summary t/f Flashcards
1
Q
Hepatitis B infection can b associated with urticaria, Gianottic-Crosti syndrome and polyarteritis nodosa
A
T
2
Q
40% of type II cryoglobulinaemia is HCV associated
A
F 70-90%
3
Q
Mixed cryoglobulinaemia is characterised by small vessel vasculitis, livedo reticularis, acrocyanosis, peripheral neuropathy, hepatosplenomegaly and hypocomplementaemia
A
T
4
Q
Hepatitis B is associated w Necrolytic acral erythema
A
F hep C
5
Q
Necrolytic acral erythema appears as well-circumscribed, dusky erythematous plaques with adherent scale
A
T
6
Q
The connection between lichen planus and hepatitis C infection may actually be due to geographical variation
A
T
7
Q
Cutaneous features of chronic liver disease
A
Acral erythema Spider naevi + telangiectasia Dilated abdominal/chest veins caput medusa Nail – clubbing, pallor, Muehrcke’s bands, Bruising, purpura Jaundice Thin skin, striae Excoriations Features of malnutrition Associated lesions xanthomas PCT Vasculitis LP
8
Q
Pigmentation in haemochromatosis is due to haemosiderin deposition in the skin
A
F Melanin
9
Q
Strongest risk factors for expression of PCT are HCV infection and homozygosity for C282Y (haemochromatosis) mutation
A
T
10
Q
Jaundice is first seen as a yellowish hue of the sclerae and soft palate
A
T
11
Q
Carotenaemia also affects the sclerae
A
F
12
Q
Acquired zinc deficiency in adults may be characterised by an reticulate eczema, erosions in the perianal and genital areas, cheilitis, hair loss and Beau’s lines
A
T
13
Q
Jaundice and panniculitis are the most common skin changes associated w pancreatitis
A
T
14
Q
Pancreatic panniculitis can be caused by acute or chronic pancreatitis, pancreatic carcinoma, pancreatic pseudocyst, traumatic pancreatitis
A
T – any cause of pancreatitis or pancreatic insult. 1/3 are caused by pancreatic carcinoma, so must always be aware
15
Q
Trousseau’s sign describes a Sister Mary Joseph nodule when it occurs in conjunction with pancreatic carcinoma
A
F 10% of cases of sister mary joseph nodule is due to pancreatic carcinoma Trusseau’s sign describes multiple, migratory superficial thrombosis and is classically associated w pancreatic ca and lung ca
16
Q
Necrolytic migratory erythema occurs in association w malignant adrenal carcinoma
A
F hyperglucagonaemia – glucagonoma – a-cell tumour in tail of pancreas Other causes include pancreatic insufficiency intestinal malaborsoprtion or protein loss liver cirrhosis aberrant glucoagon secreting tumours – bronichial or nasopharyngeal
17
Q
Glucagonomas occur in MEN syndromes
A
T but more in MEN type 1 Classically MEN type I but also MEN type II
18
Q
- Hepatitis B infection can b associated with urticaria, Gianottic-Crosti syndrome and polyarteritis nodosa
A
T
19
Q
- 40% of type II cryoglobulinaemia is HCV associated
A
F 70 – 90%
20
Q
- Mixed cryoglobulinaemia is characterised by small vessel vasculitis, livedo reticularis, acrocyanosis, peripheral neuropathy, hepatosplenomegaly and hypocomplementaemia
A
T
21
Q
- Hepatitis B is associated w Necrolytic acral erythema
A
F hepatitis C
22
Q
- Necrolytic acral erythema appears as well-circumscribed, dusky erythematous plaques with adherent scale
A
T
23
Q
- The connection between lichen planus and hepatitis C infection may actually be due to geographical variation
A
T
24
Q
- Cutaneous features of chronic liver disease
A
Acral erythema Spider naevi + telangiectasia Dilated abdominal/chest veins caput medusa Nail – clubbing, pallor, Muehrcke’s bands, Bruising, purpura Jaundice Thin skin, striae Excoriations Features of malnutrition Associated lesions xanthomas PCT Vasculitis LP
25
8. Pigmentation in haemochromatosis is due to haemosiderin deposition in the skin
F – due to melanin
26
9. Strongest risk factors for expression of PCT are HCV infection and homozygosity for C282Y (haemochromatosis) mutation
T
27
10. Jaundice is first seen as a yellowish hue of the sclerae and soft palate
T
28
11. Carotenaemia also affects the sclerae
F
29
12. Acquired zinc deficiency in adults may be characterised by an reticulate eczema, erosions in the perianal and genital areas, cheilitis, hair loss and Beau’s lines
T
30
13. Jaundice and panniculitis are the most common skin changes associated w pancreatitis
T
31
14. Pancreatic panniculitis can be caused by acute or chronic pancreatitis, pancreatic carcinoma, pancreatic pseudocyst, traumatic pancreatitis
T – any cause of pancreatitis or pancreatic insult. 1/3 are caused by pancreatic carcinoma, so must always be aware
32
15. Trousseau’s sign describes a Sister Mary Joseph nodule when it occurs in conjunction with pancreatic carcinoma
F 10% of cases of sister mary joseph nodule is due to pancreatic carcinoma Trusseau’s sign describes multiple, migratory superficial thrombosis and is classically associated w pancreatic ca and lung ca
33
16. Necrolytic migratory erythema occurs in association w malignant adrenal carcinoma
F – hyperglucagonaemia – glucagonoma – a-cell tumour in tail of pancreas Other causes include pancreatic insufficiency intestinal malaborsoprtion or protein loss liver cirrhosis aberrant glucoagon secreting tumours – bronichial or nasopharyngeal
34
17. Glucagonomas occur in MEN syndrome
T – MEN type I only No! Classically MEN type I but also MEN type II
35
18. Skin changes persist following removal of glucogonoma
F – resolve
36
19. Clinical features of Necrolytic migratory erythema include an itchy, burning rash on flexural sites including lower abdomen, groing, buttocks and thighs
T fragile bullae and vesicles, irregular centrifugal annular lesions which can crust has fluctuating course of cyclical pattern anbular cheilitis and glossitis
37
20. Other systemic features of glucagonoma
Weight loss Anaemia Diabetes Diarrhoea Weakness Venous thrombosis Psychiatric disturbances Zinc deficiency
38
21. Marked spongiosis and hyperkeratosis are typically seen in necrolytic migratory erythema
F – dyskeratotic dermatitis w superficial perivascular inflammation, mild spongiosis Clefts and necrotic keratinocytes and cellular debris
39
22. Glucagonoma can be treated with somatostatin analogues
T Octreotide – improves rash and symptoms by altering glucagon metabolism Lantreotide can last for 2 weeks
40
23. Fabry’s disease is due to alpha-galactosidase A deficiency
T
41
23.a Fabry’s disease can be treated using synthetic a-galactosidase
T
42
24. Renal disease and other systemic manifestations is due to deposition of neutral glycosphingolipids in vascular endothelium and tissue in Fabry disease
T
43
23. Features of Nail Patella syndrome
Triangular lunulae Hypoplastic thumbs Defective thumb nails Aplastic patellas w joint instability Renal failure Glaucoma Exostoses arising from the posterior aspect of the iliac bones ("iliac horns") are present in as many as 80% of patients; this finding is considered pathognomonic for the syndrome. Subluxation of radial heads
44
24. Genodermatoses associated w renal carcinoma
Birt-Hogge Dube syndrome Hereditary leiomyomatosis and renal cell carcinoma Cowden’s disease von Hippel-Lindau syndrome
45
25. Cutaneous features of systemic amyloidosis include waxy, purpuric lesions as well as hepatomegaly, oedema and carpal tunnel
T
46
26. Calciphylaxis is always associated w high serum calcium phosphate
F – usually but not always
47
27. All patients who present with cutaneous vasculitis should have a urine dipstick and serum creatinine and eGFR checked
T
48
28. Kyrle’s disease is a reactive perforating collagenosis associated w renal failure
T also associated diabetes Very itchy
49
29. Pruritus in renal failure is invariably associated w hyperuricaemia
F – often, but not always, mechanism is unclear
50
30. Nephrogenic systemic fibrosis is associated w gadoimium containing radiocontrast dyes used in patients with chronic renal failure
T
51
31. Patients with liver transplants appear to have a higher incidence of cutaneous malignancy than renal transplant patients
F – vice versa. Due to ↑ immunosuppression required + ↑ longevity post transplant
52
32. Post-renal transplant, patients BCC risk increases up to 250 fold
F – BCC ↑ risk by 10 fold. SCC ↑ risk by 65 – 250 fold
53
33. Uncontrolled expression of HPV infection may be a co-factor in the increased risk of SCC in immunosuppressed transplant patients
T
54
34. 90% of children with Kawasaki disease develop coronary artery aneurysms
F – 25%
55
25. Pericarditis can occur in systemic lupus
T
56
26. The cardiac muscle is classically the only organ not affected in systemic sclerosis
F – involvement in 80%
57
27. Stigmata of subacute bacterial endocarditis
Septic emboli or immune complex cause skin findings purpuric, pustular or erythematous non-specific small vessel vasculitis spinter haemorrhages Roth sponts – haemorrhages in conjunctivae and retina Oselrs nodes – small, tender, red papules on distal phalanx Janeway lesions – faint, red, macular lesions on thenar and hypothenar eminences
58
28. Features of Carney complex please
Skin – naevi + blue naevi, lentigines, ephelides, myxoid neurofibromas Pigmented adrenocortical nodules – adrenal hyperplasia and is therefore a rare cause of ACTH independent Cushing’s syndrome Precocious puberty in females Atrial myxomas Also GH-secreting pituitary tumours Sertoli cell and leydig cell testicular tumours Thyroid cysts Ovarian cysts and tumours
59
29. Dermatomyositis may be a paraneoplastic phenomenon due to lung cancer
T
60
30. Systemic sclerosis may be associated w fibrosing alveolitis and interstitial fibrosis
T
61
31. Loeffler’s syndrome describes pulmonary infiltrates and peripheral eosinophilia and is often due to parasitic infection
T
62
32. Relapsing polychondritis is due to autoantibodies against type III collagen
F – type II
63
33. Dermatomyositis is usually related to anti-La antibodies
F – anti-Jo-1
64
34. Yellow nail syndrome occurs without associated systemic features
F – pleural effusion, bronchiectasis, chronic lung infections, empyema, lymphoedema, sinus infections
65
35. Sickle cell anaemia and thalassaemia can be causes of recalcitrant lower leg ulcers
T
66
36. Aquagenic pruritus appears in polycythaemia rubra vera with RBC counts above 200g/L
F – aquagenic pruritus can predate PCV
67
37. Erythromelalgia is associated with sickle cell anaemia
F – with PCV
68
38. Eosinophilia myalgia syndrome is an idiopathic fibrotic condition
F associated with ingestion of tryptophan
69
39. Wells’ syndrome may clinically mimic bacterial cellulitis, but has a dense eosinophilic infiltrate
T
70
40. Hypereosinophilic syndrome has eosinophilis in excess of 1500/uL w no apparent cause for greater than 6/12
T Can have endomyocardial fibrosis, eosinophilic vasculitis, thrombosis, ane cutaneous lesions
71
41. Disorders associated w leukaemia
Sweet’s syndrome Neutrophilic dermatosis of dorsal hands Pyoderma gangrenosum Subcorneal pustular dermatosis EED Neutrophilic eccrine hidradenitis Vasculitis Eosinophilic pustular folliculitis erythroderma JXG w NF-1 juvenile chronic myelomonocytic leukaemia Leukaemia cutis Relapsing polychondritis MDS
72
42. Leukaemia cutis is more common in chronic leukaemia than acute
F – more common in acute [AML] Although can occur in any chronic and may herald a blast transformation
73
43. Coumarin necrosis is due to a temporary reduction in levels of vitamin K dependent natural anticoagulants causing a temporary state of thrombophilia
T
74
44. Warfarin necrosis is more common in Males
F – Females
75
45. What does POEMS syndrome stand for
Polyneuropathy, organomegaly of liver, spleen, lymph nodes, Endocrinopathy, Monoclonal gammopathies, skin changes
76
46. Genodermatoses with associated haematological malignancy
Chediak higashi Wiskott Aldrich Hermansky pudlak Griscelli NF-1 + JXGs Dyskeratosis congenital Fanconi’s anaemia
77
47. Erythema chronicum migrans is most commonly associated with dermatophyte infection
F – lyme borreliosis – Borrelia burgodorferi sensu lato, B afzelli, B. garinii
78
48. Erythematous plaque or urticated lesion with expands with central clearing occur in erythema chronicum migrans
T
79
49. After the initial lesion, crops of vesicles can develop and sites distant to erythema chronicum migrans site
F – lesions resembling EAC or EM can develop. Smaller than initial lesion
80
50. Histologically erythema chronicum migrans shows superficial and deep perivascular lymphocytic infiltrate around vessels and appendages w occasionally plasma cells
T
81
51. Erythema marginatum rheumaticum is associated with rheumatoid arthritis
F – rheumatic fever
82
52. erythema marginatum rehumaticum clinically consists of rings or segments of rings, pale or dull red in colour which can fade in a few hours and occur in recurrent crops in different sites
T
83
53. Erythema gyratum repens is always associated with malignancy
F – 80% of the time Has also been associated with CREST syndrome, tuberculosis, drug hypersensitivity
84
54. Erythema gyratum repens is most commonly associated w lung cancer in 33%
T – and then bowel, oesophagus, urogenital, breast, panceas, haematological
85
55. Erythema gyratum repens is thought to be immunologically mediated
T – supported by deposition of C3 or IgG in sublamina densa
86
56. Erythema gyratum repens clinically resembles the grain of wood
T
87
57. DDx for Erythema gyratum repens
Dermatophyte infection – tinea imbricate Lupus erytehamosus Necrolytic migratory erythema Erythrokeratoderma variabilis Subacute annular variant of psoriasis – Lapiere [! Its in Rook 62.108!] I had TEN T = Tinea imbricate E = Erythrokeratoderma variabilis N = NME
88
58. Annular erythema of infancy is really just EAC in children
T
89
59. In annular erythema of infancy and infective source can be sought and treated, often with a good response of cutaneous lesions
T
90
60. Annular erythema associated with extractable nuclear antigens is seen in Lupus, Sjogren’s disease, Neonatal lupus
T and is associated with anti-SSA and anti-SSB antibodies
91
61. Common associations with erythema annulare centrifugum are fungal infections, other viral infections, drugs, lymphoma
T
92
62. Histologically EAC shows perivascular ‘sleeve-like’ lymphohistiocytic infiltrate -
T
93
63. Erythema annulare centrifigum appears as a small, pink, infiltrated papule, which gradually enlarges s a ring
T
94
64. Treatment for EAC
Discovery and elimination of cause if possible Antihistamines Topical corticosteroids Vitamin D Narrow-band UVB ? systemic immunosuppressants
95
65. What does SAPHO syndrome stand for
Synovitis Acne Pustolosis Hyperostosis Osteitis
96
66. Hidradenitis suppurativa is associated with arthralgia and bone changes, but interestingly, Acne fulminans is not
F
97
67. Facial features of acromegaly include prognathism, frontal bossing, oily skin, large and furrowed tongue, triangular ears
T Also acanthosis nigricans and Addisonian like pigmentation due to ↑ MSH
98
68. Pituitary insufficiency may manifest as hyperpigmentation due to uncontrolled secretion of MSH
F – Decreased MSH – hypopigmentation, but mucous membranes retain normal colour Also ↑ sunburning and lack of tanning
99
69. Pituitary Cushing’s disease causes hyperpigmentation as secretion of pro-opiomelanocortin causes overproduction of ACTH and MSH
T
100
70. What are screening tests for Cushing’s disease
24-hour urinary cortisol and 1mg overnight dexamethasone suppression tests - values 4 x normal
101
71. Nelson’s syndrome is eponymous for empty sella syndrome
F – Nelson’s syndrome is the rapid growth of pituitary adenomas following adrenalectomy
102
72. Addisons’s disease refers to an overactive adrenal gland
F – adrenal insufficiency
103
73. Secondary adrenal insufficiency due to hypothalamic or pituitary insufficiency lacks pigmentary changes
T
104
74. Describe features of Addisonian pigmentation
Slow onset Light exposed areas – face, dorsa of hands Accentuation in genital, perineum, axillae, areolae, any areas subject to friction (eg elbows, knees, under clothing) Scars Tongue, mucous membranes Darker hair and longitudinal melanonychia Eruptive lentigines and darkening existing pigmented lesions
105
75. Addisonian pigmentation can be seen in primary adrenal insufficiency, Nelson’s syndrome, tumour casuing ectopic ACTH secretion, Cushings disease
T
106
76. In congenital adrenal hyperplasia and late onset adrenal hyperplasia 17-hydroxyprogesterone, cannot be converted to 11-deoxycortisol
T
107
77. Congenital adrenal hyperplasia is associated with endogenous steroid induced acne
F – acne is due to excessive adrogens Other symptoms include Premature pubic hair Hirsuitism Acne Temporal baldness Infertility Growth spurt
108
78. Nail changes seen in hyperthyroidism
Thin, onycholysis (Plummer’s nails), fast growing Plummer’s = onycholysis & koilonychias; begins on 4th finger
109
79. Diamond’s triad which is associated w Graves disease refers to pretibial myxoedema, thyroid acropachy, exophthalmos
T – PTO
110
80. Pretibial myxoedema develops in patients with hypothyroidism
F – hyperthyroidism
111
81. Histologically pretibial myxoedema may be seen as a thickened dermis with increased collagen
F thickened dermis, w extensive deposits of acid mucoplysaccharides acausing separation of collagen fibres
112
82. Thyroid acropachy refers to the eye changes seen in Graves disease
F – clubbing of fingers and toes in associated w soft tissue swelling of hands and feet w periosteal bone formation
113
83. Cutaneous findings of hypothyroidism include pale, cold scaly skin w asteatotic eczema and anhidrosis
T
114
84. Loss of the medial third of the eyebrow – Hertog’s sign, is common in hypothyroid patients
F – loss of lateral third
115
85. The main dermatological clinical signs seen in parathyroid disease are related to calciphylaxis and ossification
T
116
86. Paget’s disease of the breast is thought to be due to direct epidermal extension of an underlying ductal squamous cell carcinoma
F - adenocarcinoma
117
87. What are some markers for Paget’s
EMA – epithelial membrane antigen CEA carcinoembryonic antigen Cytokeratins CK 7 Mucins – MUC1 CD 23 – lymphoid and apocrine/eccrine marker
118
88. Extramammary Paget’s disease occurs in areas with eccrine ducts
F – apocrine gland bearing areas - anogenital and axillary sites
119
89. 25% have underlying cancer
T – cpd to all Paget’s
120
90. Extramammary paget’s disease can be from direct extension from carcinoma of underlying apocrine glands or from a distant tumour
T
121
91. Most common source of cutaneous metastases are upper aerodigestive tract
F – breast or melanoma
122
92. Sister Mary Joseph’s nodule is most commonly related to bowel tumours
T – only 10% pancreatic
123
93 Cutaneous metastases usually have a poor prognosis and indicate disseminated disease
T
124
94. Internal malignancies associated with Gorlins syndrome
Medulloblastoma Astrocytoma Meningioma Fibrosarcomas Uterine fibroids, desmoids and sarcomas
125
95. CDKN2A mutation is associated with melanoma and renal cell carcinoma
F Melanoma Breast Thyroid GIT SCCs Larynx Pancreas Ocular
126
96. Cowdens syndrome exhibits facial tricholemommas, acral keratosis, and palmar pits
T
127
97. Cowden’s syndrome is not associated w increased risk of cutaneous malignancy
F - melanoma
128
98. Muir Torre syndrome is associated with increased risk of thyroid carcinoma
F colonic Renal Urogenital Sebaceous adenocarcinoma endometrial
129
99. Uterine cancer is the most strongly associated with Acanthosis nigricans
F – gastric adenocarcinoma
130
100. Tripe palms alone (or with clubbing) are indicative of bronchial carcinoma
T
131
101. Sign of Lesar-Trelat (eruptive Seborrheic keratosis) is highly indicative of internal malignancy
F only weak association May also occur in HIV infection, acromegaly and in resolving phase of erythrodermic dermatoses MEAL M = Malig E = Erythroderma A = AIDs L = Lymphoproliferative 20%
132
102. Acrokeratosis paraneoplastic effects then hands and feet only
F – all peripheries inc tip of nose helices of ears, hands and feet and may then become generalised
133
103.Basex syndrome can occur without underlying malignancy
F – this is a required criterion for diagnosis - most common in SCC or upper respiratory tract or GIT and w metastases to cervical lymph nodes
134
104. Multicentric reticulohistiocytosis is associated with solid tumour
T – 25% of cases Papules around nail folds – coral bead sign, symmetrical polyarthritis
135
105. Which haematological disorder is erythromelalgia linked with
Polycythaemia rubra vera Essential thrombocytaemia
136
106 Actinic cheilitis is a cutaneous manifestation of Crohn’s disease
F – granulomatous cheilitis
137
107. Lesions associated with IBD
Erythema nodosum Aphthous ulceration Erythema multiforme Urticaria and angio-oedema Neutrophilic dermatosis – pyoderma gangrenous and sweets Vasculitis and intravascular coagulation
138
108. Pyoderma gangrenosum is more common in patients with ulcerative colitis than those with Crohn’s disease
T – 5% of all UC pts & parallels the GI disease
