FINAL Flashcards
1
Q
“the itch that rashes”
A
Atopic Dermatitis
2
Q
Charactersitics
puritic, superficial, chronic, scaly
A
Atopic Dermatitis
3
Q
Atopic Triad
A
Atopic dermatitis
Asthma
Allergic Rhinoconjunctivitis
4
Q
What causes the faulty epidermal barrier in atopic dermatitis patients?
A
Deficiency in filaggrin
Decrease in ceramides
Transdermal water loss
5
Q
Atopic Dermatitis Manifestation
superficial scaly macules (slightly yellowish - hypopigmentation), patches over the cheeks, symmetrical distribution
A
Pityriasis Alba
6
Q
Atopic Dermatitis Manifestation
darkened mildly erythematous or tanned perioribtal areas, bilaterally and symmetrically
A
Allergic Shiners
7
Q
Atopic Dermatitis Manifestation
sparse or confluent distrubtion of follicular papules, symmetric on dorsal upper arms or trunk
A
Keratosis Pilaris
8
Q
Atopic Dermatitis Manifestation
skin thickening, seen at popliteal fossa and antecubital fossa symmetrically
consequence of the itch scratch cycle
Hyperpigmentation
leathery patches
A
Lichenification
9
Q
Atopic Dermatitis Manifestation
dry “coin-lack” patches, sparsely distributed on extremities and trunk, itchy
A
Nunmular Eczema
10
Q
Atopic Dermatitis Manifestation
periorbital eczema
infraorbital folds in the skin below the eyelids
A
Dennie-Morgan folds
Dennies Pleats
11
Q
Atopic Dermatitis Manifestation
lip-smacking eczema – perioral
A
Atopic Cheilitis
12
Q
What is the most common complication of Atopic dermatitis?
A
Secondary Bacterial Infection
IMPETIGO
Staph aureus = MC cause of secondary bac infection
13
Q
Secondary Viral Infection of Atopic Dermatitis
caused by HSV
– lesions (vesicles, ulcers and crusts) on face
A
Eczema Herpeticum
= Kaposi Varicelliform Eruption
14
Q
dermatological sign that consists of fine telangiectasias around the nail
A
Braverman’s Sign
15
Q
a change observed after stroking lesions on the skin of a person with systemic mastocytosis or urticaria pigmentosa
skin biopsy shows INC number of dermal mast cells
A
Darier’s Sign
16
Q
is the appearance of new skin lesions on previously unaffected skin secondary to trauma
A
Koebner phenomenon
17
Q
TEN or SJS
greater than 30% of the body vs. less than 10% of the body surface
A
30 = TEN
10 = SJS
18
Q
When you do a skin biopsy of a patient with SJS/TEN overlap what do you see?
A
Necrotic Epithelium
No T-Cell destruction of the dermo-epidermal junction
19
Q
What are the mortality rates of TEN, SJS and the overlap?
A
SJS = 5-12%
TEN = 40%
Overlap = 10-30%
20
Q
What pathogen could cause an infection –> SJS or TEN?
A
mycoplasma pneumonia
21
Q
What could lead to toxic shock syndrome: TEN or SJS?
A
TEN
22
Q
What hallmark is seen a part of 1-14 day prodrome of SJS?
A
nonspecific upper respiratory tract infection
23
Q
What factors can cause a poor prognosis of SJS?
A
Old Age > 70
Intestinal involvement
Pulmonary Involvement
24
Q
What complications can arise from SJS/TEN overlap?
A
Blindness, pigmentary scritures/scarring
25
Most common **drugs** which cause SJS/TEN?
Sulfa: **sulfasalazine**
Antibiotics: **Ampicillin/Amoxicillin**
Antiepileptics: **phenytoin, carbmazepine, phenobarbital, lamotrigine**
26
# Controversial Tx Option -- SJS
**inhibits CD8 cells** -- **slow** progression of active disease and DEC mortality potentially
Cyclosporine
27
A patient with **Urticaria** asks how long it will take for her skin to **return to normal**?
Fleeting Time Course
30 min -- 24 hours
28
What makes **uritcaria** CHRONIC vs. ACUTE?
Chronic = > 6 weeks
29
What is reponsible for the **immune-mediated activation in Urticaria**?
MAST CELLS
| Type 1 hypersensitivity
30
What treatment is prefered in the treatment of Uritcaria?
**Second Generation H-1 Blockers:**
Cetrizine, levocetrizine, loratadine, desloratadine, fexofenadine
31
Whats linked to **more severe CSU**: Eosinophelia or Eosinopenia ?
**Eosinopenia**
32
Eosinopenia was linked to poor response of treatment with standard histamine blockers and what **monoclonal antibody**?
Omalizumabb
33
hyperpigmented mucous membranes, palmar creases, perineum, nipples and nevi
Adrenal insufficency
Addison Disease
34
Periorbital ecchymoses = racccoon eyes
Macroglossia with dental impression on tongue
waxy/translucent facial papules
Primary Amyloidosis
35
Skin disorders associated to HEP C
| history of alcholol abuse
**PCT** = porphyria cutanea tarda
**Lichen Planus**
36
# What is this associated to?
Hereditary Hemorrhagic Telangiectasia = multiple small bright red macules and papules on the tongue and lips
GASTRIC Disease
| also blue rubber bled nevus syndrome
37
# What is this associated to?
**Dermatitis Herpetiformis**
Erythematous papules on elbows/knees
| GLUTEN SENSITIVE
Gastric Disease
38
What is the most common **skin manifestation** of **diabetes**?
Diabetic **Dermopathy**
skin hyperpigmentation on **tibia**
39
# What is this associated to?
**Acanthosis nigricans** of the **neck** in a patient with insulin resistance and obseity
Diabetes
40
**eruptive xanthomas** are frequently associated with **poorly controlled** what?
diabetes mellitus
41
Patient has **erythema gyratum repens** ... what do you suspect
BREAST CANCER
42
Patient has **kaposi's sarcoma**
**red-violet papules** on the palate in addition to oral candidiasis ... what do you suspect?
HIV
43
**Pemphigus vulgaris** and **pemphigus foliaceus** are autoimmune diseases caused by what type of **hypersensitivity** reactions?
TYPE 2 = Antibody Mediated
44
**IgG** **autoantibodies** in **pemphigus vulgaris** and pemphigus **foilaceus** bind to what?
Intracellular desmosomal proteins (**desmoglein** type 1/3)
45
lysis of the intracellular adhesive junctions between neighboring squamous epithelial cells that results in the rounding up detached cells =
Acantholysis
46
**suprabasal** acantholytic blister
| **erosion**
Pemphigus **Vulgaris**
47
**subcorneal** blister
-- superficial epidermis at the level of stratum granulosum
| more **superficial**
Pemphigus **foilaceus**
48
**bullous phemphigoid** -- target antigen is located at
**HEMIdesmosomes**
| desomosomes -- pemphigus
49
What is a key **distinction** factor regarding the **blisters** between pemphigus and pemphigoid?
Pemphigus -- acantholysis
**Pemphigoid -- blister roof consists of full thickness epidermis with intact intracellular junctions** -- lacks acantholysis
50
In bullous **pemphigoid** blisters, the **supepidermal vesicle** is rich with what type of inflammatory **infiltrate**?
EOSINIOPHILIC
51
gestational pemphigoid/**herpes gestationis** usually occurs during what **trimester** of **pregnancy**?
2nd or 3rd
52
autoimmune blistering disorder associated with **gluten sensitivity** that is characterized by extremely **pruritic grouped vesicles and papules** =
Dermatitis herpetiformis
| affects mainly males -- 3rd/4th decades of life
53
in **dermatitis herpetiformis**; **IgA** antibodies bind to what
?
Gluten -- gliadin
54
# Morphology of what disease?
IgA autoanitbody at the **tips** of **dermal** **papillae**
**Microabscesses** -- vacuolization and focal dermoepidermal seperation that ultimately coalese to form a true subepidermal blister
Dermatitis Herpetiformis
55
# What disease?
microscopic and ultrastrutural studies have revealed **vacuolar degeneration of basal and parabasal keratinocytes and dermal lymphohistiocytic infiltrates**
VITILIGO
56
**Vitiligo** patients have an **increased freq.** of other **autoimmune** disorders such as:
Hashimoto thyroiditis
Graves
Pernicious Anemia
Addison disease
57
Subclass of scleroderma
MORPHEA
58
Heterogeneous spectrum of disorders is a key feature of ....
Systemic Lupus
59
+ANA titer is indicative of ...
American College of Rheumatology classification of SLE
60
Autoimmune CT disease of uncertain etiology demonstrating bimodal aged distribution of juvenile and adult forms is a key feature of ...
Dermatomyositis
61
Varaince of scleroderma consists of
CREST
62
Genetic component (endogenous) and enviroment (Exogenous)
SLE
63
immunosuppresion by DEC mast cells can be treated primarily with?
Gluccorticoids
64
Osteoporosis is a complication of?
Systemic gluccorticoid (too much of it)
65
Irritation syndrome results from
Adverse reactions to cosmetics
66
Bacterial/Fungal/Viral infections are a complication of?
Chemical Peels
67
Lateral venous system varicoses can be treated by?
Sclerotherapy
68
Mohs surgery is best indicated for:
Basal Cell Carcinomas that have ill defined borders on the face
69
This **oral** drug is used to treat **psoriasis**
MOA = binds retoind X receptors -- antiinflam/antiproliferative actions
Keratinocyte differentiation is normalized
| AE = liver problems **TERATOGEN**
Acitretin
70
this **oral** drug treats **psoriasis**
MOA = **phosphodieterase-4 inhibitor**
Apremilast
71
Thiw **TNF-alpha inhibitor** decoys a TNF-alpha receptor and are **not a monoclonal antibody**
Binds selectively to TNF-alpha
Etanercept
72
This **TNF-alpha inhibitor** is a **chimeric** **monoclonal** ab
**Binds to soluble** and **transmembrane** forms of TNF-alpha
Infliximab
73
this **TNF-alpha inhibitor is fully humanized anti-TNF-a IgG1**
binds specifically to TNF-alpha
Adalimumab
74
This **TNF-alpha inhibitor** binds selectively and **neutralizes human TNF-alpha activity**
not a complete ab -- **lacks Fc region**
* does not indue complement activation
* no ADDC or apoptosis
| treats plaque psoriarisis
Certolizumab
75
thia drug is a **human IgGK monoclonal ab**
**binds to p40 protein** subunit shared by IL-12 and IL23 **inhibiting TH1/TH17 cell mediated responses**
inhibits the release of proinflam. cytokines
Ustekinumab
76
these drugs **bind selectively to p19 subunit of IL-23 cytokine -- inhbits the release of pronflam cytokine**
Guselkumab, Tildrakizumab, Risankizumab
| 23 Forillas Tasted Rasins
77
these drugs **bind selectively with IL-17A cytokine -- inhibits the release of proinflam cytokines**
Secukinumab and Ixekizumab
78
this drug is an **anti-IL-17A RECEPTOR comp. inhibitor**
Broadalumab
79
this topical treatment **blocks calcineurin and is used to treat atopic dermatitis**
Pimecrolimus
80
This topical is used in the **treatment of scalp plaque psoriasis**
Flucinolone
81
this topical drug **binds to vit. D receptors -- inhibits keratinocyte proliferation, enhances keratinocyte differentation/inhibits inflammation**
Calcipotriene
82
This **topical, non-steroidal is a phosphodiesterase-4 inhibitor**
Roflumilast
83
This **topical; non-steroidal is an aryl hydrocarbon receptor agonist**
Tapinarof
84
Diphenydramine, Hydroxyzine and Doxepin can be used in treatment for
Pruritis
| Doxepin can proling QT interval
85
this **topical, weak hypopigmenting agent inhibits the enzyme tyrosinase**
Hydroquinone
86
This topical is a **monobenzyl ether which can cause irreversible depigmentation -- vitiligo**
Monobenzone
87
this **topical stimualtes hair growth is secondary to vasodilation
treatment of androgenetic alopecia**
Minoxidil
88
**ORAL
5alpha-reducatse enzyme inhibitor
Blocks conversion of testosterone
tx: Androgenetic alopecia**
FINASTERIDE
| preg. women should not be exposed
89
this opthalmic solution = **synthetic prostraglandin analog
increase the percent and duration of hairs in the growth phase**
TX: **Hypotrichosis of eyelashes**
Bimatoprost
90
topical cream -- **irreversible inhibitor of ornithine decarboxylase
Tx: Facial hirsutism**
Eflornithine
91
These drugs are used in **tx. of acne vulgaris -- block peptide transfer at 50S ribosomal subunit -- protein synthesis**
Erythomycin/Clindamycin
92
these **antibiotic** agents bind to **16S rRNA of the 30S subunit**
pRevents the binding of aminoacyl -tRNA to mRNA ribosome complex
**inhibits bacterial protein synthesis**
Doxycycline, Minocycline and Tetracycline
93
this topical is an **ethyl ester produrg
binds to RAR-Beta/gamma**
Tx: Acne /psoriasis
| preg catergory X
Tazarotene
94
these drugs **inhibit fungal squalene epoxidase** --> **DEC synthesis of ergosterol** --> accumulation of **squalene** --> INC membrane permeability -- **cell death**
| FUNGICIDAL
Allyamine: Terbinafine/Naftifine
Butenafine
95
What is the **first treatment that is most effective for onychomycosis**
Terbinafine
96
this oral drug binds to **keratin precursor cells** -- interferes with **microtubule function -- disrupts fungal mitosis**
Griseofulvin
| tinea captitis
97
topical treatment of tinea pedic, cruris/coporis, onychymcosis, cut. candidiasis/seborrheic dermatitis
**DISRUPTS The synthesis of DNA, RNA and protein**
CICLOPIROX
98
this topical is **reversible and noncomp. inhibitor of fungal squalene epoxidase**
| tinea pedis, cruris and corporis
Tolnaftate
99
**antiviral agent binds toll like receptor 7**
| tx: anogenital warts/molluscum contagiousm, HSV
Imiquinmod
100
oral anitivral -- **immunomodulatory effects by blocking histamine induced stimulation of T-suppressor cell activity**
| Tx: Warts/molluscum contagiosum
Cimetidine
101
anti-parastitic agent = topical
**directly absorbed -- stimulates nervous system -- seizures/death of parasitic arthropods**
| Tx: Scabies/head lice
Lindane
102
This drug can be used to treat scabies and head lice by **blocking the deactivation of Na+ channels -- uncontrabble depolarization of neuronal membranes -- seizures and ultimately paralusis and death of parasite**
Permethrin
103
treatment for riverblindness
IVERMECTIN
104
treatment of schistosomiasis
Praziquantel
105
this drug is a **humanized monoclonal IgG4 kappa ab -- binds to programmed death receptor and blocks interaction of PD-1 with its ligands -- preventing T-cell interaction**
| tx for unresectable or metastatic melanoma
Pembrolizumab/Nivolumab
106
drug = anti-CTLA -4 antibody
ipilimumab
107
drug interacts with the **high affinity-IL2 receptor -- stimulates a cytokine cascade -- prolifertes/induces B/T cells**
Aldesleukin
| Aldeseleakin 2
108
this drug is a **kinase inhibitor that targers BRAF V600E
reversible inhibitor of mitogen activated extracellular signal regulated kinase 1**
Encorafenib
| Dabrafenib
109
**reversible inhibitor of MEK1/MEK2**
inhibitor of some mutated forms of BRAF serine threonine kinase
Cobimetinib
110
**hedgehog pathway inhibitors
block PTCH1 genetic mutation**
Vismodegib and Sonidegib
111
What is the most commonly used agent for **prophylaxis** pre op surg?
Cephalosporins
112
Examples of **antiseptics** which can be used to **inhibit or kill bacteria on mucous membranes**, body tissues or skin:
Chlorhexidine
Mupirocin
Povidone Iodine Gel
113
What is the **major pathogen** in **surgical wound infections**?
S. Aureus
114
this incisional infection occurs **30-90 days** post op, involves **fascial** and **muscle** layers
Deep Incisional SSI
115
this **incisional** infection occurs **30 days post op**, involved skin and **subcutaneous** tissues
Superficial Incisional SSI
116
What **cardiac** changes do we see after a **burn**?
Loss of plasma volume
INC PVR
DEC CO
117
What **pulmonary** changes do we see after a **burn**?
DEC Compliance
118
What **renal** changes do we see due to a **burn**?
GFR Dec = dec renal blood flow
119
# What degree of burn?
nerve endings still **intact**; only epidermis is burnt so no scarring
FIRST DEGREE
120
# What degree burn?
extend to the dermis but doesnt penetrate it
SECOND Degree
121
# What degreee burn?
burns are full thickness burns that are not painful since the nerve endings are destroyed
3rd degree
122
# what degree burn
burns are also painless are full thickness plus Subcutaneous, muscle, and bone are destroyed
Fourth Degree
123
Treatment steps of burn patients
1. Stop the burn
2. Primary Survery
3. Resusitation
4. Secondary survey
5. burn center if need
124
During the **resuscitation** **phase** in a burn treatment, what is the most important part?
Fluid resuscitation since systemic capillary leak syndrome occurs after a serious burn
125
What are the **four stages of wound healing**?
Hemorrhagic
Substrate
Proliferative
Remodeling/Maturation
126
What is the **primary** **factor** of the **Hemmorhagic** phase?
platelet derived growth factor
127
During healing by **secondary intention**, **granulation tissue forms** during what phase?
Inflammatory/Substrate Phase
128
Due to the **loss of the epidermis**, **abrasions injury** may be susceptible to:
Clostridium tetni and staph aureus
