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125 Cards in this Set
- Front
- Back
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A soccer player who was kicked in the leg suffered a damaged medial meniscus. What else has been damaged?
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ACL- unhappy triad
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A gymnast who dislocates her shoulder anteriorly. What nerve has been damaged
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Axillary- C5,C6
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An X-ray shows bilateral hilar lymphadenopathy
What is the diagnosis? |
Sarcoid
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Child has weakness and enlarged calves. What is the disease and how is it inherited?
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Duchenne's
X-linked |
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25 y/o woman w/ low-grade fever, rash across her nose; wide spread edema. What disease are you concerned about?
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SLE
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85 y/o man w/ acute knee pain and swelling.
X-ray shows joint space w/o erosion. What is the diagnosis? What is seen on aspiration? |
pseudogout
rhomboid calcium pyrophosphate crystals |
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What are the layers of the epidermis from surface to base?
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Californians Like Girls in String Bikinis
Corneum Lucidum Granulosa Spinosa Basalis |
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What are the components of the epithelial cell junction?
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Zona occludens- tight junction
Zona adherens- intermediate junction- has actin filaments and E-cadherin Macula adherins (Desmosome)- small discrete sites of attachment- Desmoplakin and keratin Gap Junction- adjacent cells to communicate for electric and metabolic functions Hemidesmosome- integrin |
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How is bone formed?
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intramembranous- spontaneous bone formation w/o preexisting cartilage
Endochondral- Ossification of cartilagenous molds. Long bones form by this type of ossification at 1ry and 2ry centers. |
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What is in the Unhappy triad?
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ACL- lateral to medial; attaches anteriorly to tibia
PCL- medial to lateral; attaches posteriorly to tibia Medial collateral, and lateral collateral on the sides clipping on the lateral side gives you damage to the MCL, ACL and medial meniscus + drawer sign- ACL Abnl passive abduction- MCL |
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What are the muscles of the rotator cuff?
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SItS
Supraspinatus- helps deltoid abduct the arm Infraspinatus- laterally rotates the arm teres Minor- adducts adn laterally rotates the arm Subscapularis- medially rotates and adducts the arm. |
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What is the cycle of musculoskeletal contraction?
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conformation of the myosin head is altered w/ loss of P. Bond between actin and myosin is increased.
release of ADP causes a shift in the architecutre-> thin filament is pulled toward the sarcomere Bond between myosin and actin is broken w/ ATP Myosin head is attached ATP is hydrolysed, weak bond between actin and myosin forms |
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What is the role of Ca in muscle?
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binds to troponin C-> conformational change.
causes tropomyosin to move out of the way to allow actin/myosin cycling |
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How does teh action potential function in skeletal muscle?
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ap reactions axon terminal-> depolarizes and opens voltage gated Ca channels and causes neurotransmitter vesicle fusion and exocytosis. Postsynaptic ligand binding leads to depolarization of the postsynaptic muscle cell.
Depol travels down T tubule. Dihydropyridine receptor, voltage-sensing Ca channel protein. lies in the T-tubule membrane next to a ryanodine receptor, which lies in the sarcoplasmic reticulum Released Ca binds to troponin C, whcihc moves tropomyosin out of the way, Myosin hydrolyzes ATP and is displaced-> power stroke Contraction -> HIZ shrinkage A band is constant |
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How does smooth muscle contract?
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ap-> smooth muscle membrane depolarization-> voltage-gated Ca channels open-> increased Ca in cytoplasm-> ca binds to calmodulin-> activates myosin light-chain kinase; triggers phosphorylatio of myosin
Mosin light-chain phosphatase removes P. |
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What is the difference between disuse atrophy and denervation atrophy?
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denervation- involves both type I and type II fibers; small and angular
target fibers Reinnervation- fiber-type grouping; cluster of type I fibers adjacent to a cluster of type II fibers, instead of a mixture Disuse- angular atrophy, type II fibers |
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Duchenne muscular dystrophy
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mos commona nd most severe of the muscular dystrophies
- male - weakness in proximal muscles of the extremities at 1y/o; immobalization and waisting, death in tens - histo: random variation in muscle fiber size, necrosis of individual muscle fibers, and replacement of necrotic fibers by fibrofatty tissue - increased serum CK presents in proximal muscles of the extremities Compensatory hypertrophy of distal sites, calf muscles, followed by pseudohypertrophy. Increased fibrous tissue and adipose tissue. deficiency of dystrophin X-linked inheritance w/ many de novo mutations. Various deletions or point mutations occur-> DNA frameshift, stop codons and failure of synthesis. |
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Becker muscular dystrophy
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Becker is Better
clinically similar to Duchenne abnl, truncated dystrophin, segmental deletions, no frameshifts. less functonal |
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Faciocapulohumeral muscular dystrophy
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AD inheritance
associated w/ slowly progressive, nondisabling course and an almost normal life expectancy Sequentially involves the muscles of the face, scapular area, and humerus |
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Limb-girdle dystrophy
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AR inheritance
proximal muscles of the shoulder, pelvic girdle, or both |
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Myotonic dystrophy
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AD
increasing CTG repeats weakness w/ myotonia (can't relax once contracted) cataracts and testicular atrophy and baldness |
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central core disease
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flobby baby
normal CK - loss of mitochondria and other organelles in type I muscle fibers - muscle weakness an hypotonia, but infants can become ambulatory |
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nemaline myopahty
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tangles of small rod-shaped granules predominantly in Type I
varies clinically from a mild nonprogressive disease to severe wekaness ending in death from resp failure |
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Mitochondrial myopathies
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non-mendelian
ragged red appearance of muscle fibers. Kearns-Sayre syndrome- ophthalmoplegia, pigmentary retinopathy, heart block, cerebellar ataxia. |
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Myesthania Gravis
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auto immune against ACh receptors
muscle weakness that increases w/ use ptosis or diplopia, difficulty chewing, speaking, or swallowing complicated by resp failure Thymic tumors, hyperplasia, 3x more in women |
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Lambert-Eaton
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paraneoplastic disorder
defect in release of ACh |
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Osteoporosis
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decrease in bone mass
- impared synth or increased reorp of bone matrix - bone structures inadequate for weight bearing.-> kyphosis and short - post menopausal- egen deficienc - physical inactivigty - hypercorticism - hyper thyroid - calcium deficiency type 1- post menopausal type 2- senile > 70 W>black>asian crushc fractures-> acute back pain, loss of height, kyphosis distal radius (Colles') fractures vertebral wedge fractures Bisphos or pulsatile PTH |
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Osteitis fibrosa cystica
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von Recklinhausen disease
hyperPTH wisdespread lesions Brown tumor- cystic spaces lined by multinucleated osteoclasts and filled w/ vasc fibrous stroma often w/ brown discoloration from hemorrhage diffuse radiolucency of bone mimicking osteoporosis lab manifestations of hyperPTH high Ca, low P, and high alk phos |
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Osteomalacia
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Vit D defiicency
defective calcification of osteoid matrix increased PTH, increased serum phosphate; reversible w/ vit D 2ry to renal disease-> renal osteodystrophy |
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Rickets
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Vit D deficiency in kids
decreased Ca and excess accumulation of osteoid, leading to increased thickness of the epiphyseal growth plates and other skeletal deformities Craniotabes- thinning and softening of occipital and parietal bones Late closing of fontanelles Rachitic rosary- thickening of the costochondral junctions that results in a string-of-beads Harrison groove- depression along the line of insertion of the diaphragm inot the rib cage Pigeon breast- protrusion of the sternum Decreased height- spinal deformity |
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Paget disease
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osteitis deformans
elderly unknown etiology; viral etiology is suggested by ultrastructural, intranuclear inclusions in osteoclasts Abnl bone architecture casued by increases in bone architecture. increased osteoblastic and osteoclastic activity spine, pelvis, calvarium, femur, tibia Abnl bone architecture caused by increase in both osteoblastic and osteoclastic activity. Serum Ca, phosphorus, PTH levels are normal. Serum alk phos is elevated |
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What are the morphologic phases of paget's?
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osteolytic- osteoclastic resorption predominates
Mixed osteoblastic and osteolytic phase- new bone formation- mosaic late phase- bone density is increased, thick trabeculae; mosaic pattern is prominent |
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What are the complicatiosn of pagets
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Bone pain from fractures- bone is thick but lacks strength
High-output cardiac failure- can result from multiple functional arteriovenous sunts w/in highly vascular early lesions Hearing loss- narrowoing of the auditory foramen or direct involvement of the bones of the middle ear. Osteosarcoma- 1% of cases; otherwise seen in young people. |
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Scurvy
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Vit C deficiency
bone lesions from impared osteoid matrix formation failure of proline and lysine hydroxylation needed for collagen synth - Subperiosteal hemorrhage (painful) - Osteoporosis (metaphyseal ends of bone) - Epiphyseal cartilage not replaced by osteoid |
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Achondroplasia
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one of the most common causes of dwarfism
AD disorder caused by a mutation in the fibroblast growth factor receptor 3, located at 4p16 short limbs w/ normal head and trunk chaaracterized by narrow epiphyseal plates and bony sealing off of the area between the epiphyseal plate and the metaphysis-> short thick bones. |
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Monostotic fibrous dysplasia
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solitary lesions that are often asymptomatic, spontaneous fractures w/ pain, severe deformity
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Polyostotic fibrous dysplasia
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Multiple sites are involved, it can be associated w/ severe deformity
Fibrous bone disease |
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McCune-Albright
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Polyostotic fibrous dysplasia, precocious puberty, cafe-au-lait spots on skin and short stature, very young girls
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Aseptic necrosis
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unknown etiology
infarction from interuption of arterial blood supply 2ry to trauma, embolism, decompression syndrome "the bends" and sickle cell. in growing children - femur (legg-Calve-Prthes disease) - Tibial tubercle (Osgood-schlatter disease) - navicular bone (Kohler bone disaese) |
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Osteogenesis imperfecta
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brittle bone disease
caused by a group of specific gene mutations, all result in defective collagen synthesis, results in generalized CT abnlties, affect teeth, skin, eyes, and bones. blue sclerae from translucency of thin CT overlying the choroid - occurs in a variety of clinical types varying greatly in severity; AD dominant multiple childhood fractures are prominent clinical findings. |
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Osteopetrosis
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marble bone disease, Albers-Schonberg
- increased density of the skeleton osteoclastic activity - mult fractures in spte of increased bone density anemia as a result of decreased marrow space blindness, deafness, cranial nerve involvement because of narrowing and impingement of neural foramina - 2 clinical forms: AR - fatal, less severe AD normal Ca, P, and alk phos |
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Pyogenic osteomyelitis
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Kids- blood-boarn Staph, mos common
newborns- Group B Strep or E. coli Salmonella- sickle cell Adults- compound fracture or durgery IV drugs- pseudomonas acute pyogenic- meaphysis; distal endo fthe femur; proximal end of the tibia; proximal end of the humorus may resolve may compress vasculature w/ pyogenic exudate, resulting in ischemic necrosis of the bone and marrow. Nectoric bone is a foreign body, locus for persistent infection Subperiosteal dissection by pyogenic exudate can impare blood supply; pus can rupture and form sinuses draingn through the skin. a sleeve of new bone formation may surround the infected necrotic area localized by a surrounding wall of granulation tissue (Brodie abscess) 2ry reactive systemic amyloidosis |
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TB osteomyelitis
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Vertebrae- vertebral collapse- spinal deformity
Hip Long bones, femur and tibia Bones of the hands and feet |
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Histiocytosis X
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various sites
prolif of histiocytic cells; birbeck granules, tennsi racket cytoplasmic structures |
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Letterer-Siwe disease
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acute disseminated langerhans cell histiocytosis
agressive, fatal disorder of infants and small kids hepatosplenomegaly, lymphadenopathy, pancytopenia, pulm involvement, recurrent infections as a result of widespread histiocytic prolif |
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Hand-Schuller-christian disease
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better prognosis
before 5 y/o histiocytic proliferation mixed w/ inflammatory cells in bone, espicially in the skull, liver, spleen, and other tissues - skull lesions, Diabetes Insipitus and exophthalmos w/ orbit invovlement |
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Eosinophilic granuloma
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best prognosis of the histiocytosis
- solitary bone lesion; extraskeletal invovlement is limited to lung histiocytic prolif mixed w/ inflamm cells, macros, lymphos, eos |
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Osteochondroma
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bone growth covered by a acap of cartilage projecting form the surface of a bone
most common benign tumor of bone occurs most frequently in men younger than 25 years of age hamartoma rather than a true neoplasm originates from metaphysis of long bones w/ lower end of the femur or on the upper end of the tibia being favored locations - rarely undergoes transition to chondrosarcoma; malignant transformation is more frequent in multiple familial osteochondromatosis, rare hereditary variant characterized by mult lesiosn |
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Giant cell tumor
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oval or spindle-shaped cells intermingled with numerous multinuclear giant cells
- epiphyseal end of long bones- 50% occur about the knee - soap bubble on radiograph - peak incidence in 20-40 M>W locally aggressive and recurs |
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Osteosarcoma
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-most common 1ry malignant tumor of bone
- peak in men 10-20 metaphysis of long bones; proxima lportion of the tibia and most distal portion of th efemur are preferred sites - Pain and swelling and ocasionally path fracture - increased alk phos - lifting of the periosteum by the expanding tumor, Codman triangle; sunburst pattern of growth. - early spread to lungs, liver, and brain |
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What are the predisposing factors to Osteosarcoma
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Pagets, fibrous dysplasia, chondroma, osteochondroma
Ionizing radiation Bone infarcts Familial retinoblastoma; Rb on 13 |
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Chondrosarcoma
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malignant cartilaginous tumor
peak in men 30-60 may arise as 1ry tumor or from transformation of pre-existing cartilaginous tumors, especially multiple familial osteochondromatosis or multiple enchondromatosis - has a characteristic sites of origin incluiding the pelvis, spine, or scapula; proximal humerus or proximal femur; and femur or tibia near the knee. |
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Ewing Sarcoma
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anaplastic small blue cell malignant tumor
looks like malignant lymphoma occurs in long bones, ribs, pelvis, and scapula Peak incidence in boys younger than 15 yrs of age - follows an extremely malignant course w/ early mets responds to chemo early stages-mimics acute osteomyelitis - 11; 22 translocation - onion-skin appearance |
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Rheumatoid arthritis
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chronic inflamm disorder of synovial joints
women aged 20-50. autoimmune, presence of RF, IgM w/ anti IgG Fc specificity HLADR4 |
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What is the morphology of rheumatoid?
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synovitis
- acute inflammatory reaction w/ edema and inflamm infiltrate beginning w/ neutrophils and followed by lymphocytes and plasma cells -Hyperplasia and hypertrophy of the synovial lining-> finger like villi -Granulation tissue- pannus; extends over articular cartilage; extension of pannus to subchondral bone results in erosion and cyst formation, deformities of obth cartilage and bone -Scarring contracture and deformity from destructive inflam of ligaments, tendons, and bursae - subcutaneous rheumatoid nodules |
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what is the clinical course of rheumatoid?
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Episodic change
- fatigue, malase, anorexia, weighth loss, fever, myalgia - swelling of the joints, stiffness, in the morning or after inactivity - poly articular and symmetric joint involvement Chronic joint changes - PIP and MP joints are sites - ulnar deviation - minimal radial deviation of the wrist Extra-articular- Pleural and pericardial effusions anemia of chronic disease vasculitis lymphadenopathy pulm involvement neurologic abnlties 2ry reactive amyloidosis |
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What are the variants of rheumatoid?
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Sjogren syndrome- w/ rheumatoid
Felty syndrome: splenomegaly, neutropenia and RA Still disease (juvenile) preceded or accompanied by generalized lymphadenopathy and hepatosplenomegaly, marked fevere |
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What are the spondyloarthropathies
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No rheumatoid
HLA B27 Peripheral arthritis Sacroiliitis - Ankylosing spodylitis, Reiter, Psoriatic, IBD |
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Ankylosing spondylitis
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HLA-B27
Spine and sacroiliac joints-> rigidity and fixation of the spine as a result of bone fusion |
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Reiter syndrome
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Reiter syndrome- urethritis, conjunctivitis and arthritis- venereal or intestinal infection
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Psoriatic arthritis
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10% of pts w/ psoriasis
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IBD arthritis
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peripheral arthritis or ankylosing spondylitis w/ UC or Crohns
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Osteoarthritis
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chronic inflamm joint disease characterized by degeneration of articular cartilage w/ new bone formation subchondrally and at the margins of the affected joint
most common form of arthritis high inscidence in women mechanical trauma to the affected joints- "wear-and-tear arthritis" |
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What are the characteristic morphologic change of Osteoarthritis?
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loss of elasticity, pitting and fraying of cartilage; fragments may spearate and float into synovial fluid
Eburnation: polished, ivory-like appearance of bone, from erosion of overlying cartilage Cystic changes in subchondral bone New bone formation - increased density of subchondral bone - osteophyte- formation a the perimeter of the articular surface and at points of ligamental attachement to bone Osteophyte fracturing adn floating into synovial fluid- joint mice; Heberden nodes: osteophytes at the DIP joints Bouchar proximal interphalanges |
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What is the difference between 1ry and 2ry osteoarthritis?
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1ry- w/o known cause; genetics, inflamm
2ry- mechanical, metabolic factors cause it. (ochronosis) |
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Gout
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deposition of urate crystals in several tissues especially the joints as a result of hyperuricemia
- intense inflamm reaction beginning w/ opsonizaitno of crytstals by IgG, followed by pahgocytosis by neutrophils and eventuating in the release of proteolytic enzymes and inflamm mediators from phagocytic cells - manifest by an inflamm response that leads to extremely painful acute arthritis and bursitis - meatarsophalangeal joint of the great toe Podagra Large meal or alcohol-> hyper uricemia nodular tophi helix and the anti heliz of the ear, Achilles and other sites. 1ry- hyperuricemia w/o cause. middle-aged men familial 2ry Leukemia, MM, and Myeloproliferative syndromes w/ increased cell turnover Decreased urate excretion because of chronic renal failure Lesch-Nyhan syndrome- hyperuricemia w/ severe neuro manifestations- self-mutilation (x-linked) thiaziedes (-)birefringement |
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Chondrocalcinosis (pseudogout)
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calcium pyrophosphate dihydrate crystal deposition
Inflamm reaction in cartilage resembles gout basophilic rhomboid crystals + weak birefringement |
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How do you treat Gout?
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allopurinol
probenecid, colchicine and NSAIDS |
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Hypertrophic osteoarthropathy
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systemic disorders- chronic lung disease, congennital cyanotic heart disease, cirrhosis of the liver, IBD
- clubbing of the fingers, periostitis |
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Lupus
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women (80%); child-bearing age
ANA, immune complex inflamm lesions wireloop lesiosn in kidney Fever, malaise, lymphadenopathy and weight loss Joints- arthralgia and arthritis Skin rashes - butterfly Raynaud- vasospasm of small vessels; fingers Serosal inflammation - pericarditis and pleuritis Diffuse interstitial pulm fibrosis- pneumonitis or fibrosing alveolits Endocarditis- libman-Sacks; mitral valve Immune complex vasculitis- vessels of any organ. Splenic arterioles from onion -skin appearance Glomerular chagne- subendo immune complex Neuro and psych manifestations Eye changes, yellowish, cotton wool-like fundal lesions |
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Lupus
I'M DAMN SHARP |
Immunoglobulin
Malar Rash Discoid rash Antinuclear Ab Mucositis Neurologic Serositis- pleuritis, pericarditis Hematologic Arthritis Renal Photosensitivity |
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What labs are seen in SLE?
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LE test- mechanically damaged neutrophils; autoantibody serum
+ in 70% +ANA decreased compliment dermal-epidermal immune complexes False + syphilis test |
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Scleroderma
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Widespread fibrosis and degenerative changes that affect skin, GI, heart, muscle, and lung, kidney
young women anti-Scl70 presents w/ skin changes, polyarthralgias, esophageal symps Hypertrophy of collagen Sclerodactyly Raynaud VViceral organ- esophagus, interstitial pulm fibrosis HTN |
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CREST
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Calcinosis
raynaud Esophageal dysfunction Sclerodactyly Telangiectasia |
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Sjogren syndrome
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women in late middle age
triad- xerostomia, keratoconjunctivitis sicca, and oneof several CT or other autoimmune diseases - SLE, PSS, Polymyositis, Hoshimoto - Sicca syndrome- only drymouth and conjunctivitis; nasal vaginal dryness, bronchitis, reflux esophagitis Salivary glands- bilateral enlarged parotids diffulely infiltrated by lymphocytes and plasma cells. This cell infiltration can partly or compltely obscure the parenchyma can invole the lacrymal glands SS-A (ro), SS-B (la), hypergammaglobulinemia |
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Polymyositis
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Chronic inflammatory process especially involving the proximal muscles of the extremities
CD8 T-cell induced injury dermatomyositis- purple rash on the face and neck Increased CK, aldolase, postiver ANA anit-Jo-1 |
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Mixed CT disease
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mainly women- peak incidence at 35-40
Shares clinical features w/ other connective tissue disorders, but in contrast renal involvement is rare. arthralgias, Raynauds, esophageal hypomotility and myositis, myalgias, fatigue specific ANAs anti-nRNP/ U1RNP |
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Polymyalgia rheumatica
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Pain and stiffness in shoulders and hips, often w/ fever, malase and weight loss
no muscular wekness increased ESR occurs in pts > 50. Temporal arteritis prednisone |
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Celiac sprue
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autoimmune-mediated intolerance of gliadin leading to steatorrhea
northwern european. blunding of villi lymphocytes in the lamina propria, abnl D-xylose test. Jejunum. Dermatitis herpetiformis 10-15%-> malignancy (T-cell lymphoma) |
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Goodpastures
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pulm hemorrhages-> hemptysis
renal lesions-> hematuria, anemia, crescentic glomerulonephritis anti- BM disease theare are 2 Good Pastures for this disease: Glomerulus and Pulmonary type II hypersensitivity |
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Sarcoidosis
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Immune-mediated-widespread
noncaseating granulomas and elevated serum ACE levels. COmmon in black females. Restrictive lung disease, bilateral hilar lymphadenopathy, erythema nodosum Bells palsy, epithelial granulomas containing microscopic Schaumann and asteroid bodies, uveoparotitis, and hypercalcemia (elevated converstion of vit. D to its active form in epithelioid macrophages GRIAN Gammaglobulinemia Rheumatoid arthritis ACE increase Interstitial fibrosis Noncaseating granulomas |
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Ankylosing spondylitis
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chronic inflamm disease of spine and sacroiliac joints-> ankylosis, uveitis, and aortic regurge
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Reiter's
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Triad
Urethritis Conjunctivitis and anterior uveitis arthritis Can't see, can't pee, can't climb a tree post-Gi or chlamydia infections |
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Eczematous dermatitis
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heterogeneous group of pruritic inflam disorders
Infection Chemicals- contac dermatitis- Ags in type IV cell-mediated hypersensitivity reactions resulting from cooperation of skin of macrophages Atopy- allergy; type I anaphylactic-type; hay fever or bronchial; skin is thype IV not type I Acute- spongiosis w/ vesicle formation Chronic- acanthosis, hyperkeratosis, lichenification; focal lymphocytic dermal infiltrates Subacute- intermediate changes between acute and chronic; less spongiosis and vesiculation than in acute; less acanthosis and hyperkeratosis than in chronic eczematous dermatitis |
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Neurodermatitis
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Lichen simplex chronicus
clinically indistinguishable from chronic eczematous dermatitis - anatomic changes from scratching |
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Psoriasis
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- chronic inflamm from erythematous papules and plaques w/ characteristic silvery scaling; lesions are sharply demarcated
- most often involves the extensor surfaces of the elbows and knees as well as the scalp and sacral area - non pruritic histo: epidermal prolliferation w/ acanthosis and highly characteristic parakeratosis; minute neutrophilic abscesses (Munro abscesses) may be found w/in the parakeratotic stratum corneum may be of autoimmune etiology - can be associated w/ severe destructive rheumatoid arthritis-like lesions (psoriatic arthritis) that most commonly affect teh fingers Knees and elbows increased spinosum decreased graulosum Auspitz sign |
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Varicella
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viral infection- fever and vesicular eruption
immune may have herpes zoster may remain latent for years in dorsal root ganglia painful skin eruption of herpes zoster has a characteristic distribution along the dermatomes corresponding to the affected dorsal root ganglia |
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Pemphigus vulgaris
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people aged 30-60
acantholytic disorder characterized by formation of severe intraepidermal bullae. First lesions often occur in oral mucosa and extensive skin involvement follows. Lesions often rupture, leaving large denuded surfaces to secondary infection - prominent intraepidermal acantholysis and sparing of the basal layer. - autoimmune disorder characterized by IgG autoAbs directed against the epidermal intercellular cement; can be fatal Immunofluorescense |
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Bullous Pemphigoid
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less severe than pemphigus
subepidermal bullae, characteristic inflamm infiltrate of eosinophils in the surrounding dermis autoimmune disorder characterized by IgG autoAbs directed against epidermal Basment Membraine. Linear band of immuno fluorescense Spares oral mucosa |
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Dermatitis herpetiformis
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20-40,
recurrent pruritic blistering disorder, usually of the extensor surfaces of the knees, elbows, scalp, upper back, and sacral area. Blisters occur in groups - dermal microabscesses w/ neutrophils and eosinophils at the tips of dermal papillae which become subepidermal blistsesr - demonstrates deposits of IgA at the tips of dermal papillae Commonly associated w/ gluten sensitive enteropathy both skin lesiosn and enteropathy improve when patients are on gluten free diets. |
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Erythema multiforme
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multiple types of lesions, macules, papules, and vesicles
- target lesion hypersensitivity- malig, autoimmune, drug Stevens-Johnson syndrome is the major form of erythema multiforme. High fever, bulla formation and necrosis, ulceration of the skin, high mortality rate |
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Lichen planus
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pruritic, purple, polygonal papules; infiltrate of lymphocytes at dermoepidermal junction
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Albinism
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failure of pigment production
Ocular- melanin dysfunction of the eye- X-linked Oculocutaneous- eyes, skin hair; predisposes to actinic keratosis, basal and squamous carcinoma, and melanoma - tyrosinase-negative- failure of tyrosine conversion - tyrosine positive- unknown mechanism |
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Vitiligo
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Aquired loss of melanocytes; autoimmune
associated w/ graves, addison |
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Nevocellualr and blue nevi
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Nevocellular- benign tumor or hamartoma; melanocyes
Junctional- nevus cells confided to the epidermal-dermal junction compoud- junction and in the nevus intradermal- confined to clusters w/in the dermis Blue nevus- at birth; nodular foci of dendritic highly pigmented melanocytes in the dermis; dermal=blue |
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spitz nevus
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juvenile
benign spindle shaped cells |
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Dysplastic nevus
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atypical, irregularly pigmented lesion w/ disorderly proliferation of melanocytes, dermal fibrosis and often subjacent dermal lymphocytic infiltration
- may transform into malignant melanoma - familial in some cases; AD inheritance and a marked tnedency toward conversion to malignant melanoma |
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Lentigo maligna
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precursor to melanoma
irregular macular pigmented lesion on sun-exposed skin |
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Molluscum contagiosum
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contagious viral disorder in children and adolescents. direct contact
DNA pox virus umbilicated, dome-shaped papules |
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Verruca vulgaris
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benign papilloma
HPV, not the same as gyne neoplasms vacuolated cells (koilocytes) |
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Actinic keratosis
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premalignatn from sunlight
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Acanthosis nigricans
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marker of visceral malig
acanthosis and hyperpigmentation |
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Seborrheic keratosis
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common bengn neoplasm of older persons
raised papules w/ pasted on appearance; head, trunk and extremities |
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Keloid
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abnl prolif of CT; deranged arrangement of collagen fibers, large raised tumor-like
Trauma; ear piercing recur after resection genetics african |
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Squamous cell carcinoma
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locally invasive, rare mets
sunlight, face, back of the hands. from pre-existing actinic keratosis chemical carcinogens, arsenic, rads or x-ray invasion of dermis by sheets and islands of neoplastic epidermal cells w/ keratin pearls |
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Basal cell carcinoma
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most common of all skin tumors
sun-exposed areas. head and neck upper part of the face grossly presents as a pearly papule. telangiectatic vessels clusters of darkly staining basaloid cells w/ typical palisade arrangement of the nuclei locally aggressive, ulcerate, bleed, never mets surgical resection |
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Malignant melanoma
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Growth phases
Radial - growth in all directions, but predominantly lateral w/in the epidermis and papillary zone of the dermis - lymphocytic response is prominnet - melanomas in the radial growth phase do not mets;, cure is frequent Vertical - growht extends into reticular dermis or beyond. prognosis varies w/ depth lymphatics or hematogenous mets may occur |
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Clincial variants of melanoma
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Lentigo malgina melanoma- sun-exposed skin. Radial growth phase predominates initially; most often develops from preexisting lentigo maligna
Superficial spreading melanoma- most common variat. lesion is irregularly bordered w/ variegated pigmentation; most frequent on the trunk and extremities. Radial growth phase predominates Nodular melanoma- vertical growth phase, poor prognosis Acral-lentiginous- hands and feet of dark-skinned persons |
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Polyarteritis nodosa
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necrotizing immune complex of inflam
small and medium sized arteries - destruction of arterial media and internal elastic lamina aneurysmal nodules - HBV - fever, weight loss, malaise, ab pain, headache, myalgia, HTN - serum Abs to neutrophilic myeloperoxidase P-ANCA Kidneys- vasculitis in the arterioles and glomeruli; renal lesions and HTN cause most deaths from polyarteritis nodosa Coronary arteries from ischemic heart disease Musculoskeletal system-> myalgia, arthralgia, arthritis GI tract-> nausea, vomiting or abdominal pain CNS, ey or skin Rx- coritcosteroids, cyclophosphamide |
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Churg-Strauss
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necrotizing vasculitis; variant of poly-artertitis nodosa
prominent involvement of the pulm vasculature; marked peripheral eosinophilia asthma |
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Henoch-Schonlein purpura
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young kids
poststrep hemorrhagic urticaria extensor surfaces of arms, legs, and buttocks; fever arthralgias and GI and reanl involvement URIS |
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Serum Sickness
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generalized deposition of th AG-Ab complexes
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Wegener granulomatosis
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necrotizing granulomatous vasculitis; small to medium sized vessels of respiratory and kidney
Paranasal and lungs, necrotizing glomerulonephritis fibrinoid necrosis of small arteries and veins, early infiltration by neutrophils Granuloma formation w/ giant cells is prominent circulating anti-neutrophil cytoplasmic antibodies w/ a cytoplasmic staining pattern |
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Takayasu's arteritis
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pulseless diease
granulomatous thickening of aortic arch proximal great vessels Fever Arthritis Night sweats MYalgia SKIN nodules Ocular distrubances Weak pulses in upper extremities medium and large arteries |
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Buerger's disease
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thromboangiitis obliterans
idiopathic, segmental thrombosing vasculitis of intermediate and small peripheral arteries and veins heavy smokers Intermittent claudication, superficial nodular phlebitis, cold sensitiviety, severe pain in affected part may cause gangrene quit smoking |
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Temporal arteritis
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most common vasculitits of medium and small arteries
branches of carotis focal granulomatous unilateral headache, jaw claduication, impaired vision 1/2 have systemic polymyalgia rhematica increased ESR - steroids |
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Opiod toxicity
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addiction, resp depression, constipation, miosis, additive CNS depression w/ other drugs
No tolerance to mosis and constipation Toxicity treated w/ naloxone |
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Colchicine
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acute gout
depolymerizes microtubules impairing leukocyte chemotaxis and degranulation. GI SEs if given orally |
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Probenecid
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chronic gaout, inhibs reabsorp of uric acid
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Allopurinol
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chronic gout
inhibs xanthine oxidase, less conversion to uric acid used in lymphoma and leukemia to prevent tumor lysis |
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etanercept
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recombinant TNF
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infliximab
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TNF-Ab
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Cyclosporine
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binds to cyclophililns. COmplex blocks the diff and activation of T-cells by inhibiting calcineurin. Prevents the production of IL-2 and its receptor
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Tacrolimus
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binds to FK-binding protein inhibiting secretion of IL-2 and other cytokines
Potent immunosuppresive used in organ transplant recipients nephrotox, peripheral neuropathy, HTN, pleural effusion hyperglycemia |
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Azathioprine
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Antimetabolite derivative of 6-mercaptopurine that interferes with the metabolism and synth of nucleic acids. Toxic to proliferating lymphocytes
Kidney transplant SE bone marrow suppresssion. Active metabolite is metabbed by xanthine oxidase. allopurinol should not be give with this |
