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41 Cards in this Set

  • Front
  • Back
Composition of bone
Organic matrix: osteoblasts, osteoclasts, type I collagen, glycoproteins. Inorganic matrix: calcium hydroxyapatite, magnesium, potassium, chloride, sodium
Osteoblasts
Production of unmineralized bone. High amounts of alkaline phosphatase and PTH receptors to modulate osteoclasts
Osteoclasts
Bone resorption
Achodroplasia
Inherited dwarfism. Mutation on fibroblast growth factor receptor 3 inhibits cartilage synthesis at the epiphysial plates with decreased endochondral bone formation and premature ossification of growth plates. Short and thick extremities, large head and trunk.
Osteogenesis imperfecta
Abnormal synthesis of type I collagen. Recurrent fractures and deformities, thin blue sclera, deafness, thin skin and easy bruising
Causes of osteoporosis
Primary causes: estrogen deficiency with high IL-1 activity (postmenopausal, Turner's), genetic factors, lack of exercise, old age, nutritional. Secondary causes: Immobilization, Cushing's, thyrotoxicosis, malnutrition, corticosteroids.
Clinical features of osteoporosis
Bone is normal but in decreased amounts. Bone pain, compression fractures (vertebrae), femoral neck fracture, distal radius fracture.
Radiographic, lab and microscopic features of osteoporosis
Radiolucency of bone (osteopenia). Normal serum calcium, phosphorus and alkaline phosphatase. Thinned cortical and trabecular bone
Treatment of osteoporosis
Estrogen replacement therapy, weight bearing exercise, calcium, vitamin D, biphosphonates, calcitonin
Causes of osteomalacia and rickets
Decreased mineralization of newly formed bone due to abnormal metabolism of vitamin D. Dietary deficiency, intestinal malabsorption, lack of sunlight, renal and liver failure
Clinical features of rickets
Occurs in children. Craniotabes and frontal bossing (skull deformities), deformity of chest wall, pigeon breast, bowing of the legs. Low serum calcium with high alkaline phosphatase and PTH
Clinical features of osteomalacia
In adults, bone pain, fractures of vertebrae, hips and wrist. Low serum calcium, high alkaline phosphatase and PTH
MC pathogen in osteomyelitis
Staph
Osteomyelitis in sickle cell disease
Salmonella
Osteomyelitis in drug abusers and diabetics
Pseudomonas
Clinical features of osteomyelitis
Fever, leukocytosis, localized pain, erythema and swelling
Clinical features of osteoarthritis
Wear and tear joint chondrocyte injury with loss of articular collagen in weight-bearing joints. Stiffness, decreased range of motion, crepitus, pain that worsens with motion, old age. X-ray shows narrowing of joint space and osteophytes.
Clinical features of rheumathoid arthritis
Systemic, chronic inflamatory disease with anti-IgG autoantibodies (rheumathoid factor). Affects hands, wrists and knee, symetrical involvement, morning stiffness that improves with activity. Systemic manifestations: fever, fatigue, lymphadenopathy, rheumathoid subcutaneous skin nodules, Sjogren syndrome (15%)
Microscopic, x-ray and lab findings in rheumathoid arthritis
X-ray: juxta-articular osteoporosis and bone erosions. Micro: Synovitis, pannus (proliferation of synovium and granulation tissue over joint cartilage), radial deviation of wrist, ulnar deviation of fingers. Lab: high ESR, hypergammaglobulinemia, rheumathoid factor (anti-IgG).
Ankylosing spondylitis associations
young males, HLA-B27
Reiter syndrome
Conjunctivitis, urethritis, arthritis of ankles and knees, HLA-B27, follows gonococus infection
Causes of gout
Primary (90%) idiopathic. Secondary: Leukemia, renal disease, Lesch-Nyhan, Von Gierke
Clinical features of gout
Exquisite pain in big toe. Negatively birefringent, needle-shaped uric acid crystals and neutrophils in aspiration. Complications: joint destruction, uric acid renal calculi, renal failure. Rx.: NSAIDs, colchicine, probenecid allopurinol
Infectious arthritis clinical features
Gonococci MC. Tender, swollen and erythematous joints, monoarticular arthritis. Cloudy sinovial fluid that clots, neutrophils and positive gram stain in aspiration
Clinical features of myasthenia gravis
Autoantibodies against Ach receptors at neurmuscular junction. Ptosis, diplopia, weakness. Associated with thymic hyperplasia and thymomas. Rx.: anticholinesterase agents, thymectomy
Eaton-Lambert syndrome
Paraneoplastic syndrome of SCC of lung. Autoantibodies against the presynaptic Ca+ channels at neuromuscular junction.
Duchenne muscular dystrophy
Absence of dystrophin muscle structural protein. Onset of symptoms by age 5, progressive muscular weakness, heart failure, respiratory insuficiency and infections. High serum CK.
Guillain-Barre syndrome
Preceded by viral illness. Ascending paralysis, loss of deep tendon reflexes. Inflamation and demyelination of peripheral nerves and spinal nerve roots result in muscular weakness
Vitiligo
Irregular, completely depigmented patches devoid of melanocytes.
Melasma
Irregular blortchy patches of hyperpigmentation on the face
Freckles
Light brown macules on face, shoulders and chest. Increased melanin deposition in the basal layer of the epidermis
Nevocellular nevus (mole)
Benign tumor of melanocytes with sharp well-circumscribed borders
Malignant melanoma
Asymetric, irregular borders, variegated color, large diameter, enlarging, macule, papule or nodule. Risk factors: chronic sun exposure, fair skin, dysplastic nevus syndrome
Acanthosis nigricans
Thickened, hyperpigmented skin in axillae and groin. Associated with malignancy and gastric adenocarcinoma
Psoriasis
Well demarcated erythematous plaque with a silvery scale. Epidermal hyperplasia (acanthosis), patchy keratinization with parakeratosis. Rx.: topical steroids and radiation
Pemphigus
Autoantibodies against desmosome component desmoglein 3 results in loss of intracellular adhesion (acantholysis) and blister formation. Easily ruptured, flaccid blisters. Immunofluorescence shows net-like pattern of IgG stainning
Bullous pemphigoid
Autoantibodies against hemidesmosome component bullous pemphigoid antigens 1 and 2 result in separation of epidermis from dermis and blister formation. Tense bullae that do not rupture easily. Eosinophils are seen
Dermatitis herpetiformis
IgA autoantibodies against gliadin that deposit in the tips of the dermal papillae with subepidermal clister formation. Microabsecesses with neutrophils are seen
Squamous cell carcinoma of the skin risk factors
Chronic sun exposure, fair complexion, chronic skin ulcers, xeroderma pigmentosa, actinic keratosis
Squamous cell carcinoma of the skin clinical features
Tan nodular mass which ulcerates on sun exposed areas. Micro: nests of atypical keratinocytes invade the dermis, formation of keratin pearls, desmosomes between tumor cells
Basal cell carcinoma of the skin clinical features
Chronic sun exposure, fair complexion, xeroderma pigmontosum. Pearly papules and nodules with heaped up translucent borders, telangiectasia, ulcerations. Palisading growth pattern