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260 Cards in this Set
- Front
- Back
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What is eczema skin like?
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Vesicles due to intercellular swelling. The vesicles are filled with fluid that leaked through the the cells.
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What is the acute phase eczema?
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*oozing and crusting due to swelling b/w cells
*bulla on skin *basal cell inflamm. on histo |
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What is the chronic phase of eczema?
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Lichenification
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What is the atopy triad with which eczema is associated?
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Eczema, asthma, hayfever
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What Ig and what immune cell is elevated in the eczema pt's serum?
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IgE and eosinophils
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What MUST you have to be dx with eczema?
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pruritis (itchy skin)
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what parts of the skin does eczema involve?
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skin creases--elbow folds, back of the knees, ankles, neck
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What are the dxstic guidelines of eczema?
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*involvement with creases
*hx of having the atopic triad (IgE hyperactivity) *hx of general dry skin *Flexural eczema (eczema on cheek/forehead/outer limbs in kids under 4) *onset under age 2 |
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What is a bad se of topical steroids?
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Thins the epidermis. Therefore don't use for more than 2-3 weeks at a time.
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Where do you want to avoid steroid crm use and why?
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Places where systemic absorption of the drug is increased. Avoid this because you can get a cushingoid like state due to high systemic steroids.
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Class I steroids are the most potent Class VI steroids are the least potent
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TRUE
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Class I drug?
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Temovate (Clobetasol)
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Class II drugs?
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Lidex and Topocort
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Class IV drug?
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Elocon
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Class VI drug?
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Desowen
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What do you tell a pt to stop the itching fast?
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*Cool water/milk compresses
*ASA--b/c itch and pain ride on the same nerve |
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What do you tell a pt to stop the itching fast?
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*Cool water/milk compresses
*ASA--b/c itch and pain ride on the same nerve |
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Small pox vaccines can be given to eczema pts?
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NO! NO! no no no no no no!
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What is the mechanism of GI toxicity induced by NSAIDs and how prevalent is this se?
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Prostaglandin inhibition. PGs are necessary for mucus production that protects the GI tract.
20% |
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MOA of action of NSAIDs vs. DMARDs?
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*NSAIDS affect sxs only by inhibiting PG
*DMARDS can change the course of dz by stabilizing golgi lysosomes. |
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How are APAP and ASA diff?
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APAP doesn't have anti-inflammatory activity.
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What does Enbrel do?
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TNF R inhibitor and therefore blocks inflamm. response.
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What does minocycline do?
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blocks metalloproteinase and therefore blocks CT breakdown.
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Which drug is used to treat acute gouty arthritis and why?
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Indomethacin because it inhibits uric acid formaxn.
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Acute Urticaria resolves completely within how many weeks?
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six. Anything greater is considered chronic urticaria.
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Describe the urticaria lesion
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Annular/papular with erythematous border.
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What are causes of urticaria?
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*IgE mediated (allergies)
*Compliment *Mast Cell degranulation |
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What causes compliment mediated urticaria?
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Serum sickness, angiodema (subcutaneous edema)
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What % of urticaria is idiopathic?
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more than 75%
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How do hives arise?
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Inciting agent causes mast cell degranulation--> histamine causes capillary permeability--> protein and fluid extravasate into interstitum--> swelling
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What is the defn of dermographism?
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Hypersensitivity to touch. Anything that lightly strokes the skin can cause urticaria. Ex: running a pencil across your arm.
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What is solar urticaria?
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Urtic. in response to UVA and UVA light.
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What is cholinergic urticaria?
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Urtic. caused by cholines in response to:
exercise emotional stress increased environmental temperature |
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Cold urticaria is?
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urtic. due to cold!
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Something that looks like urticaria but is NOT is found on muscle bx to be urticarial vasculitis. What is this?
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Urticarial Vasculitis: pts tend to be sicker and the lesions last longer than 24-48h.
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What is tx for urticaria?
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*HI and H2 blockers (antihistamines)
*steroids (short term, last resort) *avoid the inciting agent |
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What is a drug eruption?
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Allergic rxn to Rxs
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What are three forms of drug eruptions?
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1) exanthem
2) urticarial drug rxn 3) hypersensitivity syndrome |
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What drug is the most common cause of drug exanthems?
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Sulfamethoxazole/trimethoprim
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What is the pattern of the lesion seen in drug exanthems?
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morbilliform with erythema and small papules.
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Pts who have hypersensitivity syndrome to drugs are most sensitive to:
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anti-convulsants, sulfonamides, and allopurinol
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Hypersensitivity syndrome sxs are:
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*elevated LFTs
*scaling, vesicles, bullae, and sloughing of the skin *fever *lympadenopathy |
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What are the viral exanthems and in what population are they seen?
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Measeles, rubella, erythema infectiosum. Most seen in peds.
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Viral exanthem rashes start where and spread where?
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Start on the face and spread to the trunk and extremities over the course of a few days.
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Hypersensitivity syndrome:
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Eyrthema Multiforme
Stevens-Johnson Synd Toxic Epidermal Necrolysis Erythema Nodosum |
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Erythema multiforme is most often due to
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HSV.
Less common is URI |
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What do EM lesions look like?
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erythematous plaques and papules with targetoid lesion. they are symmetrical
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EM lesions are mostly seen where in the body?
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Mucus membranes, palms, and soles.
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Patient presents with fever and flu like sxs. They have targetoid lesions all over their body and most signficantly, on their lips. What is likely dx>
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SJS
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TEN is also a derm emergency. What is it?
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Diffuse necrosis of the skin that leads to sloughing and loss of skin. Urgently move to burn unit.
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SJS and TEN often overlap as diagnoses. When does SJS become classified as TEN?
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when there is over 30% of skin sloughing
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When should you NOT use steroids in treating SJS?
When do you use steroids in treating TEN? |
If the SJS is advanced, DO NOT use steroids. Steroids are helpful early in the dz but harmful later.
NEVER use steroids to tx TEN. |
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What is the most common cause of SJS and TEN?
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drugs! SMX/TMP
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What is erythema nodosum? What population is it most commonly seen?
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Nodules deep in the subcuticular tissue.
Young women. |
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Where in the body is E. Nodosum most seen?
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Anterior Tibia
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What is vasculitis? How is it manifested in the skin?
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Inflamm. and necrosis of blood vessels.
It is seen as palpable purpura in the skin. |
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What is the etiology of vasculitis?
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Infection, PCN, sulfa, CT dzes such SLE, IBD, hepatitis, cancer
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What is the ddx of vasculitis? How does it present?
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Schamberg Dz. See little purpura on the lower legs only. Is probably a a capillaritis.
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What is higher frequency and therefore more damaging, UVA or UVB?
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UVB
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Which wavelength is seen in tanning salons?
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UVA
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Which wavelength causes burns that are dose dependent?
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UVB
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If you get an immediate sunburn but it's so mild you don't even know it's there, what wavelength caused it?
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UVA
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A red haired, fair skin, light eyed girl is what skin type?
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Type I
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Which kind of tanning is "better" for your skin and why?
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UVB tanning is better, because it not only darkens existent melanin but it causes new melanin to form (whichis protective). Therefore, tanning salons which only have UVA are less safe.
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Where in the body does vitiligo usu occur?
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FACE: peri-oral, peri-ocular, and on the lips.
BODY: knees, groin, armpits, butt. |
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what is Polymorphic light eruption?
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skin rash in response to the sun
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what has a faster onset, phototox or photoallergy?
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phototox
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Elderly patient comes in with large tense bulla in his lip that ruptured. He reports that this happened last month, too, but it spontaneously healed. Likely dx?
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Bullous Pemphigoid
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What is the Asbo Hanson sign?
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Lateral spread of the bullous when you press on it
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What ab is involved with dermatitis herpetiformis?
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IgA
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What GI condition is associated with D. Herpetiformis?
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Celiac Sprue (gluten insensitivity)
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What is a nevus?
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a mole. not malignant till they get in the hundreds.
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What shapes are junctional, intradermal, and compound nevi?
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flat, raised, dome-shaped.
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Describe a recurrent nevus and why it should be excised?
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Irregular border. It may precede melanoma.
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What is the main cause of melanoma?
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UV light
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Where do people of color get melanoma?
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Sole of feet
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Name the clinical features of melanoma
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assymmetrical, irregular border, varied color, bigger than 6 mm, elevated
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Seborrheic keratosis lesions are benign. What do they look like?
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Tan/brown scaly plaque
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What is the most common non melanoma skin cancer?
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Basal Cell Carcinoma
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It is a risk for what people?
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fair skinned, sun exposed
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What re the three basic kinds of BCC?
Which one is most difficult to tx? |
1) nodular
2) superficial 3) infiltrarting/morphea--hardest to tx |
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Nodular BCC is the most common. What are the characteristics?
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Pearly, waxy looking plaques. They may have telangectasias
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What superficial nerve is at risk during surgery to remove a nodule on the periorbital part of the face?
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temporal N
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How does the superficial kind of BCC differ than the other two?
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It does not come and go like the others. Instead, it gets bigger over time.
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What does the infiltrating/morphea BCC type look like?
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White/yellow scar like plaque
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What does a morphea lesion look like?
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starts out violaceous, then becomes white in the middle with a red/pink surround.
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What In Basal Cell Nevus syndrome, every tx can be used except?
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radiation. it makes it worse.
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Actinic keratosis is a scaly sun spot. It's a marker for what kind of skin cancer?
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Squamous cell carcinoma
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What does SCC in situ mean?
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It is the intermediate stage b/w actinic keratosis and full blown SCC.
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Pt presents with rythematous papules that are rapidly growing and are on the lower lip and ears--places that are sun exposed. Dx?
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SCC
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What benign lesion mimics BCC?
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Sebaceous Hyperplasia
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A 13 year old girl presents with a raised, yellow plaque on her scalp. Her mother states that when she was a newborn, this area had no hair. Dx?
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Nevus Sebaceous
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What benign lesions are found near the eyelid?
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Syringoma and hydrocystoma
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What benign skin lesion is associated with tuberous sclerosis?
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angiofibroma
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What benign cyst is located at the nail fold?
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mucous cyst
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What is an acrochordon?
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a skin tag
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Rickettsia is a parasite that causes?
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Rocky Mtn Spotted Fever
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Describe the shape and growth requirements of Rickettsia
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Coccobaccilli that are obligate intracellular parasites
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What Abx is used to empirically tx RMSF?
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Doxycycline
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Rickettsia is divided into these two groups:
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1) spotted fever
2) typhus |
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Are humans considered reservoirs for Rickettsia?
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NO! We are only incidental hosts!
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What time during the year would you see Rickettsia?
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Spring and summer
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What causes the rash in Rickettsia?
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The parasite proliferates in the endothelial cells of bvs--> vasculitis--> blocks b.f. to skin--> rash and necrosis of skin
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A pt presents with rash, fever, HA, and a hx of hiking or camping where ticks occur. DDx?
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Rickettsia!
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What state has the most spotted fever?
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N. Carolina
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In the Spotted Fever subtype, there are 3 subtypes. They are:
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1) RMSF
2) Boutonnouse Fever 3) Rickettsial Pox |
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RMSF is caused by a tick that carries what parasite?
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Rickettsia rickettsii
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When this parasite enters your skin, it goes to your_________and then proliferates in your__________
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lymphatic and blood vessels
endothelial cells |
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The edema, hemorrhage, and hypovolemia seen in Rickettsiosis is due to:
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vascular permeability caused by endothelial injury (caused by rickettsii proliferating at cost of endothelial cell)
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What kidney manifestation is seen in RMSF due to the hypovolemia?
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Pre-renal azotemia
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What other clinical manifestations of RMSF do you see?
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fever, myalgia, HA, malaise, rash (due to vasculitis), meningoencephalitis, lung problems.
**most impt to think about when making the dx is: RASH and TRAVEL HX to tick area/N. Carolina** |
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Lab shows normal WBC but low__________
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bone marrow cells: low plts and RBCs
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Mortality of RMSF is LOW if it is txed early. What do you treat with?
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Tetracycline, Doxycycline, Chloramphenicol.
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What is the characterisitc skin lesion of Boutonnouse fever?
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Tarche Noir=black area of necrosis where the tick bit
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T or F: leaving Rickettsialpox untreated is FATAL
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F. It resolves untreated in 2-3 weeks...but tx with doxycycline anyway until you are sure that you are correct in your dx!
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How do you get Rickettsial pox?
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House mice!
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Q Fever is caused by a dessication resistant parasite that is acquired by humans when they
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touch secretions of farm animals--milk, pee, poop, birth fluids
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So Q Fever is an occupational dz of:
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Farmers and Veterinarians
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How is Q Fever different than the other two Spotted Fever subtypes?
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No rash!
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Q Fever has a heart complication. What is it?
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Endocarditis. It's a common cause of aseptic endocarditis...
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Rickettsia prowazekii causes ________
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Typhus
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Typhus is associated with what kinds of living conditions?
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War, famine, overcrowding
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What is the typhus vector? the reservoir?
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body lice=vector.
flying squirrel=reservoir |
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What is the rash distribution in typhus?
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centrifugal--it moves from center to periphery
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What is the tx for typhus?
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doxycycline
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The RMSF rash is centr______while the typhus rash is centr_______
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centripetal, centrifugal
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What organism causes over 90% of elephantiasis (aka filariasis)?
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Wucheria Bancrofti
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What kind of living condns do you see filariasis?
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uncontrolled mosquito breeding in overcrowded cities
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The microfilariae (the egg) of the parasite lives in travels to through the ________ and arrive at the _________ where they mature into adults and live permanently
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lymphatic vessels, lymph node
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There are 2 stages of filariasis. In the asxtic stage, what is happening with the lymph endothelium and in the immune syst?
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The lymph endothel. is proliferating and the immune system is downregulated
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In the sxtic stage, what is happening in the lymph nodes?
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Inflammation in the nodes which leads to fibrosis of the nodes
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Do newcomers to Filariasis endemic areas get ill faster or slower than the native popul?
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faster!
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What is the diff b/w lymphangitis and lymphadenitis?
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lymphangitis=INFECTIOUS inflammation of lymph
lymphadenitis=NON-INFECTIOUS inflamm of lymph |
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In filaria, retrograde lymphadenitis is seen. It's the response to the dying adult worm. What is the pattern of spread?
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Moves from out toward center of the body
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What are other sxs of filariasis besides retrograde lymphadenitis?
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*fever
*hydrocele in males *chyluria (milky white urine) *elephantiasis (big, hard tissue due to edema and destruction of lymph tissue) |
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A pt comes in with mily white urine, big lymph nodes that spread from her hands toward her armpits, and she's had a fever. To make the definitive dx of filariasis, when do you want to draw her blood?
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late at night
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What is the drug used to tx both individuals and the community for filariasis?
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DEC
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Dracunculiasis will most likely be eradicated in the near future. What is it?
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A larva of a parasite penetrates the GI tract.
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From the GI tract where does it mature and then migrate?
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matures in the CT or in the abdomen and then migrates to the skin
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When is the larvae discharged from the skin?
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whenever the skin gets wet
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how do you remove the dracuncula worm?
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you have to roll it up with a stick, very carefully, day after day, until it's lifted. that's so weird.
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trichinosis is a parastie in what animal? we eat it when we eat this meat raw or undercooked....
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pigs! (men are pigs)
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where in the human does the parasite go to encyst and calcify?
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muscle
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pt presents with myositis, edema around the eyes, and hemorraghes in the retina and in the finger nails. Dx?
How would you treat her? |
trichinella
nothing very useful in the way of tx--steroids and albendazole may help but mostly supportive? |
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What would you tell her to avoid? What would you tell the farmers who raise the pigs?
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Avoid bears--they carry trichinella too
Grain feed swine |
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In cutaneous larval migrans, the larva creeps around the skin causing itchiness. Is it necessary to remove the larva before it causes damage?
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No. it dies on its own and causes no complications besides pruritis.
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What is cysticercosis? What popul is it most commonly seen in ?
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Pork tapeworm, seen most in mexican/L. American immigrants
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What is the neural complication of cysticercosis? What is seen on MRI of the brain?
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seizures! multiple cysts!
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When the larvae of cysticercosis encyst in the muscle, what immune cell tells you it's there? What happens if it encysts in the eye?
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eosinophils
causes vision loss |
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What is the chemical name of the histamine ring?
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Imidazole
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Mast cells store histamine. They turn blue when stained with a special dye...this is called?
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Metachromasia
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What is the entity in the mast cell that is responsible for metachromasia?
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the protegoglycan interacts with the basic dye giving a color shift.
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Why is histamine slowly synthesized and slowly metabloized? (slow turnover)?
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it is tightly bound to vesicles
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Where else is histamine found in the body?
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GI mucosa and brain. It has a faster turnover in these two locations.
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What two cells mediate the synthesis of nascent histamine?
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macrophages and plts
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what is the precursor of histamine? What is the enzyme that converts it?
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L-histidine
Histidine decarboxylase |
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What is the action of Histidine decarboxylase on L-histidine?
Is it's level high or low in the GI mucosa? |
Histidine decarboxylase removes CO2 from L-Histidine
high levels of this E in the GI mucosa |
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What are the two pathways by which histamine is metabolized? Which one is dominant?
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Oxidation and Methylation (dominant)
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What is the E in the oxidation pathway?
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Diamine oxidase
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What is the E in the methylation pathway? What is the necessary Co-factor it needs?
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Histamine-N-methyl transferase
SAM (S-adenosyl-L-methionine) |
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What does this E do to the histamine molecule with SAM?
What is the name of the product? |
It removes the a methyl group from SAM and puts it on the histamine.
N-Methylhistamine |
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What E acts on N-methylhistamine?
What is the product and how is it excreted? |
Monoamine oxidase (MAO)
MIAA. It's excreted in the urine. |
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What is a marker of histamine amnts in the tissue?
What is a marker of histamine release? |
Marker in the tissue: Histadine Decarboxylase
Marker of release: amount of MIAA in the urine |
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There are two Rs of Histamine that we must know: H1 and H2. Which one is fast vasodilation and which one is slow?
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Hi=rapid vasodilation
H2=slow vasodilation |
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Which R is found in the heart? What is the effect of stimulating these Rs?
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H2. Increase in HR, SV, and CO
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Which R is found in the bronchiolar smooth muscle and what is the effect of their stimulation?
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HI. Constriction--> wheezing
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Which R is found in the gastric mucosa? What is the effect of stim?
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H2. Increased acid and pepsin secretion.
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Which R is found in the rest of the intestinal tract smooth muscle? Effect of stim?
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H1. Smooth muscle contraction.
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Both H1 and H2 Rs are found in the skin. They cause the triple response which is what?
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1) small red spots at the site of injection
2) flare 3) wheal |
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What causes the wheal and flare rxn?
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The flush is due to stimulation of the local afferent nerves which fires the efferent nerves-->vasodilation.
The wheal is edema due to fluid leakage from the permeable capillaries. |
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H1 R raise Ca levels how?
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H1 Rs are linked to PLC which leads to IP3 and DAG formaxn. IP3 causes an increase in Ca levels.
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H2 Rs effects occur via production of what G protein product?
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cAMP
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Histamine causes contraction of smooth muscle in the stomach but not in the heart. Why?
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H1 Rs in the intestinal smooth muscle are physiologically active while H2 Rs in the heart are not.
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Histamine mediates arousal in the brain. In the brain, histamine is made in the?
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tuberomammillary bodies.
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Hist. release from the mast cells is dependent on which cation?
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Ca
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What Ig is associated with histamine release? Where does it bind to the Mast cell?
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IgE. Fc R.
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What are the diff b/w 1st and 2nd generation H1 antagonists?
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2nd gen. don't cross the BBB, they aren't anti-cholinergic so the s.e.s are less, and they have a longer duration of action.
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What are the generic names of 5 1st generation H1 antagonists?
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-diphenhydramine
-PYRIBENZAMINE -chlorphenyramine -CYCLIZINE -promethazine |
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What is the effect of H2 antagonists?
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lower HR, lower CO, and lower acid secrexn.
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What liver E does cimetidine block?
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CYP 450
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What is the only containdication of cimetidine?
What Rxs have big interactions with cimetidine? |
gastric cancer
Theophylline, phenytoin, warfarin |
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What is the MOA of cromolyn? Is it considered an anti-histamine?
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It stablizes the mast cell membrane and prevents release of histamine. It IS NOT an anti-histamine because it doesn't relax smooth muscle.
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Cromolyn can be used in young asthma pts, including the case of status asthmatics?
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it CAN be used in asthma pts, but HAS NO VALUE IN STATUS ASTHMATICUS!
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What is another indication of cromolyn?
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It can be used for allergic rhinitis when used as a spray!
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Tilade is...and is used for....
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a new Rx that is an anti-histamine release drug...used for asthma
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What do psoriasis lesions look like? Where in the body are they most common?
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Well demarcated, scaly erythematous plaques. They are most common on the elbows, scalp, and knees.
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What is the major systemic manifestation of psoriasis?
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Arthritis--sausage fingers
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What is Auspits sign?
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a dark spot due to Fe from spot bleeding after scratching off a psoriasis plaque
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What is the Koebner phenomenon?
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Lesions that appear at sites of injury
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In Lichen planus, you can see whitish lines in the plaque. These are called
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Wickim's striae
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Where in the body do find Lichen Planus lesions the most?
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trunk
mucus membranes (mouth/lips) pre-tibia |
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A teenage female presents with one big red scale (fawn-colored) and some satellite scales that surround it. She says this happened last month but resolved on its own. DDx?
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Pityriasis Rosea.
Secondary Syphilis. |
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Spaghetti and meatballs is the description that is seen on KOH test for this fungal infection. Is it superficial or deep?
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Tinea Versicolor. Superficial.
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Syphillis is associated with what tick dz?
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Lyme Dx. Lyme Dz is syphilllis reborn(??)
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"micacious" and "hyperkeratotic" are buzz words for lesions in what dz?
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psoriasis
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pustules in psoriasis form due to infiltration of what immune cell?
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neutrophils (PMNs)
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What is the oil sign?
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yellowing of the finger nail due to deposition of serum
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Psoriatic arthritis affects these joints:
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IP joins in the hands
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Why do psoriatic plaques bleed so easily when picked?
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The dermal papillae in psoriasis is thickened and extends all the way into the epidermis. When the scale is picked, it exposes the dermis where the bvs are.
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In which dermatitis do patients not scratch because there is no itch relief?
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Lichen Planus
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How come fungal infections have rings that get bigger on the skin?
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it consumes keratin and has to move out in order to "eat live skin"
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How do you differentiate b/w syphillis rash and P.R. rash?
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In syphillis, the rash will go to the palms of hands and feet. Also, see chancres on the genitalia and in oral mucosa
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What food products exacerbate Rheumatoid arthritis?
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Wheat, citrus, dairy, and nuts.
Also, coffee |
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What is desired range of Vit D?
Vit D deficiency is considered? |
Above 30 ng/ml
Belove 20 |
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What is the relationship between Vit D and Ca?
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Vit D facilitates Ca absorption in the gut
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Vit D Cascade:
Skin-->liver-->kidney--> intestine and bone |
D3-->25(OH)D-->1,25(OH)D--> gut and bones
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What is the affect of anti-oxidants on RA?
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Anti-oxidants stop oxidative damage and therefore may be protective agains the damage in RA
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Why would low fat diets aggravate RA?
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Low fat diets are low in Vit E and Vit A, two anti-oxidants that would protect against joint damage.
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The desaturase E converts omega-6 and omega-3 between each other. What factors cause the E to make more omega-6?
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high etoh
stress diabetes high 6/3 ratio |
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Supplements to reduce pain and inflamm in RA?
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Vit D, E, C
Selenium Calcium omega 3 oils olive oil EPA |
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What would daily caloric and protein requirements be for pts who need to gain weight due to RA?
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35 kcal/kg of actual weight
1.5-2.0g/kg of ideal weight |
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Why does prednisone aggravate osteoperosis?
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It causes increased Ca excrexn and decreased Ca absorpxn
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what is the action of omega-3 on bone resorpxn and inflamm?
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suppresses osteoclastic activity and pro-inflamm cytokines
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Purposes of bone?
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biomechanical
metabolism hematopoiesis |
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What's the diff b/w compact bone and spongy/cancellous bone?
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Compact bone=structure
Cancellous bone=hematopoiesis |
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Bone is comprised of three things:
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1) collagen matrix
2) mineral salts 3) cells |
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Collagen matrix is composed of:
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1) type I collagen
2) proteoglycans |
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Mineral of bone is called hypoxyapetite. It is composed of two elements:
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1) Ca
2) phosphate |
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The cells of bone are:
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osteoclasts, osteoblasts, and osteocytes
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What lines the external surface of bone? what are its two layers called?
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Periosteum
outer layer=fibrous inner layer=osteoprogenitor cells |
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What lines the internal surface of bone?
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Endosteum
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What are the two types of joints and which one allows for movement?
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1) Diarthroses=allows for free movement
2) Synarthroses=no free movement |
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Which two factors are cause an increase and Ca absorpxn and breakdown of bone?
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PTH and Vit D
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PTH responds to a _____in Ca levels. It
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drop
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What is the defn of simple arthritis?
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Joint complaints for more than 6 weeks
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What characterizes INFLAMMATORY arthritis?
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pain, swelling, warmth, erythema, and synovial thickening.
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what are sxs of RA?
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morning stiffness, multiple joints involved, symmetrical joint involvement, subcutaneous nodules.
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what are systemic sxs of RA?
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vasculitis and ILD
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in RA, what will the CBC show?
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high plt count (thrombocytosis)
normocytic, normochromic anemia |
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ESR is high/normal in RA?
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high!
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Why does bone form cysts when the cartilage erodes?
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to increase the surface area so that pressure can be spread out
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Which immune cell recognizes self-peptide as foreign and what cell does it present to?
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Macrophage. Presents to a T Cell.
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HLA gene complex is on Chromosome #?
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6
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What is Rheumatoid Factor? Which immune cell makes it? What does it do?
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RF is an anti-IgG immunoglobulin made by plasma cells. It forms complexes with IgG and then activates complement.
Complement causes the tissue inflamm. and destruction seen in RA |
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Which immune cell enters the synovium of the joint?
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neutrophil
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Presence of which Ig gives a poorer px? IgG or IgM?
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IgM
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Which cytokine mediates joint destruction in RA?
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TNF alpha
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what are the two main differences b/w OA and RA?
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in OA, there is non-symmetrical involvement and the stiffness in the a.m. is mild (severe after immobility)
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What is seen in the joint space on X Ray in OA?
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osteophytes
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What is the most common cause of septic arthritis?
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bac due to hematogenous spread
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Why is there a wide range of distribution of cortisol secretion among people?
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Levels of CYP 450 differ b/w people
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Where does the gluct. R receive cortisol in the cell?
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Cytoplasm. Binding of cort causes a conformation change that brings the R into the nucleus.
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Glucts. are catabolic. They also have waht affect on glucose with respect to the liver?
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They induce gluconeogenesis
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Addison's dz is too little/too much glucts?
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too little. these pts have a hard time maintaining blood glucose levels and adapting to stress.
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what are some clinical uses of glucts?
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skin for allergic rxns
malignancies |
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ACTH is used to dx primary and secondary adrenal cortical insufficiency. How?
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If adrenals respond to exogenous ACTH, then the problem does not lie within the adrenal cx itself and is therefore a secondary insufficiency
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Will exogenous administration of glucts. increase or decrease endogenous production?
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decrease!
Therefore, don't abruptly withdraw the drug. Decrease the amnts gradually so that the HPA axis has time to kick in again. |
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What corticosteroid is used to tx Crohn's dz and is unique in that it's delivered straight to the terminal ileum?
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Budesonide
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high levels of corticosteroids will display peripheral mineralocorticoid activity. what sx will indicate that this is happening?
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salt retention
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Which bone tumor is more common in kids: osteosarcoma or ewings?
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Ewings in kids under 10. Above age 10, it's most likely osteosarcoma
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What is the first place that bone cancers met?
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lung!
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Very distal tumors do well with surgery (T/F)
Central tumors do well with surgery (T/F) |
T
F |
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How do you decide between surgery and radiation?
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is tumor radiation sensitive?
is it completely resectable? will you kill growth plates in the resection field? will cause a secondary tumor (secondary osteogenic sarcoma)? |
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What is the defn of a periosteal reaction? How does it give you information about the tumor?
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it is the response of the periosteum to a stimulus (like growing a tumor).
The shape of the growth tells you how fast it's growingl. For ex, codman's triangle growth is so fast it's more like a tip growing out than a lump |
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Ewing's sarcoma occurs in the bone ______
Osteosarcomas occur in the bone _____ |
diaphysis (central distribution!)
metaphysis (peripheral distribution!) |
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Ewing's sarcoma has a neural origin.
PNET is a subtype of Ewing's. Where do PNETs reside? What chromosome is the gene found on? |
PNETs are in soft tissue
chromosome 22 |
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what is the best tx for Ewing's?
why not surgerical resection? |
Best tx is combo therapy: radiation with Adriamycin + VAC
Resection is usu not successful in Ewings because the cancer has met. by the time of presentation. |
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Osteosarcoma has an osteoblast origin. When is the peak incidence?
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Teens and early 20s (time of final bone growth)
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Ewings has excellent response to radiation. Do osteosarcomas respond well to radiation?
What is the best tx option for Osteosarc? |
rarely
chemo....it improves ability to resect |
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what are some late affects of tx for these two cancers?
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* secondary sarcoma at site of radiation
* infertility due to chemo |
