Slides Review 1Slides Review 1

Dr.Hulayel AlHarbiDr.Hulayel AlHarbi

43y female 43y female presented with this presented with this rash, what other rash, what other investigation investigation should be done for should be done for? her? her

molluscum contagiosummolluscum contagiosum

Molluscum contagiosum is a viral skin Molluscum contagiosum is a viral skin disease characterised by firm, round, disease characterised by firm, round, translucent, umbilicated papules translucent, umbilicated papules containing caseous matter and containing caseous matter andpeculiar capsulated bodiespeculiar capsulated bodies It is caused by a DNA virus of pox It is caused by a DNA virus of poxfamilyfamily

.HIV serology should be done.HIV serology should be done

71y female present 71y female present with several with several months of fascial months of fascial discmfort and discmfort and gritty eyes , what gritty eyes , what? is the diagnosis? is the diagnosis

systemic sclerosissystemic sclerosis

strikingly linestrikingly line--free foreheadfree forehead small beaked nosesmall beaked nose

'' puckered mouth' puckered mouth')) radial furrowing around radial furrowing aroundthe lipsthe lips multiple telangiectasia multiple telangiectasia))in advanced casesin advanced cases mouth and soft palate mouth and soft palate - - may shrink so that may shrink so that denture wearers complain of poorly fitting denture wearers complain of poorly fittingdenturesdentures The patient may be unable to close their The patient may be unable to close theireyes due to skin tetheringeyes due to skin tethering

y old lady 50 y old lady 50 presented with presented with high BP, what high BP, what clinical sign clinical sign demonestrated demonestrated her? What others her? What others cutaneous cutaneous manifestations ass manifestations ass with this with this?syndrome?syndrome

Loss of subcutaneous fat in Loss of subcutaneous fat inCushing syndromeCushing syndrome

: Other cutaneous manifestations: Other cutaneous manifestations) Early brusis ) commonest sign) Early brusis ) commonest signSkin atrophySkin atrophyStria and purpuraStria and purpura Peels off skin when adhesive tape Peels off skin when adhesive tape ) like damp tissue paper ( applied on ) like damp tissue paper ( applied on.it, Liddle,s sign.it, Liddle,s sign

60y old male heavy 60y old male heavy smoker for 20y smoker for 20y presented with 3 presented with 3 months of proximal months of proximal muscle weakness, muscle weakness, what is the Dx? what is the Dx? What other disease What other disease ass with this ass with this? syndrome? syndrome

Gottron sign in DermatomyositisGottron sign in Dermatomyositis

It associated with internal malignancy It associated with internal malignancy:in 7-50%, ass with:in 7-50%, ass withLung caLung caGastric caGastric caOvary caOvary caBreast caBreast ca Child dermatomyositis not ass with Child dermatomyositis not ass with.malignancy.malignancy

42y old man refered 42y old man refered by his dentist with by his dentist with these lesions what these lesions what?is the Dx?is the Dx

Kaposi SarcomaKaposi Sarcoma

caused by HSV-8caused by HSV-8 Classical kaposi )Ashkenazi Jews Classical kaposi )Ashkenazi Jews:)&Mediterranean origin:)&Mediterranean origin

.65y age, usually affect lower limbs.65y age, usually affect lower limbs In HIV and other In HIV and other

:immunocompromised:immunocompromised In younger age affect the face, In younger age affect the face,

bronchial tree, GI tract and eyesbronchial tree, GI tract and eyes

36y male HIV patient 36y male HIV patient presented with presented with cough and cough and haemoptysis , what haemoptysis , what? is the Dx? is the Dx

Kaposi SarcomaKaposi Sarcoma

Pulmonary manifestations include Pulmonary manifestations include pleural, parenchymal and airway pleural, parenchymal and airway lesions, and recurrent pleural lesions, and recurrent pleuraleffusions may occureffusions may occur

28y male presented 28y male presented with painful red with painful red eye. He has eye. He has previous tow previous tow attacks of shingles, attacks of shingles,? what is the Dx? what is the Dx

(Kaposi sarcoma (eye(Kaposi sarcoma (eye

.In classical KS no Rx needed.In classical KS no Rx needed In AIDS many patient will respond to In AIDS many patient will respond to.HAART.HAART In fascial lesions local radiotherapy will be In fascial lesions local radiotherapy will be effective. Other exposed areas need more effective. Other exposed areas need more.extensive radiotherapy and exesion.extensive radiotherapy and exesion In visceral disease not responding to HAART In visceral disease not responding to HAART.cytotoxic chemotherapy is indicated.cytotoxic chemotherapy is indicated

28y male presented with SOB,fever,cough. 28y male presented with SOB,fever,cough. His symptoms appeared 3 days after this His symptoms appeared 3 days after this rash, what is the Dx? Rx ? How to prevent rash, what is the Dx? Rx ? How to prevent?this complication?this complication

Chickenpox & varicella pneumoniaChickenpox & varicella pneumonia

:Treatment:TreatmentAcyclovir IV 7-10 daysAcyclovir IV 7-10 daysCorticosteroids as adjunctive therapyCorticosteroids as adjunctive therapy: Prevention: PreventionVZIG >96 hrs after exposureVZIG >96 hrs after exposure Varicella vaccine > 3 days of exposure Varicella vaccine > 3 days of exposure) ) contraindication in pregenancy) ) contraindication in pregenancy!! Acyclovir as prophylaxis!! Acyclovir as prophylaxis

52y old Greek 52y old Greek women presented women presented with DVT, which with DVT, which HLA type HLA type associated with this associated with this? syndrome? syndrome

Behcet DiseaseBehcet Disease

:Presentation:Presentation Oral & genital ulcers, Iritis, Oral & genital ulcers, Iritis, episceleritis, fever, diarrhea, abd episceleritis, fever, diarrhea, abd pain, arterial & venous thrombosis, pain, arterial & venous thrombosis,.pericarditis.pericarditis: HLA association: HLA associationHLA B5 with occular diseaseHLA B5 with occular diseaseHLA B12 with recurrent oral ulcersHLA B12 with recurrent oral ulcers

y lady with sickel 35 y lady with sickel 35 cell disease cell disease presented with abd presented with abd pain, this her pain, this her fundus exam what fundus exam what?is the Dx?is the Dx What are other What are other diseases associated diseases associated? with this fundus? with this fundus

Angioid Streaks Angioid Streaks

This uncommon condition is characterised by This uncommon condition is characterised by breaks in Bruch's membrane which breaks in Bruch's membrane whichresemble blood vesselsresemble blood vessels: Causes: CausesPseudoxanthoma elasticumPseudoxanthoma elasticumEhlers-Danlos syndromeEhlers-Danlos syndromeSickel cell diseaseSickel cell diseaseAcromegallyAcromegallyPagets diseasePagets disease Lead poisoning Lead poisoning

y old lady 78 y old lady 78 presented with this presented with this rash, what is the rash, what is the? diagnosis? diagnosis

PemphigoidPemphigoid

Large blisters healed without scarringLarge blisters healed without scarring It caused by IgG autoantibodies It caused by IgG autoantibodies.againist the basement membrane.againist the basement membrane The blisters occur in the subdermal The blisters occur in the subdermallevel so they are tense and intactlevel so they are tense and intact

72y lady presented 72y lady presented with dysphagia with dysphagia What autoantibody is What autoantibody is highly specific for highly specific for? this syndrome? this syndrome

CREST SyndromeCREST Syndrome

Calcinosis, Raynaud phenomenon, Calcinosis, Raynaud phenomenon, Esophageal dismotility, Sclerodactyly Esophageal dismotility, Sclerodactyly& Telangiectasia& Telangiectasia

Anticenteromere Abx strongly Anticenteromere Abx strongly.associated with CREST syndrome.associated with CREST syndrome

What are the What are the diseases associated diseases associated?with this condition?with this condition

Acanthosis NigricansAcanthosis Nigricans

- Endocrine : Acromegally, Cushing Endocrine : Acromegally, Cushing syndrome, Insuline resistance type 2 syndrome, Insuline resistance type 2DmDmIdiopathicIdiopathicPolycystic ovary diseasePolycystic ovary diseaseObesityObesity:malignancy:malignancy

castric ca , lymphomacastric ca , lymphoma

y female known 45 y female known 45 with DM, HTN, with DM, HTN, Hypothyrodism Hypothyrodism presented with this presented with this skin lesion which skin lesion which enlarging over the enlarging over the last 2 months what last 2 months what? is the diagnosis? is the diagnosis

Necrobiosis Lipodica DiabeticorumNecrobiosis Lipodica Diabeticorum

Predominantly affect young women Predominantly affect young women with type 1 DM and retinopathy and with type 1 DM and retinopathy and.neuropathy.neuropathy Usually begins in the pretibial region Usually begins in the pretibial region as erythematous plaque or papules as erythematous plaque or papules then gradually enlarge, darken, and then gradually enlarge, darken, and develop irregular margins with develop irregular margins with.atrophic center and ulceration.atrophic center and ulceration. It may be painful. It may be painful

y female 58 y female 58 presented with presented with gradually enlarging gradually enlarging rash. She has hx of rash. She has hx of RA. Her urine RA. Her urine dipstick was dipstick was negative and FBS negative and FBS normal. What is normal. What is? the Dx? the Dx

Necrobiosis Lipodica DiabeticorumNecrobiosis Lipodica Diabeticorum

Predominantly affect young women Predominantly affect young women with type 1 DM and retinopathy and with type 1 DM and retinopathy and.neuropathy.neuropathy Usually begins in the pretibial region Usually begins in the pretibial region as erythematous plaque or papules as erythematous plaque or papules then gradually enlarge, darken, and then gradually enlarge, darken, and develop irregular margins with develop irregular margins with.atrophic center and ulceration.atrophic center and ulceration. It may be painful. It may be painful

This 40 y male just This 40 y male just came from holiday, came from holiday, what is the DX ? what is the DX ? What type of What type of therapy is most therapy is most appropriate to appropriate to induce remission induce remission ? for this condition ? for this condition

Porphyria Cutanea TardaPorphyria Cutanea Tarda

Cutaneous photosensitivity is the Cutaneous photosensitivity is the.predominant finding with pruritic blisters.predominant finding with pruritic blisters The cause is deficiency of hepatic The cause is deficiency of hepatic.uroporphyrinogen decarboxylase.uroporphyrinogen decarboxylase Precipitant factors: alcohol, high iron, Precipitant factors: alcohol, high iron,estrogensestrogens Rx: venesection ) 450mls/week( until HB 12 Rx: venesection ) 450mls/week( until HB 12g/dlg/dl Chloroquine can promote porphyrin Chloroquine can promote porphyrin .excretion .excretion

y old Jewish lady 82 y old Jewish lady 82 presented with this presented with this rash. What is the rash. What is the? DX? DX? What is the RX? What is the RX

Pemphigus VulgarisPemphigus Vulgaris

.Blistering disease of elderly.Blistering disease of elderly Thin wall blisters usually ruptured Thin wall blisters usually ruptured easly only few can be seen intact easly only few can be seen intact.)) not like pemphigoid.)) not like pemphigoid It affect mucosal membranes )not like It affect mucosal membranes )not like.)pemphegoid.)pemphegoid It is due to IgG deposition in the It is due to IgG deposition in the.dermo-epidermal junction.dermo-epidermal junction.Rx: high doses steroids.Rx: high doses steroids

y old man treated 65 y old man treated 65 for IHD and heart for IHD and heart failure, what are failure, what are the drugs can the drugs can cause this cause this? condition? condition

GynaecomastiaGynaecomastia

: Drugs inhibit testosterone: Drugs inhibit testosterone Ketoconazole, Metronidazole, Cimetidine, Ketoconazole, Metronidazole, Cimetidine,

Etomide, CisplatinEtomide, Cisplatin:Osterogens:Osterogens

Digitalis, Oral Contraceptive pillsDigitalis, Oral Contraceptive pills:Drugs with unknown mechanism:Drugs with unknown mechanism

Isonizide, Diazepam, Omeprazole, calcium Isonizide, Diazepam, Omeprazole, calcium channel inhibitors, ACE inhibitors, tricyclic channel inhibitors, ACE inhibitors, tricyclic antidepressant, Busulphan, Marijuana, antidepressant, Busulphan, Marijuana,Heroin, SpironolactoneHeroin, Spironolactone

y old male, tall 58 y old male, tall 58 with small testes with small testes what is his what is his? karyotype? karyotype

GynaecomastiaGynaecomastia

Klinefelteris SyndromeKlinefelteris SyndromeThe karyotype 47 XXyThe karyotype 47 XXy