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Cutaneous Manifestations Of Systemic Disease Melissa > summary t/f > Flashcards

summary t/f Flashcards

1
Q

Hepatitis B infection can b associated with urticaria, Gianottic-Crosti syndrome and polyarteritis nodosa

A

T

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2
Q

40% of type II cryoglobulinaemia is HCV associated

A

F 70-90%

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3
Q

Mixed cryoglobulinaemia is characterised by small vessel vasculitis, livedo reticularis, acrocyanosis, peripheral neuropathy, hepatosplenomegaly and hypocomplementaemia

A

T

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4
Q

Hepatitis B is associated w Necrolytic acral erythema

A

F hep C

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5
Q

Necrolytic acral erythema appears as well-circumscribed, dusky erythematous plaques with adherent scale

A

T

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6
Q

The connection between lichen planus and hepatitis C infection may actually be due to geographical variation

A

T

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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

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8
Q

Pigmentation in haemochromatosis is due to haemosiderin deposition in the skin

A

F Melanin

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9
Q

Strongest risk factors for expression of PCT are HCV infection and homozygosity for C282Y (haemochromatosis) mutation

A

T

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10
Q

Jaundice is first seen as a yellowish hue of the sclerae and soft palate

A

T

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11
Q

Carotenaemia also affects the sclerae

A

F

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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

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13
Q

Jaundice and panniculitis are the most common skin changes associated w pancreatitis

A

T

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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

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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

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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

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17
Q

Glucagonomas occur in MEN syndromes

A

T but more in MEN type 1 Classically MEN type I but also MEN type II

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18
Q
  1. Hepatitis B infection can b associated with urticaria, Gianottic-Crosti syndrome and polyarteritis nodosa
A

T

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19
Q
  1. 40% of type II cryoglobulinaemia is HCV associated
A

F 70 – 90%

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20
Q
  1. Mixed cryoglobulinaemia is characterised by small vessel vasculitis, livedo reticularis, acrocyanosis, peripheral neuropathy, hepatosplenomegaly and hypocomplementaemia
A

T

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21
Q
  1. Hepatitis B is associated w Necrolytic acral erythema
A

F hepatitis C

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22
Q
  1. Necrolytic acral erythema appears as well-circumscribed, dusky erythematous plaques with adherent scale
A

T

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23
Q
  1. The connection between lichen planus and hepatitis C infection may actually be due to geographical variation
A

T

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24
Q
  1. 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

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25
Q
  1. Pigmentation in haemochromatosis is due to haemosiderin deposition in the skin
A

F – due to melanin

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26
Q
  1. Strongest risk factors for expression of PCT are HCV infection and homozygosity for C282Y (haemochromatosis) mutation
A

T

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27
Q
  1. Jaundice is first seen as a yellowish hue of the sclerae and soft palate
A

T

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28
Q
  1. Carotenaemia also affects the sclerae
A

F

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29
Q
  1. 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

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30
Q
  1. Jaundice and panniculitis are the most common skin changes associated w pancreatitis
A

T

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31
Q
  1. 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

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32
Q
  1. 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

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33
Q
  1. 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

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34
Q
  1. Glucagonomas occur in MEN syndrome
A

T – MEN type I only No! Classically MEN type I but also MEN type II

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35
Q
  1. Skin changes persist following removal of glucogonoma
A

F – resolve

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36
Q
  1. Clinical features of Necrolytic migratory erythema include an itchy, burning rash on flexural sites including lower abdomen, groing, buttocks and thighs
A

T fragile bullae and vesicles, irregular centrifugal annular lesions which can crust has fluctuating course of cyclical pattern anbular cheilitis and glossitis

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37
Q
  1. Other systemic features of glucagonoma
A

Weight loss Anaemia Diabetes Diarrhoea Weakness Venous thrombosis Psychiatric disturbances Zinc deficiency

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38
Q
  1. Marked spongiosis and hyperkeratosis are typically seen in necrolytic migratory erythema
A

F – dyskeratotic dermatitis w superficial perivascular inflammation, mild spongiosis Clefts and necrotic keratinocytes and cellular debris

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39
Q
  1. Glucagonoma can be treated with somatostatin analogues
A

T Octreotide – improves rash and symptoms by altering glucagon metabolism Lantreotide can last for 2 weeks

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40
Q
  1. Fabry’s disease is due to alpha-galactosidase A deficiency
A

T

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41
Q

23.a Fabry’s disease can be treated using synthetic a-galactosidase

A

T

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42
Q
  1. Renal disease and other systemic manifestations is due to deposition of neutral glycosphingolipids in vascular endothelium and tissue in Fabry disease
A

T

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43
Q
  1. Features of Nail Patella syndrome
A

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

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44
Q
  1. Genodermatoses associated w renal carcinoma
A

Birt-Hogge Dube syndrome Hereditary leiomyomatosis and renal cell carcinoma Cowden’s disease von Hippel-Lindau syndrome

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45
Q
  1. Cutaneous features of systemic amyloidosis include waxy, purpuric lesions as well as hepatomegaly, oedema and carpal tunnel
A

T

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46
Q
  1. Calciphylaxis is always associated w high serum calcium phosphate
A

F – usually but not always

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47
Q
  1. All patients who present with cutaneous vasculitis should have a urine dipstick and serum creatinine and eGFR checked
A

T

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48
Q
  1. Kyrle’s disease is a reactive perforating collagenosis associated w renal failure
A

T also associated diabetes Very itchy

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49
Q
  1. Pruritus in renal failure is invariably associated w hyperuricaemia
A

F – often, but not always, mechanism is unclear

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50
Q
  1. Nephrogenic systemic fibrosis is associated w gadoimium containing radiocontrast dyes used in patients with chronic renal failure
A

T

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51
Q
  1. Patients with liver transplants appear to have a higher incidence of cutaneous malignancy than renal transplant patients
A

F – vice versa. Due to ↑ immunosuppression required + ↑ longevity post transplant

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52
Q
  1. Post-renal transplant, patients BCC risk increases up to 250 fold
A

F – BCC ↑ risk by 10 fold. SCC ↑ risk by 65 – 250 fold

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53
Q
  1. Uncontrolled expression of HPV infection may be a co-factor in the increased risk of SCC in immunosuppressed transplant patients
A

T

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54
Q
  1. 90% of children with Kawasaki disease develop coronary artery aneurysms
A

F – 25%

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55
Q
  1. Pericarditis can occur in systemic lupus
A

T

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56
Q
  1. The cardiac muscle is classically the only organ not affected in systemic sclerosis
A

F – involvement in 80%

57
Q
  1. Stigmata of subacute bacterial endocarditis
A

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
Q
  1. Features of Carney complex please
A

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
Q
  1. Dermatomyositis may be a paraneoplastic phenomenon due to lung cancer
A

T

60
Q
  1. Systemic sclerosis may be associated w fibrosing alveolitis and interstitial fibrosis
A

T

61
Q
  1. Loeffler’s syndrome describes pulmonary infiltrates and peripheral eosinophilia and is often due to parasitic infection
A

T

62
Q
  1. Relapsing polychondritis is due to autoantibodies against type III collagen
A

F – type II

63
Q
  1. Dermatomyositis is usually related to anti-La antibodies
A

F – anti-Jo-1

64
Q
  1. Yellow nail syndrome occurs without associated systemic features
A

F – pleural effusion, bronchiectasis, chronic lung infections, empyema, lymphoedema, sinus infections

65
Q
  1. Sickle cell anaemia and thalassaemia can be causes of recalcitrant lower leg ulcers
A

T

66
Q
  1. Aquagenic pruritus appears in polycythaemia rubra vera with RBC counts above 200g/L
A

F – aquagenic pruritus can predate PCV

67
Q
  1. Erythromelalgia is associated with sickle cell anaemia
A

F – with PCV

68
Q
  1. Eosinophilia myalgia syndrome is an idiopathic fibrotic condition
A

F associated with ingestion of tryptophan

69
Q
  1. Wells’ syndrome may clinically mimic bacterial cellulitis, but has a dense eosinophilic infiltrate
A

T

70
Q
  1. Hypereosinophilic syndrome has eosinophilis in excess of 1500/uL w no apparent cause for greater than 6/12
A

T Can have endomyocardial fibrosis, eosinophilic vasculitis, thrombosis, ane cutaneous lesions

71
Q
  1. Disorders associated w leukaemia
A

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
Q
  1. Leukaemia cutis is more common in chronic leukaemia than acute
A

F – more common in acute [AML] Although can occur in any chronic and may herald a blast transformation

73
Q
  1. Coumarin necrosis is due to a temporary reduction in levels of vitamin K dependent natural anticoagulants causing a temporary state of thrombophilia
A

T

74
Q
  1. Warfarin necrosis is more common in Males
A

F – Females

75
Q
  1. What does POEMS syndrome stand for
A

Polyneuropathy, organomegaly of liver, spleen, lymph nodes, Endocrinopathy, Monoclonal gammopathies, skin changes

76
Q
  1. Genodermatoses with associated haematological malignancy
A

Chediak higashi Wiskott Aldrich Hermansky pudlak Griscelli NF-1 + JXGs Dyskeratosis congenital Fanconi’s anaemia

77
Q
  1. Erythema chronicum migrans is most commonly associated with dermatophyte infection
A

F – lyme borreliosis – Borrelia burgodorferi sensu lato, B afzelli, B. garinii

78
Q
  1. Erythematous plaque or urticated lesion with expands with central clearing occur in erythema chronicum migrans
A

T

79
Q
  1. After the initial lesion, crops of vesicles can develop and sites distant to erythema chronicum migrans site
A

F – lesions resembling EAC or EM can develop. Smaller than initial lesion

80
Q
  1. Histologically erythema chronicum migrans shows superficial and deep perivascular lymphocytic infiltrate around vessels and appendages w occasionally plasma cells
A

T

81
Q
  1. Erythema marginatum rheumaticum is associated with rheumatoid arthritis
A

F – rheumatic fever

82
Q
  1. 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
A

T

83
Q
  1. Erythema gyratum repens is always associated with malignancy
A

F – 80% of the time Has also been associated with CREST syndrome, tuberculosis, drug hypersensitivity

84
Q
  1. Erythema gyratum repens is most commonly associated w lung cancer in 33%
A

T – and then bowel, oesophagus, urogenital, breast, panceas, haematological

85
Q
  1. Erythema gyratum repens is thought to be immunologically mediated
A

T – supported by deposition of C3 or IgG in sublamina densa

86
Q
  1. Erythema gyratum repens clinically resembles the grain of wood
A

T

87
Q
  1. DDx for Erythema gyratum repens
A

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
Q
  1. Annular erythema of infancy is really just EAC in children
A

T

89
Q
  1. In annular erythema of infancy and infective source can be sought and treated, often with a good response of cutaneous lesions
A

T

90
Q
  1. Annular erythema associated with extractable nuclear antigens is seen in Lupus, Sjogren’s disease, Neonatal lupus
A

T and is associated with anti-SSA and anti-SSB antibodies

91
Q
  1. Common associations with erythema annulare centrifugum are fungal infections, other viral infections, drugs, lymphoma
A

T

92
Q
  1. Histologically EAC shows perivascular ‘sleeve-like’ lymphohistiocytic infiltrate -
A

T

93
Q
  1. Erythema annulare centrifigum appears as a small, pink, infiltrated papule, which gradually enlarges s a ring
A

T

94
Q
  1. Treatment for EAC
A

Discovery and elimination of cause if possible Antihistamines Topical corticosteroids Vitamin D Narrow-band UVB ? systemic immunosuppressants

95
Q
  1. What does SAPHO syndrome stand for
A

Synovitis Acne Pustolosis Hyperostosis Osteitis

96
Q
  1. Hidradenitis suppurativa is associated with arthralgia and bone changes, but interestingly, Acne fulminans is not
A

F

97
Q
  1. Facial features of acromegaly include prognathism, frontal bossing, oily skin, large and furrowed tongue, triangular ears
A

T Also acanthosis nigricans and Addisonian like pigmentation due to ↑ MSH

98
Q
  1. Pituitary insufficiency may manifest as hyperpigmentation due to uncontrolled secretion of MSH
A

F – Decreased MSH – hypopigmentation, but mucous membranes retain normal colour Also ↑ sunburning and lack of tanning

99
Q
  1. Pituitary Cushing’s disease causes hyperpigmentation as secretion of pro-opiomelanocortin causes overproduction of ACTH and MSH
A

T

100
Q
  1. What are screening tests for Cushing’s disease
A

24-hour urinary cortisol and 1mg overnight dexamethasone suppression tests - values 4 x normal

101
Q
  1. Nelson’s syndrome is eponymous for empty sella syndrome
A

F – Nelson’s syndrome is the rapid growth of pituitary adenomas following adrenalectomy

102
Q
  1. Addisons’s disease refers to an overactive adrenal gland
A

F – adrenal insufficiency

103
Q
  1. Secondary adrenal insufficiency due to hypothalamic or pituitary insufficiency lacks pigmentary changes
A

T

104
Q
  1. Describe features of Addisonian pigmentation
A

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
Q
  1. Addisonian pigmentation can be seen in primary adrenal insufficiency, Nelson’s syndrome, tumour casuing ectopic ACTH secretion, Cushings disease
A

T

106
Q
  1. In congenital adrenal hyperplasia and late onset adrenal hyperplasia 17-hydroxyprogesterone, cannot be converted to 11-deoxycortisol
A

T

107
Q
  1. Congenital adrenal hyperplasia is associated with endogenous steroid induced acne
A

F – acne is due to excessive adrogens Other symptoms include Premature pubic hair Hirsuitism Acne Temporal baldness Infertility Growth spurt

108
Q
  1. Nail changes seen in hyperthyroidism
A

Thin, onycholysis (Plummer’s nails), fast growing Plummer’s = onycholysis & koilonychias; begins on 4th finger

109
Q
  1. Diamond’s triad which is associated w Graves disease refers to pretibial myxoedema, thyroid acropachy, exophthalmos
A

T – PTO

110
Q
  1. Pretibial myxoedema develops in patients with hypothyroidism
A

F – hyperthyroidism

111
Q
  1. Histologically pretibial myxoedema may be seen as a thickened dermis with increased collagen
A

F thickened dermis, w extensive deposits of acid mucoplysaccharides acausing separation of collagen fibres

112
Q
  1. Thyroid acropachy refers to the eye changes seen in Graves disease
A

F – clubbing of fingers and toes in associated w soft tissue swelling of hands and feet w periosteal bone formation

113
Q
  1. Cutaneous findings of hypothyroidism include pale, cold scaly skin w asteatotic eczema and anhidrosis
A

T

114
Q
  1. Loss of the medial third of the eyebrow – Hertog’s sign, is common in hypothyroid patients
A

F – loss of lateral third

115
Q
  1. The main dermatological clinical signs seen in parathyroid disease are related to calciphylaxis and ossification
A

T

116
Q
  1. Paget’s disease of the breast is thought to be due to direct epidermal extension of an underlying ductal squamous cell carcinoma
A

F - adenocarcinoma

117
Q
  1. What are some markers for Paget’s
A

EMA – epithelial membrane antigen CEA carcinoembryonic antigen Cytokeratins CK 7 Mucins – MUC1 CD 23 – lymphoid and apocrine/eccrine marker

118
Q
  1. Extramammary Paget’s disease occurs in areas with eccrine ducts
A

F – apocrine gland bearing areas - anogenital and axillary sites

119
Q
  1. 25% have underlying cancer
A

T – cpd to all Paget’s

120
Q
  1. Extramammary paget’s disease can be from direct extension from carcinoma of underlying apocrine glands or from a distant tumour
A

T

121
Q
  1. Most common source of cutaneous metastases are upper aerodigestive tract
A

F – breast or melanoma

122
Q
  1. Sister Mary Joseph’s nodule is most commonly related to bowel tumours
A

T – only 10% pancreatic

123
Q

93 Cutaneous metastases usually have a poor prognosis and indicate disseminated disease

A

T

124
Q
  1. Internal malignancies associated with Gorlins syndrome
A

Medulloblastoma Astrocytoma Meningioma Fibrosarcomas Uterine fibroids, desmoids and sarcomas

125
Q
  1. CDKN2A mutation is associated with melanoma and renal cell carcinoma
A

F Melanoma Breast Thyroid GIT SCCs Larynx Pancreas Ocular

126
Q
  1. Cowdens syndrome exhibits facial tricholemommas, acral keratosis, and palmar pits
A

T

127
Q
  1. Cowden’s syndrome is not associated w increased risk of cutaneous malignancy
A

F - melanoma

128
Q
  1. Muir Torre syndrome is associated with increased risk of thyroid carcinoma
A

F colonic Renal Urogenital Sebaceous adenocarcinoma endometrial

129
Q
  1. Uterine cancer is the most strongly associated with Acanthosis nigricans
A

F – gastric adenocarcinoma

130
Q
  1. Tripe palms alone (or with clubbing) are indicative of bronchial carcinoma
A

T

131
Q
  1. Sign of Lesar-Trelat (eruptive Seborrheic keratosis) is highly indicative of internal malignancy
A

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
Q
  1. Acrokeratosis paraneoplastic effects then hands and feet only
A

F – all peripheries inc tip of nose helices of ears, hands and feet and may then become generalised

133
Q

103.Basex syndrome can occur without underlying malignancy

A

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
Q
  1. Multicentric reticulohistiocytosis is associated with solid tumour
A

T – 25% of cases Papules around nail folds – coral bead sign, symmetrical polyarthritis

135
Q
  1. Which haematological disorder is erythromelalgia linked with
A

Polycythaemia rubra vera Essential thrombocytaemia

136
Q

106 Actinic cheilitis is a cutaneous manifestation of Crohn’s disease

A

F – granulomatous cheilitis

137
Q
  1. Lesions associated with IBD
A

Erythema nodosum Aphthous ulceration Erythema multiforme Urticaria and angio-oedema Neutrophilic dermatosis – pyoderma gangrenous and sweets Vasculitis and intravascular coagulation

138
Q
  1. Pyoderma gangrenosum is more common in patients with ulcerative colitis than those with Crohn’s disease
A

T – 5% of all UC pts & parallels the GI disease

Cutaneous Manifestations Of Systemic Disease Melissa (5 decks)

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