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Dermatology > Pathophys/Path 4 > Flashcards

Pathophys/Path 4 Flashcards

1
Q

Effective treatment of skin disease requires?

A
  • timely identification or estimation of pathogen

- selection of treatment that is effective and good dosing

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2
Q

Natural Resistance of Skin

A
  • first line defense
  • physical barrier
  • secreting low pH, sebaceous fluid, fatty acids, antimicrobial peptides to inhibit growth of pathogens
  • possess normal flora, deterring others
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3
Q

Bacterial Skin Disease: Pathogenesis

A

2 step process:

1) Invasion- penetrate skin (break most common)
2) adherence to host, invasion of tissue with evasion of host defense, elaboration of toxins

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4
Q

2 Classes of Toxins

A

1) exotoxins-actively secreted proteins that cause tissue damage or dysfunction through various mechanisms (enzymatic rxns, cellular dysregulation/ pore formation w/cell lysis)
2) endotoxins

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5
Q

Impetigo

A
  • superficial, crusting epidermal skin infection that presents in bullous & nonbullous forms
  • “honey colored crusts” - superficial plack
  • young children, face, staph, strep
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6
Q

Erysipelas

A

streptococcal infection of superficial dermal lymphatics that is sharply demarcated, raised borders - strep

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7
Q

Cellulitis

A

deeper dermis and subcutaneous tissue with poorly demarcated borders
-strep

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8
Q

Cutaneous abscesses

A

collection of pus in the dermis and subcutaneous tissue

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9
Q

Folliculitis

A

superficial infection of hair follicle with pus accumulation in the epidermis

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10
Q

Furuncles

A

“boils”

deeper involvement of hair follicles in which the infection extends into the subcutaneous tissue

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11
Q

Carbuncles

A

adjacent furuncles coalesce to form a single inflamed area

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12
Q

Super antigens

A

special exotoxins seen in S aureus & S pyogenes

  • bind conserved portions of T cell receptors and activate large numbers
  • cause huge inflammatory response (severe tissue necrosis)
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13
Q

Bacterial skin disease

A

most common type of skin infection
lots of conditions
classified by skin layer/structure it infects

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14
Q

Scalded Skin Syndrome

A

toxin-producing S. aureus
mostly infants/children
adults with renal failure/immunosuppression

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15
Q

Scalded Skin Syndrome Histology, Symptoms

A
  • granular layer split in epidermis; dermis lacks inflammatory infiltrate
    -diffuse generalized erythema and superficial desqumation with flexural accentuatuin
    -mucus membranes NOT involved
    perioral and periocular crusting and radial fissuring with mild facial swelling
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16
Q

Scalded Skin Syndrome Treatment

A

Antibiotics (beta-lactmase resistant)

Supportive

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17
Q

Necrotizing Fasciitis

A

-insidious and deadly soft-tissue infection, widespread tissue necrosis
I-polymicrobial
II-strep “flesh-eating”
III-clostridial myonecrosis “gas gangrene”

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18
Q

Necrotizing Fasciitis Symptome

A
  • rapid progressoin, spreads on deep plane b/w subcutis and fascia
  • pain out of proportion to clinical findings
    • tender, warm, swelling, red
    • red and purple to grey-blue patches in 36hrs
    • violaceous/hemorrhagic bullae
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19
Q

Necrotizing Fasciitis Treatment

A

Surgery - widespread debridement

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20
Q

Toxic Shock Syndrome

A 
S. aureus - TSST-1 toxin 
cause: tampon, surgery, deep abscesses
features: fever, strawberry tongue, sun-burn like erythema, sandpaper papules, desquamatioin of hands and feet
-can go to shock
Treat: Abx and remove nidus of infection
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21
Q

Puss forming infections

A

staph, except periorificial abscesses (anaerobic)

Majority is cellulitis

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22
Q

Bacterial Skin Disease Diagnosis

A

presentation, history, culture

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23
Q

Bacterial Skin Disease Treatment

A

Abx

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24
Q

Fungal Skin Disease Categories

A

1) Superficial
2) Deep
3) Systemic

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25
Superficial fungal infections
most common confined to dead keratinous tissue, epidermis, hair follicles -caused by: dermatophytes, nondermatophyte molds, yeasts (candida, malassezia)
26
Deep fungal infections
all skin layers and extend into subcutaneous tissue | direct inoculation of skin: sporotrichosis, mycetoma, chromomycosis
27
Systemic Infection
``` immunocompromised not common inhale spore (pulmonary) -histo, blasto, coccidio -nonimmuno -crypto, aspergill, fusariosis, mucormycosis- immune compromised ```
28
Dermatophytes
superficial fungus digest keratin as nutrient -colonize highly kertinized stratum corneum, nail plate, hair follicles -don't invade, not deep, not lethal -virulence: adhear to keratin, invade by secretized enzymes
29
3 general of Dermatophytes
1) Trichophyton - most common 2) Microsporum 3) Epidermophyton
30
Tinea pedis
"athlete's foot" -superficial of foot - worldwide increase, occlusive footwear - 95% from dermatophytes
31
Tinea Unguium
(onchomycosis) - superficial infection of nail plate or bed | - nail bed deformity (onchodystrophy) with thickening (hyperkeratosis) and discoloration
32
Tinea Corporis
"ring worm" - superficial infection of glabrous skin occurring most commonly on trunk and limb -annular plaques or patches with red, raised, scaling border
33
Tinea facei
"ring worm" superficial on face | -annular plaques or patches with red, raised, scaling border
34
Tinea cruris
"jock itch" superficial infection on groin region - almost all male - erythematous patch involving inner thigh, inguinal folds - spares penis
35
Tinea capitis
superficial infection of scalp and hair | -95% caused by T tonsurans
36
Candidiasis
superficial - candida albicans-skin, mucus membranes, nails, GI tract - more in women (vulvovaginal) - immunosuppressed
37
Tinea versicolor
superficial, harmless, tropical -overgrowth of Malassezia species, formation of hypo/hyperpigmented patches and fine scale "spagiattie and meatball"
38
Viral Skin infection
most eliminated initially | some chronic
39
HPV
genital warts | resistant
40
Herpes Simplex Virus
HSV-1, HSV-2, VZV, EBV, CMV most widespread human virus produce latent, incurable infection
41
HSV-1 | HSV-2
- initial through mucosa or abraded skin - virus travel retrograde to sensory neuronal axon to nuclei - replicate/latent - reactivation: stress, fever, trauma (local), UV light, period, immunosuppression - shed w/o symptoms (1-5% of time)
42
Herpes Labilis
most common form - vesicular or ulcerative lesions of oral cavity, perioral skin, mucosa - HSV-1 - oral secretion contact
43
Herpes genitalis
- genital mucosa | - most HSV-2 some HSV-1
44
HSV-1,2 Symptoms
=Prodrome of tingling pain in region HSV-1 asymptomatic HSV-2 severe, painful vesicle formation and ulceration, constitutional (fever, lethargy)
45
HSV-1 recurrence
painful, grouped vesicles on erythematous base on vermillion border of lip for 2-3 days-heal in 4 to 5 (crusting)
46
HSV-2
- similar skin findings, but less severe than primary infection - no constitutional symptoms
47
HSV diagnosis
physical | Tsanck smear, viral culture, serologic testing, ab, tissue biopsy
48
Eczema herpeticum
HSV superinfection of atopic dermatitis
49
Herpetic whitlow
digital HSV infection
50
Herpes gladiatorum
corporeal HSV from skin to skin contact in athletics
51
Herpes Treatment
Acyclovir Valacyclovir/famciclovir Foscarnet/cidofovir
52
Varicella Zoster Virus
"chicken pox" airborn/contact very contagioius (11-20 day inc) -primary: fever, malaise, myalgia by pruritic eruption, spreading from face/scalp to trunk "dew drops on rose petal" -affects 90% unvaccinated before age 10 -self-limited, benign in children bad for adults & immunocompromised
53
Herpes Zoster
"shingles" - reactivation of latent VZV in any dorsal root ganglion - lifetime risk is ~20%, increase with age & immunocompromised - lesions are contagious until they have crusted
54
VZV Treatment
supportive, acyclovir Vaccine, live, attenuated (varivax) Zostavax (persons at least 60 years old)
55
VZV Diagnosis
clinical non-specific Tzanck, histology Specific: DFA immunochem culture PCR serology
56
Molluscum contagiosum
DNA poxvirus (molluscipox) - in healthy, disease of children - smooth, dome-shaped, umbilicated papules - intracytoplasmic inclusions within keratinocytes (Henderson-Paterson bodies) - self-limited (healthy) - destructive or medical therapies may hasten resolution
57
HPV
``` icosahedral, naked, ~55nm in diameter small closed circular double-stranded DNA Upstream regulatory region -early region -E1-8 -late-L1-L2 E6-leads to degradation of p53 E7-inactivates Rb protein *over-expression of E6 and E7 proteins in malignant tumors ```
58
HPV live cycle
-tissue/species specific -gain access to basal keratinocytes through minor abrasians in the skin/mucosa -direct/sexual contact -entry b/w L1/L2 proteins & cell surface receptors -replicated in nucleus (dep on host cell) spreads laterly then migrates upward suprabasal cells where mature virus continues (shed with desqumation)
59
Palmoplantar wart
HPV-1, volar aspect of palms/soles, tips of fingers and toes
60
Flat warts
HPV 3, 10 verruca plana smooth, skin-colored papules on face, arms, dorsal hands
61
Common warts
HPV 2
62
Genital warts
most common venereal disease scaly and papular to smooth and flesh-colored penis, vulva, perianal area HPV-6 HPV-11
63
Cervical Cancer
HPV-16,18,31,33
64
Bowenoid papulosis
HPV-16,18 hyper pigmented papules on genitalia (look like genital warts) HSIL or SCCIS
65
Erythroplasia of Queyrat
HPV 16,18 | -represents HSIL
66
Buschke-Lowenstein tumor
HPV 6,11 | "semi-malignant" verrucous carcinoma locally invasive and destructive rare metastasized
67
Oral florid papillomatosis
HPV 6,11 | smoking irradiation chronic inflammation
68
Warts:treat prevent
most self-limited Gardasil (6,11,16,18) Cervarix (16,18)
69
Digital SCC
HPV 16

Dermatology (9 decks)

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