Week 2 Flashcards
(203 cards)
1
Q
Give two advantages of topical treatments?
A
- Direct application
2. Reduced systemic effects
2
Q
Give three disadvantages of topical treatments
A
- Time consuming
- Correct dosage can be difficult
- Messy to use
3
Q
What is a cream?
A
Semisolid emulsion of oil in water containing emulsifier and preservative
4
Q
What is the term for a semisolid grease/oil (soft paraffin) containing no preservative?
A
Ointments
5
Q
What do ointments restrict?
A
Transepidermal water loss
6
Q
What is the term for a suspension or solution of medication in water, alcohol or other liquids - used to treat scalp and hair-bearing areas?
A
Lotions
7
Q
What is another term for “thickened aqueous lotion”?
A
Gels
8
Q
What is in a gel?
A
Semi-solids, containing high molecular weight polymers e.g. methylcellulose
9
Q
What do emollients enhance and name a condition they are used for?
A
Rehydration of epidermis and used for all dry/scaly conditions such as eczema
10
Q
How much emollient is prescribed weekly for patients?
A
300 - 500G
11
Q
What is wet wrap therapy used for?
A
Very dry (xerotic) skin
12
Q
Give the three mode of action points for topical corticosteroids?
A
- Vasoconstrictive
- Anti-inflammatory
- Anti-proliferative
13
Q
Name a mild topical steroid?
A
Hydrocortisone
14
Q
Name a moderate topical steroid?
A
Modrasone
Clobetasone
Butyrate
15
Q
Name a potent topical steroid?
A
Mometasone
Betamethasone
Valerate
16
Q
Name a very potent topical steroid?
A
Clobetasol
Proprionate
17
Q
What could be used to treat eczema, psoriasis, lichen planus and keloid scars?
A
Topical corticosteroids
18
Q
Give three side effects of topical steroids?
A
Thinning of the skin, purpura and stretch marks
19
Q
What are fixed telangectasia, steroid rosacea and perioral dermatitis all side effects of?
A
Topical steroids
20
Q
What antiseptic is used in acute exudative eczema, pompholyx?
A
Potassium permanganate rinse/soak/bath
21
Q
Name three topical antibiotics used for acne?
A
Clindamycin
Erythromycin
Tetracycline
22
Q
Name a topical antibiotic used for rosacea?
A
Metronidazole
23
Q
Name two topical antibiotics used for impetigo?
A
Mupirocin
fusidic acid
24
Q
Name a disease where a topical antiviral would be used?
A
Herpes simplex
25
Name two conditions where oral antivirals would be used?
Eczema herpeticum
| Herpes Zoster
26
Name two treatments for candida?
Nystatin
| Clotrimazole
27
Name two treatments for dermatophytes (ringworm)
Clotrimazole
| Terbinafine cream
28
Name a treatment for pityriasis versicolor?
Ketoconazole
29
What is menthol?
An antipruritic
30
What do keratolytics do?
Soften keratin
31
What drug type would be used for viral warts, hyperkeratotic eczema & psoriasis, corns and calluses and to remove keratin plaques in scalp?
Keratolytics
32
What is used to treat genital warts?
Podophyllin
33
What are formaldehyde, glutaraldehyde and silver nitrate all used for?
Treatment of warts
34
Give 5 options for topical psoriasis treatment?
```
Coal tar
Vitamin D analogue
Keratolytic
Topical steroid
Dithranol
```
35
What drug is an immune response modulator, ehances innate and cell-mediated immunity and has anti-viral/anti-tumour effects?
Imiquimod
36
What (trade name Aldara cream) is used for genital warts, superficial BCC and also solar keratoses, lentigo maligna, Bowen's disease and verrucae?
Imiquimod
37
What do calicneurin inhibitors do?
Suppress lymphocyte activation
38
Give two examples of calicneurin inhibitors and a condition they are used for?
Tacrolimus
Pimecrolimus
Atopic eczema
39
What is increased thickness of keratin called?
Hyperkeratosis
40
What is parakeratosis?
Persistence of nuclei in the keratin layer
41
What is acanthosis?
Increased thickness of epidermis
42
What is papillomatosis?
Irregular epithelial thickening
43
What is spongiosis?
Oedema between keratinocytes
44
What cells are involved in inflammatory cell infiltrate?
Lymphocytes and/or neutrophils
45
Give four features in the acute phase of eczema?
1. Papulovesicular
2. Red erthematous lesions
3. Oedema (spongiosis)
4. Ooze or scaling and crusting
46
Give three features of the chronic phase of eczema?
1. thickening (lichenification)
2. Elevated plaques
3. Increased scaling
47
What is itchy, ill-defined, erythematous and scaly?
Eczema
48
What is the pathogenesis and histology of contact allergic dermatitis?
Delayed type 4
| Spongiotic dermatitis
49
What is the pathogenesis and histology of contact irritant dermatitis ?
Trauma e.g. soap
| Spongiotic dermatitis
50
What is the pathogenesis and histology of atopic dermatitis?
Genetic and environmental factors resulting in inflammation
| Spongiotic dermatitis
51
What is the pathogenesis and histology of drug-related dermatitis?
Type 1 or 4 hypersensitivity reaction
| Spongiotic dermatitis and eosinophils
52
What is the pathogenesis and histology of photo-induced or photosensitive dermatitis?
Reaction to UV light
| Spongiotic dermatitis
53
What is the pathogenesis and histology for lichen simplex dermatitis?
Physical trauma to skin - scratching
| Spongiotic dermatitis and external trauma
54
What is the pathogenesis and histology of stasis dermatitis?
Physical trauma to skin - hydrostatic pressure
| Spongiotic dermatitis and extravasation of RBCs
55
What type of dermatitis can a button on jeans cause?
Nickel contact allergic dermatitis
56
In the immunopathology of contact allergic dermatitis - what do Langerhans cells in the epidermis do?
Process antigen (increased immunogenicity)
57
In the immunopathology of contact allergic dermatitis - what happens after the Langerhan cell has processed the antigen?
It is presented to the Th cells in the dermis
58
In the immunopathology of contact allergic dermatitis - what happens after the processed antgen has been presented to the Th cells in the dermis?
Sensitised Th cells migrate into lymphatics and then to regional nodes where antigen presentation is amplified
59
In the immunopathology of contact dermatitis - what happens after subsequent antigen challenge?
Specifically sensitised T cells proliferate nad migrate to and infiltrate skin causing dermatitis
60
What can be used to test contact dermatitis?
Patch testing
61
What type of dermatitis is a non-specific physical irritation rather than a specific allergic reaction?
Irritant dermatitis
62
What is nappy rash?
Irritant contact dermatitis to urine - sparing of flexures
63
What type of eczema involves pruritis, ill-defined erythema and scaling, generalised dry skin, flexural distribution and is associated with asthma?
Atopic eczema
64
Give three chronic changes with atopic eczema?
Lichenification
Excoriation
Secondary infection
65
In eczema secondary infection - what does crusting indicate?
Staph aureus infection
66
What is eczema herpeticum an infection of and what should you look for?
Herpes simplex virus
| monomorphic punched-out lesions
67
What are the five UK diagnostic criteria for atopic eczema?
Itching plus 3 or more:
```
visible flexural rash
history of flexural rash
personal history of atopy
generally dry skin
onset before age 2
```
68
The 7 treatments for eczema?
| - PATTPSB
1. Plenty of emolients
2. Avoid irritants
3. Topical steroids
4. Treat infection
5. Phototherapy - UVB
6. Systemic immunosuppressants
7. Biologic agents
69
What is the most important gene in atopic eczema?
Filaggrin
70
What is another term for photosensitive eczema?
Chronic actinic dermatitis
71
What three things is stasis eczema secondary to?
1. Hydrostatic pressure
2. Oedema
3. Red cell extravastion
72
What type of eczema has spongiotic vesicles?
Pompholyx eczema
73
What type of eczema can be caused by repetetive scratching?
Lichen simplex
74
Describe staphylococcus?
Gram positive cocci in clusters
75
Give the two important types of Staphylococcus?
1. Staph aureus (coagulase positive)
| 2. Coagulase negative Staph (epidermidis, saprophyticus)
76
What is an enzyme, produced by staphlycoccus aureus, that clots plasma?
Coagulase
77
What causes urinary tract infection in women of child-bearing age?
Staph. saprophyticus
78
How are streptococcus species classified?
By haemolysis on blood agar
79
What haemolysis is complete?
Beta
80
What toxin that damages tissues does beta-haemolytic streptococci release?
Haemolysin
81
What are the two important catagories of alpha-haemolytic streptococci?
Strep. pneumoniae
| Strep. viridans
82
Give an example species of non-haemolytic streptococci?
Enterococcus species - commensals of bowel
83
Along with cellulitis, wound infection and other minor skin sepsis - what other bacterial skin infections are caused by Staph. aureus?
Infected eczema, impetigo and staphylococcal scalded skin syndrome
84
What bacterial skin infection does Strep pyogenes (Group A strep) cause?
Necrotising fascilitis
| Erysipelas
85
What is a bacterial infection spreading along fascial planes below the skin surface leading to rapid tissue destruction?
Necrotising fascilitis
86
What is another term for tinea pedis?
Atheltes foot
87
In dermatophyte pathogenesis - what occurs after fungus has entered abraded or soggy skin?
Hyphae spread in stratum corneum
88
What does increased epidermal turnover cause?
Scaling
89
What dermatophtte causal organism comes from cats?
Microsporum canis
90
What are two treatments for scalp infections?
Terbinafine orally
| Itraconazole orally
91
How do you diagnose candida skin infection?
Swab for culture
92
How do you treat candida skin infection?
Clotrimazole cream
| Oral fluconazole
93
What is scabies caused by?
Sarcoptes scabiei
94
What is the incubation period of scabies?
Up to 6 weeks
95
In scabies - where does the itchy rash affect?
Genital areas, figner webs and wrists
96
What are the two treatments for scabies?
Malathion lotion
| Benzyl benzoate
97
Where does pediculus capitis affect?
Head louse
98
What is the treatment for lice?
Malathion
99
What disease is dermatomal?
Shingles
100
What disease is macules to papules to vesicles to scabs to recovery?
Chickenpox
101
What disease has a high mortality and is secondary to chickenpox in mother in late pregnancy?
Neonatal VZV
102
What does the later stage of shingles show?
Rash and increasing pain
103
What nerve can be affected by shingles?
Trigeminal
104
Where can you get vesicles and pain with Ramsay-Hunt syndrome?
Vesicles and pain in auditory canal and throat
105
What nerve facial palsy can you get with Ramsay-Hunt syndrome?
7th nerve palsy
106
In Ramsay-Hunt syndrome - which cranial nerve is irritated?
8th - deafness, vertigo, tinnitus
107
What virus occurs commonly in pre-school children, lasts around a week and gives primary gingivostomatitis and extensive ulceration in and around mouth>
Herpes simplex
108
What is it called when herpes simplex virus spreads to eczema?
Eczema herpeticum
109
What condition gives a blistering rash at the vermillion border?
Herpes simplex virus recurrence
110
What type of herpes simplex virus is the main cause of oral lesions?
Type 1
111
What is aciclovir an analogue of?
Guanosine
112
How is lab confirmation of herpes simplex virus obtained?
Swab with viral transport medium
113
What condition can be described with target lesions with erythema?
Erythema multiforme
114
What condition can be triggered by herpes simplex virus and mycoplasma pneumoniae bacterium?
Erythema multiforme
115
What condition gives fleshy, firm, umbilicated, pearlescent nodules 1 to 2 mm diamater?
Molluscum contagiosum
116
How can molluscum contagiosum be treated?
With liquid nitrogen
117
What is the laymans term for human papilloma virus?
Warts
118
What disease gives a blistering rash of back of mouth and is caused by enterovirus (coxsackie and echovirus)?
Herpangina
119
What is caused by parvovirus B19?
Erythema infectiosum or slapped cheek disease
120
Give three complications of parvovirus B19?
1. Spontaneous abortion
2. Aplastic crises
3. Chronic anaemia
121
How is parvovirus B19 lab confirmed?
By antibody testing - parvovirus B19 IgM test
122
What is the virus of sheep "scabby mouth" disease?
Orf
123
What can be seen on a patient with Orf?
Firm, fleshy nodule on hands of farmers
124
What can be seen on a patient with primary syphilis infection?
Painless ulcers at site of entry
125
What can be seen on a patient with secondary stage syphilis infection?
Red rash over body
Prominent on soles of feet and palms of hands
Mucous membrane "snail track" ulcers
126
What is syphilis due to?
Sexually transmitted infection with bacterium Treponema pallidum
127
How is syphilis diagnosed?
Blood test or swab of chancre for PCR
128
How is syphilis treated?
Injections of penicillin
129
What is the bacterial cause of Lyme disease?
Borrelia burgdorferi
130
What is the early presentation of Lyme disease?
Erythema migrans
131
What is the late presentation of Lyme disease?
Heart block, nerve palsies and arthritis
132
How is Lyme disease diagnosed?
Blood test for antibody to organism
133
What type of HPV is most common in warts/veruccas?
1 -4
134
What type of HPV is most common in genital warts?
Types 6 and 11
135
What type of HPV is most common in cervical cancer?
Types 16 and 18
136
What is one of the most common genodermatoses?
Tuberose sclerosis
137
Give two clinical features of Tuberose sclerosis?
1. Periungual fibromata
| 2. Longitudinal ridging
138
What condition may present as infantile seizures?
Tuberose sclerosis
139
What is the earliest cutaneous sign of Tuberose sclerosis?
Ash-lead macule
140
What type of mutation is Tuberose Sclerosis?
Autosomal dominant
141
Other than periungual fibromas, what 3 other tumours can arise in Tuberose Sclerosis?
1. Facial angiofibromas
2. Hamartomas
3. Bone cysts
142
What are shagreen patches and enamel pitting seen in?
Tuberose Sclerosis
143
What two chromosomes are affected in Tuberose Sclerosis?
Tuberin - chromosome 9
| Hamartin - chromosome 16
144
What does Tuberose Sclerosis show?
Genetic heterogeneity - mutation in TSC1 or TSC2
145
What is the penetrance like in Tuberose Sclerosis?
Variable
146
Name a group of genetic skin fragility conditions?
Epidermolysis Bullosa
147
What are the three main types of epidermolysis bullosa?
Simplex
Junctional
Dystrophic
148
What is EB aquisita?
A rare autoimmune condition
149
Describe haploinsufficiency?
Only one copy of working - reduced protein production
150
What term describes - expression of abnormal protein interferes with normal protien
Dominant negative
151
What are two clinical signs for neurofibromatosis type 1?
Cafe-au lait macules
| Neurofibromas
152
What are plexiform neuroma, axillary and inguinal freckling, optic glioma, Lisch nodules and a distinctive bony lesion all features of?
NF1
153
What can filaggrin mutations cause?
Ichthyosis vulgaris
154
What part of the skin is stratified keratinising squamous epithelium?
Epidermis
155
What cells are in the corneal layer?
Differentiated keratinised cells
156
Where are melanocytes found?
Basal layer
157
What is the dermis a matrix of?
Type 1 and type 111 collagen
158
Name two ground substances found in the dermis?
Hyaluronic acid
| Chondroitin
159
Where does the papillary dermis lie?
Just beneath the epidermis
160
What does the reticular dermis contain?
Appendage structures
161
What is the epidermal basement membrane made of?
Laminin and collagen IV
162
What is the term describing increased thickness of keratin layer?
Hyperkeratosis
163
What is the term describing persistence of nuclei in the keratin layer?
Parakeratosis
164
What is the term describing increased thickness of epithelium?
Acanthosis
165
What is papillomatosis?
Irregular epithelial thickening
166
What is the term for oedema fluid between squames appearing to increase prominence of intercellular prickles?
Spongiosis
167
What is psoriasiform?
Elongation of the rete ridges e.g. psoriasis
168
Give three aetiology points about acne vulgaris?
1. Increased androgens at puberty
2. Keratin plugging of pilosebaceous glands
3. Infection with anaerobic bacterium corynebacterium acnes
169
In acne - what do keratin and sebum build up to produce?
Comedones (blackheads/whiteheads)
170
Is rosacea commoner in females or males?>
Females
171
What condition involves recurrent facial flushing, visible blood vessels, pustules and thickening of the skin (rhinophyma)?
Rosacea
172
Name four factors that can aggravate rosacea?
1. Sunlight
2. Alcohol
3. Spicy food
4. Stress
173
What condition has vascular ectasia, patchy inflammation with plasma cells, pustules, perifollicular granulomas as its pathology?
Rosacea
174
Give three important examples of immunobullous diseases?
1. Pemphigus
2. Bullous pemphigoid
3. Dermatitis herpetiformis
175
What disease is rare autoimmune bullous, has loss of integrity of epidermal cell adhesion and responds to steroids?
Pemphigus
176
In the autoimmune condition - pemphigus vulgaris - what are IgG auto-antibodies made against?
Desmoglein 3
177
What does pemphigus vulgaris produce?
Fluid filled blisters which rupture to form shallow erosions
178
What process is common to all variants of pemphigus?
Acantholysis - lysis of intercellular adhesion sites
179
What pemphigus disease has subepidermal tense blistering and has no evidence of acantholysis?
Bullous pemphigoid
180
Describe the pathology of bullous pemphigoid
Circulating antibodies (IgG) react with a major/minor antigen of the hemidesmosomes anchoring basal cells to basement membrane. The result is local complement activation and tissue damage.
181
What autoimmune bullous disease has strong association with coeliac disease?
Dermatitis herpetiformis
182
What haplotype is dermatitis herpetiformis associated with?
HLA-DQ2
183
What condition has intensely itchy lesions - symmetrical, involves the elbows, knees and buttocks and the hallmark is papillary dermal microabscesses?
Dermatitis herpetiformis
184
Describe what is seen in chronic plaque psoriasis?
Sharply demarcated, scaly, erythematous plaques
185
Give four clinical features of psoriatic nail disease?
1. Onycholysis
2. Nail pitting
3. Dystrophy
4. Subungal hyperkeratosis
186
Name two vitamin D analogues for treatment of psoriasis?
1. Calcipotriol
| 2. Calcitriol
187
In the treatment of psoriasis sometimes fumaric acid ester can be used -what does it disrupt?
Lymphocytes
188
Give three topical treatments for acne?
1. Benzoyl peroxide - keratolytic, antibacterial
2. Vitamin A derivative (retinoid) - adapalene
3. Antibiotics - antibacterial and anti-inflammatory
189
Name an oral retinoid used for systemic treatment of acne?
Isotretinoin
190
Name two antibiotics used to treat rosacea?
Topical metronidazole
| Oral tetracycline
191
Differentiate between bullous pemphigoid and pemphigus?
Bullous pemphigoiD - split is Deeper, through DEJ
PemphiguS - split is more Superficial, intra-epidermal
192
What disease is common in elderly patients, localizesd to one area, has large tense bullae on normal skin or erythematous base, blisters burst to leave erosions, itchy erythematous plaques and papules may be the presenting feature and Nikolsky sign negative?
Bullous pemphigoid
193
What disease typically affects scalp, face, axillae and groins, has thin roofed flaccid vesicles, lesions rupture to leave raw areas and is Nikolsky sign positive?
Pemphigus vulgaris
194
Name three immunosuppressive agents used to treat both pemphigoid and pemphigus?
Azathioprine
Ciclosporin
Mycophenolate
195
Suggest four ways to investigate anaphylaxis?
1. Specific IgE specificity
2. Skin prick testing
3. Challenge test
4. Serum mast cell tryptase level during attack
196
What three things mediate itch?
1. Chemical mediators in skin
2. Nerve transmission
3. Central nervous system
197
What are the four causes of itch?
1. Pruritoceptive
2. Neuropathic
3. Neurogenic
4. Psychogenic
198
What type of itch is something (usually associated with inflammation or dryness) in skin that triggers it?
Pruritoceptive
199
What type of itch is damage of any sort to central or peripheral nerves causing it?
Neuropathic
200
What type of itch is caused by e.g. opiate effects on CNS receptors
Neurogenic
201
What type of itch is psychological with no CNS damage?
Psychogenic
202
Give 6 systemic diseases associated with itch
1. Haematological
2. Paraneoplastic
3. Liver and bile duct
4. Psychogenic
5. Kidney disease
6 Thyroid disease
203
What are 5 anti-itch treatments?
1. Sedative anti-histamines
2. Emollients
3. Antidepressants - doxepin
4. Phototherapy
5. Opiate antagonists
