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A. Block B Dermatology > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

Psoriasis is a chronic inflammatory skin disease. What is the world wide prevalence of psoriasis?

1 - 1-3%
2 - 10-13%
3 - 20-30%
4 - 30-40%

A

1 - 1-3%
- in the UK this is 2.8%

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2
Q

Psoriasis has a bimodal peak in age, with type 1 occurring <40 = early onset and type 2 = late onset occurring >40 years. Is this more common in men or women?

A
  • equal in both
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3
Q

What % of patients with psoriasis have some form of family history of Psoriasis?

1 - 6-9%
2 - 16-19%
3 - 46-49%
4 - 60-90%

A

4 - 60-90%

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4
Q

The pathogenesis of psoriasis is factorial. Which of the following has not typically been associated with Psoriasis?

1 - Environmental factors
2 - Infection strep, HIV
3 - Drugs
4 - Obesity
5 - Alcohol and smoking
6 - Psychological (stress, anxiety and depression)
7 - Skin trauma- Isomorphic phenomenon, sunlight

A

4 - Obesity

  • drugs such can cause psoriasis/drug induced psoriasis caused by anti-malarial and anti TNFs in susceptible people
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5
Q

Although the cause of Psoriasis is likely to be multifactorial, one theory is that the skin can become irritated by environmental or microorganisms that act as a trigger. This trigger causes which cell to then initiate an immune response?

1 - neutrophils
2 - macrophages
3 - dendritic cells
4 - eosinophils

A

3 - dendritic cells

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6
Q

Once the dendritic cells in the skin have been triggered they will elicit an immune response by activating T cells that release cytokines and cause inflammation. What then happens to the keratinocyte in the area?

1 - cells in the area die due to inflammation
2 - tissue scars causing abscess formation
3 - keratinocyte proliferation
4 - all of the above

A

3 - keratinocyte proliferation
- this is what causes plaques on the skin

  • typically once the trigger is removed the inflammation subsides, BUT in Psoriasis, this inflammation becomes chronic
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7
Q

Which of the following can be used to describe the most common clinical feature in a caucasian with Psoriasis?

1 - plaques
2 - pink or red underlying skin
3 - white scaly appearance on top
4 - rough to touch
5 - all of the above

A

5 - all of the above
8-9 / 10 will have these forms of plaques if they have Psoriasis
- typically can be very itchy

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8
Q

Are the plaques that are the most common feature of psoriases as evident in pigmented skin?

A
  • no
  • it is more difficult to identify the erythema
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9
Q

Where are plaques most commonly found on the body?

1 - face and head
2 - torso and extensor surface of limbs
3 - all over limbs
4 - torso only

A

2 - torso and extensor surface of limbs

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10
Q

Are psoriatic plaques present in the flexor regions of joints?

A
  • typically no
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11
Q

There are different body area specific forms of psoriases. What is a key feature of flexural psoriasis?

1 - skin has a darker form of erythema
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - rough scaling is not present and skin is smooth

A

4 - rough scaling is not present and skin is smooth
- occurs in the creases of the skin (flexures) such as in the armpit, in the groin, under breasts and in skin folds.

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12
Q

There are different body area specific forms of psoriases. What is a key feature of scalp psoriasis?

1 - skin has a darker form of erythema
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - rough scaling is not present and skin is smooth

A

2 - dandruff appearance and/or hair loss

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13
Q

There are different body area specific forms of psoriases. What is a key feature of pustular psoriasis?

1 - skin has a darker form of erythema
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - rough scaling is not present and skin is smooth

A

3 - crops of pustules on surface of hands
- pustule = fluid filled lesion

  • 2nd most common form of psoriasis
  • pustules can also be present all over the body
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14
Q

There are different body area specific forms of psoriases. What is a key feature of guttate (drop) psoriasis?

1 - typically cause by a germ following a sore throat
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - rough scaling is not present and skin is smooth

A

1 - typically cause by a germ following a sore throat

  • small scaly widespread plaques
  • can also be associated with hypopigmentation
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15
Q

There are different body area specific forms of psoriases. What is a key feature of erythrodermic psoriasis?

1 - typically cause by a germ following a sore throat
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - systemic erythema and plaques often merge together

A

4 - systemic erythema and plaques often merge together

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16
Q

There are different body area specific forms of psoriases. What is a key feature of nail psoriasis?

1 - pitting of nail with onycholysis
2 - dandruff appearance and/or hair loss
3 - crops of pustules on surface of hands
4 - systemic erythema and plaques often merge together

A

1 - pitting of nail with onycholysis
- can be in isolation or with skin psoriases

17
Q

The severity of psoriasis can be screened using which of the following scales?

1 - Dermatology Life Quality Index (DLQI)
2 - Psoriasis Area and Severity Index (PASI)
3 - Nail Psoriasis Severity Index (NAPSI)
4 - Palmoplantar pustulosis Psoriasis severity index (PPPASI)
5 - all of the above

A

5 - all of the above
- the index used depends on the form of psoriasis the patient has

  • DLQI and PASi are the most common
18
Q

Using the Dermatology Life Quality Index (DLQI) or Psoriasis Area and Severity Index (PASI), what score would indicate severe psoriasis?

1 - >5
2 - >10
3 - >15
4 - >20

A

2 - >10

19
Q

There are a large number of co-morbidities associated with psoriases. Which of the following is NOT typically associated with psoriases?

1 - Psoriatic arthritis(PsA)
2 - T1DM
3 - Cardiovascular disease
4 - Metabolic syndrome/NAFLD
5 - Obesity
6 - Anxiety and depression
7 - Alcohol abuse

A

2 - T1DM

  • the strongest association appears to be any condition where there are metabolic imbalances
20
Q

Which of the following but be the most likley differential for a patient with hand and foot psoriases?

1 - hand/foot eczema
2 - psoriasiform drug reaction
3 - pityriasis rubra pilaris
4 - secondary syphilis
5 -pityriasis rosea

A

1 - hand/foot eczema

21
Q

Which of the following is the least likley differential for a patient with psoriases?

1 - chronic eczema-Lichen simplex chronicus
2 - psoriasiform drug reaction
3 - pityriasis rubra pilaris
4 - secondary syphilis
5 - squamous cell carcinoma
6 - pityriasis rosea

A

5 - squamous cell carcinoma

22
Q

Typically how is psoriasis diagnosed?

1 - skin biopsy
2 - microbiology sample
3 - clinically
4 - imaging

A

3 - clinically
- skin biopsy can be used to rule out other conditions and if psoriasis presents atypically

23
Q

Which of the following features would be present if a skin biopsy of a patient with psoriases was taken?

1 - thickened basal cells
2 - dilated tortuous vessels in dermal papillae
3 - less keratinocyte proliferation
4 - all of the above

A

2 - dilated tortuous vessels in dermal papillae

24
Q

Patients with psoriases can be graded based on the Psoriasis Epidemiology Screening Tool (PEST). What score using the PEST tool would warrant a referral to a rheumatologist?

1 - >3
2 - >6
3 - >9
4 - >12

A

1 - >3

  • metabolic dysfunction is assessed
  • hospital anxiety and depression can also be used to refer to GP for psychiatric support
25
Q

Which of the following would be the 1st line for mild psoriasis?

1 - systemic therapy
2 - topical therapy
3 - phototherapy-narrow band UVB
4 - systemic immunosuppressants

A

2 - topical therapy

  • Coal tar preparations
  • Topical calcineurin inhibitors- 0.1%
  • Tacrolimus ointment and 1%
  • Pimecrolimus cream
  • Topical corticosteroids- note potency in reference to skin site
  • Topical vitamin D analogues
  • Topical corticosteroid and vitamin D analogue combination
  • Topical corticosteroid and salicylic acid combination
26
Q

In moderate to severe disease, or when topical therapy is not practical or not worked for psoriasis, which of the following are typically used to treat patients?

1 - systemic therapy
2 - topical therapy
3 - phototherapy-narrow band UVB
4 - systemic immunosuppressants

A

1 - systemic therapy

  • Phototherapy- Narrow band UVB, PUVA
  • Systemic retinoids such as Acitretin
  • Systemic immunosuppressants such as Methotrexate, Ciclosporin,
  • Fumaric acid esters such as Dimethyl fumarate
    Phosphodiesterase 4 inhibitors such as Apremilast
  • Injectable biologic therapy such as Anti-TNFs, IL 12/IL23, IL 23, IL 17
  • Novel systemic therapy such as Tyrosine kinase 2 inhibitor-Deucravacitinib
27
Q

Which of the following is NOT a treatment for psoriasis in children?

1 - Topicals - Corticosteroids, Vitamin D analogues, calcineurin inhibitors, Coal tar
2 - Phototherapy- Narrow band UVB
3 - Incision
4 - Systemic retinoids-Acitretin (1month- 17 years)
5 - Systemic immunosuppressants

A

3 - Incision

Biologics licensed for use in children:
Anti-TNF- Adalimumab(4-17years)
IL12/23-Ustekinumab(6-17years)
IL17A-Secukinumab(6-17years)
IL17A- Ixekizumab(6-17years)

28
Q

In a pregnant women can psoriasis get better or worse?

A
  • can improve in some patients
  • uncontrolled disease can affect pregnancy
29
Q

In pregnant women which of the following treatments cannot be used at any time during the pregnancy?

1 - Topicals/vitamin D analogues
2 - Phototherapy-Narrow band UVB
3 - Systemic immunosuppressants
4 - Biologic therapy

A

4 - Biologic therapy

Biologics
- Adalimumab = up to 1st trimester only
- Certolizumab = ok to use during pregnancy and lactation

A. Block B Dermatology (32 decks)

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