Bone, Skin, CT, Muscle Flashcards
1
Q
Most common benign primary bone tumor
A
Osteochondroma
2
Q
Most common benign primary bone tumor
A
Osteochondroma
3
Q
Genetic deficiency of carbonic anhydrase II
A
Osteopetrosis
4
Q
Failure of bone resorption –> thickened and dense bones
A
Osteopetrosis
5
Q
Bone enlargement, bone pain, arthritis
A
Paget disease of bone
6
Q
Vertebral compression fractures
A
Osteoporosis
7
Q
Blisters, Positive Nikolsky sign, desmosomes
A
Pemphigus vulgaris
8
Q
Increases risk of tendon rupture in adults
A
Fluoroquinolones
9
Q
Increases risk of tendon rupture in adults
A
Fluoroquinolones
10
Q
Premalignant, treat with 5 FU, sandpaper like
A
Actinic keratosis
11
Q
Premalignant, treat with 5 FU, sandpaper like
A
Actinic keratosis
12
Q
Sunlight improves rash, herald patch, christmas tree distribution
A
Pityriasis rosea
13
Q
Sunlight improves rash, herald patch, christmas tree distribution
A
Pityriasis rosea
14
Q
Blisters, negative Nikolsky sign, hemidesmosomes
A
Bullous pemphigoid
15
Q
Blisters, negative Nikolsky sign, hemidesmosomes
A
Bullous pemphigoid
16
Q
Sawtooth infiltrates, associated with Hepatitis C, pruritic purple papules
A
Lichen planus
17
Q
Sawtooth infiltrates, associated with Hepatitis C, pruritic purple papules
A
Lichen planus
18
Q
Hallmark features of necrotizing fasciitis
A
rapidly spreading cellulitis
tenderness beyond red border
Often caused by S. pyogenes
19
Q
Hallmark features of necrotizing fasciitis
A
rapidly spreading cellulitis
tenderness beyond red border
Often caused by S. pyogenes
20
Q
Painless white patches on tongue that cannot be scraped off
A
Hairy leukoplakia caused by EBV
21
Q
Painless white patches on tongue that cannot be scraped off
A
Hairy leukoplakia caused by EBV
22
Q
Parakeratotic scaling
A
Psoriasis
23
Q
Parakeratotic scaling
A
Psoriasis
24
Q
Keratin filled cysts
A
Seborrheic keratosis
25
Keratin filled cysts
Seborrheic keratosis
26
Sand paper, predisposition to squamous cell cancer
Actinic keratosis
27
What is endochrondral ossification?
Cartilagenous model of bone is made by chondrocytes; osteoclasts and osteoblasts later replace with woven bone and then remodel to lamellar bone.
-In adults; woven bone occurs after fractures and in Paget disease
28
Which bones of the skeleton undergo endochondral ossification?
Bones of axial and appendicular skeleton and base of skull
29
Which bones undergo membranous ossification?
Bones of calvarium and facial bones
30
What is membranous ossification?
Woven bone is formed DIRECTLY, without cartilage and then later remodeled to lamellar bone
31
Function of osteoblasts
Build bone by secreting collagen and catalyzing mineralization (differentiate from mesenchymal stem cells in periosteum)
32
Function of osteoclasts
Multinucleated cells that dissolve bone by secreting acid and collagenases; differentiate from macrophages and monocytes
33
Effects of parathyroid hormone on bone
- At low intermittent levels they exert anabolic effect on osteoblasts (build bone) and osteoclasts
- Chronically high PTH levels cause catabolic effects (osteitis fibroma cystica)
34
Effects of estrogen on bone
Inhibits apoptosis in bone forming osteoblasts and induces apoptosis in bone-resorbing osteoclasts
-Estrogen deficiency leads to osteoporosis
35
Which type of bone growth is inhibited in Achondroplasia?
Endochondral; the constitutive activation of fibroblast growth factor 3 (FGF3) inhibits chondrocyte proliferation
36
What is the mutation in Achondroplasia?
Mutation in FGFR3 (Arg for Gly substitution) inhibits chondrocyte proliferation
- 85% of mutations are sporadic
- AD; homozygosity is lethal
37
Describe bone in Osteoporosis
Trabecular (spongy) bone loses mass and interconnections despite normal mineralization and normal Ca/PO4
38
Medications that can cause osteoporosis?
PPI, H2 blockers, Anticonvulsants, Aromatase inhibitors, Medroxyprogesterone, GnRH agonists, proton pump inhibitors, glucocorticoids, unfractionated heparin, thiazolidinediones
39
Types of osteoporosis
Type I: post-menopausal; increased bone resorption from decreased estrogen levels
Type II: senile; affects men and women > 70 yrs
40
Cause of osteopetrosis
Failure of normal bone resorption from defective osteoclasts --> bone becomes thick and prone to fracture
41
Cause of osteopetrosis
Mutation in carbonic anhydrase II (osteoclasts can't generate acidic environment needed for bone resorption)
42
Complications of osteoPETROSIS
Pancytopenia
Extramedullary hematopoiesis
(Bone fills marrow space)
Can result in CN impingement and palsies as a result of narrowed foramina
43
What is cure for osteopetrosis? Why?
BM transplant
| Osteoclasts are derived from monocytes
44
What are labs in osteopetrosis?
Normal
45
Cause of Osteomalacia/Rickets
Vitamin D deficiency --> osteomalacia in adults; rickets in children; due to defective mineralization/calcification of osteoid --> soft bones bow out
46
Labs in Osteomalacia/Rickets
```
Decreased Vitamin D
Decreased serum Calcium
Increased PTH secretion
Decreased serum PO4
Increased ALP from hyperactivity of osteoblasts
```
47
Labs in Paget disease
Normal Ca, phosphorous and PTH
| Increased ALP
48
What does bone look like in Pagets?
Mosaic pattern of woven and lamellar bone
49
Complications in Paget's disease
Long bone chalk stick fracture
Increased blood flow from increased arteriovenous shunts may cause high output heart failure
Osteogenic sarcoma
Hearing loss from auditory foramen narrowing
50
Treatment for Paget's
Bisphosphonates (inhibit osteoclast activity)
51
S/E of Bisphosphonates
| Uses of Bisphosphonates
S/E: Osteonecrosis of Jaw, corrosive esophagitis
| Uses: Osteoporosis, Paget's disease, Hypercalcemia
52
What is Teriparatide?
Recombinant PTH analog given subcutaneously that increases osteoblast activity
-Used for osteoporosis, causes increased bone growth
53
Most common location of osteonecrosis? Why?
Femoral head; insufficiency of medial circumflex femoral artery
54
Causes of osteonecrosis (ASEPTIC)
```
Alcoholism
Sickle cell disease
Exogenous/endogenous corticosteroids
Pancreatitis
Trauma
Idiopathic
Caisson (the bends)
```
55
Giant cell tumor
a. Epidemiology and location
b. Characteristics
"Osteoclastoma"
a. 20-40 yrs; epiphyseal end of long bones
b. locally aggressive benign tumor often around knee; lytic lesion with soft tissue extension; SOAP bubble appearance on X-ray; multinucleated giant cells
56
Soap bubble appearance on X-ray
Giant cell tumor
57
Osteochondroma
a. Epidemiology and location
b. Characteristics
a. Males
58
Osteosarcoma
a. Epidemiology/location
b. Characteristics
a. Bimodal distribution; metaphysis of long bones; around knee
b. Codman triangle or sunburst pattern on x-ray; aggressive
59
Predisposing factors of Osteosarcoma
```
Paget disease of bone
Radiation
Li-fraumeni syndrome (p53 mutation)
Bone infarcts
Familial retinoblastoma
```
60
Ewing sarcoma
a. Epidemiology/location
b. Characteristics
a. Boys
61
Onion skin periosteal reaction in bone
Ewing sarcoma
62
Nighttime bone pain, central nidus
Osteoid osteoma
63
Joint findings in osteoarthritis
```
Subchondral cysts
Sclerosis
Osteophytes (bone spurs)
Eburnation (polished, ivory like appearance of bone)
Synovitis
Heberden nodes (DIP)
Bouchard nodes (PIP)
```
64
Which joints are NOT involved in Osteoarthritis?
MCPs
65
Joint findings in RA
Pannus formation (inflammatory granulation tissue(
Subcutaneous nodules (fibrinoid necrosis)
Ulnar deviation of fingers
Subluxation
Swan neck and boutonniere deformities
66
Which joints are rarely involved in RA?
DIPs
67
Etiology of RA
Autoimmune - mediated by cytokines and type III and IV hypersensitivity reactions
68
Antibodies in RA
```
Rheumatoid factor (anti IgG antibody)
Anti-cyclic citrullinated peptide (more specific)
```
69
Pathophysiology of Sjogrens syndrome
Autoimmune destruction of exocrine glands (lacrimal and salivary) by lymphocytic infiltrates
-either primary of secondary; associated with other autoimmune disorders
70
Inflammatory joint pain, Xeropthalmia, Xerostomia
Sjogren syndrome
71
Antibodies found in Sjogren syndrome
Antinuclear Abs
SS-A (anti-Ro)
SS-B (anti-La)
72
Most common cause of gout
Under excretion of uric acid
73
Medications that precipitate gout
Thiazide diuretics
| Niacin
74
Why does alcohol consumption often cause acute attack of gout?
Alcohol metabolites compete for the same excretion sites in kidney as uric acid does --> uric acid builds up in blood
75
Diseases associated with pseudogout
Hemochromatosis
Hyperparathyroidism
Osteoarthritis
76
Synovitis, Tenosynovitis (hand), Dermatitis (pustules)
Infectious arthritis
77
Seronegative spondyloarthropathies
Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis
78
What makes a seronegative spondyloarthropathy?
Arthritis WITHOUT rheumatoid factor (no anti-IgG Ab)
79
HLA-B27
Psoriatic arthritis
Ankylosing spondylitis
IBD
Reactive arthritis
80
Characteristics of psoriatic arthritis
Joint pain and stiffness associated with psoriasis
Asymmetric and patchy
Dactylitis (sausage fingers)
Pencil in cup deformity on X-ray
81
Ankylosing spondylitis
Ankylosis
Uveitis
Aortic regurgitation
Conduction abnormalities
82
Infections that cause reactive arthritis
```
Shigella
Salmonella
Yersinia
Campylobacter
Chlamydia
```
83
Findings in SLE
Antinuclear Abs - sensitive, not specific
Anti-dsDNA Abs - specific, poor prognosis
Anti-Smith Abs - specific, not prognostic
Anti-histone Abs - drug induced lupus
Decreased C3, C4, CH50 from immune complex formation
84
Causes of drug induced lupus
```
Sulfonamides
Hydralazine
Isoniazid
Procainamide
Phenytoin
```
85
Anti-phospholipid syndrome findings
History of thrombosis
Spontaneous abortions
Lupus anticoagulant anticardiolipin
Anti-B2 glycoprotein Abs
86
Why can anti-phospholipid syndrome cause false positive VDRL and prolonged PTT?
Anticardiolipin Abs and lupus anticoagulant cause this
| PTT is prolonged but in vivo there is hyper coagulation
87
Symptoms of polymyalgia rheumatica
Pain and stiffness in shoulders and hips
Fever, malaise, weight loss
DOES NOT cause muscular weakness
88
Association of polymyalgia rheumatica
Temporal arteritis (giant cell)
89
Findings in polymyalgia rheumatica
Increased ESR, Increased CRP, normal CK
90
Treatment of polymyalgia rheumatica
Low does steroids
91
Fibromyalgia symptoms
Chronic widespread musculoskeletal pain associated with stiffness, parasthesia, poor sleep, fatigue
92
Difference in age of those affected in polymyalgia rheumatic and fibromyalgia
Polymyalgia rheumatica: > 50 years old
| Fibromyalgia: 20-50 years
93
Polymyositis vs. Dermatomyositis inflammation
Polymyositis - endomysial inflammation with CD8+ T cells
| Dermatomyositis - perimysial inflammation and atrophy with CD4+ T cells
94
Anti Jo 1 +
Polymyositis/dermatomyositis
95
Anti-SRP +
| anti-Mi 2 +
Polymyositis/dermatomyositis
96
Associations of Myasethenia gravis
Thymoma, Thymic hyperplasia, thymic atrophy
97
Associations of Lambert Eatin Myasthenic syndrome
Small cell lung cancer
98
Pathophys of Myasthenia gravis
Autoantibodies to postsynaptic Ach receptor (nicotinic)
99
Pathophys of Lambert Eaton
Autoantibodies to presynaptic Ca channel --> decreased Ach release
100
What is myositis ossificans?
METAPLASIA of skeletal muscle into bone following muscular trauma
101
CREST
```
Limited scleroderma
Calcinosis
Raynaud phenomenon
Esophageal dysmotiligy
Sclerodactyly
Telangiectasia
```
102
What is a macule? Example?
Flat lesion with well circumscribed change in skin color ( freckle, labial macule
103
What is a patch? Example?
Macule > 1cm --> large birthmark
104
What is a papule? Example?
Elevated solid skin lesion mole (nevus), acne
105
What is a plaque? Example?
Papule > 1cm --> Psoriasis
106
What is a vesicle? Example?
Small fluid-containing blister chickenpox, shingles
107
What is a bulla? Example?
Vesicle > 1cm --> bullous pemphigoid
108
What is a pustule? Example?
Vesicle containing pus --> pustular psoriasis
109
What is a wheal? Example?
Transient smooth papule or plaque --> Hives (urticaria)
110
What is a scale? Example?
Flaking off of stratum corneum --> Eczema, psoriasis, SCC
111
What is a crust? Example?
Dry exudate --> Impetigo
112
Cause of albinism
Normal melanocyte number with decreased melanin production (from decreased tyrosinase activity or defective tyrosine transport) Also caused by failure of neural crest cell migration during development
113
Cause of Vitiligo
Autoimmune destruction of melanocytes
114
Papules and plaques with silvery scaling; parakeratotic scaling
Psoriasis
115
What is parakeratotic scaling?
Nuclei still in stratum corneum
116
Inflammatory facial skin disorder characterized by erythematous papule and pustules but no comedones
Rosacea
117
What is rhinophyma?
Bulbous deformation of nose
| Chronic inflammatory change associated with Rosacea
118
Flat, greasy pigmented squamous epithelial proliferation with keratin filled cysts
Seborrheic keratosis
119
Stuck on appearance
Seborrheic keratosis
120
Leser Trelat sign
sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy
121
Well circumscribed, tan-brown slightly raised .5-1.5 cm lesions
Seborrheic keratosis
122
Cause of bullous impetigo
Staph aureus
123
Skin infection involving upper dermis; presents as well-defined demarcation between infected and normal skin
Erysipelas
| Caused by S. pyogenes
124
Pathophys of Staph scalded skin syndrome
Exotoxin destroys keratinocyte attachments in stratum granulosum ONLY
125
Irregular, white, painless plaques on tongue that cannot be scraped off
Hairy leukoplakia
| EBV mediated
126
Autoimmune IgG Ab against desmoglein
Pemphigus vulgaris
127
Blistering skin disorder with oral mucosa involvement
Pemphigus vulgaris
128
Nikolsky sign +
Pemphigus vulgaris
| Stevens Johnson syndrome
129
Autoimmune IgG Ab against hemidesmosomes
Bullous pemphigoid
130
Tense blisters containing eosinophils; affect skin but SPARE oral mucosa
Bullous pemphigoid
131
Causes of erythema multiforme
Infections (mycoplasma pneumoniae, HSV)
Drugs (sulfa drugs, B lactase, phenytoin)
Cancers
Autoimmune disease
132
Fever, bullae formation, necorsis, sloughing of skin
Stevens Johnson syndrome
133
Causes of Stevens Johnson Syndrome
Epileptic drugs
Allopurinol
Sulfa drugs
Penicillin
134
Associations of acanthosis nigricans
```
Hyperinsulinemia (diabetes, obesity, Cushing)
Visceral malignancy (Gastric adenocardinoma)
```
135
Premalignant skin lesions caused by sun exposure
Actinic keratosis
136
Small, rough erythematous or brown papule or plaques
Actinic keratosis
137
Associations of erythema nodosum
```
Sarcoidosis
Coccidiodomycosis
Histoplasmosis
TB
Streptococcal infections
Leprosy
Crohn disease
```
138
Wickham striae?
Reticular white lines in mucosa
| Lichen Planus
139
Skin disorder associated with Hepatitis C
Lichen Planus
140
Multiple plaques with collarette scale
Pityriasis rosea (Christmas tree distribution); self resolves in 6-8 weeks
141
Keratin pearls on histology
Squamous cell carcinoma
142
Keratoacanthoma
Variant of Squamous cell carcinoma that grows rapidly and may recess spontaneously over months
143
S-100 tumor marker
Melanoma
144
Mutation in melanoma
Activating mutation in BRAF kinase
145
What is Vemurafenib?
BRAF kinase inhibitor that can be used in metastatic of unresectable melanoma
146
Alprostadil
PGE1 analog; decreases vascular tone
147
Dinoprostone
PGE2 analog; increases uterine tone
148
Carboprost
PGF2 analog; increases uterine tone
149
Epoprostenol
PGI2 analog; decreases platelet aggregation and vascular tone
150
COX-2
Inducible enzyme undetectable in most tissues except activated inflammatory cells
-Makes PGI2 --> inhibits platelet aggregation
151
S/E of Celecoxib
Increased risk of thrombosis, sulfa allergy
152
Toxicity of NSAIDs
Interstitial nephritis, gastric ulcer, renal ischemia
153
Which drugs do you avoid in gout?
Salicylates --> all but highest doses depress uric acid clearance
154
S/E of TNF alpha inhibitors
Predispose to infection --> reactivated latent TB (TNF important for granuloma formation and stabilization)
155
Etanercept
TNF alpha decoy receptor
| Used for RA, psoriasis, ankylosing spondylitis
156
Infliximab, Adalimumab
Anti-TNF alpha monoclonal Ab
| Used for IBD, RA, Ankylosing spondylitis, psoriasis
