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139 Cards in this Set
- Front
- Back
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List the layers of epidermis.
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From surface to base:
Stratum Corneum Stratum Lucidum Stratum Granulosum Stratum Spinosum Stratum Basalis. |
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Structure: Zona occludens
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Composed of claudins and occludins
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What is another name for "zona occludens"?
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Tight junctions.
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Function: Zona Occludens
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Prevents diffusion across paracellular space
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What is another name for "zona adherens"?
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Intermediate junction
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What is another name for "macula adherens"?
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Desmosome
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Structure: Macula adherens
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Small, discrete sites of attachment; cadherins connect to intermediate filaments (keratin and desmoplakin)
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Structure: Zona adherens
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Surrounds perimeter just below zona occludens; cadherins connect to actin
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Proteins: zona occludens
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Claudins and occludens
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Proteins: zona adherens
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Actin and cadherins
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Proteins: macula adherens
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Cadherins and intermediate filament proteins (keratin, desmoplakin)
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What is the external landmark used for pudendal nerve block?
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Ischial spine
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Function: Supraspinatus m.
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Abduction
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Function: Infraspinatus m.
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Lateral rotation
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Function: Teres minor m.
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Adduction
Lateral rotation |
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Function: Subscapularis
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Adduction
Medial rotation |
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Which nerve injured: dislocated lunate
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Median n.
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Which nerve injured: midshaft humeral fracture
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Radial n.
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Which nerve injured: hamate fracture
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Ulnar n.
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Manifestation: posterior cord lesion
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Wrist drop + deltoid paralysis
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Spinal level: ulnar n.
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C8, T1
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Spinal level: median n.
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C6-T1
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Spinal level: radial n.
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C5-C8
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Spinal level: axillary nerve
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C5, C6
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Spinal level: musculocutaneous n.
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C5-C7
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Motor: ulnar n.
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All intrinsic hand mm. except thenar mm. and first two lumbrical
Also, flexor carpi ulnaris |
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Motor: median n.
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All ant. compartment forearm mm. except flexor carpi ulnaris
Also, thenar mm. and first two lumbricals |
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Motor: radial n.
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All posterior compartment muscles of the arm and forearm
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Motor: axillary nerve
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Deltoid and teres minor mm.
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Motor: musculocutaneous n.
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All ant. compartment upper arm muscles
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Motor: suprascapular n.
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Supraspinatus and infraspinatus mm.
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Function: lumbricals
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MCP flexion, IP extension
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Innervation: lumbricals
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1,2 = median
3,4 = ulnar |
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Function: Interosseous mm.
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Dorsal: abduction
Palmar: adduction |
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Innervation: interosseous mm.
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Deep branch of ulnar n.
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Which nerves injured: Erb-Duchenne palsy
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Suprascapular
Axillary Musculocutaneous |
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What is "throacic outlet syndrome"?
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Cervical rib fracture compresses subclavian a. and lower trunk of brachial plexus ---> Klumpke's palsy + disappearance of the radial pulse with ipsilateral rotation of the head
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Presentation: Klumpke's palsy
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Total claw hand + thenar and hypothenar atrophy + anesthesia of medial forearm and hand
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Lesion: "ulnar claw"
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distal ulnar n.
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Presentation: "ulnar claw"
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3rd/4th lumbrical palsy ---> MCP hyperextension, IP flexion of the 4th and 5th digits upon attempted extension
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Lesion: "ulnar claw"
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proximal median n.
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Presentation: "median claw"
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1st/2nd lumbrical palsy ---> MCP hyperextension, IP flexion of the 1st, 2nd, and 3rd digits upon attempting to make a fist
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Lesion: "ape hand"
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Recurrent median n.
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Presentation: "ape hand"
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Loss of thumb abduction and opposition
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Motor: obturator n.
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Thigh abductors
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Motor: femoral n.
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Hip flexors
Knee extenders |
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Motor: common peroneal n.
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Foot dorsiflexion and eversion
Toe extension |
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Motor: tibial n.
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Foot planterflexion and inversion
Toe flexion |
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Motor: superior gluteal n.
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Hip abductors
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Motor: inferior gluteal n.
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Hip extenders
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Sensory: obturator n.
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Medial thigh
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Sensory: femoral n.
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Anterior thigh + medial leg
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Sensory: common peroneal n.
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Foot dorsum
Anterolateral leg |
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Sensory: tibial n.
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Sole of the foot
Posterior leg |
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Which is "type 1 osteoporosis"?
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Postmenopausal
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Which is "type 2 osteoporosis"?
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Senile osteoporosis
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Calcium studies: osteoporosis
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All normal
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Calcium studies: osteopetrosis
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All normal
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Enzyme deficiency: osteopetrosis
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Carbonic anhydrase II
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Diagnosis: Normal calcium studies with peripheral blood cytopenias and cranial nerve palsies
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Osteopetrosis
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Calcium studies: Paget's disease
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Elevated Alk Phos (otherwise normal)
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Diagnosis: small nidus of osteoid and woven bone surrounded by a rim of highly vascularized, fibrous stroma
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Osteoid osteoma or osteoblastoma
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Diagnosis: cystic bony spaces with osteoclasts, fibrous stroma, and hemosiderin
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Brown tumor = osteitis fibrosa cystica
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Osteoblastoma vs. osteoid osteoma
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Osteoid osteoma = <2 cm
Osteoblastoma = >2 cm |
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Which bony tumor: multinucleated giant cells
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Giant cell tumor
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Diagnosis: "soap bubbles" on bone x-ray
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Giant cell tumor
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MC benign bony tumor
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Osteochondroma
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Which bony tumor: mature bony outgrowth with a cartilage cap
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Osteochondroma
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MC location within a bone: Giant cell tumor
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Epiphysis
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MC location within a bone: Osteochondroma
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Metaphysis
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Generally speaking, who gets bone tumors?
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Young men under 30
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Which bony tumor: cartilaginous growth within the medullary canal
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Enchondroma
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2nd MC bony malignany
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Osteosarcoma
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MCC: bony malignancy
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Multiple myeloma
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MC location within a bone: osteosarcoma
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Metaphysis
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Risk factors: osteosarcoma
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Paget's disease
Bone infarcts Previous radiation Familial neuroblastoma |
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Which bony tumor: t(11;22)
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Ewing sarcoma
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What is the natural history of Ewing's sarcoma?
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Extremely aggressive with early mets
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Which bony tumor: "onion skinning"
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Ewing's sarcoma
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MC location within a bone: Ewing's sarcoma
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Diaphysis
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Which bony tumor is actually most common among men older than 30?
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Chondrosarcoma
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MCC of a joint effusion
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Osteoarthritis
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HLA association: rheumatoid arthritis
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HLA-DR4
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Causes of chronic gout
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Lesch-Nyhan
Myeloproliferative disease Thiazides von Gierke's disease |
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MCCs of septic arthritis
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Gonorrhea, Staph., and Strep.
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Who gets SLE?
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>90% of SLE patients are women between 14 and 45 years of age
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MCC of death in SLE
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Renal failure
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Conditions that can give you a positive ANA
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SLE
Scleroderma Sjogren's Poly/dermatomyositis Juvenille RA Mixed connective tissue disease |
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Which enzyme is presented at elevated levels in sarcoidosis?
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ACE
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What is the CD4:CD8 ratio in sarcoidosis?
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High (lots and lots of CD4 cells ---> granulomas)
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Labs: PMR
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Elevated ESR but normal CK (because there is no significant muscle breakdown)
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Diagnosis: prrogressive, symmetric proximal muscle weakness with a CD8+ infiltrate on muscle biopsy
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Polymyositis
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Diagnosis: proximal muscle weakness with a facial rash and purple patches over the MCP and IP joints
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Dermatomyositis
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Labs: poly/dermatomyositis
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Elevated CK
Elevated aldolase Positive ANA Positive anti-Jo 1 |
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Which muscle disease classically features "perifascicular inflammation"?
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Poly/dermatomyositis
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What are the S/Sx of mixed connective tissue disease?
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Raynaud's
Fever Arthralgias Myositis Esophageal dysmotility |
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What findings commonly accompany generalized muscle weakness in Lambert-Eaton?
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Autonomic symptoms:
Orthostatic hypotension Constipation Xerostomia Diminished pupillary response |
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Define: "hyperkeratosis"
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Increased stratum corneum thickness
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Define: "parakeratosis"
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Hyperkeratosis + retention of nuclei within stratum corneum cells
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Define: "acantholysis"
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Separation of epidermal cells
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Define: acanthosis
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Epidermal hyperplasia with increased stratum spinosum thickness
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Classic gross appearance: psoriasis
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Plaques and papules with "silvery" scaling, especially along knees and elbows
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Histologic appearance: psoriasis
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Acantholysis + parakeratosis
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What is "Auspitz sign"?
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Bleeding when a skin lesion is scraped
Suggestive of psoriasis |
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Classic gross appearance: seborrheic keratosis
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"Pasted on," flat, greasy, pigmented squamous proliferations with keratin-filled cysts
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What is the "Leser-Trelat" sign?
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Sudden apperance of dozens of seborrheic keratoses ---> suggestive of underlying malignancy (MC from GI tract)
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What is "vitiligo"?
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Irregular patches of complete depigmentation
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What causes vitiligo?
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Focal loss of melanocytes
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Diagnosis: skin infection with "honey-crusted lesions"
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Impetigo
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Define "cellulitis"
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Infeciton of dermis/sub-Q tissues
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MC pathogens: impetigo
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S. aureus or S. pyogenes
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MC pathogens: cellulitis
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S. aureus or S. pyogenes
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MC pathogens: necrotizing fasciitis
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S. pyogenes or anaerobes
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What are the histologic findings in staphylococcal scalded skin syndrome?
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Destruction of keratinocyte attachments within the stratum granulosum
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What is "Nikolsky's sign"?
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Separation of the epidermis from the dermis upon gentle manual stroking
Suggestive of pemphigus vulgaris |
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What is the presentation of pemphigus vulgaris?
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Acantholysis with blistering of the skin and oral mucosa
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How does the presentation of bullous pemphigoid differ from that of pemphigus vulgaris?
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Less severe and no oral involvement
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What is the autoimmune target in bullous pemphigoid?
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Auto-IgG against hemidesmosomes
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What is the autoimmune target in pemphigus vulgaris?
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Auto-IgG against desmosomes
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Diagnosis: IgA deposits within dermal papillae
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Dermatitis herpetiformis
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Erythema multiforme associations
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Infections: Mycoplasma, HSV
Drugs: sulfa/penicillins, phenytoin Cancers Autoimmune disease |
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Erythema nodosum associations
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Histoplasmosis
Coccidioidomycosis TB Leprosy Sarcoidosis Streptococcal infections |
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What is "lichen planus"?
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Pruritis, polygonal, purple papules with lymphocytic infiltrate
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What is associated with lichen planus?
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HCV
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Risk factors: squamous cell carcinoma
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Sun exposure and arsenic
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Classic appearance: squamous cell carcinoma
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Ulcerative, erythematous lesion with draining sinuses
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MCC of skin cancer
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Basal cell carcinoma
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Classic appearance: basal cell carcinoma
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Ulceration with "rolled edges" and "pearly papules," classically with telangiectasias
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Histology: basal cell carcinoma
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Palisading nuclei
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Function: leukotriene B4
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Neutrophil chemotaxis
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Function: leukotrienes C4/D4/E4
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Bronchoconstriction
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Function: PGI2
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Decreased platelet aggregation
Decreased uterine contraction Vasodilation |
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Function: PGE2
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Vasodilation
Increased uterine tone Increased body temperature Pain |
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Function: thromboxane A2
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Increased platelet aggregation
Vasoconstriction |
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Which gout drug decreases penicillin excretion?
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Probenecid
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MOA: probenecid
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Interferes with renal urate resorptions ---> uricosuria
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MOA: etanercept
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Recombinant TNFα receptor
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MOA: infliximab
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TNFα Mab
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MOA: adalimumab
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TNFα Mab
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