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75 Cards in this Set
- Front
- Back
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CD8 mediated proximal muscle disease in young adults
Give histo |
Polymyositis
Pale fibers, inflammation, necrosis, and fibrosis |
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AB-mediated proximal muscle disease in any age, accompanied by skin and heliotrope rash
Give histo |
Dermatomyositis
Same histo as polymyositis, but MAC/AB-mediated vascular damage and CD4 infiltrates |
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CD8 mediated proximal AND distal muscle weakness in elderly patients w/a neurogenic component
Give histo |
Inclusion body myositis
Histo shows myositis, plus rimmed vacuoles (trichome stain). CD8 and amyloid/TAU infiltrates w/poor Px |
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Urinalysis of autoimmune myositis
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Increased CPK, EMG, myoglobunuria
Jo1 and RNP ABs |
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Slow twitch fibers (type I)
Energy Mitochondria Lipid content Glycogen content |
High
Lots of mitochondria High lipids Low glycogen |
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Fast twitch fibers (type II)
Energy Mitochondria Lipid content Glycogen content |
Low energy
Few mitochondria Low lipids High glycogen |
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If muscle disease is due to myopathy (muscle defect), which do the muscle fibers look like?
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Small, rounded, central nuclei
Decreased reflexes |
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If a muscle disease is due to neurogenic (LMNs), what do the muscle fibers look like?
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Small, angulated, usually distally affected
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Type II selective muscle fiber atrophy
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steroid use
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type I selective muscle fiber atrophy
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Myotonic dystrophy (AD-trinucleotide repeats; sustained grip, face weakness)
Congenital myopathy (floppy baby) |
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Post-synaptic ACh receptor ABs
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Myasthenia gravis
Thymoma Decreased response w/stimulation Tx: AChE-I |
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Pre-synaptic ACh defect; ABs to VG Ca++ channels
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Lambert eaton syndrome
Often assc. w/small cell lung cancer Increased response w/stimulation No reversal of Sx. w/AChE-I |
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Mitochondrial myopathy
Cause and Histo |
Caused by variable clinical expression due to heteroplasmy (mutated + normal mitochondrial DNA)
Ragged red fibers and rimmed vacuoles |
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Extraintestinal manifestation of IBD, neutrophilic dermatitis
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Pyoderma gangrenosum
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What organism causes necrotizing fasciitis
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S. aureus (begins as cellulitis --> anesthetic, firm tissues)
Need to debride |
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What organism causes gas gangrene?
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Clostridium perfringes
recent trauma --> brick red muscle --> can lead to shock |
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Intermediate junctions and desmosomes (intercellular connections) are made of what?
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Intermediate junctions: E-cadherin and actin
Desmosomes: keratin |
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What are hemidesmosomes made of (connect cell to underlying ECM, BM)
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Integrin proteins
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What protein does hemidesmosome connect to?
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fibronectin
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Unhappy triad
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Clipping from lateral side when knee is extended and rigid
MCL (medial collateral) M. meniscus ACL (anterior cruciate) |
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Positive ant. drawer sign
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Tearing of ACL
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Rotator cuff muscles
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SITS
suraspinatus (helps delatoid abduct arm) Infraspinatus (lateral arm rotation) Teres minor (adduct and lateral rotation) Subscapularis (medially rotates and adducts) |
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Ulnar claw
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Distal ulnar nerve lesion
4th and 5th fingers clawed |
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Median claw
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Distal median nerve lesion
2nd and 3rd fingers claw |
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Ape hand
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Proximal median nerve lesion
Loss of opposition of thumb |
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Klumpke's total hand claw
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Lower trunk lesion (C8/T1)
all digits clawed |
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Structures in popliteal fossa
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Posterior --> anterior
tibial n. popliteal v. popliteal a. (susceptible to femoral fracture) common peroneal n. (lateral wall, susceptible to fibular head trauma) |
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What injury can cause avascular necrosis of the head of the femur?
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Fracture of femoral neck
Medial femoral circumflex a. |
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Wrist drop
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Radial nerve damage at midshaft of humerus
Wrist drop Loss of flexion of arm and wrist |
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Dorsal interosseous vs. palmar interosseous
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Dorsal- abduct
Palmar - adduct |
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What can occur when there is trauma to lateral leg or fibular neck fracture?
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Common peroneal; FOOT DROP
PED (peroneal everts and dorsiflexes) |
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What can occur when there is knee trauma?
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TIP (tibial inverts and plantarflexes)
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Femoral and tibial nerves
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Femoral- the "kicking" motion
Tibial- opposite; thigh extension, knee flexion |
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Sciatic sheath contains these nerves:
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tibial and common peroneal
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Superior gluteal n. damage
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thigh abduction loss
(+) Trendelenburg = cannot stand on foot of affected side, b/c hips droop towards the unaffected side |
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Inferior gluteal n. damage
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loss of gluteus maximus innervation
Can't jump, climb stairs, or rise from seated position |
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Sensory of foot
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Superficial peroneal = dorsum and lateral foot
tibial = heel deep peroneal = bottom of foot |
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Effects of PTH
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Increase Ca++ reabsorption from kidney
Decrease phosphate resorption from the kidney Increase osteoblastic activity --> increased ALP and RANK-L |
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Monosodium urate crystals
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Needle-shaped
negative birefringence (yellow when parallel) Seen in tophaceous gout |
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Calcium pyrophosphate crystals
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Needle-shaped
positive birefringence (blue when parallel) Seen in acute pseudogout, chondrocalcinosis, arthropathy |
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What is rheumatoid factor?
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anti-IgG AB (usually an IgM to the Fc portion of IgG)
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Rheumatoid arthritis HLA?
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DR4
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Normal joint fluid analysis
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Clear, colorless, viscous, <200WBC
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Parotid enlargement, B-cell lymphoma, dental caries, dry eyes, mouth, and rheumatoid arthritis
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Sjogren's
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Sicca syndrome
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Just like Sjogren's but no RA- maybe chronic bronchitis and refleux esophagitis
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Phases of Lyme disease
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1. erythema migrans
2. carditis, BILATERAL Bells' palsy, disabling arthritis 3. fibromyalgia |
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What virus is thought to cause Pagets?
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Paramyoxvirus
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HLA assc. w/ankylosing spondylitis?
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B27
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Genetic and environmental factors of SLE
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STAT4 gene and IL-12/Th
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Why does SLE cause false (+) VDRL/RPR?
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It has anti-phospholipid ABs that cross-react w/cardiolipin
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Antibodies of SLE and what they mean
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1. ANA- sensitive
2. anti-dsDNA- specific, poor Px 3. anti-Sm- specific 4. Antihistone- indicate drug-induced lupus |
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Recurring painful ulcers, genital and oral. Hypopyon, popliteal and femral a. aneurysms
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Behcet's syndrome (idioathic vasculitis)
Neurobechet's is cerebral hemorrage |
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What cells cause sarcoidosis?
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CD4 cells interacting w/an unknown Ag
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What disease causes elevated ACE in black females
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sarcoidosis of the lungs
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Polymyalgia rheumatica is assc. w/what Dz?
How do you Dx? |
Giant cell (temporal) arteritis
Look for Increased ESR, normal CK |
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What differentiates mixed connective tissue diseases from ANA-positive diseases?
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They have ANA and RNP ABs
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Fibrosis and collagen deposits in skin, as well as renal, pulmonary, CV, and GI manifestations
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Sclerosis
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Diffuse scleroderma AB
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anti-Scl-70 AB (anti-DNA topoisomerase I AB)
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CREST syndrome AB
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anti-centromere AB
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Differentiating b/t lipoma and liposarcoma
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Lipoma (benign) = signet ring cells
Liposarcoma = malignant; lipoblasts |
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When looking at immunofluorescent micropscopy, what do DIF and IIF actually image?
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DIF = skin antigens
IIF = serum ABs Used for BLISTERING DISORDERS |
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Auspitz sign
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bleeding when psoriasis plaque is removed (thin epidermis over dermal papillae)
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IgG against desmosomes
DIF and IIF Histo Sx? |
Pemphigus vulgaris
DIF = chicken wire b/t keratinocytes IIF = anti-desmoglein ABs Histo: acantholysis (separation of epidermal cells) (+) Nikolsky's sign (skin sloughs very easily) |
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IgG against hemidesmosomes (basement membrane)
DIF and IIF Histo Sx? |
Bullous pemphigoid
DIF = linear at BM IIF = anti-BM ABs Histo: bullae (subepidermal) Less severe than pemphigus vulgaris, sparing mucosa and (-) Nikolsky's sign |
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Skin disorder assc. w/celiac disease
Presentation |
Dermatitis herpetiformis (IgA deposition at dermal papillae tips)
Bilateral and symmetrical |
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Location of hyperplasia in acanthosis nigricans?
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stratum spinosum
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Actinic keratosis malignancy
gross and histo appearance? |
squamous cell carcinoma
locally invasive, ulcerative red lesion and keratin pearls |
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Dysplastic nevus (atypical mole) malignancy
marker for this malignancy? |
melanoma
invasive and metastatic s100 marker |
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How do you measure risk of metastasis of melanomas?
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Depth
vertical growth; "Breslow's thickness" |
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Malignancy of skin w/rolled edges in sun-exposed areas that rarely metastasizes
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Basal cell carcinoma
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LTB4
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neutrophil chemotaxis
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LTC, D, E
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bronchoconstriction
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PGI
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Decreased platelets
vasodilate uterine relaxation |
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PGE
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vasodilate
Pain uterine contraction Raise temp |
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TXA
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platelet aggregation
vasoconstriction |
