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204 Cards in this Set
- Front
- Back
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Name the layers of the epidermis in order from outer to inner.
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Stratum corneum, stratum lucidum, stratum granulosum, stratum spinosum, stratum basalis
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What is another name for a tight junction?
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zona occludens
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What proteins make up tight junctions?
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claudins, occludins
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What's another name for intermediate junctions?
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zona adherens
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Intermediate junctions are made up of?
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Cadherins connecting to actin filaments
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What's another name for a desmosome?
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macula adherens
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What makes up a desmosome?
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cadherins attached to intermediate filaments (like keratin and desmoplakin)
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Autoantibodies against desmosome is called?
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pemphigus vulgaris
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Autoantibodies against hemidesmosome is called?
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bullous pemphigoid
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What proteins are involved in hemidesmosomes?
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integrins and laminin
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What's the unhappy triad?
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MCL, ACL, meniscus (FA says lateral, DIT says both)
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What's the bigger and smaller bone in the lower leg?
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Tibia- bigger, fibula- smaller
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What does anterior and posterior refer to in terms of ACL/PCL?
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Tibial attachment
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What's the landmark for a pudendal nerve block?
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ischial spine
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What are the shoulder muscles that form the rotator cuff?
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supraspinatus, infraspinatus, teres minor, subscapularis
(SItS, small t bc it's teres minor) |
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What action does this muscle control?
supraspinatus |
abducts arm initially (before deltoid)
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What action does this muscle control?
infraspinatus |
laterally rotates arm (pitching injury)
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What action does this muscle control?
teres minor |
adducts and laterally rotates arm
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What action does this muscle control?
subscapularis |
medially rotates and adducts arm
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Where (approximately) is the surgical neck of the humerus and what nerve would be affected from a lesion there?
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More towards the shoulder, axillary
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Patient comes in with fractured surgical neck of the humerus and can't abduct at the shoulder. Lesion?
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axillary nerve
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Patient comes in with midshaft fracture of humerus and extend fingers and has wrist drop. Lesion?
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radial nerve
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Patient comes in with fracture of humerus right by elbow (supracondylar); has impaired lateral finger flexion, ape hand, and wrist deviates to ulnar side upon flexion. Lesion?
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proximal median nerve
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Patient presents with carpal tunnel syndrome; loss of lateral finger flexion and ape hand. Lesion?
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distal median nerve
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Patient presents with fracture of medial epicondyle of humerus & problems with wrist flexion (radial deviation). I suspect they might also have claw hand of 4th and 5th digits.
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proximal ulnar nerve
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Patient presents with inability to adduct and abduct fingers and claw hand of median digits (4th and 5th) after fracture of the hook of the hamate. Lesion?
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distal ulnar n.
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Patient presents with waiter's tip hand after trauma. Limb hangs by side, is medially rotated, and forearm is pronated. Lesion?
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upper trunk of brachial plexus (C5/C6)
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Patient presents at childbirth with a total claw hand. Lesion?
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lower trunk of brachial plexus (C8-T1)
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Patient presents after mastectomy with winged scapula and lymphadenopathy. What muscle and nerve are damaged?
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long thoracic n., serratus anterior muscle (which helps abduct past horizontal position)
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Patient can't feel 5th and 1/2 of 4th digit. Nerve?
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Ulnar
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Patient can't feel palm of hand, lateral 3 digits + dorsum of hand, fingertips of the same digits. Nerve?
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Median
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Patient can't feel dorsum of thumb, and median side of dorsum of hand. Nerve?
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Radial
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What are the actions of the muscles in the thenar/hypothenar eminences?
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oppose, *abduct, and flex
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What are the actions of the lumbricals?
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They flex at the MCP joint, but extend at the PIP and DIP joint (leading to all the claw hands).
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What are the actions of the dorsal and palmar interosseous muscles?
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Dorsals - ABduct (DAB)
Palmar- ADduct (PAD) |
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Lateral epichondylitis is also called?
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tennis elbow
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Medial epicondylitis is also called?
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golf elbow
Grandma Mary plays golf; Medial epicondyle |
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Patient comes in with an anterior hip dislocation. Can't feel his medial thigh and can't adduct his thigh. Nerve?
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Obturator
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Patient comes in with a plevic fracture. Can't flex hip OR extend leg. Can't feel anterior thigh and medial thigh. Nerve?
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Femoral
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Patient comes in after fibula neck fracture or cast too tight. Can't evert or dorsiflex the foot and has foot drop. Can't feel the anterolateral leg or dorsal foot. Nerve?
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Common peroneal
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Patient comes in after knee trauma. Can't invert knee or plantarflex and can't feel sole of foot. Nerve?
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Tibial
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Patient comes in after posterior hip dislocation. Can't abduct thigh, has positive Trendelenburg sign (hip drop when standing on opposite foot). Nerve?
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Superior gluteal
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Patient comes in after posterior hip dislocation. Can't jump, climb stairs, or rise from seated position. Nerve?
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Inferior gluteal
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For type 1 muscle, describe:
Fast/slow? Amount of mitochondria/myoglobin Amount of oxidative phosphorylation What muscle is used for? |
Slow twitch
Lots of myoglobin/mitochondria- red color Lots of oxidative phosphorylation Muscle is used for sustained contraction (eg balance muscles) |
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Name two dihydropiridine Ca2+ channel blockers.
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Nifedipine, amlodipine
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Which type of muscle does tropomyosin bind to?
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Skeletal
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Draw out the schematic for skeletal muscle contraction
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p. 378, FA
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What enzyme allows smooth muscle to complete power stroke?
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Myosin light chain kinase (adds on phosphate so Myosin can lose it's ADP-PO4-2 and attach to actin)
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Describe the steps in endochondral ossification vs. membranous ossification.
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Endochondral- chondrocytes lay down cartilage --> osteoclasts/blasts replace with woven bone and then remodel to lamellar bone
Membranous- woven bone formed directly (no cartilage) --> remodeled into lamellar bone |
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Which type of bone formation is not affect in achondroplasia?
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endochondrial ossification
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What is the genetic defect in achondroplasia?
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constituitive activation of FGFR3 --> inhibition of chondrocyte proliferation. (membranous bones like skull are not affected)
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Osteoporosis is a reduction in which type of bone?
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Trabecular; however, the bone that IS present is normal
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Vertebral crush fractures, femoral neck fractures, and distal radius (Colles') fractures would be associated with which disease?
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Osteoporosis
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Name 6 drugs you can give and one you shouldn't in osteoporosis,
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Estrogen (SERMs)
Calcitonin Bisphosphanates Calcium Vitamin D Pulsatile PTH Don't give glucocorticoids |
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What is osteopetrosis?
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Failure of normal bone resorption due to abnormal function of osteoclasts
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Why do you get anemia/infections in osteopetrosis?
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Because you have narrowed marrow space
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What is the gene defect in osteopetrosis?
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Deficiency of carbonic anhydrase II
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Why would you get palsies in osteopetrosis?
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bc of cranial nerve impingement due to narrowed foramina in skull
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What is osteomalacia/Rickett's and what causes it?
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It's defective bone mineralization; caused by lack of vitamin D
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What does PTH do to phosphate?
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Increase excretion by the kidney. Think "PTH - phosphate trashing hormone"
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What is Paget's disease of bone?
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Abnormal bone architecture caused by increase in both osteoblastic and osteoclastic activity
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What is possible origin of Paget's disease of bone?
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Viral (paramyxovirus?)
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What marker is highly elevated in Paget's disease of bone?
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ALP (alkaline phosphatase)
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What types of fractures do you get in Paget's disease of bone?
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lone bone chalk-stick fractures
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What heart pathology is associated with Paget's disease of bone?
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Increased blood flow from arteriovenous shunts may cause high-output heart failure.
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What cancer can Paget's disease of bone lead to?
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osteogenic sarcoma
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Patient presents with normal Ca2+, phosphate, ALP, and PTH but decreased bone mass. Hx of glucocorticoid use, thin white female. Dx?
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Osteoporosis
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Patient presents with normal lab values but thickened, dense bones & lots of fractures. Diagnosis?
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Osteopetrosis (petra= stone, STONE bones)
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Patient presents with decreased serum calcium and phosphate, normal or slightly increased ALP, and increased PTH. Patient has "soft bones". Dx?
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Osteomalacia/rickets
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Patient presents with increased serum Ca2+, decreased serum phosphate, increased ALP and increased PTH and a brown tumor. Dx?
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Osteitis fibrosa cystica (elevated PTH or pseudohypoparathyroidism)
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Patient presents with normal lab values except highly elevated ALP and abnormal bone architecture. Dx?
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Paget's disease of bone
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What is the general name for when bone is replaced by fibroblasts, collagen, and irregular bony trabeculae?
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polyostotic fibrous dysplasia
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Patient presents with multiple, unilateral bone lesions, precocious puberty, and unilateral cafe au lait spots. Diagnosis?
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McCune Albright syndrome
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Patient with Gardner's syndrome has a benign bone tumor in the skull. Diagnosis?
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osteoma
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20 year old man has a bone tumor made up of interlacing trabeculae of woven bone surrounded by osteoblasts in his proximal tibia, 1.5 cm in diameter. Dx?
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Osteoid osteoma
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20 year old man has a bone tumor made up of interlacing trabecular of woven bone in his vertebral column, 4 cm in diameter. Dx?
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Osteoblastoma
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30-year old has a tumor at the distal femur. Has a soap bubble appearance on x-ray, spindle-shaped cells with multinucleated giant cells. Dx?
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Giant cell tumor (aka osteoclastoma)
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20 year old man has a benign bone tumor with a catilagenous cap (looks like a mushroom) sticking out of his metaphysis of his femur. Dx?
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osteochondroma
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What's the most common benign bone tumor?
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osteochondroma
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Patient has a benign tumor in the distal extremities that is catilagenous. Dx?
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Enchondroma
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15-year old boy has a tumor in the metaphysis of his femur (near the knee) that has a sunburst pattern on x-ray. Dx?
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Osteosarcoma
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What's the most common malignant tumor of bone (besides multiple myeloma)?
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Osteosarcoma
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What familial disease is osteosarcoma associated with?
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retinoblastoma (Rb gene)
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12-year old boy has extremely aggressive bone tumor in scapula or diaphysis of long bone, with anaplastic, small blue cells. Has onion-skin appearance in bone and a t(11;22). Dx?
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Ewing's sarcoma
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40-year old man has a tumor in the diaphysis of his tibia that is made of cartilage and is malignant. Dx?
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chondrosarcoma
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How would you tell the difference between a chondrosarcoma and an enchondroma?
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Enchondromas tend to be in distal extremities vs. chondrosarcomas are in pelvis, spine, scapula, humerus, tibia, or femur(generally more proximal).
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Osteophytes are associated with which bone disease?
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Osteoarthritis
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Heberden's nodes and Bouchard's nodes are associated with which bone disease?
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Osteoarthritis
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What is the difference in morning stiffness lengths for osteoarthritis vs. RA?
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Osteoarthritis-< 30 minutes, RA> 30 minutes
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Name 6 possible treatments for osteoarthritis:
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Schedule acetominophen, NSAIDs/COX-2 inhibitors, steroid injections, hyaluronic acid injections, opioids, joint replacement
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Pannus formation is associated with which disease?
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RA
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What joints are not involved in RA (in hands)?
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DIP
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Name two auto-antibodies associated with RA
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1) rheumatoid factor (anti-IgG)
2) Anti-CCP (more specific, less sensitive) |
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Which HLA subtype is RA associated with?
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HLA-DR4
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What might you use to treat RA (2 categories)?
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NSAIDs, Anti-TNF agents
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Patient presents with dry eyes, dry mouth, parotid enlargement, and arthritis. Dx?
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Sjogren's syndrome
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What cancer risk is elevated if you have Sjogren's?
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B cell lymphoma
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What auto-antibodies are found in sjogren's?
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Anti SS-A (Ro) and SS-B (La)
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What's the difference between Sjogren's syndrome and sicca syndrome?
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In sicca you have dry eyes and mouth but no arthritis
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What are the cystals made of in gout?
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Monosodium urate
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What types of situations lead to gout (5)?
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Lesch Nyhan syndrome, PRPP excess, decreased uric acid excretion (thiazide diuretics), increased cell turnover, vonGierke's disease (not sure why?)
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Is gout usually due to overproduction or underexcretion of uric acid?
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Underexcretion
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Describe gout crystals.
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Needle shaped, negatively birefringent
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What does negatively birefringent mean?
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When they are under parallel light, they look yellow
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What are the cystals made of in gout?
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Monosodium urate
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What types of situations lead to gout (5)?
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Lesch Nyhan syndrome, PRPP excess, decreased uric acid excretion (thiazide diuretics), increased cell turnover, vonGierke's disease (bc lactic acid is competing for renal binding sites?)
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Is gout usually due to overproduction or underexcretion of uric acid?
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Underexcretion
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Describe gout crystals.
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Needle shaped, negatively birefringent
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What does negatively birefringent mean?
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When they are under parallel light, they look yellow
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What is a gout tophus and where is the most common location?
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A deposition of monosodium urate crystals that forms a solid blob under skin; most common location is external ear
*Note: tophi don't show up until you have had gout for 10+ years |
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Where is the classic presentation of gout (NOT tophi)?
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Big toe, MTP joint
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Why does gout attack tend to occur after alcohol consumption?
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bc uric acid competes for same excretion sites in kidney as alcohol does
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Name two treatments for chronic gout and two treatments for acute gout:
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Chronic- allopurinol, *uricosurics (probenecid)
Acute- NSAIDs, colchicine |
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What kind of crystals are found in pseudogout?
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Calcium pyrophosphate
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Describe pseudogout crystals
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Rhomboid, basophilic, weakly positively birefringent
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What does positively birefringent mean?
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Look blue when parallel to the light
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What type of joints does pseudogout normally affect?
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large joints, like knees
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How do you treat pseudogout?
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No treatment according to FA, but can give NSAIDs/colchicine according to DIT
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Name three bacteria that might cause acute infectious arthritis?
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S. aurea, streptococcus, and Neisseria gonorrhea
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Name two bacteria that could cause chronic infectious arthritis.
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TB, Lyme disease (B. burgdorferi)
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What makes something a seronegative spondyloarthropathy?
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It's an arthritis without rheumatoid factor
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What HLA type is associated with the seronegative spondyloarthropathies?
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HLA B27
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Patient with hx of psoriasis presents with dactylitis and pencil-in-cup deformity of the fingers. Dx?
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psoriatic arthritis
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Patient presents with stiff spine in the morning that improves with exercise. Disease particularly affects the sacroiliac joints. Dx?
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Ankylosing spondylitis
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What other pathologies (2) are associated with ankylosing spondylitis?
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Uveitis, aortic regurgitation
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What disease is a "bamboo spine" deformity seen in, and what is "bamboo spine"?
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Seen in: ankylosing spondylitis
It is: when the IV discs are outlined on x-ray by calcifications |
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Patient presents with vision problems (anterior uveitis), painful urination, and joint pain. Dx?
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Reactive arthritis, aka Reiter's syndrome
"can't see, can't pee, can't climb a tree" |
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What organisms might infect you and lead you to get reiter's syndrome?
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shigella, chlamydia, salmonella, yersinia, campylobacter
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What autoimmune disease is Liebmann Sachs endocarditis associated with?
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SLE
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In which autoimmune disease besides sarcoidosis can you see hilar adenopathy?
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SLE
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Why do ppl. with lupus test false-positive on syphilis VDRL test?
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Because they have anti-phospholipid antibodies that react with the cardiolipin that's used in the VDRL test
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Name 5 types of antibodies that might be elevated in lupus and which one is particularly specific for drug-induced lupus.
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Anti-nuclear, Anti-smith, Anti-dsDNA, Anti-histone (common in drug-induced), Anti-phospholipid
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What would you expect complement levels to be in SLE?
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decreased
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Why do thiazide diuretics lead to hyperuricemia?
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bc the diuretic competes with uric acid for excretion (they are both weak acids)
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Why do thiazide diuretics lead to increase glucose/diabetes (potentially)?
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They are known for decreasing K+, which controls insulin release from pancreatic cells. So by changing K+ levels you might be altering insulin release
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Why does von gierke's disease lead to hyperuricemia?
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Because in von gierke's you get lactic acidosis (because glucose gets trapped in glycolysis and it's not always aerobic?) and the lactic acid competes for excretion in the kidney with uric acid
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What would you use to treat the renal disease associated with lupus?
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Cyclophosphamide
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Mnemonic for sarcoidosis?
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GRUELING
Granulomas, Rheumatoid arthritis, Uveitis, Erythema nodosum, Lymphadenopathy, Idiopathic, Not TB, Gammaglobulinemia |
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What enzyme is elevated in sarcoidosis?
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ACE
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What neural pathology is associated with sarcoidosis?
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Bell's palsy
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What histology would you see in a sarcoid granuloma?
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- Schaumann and asteroid bodies (schaumann- protein and calcium inclusions, asteroid-lipids arranged in a star-shape)
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Why do you see hypercalcemia in sarcoidosis?
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Because 1 alpha hydroxylase activates vitamin D which increases calcium; the one alpha hydroxylase is in the epitheloid macrophages
*Note: normally you think of 1 alpha hydroxylase being located in the kidney |
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Treatment for sarcoidosis?
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Steroids
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Why is polymyalgia rheumatica a misnomer?
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bc it's not a MUSCLE disease, it's a joint disease
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Patient presents with pain and stiffness in shoulders & hips + fever, malaise, and weight loss. Patient has a hx of temporal arteritis. Dx?
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Polymyalgia rheumatica
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Would polymyalgia rheumatica have elevated CK? why or why not?
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No, because CK is a marker for muscle damage and the muscles aren't damaged in polymyalgia rheumatica
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Patient has progressive, symmetric muscle weakness of proximal muscles, inc. shoulders. Biopsy shows perifasicular inflammation. Dx?
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Polymyositis
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What is the pathphys of polymyositis?
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CD8+ T-cell induced injury to myofibers
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What are biopsy findings in polymyositis?
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Perifasicular inflammation
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Patient presents with proximal muscle weakness + malar or heliotrope rash + Gottron's papules (red scaly lesions over finger joints) + thickened, cracked skin on palmar surface of hands. Dx?
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Dermatomyositis
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What labs (4) would be elevated in either polymyositis or dermatomyositis?
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CK, aldolase, Anti-nuclear AB, Anti-Jo-1 AB
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Patients with polymyositis or dermatomyositis have increased risk for?
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cancer
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What are the antibodies against in myasthenia gravis?
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Post-synaptic AcH receptor
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What cancers is myasthenia gravis associated with?
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thymoma, bronchogenic carcinoma
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Which drug is used (short-acting) to dx myasthenia gravis?
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edrophonium
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In lambert-eaton sydrome, what are the antibodies directed against?
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presynaptic Ca2+ channel --> decreased AcH release
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What diseases is lambert eaton associated with?
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paraneoplastic disease (like small cell lung cancer)
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Name four things that can be used to treat myasthenia gravis.
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1) acetylcholinesterase inhibitors
2) thymectomy 3) glucocorticoids 4) plasmapheresis |
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Patient presents with puffy, taut skin, and sclerosis of renal, pulmonary, CV, and GI systems. Diagnosis?
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Scleroderma (probably diffuse type)
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What anti-body is associated with diffuse sleroderma?
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Anti-scl-70 antibody (anti-DNA topoisomerase I)
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Describe the pathology of CREST sleroderma.
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C-calcinosis, R- raynaud's phenomenon, E-esophageal dysmotility, S-sclerodactyly (thickening/tightness of fingers), T-telangiectasia
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What antibodies is CREST scleroderma associated with?
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Anti-centromere
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CREST scleroderma affects the skin mostly on what parts of the body?
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Fingers & face
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what bacteria causes yaws?
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c pertenue
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Name the skin disease:
soft, tan-colored, cauliflower-like lesions on hands |
verruca vulgaris
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Name the skin disease:
soft, tan-colored, cauliflower-like lesions on genitals |
condyloma acuminatum
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What's the difference between condyloma lata and condyloma acuminatum?
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condyloma acuminatum are standard genital warts caused by HPV
condyloma lata is a white, flat genital lesion associated with secondary syphilis |
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Intensely pruritic wheals that form after mas cell degranulation
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urticaria
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pruritic eruption on skin flexures, assoc. with other atopic diseases
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atopic dermatitis aka eczema
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papules and plaques with silvery scaling, esp. on knees and elbows
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psoriasis
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acanothosis (epidermal hyperplasia), parakeratotic scaling (nuclei present in stratum corneum), and increase stratum spinosum. Diagnosis?
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psoriasis
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Flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts, looks "pasted on". Dx?
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seborrheic keratosis
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Normal number of melanocytes with increased melanin pigment. Dx?
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Ephelis (freckle)
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Normal # of melanocytes with decrease melanin production due to decrease tyrosinase activity. Dx?
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albinism
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Irregular areas of complete depigmentation due to decrease in melanocytes. Dx?
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vitiligo
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Hyperpigmentation associated with pregnancy or OCP use. Dx?
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Melasma
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Name two types of bacteria that normally cause necrotizing fasciitis.
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S. pyogenes + anaerobes
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What bacteria causes scalded skin syndrome?
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s. aureus
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White, painless plaques on mouth that can't be scraped off in HIV patient. Dx?
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Hairy leukoplakia
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What causes hairy leukoplakia
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EBV
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What does immunofluorescence show in pemphigus vulgaris?
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antibodies around cells in a reticular/netlike pattern
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What is acantholysis?
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Intraepidermal bullae involving skin & oral mucosa
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What is Nikolsky's sign and when do you see it?
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separation of dermis when you stroke the skin, seen in pemphigus vulgaris
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What does immunofluorescence show in bullous pemphigoid?
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linear immunofluorescence
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What kind of cells are seen within the blisters of bullous pemphigoid?
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eosinophils
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Pruritic, purple, polygonal papules. Diagnosis?
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Lichen planus
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What's the histological finding in lichen planus?
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Sawtooth infiltrates of lymphocytes at dermal-epidermal junction
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What disease is lichen planus associated with?
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Hepatitis C
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Premalignant lesions caused by sun exposure. "cutaneous horn". Diagnosis?
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Actinic keratosis
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What gives you a greater risk (histologically) of getting carcinoma from actinic keratosis?
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greater epithelial dysplasia
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What is acanthosis nigrans?
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hyperplasia of the stratum spinosum
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What is acanthosis nigrans associated with (2)?
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Hyperinsulinemia and visceral malignancy
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Inflammatory lesions of subcutaneous fat, usually on anterior shins; associated with many diseases. Diagnosis?
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Erythema nodosum
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"Herald patch" of rash followed by a rash in a "Christmas tree" distribution. Multiple papular eruptions. Dx?
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pityrias rosea
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Red mark that appears in first few weeks of life, grows rapidly, and regresses spontaneously at 5-8 years of age.
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strawberry hemangioma
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appears in 30s-40s, red blotch, does not regress.
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cherry hemangioma
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Exposure to what kind of chemical predisposes to squamous cell carcinoma?
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arsenic
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What is the histological finding in squamous cell skin cancer?
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keratin pearls
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What is the gross finding in squamous cell skin cancer?
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ulcerative red lesion
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What is the histological finding in basal cell carcinoma?
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palisading nuclei
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What is the gross finding in basal cell carcinoma?
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rolled edges, central ulceration, telangiectsias
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What is the name for a variant of actinic keratosis that grows rapidly and regresses spontaneously?
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keratocanthoma
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What is a tumor marker for melanoma?
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S-100
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What characteristic of melanoma correlates with risk of metastasis?
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depth of tumor
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