6-04 Msk/derm/vasc

Front 1

changes in body fluid levls and osmolarity with cholera

Back 1

"isotonic contraction:" decreased ECV, no change in osmolality

Front 2

DPC vs DCC

Back 2

oncogenes on 18q: DCC causes ColonCancer, DPC causes PancreaticCancer

Front 3

tumor suppressors / oncogenes on c17

Back 3

17q: NF1, BRCA-1; 17p: p53

Front 4

pigmented macules on buccal mucosa, lips, palms, soles, skin not exposed to skin

Back 4

peutz-jeghers! (colonic JAMMertomas + Peutz all over (her) face, hands, genitals)

Front 5

treatment of hypernatremia

Back 5

water replacement, but slowly (2mEq/L/hr) -- avoid cerebral edema

Front 6

measurement of interstitial fluid vol

Back 6

plasma volume via albumin, ECF volume using inulin, subtract

Front 7

measuring fluid volmes: inulin, albumin, heavy water

Back 7

inulin: ECF; albumin: plasma volume; heavy water: total body volume

Front 8

pyknosis

Back 8

nuclear shrinking and basophilia from DNA condensation ("pykno ~ pico = small nuc and DNA")

Front 9

karyolysis

Back 9

loss of nuclear basophilia -- "lyse the karyo (nucleus) and the color leaks out"

Front 10

type of necrosis seen in an abscess

Back 10

liquefactive (same as brain?)

Front 11

karyorrhexis

Back 11

"RHECKING" the nucleus (fragmentation)

Front 12

type of amyloidosis in cardiac tissue

Back 12

usu primary amyloidosis (AL or ATTR); manifests as restrictive cardiomyopathy

Front 13

amylin

Back 13

islet amyloid polypeptide (type 2 DM)

Front 14

port wine stain

Back 14

vascular lesions a/w Sturge-Weber disease (which also includes leptomeningeal angiomatosis -- similar lesions of meninges)

Front 15

sturge-weber disease

Back 15

"sturge-chuck-weber:" port-wine stains (capillary hemangiomas), meningeal hemangiomas; eye involvement: glaucoma, retinal detachment; cns: MR, convulsions

Front 16

MCC aortic stenosis in a 25 yo

Back 16

congenitally malformed valve (mono- or bicuspid)

Front 17

vasculitis of the aortic arch

Back 17

takayasu arteritis (chronic inflam changes --> stenosis --> upper body ischemia, aka pulseless disease)

Front 18

widened pulse pressure

Back 18

AR (decreased diastolic pressure) or arteriosclerosis (increased systolic pressure)

Front 19

alkphos in kids vs adults

Back 19

kids have much higher alk phos (needed for growth), usu up to 5x greater

Front 20

Legg-Calve-Perthes disease

Back 20

idiopathic aseptic necrosis of femoral head; boys > girls, 3-10yo; can lead to osteoarthritis

Front 21

posterior wall of heart formed by

Back 21

LA (can compress esophagus)

Front 22

left border of heart formed by

Back 22

LV

Front 23

osteoid

Back 23

protein mixture (type I collagen) secreted by osteoblasts; can mineralize to become bone

Front 24

failure of osteoid mineralization

Back 24

osteomalacia / rickets

Front 25

sparse trabeculae

Back 25

osteoporosis (bony trabeculae are in normal abundance in osteomalacia, just not mineralized)

Front 26

harsh systolic murmur

Back 26

VSD

Front 27

VSD vs PDA

Back 27

VSD murmur is harsh, systolic; PDA is continuous and machinery like; VSD causes increased O2sat of RV, PDA can eventually cause R-->L shunt (once pulm vasc resistance increases), so no change in RV O2sat

Front 28

diastolic pressure gradiant between atrium and ventricle

Back 28

AV stenosis (mitral, tricuspid)

Front 29

GI diseases a/w arthropathy

Back 29

MCC: IBD (UC and Crohn's); others: bypass surgery, Whipple disease, celiac disease

Front 30

cardiac myxoma

Back 30

most frequent primary cardiac tumor: benign, 90% in atria (LA), "ball-valve" obstructions --> MS

Front 31

Prinzmetal's angina

Back 31

coronary artery spasm at rest, usu with fixed obstruction near site of spasm; tend to be younger than pts with unstable angina (due to atherosclerosis)

Front 32

artery frequently injured in knee dislocation

Back 32

popliteal (extension of superficial femoral artery, ends below the knee in a 'trifurcation:' ant tib, post tib, and peroneal)

Front 33

subendocardial vs transmural infarct

Back 33

subendocardial usu in setting of shock, affects most EKG leads; transmural is more common, ST elev in a few leads (due to coronary artery occlusion)

Front 34

thenar vs hypothenar innervation

Back 34

thenar: median n; hypothenar: ulnar n;

Front 35

congenital defect a/w osteium primum ASD (often accompanied by tricupsid/mitral valve malformations)

Back 35

down syndrome

Front 36

firing rate of IX and X nerves with respect to blood pressure

Back 36

increases with increasing blood pressure, causes increased sympathetic outflow; IX = carotid sinus baroreceptors, X = aortic arch baroreceptors

Front 37

bullous pemphigoid vs pemphigus vulgaris

Back 37

PV: anti-desmosomal Abs (intrapeidermal bullae), BP: anti-BM Abs (subepidermal bullae); PV: 1st lesion in oral mucosa --> skin --> denuded surface --> infection --> death, BP: blistering, pruritic, but spares oral mucosa and less serious than PV

Front 38

intramembranous vs. endochondral bone growth

Back 38

intramembranous: spontaneous bone formaton w/o pre-existing cartilage; endochondral: ossification of cartilaginous molds (eg long bones)

Front 39

unhappy triad

Back 39

ACL, medial collateral ligament (MCL), medial meniscus

Front 40

which side of leg is fibula on

Back 40

lateral

Front 41

anterior and posterior in ACL / PCL refer to

Back 41

sites of TIBIAL attachment (=> ACL tear allows tibia to move forward -- anterior drawer sign)

Front 42

sign of MCL tear

Back 42

abnormal massive aBduction (no ligament to restrain motion)

Hint 42

None

Front 43

rotator cuff muscles

Back 43

SItS (Supraspinatus, Infraspinatus, Teres minor, Subscapularis)

Front 44

Role of Supraspinatus

Back 44

helps deltoid aBduct arm

Front 45

role of teres minor

Back 45

laterally rotates and aDducts arm (along w/ subscapularis)

Front 46

role of subscapularis

Back 46

medially rotates and aDducts arm (along w/ teres minor)

Front 47

role of infraspinatus

Back 47

laterally rotates arm

Front 48

name the muscular dsytrophies and their inheritence

Back 48

all involve progressive muscle degeneration, increased CPK (unlike congenital myopathies): duchennes/beckers (XR); fascioscapulohumeral (AD); limb-girdle (AR); myotonic (AD, CTG repeat)

Front 49

myotonic dystrophy

Back 49

AD, CTG repeats (anticipation), wasting of muscles + cataracts and heart conduciton defects

Front 50

myasthenia gravis vs lambert eaton syndrome

Back 50

MG: improves with rest, 1' affects head/neck, Abs against nAChR, a/w thymomas; LE improves with USE, does NOT 1' affect face, Abs against presynaptic CALCIUM channels, a/w paraneoplastic tumors (eg small cell of lung);

Front 51

changes in 'bands' during muscle contraction

Back 51

HIZ shrinks: H band, I band, Z-band

Front 52

calcium channels in t-tubules

Back 52

dihydropyradine receptors (opened by depolarization of postsynaptic -muscle- cell)

Front 53

conduction to contraction of skeletal muscle

Back 53

presynaptic NT release --> small depol of postsynaptic (muscle) cell --> depol travels down to t-tubules --> opens voltage-gated Ca++ channels (dihydropyradine receptors) --> small Ca++ influx --> opens calcium-gated ryanodine receptor/channels on SR --> big increase in intracytoplasmic Ca++ --> bind Troponin C --> move tropomyosin (via Troponin I) out of the way, allow myosin-actin binding

Front 54

conduction to contraction of smooth muscle

Back 54

requires increased intracell Ca; 2 methods: 1) AP --> voltage-gated Ca++ channels open, or 2) alpha1/M3 stim --> Gq --> IP3 --> inc Ca++; once calcium increases, get unified pathway: Ca++ binds calmodulin --> activates myosin light chain kinase --> phosphorylates (activates) myosin --> cross-bridge formation and contraction

Front 55

hormonal regulators of smooth muscle contraction

Back 55

alpha1 (vasculature) and M3 (sweat glands) both cause contraction via Gq --> IP3 --> Ca++; beta2 (vasodilation) causes relaxation via Gi --| cAMP --> myosin light chain kinase activation (ie beta2 prevents activation of MLCK)

Front 56

skeletal vs smooth muscle

Back 56

skeletal has Z-lines, uses Ca++ - TropnoninC complexes to facilitate bindin, striated, multinucleated, and AP upstroke is driven by SODIUM; smooth has no Z-lines, is single nucleated, not striated, AP upstroke is driven by CALCIUM and Ca++ binds calmodulin to activate myosin light chain kinase

Front 57

pannus formation

Back 57

RA: tissue flap (inflammatory?), causes cartilage and bone destruction

Front 58

jointspace in RA vs OA

Back 58

increased in RA (inflammation), decreased in OA (wear-and-tear destruction of cartilage brings bones closer together)

Front 59

systemic sx in RA / OA

Back 59

none in OA (it’s a mechanical wear and tear process); fever, fatigue, pleuritis and pericarditis in RA

Front 60

joints affected in RA / OA

Back 60

RA: synoval joints, MCP/PIP (boutenierres, swan neck, z-thumb); OA: weight-bearing joints (hip), PIP/DIP (Bouchard's and Heberden's nodes)

Front 61

age of onset of RA/OA

Back 61

RA in middleage women (F 20-50) -- same as most AI diseases; OA: old people (disease of wear and tear)

Front 62

change with rest in RA/OA

Back 62

OA improves with rest (worse at end of the day); RA improves with movement (characterized by morning stiffness)

Front 63

infectious causes of arthritis (septic arthritis)

Back 63

MCC: S.Aureus; in sexually active young people: gonococcus--monoarticular; others: lyme disease: a/w ECM, polyarticular. See **IgM**

Front 64

Seronegative arthrititides

Back 64

a/w HLA-B27 (unlike RA: HLA-DR4): 1) ANKYLOSING SPONDYLITIS (spine and sacroiliac, uveitis); 2) REITER SYNDROME (urethritis, conjuncitivitis, arthritis); 3) PSORIATIC ARTHRITIS (10% of psoriasis patients); 4) IBD

Front 65

tx for osteoporosis

Back 65

bisphophonates --| bone resoprtion (also used for paget's disease, bone mets, multiple myeloma)

Front 66

2 types of osteoporosis

Back 66

1: post-menopause --> dec estrogen; 2: senile, M/F > 70yo

Front 67

osteopetrosis

Back 67

failure of bone marrow resorption (osteoclastic failure); can cause: 1) anemia, 2) cranial nerve dysfunction (impingment of neural foramina), 3) blindness, 4) deafness

Front 68

increased thickness of epiphyseal plates

Back 68

rickets (osteomalacia of kids): dec Vit D --> dec Ca++ --> dec mineralization of osteoid --> "Soft bones"

Front 69

brown tumor

Back 69

cystic space lined with osteoclasts and filled with fibrous stroma / blood (seen in osteitis fibrosa cystica = Von Recklinghausen's Dz of bone)

Front 70

osteitis fibrosa cystica

Back 70

primary increase in PTH --> inc Vit D, inc Ca++, dec Phosphorus; --> inc osteoclast activity, inc alk phos

Front 71

paget's disease

Back 71

inc osteoclast and blast activity --> elevated alk phos (rest normal); mosaic pattern of bone (disorganized), "cap won't fit" b/c of increased bone density, but poor structural integrity --> increased fractures; common in elderly, and can lead to osteosarcoma (rarely, but the only time you see osteosarcoma in elderly)

Front 72

osteosarcoma in elderly

Back 72

2' to paget's disease

Front 73

McCune Albright syndrome

Back 73

polyostotic fibrous displasia in little girls: café au lait spots, short stature, precocious puberty

Front 74

consequences of paget's disease

Back 74

1) bone pain from fractures (poor structural integrilty); 2) high output heart failure (shunts in highly vascular bone); 3) hearing loss; 4) osteosarcoma (rare, but only cause of osteosarcoma in elderly)

Front 75

osteomyeleitis in: 1) neonates; 2) kids; 3) adults; 4) sickle cell; 5) IVDU

Back 75

1) neonates: e.coli/grp B strep --> heme spread; 2) kids: s.aureus --> heme spread; 3) adults: surgery/fracture complication; 4) sickle cell: salmonella; 5) IVDU: pseudomonas

Front 76

histiocytosis x

Back 76

clonal proliferation of langerhans cells; see birbeck granules in cells (tennis-racket shaped cytoplasmic structures)

Front 77

types of histiocytosis x

Back 77

from worse to better: 1) Letterer-Siwe (multiorgan, multifocal); 2) Hans-Schuller-Christian (unisystem, multifocal): skull, DI, exophthalmus; 3) Eosinophilic Granuloma (unifocal, usu bone), best prognosis

Front 78

polymyalgia rheumatica

Back 78

muscle pain, stiffness, NO WEAKNESS; a/w temporal arteritis (elev ESR); usu >50yo, tx w/ prednisone

Front 79

polymyositis vs dermatomyositis

Back 79

both a/w anti-Jo-11 1, elev CK and aldolase, progressive proximal muscle weakness caused by CD8+ T-cell injury; dermatomyositis adds rash (in pattern of woman's shawl)

Front 80

anti-RNP Abs

Back 80

mixed connective tissue disease

Front 81

bone tumors around knee

Back 81

epiphysis: giant cell tumor (benign); metaphysis: osteochondroma (aka exostosis; benign), osteosarcoma (osteogenic carcinoma; malignant)

Front 82

giant cell tumor of bone

Back 82

FEMALES 20-40 yo (only bone tumor more common in females); occurs in epiphyseal end (knee), locally aggressive but benign; "soap bubble" on xray, spindle shaped cells with multinucleated giant cells histologically

Front 83

osteochondroma (exostosis)

Back 83

males < 25yo; most common benign bone tumor

Front 84

enchondroma

Back 84

benign cartilaginous tumor found in intrameddulary bone, distal extremities (hands and feet)

Front 85

3 main types of malignant bone tumors and locations

Back 85

osteosarcoma (metaphysis around knee, M 10-20y); Ewing's sarcoma (intramedullary, M < 15yo); Chondrosarcoma (intramedullary, M 30-60)

Front 86

osteosarcoma

Back 86

most common malignancy of bone, found in metaphysis near knee; M 10-20yo; Rad findings: Codman triangle, sunburst pattern; early heme spread; PREDISPOSING factors: Paget's dz (elderly), Rb gene mutation;

Front 87

chondrosarcoma

Back 87

malig intramedullary cartilaginous tumor; M 30-60yo; can be 1' or from osteochondroma

Front 88

ewing sarcoma

Back 88

intramedullary tumor; boys < 15yo; t(11;22); *extremely malignant*, early mets; histo: small blue cells, onion skin on xray; "Patrick Ewing dribbling a small blue onion; he's a little kid, but still so tall that the tumor cant get to the end of his bone (intramedullary)"

Front 89

rhabdomyosarcoma

Back 89

malig tumor of skeletal muscle, most common soft tissue sarcoma of kids; tx with dactinomycin

Front 90

anti-histone antibodies

Back 90

drug-induced lupus

Front 91

what precipitates gouty attack

Back 91

alcohol, large meal

Front 92

linear staining on immunofluorescence

Back 92

goodpasture's (anti-BM IgG)

Front 93

non-caseating granulomas

Back 93

sarcoidosis -- cause increased ACE, increased Vit D --> inc Ca++, bilateral hilar adenopathy, erythema nodosum, Bell's palsy

Front 94

psoriasis vs eczema

Back 94

psoriasis is on EXTENSOR surfaces and NON-pruritic; eczema on FLEXOR surfaces and PRURITIC

Front 95

psoriasis: epidermal changes

Back 95

epidermal hyperplasia (acanthosis); increased stratum spinosum, DECREASED stratum granulosam (psoriasis gets you more STRINGs, less GIRLS)

Front 96

auspitz sign

Back 96

a/w psoriasis: bleeding punctate spots when lesoin scraped off

Front 97

dermatitis herpetiformis

Back 97

a/w celiac disease; group (herpetiformis) of pruritic papules and vesicles

Front 98

lichen planus

Back 98

Pruritic Planar Purple Polygonal Papules; lymphocytes

Front 99

erythema multiforme

Back 99

target lesions (multiple types of lesions: macules, papules, vesicles); stevens-johnson is a very serious type

Front 100

stevens-johnson syndrome

Back 100

major form of erythema multiforme, high mortalitiy rate (necrosis and ulceration of skin)

Front 101

albinism vs vitiligo

Back 101

vitiligo is acquired, autoimmune (a/w graves, addisons), and patchy; albinism is usu result of tyrosinase deficiency (impaired tyrosine --> L-DOPA --> melanin)

Front 102

spitz nevus

Back 102

juvenile melanoma (but MISNOMER -- benign!); spindle shaped cells

Front 103

basal cell vs squamos cell carcinomas

Back 103

BASAL cell: upper face, pearly papule w/ overlying telangiectasia, pallisading nuclei; SQUAMOUS cell: lower face, sheets of cells with KERATIN PEARLS, a/w arsenic and actinic keratosis

Front 104

congenital hypothyroidism

Back 104

lethargic, poor feeding, prolonged jaundice, muscle hypotonia, macroglossia, MR (T4 needed for brain dev); inc risk of ASD/VSD

Front 105

sporothrix infection

Back 105

dimorphic fungus, xmit by thorbrick --> subq mycosis, nodules along lymphatics

Front 106

apocrine vs eccrine glands

Back 106

both used for sweat; apocrine glands "rip off piece of membrane" --> fatty, smelly (sweat); eccrine glands secrete NaCl ('sweat') directly to skin via exocytosis

Front 107

apocrine vs eccrine glands

Front 108

RANK

Back 108

essential for formation/differntiation of osteoclasts (they have RANK-receptors); hypoestrogen --> overexpression --> osteoporosis

Front 109

"gluteus medius gait"

Back 109

hip drops downoward when ipsilateral foot lifted -- caused by injury to superior gluteal nerve or gluteus medius muscle

Front 110

GVHD

Back 110

acute: within 1wk of procedure, mediated by CD4 and CD8 T cells (B Cells don't really play any role)

Front 111

2 most imp factors for osteoclast differentiation

Back 111

M-CSF and RANK-L (osteoclasts, mature and precursors, possess receptors for both)

Front 112

roles of FGF

Back 112

nevascularization, wound healing, and bone matrix formation (FGF-R mutation --> achondroplasia)

Front 113

parvovirus in kids and adults

Back 113

kids: erythema infectiousum (5th disease); adults: arthritis

Front 114

antibodies against neutrophil myeloperoxidase

Back 114

p-ANCA (PAN, Churg-Strauss)

Front 115

atherogenesis

Back 115

endothelial injury --> endothelial dysfunction / collagen exposure --> platelet adhesion/aggregation/release of {PDGF, TGF-beta} --> migration of SMC from media to intima, SMC proliferation

Front 116

hemangiosarcoma (angiosarcoma) a/w what toxins

Back 116

thorotrast, PVC, arsenic

Front 117

pulseless disease

Back 117

takayasu arteritis: granulomatous thickening of aortic arch, elevated ESR, azn females < 40yo

Front 118

which organ is rarely involved in PAN

Back 118

lung

Front 119

fatty streaks

Back 119

earliest lesion of athersclerosis, present after age 10; lipid-laden foam cells in intima

Front 120

vasculitis a/w HBV

Back 120

PAN

Front 121

malignant HTN vs diabetic hyaline arteriolosclerosis

Back 121

malignant HTN causes hyperplastic arteriolosclerosis (homogenous, onion-like, concentric thickening of arterial walls); diabetic hyaline arteriolosclerosis causes intimal thickening with homogeneous hyaline deposition in intima

Front 122

temporal arteritis is morphologically most similar to?

Back 122

takayasu arteritis (pulseless disease)

Front 123

most specific sx of giant cell (temporal) arteritis

Back 123

jaw claudication

Front 124

takayasu vs giant cell (temporal) arteritis

Back 124

usu distinction is size and location (takayasu: aorta, proximal aortic branches; temporal: distal carotids); however, both can present similarly so distinction often made based on AGE (takayasu: < 40; temporal: elderly)

Front 125

temporal arteritis vs PAN

Back 125

temporal (and takayasu) are GIANT CELL arterititides --> involve giant cells and mononuclear infiltrates; PAN is characterized by immune complexes, complement, and plasma proteins --> fibrinoid necrosis

Front 126

main mechanisms for dev of varicose veins

Back 126

incompetent venous valves

Front 127

vascular effects of tertiary syphilis

Back 127

vaso vasorum endarteritis / obliteration --> weakened adventitia --> aortic aneurysm --> AR