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97 Cards in this Set
- Front
- Back
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Type I osteoporosis
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reduction of bone mass postmenopausally
increase bone resorption due to decrease estrogen levels |
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Type II osteoporosis
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senile osteoporosis
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Treatment of osteoporosis
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estrogen and/or calcitonin; bisphosphonates or pulsatile PTH for severe cases
glucocorticoids are contraindicated |
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Failure of normal bone resorption leads to thickened, dense bones
bone defect due to abnormal osteoclasts genetic deficiency of carbonic anhydrase II can result in cranial nerve impingement and palsies due to narrow foramina |
Osteopetrosis
(marble bone disease) |
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Labs for osteopetrosis
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serum calcium, phosphate and alkaline phosphatase are all normal!!
decrease marrow space leads to anemia, thrombocytopenia, infection |
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Erlenmeyer flask x-ray
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Osteopetrosis
(bones that flare out) |
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von Recklinghausen disease
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osteitis fibrosa cystica
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Osteitis fibrosa cystica
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von Recklinghausen disease
caused by hyperparathyroidism high serum calcium, low serum phosphorus and high alkaline phosphatase |
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"Brown tumors"
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in osteitis fibrosa cystica
caused by hyperparathyroidism brown tumors: cystic spaces lined by osteoclasts, filled with fibrous stroma and sometimes blood |
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Paget's disease
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osteitis deformans
abnormal bone architecture caused by increase in both osteoblastic and osteoclastic activity possibly viral origin (occurs in elderly) long bone chalk-stick fractures increased blood flow from increased AV shunts may cause high output CHF can lead to osteogenic sarcoma |
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Labs for Paget's disease
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serum calcium, phosphorus and PTH are all normal
MARKEDLY INCREASED ALKALINE PHOSPHATASE!!! |
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Mosaic bone pattern
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Paget's disease
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Hat size can be increased: hearing loss is common due to auditory foramen narrowing
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Paget's disease
(osteitis deformans) markedly increased ALP!!! |
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Polyostotic fibrous dysplasia
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bone replaced by fibroblasts, collagen and irregular bony trabeculae
affects bones |
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McCune Albright syndrome
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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/'coast of Maine' spots)
young girls!! short stature |
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'coast of Maine' spots
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McCune Albright syndrome
(polyostotic fibrous dysplasia)...bone is replaced by fibroblasts, collagen and irregular bony trabeculae |
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Most frequently occurring benign tumors of bone
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osteochondroma and giant cell tumor
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Most frequently occurring malignant tumors of bone
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osteosarcoma, chondrosarcoma and Ewing sarcoma
(excludes metastatic carcinoma and MM...which are more common than primary bone tumors) |
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Osteochondroma (exostosis)
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most common benign bone tumor
mature bone with cartilaginous cap lower end of femur and upper end of the tibia (long metaphysis) usually in men <25 years old malignant transformation to chondrosarcoma is rare |
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Giant cell tumor (osteoclastoma)
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benign!!
most often at epiphyseal end of long bones peak incidence 20-40 years "DOUBLE BUBBLE" or "SOAP BUBBLE" appearance on x-ray spindle shaped cells with multinucleated giant cells (epiphyses of long bones, especially at the lower end of the femur and the upper end of the tibia) |
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Osteoma
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benign bone tumor!!
associated with Gardner's syndrome (FAP) new piece of bone grows on another piece of bone, often in the skull (in the diaphysis...tumor of dense mature bone...skull or facial bones) |
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Osteoid osteoma
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interlacing trabeculae of woven bone surrounded by osteoblasts
<2cm and found in proximal tibia and femur most common in men <25 years of age |
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Osteoblastoma
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in vertebral column!
(morphologically same as osteoid osteoma...interlacing trabeculae of woven bone surrounded by osteoblasts) |
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Endochondroma
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benign cartilaginous neoplasm found in intramedullary bone
usually in distal extremities (vs. chondrosarcoma which is found in pelvis, spine, scapula, humerus, tibia or femur) |
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Osteosarcoma
(osteogenic sarcoma) |
2nd most common primary malignant tumor of bone (after multiple myeloma)...osteoid and bone producing neoplasm
poor prognosis tibia and femur near the knee 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) |
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Predisposing factors to osteosarcoma
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Paget's disease of bone, bone infarcts, radiation and familiar retinoblastoma (probably due to loss of the Rb suppressor gene locus on chromosome 13)
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Radiologic signs of osteosarcoma
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Codman's triangle!!
Sunburst pattern (spiculated pattern of growth)!! (from elevation of periosteum by the expanding tumor) |
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Ewing's sarcoma
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anaplastic small blue malignant tumor
most common in boys less than 15 years old extremely aggressive with early mets, but responsive to chemotherapy in diaphysis |
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Characteristic onion-skin appearance in bone
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Ewing's tumor
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11;22 translocation
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Ewing's sarcoma
commonly appears in the diaphysis of long bones, pelvis, scapula and ribs |
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Chondrosarcoma
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malignant cartilaginous tumor
most common in men aged 30-60 may be of primary origin or from osteochondroma |
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Location of chondrosarcoma
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pelvis, spine, scapula, humerus, tibia and femur (as opposed to endochondroma, which is benign and located in the distal extremities)
expansile glistening mass within the medullary cavity |
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Sicca syndrome
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dry eyes, dry mouth, nasal and vaginal dryness, chronic bronchitis, reflux esophagitis
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Classic triad of Sjogren's syndrome
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1. xerophthalmia (dry eyes, conjunctivitis)
2. xerostomia (dry mouth, dysphagia) 3. arthritis |
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Other things associated with Sjogrens
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parotid enlargement, increased risk of B cell lymphoma, dental caries
autoantibodies to ribonucleoprotein antigens SS-A (Ro) and SS-B (La) predominantly affects females between 40 and 60 years of age |
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Septic infectious arthritis
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Staph aureus, Streptococcus and Neisseria gonorrhoeae
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Gonococcal arthritis
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monoarticular, migratory arthritis with an asymmetrical pattern
affected joint is swollen, red and painful |
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Chronic infectious arthritis
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TB (from mycobacterial dissemination) and Lyme disease
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Seronegative spondylo arthropathies
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arthritis without rheumatoid factor (no anti-IgG antibody)
strong association with B27 (gene that codes for HLA MHC I) |
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Ank spond
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chronic inflammatory disease of spine and sacroiliac joints (ankylosis...stiff spine)
uveitis and aortic regurgitation BAMBOO SPINE |
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Reiter's syndrome triad
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conjunctivitis and anterior uveitis
urethritis arthritis (can't see, can't pee, can't climb a tree!!) |
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Post-GI or chlamydia infection
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Reiter's syndrome!
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Psoriatic arthritis
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with psoriasis
asymeetric and patchy involvement Dactylitis (sausage fingers) is commonly observed "pencil and cup" deformity on x-ray seen in fewer than 1/3 of patients with psoriasis |
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False positives on syphilis tests
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LUPUS!!
because of antiphospholipid antibodies |
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antibodies to double-stranded DNA
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very specific, poor prognosis for SLE
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anti-smith antibodies
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very specific for SLE, but not prognostic
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Antihistone antibodies
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drug-induced lupus
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Sarcoidosis
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immune mediated, widespread non-caseating granulomas
elevated ACE levels!! |
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More on sarcoidosis
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restrictive lung disease, bilateral hilar lymphadenopathy, erythema nodosum, Bell's palsy, epithelial granulomas containing Schaumann and asteroid bodies
Uveoparotitis and hypercalcemia (due to elevated conversion of vitamin D to its active form in the epitheliod macrophages) |
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GRAIN for sarcoidosis
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Gammaglobulinemia
Rheumatoid arthritis ACE increase Interstitial fibrosis Noncaseating granulomas |
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increased ESR in...
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polymyalgia rheumatica
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progressive symmetric proximal muscle weakness caused by CD8+ T cell induced injury to myofibers
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Polymyositis
muscle biopsy with evidence of inflammation is diagnostic (necrotic muscle cells and a lymphocytic infiltrate) |
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heliotrope rash
increased risk of malignancy |
Dermatomyositis
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increased CK, increased aldolase and positive ANA, anti-Jo-1
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polymyositis/dermatomyositis
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Treatment of polymyositis and dermatomyositis
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steroids
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Autoantibodies to postsynaptic AChR cause ptosis, diplopia and general weakness
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Myasthenia gravis
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Associated with thymoma
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Myasthenia gravis
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Symptoms worsen with muscle use
Reversal of symptoms occurs with AChE inhibitors |
myasthenia gravis
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Autoantibodies to presynaptic calcium channels
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Lambert Eaton syndrome
results in decrease RELEASE of ACh...leading to proximal muscle weakness symptoms improve with muscle use no reversal of symptoms with AChE inhibitors alone |
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NMJ disease associated with paraneoplastic disease!
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small cell lung cancer
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antibodies to U1RNP
(anti-nRNP) |
mixed connective tissue disease
also has speckled nuclear appearance on morphologic ANA analysis |
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Raynaud's phenomenon, arthralgias, myalgias, fatigue and esophageal hypomotility
responds to steroids |
Mixed connective tissue disease
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excessive fibrosis and collagen deposition throughout the body
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scleroderma (progressive systemic sclerosis)
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Diffuse scleroderma
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widespread skin involvement, rapid progression, early visceral involvement
associated with anti-Scl-70 antibody |
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CREST syndrome
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calcinosis, raynauds, esophageal dysmotility, sclerodactyly and telangiectasia
anticentromere antibody |
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Liposarcoma
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malignant fat tumor that can be quite large
will recur unless adequately excised |
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Rhabdomyosarcoma
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most common soft tissue tumor of childhood
malignant arises from skeletal muscle, most often in head/neck |
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Lipoma
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soft, well encapsulated fat tumor
benign...simple excision is usually curative |
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Acantholysis
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separation of epidermal cells
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Acanthosis
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epidermal hyperplasia
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Parakeratosis
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hyperkeratosis with retention of nuclei in stratum corneum (psoriasis)
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Verrucae
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warts
soft, tan-colored, cauliflower like lesions epidermal hyperplasia, hyperkeratosis, koilocytosis verruca vulgaris on hands condyloma acuminatum on genitals (caused by HPV) |
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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. increased melanin pigment
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ephelis
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Acanthosis with parakeratotic scaling
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nuclei still in stratum cornem
Psoriasis!! increased stratum spinosum, decreased stratum granulosum |
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Auspitz sign
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bleeding spots when scales are scraped off
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flat, greasy, pigmented squamous epithelial proliferatoin with keratin filled cysts (horn cysts)
looks 'pasted on' common benign neoplasm of older persons |
seborrheic keratosis
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decreased melanin production, normal melanocyte number
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albinism
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decrease in melanocytes
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vitiligo
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honey colored crusting
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impetigo
staph or strep pyogenes very contagious |
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cellulitis
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painful and acute...spreading infection of dermis and subcutaneous tissues
staph aureus or strep pyogenes |
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Necrotizing fasciitis
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deeper tissue injury, usually from anaerobic bacteri and strep pyogenes...results in crepitus from methane and CO2 production
flesh eating bacteria |
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SSSS
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staphylococcal scalded skin syndrome
exotoxin destroys keratinocyte attachments in the stratum granulosum only |
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White, painless plaques on the tongue that cannot be scraped off
EBV mediated relatively specific for HIV |
hairy leukoplakia
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IgG against hemidesmosomes
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Bullous pemphigoid!!
epidermal basement membrane...linear immunofluorescence |
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Spares oral mucosa
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bullous pemphigoid
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IgG antibody against desmosomes
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Pemphigus vulgaris
potentially fatal acantholysis (separation of epithelial cells) intraepidermal bullae involving skin and oral mucosa |
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Associated with celiac disease
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dermatitis herpetiformis
pruritic papules and vesicles deposits of IgA at tips of dermal papillae |
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Toxic epidermal necrolysis
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similar to Steven Johnson syndrome
more severe with greater epidermal involvement |
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Erythema multiforme
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associated with infections, drugs, cancers, and autoimmune disease
presents with multiple types of lesions (macules, papules, vesicles, and target lesions...red papules with a pale central area) |
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Pruritic, purple, polygonal, papules
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Lichen planus
sawtooth infiltrate of lymphocytes at dermal-epidermal junction |
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Actinic keratosis
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premalignant lesions caused by sun exposure
risk of carcinoma is proportional to epithelial dysplasia precursor to squamous cell carcinoma |
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Acanthosis nigricans
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hyperplasia of stratum spinosum
hyperlipidemia association and visceral malignancy |
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"palisading" nuclei
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basal cell carcinoma
rolled edges with central ulceration...pearly papules |
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Melanoma
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significant risk of metastases
S-100 tumor marker! associated with skin exposure...fair-skinned persons are at high risk DEPTH of tumor correlates with risk of metastasis |
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Dysplastic nevus
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precursor to melanoma
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