Group Teaching - Managing Skin Disorders in Systemic Disease Flashcards
A 38 y/o femal patient present with the following symptoms:
* New onset (weeks) of:
* Rash
* Fever
* Arthritis
* Fatigue
* No new medications
Which of the following investigations is indicated?
* Urinalysis
* Vitamin C
* Lipid panel
* HbA1c
Urinalysis
Most likely diagnosis:
* Systemic Lupus Erythematosus
Investigations:
* FBC
* U&E
* ANA
* anti-dsDNA
* Complement
* Urinalysis
A newborn male patient present with the following symptoms:
* Rash
Which of the following investigations is indicated?
* Genetic testing
* Syphilis
* ECG
* Skin biopsy
ECG
Most likely diagnosis:
* Neonatal Lupus Erythematosus
* Annular rash characteristic of neonatal lupus
* 50% risk of complete heart block and consequent heart failure
* Associated with Ro and La antibodies
A 50 y/o female patient present with the following symptoms:
* New rash
* Face
* Chest
* Upper back
* Forsal hands
* Difficulty getting up stairs and carrying her shopping
Which of the following conditions are not associated with the condition illustrated?
* Diabetes mellitus
* Digital ischaemia
* Malignancy
* Interstitial lung disease
Diabetes mellitus
Which of the following signs are associated with chronic kidney disease?
* Corkscrew hairs and perifollicular purpura
* Calciphylaxis
* Casal’s necklace
* Periocular purpura
Calciphylaxis
Corkscrew hairs and perifollicular purpura:
* Corkscrew hairs and perifollicular purpura are associated with scurvy
Casal’s necklace:
* Casal’s necklace is associated with pellagra (Vitamin B3 deficiency)
Periocular purpura:
* Periocular purpura is classically observed in systemic amyloidosis
A 23 y/o male patient present with the following symptoms:
* Epilepsy
* Flu-like illness, sore eyes and oral ulceration
* Followed by extensive painful rash
* Recently started on new antiepileptic
* No other medications
Which of the following statements about this condition is incorrect?
* Complications include blindness
* Pain is a characteristic feature and diagnostic clue
* Lymphadenopathy is a characteristic feature
* Extension may occur into the gastrointestinal tract
Lymphadenopathy is a characteristic feature
- Lymphadenopathy is not a characteristic feature of SJS / TEN, but is among the diagnostic criteria for DRESS
Which of the following is true regarding itch in the absence of a rash?
* Itch in the absence of a rash indicates malingering or a psychogenic aetiology
* Chronic rubbing and scratching may cause the appearance of nodules
* Drugs are an unlikely culprit in the absence of a rash
* Iron deficiency, not iron overload cause itch
Chronic rubbing and scratching may cause the appearance of nodules
- Itching in the absence of a rash have multiple causes including internal organ dysfunction and metabolic abnormalities
- Nodular prurigo develops in the constant of chronic rubbing or scratching
- Drugs including opiates frequently cause pruritus in the absence of a rash
- Both iron deficiency and iron overload may cause itching
Which of the following is correct regarding Drug Reaction with Eosinophilia and Systemic Symptoms?
* The brain is not among organs targeted
* The complications of erythroderma account for most fatalities
* Characteristic features on biopsy allow diagnostic confirmation
* Fulminant liver failure may occur
Fulminant liver failure may occur
- The brain may be targeted in DRESS
- Fulminant liver failure accounts for most fatalities
The diagnosis is based on criteria including:
* Fever
* Lymphadenopathy ⩾ 2 sites, > 1cm
* Circulating atypical lymphocytes
* Peripheral hypereosinophilia
* Internal organs involved
* Negative ANA, Hepatitis / mycoplasma, chlamydia
* Skin involvement
* >50% BSA
* Cutaneous eruption suggestive of DRESS
* Biopsy suggestive of DRESS
Which of the following is a manifestation of sarcoidosis?
* Lupus vulgaris
* Lupus profundus
* Lupus pernio
* Lupus tumidus
Lupus pernio
Lupus vulgaris:
* Lupus vulgaris is a form of cutaneous tuberculosis
Lupus profundus:
* Lupus profundus is a form of cutaneous lupus erythematosus affecting subcutaneous fat
Lupus tumidus:
* Lupus tumidus is a variant of cutaneous lupus erythematosus
Which of the nail changes is not associated with chronic liver disease?
* Clubbing
* Muehrcke’s lines
* Terry’s nails
* Half and half nails
Half and half nails
- Half-and-half nails are associated with chronic kidney disease, and may represent a normal variant. They may be associated with Crohn’s or rarely be a normal variant
Which of the following conditions is not associated with inflammatory bowel disease?
* Pyoderma gangrenosum
* Dermatitis herpetiformis
* Hidradenitis suppuritiva
* Orofacial granulomatosis
Dermatitis herpetiformis
Which of the following are not a manifestation of malignancy?
* Lues maligna
* Pyoderma gangrenosum
* Acanthosis nigricans
* Dermatomyositis
Lues maligna
* Lues maligna is a necrotic form of secondary syphilis
Pyoderma gangrenosum:
* Has multiple associations, including malignancy
Acanthosis nigricans:
* May be associated with insulin resistance and internal malignancy
Dermatomyositis:
* May be paraneoplastic
HIV seroconversion may manifest in which of the following ways?
* Urticaria
* Erythema multiforme
* Morbilliform rash
* All of the above
All of the above
- HIV seroconversion has many variable and non-specific manifestations, necessitating a low threshold for testing
- An additional one is oral or genital ulceration
Which of the following conditions may be a manifestation of underlying Acromegaly?
* Cutis gyrata verticis
* Xerosis
* Perforating disorder
* Erythema gyratum repens
Cutis gyrata verticis
Xerosis:
* Dryness occurs in many conditions, such as: Diabetes & renal failure, but not acromegaly
Perforating disorder:
* Perforating disorders are classically observed in diabetic in renal failure
Erythema gyratum repens:
* A paraneoplastic type of annular erythema with a ‘wood-grain’ appearance
Which of the following statements are true regarding the skin in systemic disease?
* Comprehensive diagnostic investigations must be performed in each rash to avoid missing underling systemic conditions, as history is not specific nor sensitive
* Spot diagnoses indicate good clinical skills
* Dermatological diagnostic skills are desirable, but not essential, as the option to take a skin biopsy allows a histopathologist to make the diagnosis
* Management of multi-systemic diseases can be undertaken by several different specialties concurrently
Management of multi-systemic diseases can be undertaken by several different specialties concurrently
* Management of chronic disease should be undertaken by all relevant specialties in a multidisciplinary manner
Comprehensive diagnostic investigations must be performed in each rash to avoid missing underling systemic conditions, as history is not specific nor sensitive:
* Investigation should be guided by clinical skills to prevent false positive / negatives
Spot diagnoses indicate good clinical skills:
* Diagnosis requires comprehensive clinical assessment +/- diagnostic tests and consideration of differentials
Dermatological diagnostic skills are desirable, but not essential, as the option to take a skin biopsy allows a histopathologist to make the diagnosis:
* Histological features are often non-specific / non-diagnostic
A 50 y/o male patient present with the following symptoms:
* Acute myelogenous leukemia
* Extensive rash 3 weeks after allogeneic Hematopoietic stem-cell transplantation
* Multiple new drugs: pipercillin, tazobactam, mycophenolate mofetil, enoxaparin
Which of the following features renders cutaneous graft vs host disease (cGVHD) a more likely than a drug as the cause of this rash?
* Diarrhoea
* Acral involvement
* Facial involvement
* All of the above
All of the above
- In a clinically equivocal rash in a allogeneic HSCT recipient, diarrhoea, acral involvement and facial involvement all suggest cutaneous cGVHD is more likely than drugs as a cause
