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350 Cards in this Set
- Front
- Back
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Thickened, dense bone - prone to fracture
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Osteopetrosis (Marble bone disease)
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Genetic deficiency of carbonic anhydrase II - normal ALP, serum calcium, phosphate
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Osteopetrosis (Marble bone disease)
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Erlenmeyer flask on x-ray
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Osteopetrosis (Marble bone disease)
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Can cause cranial nerve impingement, palsies, anemia, thrombocytopenia, and infection
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Osteopetrosis (Marble bone disease)
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Constitutive activation of fibroblast growth factor receptor (FGFR3)
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Achondroplasia (85% sporatic cases) can be Autosomal Dominant
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Increased risk with advanced paternal age
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Achondroplasia - membranous ossification is not affected - normal head size
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Osteoporosis type I
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Postmenopausal - b/c of decreased estrogen - increased bone resorption
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Risks in someone with Osteoporosis
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Vertebral crush fractures, acute back pain, loss of height, kyphosis, femoral neck fracture
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Contraindicated in someone with Osteoporosis
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Glucocorticoids
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Osteoporosis type II
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Senile osteoporosis - in individuals over 70 years old
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Caused by hyperparathyroidism - cystic spaces lined by osteoclasts
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Osteitis fibrosa cystica
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"brown tumors"
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Osteitis fibrosa cystica - from primary or secondary hyperparathyroidism - will have high serum Calcium, low serum phosphorus (PTH causes loss of P), and increased ALP
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Vitamin D deficiency in adults
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Osteomalacia - "soft bones" - decreased calcium levels - increased secretion of PTH - decrease serum Phosphate - REVERSIBLE (give vit D)
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Vitamin D deficiency in children
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Ricketts - skeletal deformities
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Osteomalacia secondary to renal disease
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renal osteodystrophy
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Increase in osteoblast and osteoclast activity causing abnormal bone architecture (NORMAL serum Ca, P, and PTH, but increased ALP)
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Paget's disease (osteitis deformans) (possible viral origin - Paromyxovirus)
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Increase in hat size and hearing loss
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Paget's disease (osteitis deformans)
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Complications of Paget's disease (osteitis deformans)
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1. Hearing loss (auditory foramen narrowing)
2. High output heart failure (multiple functional arteriovenous shunts within highly vascular early lesions 3. Osteosarcoma |
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replacement of bone with fibroblasts, collagen, and irregular bony trabeculae
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Polyostotic fibrous dysplasia
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McCune-Albright syndrome
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form of polyostotic fibrous dysplasia
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multiple unilateral bone lesions, endocrine abnormalities (precocious puberty), and unilateral pigmented skin lesions (cafe-au-lait spots/"coast of Maine" spots)
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McCune-Albright syndrome
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Malignant bone tumors
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Chondrosarcoma, Osteosarcoma, and Ewing's sarcoma (COE)
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2 most common primary bone tumors
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1. Multiple myeloma
2. Ostogenic sarcoma (osteosarcoma) |
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Codman's triangle or sunburst pattern on x-ray
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Osteosarcoma (from elevation of periosteum)
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10-20 year old male, swelling around distal femur
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Osteosarcoma
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Increased risk of developing Osteosarcoma
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Paget's disease, bone infarcts, radiation, familial retinoblastoma
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"small blue cell" malignant bone tumor
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Ewing's sarcoma (most commonly in boys <15 years old)
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Onion-skin appearance in bone
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Ewing's sarcoma (going out for eWINGS and ONION rings)
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11;22 translocation
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Ewing's sarcoma (usually in long bones, pelvis, scapula, and ribs)
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Expansile glistening mass within the medullary cavity
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Chondrosarcoma (can be from osteochondroma - benign bone tumor)
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Aggressive bone cancer with early mets that responds to chemotherapy
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Ewing's sarcoma
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Malignant bone tumor - most commonly in men age 30-60
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Chondrosarcoma (malignant cartilaginous tumor)
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most common benign bone tumor
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Osteochondroma (exostosis) (usually in men <25 years old) - malignant transformation to chondrosarcoma (malignant) is RARE
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Bone tumor associated with Gardner's syndrome (FAP)
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Osteoma (benign) (new piece of bone grows on another piece of bone - usually in the skull)
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interlacing trabeculae of woven bone surrounded by osteoblasts - small (<2 cm) and found in proximal tibia and femur
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Osteoid osteoma (benign bone tumor)
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same morphologically as osteoid osteoma - but larger and found in the vertebral column
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Osteoblastoma (benign bone tumor)
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double bubble or soap bubble appearance on x-ray - near knee
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Giant cell tumor (benign aggressive bone tumor) - Spindle shaped cells with multinucleated giant cells
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benign cartilaginous neoplasm found in intramedullary bone
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Enchondroma (benign bone tumor)
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Bone tumors that are commonly found in the epiphysis
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Giant cell tumor (osteoclastoma) - benign
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Bone tumors that are commonly found in the metaphysis
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Osteochondroma (benign), Osteosarcoma (malignant)
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Bone tumor most commonly found in diaphysis
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Osteoid osteoma (benign), Ewing's sarcoma (malignant)
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Bone tumor most commonly found in intramedullary
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Endhondroma (benign), chondrosarcoma (malignant)
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Bone tumor locations:
D I M E |
D - Osteoid osteoma, Ewing's sarcoma
I - Enchondroma, Chondrosarcoma M - Osteochondroma, Osteosarcoma E - Giant cell tumor |
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"wear and tear arthritis"
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Osteoarthritis - leads to destruction of articular cartilage
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PIP and DIP nodes
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Osteoarthritis - never see DIP involvement in Rhematoid arthritis
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Pain worse at the end of the day
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Osteoarthritis - for Rheumatoid see stiffness worse in the morning
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Things you see with Osteoarthritis
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subchondral cysts, sclerosis, osteophytes (bone spurs), eburnationa (polished, ivory like appearance of bone), JOINT SPACE NARROWING (on x-ray), cartilage loss begins at medial aspect of knees - can cause bowlegged
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Arthritis that is noninflammatory and has no systemic symptoms
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Osteoarthritis - risk factors include (age, obesity, joint deformity)
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inflammatory disorder affecting synovial joints, with pannus formation in joints (MCP, PIP)
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Rheumatoid arthritis (can have rheumatoid nodules, ulnar deviation, sublaxation, baker's cysts (behind the knee)) NO DIP involvement!
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rheumatoid nodule
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fibrinoid necrosis surrounded by palisading histiocytes
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Boutonniere deformity and Swan neck deformity
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Rheumatoid arthritis
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If you have rheumatoid arthritis you have an increased risk of... (2 things)
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1. restrictive cardiomyopathy - with chronic inflammatory conditions have an increased risk of developing amyloid
2. quadriplegia - 80% of people have cervical spine involvement - sublaxation can cause spinal cord injury |
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Sjogren's syndrome is characterized by what 3 things?
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1. Dry eyes (xerophthalmia)
2. Dry mouth (xerostomia) 3. Arthritis |
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Parotid enlargment and dental caries
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other things associated with Sjogren's syndrome
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People with Sjogren's syndrome have an increased risk of what malignancy?
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B-cell lymphoma
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SS-A (Ro) and SS-B (La) autoantibodies present in what condition?
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Sjogren's (most commonly affects women age 40-60)
- they are ribonucleoprotien antigens |
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Sjogren's is associated with what type of arthritis?
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Rheumatoid
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Sicca syndrome
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dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis, NO arthritis!
Similar to Sjogren's |
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Strong association with HLA-DR4
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Rheumatoid arthritis and diabetes mellitus type 1
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Rheumatoid arthritis is what type of hypersensitivity reaction?
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Type III
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Rheumatoid arthritis antibodies
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80% have positive rheumatoid factor (anti-IgG antibody); anti-CCP antibody is less sensitive but more specific
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3 Seronegative spondyloarthropathies
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Arthritis without rheumatoid factor (no anti-IgG antibody)
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Strong association with HLA-B27
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PAIR
Seronegative spondyloarthropathies (Psoriasis, Ankylosing spondylitis, Reiter's syndrome) and Inflammatory bowel disease |
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Serum Ca2+, Phosphate, ALP, and PTH levels in Osteomalacia
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decreased Ca2+ and phosphate
increased PTH no change in ALP |
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Serum Ca2+, Phosphate, ALP, and PTH levels in Osteitis fibrosa cystica
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Decrease in Phosphate
Increase Ca2+, PTH, and ALP |
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Serum Ca2+, Phosphate, ALP, and PTH levels in Paget's disease
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Increase in ALP
No change in Ca2+, PTH and ALP |
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Layers of the Epidermis
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"Californian's Like Girls in String Bikinis" (CLGSB)
1. Stratum corneum (avascular) 2. Stratum lucidum 3. Stratum granulosum (water barrier) 4. Stratum spinosum (lots of desmosomes) 5. Stratum basalis (only layer with dividing cells) |
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Prevents diffusion across paracellular space
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Zona occludens (tight junction)
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Zona occludens is composed of what?
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claudins and occludins
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Surrounds perimeter just below zona occludens
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Zona adherens (intermediate junction)
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What connects to what in Zona adherens?
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Cadherins connect to actin (CADherins are Ca2+ - dependent ADhesion molecules)
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Desmosome
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Macula adherens
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What connects to what in Macula adherens?
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cadherins connect to intermediate filaments - has desmoplakin and keratin
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What is the function of a gap junction?
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Allows adjacent cells to communicate for electric and metabolic functions.
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Connects cells to underlying extracellular matrix
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Hemidesmosome
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Maintains integrity of basement membrnae
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Integrin
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Integrin binds what?
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laminin in basement membrane
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What is included in the unhappy triad?
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Anterior cruciate ligament tear
Medial cruciate ligament tear Medial meniscus tear (ACL, MCL, Medial meniscus) |
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Where is the person hit who gets an unhappy triad?
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Lateral aspect of the knee
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In valgus the knees are pointing where?
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Towards the vagina (VAlGus towards the VAGina)
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"anterior" and "posterior" in ACL and PCL refer to what?
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Site of attachment on the tibia
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Positive anterior drawer sign
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tearing of the ACL
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Abnormal passive leg abduction
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Torn MCL
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Abduction
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Moving away from the body
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Adduction
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Moving towards the body
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What nerve block do you do to relieve pain of pregnancy?
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Pudendal nerve block
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What is the landmark of a pudendal nerve block?
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ischial spine
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Where is McBurney's point? What is it a sign of?
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2/3 of the way to the anterior superior iliac spine from the umbilicus. It is a sign of appendicitis
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What is the landmark used for a lumbar puncture?
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Iliac crest
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An anterior shoulder dislocation can injury what nerve?
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Axillary nerve - can see decreased sensation over deltoid
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What are the muscles of the rotator cuff?
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SItS - small t for teres minor
Supraspinatus Infraspinatus teres minor Subscapularis |
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What is the action of the supraspinatus?
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Helps the deltoid abduct the arm (bring it way from the body)
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What is the action of the infraspinatus?
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Laterally rotates the arm
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What is the function of the teres minor?
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Adducts and laterally rotates the arm
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What is the function of the subscapularis?
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Adducts and medially rotates the arm
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What is the difference between the teres minor and the subscapularis?
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Both adducts the arm - but teres minor also laterally rotates the arm while subscapularis also medially rotates the arm.
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Median nerve dermatome on the hand?
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On palm entire hand but not pinky and 1/2 of ring finger. On back side of the hand only pointer, middle, and 1/2 of ring finger
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Ulnar nerve dermatome on the hand?
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pinky and 1/2 of ring finger on front and back of the hand
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Radial nerve dermatome on the hand?
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On palmar side - tiny area near base of the thumb - on back side of the hand the thumb, and then area below pointer and middle finger.
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Trauma to the heel of the hand or a fracture of the hook of hamate can damage what nerve?
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Ulnar nerve
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What nerve is compressed in carpal tunnel syndrome?
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Median nerve
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A superficial laceration to the hand near the thumb can damage what nerve?
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Recurrent branch of median nerve
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What nerve can be compressed in the deep forearm?
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Anterior interosseus nerve
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Fracture of medial epicondyle of humerus or lesioned by repeated minor trauma
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Ulnar nerve
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What nerve can be compressed by supracondylar fracture of humerus?
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Median nerve
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What nerve can be compressed by pronator teres syndrome?
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Median nerve
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What nerve can be stretched during sublaxation of the radius?
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Radian nerve (deep branch) - nursemaid's arm
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What nerve can be affected by midshaft fracture of the humerus?
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Radial nerve in the spinal groove
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What nerve can be compressed by incorrect use of crutches?
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Radial nerve
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Damage to upper brachial plexus causes what?
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Waiter's tip (Erb's-Duchenne palsy) - can be caused by a blow to the shoulder or trauma from delivery
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Upper brachial plexus injury damages what nerve roots?
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C5 and C6
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Findings on Erb-Duchenne palsy?
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limb hangs by side (paralysis of abductors), medially rotated (paralysis of lateral rotators), forearm is pronated (loss of biceps)
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Total claw hand (Klumpke's palsy) is cause by what?
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Damage to lower brachial plexus (nerve roots C8 and T1)
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What nerve roots contribute to the brachial plexus?
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C5, C6, C7, C8, T1
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Lesion to the radial nerve causes what?
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Wrist drop (Saturday night's palsy)
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Winging of the scapula is caused by what?
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Damage to the long thoracic nerve (comes off of T1 nerve root)
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Deltoid paralysis can be caused by damage to what nerve?
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Axillary
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Damage to the musculocutaneous nerve can cause what problems?
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difficulty flexing elbow, variable sensory loss
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Damage to what nerve causes decreased thumb function?
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Median nerve - causes ape hand
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What nerve is injured in Pope's blessing?
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Ulnar nerve - problems with intrinsic muscles of the hand
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What protects the brachial plexus from injury when the clavicle is fractured?
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Subclavius muscle
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What are the different parts of the brachial plexus in order?
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Randy Travis Drinks Cold Beer
Roots, Trunks, Divisions, Cords, Branches |
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What can cause mononeuropathy?
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CT DRIVe
Compression Trauma Diabetes Inflammation (e.g. VZV) Vasculitis |
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HLA- B27 codes for what?
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HLA MHC I
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Bamboo spine on x-ray is seen in what disease?
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Ankylosing spondylitis (strong association with HLA-B27)
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Pencil in a cup on x-ray is seen in what disease?
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Psoriatic arthritis (strong association with HLA-B27)
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Arthritis affecting spine and sacroiliac joints
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Ankylosing spondylitis (stiff spine due to fusion of joints)
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Arthritis, uveitis (swelling of the uvea that supplies most of the blood to the retina), and aortic regurgitation associated with
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Ankylosing spondylitis
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Conjunctivitis (or anterior uveitis), Urethritis, and Arthritis is associated with what condition?
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Reiter's syndrome (reactive arthritis)
Can't see, can't pee, and can't climb a tree! |
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Arthritis commonly seen after GI or Chlamydia infection
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Reactive arthritis (Reiter's syndrome)
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Joint pain, asymmetric and patchy involvement with sausage fingers.
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Psoriatic arthritis (fewer than 1/3 of patients with psoriasis develop this kind of arthritis)
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Arthritis without rheumatoid factor (no anti-IgG antibody)
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Seronegative spondyloarthropathies (ankylosing spondylitis, Reiter's syndrome (reactive arthritis), and psoriatic arthritis)
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What is the arthritis associated with inflammatory bowel disease? Which inflammatory bowel disease?
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Ankylosing spondylitis - Crohn's
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Symmetric arthritis
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Rheumatoid arthritis
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Rheumatoid arthritis, neutropenia and splenomegley
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Felty's syndrome
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Asymmetric joint distribution of red swollen and painful joints. Most commonly goes to big toe (podagra)
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Gout
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When do acute gout attacks commonly occur?
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After a large meal or after alcohol consumption (alcohol metabolites compete for same excretion sites in kidney as uric acid, causing decrease uric acid secretion and build-up in blood)
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Two ways gout can occur...
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1. Overproduction of uric acid (10%)
2. Decreased excretion of uric acid (90%) |
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Crystals for gout
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needle shaped crystals and negatively birefringent - yellow crystals under parallel light, blue crystals under perpendicular light
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Secondary causes of gout
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1. Lesch-Hyhan syndrome
2. PRPP excess 3. decreased excretion of uric acid (thiazide diuretics) 4. increased cell turnover (leukemia, multiple myeloma, myeloproliferative diseases) 5. von Gierke's disease |
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Tophus formation is seen in what condition?
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Gout - often on external ear, olecranon bursa, or Achilles tendon - are urate cyrstals in a protein matrix surrounded by fibrous connective tissue, demonstrating a foreign body giant cell reaction.
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Treatment for Gout?
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Acute: NSAID's (indomethacin) or colchicine
Chronic: Allopurinol (decreases synthesis) or Probenicid (increases excretion) |
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What crystals are seen in pseudogout?
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Calcium pyrophosphate crystals: crystals are yellow when perpendicular to light and blue when parallel to light and weakly positive birefrigent
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Basophilic, rhomboid crystals that usually affect large joints (the knees)
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Pseudogout
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Classic age and sex of person with pseudogout
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over 50 years old, both sexes affected equally
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Sex most commonly affected by gout
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Men
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Common organisms causing septic Infectious arthritis?
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1. S. aureus
2. Streptococcus 3. Neisseria gonorrhoeae |
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Monoarticular, migratory arthritis with an asymmetrical pattern
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Gonococcal arthritis (STD)
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Areas where gonococcal arthritis can affect
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1. synovitis (knee)
2. tenosynovitis (hand) 3. dermatitis (pustules) |
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Common organisms causing chronic infective arthritis?
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1. TB (from mycobacterial dissemination)
2. Lyme's disease |
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Treatment for pseudogout?
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There is NO treatment!
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Things seen in SLE
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I'M DAMN SHARP
Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid) Malar rash (butterfly rash) Discoid rash Antinuclear antibody Mucositis (oropharyngeal ulcers) Neurologic symptoms Serositis (pleuritis, pericarditis) Hematologic disorders Arthritis Renal disorders Photosensitivity |
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Age group and sex affected by Lupus?
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90% are females and between the ages of 14 and 45
most common in BLACK females |
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Fever, fatigue, weight loss, nonbacterial verrucous endocarditis, hilar adenopathy, raynaud's phenomenon
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All symptoms of Lupus (systemic lupus erythematosus)
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Kidney disease seen in patients with lupus
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wire-loop lesions in kidneys with immune complex deposition (usually nephritic syndrome)
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2 things that cause death in patients with SLE
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1. Renal failure
2. Infections |
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If you have lupus and you test positive for syphilis should you be worried?
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NO - false positives on syphilus test (RPR/VDRL) due to antiphospholipid antibodies which cross react with cardiolipin used in tests
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Lab tests in patients with SLE (4 things)
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DA(n)SH
1. Antinuclear antibodies (ANA) - sensitive, but not specific for SLE 2. Antibodies to double stranded DNA (anti-dsDNA) - very specific, poor prognosis 3. Anti-Smith antibodies (anti-Sm) - very specific, but not prognostic 4. Antihistone antibodies - drug induced lupus |
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If you have drug induced lupus what antibodies would be positive?
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Antihistone antibodies
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Antinuclear antibodies are positive in what conditions?
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SLE, Sjogren's, Sicca, Scleroderma, polymyositis, dermatomyositis, herumatoid arthritis, juvenile arthritis, and mixed connective tissue disease
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Immune mediated, widespread non-caseating granulomas
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Sarcoidosis
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Elevated serum ACE levels are seen in what condition?
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Sarcoidosis
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Ethnic group and sex most commonly affected by sarcoidosis?
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Black females
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Treatment for sarcoidosis?
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Steroids
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Findings in sarcoidosis?
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GRAIN
Gammaglobulineamia Rheumatoid arthritis ACE increase Intersitital fibrosis Noncaseating granulomas |
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schaumann and asteroid bodies, uveoparotitis, and hypercalcemia
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sarcoidosis
schaumann and asteroid bodies found in epithelial granuloams, hypercalcemia due to elevated conversion of vitamin D to its active form in epitheloid macrophages |
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restrictive lung disesae, bilateral hilar adenoapthy, bell's palsy, erythema nodosum
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Sarcoidosis
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Bilateral hilar lymphadenopathy in a black female
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Sarcoidosis (immune mediated) also see noncaseating granulomas
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pain and stiffness in neck, shoulders and hips often with fever, malaise and weight loss
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polymyalgia rheumatica (occurs in patients older than 50)
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polymyalgia rheumatica is associated with what?
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temporal (giant cell) arteritis
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Lab findings in polymyalgia rheumatica
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Increased ESR, normal CK
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Do you see muscle weakness in polymyalgia rheumatica?
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NO!
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Drug of choice for treatment for polymyalgia rheumatica?
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Prednisone (same for giant cell arteritis)
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progressive, symmetric proximal muscle weakness caused by CD8+ T cells
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Polymyositis
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Body part that is most commonly affected by polymyositis?
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the shoulders
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How do you diagnose polymyositis?
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on muscle biopsy you see inflammation
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Rash + polymyositis
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Dermatomyositis - rash can be malar or heliotrope (mainly on upper eyelids) in nature
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"shawl and face rash", gottron's papules, "mechanic hands" will have positive antibodies for what?
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Positive ANA, and anti-Jo-1
disease is dermatomyositis |
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Lab findings in dermatomyositis
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Increased Ck and increased aldolase
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Treatment for dermatomyositis
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steroids
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What are you at an increased risk for if you have dermatomyositis?
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malignancy
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In the most common NMJ disorder - what is the problem?
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autoantibodies to postsynaptic Ach receptors - disease is myasthenia gravis
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ptosis, diplopia, and general weakness worse at the end of the day
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Myasthenia gravis (autoantibodies to post synaptic Ach receptors)
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Assocaited with thymoma
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Myasthenia gravis
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AchE inhibitors are used to treat what condition?
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Myasthenia gravis
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Autoantibodies to presynaptic Ca2+ channels do what and cause what disease?
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Lambert Eaton - inhibit Ach release from entering the neuromusclar junction - proximal muscle weakness
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In what neuromuscular junction disease spares the extraocular muscles?
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Lambert Eaton
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Paraneoplastic disease associated with small cell lung cancer?
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Lambert Eaton - autoantibodies against presynaptic Ca2+ channels prevents Ach release
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For the neuromuscular junction disease where muscles improve with use do AchE inhibitors reverse the symptoms?
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No - because the Ach has problems getting into the neuromuscular junction - the disease is lambert eaton syndrome
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Disease that has antibodies to U1RNP and responds to steroids
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Mixed connective tissue disease
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Things seen in those with mixed connective tissue disease
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Raynaud's FAME
Raynaud's syndrome Fatigue Arthralgias Myalgias Esophageal hypomotility |
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Antibodies seen in mixed connective tissue disease are against what?
|
antibodies are against a mix of macromolecules: ribo-nucleo-protein
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excessive fibrosis and collagen deposition throughout the body
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Scleroderma - progressive systemic sclerosis (2 types)
1. diffuse scleroderma 2. CREST syndrome |
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Sclerosis of skin, causing it to be puffy and taut, no wrinkles
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Scleroderma
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Sclerosis of what else is seen in individuals with scleroderma?
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renal, pulmonary, cardiovascular, and GI systems
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What disease is associated with anti-scl-70 antibody (anti-DNA topoisomerase I antibody)?
|
Diffuse scleroderma (one of the 2 types of scleroderma)
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Things affected in diffuse scleroderma
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widespread skin involvment, rapid progression, and early visceral involvment
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CREST syndrome is associated with what antibody. What is CREST syndrome?
|
anticentromere antibody
Calcinosis, anticentromere Raynaud's phenomenon Esophadeal dysmotility Sclerodactyly Telangiectasia |
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limited skin involvement, often combined to fingers and face
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CREST syndrome
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4 soft tissue tumors
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1. Lipoma
2. Liposarcoma 3. Rhabdomyoma 4. Rhabdomyosarcoma |
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soft, well-encapsulated fat tumor, benign
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lipoma
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treatment for lipoma
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simple excision is usually curative
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malignant fat tumor that can be large
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liposarcoma
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treatment for liposarcoma
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Will recur unless adequately excised
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benign tumor derived from striated muscle (skeletal or cardiac)
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rhabdomyoma
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Rhabdomyoma of what organ occurs in tuberous sclerosis?
|
the heart
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most common soft tissue tumor of childhood
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rhabdomyosarcoma (malignant)
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soft tissue tumor that arises from skeletal muscle and is most commonly seen in the neck/head
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rhabdomyosarcoma
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flat discoloration <1cm
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macule
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example of a macule
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tinea versicolor
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macule > 1cm
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patch
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elevated skin lesion < 1cm
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acne vulgaris
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papule > 1cm
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plaque
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acne vulgaris is an example of what type of lesion?
|
papule
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psoriasis is an example of what type of lesion?
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plaque
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What is an example of a vesicle?
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chickenpox
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small fluid-containing blister
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vesicle
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transient vesicle
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wheal
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what is an example of a wheal?
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hives
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large fluid-containing blister
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bulla
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what is an example of a bulla
|
bullous pemphigoid
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irregular, raised lesion resulting from scar tissue hypertrophy
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keloid (common in african amercians)
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T. pertenue (yaws) is an example of what?
|
keloid
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blister containing pus
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pustule
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an example of a pustule
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impetigo
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dried exudates from a vesicle, bulla or pustule
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crust
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increased thickness of stratum corneum
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hyperkeratosis
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An example of hyperkeratosis and parakeratosis
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Psoriasis
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hyperkeratosis with retention of nuclei in statum corenum
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parakeratosis
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separation of epidermal cells
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acantholysis
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an example of acantholysis
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pemphigus vulgaris
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epidermal hyperplasia (increased spinosum)
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acanthosis
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inflammation of the skin
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dermatitis
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warts, soft, tan colored, cauliflower-like lesions
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verrucae
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Parts of the body verrucae can be found
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verruca vulgaris on hands and condyloma acuminatum on genitals (from HPV infection)
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Epidermal hyperplasia, hyperkeratosis, koilocytosis
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Verrucae
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common mole, benign
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nevocellular nevus
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hives. intensely pruritic wheals that form after mast cell degranulation
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urticaria
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Freckle. Normal number of melanocytes, increased melanin pigment
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ephelis
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pruritic eruption, commonly on skin flexures
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atopic dermatitis (eczema)
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Eczema is also associated with what conditions?
|
atopic diseases (asthma, allergic rhinitis)
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type IV hypersensitivity reaction that follows exposure to alergin - lesions occur at site of contact
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allergic contact dermatitis
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papules and plaques with silvery scaling - especially on knees and elbows
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psoriasis
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increased statum spinosum, decreased stratum granulosum - has auspitz sign
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psoriasis
auspitz sign - bleeding spots when scales are scraped off |
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psoriasis is also associated with what 2 things?
|
nail pitting and psoriatic arthritis
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Flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts (horn cysts)
|
seborrheic keratosis
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"pasted on" lesion - on head, trunk, and extremeties
|
seborrheic keratosis
|
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common benign neoplasm of older individuals
|
seborrheic keratosis
|
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|
what is the sign of leser-trelat?
|
sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy (GI or lymphoid)
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normal melanocyte number with decreased melanin production is what disease and what is the problem?
|
albinism - you get decreased melanin production due to decreased activity of tyrosinase
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failure of neural crest cell migration during development can cause what?
|
albinism
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Irregular areas of complete dipigmentation - decreased mealnocytes
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vitiligo
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hyperpigmentation associated with pregnancy (mask of pregnancy)
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melasma - can also see with OCP use
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|
honey-colored crusting is caused by what bugs?
|
S. aureus or S. pyogenes - impetigo
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is impetigo infectious?
|
YES, very - very superficial skin infection
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cellulitis is usually caused by what organisms?
|
S. pyogenes or S. aureus
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acute, painful spreading infection of dermis and subcutaneous tissues
|
cellulitis
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deeper tissue injury, usually from anaerobic bacteria and S. pyogenes
|
necrotizing fasciitis
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"flesh eating bacteria" PE sign
|
crepitus - from methane and CO2 production - necrotizing fasciitis
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|
exotoxin destroys keratinocyte attachments in stratum granulosum only
|
Etaphylococcal scalded skin syndrome (SSSS)
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Fever, generalized erythematous rash with sloughing of the upper layers of the epidermis - what is it called and what age group is it seen in
|
Staphylococcal scalded skin syndrome - seen in newborns and children
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white, painless plaques on the tongue that cannot be scraped off
|
hairy leukoplakia
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|
Hairy leukoplakia is often seen in individuals that are infected with what?
|
HIV positive patients
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Hairy leukoplakia is mediated by what virus?
|
EBV - it is commonly seen in those that are HIV positive
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Skin disorder with IgG antibody against desmosomes (anti-epithelial cell antibody)
|
pemphigus vulgaris
|
|
|
Immunofluorescence seen with pemphigus vulgaris
|
antibodies around cells of epidermis in reticular or netlike pattern
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|
acantholysis - intraepidermal bullae involving the skin and oral mucosa
|
pemphigus vulgaris
|
|
|
What is a positive Nikolsky's sign and what disease is it seen in?
|
it is separation of epidermis upon manual stroking of the skin - seen in pemphigus vulgaris
|
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oral ulcers and flaccid bullae
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pemphigus vulgaris
|
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autoimmune disorder with IgG antibody against hemidesmosomes (epidermal basement membrane; antibodies are "bullow" the epidermis)
|
bullous pemphigoid
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immunofluorscence seen in bullous pemphigoid
|
linear immunofluorescence
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|
what are within the blisters seen in bullous pemphigoid?
|
eosinophils
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what is more severe pemphigus vulgaris or bullous pemphigoid?
|
pemphigus vulgaris
|
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tense bullae - sparing oral mucosa
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bullous pemphigoid
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Negative Nikolsky's sign
|
seen in bullous pemphigoid - don't see separation of epidermis upon manual stroking of skin
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pruritic papules and vesicles - deposits of IgA at the tips of dermal papillae
|
Dermatitis herpatiformis
|
|
|
dermatitis herpetiformis is associated with what condition?
|
Celiac's disease
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Disease associated with mycoplasma pneumoniae, HSV, drugs (sulfa drugs, B-lactams, phenytoin), cancers, and autoimmune disease
|
erythema multiforme
|
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|
disease that presents with a lot of different lesions - macules, papules, vesicles, and target lesions
|
erythema multiforme
|
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|
fever, bulla formation and necrosis, sloughing of skin and high mortality rate
|
stevens-johnsons syndrome - usually associated with adverse drug reaction
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|
What is a more severe form of stevens-johnsons syndrome?
|
toxic epidermal necrolysis
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|
pruritic, purple, polygonal papules
|
lichen planus
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|
lichen planus is associated with what infection?
|
Hepatitis C
|
|
|
sawtooth infiltrate of lymphocytes at dermal-epidermal junction
|
lichen planus
|
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|
premalignant lesions caused by sun exposure
|
actinic keratosis
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|
"cutaneous horn", small, rough, erythematous or brownish papules
|
actinic keratosis
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|
|
In actinic keratosis the risk of carcinoma is proportional to what?
|
epithelial dysplasia
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|
skin condition associated with hyperinsulinemia (from Cushing's disease or diabetes)
|
acanthosis nigricans
|
|
|
In acanthosis nigricans you get hyperplasia of what skin layer?
|
statum spinosum
|
|
|
Erythema nodosum is associated with what infections? (6)
|
TLC SSH
TB Leprosy Coccidioidomycosis Streptococcal infections Sarcoidosis Histoplasmosis |
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|
Inflammatory lesions of subcutaneous fat, usually on anterior shins
|
erythema nodosum
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|
herald patch followed days later by christmas tree distribution
|
pityriasis rosea
|
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|
multiple papular eruptions; remits spontaneously
|
pityriasis rosea
|
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|
lesion that appears the first few weeks of life; grows rapidly and regresses spontaneously at 5-8 years of age
|
strawberry hemangioma
|
|
|
red lesion that appears in 30s - 40s; does not regress
|
cherry hemangioma
|
|
|
actinic keratosis is a percursor to what kind of cancer?
|
squamous cell carcinoma
|
|
|
squamous cell carcinoma is associated with what two things?
|
sun exposure and arsenic exposure
|
|
|
skin cancer that commonly appears on hands and face it is locally invasive but rarely metastasizes
|
squamous cell carcinoma
|
|
|
keratin pearls on histopathology - ulcerative red lesion grossly
|
squamous cell carcinoma
|
|
|
variant of squamous cell carcinoma that grow rapidly (4-6 weeks) and regresses spontaneously
|
keratoacanthoma
|
|
|
squamous cell carcinoma is associated with what?
|
chronic draining sinuses
|
|
|
tumor that has palisading nuclei
|
basal cell tumors
|
|
|
locally invasive skin cancer that rarely metastasizes
|
squamous cell carcinoma and basal cell carcnioma
|
|
|
skin cancer that you see rolled edges with central ulceration
|
basal cell carcinoma
|
|
|
Gross pathology of a skin cancer: pearly papules, commonly with telangictasias
|
basal cell carcinoma
|
|
|
common skin tumor with significant risk of metastasis
|
melanoma
|
|
|
dysplastic nevus is a precursor to what?
|
melanoma
|
|
|
What cancer has S-100 as a tumor marker?
|
melanoma
|
|
|
cancer that fair skinned person's are at greater risk
|
melanoma
|
|
|
For melanoma what correlates with risk of metastasis?
|
Depth of tumor
|
|
|
Skin cancer that has dark irregular boarders
|
melanoma
|
|
|
If damage to the axillary nerve occurs - what would be the motor deficit that you would have?
|
You would not be able to abduct your arm at the shoulder
|
|
|
If you could not extend your wrist, or fingers at the MCP joint, supinate or do extension and abduction at the thumb what never is damaged?
|
Radial nerve (C5-C8)
|
|
|
A proximal lesion in the Median nerve would cause a motor deficit in which areas?
|
opposition of the thumb
|
|
|
A distal lesion in the Median nerve would cause a motor deficit in which areas?
|
lateral finger flexion and wrist flexion
|
|
|
Damaged to what nerve would create problems flexing the arm at the elbow
|
Musculocutaneous nerve (C5-C7)
|
|
|
FOOSH injury can damage what nerve?
|
Ulnar
|
|
|
FOOSH injury could cause what sensory defects?
|
loss of medial 1 1/2 fingers, and hypothenar eminence (damage to ulnar nerve)
|
|
|
radial nerve injury would cause what sensory deficits?
|
loss of sensation over posterior arm and dorsal hand and dorsal thumb
|
|
|
proximal median nerve lesion would cause what sensory defects?
|
dorsal and palmar aspects of lateral 3 1/2 fingers, and thenar eminence
|
|
|
distal median nerve lesion would cause what sensory defects?
|
dorsal and palmar aspects of lateral 3 1/2 fingers
|
|
|
with a proximal ulnar nerve lesion you would have what motor deficits?
|
medial finger flexion and wrist flexion
|
|
|
Inability to abduct and adduct the fingers (interossei), adduct the thumb, and extend the 4th and 5th finger lumbricles - what nerve is damaged?
|
Distal Ulnar lesion
|
|
|
Embyrologic or childbirth defect where a cervical rib can compress the subclavian artery what is it called and what is affected?
|
thoracic outlet syndrome - affects inferior trunk of the brachial plexus (C8, T1)
|
|
|
Disapearance of radial pulse upon moving the head towards the opposite side is seen in what condition?
|
thoracic outlet syndrome
|
|
|
What are the 4 things seen in thoracic outlet syndrome?
|
1. atrophy of the thenar and hypothenar eminences
2. atrophy of the interosseous muscles 3. sensory deficits on the medial side of the forearm and hand 4. disappearance of radial pulse upon moving head towards the opposite side |
|
|
lesion of lower trunk (C8, T1) of brachial plexus
|
clawing of all digitis - Klympke's total claw
|
|
|
Muscles the radial nerve innervates
|
BEST
Brachioradialis Extensors of the wrist and finger Supinator Triceps |
|
|
The "great extensor nerve"
|
radial nerve
|
|
|
Functions of the thenar muscles
|
OAF (oppose, abduct, flex)
Opponens pollicis Abductor pollicis Flexor pollicis brevis |
|
|
Functions of hypothenar msucles
|
OAF (oppose, abduct, flex)
Opponens digiti minimi Abductor digiti minimi Flexor digiti minimi |
|
|
Function of the Dorsal interosseous muscles
|
DAB
Dorsal interosseous muscle abducts |
|
|
Function of Palmar interosseous muscles
|
PAD
Palmar interosseous muscle adducts |
|
|
Which muscles flex at the MP joint?
|
Lumbricles
|
|
|
Tennis elbow
|
repetitive trauma to lateral epicondylitis
|
|
|
Golf elbow
|
repetitive trauma to medial epicondylitis
|
|
|
Function of Peroneal nerve
|
PED
Peroneal everts and dorsiflexes; if injured, foot dropPED (dorsiflex=extend foot) |
|
|
Function of tibial nerve
|
TIP
Inverts and plantarflexes; if injured can't stand on TIPtoes |
|
|
COX-2 inhibitor only
|
Celecoxib (spares gastric mucosa)
|
|
|
COX-1 and COX-2 reversible inhibitor with no anti-inflammatory affect
|
Acetaminophen (tylenol)
|
|
|
Antidote for acetaminophen overdose
|
N-acetylcysteine - restores glutathione
|
|
|
Difference between Aspirin and Acetaminophen
|
Aspirin - irreversibly inhibits COX-1 and COX-2 also has anti-platelet function
Acetaminophen - reversibly inhibits COX-1 and COX-2 does NOT have anti-inflammatory funciton |
|
|
Class of drugs with -ronate ending
|
bisphosphonates - inhibit osteoclast activity
|
|
|
Uses for bisphosphonates?
|
Paget's disease, malignancy related hypercalcemia, postmenopausal osteoporosis
|
|
|
Colchicine is used to treat what? How does it work?
|
Used to treat acute gout. Binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation
|
|
|
Drugs used to treat chronic gout.
|
Allopurinol (to decrease uric acid production - inhibits xanthine oxidase)
Probenecid - (to increase excretion of uric acid - inhibits reabsorption of uric acid in urine) |
|
|
3 TNF-alpha inhibitors
|
Etanercept
Infliximab Adalimumab |
|
|
Anti-TNF antibody - used to treat Crohn's disease, RA, and ankylosing spondylitis
|
Infliximab (careful - it predisposes to infections (reactivation of TB))
|
|
|
Entanercept
|
Recombinant form of TNF that binds to TNF and inhibits it from working - used for RA, psoriasis, ankylosing spondylitis
|
|
|
Antibody that directly binds TNF-alpha receptors and does not allow TNF-alpha to bind
|
Adalimumab - used for RA, psoriasis, ankylosing spondylitis
|
