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105 Cards in this Set
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OA
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destroy articular cartilage
subchondral cysts sclerosis osteophytes eburnation (polish ivory appearance) |
Heberden's nodes in DIP
Bouchard's nodes in PIP bowlegged non-inflammatory thick capsule synovial hypertrophy |
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eccrine glands
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sweat
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apocrine gland
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milky viscid secretions in axillae, genitalia, and areolae that function beginning in puberty
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zona occludens
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tight jxn, prevents diffusion. claudins and occludins
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zon adherens
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intermediate jxn. beneath occludents. cadherins, actin, (calcium dep)
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macula adherens
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desmosome. small, discrete sites of attachment, cadherins connect to intermediate filaments. keratin, desmoplakin
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pepmhigus vulgaris
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integrins
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basement membrane, binds to laminin
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ACL attaches anteriorly at
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tibia
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torn MCL sign
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abormal passive abduction
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fall on outstretched hand fractures
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scaphoid
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Some Lovers Try Positions That They Can't Handle
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Scaphoid, Lunate, Triquetium, Pisiform, Trapezium, Trapezoid, Capitate, Hamate. (radial to ulnar)
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pronator teres syndrome involves injury to _____ nerve
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median
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C5,6 roots
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axillary nerve
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deltoid
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radial nerve
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C5-T1
wrist drop |
BEST extensors
brachioradialis extensors of wrist and fingers supinators triceps |
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median nerve
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C5-T1. prox: fx of supracondular humerus. opposition of thumb, lateral finger flexion, wrist flexion. ape hand (thenar atrophy)
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distal: dislocated lunate. wrist flexion. pope's blessing hand
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ulnar nerve
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C8, T1
prox: hypothenar eminence, radial deviation of wrist upon wrist flexion |
distal: hook of hamate fx (fall onto outstretched hand). abd/adduct fingers, adduct thumb, extend 4/5 fingers. claw hand, ulnar deviation of wrist upon wrist flexion
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musculocutaneous nerve
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C5-7.
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Erb Duchenne
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C5,6
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Klumpke's palsy and thoracic outlet syndrome
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inferior trunk of brachial plexus (c8, t1). cervical rib can compress subclavian and inferior trunk, resulting in thoracic outlet syndrome
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1) atrophy of thenar and hypothenar eminences
2) atrophy of interosseous muscles 3) sensory deficits on medial side of forearm and hand 4) disappearance of radial pulse upon moving head ipsilateral |
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long thoracic nerve
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c5-7 injury during mastectomy leads to winged scapula and lymphedema
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obturator nerve
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L2-4. anterior hip dislocation. thigh adduction. medial thigh sensation
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femoral nerve
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L2-4 pelvic fx. thigh flexion and leg extension. anterior thigh and medial leg sensation.
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common peroneal nerve
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L4-S2. fibula neck fx. foot drop. anterolateral leg and dorsal foot sensation.
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tibial nerve
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L4-S2. knee trauma. foot inversion and plantarflexion, toe flexion. sole of foot sensation
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superior gluteal nerve
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L4-S1. posterior hip dislocation or polio. thigh abduction. pos Trendelenberg - contralateral hip drop.
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inferior gluteal nerve
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L5-S2. posterior hip dislocation. can't jump, climb stair, rise from seat.
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PED TIP
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peroneal everts and dorsiflexes, if hurt, foot drops
tibial inverts and plantarflexes, if hurt, can't stand on tiptoes. |
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sciatic nerve
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L4-S2. posterior thigh. splits into common peroneal and tibial
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ryanodine receptor
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in sarcoplasmic reticulum
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muscle contraction
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depol of DHP receptor coupled to ryanodine releases Ca from SR. Ca binds troponin C that causes tropomyosin to move off actin. myosin releases ADP and power strokes along actin. HI short, A always same.
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one slow red ox
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Type I is slow, incr mitochondria and myoglobin. sustained contraction
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smooth muscle contraction
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Calcium binds to calmodulin, which activate myosin light chain kinase. vasodilation inhibits MLCK
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achondroplasia
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constitutive activation of FGFR3 inhibits chondrocyte proliferation. adv paternal age. sporadic 85%, also AD
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osteoporosis
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trabecular (spongy) bone loses mass
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osteopetrosis (marble bone dz)
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thick, dense bones prone to fx. abnormal osteoclasts. Ca, PO4, ALP normal. prinary spongiosa fills medullary cavity, dec marrow space so anemia, thrombocytopenia, ifxn. extramedullary hematopoiesis.
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genetic dec of carbonic anhydrase II
xray Erlenmeyer flask bones. can impinge CNs |
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osteomalacia
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defective mineralization of osteoid leads to soft bones
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vitD def leads to dec Ca, incr PTH, dec PO4
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Paget's dz (osteitis deformans)
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abnormal bone architecture caused by incr in blasts and clasts. maybe from paramyxovirus. INCR ALP.
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chalk-stick fx.
hat size can be incr, hearing loss common |
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osteitis fibrosa cystica
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brown tumors
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polyostotic fibrous dysplasia
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bone replaced by fibroblasts, collagen, irreg bony trabeculae. mccune-albright
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giant cell tumor (osteoclastoma)
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20-40yo. epiphyseal. benign. locally aggressive. knee. double bubble xray. spindle cells with multinucleated giant cells.
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osteochondroma (exostosis)
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most common benign. men<25. metaphysis
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osteosarcoma (osteogenic sarcoma)
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2nd most common primary malignant bone tumor (MM is 1). men 10-20. risks: paget, Rb, radiation. metaphysis, knee. codmans triangle or sunburst on xray. poor prog.
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ewings
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boys<15. diaphysis. pelvis, scapula, ribs, long bones. anaplastic small blue cell malignant. early mets, responds to chemo. onion skin bones. Ewings onion rings.
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11;22
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chondrosarcoma
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men 30-60. pelvis, spine, scapula, humerus, tibia, femur. expansile glistening mass within medullary cavity
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RA
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pannus in MCP, PIP, joint space narrowing, increased synovial fluid, swan neck, boutonniere, subq rheum nodules (fibrinoid necrosis surrounded by palisading histiocytes), subluxation, bakers cysts, no DIP. systemic sx (fever, fatigue, pleuritis, pericarditis)
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type III HS. positive rheumatoid factor (anti-IgG), anti-CCP less sens, more spec. HLA-DR4
tx: COX2i, sulfasalazine, hydroxychloroquine, TNFai |
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Sjogrens
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1) xerophthalmia
2) xerostomia 3) arthritis parotid enlarge, incr risk B cell lymph, dental caries Sicca if dryness, chronic bronchitis, reflux esophagitis, but no arthritis |
Abs to ribonucleoprotein Ag, SS-A (ro) and SS-B (la). females 40-60. assoc with RA
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Gout
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monosodium urate crystals. hyperuricemia (Lesch-Nyhan, PRPP excess, decr excretion d/t HCTZ, incr cell turnover, von Gierkes. 90% underexcretion.
tx: NSAID (indomethacin) and colchicine acutely allopurinol, febuxostat, probenecid chronic |
neg birefringe needles. yellow parallel. (blue perp). men. podagra is big toe. tohpus on external ear, olecranon bursa, achilles tendon. attacks after lots of alcohol (competes with uric acid for excretion in kidney) or large meal.
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pseudogout
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calcium pyrophosphate
basophilic rhomboid crystals. positive birefringe knee, both sex>50. |
tx: NSAID, steroids, colchicine
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infectious arthritis
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septic: s aureus, strep, n gon. gon is monoarticular, migratory. STD is synovitis, tenosynovitis, dermatitis
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chronic: TB, Lyme
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osteonecrosis
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trauma, high-dose steroids, alcoholism, sickle cell cause
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seroneg spondyloarthropathies
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HLAB27. males. PAIR.
Psoriatic arthritis: dactylitis, pencil in cup Ankylosing Spondylitis: fusion of spine, sacroiliac. uveitis, aortic regurg. bamboo spine IBD Reactive arthritis (Reiters): can't see, can't pee, can't climb a tree: Conjunctivitis/uveitis, urethritis, arthritis. post GI or chlamydia |
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SLE
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Libman-Sacks endocarditis, hilar adenopathy, Wireloop kidney, antiphospholipid Abs cross react with cardiolipin.
Labs: ANA (sens, not spec), anti-dsDNA (spec, poor prog), anti-Sm (spec), Anti-hist (drug) |
mucositis, neurological probs, hematological probs
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sarcoidosis
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elevated serum ACE. black women. interstitial fibrosis, bilateral hilar LApathy, erythema nodosum, Bells palsy, epithelial granulomas with microscopic Schaumann and asteroid bodies, uveoparaotitis, hyperCa
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tx: steroids
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polymyalgia rheumatica
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pain and stiff shoulder/hips, fever, malaise, WL.
>50, with temporal arteritis |
incr ESR, norm CK
tx: prednisone |
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fibromyalgia
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women 30-50. pain, stiff, paresthesia, poor sleep, fatigue. 11 of 18 tender points
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polymyositis
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prog symm prox muscle weak. CD8 injury to myofibers. shoulders.
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dermatomyositis
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malar rash, gottron's papules, heliotrope rash, shawl and face rash, mechanic hands, incr risk malignancy.
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muscle bx shows perifascicular atrophy to dx.
incr CK, incr aldolase, pos ANA & anti-Jo1 tx: steroids |
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myasthenia gravis
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most common NMJ disorder. postsyn AchR Abs. ptosis, diplopia, gen weak. thymoma. sx worse with use.
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tx: AchE inhib
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lambert eaton
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Abs to presynaptic Ca channel. decr Ach release. prox muscle weak. improve with use.
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scleroderma
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puffy taut skin, 75% female
diffuse: widespread skin, rapid prog, early visceral involve. anti-Scl70 (DNA topo) |
CREST: Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactyly, Tenangiectasia. limited skin (fingers/face). more benign. antiCentromere ab.
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hyperkeratosis
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incr thickness of stratum corneum
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psoriasis
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parakeratosis
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hyperkeratosis with retention of nuclei in stratum corneum
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psoriasis
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acantholysis
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separation of epidermal cells
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pemphigus
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acathosis
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epidermal hyperplasia, incr spinosum
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verrucae
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epidermal hyperplasia, hyperkeratosis
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ephelis
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freckle. incr melanin pigment
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atopic dermatitis
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pruritic. flexures. asthma, allergic rhinitis. eczema.
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allergic contact dermatitis
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type IV HS
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psoriasis
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silvery scaling on knee/elbows. acanthosis with parakeratotic scaling, incr spinosum, decr granulosum, auspitz sign (bleeding spots when scraped)
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nail pitting
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seborrheic keratosis
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flat greasy pigmented squamous epithelial proliferation with keratin-filled cysts. older people
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Leser-Trelat: sudden appearance of multiple SKs indicates underlying malignancy
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albinism
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decr melanin prod bc decr tyrosinase. failed neural crest cell migration
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vitiligo
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decr in melanocytes
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melasma (chloasma)
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hyperpigment assoc with pregnancy or OCP
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impetigo
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s aureus or s pyogenes. very contagious
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cellulitis
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dermis and subq. s aureus or s pyogenes.
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necrotizing fasciitis
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deeper tissue inhury, with anaerobic bacteria and s pyogenes. crepitus from methane and CO2
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staph scalded skin syndrome
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exotoxin destroys keratinocyte attachments in stratum granulosum. fever, erythematous rash with sloughing of upper epidermis. newborns and kids
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hairy leukoplakia
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EBV, HIV
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pemphigus vulgaris
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potentially fatal. IgG agst desmosomes. netlike pattern. acatholysis - intraepi bullae causing flaccid bluster in skin and mucosa. positive nikolsky - separation of epidermis if stoke
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bullous pemphigoid
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IgG agst hemidesmosomes. linear. eosinophils in tense blisters, no mucosa involved.
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dermatitis herpetiformis
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pruritic papules/vesicles. deposits of IgA at tips of dermal papillae. celiac
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erythema multiforme
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mycoplasma, HSV, sulfa, beta lactams, phenytoin, cancer, AI. multiple types of lesions at once
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stevens johnson
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fever, bulla, necrosis, skin sloughing, high mortality rate. adverse drug rxn. more severe is toxic epidermal necrolysis
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lichem planus
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Pruritic, Purple, Polygonal, Papules. sawtooth infiltrate of lymphocytes at D-E jxn. Hep C
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acanthosis nigricans
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hyperplasia of spinosum. visceral malignancy
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erythema nodosum
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inflamm lesions of subQ fat, usu on anterior skins. assoc with coccidioidomycosis, histoplasmosis, TB, leprosy, strep ifxn, sarcoid
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pityriasis rosea
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herald patch followed days later by xmas tree distribution. multiple papular eruptions, then remits
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SCC
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sunlight, arsenic. ulcerative red lesion, keratin pearls
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keratoacanthoma
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variant of SCC, grows fast (4-6wks), regresses spontaneously
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BCC
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most common. local invasive but almost no mets. rolled edges with central ulceration, pearly papules, common telangiectasia, palisading nuclei
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melanoma
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S-100
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Lipoxygenase pathway yields
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Leukotrienes
LTB4 PMN chemotactic LTC4,D4,E4 for bronchoconstrict, vasoconstrict, SM contract, incr vasc perm |
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PGI2
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inhibits platelet aggreg and promotes vasodil
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aspirin tox
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hyperventilation, tinnitus, acute renal failure, interstitial nephritis, upper GI bleed
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NSAID tox
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renal damage, edema, aplastic anemia, GI distress, ulcer
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celecoxib tox
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incr risk thrombosis, sulfa allergy
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tylenol
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no anti-inflamm. tox: hepatic necrosis. metabolite depletes glutathione. N-acetylcysteine regenerates glutathione
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bisphosphonates
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-dronate
inhibit osteoclasts use: malignancy assoc hyperCa, Paget, postmeno osteo tox: corrosive esophagitis (except zoledronate), N, D, osteonecrosis of jaw |
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probenecid
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inhibits resorption of uric acid in PCT, also inhibits secretion of PCN
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allopurinol
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inhibits xanthine oxidase, decr conversion of xanthine to uric acid. prevents tumor-lysis assoc urate nephropathy in leuk/lymph.
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incr conc of azathioprine and 6MP. salicylates depress uric acid clearance.
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febuxostat
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inhibits xanthine oxidase
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colchicine
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impairs leukocyte chemotaxis and degranulation. GI sfx.
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etanercept
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decoy receptor. RA, psoriasis, ankylosing spondylitis
can reactivate TB |
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infliximab
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Crohns, RA, ankylosing spondylitis
can reactivate TB |
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adalimumab
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RA, psoriasis, ankylosing spondylitis
can reactivate TB |
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