21 - 123 - CUTANEOUS CHANGES IN NUTRITIONAL DISEASE

Question 1

Clinical features of marasmus except
a. Failure to thrive

b. Loss of subcutaneous fay and muscle mass
c. Diarrhea, constipation
d. Generalized dermatitis (Flaking enamel paint)

Answer 1

d. Generalized dermatitis (Flaking enamel paint)
Page 2202. Feature of kwashiorkor table 123-2

Question 2

This can be seen at costochondral junctions of the anterior ribs, creating the well-known “rachitic rosary.”
a. Vitamin A deficiency

b. Vitamin B deficiency
c. Vitamin C deficiency
d. Vitamin D deficiency

Answer 2

d. Vitamin D deficiency
Page 2210. The classic manifestations of vitamin Ddeficient rickets are skeletal. Calcium and phosphorus deficiency leads to poor calcification of new bones, resulting in fraying and widening of the metaphysis. This can be seen at costochondral junctions of the anterior ribs, creating the well-known “rachitic rosary.”

Question 3

Signs of acute riboflavin deficiency include a deep-red erythema, epidermal necrolysis and _____________.
a. Mucositis

b. Angular stomatitis
c. Seborrheic dermatitis-like dermatitis
d. Photophobia

Answer 3

a. Mucositis
Page. 2213. Signs of acute riboflavin deficiency include a deep-red erythema, epidermal necrolysis, and mucositis. Other choices are signs of chronic deficiency.

Question 4

Condition/s that can predispose the development of pellagra:
a. GI disorders

b. Alcoholism
c. Carcinoid syndrome
d. Isoniazid intake
e. All of the above

Answer 4

E

Question 5

A patient from South Africa with psychosis was referred by the neurology department due to painful pruritic dermatitis in photoexposed areas. He is also dehydrated due to diarrhea. Upon further questioning, diet consists mostly of corn and maize. The best treatment for this patient is:
a. Folic acid 5mg/day

b. Pyridoxine 100mg/day
c. Nicotinamide 500mg/day
d. Cyanocobalamin 1mg/day

Answer 5

c. Nicotinamide 500mg/day
Page. 2214. The patient is suffering from pellagra (vitamin B3/Niacin defiency)

Question 6

The earliest cutaneous sign of scurvy is_____________.

Answer 6

Phrynoderma

Question 7

The earliest cutaneous sign of scurvy is_____________.
a. Corkscrew hairs

b. Woody edema
c. Phrynoderma
d. Hemorrhage

Answer 7

c. Phrynoderma
Page 2219. The earliest cutaneous sign of scurvy is phrynoderma, which is the enlargement and keratosis of hair follicles, especially on the posterolateral aspect of the arms, resembling keratosis pilaris.

Question 8

Menkes disease in associated with:

a. Copper deficiency
b. Selenium deficiency
c. Iron deficiency
d. Zinc deficiency

Answer 8

a. Copper deficiency

Question 9

True about acrodermatitis enteropathica except

a. AE presents soon after weaning in affected infants or during the fourth to tenth week of life in infants who are not breastfed.
b. The classic features of AE include alopecia, diarrhea, lethargy, and an acute eczematous and erosive dermatitis favoring periorificial (perioral, periocular, anogenital) and acral areas.
c. Diarrhea is seen in all cases.
d. In children, 0.5 to 1.0 mg/kg of elemental zinc given as 1 to 2 daily doses is recommended for mild to- moderate zinc deficiency

Answer 9

c. Diarrhea is seen in all cases.

Question 10

Features of vitamin A toxicity except:
a. Dry skin

b. Bone pain
c. Pseudomotor cerebri
d. Phrynoderma

Answer 10

d. Phrynoderma
Page. 2205 (table 123-5 manifestation of vitamin A deficiency)

Question 11

A 5-year-old African was seen due to gangrene of the soft and hard tissue of the face. He was also malnourished with vitamin deficiencies and immune dysregulation. Which is true about this condition.
. The one known risk factor for this condition is poverty.

b. This condition is caused by a poly microbial infection.
c. The evolution is rapid, taking 24-48 hours
d. Management of acute noma is geared toward minimizing damage, but invasive intraoral procedures are contraindicated.
e. All of the above

Answer 11

E
Diagnosis is Noma

Question 12

caused by chronic global nutrient deficiency and characterized by dry, loose, and wrinkled skin with a loss of subcutaneous fat

Answer 12

Marasmus

Question 13

caused by inadequate protein or fat in the context of ongoing carbohydrate intake and characterized by generalized edema with a “flaky paint” dermatosis.

Answer 13

Kwashiorkor

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Answer 19

If a child experiences intermittent periods of kwashiorkor and improved nutrition, alternate bands of light and dark color within the hair shaft may be observed and has been referred to as the “flag sign” (Fig. 123-4A).

Question 20

The generalized dermatitis in edematous PEM has been likened to flaking enamel paint, with the pattern of skin fissuring suggesting cracked or “crazy” pavement (Fig. 123-3).

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