Cutaneous Manifestations Of Gi Disease

Front 1

a. What causes pseudoxanthoma elasticum?

Back 1

i. Affects elastic fibers found in skin, blood vessels, and heart valves
ii. Elastic fibers degenerate and then calcify and accumulate

Front 2

b. What are the symptoms of pseudoxanthoma elasticum?

Back 2

i. Plucked chicken skin appearance
ii. Angioid streaks in eye
iii. Fragmentation of medium sized vessels

Front 3

a. What is hereditary hemorrhagic telangiectasia?

Back 3

i. Multisystem vascular dysplasia in GI tract, pulmonary, and nervous system

Front 4

b. What is the presenting symptom of hereditary hemorrhagic telangiectasia in childhood?

Back 4

i. Epistaxis

Front 5

c. What is the characteristic appearance of hereditary hemorrhagic telangiectasia?

Back 5

i. Red blanchable macules on oral mucosa and lips
ii. Also develop in GI tract
iii. Symptomatic and asymptomatic bleeding
iv. Pulmonary fistulas
v. AV malformations of the brain

Front 6

a. What causes acrodermatitis enteropathica?

Back 6

i. Intestinal malabsorption of zinc
ii. Can be genetic or acquired

Front 7

b. In what population does acrodermatitis enteropathica present?

Back 7

i. 3 weeks to 18 months of life

Front 8

c. What is the appearance of acrodermatitis enteropathica?

Back 8

i. Red scaly lesions in groin, face, and acral regions

Front 9

d. How do you resolve acrodermatitis enteropathica?

Back 9

i. Zinc supplementation

Front 10

va. What is the presentation of metastatic Crohn disease?

Back 10

i. Cutaneous granulomas outside GI tract

Front 11

a. What is pyoderma gangrenosum?

Back 11

i. Uncommon, chronic, recurrent ulcerative neutrophilic disease

Front 12

b. With what is pyoderma gangrenosum associated?

Back 12

i. Systemic disease

Front 13

c. What is the progression of pyoderma gangrenosum?

Back 13

i. Initial lesion is tender papulopustule
ii. Surroundeding erythema undergoes necrosis
iii. Ulceration with purulent base
iv. Gunmetal-colored border

Front 14

d. How does pyoderma gangrenosum heal?

Back 14

i. With atrophic cribriform pigmented scars

Front 15

e. What are the four types of pyoderma gangrenosum?

Back 15

i. Ulcerative
ii. Pustular
iii. Bullous
iv. Superficial granulomatous/vegetative

Front 16

f. With what is ulcerative pyoderma pigmentosum associated?

Back 16

i. Trauma→ ***pathergy***
ii. Painful!

Front 17

g. What can cause pathergy in ulcerative pyoderma gangrenosum?

Back 17

i. Steroid injections

Front 18

h. With what is bullous pyoderma gangrenosum associated?

Back 18

i. Leukemia

Front 19

i. With what intestinal disorder is pyoderma gangrenosum associated?

Back 19

i. More UC than CD

Front 20

j. What causes pyoderma pigmentosum?

Back 20

i. Associated disease→ UC/CD, PAPA syndrome
ii. Idiopathic

Front 21

k. What is PAPA syndrome?

Back 21

i. Pyogenic sterile Arthritis
ii. Pyoderma gangrenosum
iii. severe cystic Acne

Front 22

l. How do you dx pyoderma gangrenosum?

Back 22

i. Dx of exclusion

Front 23

m. What are the hisotological hallmarks of pyoderma gangrenosum?

Back 23

i. Massive dermal edema
ii. Epidermal neutrophilic abscesses at border

Front 24

n. How do you tx pyoderma gangrenosum?

Back 24

i. Based on severity of disease
ii. Mild→ topical steroid
iii. More severe→ TNFa inhibitors

Front 25

a. What must you r/o in order to dx recurrent aphthous stomatitis?

Back 25

i. Beçhet’s disease
ii. IBD
iii. Cyclic neutropenia
iv. B12/folate deficiencies
v. HIV

Front 26

b. What are the three forms of recurrent aphthous stomatitis?

Back 26

i. Minor
ii. Major
iii. Herpetiform

Front 27

c. What types of recurrent aphthous stomatitis require a systemic workup?

Back 27

i. Major
ii. Herpetiform

Front 28

d. What is recurrent aphthous stomatitis?

Back 28

i. Resembles minor aphthous ulcers
ii. Greater number of lesions

Front 29

e. How do you tx recurrent aphthous stomatitis?

Back 29

i. Topical corticosteroids
ii. Topical lidocaine

Front 30

a. With what is necrolytic migratory erythema associated?

Back 30

i. Islet cell tumor of the pancreas→ glucagon secreting

Front 31

a. What are the symptoms of necrolytic migratory erythema?

Back 31

i. Annular and arcuate
ii. Erythematous papules coalesce to form large plaques with necrosis
iii. Superficial dermis is sloughed off

Front 32

a. What are the cutaneous manifestations of hepatic disease and cirrhosis?

Back 32

i. Terry’s nails
ii. Palmar erythema
iii. Thinning of hair
iv. Pruritis
v. Telangiectasia

Front 33

a. What is the tx of hemochromatosis?

Back 33

i. Phlebotomy

Front 34

a. What is the ocular presentation of Wilson’s disease?

Back 34

i. Kayser-Fleischer ring

Front 35

a. What are the two types of cutaneous lesions that can occur in pancreatitis?

Back 35

i. Purpura
ii. Panniculitis

Front 36

b. What is panniculitis?

Back 36

i. Inflammation of adipose tissue due to direct effect of pancreatic enzymes

Front 37

a. What is Turner’s sign?

Back 37

i. Purpura of the flank
ii. Presents in pancreatitis

Front 38

d. What is Cullen’s sign?

Back 38

i. Periumbilical purpura
ii. Presents with pancreatitis

Front 39

a. What are the symtpoms of Peutz-Jegher syndrome?

Back 39

i. Perioral melanotic freckles
ii. GI polyps→ jejunum and small intestine

Front 40

b. What is the risk of cancer with Peutz-Jegher syndrome?

Back 40

i. Cancer risk increases 10-18x

Front 41

c. Where does Peutz-Jegher syndrome present?

Back 41

i. Upper GI

Front 42

a. Where does Gardner syndrome present?

Back 42

i. Lower GI

Front 43

b. What are the symptoms of Gardner syndrome?

Back 43

i. Epidermal inclusion cysts, osteomas, lipomas, fibromas

Front 44

c. With what is Gardner syndrome associated?

Back 44

i. Intenstinal polyposis of colon and rectum

Front 45

d. How do you tx Gardner syndrome?

Back 45

i. Total colectomy

Front 46

a. What is the presentation of dermatitis herpetiformis?

Back 46

i. Pruritic grouped vesicles
ii. Mostly on extensor surfaces, scalp, nuchal areas, and buttocks

Front 47

b. What are the oral symptoms of dermatitis herpetiformis?

Back 47

i. Dryness, ulceration
ii. Permanent tooth enamel defects

Front 48

c. What are the symptoms of dermatitis herpetiformis?

Back 48

i. Itching
ii. Burning**** HD!!
iii. Chronic, relapsing with spontaneous improvement

Front 49

a. With what is dermatitis herpetiformis associated?

Back 49

i. Celiac disease
ii. Thyroid disease
iii. T-cell lymphoma

Front 50

e. Where is IgA found in dermatitis herpetiformis?

Back 50

i. Tips of dermal papillae

Front 51

a. What antibodies are found in dermatitis herpetiformis?

Back 51

i. Antiendomysial antibodies
ii. Antigliadin antibodies

Front 52

g. How do you tx dermatitis herpetiformis?

Back 52

i. Dapsone→ blocks PMN mediated inflammation
ii. Gluten free diet

Front 53

h. What must you screen for before putting a patient on dapsone?

Back 53

i. GP6 DH deficiency

Front 54

a. What is Leser-Trelat?

Back 54

i. Rare cutaneous marker of internal malignancy
ii. Usually for gastric or colonic adenocarcinoma

Front 55

b. What is the onset and presentation of Leser-Trelat?

Back 55

i. Abrupt onsent of many sebborheic keratosis

Front 56

a. What is the presentation of necrobiosis lipoidica diabeticorum?

Back 56

i. Single or multiple red-brown papules that progress to yellow-brown
ii. Common sites include shins, ankles, calves, thighs, and feet

Front 57

b. What is the histological hallmark of necrobiosis lipoidica diabeticorum?

Back 57

i. Plasma cells

Front 58

c. How do you tx necrobiosis lipoidica diabeticorum?

Back 58

i. Prevent ulcers
ii. Control of diabetes has no effect on lesions

Front 59

a. What are diabetic bullae?

Back 59

i. Rapid onset
ii. Painless tense blisters on hands and feet

Front 60

b. How do diabetic bullae heal?

Back 60

i. Spontaneous healing in 2-5 weeks

Front 61

a. What is recurrent candidiasis?

Back 61

i. Erythematous, well demarcated eruptive xanthomas

Front 62

b. What do you use to tx cutaneous candidiasis?

Back 62

i. Powder with antifungal agent

Front 63

a. What is acanthosis nigricans?

Back 63

i. Velvety, grayish-brown thickening of the neck, axillae, and groin

Front 64

b. What can acanthosis nigricans be a sign of?

Back 64

i. Insulin resistance

Front 65

c. What can acanthosis nigricans precede?

Back 65

i. Adenocarcinoma of the GI

Front 66

d. How do you tx acanthosis nigricans?

Back 66

i. Tx underlying disorder

Front 67

a. What causes Cushing’s syndrome?

Back 67

i. Chronic excess of glucocorticoids

Front 68

b. What are the signs/sx of Cushing’s syndrome?

Back 68

i. Central obesity→ moon face
ii. Striae
iii. Hypertrichosis on face/body
iv. Facial acne
v. Buffalo hump

Front 69

a. What are the signs/sx of porphyria cutanea tarda?

Back 69

i. Vesicles and bullae on sun-exposed areas
ii. Facial hypertrichosis

Front 70

b. What is the underlying cause of porphyria cutanea tarda?

Back 70

i. Hepatitis C
ii. Alcoholism