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dermatology > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

How can psychological stress trigger a skin condition

A

Activate the hypothalamus and hypophysis resulting in release of neuromediators
Can stimulate release of norepinephrine and cortisol from the adrenal glands
OR
Leukocytes into the blood stream via receptors

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2
Q

Give examples of neuromediators

A

Corticotropin-releasing hormone, melanocyte stimulating hormone

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3
Q

Role of dryness of skin in defence against infection

A

Desiccates microorganisms

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4
Q

Role of sebum in defence against infection

A

Inhibits bacterial growth

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5
Q

What is staph

A

Gram positive cocci in clusters

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6
Q

Skin and soft tissue treatment options for MRSA

A

Doxycycline, co-trimoxazole, clindamycin

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7
Q

Clinical relevance of staph. Saprophyticus

A

Causes UTIs in women of child bearing age

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8
Q

Name 3 bacteria that may be commensals

A

Staph. Epi
Corynebacterium
Propionibacterium

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9
Q

Give an example of a fungal infection

A

Candidiasis

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10
Q

Clinical presentation of candidiasis

A

Infection of the skin folds - under the breasts, groin, abdominal skin folds

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11
Q

Diagnosis of candidiasis

A

Swab for culture

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12
Q

Management of candidiasis

A

Clotrimazole cream, oral fluconazole

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13
Q

Who usually gets ringworm

A

Men

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14
Q

How do we get a ringworm infection

A

Most commonly from infected humans
Animals
Soil

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15
Q

Causal organisms of ringworm

A

Trichophyton rubrum, T.mentagrophytes and microsportum canis

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16
Q

Pathophysiology of ringworm

A

Fungus enters
Hyphae spread to stratum corneum
Increased epidermal turnover causes scaling
Inflammatory response in the dermis

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17
Q

What type of tissue can ringworm infect

A

ONLY keratinised tissue

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18
Q

How does ring worm infection get its appearance

A

Lesion grows outwards and heals in the centre leaving a ring appearance

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19
Q

Local management of ringworm

A

Clotrimazole cream, topical nail paint

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20
Q

Management of scalp ringworm

A

Terbinafine or itraconozole orally

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21
Q

Who gets scalp ringworm

A

Children

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22
Q

What causes scabies

A

Sarcoptes scabiei

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23
Q

Incubation period of scabies

A

Around 6 weeks

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24
Q

Clinical presentation of scabies

A

Intensely itchy rash
Burrows

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25
Q

Where does scabies tend to affect

A

Finger webs, wrists, genital area

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26
Q

Management of scabies

A

Malathion lotion applied overnight and washed off the next day

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27
Q

Management of lice

A

Malathion

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28
Q

What are the 3 main components of a dermatology clinical examination

A

Distribution
Configuration
Morphology

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29
Q

Discrete configuration of lesions

A

Lesions are well demarcated, can be clearly seen individually

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30
Q

Coalescing configuration of lesions

A

Individual lesions present but starting to merge together to form larger abnormal areas

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31
Q

Confluent configuration of lesions

A

No normal skin visible

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32
Q

Annular configuration of lesions

A

Lesions in a ring-shaped pattern

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33
Q

What is pitting of the nails

A

Small depressions of the nail plate

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34
Q

What is oncholysis

A

Separation of the nail plate from bed

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35
Q

What is hypertrichosis

A

General excess growth of hair

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36
Q

Name some local causes of hypertrichosis

A

Naevi, faun tail, chronic scarring, inflammation

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37
Q

State general causes of hypertrichosis

A

Malnutrition, anorexia, porphyria, occult malignancy, drugs

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38
Q

Name some drugs that can cause hypertrichosis

A

Minoxidil
Phenytoin
Cyclosporin

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39
Q

What is hirsutism

A

Excess growth in a male pattern

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40
Q

What is erythema

A

Vascular dilatation

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41
Q

What is purpura

A

Extravasation of blood

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42
Q

How to differentiate between erythema and purpura

A

Erythema blanches on pressure

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43
Q

What is petechia

A

1-2 mm area of flat purpura

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44
Q

What is a macule

A

Localised flat colour change <1 cm

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45
Q

What is a patch

A

Localised flat colour change >1 cm

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46
Q

What is a papule

A

Localised elevated area <0.5cm

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47
Q

What is a nodule

A

Localised elevated area >0.5 cm

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48
Q

Describe a maculopapular rash

A

Has both flat and elevated components

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49
Q

What is a plaque

A

Raised edge and flatter surface >1 cm

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50
Q

What is a pustule

A

Pus filled raised lesion

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51
Q

What is a vesicle

A

Fluid filled raised lesion <0.5cm

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52
Q

What is a bulla

A

Fluid filled raised lesion >0.5 cm

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53
Q

What is a wheal

A

Compressible dermal swelling

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54
Q

What is a cyst

A

Nodule containing semi-solid material

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55
Q

What is scale

A

Accumulated fragments of keratin layer

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56
Q

What is crust

A

Dried exudate

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57
Q

What is lichenification

A

Thickening with increased skin markings

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58
Q

What is a scar

A

Area where normal tissue is replaced by fibrous tissue

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59
Q

What is a fissure

A

A linear split in the epidermis

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60
Q

What is an erosion

A

A superficial break in the epidermis

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61
Q

What is an ulcer

A

A deeper break into the epidermis

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62
Q

What are predisposing factors

A

Past factors which contribute to the development of a problem

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63
Q

What are precipitating factors

A

Current factors or stressors that triggered the current problem at this time

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64
Q

What are perpetuating factors

A

Issues that contribute to the problem continuing

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65
Q

What are heuristics

A

Mental shortcuts that allow people to solve problems and make judgements quickly and efficiently based on past experiences

66
Q

What is fundamental attribution error

A

The tendency to be judgemental and blame people rather than examine the circumstances that might have been responsible for

67
Q

What is hindsight bias

A

Knowing the outcome may influence the perception of past events and prevent a realistic appraisal of what actually occurred

68
Q

What are the 3 main types of hair

A

Lanugo
Vellus
Terminal

69
Q

What is lanugo hair

A

Fine long hairs covering the foetus
Shed around 1 month before birth

70
Q

What is vellus hair

A

Fine, short hair covering much of the body surface
Replaces lanugo hairs

71
Q

What is terminal hair

A

Long, coarse hairs

72
Q

What influences terminal hair growth

A

Androgen levels

73
Q

Where do we find terminal hair

A

Scalp and pubic area

74
Q

What does Hutchinsons sign look like

A

Spreading pigmentation

75
Q

What might hutchinsons sign indicate

A

Malignant melanoma

76
Q

What causes beaus lines

A

Transient arrest in nail growth which occurs during acute stress or illness

77
Q

Name some non-scarring alopecia

A

Alopecia areata
Traction alopecia
Tines capitis

78
Q

Name some scarring causes alopecia

A

CDLE
lichen planus
Frontal fibrosinf alopecia

79
Q

What are virulence factors

A

Factors responsible for pathology and variation in virulence within and between groups of pathogens

80
Q

Name 5 virulence factors

A

Adhesin
Invasin
Impedin
Agressin
Modulin

81
Q

How does adhesin work

A

Enables binding of the organism to the host tissue

82
Q

How does invasin work

A

Enables the organism to invade the host cell or tissue

83
Q

How does impedin work

A

Enables the organism to avoid the host defence mechanisms

84
Q

How does agressin work

A

Causes damage to the host directly

85
Q

How does modulin work

A

Induces damage to the host indirectly

86
Q

What is the commonest cause of toxic shock

A

TSST-1

87
Q

What causes scalded skin syndrome

A

Exfoliating toxins A and B from staph aureus

88
Q

Clinical sign of scalded skin syndrome

A

Positive nikolsky sign

89
Q

Where is scalded skin syndrome usually seen

A

Neonatal face, axilla and groin

90
Q

What is toxic shock syndrome linked to

A

Tampon use

91
Q

Diagnostic criteria for toxic shock

A

Fever >39
Diffuse macular erythroderma and desquamation
Hypotension
>3 organs involved

92
Q

How does protein A act as a virulence factor

A

Binds to the Fc portion of antibodies, rendering them inaccessible to opsonins, impairing phagocytosis

93
Q

How does coagulase act as a virulence factor

A

Protects against phagocytosis

94
Q

What is coagulase

A

Protein enzyme tightly bound to the surface of staph aureus which can coat its surface with fibrin upon contact with blood

95
Q

How does a capsule act as a virulence factor

A

Protects bacteria against phagocytosis

96
Q

What is Panton-valentine leukocidin

A

Specific secreted proteins that form one functional complex that attacks white blood cells

97
Q

Describe strep pyogenes

A

Gram positive cocci in chains, coagulase negative

98
Q

Where in the body is strep pyogenes usually found

A

Pharynx

99
Q

What most commonly causes necrotising fasciitis type 2

A

Strep pyogenes

100
Q

What is the risk of an affected child if a parent has an autosomal dominant disorder

A

50%

101
Q

What is haploinsufficiency

A

Only one copy of working gene

102
Q

What happens in dominant negative mutations

A

Expression of abnormal protein interferes with the normal protein

103
Q

What happens in a gain of function mutation

A

Mutant protein gains a new function affecting cell processes

104
Q

What is the risk of an affected child if the parent is a carrier of an autosomal recessive disease

A

1/4

105
Q

What are the 5 layers of the scalp

A

Skin
Connective tissue
Aponeurosis
Loose connective tissue
Periosteum

106
Q

What nerve supplies motor function to the muscles of mastication

A

The Trigeminal nerve

107
Q

How many divisions does the Trigeminal nerve have

A

3

108
Q

Name the divisions of the Trigeminal nerve

A
  1. Opthalamic
  2. Maxillary
  3. Mandibular
109
Q

How do we test for the Trigeminal nerve

A

Gently brush the skin of each dermatome while the patient has their eyes closed
Get them to tell you when they feel it
Compare on both sides

110
Q

Roles of the facial nerve (4)

A

Controls the facial expression muscles
Controls inner ear that moderates volume of sound
Helps make tears
Relays information about taste to the brain

111
Q

Clinical testing of the motor function of the facial nerve

A

Frown, close eyes tightly, smile, puff out cheeks

112
Q

Name the methods of local anaesthesia (4)

A

Topical
Local infiltration
Nerve block
Field block

113
Q

What should be used with lignocaine as an anaesthetic

A

Adrenaline

114
Q

Why is adrenaline used alongside anaesthesia

A

Prolongs it and reduces bleeding

115
Q

When is electrosurgery used

A

Treatment of minor skin lesions

116
Q

What happens in a snip excision

A

Grasp lesion with skin hook and cut across the base of the lesion

117
Q

When is a snip excision used

A

Minor skin lesions

118
Q

What is curettage

A

Scraping of abnormal tissue

119
Q

What is a shave excision

A

Flat blade of a scalpel drawn through a raised lesion to remove it

120
Q

What does an elliptical excision look like (to me)

A

An eye

121
Q

Why do we not worry about UVC rays

A

They are blocked by the ozone layer

122
Q

Which UV is our biggest concern

A

UVA

123
Q

Compare the wavelengths of UVA and UVB

A

UVB has a shorter wavelength

124
Q

Benefits of UVR exposure

A

Vitamin D synthesis
Heat
Vision
Circadian rhythms
Bactericidal and virucidal
Therapeutic and diagnostic uses

125
Q

How can UVR cause immunosuppression (3)

A

Depletion of langerhans cells in the skin and reduced ability to present antigens
Generation of UV induced regulatory T cells with immune suppressive activity
Secretion of anti-inflammatory cytokines

126
Q

How does UVB cause DNA damage

A

Absorbed by DNA in the nucleus of a keratinocyte
Induces covalent linkages between pyrimadines in the same DNA strand producing CPDs and 6-4 PPs

127
Q

What are CPDs

A

Cyclobutane pyrimadine dimers

128
Q

How does UVA cause mutations

A

Indirect oxidative damage

129
Q

Signature mutation caused by UVB

A

CC - TT mutation

130
Q

Signature mutation caused by UVA

A

C - A point mutation

131
Q

What is an oncogene

A

Overactive form of a gene that positively regulates cell division

132
Q

What is a tumour suppressor

A

A gene that negatively regulates cell division to prevent the formation of a tumour

133
Q

Give some examples of erythematous exanthems that start on the face

A

Measles, rubella, erythema infectiosum

134
Q

What causes rubella

A

Togavirus

135
Q

Clinical presentation of erythema infectiosum

A

Slapped cheek on the face

136
Q

Virus associated with erythema infectiosum

A

HSV 6

137
Q

Give some examples of erythematous exanthems that tend to start on the trunk

A

Roseola
Scarlet fever
Unilateral laterothoracic exanthem

138
Q

At what point are you no longer infectious with chicken pox

A

Until all lesions are crusted over

139
Q

Management of chickenpox

A

Acyclovir in immunosuppressed patients

140
Q

What causes measles

A

Paramyxovirus called MeV

141
Q

How does measles spread

A

From person to person via respiratory droplets

142
Q

How does measles spread through the body

A

Enters through the respiratory tract, spreads to regional lymph nodes and then to other organs

143
Q

Clinical presentation of measles

A

Fever >39
Generalised maculopapular rash
One or more of: conjunctivitis, cough, coryza

144
Q

Koplik spots

A

A sign of measles before the onset of a rash

145
Q

Investigations for measles

A

PCR
serology: IgM, IgG
Viral isolation

146
Q

Prevention of measles

A

Live vaccine

147
Q

Who cannot receive a live vaccine

A

People who are immunosuppressed

148
Q

Complication of measles

A

Increased risk of bacterial superinfection

149
Q

Pathophysiology of HSV

A

Virus enters epidermis and penetrates endings of sensory and autonomic nerves
Establishes a latent infection in local ganglia
Reduction in immune function leads to reactivation

150
Q

Clinical presentation of HSV

A

Localised vesicular rash
Neuropathic pain
Fever, malaise

151
Q

Investigation for HSV

A

PCR

152
Q

Management of HSV

A

Acyclovir

153
Q

What is the MOA of acyclovir

A

Inhibits the activity of viral DNA polymerase and prevents the virus from multiplying and spreading in the body

154
Q

Role of thyroid hormone in the skin

A

Promotes fibroblasts activity
Regulates epidermal differentiation
Essential for hair formation and sebum production
Effects on skin perfusion

155
Q

Name some places in the skin you may find thyroid hormone receptors

A

Keratinocytes, fibroblasts, arrector pili muscle cells, sebaceous gland cells

156
Q

What is first line for phototherapy

A

UVB

157
Q

When is PUVA first choice

A

Mycosis fungoides, pityriasis rubra pilaris, pustular psoriasis or erythrodermic psoriasis

158
Q

Common side effect of UVB therapy

A

Erythema

159
Q

What should be done before starting any phototherapy

A

Minimal phototoxic dose test

160
Q

When might UVA1 treatment be used

A

Atopic eczema
Granuloma annulare

dermatology (13 decks)

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