Week 1 Flashcards
(119 cards)
1
Q
What are some of the common cuases of skin conditions?
A
Drugs Stress ingections Disease Genetics Allergies Systemic diseases
2
Q
Define prevalence?
A
Total number of cases within the population at any time
3
Q
Define incidence
A
Number of new cases described as a % of population who get the disease over a set period of time
4
Q
Define illness behaviour
A
Concept that different people will react to the same thing differently due to perception influenced by their demographic and psycholical factors and their social situation.
5
Q
What is the difference between an illness and disease?
A
Illness is the experience of discomfort and suffering, disease is a pathological condition
6
Q
When you walk in a room you first will see how busy it is, then recognise faces. What is this phenomenom of the brain described as ?
A
Gestalt psychology, that the brain sees the whole picture first then interprets it
7
Q
Raw reactions to things are controlled by neural pathways where in the brain?
A
Amygdala
8
Q
Young man presents with skin disease following blaschkos lines. What does this indicate?
A
It is a prenatal disease
Blaschkos lines are how the skin was warped and stretched during foetal development so if it follows one of these lines you know it was prenatal
9
Q
Give some examples of skin appendages
A
Hair
Nails
Glands
Mucosae
10
Q
From when in the womb does the skin begin to develop? And until when?
A
4 weeks- periderm, basal layer, dermis estabilshed
16 weeks; epidermis layers formed keratin, granular, prickle cell, basal layer, dermis
26 weeks; skin appendages formed hair, melanocytes
11
Q
What is a keratinocyte? Where do they originate in the skin?
A
Any cell that contains structural keratin e.g prickle cells
Originate from the basal membrane
12
Q
Name the 4 layers of the epidermis from deep to superficial
A
Basal layer, prickle cell layer, granular layer, keratin layer
13
Q
Name the 3 main layers of skin from superficial to deep
A
Epidermis
Dermis
Subcutaneous/ superficial fascia
14
Q
What is the patholigcal process that causes patches of mucosa to appear white in the mouth
A
The mucosa and dermis have become thickened so you cant see the blood vessels anymore making it white
15
Q
What layer of the skin would you find corneocytes? What is their function
A
The keratin layer of the epidermis
Composed of keratin and filaggrin that allows water to be retained
16
Q
Describe the path of blood from the heart to the hand
A
Brachiocephalic -> axillary -> brachial -> radial/ ulnar -> deep/superficial palmar arches -> metacarpal and digital arteries
17
Q
Man is bleed profusely from his right him around the biceps brachii, where would you pinch to cut of blood flow
A
Proximal to the bleeding
Subclavian artery
18
Q
What is an end artery? Give an example of where you would find an end artery
A
Where only one artery supplies an area of the body. The hand
19
Q
Where is the cubital fossa?
A
The elbow
20
Q
What is the venous supply to the thumb? Medial or lateral supply?
A
Lateral supply by the cephalic vein
21
Q
What vein runs medially in the upper limb?
A
The basilic vein
22
Q
Which vein is venopuncture usually taken from ? What vessels does this bridge?
A
The median cubital vein
The cephalic vein and the basilic vein
23
Q
Describe the arterial blood flow in the foot
A
Dorsalic pedis artery-> medial and lateral plantar arteries -> arcutate artery/ deep plantar arteries-> metatarsal and digital arteries
24
Q
What is the general rule for the path of lympathics?
A
they follow the venous supply
25
Describe the venous path of blood beginning at the tibial vein to theheart
Tibial-> popliteal -> femoral -> external iliac vein -> common iliac vein -> IVC ->right atrium
26
What can cause venous ulceration?
Where there is a micronutrient deficiency in the blood so the skin becomes itchy, dry and inflamed
27
What is a vena comitantes? What is the function?
Where multiple veins will be wrapped in a bundle around an artery, so when the artery pulses it pushes blood in the veins back up to the heart
28
Where do the lymphatics of the upper limbs drain into? Where does this then drain?
Axillary lymph nodes
Subclavian lymphatics
29
Mans thumb gets infected, describe the path of the lymph nodes you expect to be enlarged
Cephalic nodes and apical axillary lymph nodes
30
Mans pinky gets infected, describe the path of the lymph nodes you expect to be enlarged
Basilic -> cubital nodes -> lateral axillary nodes
31
Describe the origin of the great saphenous vein and where it drains into
Arises from dorsal venous arch
Drains into the femoral vein
On medial aspect of the lower limb. Superficial vein
32
Describe the origin of the small saphenous vein and where it drains into
From dorsal venous arch
Drains into popliteal vein
On posterior midline of leg superficial vein
33
Name the cell type that produces pigment by converting tyrosine into melanin
What layer of skin are they in
Melanocytes
| Basal layer
34
What is the function of langerhans cells
Interpresed in the epidermis antigen presenting cells
35
What is the function of merkel cells
Mechanoreceptors attached to the spinal cord that detect sensory information
36
What are the 3 phases of the life cycle of the hair follicle
| What receptor stimulates this
Anagen (growing)
Catagen (involuting)
Telogen (resting)
Androgen receptor
37
Damage of what area of the nail will cause poorly differentiated nails
The nail matrix
38
What is the histology of a scar
Loss of skin appendages so the body fills the defect with collagen from fibroblasts
39
What is the function of the dermo-epidermal junction
Sticks the dermis and the epidermis together supporting the whole skin structure and allowing diffusion of blood across the layers
40
What is the condition vitiligo a problem with?
There is a loss of melanocytes resulting in patches of pigment in the skin
41
What is the problem with nelsons syndrome?
Hyperpigmentation due to excess secretion of ACTH and likely to gret adrenal tumours and mailgnant melanoma. Common to get in people with CUSHINGS
42
What embryological layer does the hair follicle originate from?
The mesoderm
43
What is the problem with alcopecia areata?
Autoimmune condition where hair is attacked by lymphocytes so falls out
44
What process can cause thickening of the nail?
Hyperkeratonosis
45
Why does bullous pemphigoid occur?
Due to a problem with the dermo-epidermal junction so causes blisters
46
What is the problem with epidermolysis bullosa?
Occurs in kids, can be life threatening, problem with dermo-epidermal junction
47
What is photoaging?
Where elastic fibre production fails in the dermis fails and becomes disordered. Natural aging process
48
What is the arrangement ofthe blood vessels in the dermis?
Horizontal plexus
49
What are some of the cell types that sense pressure and vibration in the skin that activate nerves?
Pacinian (Pressure)
| Meissners (vibration)
50
What is hursutism?
Process in men and women where hair grows where it is usually abscent
51
What is the function of the sebaceous glands?
Natures moisturiser for the skin, in the hair follicles
52
What is the function of the apocrine glands?
They are scent glands, used so people can identify familiar smells and run from those they dont know. Pheramones??
53
What is the function of eccrine glands? What supply controls them?
They are sweat glands found in all areas of the body, activated by alcohol, spicy foods. Controlled by sympathetics cholinergenic
54
What condition can occur from taking paracetamol and ecchinacea?
Toxic epidermal necrolysis; fail in dermal-epidermal layer, DANGER, heat loss, proteins lost so hypoalbuminaemia, infection
55
What skin condition can be caused by t cell lymphoma?
Erythroderma
| Where 80-90% body red dry skin and dermatitis
56
Longer wavelength light takes longer to burn the skin than short wavelength. T/F
True
| UVB short wavelength so penetrates epidermis easy
57
Osteomalacia is caused by a deficiency in what?
Vitamin D as cant then absorb calcium so get soft bones
58
Why can neuropathic ulceration occur, common in what group of people?
Due to inability to feel something erroding into the skin. Diabetes mellitus and leprosy
59
Man presents with acute urticaria, angioedema of the lips, pruritus and erythema of the face and arms. And has recently been vomiting. Diagnosis?
IgE mediated allergy
60
Man presents with pruritus, erythema and atopic eczema around the hands and arms. The eczema doesnt go away with creams or ointments. Diagnosis
Non-IgE mediated allergy
61
How would you test for an IgE mediated food allergy?
Skin prick test/ blood test for IgE antibody
62
How would you test for a non-IgE mediated food allergy?
Through food elimination
63
Why do obese people get drier skin than other people?
Due to increased transepidermal water loss from the sebaceous sweat glands becoming overactive from the androgens hormone being secreted
64
What is the relationship between lymphoedema and obesity
Fat compresses the lymphatics so they cant drain properly due to reduced movements causing inflammation and chronic damage
65
What is the relationship between chronic venous insufficiency and obesity
Due to compression from fat there is reduced blood flow to areas of the skin so ulcers form
66
Man presents with papules on the thighs and upper arms with dry skin, his diet lacks milk, eggs and doesnt eat many leafy veg. What is he deficient in
Vit A causing the keratotic follicular
67
Women presents with easily bruising, purpura and a bleeding tendency. She was recently on a long course of antibiotics. Diagnosis?
Lack of vit K
68
Man presents with a dry, red, painful tongue and chellosis and angular stomatitis. He doesnt have a healthy diet and orders out a lot. Diagnosis?
Vit B2 deficiency (riboflavin)
69
Chinese women presents with itchy red rash on both hands, headaches and diarrhoea. Diagnosis?
Pellagra due to vit B3 deficiency 4Ds
| Dermatitis, delerium, diarrhoea, death
70
Man presents with fatigue, pallor, angular stomatitis, big tongue and discoloured skin. He eats take out most nights
Folate deficiecy so fatigue/pallor
71
What is porphyria?
A group of conditions that have a break down in the metabolic chain to produce porphyrins in your body. Necessary for your RBCs
72
What is cutaneous photosensitivity
Abnormal response to UV radiation and sometime visible light
73
What enzyme does erythopoetic protoporphyria lack?
Ferrochelatase
74
What is a virulence factor?
One discrete component responsible for most symptoms of disease
75
Give some examples of virulence factors
```
Adhesin (to colonise a host)
Invasin (invading protiens)
Impedin (evade host defenses)
Aggresin (direct damage to proteins)
Modulin (proteins causing damage indirectly)
```
76
Which bacteria is common to get in skin infections of the immunocompromised
Staph epidermis
77
What type of bacteria is found in the armpit/ on the skin
```
Armpit= gram -
Skin= gram +
```
78
What is the fundamental principle of porphyrias and how they cause damage
Different porphyrias stop the haem cascade in different areas, these porphyrins (metabolits of the cascade) act as chromophores which absorb light and cause free radical formation that results in inflammation and damage. The different metabolites have different solubilities and so disperse to different areas in the skin so hence different symptoms
79
Man presents with pain and a prickling burning of the dorsal surface of the hands and on the tops of his bald head. Its occurred for a while now, and he now is also getting some pain in his RUQ after eating. To ease the pain he applies a cold water towel. Diagnosis? What investigation and result would you expect?
Erythropoetic protoporphyria
Accumulation of protoporphyrin IX in dermis causing damage and causing gallstones.
Woods lamp with long UVA radiation over urine sample to see if it comes up red
80
Man with known alcoholism presents with large blistering on the hands and back of the neck. Diagnosis ? Woods lamp test positive
Porphyria cutanea tarda
Due to liver iron overload and from chronic liver inflammation. Alcohol known cause of this
81
Young women presents acute abdominal pain poorly localised, urinary retention, tachycardia and mild psychosis. Possible diangosis?
Appendicitis
Polyneuropathy/ mononeuritis multiplex
ACUTE INTERMITTENT PORPHRIA
82
What are the three parameters to diagnose toxic shock syndrome
Drop blood pressure to less than 90mmhg
Rash
More than three organ systems involved
83
Young child attends nursery and returns with a red sore on his face that progresses over the day to a blister- hes been itching at it. Diagnosis? Possible pathogen?
Impetigo- contagious
S.pyogenes
Staphylococcus aureus
84
Old women presents to A/E with large section of red angry skin on her upper thigh, pieces of skin are peeling off and you can see some of the underlying tissue. She says yesterday it was a small section. Diagnosis? Treatment?
Necrotising fasctitis
S. Pyogenes
Surgical removal and antibiotics
85
Young women with eczema presents with large raised red patches on her legs, some are blistering and have well defined edges. She is feverish. Diagnosis
Erysipelas; s. Pyogenes due to invading through eczema break in the skin
86
Young women presents with large red/ purple areas on back of the leg they are swollen and painful. The patch has undefined edges. Diagnosis
Cellulitis
87
How would you investigate a possible food allergy?
Blood test IgE specific antibodies
Skin prick test!! (Serum mast cell tryptase level)
Challenge test
88
Man presents with urticaria of the face, wheezing, angioedema of the lips and an increase in resp rate. This was 10 minutes after consuming a peanut. What type of hypersensitivity?
Type 1
89
Treatment for type 1 hypersensitivity reactions?
Avoidance
Antihistamines
Corticosteroids (prednisolone oral)
Adrenaline auto-injector
90
How do you diagnose a type IV hypersensititivy reaction?
Patch test- allergen to skin for 2 days then view to see if there is a reaction
91
Treatment for type IV hypersensitivity?
Emollients topical steroids, UV phototherapy, immunosuppresants
92
What effect do topical drugs have on the body? what types of things used to treat?
Local effects
| Eczema, superficial skin infections, itch, dry skin, warts
93
What are the two ways that drugs penetrate the keratin layer?
Transcellularly or intercellularly (hydrophobic drugs) through the corneocytes
94
For a lipophilic drug what is the ideal base for absorption. Why?
Hydrophillic base
As it has a preference for the lipid in the skin rather than the base on top of the skin, therefore will move into the skin
95
What is the function of an excipient in a drug ointment?
Improve solubility of the drug, this causes an equilibrium to be set up between unsoluble drug soluble drug -> absorbed
96
What is the relevance of the stratum corneum on drug absorption?
Based on the thickness of the stratum corneum the rates of absorption will be different so drug dosage should be different
97
What is the local effect of gluctocorticoids in the skin
Anti-inflammatory
Immunosuppresant
Vasoconstricting on vessels
Antiproliferation of keratinocytes and fibroblasts
98
What is steroid rebound of glutocorticoids
Due to downregulation of glucocorticoids receptors from overstim. Endogenous gluctocorticoids are no longer effective so can cause skin atrophy, systemic effects, spread infection, steroid resacea, stretch marks
99
Young women is vegan what vitamin found only in animal products is she likley to miss?
Vitamin B12
100
Women presents with hyperkeratosis (thickening of skin) around hair follicles, bent hairs, inflamed gums and her scab has taken a long time to heal. What is she deficient in?
Vitamin C (ascorbic acid
101
Vitamin A is common in what foods?
Green leafy veg, bright fruit,
102
Women presents with dermatitis of the face, loose stools and is constantly feeling spaced out. Diagnosis?
Pellagra 3Ds diarrhoea, dermatitis, delerium
Niancin vit B3
103
Women presents with dermatitis of face, scalp, neck, shoulders, buttocks and perineum and an inflammed tongue. She is a vegeterian but avoids cabbage and avacados. Likely deficiency?
Vit B6
104
Women presents inflammed lips, corner of the mouth. With an erythmatous dry painful tongue. She is a vegan and hates green veg. Deficiency?
Vitamine B2
105
What is the function of the
| Sebaceous, apocrine and eccrine glands?
Sebaceous maintain skin barries
Apocrine scent glands
Eccrine moisturise skin
106
How do the deep veins in the muscular compartments get blood back to the heart?
By running in vena comitantes, where they are wound around an artery so when it pulses it pushes out blood.
And the musclular pump
107
You get a blood clot in your fibular vein, describe the path it would take to become a pulmonary embolism ?
```
Fibular vein
Popliteal
Femoral vein
External iliac vein
Common iliac vein
IVC
Right atrium
Right ventricle
Pulmonary trunk
R/L pulmonary artery
```
108
Give some examples of symptoms cohesive with an IgE mediated allergy? What would the onset be?
FAST and ACUTE
```
Acute urticaria (hives and skin rash )
Angioedema (lips, mouth, tongue and eyes)
Nausea
Colicky abdo pain
Vomiting
Diarrhoea
Nasal itch, sneeze, wheeze, chest tightness
Pruritus
Erythema
```
109
Give some examples of non-IgE mediated allergy symptoms. What would the onset be?
Delayed and non-acute
```
Atopic eczema mainly
GORD
Abdo pain
Infantile colic
Constipation
Perianal redness
Pallor/tired
```
110
What is the difference between an allergy and intolerance
Allergy- symptoms for immune reaction by IgE or T cells
Intolerance- non- immune reaction like enzyme deficiency
111
If you suspect an IgE mediated allergy what ttest shoud you run?
Skin prick test
| Blood test for IGE antibodies for suspected foods
112
If you suspect a non-IgE medated allergy what test would you run
None
Food elimination with diary
113
What are some of the skin manifestations from obestiy?
Acanthosis nigricans; thickening and pigmented skin folds
Skin tags
Hirsutism; male distributino of hair in femaleas
Acne
Hidradenitis suppurativa- inflam disease with boils and abscess formation
Stretch marks
Androgenetic alopecia
114
What is marasmus?
Nutrient deficiency so weight loss as fat breaks down
Presents ars dry, loose wrinkled skin with alopecia
115
Where in the skin layers would you find
1. CD8 T cells
2. . CD4 T cells?
CD8 killer t cells in the epidermis
CD4 helper t cells in the dermis
116
What are the parameters to diagnose toxic shock syndrome?
Overstumulation of the immune system from massive release of cytokines
Need;
— drop in BP <90
— rash
—- more than 3 systems involved
117
What virulence factor is released by S. pyogenes that can cause cellulitis and impetigo\?
SLS
Streptolysin
118
What cell type mediates a type 1 hypersensitivity reaction?
Mast cells
Antubodies
Allergic reactions
119
What cell type mediates a type 4 hypersensitivity reaction?
T cells
