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dermatology > formative questions > Flashcards

formative questions Flashcards

1
Q

A 58 year old man presents in July with blisters on the dorsal aspect of his hands which have been appearing over the last few months, crust over and heal leaving scarring. He works as a joiner and is aware that his skin has also been more fragile than usual. You notice that he has a lot of hair growing on his cheeks. He is generally well and on no medication
What is the most likely diagnosis?

A

porphyria cutanea tarda

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2
Q

what is porphyria cutanea tarda

A

a rare disorder characterised by painful blistering skin lesions that develop on sun-exposed skin (photosensitivity)

it is caused by the deficiency of the enzyme - uroporphyrinogen III decarboxylase

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3
Q

characteristics of mucosal membranes

A

-often affected by skin disease eg blistering disease
-are not keratinised
-have many sensory functions eg taste
-contain glands eg lacrimal glands / sebaceous glands

> they are highly specialised for function

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4
Q

which is the component of the MRSA stain which causes severe skin infection such as necrotising fasciitis

A

panton valentine leukocidin
-it is a cytotoxin associated with highly virulent strains of staph.aureus causing necrolytic skin infections

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5
Q

function of sebaceous glands

A

maintain skin barrier

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6
Q

function of meissners corpuscle

A

vibration sensation

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7
Q

function of pacinian corpuscles

A

pressure sensation

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8
Q

functions of apocrine glands

A

scent glands

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9
Q

function of eccrine glands

A

moisten palms/soles for grip

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10
Q

lymphatics function

A

immune surveillance

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11
Q

journey of RBC from big toe to heart

A

deep plantar vein >
great saphenous vein >
femoral vein >
external iliac vein >
common iliac vein >
abdominal vena cava >
inferior vena cava >
RA

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12
Q

T/F nails are biochemically similar to hair

A

T - nails are made of hard and densely packed keratin, similar to hair
fingernails grow at 0.1mm per day, toe nails are slower, are commonly affected by disease

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13
Q

journey of RBC from lungs to big toe

A

pulmonary vein >
left side of heart >
aorta >
abdominal artery >
common iliac artery >
external iliac artery >
femoral artery >
popliteal artery >
dorsalis pedis

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14
Q

what phases are: anagen, catagen, telogen

A

anagen = growing phase
catagen = involuting phase
telogen = resting phase

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15
Q

T/F type II sensitivity is IgG and IgM mediated

A

T

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16
Q

what is C

A

melanocytes

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17
Q

what is A

A

keratin layer

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18
Q

what is in F

A

epidermis and dermis

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19
Q

where are fibroblasts found

A

G - the dermis

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20
Q

which is the sebaceous gland

A

D

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21
Q

define skin failure

A

loss of normal temperature control with inability to maintain core body temperature
failure to prevent percutaneous loss of fluid, electrolytes and protein with resulting imbalance and failure of the mechanical barrier to prevent penetration of foreign materials

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22
Q

characteristics of Langerhan cells

A

-formed in bone marrow
-can be found in prickle cell layer of the epidermis
-can be found in dermis
-can be found in lymph nodes
-present antigen to sensitised lymphocytes

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23
Q

T/F type III sensitivity is immune complex mediated

A

T

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24
Q

functions of the skin

A

barrier function
thermo-regualtion
immune defense
metabolism and detoxification
communication
sensory

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25
Q

A 3 year old boy presents on a sunny day in June. His mother reports he keeps crying and rubs at his skin when playing outside and this has been going on for a few weeks. His skin is sometimes a bit red, but there is never a rash and his skin is clear on examination now. He is skin type 1 with a few freckles evident, generally well, on no medication and there is no family history of skin problems.
What is the most likely diagnosis?

A

erythropoietic protoporphyria

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26
Q

what is erythropoietic protoporphyria

A

an inherited porphyria resulting in the accumulation of protoporphyrins in RBCs that cause acute painful photosensitivity and potential liver disease

typically presents in early childhood with immediate pain and crying upon exposure to sunlight

caused by deficiency of ferrochelatase

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27
Q

what cell types are found in the dermis

A

fibroblasts
lymphatics
ground substance

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28
Q

what are the descriptions for each of these

A
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29
Q

what enzyme is deficiency in acute intermittent porphyria

A

PBG (porphobilinogen) deaminase
-results in acute neurotoxic reaction in many tissues

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30
Q

where is Vit D metabolised

A

keratinocytes - B

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31
Q

what provides tensile strength

A

collagen - found at G

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32
Q

where does epidermal proliferation occur

A

cells in epidermis proliferate form the basal layer
labelled C

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33
Q

where is energy stored

A

E - subcutaneous fat

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34
Q

what is the enzyme deficiency responsible for erythrpoietic porphyria

A

ferrochelatase

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35
Q

which is:
nail bed
nail matrix
nail plate
hyponychium
lunula

A

nail bed = F
nail matrix = E
nail plate = A
hyponychium = G
lunula = B

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36
Q

characteristics of normal skin

A

-cells taken 28 days to migrate from basal > keratin layer
-nuclei loss starts in the granular layer and is complete in the keratin layer
-80% of the keratin layer is keratin and filaggrin
-the granular layer is usually 2-3 cells thick
-filaments are intercellular

37
Q

what percentage of skin problems make up all GP consultations

A

15-23%

38
Q

where is the papilla and matrix

A

J

39
Q

which is the arrector pili muscle

A

I

40
Q

function of fibroblasts

A

produce collagen

41
Q

function of sebaceous glands

A

produce sebum which lubricates the skin

42
Q

melanocytes function

A

protect DNA by producing melanin which absorbs UV radiation

43
Q

function of the keratin layer

A

impermeable to water

44
Q

what is A, B and C?

A

A = keratin layer
B = granular layer
C = prickle cell layer

45
Q

what is D, E, F?

A

D = basal layer
E = dermo-epidermal junction
F = dermis

46
Q

what is the definition of prevalence

A

the proportion of a population affected by a disease at any given time

47
Q

function of impedin

A

enables the organism to avoid the host defence mechanisms

48
Q

function of invasin

A

enables the organism to invade a host tissue

49
Q

function of aggressin

A

causes damage to the host directly

50
Q

function of adhesin

A

enables binding of the organism to host tissue

51
Q

function of modulin

A

causes damage to the host indirectly

52
Q

which systems are important in maintaining good circulation in the lower limbs

A

muscle pump
venous valves
pulse pressure

53
Q

what is the description of each these

A
54
Q

foetal development facts …

A

sweat glands do not develop until 6 months gestation

melanocytes migrate to the skin from the neural crest

blaschko patterns is developmental and not along nerves, vessels or lymphatics

the basal layer is the most metabolically active

55
Q

where can highly metabolically active small cuboidal cells be found

A

basal layer

56
Q

where can odland bodies be found

A

granular layer

57
Q

where can corneocytes be found

A

keratin layer

58
Q

where can polyhedral cells and desmosomes be found

A

prickle cell layer

59
Q

T/F topical steroids are lipophilic

A

T
- this allows passive diffusion across the plasma membrane where they combine with cell receptors and bind to steroid responsive elements in the DNA

topica steroids are:
anti-proliferative
anti-inflammatory
vasoconstrictive

60
Q

describe this lesion

A

plaque
well-defined
scaly

61
Q

T/F the developmental growth pattern of skin follows Blaschko’s lines

A

T

62
Q

where do these dermatophyte infections reside :
tinea cruris = A
tinea unguium = B
tinea barbae = C
tinea pedis = D
tinea capitis = E
tinea magnum = F
tinea corporis = G

A

A = groin
B = nails
C = beard
D = foot duh
E = scalp
F = hands
G = body

63
Q

sorry cba making a q for this

A
64
Q

description of creams

A

semisolid emulsion of oil in water - cosmetically acceptable, non-greasy

65
Q

description of ointments

A

semisolid grease/oil - has no preservative in it, greasy, less cosmetically attractive

66
Q

description of lotions

A

liquid formation

67
Q

description of gels

A

thickened aqueous solutions

68
Q

descriptions of pastes

A

semisolids, stiff, greasy, difficult to apply, often used in cool/drying/soothing bandages

69
Q

investigation for:
ring worm
shingles
scabies
impetigo

A
70
Q

T/F cafe au lait macules are present in 90% of cases of Neurofibromatosis type 1

A

T

71
Q

what type of inheritance is this ?

A

autosomal dominant

72
Q

which strains of HPV are most common in warts and verrucas

A

types 1-4

73
Q

T/F cream are more likely than ointments to cause sensitisation

A

T
-creams contain preservatives

74
Q

T/F an adult requires 10mg of ointment for an overall application

A

F - at least 30mg

75
Q

A 18 month old child presents with his mother in your GP surgery. He has been affected with a flexural rash for the past month. The rash is seen on examination as shown in the diagram. The child scratches the rash, often leaving excoriations. The child has no other known health problems, however his 6 year old sister has asthma.
what is it

A

atopic eczema

76
Q

A 20 year old woman presented with gradually worsening areas of scale and erythema with slight itch in the distribution shown. There is no previous or family history of skin problems and she is generally well. She is not currently using any therapies. Most likely diagnosis ?

A

psoriasis vulgaris

77
Q

A 28 year old surgical theatre nurse with no history of skin disease presented with chronic erythema, scale and itch of both hands as shown. It improved when she was on holiday but then steadily deteriorated on return to work and she has since been off on sick leave.

A

patch testing

78
Q

A 66 year old man presented with a 2 week history of a blistering rash. Which clinical feature would be typical of diagnosis of Bullous Pemphigoid?

A

a history of itch in the months preceding the onset of blistering

79
Q

what is bullous pemphigoid

A

a rare autoimmune disease, typically affects people over 60

is a result of an attack on the basement membrane of the epidermis by IgG/ IgE

80
Q

what makes up the Atopic Triad

A

(atopic) eczema
asthma
hayfever

81
Q

T/F barley doesn’t contain gluten

A

F - does contain gluten

(derm relevance = dermatitis herpetiformis is managed with a gluten free diet)

82
Q

The woman is a 20 year old waitress. She is already very conscious of her skin at work and does not want to have to put any greasy or smelly treatment on as it may show on her shirt.
which therapy is best suited for her?

A

vit D analogue cream

83
Q

1st line treatment of rosacea

A

topical metronidazole

84
Q

what pathology is this ?

A

intra-epidermal bulla = bullous pemphigoid

85
Q

what pathology is this ?

A

hyperkeratosis = psoriasis

86
Q

what pathology is this ?

A

papillomatosis

87
Q

what pathology is this ?

A

sub-epidermal bulla = pemphigus vulgaris

88
Q

what pathology is this ?

A

spongiosis

dermatology (8 decks)

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