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302 Cards in this Set
- Front
- Back
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what are the layers of the epidermis?
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surface to base: startums - Corneum, Lucidum, Granulosum, Spinosum and Basalis (Californians Like Girls in String Bikinis)
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define zona occludens
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tight junctions: prevents diffuse acorss paracellular space; composed of claudins and occludins
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define zona adherens
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intermediate junction: surround perimeter just below zona oclusdens; cadherins connect to actin
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define macula adherens
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desmosome: small discrete sites of attachment, cadherins connect to intermediate filaments via desmoplakin
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define gap junction
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allows adjacent cells to communicate for electric and metabolic function
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define hemidesmosome
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connects cels to underlying extracellular matrix
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what are integrins?
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they maintain the integrity of the BM, binds to lamin within the BM
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what makes up the unhappy triad knee injury?
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damage to the medical collateral ligament, (MCL), medial meniscus and anterior crucitate ligament (ACL)
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what test indicates tearing of the ACL?
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positive anterior drawer sign
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what indicates tron MCL?
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abnormal passive abdunction
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where do the ACL and PCL connect on the tiba?
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ACL attaches anterior on the tibia and PCL attaches posteriorly
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what are the muscles that make up the rotator cuff?
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SItS: Supraspinatus, Infraspinatus, Teres minor, Subscapularis (the t in SItS is little because it is teres MINOR)
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what is the function of supraspinatus?
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helps deltoid abduct arm
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what is the function of infraspinatus?
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laterally rotates arm
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what is the function of teres minor
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adducts and laterally rotates arm
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what is the function o f subscapularis?
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medially rotates and adducts the arm
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which two muscles of the rotator cuff are located posteriorly?
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infraspinatus and teres minor
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which muscle of the rotator cuff is located superiorly?
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supraspinatus
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which muscle of the rotator cuff is located anteriorly?
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subsacpularis
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what is the most likely cause of compression of C7 root?
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comporessed by cervical disk lesion
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what is the most likely cause of lesion of the upper trunk of the brachial plexus?
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trauma
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what is the most likely cause of lesion of the axiallry nerve?
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lesioned by fracture or the surgical neck of the humerus, disolcation of the humerous and intramuscular injections
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what is the most likely cause of lesion of the radial nerve in the spiral groove?
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lesioned by midshaft fracture of the humerus
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what is the most likely cause of compression of lower trunk of the brachial plexus?
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compressed by cervical rib or by Pancoast tumor of the lung
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what is the most likely cause of compression of the radial nerve?
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compressed in axilla by incorrect use of crutches
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what is the most likely cause of compression of the median nerve?
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compressed by supracondylar fracture of the humerus, pronator teres syndrome; and at the wrist in carpal tunnel syndrome and by dislocated lunate bone
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what is the most likely cause of lesion of the ulnar nerve?
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lesioned by repeated minor trauma, and fracture of the medial epicondyle of the humerus; and in the hand by trauma to the heel of the hand and fracture of the hood of the hamate bone
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what is the most likely cause of compression of the anterior interossesous nerve?
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compressed in the deep formarm
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what is the most likely cause of lesion of the deep branch of the radial nerve?
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stretched by subluxation of the radius
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what is the most likely cause of lesion of the recurrent branch of the median nerve?
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lesioned by superficial laceration
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what is caused by lesion of the upper trunk of the brachial plexus?
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waiter's tip hand (Erb's palsy)
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what is caused by lesion of the lower trunk of the brachial plexus?
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total claw hand (Klumpke' palsy)
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what is caused by lesion of the posterior cord of the brachial plexus?
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wrist drop
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what is caused by lesion of the long thorasic nerve?
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winged scapula
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what is caused by lesion to the axillary nerve?
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deltoid paralysis
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what is caused by lesion to the radial nerve?
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Saturday night palsy (wrist drop)
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what is caused by lesion to the musculocutaneous nerve?
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difficulty flexing elbow and varied sensory loss
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what is caused by lesion to the median nerve?
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decreased thumb function = "ape hang" or "pope's blessing"
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what is caused by lesion to the ulnar nerve?
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intrinsic muscles of the hand paralysis - "claw hand"
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what protects the brachial plexus from fracture of the clavical?
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the subclavius muscle
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what kind of motor and sensory deficits are seen with fracture of the surgical neck of the humerous?
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axillary nerve damage = deficit with arm abduction at should and sensory deficit over the deltoid muscle
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what kind of motor and sensory deficits are seen with dislocation of the humeral head?
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axillary nerve damage = deficit with arm abduction at should and sensory deficit over the deltoid muscle
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what kind of motor and sensory deficits are seen with fracture of the midshaft of the humerous?
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Radial nerve damage = deficit with wrist extension, finger extension at MCP joint, supination and thumb extesion and abduction; sensory deficit over the posterior arma nd dorsal hand and thumb
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what kind of motor and sensory deficits are seen with fracture of the of supracondylar humerus?
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Median nerve damage = deficit with opposition of the thumb, sensory deficit over the dorsal and palmar aspects of the lateral 3 1/2 fingers and thenar eminence
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what kind of motor and sensory deficits are seen with capral tunnel syndrome?
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median nerve damage = deficit with lateral finger flexion and wrist flexion; sensory deficit over the dorsal and palmar aspects of the lateral 3 1/2 fingers
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what kind of motor and sensory deficits are seen with dislocation of the lunate bone?
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median nerve damage = deficit with lateral finger flexion and wrist flexion; sensory deficit over the dorsal and palmar aspects of the lateral 3 1/2 fingers
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what kind of motor and sensory deficits are seen with fracture of the medial epicondyle of the humerus?
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ulnar nerve damage = deficit with finger flexion and wrist flexion, sensory deficit over the medial 1 1/2 finger and hypthenar eminence
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what kind of motor and sensory deficits are seen with fracture of the hook of the hamate bone (falling onto outstretched hands)?
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ulnar nerve damage = deficit with abduction and adduction of fingers, adduction of thumb and extension of the 4th and 5th fingers, sensory deficit over the lateral 1 1/2 fingers and hypothenar eminence
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what kind of motor and sensory deficits are seen with upper trunk compression?
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musculocutaneous nerve damage = deficit with felxion of arm at elbow and sensory deficit of the lateral forearm
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what is the thoracic outlet syndrome?
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due to embryological or childbirth defect of the inferior trunk of the brachial plexus (C8 and T1) leads to: 1. atrophy of the thenar and hypothenar eminences, 2. atrophy of the interosseous muscles, 3. sensory deficits of the medial side of the forearm and hand and 4. disappearance of teh radial pulse upon moving the head toward the opposite side
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what is the function of the lumbrical muscles?
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flex the MCP joints and extend the DIP and PIP joints
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what lumbrical function is lost in ulnar claw?
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distal ulnar nerve lesion leads to loss of medial lumbrical function = 4th and 5th digits are clawed
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what lumbrical function is lost in median claw?
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distal median nerve lesion leads to loss of lateral lumbrical function = 2nd and 3rd digits are clawed
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what muscle function is lost in "ape hand"
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proximal median nerve lesion leads to loss of opponens pollicis function = unopposable thrmb (can't abduct)
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what lumbrical function is lost in Klumpke's total claw?
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lesion of the lower trunk of the brachial plexus leads to loss of all lumbricals, forearm finger flexors and finger extensors = clawing of all digits
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what mucles are innervated by the radial nerve?
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the "great extensor nerve" innervates the brachioradialis, extensors of the wrist and fingers, supinator and triceps (radial nerve innervates the BEST)
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define supination
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rotate palm upwards as if carrying a bowl of SOUP
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what muscles comprise the thenar eminence?
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opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis
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what muscles comprise the hypothenar eminence?
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opponens digiti minimi, abductor digitis minimi and flexor digiti minimi
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what is the function of dorsal interosseous muscles?
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abduct the fingers (DAB = Dorsals ABduct)
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what is the function of the palmar interosseous muscles?
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adduct the fingers (PAD = Palmar ADDuct)
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what is tennis elbow?
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Lateral epicondylitis = repetitive elbow trauma that causes tiny tears in tendors and muscles
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what is golf elbow?
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medial epicondylitis = repetitive elbow trauma that causes tiny tears in the tendons and muscles (you have to keep your arm close to your body for a good golf swing = medial)
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what nerve is damaged and deficits are seen with anterior hip dislocation?
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obturator nerve; thigh adduction and sensory deficit over the medial thigh
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what nerve is damaged and deficits are seen with pelvic fracture?
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femoral nerve; thigh flexion and leg extension and sensory deficit over the anterior thigh and medial leg
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what nerve is damaged and deficits are seen with trauma to the lateral aspect of the leg?
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common peroneal nerve; foot eversion and dorsiflexion and toe extension are lost; sensory deficit over the anteriolateral leg and dorsal aspect of the foot
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what nerve is damaged and deficits are seen withfracture of the fibula neck?
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common peroneal nerve; foot eversion and dorsiflexion and toe extension are lost; sensory deficit over the anteriolateral leg and dorsal aspect of the foot
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what nerve is damaged and deficits are seen with knee trauma?
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tibial nerve; foot inversion and plantarflexion and toe flexion are lost; sensory deficit over the sole of the foot
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what nerve is damaged and deficits are seen with posterior hip dislocation?
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superior gluteal nerve; thigh abduction is lost (positive Trendelenburg sign); and inferior gluteal nerve = can't jump, climb stairs or rise from seated position
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what nerve is damaged and deficits are seen with polio?
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superior gluteal nerve; thigh abduction is lost (positive Trendelenburg sign)
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what is the function of the peroneal nerve?
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PED = Peroneal Everts and Dorsiflexes the foot; if injured = foot dropPED
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what is the function of the tibial nerve?
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TIP = Tibial Inverts and Plantarflexes; if injured can't stand on TIPtoes
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what is the sequence of muscle contraction in striated muscle?
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1. AP opens voltage gated Ca channels inducing NT relseae, 2. NT leads to depolarization of the motor end plate, 3. depole travels along muscle cell and down the T-tubules, 4. dop opens voltage gated dihydropyridine recpotr which is coupled to the ryanodine recptor causes Ca release from the SR, 5. Ca binds to troponin, moving tropomyosin revealing actin binding sites; 7. myosin binds to actin
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what are the steps of the myosin-actin power stroke?
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1. myosin binds to exposed actin bindings sites, 2. Pi is released for the power stroke to occur, 3. ATP binds to myosin displacing the actin-myosin bond, 4. myosin hydrolyzes ATP to recock from the power stroke position
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what bands are shorted in muscle contraction in striated muscle?
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Z, H and I bands shorten, A band remains the same length
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what are is the sequence of muscle contraction in smooth muscle?
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AP depolarizes the muscle membrane, voltage gated Ca channel opens, Ca binds to calmodulin which activates myosin light chian kinase which phosphorylates myosin and allows for contraction; dephosphorylated myosin causes relaxation
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what causes relaxation in smooth muscle?
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myosin light-chain phophatase which dephophorylates and allows for relaxation
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define endochondrial ossification
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occurs in longitudinal bone growth - cartilaginou smodel of the bone is first made by chondrocytes, osteoclasts and blasts later replace the cartilage with woven bone which is subsequently remodeled to lamellar bone
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define membranous ossification
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occurs in flat bone growth (skull, ficial bones and axial skeleton), woven bone is formed without cartilage model, wooven bone is remodeled to lamellar bone
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how is achondroplasia inherited?
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AD - associated with advanced paternal age
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define achondroplasia
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failure of longitudinal bone growth = short limbs; membranous ossification is not affected = normal sized head; common cause of dwarfism, normal life span and fertility
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what is the mutation that causes acondroplasia?
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fibroblast GF receptor (FGFR3) mutation - impaired cartilage matureation in the growth plate
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define osteoporosis
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reduction of bone mass inspite of normal bone mineralization; SPARSE TRABECULAE!
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what is type 1 osteoporosis?
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postmenopausla - increased bone resorption due to low estrogen levels
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what is type 2 osteoporosis?
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senile osteoporosis - affects men and women > 70 year
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what are the consequences of osteoporosis?
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vertebral crush fractures - acute back pain, loss of height and kyphosis; vertebral wedge fractures and Colles' fractures
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what are Colles' fractures?
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distal radius fractures caused by osteoporosis
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what is the prophylaxis for osteoporosis?
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exercisea nd calcium ingestion before age 30
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what is the treatment for osteoporosis?
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estrogen and or calcitonin, bisphosphonates or pulsatile PTH for severe cases; steroids are contraindicated
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define osteopetrosis
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"marble bone disease": failure of normal bone resorption leads to thickened, dense bones
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what is the defect that osteopetrosis?
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abnormal funciton of osteoclasts
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what are the lab findings in osteopetrosis?
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NORMAL: serum calcium, phosphate and alkaline phosphatase (ALP)
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what is a consequence of osteopetrosis?
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decreased marrow space leads to anemia, thrombocytopenia and infection; also can result in cranial nerve impingment and palsies due to narrowed foramina
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what is the etiology of osteopetrosis?
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genetic deficiency of carbonic anhydrase II
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what disease has "Erlenmeyer flask" bones that flare out on x-ray?
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osteopetrosis
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what is osteomalacia/rickets?
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defective mineralization/calcification of osteoid = results in soft bones; reversible when vitamin D is replaced
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what is the etiology of osteomalacia/rickets?
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vitamin D deficiency in adults - leads to decreased calcium levles and increased PTH and decreaed phosphate; Vitamin D deficieny in kids is rickets
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what is osteitis fibrosa cystica?
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"brown tumors" - cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood
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what is the etiology of osteitis fibrosa cystica?
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hyperPTH
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what are the lab value findings in osteitis fibrosa cystica?
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high serum calcium, lower serum phosphorus, high ALP
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what is Paget's disease of the bone (osteitis deformans)?
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abnormal bone architecture caused by an increase in BOTH osteoblastic and osteoclastic activity, possibly viral in orign (B19)
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what are the lab value findings in Paget's disease of the bone?
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serum calcium, phosphorus and PTH are normal; ALP is elevated
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what are the consequences of Paget's disease of bone?
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long bone chalk-stick fractures, high output CHF due to infected blood flow from arteriovenous shunts; can lead to osteogenic sarcoma
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what disease causes increased hat size and hearing loss?
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Paget's diseae of bone
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findings: normal serum calcium, phosphate, ALP and PTH; decreased bone mass
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osteoporosis
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findings: normal serum calcium, phosphate, ALP and PTH; thickened dense bones
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osteopetrosis
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findings: decreased serum calcium and phosphate, increased PTH
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osteomalacia/rickets - soft bones
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findings: increased serum calcium, ALP and PTH, decreased phosphate
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osteitis fibrosa cystica - "brown tumors"
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findings: increased ALP
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Paget's disease - Abnormal bone architecture
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what is polyostotic fibrous dysplasia?
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bone is replaced by fibroblasts, colalgena nd irregular bony trabeculae - affects many bones
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what is McCune-Albright syndrome?
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a form fo polyostotic fibrous dysplasia characterized by multiple unilateral lesions associated with endocrine abnormalities (precocious puberty) and unilateral pigmented skin lesions (café-au-lait and "coast of Maine" spots
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what cancer is associated with Gardner's syndrome?
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osteoma
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define osteoma
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new piece of bone grows on another piece of bone - often in the skull
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define osteoid osteoma
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interlacing trabeculae of woven bone that is surrounded by osteoblasts <2cm found in proximal tiba and femor
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what age group gets osteoid ostemoas?
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men <25yoa
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what is osteoblastoma?
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same as osteoid osteoma (interlacing trabeculae of woven bone surrrounded by osteoblasts) but larger and found in the vertebral colum
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what is giant cell tumor (osteoclastoma)?
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locally aggressive benign tumor often around the distal femur, proximal tibia (knee region) that contains spindle-shaped cells with multinucleated giant cells
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what bone tumor contains spindle-shaped cels with mutlinucleated giant cells?
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giant cell tumor (osteoclastoma)
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what bone tumor has "double bubble" or "soap bubble" on x-ray?
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giant cell tumor (osteoclastoma)
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what age group gets osteoclastomas (giant cell tumors)?
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20-40 year olds
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what is osteochondroma?
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mature bone with cartilagionous cap commonly on the metaphysis of long bones; malignant transforamtion rare
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what is the most common bone tumor?
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osteochondroma (exostosis)
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what age group gets osteochondromas?
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men < 25 yoa
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what is enchondroma?
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benign cartilaginous neoplasm found in intramedullary bone usually in the distal extremities (as opposed to chondrosarcomas)
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what population gets osteosarcomas?
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men 10-20 yoa
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where are osteosarcomas commonly found?
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metaphysis of long bones often around knee region
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what are the predisposing factors to osteosarcomas?
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Paget's disease of bone, bone infarcts, radiation and familial retinoblastoma
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what bone tumor has Codman's triangle ro sunburst pattern on x-ray?
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osteosarcoma
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what tumor is made of anaplastic small blue cells?
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Ewing's sarcoma
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what age group gets Ewing's sarcoma?
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boys < 15 yoa
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what cancer has 'onion skinning' appearance of bone?
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Ewing's sarcoma
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what are the characteristics of Ewing's sarcoma?
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extremely aggressive with early metastases but responsive to therapy
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where is Ewing's sarcoma found?
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diaphysis of long bones, pelvis, scapula and ribs
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what translocation is associated with Ewing's sarcoma?
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t(11;22)
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what is chondrosarcoma?
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malignant cartilaginous tumor located in the pelvis, spine, scapula, humerus, tibia and femur
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what tumor presents as an expansile glistening mass within the medullary cavity?
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chondrosarcoma - can be primary or from osteochondroma
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what bone tumor is located in the epiphysis?
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giant cell tumor (osteoclastoma) - benign
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what bone tumors are located in the metaphysis?
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benign: osteochondroma; malignant: osteosarcoma
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what bone tumors are located in the diaphysis?
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benign: osteoid osteoma; malignant: Ewing's sarcoma
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what bone tumors are located in the intramedullary space?
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benign: enchondroma; malignant: chondrosarcoma
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what is the cause of osteoarthritis?
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mechanical wear and tear that leads to destruction of articular cartilage, subcondral cysts, sclerosis and osteophytes, eburnation, Heberden's nodes (DIP) and Bouchard's nodes (PIP)
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what are the predisposing factors to osteoarthritis?
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age, obesity, and joint deformity
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what classically presents with pain in weight bearing joints after use (at the end of the day)
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osteoarthritis - pain improves with rest
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is osteoarthritis an inflammatory process?
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no- it is noninflammatory and has no systemic symptoms
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where does cartilage loss bengin in the knees?
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on the medial aspect = "bowlegged"
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what is rheumatoid arthritis?
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autoimmune-inflammatory disorder affecting synovial joints with pannus formation, subcutaneous nodules, ulnar deviation, subluxation, Baker's cyst (behind the knees)
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what joints are spared in RA?
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DIPs
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what HLA and Ab's are associated with RA?
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RA factor (anti-IgG Ab) + in 80%; HLA-DR4 association; females > males
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what classically presents with morning stiffness that improves with use?
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RA - has symmetric joint involvment and systemic symptoms (fever, fatigue, pleuritis and pericarditis)
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what presents with: xerophthalmia, xerostomia and arthritis
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Sjogren's syndrome (associated with RA)
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what are the consequences of sjogren's syndrome?
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parotid enlargement, increased risk of B-cell lymphoma and dental caries
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what Ab are assoicated with Sjogren's syndrome?
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Ab to ribonucleoprotien Ag's = SS-A (Ro) and SS-B (La)
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what population gets Sjogren's syndrome?
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predominantly affects females between 40-60 yoa
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what is Sicca syndrome?
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dry eye, mouth, nasal and vaginal dryness, chronic bronchitis and reflux esophagitis but NO arthritis
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what presents with red, swollen painful joints in the extremities
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gout -more common in men
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when I say tophus formation, you say
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gout (tophus often form on the external ear or Achilles tendon
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what precipitates acute gout attacks?
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large meal or alcohol consumption
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when I say podagra, you say
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gout - painful MTP joint of the big toe
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what has precipitation of monodosium urate crystal into joints?
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gout
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what causes monosodium urate crystals to precipitate in joints?
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hyperuricemia - can be caused by Lesch-Nyhan syndrome, PRPP excess, decreased excretion of uric acid (thiazide diuretics), increased cell turnover or von Gierke's disease
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what disease has needle shaped negatively birefringent crystals in the joints?
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gout - negatively birefringent = yelllow under parallel light
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what is the treatment for gout?
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colchicine, NSAIDs (indomethacin), probenecid and allopurinol
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what disease has calcium pyrophosphate cyrstals deposited in joint space?
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pseudogout
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what disease has basophilic rhomboid cyrstals that are weakly positively birefringent, deposited in the joints?
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pseudogout
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which joints are affected by pseudogout?
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large joints - knee; >50 yoa, both sexes
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what disease has crystals that are yellow when perpendicular and blue when parrallel?
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pseudogout
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which disease has crystals that are yellow when parallel, and blue with perpendicular?
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gout
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what are the most common organisms in septic infectious arthritis?
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S. aureus, Streptococccus, N. gonorrhoeae
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what presents with monoarticular, migratory arthritis with asymmetrical pattern with the affected joint being swollen, red and painful?
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gonococcal arthritis
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what is the most common cause of chronic infectious arthritis?
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TB and Lyme disease
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Define seronegative spondyloarthropathies
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arthritis without rheumatoid factor
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what HLA is associated with seronegative spondyloarthropaties?
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HLA-B27; occurs more often in males
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what are the 4 seronegative spondyloarthropathies?
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1. ankylosing spondylitis, 2. Reiter's syndrome, 3. Psoriatic arthritis, 4. inflammatory bowel disease arthritis
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define ankylosing spondylitis
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chronic inflammatory disease of the spine and sacroiliac joints
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what are the characteristics of ankylosing spondylitis?
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ankylosis (stiff spine due to fusion of joints), uveitis and aortic regurgitation
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when I say bamboo spine, you say
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ankylosing spondylitis
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what presents with conjunctivitis/anterior uveitis, urethritis and arthritis?
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Reiter's syndrome
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Define Reiter's syndrome
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"can't see, can't pee, can't climb a tree": conjunctivitis and anterior uveitis, urethritis, and arthritis
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what is associated with Reiter's syndrome?
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Post-GI or chlamydia infection
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define psoriatic arthritis
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joint pain and stiffness associated with psoriasis
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When I say dactylitis, you say
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psoriatic arthritis
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when I say "pencil in cup" deformity, you say
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psoriatic arthritis
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what are the charactersitis of psoriatic arthritis
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asymmetric and patchy involvement, dactylitsi (sausage fingers) and pencil in cup deformity; seen in fewer than 1/3 of pts with psoriasis
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what is the most common cause of death in lupus?
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renal failure and infections
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what disease causes a false positive on the syphilis test?
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lupus due to antiphospholipid Ab which cross reaction with cardiolipin used in the test
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what Ab are senstive, but not specific for lupus?
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ANA
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what antibodies are specific and prognositic for lupus?
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anti-dsDNA - very specific, poor prognosis
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what antibodies are specific but not prognostic for lupus?
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anti-Smith Ab - very specific but not prognostic
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what antibodies are associated with drug induced lupus?
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anti-histone Ab
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what is associated with antihistone Ab's?
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drug induced lupus
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what are the consequences of lupus?
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nonbacterial verrucous endocarditis, hilar adenopathy, wire-loop lesionsin kidney
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what are the diagnostic criteria for lupus?
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I'M DAMN SHARP: Immunoglobulins, Malar rash, Discoid rash, Antinuclear antibodies, Mucositis (oropharyngeal ulcers), Serositis (pleuritis and pericarditis), Hematologic disorders, Arthritis, Renal disorders, Photosensitivity
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What diseases are associated with +ANA?
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SLE, Sjogren's (and sicca), scleroderma, polymyositis, dermatomyositis, RA, JRA, mixed CT disease
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what population is lupus seen in?
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90% are female, 14-45yoa; most common and severe in black females
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define sarcoidosis
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immune-mediated, widespread noncaseating granulomas and elevated serum ACE levels - common in black females
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What characterizes sarcoidosis?
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GRAIN: Gammaglobulinemia, RA, ACE increase, Interstitial fibrosis, Noncaseating granulomas
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what diseases are associated with sarcoidosis?
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restrictive lung disease, bilateral hilar lymphadenopathy, erythema nodosum, Bell's palsy, epithelial granulomas containign micorscopic Schuamann and asteroid bodies, uveoparotitis and hypercalcemia
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what disease is associated with microscopic Schaumann and asteroid bodies?
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sarcoidosis
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what is the treatment for sarcoidosis?
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steroids
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what is polymyalgia rheumatica?
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pain and stiffness in shoulders, and hips often with fever, malaise and weight loss - NO muscular weakness
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what population gets polymyalgia rheumatica?
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pts >50 yoa and associated with temporal (giant cell) arthritis
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what are the lab value findings are in polymyalgia rheumatica?
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increased ESR, normal CK
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what is the treatment for polymyalgia rheumatica?
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prednisone
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define polymyositis
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progressive symmetric proximal muscle weakness - often involves shoulders
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what causes the damage seen in polymyositis?
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CD8+ induced injury to myofibrils
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what is diagnostic for polymyositis?
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muscle biopsy with evidence of inflammation
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define dermatomyositis
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similar to polymyositis but also involves malar rash, heliotrope rash, shawl and face rashand Gottron's papules
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what is a consequence of dermatomyositis?
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increased risk of malignancy (espeically within the first year after diagnosis)
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what are the lab value findings for polymyositis/dermatomyosis?
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increased CK and aldolase; postiive ANA, anti-Jo-1
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what is the treatment for polymyositis/dermatomyositis?
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steroids
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what is the most common NMJ disorder?
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myasthenia gravis
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define MG
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AutoAb's to postsynaptic AChR causes ptosis, diplopia and general weakness; symtpoms worsen with muscle use
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what is associated with MG?
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thymoma
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what is Lambert-Eaton syndrome?
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autoantibodies to presynaptic Ca cahnnels results in decreased ACh release leading to proximal muscle weakness; symptoms improve with muscle use
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what is associated with Lambert-Eaton syndrome?
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paraneoplastic disease (small cell lung cancer)
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define scleroderma
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excessive fibrosis and collagen deposition throughout the body - commonly sclerosis of the skin
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what disease causes skin changes: puffy and taut skin with absence of wrinkles?
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scleroderma
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what organs are affect by scleroderma?
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skin, kidneys, lungs, cardiovascular system and GI system
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define diffuse scleroderma
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widespread skin involvement with rapid progression and early visceral involvement
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what disease is associated with Anti-Scl-70?
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diffuse scleroderma
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what disease is associated with anti-DNA topoisomerase I Ab?
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diffuse scleroderma
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define CREST
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Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodyactyly and Telangiectasia = is limited to the skin and confined to fingers and face
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what disease is associated with Anti-Centromere Ab?
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CREST
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define lipoma
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soft, well-encapsulated benign fat tumor; that is cured by simile excision
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define lipsarcoma
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mlaignant fat tumor that can be very large, will recur unless adequately excised
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define rhabdomyosarcoma
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malignat soft tissue tumor that arises from skeletal muscle - oten in head/neck
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what is the most common soft itssue tumor of childhood?
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rhabdomyosarcoma
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what is a flat discoloration <1cm
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macule - i.e. tinea versicolor
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what is a flat discoloration >1cm
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patch
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what is an elevated skin lesion <1cm?
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papule - i.e. acne vulgaris
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what is an elevated skin lesion >1cm?
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plaque - i..e psoriasis
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what is a samll fluid-containing blister?
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vesicle - i.e. chicken pox
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what is a transient small fluid containing blister?
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wheal - i.e. hives
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what is a large fluid-containing blister?
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bulla - i.e. bullous pemphigoid
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what is an irregular raised lesion resulting from scar tissue hypertrophy?
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keloid - follows truama, espeically in blacks
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what is a blister containing pus?
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pustule - i.e. impetigo
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what is dried exudate from a vesicle, bulla or pustule?
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cryst
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what is increased thickness of the stratum corneum?
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hyperkeratosis - i.e. psoriasis
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what is hyperkeratosis with renteion of nuclei in the stratum corneum?
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parakeratossi - i.e. psoriasis
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what is separation of epidermal cells?
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acatholysis - i.e. pemphigus vulgaris
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what is epidermal hyperplasia?
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acanthosis
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what is inflammatio of the skin called?
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dermatitis
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warts, soft tan-colored cauliflower-like lesions
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verrucae
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what are the histological changes associated with verrucae?
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epidermal hyperplasia, hyperkeratosis and koilocytosis
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where is verruca vulgaris located?
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on hands
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where is condyloma acuminatum located?
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genitals - due to HPV
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what is a nevocullar nevus?
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common mole - benign
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what is urticaria?
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hives - intensely pruritic wheals that form after mast cell degranulation
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what is ephelis?
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freckle. Normal number of melanocytes with increased activity (melanin pigment)
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what is atopic dermatitis?
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pruritic eruption commonly on skin flexures associated with other atopic diseases (asthma, allergic rhinitis)
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what is allergic contact dermatitis?
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type IV HS reaction that follows exposure to an allergen. Lesions occur at site of contact
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what is psoriasis?
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papules and plaques with silvery sclaing, especially on knees and elbows (1/3 of pts also have arthritis)
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what histological changes are seen in psoriasis?
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acanthosis with parakeratotic sclaing (nuclei are still in stratum corneum)
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what changes in epidermal layers are seen in psoriasis?
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increased stratum spinosum and decreased stratum granulosum
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what is Auspitz sign?
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bleeding spots when scales are scrpaed off - associated with psoriasis
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what disease is associated with nail pitting?
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psoriasis
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what is seborrheic keratosis?
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flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts, that occur on head, trunk and extremities
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what skin tumor looks 'pasted on'
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seborrheic keratosis
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define albinism
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normal melanocyte number with decreased melanin production due to decreased activity of typrosinase; can be caused by failure of neural crest cell migration during development
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define vitilgo
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irregular areas of complete depigmentation - caused by decreased number of melanocytes
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define melasma
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hyperpigmentation associated with pregnancy "mask of pregnancy" or OCP use
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define impetigo
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very superficial skin infection caused by S. aureus or S. pyogene - hihgly contaigious with honey colored crusting
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what skin disorder has honey-colored crusting?
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impetigo
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define cellulitis
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acute painful spreading infection of the dermis and subcutaneous tissue, usually due to S. pyogenes or S. aureus
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define necrotizing fasciitsi
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deeper tissue injury, usually from anaerobic bacteria and S. pyogenes - results in crepitus from methane and CO2 produciton
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what disease results in crepitus of the skin?
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necrotizing faciitis
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define staph scladed skin syndrome
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exotoxin destroys keratinocyte attachments in the stratum granulosum only
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what disease is characterized by fever and generalized erythematous rash with sloughing of the upper layers of the epidermis?
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SSSS - seen in newborns and children
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define hairy leukoplakia
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white, painless plaques on the tongue that cannot be scraped off - relatively specific for HIV; EBV mediated
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what virus is associated with hairy leukoplakia?
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EBV
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what skin disease is created by antibodies against desmosomes
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pemphigus vulgaris (anti-epithelial cell Ab)
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what is pemphigus vulgaris characterized?
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acantholysis - intraepidermal bullae involving the skin and oral mucosa
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what is Nikolsky's sign?
|
spearation of epidermis upon manual stroking of skin - seen in pemphigus vulgaris
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pemphigus vulgaris
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potentially fatal autoimmune skin disorder with IgG antibodies against desmosomes that shows immunofluorescence throughout the epidermis
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define bullous pemphigoid
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autoimmune disorer with IgGs against hemidesmosomes (BM) that shows linear immunofluroescnece
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what skin disease is caused by Ab's against hemodesmosomes?
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Bullous pemphigoid
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what skin disease contains eosinophils within blisters?
|
Bullous pemphigoid
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what areas of the skin are affected by bullous pemphigoid?
|
spares oral mucosa, less severe than pemphigus vulgaris and Nikolsky sign negative
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define dermatitis herpetiformis
|
pruritic papules and vesicles with deposits of IgA at the tips of dermal papillae; associated with celiac diseae
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what skin disease is associated with celiac disease?
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dermatitis herpetiformis
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what skin disease has IgA deposits at the tips of dermal papillae
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dermatitis herpetiformis
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define erythema multiforme
|
macules, papules, vesicles and target lesions that are associated with infections (mycoplasma pneumoniae, HSV), drugs, cancers and autoimmune diseases
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define Stevens-Johnson syndrome
|
fever, bulla formationand necrosis, sloughing of ksin and a high mortality rate; usually associated with adverse drug reaction
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define toxic epidermal necrolysis
|
similar to SJS but with greater epidermal involvment
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define Lichen Planus
|
Pruritic, Purple, Polygonal, Papules
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what skin disease is associated with sawtooth infiltration of lymphocytes at the DEJ
|
lichen planus
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what virus is associated with lichen planus?
|
hep C
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define actinic keratosis
|
premalignant lesions caused by sun exposures that are small, rough, erythematous or brownsih papules "Cutaneous horn"; risk of carcinoma is proportional to epithelial dysplasia
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define acanthosis nigricans
|
hyperplasia of the stratum spinosum - associated with hyperinsulinemia and visceral malgnancy
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define erythema nodosum
|
inflammatory lesions of subQ fat, usually on anterior shins
|
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what is associated with erythema nodosum?
|
coccidioiomycosis, histoplasmosis, TB, leprosy, strep infections and sarcoidosis
|
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|
define pityriasis rosea
|
"herald patch" followed days later by "christmas tree" distribution. Mutliple papular eruptions that remits spontaneously
|
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what are the predisposing factors for SCC of the skin
|
excessive exposure to sunlight and arsenic, actinic keratosis is a precursor
|
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|
what skin cancer has keratin pearls in histology?
|
SCC
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where do SCC of the skin commonly occur?
|
hands and face, lower lip
|
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what are the characteristics of SCC of the skin?
|
locally invasion but rarely metastasizes, ulcerative red lesion associated with chronic draining sinuses
|
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|
what are the charactersitics of basal cell carcinoma?
|
common in sun-exposed skin, locally invasive but almost never metastasizes, rolled edges with central ulceration, pearly papules grossly
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|
what skin cancer has palisading nuclei?
|
basal cell carcinoma
|
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|
what are the characteristics of melanoma?
|
signficiant risk fo metastasis, associated with sun exposure, dark with irreuglar borders grossly; fair pts have increased risk
|
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|
what cancer is associated with S-100 tumor marker?
|
melanoma
|
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what correlates with risk of metastasis in melanomas?
|
depth of tumor
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what is the precursor lesion to melanoma?
|
dysplastic nevus (atypical mole)
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