Derm in Cardiology

Question 1

dermatology findings associated with Marfan’s Syndrome

Answer 1

*ectopia lentis (lens dislocation)
*arched palate
*pectus excavatum (sternal abnormalities)
*skin laxity
*scoliosis
*Marfanoid habitus
*hyper-flexibility of wrists & fingers
*striae distensae (stretch marks)

Question 2

ectopia lentis (lens dislocation) in Marfan’s Syndrome

Answer 2

*upward lens dislocation
*can be seen on dilated eye exam
*risk for glaucoma later in life

Question 3

arched palate in Marfan’s Syndrome

Answer 3

*highly arched palate in the roof of the mouth
*easily visualized on oral examination

Question 4

pectus excavatum (sternal abnormalities) in Marfan’s Syndrome

Answer 4

*congenital abnormality of sternum and ribs
*grow inwards
*often most noticeable during puberty
*requires surgical correction

Question 5

skin laxity in Marfan’s Syndrome

Answer 5

*skin can be more stretchy, especially on extremities

Question 6

scoliosis in Marfan’s Syndrome

Answer 6

*abnormal curvature of the spine can be a common manifestation of Marfan Syndrome

Question 7

Marfanoid Habitus in Marfan’s Syndrome

Answer 7

*abnormalities of the long bones
*very tall stature
*long thin arms & legs

Question 8

characteristic hand findings in Marfan’s Syndrome

Answer 8

*hyper-flexibility of wrists/fingers
*long spidery appearing fingers

Question 9

striae distensae in Marfan’s Syndrome

Answer 9

*stretch marks
*increased presence of stretch marks on trunk, hips, thighs

Question 10

cardiac findings in Marfan’s Syndrome

Answer 10

*mitral valve prolapse
*aortic valve insufficiency
*aortic root dilation
*aortic dissection and/or rupture

Question 11

Marfan’s Syndrome - genetic mutation

Answer 11

*genetic disorder that affects connective tissues
*arises from a mutation of the fibrillin 1 gene (FBN1) on chromosome 15
*inherited in autosomal dominant fashion with variable expressivity
*individuals affected are characteristically tall and thin, with long arms, legs, fingers, and toes
*also associated with cardiac abnormalities

Question 12

stasis dermatitis

Answer 12

*seen in patients with poor circulation, such as those with diabetes and vascular disease
*woody discoloration to the skin, mostly anterior leg
*skin becomes firm (indurated) and can be sore to touch
*almost always BILATERAL
*can develop blisters within plaques of stasis dermatitis

Question 13

venous stasis ulcers

Answer 13

*progression of stasis dermatitis
*when small vessel circulation in the legs becomes poor enough, skin can break down
*ulcers develop on legs, usually ANTERIOR
*painful (moderate intensity)

Question 14

arterial ulcers

Answer 14

*result of occlusion of small arteries that supply skin
*seen in peripheral vascular disease and thromboembolic disease
*VERY PAINFUL
*punched out appearance
*commonly found on medial malleoli or dorsal foot

Question 15

lyphedema

Answer 15

*swelling of the extremities, usually legs
*caused by dysfunction of lymphatic system
*contributing illnesses: obesity, pregnancy, prior vascular surgery, removal of lymph nodes
*graded based on scale of pitting and rebound

Question 16

dermatology findings associated with Ehlers-Danlos Syndrome

Answer 16

*blue sclerae
*gorlin skin
*Ehlers-Danlos facies
*easy bruising
*skin laxity
*fish-mouth scars
*joint laxity
*club foot

Question 17

blue sclerae in Ehlers-Danlos Syndrome

Answer 17

*thinning of the scleral soft tissue allows it to become translucent, giving it a blue hue
*can be seen in Ehlers-Danlos & osteogenesis imperfecta

Question 18

Gorlin sign in Ehlers-Danlos Syndrome

Answer 18

*ability to touch the tip of the tongue to the nasal tip
*~50% of patients with inherited connective tissue disease such as Ehlers-Danlos can do this

Question 19

Ehlers-Danlos Syndrome facies

Answer 19

*several distinguishing facial features:
-small ear lobes
-prominent eyes
-narrow nose
-thin lips
-small chin

Question 20

easy bruising in Ehlers-Danlos Syndrome

Answer 20

*one of the most common features in Ehlers-Danlos Syndrome
*often mistaken for child or domestic abuse

Question 21

skin laxity in Ehlers-Danlos Syndrome

Answer 21

*skin can be more stretchy, especially on extremities

Question 22

fish-mouth scars in Ehlers-Danlos Syndrome

Answer 22

*wide atrophic scars
*often overlying knees or elbows
*poor wound healing with dehiscence (separation) of wounds common

Question 23

joint laxity in Ehlers-Danlos Syndrome

Answer 23

*hyper-mobile joints can lead to early onset arthritis and joint instability
*may require corrective braces for knees and ankles

Question 24

club foot in Ehlers-Danlos Syndrome

Answer 24

*malposition of the talus (heel bone) of the foot, often accompanying thickening of surrounding ligaments
*can be corrected with orthotics, physical therapy, or surgery if needed
*about 10% of patients with Ehlers-Danlos Syndrome have club foot

Question 25

cardiac findings in Ehlers-Danlos Syndrome

Answer 25

*patients with vascular subtype of Ehlers-Danlos Syndrome (collagen III) are at highest risk for cardiovascular complications
*aneurysms of iliac, mesenteric, and renal arteries
*women can have uterine rupture during pregnancy or childbirth

Question 26

Ehlers-Danlos Syndrome - genetic mutation

Answer 26

*a genetic connective tissue disorder that affects collagen synthesis
*classical (collagen V mutations) vs. vascular (abnormal collagen III)
*a group of disorders encompassing several subtypes with different genetic abnormalities
*can be autosomal dominant or recessive, or can be a de novo (new) mutation

Question 27

dermatology findings associated with IV drug use

Answer 27

*infectious nodules
*skin popping

Question 28

infectious nodules in IV drug use

Answer 28

*patients who abuse IV drugs can get skin infections at the site of injections, or can get seeding of skin from a hematogenous source of infection
*appear as erythematous or dark firm crusted papules or small nodules
*typically on arms, often tracking up arm in linear fashion

Question 29

skin popping in IV drug use

Answer 29

*can see atrophic scars on hands, arms, or in between fingers from intradermal injection of IV drugs when vascular access is not available

Question 30

dermatology findings associated with endocarditis

Answer 30

*Janeway lesions
*Osler nodes
*splinter hemorrhage

Question 31

Janeway lesions in endocarditis

Answer 31

*flat erythematous blanching macules on palms or feet
*PAINLESS

Question 32

Osler nodes in endocarditis

Answer 32

*erythematous PALPABLE nodules on finger pads or toe pads
*PAINFUL (O = ouch)

Question 33

splinter hemorrhages in endocarditis

Answer 33

*small non-blanching erythematous lines in fingernails and toenails