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403 Cards in this Set
- Front
- Back
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transient synovitis of hip presentation
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-preceding URI in 50%
-male -hip pain/limp -NSAIDS |
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septic arthritis of hip presentation
|
-ill/tooxic appearing
-refusal to walk/bear weight -2nd most after knee -staph/strep |
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organism implicated in septic arthritis of hip
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staph
strep |
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most common site of osteomyelitis in children
|
proximal femur
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osteomyelitis of hip presentation
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-allow gentle manipulation of hip joint
-similar to septic hip |
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legg-calve-perthes (LCP): what is it
|
-avascular necrosis of femoral head
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LCP presentation
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5 yo boy coming in with limp
-limp/hip pain -dec ROM of hip secondary to pain -MRI |
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presentation of slipped capital femoral epiphysis
|
-older boy (13-14yo)
-obese -limp, abnL internal rotation of hip |
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osteoid osteoma presentation
|
-b9
-usually older child -night time pain -ovoid lesion with surrounding cortical thickening |
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patellofemoral pain presentation
|
-girls- adolescents
-pain in ant knee -pain walking downhill -theater sign -weak quads |
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what is osgood-schlatter dz
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-repeated trauma to tibila tuberosity leading to microavulsion fx
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presentation of osgood-schlatter
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-athletes
-pain over tubercle, worse w/ exercise -unable to knee -tendernes,, swelling -enlarged/fragmented tubercle |
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b9 hypermobility syndrome
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-pain at night
-legs (esp knees) -dislocate joints -collagen type III dysfunction |
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most commone rhuematic dz of childhood
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JIA
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most common type of JIA
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oligo
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joints involved in oligo JIA
|
large joints
esp knees |
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oligo JIA presentation
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early childhood
girls iridocyclitis/uveitis |
|
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polyrthritis: RF + vs RF -
|
both:
-large and small joints -symmetrical -female RF+ -late childhood -rheumatoid nodules -very destructive/severe RF- -any age -mild manifestations |
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systemic JIA presentation
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-daily fever spikes
-salmon evanescent rash -hepatosplenomegaly -serositis -pleuritis |
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rash in systemic JIA
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-trunk, proximal extremities
, pressure points -short duration, migratory -not puritic |
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enthesitis related JIA presentation
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-sacroiliac joint tenderness
-inflamm spinal pain -HLA B27 -less than 40 -uveitis, spodyloarthritis, sacroilitis w/ IBD -uveitis with pain, redness, photophobia |
|
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psoriatic arthritis
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-arth and psoriasis
-dactylitis -nail abnL -psoriasis in relative -DIPs |
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3 main CT dz we talked about
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-juvenille SLE
-scleroderma -juvenille dermatomyositis |
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juvenile SLE patho
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-autoimmune dz characterized by widespread inflamm of blood vessles and CT
|
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presentation of juvenile SLE
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- ANA +
- adolescent female - constitutional symptoms - AA and hispanic |
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susceptibility to SLE
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-genetics (HLADR2DR3)
-complement def (partial) -environmental (smoking, UV, diet, meds) |
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juvenile scleroderma patho
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excessive acumulation of collagen in tissues; inc TGF
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most common type of juvenile scleroderma
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linear
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presentation of linear juvenile scleroderma
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-linear streaks of upper < lower extremities
-en coup de sabre |
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morphea scleroderm
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-plaques with red margin and hypopigmentation in the middle
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presentation of juvenille hermatomyositis
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-limping
-refusal to climb steps -rash |
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characteristic cutaneous changes in juvenille hermatomyositis
|
-symmetric weakness of proximal musculature
-heliotrope rash -gottron's papules -elevated muscle enzymes -necrosis/inflamm of muscle |
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finding:
hep B vasculitis? |
PAN
|
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finding:
leading cause of acquired heart dz in devo countries vasculitis? |
kawasakis
|
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|
finding:
testicular pain vasculitis? |
PAN
|
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finding:
tx of corticosteroids started immediately vasculitis? |
giant cell
|
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finding:
young asian women vasculitis? |
takayasu's
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finding:
absent pulses, HTN vasculitis? |
takayasu's
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finding:
renal pulmonary w/ URT involvement vasculitis? |
granulomatosis with polyangtitis (wegners)
|
|
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finding:
antiproteinase 3 c-ANCA vasculitis? |
granulomatosis with polyangtitis (wegners)
|
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finding:
asthma, eosinophila, rash vasculitis? |
churg strauss
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finding:
antimyeloperoxidase p-ANCA vasculitis? |
MPA
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finding:
most common in children vasculitis? |
HSP
|
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finding:
hep C vasculitis? |
essential mized cryoglobulinemia
|
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|
finding:
oral, nasal, genital ulcers vasculitis? |
behcet's syndrome
|
|
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finding:
abnL pathergy test vasculitis? |
behcet's
-nonspecific skin reaction after intradermal saline injection |
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finding:
bilateral panuveitis vasculitis? |
bachet's
sarcoid |
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finding in behcet's?
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small vessel vasculitis (ANCA-)
-leukocytoclastic venulitis with fibrinoid necrosis |
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finding:
palpable purpura on ankles and feet vasculitis? |
essential mixed cyroglobinuliemia
|
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finding:
follows an upper RTI vasculitis? |
HSP
|
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finding:
palpable purpura on buttocks and lower extremities vasculitis? |
HSP
|
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HSP patho
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small vessel vasculitis
-immune complex deposition dz with IgA |
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MPA vs CSS
|
MPA:
-no granulomas -no asthma -pANCE -no eosin CSS: -eosin -pANCA -asthma -granulomas |
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finding:
ear fullness without ear infection vasculitis? |
wegners
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|
|
finding:
PMR (& what is it) vasculitis? |
giant cell arteritis
-flu-like symptoms with joint and muscle pain |
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patho of GCA
|
-granulomatous vasculitis and intimal fibrosis
-segmental -branches of carotid artery(most common temporal) -med/large |
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presentation of GCA
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-> 50 yo
-females -headaches -jaw claudication -high risk of blindness if untx -elevated ESR -nL CK |
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presentation of wegners
|
-males
->40 yo -nasopharynx, lungs, kidneys -sinusitis -nasal mucosal ulceration -hemoptysis w/ bilateral lung infiltrates -rapidly progressing glomeruonephritis |
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patho of wegners
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necrotizing, granulomatous vasculitis of small arteries and veins with granuloma formation
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patho of kawasakis
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-coronary arteries
-generalized vasculitis, infiltration of neutros and lymphos leading to destruction of internal elastic lamina and fibroblastic proliferation |
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presentation of kawasakis
|
-bilateral conjunctivitis
-rash on palms and soles with peeling -strawberry tongue -cervial lymphadenopathy -coronary anuerysms |
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tx of kawasakis
|
aspirin and IV IG
|
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PAN patho
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small/med necrotizing vasculitis
-no grans -segmental -branch points -early fibrinoid necrosis followed by healing with fibrosis which leads to dilatations/aneurysms -string of pearls |
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presentation of PAN
|
-ab pain, melena
-hematuria -splinter hemorrhages -ankles purpura rash -testicular pain -neuro disturbances -cANCA (MPO) |
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finding:
asian children < 4 yo vasculitis? |
kawasakis
|
|
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patho of EMC
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cryoglobulins are cold precipitable monoclonal or polyclonal IgGs
-small vessel -circulating cryoprecipitates |
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|
function of ACL tears
|
-turning/twisting/pivoting
-instability of tibio-femoral joint |
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|
hx of ACL tear
|
-pivot/twist
-pop/swell -females |
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|
exam of ACL tears
|
-effusion
-limited ROM -tenderness -+lachman test |
|
|
pathognomic of ACL tears
|
segond fx (avulsion fx of lateral tibila plateau)
|
|
|
tx of ACL tears
|
age, activity, arthriti,
-PT -icing/nsaids -reconstruction |
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|
ACL reconstruction: allo vs auto
|
alllo: expensive, risk of viral transmission, higher fail rates, higher rates of post=op instab
auto: cheaper, heal predictably, remodel better, lower fail rates |
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meniscus tears: hx
|
-acute: twist/pivot
-chronic: pain with twisting, |
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exam findings of men tear
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-tibfem joint line tenderness
-effusion -+mcmurrays -quad atrophy |
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tx of meniscus
|
type of tear, age, activity, shape of tear
-acute, young, peripheral, shape |
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patellar dislocation: hx
|
-acute, twisting, swelling
-always lateral |
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exam findings in patellar dislocation
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-effusion, medial pain, lateral pain
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tx of patellar dislocation
|
non surg:
-first time, recurrent instability surg: -avulsion fx, persistent aubluxation, osteochondral loose body, chronic reccurent instab |
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non op tx of pat disloc
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-core, hip, quads, patellar stabilizer bracing
|
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articular cartilage hx
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-twisting, acl tear, patellar dislocation
-chronic: osteoarthritis -osteochondral: AVN |
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exam findings of articular cartilage injury
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-pain, effusion, quad strophy, loose body, weight bearing line with coronal plane alignment
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|
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tx decision factors for artic cart injury
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-loose body
-arthritis -non op before -size -limb alignment -subchondral involvement -age |
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non op artcart injury
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-no loose: pt and icing, nsaids
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|
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op for art injury
|
-remove loose bodies
-realign with osteotomy -debridement, marry stim, osteochon transfer, cartilage cell transplant MOTION for POSTOP |
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finding: pain of snuffbox
what is it? |
scaphoid fx
|
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What are the signs and symptoms of Acute Carpal Tunnel Syndrome?
|
– Pain, parasthesias, numbness in
median nerve distribution – Often associated with distal radius fracture |
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Goal of hip fracture treatment in elderly?
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early mobilization
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Describe fractures using basic terms
|
• What bone?
• Where on the bone? – Proximal, distal, diaphyseal • Open vs Closed • Simple vs Comminuted (crushed) • Intra-articular vs Extra-articular |
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pathophys of SLE
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-generates Abs vs host that damage multiple tissues
-type II (cytotoxic) and type III (Ag-Ab complex deposition) HSR |
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lupus criteria neumonic
|
I-mmunologic
M-alar D-iscoid rash A-rthritis M- N-euro S-erositis H-ematologic A-NA R-enal dz P-leuritis and pericarditis |
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one of common causes of death in lupus pts
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-renal damage (diffuse proliferative glomerulonephritis)
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heart involvment in SLE
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-endo, myo, pericarditis
-libman-sacks endocarditis (veggies on both sides of the valve - deposition of Ag-Ab complexes) |
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hematologic involvement of SLE
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-anemia
-thrombocytopenia -leukopenia |
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immunological findings in SLE
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-ANA (highly sensitive)
-antidsDNA (highly specific) -antiSMITH |
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drug induced SLE
characteristic Ab |
-hydralazine
-procainamide -isoniazid (others: minoclycline, TNF inhibitors) removal results in remission -antihistone Ab |
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rashes seen in SLE
|
-malar (spares nasolabial folds)
-discoid: rash in between knuckles, subacute cutaneous, raynauds |
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antiphospholipid syndrome
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-seen in SLE
-autoAb against Prs bound to phospholipids -anticardiolipin, and lupus antiCoAg -lead to false + syphillis, and falsely-elevated PTT |
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complication of the lupus antiCoAg Ab
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arterial and venous thrombosis
-DVT, hepatic vein thrombosis, placental thrombosis (recurrent preg loss), stroke -requires lifelong antiCoAg |
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NLS organ system symptos
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-usually disappear w/ clearance of materal Abs (6-8 mo)
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NLS heart risk due to
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anti SSA or anti SSB in mother place fetus at high risk for devo of congenital health block
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pregnancy outcome in NLS
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-rash lasts for avg of 17 week
-renal or CNS activity has poor outcome -thrombocytopenia is worrisome |
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what is sjogren syndrome
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autoimmune destruction of lacrimal and salivary glands
-lymphocyte-mediated damage (type IV HSR) with fibrosis |
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classic presentation of sjogren syndrome
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-dry eyes
-dry mouth -recurrent dental carries in older woman -"can't chew a cracker, dirt in my eyes" |
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Abs in sjogren syndrome
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-ANA
-antiribonucleoprotein aka antiSSA and antiSSB (targets of these Ab: ribonucleoproteins) |
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bx in sjogrens
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-diffuse collection of lymphos in parotid gland
-eosinophillic deposit of thickened secretion in lumen of salivary duct -focal lympho salidenitis in minor salivary gland |
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sjogrens pts are at increased risk of what GI problem?
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B-cell lymphoma (MALT)
-unilateral enlargement of partoid late in dz course |
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sicca infection risks
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gram +
candidiasis |
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renal problems seen in sjogrens
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-distal renal tubular acidosis
-hypokalemic paralysis -rare glom dz |
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liver problems seen in sjogrens
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-Anti Mi (PBC)
-hep C |
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which autoimmune dz has a strong assoc with thyroid dz
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sjogrens
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waldenstrom's macroglobulinemia seen in?
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late sjogrens
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what is scleroderma
|
autoimmune tissue damage with activation of fibroblasts and deposition of collagen (fibrosis)
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diffuse scleroderm characteristics
|
-exhibits skin involvement and early visceral involvement
-diffuse skin thickening -proximal extremities -symmetrical (upper body) -esophagus most commonly affected (disordered motility) |
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Abs seen in diffuse scleroderma
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-ANA
-anti DNA topoisomerase I (Scl-70) -no anti-centromere Abs |
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visceral invovlement in scleroderma
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lungs, heart, GI, kidneys
|
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localized/limited scleroderm characteristics
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-local skin and late visceral invovlement
-Calcinosis/antiCentromere Ab Raynaud Esophageal dysmotility Sclerodactyly Telangiectasias of skin |
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Raynauds - primary
|
-15-30 yo
-symmetric -familial -no ulcers, gangrene, pitting -no capillary dropout in nailfold -negative ANA |
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Raynauds - secondary
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->40 yo
-male -digital ulcers -asymmetric -abnL capillary dropout in nailfolds |
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Ab seen in limited/localized scleroderma
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anti-centromere Ab
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skin changes in scleroderma
|
-puffy hands
-pruritis -hyperpigmentation (may change to spotty hypopig) -telang -calcinosis -digital ulcers |
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GI findings in scleroderma
|
-esophageal dysmotlity, GERD
-wide mouthed diverticuli -GAVE (watermelon stomach) -thinning gastric mucosa) |
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pulmonary findings in scleroderma
|
-diffuse SSc - pulmonary fibrosis
-leading cuase of death -ground glass -restrictive - lower lobe -pulmonary arterial HTN - |
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cardiac findings in scleroderma
|
-arrhytmias
-effusion/carditis |
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renal findings in scleroderma are treated with
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tx with ACE Inhibitors for blood pressure control
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bone findings in scleroderma
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-tendon friction rubs
-myopathy -osteolytis |
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Ab seen in MCTD
|
serum Abs against U1 ribonucleoprotein
anti U1-RNP |
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CRP activates
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classic C' pathway
|
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elevated CRP indicates
|
-bacterial infection
-vasculitis -malignancy (not good indicator of lupus activity) |
|
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CRP is synthesized in response to
|
Il6 and other cytokines
|
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autoAbs are markers for
|
chronic immunoinflammation and rheumatic dz
|
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slu antiphosphos
|
-lupus antiCoAg
-anticardiolipin Ab -anti B2 glycoprotein I Ab |
|
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ANA specificity levels
|
1. sle
2. mctd 3. scleroderma 4. polymyositis 5. sjogrens |
|
|
anti UiRNP correlates with
|
mild SLE
raynauds restrictive lung dz |
|
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anti SSa correlates with
|
subacute cutaneous luus
|
|
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anti ribosomal phosphoproteins correlates with
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CNS vasculitis (cerebritis)
|
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CH50 correlates with
|
rule out C' deficiencies
-ability of serum to lyse 50% of standard RBCs with antiSRBC Ab |
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C3 and C4 use
|
need base line
-c4: more sensitive to minor episodes of C' activation of classical pathway |
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autoAbs in sjogrens
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anti SSA (can be ANA negative) and SSB
|
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anti-centromere seen in
|
limited/localized scleroderma
|
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anti-topoisomerase I (Scl-70)
|
diffuse scleroderma
|
|
|
RF
|
rheumatoid factor
-autoAb against Fc portion of IgG ordered with anti-CCP |
|
|
anti-CCP
|
cyclic citriulinated peptide
-ordered with RF -deimination of arginine residues within proteins to citrulline by PADI enzyme -citrullinated proteins are found in synovial lining of RA pts - target of autoimmune response -presence of RF and anti-CCP in individual with 2 or more relatives with RA gives 100% predictive value for devo of RA |
|
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ANCAS location
|
primary cytoplasmic granules of PMNs and mono lysosomes
|
|
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2 common ANCAs
|
myeloperoxidase and proteinase 3
|
|
|
gold standard for ANCA
|
indirect immunofluoresense
|
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cANCA
-seen in? -fixing? |
wegeners
-methanol or ethanol |
|
|
pANCA
-seen in -fixing? |
churg strause, MPA
methanol PMN -myeloperoxidase |
|
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atypical ANCA
|
faint cyto and strong linear perinuclear staining
|
|
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anti-ribosomal Ab
|
cytoplasmic but also stain lymphos
|
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smooth muscle Ab
|
cytoplasmic staining
|
|
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polyclonal hypergammaglobulinmeia
|
faint homogenous cytoplasmic pattern
|
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proteinase 3 - main target of
|
cANCA
|
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myeloperoxidase - main target of
|
pANA or pauci-immune GN
|
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elevated ESR and cRP are not specific for
|
rheumatolgoic process
|
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ESR elevation caused by
|
many
|
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myeloperoxidase fixation
|
-ethanol: leave grnaules and migrate to postive charged nuclear membrane
|
|
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*pathognamonic of ACL tear
|
lateral bone bruising from pivot shift episode
|
|
|
hemidesmosomes are seen where?
|
stratum basale
|
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|
cells in stratum basale
|
round to ovoid with large nuclei and prominent nucleoli
|
|
|
tonofilaments are seen in
|
stratum basale, stratum spinosum, granulosum
-specialized intermediate filaments |
|
|
mitotically active layer
|
stratum basale
|
|
|
stratum spinosum cells
|
round to polyhedral with prominent nuclei
|
|
|
prominent feature of stratum spinosum
|
desmosome
|
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|
what are desmosomes
|
cell surface extensions which culminate in a large number of junctions between cells on all sides
-prevent premature exfoliation of skin |
|
|
stratum granulosum color
|
very basophilic
|
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stratum granulosum very rich in
|
keratohyaline granules
|
|
|
keratohyaline granules promote
|
production of keratin through activation and release of lysosomal enzymes
|
|
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what is a special content of stratum granulosum
|
glycolipid secreted into ECspace
-forms barrier to water |
|
|
stratum lucidum
|
hard to ID, only found in thick skin, first layer that exhibits total lack of cell structure
|
|
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stratum corneum layers of
|
keratinized cells devoid entirely of identifiable cell structures
|
|
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stratum corneum often seen as
|
thin layers or wisps in varying stages of exfoliation
|
|
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papillary layer of dermis color
|
lighter than reticular layer
|
|
|
contents of papillary layer of dermis
|
type I and III collagen fibers, elastic fibers, ground substance, fibroblasts, blood vessels, and some inflammatory cells
|
|
|
reticular layer of dermis appearance
|
more coarse owing to abundance of thicken collagen fibers and elastic fibers, smooth muscle, eccrine sweat glands, sweat gland ducts, and bases of hair follicles
|
|
|
eccrine sweat glands
|
-highly coiled, in dermis and sometimes in hypodermis
|
|
|
cells of eccrine sweat glands
|
-clear, serous
-dark, mucous -myoepithelial cells |
|
|
eccrine glands vs. their ducts
|
glands are bigger, 3 cell types, and lighter.
ducts have stratified cuboidal epithelium, are basophilic, and fuse with epidermis (corneum) |
|
|
what are seen in very, very, very thick skin
|
rete ridges and dermal papillae
|
|
|
melanocytes location
|
stratum basale and stratum spinosum
|
|
|
melanocyte staining
|
brown/black
|
|
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function of melanocytes
|
synthesis and delivery of melanin to keratinocytes for protection
|
|
|
pacinian corpuscles shpe
|
large round to ovoid that resemble onions
|
|
|
pacinian corpuscles composition
|
composed of central nerve fiber that is surrounded by layers of cells which are continuous with the endoneurium
|
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|
function and location of pacinian corpuscles
|
detect deep pressure and found in dermis and hypodermis
|
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|
meissner's corpuscles function and location
|
light touch; found in apical portion of the dermal papillae
|
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|
meissner's corpuscles appearance
|
cyclindrical, no along longitduinal axis of papillae
|
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|
composition of hypodermis
|
unilocular fat, and attaches skin to underlying fascia
-portions of hair follicles, eccrine sweat glands, and ducts |
|
|
sebaceous glands found where
|
attached to upper 1/3 of hair follicle in dermis
|
|
|
sebaceous glands cells
|
stratified layers of round cells with single nuclei; as they progress to duct they become pyknotic and lighten up and die off to form sebum which is secreted by these cells (holocrine)
|
|
|
apocrine sweat glands found in
|
axilla, anorectal junction, and genital areas
|
|
|
apocrine sweat gland appearance
|
larger, irregular shape, dilated lumens
|
|
|
secretions of apocrine sweat gland
|
viscous and become odiferous owing to actions of bacteria on surface of skin ("musk") - merocrine!!
|
|
|
components of hear follicle
|
at the base: hair root
hair root forms the hair bulb which has an invagination called the papilla (blood vessels and nerves). majority of cells that comprise the hair root are called the matrix |
|
|
hair follicle equivalent of stratum basale
|
matrix
|
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hair follicle equivalent of stratum granulosum
|
internal root sheath (undergoes keratinization to produce the hair shaft)
|
|
|
hair follicle equivalent of stratum spinosum
|
external root sheath
|
|
|
pyelosebaceous unti
|
-hair follicle
-sebaceous gland -arrector pili m. |
|
|
smooth muscle associated with hair follicle and function
|
arrector pili muscle
-contraction causes erection of hair |
|
|
livedo reticularis patho
|
vascular condition characterized by purplish discoloration of skin, usu on legs
lacy or net-like and can be aggrevated by the cold |
|
|
livedo reticularis associated with
|
lupus, antiphospholipid syndrome, calciphylaxis, and medications (i.e. hydroxurea)
|
|
|
Reed's syndrome pathology
|
patient with multiple leiomyomas (smooth muscle tumors) - brown to pink papules
|
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|
Reed's syndrome genetics
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AD; defect in chromosome 1q42-43 (the gene encoding fumarate hydratase)
fumarate hydratase is responsible for |
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presentation of Reed's syndrome
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pseudo-darier sign may be present which is transient piloerection of elevation of a lesion induced by rubbing, FH, uterine lesions, renal Cancer
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acral areas
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hands, feet, ears and nose
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blaschko's lines
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somatic mosaicsm
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nummular
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circular or oval lesions or drops
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characteristic of BCC
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arborizing pattern of blood vessels
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KOH test
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tinea: hyphae in skin/hair
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scabies prep test
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scabetic infestation: mite, eggs, waste
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trichogram test
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hair abnormalities: genetic and acquired
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tzanck smear test
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HSV/VZV evaluation: can't tell these two apart with this test
looking for: 1) molding of nuclei - taking shape of each other 2) margination of chromatin - darker on outer portion of nucleus 3) multinucleation |
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use of shave biopsy
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squamous cell carcinoma, benign appearing neoplasms
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use of punch biopsy
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dermatitis/eruption: want to see epidermis, dermis, and subcutis
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use of incisional biopsy
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need a sample of lesion for diagnosis, not all of lesion is removed
large lesion that we think is deep down i.e. erythema nodosum - inflammation in subQ (bruise-like lesions on shins) |
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use of excisional biopsy
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removal of the entire lesion with some margin if you have a suspicion for melanoma
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use of wedge biopsy
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deep biopsy geared to get adipose
most commonly referencing panniculitis or vasculitis |
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use of indirect immunoflouresence
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immunobullous, collagen vascular disease
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lichen planus assocation
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hepatitis C
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Patch testing - tool for:
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a tool for identifying allergens in patients with allergic contact dermatitis
this test detects a delayed type IV hypersensitivity reaction |
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grading for patch testing
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1+ palpable erythema
2+ papules and vesicles 3+ bullae positive result must be relevant to the eruption |
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psoriasis appearance
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well-demarcated plaques with silvery scale
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side effects of corticosteroids
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1) thinning of skin
2) lightening of skin color 3) acne 4) striae formation 5) ulceration (especially in patients with impaired circulation) |
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side effects of Antibiotics
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1) phototoxicity
2) stephens johnson syndrome/Erythema multiforme |
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side effects of immunosuppressants
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1) reactivation of latent TB
2) decreased immune surveillance for tumor prevention |
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guidelines for Mohs surgery
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1) skin cancers greater than 2 cm in diameter
2) lesions on skin and face - particulary in embryonic fusion planes, eyelids, nasolabial/nasofacial folds 3) histologically infiltrative skin tumors or ill-defined tumors 4) recurrent skin tumors 5) tumors in sites of previous radiation therapy 6) tumors in immunosuppressed patients (i.e. transplant patients) |
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how does phototherapy work?
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UVB/UVA target lymphocytes in skin
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phototherapy can be used for what syndromes?
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1) psoriasis
2) atopic dermatitis 3) generalized pruritis 4) mycosis fungiodes |
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treatment for acne
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retinoids, corticosteroids, antibiotics, photodynamic, chemical peels
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treatment for psoriasis
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retinoids, corticosteroids, immunosuppressants, biologics, phototherapy
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treatment for verruca
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destructive methods: salacylic acid, urea, canthraridin (causes blistering), liquid nitrogen
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treatment for bullous pemphigoid/pemphigus
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corticosteroids, immunosuppressants, immunoglobulins
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macules definition
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flat, nonpalpable lesion of different color than the surrounding skin
less than 1 cm in diameter |
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patch definition
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similar to macule (flat, nonpalpable lesion of a different color than the surrounding skin
larger than 1 cm in diameter |
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papule definition
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small, palpable, elevated skin lesion less than 1 cm in diameter
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plaque definition
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similar to papule (small, palpable, elevated skin lesion)
larger than 1 cm in diameter |
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vesicle definition
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small, fluid-containing blister
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bulla definition
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large, fluid containing blister
0.5 cm or more in diameter |
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pustule definition
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blister containing pus
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crust definition
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dried exudate from a vesicle, bulla, or pustule
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hyperkeratosis definition
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increased thickness of the stratum corneum
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parakeratosis definition
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hyperkeratosis with retention of nuclei of keratinocytes
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acanthosis definition
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thickening of the epidermis
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spongiosis definition
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epidermal intercellular edema with widening of intercellular spaces
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acantholysis definition
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separation of epidermal cells one from the other; cells appear to float within the extracellular fluid
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lichenification definition
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accentuation of skin markings caused by scratching
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nodules definition
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similar to papule (small, palpable, elevated skin lesion)
larger than 1 cm in diameter centered in the dermic or subQ tissue |
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tumors definition
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soft or firm, freely movable or fied masses of various shapes and sizes
larger than 2 cm in diameter |
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wheals definition
(aka) |
hives
transient, edematous, plateau-like elevations |
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scales (exfoliation) definition
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collection of stratum corneum/keratin
when formation of keratin is rapid or process of normal keratinzation is interfered with the result is scaling |
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erosion definition
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loss of some or all of epidermis
it may become crusted but heals without scar |
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ulcers definition
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excavations resulting from loss of all epidermis and some of dermis
heal with a scar |
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fissures (cracks, clefts) definition
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linear clefts through epidermis and into dermis. occur where skin is thickened and inelastic from inflammation and dryness
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excoriations and abrasions definition
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scratch marks
linear lesions produces by mechanical means involving epidermis and superficial dermis abrasion: skin damage as a result of mechanical trauma or constant friction |
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atropy definition
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thinning of any part of the skin; within time there is a depression
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scars definition
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composed of new connective tissue that replaces lost substance in dermis or deeper parts of the skin as a result of injury or disease
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burrow definition
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narrow, elevated tortuous channel produced by a parasite
-scabies |
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telangiectasia definition
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dilated superficial blood vessels
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petechiae definition
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pinpoint to round, red spots resulting from intradermal hermorrhage
-described as red macules that are less than 1 cm and non-palpable |
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ecchymoses definition
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red to purple areas resulting from intradermal hermorrhage
-described as red to purple patches greater than 1 cm and non-palpable |
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"palpable" purpura definition
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circumscribed, purple, palpable hemorrhage into skin, which is usually less than 1 cm in diameter
-leukocytoclastic vasculitis (behcet's) |
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zosteriform definition
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following dermatomes
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color of a lesion is affected by
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-color of skin
-type of pigment within the lesion -where the pigment is in the skin -presence or absence of inflammation -thickeness of epidermis -hydration of skin |
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color of skin is determined by
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-oxyhemoglobin
-melanin -reduced hemoglobin -carotene |
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key morphologic finding of lichenoid
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key morphologic finding of lichenoid
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key morphologic finding of psoriasiform
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regular epidermal hyperplasia
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key morphologic finding of spongiotic
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intraepidermal intercellular edema
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key morphologic finding of vesiculobullous
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blistering within or beneath the epidermis
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key morphologic finding of granulomatous
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chronic granulomatous inflammation
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key morphologic finding of vasculopathic
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pathological changes in cutaneous blood vessels
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pathology of lichenoid
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compact hyperkeratosis, wedge-shaped hypergranulosis, epidermal acanthosis with saw tooth rete ridges, basal cell damage resultin in dyskeratotic keratinocytes, and band like lymphocytic infiltrate
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clinical appearnace of lichenoid
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flat with subtle fine white dots and lines
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primary lesion of lichenoid
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purple, polygonal, pruritic, flat-topped papule; the surface has a fine reticulate pattern of white dots and lines
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location of lichenoid
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wrists and ankles
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nail involvments of lichenoid
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longitudinal ridging and nail splitting; pterygium formation is characteristic
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treatement of lichenoid
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steroids, retinoids, light therapy, cyclosporin
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pathogenesis of lichenoid
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T-cell immune mediated
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pathology of psoriasiform
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hyperkeratosis and parakeratosis, collections of neutros within stratum corneum and stratum spinosum, regular epidermal acanthosis, dilated capillary loops and dermal inflammatory infiltrate of lymphocytes and neutrophils
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munro's microabscesses
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neutrophils in stratum corneum
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spongiform pustule of kogoj
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neutrophils in stratum spinosum
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clinical appearnace of psoriasiform
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increased epidermal proliferation resulting in accumulation of stratum corneum
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main symptom of psoriasiform
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pruritis
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primary lesion of psoriasiform
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sharply demarcated, erythematous papules and plaques overlying silver scale; removal of the scale results in pinpoint bleeding (auspitz sign)
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location of psoriasiform
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scalp, elbows, and knees - symmetric
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nail involvments of psoriasiform
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pitting, onycholysis, oil spots
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pathogenesis of psoriasiform
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genetic predisposition; Th1 mediated process which results in release of cytokines including TNF
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spongiotic/eczematous - associated with?
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allergic rhinitis and asthma
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diseases included in spongiotic/eczematous
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atopic dermatitis, contact dermatitis, seborrheic dermatitis
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pathogenesis of atopic dermatits
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abberant T cell response, perhaps to staph superantigen results in activation of TH2 cells
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hallmark of atopic dermatits
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puritis
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presentation of 2+ year olds with atopic dermatits
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chronic, lichenified and scaling form of the disease
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location of chronic form of atopic dermatits
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face, neck, trunk, flexural aspects of extremities
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location of atopic dermatits
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scalp, face (especially the cheeks), posterior neck, trunk, and extensor aspects of the extremities
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atopic dermatits prone to develop what?
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secondary infection with staphylococcal organisms, as well as viruses and fungi
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two types of contact dermatitis
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irritant and allergic
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irritant dermatitis caused by
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chemical exposure
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acute corrosion is caused by
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single exposure to strong acids and alkalis
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acute irritation is caused by
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a single exposure to chemicals such as strong solvents and non-corrosive acids and bases
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cumulative irritation is caused by
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repeated exposures particulary to surfactants and emulsifiers
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phototoxicity is caused by
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exposure to irritating chemicals which require light for their activation
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clinical presentation of irritant contact dermatitis
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varies based on irritant: i.e. corrosion following phenol exposure or chronic scaling and xerotic dermatitis of "dishpan" hands
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allergic contact dermatitis is caused by
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exposure to chemicals to which the individual has previously become sensitized
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allergic contact dermatitis is what type of reaction
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type IV or delayed-type Hypersensitivity reaction of skin
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clinical presentation of allergic contact dermatitis
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erythematous, scaling, papulovesicular dermatitis at sites of contact with the allergen
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treatment of allergic contact dermatitis
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glucocorticosteroid and oral antihistamine
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proposed etiology of seborrheic dermatitis
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overgrowth of pityrosporum, a yeast that normally inhabits sebaceous skin
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types of seborrheic dermatitis
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infantile and adults
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infantile seborrheic dermatitis
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within the first months of life and affects the scalp and intertriginous areas with scales and cruse; the ears and neck might be involved
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adult seborrheic dermatitis
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scalp, face, neck, mid upper chest and intertriginous zones; on the face it involves eyebrows, nasolabrial folds, and retroauricular areas
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vesiculubullous: what correlates with pathogenesis of disease
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level of seperation of skin
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pathology of pemphigus vulgaris
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suprabasilar split with characteristic "tomb stone" formation, acantholysis of keratinocytes, and dermal infiltrate with scattered eosinophils
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clinical presentation of pemphigus vulgaris
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mucous membrane, oral mucosa, intraepidermal blistering, vesicles are flaccid and rupture easily, leaving weeping and crusted erosions
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pathogenesis of pemphigus vulgaris
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-autoimmune blistering disorder
-autoantibodies against desmoglein 3 which is localized to the desmosomes of keratinocytes |
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pathology of bullous pemphigoid
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subepidermal bulla with dermal infiltrate with numerous eosinophils
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clinical presentation of bullous pemphigoid
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autoimmune blistering disorder, most common of subepidermal, occurs mostly in elderly patients, oral involvement is seen, flexural and intertriginous areas
-bullae are large and tense and occur on normal or erythematous skin |
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pathogenesis of bullous pemphigoid
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autoantibodies against antigens of the hemidesmosome on basal keratinocytes
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granuloma annulare pathology
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dermal collection of histiocytes and lymphocytes surrounding areas of altered collagen
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clinical presentation of localized granuloma annnulare
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-lesions are pink-purple thinly bordered annular papules and plaques
- overlying epidermis is normal -appear on lateral or dorsal surfaces of hands, elbows, dorsal feet, and ankles |
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clinical presentation of generalized granuloma annnulare
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diffuse, symmetric, papular, or annular eruption of 10-100s of lesions; lesions favor the neck, upper trunk, upper extremities
-asymptomatic or pruritis |
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granuloma annnulare may be associated with what?
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diabetes
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leukocytoclastic vasculitis pathology
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-involves vessels in the superficial vascular plexus,
-heavy infiltrate of neutrophils with leukocytoclasis (neutrophils degeneration) -vessel walls are thickened by exudation of fibrin (fibrinoid necrosis) and erythrocyte extravasation |
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clinical presentation of leukocytoclastic vasculitis
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palpable purpura
-elevated because inflammation and edema and purpuric because of extravasation of erythroocytes from vessels -lower extremities |
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pathogenesis of leukocytoclastic vasculitis
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immune complex mediated disease leading to complement cascade activation; antigen might be endogenous or exogenous
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patient presents with elevated muscle enzymes, symmetrical weakness of limb girdle muscles & anterior flexors of the neck, heliotrope rash and gottrons papules
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dermatomyositis
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old woman names Rena presents with decreased oral apperture, tight taut skin, salt and pepper discoloration, yellowish skin, digital ulcers.
what meds should she get and what meds should she avoid? |
progressive systemic sclerosis
take ACE-inhibitors and avoid prednisone |
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britney spear's music video toxic shows britney looking like she has what?
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a sunburn (photo-toxic drug reaction)
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DRESS signs and symptoms
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-peripheral eosinophilia
-elevated liver enzymes, -facial edema |
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hepatitis C associations
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-cryoglobulinemia
-telangiectasias -PAN -lichen planus -porphyria cutanea tarda -necrolytic acral erythema |
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stage 1 of lyme disease
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erythema chronicum migrans, flulike symptoms
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stage 2 of lyme disease
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neurologic (bell's palsy) and cardiac (AV nodal block) manifestations
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stage 3 of lyme disease
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chronic monoarthritis and migratory polyarthritis
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BAKE a Key Lyme pie:
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Bell's palsy (bilateral)
Arthritis Kardiac block Erythema migrans |
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rocky mountain spotted fever symptoms
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rash on palms and soles (migrating to wrists, ankles, then trunk), headache, fever
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you drive CARS using your palms and soles
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Palm and sole rash is seen in Coxsackievirus A infection (hand, foot, and mouth disease, Rocky mountain spotted fever, and Syphillis
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primary syphilis
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painless chancre (localized)
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secondary syphilis
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secondary = systemic
-palms and soles rash -treponemes on darkfiel microscopy |
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tertiary syphilis
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gummas, aortitis, neurosyphilis, argyll-robertson pupil
signs: broad based ataxia, positive romberg, charcot joint, stroke without HTN |
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signs of congenital syphilis
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-saber shins
-saddle nose -CN VIII deafness -hutchinson teeth -mulberry molars |
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argyll robertson pupil
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prostitutes pupil - accomodates but does not react
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VDRL
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-viruses, drugs, rheumatic fever, lupus and leprosy
-nonspecific antibody that reacts with beef cardiolipin -screening tool for these diseases |
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blastomycosis clinical findings
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-inflammatory lung disease
-granulomatous nodules -verrucous or papulopustules Blasto Buds Broadly |
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cryptococcus clinical findings
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molluscum in AIDs patients
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fusarium lesions
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vesiculo-necrotic
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causes of leukocytoclastic vasculitis
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-Viral hep (b and c)
-autoimmune -strep, staph, infections -cryoglobulins -UC, uticarial vasculitis -Lymphoproliferative disease -idiopathic -thiazides, phenothiazines -iodides -sulfa-based drugs, penicilin, Antibiotics |
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HSP characteristics
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after viral infection or strep pharyngitis, IgA, extensor surfaces
palpable purpura |
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cutaneous findings in churg-straus
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nodules, papules on fingertips, purpura, leukocytoclastic vasculitis
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most diagnostic lesion of PAN
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subcutaneous nodules along course of blood vessels, overlying skin is normal or slightly erythematous
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janeway lesions
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endocarditis; NON-TENDER purpuric on palms and soles
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roth spots
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retinal hemorrhages with pale or yellow centers
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osler's nodes
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TENDER purpuric lesions on pads of fingers/toes
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kawasaki's cutaneous findings
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hand-foot erythema and desquamation; morbiliform lesions
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erythema nodosum
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inflammatory lesion of subQ fat on anterior shins, painful, dull-red nodules
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necrobiosis lipodica is associated with
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diabete mellitus
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necrobiosis lipoidica
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collagen degeneration with granulomatous response; shiny patches that enlarge, turn yellow
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acanthosis nigricans on palms is a
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paraneoplastic syndrome
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acrodermatitis enteropathica associated with
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zinc deficiency
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hereditary hemorrhagic telangiectasia present with
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nose-bleed, melena/GI bleeding
first appear with mouth/under tongue telangiectasias |
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hereditary hemorrhagic telangiectasia genes
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endoglin or ALK1 gene
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pretibial myxedema
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hyperthyroidism
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paraneoplastic syndrome:
dermatomyostits cancer: |
ovarian, GU, adeno
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paraneoplastic syndrome:
leser-trelat cancer: |
sudden eruptions of sebborrheic keratosis
adenocarcinoma (stomach/colon) |
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paraneoplastic syndrome:
pemphigus cancer: |
lung cancer, non-hodkins lymphoma
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sweet's syndrome
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acute febrile neutrophilic dermatosis
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pyoderma gangrenosa is associated with
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IBD, hep C, HIV
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most common locations of squamous cell carcinoma
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lips, ears, genitals
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keratoacanthoma locations
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central face, hands, and arms
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greatest risk factor for metastasis of melanoma
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breslow's depth: depth of invasion
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what upstages melanoma
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ulceration!!!
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most common site of metastasis in leimyosarcoma
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lungs
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kaposi's sarcoma virus
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herpes 8
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organ involvement in the derm emergencies
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-TEN
-DRESS -strep TSS -meningo -lyme |
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shock seen in the derm emergencies
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-sterp TSS
-NF -gangrene -meningo |
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debridement necessary in which derm emergencies but not in which one?
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-strep TSS
-gangrene not TEN |
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fever seen in which derm emergencies
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-RMSF
-SJS -staph TSS -SSSS -DRESS |
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which derm emergency turns up 2-6 weeks after start of drug
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DRESS
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finding:
blue red on ear lobe derm emergency? |
lyme
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finding:
joint, heart involvement derm emergency? |
lyme
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finding:
distal to central rash derm emergency? |
RMSF
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finding:
petechial eruption concentrated on extremities derm emergency? |
meningococcemia
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acute febrile, petechia., purpura- think what?
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meningococcal
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what can be seen under the microscope in meningococcemia
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gram negative diplococci
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finding:
anemia derm emergency? |
myonecrosis (gas gangrene)
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finding:
bronze color derm emergency? |
myonecrosis
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finding:
severe pain derm emergency? |
necrotizing fascitis
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finding:
necrosis down to fat and fascia derm emergency? |
necrotizing fascitis
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finding:
usually no rash derm emergency? |
strep TSS
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pathogenesis of staph TSS
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TSST-1: super antigen binds to MHC II and T cell receptor causing polyclonal T cell activation
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staph Scalded skin syndrome pathogenesis
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exotoxins attaack stratum granulosum
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drugs causing DRESS
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need a nice DRESS for ASA formal:
allopurinol sulfonamides anticonvulsants |
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daily labs are needed for which syndrome
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DRESS
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finding:
HSV, myco infections derm emergency? |
erythema multiforme and stevens-johnson syndrome
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finding:
optho consult derm emergency? |
stevens-johnson syndrome
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lesions seen in erythma multiforme
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vesicles, papules, macules, target lesions, oral lesions
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mucosal involvement in derm emergencies
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EM
SJS |
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arthralgias seen in derm emergencies
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lyme
meningococcemia DRESS |
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major arterial blood supply to the head of the femur
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medial and lateral circumflex femoral arteries (branch of obturator)
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stages of bone healing
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1. inflammatory: hematoma, resorpotion
2. reparative: new blood vessels, callus (cells from surface of periosteum) 3. remodeling: callus becomes ossified, remodeling |
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radiologic features of osteoarthritis (LOSS)
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Loss of joint space, Osteophytes, and Subchondral Sclerosis
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morning stiffness > 30 minutes
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RA
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soft, warm, tender joints
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RA
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pathophysiology of osteoarthritis
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degenerative noninflammatory changes in articular cartilage secondary to chondrocyte dysfunction.
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pathophysiology of rheumatoid arthritis
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autoimmune inflammatory disorder that destroys articular cartilage; mediated by CD4 T cells , macs, and cytokines which promote inflammatory response
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innervations of rotator cuff muscles
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Supraspinatus: c4-c6
Infraspinatus: c4-c6 Teres Minor: C5-c6 subscapularis: c5-c7 |
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heart complications in SLE
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can develop pericarditis which leads to friction rub
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