Sec 26 Skin Manifestations of Internal Organ Disorders Flashcards
1
Q
Hyperelastic velvety skin that rebounds to the original position after being stretched, “cigarette-paper” scars, and hyperextensible joints; mitral and tricuspid prolapse, dilatation of the aorta and pulmonary artery, arterial rupture, myocardial infarction, and emphysema may accompany this syndrome
A
Ehlers-Danlos syndrome
2
Q
Progressive looseness of the skin with pendulous folds and droopy eyelids may be associated with generalized hyperelastosis leading to aortic dilatation and rupture, congestive heart failure, or cor pulmonale with pulmonary artery stenosis and progressive emphysema
A
Cutis laxa
3
Q
Skin is thick, lax, and yellowish, especially over the axillae, antecubital area, and neck; yellow patches may occur on mucous membranes, especially the labia; alterations in the ABCC6 gene may also lead to arteries becoming calcified, the aortic and mitral valves thickened, and cardiovascular symptoms, such as angina pectoris and claudication are frequent symptoms
A
Pseudoxanthoma elasticum (PXE)
4
Q
Skin appears atrophic and tight from a very early age with marked loss of subcutaneous tissue and leg ulceration; coronary atherosclerosis frequently leads to premature death by myocardial infarction
A
Hutchinson-Gilford syndrome (progeria)
5
Q
The skin is pale due to anemia and often exhibits a distinctive muddy hue, due to accumulation of carotenoid and nitrogenous pigments (urochromes) in the dermis.
A
Chronic Renal Failure
6
Q
An increase in the absolute amount of desaturated (reduced) hemoglobin results in a purple–blue discoloration of the skin.
A
Cyanosis
7
Q
Develops when there is normal arterial oxygen saturation but reduced blood flow, such as low-output cardiac failure and local vasoconstriction. Seen on cooler areas such as the nose, lips, earlobes, and fingertips.
A
Peripheral cyanosis
8
Q
Occurs in states that produce low arterial oxygen saturation, such as congenital heart disease with intracardiac or intrapulmonary right-to-left shunting, or severe lung disease. Usually visible on warm areas of the skin like the tongue, oral mucosae, and conjunctivae.
A
Central cyanosis
9
Q
Caused by an increase in the amount of saturated hemoglobin, an increase in the diameter or actual number of skin capillaries, or a combination of these factors.
A
Erythema
10
Q
This is most pronounced on the tongue, lips, nose, earlobes, conjunctivae, and fingertips. It is due to increased amounts of saturated hemoglobin producing erythema with increased amounts of desaturated hemoglobin producing cyanosis because of the inability of the body to fully oxygenate the increased absolute amounts of hemoglobin.
A
Polycythemia
11
Q
Paroxysmal intense condition of the face, neck, chest, and abdomen, often with telangiectases of the face and neck, may occur in patients with carcinoid tumors, systemic mastocytosis, and pheochromocytoma, alone or in Sipple syndrome.
A
Flushing
12
Q
Common in primary biliary cirrhosis (PBC) and may be an early presenting sign. It initially involves exposed areas, but gradually becomes generalized. Blotchy, circumscribed areas of dirty brown pigmentation are also occasionally evident.
A
Melanosis
13
Q
A condition in which small white macules, sometimes with a central spider, appear on the skin of the buttocks, back, thighs, and forearms, may occur in cirrhosis and, rarely, in PBC.
A
Guttate hypomelanosis
14
Q
The generalized metallic gray or bronze-brown color of the skin. There is accentuation in sunexposed and traumatized skin, and occasionally there is buccal and conjunctival pigmentation.
A
Hemochromatosis
15
Q
Gives rises to lichenified, and often deeply pigmented skin in sunexposed sites and can develop in patients with alcoholic liver disease.
A
Pellagra
16
Q
Causes pigmentation of the distal extremities in a glove and stocking distribution.
A
Vitamin B 12 deficiency
17
Q
Results from increased cellular or connective tissue binding of bilirubin and its metabolites in the skin producing a generalized coloration of the skin, mucous membranes, and other body tissues varying in hue from faint golden to dark green-yellow. Results from an imbalance between tissue production and hepatic clearance of bilirubin.
A
Jaundice
18
Q
Yellow skin pigmentation due to ingestion of tomato juice.
A
Lycopenemia
19
Q
One of the most common and distressing symptoms of hepatobiliary disease. More commonly occurs in conditions causing cholestasis and range from mild and transient to severe and prolonged. Usually most marked on the extremities and only rarely involves the neck and face, and genitalia.
A
Pruritus
20
Q
Neurotransmitter receptor antagonist which has been advocated for the pruritus of cholestasis
A
Nalmefene
21
Q
Has been thought to be caused by a combination of increased serum histamine, vitamin A, and parathyroid hormone (PTH); mast cell hyperplasia; peripheral polyneuropathy; xerosis; and inflammatory factors. Clinically, the skin may appear normal or demonstrate a variety of lichenified or hyperkeratotic lesions.
A
Renal pruritus
22
Q
Excessive growth of lanugo hair is a rare complication of gastrointestinal cancer.
A
Hypertrichosisalas Lanuginosa
23
Q
One of the amine precursor uptake and decarboxylation (APUD) cell tumors, usually arises in the islet cells of the pancreas, and occurs in association with a distinctive necrolytic migratory erythema.
A
Glucagonoma
24
Q
Are normal in their distal 50% and white in the proximal 50% and found in CRF.
A
Lindsey, or Half-and-half, nails
25
Flushing of the nail beds that is synchronous with the heartbeat which is a sign of aortic regurgitation.
Quincke pulsation
26
Intensely white nails characteristic of cirrhosis. Thumbs and forefingers are often most affected. The whiteness does not alter with nail growth or with compression of digital vessels and is thought to be due to the opacity of the nail plate itself. The so-called watch-glass deformity may accompany white nails.
Terry nails
27
A bluish color of the lunular portion of nails, occurs in hepatolenticular degeneration (Wilson disease)
Azure lunulae
28
MC in: Nail clubbing
Bronchogenic carcinoma
Suppurative lung disease
Endocarditis
Congenital heart disease
29
Beaking or distal curvature of the nail. There may be loss of the angle between the nail and cuticle. Sponginess or “floating” of the nail when pressure is applied is also characteristic and the size of the terminal tuft may increase.
Anatomically, there is an increased thickness of the nail bed.
Nail clubbing
30
Yellow nail syndrome
Yellow nails
Primary lymphedema
Pleural effusion(s)
31
The characteristics of the nails include thickening, transverse ridging, diminished growth, increased curvature with a “hump,” and onycholysis. The lunulae and cuticles may be absent. The color may vary from pale yellow to green. The nail changes are secondary to congenitally hypoplastic lymphatics, leading to lymphedema, which is characteristically slowly progressive and somewhat asymmetric, with induration and hyperkeratosis extending to the thighs. Periodic lymphangitis is frequent and may contribute to the swelling.
Yellow nail syndrome
32
A chronic clinical syndrome that is characterized by recurrent attacks of burning pain in the hands and/or feet with redness and warmth. There may be swelling that extends to the elbows and knees. May be primary or secondary to a disorder such as atherosclerosis, hypertension, and polycythemia. Symptoms are thought to be caused by vascular dysfunction including arteriovenous shunting and reduced capillary perfusion with subsequent tissue hypoxemia.
Erythromelalgia (labile hyperthermia)
33
A primary form of HOA, is frequently familial with an onset around puberty, and has a number of cutaneous manifestations. Distinctive thickening and furrowing of the skin of the scalp, forehead, and cheeks may create leonine facies.
Pachydermoperiostosis
34
There is an exaggeration of normal mottling; the hands are warm and bright red, especially on the palm, the dorsae of the hands, the fingers, and the nail bases. Or there is well-demarcated redness of the hypothenar eminence that gradually spreads to the fingertips and then to other areas of the palm.
Palmar erythema
35
The most representative and classic vascular lesion of chronic liver disease. Clinically, it has a central arteriole from which numerous small, twisted vessels radiate. They range in size from a pinhead to 2 cm. Larger lesions can be seen to pulsate when pressed with a glass slide. Pressure over the central arteriole causes blanching of the whole lesion. These are characterized by the abnormal permanent dilatation of end vessels. Histologically, they consist of a central ascending arteriole ending in a thin-walled ampulla.
Spider nevus
36
Tortuous small arteries that traverse the margins of the ocular sclerae that develop in patients with chronic liver disease.
Corkscrew scleral vessels
37
A postcricoid web is associated with koilonychia, angular stomatitis, a sore tongue, and, usually, iron deficiency in this syndrome where up to 10% of patients with a postcricoid web develop carcinoma at the site.
Plummer–Vinson (Paterson–Kelly) syndrome
38
Characterized by inflammation and destruction of cartilage and connective tissues, including those of the cardiopulmonary system. It is idiopathic but frequently associated with other immunologic disorders such as systemic lupus erytematosus (SLE). Auricular chondritis with pain, swelling, and redness of the pinna but complete sparing of the lobes is characteristic.
Relapsing polychondritis
39
A form of proteinenergy malnutrition, causes hair to become hypopigmented, varying from red–yellow to white, and curly. There may be alternating bands of pale and dark hair.
Kwashiorkor
40
This is an autosomal recessive mutation in desmoplakin, a desmosomal protein important in cell adhesion. Generalized striate keratodermas are seen, particularly on the palmoplantar epidermis, with woolly hair and dilated left ventricular cardiomyopathy leading to arrhythmias, heart failure, and early sudden death
Naxos Disease
41
The most common primary tumors of the heart. The cardiopulmonary findings include, in order of frequency, congestive heart failure, mitral murmur, chest pain, pulmonary edema, and pulmonary emboli. The cutaneous manifestations include biphasic digital color changes on cold exposure, skin lesions may simulate collagen vascular disease or vasculitis with tender, violaceous, nonblanching, annular, and serpiginous lesions of the digital pads, as well as splinter hemorrhages presenting as a systemic vasculitis or infective endocarditis. Characteristic pruritic, erythematous papules as well as cyanosis and ecchymosis of the extremities may also occur.
Atrial myxoma
42
An autosomal dominant disorder comprising lentigines; electrocardiogram conduction defects; ocular hypertelorism; pulmonary stenosis; abnormalities of genitalia; retardation of growth and sensorineural deafness. Electrocardiographic features include axis deviation; prolonged P–R interval, bundle branch block, and complete heart block.
LEOPARD Syndrome
43
Exquisitely painful, tender, and located distally on the digital tufts seen in Bacterial endocarditis. Histologically, are a perivasculitis or necrotizing vasculitis without microabscess formation or other evidence of infection or emboli.
Osler nodes
44
Nontender lesions and located proximally on the palms and soles seen in Bacterial endocarditis. Histologically, they are vasculitis with microabscess formation.
Janeway lesions
45
Acute or chronic pericarditis is an important feature of this. Pericardial effusions may be occult, and constrictive pericarditis and tamponade may occur. Additionally, small-vessel involvement of the myocardium may lead to fibrosis which may cause arrhythmias and sudden death.
Systemic sclerosis
46
An autosomal dominant trait, characterized clinically by punctate, linear, or spider-like telangiectasias of the skin, especially on the upper body, oral and nasal mucous membranes, and nail beds. Radiating arms about an elevated punctum are the most characteristic feature, especially on the lips and tongue. They are distinguished from spider nevi in that they do not pulsate. Recurrent epistaxis, often beginning in childhood or adolescence, is the most frequent presenting symptom.
Osler–Weber–Rendu disease
47
May cause mild respiratory symptoms and be associated with transient pulmonary infiltrates and a peripheral eosinophilia called Löffler syndrome. Skin lesions may present as patchy urticaria or erythematous papular eruptions.
Cutaneous larva migrans,
48
Petechiae, respiratory insufficiency, and cerebral dysfunction after long bone fracture. The petechiae are most common on the neck, axillae, shoulders, chest, and conjunctivae. They often appear before other manifestations on the second or third day after injury, and appear in crops. When widespread, they herald more significant cerebral and pulmonary dysfunction. Histologically, fat globules are present within dermal and pulmonary vessels.
Fat embolism syndrome
49
Skin changes include confluent, waxy papules, plaques, and scarring, particularly on the face. The tongue is enlarged. Oropharyngeal and laryngeal mucous membranes are usually affected early in the course of the disease, during infancy or childhood. Laryngeal infiltration may present early on as hoarsness, and may progress to obstruction and respiratory insufficiency. The trachea and main stem bronchus may be thickened and studded with warty projections.
Lupoid Proteinosis (Hyalinosis Cutis et Mucosae)
50
An uncommon disorder presenting with characteristic mucocutaneous lesions consisting of deeply set, firm, small papules in association with a deforming arthritis, fever, malaise, weight loss, and myopathy. Neurofibroma-like, soft, sessile, larger lesions have been reported, as has an association with malignancy. Cardiopulmonary complications include pleural effusions, pulmonary infarctions, pericarditis, angina pectoris, myocardial infarction, and congestive heart failure.
Multicentric reticulohistiocytosis
51
May cause waxy induration of the skin, with hemorrhagic skin changes on stroking (pinch purpura). Amyloid deposition within the vessels is found in clinically normal skin in up to 50% of patients. Cutaneous involvement occurs most often in the primary and myeloma-associated types, and therefore serves as a marker for cardiopulmonary involvement. Congestive heart failure with cardiomegaly or a restrictive cardiomyopathy occurs. Pathologically, there is infiltration of the endocardium, myocardium, pericardium, valves, and coronary vessels.
Systemic amyloidosis
52
A rare angiocentric and angiodestructive, Epstein–Barr virus-associated B cell lymphoproliferative disorder, varying from an indolent process to an aggressive large cell lymphoma. The skin is the extrapulmonary organ most commonly involved. The disease also affects the lungs, heart, central nervous system, and kidneys. Although many patients remain asymptomatic, cough, dyspnea, and chest pain may occur. Chest X-rays show transient infiltrates which may progress to nodules that cavitate and cause profuse hemoptysis.
Lymphomatoid granulomatosis
53
Lung involvement in SLE
1. Diffuse interstitial pneumonitis
2. Acute pneumonitis
3. Intrapulmonary hemorrhage
4. Diaphragm dysfunction with decreased lung volume
5. Pulmonary hypertension with cor pulmonale
6. Fibrosing alveolitis
54
In patients with cirrhosis portal-systemic collateral vessels may be seen and are a clue to the existence of portal hypertension. Often, the umbilical vein is dilated and visible in the epigastrium.
Caput medusae
55
The cutaneous marker for several inherited lysosomal disorders, due to deficiency of a number of enzymes, notably α-galactosidase A (the cause in Anderson–Fabry disease). Signs include severe, painful neuropathy; progressive renal, cardiovascular, and cerebrovascular dysfunction. Gastrointestinal symptoms include abdominal pain and diarrhea. The diagnosis may be missed without the skin signs.
Angiokeratoma corporis diffusum
56
Palpable purpura, especially on the legs and buttocks, and may occur in conjunction with joint swelling. Up to 76% of patients have gastrointestinal involvement, ranging from colicky abdominal pain, nausea, and vomiting to bloody diarrhea, intussusception, and pancreatitis. Renal involvement is common, especially in patients with bloody stools. Upper gastrointestinal endoscopy reveals multiple raised erythematous lesions or ulceration that resolves after systemic treatment with glucocorticoids.
Henoch–Schönlein purpura
57
An idiopathic, systemic, obliterative vasculopathy. The characteristic skin lesions are recurrent crops of porcelain-white atrophic papules with an elevated erythematous border. These may have been present for years with no other apparent disease although gut vessels are involved in half of the cases. Clinically bleeding, abdominal pain, diarrhea, malabsorption, and bowel perforation with peritonitis occur.
Malignant atrophic papulosis
58
A nonneoplastic tumor composed of tissue elements normally present in that organ.
Hamartoma
59
An autosomal dominant disorder characterized by cutaneous cysts and premalignant adenomatous polyps, particularly in the colorectum. Duodenal and hepatic carcinoma can also occur. The cutaneous lesions frequently predate the gastrointestinal lesions and include solitary or multiple epidermoid cysts, fibromas, lipomas, pilomatricomas, facial osteomas, and distinctive ocular lesions.
Gardner syndrome
60
Autosomal dominant and characterized by small darkly pigmented macules around the mouth, on the lips, buccal mucosa, and digits. A histologically unique type of hamartomatous polyp occurs, mainly in the small intestine, which predisposes to recurrent intussusception. Bleeding is relatively rare, but up to 2% of patients develop adenocarcinoma of the stomach, duodenum, and colon. There is also an increased risk of malignancy in general.
Peutz–Jeghers syndrome
61
There is patchy alopecia and characteristic, nail changes. Inflammatory polyps are present in the stomach and bowel, and abdominal pains with a severe protein-losing enteropathy are common.
Cronkhite-Canada syndrome
62
Oral granulomatous nodules are common where they may coalesce to give a “cobblestone” appearance. It is one cause of granulomatous cheilitis, which may predate bowel disease by several years. Granulomas may also occur in the perineum, at colostomy and ileostomy sites, and in association with scars, sinuses, and fistulas. Very rarely, granulomas occur at sites not contiguous with the bowel, such as the trunk and limbs.
Crohn disease
63
Bruising of the skin around the umbilicus in acute pancreatitis
Cullen sign
64
Bruising of the skin n the flanks in acute pancreatitis
Grey Turner sign
65
Classically causes follicular keratoses, hemorrhage, and corkscrew hairs
Vitamin C deficiency
66
Causes pellagra with its triad of diarrhea, dermatitis, and dementia.
Deficiency of vitamin B3
67
Occurs in obstructive jaundice and leads to impaired coagulation, resulting in cutaneous hemorrhage with ecchymoses and purpura.
Malabsorption of vitamin K
68
Presents with angular stomatitis, smooth painful tongue, and fragile/brittle nails, which have longitudinal ridging and lamellation. In severe deficiency, koilonychia, a spoonlike convexity of the nails, develops. Hair changes include diffuse scalp alopecia with brittle, split hairs. All take a long time to resolve on replacement therapy.
Iron deficiency
69
Usually presents at weaning or in very early infancy with dermatitic or vesicobullous lesions of the hands, on the feet, and around the mouth and anus, together with progressive alopecia and “failure to thrive.”
Acrodermatitis enteropathica
70
May appear in patients with chronic hepatitis, whatever the underlying cause and even before glucocorticoid therapy
Cutaneous striae
71
Four main cutaneous associations of hepatitis B
1. A serum sickness-like syndrome
2. Cryoglobulinemia
3. Polyarteritis nodosa
4. Papular acrodermatitis of childhood
72
Usually affects children. The appearance of monomorphic, flat-topped, erythematous papules on the face and limbs is characteristic. This eruption is self-limiting and asymptomatic in most, but may be accompanied by lymphadenopathy.
Papular acrodermatitis (Gianotti–Crosti syndrome)
73
A rare autosomal recessive disorder characterized by ataxia, seizures, severe mental retardation, hepatomegaly with liver dysfunction, and brittle hair.
Argininosuccinic aciduria
74
Occurs as a rare complication of Stevens–Johnson syndrome and has been reported to precede the skin signs.
Cholestatic hepatitis
75
Two skin changes that occur in acute renal failure
Edema and uremic frost
76
Vascular calcification is common in patients with long-term CRF, and is seldom symptomatic. Occasionally, however, calcified vessels may thrombose acutely, resulting in a this syndrome. This acute thrombosis produces livedoid areas that are excruciatingly painful due to ischemia, and quickly become hemorrhagic and ulcerate. PTH is usually markedly elevated.
Calciphylaxis
77
Resembles scleromyxedema clinically and histopathologically. Largely occurs in patients with end stage renal disease, most of whom are on hemodialysis and described in a few patients with ARF. Clinically, patients progressively develop erythematous, sclerotic dermal plaques on the arms and legs, with sparing of the head and neck. Pruritus is a common feature.
Nephrogenic fibrosing dermopathy
78
Involvement on the back of the hands over the knuckles and even on the palms can be seen. When the palms are involved, the rugated appearance of the palmar surface has been called this which is usually associated with acanthosis nigricans.
Tripe palms
79
Presents as tightness and thickening of the skin and periarticular connective tissue of the fingers, resulting in a painless loss of joint mobility. Initial involvement of the distal interphalangeal joints of the fifth digit usually progresses proximally to involve all fingers. Larger joints of the elbow, knee, and foot may be affected. The actual joint space, however, remains uninvolved, so it is not a true arthropathy. This disorder is characterized by the “prayer sign,” which is an inability to approximate the palmar surfaces and interphalangeal joint spaces with the hands pressed together and fingers separated.
Diabetic Limited Joint Mobility
80
Disease of long-standing diabetes associated with obesity. Presents with the insidious onset of painless, symmetric induration and thickening of the skin on the upper back and neck. Spreading to the face, shoulders, and anterior torso may occur. The skin retains a nonpitting, woody, peau d’orange quality. May experience decreased sensation to pain and light touch over the affected areas and difficulties with upper extremity and neck range of motion.
Sclerema diabeticorum
81
Present clinically as 1- to 4-mm, reddish-yellow papules on the buttocks and extensor surfaces of the extremities. The lesions occur in crops and may coalesce into plaques over time. These are generally asymptomatic but there is often underlying severe hypertriglyceridemia (>1,000 mg/dL) and potentially undiagnosed diabetes. Histologic and biochemical studies show that lipoproteins (mainly chylomicrons) in the blood permeate cutaneous vessel walls and accumulate in macrophages in the dermis.
Eruptive xanthomas
82
On funduscopic examination, appears as pale pink to white retinal arterioles and venules. Triglyceride levels above 4,000. The fundus may have a milky hue.
Lipemia retinalis
83
Callus formation precedes necrosis and breakdown of tissue over bony prominences of feet, usually on great toe and sole, over first and/or second metacarpophalangeal joints. These are surrounded by a ring of callus and may extend to underlying joint and bone. Complications are soft tissue infection and osteomyelitis.
Diabetic ulcers
84
Bacterial infections More Common or Severe in Diabetes
Invasive Group B Strep
Invasive Group A Strep
Malignant external otitis
Necrotizing fasciitis
85
This disorder was named after characteristic histologic findings and was first described in patients with diabetes. Presents with one to several sharply demarcated yellow–brown plaques on the anterior pretibial region. The lesions have a violaceous, irregular border that may be raised and indurated. Initially, often presents as red–brown papules and nodules that may mimic sarcoid or granuloma annulare (GA). Over time, the lesions flatten, and a central yellow or orange area becomes atrophic, and commonly telangiectasias are visible, taking on the characteristic “glazed-porcelain” sheen. Aside from the shins, other sites of predilection include ankles, calves, thighs, and feet.
Necrobiosis lipoidica diabeticorum
86
Atrophic skin lesions of the lower extremity, or shin spots seen in diabetics. Presents as small (<1 cm), atrophic, pink to brown, scar-like macules on the pretibial areas. The lesions are asymptomatic and clear within 1-2 years with slight residual atrophy or hypopigmentation. The appearance of new lesions gives the sense that the pigmentation and atrophy are persistent.
Diabetic dermopathy
87
Comprise an overlapping group of disorders characterized by transepidermal elimination or “spitting” of altered dermal constituents. Included in this group are Kyrle disease, reactive perforating collagenosis, perforating folliculitis, and elastosis perforans serpiginosa. these lesions appear as pruritic, keratotic papules mainly on the extensor surfaces of the extremities.
Acquired perforating disorders
88
Abrupt, spontaneous development of blisters on the lower extremities without other demonstrable cause usually the toes, feet, and shins, arising in normal skin. The pathogenesis is unknown. The blisters are usually painless and not pruritic. Healing occurs within 2-5 weeks and rarely leaves scarring. Histopathologic examination of the bullae shows an inconsistent level of separation varying from intraepidermal to subepidermal. No immunopathologic features are consistently observed.
Bullosis diabeticorum
89
This hormone is secreted by adipose tissue in proportion to total body fat. It regulates energy homeostasis, neuroendocrine function, and metabolism. Rare cases in humans have shown that its deficiency causes extreme obesity, hyperphagia, diabetes, neuroendocrine abnormalities, and infertility, all of which can be reversed by administration of exogenous.
Leptin
90
Is an endogenous hypothalamic melanocortin receptor antagonist, which causes obesity when overexpressed. The gene is closely related to agouti, a skin pigmentation gene, which causes yellow coat color and obesity when overexpressed in mice.
Agouti-related protein (AGRP)
91
Definition of Metabolic syndrome
1. Abdominal Obesity
2. Serum triglycerides ≥150 mg/dl (or drug treatment for elevated triglycerides)
3. Serum HDL cholesterol <40 mg/dl in men and <50 mg/dl in women (or drug treatment for low HDL-C)
4. Blood pressure ≥130/85 (or drug treatment for elevated blood pressure)
5. Fasting plasma glucose ≥100 mg/dl (or drug treatment for elevated blood glucose)
92
Refer to the hyperplastic growth of thyroid tissue that is functioning independent of TSH regulation, resulting in increased levels of thyroid hormone.
Toxic adenoma and toxic multinodular goiter
93
Results from the excess levels of thyroid hormones with resultant hypermetabolism
Hyperthyroidism (also known as thyrotoxicosis)
94
Is characterized by hypometabolism secondary to diminished levels of thyroid hormone.
Hypothyroidism (or myxedema)
95
Hypertrophy of the thyroid gland from persistent stimulation
Goiter
96
Cutaneous findings in Hyperthyroidism
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Soft, velvety, infant-like skin
Thyroid dermopathy
Soft, fine with diffuse nonscarring alopecia
Facial flushing
Palmar erythema
Hyperpigmentation
Plummer’s nails
Thyroid acropachy
Hyperpigmentation
```
97
Concave shape nails with distal onycholysis
Plummer’s nails
98
Most commonly seen with Graves disease but has been reported in hypothyroid patients as well. Occurs bilaterally as painless nonpitting nodules and plaques with variable coloring and a waxy, indurated texture. The distribution can range from very circumscribed to diffuse, but by far the most common location is on the extensor surfaces of the legs. Some cases can exhibit a peau d’orange appearance as well.
Thyroid dermopathy
99
Refers to digital clubbing, softtissue swelling of the hands and feet, and the presence of characteristic periosteal reactions. This very rare clinical finding is also associated with thyroid dermopathy and exophthalmos, and almost always presents after the diagnosis and treatment of hyperthyroidism.
Thyroid acropachy
100
Cutaneous findings in Hypothyroidism
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Myxedema
Cool temperature
Doughy, dry skin with fine wrinkling
Yellow–orange carotenemia
Dry, brittle hair
Slow growth of hair and nails
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101
The most classic finding associated with hypothyroidism. It occurs as a result of dermal accumulation of mucopolysaccharides, namely, hyaluronic acid and chondroitin sulfate, and tends to resolve with treatment of the hypothyroidism. Tends to be generalized but can appear more striking in the extremities. Characteristic facial changes can be seen, including a broadened nose, thickened lips, puffy eyelids, and macroglossia with a smooth and clumsy tongue. The skin can be doughy, swollen, and waxy, but without pitting.
Myxedema
102
Facial plethora suggestive of compression when patients with large retrosternal goiters raise their arms above their head.
Pemberton’s sign
103
The most common cause of hypercalcemia in outpatients
Hyperparathyroidism
104
Most common cause of hypercalcemia in hospitalized patients
Malignancy
105
Most common causes of hypocalcemia
Vitamin D deficiency
| Surgically induced hypoparathyroidism
106
Secreted by the parathyroid gland in response to low levels of serum calcium and acts as one of the main regulators of calcium levels in the body.
Parathyroid hormone (PTH)
107
Results from abnormal function of the parathyroid gland, resulting in increased levels of PTH.
Primary hyperparathyroidism
108
Cutaneous findings in Hypoparathyroidism
Scaly, hyperkeratotic, puffy skin
Patchy alopecia with hair thinning
Brittle nails with transverse ridging
109
Excessive production of endogenous cortisol manifests clinically as
Cushing syndrome
110
Increased central adiposity (moon facies and buffalo hump) with thinning of the extremities
Skin thinning and easy bruisability
Violaceous striae
Acanthosis nigricans
Increased dermatophyte and candidal skin and nail infections
Rarely, hyperpigmentation
Cutaneous findings in Cushing syndrome
111
Hyperpigmentation of skin and mucous membranes
Longitudinal pigmented bands in the nails
Vitiligo
Decreased axillary and pubic hair in women
Calcification of auricular cartilages in men
Cutaneous findings in Addison disease
112
Destruction of the adrenal glands and the resulting life-threatening deficiency of glucocorticoids, mineralocorticoids, and adrenal androgens
Addison disease
113
In the setting of an acute bacterial infection, bilateral adrenal infarction due to adrenal hemorrhage is known as
Waterhouse–Friderichsen syndrome
114
Kligman’s formula
5% hydroquinone
0. 1% tretinoin
0. 1% dexamethasone
115
Sudden onset of acne
Severe acne refractory to conventional treatments
Irregular menstrual periods
Hirsutism
Hyperandrogenism
116
Increased central adiposity (moon facies and buffalo hump) with thinning of the extremities
Skin thinning and easy bruisability
Violaceous striae
Acanthosis nigricans
Increased dermatophyte and candidal skin and nail infections
Rarely, hyperpigmentation
Cutaneous findings in Cushing syndrome
117
Secreted by the pituitary in a pulsatile fashion and reaches its maximum rate during puberty and then declines over time
Growth Hormone
118
Enlargement of hands and feet with a doughy texture
Increased ring, glove, shoe, and hat size
Jaw enlargement with separation of teeth (prognathism)
Macroglossia
Cutis vertices gyri
Acanthosis nigricans
Hirsutism
Hyperhidrosis
Brittle thick nails
Cutaneous findings in Acromegaly
119
A multisystem granulomatous disease of unknown cause. The lung is the most commonly affected organ, but the skin is frequently involved.
Sarcoidosis
120
Development of sarcoidosis requires at least three major events:
1. Exposure to antigen(s),
2. Acquired cellular immunity directed against the antigen and mediated through antigen-presenting cells and antigen-specific T lymphocytes
3. The appearance of immune effector cells that promote a nonspecific inflammatory response
121
Describes the relatively symmetric, violaceous, indurated plaques and nodules that occur on the nose, earlobes, cheeks, and digits. This clinical variant of sarcoidosis is distinctive and has been associated with systemic involvement.
Lupus pernio
122
Pink papules and plaques with prominent telangiectasias that usually occur on the face and may be a variant of lupus pernio, as both lesions usually appear on the face and can be violaceous. However, these tend to be less numerous than the papular and lupus pernio forms.
Angiolupoid lesions
123
Rarely, sarcoidosis can present as persistent subcutaneous nodules. The nodules may be tender or painless and preferentially occur on the extremities.
Darier-Roussy sarcoid
124
The bilateral enlargement of the lacrimal, parotid, sublingual, and submandibular glands may be caused by Sarcoidosis
Mikulicz syndrome
125
The main nonspecific cutaneous manifestation of sarcoidosis (prevalence of approximately 17%)
Erythema nodosum
126
The most common organ involved with sarcoidosis
Lung
127
The most common ocular manifestation in sarcoidosis and can lead to cataracts and glaucoma
Uveitis
128
Reflect the total granuloma burden in sarcoidosis; useful to monitor the course of sarcoidosis.
Serum Angiotensin-Converting Enzyme (SACE) levels
129
Histopathology: noncaseating granulomatous inflammation with multinucleated giant cells and a surrounding zone of lymphocytes.
Sarcoidosis
130
Chest radiograph findings: sarcoidosis
Asymptomatic hilar adenopathy
131
Bilateral lacrimal and parotid gland uptake in Gallium-67 scanning
Panda sign
132
Bilateral hilar and right paratracheal uptake in Gallium-67 scanning
Lambda sign
133
Good Prognosis for Sarcoidosis
Erythema nodosum
| Stage I vs. II–III CXR
134
Poor Prognosis for Sarcoidosis
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African descent
Extrathoracic disease
Age >40 years
Splenic involvement
Lupus pernio
Disease duration >2 years
FVC <1.5 L
Stage IV CXR/aspergilloma
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