Metabolic Disorders Quiz: Lipoid Proteinosis and Systemic Amyloidosis
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Questions and Answers

What is the treatment of choice for lipoid proteinosis causing hoarseness of voice?

  • Acitretin (correct)
  • Steroid
  • Chemo
  • Anti siRNA

What genetic mutation is associated with Legius syndrome, which presents without tumors, freckles, lipoma, macrocephaly, and ADHD?

  • SPRED1 gene mutation (correct)
  • Fibrous dysplasia gene mutation
  • GNAS mutation
  • NF1 gene mutation

In a case of severe itchy macular hyperpigmentation on the back (macular amyloidosis), what investigation would be most appropriate?

  • Blood PTN fixation or detection
  • Congo red (correct)
  • Fat aspiration
  • Calcitonin level or thyroid scan

What would be the next step for a patient suspected of systemic amyloidosis?

<p>Serum protein electrophoresis (B)</p> Signup and view all the answers

What is the next step for a female patient with macular amyloidosis?

<p>Consult an endocrinologist (B)</p> Signup and view all the answers

In a pediatric patient with erythema and bone pain, histological findings of epithelioid granuloma and few lymphocytes point to a gene defect associated with which syndrome?

<p>TNFR1 syndrome (B)</p> Signup and view all the answers

What gene defect is associated with Fabry's disease?

<p>GLA gene (B)</p> Signup and view all the answers

A male patient with an erythematous rash and bone pain should have a bone x-ray performed on which site if the skull or cranium is not present?

<p>Spine (B)</p> Signup and view all the answers

What is the most common association of macular amyloidosis?

<p>No known specific association (B)</p> Signup and view all the answers

What mutation is responsible for causing Langerhans cell histiocytosis?

<p>Mutation in BRAF gene (A)</p> Signup and view all the answers

In a patient with cutaneous amyloidosis, what organ association is commonly seen?

<p>(Renal) kidney involvement (A)</p> Signup and view all the answers

(Tubers xanthoma) bilateral nodules on the Achilles tendon are typically associated with an elevation in which investigation?

<p>(Cholesterol) serum cholesterol levels (C)</p> Signup and view all the answers

(Angiokeratoma) presenting with hyperkeratosis and rete ridges encircling dilated vessels in the papillary dermis points to a defect in which enzyme?

<p>(Galactosidase A) alpha-galactosidase A (A)</p> Signup and view all the answers

In a patient with neurofibromatosis, what association is commonly seen?

<p>Pheochromocytoma development (A)</p> Signup and view all the answers

In a case of Wilson's disease, what would you expect to find in the epidermis?

<p>Elastic fiber accumulation (B)</p> Signup and view all the answers

In a patient with Wilson's disease, what would you expect to find in the epidermis?

<p>Elastic fibers (C)</p> Signup and view all the answers

In a case of severe itchy macular hyperpigmentation on the back (macular amyloidosis), what investigation would be most appropriate?

<p>Bone marrow biopsy (D)</p> Signup and view all the answers

A male patient with an erythematous rash and bone pain should have a bone x-ray performed on which site if the skull or cranium is not present?

<p>Spine (A)</p> Signup and view all the answers

In a patient with cutaneous amyloidosis, what organ association is commonly seen?

<p>Renal impairment (D)</p> Signup and view all the answers

(Tubers xanthoma) bilateral nodules on the Achilles tendon are typically associated with an elevation in which investigation?

<p>Cholesterol level (A)</p> Signup and view all the answers

(Angiokeratoma) presenting with hyperkeratosis and rete ridges encircling dilated vessels in the papillary dermis points to a defect in which enzyme?

<p>Galactosidase A (A)</p> Signup and view all the answers

In a case of Wilson's disease, what will you expect to find in the epidermis?

<p>Elastic fibers (C)</p> Signup and view all the answers

In a pediatric patient with erythema and bone pain, histological findings of epithelioid granuloma and few lymphocytes point to a gene defect associated with which syndrome?

<p>ACE Fabry's disease defect (picture) (A)</p> Signup and view all the answers

A female patient with macular amyloidosis would most likely require what investigation next?

<p>Immunofixation (B)</p> Signup and view all the answers

A child with porphyria would most likely benefit from which treatment approach?

<p>Phlebotomy (D)</p> Signup and view all the answers

A patient with skin-colored papules and elastic skin on the neck and angoid streaks on retina should consider taking which action next?

<p>Start Biologic (C)</p> Signup and view all the answers

What investigation would be most appropriate for a patient with sever itchy macular hyperpigmentation on the back (macular amyloidosis)?

<p>Congo red (A)</p> Signup and view all the answers

For a 10-year-old child with normal findings but scars on knuckles, which porphyria investigation would be expected to be positive and which negative?

<p>Urine porphyrin: negative, Blood porphyrin: positive (D)</p> Signup and view all the answers

In a case of severe itchy macular hyperpigmentation on the back (macular amyloidosis), what would be the most appropriate association?

<p>Systemic amyloidosis (B)</p> Signup and view all the answers

In a case of lipoid proteinosis causing hoarseness of voice, what is the most appropriate treatment?

<p>Chemo Steroid + Melphalan (B)</p> Signup and view all the answers

In a patient with neurofibromatosis, what association is commonly seen?

<p>Café au lait macules (D)</p> Signup and view all the answers

What association would be commonly found in a patient with Legius syndrome caused by SPRED1 gene?

<p>Macrocephaly (A)</p> Signup and view all the answers

Which investigation is typically elevated in a patient with tuberous xanthoma (bilateral nodules on the Achilles tendon)?

<p>Calcitonin level (A)</p> Signup and view all the answers

(Angiokeratoma) presenting with hyperkeratosis and rete ridges encircling dilated vessels in the papillary dermis points to a defect in which enzyme?

<p>alpha-galactosidase A (D)</p> Signup and view all the answers

In a patient with cutaneous amyloidosis, what organ association is commonly seen?

<p>Kidney (B)</p> Signup and view all the answers

What would be the next step for a patient suspected of systemic amyloidosis?

<p>Blood or urine electrophoresis (C)</p> Signup and view all the answers

A male patient with an erythematous rash and bone pain should have a bone x-ray performed on which site if the skull or cranium is not present?

<p>Arm (D)</p> Signup and view all the answers

What genetic mutation is associated with Legius syndrome, which presents without tumors, freckles, lipoma, macrocephaly, and ADHD?

<p>SPRED1 gene (C)</p> Signup and view all the answers

Which gene defect is associated with Legius syndrome, presenting without tumors, freckles, lipoma, macrocephaly, and ADHD?

<p>SPRED1 (C)</p> Signup and view all the answers

In a case of lipoid proteinosis causing hoarseness of voice, what is the most appropriate treatment?

<p>Steroid Acitretin (A)</p> Signup and view all the answers

What investigation would be most appropriate for a patient with severe itchy macular hyperpigmentation on the back (macular amyloidosis)?

<p>Congo red (B)</p> Signup and view all the answers

In a patient with generalized hyperpigmentation, hepatomegaly, and diabetes, what association would be expected?

<p>McCune-Albright syndrome by GNAS mutation (A)</p> Signup and view all the answers

Which investigation would be most appropriate for a 10-year-old child with normal findings but scars on knuckles, to differentiate between porphyria types?

<p>Urine porphyrin negative blood porphyrin positive (A)</p> Signup and view all the answers

(Angiokeratoma) presenting with hyperkeratosis and rete ridges encircling dilated vessels in the papillary dermis points to a defect in which enzyme?

<p>Fabry's disease enzyme (D)</p> Signup and view all the answers

What is the next most appropriate step for a female patient with macular amyloidosis?

<p>Seek evaluation by an ophthalmologist. (A)</p> Signup and view all the answers

In a case of juvenile xanthogranuloma, what would be the next most appropriate step?

<p>Consult with an ophthalmologist. (B)</p> Signup and view all the answers

For a 40-year-old female with generalized purpuric eruption and sole ulcer, what would be the most appropriate treatment?

<p>Methotrexate. (A)</p> Signup and view all the answers

What should be monitored during treatment for mastocytosis aggravated by a drug?

<p>Serum creatinine levels. (B)</p> Signup and view all the answers

In a patient with skin-colored papules, elastic skin on the neck, and angoid streaks on the retina, what action is most appropriate?

<p>Introduce simvastatin. (C)</p> Signup and view all the answers

What is the best investigation to order for a patient with perforating disease, consistent clinical features, and renal failure?

<p>Serum creatinine test. (C)</p> Signup and view all the answers

What investigation is needed for a patient with nodules on the olecranon ligament?

<p>[X-ray of the affected area. (A)</p> Signup and view all the answers

What is the treatment of choice for end-stage renal disease with perforating disease?

<p>[NBUVB phototherapy]. (C)</p> Signup and view all the answers

A 3-month-old child presents with vomiting and brown lesions, and an X-ray shows osteolytic lesions. What is the most appropriate treatment?

<p>Vincristine or vinblastine (A)</p> Signup and view all the answers

What is the most appropriate treatment for an infant with low weight and multiple brown lesions with X-ray findings of osteolytic lesions?

<p>Vincristine (A)</p> Signup and view all the answers

In a patient with lipoid proteinosis causing hoarseness of voice, which treatment should be avoided due to the potential severity of adverse reactions?

<p>Chemo Steroid + Melphalan (A)</p> Signup and view all the answers

In a case of generalized hyperpigmentation, hepatomegaly, and diabetes, what association would be expected?

<p>Hemochromatosis (D)</p> Signup and view all the answers

What investigation is most appropriate for a 10-year-old child with normal findings but scars on knuckles?

<p>Blood porphyrine positive (A)</p> Signup and view all the answers

In a case of macular amyloidosis, what investigation would be most appropriate?

<p>Congo red (A)</p> Signup and view all the answers

Which gene defect is associated with Legius syndrome, presenting without tumors, freckles, lipoma, macrocephaly, and ADHD?

<p>SPRED1 gene (B)</p> Signup and view all the answers

What is the next most appropriate step for a patient suspected of systemic amyloidosis?

<p>Blood or urine electrophoresis (A)</p> Signup and view all the answers

What is the next most appropriate step for a female patient with macular amyloidosis?

<p>Consult an ophthalmologist. (D)</p> Signup and view all the answers

In a case of Langerhans cell histiocytosis, which investigation would be needed if the skull or cranium is not present?

<p>X-ray on the leg. (C)</p> Signup and view all the answers

In a patient with nodules on the olecranon ligament, what investigation would be most appropriate?

<p>Cholesterol levels test. (B)</p> Signup and view all the answers

In a patient with vesicular eruption on hand, arm, and face, with no inflammatory infiltrate in the histopathology, what would be the most appropriate treatment?

<p>Phlebotomy if porphyria cutanea tarda (PCT) is present. (C)</p> Signup and view all the answers

In a case of Hypothesia and hypohydrosis, which investigation would be most appropriate?

<p>Mucinosis muco-polysaccharide test. (C)</p> Signup and view all the answers

In a case of scleromyxoedema with waxy papules on the face and upper back, what would be the most appropriate treatment?

<p>Intravenous immunoglobulin (IVIG) therapy. (B)</p> Signup and view all the answers

In an infant with low weight and multiple brown lesions, which treatment is most appropriate if X-ray findings show osteolytic lesions?

<p>Vincristine therapy. (C)</p> Signup and view all the answers

(Angiokeratoma) presenting with hyperkeratosis and rete ridges encircling dilated vessels in the papillary dermis points to a defect in which enzyme?

<p>[Galactosidase A]. (C)</p> Signup and view all the answers

In a pediatric patient with erythema and bone pain, histological findings of epithelioid granuloma and few lymphocytes point to a gene defect associated with which syndrome?

<p>Defect in Fabry's disease gene (GLA galactosidase A). (D)</p> Signup and view all the answers

In a patient with skin-colored papules, elastic skin on the neck, and angoid streaks on retina, what action is most appropriate?

<p>Consider biologic therapy. (A)</p> Signup and view all the answers

Study Notes

Lipoid Proteinosis

  • Treatment of choice for hoarseness of voice: Voice therapy
  • Avoid corticosteroids due to potential severe adverse reactions

Legius Syndrome

  • SPRED1 gene defect is associated with Legius syndrome without tumors, freckles, lipoma, macrocephaly, and ADHD

Macular Amyloidosis

  • Most appropriate investigation: Skin biopsy
  • Next step for suspected systemic amyloidosis: Further investigations like echocardiogram, bone marrow biopsy, and renal function tests
  • Next step for female patients: Genetic testing for mutations in the FGA gene

Systemic Amyloidosis

  • Next step for suspected systemic amyloidosis: Further investigations like echocardiogram, bone marrow biopsy, and renal function tests

Pediatric Erythema & Bone Pain

  • Histological findings of epithelioid granuloma and few lymphocytes suggest Birbeck granule deficiency associated with Chediak-Higashi syndrome

Fabry's Disease

  • Gene defect associated with Fabry's disease: α-galactosidase A deficiency

Erythematous Rash & Bone Pain

  • Bone x-ray for a male patient with erythematous rash and bone pain should be performed on the long bones if skull or cranium is not present.

Cutaneous Amyloidosis

  • Common organ association: Renal involvement

Tubers Xanthoma

  • Bilateral nodules on Achilles tendon are typically associated with elevated lipid levels

Angiokeratoma

  • Hyperkeratosis and rete ridges encircling dilated vessels in the papillary dermis point to a defect in α-galactosidase A enzyme

Neurofibromatosis

  • Common association: Lisch nodules on the iris

Wilson's Disease

  • Expected finding in the epidermis: Increased melanin deposition

Porphyria

  • Treatment for a child with porphyria: Avoidance of sunlight and photoprotective measures

Skin-Colored Papules, Elastic Skin, and Angoid Streaks

  • Action to consider: Genetic testing for Ehlers-Danlos syndrome

Porphyria Investigation

  • A 10-year-old child with normal findings and scars on knuckles:
    • Expected positive investigation: Porphobilinogen deaminase activity
    • Expected negative investigation: Uroporphyrinogen I synthase deficiency

Juvenile Xanthogranuloma

  • Next step: Observation and follow-up

Generalized Purpuric Eruption and Sole Ulcer

  • Treatment: Corticosteroids

Mastocytosis

  • Monitor liver function tests during treatment for mastocytosis to assess drug-induced liver injury.

Perforating Disease

  • Investigation: Skin biopsy

Nodules on the Olecranon Ligament

  • Investigation: Skin biopsy

End-Stage Renal Disease with Perforating Disease

  • Treatment: Kidney transplantation

3-Month-Old Child with Vomiting, Brown Lesions, and Osteolytic Lesions

  • Treatment: Bisphosphonates

Hypothesia and Hypohydrosis

  • Investigation: Nerve conduction studies

Scleromyxoedema

  • Treatment: Topical corticosteroids

10-Year-Old Child with Normal Findings and Scars on Knuckles

  • Investigation: Porphobilinogen deaminase activity

Langerhans Cell Histiocytosis

  • Investigation: Bone marrow biopsy

Vesicular Eruption on Hand, Arm, and Face

  • Treatment: Topical corticosteroids

Generalized Hyperpigmentation, Hepatomegaly, and Diabetes

  • Association: Hemochromatosis

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Description

Test your knowledge of metabolic disorders with this quiz covering lipoid proteinosis and systemic amyloidosis. Answer questions about treatment options, diagnostic procedures, and management of these conditions.

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