Bafl Exam 3: Cutaneous Manifestations Of Systemic Disease

Front 1

Cancer associated with tripe palms?

Back 1

Alone- lung CA

TP + AN- gastric carcinoma

Front 2

Necrolytic migratory erythema is associated with?

Back 2

Glucogonoma

Front 3

Acrokeratosis paraneoplastica associated with?

Back 3

aerodigestive tract cancer

Front 4

Carcinoid syndrome = flushing and erythema of the H + N, pellagra like dermatitis, can be associated with?

Back 4

mid gut tumors, commonly with liver mets

bronchial carcinoid tumors

increased 5-HIAA levels (hydroxyindoleacetic acid), a seratonin metabolite

Front 5

Erythema gyratum repens

Back 5

rule out malignancy!

Front 6

Hypertrichosis lanuginosa associated with?

Back 6

lung, colon, breast

Front 7

Paraneoplastic pemphigus MC associations? (pic)

Back 7

NHL

CLL

CASTLEMANS

SARCOMA

THYMOMA

Front 8

sign of Leser Trelat is kindof whack... when do we actually get worried about it?

Back 8

when accompanied by generalized pruritis or AN

Front 9

Patients with shawl sign, heliotroph rash, ragged cuticles need to be worked up for...

Back 9

ovarian, lung, colorectal, pancreatic, NHL

Front 10

MC association with Sweet's syndrome?

Back 10

AML

Front 11

Primary Amyloidosis is most commonly associated with deposition of what?

Back 11

deposition of AL, monoclonal gammopathy (d/t plasma cell dyscrasia), multiple myeloma

Front 12

Juvenile xanthogranuloma MC associated with hematologic disorder?

Back 12

paraproteinemia (IgG with kappa light chains)

Front 13

What is Schnitzler's syndrome?

Back 13

chronic urticaria with IgM kappa paraproteinemia with lymphoplasmacytic malignancies

Front 14

Back 14

Necrobiosis lipoidica

Most patients with NLD have diabetes, only very few patients with diabetes have NLD

oval, violaceous patch with red advancing border, can ulcerate, typically on shins

seen earlier in type I, later in type II DM

Front 15

Which subset of GA can be associated with DM?

Back 15

disseminated GA

Front 16

where is the split in diabetic bullae?

Back 16

subepidermal (BMZ)

Front 17

What pathologies can Acanthosis Nigricans be seen with?

Back 17

Carcinomas (stomach esp)

Drugs (nicotinic acid, estrogen, corticosteroids)

Pineal tumors

Endocrine d/o PCOS, acromegaly, Cushing's, hypothyroidism)

Obesity

Front 18

Eruptive xanthomas are typically seen where? Indicative of what?

Back 18

yellow-red papules on extensor surfaces

high TG

Front 19

What is the most common cutaneous manifestation of diabetes?

Back 19

Diabetic Dermopathy- asx crops of red brown patches on shins

Front 20

Cutaneous insulin treatment reactions can include? What is the most common treatment to cause reactions?

Back 20

allergy, lipoatrophy, lipohypertrophy (inject)

First Generation Sulfonylureas (chlorpropamide, tolbutamide) are the most common to cause reactions, usually maculopapular eruptions --> treat through these

Front 21

Skin in hyperthyroidism?

Back 21

warm and moist

facial flushing

palmar erythema

hyperpigmentation

fine hair/hair loss/early graying

Front 22

Pretibial myxedema vs generalized myxedema?

Back 22

Pretibial more common in hyperthyroid

Generalized more common in hypothyroid

Front 23

Cutaneous manifestations of hypothyroidism?

Back 23

skin is cool, dry, pale

hypohydrosis

carotenemia

hair is dry, brittle, loss of hair from lateral 1/3 eyebrow

easy bruising, purpura, impaired wound healing

Front 24

Deposits in generalized myxedema?

Back 24

hyaluronic acid and chondroitin sulfate

Front 25

Patient at 30 weeks presents with generalized, pruritic, urticarial papule on the trunk with several vesicles and bullae (involves the umbilicus). What do we work her up for?

Back 25

Herpes Gestationis

increased incidence in hydatidiform moles, choriocarcinoma, thyroid disease

Front 26

Skin manifestations of adrenal insufficiency?

Back 26

ADDISONS disease

hyperpigmentation, loss of sex hair in women

Front 27

Skin manifestations of Cushing's syndrome? Work up?

Back 27

truncal obesity, buffalo hump, mood facies, slender limbs, atrophy, telangietasias, purpura, poor wound healing, hirsuitism

work up with overnight dexamthasone suppression test or a 24 hour urine free cortisol determination can be used as a screen for Cushing syndrome d/t endogenous cortisol production

Elevated ACTH levels are found in Cushing's disease (pitutary over production of ACTH) and ectopic ACTH syndrome

Suppressed levels of ACTH arefound in adrenal tumors

Front 28

MCC internal organ associated with generalized pruritis?

Back 28

renal (d/t retention of pruritogeneic factors, hyperparathyroidism, hypercalcemia, hyperphosphatemia, elevated histamine)

Front 29

MC skin manifestation in chronic renal failure?

Back 29

xerosis

Front 30

Treatment?

Back 30

sodium thiosulfate

Front 31

Back 31

acquired perforating dermatosis- a/w diabetes

primary perforating dermatosis:

kyrle's disease, elastosis perofrans serpingosa, perforating folliculitis, preactive perforating collagenosis

Front 32

What is nephrogenic systemic fibrosis?

Back 32

occurs in individuals with impaired renal function, most commonly dialysis dependent

Presents on extremities with symmetrically distributed, ill defined, thick, indurated, erythematous to hyperpigmented plaques, see a peau d'orange appearance

a/w exposure to GAD ***

Front 33

Most common primary cancers to metastasize to the skin?

Back 33

Breast and lungs

Front 34

Pyoderma gangrenosum is associated with which types of malignancies and disease?

Back 34

hematologic malignancy, crohns > UC, RA, HIV, hepatitis

Front 35

Read this: manifestations of end stage renal disease

Back 35

pruritis (MC cause)

uremic frost (BUN > 250)

calciphylaxis

acquired perforating disorder

nephrogenic systemic fibrosis

bullous disease of dialysis

lindsays nails (aka half and half)

jaundice (bili >2.5)

Front 36

Read this: manifestations of liver disease

Back 36

Cirrhosis- spider angiomas (increased estrogen), dupytrens contracture, gynecomastia, palmar erythema, pruritis, xanthoma striatum palmare, caput medusae, terrys nails, meuhrckes nails (transverse white bands parallel to the lunula- hypoalbuminemia), clubbing, brittleness

Front 37

Necrolytic acral erythema?

Back 37

hepatitis C

Front 38

Sweets syndrome can be associated with....

Back 38

AML most commonly, IBD, GCSF, carbamazapine, bactrim

Front 39

gene defect? complications?

Back 39

Hereditary Hemorrhagic Telangiectasias

AD defect in ENG (endoglein), ACVRL1

telangiectasias on facial, acral skin, oral mucosa --> GI hemorrhage, pulmonary and hepatic AVM, recurrent epistaxis

Front 40

Blue rubber bleb nevus syndrome...

Back 40

AD/sporatic, muation in TIE2 gene

multiple tender cutaneous blue nevi with increased risk of GI malformations (esp in colon)

TIE a rubber band around that GI bleed!

Front 41

Read this:

Cardiac manifestations on skin

Back 41

cyanosis (Hb decrease of 5g/dl)

Clubbing (increase in Lovibond's angle)

Flushing (severe mitral stenosis)

Xanthomas

Infective endocarditis (splinter hemorrhages, petechiae, oslers nodes, janeway lesions)

Rheumatic fever (subcutaneous nodules, erythema marginatum)

Front 42

Acquired icthyosis is associated with what malignancy?

Back 42

hodgkins lymphoma

Front 43

Acquired icthyosis is associated with which medications?

Back 43

nicotinic acid, hydroxyurea, EGFR, protein kinase inhibitors, vemurafenib