Skin and Eye Disorders Flashcards
(119 cards)
1
Q
Normal functions of skin
A
protection
sensation
thermoregulation
immunomodulation
production of vitamin D
2
Q
layers of the skin
A
epidermis
dermis
hypodermis
3
Q
epidermis
A
thinnest layer
avascular
normal skin flora here
4
Q
Glaucoma
A
Damage to optic nerve that leads to visual field loss and blindness
5
Q
skin flora of the epidermis
A
staph epidermidis
staph aureus
Candida albicans
6
Q
4 layers of epidermis
A
cornified
granular
spinous
basal
7
Q
What is glaucoma characterized by?
A
Changes in optic disc
Elevated IOP
8
Q
dermis
A
thickest
nutrition and support
hair follicles, sebaceous glands and sweat glands
9
Q
the type of cells in the dermis and what they do
A
fibroblasts - collagen and scar formation
macrophages - immune regulators and growth regulators
10
Q
Types of Glaucoma
A
Open-angle glaucoma (OAG)
Closed-angle glaucoma (CAG)
11
Q
the dermis contains multiple
A
nerve endings, lymphatics and vasculature
12
Q
What is aqueous humor produced by?
A
Ciliary body
13
Q
hypodermis
A
variable thickness
fat storage
provides insulation, padding, protection
mobility
protects from friction
14
Q
Where is aqueous humor secreted?
A
Into posterior chamber
15
Q
growths
A
cysts, raised bumps on skin
16
Q
Pathway of aqueous humor
A
Pressure pushes aqueous humor between iris and lens, through pupil to the anterior chamber
17
Q
rashes
A
dermatitis
inflammatory skin condition
18
Q
macules and patches
A
flat areas of discoloration
19
Q
papules and plaques
A
elevated palpable lesions
20
Q
vesicles and bullae
A
fluid filled spaces within the skin
21
Q
Aqueous humor leaves eye through
A
- Filtration through trabecular meshwork to Schlemm’s canal
- Through ciliary body - uveosceral outflow
22
Q
pustules
A
vesicles/bulla with purulent fluid
23
Q
nodules
A
solid, rounded skin lesion
24
Q
common skin disorders include
A
acne
psoriasis
atopic dermatitis
dermatologic drug reactions
25
acne
chronic multifactorial disease
most common in urban areas
can cause scarring and hyperpigmentation
overall equal in men and women
26
Normal IOP
10-21 mmHg
27
IOP is regulated by
Production and outflow of aqueous humor
28
IOP at risk for glaucoma
> 22 mmHg
29
acne in adolescents is more severe in ______
acne in adults is more severe in ______
boys
women
30
4 major factors of acne
increased sebum production
alteration of keratinization process
bacterial colonization
production of inflammatory mediators
31
IOP is higher in the am or pm?
AM
32
environmental etiology of acne
exacerbated by heat/humidity
friction, clothing, hairstyles can have a negative impact
sunlight can improve acne in some
33
Classification of Gluacoma
Primary or Secondary
34
Risk factors for Open-angle Glaucoma
Older, IOP level, Myopia, African/hispanic, Type 2 DM
35
diet etiology of acne
dairy
high glycemic load diet
increased saturated fats
36
can smoking have an effect on acne?
yes
37
Risk factors for Angle-closure Glaucoma
Older, ocular trauma, female, Asian, hyperopia, pseudoexfoliation
38
in acne, puberty leads to
maturation of adrenal glands which increase androgen and sebaceous gland activity
39
when the sebaceous lipid profile is altered due to stress, irritation, etc. , it leads to
inflammation and formation of acne lesions
40
Open-Angle Glaucoma
Progressive, chronic optic neuropathy
41
sebum
induced by different receptors (histamine, DHT, CRH, IGF, peroxisome-proliferator activated receptors)
42
Pathophys of OAG
Blockage of trabecular meshwork --> changes in aqueous outflow --> High IOP
43
when linoleum acid is decreased, what happens to sebum?
sebum production increases
44
Along with high IOP, OAG must present
Optic disc/retinal nerve fiber structural abnormalities
Visual field abnormalities
45
C. Acne activates both the
innate immunity and T cell response
46
C. Acne produces _______ that hydrolyzes sebum triglycerides into ________________ which lead to _________________
lipase
free fatty acids
increased keratinization
47
C. Acne leads to ____________ lesions which lead to
inflammatory
scarring and hyperpigmentation
48
noninflammatory lesions presentation
closed comedones (rupture easy)
open comedones (stable)
49
inflammatory lesions presentation
papules/pustules (raised, white with pus)
nodules (warm, tender, firm)
cysts (inflamed, double comedones)
50
Acute Angle-Closure Glaucoma
Acute attack = medical emergency
Very high IOP may lead to complete pupillary blockage
51
acne can be anywhere on the body besides for
palms and soles
52
Pathophys of Acute Angle-Closure Glaucoma
Pupil dilates to where iris contracts and may adhere to lens --> blocks flow of aqueous humor --> complete blockage
53
Psoriasis
chronic, autoimmune T lymphocyte mediated systemic disease
54
Psoriasis presents as
sharply marginated and erythematous silvery scales with fixed plaques
55
the most common type of psoriasis
plaque psoriasis
56
plaque psoriasis
most common
raised red lesions covered in silvery white scales on the knees, scalp, elbows and back
57
What medications can you not take with angle-closure glaucoma?
Ones with anticholinergic properties
58
Psoriatic arthritis
1/3 patients
joint stiffness and pain
can lead to permanent irreversible joint damage
59
other forms of psoriasis
guttate
inverse
pustular
erythrodermic
nail
60
Non-acute closed angle glaucoma
IOP is usually normal
61
psoriasis genetic factors
PSORS1 chromsome 6
62
Drug-induced OAG
Corticosteroids
63
precipitating factors that trigger abnormal immune response is psoriasis
injury
infection
alcohol, smoking
obesity
stress
drugs - beta blockers
64
Drug-induced angle-closure glaucoma
Anticholinergics
Miotics
Amphetamines
Decongestants
65
types of medications that can worsen preexisting psoriasis
NSAIDS
lithium
antimalarials
beta-blockers
fluoxetine
corticosteroid withdrawal
66
Symptoms of OAG early disease
Asymptomatic
Slightly high IOP
Decreased outflow
Optic disc changes
67
comorbidities of psoriasis due to chronic inflammation
CV disease
insulin resistance
68
psoriasis pathophysiology
genetic/environmental stimuli
innate immune response --> cytokine release
adaptive immunity activates T cells --> more cytokine release
epidermal hyperplasia, dermal inflammation, silvery scales
69
Symptoms of OAG advanced disease
Gradual vision loss
Elevated IOP
Optic nerve degeneration
70
Psoriasis comorbidities
Psoriatic arthritis
metabolic syndrome
CV disease
Chron's disease
MS
malignancies
psychiatric (depression)
decreased life expectancy (atherosclerosis/CV disease)
71
clinical presentation of plaque psoriasis
lesions/plaques are red-violet color, well demarcated
silver, flaking scales, bleeding
pruritis (50%)
72
Eczema is more prevalent in...
Young children
73
plaque psoriasis is mold, moderate, severe depending on
BSA involvement
74
Genetic predispositions to eczema include
1. Skin barrier dysfunction
2. FLG gene mutation
3. Th2-helper cell imbalance
75
skin lesions of plaque psoriasis are in
a specific area (knees, elbows)
76
dermatologic drug interactions account for
15-20% of all ADRs
77
risk factors of dermatologic drug interactions
previous drug reaction
multiple drug therapy
concurrent illness
dosage increase
comorbidities
78
Th2-helper cell imbalance
Leads to increased IL production --> increased serum IgE --> inflammation
79
Pathophys of Atopic Dermatitis
Dendritic cells meet allergens and enhance Th2 cells --> increased IgE and ILs
Reduced AMPs --> increased susceptibility to infections
80
irritant drug reactions
topical route
localized irritation
81
allergic drug reactions
topical/systemic
induces an immune reaction, may first present as a skin reaction and become systemic
82
type 1 allergic reaction
immediate (IgE)
allergen binds to IgE --> release inflammatory mediators
83
type 2 allergic reaction
delayed
cytotoxic cell destruction
84
Atopic Dermatitis Predisposing Factors
Climate, infections, genetics
Allergens
85
type 3 allergic reaction
delayed (immune complex)
antigen antibody complexes form and deposit on blood vessel walls
86
Clinical presentation of Atopic Dermatitis
Atopic pleat
Headlight sign
Hyperpigmented eyelids
Keratosis pilaris
Lichenification
87
type 4 allergic reaction
delayed (T cell mediated)
antigen cause activation of T lymphocytes which release cytokines
88
type 1 allergic reaction signs
urticaria/angioderma
89
type 3 allergic reaction signs
serum sickness
vasculitis
drug induced lupus
90
type 4 allergic reaction signs
contact dermatitis
maculopapular rashes
exanthems
91
Essential features of Atopic Dermatitis
Pruritus
Eczema
92
Minor features of Atopic Dermatitis
Early onset
Atopy
Xerosis
93
type 1 allergic reaction drug causes
penicillin (anaphylaxis)
94
type 3 allergic reaction drug causes
penicillin - serum sickness
minocycline - vasculitis
95
type 4 allergic reaction drug causes
sulfonamide antibiotics
penicillins
TB PPD test
96
Vasculitis
Inflammation and blood vessel wall necrosis
97
exanthems
rash without fever, most common
urticaria and angioedema
blistering
pustular
98
Vasculitis involves
papules, nodules, ulcerations, vesiculobullous lesions
99
exanthems includes
Severe cutaneous adverse reactions to drugs (SCARs)
SJS/TEN
DRESS
100
Anaphylaxis - Type 1 hypersensitivity
life threatening
usually immune mediated
acute onset and can have a late phase
101
Drugs that can cause vasculitis
Allopurinol
Penicillins
Sulfonamides
Thiazides
Phenytoin
Vancomycin
102
acute onset of anaphylaxis includes
skin, respiratory tract and decrease in blood pressure
103
DRESS
Drug Rash with Eosinophilia and Systemic Symptoms
104
most common medications causing anaphylaxis
penicillins, aspirin, NSAIDs and insulin
105
1st skin symptoms of anaphylaxis
flushing, pruritus, urticaria and angioedema
106
Triad for DRESS
1. Rash
2. Eosinophilia
3. Internal organ involvement
107
2nd respiratory symptoms of anaphylaxis
throat and chest tightness, dysphagia, dysphonia, hoarseness, cough, stridor, SOB
108
Drugs associated with DRESS
Anticonvulsants
Allopurinol
Sulfonamides
109
3rd symptoms of anaphylaxis include
dizziness, hypotension and GI symptoms
110
most fatal symptoms of anaphylaxis
respiratory symptoms
111
Erythema multiforme (EM)
Round 'bull's eye' rings
Not always associated with drug reactions --> herpes simplex
112
Stevens-Johnson Syndrome (SJS)
Severe EM
Flu-like symptoms
Rash and exfoliation of skin
113
Toxic Epidermal Necrolysis (TEN)
Severe SJS
Cytotoxic T-cells --> proteases cleave keratinocyte proteins --> apoptosis
114
Dermatologic Emergencies
SJS and TEN
115
SCARs
SJS
TEN
EM
116
Progression of SCARs
Include mucous membrane erosion and epidermal detachment
117
Complications of SCARs
Permanent visual impairment
Nail loss, scarring
Irregular pigmentation
118
Drugs that cause SCARs
Sulfonamides (TMP-SMX)
Allopurinol
Penicillins
Carbamazepine
Cephalosporins
119
SJS and TEN Pathophys
Type IV Hypersensitivity Reactions
Cytotoxic T cells attack epithelial cells in mucosa and epidermis
