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83 Cards in this Set

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achondroplasia
-falure of longitudinal bone growth==>short limbs
-nl membrane ossification (nl skull, facial bones, axial skeleton)
-impaired cartilage maturation in growht plate d/t mutated fibroblast growth factor receptor
what is mutated in achondroplasia
mutated fibroblast growth factor receptor (GFR)

==>impaired cartilage maturation in growth plate
subchondral cysts

=>dz?
Osteoarthritis
eburnation

==>dz?
osteoarthritis
Bouchard's and Heberdon's nodes

==>dz?
osteoarthritis
destruction of articular cartilage

==>dz?
osteoarthritis
bone and cartilage erosion

==>dz?
Rheumatoid arthritis
incr synovial fluid in joint space

==>dz?
Rheumatoid arthritis
pannus

==>dz?
Rheumatoid arthritis
subluxation of joints

==>dz?
Rheumatoid arthritis
Boutonniere deformity

==>dz?
Rheumatoid arthritis
swan-neck deformity

==>dz?
Rheumatoid arthritis
Z-thumb deformity

==>dz?
Rheumatoid arthritis
describe bone mineralization in osteoporosis
nl bone mineralization

(but incr bone resorption)
osteoporosis : Type I vs II
Type I= post-menopausal
(decr estrogen==>incr bone resorption)

Type II= Senile osteoporosis (>70 y/o)
distal radius fractures is assoc with what dz
osteoporosis

(distal radius fractures= Colles fractures)
Tx osteoporosis
for severe osteoporosis, tx wtih bisphosphonates (patrick's mneumonics) or pulsatile PTH
thickened, dense bones
anemia, thrombocytopenia, infxn

dz?
et?
serum Ca, phosphate, and alk phos levels?
dz=Osteopetrosis (marble bone dz)

et=osteoclasts do not resorb bone like they should

serum Ca, phosphate, and ALK PHOS levels are nl

(alk phos ~ osteoBLASTic activity)

thickened dense bones
==>decr BM space
==>anemia, thrombocytopenia, decr WBC cause infxn (~aplastic anemia)
osteomalacia/rickets

-desc
-reversible
deficient Vit D
==>defective bone mineralization
==>soft bones

-Osteomalacia (Vit D deficiency in adults) is reversible

-Rickets (Vit D deficiency in kids)
==>decr calcification
==>incr osteoid accumulation
==>incr thcikness of epiphyseal growth plate & other Sk deformities
osteitis fibrosa cystica
von Recklinghausen Dz of bone

-d/t hyper-PTH

*brown tumors (cystic spacews lined by osteoclasts, filled with fibrous stroma and blood)

hyper-PTH==>high serum Ca, low serum phosphorus

-high alk phos (~osteoblastic activity)
cystic spaces lined by osteoclasts, filled with fibrous stroma and blood
=brown tumors

==>osteitis cystica fibrosa (AKA von Recklinghausen Dz of bone)

-d/t hyper-PTH

hyper-PTH==>high serum Ca, low serum phosphorus

-high alk phos (~osteoblastic activity)
describe cardiac abnl secondary to Paget's dz of bone
In Paget's dz of bone, A-V shunts cause incr blood flow

==>high-output CHF
polyostitic fibrous dysplasia
"polyostitic fibrous dysplasia"

-"polyostotic"==>affects multiple bones

-"fibrous dysplasia"==>bone replaced by fibroblasts, collagen, and irregular bony trabeculae; QBank: "unmineralized whorls of connective tissue"

-Albright's syndrome (imagine Madeleine Albright as a young girl with big boobs (precocious pubery) with these other Sx) is a type of polyostitis fibrous dysplasia in which there are:

*multiple unilateral bone lesions
*unilateral pigmented skin lesions (i.e. on one side of back)
*endocrine abnl (precocious puberty)
multiple unilateral bone lesions are associated with what endocrine and skin abormalities?
-this is Albright's syndrome (imagine Madeleine Albright with these Sx), which is a type of polyostitis fibrous dysplasia in which there are:

*multiple unilateral bone lesions
*unilateral pigmented skin lesions
*endocrine abnl (precocious puberty)
polymyalgia rheumatica is assoc w what vascular problem

how Tx
temporal (giant cell) arteritis

Tx with prednisone
polymyositis

-desc
-et
-how Dx
-lab tests show what
=progressive symmetric muscle weakness

-et: CD8+ T-cell induced injury to myofibers

Dx=muscle biopsy with evidence of inflammation

-labs for polymyositis/dermatomyositis show:
*incr CK (indicates muscle destruction b/c CK is in muscle)
*incr aldolase
*positive ANA
*anti-Jo-1
dermatomyositis

-desc
-et
-lab tests show what
-similar to polymyositis (progressive symmetric muscle weakness d/t CD8+ T-cell induced injury to myofibers)

-but also "shawl and face" skin rash and incr risk of malignancy

-labs for polymyositis/dermatomyositis show:
*incr CK (indicates muscle destruction b/c CK is in muscle)
*incr aldolase
*positive ANA
*anti-Jo-1
*incr CK
*incr aldolase
*positive ANA
*anti-Jo-1

suggest what
polymyositis/dermatomyositis

(incr CK indicates muscle destruction b/c CK is in muscle)
anti-Jo-1 suggest
polymyositis/dermatomyositis
antibodies to U1RNP
mixed connetive tissue dz:

-Raynaud's
-arthralgias/myalgias
-esophageal dysmotility
SSA & SSB
Sjogren's Syndrome

(SS=Sjogren's Syndrome)
Ro antibodies
=SSA

(SS=Sjogren's Syndrome)
La antibodies
=SSB

(SS=Sjogren's Syndrome)
risks assoc with Sjogren's syndrome
incr risk of B-cell lymphoma & dental caries
sicca syndrome
(~Sjogren's)

dry eyes
dry mouth
nasal & vaginal dryness ("Vaginal dryness? sicca!")
chronitic bronchitis
refluex esophagitis
wire loop lesions in kidney
SLE
what dz can cause false + on syphilis tests (RPR/VDRL)
SLE
autoantibodies in lupus
1. ANA: sensitive but not specific
2. anti-ds DNA: very specific, poor prognosis
3. anti-Smith: very specific, but not prognostic
4. antihistone Ig: drug-induced lupus
antihistone Ig
drug-induced lupus
anti-dsDNA
lupus
anti-Smith antibodies
lupus
et of gout
1. decr excretion of uric acid (i.e. thiazide diuretics competitively inhibit uric acid excretion)

2. Lesch-Nyhan

3. PRPP excess

4. G6PD
podagra
painful MTP joint (big toe) in gout
pseudogout

-type of crystals
-MC joint affected
Ca++ pyrophosphate

MC joint affected=knee
sarcoidosis
"GRAN"uloma
G=Gammaglobulinemia (incr IgG)
R=Rheumatoid arthritis (also assoc w/incr IgG)
A=ACE increase
N=noncaseating granulomas

-interstitial lung dz
-bilateral enlarged hilar LN
-uveitis
-parotitis
-erythema nodosum of skin (red nodules ~ RA)
-high Ca++ (d/t elevated activation of Vit D in epithelioid macrophages)
-Bell's palsy
anticentromere antibody
CREST (anti-CENT-romere sounds like of like CREST)
anti-Scl-70 antibody
diffuse scleroderma
pinpoint bleeding if scrape off this skin lesion
pinpoint bleeding=Auspitz sign

==>Psoriasis
atopic dermatitis
AKA eczema
allergic contact dermatitis is what type of hypersensitivity
Type IV
dermatitis herpetiformis

-pathogenesis
-asoc w what dz
IgA deposits at tips of dermal papillae
==>papules & vesicles

-assoc w celiac dz
lichen planus
pruritic papules & vesicles

lymphocytic infiltrate at epidermal-dermal jxn (mneum: "PLANe of lymphocytes at epidermal-dermal PLANE)
erythema multiforme
"multiforme"==>multiple types of lesions:
*target lesions (red papules with pale central area)
*macules
*papules
*vesicles

-assoc w/"multiple" causes:
*infections--esp Mycoplasma pneumoniae
*drugs
*cancer
*autoimm dz
seborrheic keratosis
=senile keratosis (old ppl get it)

-BENIGN
-sharply demarcated plaques/papules with "stuck on" appearance
-squamous epithelium proliferation w/keratain-filled cysts
Stevens Johnson syndrome
-assoc w sulfa drugs and anticonvulsant drugs

-severe form of erythema multiforme
-high mortality rate
-high fever
-bulla (fluid filled blister >0.5 cm) formation and necrosis
-skin ulceration
actinic keratosis

-risk assoc with what
-precursor to SCC

-risk of CA is proportional to epithelial dysplasia
keloid
-abnl proliferation of dermal connective tissue
==>raised, tumor-like scars

-follows trauma to skin (i.e. ear piercing, surgical wounds)

-AfAm
arsenic exposure is assoc w/what skin cancer
SCC
skin SCC is assoc with exposure to what?
arsenic
skin lesion with pearly papules
skin BCC
skin tumor that shows "palisading nuclei"
skin BCC
dysplastic nevus
precursor to melanoma
MC malignant skin lesion
BCC
sudden outcropping of raised pigmented papules/plaques (look like moles)

-what are they
-what does the sudden outcropping of them suggest?
=seborrheic keratosis

suggest stomach adenoCA
acanthosis nigricans suggest what
stomach adenoCA
bone tumor:

“double bubble” or “soap bubble appearance on X-ray”

-which bone tumor?
-site?
giant cell tumor

Epiphysis of long bones;
Distal femur, prox tibia
MC benign bone tumor?

site?
osteochondroma

-mature bone capped by cartilage
-♂ <25 y/o

site=Metaphysis of long bones
MC malignant bone tumor?

-desc
site?
osteosarcoma

*Codman’s triangle
♂ 10-20 y/o

site=Metaphysis of long bones
cartilage tumors
-benign
-malignant
Enchondroma:
Benign cartilage tumor
Site=intramedullary bone (like chondrosarcoma),
BUT in hands/feet (vs chondrosarcoma)


Chondrosarcoma:
Malignant cartilage tumor
Site=intramedullary bone (like enchondroma),
BUT in pelvis, spine, scapula, humerus, tibia, femur
“onion skin appearance” on X-ray

-which bone tumor?
-benign or malignant?
-site?
Ewing’s sarcoma

-malignant
-“onion skin appearance” on X-ray (mneum: go out for eWINGS and onion rings)
-t (11,22)
-Site=Diaphysis of long bones, pelvis, scapula, & ribs
Buerger's disease
AKA thrombitis obliterans

(Tip: visualize!)
-thrombosing vasculitis of small-medium peripheral vessels
==>claudication (very painful!)
==>cold insensitivity (Raynaud's)
==>superficial nodular phlebitis

-seen in heavy smokers
MC vasculitis

-name
-affects what arteries
-Sx
-assoc w/what MSK problem
-Tx
temporal arteritis (AKA giant cell arteritis)

-affects medium-small arteries, usu branches of carotid A

Sx:
-jaw claudication
-impaired vision (occlusion of opthalmic artery, can cause blindness)
-unilateral H/A
-assoc w/polymyalgia rheumatica

Tx: steroids (b/c inflammatory)
jaw claudication
elevated ESR

Dx?
temporal arteritis (AKA giant cell arteritis)
unilateral H/A
imparied vision
elevated ESR
temporal arteritis (AKA giant cell arteritis)
vasculitis of kidney, lungs/upper airway

-what type of Hypersensitivity
Wegener’s granulomatosis

Type 3 hypersens
vasculitis of kidney, GI

-Dz?
-what type hypersensitivity?
-assoc w/what dz
polyarteritis nodosa

P-ANCA +
Type 3 hypersens

*assoc w/Hep B

-Tx: corticosteroids (to reduce inflammation), cyclophosphamide
perforation of nasal septum
chronic sinusitis
otits media
mastoiditis
hemoptysis
hematuria & red cell casts

-Chest X-ray shows large nodular densitis

==>Dx?
Wegener's granulomatosis
Wegener's granulomatosis

Sx?
Tx?
perforation of nasal septum
chronic sinusitis
otits media
mastoiditis
hemoptysis
hematuria & red cell casts

-Chest X-ray shows large nodular densitis

Tx: corticosteroids (to reduce inflamm), cyclophosphamide
granulomatous vasculitis involving lungs, heart, skin, kidneys, nerves

-what cells do you see?
Eo's

(this is Churg-Strauss syndrome)
-vasculitis in infants/kids
-fever
-congested conjunctiva
-chaps in lips/oral mucosa
-lymphadenitis

==>Dz?
==>prognosis
==>risk?
Kawasaki dz

-acute, self-limiting but may develop coronary aneurysms
Goljan: palpable purpura means what?
=small vessel vasculitis
=ImCo (Type 3 hypersens)
telangiectasia
A-V malformation in small vessels
hereditary hemorrhagic telangiectasias have what inheritance pattern?

-Sx?
AD

Sx:
nosebleeds
skin discolorations