Cutaneous Manifestations of Systemic — CTD

A 28-year-old woman develops a photosensitive malar rash that spares the nasolabial folds, with arthralgia and fatigue. Best first-line disease-modifying step for skin?

A 45-year-old man has annular, non-scarring, photosensitive plaques on shoulders/forearms; anti-Ro/SSA positive. Likely diagnosis?

A 36-year-old woman has scarring plaques with follicular plugging on cheeks/scalp and irreversible alopecia in involved areas. Best local therapy?

A 32-year-old woman presents with tender subcutaneous nodules on upper arms; biopsy shows lobular panniculitis with lymphocytes and hyaline fat necrosis. Diagnosis?

A newborn has annular erythematous plaques and congenital heart block. Mother is asymptomatic. Which maternal autoantibodies are most associated?

A 54-year-old develops violaceous papules over MCP/PIP joints and a heliotrope rash with proximal muscle weakness. Initial systemic treatment?

A 41-year-old with dermatomyositis has ulcerative Gottron papules, “mechanic’s hands,” and rapidly progressive dyspnea. Most concerning association?

A 7-year-old with juvenile dermatomyositis develops firm subcutaneous calcified nodules over elbows and buttocks. Name and approach?

A 52-year-old with fever, tender edematous erythematous plaques on face/neck, neutrophilia, and arthralgia. Associated triggers include?

A 34-year-old with undermined painful ulcer on leg after minor trauma; IBD history. Best immediate wound approach?

A 57-year-old woman with Raynaud phenomenon, sclerodactyly, telangiectasias, and calcinosis. Most likely autoantibody and key complication?

A 49-year-old man with diffuse skin thickening and early ILD is started on high-dose prednisone for pruritus. Two weeks later he develops abrupt hypertension and renal failure. Diagnosis/management?

A 43-year-old with progressive skin tightening of trunk/upper arms, fingertip ulcers, and crackled “salt-and-pepper” dyspigmentation. Preferred first-line for Raynaud/digital ischemia?

A 46-year-old woman has erythema and scale on V of neck (“V sign”), shawl distribution, and periungual telangiectasias without weakness. Best term and workup?

A 35-year-old woman with recurrent painful oral aphthae, genital ulcers, acneiform papules, and pathergy positivity. Diagnosis and ocular risk?

A 60-year-old with palpable purpura on legs after starting a new antibiotic; biopsy: leukocytoclastic vasculitis. Best initial step?

A 9-year-old with palpable purpura on buttocks/legs, colicky abdominal pain, hematuria, and arthralgia. Diagnosis and key test?

A 55-year-old man with livedo racemosa, subcutaneous nodules along arteries, testicular pain, and mononeuritis multiplex; HBV positive. Disease and treatment?

A 48-year-old with chronic sinusitis, epistaxis, nonhealing ulcers, and palpable purpura; c-ANCA (PR3) positive. Best induction therapy?

A 44-year-old asthmatic with eosinophilia, neuropathy, and purpuric rash. Most likely vasculitis?

A 56-year-old with purpura, arthralgias, neuropathy, low complement, and HCV infection; cryoglobulins positive. Key management?

A 59-year-old with painful retiform purpura on thighs and ESRD on dialysis; biopsy shows calcifying arteriolopathy. Most appropriate step?

A 42-year-old with painful white atrophic stellate scars on ankles/feet (“atrophie blanche”), livedoid pattern, and recurrent ulcers. Diagnosis/therapy?

A 58-year-old with tense bullae on sun-exposed dorsal hands, hypertrichosis of cheeks, and liver disease. Best confirmatory test?

A 50-year-old with periorbital violaceous plaques and yellowish papules; paraproteinemia present. Likely diagnosis?

A 62-year-old with papular mucinosis, generalized waxy papules, and limited mobility; IgG-λ monoclonal protein detected. Diagnosis?

A 40-year-old with nonhealing pretibial plaques with yellow-brown atrophic centers and telangiectasia; diabetic. Management?

A 33-year-old with erythema nodosum presents with tender nodules on shins and ankle arthralgia; CXR shows bilateral hilar lymphadenopathy. Most likely syndrome?

A 47-year-old with indurated violaceous plaques on nose and cheeks, nasal obstruction, and lupus pernio on exam. Next key evaluation?

A 29-year-old with “puffy hands,” Raynaud phenomenon, arthritis, and myalgias; anti–U1 RNP strongly positive. Most consistent diagnosis?

A 63-year-old woman with chronic xerosis, parotid enlargement, palpable purpura, and low C4. Underlying systemic disease?

A 50-year-old presents with fixed painful wheals lasting >24 hours and leaving bruising; low complement and anti–C1q antibodies. Diagnosis?

A 58-year-old man after aortic catheterization develops livedo reticularis, blue toes, eosinophilia, and renal dysfunction. Diagnosis?

A 40-year-old woman with Raynaud phenomenon asks about red flags for secondary disease. Which is most concerning?

A 61-year-old with thickened, hard skin plaques on trunk (“plate-like”), no Raynaud, normal nailfolds. Likely diagnosis?

A 55-year-old with painful, nonhealing digital tip ulcers, telangiectasias, and calcinosis; GI reflux and dysphagia. Pulmonary screening priority?

A 62-year-old man with photosensitive blisters and hypertrichosis of cheeks; ferritin high; HCV positive; on estrogen therapy. Preferred treatment?

A 44-year-old with firm papules/plaques on earlobes, nasal tip, and cheeks; biopsy: non-caseating granulomas. Cutaneous diagnosis and first-line systemic therapy?

A 52-year-old woman with swelling and pain in ear sparing lobules, nasal bridge tenderness, and hoarseness. Likely disease?

A 37-year-old with dermatomyositis is counseled on cancer risk. Which statement is accurate?

A 26-year-old woman develops painful violaceous acral plaques each winter on fingers and toes; biopsy shows interface dermatitis with dermal mucin and granular IgM/IgA/C3 at the DEJ. Most likely diagnosis?

A 38-year-old with livedo racemosa (broken, branching pattern) and recurrent TIAs. What syndrome should be suspected?

A 34-year-old with recurrent miscarriages and livedo reticularis has positive lupus anticoagulant and anticardiolipin IgG. Skin finding reflects which pathophysiology?

A 62-year-old with long-standing rheumatoid arthritis develops firm subcutaneous nodules over extensor elbows; biopsy shows palisading granulomas with necrobiosis. Best management?

A 51-year-old presents with sudden limb induration, “peau d’orange,” and a linear depression along superficial veins (groove sign). Eosinophils elevated. Diagnosis?

A 59-year-old woman with limited cutaneous systemic sclerosis has recurrent ischemic fingertip ulcers. Which agent reduces formation of new digital ulcers?

A 55-year-old with systemic sclerosis has severe reflux and dysphagia. Best long-term management?

A 46-year-old with systemic sclerosis shows mottled hyper- and hypopigmentation with “salt-and-pepper” pattern on trunk. Mechanism?

A 29-year-old with secondary Raynaud phenomenon asks about non-pharmacologic control. Most effective first steps?

A 63-year-old with SSc presents with critical digital ischemia and rest pain. Best immediate intervention?

A 44-year-old woman with dermatomyositis has severe scalp pruritus with poikiloderma and perifollicular scale. Helpful skin-directed therapy?

A 12-year-old with juvenile dermatomyositis develops painful chalky plaques over joints. Reasonable adjunct for calcinosis?

A 37-year-old with heliotrope rash and Gottron papules but normal strength/enzymes. Term?

In adult-onset dermatomyositis, which antibody confers highest malignancy association?

A 9-year-old with JDM and extensive calcinosis is most likely to have which antibody?

A patient with photoaccentuated poikilodermatous plaques on upper chest/back and prominent “shawl sign.” Antibody often associated with good response to therapy?

A 48-year-old with mechanic’s hands, Raynaud, arthralgia, and ILD. Which autoantibody fits best and what to prioritize?

A 33-year-old with edematous urticarial plaques that last >24 h and resolve with residual hyperpigmentation; complement low. Most likely entity?

A 40-year-old with indurated annular urticarial plaques on trunk, photosensitive, responds to antimalarials; biopsy: dermal mucin without epidermal damage. Diagnosis?

A 57-year-old with chronic HCV has palpable purpura, arthralgias, neuropathy, and low C4. Best disease-modifying step?

Which factors increase scleroderma renal crisis risk?

A 10-year-old with a linear, depressed, sclerotic plaque on the forehead causing eyebrow alopecia and facial asymmetry. Best systemic regimen?

Which livedo pattern is most concerning for vasculopathy?

A 42-year-old with multiple porcelain-white atrophic papules with telangiectatic rims on trunk; later abdominal pain from bowel perforation. Diagnosis?

A 53-year-old with SSc has facial telangiectasias causing psychosocial distress. Evidence-based cosmetic therapy?

A patient with sarcoidosis has disfiguring lupus pernio refractory to steroids/methotrexate. Next targeted option with best evidence?

A 68-year-old with long-standing RA develops leg ulcers, mononeuritis multiplex, and nailfold infarcts. Diagnosis/first-line induction?

Which laboratory triad confirms antiphospholipid antibody testing?

A dialysis patient develops woody induration and brawny plaques after gadolinium-enhanced MRI; joint contractures progress. Diagnosis?

A 64-year-old with periorbital “pinch” purpura, waxy papules, and macroglossia. Best confirmatory test?

A postoperative patient develops rapidly enlarging, exquisitely painful ulcer at the incision with violaceous undermined border; cultures negative. Diagnosis/management?

A 49-year-old with violaceous plaques over joints and extensor surfaces; biopsy: leukocytoclastic vasculitis with “onion-skin” fibrosis; IgA paraprotein present. Diagnosis/therapy?

A 58-year-old has painful purpura and ulcers on calves during cold exposure; serum tests negative for cryoglobulins but positive for plasma cryofibrinogen. Diagnosis?

A 48-year-old with diffuse SSc has progressive skin thickening and tendon friction rubs. Which immunomodulator has evidence for skin/ILD benefit?

A 36-year-old with SLE develops retiform purpura on thighs and gangrenous toe; labs: high aPTT due to LA. What is the immediate therapy?

A 30-year-old with SLE has recurrent painful oral ulcers and malar rash. Which drug reduces mucocutaneous flares and improves survival?

A patient with sarcoidosis has subcutaneous tender nodules on extremities; biopsy: panniculitis with granulomas in septa and lobules. Name?

A 58-year-old woman has fixed, purpuric macules on lower legs that coalesce into ivory-white atrophic scars over months (atrophie blanche). Pathogenesis and therapy?

A 47-year-old with systemic sclerosis and pulmonary arterial hypertension asks about skin telangiectasias significance. Which statement is true?

A 52-year-old with SSc develops acute severe hypertension, headache, and rising creatinine; smear shows schistocytes. Immediate management?