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2nd Year - Dermatology > Nutrition 1 and 2 - Pre-reading and SGW > Flashcards

Nutrition 1 and 2 - Pre-reading and SGW Flashcards

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1
Q

What is a food allergy in comparison to a food intolerance?

A

When symptoms are caused by an immune reaction

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2
Q

What type of antibody usually mediates a food allergy?

A

IgE (sometimes non-IgE - thought to be T cell mediated, but not well understood)

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3
Q

What is a food intolerance in comparison to a food allergy?

A

A non-immune reaction

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4
Q

What causes a lactose intolerance?

A

A lactase enzyme deficiency leading to poor breakdown of lactose in the GI tract - the excess unabsorbed lactose results in symptoms

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5
Q

What are symptoms and signs of an IGE-mediated food allergy which affect the skin? (4)

A

Pruritus
Erythema
Acute urticaria
Acute angioedema

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6
Q

What are signs and symptoms of a non-IgE mediated allergy that affects the skin? (3)

A

Pruritus
Erythema
Atopic eczema

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7
Q

What are signs and symptoms affecting the GI tract of an IGE-mediated food allergy? (6)

A 
Angioedema of the lips, tongue and palate
Oral pruritus
Nausea
Colicky abdominal pain
Vomiting
Diarrhoea
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8
Q

What are signs and symptoms of a non-IgE mediated food allergy which affect the GI tract? (10)

A 
Gastro-oesophageal reflux disease
Loos or frequent stools
Blood and/ or mucus in stools
Abdo pain
Infantile colic
Food refusal or aversion
Constipation
Perianal redness
Pallor and tiredness
Faltering growth in conjunction with at least one or more GI symptoms above
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9
Q

What are 2 groups of signs/ symptoms of an IgE mediated food allergy which affects the resp system?

A

Upper resp tract symptoms e.g. nasal itching, sneeze, rhinoorhea)
Lower rest symptoms e.g. cough, wheezing

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10
Q

What is 1 group of signs/ symptoms of an IgE mediated food allergy that affects the resp system?

A

Lower resp. symptoms e.g. cough, chest tightness

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11
Q

What type of food allergy causes signs/ symptoms of anaphylaxis or other systemic allergic reactions?

A

IgE mediated food allergies

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12
Q

A food allergy should be suspected in children and young people who’s symptoms do not respond adequately to treatment for what 3 illnesses?

A

Atopic eczema
Gastro-oesophageal regular disease
Chronic GI symptoms including chronic constipation

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13
Q

Give 3 examples of atopic diseases?

A

Atopic eczema
Asthma
Allergic rhinitis

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14
Q

In terms of acute/ non-acute and rapid/ delayed onset of symptoms, describe IgE and non-IgE mediated food allergies?

A

IgE - Rapid, acute

non-IgE - Delayed, non-acute

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15
Q

If an IgE-mediated allergy is suspected in a child/ young person, what tests should be offered to them?

A

A skin prick test and/ or blood tests

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16
Q

If a non-IgE mediated allergy is suspected, what treatment/ tests should be offered to the patient?

A

Trial elimination of the suspects allergen (normally for between 2 - 6 weeks) and reintroduce after the trial

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17
Q

What is thought to case the reduced mechanical strength of skin in obesity?

A

A failure of collagen deposition to match the increased surface area

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18
Q

Why does the skin tend to be dry in obese patients?

A

Increased trans-epidermal water loss

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19
Q

What causes irritation between skin folds in obese patients?

A

Increased activity of apocrine and eccrine sweat glands in enlarged skin folds increases moisture/ skin maceration and friction in folds

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20
Q

How does microvascular dysfunction in obese patients lead to hypertension?

A

It results in increased skin blood flow

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21
Q

What effect does obesity have on lymphatics?

A

Pressure from fat impedes lymphatic flow and causes leakage of protein rich lymphatic fluid into subcutaneous tissues

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22
Q

How can obesity lead to increased hormone production?

A

The endocrine roles of adipose tissues may be altered leading to increased hormone production e.g. testosterone

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23
Q

How does obesity affect sebaceous glands?

A

Increased androgens (male sex hormones) produced in peripheral fat stimulate sebaceous glands

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24
Q

What is the name for the velvety thickening and pigmentation of the skin folds, usually axillae?

A

Acanthosis nigricans

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25
What is frequently found around the neck and axillae of obese patients?
Skin tags (acrochordons)
26
What 2 direct skin manifestations of obesity are associated with insulin resistance?
``` Acanthosis nigricans Skin tags (acrochordons) ```
27
What is the name for increased hair in females in male distribution due to obesity?
Hirsutism
28
Why do patients with obesity frequently get acne?
Due to increased sebaceous gland activity
29
What is the name for a chronic inflammatory disease where boils and abscesses form and scar in apocrine gland areas esp. axillae, groin)? - seen in obese patients
Hidradenitis suppurativa
30
What is the name for male pattern balding in men/ women? - seen in obese patients
Androgenetic alopecia
31
What are stretch marks? What is the proper name for this?
Type of warring associated with dermal connective tissue injury in response to local stretching forces Striae distensae
32
What is the sequence of events that leads to obese patients legs becoming grossly enlarged?
Increased subcutaneous fat causes reduced lymphatic drainage leading to swelling Gradually worsening swelling causes chronic inflammation leading to fibrosis Reduced tissue oxygenation and swelling results in bacterial overgrowth Cellulitis develops easily and leads to further lymphatic damage A downward spiral develops if left untreated and ultimately the skin becomes thick and warty and the lower leg and foot become permanently enlarged, often grossly
33
What is the sequence of events in chronic venous insufficiency that leads in venous ulceration in obese patients?
Abdominal obesity resists venous return from the legs Veins dilate and valves become incompetent, varicose veins develop The increased hydrostatic pressure in the vessels results in red blood cell leakage into tissue resulting in swelling, haemosiderin pigmentation and inflammation (due to breakdown products) Chronic scarring eventually occurs The skin may ulcerate (venous stasis ulceration)
34
What are 5 skin diseases aggravated by obesity?
``` Lymphoedema Chronic venous insufficiency Skin infections Intertigo Psoriasis ```
35
What is intertrigo?
Macerated red plaques which develop in skin folds due to high moisture levels, friction, increased pH and reduced barrier function that are prone to secondary infection
36
What role does vitamin A play in terms of the skin?
Vital for epithelial proliferation, keratinisation and development
37
What are the sources of vitamin A?
Animal - milk, liver, eggs, oily fish | Plant - green leafy veg, bright yellow/ orange fruit and veg
38
How does a vitamin A deficiency present in terms of the skin?
Keratotic follicaular papules on the thighs and upper arms, dry skin
39
How to diagnose a vitamin A deficiency?
Measure serum vitamin A
40
What is vitamin K essential for?
Several blood coagulation factors
41
What are the main sources of vitamin K?
Green leafy veg, liver, legumes, vegetable oils (also produced in GI tract by bacteria - therefore can be affected by prolonged antibiotics)
42
Presentation of vitamin K deficiency?
Bleeding tendency, seen in skin as proper and easy bruising
43
How to diagnose a vitamin K deficiency?
Measure coagulation and serum Vitamin K
44
What is another name for Vitamin B2?
Riboflavin
45
What is the role of vitamin B2 (riboflavin)?
Essential co-factor in numerous metabolic reactions
46
What are the sources of vitamin B2 (riboflavin)?
Milk, liver, meat, eggs, green leafy veg
47
What are the signs of a vitamin B2 (riboflavin) deficiency?
Lesions of the margins of the lips (chalices) and corners of the mouth (angular stomatitis) Painful red dry tongue
48
How do you diagnose a vitamin B2 (riboflavin) deficiency?
Measure the activity coefficient of erythrocyte glutathione reductase (EGR)
49
What is another name for Vitamin B3?
Niacin
50
What is the role of vitamin B3 (niacin)?
Essential co-factor in numerous metabolic reactions
51
What are the sources of vitamin B3 (Niacin)?
Meat, fish, nuts, coffee | Also converted from dietary tryptophan (essential amino acid) in the body
52
What are the symptoms/ signs of a vitamin B2 (Niacin) deficiency?
``` Pellagra: dermatitis (worse on sun exposed areas) Delirium Diarrhoea - with abdo pain, vomiting Death - in 4-5 years if not treated ```
53
Diagnosis of vitamin B3 deficiency?
Clinical diagnosis, as difficult to measure niacin levels | Nicotinamide supplementation brings rapid improvement
54
What is the role of Vitamin B6?
Co-enzymes for many processes
55
What are the source of vitamin B6?
Meat, cereals, milk, potatoes, banks, nuts and pulses
56
Symptoms of a vitamin B6 deficiency?
Dermatitis of face, scalp, neck, shoulders, buttocks and perineum, tongue inflammation (glossitis)
57
Diagnosis of a vitamin B6 deficiency?
Measure serum or urinary Vitamin B6 | Trial of supplement
58
What is the role of folate?
Critical co-enzyme
59
What are the sources of folate?
liver, green leafy veg, beans, nuts and milk
60
Symptoms/ signs of a folate deficiency?
Anaemia, angular stomatitis, glossitis, hair depigmentation, sin and mucous membrane pigmentation
61
Diagnosis of a folate deficiency?
Measure serum folate
62
Role of vitamin B12?
Critical co-enzyme
63
Sources of vitamin B12?
Only found in foods of animal origin such as meat, milk, fish and eggs
64
Signs/ symptoms of a vitamin B12 deficiency?
Anaemia, angular stomatitis, glossitis, hair depigmentation, sin and mucous membrane pigmentation
65
Role of biotin?
Essential co-factor for carboxylase enzymes
66
Sources of Biotin?
Cereals, meat, milk, eggs, pulses, nuts - also produced by GI bacteria
67
Presentation of biotin deficiency?
Rare - facial dermatitis, glossitis, alopecia
68
Diagnosis of a biotin deficiency?
Serum biotin
69
Other name for vitamin C?
Ascorbic acid
70
Role of vitamin C?
Essential co-factor in collagen formation
71
Sources of vitamin c?
Citrus fruit, strawberries, balckcurrants, tomatoes, potatoes
72
Presentation of a vitamin C deficiency?
hYperkeratosis around hair follicles, bent hairs, inflamed gums, poor wound healing - fatigue, malaise, muscle and bone pain
73
Diagnosis of a vitamin C deficiency?
Clinical - supplements bring a rapid improvement
74
Role of zinc?
Required for many metabolic pathways - required for structure and function of skin and so vital for wound healing
75
Sources of zinc?
Meat, fish, milk, eggs, cereals, nuts and pulses
76
Presentation of a Zinc deficiency?
Genetic = acrodermatitis enteropathica (autosomal recessive) - caused by a lack of zinc absorption = diarrhoea, alopecia dry/ brittle hair, perioral, facial and aural dermatitis Acquired - more common, and may be due to increased elimination of zinc secondary to burns or infection - dermatitis rash of hands and feet mainly
77
Diagnosis of a zinc deficiency?
Serum zinc measurement
78
What are the 2 forms of protein energy malnutrition?
Mrasmus | Kwashiorkor
79
What is Marasmus?
Blobal nutrient deficincy causing weight loss by fat breakdown
80
Appearance of a child with Marasmus?
Very thin and muscle wasting No oedema Skin is dry, wrinkled and lose from subcutaneous fat and muscle loss Hair is thin, brittle and can cause alopecia
81
What is Kwashiorkor caused by?
Very low protein intake with reasonable carbohydrate intake
82
Appearance of a child with Kwashiorkor?
Oedema is present and children often develop an enlarge pot bello Skin looks irregular or patchy discolouration caused by pigmentary change Dark, dry skin amy split when stretched revealing pale areas between the cracks (crazy, paving dermatosis)
83
What is the proper name for piriton?
Chlorphenamine
84
Is he prick test or blood tests more definitive for diagnosing an IgE mediated allergy?
prick tests are more definitive
85
what can cause a prick test to show a false negative?
If the patient has ingested anti-histamines
86
Is it common for food to play a role in adult eczema?
Very uncommon (Very common in children)
87
How to insert an epipen?
``` "Blue to sky, orange to the thigh" Remove blue cap Push into thigh Hold for 10 secs Remove and massage area ```

2nd Year - Dermatology (16 decks)

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