Medicine General 02

Question 1

Malignant Melanoma Types

Answer 1

• Lentigo maligna melanoma: arises from chronically sun exposed skin
• Superficial spreading MM
• Nodular MM
• Acral-lentiginous MM: arising from palm, soles & nail beds
• Ocular MM
• Mucosal MM
  < 30% from pre-existing nevus

Question 2

ABCDE rule for melanoma evaluation

Answer 2

A - asymmetric
B - borders are irregular
C - color variegation
D - diameter > 6 mm
E - evolution ie changing appearance, growing in size

Question 3

Black box warning: Tacrolimu,s, Pimecrolimus topical

Answer 3

Can cause T cell lymphoma and should be sparingly used. Risk is more with those with HIV, iatrogenic immunosuppressive Rx, past lymphoma etc.

Question 4

Inherited platelet function disorders

Answer 4

1. Glanzman’s disease (GPIIb/IIIa deficiency)
2. Bernard Soulier disease (GP deficiency)
3. Chediak Higashi syndrome (abnormal platelet granules)
4. Grey platelet syndrome (Alfa granule deficiency)
5. Storage pool disease
6. Secretion defect

Question 5

Thrombocytopenia - low production

Answer 5

Myelosuppression:
- viral infections
- drugs, alcohol
- infiltration/failure/fibrosis
ITP, 1/3 rd of cases
B12 or folate deficiency
Inherited disorders

Question 6

Thrombocytopenia- increased destruction/ consumption

Answer 6

Immune:
- Idiopathic, ITP
- drug induced
- SLE
- HIV related
Non Immune:
- massive transfusion
- Hypersplenism
- DIC, TTP

Question 7

Koebner phenomenon

Answer 7

Psoriatic changes occurs at the site of skin trauma for example at a simple scratch which turns into a plaque like changes.
Obesity worsened psoriasis and good weight loss improves it.

Question 8

Inverse psoriasis

Answer 8

Psoriasis changes only at the flexures like axilla, groin or popliteal fossa is termed inverse psoriasis( regular one favors extensor surfaces)
Nail pitting, onycholysis, koebner phenomenon seen in both.
Flare triggers - beta blockers, anti malarials, Statins, Lithium.

Question 11

Medications which can induce Cutaneous SLE

Answer 11

Subacute Cutaneous Lupus:
Anti Ro/SSA +ve
- Hydrochlorothiazide
- Calcium Channel blockers
- H2 blockers
- proton pump inhibitors
- ACE inhibitors
- TNF inhibitors
- Terbinafine

Question 13

Myogenic Hyperuricemia

Answer 13

Myogenic hyperuricemia, as a result of the purine nucleotide cycle running when ATP reservoirs in muscle cells are low, is a common pathophysiologic feature of glycogenoses, such as GSD-III, which is a metabolic myopathy impairing the ability of ATP (energy) production for muscle cells. In these metabolic myopathies, myogenic hyperuricemia is exercise-induced; inosine, hypoxanthine and uric acid increase in plasma after exercise and decrease over hours with rest. Excess AMP (adenosine monophosphate) is converted into uric acid.

Question 14

Porphyria cutanea tarra

Answer 14

Genetic,
Triggers: Estrogens, ALD, Hemochromatosis, Hepatitis C
Lesions -
= on dorsum of hand macular rash, painless on exposure to sunlight
= facial hypertrichosis
= facial hyperpigmentation
Lab test -
Urinary porphyrins
Liver function tests
Hepatitis C serology
Hemochromatosis work up
Treatment: barrier sun protection with clothing and sun screens. Wavelength of triggering light is beyond that absorbed by sunscreens SO THEY MAYNOT HELP.

Question 15

Pseudo porphyria

Answer 15

Similar lesions on dorsum of hand on sun exposure, specially when taking medications like:
- Tetracycline
- NSAIDs: Naproxen
- Voriconazole
Histopathology of lesions same as porphyria but urinary porphyrins normal