(derm) managing skin disorders in systemic disease Flashcards
look at the following images
which condition below is not associated with the pathology indicated?
a) diabetes mellitus
b) digital ischaemia
c) malignancy
d) interstitial lung disease
diabetes mellitus is not associated with the signs of dermatomyositis shown
digital ischamia = subtype with anti-MDA5 antibodies
malignancy = anti-p155 antibodies
interstitial lung disease = subtype with anti-MDA5 antibodies
can dermatomyositis be associated with diabetes mellitus?
if the dermatomyositis patients are treated with prednisolone = can lead to the development of diabetes mellitus
what are Gottron’s papules?
red or violet bumps that form on the outside joints of the hand specifically at the points of the metacarpophalangeal and the interphalangeal joints
what is Shawl sign?
characteristic erythematous rash distributed in a ‘shawl’ pattern over the neck, upper back, chest and shoulder
which of the following are associated with chronic kidney disease?
a) corkscrew hairs and perifollicular purpura
b) calciphylaxis
c) Casal’s necklace
d) periocular purpura
b) calciphylaxis
corkscrew hairs and perifollicular purpura = associated w scurvy
calciphylaxis = associated w CKD
Casal’s necklace = associated w vitamin B3 (niacin) deficiency
periocular purpura = associated w dermatomyositis/systemic amyloidosis
explain how chronic kidney disease leads to calciphylaxis
altered calcium metabolism
= deposition in arterioles (calcium accumulates in small blood vessels of the fat and skin tissues)
= necrosis in the skin it supplies
= calciphylaxis
what are corkscrew hairs and perifollicular purpura commonly associated with?
scurvy
what is Casal’s necklace commonly associated with?
pellagra (vitamin B3 deficiency)
what is periocular purpura commonly associated with?
systemic amyloidosis
which of the following statements about the disease shown are incorrect?
a) complications include blindness
b) pain is a characteristic feature and diagnostic clue
c) lymphadenopathy is a characteristic clue
d) extension into the GI tract may occur
c) lymphadenopathy is a characteristic clue
the condition shown is SJS/TEN and lymphadenopathy is not characteristic of this but is part of the diagnostic criteria for DRESS
what must you ensure when treating someone with SJS/TEN?
involve opthalmology in every case even if they don’t have ocular involvement at presentation to prevent the devastating complication of blindness
+ must assess for pain
what does the following image show?
denudation = loss of surface layers, such as the epithelium
(epidermal necrosis = hallmark of SJS/TEN)
which of the following is true with regards to an itch in the absence of a rash?
a) indicates malingering or a psychogenic aetiology
b) chronic rubbing or scratching may cause the appearance of nodules
c) drugs are an unlikely culprit
d) iron deficiency, not iron overload causes an itch
b) chronic rubbing or scratching may cause the appearance of nodules = NODULAR PRURIGO
a = can have multiple causes, not just one
c = drugs, including opiates, frequently cause pruritus in the absence of a rash
d = both can cause itching
which of the following is correct regarding Drug Reaction with Eosinophilia and Systemic Symptoms?
a) the brain is not among the organs targeted
b) the complications of erythroderma account for most of the fatalities
c) characteristic features on biopsy allow diagnostic confirmation
d) fulminant liver failure may occur
d) fulminant liver failure may occur
a = brain is targeted in DRESS
b = fulminant liver failure accounts for most fatalities
c = diagnosis is based on symptoms in a criteria AND biopsy (contributes to, not determines, the diagnosis)
which of the following is a manifestation of sarcoidosis?
a) lupus vulgaris
b) lupus profundus
c) lupus pernio
d) lupus tumidus
lupus pernio = bluish-red or violaceous nodules and plaques over the nose, cheeks and ears
a = form of cutaneous tuberculosis
b = form of cutaneous lupus erythematosus
d = variant of cutaneous lupus erythematosus
what is lupus vulgaris?
form of cutaneous tuberculosis
which of the following nail changes are not associated with chronic liver disease?
half and half nails are NOT associated with chronic liver disease, but instead with chronic kidney disease
= may be associated w Crohn’s or a normal variant
(clubbing = wide differential diagnoses; muehrcke’s lines = transverse white lines on the nails; terry’s nails = whitened nail bed with a rim of erythema at the distal end)
which of the following conditions is not associated with inflammatory bowel disease?
a) pyoderma gangrenosum
b) dermatitis herpetiformis
c) hidradenitis suppuritiva
d) orofacial granulomatosis
dermatitis herpetiformis (sssociated with coeliac disease)
(all others associated w IBD)
which of the following are not a manifestation of malignancy?
a) lues maligna
b) pyoderma gangrenosum
c) acanthosis nigricans
d) dermatomyositis
a) lues maligna = necrotic form of secondary syphilis
pyoderma gangrenosum = has multiple associations, including malignancy
acanthosis nigricans = may be associated with internal malignancy or insulin resistance
dermatomyositis = can be paraneoplastic
which of the following conditions may be indicative of underlying acromegaly?
a) cutis gyrata verticis
b) xerosis
c) perforating disorder
d) erythema gyratum repens
a) cutis gyrata verticis
xerosis = dryness occurs in many conditions, such as: diabetes, renal failure, but NOT acromegaly
perforating disorder = classically observed in diabetes, renal failure
eythema gyratum repens = a paraneoplastic type of annular erythema with a wood-grain appearance
what is perforating disorder and when is it observed?
perforating disorder = classically observed in diabetes, renal failure
what is erythema gyratum repens?
eythema gyratum repens = a paraneoplastic type of annular erythema with a wood-grain appearance
which of the following renders GVHD (graft vs host disease) a more likely cause of this rash than drug consumption?
a) acral involvement
b) facial involvement
c) diarrhoea
d) all of the above
d) all of the above
in a clinically equivocal rash in a allogenic HSCT (haemopoietic stem cell transplant) recipient, diarrhoea + facial + acral involvement all suggest cutaneous GVHD is a more likely cause than drugs
which of the following investigations is indicated for this presentation?
(new onset) fever, rash, arthritis, no new medication
A) urinalysis
B) vitamin C
C) lipid panel
D) HbA1c
A) urinalysis
= suspect systemic lupus erythematosus
(also do FBC, U&E, ANA, anti-dsDNA, complement tests)
which of the following investigations is indicated in this newborn patient with a rash?
A) genetic testing
B) syphilis
C) ECG
D) skin biopsy
C) ECG
= annular rash characteristic of neonatal lupus
= 50% risk of complete heart block and consequent heart failure
(associated with Ro and La antibodies)
what does this neonatal annular rash indicate and why is this dangerous?
= annular rash characteristic of neonatal lupus
= 50% risk of complete heart block and consequent heart failure
which antibodies are associated with this neonatal rash?
associated with Ro and La antibodies
which blood test would be done for a patient that presents with the following condition?
acanthosis nigricans
do a HbA1c test to assess blood glucose levels for prediabetes or diabetes
which blood test would be done for the following presentation?
corkscrew hairs = indicative of vitamin C deficiency/scurvy
so do a vitamin C test
which blood test would be done for the following presentation?
lipid profile
= presentation of eruptive xanthelasma (white/yellow lumps of fatty material) is indicative of hyperlipidaemia
for which condition is this a common presentation?
epidermal necrosis (denudation) is a common presentation for SJS/TEN
what is shown in the following picture and how does this develop?
nodular prurigo
= can develop due to chronic rubbing or scratching
what do the following nails indicate?
half and half nails
= usually indicate chronic kidney disease or Crohn’s disease but can appear in someone who is completely normal and healthy
what do the following nails suggest?
clubbing
= has a very wide differential diagnosis (e.g. hypoxia, liver disease, cardiovascular disease, lung disease etc)
what does the following presentation suggest?
cutis gyrata verticis
= indicative of underlying acromegaly
what is the following presentation classically a sign of?
perforating disorder
= classically seen in diabetic renal failure
