Derm Quiz 1

Front 1

What foods can be taken out of a child's diet in order to avoid contact dermatitis?

Back 1

eggs, milk, peanuts, soybeans, fish, wheat

Front 2

What are eliciting factors that can cause atopic dermatitis?

Back 2

Food, inhaled allergens (dust mites), microbial agents (Staph. aureus), skin dehydration (bathing), hormonal (pregnancy, menstruation, thyroid), clothing , emotional stress

Front 3

Seborrhic dermatitis- first line treatment

Back 3

Ketoconazole
1%- OTC
2%- Prescription

Front 4

What type of dermatitis is referred to as the itch that rashes?

Back 4

atopic dermatitis

Front 5

What are eliciting factors that can cause atopic dermatitis?

Back 5

Food, inhaled allergens (dust mites), microbial agents (Staph. aureus), skin dehydration (bathing), hormonal (pregnancy, menstruation, thyroid), clothing , emotional stress

Front 6

Clinical features of atopic dermatitis

Back 6

Pruritis and scratching
periods of exacerbation and remissions
characteristic lesions:
BENDS IN ARMS/ HANDS, front and sides of neck, eyelids


personal or family history of atpoy

Front 7

Seborrhic dermatitis is usually seen WHERE on the body?

Back 7

face
nasolabial folds

Front 8

Seborrhic dermatitis- first line treatment

Back 8

Ketoconazole
1%- OTC
2%- Prescription

Front 9

What can exacerbate seborrhic dermatitis?

Back 9

physical activity/ sweating
males more likely to get this

Front 10

What type of dermatitis is referred to as the itch that rashes?

Back 10

atopic dermatitis

Front 11

Acute atopic dermatitis

Back 11

erythematous patches, papules, palques with or without scale

skin appears puffy/ edematous

crusted erosions and excoriations from scratching

Front 12

Clinical features of atopic dermatitis

Back 12

Pruritis and scratching
periods of exacerbation and remissions
characteristic lesions:
BENDS IN ARMS/ HANDS, front and sides of neck, eyelids


personal or family history of atpoy

Front 13

Chronic

Back 13

lichenification

alopecia, fissures, periorbital pigmentation

Front 14

Seborrhic dermatitis is usually seen WHERE on the body?

Back 14

face
nasolabial folds

Front 15

Treatment options for atopic dermatitis (methods)

Back 15

-ed to stop rub/ scratch
-antipruritic tx
-avoid cutaneous irritant
-moisturizer
-topical anti inflammatory

-secondary: crusts/ weeping should be treated

Front 16

What can exacerbate seborrhic dermatitis?

Back 16

physical activity/ sweating
males more likely to get this

Front 17

Treatment options for atopic dermatitis: first line

second line

Back 17

-topical corticosteroids
-sedating antihistamine (only using if interrupting sleep)

-antibiotics: acutely infected lesions
-calineurin inhibitors for flare ups and maintenance

Front 18

Acute atopic dermatitis

Back 18

erythematous patches, papules, palques with or without scale

skin appears puffy/ edematous

crusted erosions and excoriations from scratching

Front 19

Chronic

Back 19

lichenification

alopecia, fissures, periorbital pigmentation

Front 20

Treatment options for atopic dermatitis (methods)

Back 20

-ed to stop rub/ scratch
-antipruritic tx
-avoid cutaneous irritant
-moisturizer
-topical anti inflammatory

-secondary: crusts/ weeping should be treated

Front 21

Treatment options for atopic dermatitis: first line

second line

Back 21

-topical corticosteroids
-sedating antihistamine (only using if interrupting sleep)

-antibiotics: acutely infected lesions
-calineurin inhibitors for flare ups and maintenance

Front 22

Mild to moderate atopic dermatitis treatment options

Back 22

-emollients
-topical steroids
once daily use of potent agents (short term)

OR prlonged use of intermittent potent steroids (twice weekly)

Front 23

Moderate to severe (second line agents) for atopic dermatitis

Back 23

-topical calcineurin inhibitors: tacrlimus
-UV photothearpy
-cyclosporine, azothioprine, mycophenolate (immunosuppressants)

Front 24

Probiotics in prevention of atopic derm

Back 24

-appear to offer SOME benefit in tx and prevention, need more studies to clarify

Front 25

MOA of calcineurin inhibitors

Back 25

inhibits activation of t lymphocytes, inhibit other cytokines and interleukins

Front 26

FDA warning for tacrolimus and pimecrolimus

Back 26

risk of skin cancers and lymphoma, related to dose and duration

Front 27

What is the most common cause of seborrhic dermatitis?

Back 27

ubiquitious fungus
Pityrosporum ovale- now classifies as Malassezia species

Front 28

Which is more effective topical steroids or calcineurin inhibitors?

Back 28

topical steroids

Front 29

Mild to moderate atopic dermatitis treatment options

Back 29

-emollients
-topical steroids
once daily use of potent agents (short term)

OR prlonged use of intermittent potent steroids (twice weekly)

Front 30

Clinical presentation of seborrhic dermatitis

Back 30

greasy scales overlying erythematous patches or plaques, gradual onset, pruritis increases upon perspiration

skin lesions yellowish, graywhite

SD on scalp associated with dandruff

Front 31

Moderate to severe (second line agents) for atopic dermatitis

Back 31

-topical calcineurin inhibitors: tacrlimus
-UV photothearpy
-cyclosporine, azothioprine, mycophenolate (immunosuppressants)

Front 32

MOA of ketoconazole

Back 32

Broad spectrum antifungal that impairs ergosterol synthesis

Front 33

Probiotics in prevention of atopic derm

Back 33

-appear to offer SOME benefit in tx and prevention, need more studies to clarify

Front 34

Admin/ duration of ketoconazole

Back 34

o Twice weekly X 4 weeks; at least 3 days between applications (shampoo)
o Twice daily X 4 weeks (cream; foam)
o Daily X 2 weeks (gel)

Front 35

MOA of calcineurin inhibitors

Back 35

inhibits activation of t lymphocytes, inhibit other cytokines and interleukins

Front 36

FDA warning for tacrolimus and pimecrolimus

Back 36

risk of skin cancers and lymphoma, related to dose and duration

Front 37

What is the most common cause of seborrhic dermatitis?

Back 37

ubiquitious fungus
Pityrosporum ovale- now classifies as Malassezia species

Front 38

Which is more effective topical steroids or calcineurin inhibitors?

Back 38

topical steroids

Front 39

Clinical presentation of seborrhic dermatitis

Back 39

greasy scales overlying erythematous patches or plaques, gradual onset, pruritis increases upon perspiration

skin lesions yellowish, graywhite

SD on scalp associated with dandruff

Front 40

MOA of ketoconazole

Back 40

Broad spectrum antifungal that impairs ergosterol synthesis

Front 41

Admin/ duration of ketoconazole

Back 41

o Twice weekly X 4 weeks; at least 3 days between applications (shampoo)
o Twice daily X 4 weeks (cream; foam)
o Daily X 2 weeks (gel)

Front 42

Side effects of ketoconazole

Back 42

o Cream/gel – contact dermatitis, headache, burning/irritation, paresthesia (all are relatively uncommon)
o Shampoo - Hair loss, scalp/skin irritation, abnormal hair texture, dry skin, itching (all are relatively uncommon)- people do not like the way this makes their hair feel
o Foam – burning (10%), application site reaction (6%), contact sensitization, dryness, erythema

Front 43

How is ALLERGIC contact dermatitis related to the immune system

Back 43

Overactivity of CD 8 T cells and under response of CD4

considered a breakdown of the skin's immune tolerance to haptens

Front 44

Most common cause of CONTACT derm

Back 44

skin care

fragrance
cosmetics: skin care/ hair
Topical meds: lanolin, caine derivatives, NEOMYCIN, antihistamines
Other: terpentine, mercury, nickel sulfate (jelwery, jeans, glasses)

Front 45

Most common topical antibiotic that causes contact derm

Back 45

NEOMYCIN

Front 46

British guidelines vs. Asthma/ allergy guidelines

Back 46

British use calcineurin, cyclosporine, and azothiaprine second line

Front 47

First line treatment for contact dermatitis

Back 47

get rid of irritant
topical steroids

Front 48

First line for allergic dermatitis

Back 48

topical steroids

Front 49

What is the identifier for psoriasis susceptibility? (genetic identifier)

Back 49

PSORS1

Front 50

Common areas of psoriasis distribution

Back 50

-scalp
-ears
-elbows
-knees
-belly button/ umbilical
-gluteal cleft/ genatalia
-nails

Front 51

Most common form of psoriasis

Back 51

-plaque
start as small papules
develop into dry, silvery, thick, scaly patches

Front 52

Drop like psoriasis is called?
What is it normally proceeded by?

Back 52

Guttate
streptococcal or viral infection

Front 53

Rare but serious form of psoriasis

Back 53

Pustular
-palms/ soles of feet
-large lakes of pus
-decrease mobility and function
-can occur due to withdrawal of systemic corticosteroids

Front 54

Form of psoriasis caused by withdrawal of corticosteroids

Back 54

Pustular psoriasis

Front 55

This psoriasis can affect 100% of body surface area

Back 55

Erythrodermic
-affects thermoregulation
-hospitalized
-fluid/ electrolyte, protein abnormalities
-rare

Front 56

Nail psoriasis occurs most in the fingernails or toenails?

Back 56

Most often in fingernails, nails pulling away from bed- leads to infection

NOT onychomyosis

Front 57

Describe the presentation of the psoriasis on the scalp

Back 57

diffuse scaling to thickened plaques- most have erythamatous scalp

Front 58

Patients that develop extensive skin disease, scalp or nail psoriasis are more likely to develop what?

Back 58

Psoriatic arthritis
difficult to distinguise from RA (check rheumatoid arthritis, no increase in RF)

Front 59

Three major treatment goals in psoriasis

Back 59

1. Resolution of lesions
2. maximize efficacy/ decrease side effects
3. improve quality of life

Front 60

Mild psoriasis is <____ % BSA
Moderate psoriasis is ___ - ____ % BSA
Severe psoraiasis is > ____ % BSA

Back 60

5%- use corticosteroids
5-10%
10%

Front 61

Phototherapy is used to treat mild, moderate, or severe psoariasis?

Photochemotherapy is used to treat mild, moderate, or severe psoriasis?

Back 61

Phototherapy: moderate disease (UVB light)

Photochemotherapy: severe
PUVA (photosensitizer-psoralene) + UVA

Front 62

4 systemic agents reserved to treat severe psoriasis

Back 62

Mycophenolate
Cyclosprine
Retinoids
Biologicals

Front 63

Emollients help psoriasis by doing what to the skin?

Back 63

moisturize/ hydrate skin
oily film that locks water
may be used over large surface areas

Front 64

Topical corticosteroids help psoriasis by doing what to the skin?

Back 64

decrease itching, erythema, and scaling

Front 65

What is Dovonex (used in psoriasis)

Back 65

Vitamin D derivative
regulates cell proliferation/ immune modulating!

takes two weeks to start working, max 6-8 weeks
do not exceed 100gm per week (200mg calcitriol)

Front 66

What is Taclonex (used in psoriasis)

Back 66

calcipotriene plus Betamethasone
-vit D derivative + corticosteroid, only need to apply once a day

Front 67

True or False: Psoriasis is most common in men than women

Back 67

False= equal incidence in men and women

Front 68

What are common comorbidities with psorasis

Back 68

Crohns disease
MS
Cardiovascular
Lymphoma/ skin cancer
DM, Obesity, metabolic syndrome
Depression/ suicide
Substance abuse

Front 69

Can retinoids be used in pregnant patients

Back 69

NO, category x

Front 70

Synthetic retionoids (Tazorac) are effect agents for what body parts?

Back 70

scalp and face

Front 71

How does coal tar effect psoriasis

Back 71

decreases development of scales and epidermal cell division/ turnover

not used- smelly and greasy

Front 72

Herbal product used in psoriasis

Back 72

Anthralin- not used often, apply at night wash in morning
Derived from araroba tree
inhits cell synthesis

Front 73

Salicylic acid is a type of what treatment class for psoriasis

Back 73

Keratolytics

-exfoliates scales
-decreases hyperkeratosis, decreases cohesion of skin cells
-possible irritation (N/V, tinnitus, hyperventilation)

Front 74

First line therapy for psoriasis

Back 74

-calcipotriene and topical steroids
-use adjunctive and/ or synergistic therapies

Front 75

Second line therapy for limited psoriasis (<5%)

Back 75

short term use of systemic agent

Front 76

MOA of methotrexate (used in psoriasis)

Contraindications:

Monitoring

Back 76

-folic acid antagonist, blocks DNA synthesis
-may give FA on non-MTX days (once a week)

CI: alcoholics, pregnancy, breast feeding, heme abnormal, infections, renal adjustment

Monitoring: CBC, Bun/Scr, PPD, LFT, CXR

Front 77

Acitretin (used in psoriasis)
MOA
CI
Monitoring

Back 77

-retinoid analog
-teratogenic--CI in pregnancy within 3 years of discontinuation
-CI: alcoholics/ pregnancy, child bearing age
-Monitor: pregnancy, lipids, LFTs, blood glucose (if DM)

Front 78

Immunosuppressant therapy in psoriasis is Cyclosprine/ Tacrolimus

Cyclosprine
MOA
CI

Back 78

MOA: inhibit T cell activation
CI:renal, uncontrolled HTN

Front 79

Immunosuppressant therapy in psoriasis is Cyclosprine/ Tacrolimus

Tacrolimus MOA

Back 79

Tacolimus interferes with IL production, destroys neutrophils

NOT used often, none as effective as cyclosporine

Front 80

Biologic agents used in psoriasis

Alefacept:
MOA?

Back 80

Alefacept
-monoclonal ab that bonds to CD2 on T lymph and inhibits activation of Tcells

-inactivates T cells

Front 81

3 TNF inhibitors used in psoriasis

Back 81

Adalimumab
Etanercept
Infliximab