CC March 2017 Psoriasis

echoecho's version from 2018-04-17 03:42


Question Answer
Define psoriasis?an autoimmune disease characterized by inflammatory skin lesions with varying morphology including silvery scales, plaques, papules and pustules
The disease typically presents between the ages of ____ and ____, with a second peak in incidence between the ages of ___ and ____?15;30 ; 57;60
Are men and women affected equally? yes
About ____% of patients w/ psoriasis have a family hx of the disease?30
An increased risk of the _______ syndrome has been found in patients with psoriasis and appropriate screening should be obtained?metabolic
Psoriasis is associated with the development of what diseases?CVD, lymphoma (infrequent)
Depression is common, affecting up to ____% of patients, and impaired quality of life and social isolation are reported?60
Psoriasis is classified into different types based on the morphology of the skin lesions. The most common variant, (80-90% of all cases) is the _______ psoriasis?plaque
Describe plaque psoriasis?eyrthematous plaques covered with silvery scale. Pruritic
Describe guttate psoriasis?presents after streptococcal infection, presents with papular lesions 1-10 mm in diameter
Describe pustular psoriasis?sterile pustular lesions usually confined to palms and soles of feet (although a rare form of pustular psoriasis presents with more widespread lesions and fever)
Describe inverse psoriasis?uncommon, with moist plaques in intertriginous areas and navel, often complicated with secondary infection
Describe erythrodermic psoriasis?involves more than 90% of the body surface area
Acute erythrodermic psoriasis may result in what?significant fluid and electrolyte loss requiring hospitalization
What can psoriasis cause on nails? pitting lesions of the nails with pitting, onycholysis and thickening
Psoriasis may have systemic manisfestations, true or false?true
*** An estimated ___ to ____% of patients with develop psoriatic arthritis. Although arthritis may present at the same time as skin lesions, the average time from diagnosis of psoriasis to onset of psoriatic arthritis is ____ years?25; 30; 10
Several patterns of joint involvement have been reported. It can be symmetric, resembling a mild form of______ _______or asymmetric, affecting any joint?rhuematoid arthritis
What is a distinctive finding in some patients w/ psoriatic arthritis in which inflammation and swelling is NOT confined to the joints, but rather involves the entire digit?dactylitis or "sausage digit"
Psoriasis may be treated with what 3 ways?1) topical agents 2) phototherapy 3) systemic drugs
The treatment approach depends upon the ______ of the disease and patient comorbidities?severity
For patients w/ limited disease, first-line topical therapies include what?1) glucocorticoids 2) vit D analogs such as calcipotrien (Dovonex) 3) retinoid like tazarotene (Tazorac)
Topical calcineurin inhibitors like what meds are approved for use in pts at least 2 years of ages?1) tacrolimus (Protopic) 2) pimecrolimus (Elidel)
How are calcineurin inhibitors different from steroids?1) less likely than steroids to cause skin atrophy 2) generally well tolerated
Rare cases of _____ cancers and ______ have been reported in pts using topical calcineurin inhibitors?skin; lymphomas
Although causality has not been established, the FDA approved labels for these medications indicate that ______term use should be avoided?long
Pts w/ extensive skin involvement are candidates for what treatment?phototherapy ; systemic therapies
Pts w/ psoriatic arthritis are commonly treated with what?nonbiologic systemic therapies
Each systemic agent has the potential for unique side effects and require what?evaluation and monitoring
List the nonbiologic systemic therapies?1) Methotrexate (Otrexup) 2) cyclosporine (Sandimmune), oral retinoid acitretin (Soriatane)
Methotrexate is potentially ______toxic?hepatotoxic
*** Patients on methotrexate therapy should have routine monitoring of what tests? and what biopsy should be considered in high-risk pts after a cumulative dose of 1 g?LFTs; liver biopsy
Several biologic agents are indicated for severe psoriasis and/or psoriatic arthritis? List these?1) tumor necrosis factor inhibitors and adalimumab (Humira) 2) etanercept (Enbrel) 3) infliximab(remicade) and Ustekinumab (Stelara)
True or false, long-term data is limited fro ustekinumab?true
What do the biologic agents target?various components of the cytokine inflammatory cascade
Because biologica agents cause immunosuppression, patients should be screened for what?latent TB infection (screen prior to initiating treatment)
Why should systemic glucocorticoids NOT be used?because discontinuation of therapy may lead to severe and potentially life-threatening PUSTULAR psoriasis
*** SUMMARY = Psoriasis is a chronic inflammatory kin disease; what percentage will have associated arthritis?25-30%
*** SUMMARY = Psoriasis may be treated what 3 ways?1) topical agents 2) phototherapy 3) systemic drugs
*** SUMMARY = Topical steroids are effective for _____ disease; what other 3 med classifications can be used for treatment?Mild; topical calcineurin inhibitors, vit D analogs, retinoids
*** SUMMARY = List nonbiologic systemic therapies?1) Methotrexate 2) cyclosporine 3) acitretin
*** SUMMARY = Biologic agents include?1) tumor necrosis factor inhibitors (used in severe disease but require monitoring for infection and can be quite expensive)