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260 Cards in this Set

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  • Back
What is eczema skin like?
Vesicles due to intercellular swelling. The vesicles are filled with fluid that leaked through the the cells.
What is the acute phase eczema?
*oozing and crusting due to swelling b/w cells
*bulla on skin
*basal cell inflamm. on histo
What is the chronic phase of eczema?
What is the atopy triad with which eczema is associated?
Eczema, asthma, hayfever
What Ig and what immune cell is elevated in the eczema pt's serum?
IgE and eosinophils
What MUST you have to be dx with eczema?
pruritis (itchy skin)
what parts of the skin does eczema involve?
skin creases--elbow folds, back of the knees, ankles, neck
What are the dxstic guidelines of eczema?
*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
What is a bad se of topical steroids?
Thins the epidermis. Therefore don't use for more than 2-3 weeks at a time.
Where do you want to avoid steroid crm use and why?
Places where systemic absorption of the drug is increased. Avoid this because you can get a cushingoid like state due to high systemic steroids.
Class I steroids are the most potent Class VI steroids are the least potent
Class I drug?
Temovate (Clobetasol)
Class II drugs?
Lidex and Topocort
Class IV drug?
Class VI drug?
What do you tell a pt to stop the itching fast?
*Cool water/milk compresses
*ASA--b/c itch and pain ride on the same nerve
What do you tell a pt to stop the itching fast?
*Cool water/milk compresses
*ASA--b/c itch and pain ride on the same nerve
Small pox vaccines can be given to eczema pts?
NO! NO! no no no no no no!
What is the mechanism of GI toxicity induced by NSAIDs and how prevalent is this se?
Prostaglandin inhibition. PGs are necessary for mucus production that protects the GI tract.

MOA of action of NSAIDs vs. DMARDs?
*NSAIDS affect sxs only by inhibiting PG
*DMARDS can change the course of dz by stabilizing golgi lysosomes.
How are APAP and ASA diff?
APAP doesn't have anti-inflammatory activity.
What does Enbrel do?
TNF R inhibitor and therefore blocks inflamm. response.
What does minocycline do?
blocks metalloproteinase and therefore blocks CT breakdown.
Which drug is used to treat acute gouty arthritis and why?
Indomethacin because it inhibits uric acid formaxn.
Acute Urticaria resolves completely within how many weeks?
six. Anything greater is considered chronic urticaria.
Describe the urticaria lesion
Annular/papular with erythematous border.
What are causes of urticaria?
*IgE mediated (allergies)
*Mast Cell degranulation
What causes compliment mediated urticaria?
Serum sickness, angiodema (subcutaneous edema)
What % of urticaria is idiopathic?
more than 75%
How do hives arise?
Inciting agent causes mast cell degranulation--> histamine causes capillary permeability--> protein and fluid extravasate into interstitum--> swelling
What is the defn of dermographism?
Hypersensitivity to touch. Anything that lightly strokes the skin can cause urticaria. Ex: running a pencil across your arm.
What is solar urticaria?
Urtic. in response to UVA and UVA light.
What is cholinergic urticaria?
Urtic. caused by cholines in response to:

emotional stress
increased environmental temperature
Cold urticaria is?
urtic. due to cold!
Something that looks like urticaria but is NOT is found on muscle bx to be urticarial vasculitis. What is this?
Urticarial Vasculitis: pts tend to be sicker and the lesions last longer than 24-48h.
What is tx for urticaria?
*HI and H2 blockers (antihistamines)
*steroids (short term, last resort)
*avoid the inciting agent
What is a drug eruption?
Allergic rxn to Rxs
What are three forms of drug eruptions?
1) exanthem
2) urticarial drug rxn
3) hypersensitivity syndrome
What drug is the most common cause of drug exanthems?
What is the pattern of the lesion seen in drug exanthems?
morbilliform with erythema and small papules.
Pts who have hypersensitivity syndrome to drugs are most sensitive to:
anti-convulsants, sulfonamides, and allopurinol
Hypersensitivity syndrome sxs are:
*elevated LFTs
*scaling, vesicles, bullae, and sloughing of the skin
What are the viral exanthems and in what population are they seen?
Measeles, rubella, erythema infectiosum. Most seen in peds.
Viral exanthem rashes start where and spread where?
Start on the face and spread to the trunk and extremities over the course of a few days.
Hypersensitivity syndrome:
Eyrthema Multiforme
Stevens-Johnson Synd
Toxic Epidermal Necrolysis
Erythema Nodosum
Erythema multiforme is most often due to
Less common is URI
What do EM lesions look like?
erythematous plaques and papules with targetoid lesion. they are symmetrical
EM lesions are mostly seen where in the body?
Mucus membranes, palms, and soles.
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>
TEN is also a derm emergency. What is it?
Diffuse necrosis of the skin that leads to sloughing and loss of skin. Urgently move to burn unit.
SJS and TEN often overlap as diagnoses. When does SJS become classified as TEN?
when there is over 30% of skin sloughing
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.
What is the most common cause of SJS and TEN?
drugs! SMX/TMP
What is erythema nodosum? What population is it most commonly seen?
Nodules deep in the subcuticular tissue.

Young women.
Where in the body is E. Nodosum most seen?
Anterior Tibia
What is vasculitis? How is it manifested in the skin?
Inflamm. and necrosis of blood vessels.
It is seen as palpable purpura in the skin.
What is the etiology of vasculitis?
Infection, PCN, sulfa, CT dzes such SLE, IBD, hepatitis, cancer
What is the ddx of vasculitis? How does it present?
Schamberg Dz. See little purpura on the lower legs only. Is probably a a capillaritis.
What is higher frequency and therefore more damaging, UVA or UVB?
Which wavelength is seen in tanning salons?
Which wavelength causes burns that are dose dependent?
If you get an immediate sunburn but it's so mild you don't even know it's there, what wavelength caused it?
A red haired, fair skin, light eyed girl is what skin type?
Type I
Which kind of tanning is "better" for your skin and why?
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.
Where in the body does vitiligo usu occur?
FACE: peri-oral, peri-ocular, and on the lips.
BODY: knees, groin, armpits, butt.
what is Polymorphic light eruption?
skin rash in response to the sun
what has a faster onset, phototox or photoallergy?
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?
Bullous Pemphigoid
What is the Asbo Hanson sign?
Lateral spread of the bullous when you press on it
What ab is involved with dermatitis herpetiformis?
What GI condition is associated with D. Herpetiformis?
Celiac Sprue (gluten insensitivity)
What is a nevus?
a mole. not malignant till they get in the hundreds.
What shapes are junctional, intradermal, and compound nevi?
flat, raised, dome-shaped.
Describe a recurrent nevus and why it should be excised?
Irregular border. It may precede melanoma.
What is the main cause of melanoma?
UV light
Where do people of color get melanoma?
Sole of feet
Name the clinical features of melanoma
assymmetrical, irregular border, varied color, bigger than 6 mm, elevated
Seborrheic keratosis lesions are benign. What do they look like?
Tan/brown scaly plaque
What is the most common non melanoma skin cancer?
Basal Cell Carcinoma
It is a risk for what people?
fair skinned, sun exposed
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
Nodular BCC is the most common. What are the characteristics?
Pearly, waxy looking plaques. They may have telangectasias
What superficial nerve is at risk during surgery to remove a nodule on the periorbital part of the face?
temporal N
How does the superficial kind of BCC differ than the other two?
It does not come and go like the others. Instead, it gets bigger over time.
What does the infiltrating/morphea BCC type look like?
White/yellow scar like plaque
What does a morphea lesion look like?
starts out violaceous, then becomes white in the middle with a red/pink surround.
What In Basal Cell Nevus syndrome, every tx can be used except?
radiation. it makes it worse.
Actinic keratosis is a scaly sun spot. It's a marker for what kind of skin cancer?
Squamous cell carcinoma
What does SCC in situ mean?
It is the intermediate stage b/w actinic keratosis and full blown SCC.
Pt presents with rythematous papules that are rapidly growing and are on the lower lip and ears--places that are sun exposed. Dx?
What benign lesion mimics BCC?
Sebaceous Hyperplasia
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?
Nevus Sebaceous
What benign lesions are found near the eyelid?
Syringoma and hydrocystoma
What benign skin lesion is associated with tuberous sclerosis?
What benign cyst is located at the nail fold?
mucous cyst
What is an acrochordon?
a skin tag
Rickettsia is a parasite that causes?
Rocky Mtn Spotted Fever
Describe the shape and growth requirements of Rickettsia
Coccobaccilli that are obligate intracellular parasites
What Abx is used to empirically tx RMSF?
Rickettsia is divided into these two groups:
1) spotted fever
2) typhus
Are humans considered reservoirs for Rickettsia?
NO! We are only incidental hosts!
What time during the year would you see Rickettsia?
Spring and summer
What causes the rash in Rickettsia?
The parasite proliferates in the endothelial cells of bvs--> vasculitis--> blocks b.f. to skin--> rash and necrosis of skin
A pt presents with rash, fever, HA, and a hx of hiking or camping where ticks occur. DDx?
What state has the most spotted fever?
N. Carolina
In the Spotted Fever subtype, there are 3 subtypes. They are:
2) Boutonnouse Fever
3) Rickettsial Pox
RMSF is caused by a tick that carries what parasite?
Rickettsia rickettsii
When this parasite enters your skin, it goes to your_________and then proliferates in your__________
lymphatic and blood vessels

endothelial cells
The edema, hemorrhage, and hypovolemia seen in Rickettsiosis is due to:
vascular permeability caused by endothelial injury (caused by rickettsii proliferating at cost of endothelial cell)
What kidney manifestation is seen in RMSF due to the hypovolemia?
Pre-renal azotemia
What other clinical manifestations of RMSF do you see?
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**
Lab shows normal WBC but low__________
bone marrow cells: low plts and RBCs
Mortality of RMSF is LOW if it is txed early. What do you treat with?
Tetracycline, Doxycycline, Chloramphenicol.
What is the characterisitc skin lesion of Boutonnouse fever?
Tarche Noir=black area of necrosis where the tick bit
T or F: leaving Rickettsialpox untreated is FATAL
F. It resolves untreated in 2-3 weeks...but tx with doxycycline anyway until you are sure that you are correct in your dx!
How do you get Rickettsial pox?
House mice!
Q Fever is caused by a dessication resistant parasite that is acquired by humans when they
touch secretions of farm animals--milk, pee, poop, birth fluids
So Q Fever is an occupational dz of:
Farmers and Veterinarians
How is Q Fever different than the other two Spotted Fever subtypes?
No rash!
Q Fever has a heart complication. What is it?
Endocarditis. It's a common cause of aseptic endocarditis...
Rickettsia prowazekii causes ________
Typhus is associated with what kinds of living conditions?
War, famine, overcrowding
What is the typhus vector? the reservoir?
body lice=vector.
flying squirrel=reservoir
What is the rash distribution in typhus?
centrifugal--it moves from center to periphery
What is the tx for typhus?
The RMSF rash is centr______while the typhus rash is centr_______
centripetal, centrifugal
What organism causes over 90% of elephantiasis (aka filariasis)?
Wucheria Bancrofti
What kind of living condns do you see filariasis?
uncontrolled mosquito breeding in overcrowded cities
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
lymphatic vessels, lymph node
There are 2 stages of filariasis. In the asxtic stage, what is happening with the lymph endothelium and in the immune syst?
The lymph endothel. is proliferating and the immune system is downregulated
In the sxtic stage, what is happening in the lymph nodes?
Inflammation in the nodes which leads to fibrosis of the nodes
Do newcomers to Filariasis endemic areas get ill faster or slower than the native popul?
What is the diff b/w lymphangitis and lymphadenitis?
lymphangitis=INFECTIOUS inflammation of lymph
lymphadenitis=NON-INFECTIOUS inflamm of lymph
In filaria, retrograde lymphadenitis is seen. It's the response to the dying adult worm. What is the pattern of spread?
Moves from out toward center of the body
What are other sxs of filariasis besides retrograde lymphadenitis?
*hydrocele in males
*chyluria (milky white urine)
*elephantiasis (big, hard tissue due to edema and destruction of lymph tissue)
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?
late at night
What is the drug used to tx both individuals and the community for filariasis?
Dracunculiasis will most likely be eradicated in the near future. What is it?
A larva of a parasite penetrates the GI tract.
From the GI tract where does it mature and then migrate?
matures in the CT or in the abdomen and then migrates to the skin
When is the larvae discharged from the skin?
whenever the skin gets wet
how do you remove the dracuncula worm?
you have to roll it up with a stick, very carefully, day after day, until it's lifted. that's so weird.
trichinosis is a parastie in what animal? we eat it when we eat this meat raw or undercooked....
pigs! (men are pigs)
where in the human does the parasite go to encyst and calcify?
pt presents with myositis, edema around the eyes, and hemorraghes in the retina and in the finger nails. Dx?
How would you treat her?

nothing very useful in the way of tx--steroids and albendazole may help but mostly supportive?
What would you tell her to avoid? What would you tell the farmers who raise the pigs?
Avoid bears--they carry trichinella too

Grain feed swine
In cutaneous larval migrans, the larva creeps around the skin causing itchiness. Is it necessary to remove the larva before it causes damage?
No. it dies on its own and causes no complications besides pruritis.
What is cysticercosis? What popul is it most commonly seen in ?
Pork tapeworm, seen most in mexican/L. American immigrants
What is the neural complication of cysticercosis? What is seen on MRI of the brain?
seizures! multiple cysts!
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?

causes vision loss
What is the chemical name of the histamine ring?
Mast cells store histamine. They turn blue when stained with a special dye...this is called?
What is the entity in the mast cell that is responsible for metachromasia?
the protegoglycan interacts with the basic dye giving a color shift.
Why is histamine slowly synthesized and slowly metabloized? (slow turnover)?
it is tightly bound to vesicles
Where else is histamine found in the body?
GI mucosa and brain. It has a faster turnover in these two locations.
What two cells mediate the synthesis of nascent histamine?
macrophages and plts
what is the precursor of histamine? What is the enzyme that converts it?
Histidine decarboxylase
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
What are the two pathways by which histamine is metabolized? Which one is dominant?
Oxidation and Methylation (dominant)
What is the E in the oxidation pathway?
Diamine oxidase
What is the E in the methylation pathway? What is the necessary Co-factor it needs?
Histamine-N-methyl transferase

SAM (S-adenosyl-L-methionine)
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.

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.
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
There are two Rs of Histamine that we must know: H1 and H2. Which one is fast vasodilation and which one is slow?
Hi=rapid vasodilation
H2=slow vasodilation
Which R is found in the heart? What is the effect of stimulating these Rs?
H2. Increase in HR, SV, and CO
Which R is found in the bronchiolar smooth muscle and what is the effect of their stimulation?
HI. Constriction--> wheezing
Which R is found in the gastric mucosa? What is the effect of stim?
H2. Increased acid and pepsin secretion.
Which R is found in the rest of the intestinal tract smooth muscle? Effect of stim?
H1. Smooth muscle contraction.
Both H1 and H2 Rs are found in the skin. They cause the triple response which is what?
1) small red spots at the site of injection
2) flare
3) wheal
What causes the wheal and flare rxn?
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.
H1 R raise Ca levels how?
H1 Rs are linked to PLC which leads to IP3 and DAG formaxn. IP3 causes an increase in Ca levels.
H2 Rs effects occur via production of what G protein product?
Histamine causes contraction of smooth muscle in the stomach but not in the heart. Why?
H1 Rs in the intestinal smooth muscle are physiologically active while H2 Rs in the heart are not.
Histamine mediates arousal in the brain. In the brain, histamine is made in the?
tuberomammillary bodies.
Hist. release from the mast cells is dependent on which cation?
What Ig is associated with histamine release? Where does it bind to the Mast cell?
IgE. Fc R.
What are the diff b/w 1st and 2nd generation H1 antagonists?
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.
What are the generic names of 5 1st generation H1 antagonists?
What is the effect of H2 antagonists?
lower HR, lower CO, and lower acid secrexn.
What liver E does cimetidine block?
CYP 450
What is the only containdication of cimetidine?

What Rxs have big interactions with cimetidine?
gastric cancer

Theophylline, phenytoin, warfarin
What is the MOA of cromolyn? Is it considered an anti-histamine?
It stablizes the mast cell membrane and prevents release of histamine. It IS NOT an anti-histamine because it doesn't relax smooth muscle.
Cromolyn can be used in young asthma pts, including the case of status asthmatics?
it CAN be used in asthma pts, but HAS NO VALUE IN STATUS ASTHMATICUS!
What is another indication of cromolyn?
It can be used for allergic rhinitis when used as a spray!
Tilade is...and is used for....
a new Rx that is an anti-histamine release drug...used for asthma
What do psoriasis lesions look like? Where in the body are they most common?
Well demarcated, scaly erythematous plaques. They are most common on the elbows, scalp, and knees.
What is the major systemic manifestation of psoriasis?
Arthritis--sausage fingers
What is Auspits sign?
a dark spot due to Fe from spot bleeding after scratching off a psoriasis plaque
What is the Koebner phenomenon?
Lesions that appear at sites of injury
In Lichen planus, you can see whitish lines in the plaque. These are called
Wickim's striae
Where in the body do find Lichen Planus lesions the most?
mucus membranes (mouth/lips)
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?
Pityriasis Rosea.
Secondary Syphilis.
Spaghetti and meatballs is the description that is seen on KOH test for this fungal infection. Is it superficial or deep?
Tinea Versicolor. Superficial.
Syphillis is associated with what tick dz?
Lyme Dx. Lyme Dz is syphilllis reborn(??)
"micacious" and "hyperkeratotic" are buzz words for lesions in what dz?
pustules in psoriasis form due to infiltration of what immune cell?
neutrophils (PMNs)
What is the oil sign?
yellowing of the finger nail due to deposition of serum
Psoriatic arthritis affects these joints:
IP joins in the hands
Why do psoriatic plaques bleed so easily when picked?
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.
In which dermatitis do patients not scratch because there is no itch relief?
Lichen Planus
How come fungal infections have rings that get bigger on the skin?
it consumes keratin and has to move out in order to "eat live skin"
How do you differentiate b/w syphillis rash and P.R. rash?
In syphillis, the rash will go to the palms of hands and feet. Also, see chancres on the genitalia and in oral mucosa
What food products exacerbate Rheumatoid arthritis?
Wheat, citrus, dairy, and nuts.

Also, coffee
What is desired range of Vit D?

Vit D deficiency is considered?
Above 30 ng/ml

Belove 20
What is the relationship between Vit D and Ca?
Vit D facilitates Ca absorption in the gut
Vit D Cascade:

Skin-->liver-->kidney--> intestine and bone
D3-->25(OH)D-->1,25(OH)D--> gut and bones
What is the affect of anti-oxidants on RA?
Anti-oxidants stop oxidative damage and therefore may be protective agains the damage in RA
Why would low fat diets aggravate RA?
Low fat diets are low in Vit E and Vit A, two anti-oxidants that would protect against joint damage.
The desaturase E converts omega-6 and omega-3 between each other. What factors cause the E to make more omega-6?
high etoh
high 6/3 ratio
Supplements to reduce pain and inflamm in RA?
Vit D, E, C
omega 3 oils
olive oil
What would daily caloric and protein requirements be for pts who need to gain weight due to RA?
35 kcal/kg of actual weight

1.5-2.0g/kg of ideal weight
Why does prednisone aggravate osteoperosis?
It causes increased Ca excrexn and decreased Ca absorpxn
what is the action of omega-3 on bone resorpxn and inflamm?
suppresses osteoclastic activity and pro-inflamm cytokines
Purposes of bone?
What's the diff b/w compact bone and spongy/cancellous bone?
Compact bone=structure
Cancellous bone=hematopoiesis
Bone is comprised of three things:
1) collagen matrix
2) mineral salts
3) cells
Collagen matrix is composed of:
1) type I collagen
2) proteoglycans
Mineral of bone is called hypoxyapetite. It is composed of two elements:
1) Ca
2) phosphate
The cells of bone are:
osteoclasts, osteoblasts, and osteocytes
What lines the external surface of bone? what are its two layers called?

outer layer=fibrous
inner layer=osteoprogenitor cells
What lines the internal surface of bone?
What are the two types of joints and which one allows for movement?
1) Diarthroses=allows for free movement
2) Synarthroses=no free movement
Which two factors are cause an increase and Ca absorpxn and breakdown of bone?
PTH and Vit D
PTH responds to a _____in Ca levels. It
What is the defn of simple arthritis?
Joint complaints for more than 6 weeks
What characterizes INFLAMMATORY arthritis?
pain, swelling, warmth, erythema, and synovial thickening.
what are sxs of RA?
morning stiffness, multiple joints involved, symmetrical joint involvement, subcutaneous nodules.
what are systemic sxs of RA?
vasculitis and ILD
in RA, what will the CBC show?
high plt count (thrombocytosis)
normocytic, normochromic anemia
ESR is high/normal in RA?
Why does bone form cysts when the cartilage erodes?
to increase the surface area so that pressure can be spread out
Which immune cell recognizes self-peptide as foreign and what cell does it present to?
Macrophage. Presents to a T Cell.
HLA gene complex is on Chromosome #?
What is Rheumatoid Factor? Which immune cell makes it? What does it do?
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
Which immune cell enters the synovium of the joint?
Presence of which Ig gives a poorer px? IgG or IgM?
Which cytokine mediates joint destruction in RA?
TNF alpha
what are the two main differences b/w OA and RA?
in OA, there is non-symmetrical involvement and the stiffness in the a.m. is mild (severe after immobility)
What is seen in the joint space on X Ray in OA?
What is the most common cause of septic arthritis?
bac due to hematogenous spread
Why is there a wide range of distribution of cortisol secretion among people?
Levels of CYP 450 differ b/w people
Where does the gluct. R receive cortisol in the cell?
Cytoplasm. Binding of cort causes a conformation change that brings the R into the nucleus.
Glucts. are catabolic. They also have waht affect on glucose with respect to the liver?
They induce gluconeogenesis
Addison's dz is too little/too much glucts?
too little. these pts have a hard time maintaining blood glucose levels and adapting to stress.
what are some clinical uses of glucts?
skin for allergic rxns
ACTH is used to dx primary and secondary adrenal cortical insufficiency. How?
If adrenals respond to exogenous ACTH, then the problem does not lie within the adrenal cx itself and is therefore a secondary insufficiency
Will exogenous administration of glucts. increase or decrease endogenous production?
Therefore, don't abruptly withdraw the drug. Decrease the amnts gradually so that the HPA axis has time to kick in again.
What corticosteroid is used to tx Crohn's dz and is unique in that it's delivered straight to the terminal ileum?
high levels of corticosteroids will display peripheral mineralocorticoid activity. what sx will indicate that this is happening?
salt retention
Which bone tumor is more common in kids: osteosarcoma or ewings?
Ewings in kids under 10. Above age 10, it's most likely osteosarcoma
What is the first place that bone cancers met?
Very distal tumors do well with surgery (T/F)

Central tumors do well with surgery (T/F)

How do you decide between surgery and radiation?
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)?
What is the defn of a periosteal reaction? How does it give you information about the tumor?
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
Ewing's sarcoma occurs in the bone ______

Osteosarcomas occur in the bone _____
diaphysis (central distribution!)

metaphysis (peripheral distribution!)
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
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.
Osteosarcoma has an osteoblast origin. When is the peak incidence?
Teens and early 20s (time of final bone growth)
Ewings has excellent response to radiation. Do osteosarcomas respond well to radiation?

What is the best tx option for Osteosarc?
rarely improves ability to resect
what are some late affects of tx for these two cancers?
* secondary sarcoma at site of radiation
* infertility due to chemo