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Derm1 > Skin S/S of systemic Dz > Flashcards

Skin S/S of systemic Dz Flashcards

1
Q

3 manifestations of hyperthyroidism?

A

Diffuse goiter
Ophthalmopathy (lid lag, proptosis, chemosis, conjectivitis, exophthalmos)
Dermopathy (pretibial myxedema)
Occuring Independent or together

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2
Q

Hyperthyroidism morphology

A

Moist, smooth, warm skin
Hyperhidrosis
Palmer erythema
Soft, fine, or thinning hair
Bronze tint to skin
Thyoid acropachy - digital clubbing, periosteal change
Plummers Nail - Onycholysis (brittle concave nails)

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3
Q

Hypothyroidsm features

A 
Flat affect
Large smooth red clumsy tongue
Skin - swollen, cool, waxy, dry, coarse, pale, wrinkles
Eyelid puffy
Yellow tint to palm/soles - carotenemia
Hair is dry , coarse and brittle
Lat 3rd eyebrow = alopecia
Nails gorw slow and are brittle
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4
Q

Thyroid disease Pretibial myxedema Early S/S

A

Bilateral, asymmetric, firm nonpitting nodules and plaques

Pink or purple skin color

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5
Q

Thyroid disease Pretibial myxedema Late S/S

A

Confluence of nodules becomes symmetric
Severe = lower legs/dorsal feet disfigured
Exaggeration of hair follicles (orange peel look)

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6
Q

Pretibial myxedema occurs w/?

A

Hyper or hypo-thyroidism
Even can occurs w. Euthyroid pts
MC- ass/w graves Dz

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7
Q

TXT Pretibial myxedema

A

Topical Steroids w/ occl.
Compression stockings (20-40mm Hg)
Intralesional Triamcinolone

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8
Q

Hyperthyroidism Systemic TXT?

A

Surgical ablation or radioactive Iodine

Anti-thyroid drugs (PTH-methimazole)

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9
Q

Hypothyroidism TXT?

A

Replacement therapy w/ Levothyroxine (T4)

-will correct skin defects

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10
Q

Vitiligo is

A

Acquired loss of pigmentation due to absence of melanocytes because of Autoimmune Dz or genetics

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11
Q

Types of vitiligo?

A 
Type A (MC) - generalized
Type B - segmental
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12
Q

Type A Vitiligo attributes

A

Systemic - White macules
-Dorsal hands, Face, Body folds, genitalia, orifices
-Koebnerized at elbows or w/ sunburn
Ass/w Halo nevi

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13
Q

Type B Vitiligo attributes

A

Asymmetric pattern
Follicles also depigmented
Earlier onset

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14
Q

Vitiligo concerns -

A

Psychologic
Eye - depigment retinal epithelium = uveitis risk
Ear - depigment membranous labyrinth = hearing issue
Aseptic meningitis - leptomeningeal melanocyte death

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15
Q

Vitiligo comorbidities?

A 
Alopecia areata
Hypothyroidism
Graves Dz
Addison Dz
Pernicious anemia
DM1
Melanoma
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16
Q

Vitiligo TXT

A

Fair skin - no TXT (Avoid tanning)

Stim melanocyte migration w/in hair follicle reservoir

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17
Q

Cushing syndrome/Disease is?

A

Resdistribution of adipose

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18
Q

Cushing syndrome/Disease well known S/S?

A 
Central obesity
moon facies
buffalo hump
Abd purple striae
Distal extremitis muscle wasting
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19
Q

Cushing syndrome/Disease atrophic skin S/S?

A

Bright purple straie, eccymosis

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20
Q

Cushing syndrome/Disease other skin S/S?

A

Steroid acne

Hirsutism

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21
Q

What is hirsutism?

A

Adrenal androgens

  • Facial hypertrichosis
  • Androgenic alopecia - Females
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22
Q

Cushing syndrome/Disease etiology

A

Adrenal axis Dysfx

Iatrogenic - (PO/Top) CCS

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23
Q

Cushing syndrome/Disease labs

A

Overnight dexamethasone suppression test

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24
Q

Cushing syndrome/Disease TXT?

A

Decrease or D/C CCS

Endocrine W/U to correct UC

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25
Q

Acanthosis Nigricans is?

A

Nonspecific rxn patten of symmetrical brown thickening of skin that has velvety texture and is hyperpigmented
Can become leathery, warty, or papillomatous

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26
Q

A pt w/ Acanthosis Nigricans must go see who?

A

GI referal to R/O stomach cancer

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27
Q

Acanthosis Nigricans distro?

A 
MC - Axilla
Flexors of neck
Groin
Belt line
Dorsal surfaces of fingers
Around areola
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28
Q

Acanthosis Nigricans MC etiology?

A 
Gastic Malig
(Others is endorcinopathy)
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29
Q

Acanthosis Nigricans TXT?

A

Asymptomatic Lesions - dont req TXT
Ammonium lactate - softens lesions
Tretinoin cream - Thins Hyperkeratotic skin
TXT malig or endocrinopathy PRN

30
Q

Xanthomas is?

A

Lipids deposits in the skin and tendons 2/2 to hyperlipidemia

31
Q

Xanthomas 5 major types?

A 
Xanthelasma -MC - Check lipids
Eruptive
Plane
Tuberous
Tendinous
32
Q

Xanthelasma attributes -

A

MC

Superficial, flat, yellow plaques around eyes (inner/outer canthus)

33
Q

Xanthelasma is an independent RF for?

A

CV death (Even tho 50% of pts have normal lipids)

34
Q

Eruptive xanthomas attributes -

A

Yellow 1-4mm papules w/ red halo
Sudden onset of crops
Distro - Ext surfaces arm/legs, ass, pressure points
Clears rapidly -serum lipids levels decrease
S/S of hypertriglyceridemia

35
Q

Tuberous Xanthoma attributes -

A

Slow evolving yellow papules, nodules, tumors
Distro- Knees, elbows, ext surfaces of palms and body
painless
S/S of hypertrigly or biliary cirrhosis
Can persist post TXT

36
Q

Tendinous Xanthoma attributes -

A

Smooth deeply situated nodules
Nodules attach to tendons, ligaments, fascia
MC attachment is Achilles
S/S of hyperlipidemia or Biliary cirrhosis
May persist post TXT

37
Q

Xanthom TXT

A 
Low fat/calorie diet
Stop Smoking
Exercise
TXT dyslipidemia
Trichloroacetic acid (TCA) for cosmetic purposes
38
Q

Granuloma Annulare is a?

A

Self limiting condition w/ no etiology that affects children or young adults (F:M 2:1)

39
Q

Granuloma Annulare morphology?

A

Ring of small firm flesh colored red papules
Localized - lateral/dorsal hands/feet (MC) (Bo/knee)
Undegoes central involution
Ring of papules slowly increase in diameter

40
Q

Granuloma Annulare generalized form is ass/w?

A

DM or HIV

41
Q

Granuloma Annulare TXT?

A

None - Spon resolve
Toublesome
- Topical steroid w/ occl.
- Intralesional steroid - Triamcinolone acetonide in ring
Disseminated GA - PUVA (or Dapsone, isotretinoin, hydroxychloroquine)

42
Q

Sarcoidosis is a? pop? presents?

A

Systemic granulomatous dz affecting <40yo

Fever, Fatigue, wgt loss, dyspnea

43
Q

Sarcoidosis Morphology early?

A 
Skin colored papules or brown/purple plaues on face, ext, buttocks, trunk
Erythema nodosum (MC) Nonspecific lesion
44
Q

Sarcoidosis morphology later?

A

Hyper/hypepigmented macules, papules, blue/red plaques

Affinity for scars

45
Q

Sarcoidosis appearance under a slide?

A

Apple jelly appearance

46
Q

MC nonspecific lesions for Sarcoidosis?

A

Erythema nodosum - Red node-like swelling over shins w/ ill-defined border preceded by flu-;like systems

47
Q

Sarcoidosis and lupus pernio?

A

Diffuse violaceous, soft, doughy, infltrations of nose, cheeks or earlobes

48
Q

Lupus pernio is ass/w

A

Sarcoidosis

49
Q

Sarcoidosis disto?

A

Skin - Anywhere (Esp. Face, Eyes-uveitis, Nose, Mouth, Ext)

Sys - Lung, Bones

50
Q

Sarcoidosis W/U?

A 
Broncoscopic, lesional, lymph node Bx
CXR
Eye exam
EKG
Labs (^Ca, Bun/Cr)
51
Q

Sarcoidosis confirmational Dx?

A

Broncoscopic, lesional, lymph node Bx

52
Q

Sarcoidosis CXR results?

A

Hilar LAD

Pulm infiltrate

53
Q

Sarcoidosis TXT?

A

(PO) Steroids - skin, ocular, pulm, heart Dz
Sml lesions - Intralesional CCS - Triamcinolone
Failed (PO) Steroids > Methotrexate

54
Q

Necrobiosis Lipoidica disto

A

Anterior tib/fib

55
Q

Necrobiosis Lipoidica morphology

A

Starts - Oval, violaceous, patch, that expands slowly
Evolves-red advancing border, w/ yellow-brown center
-atrophies, waxy, prominent telangiectasia
Ulcerates

56
Q

Necrobiosis Lipoidica Dx how?

A

Clinically

57
Q

Necrobiosis Lipoidica - Degenerative ischemic changes

A

Thinning, Shallow depressed scars, Woody induration DM dermaopathy w/w/out vesicles/bulla

58
Q

Necrobiosis Lipoidica etiology ass/w?

A

DM (and/or microangiopathy)

59
Q

Necrobiosis Lipoidica can evolve into?

A

SCC - rare

60
Q

Necrobiosis Lipoidica TXT -

A 
No evidence based guidelines
- Top/IL steroids (stops inflam but causes atrophy)
Systemic PO steroids - 3-5wk
-Pentoxifylline
-ASA
61
Q

Kaposi’s Sarcoma is?

A

Vascular neoplasm (Aids related)

62
Q

Kaposi’s Sarcoma 5 sub-types

A 
Classic
African Cutaneous
African LAD
AIDS
Immunosuppressive
63
Q

Classic Kaposi’s Sarcoma attributes?

A

Older men
Slow progression
Distro - Hands/feet, Low legs (progress up arms/legs)
HIV/AIDS distro anywhere, (MC - trunk, head, neck)

64
Q

What is the MC tumor in AIDS pts?

A

Classic Kaposi’s Sarcoma

65
Q

Classic Kaposi’s Sarcoma AIDS related morphology?

A

Slightly raised elongated/oval rust colored infilitrates that are poorly demarcated
Progress rapidly to > Red/Purple nodules/plaques
Ulcerates and bleeds

66
Q

How to differ Lichen Planus vs Kaposi’s Sarcoma?

A

Firm pressure > decreases size of nodules
Releasing pressure > returns to/increases in size
Sign of Kaposi’s Sarcoma

67
Q

Kaposi’s Sarcoma disto?

A

Older men on legs

HIV - trunk/face

68
Q

Kaposi’s Sarcoma Dx?

A

Bx - proliferated BVs w/ neoplastic endothelial cells

69
Q

Does someone have to have aids to have Kaposi’s Sarcoma?

A

No

70
Q

Kaposi’s Sarcoma etiology

A

HHV-8 human herpes virus (oral cavity primary source M2M sex)

71
Q

Kaposi’s Sarcoma TXT

A

Liqoud nitrogen cryotherapy
Excise
Intralesional chemo (nodular lesions >1cm) -Vinblastine
Radiotherapy for LRG tumor masses
HAART for extensive AIDS related Dz (anti-retovirals)

Derm1 (7 decks)

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