Theme 1:
Systemic
Diseases
Summary
1
,Content
Week 1: Rash..........................................................................................................................................4
The skin..............................................................................................................................................4
Efflorescence......................................................................................................................................6
Psoriasis..............................................................................................................................................9
Other autoimmune skin diseases.....................................................................................................10
Other skin disorders.........................................................................................................................11
SCARs................................................................................................................................................12
Pharmacokinetics.............................................................................................................................13
Week 2: Joint problems and pain.........................................................................................................15
Joints................................................................................................................................................15
Joint pain and problems...................................................................................................................16
Inflammatory arthritis......................................................................................................................17
Microbiology.....................................................................................................................................21
Syphilis..........................................................................................................................................21
Relapsing fever.............................................................................................................................21
Lyme.............................................................................................................................................21
NSAIDs: Non-steroidal anti-inflammatory drugs...............................................................................22
DMARDs: Disease modifying anti-rheumatic drugs..........................................................................22
Biologicals.........................................................................................................................................23
Week 3: Butterfly erythema.................................................................................................................24
Immunologic tolerance and autoimmunity......................................................................................24
Autoimmune diseases......................................................................................................................25
Systemic lupus erythematosus.....................................................................................................25
Antiphospholipid syndrome..........................................................................................................26
Scleroderma.................................................................................................................................26
Sjögren’s syndrome......................................................................................................................27
Systemic vasculitis........................................................................................................................27
Polymyalgia rheumatica...............................................................................................................28
Giant cell arteritis.........................................................................................................................28
Wegener’s disease........................................................................................................................29
Churg-Strauss syndrome...............................................................................................................29
Dermatology.....................................................................................................................................29
Discoid lupus erythematosus........................................................................................................29
Vitiligo...........................................................................................................................................29
2
, The kidneys: anatomy and histology................................................................................................31
Blood circulation...........................................................................................................................31
Microscopic image of the glomerulus...........................................................................................32
Different parts of the nephron and their functions......................................................................33
Juxtaglomerular apparatus...........................................................................................................35
Water and electrolyte balance.........................................................................................................35
Body fluid compartments.............................................................................................................35
Indicator dilution method.............................................................................................................35
Disturbance of the balance...........................................................................................................35
Regulation of renal blood flow.....................................................................................................35
Water, sodium, potassium, calcium and phosphate balance...........................................................36
Tubular reabsorption........................................................................................................................37
Micturition........................................................................................................................................37
Week 4: Complaints due to kidney injury.............................................................................................38
Acute kidney injury...........................................................................................................................38
Acute tubular necrosis..................................................................................................................39
Interstitial nephritis......................................................................................................................40
Crescentic glomerulonephritis......................................................................................................40
Chronic kidney disease.....................................................................................................................41
Nephritic vs nephrotic syndrome.....................................................................................................42
Dialysis..............................................................................................................................................43
Glomerular filtration.........................................................................................................................44
3
,Week 1: Rash
The skin
Function:
- Microbial barrier
- Prevents water loss
- Protects against UV radiation
- Sensory organ
- Aids in temperature regulation
- Production of vitamin D
Several layers:
Epidermis = stratified squamous epithelium
- Consists of keratinocytes undergo terminal differentiation (=keratinisation)
form distinct epithelial layers:
1. Stratum corneum: outer layer containing squames
2. Stratum granulosum: contains keratinocytes contain fillagrin binds to the
tonofibrils
3. Stratum spinosum: polyhedral cells containing bundled keratin and tonofibrils
4. Stratum basale: cuboidal cells attached to the basement membrane
Hemidesmosomes: attach cells to the basement membrane
Desmosomes: attach cells to each other
The epidermis contains:
- Epidermal ridges: enlarges epidermis – dermis connection
- Dermal papillae: supplies epidermis with blood
- Melanocytes: synthesise melanin protects against UV radiation of the sun
- Langerhans cells: APCs that digest microbes on the skin
4
,Dermis: contains two layers:
1. Papillary layer: loose connective tissue with micro vessels
2. Reticular layer: dense irregular connective tissue containing larger blood vessels
Subcutaneous tissue: contains sensory receptors
Type Function
Free nerve endings Detect pain and temperature
Merkel cells Detect light touch
Meissner corpuscles Mechanoreceptors to detect light touch
Lamellated/Pacinian corpuscles Detect pressure and firm touch
5
,Efflorescence
Primary: to determine primary skin disorder
Macule Nodule
Plaque Papule
Weal Vesicle
Bulla Pustule
6
,Comedo
Secondary: to determine manifestation of underlying skin disorder
Crust Scalling
Excoriation Erosion
Atrophy Ulcer
7
, PEDESCE:
- Place
- Extent
- Distribution
- Edge
- Shape
- Colour
- Efflorescence
8
Systemic
Diseases
Summary
1
,Content
Week 1: Rash..........................................................................................................................................4
The skin..............................................................................................................................................4
Efflorescence......................................................................................................................................6
Psoriasis..............................................................................................................................................9
Other autoimmune skin diseases.....................................................................................................10
Other skin disorders.........................................................................................................................11
SCARs................................................................................................................................................12
Pharmacokinetics.............................................................................................................................13
Week 2: Joint problems and pain.........................................................................................................15
Joints................................................................................................................................................15
Joint pain and problems...................................................................................................................16
Inflammatory arthritis......................................................................................................................17
Microbiology.....................................................................................................................................21
Syphilis..........................................................................................................................................21
Relapsing fever.............................................................................................................................21
Lyme.............................................................................................................................................21
NSAIDs: Non-steroidal anti-inflammatory drugs...............................................................................22
DMARDs: Disease modifying anti-rheumatic drugs..........................................................................22
Biologicals.........................................................................................................................................23
Week 3: Butterfly erythema.................................................................................................................24
Immunologic tolerance and autoimmunity......................................................................................24
Autoimmune diseases......................................................................................................................25
Systemic lupus erythematosus.....................................................................................................25
Antiphospholipid syndrome..........................................................................................................26
Scleroderma.................................................................................................................................26
Sjögren’s syndrome......................................................................................................................27
Systemic vasculitis........................................................................................................................27
Polymyalgia rheumatica...............................................................................................................28
Giant cell arteritis.........................................................................................................................28
Wegener’s disease........................................................................................................................29
Churg-Strauss syndrome...............................................................................................................29
Dermatology.....................................................................................................................................29
Discoid lupus erythematosus........................................................................................................29
Vitiligo...........................................................................................................................................29
2
, The kidneys: anatomy and histology................................................................................................31
Blood circulation...........................................................................................................................31
Microscopic image of the glomerulus...........................................................................................32
Different parts of the nephron and their functions......................................................................33
Juxtaglomerular apparatus...........................................................................................................35
Water and electrolyte balance.........................................................................................................35
Body fluid compartments.............................................................................................................35
Indicator dilution method.............................................................................................................35
Disturbance of the balance...........................................................................................................35
Regulation of renal blood flow.....................................................................................................35
Water, sodium, potassium, calcium and phosphate balance...........................................................36
Tubular reabsorption........................................................................................................................37
Micturition........................................................................................................................................37
Week 4: Complaints due to kidney injury.............................................................................................38
Acute kidney injury...........................................................................................................................38
Acute tubular necrosis..................................................................................................................39
Interstitial nephritis......................................................................................................................40
Crescentic glomerulonephritis......................................................................................................40
Chronic kidney disease.....................................................................................................................41
Nephritic vs nephrotic syndrome.....................................................................................................42
Dialysis..............................................................................................................................................43
Glomerular filtration.........................................................................................................................44
3
,Week 1: Rash
The skin
Function:
- Microbial barrier
- Prevents water loss
- Protects against UV radiation
- Sensory organ
- Aids in temperature regulation
- Production of vitamin D
Several layers:
Epidermis = stratified squamous epithelium
- Consists of keratinocytes undergo terminal differentiation (=keratinisation)
form distinct epithelial layers:
1. Stratum corneum: outer layer containing squames
2. Stratum granulosum: contains keratinocytes contain fillagrin binds to the
tonofibrils
3. Stratum spinosum: polyhedral cells containing bundled keratin and tonofibrils
4. Stratum basale: cuboidal cells attached to the basement membrane
Hemidesmosomes: attach cells to the basement membrane
Desmosomes: attach cells to each other
The epidermis contains:
- Epidermal ridges: enlarges epidermis – dermis connection
- Dermal papillae: supplies epidermis with blood
- Melanocytes: synthesise melanin protects against UV radiation of the sun
- Langerhans cells: APCs that digest microbes on the skin
4
,Dermis: contains two layers:
1. Papillary layer: loose connective tissue with micro vessels
2. Reticular layer: dense irregular connective tissue containing larger blood vessels
Subcutaneous tissue: contains sensory receptors
Type Function
Free nerve endings Detect pain and temperature
Merkel cells Detect light touch
Meissner corpuscles Mechanoreceptors to detect light touch
Lamellated/Pacinian corpuscles Detect pressure and firm touch
5
,Efflorescence
Primary: to determine primary skin disorder
Macule Nodule
Plaque Papule
Weal Vesicle
Bulla Pustule
6
,Comedo
Secondary: to determine manifestation of underlying skin disorder
Crust Scalling
Excoriation Erosion
Atrophy Ulcer
7
, PEDESCE:
- Place
- Extent
- Distribution
- Edge
- Shape
- Colour
- Efflorescence
8
