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Step 1 AB > Bone, Skin, CT, Muscle > Flashcards

Bone, Skin, CT, Muscle Flashcards

1
Q

Most common benign primary bone tumor

A

Osteochondroma

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2
Q

Most common benign primary bone tumor

A

Osteochondroma

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3
Q

Genetic deficiency of carbonic anhydrase II

A

Osteopetrosis

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4
Q

Failure of bone resorption –> thickened and dense bones

A

Osteopetrosis

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5
Q

Bone enlargement, bone pain, arthritis

A

Paget disease of bone

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6
Q

Vertebral compression fractures

A

Osteoporosis

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7
Q

Blisters, Positive Nikolsky sign, desmosomes

A

Pemphigus vulgaris

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8
Q

Increases risk of tendon rupture in adults

A

Fluoroquinolones

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9
Q

Increases risk of tendon rupture in adults

A

Fluoroquinolones

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10
Q

Premalignant, treat with 5 FU, sandpaper like

A

Actinic keratosis

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11
Q

Premalignant, treat with 5 FU, sandpaper like

A

Actinic keratosis

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12
Q

Sunlight improves rash, herald patch, christmas tree distribution

A

Pityriasis rosea

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13
Q

Sunlight improves rash, herald patch, christmas tree distribution

A

Pityriasis rosea

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14
Q

Blisters, negative Nikolsky sign, hemidesmosomes

A

Bullous pemphigoid

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15
Q

Blisters, negative Nikolsky sign, hemidesmosomes

A

Bullous pemphigoid

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16
Q

Sawtooth infiltrates, associated with Hepatitis C, pruritic purple papules

A

Lichen planus

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17
Q

Sawtooth infiltrates, associated with Hepatitis C, pruritic purple papules

A

Lichen planus

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18
Q

Hallmark features of necrotizing fasciitis

A

rapidly spreading cellulitis
tenderness beyond red border
Often caused by S. pyogenes

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19
Q

Hallmark features of necrotizing fasciitis

A

rapidly spreading cellulitis
tenderness beyond red border
Often caused by S. pyogenes

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20
Q

Painless white patches on tongue that cannot be scraped off

A

Hairy leukoplakia caused by EBV

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21
Q

Painless white patches on tongue that cannot be scraped off

A

Hairy leukoplakia caused by EBV

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22
Q

Parakeratotic scaling

A

Psoriasis

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23
Q

Parakeratotic scaling

A

Psoriasis

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24
Q

Keratin filled cysts

A

Seborrheic keratosis

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25
Q

Keratin filled cysts

A

Seborrheic keratosis

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26
Q

Sand paper, predisposition to squamous cell cancer

A

Actinic keratosis

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27
Q

What is endochrondral ossification?

A

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

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28
Q

Which bones of the skeleton undergo endochondral ossification?

A

Bones of axial and appendicular skeleton and base of skull

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29
Q

Which bones undergo membranous ossification?

A

Bones of calvarium and facial bones

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30
Q

What is membranous ossification?

A

Woven bone is formed DIRECTLY, without cartilage and then later remodeled to lamellar bone

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31
Q

Function of osteoblasts

A

Build bone by secreting collagen and catalyzing mineralization (differentiate from mesenchymal stem cells in periosteum)

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32
Q

Function of osteoclasts

A

Multinucleated cells that dissolve bone by secreting acid and collagenases; differentiate from macrophages and monocytes

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33
Q

Effects of parathyroid hormone on bone

A
  • At low intermittent levels they exert anabolic effect on osteoblasts (build bone) and osteoclasts
  • Chronically high PTH levels cause catabolic effects (osteitis fibroma cystica)
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34
Q

Effects of estrogen on bone

A

Inhibits apoptosis in bone forming osteoblasts and induces apoptosis in bone-resorbing osteoclasts
-Estrogen deficiency leads to osteoporosis

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35
Q

Which type of bone growth is inhibited in Achondroplasia?

A

Endochondral; the constitutive activation of fibroblast growth factor 3 (FGF3) inhibits chondrocyte proliferation

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36
Q

What is the mutation in Achondroplasia?

A

Mutation in FGFR3 (Arg for Gly substitution) inhibits chondrocyte proliferation

  • 85% of mutations are sporadic
  • AD; homozygosity is lethal
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37
Q

Describe bone in Osteoporosis

A

Trabecular (spongy) bone loses mass and interconnections despite normal mineralization and normal Ca/PO4

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38
Q

Medications that can cause osteoporosis?

A

PPI, H2 blockers, Anticonvulsants, Aromatase inhibitors, Medroxyprogesterone, GnRH agonists, proton pump inhibitors, glucocorticoids, unfractionated heparin, thiazolidinediones

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39
Q

Types of osteoporosis

A

Type I: post-menopausal; increased bone resorption from decreased estrogen levels
Type II: senile; affects men and women > 70 yrs

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40
Q

Cause of osteopetrosis

A

Failure of normal bone resorption from defective osteoclasts –> bone becomes thick and prone to fracture

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41
Q

Cause of osteopetrosis

A

Mutation in carbonic anhydrase II (osteoclasts can’t generate acidic environment needed for bone resorption)

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42
Q

Complications of osteoPETROSIS

A

Pancytopenia
Extramedullary hematopoiesis
(Bone fills marrow space)
Can result in CN impingement and palsies as a result of narrowed foramina

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43
Q

What is cure for osteopetrosis? Why?

A

BM transplant

Osteoclasts are derived from monocytes

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44
Q

What are labs in osteopetrosis?

A

Normal

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45
Q

Cause of Osteomalacia/Rickets

A

Vitamin D deficiency –> osteomalacia in adults; rickets in children; due to defective mineralization/calcification of osteoid –> soft bones bow out

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46
Q

Labs in Osteomalacia/Rickets

A 
Decreased Vitamin D
Decreased serum Calcium
Increased PTH secretion
Decreased serum PO4
Increased ALP from hyperactivity of osteoblasts
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47
Q

Labs in Paget disease

A

Normal Ca, phosphorous and PTH

Increased ALP

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48
Q

What does bone look like in Pagets?

A

Mosaic pattern of woven and lamellar bone

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49
Q

Complications in Paget’s disease

A

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

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50
Q

Treatment for Paget’s

A

Bisphosphonates (inhibit osteoclast activity)

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51
Q

S/E of Bisphosphonates

Uses of Bisphosphonates

A

S/E: Osteonecrosis of Jaw, corrosive esophagitis

Uses: Osteoporosis, Paget’s disease, Hypercalcemia

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52
Q

What is Teriparatide?

A

Recombinant PTH analog given subcutaneously that increases osteoblast activity
-Used for osteoporosis, causes increased bone growth

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53
Q

Most common location of osteonecrosis? Why?

A

Femoral head; insufficiency of medial circumflex femoral artery

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54
Q

Causes of osteonecrosis (ASEPTIC)

A 
Alcoholism
Sickle cell disease
Exogenous/endogenous corticosteroids
Pancreatitis
Trauma
Idiopathic
Caisson (the bends)
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55
Q

Giant cell tumor

a. Epidemiology and location
b. Characteristics

A

“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

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56
Q

Soap bubble appearance on X-ray

A

Giant cell tumor

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57
Q

Osteochondroma

a. Epidemiology and location
b. Characteristics

A

a. Males

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58
Q

Osteosarcoma

a. Epidemiology/location
b. Characteristics

A

a. Bimodal distribution; metaphysis of long bones; around knee
b. Codman triangle or sunburst pattern on x-ray; aggressive

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59
Q

Predisposing factors of Osteosarcoma

A 
Paget disease of bone
Radiation
Li-fraumeni syndrome (p53 mutation)
Bone infarcts
Familial retinoblastoma
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60
Q

Ewing sarcoma

a. Epidemiology/location
b. Characteristics

A

a. Boys

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61
Q

Onion skin periosteal reaction in bone

A

Ewing sarcoma

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62
Q

Nighttime bone pain, central nidus

A

Osteoid osteoma

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63
Q

Joint findings in osteoarthritis

A 
Subchondral cysts
Sclerosis
Osteophytes (bone spurs)
Eburnation (polished, ivory like appearance of bone)
Synovitis
Heberden nodes (DIP)
Bouchard nodes (PIP)
64
Q

Which joints are NOT involved in Osteoarthritis?

A

MCPs

65
Q

Joint findings in RA

A

Pannus formation (inflammatory granulation tissue(
Subcutaneous nodules (fibrinoid necrosis)
Ulnar deviation of fingers
Subluxation
Swan neck and boutonniere deformities

66
Q

Which joints are rarely involved in RA?

A

DIPs

67
Q

Etiology of RA

A

Autoimmune - mediated by cytokines and type III and IV hypersensitivity reactions

68
Q

Antibodies in RA

A 
Rheumatoid factor (anti IgG antibody)
Anti-cyclic citrullinated peptide (more specific)
69
Q

Pathophysiology of Sjogrens syndrome

A

Autoimmune destruction of exocrine glands (lacrimal and salivary) by lymphocytic infiltrates
-either primary of secondary; associated with other autoimmune disorders

70
Q

Inflammatory joint pain, Xeropthalmia, Xerostomia

A

Sjogren syndrome

71
Q

Antibodies found in Sjogren syndrome

A

Antinuclear Abs
SS-A (anti-Ro)
SS-B (anti-La)

72
Q

Most common cause of gout

A

Under excretion of uric acid

73
Q

Medications that precipitate gout

A

Thiazide diuretics

Niacin

74
Q

Why does alcohol consumption often cause acute attack of gout?

A

Alcohol metabolites compete for the same excretion sites in kidney as uric acid does –> uric acid builds up in blood

75
Q

Diseases associated with pseudogout

A

Hemochromatosis
Hyperparathyroidism
Osteoarthritis

76
Q

Synovitis, Tenosynovitis (hand), Dermatitis (pustules)

A

Infectious arthritis

77
Q

Seronegative spondyloarthropathies

A

Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis

78
Q

What makes a seronegative spondyloarthropathy?

A

Arthritis WITHOUT rheumatoid factor (no anti-IgG Ab)

79
Q

HLA-B27

A

Psoriatic arthritis
Ankylosing spondylitis
IBD
Reactive arthritis

80
Q

Characteristics of psoriatic arthritis

A

Joint pain and stiffness associated with psoriasis
Asymmetric and patchy
Dactylitis (sausage fingers)
Pencil in cup deformity on X-ray

81
Q

Ankylosing spondylitis

A

Ankylosis
Uveitis
Aortic regurgitation
Conduction abnormalities

82
Q

Infections that cause reactive arthritis

A 
Shigella
Salmonella
Yersinia
Campylobacter
Chlamydia
83
Q

Findings in SLE

A

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
Q

Causes of drug induced lupus

A 
Sulfonamides
Hydralazine
Isoniazid
Procainamide
Phenytoin
85
Q

Anti-phospholipid syndrome findings

A

History of thrombosis
Spontaneous abortions
Lupus anticoagulant anticardiolipin
Anti-B2 glycoprotein Abs

86
Q

Why can anti-phospholipid syndrome cause false positive VDRL and prolonged PTT?

A

Anticardiolipin Abs and lupus anticoagulant cause this

PTT is prolonged but in vivo there is hyper coagulation

87
Q

Symptoms of polymyalgia rheumatica

A

Pain and stiffness in shoulders and hips
Fever, malaise, weight loss
DOES NOT cause muscular weakness

88
Q

Association of polymyalgia rheumatica

A

Temporal arteritis (giant cell)

89
Q

Findings in polymyalgia rheumatica

A

Increased ESR, Increased CRP, normal CK

90
Q

Treatment of polymyalgia rheumatica

A

Low does steroids

91
Q

Fibromyalgia symptoms

A

Chronic widespread musculoskeletal pain associated with stiffness, parasthesia, poor sleep, fatigue

92
Q

Difference in age of those affected in polymyalgia rheumatic and fibromyalgia

A

Polymyalgia rheumatica: > 50 years old

Fibromyalgia: 20-50 years

93
Q

Polymyositis vs. Dermatomyositis inflammation

A

Polymyositis - endomysial inflammation with CD8+ T cells

Dermatomyositis - perimysial inflammation and atrophy with CD4+ T cells

94
Q

Anti Jo 1 +

A

Polymyositis/dermatomyositis

95
Q

Anti-SRP +

anti-Mi 2 +

A

Polymyositis/dermatomyositis

96
Q

Associations of Myasethenia gravis

A

Thymoma, Thymic hyperplasia, thymic atrophy

97
Q

Associations of Lambert Eatin Myasthenic syndrome

A

Small cell lung cancer

98
Q

Pathophys of Myasthenia gravis

A

Autoantibodies to postsynaptic Ach receptor (nicotinic)

99
Q

Pathophys of Lambert Eaton

A

Autoantibodies to presynaptic Ca channel –> decreased Ach release

100
Q

What is myositis ossificans?

A

METAPLASIA of skeletal muscle into bone following muscular trauma

101
Q

CREST

A 
Limited scleroderma
Calcinosis
Raynaud phenomenon
Esophageal dysmotiligy
Sclerodactyly
Telangiectasia
102
Q

What is a macule? Example?

A

Flat lesion with well circumscribed change in skin color ( freckle, labial macule

103
Q

What is a patch? Example?

A

Macule > 1cm –> large birthmark

104
Q

What is a papule? Example?

A

Elevated solid skin lesion mole (nevus), acne

105
Q

What is a plaque? Example?

A

Papule > 1cm –> Psoriasis

106
Q

What is a vesicle? Example?

A

Small fluid-containing blister chickenpox, shingles

107
Q

What is a bulla? Example?

A

Vesicle > 1cm –> bullous pemphigoid

108
Q

What is a pustule? Example?

A

Vesicle containing pus –> pustular psoriasis

109
Q

What is a wheal? Example?

A

Transient smooth papule or plaque –> Hives (urticaria)

110
Q

What is a scale? Example?

A

Flaking off of stratum corneum –> Eczema, psoriasis, SCC

111
Q

What is a crust? Example?

A

Dry exudate –> Impetigo

112
Q

Cause of albinism

A

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
Q

Cause of Vitiligo

A

Autoimmune destruction of melanocytes

114
Q

Papules and plaques with silvery scaling; parakeratotic scaling

A

Psoriasis

115
Q

What is parakeratotic scaling?

A

Nuclei still in stratum corneum

116
Q

Inflammatory facial skin disorder characterized by erythematous papule and pustules but no comedones

A

Rosacea

117
Q

What is rhinophyma?

A

Bulbous deformation of nose

Chronic inflammatory change associated with Rosacea

118
Q

Flat, greasy pigmented squamous epithelial proliferation with keratin filled cysts

A

Seborrheic keratosis

119
Q

Stuck on appearance

A

Seborrheic keratosis

120
Q

Leser Trelat sign

A

sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy

121
Q

Well circumscribed, tan-brown slightly raised .5-1.5 cm lesions

A

Seborrheic keratosis

122
Q

Cause of bullous impetigo

A

Staph aureus

123
Q

Skin infection involving upper dermis; presents as well-defined demarcation between infected and normal skin

A

Erysipelas

Caused by S. pyogenes

124
Q

Pathophys of Staph scalded skin syndrome

A

Exotoxin destroys keratinocyte attachments in stratum granulosum ONLY

125
Q

Irregular, white, painless plaques on tongue that cannot be scraped off

A

Hairy leukoplakia

EBV mediated

126
Q

Autoimmune IgG Ab against desmoglein

A

Pemphigus vulgaris

127
Q

Blistering skin disorder with oral mucosa involvement

A

Pemphigus vulgaris

128
Q

Nikolsky sign +

A

Pemphigus vulgaris

Stevens Johnson syndrome

129
Q

Autoimmune IgG Ab against hemidesmosomes

A

Bullous pemphigoid

130
Q

Tense blisters containing eosinophils; affect skin but SPARE oral mucosa

A

Bullous pemphigoid

131
Q

Causes of erythema multiforme

A

Infections (mycoplasma pneumoniae, HSV)
Drugs (sulfa drugs, B lactase, phenytoin)
Cancers
Autoimmune disease

132
Q

Fever, bullae formation, necorsis, sloughing of skin

A

Stevens Johnson syndrome

133
Q

Causes of Stevens Johnson Syndrome

A

Epileptic drugs
Allopurinol
Sulfa drugs
Penicillin

134
Q

Associations of acanthosis nigricans

A 
Hyperinsulinemia (diabetes, obesity, Cushing)
Visceral malignancy (Gastric adenocardinoma)
135
Q

Premalignant skin lesions caused by sun exposure

A

Actinic keratosis

136
Q

Small, rough erythematous or brown papule or plaques

A

Actinic keratosis

137
Q

Associations of erythema nodosum

A 
Sarcoidosis
Coccidiodomycosis
Histoplasmosis
TB
Streptococcal infections
Leprosy
Crohn disease
138
Q

Wickham striae?

A

Reticular white lines in mucosa

Lichen Planus

139
Q

Skin disorder associated with Hepatitis C

A

Lichen Planus

140
Q

Multiple plaques with collarette scale

A

Pityriasis rosea (Christmas tree distribution); self resolves in 6-8 weeks

141
Q

Keratin pearls on histology

A

Squamous cell carcinoma

142
Q

Keratoacanthoma

A

Variant of Squamous cell carcinoma that grows rapidly and may recess spontaneously over months

143
Q

S-100 tumor marker

A

Melanoma

144
Q

Mutation in melanoma

A

Activating mutation in BRAF kinase

145
Q

What is Vemurafenib?

A

BRAF kinase inhibitor that can be used in metastatic of unresectable melanoma

146
Q

Alprostadil

A

PGE1 analog; decreases vascular tone

147
Q

Dinoprostone

A

PGE2 analog; increases uterine tone

148
Q

Carboprost

A

PGF2 analog; increases uterine tone

149
Q

Epoprostenol

A

PGI2 analog; decreases platelet aggregation and vascular tone

150
Q

COX-2

A

Inducible enzyme undetectable in most tissues except activated inflammatory cells
-Makes PGI2 –> inhibits platelet aggregation

151
Q

S/E of Celecoxib

A

Increased risk of thrombosis, sulfa allergy

152
Q

Toxicity of NSAIDs

A

Interstitial nephritis, gastric ulcer, renal ischemia

153
Q

Which drugs do you avoid in gout?

A

Salicylates –> all but highest doses depress uric acid clearance

154
Q

S/E of TNF alpha inhibitors

A

Predispose to infection –> reactivated latent TB (TNF important for granuloma formation and stabilization)

155
Q

Etanercept

A

TNF alpha decoy receptor

Used for RA, psoriasis, ankylosing spondylitis

156
Q

Infliximab, Adalimumab

A

Anti-TNF alpha monoclonal Ab

Used for IBD, RA, Ankylosing spondylitis, psoriasis

Step 1 AB (29 decks)

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