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413 Cards in this Set
- Front
- Back
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what are the layers of the epidermis
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BSGLC
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what are eccrine glands
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sweat glands present in skin throughout body, secrete watery Na/Cl solution
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what are merocrine glands
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aka eccrine
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what are apocrine glands
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found in axilla and pubic area, secrete viscous milky fluid (by budding), odorous after bacterial digestion
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what are holocrine glands
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sebaceous glands, cells accumulate secretions and rupture
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what glands have androgen receptors
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holocrine sebaceous glands
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what layer of skin is the site for dermatophyte infections
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stratum corneum
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what layer of skin is thinned in psiorasis
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stratum granulosum
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what layer of skin is thickened in psoriasis
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stratum spinosum
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what layer of skin is thickened in acanthosis nigricans
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stratum spinosum
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what layer of skin contains melaocytes
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stratum basalis
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what type of adhesion contains claudins and occludens
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zona occludens
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what type of adhesion contains cadherins
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zona adherens, macula adhrens
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what type of adhesion contains actin
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zona adherens
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what type of adhesion contains intermediate filaments
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macula adherens
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what type of adhesion contains keratin and desmoplakin
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macula adherens
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what type of adhesion contains connexons
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gap junction
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what 3 structures are injured in unhappy triad
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1. MCL 2. ACL 3. lateral meniscus
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anterior drawer sign indicates tearing of what
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ACL
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describe the attachment points of the ACL
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medial surface of lateral condyle of femur to anterior tibia
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landmark for pudendal nerve
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ischial spine
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where is mcburney's point
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2/3 from umbilicus to ASIS
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where is L4 (location for LP)
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iliac crest
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describe the attachment of the rotator cuff muscles
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subscapularis inserts on lesser tubercles, others insert on the greater tubercle (most lateral part of humerus). between the three that insert on greater tubercle, supraspinatus is most anterior, then comes infraspinatus, then teres minor. p371
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most common rotator cuff injury
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supraspinatus
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function of supraspinatus
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initial abduction of arm
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what nerve supplies the supraspinatus
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suprascapular n C56
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impingement injury that can occur with supraspinatus
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tendon can get impinged b/w acromion and head of humerus. Pain with abduction against resistance
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function of infraspinatus
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lateral rotation of arm
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what nerve supplies the infraspinatus
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suprascapular n C56
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in what kind of injury does dmg to infraspinatus take place
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pitching injury
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function of teres minor
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lateral rotation and adduction
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function of subscapularis
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medial rotation and adduction
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what nerve supplies the teres major
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axillary n C56
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what nerve supplies subscapularis
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subscapular n C56
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that muscles are involved in raising arm above horizontal
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deltoid, serratus anterior (long thoracic), trapezius (XI)
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dislocation vs seperation of shoulder
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dislocation = head of humerus rotating out. Separation = clavicle separating from the acromion and coracoid process
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what structures can get dmged with ant dislocation of shoulder
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post circumflex and axillary n
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repeated ant dislocation of shoulder can result in
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1. "Bankart" lesion - injury to ant glenoid labrum 2. "Hill Sachs" fracture - post sup head of humerus
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3 insertions of SCM
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1. sternum 2. clavicle 3. mastoid process
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describe what muscles have attachments to clavicle
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supermedial = SCM. Inferomedial to inferolateral = pectoralis major, subclavius, deltoid
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relationship of quadrator to psoas
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quadrator is lateral and posterior to psoas. Psoas is proximal to spine
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review upper extremity anatomy
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p372
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what nerve root is oft compressed by cervical disk lesion
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C7
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what nerve is lesioned by dislocation of humerus
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axillary n C56
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what nerve can be lesioned by IM injections into deltoid
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axillary n C56
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what nerve is compressed when incorrectly using crutch
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radial n
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what nerve is lesioned by midshaft fracture of humerus
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radial n
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what nerve is compressed by supracondylar fracture of humerus
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median n (proximal lesion)
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what nerve is injured by fracture of medial epicondyle of humerus
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ulnar n
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what nerve is streched by subluxation of radius
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radial n (deep branch)
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what nerve supplies the latissimus dorsi
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thoracodorsal n
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what nerve supplies the teres major
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lower subscapular
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what is the order of divisions of the brachial plexus
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root, trunk, division, cord, branch
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lesion of upper trunk of brachial plexus leads to
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erb duchenne palsy (waiter's tip)
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lesion of lower trunk of brachial plexus leads to
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klumpke's palsy (total claw hand)
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what can cause wrist drop
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radial n dmg, posterior cord dmg
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what protects the brachial plexus from injury during clavicle fracture
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subclavius muscle
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what vessel runs with the dorsal scapular n
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dorsal scapular a
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what vessel runs with the long thoracic n
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lateral thoracic a
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what vessel runs with the axiallary n
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post circumflex a
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what vessel runs with the suprascapular n
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suprascapular a
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what vessel runs with the thoracodorsal n
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thoracodorsal a
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what vessel runs with the radial n
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deep brachial a
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what vessel runs with the ulnar n
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ulnar a
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what vessel runs with the median n
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brachial a
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what vessel runs with the ant interosseus n
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ant interosseus a
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what vessel runs with the deep radial branch of the radial n
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post interosseus
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function of teres major
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MR, extension, adduction
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review brachial plexus
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p373
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sensory deficit with axillary n dmg
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over deltoid
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what is Saturday night palsy
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compression of axilla by back of chair or crutches (radial n)
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sx of radial n dmg
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wrist drop
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what muscles does radial nerve supply
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brachioradialis, extensors of wrist & fingers, supinators, triceps
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sensory area supplied by radial nerve
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posterior arm and dorsal hand around on thumb and that area
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sensation served by median nerve
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dorsal and palmar sensation of lateral 3 1/2 fingers
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dislocated lunate can cause what nerve injury
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distal median nerve lesion
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motor deficits on proximal ulnar n lesion (specific to proximal)
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1. medial finger flexion 2. wrist flexion
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sensation served by ulnar n
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medial 1/2 fingers
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fracture of hook of hamate can dmg what nerve
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distal ulnar
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motor deficits on distal ulnar n lesion
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1. abduction and adduction of fingers (interossei) 2. adduction of thumb 3. extension of 4th and 5th fingers (i.e. ulnar claw)
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sx of proximal ulnar n lesion
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radial deviation of wrist on wrist flexion
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motor deficit on MC nerve dmg
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biceps, brachialis, corachobrachialis
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what can cause MC nerve dmg
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upper trunk compression
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common causes of median nerve entrapment
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1. pregnancy 2. RA
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numbness and tingling in lateral fingers that radiates to elbow w/ thenar wasting
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carpal tunnel
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causes of erb duchenne palsy
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1. blow to shoulder 2. trauma during delivery
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sx of erb duchenne palsy
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waiter's tip - medial rotation, lack of abduction, forearm pronated (loss of biceps)
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sx of thoracic outlet syndrome
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1. atrophy of thenar and hypothenar eminence 2. atrophy of interosseus 3. sensory deficits on medial side of forarm and hand 4. disappearance of radial pulse on moving head to ipsi side
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function of lumbricals
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flex MCP, extend IP's
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defect in ulnar claw
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distal ulnar nerve lesion means no lumbrical function on medial digits. Extension of hand leaves medial digits flexed
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making fist w/ prox medial n vs distal ulnar n
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they appear similar. Prox medial n lesion, lose lateral flexors. Distal ulnar n lesion, lose medial extensors
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sx of klumpke's claw hand
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lower trunk lesion results in lesion to all lumbricals
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function of dorsal interosseus muscles
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abduct fingers
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function of palmar interosseus muscles
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adduct the fingers
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anterior hip dislocation can injure what nerve
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femoral n L234
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pelvic fracture can injure what nerve
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obturator n L234
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trauma to lateral leg can injure what nerve
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common peroneal L4-S2
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trauma to fibula neck can injure what nerve
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common peroneal L4-S2
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lead poisoning has a tendency to injure what nerve in the LE
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common peroneal L4-S2
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trauma to knee tends to injure what nerve
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tibial n L4-S2
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posterior hip dislocation can injure what nerve
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sup gluteal L4-S1, inf gluteal L5-S2
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polio tends to lesion what LE nerve
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sup gluteal L4-S1
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motor function of obturator
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thigh adduction
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sensory function of obturator
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medial thigh
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motor function of femoral n
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thigh and leg flexion
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sensory function of femoral n
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ant thigh and leg
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motor function of common peroneal
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PED = eversion, dorsiflexion
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sensory function of common peroneal
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anterolateral leg, dorsal foot
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motor function of tibial n
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TIP = inversion and plantarflexion
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sensory function of tibial n
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sole of foot
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motor function of superior gluteal
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thigh abduction, medial rotation
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motor function of inferior gluteal n
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thigh extension, lateral rotation
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what nerve roots make up sciatic nerve
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L4-S2
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relationship of saphenous n and great saphenous v & medial malleolus
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both pass anterior to medial malleolus
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what is the arrangement of structures posterior to the medial mallelus
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Tom Dick ANd Harry = tibilias posterior, flexor Digitorum longus, tibial artery, tibial nerve, flexor hallucis longus (these are from ant to post)
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trendelenberg sx results from dmg to what nerve
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superior gluteal n L4-S1
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review structure of sarcomere
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p377
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which section of sarcomere always remains the same length
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A band. HIZ shrinks
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what is the A band
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length of thick filament
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what is I band
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section that is ONLY thin filament
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what is H zone
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section that is ONLY thick filament
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excitation in skeletal muscle vs cardiac
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voltage senstive DHP receptor is mechanically coupled to SR
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what area of butt should injections target. What structures exist in other quadrants
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supralateral. Sciatic n is on the inferomedial, superior gluteal n is in superomedial, and inferolateral has tendons of gluteal mm
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what makes up collateral circulation at trochanter of hip
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sup and inf gluteal, lat and medial femoral circulfex.
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what is the most vulnerable blood supply to trochanter of hip in a femoral neck fracture
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medial circumflex
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what is the sequence of the carpal bones
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scaphoid is under 2nd digit on 2nd row. Going medially and then back laterally: lunate, triquetrum/pisiform, hamate, capitate, trapezoid, trapezium
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type 1 vs type 2 muscle fibers
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1. slow vs fast twich 2. red vs white 3. oxidative vs anaerobic
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review power cycle
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p378 - ADP-myosin binds actin, ADP is released, mysin performs power stroke, ATP binds, myosin releases actin, cleavage of ATP starts the cycle again
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what amino acid is needed to synthesize NO
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arginine
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what enzyme promotes smooth muscle contraction? Inhibits?
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myosin light chain kinase promotes. Myosin light chain phosphatase inhibits it
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what things can regulate MLCK
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calcium entry into cell can stimulate MLCK. PGE2 and epinephrine acting through cAMP can inhibit MLCK
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what things can regulate myosin light chain phosphatase
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cGMP (like from NO) stimulates myosin light chain phosphatase
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endochondrial ossification vs membranous ossification
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1. longitudinal vs flat bone growth 2. bone made on cartilage and later vs bone made directly
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what embryologic germ layer do osteoblasts come from
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mesenchyme
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how can osteoclast activity be measured
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TRAP, urinary hydroxyproline, urinary deoxypyridinoline (most specific)
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membranous vs endochondrial ossification in achondroplasia
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membranous is fine, endochondrial fails
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pathogenesis of achondroplasia
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FGFR3 is constitutively expressed which nonintuitively inhibits chondrocyte proliferation
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inheritance of achondroplasia
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most sporadic, but some AD
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what can increase risk of getting achondroplasia
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advanced paternal age
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bone mass, bone mineralization in osteoporosis
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reduction of bone mass, increased bone mineralization
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type 1 vs type 2 osteoporosis
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type 1 = postmenopausal due to increased bone resorption. Type II = senile osteoporosis, due to decreased osteoblast activity
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common fractures in osteoporosis
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vertebral crush fracture, femoral neck, distal radius
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risk factors for osteoporosis
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smoking, decreased sex hormones, no exercise, GLUCOCORTICOID, HEPARIN
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how to dx osteoporosis
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bone density scan of femur and lumbar spine
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ways to tx osteoporosis
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estrogen (SERM), calcitonin, bisphosphonate, pulsatile PTH
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defect in osteopetrosis
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abnormal function of osteoclasts. Deficiency in carbonic anhydrase II
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complications of osteopetrosis
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1. pancytopenia due to BM crowding, and extramedullary hematopoiesis. 2. Nerve impingement due to narrowed foramina that can lead to visual/hearing loss 3. fracture
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erlenmeyer flask bones
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osteopetrosis
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bone mass, bone mineralization in osteomalacia
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both are decreased
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defect in paget's dz
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increase in both osteoblastic and osteoclastic activity that leads to disorganized, "mosaic" bone
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complications of paget's dz
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1. nerve impingement that can leads to hearing loss 2. fracture 3. increased AV shunting can cause high CO HF 4. osteogenic sarcoma
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serum Ca, phosphate, ALP, PTH in: osteoporosis
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-, -, -, -
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serum Ca, phosphate, ALP, PTH in: osteopetrosis
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-, -, -, -
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serum Ca, phosphate, ALP, PTH in: osteomalacia
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down, down, -, up
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serum Ca, phosphate, ALP, PTH in: osteitis fibrosa cystica
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up, down, up, up
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serum Ca, phosphate, ALP, PTH in: pagets dz
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-, -, up, down
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defect in polyostotic fibrous dysplasia
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bone replaced by fibroblasts, collagen, and irregular bony trabeculae
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triad of mccune albright
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fibrous dysplasia of bone (multiple UNILATERAL bone lesions) + precocious puberty + café au lait spots
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what is osteoma assoc w
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FAP (gardner)
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what two benign bone tumors are especially painful because of prostaglandin release
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osteoid osteoma, osteoblastoma
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double bubble/soap bubble appearance on x ray
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giant cell tumor
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spindle shaped cells with multinucleated giant cells on x ray
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giant cell tumor
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what may osteochondroma progress to
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chondrosarcoma
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risk factors for osteosarcoma
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paget dz, radiation, bone infarct, familial retinoblastoma
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sunburst pattern on x ray
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aka codman's triangle, elevation of periosteum. Seen with osteosarcoma, but also pyogenic osteomyelitis.
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anaplastic small blue cells in bone
|
ewing
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translocation in ewing sarcoma
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11-22
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onion skin appearance in bone
|
ewing
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what bone tumor has homer wright pseudorosette
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ewing
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expansile glistening mass within medullary cavity
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chondrosarcoma
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what bone tumors are found in the medullary cavity
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chondrosarcoma, enchondroma (i.e. everything chondro except osteochondroma)
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age range of osteochondroma
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teen and adult
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age range of enchondroma
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adult
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age range of osteoid osteoma
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teen
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age range of osteoblastoma
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teen
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age range of giant cell tumor
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adult
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age range of chondrosarcoma
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adult
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age range of osteosarcoma
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teen
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age range of ewing sarcoma
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teen
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most common location of osteoma
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facial bone
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mc location of osteoid osteoma
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prox tibia and femur
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mc location of osteoblastoma
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vertebrae
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mc location of giant cell tumor
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epiphysis of knee
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mc location of osteochondroma
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metaphysis of distal femur
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mc location of enchondroma
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medullary cavity of distal extremities
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mc location of osteosarcoma
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metaphysis of knee
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mc location of ewing sarcoma
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diaphysis of long bone, pelvis, scapula, rib
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mc location of chondrosarcoma
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medullary cavity of axial skeleton, prox femur, pelvis
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what tissues can give rise to neoplasm of bone
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BM (MM), osteoblast, osteoclast-like cells, cartilage, fibroblast, histiocytes
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bone spurs + joint space narrowing + sclerosis + subchondral bone cyst
|
osteoarthritis
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heberden's node
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DIP in osteoarthritis
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bouchard's node
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PIP in osteoarthritis
|
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pain in joints at the end of the day, improving with rest
|
osteoarthritis
|
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why does cartilage loss begin on medial side in osteoarthritis
|
majority of weight is on that side
|
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histology of rheumatoid nodules
|
fibrinoid necrosis by palisading histiocytes
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what type of joints are affected in RA
|
synovial joints
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what is a baker's cyst and what is it assoc w/
|
poplitieal/gastroc bursitis, cyst behind knee. RA
|
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type of HS seen in RA
|
HSIII (II also probably)
|
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progressively increasing morning stiffness that improves with use, deformed joints
|
RA
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what dz has pannus formation
|
RA. Pannus = connective tissue growth that covers joint surface
|
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is joint fusion seen in osteoarthritis or RA
|
RA
|
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hla assoc of ra
|
dr4
|
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RA + autoimmune neutropenia + splenomegaly
|
felty's syndrome
|
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swan neck deformity
|
ra
|
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z thumb deformity
|
ra
|
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boutonniere deformity
|
ra
|
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|
traid of sjogren
|
xeropthalmia + xerostomia + arthritis
|
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sicca syndrome
|
dry eyes, dry mouth, chronic bronchitis, reflux esophagitis and NO arthritis (recall sjogren's has arthritis). Type of sjogren
|
|
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complication of sjogren
|
b cell lymphoma, dental caries (nothing to fight bacteria in mouth)
|
|
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autoantibodies in sjogren
|
ss-a, ss-b (ro, la)
|
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|
prepatellar bursitis
|
housemaid's knee -- overuse in athletics, obesity
|
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what antimicrobial can tx ra
|
chloroquine
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composition of crystals in gout
|
monosodium urate
|
|
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causes of gout
|
lesch nyhan, decreased excretion (thiazide, alcohol), increased cell turnover (cancer), von gierke. 90% due to undersecretion
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appearance of gout crystals under polarized light
|
negatively birefringent = yellow niddle shaped crystals under parallel light
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is gout symmetric or assymetric
|
assymetric
|
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what is podogra
|
uric crystal deposits on big toe
|
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what is a tophus
|
fibrosed urate crystals w/ inflammation
|
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where are tophi commonly located
|
ear, elbow, achilles
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birefringence of pseudogout
|
rhomboid crystals that are weakly positively birefrengint (blue under parallel light)
|
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|
most common location of pseudogout
|
knee
|
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common causes of acute septic arthritis
|
saureus, strep, gonococcus
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is gonococcal arthritis polyarthritis or monoarthritis?
|
mono, asymmetric that may migrate
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sx of gonococcal arthritis
|
STD = synovitis, tenocynovitis, dermatitis
|
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causes of chronic septic arthrits
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TB, lyme dz
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what are the 4 HLA B27-associated spondyloarthropathies
|
PAIR - psoriatic arthritis, ankylosing spondylitis, IBD, reiter's
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is psoriatic arthritis symmetric
|
no
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is RA symmetric
|
yes
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what type of arthritis can cause dactylitis
|
sausage fingers = psoriatic arthritis
|
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pencil in cup deformity on xray
|
psoriatic arthritis
|
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uveitis, sacroilitis, AR
|
alkylosing spondylitis
|
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why do ankylosing spoldylitis pts have decreased blood pH
|
bamboo spine restricts movement of chest cavity
|
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conjunctivitis/uveitis, urethritis, arthritis
|
reiters
|
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what may predispose to reiter's syndrome
|
post GI (eg shigella) or chlam
|
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sx of SLE, how many are needed for dx
|
4. IM DAMN SHARP = Ig(smith, dsDNA), mucositis, discoid rash, arthritis, malar rash, neurologic, serositis, hematologic, ANA, renal, photosensitivity
|
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|
race association of SLE
|
black females
|
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what lung pathology can SLE cause
|
pleuritis, hilar adenopathy
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mcc death sle
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nephritic syndrome
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sx differences b/w sle and drug induced lupus
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antihistone ab's, less renal and CNS involvement
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features of sarcoidosis
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GRUELING = granuloma (noncaseating), RA, uveitis, erythema nodosum, (bilateral hilar) lymphadenopathy, idiopathic, interstitial fibrosis, not TB, gammaglobulinemia
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race association of sarcoidosis
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black females
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what enzyme is elevated in sarcoidosis
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ACE
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what neurological deficit assoc w sarcoidosis
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bells palsy
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pathogenesis of sarcoidosis
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improper activation of CD4 Th cells
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Schaumann and asteroid bodies
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sarcoidosis
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why is there hypercalcemia in sarcoidosis
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release of vitamin D by epitheloid macrophages
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does polymyalgia rheumatica cause muscle weakness
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no
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does polymyositis cause muscle weakness
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yes
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what dzz is polymyalgia rheumatica assoc w
|
giant cell arteritis
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what is heliotrope rash
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racoon eyes seen in polymyositis
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what muscles affected most by polymyalgia rheumatica
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shoulders and hips
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what type of inflammation seen in polymyositis
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perifascicualr
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most common location of polymyositis
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shoulders
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pattern of muscle weakness in polymyositis
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progressive symmetric proximal
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is polymyositis symmetric
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yes
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what cell causes damage in polymyositis
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CTL
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sx seen in dermatomyositis
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heloptrope rash, malar rash, shawl and face rash, gottron's papules, mechanics hands
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complication of dermatomyositis
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malignancy
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lab findings in polymyalgia vs polymyositis
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polymyalgia: normal CK, elevated ESR. Polymyositis: elevated CK, increased aldolase, positive ANA and anti-Jo-1
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NMJ dz where sx worsen with muscle use
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myasthenia
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NMJ dz where sx improve w muscle use
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lambert eaton
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is myasthenia always have thymic involvment
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50% have hyperplasia, 20% have atrophy, 15% have thymoma
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pattern of muscle weakness in lambert eaton
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proximal weakness
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differences in sx: lambert eaton vs myasthenia
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l-e has hyporeflexina and autonomic sx (dry mouth, impotence)
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4 ways to tx myathenia
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1. thymectomy 2. achei 3. gc's 4. plamsaphoresis
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anterior vs posterior uveitis
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anterior = inflammation of iris and ciliary body. Posterior = inflammation of choroid and posterior eye
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puffy taught skin with no wrinkles throughout body
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scleroderma
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what systems may be involved in scleroderma
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renal, pulmonary, cardiovascular, GI
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CREST syndrome
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calcinosis/centromere, raynaud, esophageal dysmotility, sclerodactyly, telangiectasia
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skin involvement: diffuse vs crest
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diffuse has more
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common cause of death in diffuse scleroderma
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respiratory failure
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what is acanthosis
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thickening of stratum spinosum
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what is hyperkeratosis
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thickening of stratum corneum
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what is parakeratosis
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hyperkeratosis w/ retention of nuclei
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what is acantholysis
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seperation of epidermal cells
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sx of fibromyalgia
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muscle tenderness in 11/18 particular sites. Chronic generalized pain, fatigue, cognitive and mood disturbance, sleep problem, depression/ansiety
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what is contracture
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contraacted tissue of wound caused by increased MMP and fibroblast activity @ palm soles, thorax, burn site
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epidermal hyperplasia and hyperkeratosis with koilocytosis
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verrucae
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verrucae on genitals is called
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condyloma acuminatum
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does urticaria have epidermal involvement
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no
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what is ephelis
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freckle - increased melanin, no increase in melanocytes
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what skin dzz are pruritic
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urticaria, atopic dermatitis, dermatitis herpetiformis, lichen planus
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where is atopic dermatitis often located
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skin flexures
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what type of hypersensitivity is seen in atopic dermatitis
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hs1
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does atopic dermatitis have epidermal involvement
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yes
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where is psoriasis most oftenseen
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knees and elbows
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acanthosis, parakeratosis, scaling, decreased stratum granulosum w/ nail pitting
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psoriasis
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what is auspitz sign
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bleeding points when scales are scraped off of psoriasis
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flat, greasy, pigmented epithelial proliferation w/ keratin filled cysts
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seborrheic keratosis
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what is leser trelat
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sudden appearance of multiple seborrheic keratoses indicating underlying visceral malignancy
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4 pathogenic mechanisms of acne vulgaris
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1. hyperkeratosis 2. increased sebum 3. proprionobacteria 4. inflammation
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pathogenesis of albinism
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normal melanocyte count with decreased melanin production. OR NC migration fail
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pathogenesis of vitiligo
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decrease in melanocytes (only one that has decreased melanocytes)
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what is melasma/chloasma
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hyperpigmentation associated with pregnancy or OCP
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honey colored crust on nasolabial fold that spreads among siblings
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impetigo. IMPETIGO IS HIGHLY CONTAGIOUS
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mechanism of cellulitis
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saureus and spyogenes secrete hyalunoridase, which breaks down GAGs and helps spread
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cause of crepitis in necrotizing fasciitis
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methane and CO2 production from bacteria
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what layer of skin is destroyed in scalded skin syndrome
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stratum granulosum ONLY
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reticular immunofluorescence with acantholysis
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pemphigus vulgaris
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autoimmune destruction of epidermis with linear immunofluorescence
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bullous pemphigoid
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what skin dzz has eosinophils within blisters
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bullous pemphigoid
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distribution of lesions - pemphigus vulgaris vs bullous pemphigoid
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pemphigus can affect skin and oral mucosa. Pemphigoid only affects skin and spares oral mucosa
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IgA at tips of dermal papillae
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dermatitis herpetiformis
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what can cause erythema multiforme
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infections (eg mycoplasma, hsv), drugs, autoimmune, cancer
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what characteristic type of lesion is seen with erythema multiforme
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targetoid lesion
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fever, bullae, sloughing of skin. High mortality
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SJS/TEN
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distribution of erythema multiforme vs SJS
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erythema multiforme does not affect oral mucosa. SJS and TEN affect larger than 10% of body surface area
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4 P's of lichen planus
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pruritic, papule, purple, polygonal
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sawtooth infiltrate of lymphocytes at dermal-epidermal junction
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lichen planus
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what dz is lichen planus assoc w
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hcv
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what does solar keratosis predispose to
|
solar keratosis = actinic keratosis. Scc of skin
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what skin layer proliferates in acanthosis nigricans
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stratum spinosum
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what is acanthosis nigricans assoc w
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hyperinsulin state, or visceral malignancy (esp gastric adenocarcinoma)
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causes of erythema nodosum
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1. coccidioidomycosis 2. histo 3. TB, leprosy 4. strep (eg. RF) 5. sarcoidosis
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what drug is assoc w acanthosis nigricans
|
niacin
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herald patch folled by christmass tree
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pityriasis rosea
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course of strawberry hemangioma
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first few weeks of life -> grows rapidly -> regresses spontaneously at 5-8yo
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course of cherry hemangioma
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appears in 30-40; does not regres
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pathogenesis of seborrheic dermatitis
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m furfur hydrolyzes sebum, eat part of it, and the other part of it irritates the scalp, which produces inflammation and scaling
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white yellow scales on scalp
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seborrheic dermatitis
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appearance of black widow spider
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hourglass on belly
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toxin of black widow spider causes
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spasm of upper thigh and abdomen
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bit of black widow spider vs brown recluse
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black widow = painful. Brown recluse = painless
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toxin of brown recluse causes
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necrosis of skin
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appearnce of brown recluse spider
|
violin
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risk factors for scc of skin
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sunlight, arsenic, chronic draining sinus tract
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what is keratocanthoma
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benign scc that grows quickly then regresses spontaneously
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location of squamous cell carcinoma vs bcc
|
goljan: scc is lower lip and below. Bcc is upper lip and above
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pearly papules w/ telangiectasia, rolled edges w/ central ulceration.
|
bcc
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what type of skin cancer has palisading nuclei
|
bcc
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risk factors for melanoma
|
ABCD = assymetry, borders (irregular), color (multicolored), diameter/depth
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what does prognosis of melanoma depend on
|
depth of tumor
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marker for melanoma
|
s100
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most common type of melanoma
|
superficial spreading
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what melanoma is least likely to metastize
|
lentigo maligna - on fact, elderly, fawn colored
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what is the most malignant type of melanoma
|
acrosentigous - blacks, 1* dz often under nails, palms, feet
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what leukotriene is important for neutrophil chemotaxis
|
LTB4
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|
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function of other leukotrienes
|
bronchoconstriction, vasoconstriction, smooth muscle contraction, increased vascular permeability
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|
|
what drug inhibits leukotriene receptor
|
zifirlukast, montelukast (kast inhibits last step of LT pathway)
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|
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what drug inhibits lipoxygenase
|
zileuton
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|
|
review arachadonic acid pathway
|
p391
|
|
|
low dose vs intermediate dose vs high dose of aspirin
|
1. low dose = <300. high dose = >2400 2. low dose = antiplatelet; intermedite dose = antipyretic, analgesic; high dose = anti-inflammatory
|
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|
what NSAID has the least side effects
|
naproxen
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|
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COX1vsCOX2
|
COX2 is responsible for the inflammatory effects. COX1 is more housekeeping
|
|
|
toxicity of COX2
|
1. sulfa 2. thrombosis
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main location of action of acetaminophen
|
CNS (peripheral inactivation)
|
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|
what MSK drug can cause corrosive esophagitis
|
bisphosphonate
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what MSK drug can cause osteonecrosis of jaw
|
bisphosphonate
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what MSK drug impairs leukocyte chemotaxis and degranulation
|
colchicine
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what MSK drug is contraindicated in gout
|
salicylates, because they depress uric acid clearance at low dose
|
|
|
mechanism of etanercept
|
TNF decoy
|
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mechanism of infleximab
|
anti-tnf antibody
|
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|
complication of anti-TNF
|
can reactivate TB
|
|
|
what MSK dz can hydroxychloroquine tx
|
seronegative RA and SLE
|
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toxicity of hydroxychloroquine
|
permanent retinal dmg
|
|
|
distinct characteristic of rubella vs measles
|
1. 3 day fever 2. painful postauricular lymphadenopathy
|
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polyarthritis in adults around sick children
|
parvovirus
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|
maculopapular rash begins after fever in children
|
measles, rubella, roseola
|
|
|
high fever that can produce seizures in children most often caused by
|
roseola
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|
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radicular pain and pruritis before rash in adults
|
herpes zoster
|
|
|
septic shock after using contaminated tampon
|
s aurues - toxic shock syndrome
|
|
|
cellulitis w/ raised borders and orange peel appearance
|
erysipelas caused by spyogenesi
|
|
|
hypopigmentation, autoamputation, peripheral neuropathy
|
tuberculoid leprosy
|
|
|
blackhead vs whitehead
|
black = open comedones
|
|
|
tx for tinea capitis
|
must use oral terbinafine
|
|
|
mcc of tinea capitis in blacks vs whites
|
blacks = trichophyton. Whites = microsporum
|
|
|
what can cause cutenous larva migrans
|
ancylostoma
|
|
|
what is dysplastic nevus syndrome
|
AD dz with >100 nevi on skin that develop into malignant melanomas
|
|
|
flesh colored lesion with stalk usually in elderly
|
acrochordon/fibroepithelial tag
|
|
|
pilar cyst
|
epidermis of hair sheath forms cyst on scalp and face
|
|
|
AD itchy dry scaly skin with increased stratum corneum
|
ichthyosis vulgaris
|
|
|
mcc of dry skin in elderly due to decreased skin lipids
|
xerosis
|
|
|
white reticular pattern on surface of purple papula
|
wickham's stria ssoc w/ lichen planus
|
|
|
is there an gender diference in psoriais
|
no
|
|
|
small collections of neutrophils in stratum corneum associated with inflammatory dz
|
psoriasis (munro abscess)
|
|
|
is erythema nodosum painful
|
yes
|
|
|
erythematous papule that becomes plaque on dorsum of hand and feet in diabetic pt
|
granuloma annulare
|
|
|
what is acne rosacea cuased by
|
mit (demodex) -> inflammation of pilosebaceous unit
|
|
|
what skin dz can cause rhinophyma
|
acne roseasia
|
|
|
what is pyoderma gangrenosum assoc w
|
IBD, myeloproliferative, RA, seronegative sondyloarthropathy
|
|
|
what is aseptic necrosis of bone caused by
|
disruption of microcirculation
|
|
|
what is legg calve parthus syndrome
|
aseptic necrosis of femoral head ossification center
|
|
|
trauma that leads to ischemia that leads to inflammation of osteochondritis LIMITED to articular epiphysis. where it usually occur?
|
osteochondritis dissencs. distal femur
|
|
|
what is osgood schlatter syndrome
|
painful tibial swelling in boys that leads to knobby knees
|
|
|
arthralgia vs arthritis
|
joint pain vs joint pain + inflammatin (swelling, warmth, tenderness)
|
|
|
what dzz can have morning stiffness
|
RA, SLE, polymyalgia rheumatica
|
|
|
what organisms can cause infection of muscle (skeletal)
|
trichinella, sgroup a strep
|
|
|
what can cause fibrosarcoma? Where does it occur
|
irradiation. Thigh, upper limb
|
|
|
prolif of dermal spindle cells that leads to red nodule w/ dimple when squeezed in LE
|
dermatofibroma
|
|
|
stiff spine, uveitis, aortic regurg
|
ankylosing spondylitis
|
|
|
is acrosentigous melanona assoc w smoking
|
no
|
|
|
pancoast tumor can compress what part of brachial plexus
|
lower trunk
|
|
|
where can ant interosseous n get compressed
|
deep forearm
|
|
|
autoantibodies to ribonucleoprotein antigens
|
sjogren
|
|
|
what autoimmune dz can increase risk of toothaches
|
sjogrens increases risk of dental caries
|
|
|
increased risk of what malig w sjogrens
|
b cell lymphoma
|
|
|
what other autoimmune dz is sjogren assoc w
|
RA
|
|
|
what nerve serves the lumbricals on the hand
|
median (lateral) and ulnar (medial)
|
|
|
reflex contraction of the psoas muscle could cause what injury
|
avulsion of lesser trochanter of the femur
|
|
|
what is the difference b/w distal and proximal median nerve lesions that produce claw hand
|
distal produced "median claw" - loss of lateral lumbricals leads to clawing of 2&3rd digits.
prox produces "benediction sign", similar to ulnar claw, where loss of flexion of d2-3 results in those being extended |
|
|
lesion of median nerve at or above elbow can result in what motor deficit
|
weakness in pronation and ulnar deviation of wrist upon wrist flexion
|
|
|
what is ape hand? what lesion could cause this finding?
|
thenar atrophy + loss of opposition.
any median n lesion can produce it |
|
|
where does lesion have to occur for median claw
|
after branch containing c5-7 that feeds forearm flexors
|
|
|
what branch does median nerve give off before entering the carpal tunnel
|
palmar branch which gives sensation to BASE OF palm and ball of thumb
|
|
|
deposits of what are increased in osteomalacia
|
osteoid
|
|
|
what layer of skin is thickened with callus
|
stratum corneum
|
|
|
describe role of camp in smooth muscle, cardiac muscle
|
camp relaxes smooth muscle, contracts cardiac
|
|
|
how does camp and cgmp work in smooth muscle
|
camp inhibits mlck.
cgmp activates myosin light chain phosphatase |
|
|
skin deposits seen in SLE
|
complement and IgG along dermal-epidermal border
|
|
|
where do osteoblasts in bone repair come from
|
periosteum
|
|
|
what molecule do bisphosphonates resemble
|
pyrophosphate
|
|
|
what is suspected etiology of pagets dz
|
paramyxovirus invasion of osteoclast
|
