Immunology Exam 2 Questions with
Latest Update
D. It's infectious but can be cured - Answer-All of the following statements about
psoriasis is true EXCEPT?
A. It's a chronic inflammatory skin disorder
B. Hyperproliferation of the skin and inflammatory cell infiltration
C. It's characterized by red, scaly patches
D. It's infectious but can be cured
E. Abnormal T-cell activation is usually observed
plaque psoriasis - Answer-most common form of psoriasis?
psoriasis (plaque) - Answer-characterized by raised, red, and often pruritic patches of
skin covered by a silvery-white accumulation of dead skin cells
True - Answer-T/F: Psoriasis can cause serious QOL and psychosocial issues.
systemic manifestations (especially arthritis) - Answer-psoriasis is a chronic skin
condition often associated with?
15-30 YOA; equal between both sexes - Answer-onset of psoriasis? are men or women
more effected?
first-degree - Answer-Approx. 1/3 of patient with psoriasis have a _______-degree
relative with this condition
False; HIV infection has NOT been shown to trigger psoriasis - Answer-T/F: HIV
infection has been shown to trigger psoriasis and exacerbate existing disease. as the
infection progresses, psoriasis often worsens
Lithium; ACEI; Beta-blockers; Interferons; NSAIDs; Tetracyclines - Answer-Name the
Drugs that precipitate or exacerbate psoriasis? (6 total)
C. Timoptic
E. Eskalith; Lithobid - Answer-Which of the following drugs may precipitate new-onset
psoriasis? (Select ALL that apply)
A. Corticosteroids
B. Imuran
C. Timoptic
D. Thiazide diuretics
E. Eskalith; Lithobid
,inflammation in the dermis and hyper proliferation with abnormal differentiation of the
epidermis - Answer-What are the psoriasis skin lesions a result of?
Pathophysiology of psoriasis - Answer-Dysregulation of activated T cell interactions with
antigen-presnseting cells and overproduction of pro-inflammatory cytokines such as
interferon-gamma and TNF-a
IL-17, 22 and 23 - Answer-Which interleukins serve as mediators, subsequently
activating keratinocytes to be released in psoriasis?
Patho of psoriasis: Pro-inflammatory - Answer-life cycle of the skin cells is altered; the
keratinocytes proliferate and mature rapidly, and terminal differentiation is incomplete
Patho of psoriasis: Hyperkeratosis - Answer-immune derangements causes the
characteristic thick, scaly skin lesions seen in patients with psoriasis
Plaque (psoriasis vulgaris); Inverse; Guttate/Eruptive; Pustular; Erythrodermic; Scalp;
Nail; Psoriatic arthritis - Answer-Name the 8 types of psoriasis
Plaque psoriasis - Answer--Most common form of psoriasis;
-Patches start off in small areas and appear symmetrically
-Patches gradually enlarge and develop thick, dry plaque
-May become ring shaped (annular) with a clear center and scaly raised borders that
may be wavy.
Inverse Psoriasis - Answer--Patches usually appear as smooth, inflamed patches
without a scaly surface
-Occur in folds of the skin, such as the armpits, breast or in the groin area
-May be resistant to treatment
Guttate/Eruptive - Answer--Characterized by lesions that are less than 1 cm in diameter
and are found over the upper trunk and proximal extremities
-Typically occurs in children and adolescents and frequently appears following a
bacterial or viral infection of the upper airways.
-Lesions appear suddenly and are self-resolving, clearing within 3 to 4 weeks
Pustular - Answer--An acute form in which small pustules develop in painful inflamed
skin
-Often caused by current infection and abrupt withdrawal of systemic and topical
corticosteroids.
Erythrodermic - Answer--Affects the whole body, generally over 90% of the BSA.
-Skin appears bright red and is covered by superficial scales.
-Can lead to hypothermia, hypoalbuminemia, and high output cardiac failure
,Scalp Psoriasis - Answer--Characterized by plaques on the scalp and along the hair
margin, the plaques becoming thicker and crusted as the disease develops.
-Plaques may be described as a dandruff-like desquamation of the scalp
Nail Psoriasis - Answer--Tiny white pits scattered in groups across the nail.
-Toenails and sometimes may have yellowish spots
-Long ridges may develop across and down the nail
-Nail bed separates from the skin of the finger and collections of dead skin can
accumulate underneath the nail
Psoriatic Arthritis (PsA) - Answer--Affects up to one third of patients with psoriasis and
is a destructive arthropathy
-Characterized by stiffness, pain, swelling, and tenderness of the joints and surrounding
ligaments and tendons
-Erosive and deforming arthritis occurs in 40% to 60% of patients with PsA
-High levels of tumor necrosis factor (TNF)-a, IL-8, IL-6, IL-1, IL-10, and matrix
metalloproteinases are present in the joint fluid of patients with early PsA.
Mild psoriatic arthritis - Answer-Response to therapy: Topical therapy
Impact on QOL: Minimal
Moderate psoriatic arthritis - Answer-Response to therapy: DMARDs or TNF blocker
Impact on QOL: Impacts daily tasks of living and psychical/mental functions; lack of
response to NSAIDs
Severe psoriatic arthritis - Answer-Response to therapy: DMARDs plus TNF blockers or
other biological therapies
Impact on QOL: Cannot perform daily taks of living without pain or dysfunction; large
impact on physical/mental functions; lack of response to either DMARDs or TNF
blockers as monotherapy
Diagnosis and Assessment: Objective assessment of psoriasis - Answer-body surface
area (BSA) involvement, disease location, thickness and symptoms, presence or
absence of psoriatic arthritis, and any associated comorbidities
Diagnosis and Assessment: Subjunctive assessment of psoriasis - Answer-Diagnosis
and Assessment:
Mild psoriasis' skin involvement - Answer-less than or equal to 5% BSA involvement
Moderate psoriasis' skin involvement - Answer-PASI ≥8 (higher in trials of biologics)
Severe psoriasis' skin involvement - Answer-The rule of tens: PASI ≥10 or DLQI ≥10 or
BSA ≥10%; BSA greater than or equal to 20% is used as the lower limit
, 50% - Answer-more than what percentage of patients with psoriasis have associated
pruritic?
PsA, depression, hypertension, obesity, diabetes mellitus, Crohn disease, anxiety,
alcoholism - Answer-What are other associated congeners related to the clinical
presentation of plaque psoriasis?
PGA - Physicians/Patients Global Assessment (psoriasis) - Answer-Severity is
estimated by both clinician and patient using a static global assessment score, which
uses the descriptions "clear", "nearly clear", "mild", "moderate", "severe" or "very
severe".
BSA - Body Surface Area (psoriasis) - Answer-Severity is defined by how much of the
body surface area is affected.
PASI - Psoriasis Area and Severity Index - Answer-- Measure of overall severity and
extent of psoriasis by assessing BSA and intensity of redness, thickness and scaling.
- A single score is calculated and ranges between 0 (no disease) to 72 (maximal
disease)
Non-rx therapy for psoriasis - Answer--Avoid triggers such as stress, smoking, and
alcohol
-Dry skin is a trigger factor, - emollients may be used to hydrate the stratum corneum to
minimize water loss, lubricate the skin, and relieve pruritus
-Should bathe in warm water with lubricating bath products two to three times a week.
Pharmacotherapy for psoriasis - Answer--Topical Therapies
-UV Light Therapy
-Systemic Therapies
Topical Therapy for psoriasis - Answer-Topical corticosteroids
Coal Tar
Anthralin
Calcipotriene
Tazarotene
Tacrolimus/Pimecrolimus
Adjunctive therapy: Emollients/Keratolytics
Topical Corticosteroids (psoriasis) - Answer--used for Mild to moderate plaque-type
psoriasis (first-line)
-Anti-inflammatory, antiproliferative, immunosuppressive, and vasoconstrictive effects
-More resistant or extensive disease (adjunct)
-Nail psoriasis (high-potency first-line)
-Scalp psoriasis (first-line)
-Can combine or alternate with vitamin D analogues, tazarotene, or emollient to improve
efficacy and reduce adverse effects.
