formative questions Flashcards by Yasmin Wheeler

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?

porphyria cutanea tarda

How well did you know this?

Not at all

Perfectly

what is porphyria cutanea tarda

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

How well did you know this?

Not at all

Perfectly

characteristics of mucosal membranes

-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

How well did you know this?

Not at all

Perfectly

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

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

How well did you know this?

Not at all

Perfectly

function of sebaceous glands

maintain skin barrier

How well did you know this?

Not at all

Perfectly

function of meissners corpuscle

vibration sensation

How well did you know this?

Not at all

Perfectly

function of pacinian corpuscles

pressure sensation

How well did you know this?

Not at all

Perfectly

functions of apocrine glands

scent glands

How well did you know this?

Not at all

Perfectly

function of eccrine glands

moisten palms/soles for grip

How well did you know this?

Not at all

Perfectly

lymphatics function

immune surveillance

How well did you know this?

Not at all

Perfectly

journey of RBC from big toe to heart

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

How well did you know this?

Not at all

Perfectly

T/F nails are biochemically similar to hair

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

How well did you know this?

Not at all

Perfectly

journey of RBC from lungs to big toe

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

How well did you know this?

Not at all

Perfectly

what phases are: anagen, catagen, telogen

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

How well did you know this?

Not at all

Perfectly

T/F type II sensitivity is IgG and IgM mediated

How well did you know this?

Not at all

Perfectly

what is C

melanocytes

How well did you know this?

Not at all

Perfectly

what is A

keratin layer

How well did you know this?

Not at all

Perfectly

what is in F

epidermis and dermis

How well did you know this?

Not at all

Perfectly

where are fibroblasts found

G - the dermis

How well did you know this?

Not at all

Perfectly

which is the sebaceous gland

How well did you know this?

Not at all

Perfectly

define skin failure

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

How well did you know this?

Not at all

Perfectly

characteristics of Langerhan cells

-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

How well did you know this?

Not at all

Perfectly

T/F type III sensitivity is immune complex mediated

How well did you know this?

Not at all

Perfectly

functions of the skin

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

How well did you know this?

Not at all

Perfectly

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?

erythropoietic protoporphyria

what is erythropoietic protoporphyria

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

what cell types are found in the dermis

fibroblasts lymphatics ground substance

what are the descriptions for each of these

what enzyme is deficiency in acute intermittent porphyria

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

where is Vit D metabolised

keratinocytes - B

what provides tensile strength

collagen - found at G

where does epidermal proliferation occur

cells in epidermis proliferate form the basal layer labelled C

where is energy stored

E - subcutaneous fat

what is the enzyme deficiency responsible for erythrpoietic porphyria

ferrochelatase

which is: nail bed nail matrix nail plate hyponychium lunula

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

characteristics of normal skin

-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

what percentage of skin problems make up all GP consultations

15-23%

where is the papilla and matrix

which is the arrector pili muscle

function of fibroblasts

produce collagen

function of sebaceous glands

produce sebum which lubricates the skin

melanocytes function

protect DNA by producing melanin which absorbs UV radiation

function of the keratin layer

impermeable to water

what is A, B and C?

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

what is D, E, F?

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

what is the definition of prevalence

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

function of impedin

enables the organism to avoid the host defence mechanisms

function of invasin

enables the organism to invade a host tissue

function of aggressin

causes damage to the host directly

function of adhesin

enables binding of the organism to host tissue

function of modulin

causes damage to the host indirectly

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

muscle pump venous valves pulse pressure

what is the description of each these

foetal development facts ...

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

where can highly metabolically active small cuboidal cells be found

basal layer

where can odland bodies be found

granular layer

where can corneocytes be found

keratin layer

where can polyhedral cells and desmosomes be found

prickle cell layer

T/F topical steroids are lipophilic

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

describe this lesion

plaque well-defined scaly

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

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

sorry cba making a q for this

description of creams

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

description of ointments

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

description of lotions

liquid formation

description of gels

thickened aqueous solutions

descriptions of pastes

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

investigation for: ring worm shingles scabies impetigo

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

what type of inheritance is this ?

autosomal dominant

which strains of HPV are most common in warts and verrucas

types 1-4

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

T -creams contain preservatives

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

F - at least 30mg

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

atopic eczema

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 ?

psoriasis vulgaris

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.

patch testing

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 history of itch in the months preceding the onset of blistering

what is bullous pemphigoid

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

what makes up the Atopic Triad

(atopic) eczema asthma hayfever

T/F barley doesn't contain gluten

F - does contain gluten (derm relevance = dermatitis herpetiformis is managed with a gluten free diet)

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?

vit D analogue cream

1st line treatment of rosacea

topical metronidazole