Test 21  (systemic diseases) 

Refer to this picture for question 1.

 
1. Related features include:

a. 

b. 

c. 

d. 

e. 
 

Answera.T   b.T  c.T  d.T  e.T
The picture shows serous retinal detachment in a pigmented eye. The diagnosis in this case is Vogt-Koyanagi-Harada's disease. Recently, 
this disease has been split into two variants: Vogt-Koyanagi's variant and Harada's variant. 
Related features include hearing loss (a. shows hearing aids 
through the decades), poliosis (b.), whitelock (e.) and iris
nodules (d). c. shows hypo pigmentation of the fundus after spontaneous reattachment of the retina giving the so-called "sun-set glow"

 

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Refer to this picture for question 2.

2. Blood films related to the above appearance include:

a. 

b. 

c. 

d. 

e. 

Answera.T   b.F  c.T   d.T  e.T
The referring picture shows a patient with jaundice.
Disorder of red blood cells that can give rise to this 
include beta-thalassemia (a. shows target cells and nucleated red blood cells), sickle cell anaemia (c. shows sickle cells), spherocytosis (d. shows round 
spherocytes) and malaria (e. shows Plasmodium falciparum within the red blood cells).
b. shows iron deficiency anaemia with hypochromia and microcytosis.

 
 
 

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Refer to this picture for question 3.

3. The above condition can be caused by:

a. 

b. 

c. 

d. 

e. 

Answera.T   b.T  c.T  d.T  e.T
Pingueculae is seen in the referring picture.
This is usually caused by ultraviolet light (a).
Welding (b) also increases the incidence.
Gaucher's disease is a rare cause of pingueculae. It is a rare autosomal recessive disorder. It is caused by deficiency of the enzyme glucocerebrosidase, which 
breaks down a certain lipid called glucocerebroside. 
Without this enzyme, the lipid builds up, causing the 
disease's symptoms. The type and severity of symptoms can vary widely among individuals with the disease. Symptoms include anaemia, fatigue, and enlarged liver and spleen. Patients can also suffer from easy bleeding and bruising, and deterioration of bones, leading to frequent fractures. Gaucher disease is the most prevalent lysosomal storage disorder. Diagnosis of the disease is via assay of decreased glucocerebrosidase activity in peripheral blood samples and the findings of Gaucher's 
cells in the body tissue (ie. accumulation of undegraded glucocerebroside in monocyte-macrophage cells). c. shows Gaucher's cells from the spleen and d. from the bone marrow. e. shows osteopenia in Gaucher's disease. 
 
 

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Refer to the picture above for question 4.

4. Recognized causes for the above condition include:

a. 

b. 

c. 

d. 

e. 

Answera.T  b.T  c.T  d.T   e.T
The referring picture shows band keratopathy which can result from hypercalcaemia.
a. shows leuconychia ie. white finger nail. This can 
occur in renal failure. Poorly managed renal failure can give rise to increased parathyroid hormone activity leading to band keratopathy.
b. and d. are features of sarcoidosis. b. shows lupus 
pernio and cheek infiltration by sarcoid. d. shows 
osteolysis of the terminal phalanx (arrowed) giving it a lacy trabecular pattern.
c. shows an enlarged parathyroid gland below the thyroid gland and is suggestive of hyperparathyroidism.
e. shows pathological fracture in metastatic breast carcinoma.

 
 

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Refer to the picture above for question 5.

 
5. Causes of the above appearance include:

a. 

b. 

c. 

d. 

e. 

Answera.F   b.F  c.F  d.F  e.F
While all the above conditions can give rise to acquired 
Horner's syndrome. This patient has congenital Horner's syndrome as evidenced by the ipsilateral hypochromic iris.
a. shows a malignant thyroid cancer.
b. is internal carotid artery aneurysm in the cavernous sinus.
c. is syringomyelia note the cystic spaces within the cervical spinal cord.
d. is Pancoast's tumour involving the right pulmonary apex.
e. is a traumatic dissecting carotid artery.

 
 

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