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* DIT each session > Day 8.3 MSK/Derm > Flashcards

Day 8.3 MSK/Derm Flashcards

1
Q

What are the seronegative spondylo-arthropathies?

A

Arthritis w/o RF (sero-negative- so no anti-IgG Ab).
Strongly a/w HLA-B27 (which codes for MHC-I). More common in males.
Ankylosing spondylitis
Reactive arthritis (Reiter’s)
Psoriatic arthritis

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2
Q

Ankylosing spondylitis

A

Chronic inflam dz of spine and sacroiliac joints leads to ankylosis (stiff spine dt joint fusion), uveitis, and aortic regurg.
Stiffness improves w (or requires) exercise
Sacroiliitis = think ank spond!
Bamboo spine - IV discs outlined by calcifications.

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3
Q

Reactive arthritis (Reiter’s)

A 
Classic triad:
1. Conjunctivitis and anterior uveitis
2. Urethritis
3. Arthritis
Can't see, pee, climb a tree
Often post-GI (shigella flexneri) or post-Chlamydia infection
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4
Q

Psoriatic arthritis

A 
Joint pain and stiffness a/w psoriasis.
Asymmetric and patchy involvement.
Dactylitis (sausage fingers)
Pencil in cup deformity on xray.
Seen in fewer than 1/3 of pts w psoriasis
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5
Q

Rx for seronegative spondyloarthropathies

A

Anti-TNFa agents: Etanercept, Infliximab, Adalimumab

also NSAIDs and steroids can be used.

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6
Q

SLE lab results

A

ANA+ (anit-nuclear Ab. good screening test, but not specific for SLE)
Anti-dsDNA Ab (esp for renal dz. poor pgx)
Anti-Smith Ab
Anti-histone Ab (for drug-induced)

Also, will have false-pos VRDL for syphilis dt anti-phospholipid Ab, which cross-react w cardiolipin (aka anti-cardiolipin Ab)

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7
Q

SLE epi and sx

A 
Black Female, 14-45 yo
Fever, fatigue, weight loss
non-bacterial verrucous endocarditis
hilar adenopathy
Raynaud's
Wire-loop lesions in kidney w immune complex deposition (usu nephritic syndr)
Death from renal failure and infections.
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8
Q

Causes of drug-induced SLE

A 
SHIPP:
Sulfonamides
Hydralazine
INH
Phenytoin
Procainamide
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9
Q

SLE: I’M DAMN SHARP sx

A

Immunglobulins (anti-dsDNA, anti-Sm, antiphospholipid)
Malar rash

Discoid rash
ANA+
Mucositis (oropharyngeal ulcers)
Neurologic disorders (seizure, psychosis)

Serositis (pleuritis, pericarditis)
Hematologic disorders (anemia, leukopenia, lymphopenia, thrombocytopenia)
Arthritis
Renal disorders
Photosens
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10
Q

Things that can give ANA+

A 
SLE
Sjorgren's (and sicca)
Scleroderma
Polymyositis
Dermatomyositis
RA
Juvenile arthritis
MCTD
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11
Q

Rx for SLE

A

Glucocorticoids
NSAIDs
Hydroxy-chloroquine (anti-malarial)
Cyclophosphamide

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12
Q

Sarcoidosis

A

Immune-mediated non-caseating granulomas that are widespread, plus elevated serum ACE levels.
Common in black females.

A/w GRAIN:
Gammaglobulinemia
Rheum arthritis
ACE increase
Interstitial fibrosis
Non-caseating granulomas
and
Restrictive lung dz
Bilateral hilar lymphadenopathy 
Erythema nodosum
Bell's palsy
epithelial granulomas containing Schaumann and asteroid bodies
Uveopartotitis
Hyper-calcemia (d.t elevated Vit D, which is converted a lot to its active form in epitheloid macrophages.

Rx: Steroids

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13
Q

What is erythema nodosum?

A

Painful, nodular inflam of subcutaneous fat, classically on the anterior shin (in front of tibia)
Seen in sarcoidosis

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14
Q

What is polymyalgia rheumatica?

A

Pain/stiffness in shoulders and hips, often w fever, malaise, weight loss.
Despite the name myalgia, it does NOT cause muscular weakness.
Occurs in pts >50yo
A/w temporal (giant cell) arteritis

Findings: elevated ESR and normal CK (aka CPK), a marker for muscle cell breakdown

Rx: Prednisone (steroids)

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15
Q

What are the findings and Rx for polymyositis and dermatomyositis?

A

Increased CK, increased aldolase
Positive ANA
Anti-Jo1 Ab

Rx: steroids

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16
Q

Polymyositis

A

progressive symmetrical proximal musc weakness caused by CD8+ T-cell induced injury to myofibers.
Most often involves shoulders (and pelvis)- most musc dz affects proximal musc, whereas nerve dz affects distal.
Dx by musc biopsy showing evidence of inflam

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17
Q

Dermatomyositis

A 
Like polymyositis (symm proximal musc weakness d.t CD8+ injury to myofibers)
But also involves malar rash, heliotrope rash (around eyes), shawl-and-face rash, Gottron's papules, mechanic's hands.
Increased risk of malignancy (the normal neoplasms- lung, breast, etc)
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18
Q

Myasthenia Gravis

A

Most common NMJ disorder.
Auto-Ab to the post-synaptic ACh receptor
Causes ptosis, diplopia, general weakness
A/w thymoma
Sx get worse (!) w musc use
Rx: AChE inhibitors (cause ACh to stay around longer)

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19
Q

Lambert-Eaton syndrome

A

NMJ dz
Auto-Ab to presynaptic Ca2+ channel, results in decreased ACh release, so proximal musc weakness.
Unlike MG, extraocular musc are spared.
Assc w paraneoplastic dz (sml cell lung cancer)
Sx improve w musc use (test: isometric contraction improves musc strength)
No reversal of sx w AChE inhibtors alone.

So: dry mouth + impotence + muscle weakness, and assoc w sml cell lung carcinoma = lamb-eaton

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20
Q

Mixed CT Dz

A 
Raynaud's FAME:
Raynaud's
Fatigue
Arthralgias
Myalgias
Esophageal hypomotility

Ab to U1RNP
Responds to steroids

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21
Q

Scleroderma

aka PSS- progressive systemic sclerosis

A

Excessive fibrosis and collagen deposits thru-out body.
Commonly in skin- puffy taut skin w no wrinkles
There is also sclerosis of renal, pulm, CV, and GI systems
75% female.
“bulking” dz
2 types= diffuse and CREST

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22
Q

Diffuse scleroderma

A

widespread skin involvement, rapid progression, early visceral involvement.
Anti-Scl-70 Ab (aka Anti- DNA topoisomerase I Ab)

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23
Q

CREST scleroderma

A 
CREST:
Calcinosis (subepithelial Ca2+ deposits)
Raynaud's
Esophageal dysmotility
Sclerodactyly (sausage fingers)
Telangiectasia

Limited skin involvement- confined to fingers and face.
More benign than diffuse.
Anti-Centromere Ab

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24
Q

Lipoma

A

Benign
Soft, well-encapsulated fat tumor
Cure by simple excision

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25
Q

Liposarcoma

A

Malignant fat tumor; can be very lg.

Will recur unless absolutely all of it is removed

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26
Q

Rhabdomyoma

A

Benign tumor derived from striated musc (either skeletal or cardiac)
Cardiac rhabdomyoma is common in tuberous sclerosis

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27
Q

Rhabdomyosarcoma

A

Malignant
Most common soft tsu tumor of childhood
Arises from skel musc, most often in head/neck

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28
Q

Derm:
Macule
Patch

A

Both macules and patches are flat lesions
Macule - flat discoloration 1cm
Ex: tinea versicolor

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29
Q

Derm:
Papule
Plaque

A

Both papules and plaques are elevated lesions
Papule - elevated and 1cm

Papule: acne vulagris
Plaque: psoriasis

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30
Q

Derm:
Vesicle
Wheal
Bulla

A

These are blisters
Vesicle- sml fluid containing blister (chickenpox)
Wheal - transient vesicle (hives)
Bulla - lg fluid containing blister (bullous pemphigoid)

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31
Q

Derm: Keloid

A

Irregular raised lesion resulting from scar tsu hypertrophy.
Follows trauma to skin, esp in african americans.
Basically just excess collagen- too much scarring.
Often on upper chest, ear lobe.
Ex: T. perenue (yaws)
Rx inject local steroids

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32
Q

Derm:
Pustule
Crust

A

Pustule - blister containing pus (impetigo)

Crust- dried exudate from a vesicle, bulla, or pustule

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33
Q

Derm:
Hyperkeratosis
Parakeratosis

A

Hyperkeratosis: increased thickness of the stratum corneum (psoriasis)

Parakeratosis: hyperkeratosis w retention of nuclei in the stratum corneum (also psoriasis)

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34
Q

Derm:
Acantholysis
Acanthosis

A

Acantholysis: separation of epidermal cells (pemphigus vulgaris)

Acanthosis: epidermal hyperplasia d/t increased spinosum layer (acanthosis nigricans)

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35
Q

Dermatitis

A

Inflam of the skin

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36
Q

Skin disorders: Verrucae

A

Warts
Soft tan cauliflower-like lesions
Epidermal hyperplasia, hyperkeratosis, koilocytosis
Verucca vulgaris on hands
Condyloma acuminatum on genitals (caused by HPV)

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37
Q

Skin disorders: Nevocellular nevus

A

common mole. benign

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38
Q

Skin disorders: Uticara

A

Hives

Intensely pruritic wheals that form after mast cell degeneration

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39
Q

Skin disorders: Ephelis

A

Freckle.

Normal number of melanocytes, but increased melanin pigment

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40
Q

Skin disorders: atopic dermatitis (aka eczema)

A

Pruritic eruption, commonly on skin flexures (eg anticubital fossa of knee)
Often a/w other atopic dz (asthma, allergic rhinitis)
Common px: kids <1yo getting bathed too frequently.

41
Q

Skin disorders: allergic contact dermatitis

A

Type IV HPS
Follows exposure to allergen- eg nickel, poison ivy
Lesions occur at site of contact

42
Q

Skin disorders: psoriasis

A

Papules and plaques (elevated) w silvery scaling (!), esp on knees and elbows.
Acanthosis (spinosum hyperplasia) with parakeratotic scaling (nuclei still in stratum corneum)
Increased stratum spinosum, decreased stratum granulosum
Auspitz sign: bleeding spots when scales are scraped off
Can be a/w nait pitting and psoriatic arthritis

43
Q

Skin disorders: Seborrheic keratosis

A

Flat, greasy, pigmented sq epithelial proliferation w keratin-filled cysts (horn cysts).
Looked “pasted on”
Lesions on head, trunk, extremities
Common benign neoplasm of ELDERLY (young ppl get moles, old ppl get seborrheic keratosis)

Sign of Leser-Trelat: sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (eg GI lymphoid)

44
Q

Pigment disorders: albinism

A

Normal melanocyte number, but decreased melanin production d/t decreased activity of tyrosinase. (melanin is made from tyrosine).

Can also be caused by failure of neural crest cell migration during devt

45
Q

Pigment disorders: vitiligo

A

Irregular areas of complete depigmentation

Caused by decreased number of melanocytes

46
Q

Pigment disorders: melasma

A

Hyperpigmentation a/w pregnancy (mask of pregnancy) or with OCP use

47
Q

Infectious disorders: impetigo

A

V superficial skin infection
Usu from S. aureus or S. pyogenes
Highly contagious
Honey-colored crusting around lips/mouth

48
Q

Infectious disorders: Cellulitis

A

Acute, painful spreading infection of dermis and subcutaneous tsu.
Usu from S. pyogenes or S. aureus

49
Q

Infectious disorders: Necrotizing fasciitis

A

Deep tsu injury, usu from anaerobic bacteria or from S. pyogenes.
Results in crepitus (popping) from methane and CO2 production
Flesh-eating bacteria

50
Q

Infectious disorders: SSSS staphylococcal scalded skin syndrome

A

Staph exotoxin destroys keratinocyte attachments in the stratum granulosum (only).
Px w cough, fever, generalized erythematous rash, and sloughing off of upper layers of epidermis
See in newborns and children

51
Q

Infectious disorders: Oral Hairy Leukoplakia

A

White painless plaques on tongue that CANNOT be scraped off.
Caused by EBV
Occurs in HIV+ pts

52
Q

Blistering disorders: Pemphigus vulgaris

A

Auto-immune: IgG Ab against desmosomes (which connect cells to cells)
aka anti-epithelial cell Ab, anti-desmoglian Ab
Can be fatal.
Immunoflurescence: Ab around cells of epidermis in reticular/netlike pattern

Acantholysis: intraepidermal bullae involving skin and oral mucosa (diagnostic)

Positive Nikolsky’s sign- separation of epidermis upon manual stroking of skin

53
Q

Blistering disorders: Bullous pemphigoid

A

Auto-immune. IgG Ab against hemidesmosomes (connect cell to BM).
Ab are “bullow” (below) the epidermis
Shows linear immunofluorescence.
Eosinophils w/in blisters.

Similar but less severe than pemphigus vulgaris- affects skin, but spares oral mucosa, and there is a negative Nikolsky’s sign (epidermis doesn’t separate on stroking)

54
Q

Blistering disorders: Dermatitis herpetiformis

A

Pruritic papules and vesicles
Deposits of IgA at tips of dermal papillae
A/w celiac dz

55
Q

Blistering disorders; Erythma multiforme

A

A/w infections (mycoplasma pneumoniae, HSV) and esp w drug rxns- sulfa, B-lactams, phenytoin. Also assoc w cancer and auto-imm dz.
Px: multiple types of lesions- macules, papules, vesicles, target lesions (pale center)

56
Q

Blistering disorders; Stevens-Johnson Syndrome

A

Fever, bulla formation (bulla- lg fluid blister), and necrosis, with sloughing of skin.
High mortality rate.
Usu a/w adverse drug rxn

More severe form: TEN toxic epidermal necrolysis. >30% of body area is sloughing off and detaching.
Caused by seizure meds, sulfa, -cillins, allopurinol

57
Q

Misc skin: Lichen planus

A

PPPP: pruritic, purple, polygonal papules
Sawtooth infiltrate of lymphocytes at dermal/epidermal jn.
Assoc w HCV

58
Q

Misc skin: Actinic keratosis

A

Pre-malignant lesions caused by sun exposure.
Small rough sandpapery erythematous or brownish papules. “Cutaneous horn”
Risk of carcinoma is proportional to epithelial dysplasia.
Rx: 5-FU turns it beefy red

59
Q

Misc skin: Acanthosis nigricans

A

Hyperplasia of stratum spinosum.
A.w hyperinsulinemia (cushings dz, diabetes)
if >40 w new acanthosis nigricans- visceral malignancy.

60
Q

Msic skin: Erythema nodosum

A

Inflammatory lesions of subcutaneous fat, usu on anterior shins
A/w cocci, histoplasmosis, TB, leprosy, strep infections, sarcoidosis

61
Q

Misc skin: Pityriasis rosea

A

“Herald patch” on trunk/back followed days later by “xmas tree” distribution.
Multiple papular eruptions, remits spontaneously. Benign.

62
Q

Misc skin: Strawberry hemangioma vs Cherry hemanigoma

A

Strawberry: first few weeks of life, grows rapidly and regresses spontaneously at 5-8 yo.
Cherry- appears in 30s-40s, does not regress.

63
Q

4 causes of acne

A

Hyperkeratosis
Sebum overproduction
Proliferation of Proprionibacterium acnes
Inflammation

64
Q

How to treat acne

A

Proliferation of P. acnes: Benzol peroxide (1st line), erythromycin, tetracycline, topical clindamycin, sulfacetamide

Sebum overproduction: isotretinoin, spironolactone (anti-androgen), estrogens

Hyperkeratosis: Vitamin A analogs, topical retinoic acid, isotretinoin

Inflam: short term local steroid injection at lvl of lesion

65
Q

Skin rash + proximal muscle weakness

A

Dermatomyocytis

66
Q

Most common skin cancers

A
  1. Basal cell carcinoma
  2. Sq cell carcinoma
  3. Melanoma
67
Q

List skin cancers in order of metastatic potential:

A
  1. melanoma (worst)
  2. sq cell carcinoma
  3. basal cell carcinoma
68
Q

Melanoma

A

Skin cancer w high risk of metastasis
Dark w irreg borders.

S-100 tumor marker
a/w sunlight exposure, fair-skinned pts at incrsd risk
Depth of tumor correlates w risk of metastasis

ABCD:
Asymmetry, Border irreg, Color (diff colors w/in same lesion), Diameter (bigger than pencil eraser)

69
Q

What is a precursor to melanoma?

A

Dysplastic nevus (atypical mole)

70
Q

Basal cell carcinoma

A

Most common skin cancer.
Locally invasive, but usu never metastasizes.
Rolled edges w central ulceration.
Histo: palisading nuclei (nuclei line up long-ways)
Gross: pearly papules, commonly w telangiectasias

71
Q

Squamous cell carcinoma

A

2nd most common skin cancer after basal cell.
A/w excessive sunlight and arsenic exposure.
Common on hands/face
Locally invasive, rarely metastasizes.
Ulcerative red lesion- erosive.
A/w chronic draining sinuses.
Histo: keratin pearls

72
Q

Precursor to sq cell carcinoma

A

Actinic keratosis (sandpaper lesion)

73
Q

Keratoacanthoma

A

variant of sq cell carcinoma that grows rapidly (4-6wks) and regresses spontaneously (4-8wks)
Dome-shaped, wartlike.

74
Q

Mech of Aspirin

A

Irreversibly (!!) inhibits COX-1 and COX-2 by covalent binding, which causes less TXA2 and prostaglandins to be produced.

75
Q

Aspirin clinical use

A 
Low dose (&lt;300mg/day): decreases plt aggregation
Med dose (300-2400mg/day): antipyretic and analgesic
High dose (2400-4000 mg/day): anti-inflam
76
Q

Toxicity of aspirin

A

Gastric upset
Chronic use can lead to acute renal failure, interstitial nephritis, and upper GI bleeding.
Reye’s syndrome in kids w viral infection.

77
Q

Acetominophen mechanism

A

Reversibly inhibits COX, mostly in CNS. Inactivated peripherally.

78
Q

Acetominophen clinical use

A

anti-pyretic, analgesic, but does not have anti-inflam properties.
use instead of aspirin in kids w viruses so they don’t get reye’s

79
Q

Acetominophen toxicity

A

overdose causes hepatic necrosis

acetaminophen metabolite depletes glutathione and forms toxic tsu adducts in the liver.

80
Q

What is the antidote to acetaminophen OD?

A

N-acetylcysteine (it regenerates glutathione)

81
Q

What is N-acetylcysteine used for?

A

Antidote for acetaminophen OD
Prevents contrast-induced nephropathy
Mucolytic (breaks up mucous plugs, eg in CF, bronchial asthma)

82
Q

What is fibromyalgia?

A

Excess muscular tenderness in 11/18 sites

Chronic generalized pain, fatigue, sleep disturbances, HA, cognitive difficulty, mood disturbances (30% have deprsn/anx)

83
Q

Rx for fibromyalgia

A

Pregabalin, milnacipran (SNRI)
Amitryptiline (helps to sleep), low-dose analgesic, fluoxetine

Reassurance, exercise.stretching, sleep, relaxation techniques, stress reduction

84
Q

What skin disorder has pruritic, purple, polygonal papules?

A

Lichen planus

85
Q

What skin disorder has life threatening rash w bulla?

A

Stevens-Johnson Syndrome (and TEN)

Pemphigus vulgaris

86
Q

What skin disorders consists of pruritis a/w asthma?

A

Eczema (atopic dermatitis)

87
Q

What skin disorder has pruritic veslcles and is a.w celiac dz?

A

Dermatitis herpetiformis

88
Q

What skin disorder exhibits an allergy to nickel?

A

Contact dermatits (type IV HPS)

89
Q

What skin disorder results in a thickened scar esp around face.chest?

A

Keloids

90
Q

What skin disorder has Ab against epidermal BMs?

A

Bullous pemphigoid (Ab against hemidesmosomes)

91
Q

What skin disorder has Ab against epidermal cell surface?

A

Pemphigus vularis (Ab against desmosomes)

92
Q

What skin disorder exhibits parakeratotic scaling?

A

Psoriasis

93
Q

What skin disorder has keratin-filled cysts?

A

Seborrhic keratosis (in old pts)

94
Q

What skin disorder is characterized by sand paper lesions and predisposes to sq cell cancer?

A

Actinic keratosis

95
Q

What skin disorder exhibits skin rash w proximal musc weakness?

A

Dermatomyositis

96
Q

What skin disorder features honey-crusting lesions common around the nose/lips?

A

Impetigo

97
Q

What skin disorder exhibits hyperderatosis and koilocytosis?

A

Verruca (warts- from HPV)

98
Q

What skin disorder shows palisading nuclei on histology?

A

Basal cell carcinoma

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