7.2 - The skin in systemic disease tutorial Flashcards
38y/o female presents with: new onset (weeks) of rash, fever, arthritis, fatigue.
No new medications.
Which of the following investigations is indicated?
A. Urinalysis
B. Vitamin C
C. Lipid panel
D. HbA1c
A: SLE - FBC, U&E, ANA, anti-dsDNA, complement, urinalysis
(B: scurvy)
(C: eruptive xanthelesma)
(D: diabetes - acanthosis nigricans, skin infections, xanthelesma)
Newborn baby presents with a rash.
Which of the following investigations is indicated?
A. Genetic testing
B. Syphilis
C. ECG
D. Skin biopsy
C - ECG (annular rash characteristic of neonatal lupus, 50% risk of complete heart block and consequent heart failure, associated with Ro and La antibodies)
50y/0 female presents with new rash - face, chest, upper back and dorsal hands.
Difficulty getting up stairs and carrying her shopping.
Which of the following conditions are NOT associated with the condition illustrated?
A. Diabetes mellitus
B. Digital ischaemia
C. Malignancy
D. Interstitial lung disease
A - Diabetes mellitus
Condition is dermatomyositis - Gottron’s papules, heliotrope rash, shawl sign are all indicative
Options B, C and D can be subtypes of dermatomyositis
Which of the following signs are associated with chronic kidney disease?
A. Corkscrew hairs and perifollicular purpura
B. Calciphylaxis
C. Casal’s necklace
D. Periocular purpura
B - Calciphylaxis
(A - associated with scurvy)
(C - associated with pellagra - vitamin B3 deficiency)
(D - classically observed in systemic amyloidosis)
23y/o with Hx of epilepsy. Presents with flu-like illness, sore eyes and oral ulceration, followed by extensive painful rash. Skin is peeling off.
Recently started on new antiepileptic, no other medications.
Which of the following statements about this condition is incorrect?
A. Complications include blindness
B. Pain is a diagnostic feature and diagnostic clue
C. Lymphadenopathy is a characteristic feature
D. Extension may occur into the GI tract
C - Lymphadenopathy is not a characteristic feature of SJS/TEN (but it is among the diagnostic criteria for DRESS)
Which of the following is true regarding itch in the absence of a rash?
A. Itch in the absence of a rash indicates malingering or a psychogenic aetiology
B. Chronic rubbing and scratching may cause the appearance of nodules
C. Drugs are an unlikely culprit in the absence of a rash
D. Iron deficiency, not iron overload causes itch
B - nodular prurigo develops in the constant of chronic rubbing or scratching
(A - multiple causes including internal organ dysfunction and metabolic abnormalities)
(C - drugs including opiates frequently cause pruritis in absence of rash)
(D - both iron deficiency and overload may cause itching)
Which of the following is correct regarding Drug Reaction with Eosinophilia and Systemic Symptoms?
A. The brain is not among organs targeted
B. The complications of erythroderma account for most fatalities
C. Characteristic features on biopsy allow diagnostic confirmation
D. Fulminant liver failure may occur
D
(A - brain may be targeted)
(B - fulminant liver failure accounts for most fatalities)
(C - diagnosis based on diagnostic criteria not biopsy)
Which of the following is a manifestation of sarcoidosis?
A. Lupus vulgaris
B. Lupus profundus
C. Lupus pernio
D. Lupus tumidus
C - Lupus pernio
(A - form of cutaneous TB)
(B - form of cutaneous lupus erythematosus affecting subcutaneous fat)
(D - variant of cutaneous lupus erythematosus)
Which of the following changes is not associated with chronic liver disease?
A. Clubbing
B. Muehrcke’s lines
C. Terry’s nails
D. Half and half nails
D - Half and half nails (associated with chronic kidney disease and may represent a normal variant, may be associated with Crohn’s or rarely be a normal variant)
Which of the following conditions is not associated with inflammatory bowel disease?
A. Pyoderma gangrenosum
B. Dermatitis herpetiformis
C. Hidradenitis suppurtiva
D. Orofacial granulomatosis
B - Dermatitis herpetiformis (tiny itchy blisters)
Which of the following are not a manifestation of malignancy?
A. Lues maligna
B. Pyoderma gangrenosum
C. Acanthosis nigricans
D. Dermatomyositis
A - Lues maligna (ulcerative, necrotic form of secondary syphilis)
HIV seroconversion may manifest in which of the following ways?
A. Urticaria
B. Erythema multiforme
C. Morbilliform rash
D. All of the above
D - All of the above
HIV seroconversion has many variable and non-specific manifestations = low threshold for testing
An additional one is oral or genital ulceration
Which of the following conditions may be a manifestation of underlying acromegaly?
A. Cutis gyrata verticis
B. Xerosis
C. Perforating disorder
D. Erythema gyratum repens
A - Cutis gyrata verticis
(B - dryness occurs in many conditions like diabetes and renal failure but not acromegaly)
(C - perforating disorders classically observed in diabetes renal failure)
(D - paraneoplastic type of annular erythema with a ‘wood-grain’ appearance)
Which of the following statements is true regarding the skin in systemic disease?
A. Comprehensive diagnostic investigations must be performed in each rash to avoid missing underlying systemic conditions, a history is not specific nor sensitive
B. Spot diagnoses indicate good clinical skills
C. Dermatological diagnostic skills are desirable, but not essential, as the option to take a skin biopsy allows a histopathologist to make the diagnosis
D. Management of multi-systemic diseases can be undertaken by several different specialities concurrently
D - Management of chronic disease should be undertaken by all relevant specialties in a multidisciplinary manner
50y/o male with Hx of acute myelogenous leukaemia. Presents with extensive rash 3 weeks after allogeneic haematopoietic 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?
A. Diarrhoea
B. Acral involvement (extremities)
C. Facial involvement
D. All of the above
D - in a clinically equivocal rash in an allogeneic HSCT recipient, diarrhoea, acral involvement and facial involvement all suggest cutaneous cGVHD is more likely than drugs as a cause
