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andrei > Andrei 28 > Flashcards

Andrei 28 Flashcards

1
Q

Type of psoriasis based on age of onset

A

Type I - onset before 40yo and associated with HLA

TYPE II- >40yo

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2
Q

Prevalence of psoriasis

A

Lower in asians, M=F

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3
Q

Age of onset

A

15-30yo

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4
Q

Genetic epidemiology

A

UV+genetics

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5
Q

Traumatic induction of psoriasis in non lesional skin

A

Koebner (isomorphic response)

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6
Q

Koebner occurs more frequently during

A

Flares, ALL or NONE phenomenon

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7
Q

Koebner. Occurs _ to _ days after injury and from _ to_% of patients

A

7-14; 25-75%

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8
Q

MC form of psoriasis seen in __%

A

Psoriasis vulgaris; 90%

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9
Q

May extend laterally and become circinate because of confluence of several plaques

A

Psoriasis gyrata

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10
Q

Occasionally, there is partial central clearing, resulting in ringlike lesions

A

Annular psoriasis

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11
Q

associated with lesional clearing and portends a good prognosis.

A

Annular psoriasis

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12
Q

refers to lesions in the shape of a cone or limpet.

A

Rupioid psoriasis

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13
Q

refers to a ring- like, hyperkeratotic concave lesion, resembling an oys- ter shell.

A

Ostraceous psoriasis

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14
Q

is an uncommon form characterized by thickly scaling, large plaques, usually on the lower extremities.

A

elephantine psoriasis

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15
Q

hypopigmented ring (Woronoff ring) surrounding individual psoriatic lesions may occasionally be seen and is usually associ- ated with___

A

treatment, most commonly UV radiation or topical corticosteroids

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16
Q

Pthogenesis of woronoff ring

A

Inhibition of prostaglandin synthesis

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17
Q

Guttate psor is characterized by eruption of small _ to _ papules over the upper trunk and proxi- mal extremities

A

0.5-1.5cm

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18
Q

has the strongest association to HLA-Cw6 and ___

A

Guttate psoriasis; strep throat infection

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19
Q

T/F antibiotic treatment has been shown to be beneficial or to shorten the disease course

A

False; not beneficial

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20
Q

Onset in older, chronic, 1-2 cm, thicker and scalier than guttate

A

Small plaque psoriasis

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21
Q

Scaling is usually minimal or absent, ; glossy sharply demarcated erythema, _____is impaired in affected areas.

A

Inverse psoriasis; sweating

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22
Q

the most prominent feature in erythrodermic psoriasis

A

Erythema

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23
Q

T/F ; there are thick, adherent, white scale in erythrodermic psor

A

F; superficial scaling

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24
Q

Hypothermia is caused by

A

Vasodilation; causing excessive loss of heat

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25
Q

Hypohidrotic/hyperhidrotic

A

HYPOhidrotic because of occlusion of the sweat ducts; can cause hyperthermia in warm climates

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26
Q

___ is common due to vasodilation and loss of protein

A

LE edema

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27
Q

Two forms of psoriatic erythroderma

A

first form, chronic plaque psoriasis -> relative responsive to therapy. In the second form, generalized erythroderma may present suddenly and unexpectedly or result from nontolerated external treatment (eg, UVB, anthralin), thus representing a generalized Koebner reaction.

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28
Q

In children, pustular psoriasis can be complicated by sterile, lytic lesions of bones and can be a manifestation of the

A

SAPHO syndrome

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29
Q

T/F. Gen pustular psoriasis/von zumbuch is usually preceded by other forms of the disease.

A

T

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30
Q

Von zumbuch is characterized by

A

fever + sudden generalized eruption of sterile pustules 2 to 3 mm in diameter

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31
Q

The pustules usually arise on__ first as patches

A

highly erythematous skin,

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32
Q

cause of generalized psoriasis von Zumbusch type is unknown. Various provoking agents include___

A

infections, irritating topical treatment (Koebner phenomenon), and withdrawal of oral corticosteroids

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33
Q

Von zumbuch- associated with prominent systemic signs and can potentially have life-threatening complications such as__

A

hypocalcemia, bacterial superinfection, sepsis, and dehydration.

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34
Q

to occur after a viral infection and consists of widespread pustules with generalized plaque psoriasis.

A

Exanthematic pustular psoriasis

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35
Q

Distuingishes Exanthematic pustular psoriasis from Von zumbuch

A

no constitutional symptoms, and the disorder tends not to recur.; overlaps with AGEP

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36
Q

The characteristic features of annular pustular psoriasis are___ that sometimes resembles erythema annulare centrifugum. Identical lesions are found in patients with ___

A

pustules on a ringlike erythema; impetigo herpetiformis (third trimester untl delivery)

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37
Q

impetigo herpetiformis is often associated with __

A

hypocalcemia.

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38
Q

__of patients with PPPP having concomitant chronic plaque psoriasis. (Pustulosis Palmaris et Plantaris)

A

27%

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39
Q

T/F Pustulosis palmaris et plantaris is more common in Male (about 78%) with a median age of onset of 47 years.

A

F; female

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40
Q

___ can be seen with pustulosis palmaris et plantaris, with a prevalence of 13% to 25%.1

A

Psoriatic arthritis (PsA)

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41
Q

__is strongly associated with pustulosis palmaris et plantaris

A

Smoking

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42
Q

is an extremely rare localized ster- ile pustular eruption of the fingers and toes

A

Acrodermatitis continua of Hallopeau, also known as dermatitis repens,

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43
Q

Acrodermatitis continua of Hallopeau, also known as dermatitis repens, may occur after

A

minor trauma or infection.

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44
Q

T/f nail loss is uncommon in dermatitis repens

A

F; common

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45
Q

presents with erythematous plaques with greasy scales localized to seborrheic areas (scalp, glabella, nasolabial folds,

A

sebopsoriasis

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46
Q

Napkin psoriasis usually begins between the ages of __ and __ months and first appears in the diaper

A

3 and 6

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47
Q

T/F; the rash in napkin psoriasis responds readily to treatment and tends to disappear after the age of 1 year.

A

T

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48
Q

Nail changes are frequent in psoriasis, being found in up to __ of patients,

A

40%

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49
Q

Nail involvement increases with __ and __ and presence of ___.

A

with age, with duration and extent of disease, and with the presence of PsA

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50
Q

___is one of the commonest features of psoriasis, involving the fingers more often than the toes

A

Nail pitting

51
Q

__ has a stron- ger association with PsA than other nail changes.

A

Onychodystrophy

52
Q

caused by psoriasiform hyperplasia, parakeratosis, micro- vascular changes, and trapping of neutrophils in the nail bed.

A

Oil spots and salmon patches

53
Q

___is considered to be nearly specific for psoriasis

A

oil spotting

54
Q

anonychia can be seen in other forms of __ psoriasis.

A

pustular

55
Q

is an idiopathic inflammatory disorder resulting in the local loss of filiform papillae.

A

benign migratory glossitis or glossitis areata migrans,

56
Q

Arthritis is a common extracutaneous manifestation of psoriasis seen in up to __ of patients.

A

40%

57
Q

Neutrophils exit from the tips of a subset of dermal capillaries (the “squirt- ing papillae”), leading to their accumulation in the overlying parakeratotic stratum corneum ___and, less frequently, in_____(spongiform pustules of Kogoj).

A

(Munro’s microabscesses) ; the spinous layer

58
Q

The best- characterized T cells are the ____Predominantly of the memory phenotype___, these cells express the cutaneous lymphocyte antigen, a ligand for E-selectin,

A

CD4+ and CD8+ subsets. ; (CD45RO+)

59
Q

T/F: The cytokine profile of psoriatic lesions is rich in interferon (IFN)-γ, indicative of T helper 2 (Th2) polarization of CD4+ cells, and T cytotoxic 1 (Tc1) polarization of CD8+ cells

A

F; Th1

60
Q

Two other subsets of CD4+ T cells, stimulated by __and
characterized by production of __ or __ have been shown to play a major role in maintaining chronic inflammation in psoriasis

A

interleukin (IL)-23

; IL-17 or IL-22

61
Q

__suppress immune responses in an antigen-specific fashion and are responsible not only for downregulating successful responses to pathogens but also for the maintenance of immunologic tolerance

A

Regulatory T cells (Tregs)

62
Q

are prominent in developing psoriasis lesions, with neutrophils appearing somewhat later.

A

macrophages

63
Q

When activated,__ cytokines are strong activators of keratinocytes,
leading to secretion of chemotactic proteins, particu- larly neutrophil chemokines, thereby amplifying and sustaining the inflammatory process.

A

IL-36

64
Q

The major genetic signal for psoriasis in the MHC is ___, which encodes HLA-Cw6 protein

A

HLAC∗0602

65
Q

IL-23 signaling promotes the survival and expansion of__–expressing T-cells, which protect epithelia against microbial pathogens.

A

IL-17

66
Q

T/F: obese individuals are more likely to present with severe psoriasis.

A

T

67
Q

T/F : Heavy smoking (>20 cigarettes daily) has been associ- ated with more than a twofold increased risk of severe psoriasis.

A

T

68
Q

An association between __ infection and guttate psoriasis has been repeatedly confirmed

A

streptococcal throat

69
Q

Psoriasis has also been associated with hepatitis _ infection.

A

C

70
Q

Medications that exacerbate psoriasis include

A

antimalarials, β blockers, lithium, nonsteroidal antiinflammatory drugs (NSAIDs), IFNs-α and -γ, imiquimod, angiotensin-converting enzyme inhibitors, and gemfibrozil.

71
Q

T/F: Laboratory abnormalities in psoriasis are usually not

specific and may not be performed in all patients

A

T

72
Q

__ and __have been associated with more widespread and recurrent disease

A

younger age of onset and positive family history

73
Q

Guttate psoriasis is often a self-limited dis- ease, lasting from___ weeks without treatment

A

12 to 16

74
Q

__ and __have a poorer prognosis, with the disease tending to be severe and persistent.

A

Erythrodermic and generalized pustular psoriasis

75
Q

__ can be regarded as appropriate for continuous use.

A

calcipotriol, methotrexate (MTX), and acitretin

76
Q

In patients with erythrodermic and pustular psoriasis, treatments with an irritant potential should be avoided, and __, __ and __are the treatments of first choice.8

A

acitretin, MTX, or short-course cyclosporin

77
Q

Anthralin can be combined with UVB phototherapy with good results (__regimen).

A

the Ingram

78
Q

Anthralin’s Most common side effects are __ and __

A

irritant contact dermatitis and staining of clothing, skin, hair, and nails.

79
Q

To prevent auto-oxidation,__

(1% to 2%) should be added

A

salicylic acid

80
Q

The concentration is increased weekly (0.05-0.1%) in individually adjusted increments up to __ until the lesions resolve.

A

4%

81
Q

Scalp psoriasis should be treated with great caution as anthralin can stain hair___

A

purple to green.

82
Q

is a third-generation retinoid for topical use that reduces mainly scaling and plaque thickness, with limited effectiveness on erythema.

A

Tazarotene

83
Q

It has been recommended that UV doses be reduced by at least __if tazarotene is added to phototherapy.

A

one third

84
Q

blocking both T-lymphocyte signal transduction and IL-2 transcription.

A

Tacrolimus

85
Q

Tacrolimus for treatment of____ these agents appear to provide effective treatment

A

inverse and facial psoriasis,

86
Q

MOA is reduction of keratinocyte adhe- sion and lowering the pH of the stratum corneum, which results in reduced scaling and softening of the plaques, thereby enhancing absorption of other agents.

A

Salicylic acid

87
Q

T/f: Topical salicylic acid decreases the efficacy of UVB phototherapy

A

T

88
Q

T/F: systemic absorption of SSA can occur, particularly in patients with abnormal hepatic or renal function and when applied to more than 20% of the body surface area.

A

T

89
Q

The mechanism of action of phototherapy appears to involve . The mechanism of depletion may involve apoptosis, accompanied by a shift from a Th1 to a Th2 response in lesional skin

A

selective depletion of T cells,

90
Q

The objective is to maintain a____ as a clinical indica- tor of optimal dosing.

A

minimally perceptible erythema

91
Q

____increase the efficacy of UVB light, particularly in patients with chronic and hyperkeratotic plaque–type psoriasis.

A

Systemic drugs, such as retinoids,

92
Q

The monochromatic 308-nm excimer laser can deliver supraerythemo- genic doses of light focally to lesional skin. is commonly used for patients with _____

A

stable recalcitrant plaques, par- ticularly of the elbows and knees.

93
Q

Is highly effective for chronic plaque psoriasis and is also indicated for the long-term management of severe forms of psoriasis, including psoriatic erythroderma and pustular psoriasis

A

Methotrexate

94
Q

MTX was found to be effective at much lower doses __ in the management of psoriasis,

A

(0.1–0.3 mg/kg/wk)

95
Q

the main mechanism of antiinflammatory action of MTX is____ This leads to accumulation of extracellular adenosine, which has potent anti-inflammatory activities.

A

inhibition of (AICAR [5-aminoimidazole-4-carboxamide ribonucle- otide] transformylase), an enzyme involved in purine metabolism.

96
Q

reduces certain side effects, such as nausea and megaloblastic anemia, without diminishing the efficacy of anti-psoriatic treatment.

A

folic acid (1–5 mg/day)

97
Q

MTX should therefore not be administered to patients with impairment in ___ function

A

renal

98
Q

if with risk factors, do liver biopsy when cumulative MTX dose reaches ___. In contrast, patients with one or more risk factors: baseline liver biopsy either ___ or ___ and ___.

A

of 3.5 to 4.0 g.

before treatment or after 2 to 6 months of treatment

dose of 1.0 to 1.5 g

99
Q

Risk factor for liver injury

A

The risk factors include current or past alcohol consumption, persistent abnormalities of liver function enzymes, personal, or family history of liver disease, exposure to hepatotoxic drugs or chemicals, diabetes mellitus, hyperlipidemia, and obesity

100
Q

is the only antidote for the hematologic toxicity of MTX. When an overdose is suspected, an immediate leucovorin dose of __ should be given parenterally or orally, and subse- quent doses should be given every 6 hours

A

Leucovorin calcium (folinic acid); 20 mg

101
Q

Discontinuation of MTX treatment is required in the event of

A

hepatotoxicity, hematopoietic suppression, active infections, nausea, and pneumonitis.

102
Q

, may interact with MTX to increase toxicity.

A

NSAIDs and sulfonamides

103
Q

most responsive to etretinate or acitretin as monotherapy include___

A

generalized pustular and erythrodermic psoriasis

104
Q

To reduce risk of gastrointestinal (GI) symptoms the drug is titrated over a period of 1 week, starting at___ dosing at day 1 and ending in___ dosing on day 6, which is maintained for the duration of treatment.

A

10-mg; 30-mg twice-a-day

105
Q

dverse effects include GI symptoms such as diarrhea, nausea, and headaches. Worsening of depression has been described, and the

A

Apremilast

106
Q

Worsening of depression has been described, and the drug should be used with caution in individuals with history of depression or suicidal thoughts or behaviors.

A

Apremilast

107
Q

down- stream signaling of multiple proinflammatory cyto- kines, including IL-2, IL-4, IL-9, IL-13, IL-21, type I and II IFN signaling, IL-6, and to a lesser extent IL-12 and IL-23

A

Tofacitinib

108
Q

It is highly effective for cutaneous psoriasis and can also be effective for nail psoriasis ; is particularly useful in patients who present with widespread, intensely inflammatory, or frankly erythrodermic psoriasis

A

CsA

109
Q

The dosage ranges from ___Because the nephro- toxic effects of CsA are largely irreversible,

A

2 to 5 mg/kg/day.

110
Q

The most common adverse effects noted in patients using CsA for short periods of time are

A

neurologic, including tremors, headache, paresthesia, or hyperes- thesia.

111
Q

Long-term treatment of psoriasis with low-dose CsA was found to increase risk of

A

nonmelanoma skin cancers.

112
Q

are given until a major improvement is achieved and are then withdrawn.; can be stopped abruptly because rebound phenomena have not been observed.

A

Fumaric acid esters (FAEs)

113
Q

systemic steroids may have a role in the management of ___ and ___ if other drugs are ineffective.

A

persistent, otherwise uncontrollable, erythroderma and in fulminant generalized pustular psoriasis (von Zumbusch type)

114
Q

is an antimetabolite wherein nearly 50% of patients who achieve marked improvement develop bone marrow toxicity with leukopenia or thrombo- cytopenia.

A

Hydroxyurea

115
Q

Currently, three types of biologics are approved or are in development for psoriasis

A

: (1) recombinant human cytokines, (2) fusion proteins, and (3) monoclonal antibodies, which may be fully human, humanized or chimeric.

116
Q

__ is a chimeric monoclonal antibody that has high specificity, affinity, and avidity for TNF-α..

A

Infliximab

117
Q

___is a human recombinant, soluble, TNF-α receptor-Fc IgG fusion protein that binds TNF-α and neutralizes its activity.

A

Etanercept

118
Q

are fully human recombinant IgG1 monoclonal antibodies and specifically targets TNF-α

A

Adalimumab and golimumab

119
Q

is a polyethylene glycol (PEG) Fab′ fragment of a humanized TNF inhibitor monoclonal antibody. Currently, golimumab and certolizumab pegol are only FDA approved for PsA

A

Certolizumab pegol

120
Q

T/f Clinical studies have found infliximab and adalimumab to be slightly more effective than etanercept in the treatment of psoriasis.

A

Clinical studies have found infliximab and adalim- umab to be slightly more effective than etanercept in the treatment of psoriasis.

121
Q

is a human monoclonal antibody that binds the shared p40 subunit of IL-12 and IL-23 and prevents interaction with their receptors. This treat- ment blocks IL-12, which is critical for Th1 differentiation, but its inhibitory effect on IL-23 may be more important.

A

Ustekinumab; IL23- chrnic inflamm

122
Q

___ is a fully human antibody, and___ is a humanized antibody that binds and neutralizes IL-17A

A

Secukinumab; ixekizumab

123
Q

__, a fully human antibody targeting the IL-17 receptor α chain, is also highly effective

A

Brodalumab

124
Q

____are the treatments with the most well- documented efficacy in PPPP.____ has been used to treat pustulosis palmaris et plantaris

A

Phototherapy, cyclosporine, and topical steroids; tonsillectomy

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