

Atopic eczema

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64
Q

Give three chronic changes with atopic eczema?

A

Lichenification
Excoriation
Secondary infection

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65
Q

In eczema secondary infection - what does crusting indicate?

A

Staph aureus infection

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66
Q

What is eczema herpeticum an infection of and what should you look for?

A

Herpes simplex virus

monomorphic punched-out lesions

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67
Q

What are the five UK diagnostic criteria for atopic eczema?

A

Itching plus 3 or more:

visible flexural rash
history of flexural rash
personal history of atopy
generally dry skin
onset before age 2
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68
Q

The 7 treatments for eczema?

- PATTPSB

A
  1. Plenty of emolients
  2. Avoid irritants
  3. Topical steroids
  4. Treat infection
  5. Phototherapy - UVB
  6. Systemic immunosuppressants
  7. Biologic agents
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69
Q

What is the most important gene in atopic eczema?

A

Filaggrin

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70
Q

What is another term for photosensitive eczema?

A

Chronic actinic dermatitis

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71
Q

What three things is stasis eczema secondary to?

A
  1. Hydrostatic pressure
  2. Oedema
  3. Red cell extravastion
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72
Q

What type of eczema has spongiotic vesicles?

A

Pompholyx eczema

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73
Q

What type of eczema can be caused by repetetive scratching?

A

Lichen simplex

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74
Q

Describe staphylococcus?

A

Gram positive cocci in clusters

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75
Q

Give the two important types of Staphylococcus?

A
  1. Staph aureus (coagulase positive)

2. Coagulase negative Staph (epidermidis, saprophyticus)

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76
Q

What is an enzyme, produced by staphlycoccus aureus, that clots plasma?

A

Coagulase

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77
Q

What causes urinary tract infection in women of child-bearing age?

A

Staph. saprophyticus

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78
Q

How are streptococcus species classified?

A

By haemolysis on blood agar

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79
Q

What haemolysis is complete?

A

Beta

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80
Q

What toxin that damages tissues does beta-haemolytic streptococci release?

A

Haemolysin

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81
Q

What are the two important catagories of alpha-haemolytic streptococci?

A

Strep. pneumoniae

Strep. viridans

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82
Q

Give an example species of non-haemolytic streptococci?

A

Enterococcus species - commensals of bowel

83
Q

Along with cellulitis, wound infection and other minor skin sepsis - what other bacterial skin infections are caused by Staph. aureus?

A

Infected eczema, impetigo and staphylococcal scalded skin syndrome

84
Q

What bacterial skin infection does Strep pyogenes (Group A strep) cause?

A

Necrotising fascilitis

Erysipelas

85
Q

What is a bacterial infection spreading along fascial planes below the skin surface leading to rapid tissue destruction?

A

Necrotising fascilitis

86
Q

What is another term for tinea pedis?

A

Atheltes foot

87
Q

In dermatophyte pathogenesis - what occurs after fungus has entered abraded or soggy skin?

A

Hyphae spread in stratum corneum

88
Q

What does increased epidermal turnover cause?

A

Scaling

89
Q

What dermatophtte causal organism comes from cats?

A

Microsporum canis

90
Q

What are two treatments for scalp infections?

A

Terbinafine orally

Itraconazole orally

91
Q

How do you diagnose candida skin infection?

A

Swab for culture

92
Q

How do you treat candida skin infection?

A

Clotrimazole cream

Oral fluconazole

93
Q

What is scabies caused by?

A

Sarcoptes scabiei

94
Q

What is the incubation period of scabies?

A

Up to 6 weeks

95
Q

In scabies - where does the itchy rash affect?

A

Genital areas, figner webs and wrists

96
Q

What are the two treatments for scabies?

A

Malathion lotion

Benzyl benzoate

97
Q

Where does pediculus capitis affect?

A

Head louse

98
Q

What is the treatment for lice?

A

Malathion

99
Q

What disease is dermatomal?

A

Shingles

100
Q

What disease is macules to papules to vesicles to scabs to recovery?

A

Chickenpox

101
Q

What disease has a high mortality and is secondary to chickenpox in mother in late pregnancy?

A

Neonatal VZV

102
Q

What does the later stage of shingles show?

A

Rash and increasing pain

103
Q

What nerve can be affected by shingles?

A

Trigeminal

104
Q

Where can you get vesicles and pain with Ramsay-Hunt syndrome?

A

Vesicles and pain in auditory canal and throat

105
Q

What nerve facial palsy can you get with Ramsay-Hunt syndrome?

A

7th nerve palsy

106
Q

In Ramsay-Hunt syndrome - which cranial nerve is irritated?

A

8th - deafness, vertigo, tinnitus

107
Q

What virus occurs commonly in pre-school children, lasts around a week and gives primary gingivostomatitis and extensive ulceration in and around mouth>

A

Herpes simplex

108
Q

What is it called when herpes simplex virus spreads to eczema?

A

Eczema herpeticum

109
Q

What condition gives a blistering rash at the vermillion border?

A

Herpes simplex virus recurrence

110
Q

What type of herpes simplex virus is the main cause of oral lesions?

A

Type 1

111
Q

What is aciclovir an analogue of?

A

Guanosine

112
Q

How is lab confirmation of herpes simplex virus obtained?

A

Swab with viral transport medium

113
Q

What condition can be described with target lesions with erythema?

A

Erythema multiforme

114
Q

What condition can be triggered by herpes simplex virus and mycoplasma pneumoniae bacterium?

A

Erythema multiforme

115
Q

What condition gives fleshy, firm, umbilicated, pearlescent nodules 1 to 2 mm diamater?

A

Molluscum contagiosum

116
Q

How can molluscum contagiosum be treated?

A

With liquid nitrogen

117
Q

What is the laymans term for human papilloma virus?

A

Warts

118
Q

What disease gives a blistering rash of back of mouth and is caused by enterovirus (coxsackie and echovirus)?

A

Herpangina

119
Q

What is caused by parvovirus B19?

A

Erythema infectiosum or slapped cheek disease

120
Q

Give three complications of parvovirus B19?

A
  1. Spontaneous abortion
  2. Aplastic crises
  3. Chronic anaemia
121
Q

How is parvovirus B19 lab confirmed?

A

By antibody testing - parvovirus B19 IgM test

122
Q

What is the virus of sheep “scabby mouth” disease?

A

Orf

123
Q

What can be seen on a patient with Orf?

A

Firm, fleshy nodule on hands of farmers

124
Q

What can be seen on a patient with primary syphilis infection?

A

Painless ulcers at site of entry

125
Q

What can be seen on a patient with secondary stage syphilis infection?

A

Red rash over body
Prominent on soles of feet and palms of hands
Mucous membrane “snail track” ulcers

126
Q

What is syphilis due to?

A

Sexually transmitted infection with bacterium Treponema pallidum

127
Q

How is syphilis diagnosed?

A

Blood test or swab of chancre for PCR

128
Q

How is syphilis treated?

A

Injections of penicillin

129
Q

What is the bacterial cause of Lyme disease?

A

Borrelia burgdorferi

130
Q

What is the early presentation of Lyme disease?

A

Erythema migrans

131
Q

What is the late presentation of Lyme disease?

A

Heart block, nerve palsies and arthritis

132
Q

How is Lyme disease diagnosed?

A

Blood test for antibody to organism

133
Q

What type of HPV is most common in warts/veruccas?

A

1 -4

134
Q

What type of HPV is most common in genital warts?

A

Types 6 and 11

135
Q

What type of HPV is most common in cervical cancer?

A

Types 16 and 18

136
Q

What is one of the most common genodermatoses?

A

Tuberose sclerosis

137
Q

Give two clinical features of Tuberose sclerosis?

A
  1. Periungual fibromata

2. Longitudinal ridging

138
Q

What condition may present as infantile seizures?

A

Tuberose sclerosis

139
Q

What is the earliest cutaneous sign of Tuberose sclerosis?

A

Ash-lead macule

140
Q

What type of mutation is Tuberose Sclerosis?

A

Autosomal dominant

141
Q

Other than periungual fibromas, what 3 other tumours can arise in Tuberose Sclerosis?

A
  1. Facial angiofibromas
  2. Hamartomas
  3. Bone cysts
142
Q

What are shagreen patches and enamel pitting seen in?

A

Tuberose Sclerosis

143
Q

What two chromosomes are affected in Tuberose Sclerosis?

A

Tuberin - chromosome 9

Hamartin - chromosome 16

144
Q

What does Tuberose Sclerosis show?

A

Genetic heterogeneity - mutation in TSC1 or TSC2

145
Q

What is the penetrance like in Tuberose Sclerosis?

A

Variable

146
Q

Name a group of genetic skin fragility conditions?

A

Epidermolysis Bullosa

147
Q

What are the three main types of epidermolysis bullosa?

A

Simplex
Junctional
Dystrophic

148
Q

What is EB aquisita?

A

A rare autoimmune condition

149
Q

Describe haploinsufficiency?

A

Only one copy of working - reduced protein production

150
Q

What term describes - expression of abnormal protein interferes with normal protien

A

Dominant negative

151
Q

What are two clinical signs for neurofibromatosis type 1?

A

Cafe-au lait macules

Neurofibromas

152
Q

What are plexiform neuroma, axillary and inguinal freckling, optic glioma, Lisch nodules and a distinctive bony lesion all features of?

A

NF1

153
Q

What can filaggrin mutations cause?

A

Ichthyosis vulgaris

154
Q

What part of the skin is stratified keratinising squamous epithelium?

A

Epidermis

155
Q

What cells are in the corneal layer?

A

Differentiated keratinised cells

156
Q

Where are melanocytes found?

A

Basal layer

157
Q

What is the dermis a matrix of?

A

Type 1 and type 111 collagen

158
Q

Name two ground substances found in the dermis?

A

Hyaluronic acid

Chondroitin

159
Q

Where does the papillary dermis lie?

A

Just beneath the epidermis

160
Q

What does the reticular dermis contain?

A

Appendage structures

161
Q

What is the epidermal basement membrane made of?

A

Laminin and collagen IV

162
Q

What is the term describing increased thickness of keratin layer?

A

Hyperkeratosis

163
Q

What is the term describing persistence of nuclei in the keratin layer?

A

Parakeratosis

164
Q

What is the term describing increased thickness of epithelium?

A

Acanthosis

165
Q

What is papillomatosis?

A

Irregular epithelial thickening

166
Q

What is the term for oedema fluid between squames appearing to increase prominence of intercellular prickles?

A

Spongiosis

167
Q

What is psoriasiform?

A

Elongation of the rete ridges e.g. psoriasis

168
Q

Give three aetiology points about acne vulgaris?

A
  1. Increased androgens at puberty
  2. Keratin plugging of pilosebaceous glands
  3. Infection with anaerobic bacterium corynebacterium acnes
169
Q

In acne - what do keratin and sebum build up to produce?

A

Comedones (blackheads/whiteheads)

170
Q

Is rosacea commoner in females or males?>

A

Females

171
Q

What condition involves recurrent facial flushing, visible blood vessels, pustules and thickening of the skin (rhinophyma)?

A

Rosacea

172
Q

Name four factors that can aggravate rosacea?

A
  1. Sunlight
  2. Alcohol
  3. Spicy food
  4. Stress
173
Q

What condition has vascular ectasia, patchy inflammation with plasma cells, pustules, perifollicular granulomas as its pathology?

A

Rosacea

174
Q

Give three important examples of immunobullous diseases?

A
  1. Pemphigus
  2. Bullous pemphigoid
  3. Dermatitis herpetiformis
175
Q

What disease is rare autoimmune bullous, has loss of integrity of epidermal cell adhesion and responds to steroids?

A

Pemphigus

176
Q

In the autoimmune condition - pemphigus vulgaris - what are IgG auto-antibodies made against?

A

Desmoglein 3

177
Q

What does pemphigus vulgaris produce?

A

Fluid filled blisters which rupture to form shallow erosions

178
Q

What process is common to all variants of pemphigus?

A

Acantholysis - lysis of intercellular adhesion sites

179
Q

What pemphigus disease has subepidermal tense blistering and has no evidence of acantholysis?

A

Bullous pemphigoid

180
Q

Describe the pathology of bullous pemphigoid

A

Circulating antibodies (IgG) react with a major/minor antigen of the hemidesmosomes anchoring basal cells to basement membrane. The result is local complement activation and tissue damage.

181
Q

What autoimmune bullous disease has strong association with coeliac disease?

A

Dermatitis herpetiformis

182
Q

What haplotype is dermatitis herpetiformis associated with?

A

HLA-DQ2

183
Q

What condition has intensely itchy lesions - symmetrical, involves the elbows, knees and buttocks and the hallmark is papillary dermal microabscesses?

A

Dermatitis herpetiformis

184
Q

Describe what is seen in chronic plaque psoriasis?

A

Sharply demarcated, scaly, erythematous plaques

185
Q

Give four clinical features of psoriatic nail disease?

A
  1. Onycholysis
  2. Nail pitting
  3. Dystrophy
  4. Subungal hyperkeratosis
186
Q

Name two vitamin D analogues for treatment of psoriasis?

A
  1. Calcipotriol

2. Calcitriol

187
Q

In the treatment of psoriasis sometimes fumaric acid ester can be used -what does it disrupt?

A

Lymphocytes

188
Q

Give three topical treatments for acne?

A
  1. Benzoyl peroxide - keratolytic, antibacterial
  2. Vitamin A derivative (retinoid) - adapalene
  3. Antibiotics - antibacterial and anti-inflammatory
189
Q

Name an oral retinoid used for systemic treatment of acne?

A

Isotretinoin

190
Q

Name two antibiotics used to treat rosacea?

A

Topical metronidazole

Oral tetracycline

191
Q

Differentiate between bullous pemphigoid and pemphigus?

A

Bullous pemphigoiD - split is Deeper, through DEJ

PemphiguS - split is more Superficial, intra-epidermal

192
Q

What disease is common in elderly patients, localizesd to one area, has large tense bullae on normal skin or erythematous base, blisters burst to leave erosions, itchy erythematous plaques and papules may be the presenting feature and Nikolsky sign negative?

A

Bullous pemphigoid

193
Q

What disease typically affects scalp, face, axillae and groins, has thin roofed flaccid vesicles, lesions rupture to leave raw areas and is Nikolsky sign positive?

A

Pemphigus vulgaris

194
Q

Name three immunosuppressive agents used to treat both pemphigoid and pemphigus?

A

Azathioprine
Ciclosporin
Mycophenolate

195
Q

Suggest four ways to investigate anaphylaxis?

A
  1. Specific IgE specificity
  2. Skin prick testing
  3. Challenge test
  4. Serum mast cell tryptase level during attack
196
Q

What three things mediate itch?

A
  1. Chemical mediators in skin
  2. Nerve transmission
  3. Central nervous system
197
Q

What are the four causes of itch?

A
  1. Pruritoceptive
  2. Neuropathic
  3. Neurogenic
  4. Psychogenic
198
Q

What type of itch is something (usually associated with inflammation or dryness) in skin that triggers it?

A

Pruritoceptive

199
Q

What type of itch is damage of any sort to central or peripheral nerves causing it?

A

Neuropathic

200
Q

What type of itch is caused by e.g. opiate effects on CNS receptors

A

Neurogenic

201
Q

What type of itch is psychological with no CNS damage?

A

Psychogenic

202
Q

Give 6 systemic diseases associated with itch

A
  1. Haematological
  2. Paraneoplastic
  3. Liver and bile duct
  4. Psychogenic
  5. Kidney disease
    6 Thyroid disease
203
Q

What are 5 anti-itch treatments?

A
  1. Sedative anti-histamines
  2. Emollients
  3. Antidepressants - doxepin
  4. Phototherapy
  5. Opiate antagonists

JL Dermatology (6 decks)

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