Derm/MSK Flashcards
Where is knee pain located in Pes Anserine Pain syndrome?
aka Pes Anserine Bursitis
MEDIAL pain / MEDIAL bursitis
Describe the Noble test.
pt lies on side
experiences pain when doctor applies pressure to the LATERAL side of a flexed knee
A + NOBLE test indicates what knee condition?
Iliotibial band syndrome (ITBS)
A sessile growth with a cartilage CAP on a bone is mnemonic for what bone tumor?
= Osteochondroma
- sessile = pendunculated = mushroom like growth
Osteo-chondroma is a BENIGN bone tumor that grows on what area of the bone?
Metaphysis
(M)ushroom (M)etaphysis
Any bone tumor that ends in -SARCOMA will present with what symptoms?
B symptoms!
- fevers
- pain thats worse at night
- elevated inflammatory markers
Chrondro-SARCOMA is the malignant form of osteo-chrondroma and presents at what age?
> 50yo
Chrondro-SARCOMA is associated with what bone condition seen in older males?
Pagets disease of the bone
“Moths eating Popcorn” is mnemonic for what bone malignancy?
Chondro-SARCOMA
Ewing SARCOMA affects what area of the bone?
Diaphysis
diameter of the wing
Ewing SARCOMA presents with what finding on Xray?
Onion skinning + Codmans triangle
Osteo-SARCOMA presents with what finding on Xray?
SUBURST appearance of lytic bone lesions and/or Codman triangles
Osteo-SARCOMA presents at what age?
Bi-modal
10 & 30 yo
Osteo-SARCOMA is located to what area of the bone?
metaphysis
Sun(burst) & Moon (metaphysis)
Osteo-SARCOMA is associated with which occular malignancy?
Which childhood malignancy syndrome?
Retinoblastoma
Li-Fraumeni syndrome (Sarcoma, Breast, Adrenal, & Leukemia malignancies)
what benign bone disease looks JUST like chondro-SARCOMA but has no B symptoms?
chrondoBLASToma
ChondroBLASToma occurs at what area on the bone?
Epiphysis
(E)PIC (B)last
A diabetic with back pain (and elevated ESR/CRP) =
vertebral osteomyelitis!!
aka Spondylitis, Spondylodiscitis
what is the definitive confirmatory test for vertebral osteomyelitis?
CT-guided aspiration biopsy
which bullae/blistering condition bullows below the epidermis to attack hemidesmosomes?
what autoantibody & complement is found?
BULLOUS pemphigoid
linear deposits of IgG and C3 along the basement membrane.
what bullae/blistering condition affects OLD ppl by making them itchy?
BULLOUS pemphigoid
Old like bull
which bullae/blistering condition has a positive nikolsky sign & mucosal involvement?
Pemphigus vulgaris; they rub away bc they are flaccid & painful (unlike bullous which is tense/itchy)
how do you know a patient with severe burn wounds has skin infection by looking at temp?
hypothermia (95 F) + oligouria + leukocytosis
what is the cause of complex regional pain syndrome?
what are the 3 clx features?
trauma (fracture, surgery, etc)
DEC temp, burning pain, weakness, edema
what is the tx for complex regional pain syndrome?
physical and occupational therapy (learn to cope with pain)
which 3 veins are the ONLY originators of DVT & Pulmonary embolisms?
PROXIMAL deep veins: Iliac, Femoral, Popliteal
which burn victims need Serial arterial blood gas analysis?
inhalation + burn victims.
dont bother with serial blood gas unless that pt isnt breathing properly
a circumferential / “encircling” burn is mnemonic for what incoming condition?
how do you monitor this pt?
compartment syndrome
serial pulses & capillary fillings
koplik spots is mnemonic for ___
measles, mumps, rubella
wells criteria for DVT.
at what point is it high test probability > dx w/ US?
- active cancer
- Hx DVT
- Hx of immobilization (bed ridden/surgery)
- clx signs (entire leg swollen, pain, fever, +Homan)
- > 2 = perform an US to dx
Why dont you run a d-dimer on post op patients?
It will always be false positive. therefore D-dimer on post op pts is a contraindication
how do obturator nerve injuries happen?
loss of sensation is localized to ____
pelvic (ring) fractures
medial thigh
what does an urticarial rash/hives look like on a patient?
a red Confluent rash
what are the ways to get urticaria besides an allergic reaction?
INFECTIONS w/ virus, parasite, bacteria»_space;> post infection urticaria
Papillary dermal IgA deposition is mnemonic for what rash
dermatitis herpetiformis= IgA deposits in the dermal layer
celiac disease
Trichophyton rubrum
Tinea corporis (ring worm)
who is at higher risk for diffuse trichophyton rubrum infections?
diabetes & HIV
Epidermal keratinocyte hyperproliferation is a typical feature of ______
psoriasis
bullous pemphigoid and pemphigus vulgaris are Type ___ HS rxn rashes?
Cutaneous cytotoxic reaction (Type 2)
polyarthritis nodosa should be considered in young adults presenting with ____ or ______.
stroke
MI
PAN = T3HS rxn = complexes deposited in blood vessels> stenosis> stroke/MI
conditions caused by defects in:
Type 1 collagen Type 2 collagen Type 3 collagen Type 4 collagen Type 5 collagen
Type 1 collagen = osteogenesis imperfecta
Type 2 collagen = cartilage probs
Type 3 collagen = Vascular ehlers danlos (aortic dissection, ruptures AAA, subarachnoid hemorrhage)
Type 4 collagen = alport syndrome
Type 5 collagen = classic elhers danlos
Redness and profuse watery discharge that starts in one eye and rapidly spread to the other is dead give away for what eye complication?
what ear findings are seen?
pink eye (EPIDEMIC keratoconjuctivitis)
Unilateral preauricular lymphadenopathy
what are the clx features of lichen sclerosis in women, children, & men (yes everyone gets it ;) )
ALL: severely itchy, white plaques on vulva & anus (anal fissures)
women = figure 8 of vulva and anus + dyspaurenia
men = penile white plaque lesions + phimosis (cant retract foreskin)
child = figure 8 + constipation (pain from anal fissures)
risk factors for avascular necrosis
SLE, steroid use, alcohol use, SCD
what is the age range for transient synovitis? this is very important to remember.
< 10 yo
TENsient synovitis
what always precedes transient synovitis (hint: this is the reason why its transient)
URT infection
what is the pathophys of avascular necrosis? (hint: this is the reason there is no leukocytosis or systemic signs)
decrease blood flow to the bone
legg cathe perthe is a subtype of
avascular necrosis
what does seronegative mean?
what are the seronegative arthritides?
negative for RF
ankylosing spondylitis, reactive/postinfectious arthritis, psoriatic arthritis
what are seronegative arthritides strongly positive for?
ANA & HLA-B27 !!
what is the classic style of reactive/post infectious arthritis joint pain?
asymmetric & migratory = 1 joint at a time
Arthritis after a gastritis or UTI/cervicitis/urethritis?
post infectious/reactive arthritis
what are the 4 types of juvenile idiopathic arthritis?
Seronegative polyarticular juvenile idiopathic arthritis
Oligoarticular juvenile idiopathic arthritis
Systemic juvenile idiopathic arthritis
Psoriatic JIA
what gender & age gets oligoarticular juvenile idiopathic arthritis ?
FEMALE (4:1)
TODDLERS (2-4 yo little girls)
how many joints does Oligoarticular juvenile idiopathic arthritis affect?
which joints are affected most?
< 4 joints bc Oligo means few/not many
Weight bearing joints like knee, ankle, wrist
what important skin PE findings in systemic juvenile idiopathic arthritis sets it apart from the other 2 (oligo & poly)?
Systemic will present with salmon pink rash rash in addition to the arthritis
how many joints does systemic juvenile idiopathic arthritis affect?
why this #?
< 1 joint !!
only affects 1 joint bc its too busy causing all those systemic issues (fever, rash, lymphadenopathy)
how many joints does polyarticular juvenile idiopathic arthritis affect?
which joints are affected most?
> 5 joints bc Poly means MANY
teeny tiny joints in the fingers and hands only
which juvenile idiopathic arthritis (s) present with uveitis?
oligioarticular JIA
seronegative polyarticular JIA
psoriatic JIA
what is the age cut off for JIA?
how long does arthritis have to last to be considered JIA?
< 16 yo
must last > 6 weeks
what is keratoconjunctivitis sicca?
dry eyes
what is the pathophys of a radial head subluxation?
what are the clx findings in a child with radial subluxation?
traction of the arm with pull the radial head out from under the annular ligament that holds it in place.
elbow flexion ++ forearm protonation
how do you treat radial subluxation?
Manual reduction via either:
supination of the forearm
hyperprotonation forearm
why do you NOT order a xray for a child with radial subluxation?
NO XRAY bc NO FRACTURE
what is the classic presentation of a rosacea rash?
what triggers rosacea rash?
red telangiectia & pustules
triggered by INC body temp (heat, alcohol, stress, spicy food, nicotine)
what organ does rosacea involve besides the skin?
EYE> ocular rosacea
what rash is pathognomonic for CHRONIC Sarcoidosis?
what does it look/feel like?
Lupus pernio (looks just like a malar rash but is NEGATIVE for ANA markers= NOT sle)
nonpruritic, painless violaceous skin plaques and/or nodules on the nose and cheeks
Lupus vulgaris is pathognomonic for what disease?
what are the characteristics of the rash?
TB!!
painful nodules that ulcerate
the only LUPUS rash = malar, discoid; any rash that starts with “lupus” is NOT true SLE
what muscle does the inferior gluteal nerve innervate?
what is the function of this muscle?
Inf gluteal n innervates the Gluteus MAXIMUS muscle
gluteus maximus muscle causes thigh EXTENSION
damage to what nerve > positive trendelenberg sign
what muscles does it innervate?
damage to the SUPERIOR gluteus n
innervates gluteus medius & minimus
what imaging do ALL rheumatoid arthritis and Down Syndrome pts need before undergoing general anesthesia for surgery?
why?
RA & Downs pts need LATERAL XRAYS of the extended and flexed cervical spine (C1 & C2)
RA & Downs pts suffer from alanto(CI) ataxial(C2) instability EARLY in the diseases.
the position of the neck is hyper-extended when anesthesia is used during surgery» subluxation of C1–C2> cervical spinal cord injury
what are the rash characteristics in scarlet fever?
- begins on NECK> trunk & groin
- Pastia lines (LINEAR rash in groin, underarm, and elbow creases)
- 7–10 days after resolution of rash you get skin peeling (desquamation)
another name for Fifth disease.
what is the causative organism?
Erythema infectiosum
Parvovirus
another name for sixth disease.
what is the causative organism?
Roseola Infantum or Exanthem subitum (from Latin: “subitus” = sudden) describes a “sudden exanthem” (upon fever cessation).
Human Herpes Virus 6 (HHV6)
what is the only abnormal CBC finding in Pagets disease ?
increased serum alkaline phosphatase is often the only abnormal marker of bone metabolism
(calcium, phosphate, and parathyroid hormone are NORMAL)
what tool is used to dx acute compartment syndrome?
MANOMETRY = measures pressure/movement
what radiculopathy causes weak patellar reflex?
L4
what radiculopathy causes weak achilles tendon reflex?
S1
what radiculopathy causes weak heel walk/ankle dorsiflexion?
L5
what radiculopathy causes weak tippy toe walk/plantar flexion?
S1
what radiculopathy causes weak leg extension?
L4
what radiculopathy causes weak hip flexion?
L3
S1 gives sensation to :
lateral foot
L3 gives sensation to :
ant lateral thigh & medial leg
L4 gives sensation to :
knee/patella & medial foot
L5 gives sensation to :
section between 1st & 2nd toes
what nerve roots cause Diminished sensation of the anus and genitalia?
L3-S5= cauda equina syndrome
fluctuant fluid over the patella =
Pre-patellar bursitis
what actions/professions cause Pre-patellar bursitis?
overuse/trama via frequent kneeling (carpenter, plumbing, mechanics)
CHRONIC Inflammatory Demyelinating Polyneuropathy (CIDP) is a subtype of ______ that presents just like it, BUT onset greater than 2 months instead of acute.
what autoantibodies are positive in CIDP
GB syndrome
Positive GM1 ganglioside autoantibodies
CIDP looks JUST like GB syndrome but pt will have symptoms for >2 months
what does Tinea Capitis look like?
how do you get it?
bald patches (alopecia) with hair trying to regrow
ALWAYS in children who share hats/combs/pillows
what is the PE maneuver to dx AC joint injury?
what is the next step in management?
pain with adduction of the affected arm across the other side of the pts body
immediate Xray!!!
FYI: AC injuries occur when pts fall onto an adducted/bent arm (biking, horse back riding)
