A 58-year-old tall man with small testes likely has Klinefelter syndrome, a genetic condition where the sex chromosomes are XXY instead of the typical XY for males. Klinefelter syndrome can cause gynecomastia (breast growth in males) and small testes due to decreased testosterone levels.

1. Slides Review 1 Dr.Hulayel AlHarbi

2. 43y female presented with this rash, what other investigation should be done for her ?

3. molluscum contagiosum Molluscum contagiosum is a viral skin disease characterised by firm, round, translucent, umbilicated papules containing caseous matter and peculiar capsulated bodies It is caused by a DNA virus of pox family HIV serology should be done.

4. 71y female present with several months of fascial discmfort and gritty eyes , what is the diagnosis ?

5. systemic sclerosis strikingly line - free forehead small beaked nose ' puckered mouth' ( radial furrowing around the lips multiple telangiectasia ( in advanced cases mouth and soft palate - may shrink so that denture wearers complain of poorly fitting dentures The patient may be unable to close their eyes due to skin tethering

6. 50 y old lady presented with high BP, what clinical sign demonestrated her? What others cutaneous manifestations ass with this syndrome?

7. Loss of subcutaneous fat in Cushing syndrome Other cutaneous manifestations : Early brusis ( commonest sign ) Skin atrophy Stria and purpura Peels off skin when adhesive tape ( like damp tissue paper ) applied on it, Liddle,s sign.

8. 60y old male heavy smoker for 20y presented with 3 months of proximal muscle weakness, what is the Dx? What other disease ass with this syndrome ?

9. Gottron sign in Dermatomyositis It associated with internal malignancy in 7-50%, ass with: Lung ca Gastric ca Ovary ca Breast ca Child dermatomyositis not ass with malignancy.

10. 42y old man refered by his dentist with these lesions what is the Dx?

11. Kaposi Sarcoma caused by HSV-8 Classical kaposi (Ashkenazi Jews &Mediterranean origin): 65y age, usually affect lower limbs. In HIV and other immunocompromised: In younger age affect the face, bronchial tree, GI tract and eyes

12. 36y male HIV patient presented with cough and haemoptysis , what is the Dx ?

13. Kaposi Sarcoma Pulmonary manifestations include pleural, parenchymal and airway lesions, and recurrent pleural effusions may occur

14. 28y male presented with painful red eye. He has previous tow attacks of shingles, what is the Dx ?

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

16. 28y male presented with SOB,fever,cough. His symptoms appeared 3 days after this rash, what is the Dx? Rx ? How to prevent this complication?

17. Chickenpox & varicella pneumonia Treatment: Acyclovir IV 7-10 days Corticosteroids as adjunctive therapy Prevention : VZIG <96 hrs after exposure Varicella vaccine < 3 days of exposure ( contraindication in pregenancy ) Acyclovir as prophylaxis !!

18. 52y old Greek women presented with DVT, which HLA type associated with this syndrome ?

19. Behcet Disease Presentation: Oral & genital ulcers, Iritis, episceleritis, fever, diarrhea, abd pain, arterial & venous thrombosis, pericarditis. HLA association : HLA B5 with occular disease HLA B12 with recurrent oral ulcers

20. 35 y lady with sickel cell disease presented with abd pain, this her fundus exam what is the Dx? What are other diseases associated with this fundus ?

21. Angioid Streaks This uncommon condition is characterised by breaks in Bruch's membrane which resemble blood vessels Causes : Pseudoxanthoma elasticum Ehlers-Danlos syndrome Sickel cell disease Acromegally Pagets disease Lead poisoning

22. 78 y old lady presented with this rash, what is the diagnosis ?

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

24. 72y lady presented with dysphagia What autoantibody is highly specific for this syndrome ?

25. CREST Syndrome Calcinosis, Raynaud phenomenon, Esophageal dismotility, Sclerodactyly & Telangiectasia Anticenteromere Abx strongly associated with CREST syndrome.

26. What are the diseases associated with this condition?

27. Acanthosis Nigricans Endocrine : Acromegally, Cushing syndrome, Insuline resistance type 2 Dm Idiopathic Polycystic ovary disease Obesity malignancy: castric ca , lymphoma

28. 45 y female known with DM, HTN, Hypothyrodism presented with this skin lesion which enlarging over the last 2 months what is the diagnosis ?

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

30. 58 y female presented with gradually enlarging rash. She has hx of RA. Her urine dipstick was negative and FBS normal. What is the Dx ?

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

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

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

34. 82 y old Jewish lady presented with this rash. What is the DX ? What is the RX ?

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

36. 65 y old man treated for IHD and heart failure, what are the drugs can cause this condition ?

37. Gynaecomastia Drugs inhibit testosterone : Ketoconazole, Metronidazole, Cimetidine, Etomide, Cisplatin Osterogens: Digitalis, Oral Contraceptive pills Drugs with unknown mechanism: Isonizide, Diazepam, Omeprazole, calcium channel inhibitors, ACE inhibitors, tricyclic antidepressant, Busulphan, Marijuana, Heroin, Spironolactone

38. 58 y old male, tall with small testes what is his karyotype ?

39. Gynaecomastia Klinefelteris Syndrome The karyotype 47 XXy