GRANULOMATOUS DISEASES OF THE SKIN Flashcards
1
Q
diseases or inflammatory reactions that are characterized by the formation of a granuloma are called what?
A
Granulomatous diseases
2
Q
What is a Granuloma?
A
a focus of chronic inflammation made of microscopic aggregrates of macrophages that are transformed into epitheloid-like cells and are surrounded by a collar of mononuclear leucocytes principally lymphocytes and occasionally plasma cells with or without the presence of giant cells.
3
Q
Mention 5 examples of infectious Granulomas?
A
Tuberculosis Leprosy Histoplasmosis Cryptococcosis Coccidioidomycosis Blastomycosis Cat Scratch disease
4
Q
Itemize 5 examples of non-infectious granulomas
A
Sarcoidosis Crohn’s disease Berylliosis Wegener’s granulomatosis Churg-Strauss Syndrome Pulmonary Rheumatoid Nodules
5
Q
What etiological agents of TB constitute the mycobacterium TB complex?
A
M. tuberculosis M. bovis(unpasteurized milk) M. africanum(africa) M. canetti(rare) M. microti(immunocompromised)
6
Q
Mention 5 distinctive features of Mycobacterium TB?
A
obligate aerobe Slender, slightly curved & rod shaped AFB by Ziehl-Neelsen staining technique Lipids = 50% of dry weight divides every 16 to 20 hours can withstand weak disinfectants and can survive in a dry state for weeks.
7
Q
Mycobacterium tuberculosis is an obligate anerobe (T/F)?
A
False
It’s an obligate aerobe
8
Q
Mention 6 facts that depicts the Global burden of TB ?
A
~ 8 million new cases of active TB per year
2-3 million deaths worldwide per year
1 in 3 persons with Mycobacterium tuberculosis infection
new infections occur at a rate of one per second
one in ten latent infections will progress to active TB disease,
14.6 million chronic active TB cases
9
Q
Mention 10 epidemiological indicators of risk for TB?
A
HIV positive , substance abuse diabetes mellitus , Silicosis prolonged corticosteroid/ immunosuppressive therapy cancer of the head and neck leukemia and Hodgkin’s end stage renal disease intestinal bypass or gastrectomy, chronic malabsorbtion syndromes low body weight Contact with infectious patient Healthcare worker Homeless or unstably housed Foreign-born from high prevalence country Residence in institution
10
Q
How is TB transmitted?
A
Via coughing, sneezing, or spitting
A single sneeze can release up to 40,000 droplets.
11
Q
Primary TB is seen in Non- immune host and often seen in children (T/F)?
A
True
12
Q
Where is the usual location of the ghon focus ?
A
It is usually subpleural, often in the mid to upper zones
13
Q
What constitutes the ghon Complex?
A
Ghon focus
Enlarged lymphatics
Enlarged regional LN
14
Q
How long does it take for viable tubercle bacilli to be transported through the lymphatics to establish secondary sites?
A
within 2wks
15
Q
development of cellular immunity (delayed-type hypersensitivity) in TB occurs when?
A
during the next 4 weeks(3–8 weeks)
16
Q
positive reaction in the skin to an intradermal injection of protein from tubercle bacilli (tuberculin/PPD) occurs due to what?
A
development of cellular immunity (delayed-type hypersensitivity)
17
Q
In active TB, 75% are asymptomatic (T/F)?
A
False
Show pulmonary symptoms
18
Q
Mention 5 symptoms of tuberculosis?
A
Asymptomatic Chronic Cough(>3wks) Weight loss Night sweats Chest pain Fever
19
Q
Extrapulmonary TB account for 25% of active cases (T/F)?
A
False
75%
20
Q
Outline 5 extrapulmonary sites of TB affectation?
A
Pleura (tuberculous pleurisy) CNS(meningitis) Lymphatic system (scrofula of the neck) Urogenital TB Bone & joints (Pott’s dx of the spine) Skin TB
21
Q
The incidence of cutaneous tuberculosis appears very high (T/B)?
A
False
It’s very low
22
Q
Cutaneous tuberculosis shows varied immunological reaction of the skin to mycobacterium tuberculosis (T/F)?
A
True
23
Q
Cutaneous involvement is a rare manifestation of tuberculosis (T/F)?
A
True
24
Q
Classify cutaneous tuberculosis?
A
INOCULATION TUBERCULOSIS(EXOGENOUS SOURCES)
- Tuberculosis chancre
- Warty tuberculosis(verruca cutis)
- Lupus vulgaris (some)
SECONDARY TUBERCULOSIS(ENDOGENOUS SOURCES)
Contiguous spread —- scrofuloderma
Auto -innoculation —- orificial tuberculosis
HEMATOGENOUS TUBERCULOSIS
Acute miliary tuberculosis
Lupus vulgaris (some)
Tuberculous gumma
ERUPTIVE TUBERCULOSIS (TUBERCULIDS)
Micropapular —- lichen scrofulosorum
Papular. —-papular or papulonecrotic tuberculids
Nodular —- Erythema induratum
25
Tubercle bacilli may invade an intact cutaneous barrier (T/F)?
False
It cannot!
Minor trauma to the skin provides a portal of entry to the bacilli
26
Itemize 4 possibly sources of exogenous cutaneous inoculation of TB
```
Circumcision
tatooing and nose and ear piercing
Exposure to patients,body fluid or animal carcasses infected tubercle bacilli
roadside trauma
BacilliCalmetteGuerin(BCG)vaccination
injection needle.
```
27
Itemize a possible sources of endogenous cutaneous inoculation of TB?
from sputum in a patient with active TB e.g from finger sucking
28
TB chancre is the result of inoculation of M.tuberculosis into the skin of an individuals with acquired immunity to the organism (T/F)
False
| In individuals without natural or acquired immunity to the organism.
29
TB chancre results following exogenous M. TB inoculation after an incubation period of what?
incubation period of 2-4wks
30
TB chancre is characteristically accompanied by painful enlarged regional glands (T/F)?
False
| Painless!
31
TB chancre eventually heals slowly without scarring (T/F)?
False
| Heals with scarring
32
It often starts as a brownish papule or nodule which breaks down to form an indurated ulcer with an undermined edge and a granular haemorrhagic base. This is the correct description of what?
TB chancre!
33
lupus vulgaris may occasionally develop at the site of resolving TB chancre or draining sinuses (T/F)
True!
34
The enlarged draining lymph nodes seen in TB chancre usually subside slowly and may calcify or form cold abscesses and sinuses (T/B)?
True!
35
Mention 5 differentials of tuberculous chancre?
```
Sporotrichosis
Blastomycosis
Histoplasmosis
Nocardiosis
Syphilis
Tularemia
leishmaniasis
```
36
Warty TB is otherwise called what?
TUBERCULOUS VERRUCOSA CUTIS
37
exogenous inoculation of bacilli into the skin of a previously sensitized person with strong immunity may result in warty TB (T/F)?
False
| It's endogenous innoculation
38
Warty TB lesions is always accompanied by a central clearing (T/F)?
False
| Lesions are with or without central clearing
39
Lesions of warty TB are usually multiple beginning as a small papule, which becomes hyperkeratotic resembling a wart (T/F)?
False
| They are usually solitary
40
dorsa of the finger, hands is a frequent location for warty TB in children (T/F)?
False
| It's In adults!
41
Warty TB frequently affects what body area in children?
the ankle and buttocks in children.
42
What characteristic histopathological finding is seen in warty TB?
pseudoepitheliomatous hyperplasia of the epidermis and hyperkeratosis
43
Culture will be positive in all cases of warty TB?
False
| in slightly more than 50% of cases.
44
Warty TB lesions are pauci-bacillary (T/F)?
True!
| The number of AFB is usually scanty. TST is positive.
45
Outline 5 differentials of warty TB?
```
Lichen planus
Verruca vulgaris
Verrucous epidermal nevus
Blastomycosis
chromoblastomycosis
```
46
Scrofuloderma skin lesions result from hypersensitivity reactions to tubercle bacillus (T/F)?
False!
| result from the direct extension of underlying TB infection of lymph nodes, bone or joints
47
Scrofuloderma skin lesions is most commonly found in what body area?
The neck from cervical adenitis
48
Scrofuloderma is a superficial, cutaneous swelling, firmly attached to the skin with multiple discharging sinuses, interspersed with cord-like scar (T/F)?
False
| It's a deep lesion!
49
Scrofuloderma is often a sequel to long-standing neglected adenitis or following surgical intervention (T/F)?
True!
50
A TB infection of the mucosa or the skin adjoining orifices in a patient with advanced internal TB is known as?
Tuberculosis cutis orificialis
51
Tuberculosis cutis orificalis is usually restricted to the mouth (T/F)?
False
| Any of the orifice;- mouth, genitalia and anus could be involved.
52
What is the typical type of patient usually affected by tuberculosis cutis orificalis?
The affected patient is usually an ADULT with POOR GENERAL HEALTH and IMPAIRED CELL MEDIATED IMMUNITY, who has LONG-STANDING TB of one or more internal organ
53
Tuberculosis cutis orificalis is commonly seen in children (T/F)?
False
| Adults
54
What is unique about ulcers seen in tuberculosis cutis orificalis?
The ulcer are clasically chronic with no tendency to heal.
55
How will tuberculosis cutis orificalis present clinically?
Presents as multiple crusted small ulcers usually commencing as edematous red nodules which break down
56
What group of patients are at risk of military TB?
immunosuppressed ptx e. g
from malnutrition
AIDS
post measles debility
57
How does military TB present clinically?
It present as disseminated papules, vesicles , pustules or hemorrhagic lesion in a patient who is obviously ill
The vesicles and pustules break down to form small necrotic ulcers
58
A progressive form of cutaneous TB occuring in a person with a moderate or high degree of immunity is known as?
Lupus vulgaris
59
Lupus vulgaris is commonly seen in adults (T/F)?
False
| Children!
60
Mention 4 forms of lupus vulgaris?
```
Plaque form
ulcerative form
multilating form
vegetative form
tumor-like form
papular and nodular lesion
```
61
An extreme morphological variation sometimes seen in lupus vulgaris is?
crusted paranasal lesion partition in children
62
Lupus vulgaris may show mucosal involvement (T/F)
True
63
Individuals with depleted CMI against tubercle bacilli show worsening course of ulcerations in lupus vulgaris (T/F)?
True!
64
How would lupus vulgaris present clinically?
It may present as progressive, non- healing ,bizzare papules/plaques , with a smooth or warty surface ,dry or showing oozing in places.
65
Mention 2 differentials of lupus vulgaris?
Crusted impetigo
| Tuberculoid leprosy
66
symmetric generalized exanthems(eruptions) in the skin of tuberculous patients, possibly resulting from hypersensitivity reactions to tubercle bacillus are known as what?
Tuberculids!
67
Typically, patients with tuberculids are in relatively poor health and show negative tuberculin sensitivity, positive staining and culture for pathogenic mycobacteria in affected tissue (T/F)?
False!!!
Patients are in relatively GOOD HEALTH
show POSITIVE tuberculin sensitivity
NEGATIVE staining and culture for pathogenic mycobacteria in affected tissue.
68
Tuberculid Skin lesions heal with remission or treatment of TB (T/F)?
True!
69
Recent findings suggest that tuberculids are manifestations of hematogenous spread of bacilli in patients with tuberculin immunity (T/F)?
True!
70
Lichen scrofulosorum is typically found in adults with systemic TB (T/F)?
False
| In children!
71
infundibulofolliculitis is a known differential of lichen scrofulosorum (T/F)?
True
72
Common sites of affectation in lichen scrofulosorum includes?
Abdomen, chest & back
73
symptomless papules of follicular distribution occurring in groups over the chest of child diagnosed with systemic TB is mostly likely to be what?
Lichen scrofulosorum!
74
chronic and recurrent symmetric eruption of necrotizing skin papules appearing in clusters and healing with varioliform (ie resembling smallpox) scars is most likely to be what?
Papulonecrotic tuberculid
75
Papulonecrotic tuberculid skin lesions will resolve after anti-TB therapy (T/F)?
True!
76
Tubercle bacilli are difficult to demonstrate in papulonecrotic tuberculids (T/F)?
True
77
patients with papulonecrotic tuberculids usually have an internal focus of TB and are tuberculin sensitive (T/F)?
True
78
Papulonecrotic tuberculids rarely respond to antituberculous chemotherapy (T/F)?
False
| They respond rapidly to antituberculous chemotherapy.
79
The tuberculin skin test is negative in papulonecrotic tuberculids (T/F)?
False
| It's positive!
80
Lesions appear on the flexor aspects of extremities in a symmetric distribution, often in clusters. (T/F)?
False
| It's on the extensor surface
81
body areas commonly affected by papulonecrotic tuberculids includes?
the extensor aspects of extremities (knees, elbows, buttocks, lower trunk)
82
Individual lesions are asymptomatic, small, dusky red papules with a central punctum or crust correctly describes what?
Papulonecrotic tuberculids
83
Papulonecrotic tuberculids resolve after 2 weeks without leaving scars (T/F)?
False
| INVOLUTION is common after 6-8 weeks and leaves pitted scars.
84
Erythema induratum is solely associated with active TB (T/F)?
False
| Both with past and active TB
85
A persistent or recurring condition associated with Past or Active TB is known as?
Erythema induratum
86
Inflammatory cutaneous and subcutaneous nodules that may ulcerate and scar occur in the posterior calves is the correct description for what?
Erythema induratum
87
Erythema induratum is more commonly seen in men (T/F)?
False!
| More in women
88
About 50% of patients with Erythema induratum are men (T/F)?
False
| <10%
89
Erythema induratum Lesions arise in small numbers as painless indurated plaques and nodules that may progress to ulceration and scarring (T/F)?
False
| Lesions are tender!
90
Erythema induratum Lesions arise in small numbers as painless indurated plaques and nodules that may progress to ulceration and scarring (T/F)?
False
| Lesions are tender!
91
Tubercle bacilli are seen, and mycobacterial cultures usually are positive in Erythema induratum leaions
False
Tubercle bacilli are not seen!
mycobacterial cultures usually are negative.
92
Erythema induratum rarely recurs for years(T/F)?
False
| It often recurs for years
93
A patient presents with lesions that resembles Erythema induratum lesions, what investigations could done to make a diagnosis?
```
Skin Biopsy
Microscopy (tuberculoid granulomas);
Bacteriological culture(Lowenstein Jensen medium)
Detection of mycobacterial DNA by PCR.
Tuberculin skin tests.
Diascopy
```
94
Itemize 5 examples of culture media that can be used in diagnosis of TB?
Culture
Egg-based media (e.g. Lowenstein-Jensen) 4-8 wks
Agar-based media (e.g. Middlebrook 7H10) 4-6 wks
BACTEC liquid medium 2-4 wks
Mycobacterial growth indicator tube (MGIT) 2-4 wks
Septi-Chek
95
Outline the steps in staining for diagnosis of TB?
Carbol fuchsin-based stains is used!
Utilize a regular light microscope
Must be read at a higher magnification
Two types: Ziehl-Neelsen and Kinyoun
Both use carbol fuchsin/phenol as the PRIMARY DYE dye
Smear is then decolorized with acid-(HCI) alcohol and counter-stained with methylene blue
96
Outline how AFB smear result is reported?
```
Nos of AFB found
0 ----- negative
1-2/300 fields ----- +/-
1-9/100 fields ------ 1+
1-9/10 fields ------- 2+
1-9/1 field ------- 3+
>9/ 1 field ------- 4+
```
97
The tuberculin skin test is otherwise called what?
Mantoux test
98
________Is a screening tool for tuberculosis and for tuberculosis diagnosis?
Mantoux test
99
Outline how the Mantoux test is carried out?
The test is done injecting 0.1ml of a liquid containing 5 tuberculin unit(TU) purified protein derivative(PPD) into the top layers of the skin .
The skin test should be read 2-3 days after the injection .
The diameter of hard skin thickening is recorded in mm
100
Induration measuring 5mm or more is considered positive for what group of patients?
HIV-infected patient
in those with risk of developing TB
in recent close contact
in those with chest x-ray finding with healed TB.
101
PPD measuring > 10mm is considered positive in what group of patients?
intravenous drug user
HIV negative IV drug user
those born in foreign countries of high TB prevalence
Mycobacteriology lab personell
102
Induration greater than 15mm is positive for all (T/F)?
True!
103
PPD induration of 0-4mm is negative (T/F)?
True
104
Itemize 5 causes of false negative Mantoux test result?
```
Immunosupression
Malnutrition
Sarcoidosis
Hodgkin lymphoma
Measles
```
105
Treatment regimen adequate for pulmonary TB are also effective for extra pulmonary disease (T/F)?
True
106
What treatment regimen is used in the management of ptx with extrapulmonary TB?
DOTS!
ISONIAZID
5mg/kg with max dose of 300mg
(pyridoxine to prevent peripheral neuropathy)
RIFAMPICIN
300-600mg
PYRIZINAMIDE
15-30mg/kg with max dose of 2g daily
ETHAMBUTOL
15-25mg/kg(400mg) for 2month.
Then isoniazid and rifampicin for a further 4month.
107
What are the 2nd line agents used in the treatment of TB?
AMINOGLYCOSIDES
amikacin (AMK), kanamycin(KM);
POLYPEPTIDES
capreomycin, viomycin, enviomycin;
FLUOROQUINOLONES
Ciprofloxacin (CIP), ofoxacin, levofloxacin, moxifloxacin (MXF);
THIOAMIDES
ethionamide, prothionamide
CYCLOSERINE
P-AMINOSALICYLIC ACID(PAS or P).
108
Surgical treatment is the definitive treatment for TB (T/F)?
False
| It's pharmacological tx
109
Itemize 5 ways of preventing TB?
```
BCG vaccination
Improved social conditions;- housing, nutrition
Case detection and treatment
Contact tracing
Pasteurization of milk
```
110
State the role of surgery in treatment of cutaneous TB?
The role of surgery in cutaneous TB is limited.
Hypertrophic and verrucuos lesion of Lupus vulgaris and TB verrucosa have been treated with ELECTROSURGERY , CRYOSURGERY and CURETTAGE with ELECTRODISSECTION as an adjunct measure with pharmacologic therapy as the primary method of treatment.
111
Itemize 4 systemic effects of atypical mycobacteria?
septic arthritis
abscesses
skin and bone infection
They may also affect the lungs, gastrointestinal tract, lymphatic system and other parts of the body.
112
Atypical Mycobacterial causing cutaneous conditions are generally resistant to standard antiTB drugs (T/F)?
True!
113
What 2 atypical mycobacterium are implicated in cutaneous conditions?
M. Ulcerans
| M. Marinum
114
M. Ulcerans cause cutaneous and sometimes systemic manifestations (T/F)?
False
| M. Ulcerans and M. Marinum are restricted to the skin in man
115
Atypical mycobacterium grow optimally above the internal body temp (T/F)?
False!
| They grow optimally BELOW the internal body temp @ 32-33degrees
116
What organism is implicated in swimming pool or fish tank Granuloma?
M. Marinum
117
M. Marinum typically affects intact skin (T/F)?
False
| Infects previously abraded or damaged skin
118
What are the usually affected sites in fish tank Granuloma?
elbows, knees of swimmers and hands of aquarists
119
Why are aquarists and swimmers predisposed to infection by M. Marinum?
Because M. Marinum Lives saprophytically in swimming pools and fish tanks
120
What is the incubation period for M. Marinum?
Incubation period is about 3wks
121
What is the typical pattern of spread after M. Marinum infection?
LYMPHANGITIC SPREAD usually follow as nodules arise in a LINEAR FASHION
122
What are the treatment options for fish tank Granuloma?
COTRIMOXAZOLE 2tabs bd for 4-6wks
| Alternative drug is TETRACYCLINE.
123
Buruli ulcers are typically caused by?
M. Ulcerans
124
chronic, indolent, necrotizing disease of the skin and soft tissue, usually a solitary lesion located on the exposed anteriolateral aspect of the limb is the correct description of what?
Buruli ulcers!
125
What are the 3 phases of buruli ulcers ?
Pre-ulcerative phase
Ulcerative phase
Reactive phase
126
Burulin test is typically positive in the ulcerative phase of the infection (T/F)?
False
| It's positive in the reactive phase
127
Buruli ulcers typically lack exudate (T/F)?
True!
128
Buruli ulcers are rarely associated with skin and soft tissue necrosis (T/F)?
False
| They are typically associated with skin and soft tissue necrosis!
129
Spontaneous healing of buruli ulcers usually occurs after 1 year (T/F)?
True
130
Metastatic bone lesions may sometimes be associated with buruli ulcers (T/F)?
True!
131
Buruli ulcers typically do not destroy nerves and blood vessels (T/F)?
False
| They do!
132
cellular infiltrate with granuloma formation is typical of Pre-ulcerative phase of buruli ulcers (T/F)?
False!
| It's the reactive phase
133
Buruli ulcers typically heal with massive fibrosis and contracted scars (T/F)?
True!
134
spontaneous healing with massive fibrosis and contracted scars typically occurs in what phase of buruli ulcers?
The reactive phase
135
Skin and soft tissue necrosis seen in buruli ulcers is rarely extensive (T/F)?
False
| It can be extensive involving as much as 15% of skin surface and may extend deep, exposing fascia, muscle and bone
136
Initial lesions in buruli ulcers are usually very painful (T/F)?
False
| They are painless
137
Describe the typical pattern of clinical presentation seen in Buruli ulcers?
The initial lesion is a closed, diffuse & painless swelling, painless dermal papule or subcutaneous nodule
This then breaks down to form a necrotic ulcer with extensively undermined edges with area of tisssue destruction extending further under the skin far beyond the visible edge of the ulcer.
138
What are the treatment options for buruli ulcers?
EXCISION and CLOSURE in the pre-ulcerative phase
RIFAMPICIN or CLOFAZIMINEin the anergy phase
Thermostatically controlled HEATING OF THE AFFECTED LIMB, this conserves viable tissue & promotes repair
Promote healing by SKIN GRAFTING, EXCISION of fibrous tissue, SPLINTING & PHYSIOTHERAPY in the reactive phase
139
Sarcoidosis skin disease is also known as what?
Besnier-Boeck’s disease
140
Besnier-Boeck’s disease is typically a Multisystemic granulomatous inflammatory dx (T/F)?
True!
141
What body areas are usually affected in Besnier-Boeck’s disease?
```
the skin
lungs
Lymph nodes
liver
spleen
parotidglands
eyes.
```
142
Granulomas are typically seen in what body sites in Besnier-boeck's dx?
commonly
lungs & Lymph nodes
less commonly
CNS, heart, bones, upper resp tract
143
Besnier-boeck's dx affects all age, race and gender (T/F)
True!
144
Besnier-boeck's dx is Commoner in those of black ancestry; African Americans (T/F)?
True!
145
In what group of individuals is the prevalence of Besnier-boeck's dx typically high?
in FEMALES (African American women)
146
Besnier-boeck's dx typically has a unimodal age distribution (T/F)?
False
| Bimodal age distribution (25-35 & 45-65 yrs in women)
147
The worldwide incidence of Besnier-boeck's dx is typically higher in men (T/F)?
False
It's higher in women!
19/100,000 in WOMEN
16.5/100,000 in MEN
148
The incidence of Sarcoidosis skin disease is typically constant (T/F)?
False
| It varies!
149
Besnier-boeck's dx is often asymptomatic (T/F)?
True
150
Skin lesions in Besnier-boeck's dx typically affects 80% of patients (T/F)?
False
| Only 20-30%
151
What are the clinical features of Besnier-boeck's dx?
Often asymptomatic!
CONSTITUTIONAL SYMPTOMS
fever, Fatigue, Weight loss
PULMONARY
Dry hacking cough, dyspnoea, chest pain, chest tightness.
OCULAR
Anterior uveitis
NEUROSARCOIDOSIS
most frequently Facial nerve palsy
LYMOHADENOPATHY
SKIN LESIONS(20-30%)
152
What are the skin lesions seen in Sarcoidosis?
```
papules
nodules
plaques
subcutaneous nodules
scar sarcoidosis
erythroderma
ulcerations
```
153
Parotid gland involvement in Sarcoidosis often results in ?
facial nerve paralysis
154
What are the 3 different ways skin lesions in Sarcoidosis can present?
The skin lesion may appear before the systemic disease or may occur simultaneously or several years after the systemic disease.
155
Erythema nodosum is especially seen in elderly men (T/F)
Very false!
| It's seen in YOUNG WOMEN!
156
An acute, self limiting process characterized by Painful red nodules(1-5cm) found on the shins
Occuring in early stages of Sarcoidosis especially in young women typically describes what?
Erythema nodosum!
157
Erythema nodosum typically appears in the late stages of Sarcoidosis (T/F)?
False!
| It's seen in the early stages
158
What skin lesion is pathognomonic of Sarcoidosis?
Lupus pernio!
159
What skin lesion is often associated with sarcoidosis of the upper respiratory tract ?
Lupus pernio
160
Course of lupus pernio is usually acute and rarely result in severe cosmetic disfigurement (T/F)?
False
| Course is usually CHRONIC, and may result in severe cosmetic disfigurement
161
What body areas are usually affected by lupus pernio?
Usually over the NOSE, EARS, LIPS, CHEEKS but it can appear on the DORSA OF THE HANDS, FINGERS, TOES and FOREHEAD
162
A patient presents with Red to purple or violaceous infiltrated plaques and nodules over the nose, ears, lips, cheeks with hx of Dry hacking cough, dyspnoea, chest pain, chest tightness. What's the most likely diagnosis?
Lupus pernio with associated Sarcoidosis of the upper respiratory tract
163
What is lofgren syndrome?
```
An ACUTE form of sarcoidosis
Described as a triad of
*ERYTHEMA NODOSUM
*POLYARTHRITIS
*HILAR ADENOPATHY [ unilateral or bilateral].
```
```
OTHER FEATURES
anterior uveitis
fever
ankle periarthritis
arthralgias
pulmonary involvement
```
164
Lofgren syndrome typically resolves spontaneously from 6-8 weeks to up to 2 years after onset (T/F)
True!
165
an acute disease with an excellent prognosis characterized by Erythema nodosum, polyarthritis and bilateral hilar adenopathy often seen in patients with Sarcoidosis typically describes what?
Lofgren syndrome!
166
Papules, nodules and plaques seen in Sarcoidosis often resolve with hypopigmentation (T/F)?
False
| Resolves with hyperpigmentation
167
Brownish reddish, HYPOPIGMENTED, itchy
Solitary or multiple often asymptomatic lesions seen on the face,shoulder,arms of patients with Sarcoidosis typically describes what?
The characteristic papules, nodules and plaques of Sarcoidosis
168
Papules, nodules and plaques seen in Sarcoidosis are usually of similar sizes,nos &distribution (T/F)?
False
| They are of VARYING sizes,nos &distribution
169
Kveim’s test is used in what disease?
Sarcoidosis
170
Schumann bodies are typically found in Besnier-boeck's dx (T/F)?
True!
171
What is the characteristic laboratory finding seen in sarcoidosis
naked non caseating granulomas
Caseating necrosis is absent
Islands of epithelioid cells may contain a few langhans giant cells which may contain asteroid or schaumann bodies
172
What is the most specific test utilized in Sarcoidosis skin diseases?
Kveim's test!
173
Kveim's test is positive in Besnier-boeck's dx (T/F)?
True!
174
Tuberculin-type skin test is a rather less sensitive test carried out in Sarcoidosis (T/F)? Why is this so?
True!
| Tuberculin-type skin tests are negative due to cutaneous anergy
175
What investigations would you order for in a suspected case of Sarcoidosis?
```
It's Diagnosed by exclusion!
CXR
ECG
Ocular exam
LFTs
RFTs
Serum calcium
24-hr urine calcium
Tissue biopsy of LNs
Chest CT scan
```
176
What % of ptx with Sarcoidosis do not require therapy?
30-70%
177
What treatment would you offer a patient with Sarcoidosis?
```
CORTICOSTEROIDS
IMMUNOSUPPRESSANTS:
Metothrexate
Azathioprine
Hydroxychloroquine
```
178
Itemize 10 clinical manifestations of Sarcoidosis?
```
Pain
fever
diarrhoea
constipation
weight loss
Skin lesions ----- 40%
Ocular involvement; inflammation
Gallstones
Kidney stones
Arthritis
```
179
Painless vulvar or scrotal ulceration is typically seen in crohn's skin disease (T/F)
False
| It's painful!
180
Mention 5 distinctive dermatoses seen in crohn's skin dx?
```
Erythema Multiforme
Erythema Nodosum
angular cheilitis
granulomatous cheilitis
pyoderma gangrenosum
```
181
Any part of the skin can be affected in crohn's skin dx (T/F)?
True!
182
A patient presents with Spots, plaques found on the trunk, arms and legs which were mildly itchy, there were also fissures and abscesses around his perineal and perianal region, this patient likely has what?
Crohn's skin disease
183
skin involvement in crohn's dx is often an extension of the intestinal disease (T/F)?
True!
184
How is the diagnosis of crohn's skin dx made?
SKIN BIOPSY;
| non caseating granulomas similar to those found in intestinal lesions of Crohn’s are seen
185
What are the treatment options in crohn's skin dx?
PALLIATIVE
ORAL CORTICOSTEROIDS
AZATHIOPRINE
SULFASALAZINE
