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Dermatology > Week 2 > Flashcards

Week 2 Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the two main types of topical therapy

A

Topical steroids

emollients

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2
Q

What is the main purpose of emollient use?

A

They enhance epidermis rehydration in dry/scaly skin conditions.

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3
Q

What form of therapy is used to treat severe eczema in young children?

A

Wet wrap therapy

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4
Q

Identify four possible side effects of topical steroids

A 
Rosacea
stretch marks
purpura
skin thinning
perioral dermatitis
telangectasia
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5
Q

What are the three modes of action of topical corticosteroids?

A

vasoconstrictive
anti-inflammatory
immunosuppressant

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6
Q

Modrasone, Clobetasone, Butyrate, Mometasone, Betamethasone, Valerate are all examples of what type of drug?

A

Topical corticosteroids

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7
Q

Povidone iodine , Chlorhexidine , Triclosan , Hydrogen peroxide are all examples of what type of drug? Give three uses for such drugs

A

Antiseptics

recurrent skin infections, skin cleansing, wound irrigation

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8
Q

Give three skin conditions which may be treated with antibiotics

A 
rosacea
impetigo
acne
cellulitis
folliculitis
carbuncles
Staphloccocal scalded skin syndrome
erysipelas
necrotising fasciitis
gas gangrene (clostridium)
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9
Q

Identify three skin infections that are treated with antiviral agents

A

herpes zoster (shingles)
herpes simplex
eczema herpeticum

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10
Q

Identify three skin conditions which require anti-fungal treatment

A

candida (thrush)
dermatophytes (ringworm)
pityriasis versicular

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11
Q

What is the purpose of keratolytic drugs?

A

They soften keratin e.g. viral warts, hyperkeratotic eczema and psoriasis, corns, calluses

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12
Q

Identify 6 possible topical treatments of psoriasis

A 
emollients
keratolytics
Vit D analogues
coal tar
topical steroid
dithranol
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13
Q

What is hyperkeratosis?

A

Increased thickness of the keratin layer.

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14
Q

What is parakeratosis?

A

Persistence of nuclei in the keratin layer

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15
Q

What is acanthosis?

A

Increased thickness of epithelium

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16
Q

What is papillomatosis

A

Irregular epithelial thickening

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17
Q

What is spongiosis?

A

Oedema between the squamous cells

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18
Q

What are the four main reaction patterns of inflammatory skin conditions?

A

psoriasiform- elonagtion of rete pegs
spongiotic- intraepidermal oedema
lichenoid- basal layer damage
vesiculobullous- blistering

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19
Q

What is lichen planus? What are its main characteristics? How is it usually treated?

A

Idiopathic chronic inflammatory skin disease.
Characterised by intensely pruritic, purple papules effecting flexural aspect of wrists, forearms and lower legs. Also effects oral mucosa
responds well to corticosteroids

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20
Q

What is pemphigus? what is the most common form of pemphigus?

A

A rare autoimmune bullous disease where there is loss in keratinocyte adhesion
Pemphigus vulgaris

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21
Q

What process is common to all forms of pemphigus?

A

acantholysis- lysis of intercellular cell adhesion sites

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22
Q

What auto-antibodies are evident in pemphigus vulgaris?

A

IgG auto-antibodies against desmoglein 3 (a desmosomal protein) leading to loss of keratinocyte adhesion

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23
Q

Dermatitis herpetiformis is the cutaneous manifestation of what disease?

A

Coeliac disease

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24
Q

Identify 4 possible symptoms of an allergic reaction

A

urticaria
angioedema
wheezing
anaphylactic shock

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25
Q

What are the two main allergy investigations?

A

Skin prick testing

challenge testing

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26
Q

How do you treat anaphylactic shock?

A

adrenaline autoinjector

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27
Q

What is the name of allergens that effect the skin? Give some examples

A

Haptens

tattoo ink, fragrances, latex, plants

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28
Q

Identify 4 antibiotics which could be used to treat MRSA

A

doxycycline
clindamycin
vancomycin
co-trimoxazole

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29
Q

What are excoriations?

A

scratch marks

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30
Q

What is the alternative name for dermatitis?

A

exzema

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31
Q

What is pruritis?

A

The medical term for itch

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32
Q

Where is pruritis processed?

A

Forebrain and hypothalamus

33
Q

Which nerves transmit itch?

A

Unmyelinated C fibres

34
Q

Itch is associated with mediators released from ______ _____ ___________.

A

Mast cell degranulation

35
Q

Identify four causes of itch

A

Pruritoceptive- inflammation/dryness triggers
Neuropathic- due to damage to central or peripheral nerves
Neurogenic- no damage but caused by e.g. opiate effects on CNS
Psychogenic- psychological e.g. delusion of infestation

36
Q

Identify some risk factors for drug eruptions

A

age
female>males
genetics
concomitant diseases

37
Q

Exanthematous drug reactions appear as a widespread ____________ rash. They are _____ mediated drug reactions (type ____ hypersensitivity) and are related to ___________ use.

A

maculopapular
T-cell
IV
Antibiotic

38
Q

What is the difference between macules and papules?

A

Macules are flat non-palpable lesions whereas

Papules are small <0.5cm palpable lesions

39
Q

Uriticarial drug reactions either are a matter of ______ mediated hypersensitivity and erupt upon ________ exposure or are caused by direct release of _______ ________ from mast cells upon _________ exposure.

A 
IgE
secondary
inflammatory mediators
mast cells
first
40
Q

Identify four types of drug which could cause fixed drug eruptions

A

Tetracyclines, doxycycline
NSAIDS
Carbamazepine (anti-convulsant)
Paracetamol

41
Q

Identify four severe cutaneous drug eruptions

A

Toxic Epidermal Necrolysis
Stevens-Johnson syndrome
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
Acute Generalised Exanthematous Pustulosis

42
Q

Identify four drugs which commonly cause phototoxicity

A 
Amiodarone
Doxycycline
Quinine
Chlorpromazine
Thiazide
NSAIDs
PPIs
43
Q

Which two hormones are raised in obesity and have skin manifestations?

A

Androgens

Insulin

44
Q

Why is there increased androgen production in obesity?

A

Increased peripheral fat where androgen production can occur

45
Q

Identify 2 skin manifestations of hyperinsulinaemia

A

Acanthosis Nigricans

Skin tags- Acrochordons

46
Q

Identify 4 skin manifestations of hyperandrogenaemia

A

Hirsutism- male pattern hair growth
Androgenetic Alopecia- male pattern hair loss
Acne- increased sebaceous gland activity
Hidradenitis suppurativa

47
Q

How come obesity causes lymphoedema? How come Lymphoedema can lead to cellulitis?

A

Increased subcutaneous fat mass leads to reduced lymphatic drainage leading to swelling. Persistent oedema leads to chronic inflammation and fibrosis. Reduced oxygen supply allows bacterial overgrowth leading to cellulitis

48
Q

What vascular pathology may be exacerbated by abdominal obesity?

A

Chronic venous insufficiency because abdominal obesity inhibits venous return

49
Q

Identify 5 skin diseases that are exacerbated by obesity

A 
Chronic venous insufficiency
lymphoedema
psoriasis
skin infections
Intertigo- macerated skin plaques that occur in skin folds
50
Q

What disease can result form Vitamin B3 deficiency (Niacin)?

A

Pellagra (Dermatitis, delirium, diarrhoea, death)

51
Q

What are the characteristic clinical features of Psoriasis? Name some of the other presentations of psoriasis

A

Well-demarcated, red plaques with thick scale.
appear on elbows, knees, scalp and elsewhere.
Guttate, erythrodermic, pustular, psoriatic arthritis, enthesis, nail changes

52
Q

What type of psoriasis is prevalent in heavy smokers?

A

Erythrodermic and pustular psoriasis

53
Q

Give two examples of Vitamin D analogues

A

Calcitriol, tacalcitrol, calcipotriol

54
Q

What are the characteristic features of Lichen planus

A

Characterised by intensely pruritic pink-purple polygonal plaques effecting flexural aspect of wrists, forearms, lower legs.

55
Q

How is Lichen planus treated?

A

Potent corticosteroids

56
Q

How does Pemphigus vulgaris present? How is it treated?

A

Presents as blisters which rupture leaving behind shallow erosions.
Systemic corticosteroids

57
Q

Describe the pathophysiology of Bullous pemphigoid

A

Autoantibodies against hemidesmosomes cause basement membrane split at the dermo-epidermal junction. Appears as large haemorrhagic/serous blisters.

58
Q

What are comodones?

A

Swollen and inflamed pilosebaceous units

59
Q

Describe the presentation of acne

A

Comodones, blackheads, macules and papules of the skin distributed on the face, neck, upper back, anterior chest.

60
Q

Describe some of the treatments of acne vulgaris

A 
Topical retinoids
topical benzoyl peroxide
oral lymecycline
tetracyclines
oral contraceptive pill
Isotretinoin (in severe acne)
61
Q

What is telangiectasia?

A

Dilated venules at skin surface which appear as red meshworks

62
Q

Demodex mites are associated with what skin condition?

A

Rosacea

63
Q

How is rosacea treated

A

Topical metronidazole
azelaic acid/invermectin
tetracyclines/doxycyclines

64
Q

Describe a typical presentation of eczema

A

Usually in infancy
dry, red, pruritic skin with excoriations and lichenification
Flexures of elbows, knees, ankles, wrists
Experience period where controlled and also flares

65
Q

Describe the pathophysiology of atopic eczema

A

Patient has Genetic filaggrin deficiency and so the keratinocyte barrier is impaired and antigenic material can penetrate the skin easier. These antigens and microbes activate CD4 T cells resulting in raised interluikins. Mast cells degranulate releasing IgE antibodes.

66
Q

What protein deficiency is shown in atopic eczema?

A

Filaggrin deficiency

67
Q

Describe the management of eczema during 1. maintenance and 2. flares

A
  1. Regular use of emollients, avoid environmental triggers
  2. Emollients and topical steroids, treat complications with antibiotics
    possible zinc wet wraps, phototherapy, immunosuppressants such as methotrexate and azathioprine, topical tacrolimus
68
Q

Name some possible environmental triggers of atopic eczema

A 
change in temperature
plants
washing agents
dietary products
emotional stress
69
Q

Identify the cardinal features of eczema (dermatitis)

A

pruritis
erythema
excoriations
lichenification

70
Q

What is lichenification?

A

Prominent lines from repeated scratching

71
Q

Give three histological features of eczema

A

spongiosis, hyperkeratosis, acanthosis

72
Q

What is the difference between allergic dermatitis and irritant contact dermatitis?

A

Allergic dermatitis shows type 4 hypersensitivity and is a reaction to allergens whereas irritant contact dermatitis is due to frequent contact with an irritant.

73
Q

What is tuberous sclerosis? What characterises this condition?

A

It is a genetic condition that is characterised by hamartomas in various organs. Hamartomas are benign neoplastic lesions of the tissue from which they originate

74
Q

What gene mutations are found in tuberous sclerosis?

A

Mutations of TSC1 (tuberin) and TSC2 (Hamartin). Hamartin and tuberin interact with one another to control the growth and size of cells

75
Q

What are the main skin manifestations of tuberous sclerosis?

A 
Cafe-au-lait spots
poliosis
ash leaf hyperpigmentation
subungal fibroma
angiofibroma
Shagreen patches
76
Q

Define neurofibromatosis type 1

A

A condition characterised by nerve tumours in the nervous system and caused by mutation of the NF1 gene on chromosome 17 which codes for neurofibromin which is a tumour suppressor gene

77
Q

Name the 7 possible diagnostic criteria for NF1 which is shortened by the pneumonic CRABBING

A 
Cafe-au-lait spots
Relative with NF1
Axillary or inguinal freckles
Bony dysplasia such as Bowing of a long bone or sphenoid wing dysplasia
Iris Hamartomas (Lisch nodules)
Neurofibromas
Glioma of optic nerve
78
Q

What are erysipelas?

A

Localised skin infection caused by Strep pyrogenes

79
Q

What is the treatment of choice for scabies?

A

Permethrin cream

Dermatology (3 decks)

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