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155 Cards in this Set

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  • Back
Name the epidermis layers (from surface to base).
"Calforinians Like Girls in String Bikinis"
- stratum corneum
- stratum lucidum
- stratum granulosum
- stratum spinosum
- stratum basalis
What are Zona occuldens? What are their functions?
- tight junctions
- composed of claudins and occludins
- prevents diffusion across paracellular space
What are zona adherens? What are their functions?
- intermediate junctions
- surrounds perimeter just below zona occludens
- cadherins connect to actin (CADherins are Ca-dependent ADhesion molecules)
What are macula adherens? what are their functions?
- what disease is caused by autoantibodies against macula adherens?
- desmosome
- small, discrete sites of attachment
- cadherins connect to intermediate filaments
- autoantibodies = pemphigus vulgaris
What are gap junctions? What are their functions?
- allows adjacent cells to communicate for electric and metabolic functions
What are integrins? What are their functions?
maintain integrity of basement membrane; binds to laminin in BM
What are hemidesmosomes? What are their functions?
- what disease is caused by autoantibodies against hemidesomosomes?
- connects cells to underlying extracellular matrix
- autoantibodies = bullous pemphigoid
What is the "unhappy triad"/knee injury? How does it occur?
- common football injury
- force from the lateral side --> damage to the "unhapyp triad"
1. medial collateral ligament (MCL)
2. anterior cruciate ligament (ACL)
3. Lateral meniscus
What is the landmark for pudendal nerve block?
ischial spine
What is the landmark to find the appendix?
2/3 of the way from the umblicius to the anterior superior iliac spine (McBurney's point)
What are the shoulder muscles that form the rotator cuff? What are their functions?
"SItS"
- Supraspinatus - abducts arm initially (before deltoid; most common rotator cuff injury)
- Infraspinatus - laterally rotates arm; pitching injury
- teres minor - adducts and laterally rotates arm
- subscapularis - medially rotates and adducts arm
What is the cause of injury, deficits and sign of damage to axillary nerve (C5, C6)?
- cause of injury: fractured surgical neck of humerus, dislocation of humeral head
- motor: deltoid- arm abduction at shoulder
- sensory: over deltoid muscle
- sign: flattened deltoid
What is the cause of injury, deficits and sign of damage to radial nerve (C5-C8)?
- cause: fracture at midshaft of humerus (saturday night palsy)
- motor: "BEST extensors", brachioradialis, extensors of writs and fingers, supinators, tricepts
- sensory: posterior arm and dorsal hand/thumb
- sign: wrist drop
What is the cause of injury (proximal lesion), deficits and sign of damage to median nerve (C6, C8, T1)?
- cause: fracture of supracondylar humerus
- motor: lateral finger flexion, wrist flexion
- sensory:dorsal and palmar aspects of lateral 3.5 fingers, thenar eminence
- sign: "Ape hand"; thenar atrophy, loss of opposability of thumb
What is the cause of injury (distal lesion), deficits and sign of damage to median nerve (C6, C8, T1)?
- cause: carpal tunnel sydrome, dislocated lunate
- motor: opposition of thumb
- sensory: dorsal and palmar aspects of lateral 3/5 fingers
- sign: ulnar deviation of wrist upon wrist flexion
What is the cause of injury (proximal), deficits and sign of damage to ulnar nerve (C8, T1)?
- cause: fracture of medial epicondyle of humerus, "funny bone"
- motor: medial finger flexion, wrist flexion
- sensory: medial 1.5 fingers hypothenar eminence
- sign: radial deviation of wrist upon wrist flexion
What is the cause of injury (distal), deficits and sign of damage to ulnar nerve (C8, T1)?
- cause: fracture of hook of hamate (falling onto outstretched hand)
- motor: abduction and adduction of fingers (interossi), adduciton of thumb, extension of 4th and 5th fingers (lumbricals)
- sensory: none
- sign: ulnar claw hand (when asked to stragthen fingers - "pope's blessing/hand of benediction)
What is the cause of injury, deficits and sign of damage to musculocutaneous nerve (C5-C7)?
- cause: upper trunk compression
- motor: biceps, brachialis, coracobrachialis, flexion of arm at elbow
- sensory: lateral forearm
- sign: none
Describe an Erb-Duchenne palsy (Waiter's tip)
- traction or tear of the upper trunk of the brachial plexus (C5 and C6 roots)
- follows blow to shoulder or trauma during delivery
- findings: limb hangs by side (paralysis of abductors), medially rotated (paralysis of lateral rotators), forearm is pronated (loss of biceps)
Describe Klumpke's palsy
- an embryologic or childbirth defect affecting inferior trunk of brachial plexus (C8, T1); a cervical rib can compress subclavian artery and inferior trunk, resulting in thoracic outlet syndrome
What are the features of thoracic outlet syndrome?
1. atrophy of the thenar and hypothenar eminences
2. atrophy of the interosseous muscles
3. sensory deficits ont he medial side of the forearm and hand
4. disappearance of the radial pulse upon moving the head toward the ipsilateral side
what is the function of the lumbricals?
flex the MCP joints and extend both the HIP and PIP joints
Describe an ulnar claw.
distal ulnar nerve lesion --> loss of medial lumbircal function
- 4th and 5th digits are clawed ("pope's blessing"
- cannot extend 4th and 5th digits
- when try to open hand, pinky and ring finger stay clawes
Describe a median claw.
- distal median nerve lesion (after branch containing C5-C7 branches off to feed forearm flexors) --> loss of lateral lumbrical function
- 2nd and 3rd digits are clawed
- cannot extend 2nd and 3rd digits
Describe an "Ape hand"
- proximal median nerve lesion --> loss of opponens pollicis muscle function --> unopposable thumb (inability to abduct thumb)
Describe Klumpke's total claw
- lesion of lower trunk (C8,T1) of brachial plexus --> loss of function of all lumbricals; forearm finger flexors (fed by part of median nerve with C5-C7) and finger extensors (fed by radial nerve) are unopposed --> clawing of all digits
What is the cause of a winged scapula and lymphedema?
- damage to long thoracic nerve (C5-C7)
- which supplies the serratus anterior - connects scapula to thoracic cage
- used for abduction above horizontal position
- can be injured in masectomy
What are the muscles that make up the thenar muscles? innervation?
- opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
- median nerve
What are the muscles that make up the hypothenar muscles? innervation?
- opponens digiti minimi, abductor digiti minimi, flexor digit minimi
- ulnar nerve
What is the funtion of the dorsal interosseous muscles? palmar interosseous muslces?
- dorsal = ABduct (DAB)
- palmar = ADduct (PAD)
What are the consequences of repetitive elbow trauma?
- degenerative injury due to repeated use; leads to tiny tears in tendons and muscles
- may be inflammtory (i.e. lateral epicondylitis (tennis elbow), medial epicondylitis (golf elbow)
What is the cause of injury, motor and sensory deficit to the obturator nerve (L2-L4)?
- cause: anterior hip dislocation
- motor: thigh adduction
- sensory: medial thigh
What is the cause of injury, motor and sensory deficit to the femoral nerve (L2-L4)?
- cause: pelvic fracture
- motor: thigh flexion and leg extension
- sensory: anterior thigh and medial elg
What is the cause of injury, motor and sensory deficit to the common peroneal (L4-S2)?
- cause: trauma to lateral aspect of leg or fibula neck fractuer
- motor: foot eversion and dorsiflexion; toe extension; foot drop, foot slap, steppage gait
- sensory: anterolateral leg and dorsal aspect of foot
What is the cause of injury, motor and sensory deficit to the tibial nerve (L4-S2)?
- cause: knee trauma
- motor: foot inversion and plantarflexion; toe flexion
- sensory: sole of foot
What is the cause of injury, motor and sensory deficit to the superior gluteal (L4-S1)?
- cause: posterior hip dislocation or polio
- motor: thigh abduction (positive Trendelenburg sign - hi drops when standing on opposite foot)
- sensory: none
What is the cause of injury, motor and sensory deficit to the inferior gluteal nerve (L5-S2)?
- cause: posterior hip disloation
- motor: can't jump, climb stairs or rise from seated position; can't push inferiorly (downward)
If you injure the peroneal nerve, what will happen?
- PED = peroneal everts and dorsiflexes
- if injured, foot dropPED
if you injure the tibial nerve, what will happen?
- TIP = tibial inverts and plantarflexes
- if injured, can't stand on TIPtoes
Which nerve splites into the common peroneal and tibila nerve? Where does this occur
- sciatic nerve
- posterior thigh
Describe the process of muscle contraction.
1. AP depolarization opens voltage-gated Ca2+ channels, inducing nt release
2. postsynaptic ligand binding leads to muscle cell depolarization in the motor end plate
3. depolarization travels along muscle cell and down the T-tubule
4. Depolarization of teh voltage-sensitive dihydropyridine receptor, coupled to the ryanodine receptor on the SR, induces a conformational change causing calcium release from SR (calcium-induced calcium release)
5. released calcium binds to troponin C, causing a conformational change that moves tropomyosin out of the myosin-binding groove on actin filaments
6. Myosin releases bound ADP and is displaced on the actin filament (power stroke). Contraction results in H and I band shortening, but the A band remains the same length

*A band is Always the same length, HIZ shrinkage*
Describe the characteristics of type 1 muscle fibers.
- slow twitch
- red fibers due to increase mitochondria and myoglobin concentration (increased oxidative phosphorylation) --> sustained contraction

*think "one slow red ox"*
Describe the characteristics of type 2 muscle fibers.
- fast twitch
- white fibers due to decreased mitochondria and myoglobin concentration (increased anaerobic glycolyisis)
- weight training results in hypertrophy of fast-twitch muscle fibers
Describe the process of endochondral ossification.
- longitudinal bone growth
- cartilaginous model of bone is first made by chondrocytes
- osteoclasts and osteoblasts later replace with woven bone and remodel to lamellar bone

-
Describe the process of membranous ossification.
- flat bone growth (skull, facial bones, and axial skeleton)
- woven bone formed directly without cartilage
- later remodeled to lamellar bone
What is the source for osteoblasts?
mesenchymal stem cells in periosteum
Describe achondroplasia.
- failure of longitudinal bone growth (endochondrial ossification) --> short limbs
- membranous ossification is not affected --> large head
- constitutive activation of fibroblast growth factor receptor (FGFR3) actually inhibits chondrocyte proliferation
- >85% of mutations occur sporadically and are associated with advanced paternal age, but the condition also demonstrates autosomal-dominant inheritance
- common cause of dwarfism
- normal life span and fertility
What is osteoporosis? What are possible consequences?
- reduction of primarily trabecular (spongy) bone mass despite normal bone mineralization and lab values
- consequences: vertebral crush factures (acute back pain, loss of height, kyphosis)
Describe Type I osteoporosis and its consequences.
- postemenopausal
- increased bone resorption due to decreased estrogen levels
- consequences: femoral neck fracture, distal radius (Colles') fracture
Describe Type II osteoporosis and its consequences.
- senile osteoporosis
- affects men and women >70 years of age
- prophylaxis: exercise and calcium ingestion before age 30
- treatment: estrogen (SERMS) and/or calcitonin; bisphosphonates or pulsatile PTH for severe cases; glucocorticoids are contraindicated
Describe marble bone disease.
- failure of normal bone resorption --> thickened, dense bones that are prone to fracture.
- bone defect is due to abnormal function of osteoclasts
- serum calcium, phosphate, and alkaline phosphatase (ALP) are normal
- decreased marrow space leads to anemia, thrombocytopenia, infection
- increased extramedullary hematopoiesis
- genetic deficiency of carbonic anhydrase II
- X-rays show "Erlenmeyer flask" bones that flare out
- can result in cranial nerve impingement and palsies due to narrowed foramina
Describe osteomalacia/rickets.
- defective mineralization/calcification of osteoid --> soft bones
- vitamin D defeiciency in adults --> decrease calcium levels --> increase secretion of PTH, decrease in serum phosphate
- reversible when vitamin D is replaced
- vitamin D deficiency in childhood causes rickets
What is Paget's disease (osteitis deformans)?
- abnormal bone architecture caused by increase in both osteoblastic and osteoclastic activity
- possibly viral in origin (paramyxovirus)
- serum calcium, phosphorus, and PTH levels are norml
- increase ALP
- mosaic bone pattern; long bone chalk-stick fractures
- increase blood flow from increase arteriovenous shunts may cause high output heart failure
- can lead to osteogenic sarcoma
- hat size can be increased
- hearing loss is common due to auditory foramen narrowing
What is polyostotic fibrous dysplasia?
- bone is replaced by fibroblasts, collagen, and irregular bony trabeculae
- affects many bones
- McCune-Albright syndrome is a form of polyostotic fibrous dysplasia characterized by multiple unilateral bone lesions associated with endocrine abnormalities (precocious puberty) and unilateral pigmented skin lesions (cafe-au-lait spots)
List the types of benign primary bone tumors.
1. osteoma
2. osteoid osteoma
3. osteoblastoma
4. Giant cell tumor (osteoclastoma)
5. osteochondroma (exostosis)
6. enchondroma
Describe osteoma.
- asociated with Garnder's syndrome (FAP)
- new piece of bone grows on another piece of bone, often in the skull.
Describe osteoid osteoma.
- interlacing trabeculae of woven bone surrounded by osteoblasts
- <2 cm and found in proximal tibia and femur
- most common in men <25 years of age
Describe osteoblastoma.
- same morphologically as osteoid osteoma, but larger and found in vertebral column
-->interlacing trabeculae of woven bone surrounded by osteoblasts
Describe giant cell tumor (osteoclastoma).
- occurs most commonly at epiphyseal end of long bones
- peak incidence 20-40 years of age
- locally aggressive benign tumor often around the distal femur, proximal tibial region (knee)
- characteristic "double bubble" or "soap bubble" appearance on x-ray
- spindle-shaped cells with multinucleated giant cells
What is osteochondroma (exotosis)?
- most common benign bone tumor
- mature bone with cartilaginous cap
- usually in men <25 years of age
- commonly originates from metaphysis
- malignant transformation to chondrosarcoma is rare
What is enchondroma?
- benign cartilaginous neoplasm found in intramedullary bone
- usually distal extremities (vs. chondrosarcoma)
What are some malignant tumors?
1. osteosarcoma (osteogenic sarcoma)
2. Ewing's sarcoma
3. Chondrosarcoma
What is osteosarcoma (osteogenic sarcoma)?
- 2nd most common primary malignant tumor of bone (after multiple myeloma)
- peak incidence in men 10-20 years of age
- commonly found in the metaphysis of long bones, often around distal femur, proximal tibial region (knee)
- predisposing factors include Paget's disease of bone, bone infarcts, radiation, and familial retinoblastoma
- Codman's triangle or sunburst pattern (from elevation of periosteum) on x-ray
- poor prognosis
What is Ewing's sarcoma?
- anaplastic small blue cell malignant tumor
- most common in boys <15
- extremely aggressive with early mets, but responsive to chemotherapy
- characteristic "oninon-skin" appearance in bone ("going out for Ewings and onion rings")
- commonly appears in diaphysis of long bones, pelvis, scapula and ribs
- 11;22 translocation
Describe chondrosarcoma
- malignant cartilaginous tumor
- most common in men aged 30-60
- usually located in pelvis, spine, scapula, humerus, tibia, or femur
- may be of primary origin or from osteochondroma
- expansile glistening mass with the medullary cavity
What are the characteristics, predisposing factors and classic presentation of osteoarthritis?
- mechanical- wear and tear of joints leads to destruction of articular cartilage, subcondral cysts, sclerosis, osteophytes (bone spurs), eburnation (polished, ivory-like appearance of bone), Heberden's nodes (DIP), and Bouchard's nodes (PIP)
- predisposing factors: age, obesity, joint deformity
- classic presentation: pain in weight-bearing joints after use (i.e. at end of day), improving with rest. In knees, cartilage loss begins on medial aspect ("bowlegged"). Noninflammatory. no systemic symptoms
Describe the characteristics of rheumatoid arthritis.
- autoimmune- inflammatory disorder affecting synovial joints, with pannus formation in joints (MCP, PIP), subcutaneous rheumatoid nodules (fibrinoid necrosis surrounded by palisading histocytes), ulnar deviation, subluxation, Baker's cyst (behind the knee),
- No DIP involvement
- females >males; type III hypersensitivity
- 80% of RA pateitns have positive rheumatoid factor (anti-IgG Ab); anti-CCP Ab is less sensitive but more specific
- strong association with HLA-DR4
- classic presentaiton: morning stiffness lasting >30 minutes and improving with use, symmetric joint involvement, systemic symptoms (fever, fatigue, pleuritis, pericarditis)
Describe the characteristics of Sjogren's syndrome.
- classic triad: 1. Xerophthalmia (dry eys, conjunctivitis, "sand in my eyes"), 2. Xerostomia (dry mouth, dysphagia), 3. Arthritis
- parotid enlargement, increase risk of B-cell lymphoma, dental caries
- autoantibodies to ribonuceloprotein antigens, SS-A (Ro), SS-B (La)
- Predominantly affects females between 40-60 years of age
- associated with rheumatoid arthritis
What are the characteristics of Sicca syndrome?
- dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis
- no arthritis
What are the findings of gout?
- precipitation of monosodium urate crystasl into joints due to hyperuricemia, which can be caused by Lesch-Nyhan syndrom, PRPP excess, decrease excretion of uric acid (i.e. thiazide diuretics), increased cell turnover, or von Gierke's disease
- 90% due to underexcretion
- 10% due to overproduction
- crystals are needle shaped and negatively birefringent = yellow crystals under parallel light
- most common in men
- 10
What are the symptoms of gout?
- asymmetric joint distribution
- join is swollen, red and painful
- classic manifestation is painful MTP joint of the big toe (podagra)
- tophus formation (often on external ear, olecranon bursa, or Achilles tendon)
- acute attack tends to occur after a large meal or alcohol consumption (alcohol metabolites compete for same excretion sites in kidney as uric acid, causing decreased uric acid secretion and subsequent buildup in blood)
What is the treatment for gout?
- acute: NSAIDs (i.e. indomethacin), colchicine
- chronic: allopurinol, uricosurics (i.e. probenecid)
What are the characteristics of pseudogout?
- caused by deposition of calcium pyrophosphate crystals within the joint space
- forms basophillic, rhomboid crystals that are weakly positively birefringent
- usually affects large joints (classically the knee)
- >50 years old, both sexes affected equally
- no treatment
What is the difference in findings between gout and pseudogout?
- gout: crystals are yellow when parallel and blue when perpendicular to the light
- pseudogout: crystals are yellow when perpendicular and blue when parallel to the light
What are the types of infectious arthritis which are septic?
- S. aureus, Streptococcus, and Neisseria gonorrhoease are common
- gonococcal arthritis is an STD that presents as a monoarticular, migratory arthritis with an asymmetrical pattern
- affected joint is swollen, red and painful

*STD = Synovitis (i.e. knee), Tenosynovitis (i.e hand), Dermatitis (i.e. pustules)*
What are the types of infectious arthritis which are chronic?
- TB (from mycobacterial dissemination)
- Lyme disease
What are the characterisitcs of seronegative spondyloarthropathies? What are the types?
- arthritis without rheumatoid factor (no anti-IgG antibody)
- strong association with HLA-B27
- occurs more often in males
- types: "PAIR"
--> Psoriatic arthitis
--> Ankylosing spondylitis
--> Inflammatory bowel disease
--> Reactive arthritis (Reiter's syndrome)
What are the characteristics of Psoriatic arthritis?
- joint pain and stiffness associated with psoriasis
- assymetric and patchy involvement
- dactylitis ("sausage fingers"), "pencil-in-cup" deformity on X-ray
- seen in fewer than 1/3 patients with psoriasis
What are the characteristics of ankylosing spondylitis?
- chronic inflammatory disease of spine and sacroiliac joints --> ankylosis (stiff spine due to fusion of joints), uveitis, and aortic regurgitation
What are the characteristics of inflammatory bowel disease?
- crohn's disease, ulcerative colitis
What are the characterisitcs of Reactive arthritis (Reiter's syndrome)?
- classic triad:
1. conjunctivitis and anterior uveitis
2. urethritis
3. arthritis
- post GI or chlamydia infections
* can't see, can't pee, can't climb a tree*
Describe the charactersitics of Systemic lupus erythematosus.
- 90% of female and between ages 14-45
- most common and severel in black females
- symptoms: fever, fatigue, weight loss, nonbacterial verrucous endocarditis, hilar adenopathy, and Raynaud's phenomenon
- wire-loop lesions in kidney with immune complex deposition (usually nephritic syndrome)
- death from renal failure and infections
- false positives on syphilis tests (RPR/VDRL) due to antiphospholipid Abs, which cross-react with cardiolipin used in tests
Lab tests used to test for systemic lupus erythematosus, will detect presence of which antibodies?
1. antinuclear antibodies (ANA) - sensitive (primary screening) but not specific for SLE
2. Antibodies to db-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
What does "I'M DAMN SHARP" stand for in relation to SLE?
- Immunoglobulins (anti-dsDNA, anti-Sm, antiphospholipid)
- Malar rash
- Discoid rash
- Antinuclear antibody
- Mucositis (oropharyngeal ulcers)
- Neurologic disorders
- Serositis (pleuritis, pericarditis)
- Hematologic disorders
- Arthritis
- Renal disorders
- Photosensitivity
What are the characteristics of sarcoidosis?
- characterized by immune-mediated, widespread noncaseating granulomas and elevated serum ACE levels
- common in black females
- associated with restrictive lung disease, bilateral hilar lymphadenopathy, erythema nodosum, Bell's palsy, epithelial granulmoas contaiing micrscopic Schaumann and asteroid bodies, uveoparotitis, and hypercalcemia (due to elevated 1alpha-hydroxylase-mediated vitamin D activation in epithelioid macrophages)
What is the treatment for sarcoidosis?
steroids
What does "GRAIN" stand for in relation to sarcoidosis?
- Gammaglobulinemia
- Rheumatoid arthritis
- ACE increase
- Interstitial fibrosis
- Noncaseating granulomas
What are the symptoms, findings, and treatment for polymyalgia rheumatica?
- symptoms: pain and stiffness in shoulders, hips, often with fever, malaise, and weight loss
- does not cause muscular weakness
- occurs in patients >50 years of age; associated with temporal (giant cell) arteritis
- findings: increase ESR, normal CK
- treatment: prednisone
What are the symptoms of polymyositis?
- progressive symmetric proximal muscle weakness caused by CD8+ T cell-induced injury to myofibers
- most often involves shoulders
- muscle biopsy with evidence of perifascicular inflammation is diagnostic
What are the symptoms of dermatomyositis?
- similiar to polymyositis, but also involves malar rash, (similar to SLE), heliotrope rash "shawl and face" rash, Gottron's papules, "mechanic's hands."
- increasek risk of malignancy
What are the findings for polymyositis and dermatomyositis?
- increase CK
- increase aldolase and positive ANA, anti-Jo-1
What is the treatment for polymyositis and dermatomyositis?
steroids
Describe the features of myasthenia gravis.
- most common NMJ disorder
- autoantibodies to postsynaptic AChR cause ptosis, diplopia, and general weakness
- associated with thymoma
- symptoms worsen with muscle use (diagnose with nerve stimulation/compound muscle AP test)
- reversal of symptoms occurs with AChE inhibitors
Describe the features of Lambert-Eaton syndrome.
- autoantibodies to presynaptic calcium channel results in decrease ACh release leading to proximal muscle weakness
- associated with paraneoplastic disease (small cell lung cancer)
- symptoms improve with muscle use
- no reversal of symptoms with AChE inhibitors alone
Describe the characteristics of scleroderma (progressive systemic sclerosis - PSS).
- excessive fibrosis and collagen deposition throughout the body
- commonly sclerosis of skin, manifesting as puffy and taut skin with absence of wrinkles
- also sclerosis of renal, pulmonary, cardiovascular, and GI systems
- 75% females
- two common types
What are the two common types of Scleroderma (progressive systemic sclerosis - PSS)? Describe their characteristics.
1. Diffuse scleroderma - widespread skin involvement, rapid progression, early visceral involvement
- associated with anti-Scl-70 antibody (anti-DNA topoisomerase I Ab)
2. CREST syndrome - Calcinosis, Raynaud's phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia
- limited skin involvement, often confined to fingers and face
- more benign clinical course
- associated with anti-Centromere antibody (C for CREST)
What are the features of verrucae?
- warts
- soft, tan-colored cauliflower-like lesions
- epidermal hyperplasia, hyperkeratosis, koilocytosis
- verruca vulgaris on hands; condyloma accuminatum on genitals (caused by HPV)
What are the features of nevocellular nevus?
- common mole
- benign
What are the features of urticaria?
- hives
-intensely pruritic wheals that form after mast cell degranulation
What are the features of ephelis?
- freckle
- normal number of melanocytes
- increase melanin pigment
What are the features of atopic dermatitis (eczema)?
- pruritic eruption, commonly on skin flexures
- often associated with other atopic diseases (asthma, alelrgic rhinitis)
What are the features of allergic contact dermatitis?
- Type IV hypersensitivity reaction that follows exposure to allergen
- lesions occur at site of contact (i.e. nickel, poison ivy)
What are the features of psoriasis?
- papules and plaques with silvery scaling, especially on knees and elbows
- acanthosis with parakeratotic scaling (nuclei still in stratum corneum)
- increase stratum spinosum
- decrease stratum grnulosum
- Auspitz sign - bleeding spots when scales are scraped off
- can be associated with nail pitting and psoriatic arthritis
What are the features of seborrheic keratosis?
- flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cyts)
- looks "pasted on"
- lesions occur on head, trunk and extremities
- common benign neoplasm of older persons
- sign of Leser-Trelat - sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy (i.e. GI, lymphoid)
What are the features of albinism?
- normal melanocyte number with decrease melanin production due to decrease activity of tyrosinase
- can also be caused by failure of neural crest cell migration during development
What are the features of vitiligo?
- irregular ares of complete depigmentation
- caused by a decrease by melanocytes
What are the features of melasma (chloasma)?
- hyperpigmentation associated with pregnancy ("mask of pregnancy") or OCP use
What are the features of impetigo?
very superficial skin infection
- usually from S. auerus or S. pyogenes
- highly contagious
- honey-colored crusting
What are the features of cellulitis?
- acute, painful spreading infection of dermis and subcutaneous tissues
- usually from S. pygoenes or S. aureus
What are the features of necrotizing fasciitis?
- depper tissue injury, usually from anaerobic bacteria and S. pyogenes
- Results in crepitus from methane and carbon dioxide production
- "flesh-eating bacteria"
what are the features of staphylococcal scalded skin syndrome?
- exotoxin destroys keratinocyte attachments in the stratum granulosum only
- characterized by fever and generalized erythematous rash with sloughing of the upper layers of the epidermis
- seen in newborns and children
What are the features of hairy leukoplakia?
- white, painless plaques on the tongue that cannot be scraped off
- EBV mediates
- occurs in HIV-positive patients
What are the features of pemphigus vulgaris?
- potentially fatal autoimmune skin disorder with IgG Ab against desmosomes (anti-epithelial cell Ab)
- immunofluorescence reveals Abs around cells of epidermis in a reticular or netlike pattern
- Acantholysis - intrapeidermal bullae involving the skin and oral mucosa
- positive Nikolsky's sign (separation of epidermis upon manual stroking of skin)
What are the features of bullous pemphigoid?
- autoimmune disorder with IgG Ab against hemidesmosomes (epidermal basement membrane; Abs are "bullow" the epidermis)
- shows linear immunofluorescence
- Eosinophils within blisters
- similar to but less severe than pemphigus vulgaris
- affects skin but spares oral mucosa
- negative Nikolsky's sign
What are the features of dermatitis herpetiformis?
- pruritic papules and vesicles
- deposits of IgA at the tips of dermal papillae
- associated with celiac disease
What are the features of erythema multiforme?
- associated with infections (i.e. M. pneumoniae, HSV), drugs (i.e. Sulf drugs, B-lactams, phenytoin), cancers, and autoimmune diseases
- presents with multiple types of lesions (macules, papules, vesicles, and target lesions - red papules with a pale central area)
What are the features of Stevens-Johnson Syndrome?
- characterized by fever, bulla formation and necrosis, sloughing of skin, and a high mortality rate
- usually associated with adverse drug reaction
- a more severe form of Stevens-Johnson syndrome is known as toxic epidermal necrolysis
What are the features of Lichen planus?
- Pruritic, Purple, Polygonal Papules
- sawtooth infiltrate of lymphocytes at dermal-epidermal junction
- associated with hepC
What are the features of Actinic keratosis?
- premalignant lesions caused by sun exposure
- small, rough, erythematous or brownish papules
- "cutaneous horn"
- risk of carcinoma is proportional to epithelial dysplasia
What are the features of acanthosis nigricans?
- hyperplasia of stratum spinosum
- associated with hyperinsulinemia (i.e from Cushing's disease, diabetes) and visceral malignancy
What are the features of erythema nodosum
- inflammatory lesions of subcutaneous fat, usually on anterior shins
- associated with coccidioidymycosis, histoplasmosis, TB, leprosy, streptococcal infections, sarcoidosis
What are the features of pityriasis rosea
"herald path" followed days later by "Xmas tree" distribution
- multiple papular eruptions; remits spontaenously
What are the features of strawberry hemangioma?
first few weeks of life (1/200 births)
- grows rapidly and regresses spontaneously at 5-8 years of age
What are the features of cherry hemangioma?
- appears in 30-40s; does not regress
What are the characteristics of squamous cell carcinoma?
- very common
- associated with excessive exposure to sunlight and arsenic exposure
- commonly appear on hands and face
- locally invasive, but rarely metastasizes
- ulcerative red lesion
- associated with chronic draining sinuses
- histopathology -> keratin "pearls"
*Actinic keratosis is a precursor to squamous cell carcinoma*
What are the characteristics of basal cell carcinoma?
- most common in sun-exposed areas of body
- locally invasive, but almost never metastasizes
- rolled edges with central ulceration
- gross pathology -> pearly papules, commonly with telangiectasias
*basal cell tumors have "palisading" nuclei*
What are the features of melanoma?
- common tumor with significant risk with metastasis
- S-100 tumor marker
- Associated with sunlight exposure
- fair-skinned persons are at increased risk
- depth of tumor correlates with risk of metastasis
- dark with irregular borders
*dysplastic neuvs (atypical mole) is a precursor of melanoma*
What is the mechanism of aspirin?
- irreversibly inhibits cyclooxygenase by covalent binding, which decreases synthesis of both thromboxane and prostaglandin
- a type of NSAID
What is the clinical use of aspirin?
- low dose (<300 mg/day) ->decreases platelet aggregation
- intermediate dose (300-2400 mg/day) --> antipyretic and analgesic
- high dose (2400-4000 mg/day) -> anti-inflammatory
What is the toxicity of aspirin?
- gastric upset
- chronic use can lead to acute renal failure, interstitial nephritis and upper GI bleeding
- Reye's syndrome in children with viral infection
What are some common NSAIDs?
ibuprofen, naproxen, indomethacin, ketorolac
What is the mechanism of NSAIDs?
- reversibly inhibit cyclooxygenase (both COX-1 and COX-2)
- block prostaglandin synthesis
What is the clinical use of NSAIDs?
antipyretic, analgesic, anti-inflammatoyr
- indomethacin is used to close a PDA
What is the toxcity of NSAIDs?
- renal damage, fluid retention, aplastic anemia, GI distress, ulcers
What is the mechanism of COX-2 inhibitors (Celecoxib)?
- reversibly inhibits specifically the cyclooxygenase (COX) isoform 2, which is found in inflammtory cells adn vascular endothelium and mediates inflammation and pain
- spares COX-1, which helps maintain the gastric mucosa, thus should not have the corrosive effects of other NSAIDs on the GI lining
What is the clinical use of COX-2 inhibitors (Celecoxib)?
- rheumatoid and osteoarthritis
- patients with gastritis or ulcers
What is the toxicity of COX-2 inhibitors (Celecoxib)?
- increased risk of thrombosis
- sulfa allergy
- less toxicity to GI mucosa (lower incidence of ulcers, bleeding than NSAIDs)
What is the mechanism of acetaminophen?
- reversibly inhibits cyclooxygenase, mostly in CNS
- inactivated peripherally
What is the clinical use of acetaminophen?
- antipyretic, analgesic, but lacking anti-inflammatory properties
- used instead of aspirin to prevent Reye's syndrome in children with viral infections
What is the toxicity of acetaminophen?
- overdose produces hepatic necrosis
- acetaminophen metabolit depletes glutathione and forms toxic tissue adducts in liver
- N-acetylcysteine is antidote --> regenerates glutathione
What is the mechanism for bisophosphonates?
- inhibit osteoclastic activity
- reduce both formation and resorption of hydroxyapatite
What are some common bisophosphonates?
- etidronate, pamidronate, alendronate, risedronate, zoledronate (IV)
What is the clinical use of bisphosphonates?
- malignacy-associated hypercalcemia, Paget's disease of bone, postmenopausal osteoporosis
What is the toxicity of bisphosphonates?
corrosive esophagitis (except zoledronate), nausea, diarrhea, osteonecrosis of the jaw
Describe the characteristics of the gout drug, colchicine.
-used for acute gout (w/NSAIDs)
- binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation
- GI side effects, especially if given orally
Describe the characteristics of the gout drug, probenecid
- used for chronic gout
- inhibits reabsorption of uric acid in PCT (also inhibits secretion of penicillin)
Describe the characteristics of the gout drug, allopurinol.
= used for chronic gout
- inhibits xanthine oxidase, decrease conversion of xanthine to uric acid
- also used in lymphoma and leukemia to prevent tumor lysis-associated urate nephropathy
- increased concentrations of azathioprine and 6-MP (both normally metabolized by xanthine oxidase)
What are common TNF-alpha inhibitors?
- ethanercept
- infliximab
- adalimumab
What is the mechanism of ethanercept?
- recombinant form of human TNF receptor that binds TNF
What is the clinical use of etanercept?
- rheumatoid arthritis
- psoriasis
- ankylosing spondylitis
What is the mechanism of infliximab?
- anti-TNF Ab
What is the clinical use of infliximab?
- Crohn's disease
- rheumatoid arthritis
- ankylosing spondylitis
What is the toxicity of infliximab?
predisposes to infections (reactivation of latent TB)
What is the mechanism of adalimumab?
anti-TNF Ab
What is the clinical use of adalimumab?
- rheumatoid arthritis
- psoriasis
- ankylosing spondylitis