Diseases Week 4 Flashcards
Chagas’ disease (American Trypanosomiasis)
Causative agent: Trypanosoma cruzi Vector: Triatomine Bug Symptoms: Romana sign (swelling of the child’s eyelid), Chagastic cardiomyopathy, megacolonic colon or esophagous, Acute: often asymptomatic Chronic disease: 20-40% of patients. *US transmission through blood supply or organ donations. Can reappear in chronic inderminate individuals if they become immuncompromised Treatment: Nifurtimox and Benznidazole (induce oxidative stress; requires type I nitroreductase to activate which is only in tyrpansosomes; very toxic)
Lymphatic filariasis (elephantiasis)
Causative agent: nematode Wuchereria bancrofti. Vector: female mosquito Endemic areas: Asia, Africa, Western Pacific, Caribbean, and South America. (Number one cause of global disability) Symptoms: Adults in lymphatics, lymphedema, elephantiasis, hydrocele in men. Social shunning, Tests: blood smear taken at night, serological assay. Treatment: Diethylcarbamazine (DEC) ; MDA has been effective. Lymphadema and elephantiasis are NOT indicaitons for DEC becasue most people w/ lymphadema are not actively infected.
- Cycling, rowing and other activities that require repetitive hip extension while seated may overwhelm the bursa’s ability to dissipate applied stress
Ischial bursitis aka weaver’s bottom
Causative agent - dengue virus and Chikungunya virus Symptoms- biphasic fever, pharyngitis, cough, arthralgias, generalized maculopapular rash but not on palms and soles, Transmission - mosquito borne. Not present outside tropics or in winter months Incubation - 3-8 days Management- prevent mosquitos, manage symptoms
Dengue fever
Casative agent: Orf virus Symptoms - Small pimple on hands with no other symptoms. History of sheep handling. transmission - zoonosis from sheep; especially in spring Management- duration is 30-40 days and resolves spontaneously with only symptomatic care; wearing of gloves.
Ecthyma contagiosum (Orf virus)
Glomus tumor and glomangioma
benign typically painful tumor showing differentiation to the modified smooth muscle cells of the glomus body (AV structure involved in thermoreg) Most often in distal digits.
Limited hip extension during mid-stance, compensated for by hyperextension of trunk. Damage to inferior gluteal nerve and thus parlysis of gluteus maximus.
Gluteal lurch
- Paralyzed gluteus medius and minimus muscles as a result of injury to the superior gluteal nerve - Normal steadying effect of these muscles is lost so when the foot is raised on the normal side, the pelvis falls on that side. - Also caused by congenital dislocation of the hip or nonunion of a fracture of the femoral neck - Supporting mechanism fails & pelvis sinks when an attempt is made to stand on the affected limb
Gluteal limb. Trendelenburg’s sign
Echo virus
Causative agent: echovirus (enterovirus) Symptoms - flu-like process with mild fever, malaise, abdominal cramping, diarrhea, and non-specific maculopapular rash of trunk. Transmission: fecal oral Incubation 3-6 days Diagnosis - clinical course, viral isolation from feces, serology Management - symptomatic meds, hygeine, care with diaper changing
Causative agent: nematode Wuchereria bancrofti. Vector: female mosquito Endemic areas: Asia, Africa, Western Pacific, Caribbean, and South America. (Number one cause of global disability) Symptoms: Adults in lymphatics, lymphedema, elephantiasis, hydrocele in men. Social shunning, Tests: blood smear taken at night, serological assay. Treatment: Diethylcarbamazine (DEC) ; MDA has been effective. Lymphadema and elephantiasis are NOT indicaitons for DEC becasue most people w/ lymphadema are not actively infected.
Lymphatic filariasis (elephantiasis)
Soft tissue characterized by myxoid change involving extracellular mucin accumulation w/ associated cellular proliferation. Most common is ganglion cyst (wrist most common). Ganglion adn digital mucus cysts are the most common mesenchymal lesion of the hand and wrist. history of trauma in 50%
Myxomatous lesions
Hyperthyroidism can cause muscle degeneration and necrosis w/ regeneration. Look for exopthalmic opthalmoplegia. Pts. also get muscle fiber atrophy w/ hypothyroidism.
Thyrotoxic myopathy
Toxoplasmosis
Causative agent: Toxoplasma gondii Vector: Cat via fecal oocysts via litter box or undercooked meat, or blood transfusion. Epidemiology: 25% of US population. Mostly asymptomatic, but flu-like symptoms are possible Symptoms: neurotropic parasite, intracellular encystment in host muscle and brain cells. Opportunistic: two populations are vulnerable - immunocompromised and pregnant. immunocomprimised - form cerebral abscesses, most common focal brain disorder in AIDS, fever, confusion, headache, seizures, nauseua, poor coordination. Occular toxoplasmosis: most common: red, painful, photophobic eye, “headlight in the fog” lesion with multiple surrounding healed chorioretinal scars in one eye. A fetus if the mother is first infected during that pregnancy: stillbirth or miscarriage, abnormal head size, may be normal at birth with later complications. The earlier in pregnancy the more severe the symptoms. Tests: serological testing is possible, but diagnosis requires some estimate of infx Treat: occular, immunocompromised, and pregnant women with Atovaquone, or sulfadiazine and pyrimethamine.
Causative agent: herpes varicella-zoster virus Symptoms - begin w/ general malaise, mild fever (101-102) and pruritic rash beginning centrally and expanding. Develops from from macule and papule to vesicle in 24 hrs. Drew drop on rose petal. Latent infx may insue (shingles/ herpes zoster). Reye syndrome w/ Aspirin Transmission - nasopharyngeal, skin lesion contact, easily air spread. Peaks in late winter and spring Incubation - 14-16 days communicability - 1-2 days before rash until 5 days after rash crusts diagnose by visual inspection and symptoms, serology management - strict isolation, avoid aspirin, avoid hospitilizaiton exposure to immunocomprimised. active immunization, VZIG to exposed susceptibles and immunocompromised. Oral acyclovir within 24 hrs.
Chicken Pox (varicella)
Causative agent: rubeola, paramyxovirus Symptoms: rhinitis, cough, conjunctivitis, discrete red rash, high fever. Oral lesions of Koplik spots on buccal mucosa. Total illness may last one week Transmission - np droplet, direct contact, peaks in winter and spring and in two to five year cycles Incubaiton - 8-12 days Management - active immunization, may use immune globulin in susceptibles. Isolation, symptomatic meds, vitamin A
Measles
Causative agent: Trypanosome brucei two subspecies: gambiense in West Africa and rhodesiense in East Africa Vector: Tsetse fly Symptoms: Differentiated from T. cruzi by dividing trypanosomes in blood First stage: possible chancre at site of bite, fever, headache, swollen lymph nodes, muscle and joint aches, possibly rash or itchiness Second Stage CNS involvement, neurological symptoms include SOMNOLENCE (extreme sleepiness, esp. at inappropriate times), altered gait, tremors, cranial neuropathies, urinary incontinence. Time scale: gambiense -CNS involvement after 1-2 years, death usually in 3 if not treated rhodesiense: CNS involvement after a few weeks, death in a few months if not treated. Treatment: Suramin, pentamidine, eflornithine, MELASOPROL (only drug once in CNS and vs gambiense. Painful injection and side effects - 5-10% encepalopathy with one half dying.)
African Sleeping Sickness (African Trypanosomiasis)
Can be localized or diffuse. Localized - solitary slow growing painless mass of tendon sheaths of fingers and wrists. Most common mesenchymal neoplasm of hand. Diffuse - usually knee. rare
Tenosynovial giant cell tumor
Smallpox (Variola)
Causative agent: variola poxvirus Transmission: direct contact wit skin lesions and mucous membranes. Incubation: 12 days Management - strict isolation, active immunization, VIG within 24 hrs of contact
- Bruise or contusion of the iliac crest, usually in the anterior part - May also refer to contusions/avulsions of the greater trochanter, ASIS, AIIS or an avulsion of the muscles from the crest should be termed avulsion fractures
Hip pointer
Inclusion Body Myositis
Typically affects pts over 50. Most common inflammatory myopathy in pts over 65. Often begins w. distal muscles in contrast to dermatomyositis and polymyositis. May be asymetric. Unknown pathogenesis. Modest CK increase. No benefit of immunosuppressives.
agressive malignant sarcomas showing endothelial differentiation.
Angiosarcoma
- Athletes and women are more likely to develop - Trauma in buttock is associated w/ hypertrophy & spasm of the piriformis compresses sciatic nerve (50% of cases) - Common fibular division splits & goes through piriformis where it is compressed (12% of cases)
Pyriformis syndrome
Spinal Muscular Atrophy
Group of mainly autosomal recessive motor neuron diseases that present in childhood or adolescence. Most forms are associated with mutations affecting survival moror neuron 1 (smn1) - patients expereince loss of motor neurons leading to muscle atrophy and weakness. Most common SMA is Werdnig-Hoffmann disease
Dermatofibrosarcoma protuberans (DFSP)
Intermediate malignancy prone to local recurrences. tumor of skin containing cellular elements that resemble both fibroblasts and histiocytes (tissue macrophages).
River Blindness or Robles Disease Vector: Blackfly Causative agent: Onchocera volvulus Symptoms: lives in subcutaneous tissues and often causes subcutaneous nodules. Typically found in skin and lymphatics. Eye and skin disease. Hyperpigmented skin. Severe itching, eye lesions, and skin lesions. Inflammatory response often caused by bacterium Wolbachia pipientis, a symbiont of the worms. Keratitis (inflammation of cornea) that is deep and chronic can lead to permanent blindness, and the opacity of the affected area. In chronic infection destruction of elastic fibers in the skin. Positive diagnosis w/ skin snip method. Treat with Ivermectin. Remember IVERmectin for rIVERblindness. Can add doxy for Wolbachia pipentis. MDA can be effective
Onchocerciasis
Neuritis of the sciatic nerve characterized by intense pain at the back of the leg and/or thigh Can also be caused by pressure on a root of the nerve, e.g., from a herniated disc
Sciatica
Causative agent: Leishmania spp. Vector: Sandfly Endemic areas: East Africa, Asia, and Latin America Three types: Cutaneous (most common), Mucocutaneous (rare), and Visceral (most lethal) Symptoms: Cutaneous - One or more skin sores. Often volcano like. Can be painful or painless. Some w/ local swollen glands. Mucocutaneous - very rare but results from metastasis of an untreated cutaneous case Visceral - also called kala-azar. Life threatening. Weight loss SPLENOMEGALY and hepatomegaly, swollen glands, low blood counts. HIV opportunistic infx. Tests: Consult CDC, microscopic detection of the organism in blood or tissue sample. Treatment: Sodium stibogluconate and meglumine antimoniate. (IM with high amt of resistance); Miltefosine (high toxicity, good for resistant strains); Liposomal Amphotericin B (visceral form, nephrotoxity and infusion toxicity)
Leishmaniasis
Leishmaniasis
Causative agent: Leishmania spp. Vector: Sandfly Endemic areas: East Africa, Asia, and Latin America Three types: Cutaneous (most common), Mucocutaneous (rare), and Visceral (most lethal) Symptoms: Cutaneous - One or more skin sores. Often volcano like. Can be painful or painless. Some w/ local swollen glands. Mucocutaneous - very rare but results from metastasis of an untreated cutaneous case Visceral - also called kala-azar. Life threatening. Weight loss SPLENOMEGALY and hepatomegaly, swollen glands, low blood counts. HIV opportunistic infx. Tests: Consult CDC, microscopic detection of the organism in blood or tissue sample. Treatment: Sodium stibogluconate and meglumine antimoniate. (IM with high amt of resistance); Miltefosine (high toxicity, good for resistant strains); Liposomal Amphotericin B (visceral form, nephrotoxity and infusion toxicity)
Rhadomyoma
benign tumor of skeletal muscle. very rare
Gluteal lurch
Limited hip extension during mid-stance, compensated for by hyperextension of trunk. Damage to inferior gluteal nerve and thus parlysis of gluteus maximus.
Autoimmune disease caused by immune mediated loss of function of the AChR. Associated w/ thymic abnormalities. Muscle weakness may be generalized or localized to extraocular muscles. Diagnose w/ autoantibodies or electrophys testing. Treatment - antichoinesterases, immunosuppresants, plasmpapheresis in acute cases, thymectomy in those w/ thymic tumors.
Myasthenia gravis
Myxomatous lesions
Soft tissue characterized by myxoid change involving extracellular mucin accumulation w/ associated cellular proliferation. Most common is ganglion cyst (wrist most common). Ganglion adn digital mucus cysts are the most common mesenchymal lesion of the hand and wrist. history of trauma in 50%
Common warts, plantar warts, flat (juvenile) warts, genital warts, condylomata
Causative agent: Human papilloma virus Symptoms - small skin growth that gradually enlarges. relatively few symptoms, hyperkeratinization, cauliflower like appearance. Incubation: 3 months to many years Management: liquid nitrogen, various acids, laser, surgical, podophyllum
- Common in individuals who run and kick hard (baseball, basketball, football and soccer) - Parts of the proximal attachment to the ischial tuberosity may tear (avulsion) - Twice as common as quadriceps strains.
Hamstring
Kaposi’s sarcoma
malignant vascular tumor caused by human herpes virus 8. HHV 8 w/ a cofacter results in endothelial proliferation. Four types exist: 1.)Chronic KS (Classic or European) - Eastern European and Ashkenazi Jews or Mediterranean. Not associated w/ HIV. SQ tissues of lower extremeties and are asymptomatic 2.)Lymphadenopathic KS - endemic in Africa and afflicts young males and children. lymph and occasional organ involvement. Agressive 3.)Transplant-Associated KS - occurs in the setting of a solid organ transplant w/ longterm immunosuppression. 4.)AIDS-associated (epidemic) KS: originally found in 1/3 or AIDS pts, but now only 1% due to antiretrovirals. Can involve lymph nodes and organs.
X-linked gene that encodes for dystrophin protein is mutated. Lack of dystrophin protein adjacent to sarcolemma leads to loss of ability to transfer contractile force to connective tissue. BMD pts have some dystrophin PTs present with milder and later symptoms than DMD. Eventually muscles become almost completely replaced by CT. Survive into 40s and beyond. Elevated creatine kinase is marker. Female carriers have high ck and cardiomyopathy
Becker’s MD
Dengue fever
Causative agent - dengue virus and Chikungunya virus Symptoms- biphasic fever, pharyngitis, cough, arthralgias, generalized maculopapular rash but not on palms and soles, Transmission - mosquito borne. Not present outside tropics or in winter months Incubation - 3-8 days Management- prevent mosquitos, manage symptoms
Hemangioma
Benign tumor of skin blood vessels that is most often found in skin.
One of the most common sarcomas of adulthood; typically arises in the deep soft tissues of the proximal extremities and retro peritoneum. Morhpolgical variants: 1.)well-differentiated (indolent w/ local recurrence - use surgical excision) 2.)Myxoid/round cell liposarcoma (intermediate malignancy) 3.) pleomorphic liposarcoma (aggressive tumor, frequently mets)
Liposarcoma
Palmar fibrous proliferation can cause skin puckering and progressive flexure contracture. Similar pathogensis possible on plantar and penis (peyroinie disease)
Palmar fibromatosis (Dupuytren’s contracture)
Leiomyoma
benign tumor of smooth muscle. Most commonly of uterus - present in 77% of women “uterine fibroids” Leiomyomas of the GI are usually well circumscribed tumors.
Most common soft tissue tumor of adults; various subtypes: conventional (most common - well circumscribed encapsulated mass of mature adipose tissue), angiolipoma, spindle cell lipoma/pleiomorphic, myolipoma, chondroid lipoma, angiomyolipoma (kindey), and myelolipoma. treatment - surgical excision Note: patients on long term coricosteroid therapy can get overgrowth of mature adipose tissue in the face (moon face) and on the back (buffalo hum), called “steroid lipomatosis”
Lipoma
Hamstring
- Common in individuals who run and kick hard (baseball, basketball, football and soccer) - Parts of the proximal attachment to the ischial tuberosity may tear (avulsion) - Twice as common as quadriceps strains.
- Contusion & tearing of muscle fibers thigh hematoma (collection of blood); pain and stiffness
Charliehorse
- Common because of the stretching mechanism secondary to tethering of the vessel at the adductor hiatus or by direct contusion by the posterior tibial plateau - Also common - fractures of the distal femur or the tibial plateau - Immediate surgery is the only treatment option in open knee dislocation with an associated popliteal artery injury because a popliteal artery injury is limb threatening - Supracondylar fracture of the femur may injury popliteal artery
Damage to popliteal artery.
Malignant peripheral nerve sheath tumor (MPNST)
Highly malignant sarcoma that usually arises in association w/ the major nerve trunks. Close to 50% have NF1.
caused by repeated minor trauma. typically of interdigital plantar nerve between third and fourth toes.
Motor neuroma
Mononucleosis
Causative agent: Epstein-Barr virus, herpes virus 4 Symptoms- Increased posterior cervical lymph nodes, tender enlarged spleen, atypical lymphocytes, extreme tiredness, possible maculopapular rash on trunk, jaundice, sore throat, adolescent Transmission: close contact, pharyngeal secreations, non-seasonal Tests: rapid mono test, hetertrophile antibody Management: symptomatic treatment, avoid contact sports, possible steroids, observe for jaundice
Polymyositis
Immunologic disease with immunologic injury and damage to small bv and capillaries in the skeletal muscle. Pathogenesis is believed to be caused by CD8+ T-cells. Clincal manifestations are muscle weakness w/o rash. Patients will have elevated CK. Treat with immunosuppressive agents.
malignant vascular tumor caused by human herpes virus 8. HHV 8 w/ a cofacter results in endothelial proliferation. Four types exist: 1.)Chronic KS (Classic or European) - Eastern European and Ashkenazi Jews or Mediterranean. Not associated w/ HIV. SQ tissues of lower extremeties and are asymptomatic 2.)Lymphadenopathic KS - endemic in Africa and afflicts young males and children. lymph and occasional organ involvement. Agressive 3.)Transplant-Associated KS - occurs in the setting of a solid organ transplant w/ longterm immunosuppression. 4.)AIDS-associated (epidemic) KS: originally found in 1/3 or AIDS pts, but now only 1% due to antiretrovirals. Can involve lymph nodes and organs.
Kaposi’s sarcoma
Rhabdomyolysis
Rhabdomyolysis is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and often causes tubular necrosis. (myoglobinuria)
X-linked gene that encodes for dystrophin protein is mutated. Lack of dystrophin protein adjacent to sarcolemma leads to loss of ability to transfer contractile force to connective tissue. DMD pts have little or no dystrophin. Pts present around age 5 with weakness in pelvic girdle followed by pectoral girdle. Duck like gait and gower’s maneuver (need to use hands on knees to stand up. Also pseudohypertrophy of calves. Life expectancy of 35yrs. Death via respiratory insufficiency or cardiomyopathy. Elevated creatine kinase is marker. Female carriers have high ck and cardiomyopathy
Duchenne’s Muscular Dystrophy
Lipoma
Most common soft tissue tumor of adults; various subtypes: conventional (most common - well circumscribed encapsulated mass of mature adipose tissue), angiolipoma, spindle cell lipoma/pleiomorphic, myolipoma, chondroid lipoma, angiomyolipoma (kindey), and myelolipoma. treatment - surgical excision Note: patients on long term coricosteroid therapy can get overgrowth of mature adipose tissue in the face (moon face) and on the back (buffalo hum), called “steroid lipomatosis”
Poplitieal aneurysm
Aneurysm in popliteal artery behind knee. Treat with open surgery. Internal graft is an option for patients w/ weak cardiopulmonary systems.
Leiomyosarcoma
Malignant tumor showing smooth muscle differentiation . Increased nuclear pleomorphism and mitotic activity when compared to leiomyoma.
Dermatomyositis
Immunologic disease with immunologic injury and damage to small bv and capillaries in the skeletal muscle. Activated B and T cells and antibodies with complement are involved w/ capillary damage. Clincal manifestations are muscle weakness and skin rash. Classic rash is a violaceous discoloration of upper eyelids associated w/ periorbital edema, accompanied by a scaling erythemetous eruption or dusky red patches over knuckles, elbows, and knees (Gottron papules). *Check for malignancies (15-25% have underlying) Patients will have elevated CK. Treat with immunosuppressive agents.
Neurofibroma
present as discrete localized masses - most commonly as cutaneous neurofibroma or in a peripheral nerve as a solitary neurofibroma. The presence of multiple suggest NF1 (tumor suppressor mutation).
Measles
Causative agent: rubeola, paramyxovirus Symptoms: rhinitis, cough, conjunctivitis, discrete red rash, high fever. Oral lesions of Koplik spots on buccal mucosa. Total illness may last one week Transmission - np droplet, direct contact, peaks in winter and spring and in two to five year cycles Incubaiton - 8-12 days Management - active immunization, may use immune globulin in susceptibles. Isolation, symptomatic meds, vitamin A
benign typically painful tumor showing differentiation to the modified smooth muscle cells of the glomus body (AV structure involved in thermoreg) Most often in distal digits.
Glomus tumor and glomangioma
- Uncommon because of its deep location in the popliteal fossa and posterior compartment - Causes: deep lacerations and posterior dislocation of the knee joint - Paralysis of the muscles in the posterior compartment of the leg and intrinsic muscles of the sole of the foot will occur.
Injury to tibial nerve
skin spider-like vascular malformations seen in association w/ estrogen excess (pregnancy, cirrhosis)
Spider angiomas
Dermatofibroma
Benign tumor of skin containing cellular elements that resemble both fibroblasts and histiocytes (tissue macrophages).
Causative agent: Epstein-Barr virus, herpes virus 4 Symptoms- Increased posterior cervical lymph nodes, tender enlarged spleen, atypical lymphocytes, extreme tiredness, possible maculopapular rash on trunk, jaundice, sore throat, adolescent Transmission: close contact, pharyngeal secreations, non-seasonal Tests: rapid mono test, hetertrophile antibody Management: symptomatic treatment, avoid contact sports, possible steroids, observe for jaundice
Mononucleosis
Enterovirus D-68
Causative agent: Enterovirus D-68 Symptoms - non-specific respiratory virus with possible exanthem. Most severe with asthma. Peaked in mid-August this year. Transmission - respiratory secretions, Incubaiton - 1-5 days Diagnosis - clinical course, serology, episodes of paralysis in arms and legs? management - symptomatic meds, hygeine, admission to hospital w/ child w/ asthma and serious respiratory Sx
Causative agent: Trypanosoma cruzi Vector: Triatomine Bug Symptoms: Romana sign (swelling of the child’s eyelid), Chagastic cardiomyopathy, megacolonic colon or esophagous, Acute: often asymptomatic Chronic disease: 20-40% of patients. *US transmission through blood supply or organ donations. Can reappear in chronic inderminate individuals if they become immuncompromised Treatment: Nifurtimox and Benznidazole (induce oxidative stress; requires type I nitroreductase to activate which is only in tyrpansosomes; very toxic)
Chagas’ disease (American Trypanosomiasis)
Casative agent: HSV 1 and 2 virus Symptoms - Stinging erythemetous lesion develops at junction of skin and lip (Also gingiva, tongue, and genital region). Proceeds to crusted sore. Lasts up to 10-12 days. No systemic symptoms. Transmission - direct contact, sexual and birthing contacts, associated with stress incubation - 2 days to 2 weeks, latent and recurrent Management - drying agents, acyclovir ointment locally, acyclovir, famiciclovir, valaciclovir, penciclovir - oral and IV protect newborns from exposure, special drug precautions during pregnancy.
cold sore, herpetic gingivostomatitis, genital herpes, whitlow (tip of finger)
Typically affects pts over 50. Most common inflammatory myopathy in pts over 65. Often begins w. distal muscles in contrast to dermatomyositis and polymyositis. May be asymetric. Unknown pathogenesis. Modest CK increase. No benefit of immunosuppressives.
Inclusion Body Myositis
Causative agent: Rubella (toga virus) Symptoms upper respiratory symtoms, malaise, low grade fever, fine maculopapular rash, rapidly clears, Forcheimer spots on the soft palat/uvula. A significant congenital form may develop in fetuses exposed early in pregnancy, post auricular node Incubation - 16-18 days Management - isolation, symptomatic meds, immunizaitons, consider globulin for pregnant and susceptibles
Rubella
- Irritation of the distal portion of the IT band as it rubs against the lateral femoral condyle - Overuse injury inflammation and irritation of the illiotibial band - Most common in long distance runners, but also in weight lifters who do heavy weight squats - Pain typically felt on the lateral aspect of the knee or lower thigh, and is often more intense when descending stairs, or getting up from a seated position - Treatment: rest and reduce inflammation in the usual ways.
Iliotibial band syndrome
Immunologic disease with immunologic injury and damage to small bv and capillaries in the skeletal muscle. Pathogenesis is believed to be caused by CD8+ T-cells. Clincal manifestations are muscle weakness w/o rash. Patients will have elevated CK. Treat with immunosuppressive agents.
Polymyositis
Causative agent: Enterovirus D-68 Symptoms - non-specific respiratory virus with possible exanthem. Most severe with asthma. Peaked in mid-August this year. Transmission - respiratory secretions, Incubaiton - 1-5 days Diagnosis - clinical course, serology, episodes of paralysis in arms and legs? management - symptomatic meds, hygeine, admission to hospital w/ child w/ asthma and serious respiratory Sx
Enterovirus D-68
Hand foot and mouth disease,
Causative agent: Cocksackie virus (enterovirus) Symptoms - malaise and mild fever, sore throat, lesions in mouth and extremeties. Enanthem occurs within one or two days after onset of symtoms followed by exanthem. Possible ulcerative rash in posterior phalanx. Hand. Foot. Mouth. Transmission - nasopharyngeal droplet, saliva, fecal. Peaks in summer and early fall. Incubation: 3-6 days Diagnosis: clinical appearance, virus isolation from mucous membranes, and fecal serology Management - Symptomatic medications, protect newborns, good handwashing and personal hygeine.
Neurofibromatosis
Autosomal dominant disorder w/ variable expression. Type 1 (NF1) - chromosome 17 tumor suppressor neurofibromin –> associated w/ cafe au lait spots, optical glioma, and many other skin tumors Type 2 (NF2) - chromosome 22 coding for merlin –> bilateral acoustic schwaanomas, spinal schwaanomas, meningiomas, juvenile cataracts.
Damage to popliteal artery.
- Common because of the stretching mechanism secondary to tethering of the vessel at the adductor hiatus or by direct contusion by the posterior tibial plateau - Also common - fractures of the distal femur or the tibial plateau - Immediate surgery is the only treatment option in open knee dislocation with an associated popliteal artery injury because a popliteal artery injury is limb threatening - Supracondylar fracture of the femur may injury popliteal artery
Ischial bursitis aka weaver’s bottom
- Cycling, rowing and other activities that require repetitive hip extension while seated may overwhelm the bursa’s ability to dissipate applied stress
Malignant hyperpyrexia (malignant hyperthermia)
Rare clinical syndrome characterized by a marked hypermetabolic state triggered by certain inhalational anesthetics. Associated with mutations in proteins that control levels of cytosolic calcium.
rhabdomyosarcoma
Malignant tumor showing skeletal muscle differentiation. Most common soft tissue sarcoma of childhood and adolescence. Three main types: 1.) Embryonal rhabdomyosarcoma - most common subtype. head, neck, GU. Botryoid subtybe in mucousal lining of hollow organs 2.)Alveolar rhabdomyosarcoma - deep soft tissues of the exremeties. 3.) Pleomorphic rhabdomyosarcoma - rares and usually in deep soft tissue of adults. All are very aggressive and require multimodal therapy.
Varicose veins
Incompetant valves in venous return in legs causing back pooling of blood and large squigly superficial veins. - Causative factors: carrying extra weight, long hours of sitting or standing, smoking Deep venous thrombosis (DVT) can inhibit venous return Pregnant women often develop varicose veins, but they usually resolve on their own within a year. Treatment is via sclerotherapy, vein stripping, ablation, and laser therapy. Spider veins are a similar mild cosmetic problem.
Characterized by cytologic pleomorphism, bizarre multinucleated cells, and storiform architecture. Now classified as myxofibrosarcoma or undifferentiated pleomorphic sarcoma.
Malignant fibrous histiocytoma (MFH)
Group of mainly autosomal recessive motor neuron diseases that present in childhood or adolescence. Most forms are associated with mutations affecting survival moror neuron 1 (smn1) - patients expereince loss of motor neurons leading to muscle atrophy and weakness. Most common SMA is Werdnig-Hoffmann disease
Spinal Muscular Atrophy
Causative agent: Toxoplasma gondii Vector: Cat via fecal oocysts via litter box or undercooked meat, or blood transfusion. Epidemiology: 25% of US population. Mostly asymptomatic, but flu-like symptoms are possible Symptoms: neurotropic parasite, intracellular encystment in host muscle and brain cells. Opportunistic: two populations are vulnerable - immunocompromised and pregnant. immunocomprimised - form cerebral abscesses, most common focal brain disorder in AIDS, fever, confusion, headache, seizures, nauseua, poor coordination. Occular toxoplasmosis: most common: red, painful, photophobic eye, “headlight in the fog” lesion with multiple surrounding healed chorioretinal scars in one eye. A fetus if the mother is first infected during that pregnancy: stillbirth or miscarriage, abnormal head size, may be normal at birth with later complications. The earlier in pregnancy the more severe the symptoms. Tests: serological testing is possible, but diagnosis requires some estimate of infx Treat: occular, immunocompromised, and pregnant women with Atovaquone, or sulfadiazine and pyrimethamine.
Toxoplasmosis
benign tumor of skeletal muscle. very rare
Rhadomyoma
Becker’s MD
X-linked gene that encodes for dystrophin protein is mutated. Lack of dystrophin protein adjacent to sarcolemma leads to loss of ability to transfer contractile force to connective tissue. BMD pts have some dystrophin PTs present with milder and later symptoms than DMD. Eventually muscles become almost completely replaced by CT. Survive into 40s and beyond. Elevated creatine kinase is marker. Female carriers have high ck and cardiomyopathy
Ethanol myopathy
binge drinking can produce and acute toxic syndrome of rhabdomyolysis, with rapid breakdown of skeletal muscle.
Lamber-Eaton Syndrome
Immune disorder due to autoantibodies directed vs presynaptic calcium channels. In contrast to MG rapid repetitive stimulation of of the affected muscle increases the muscle response. Typical presentation is extreme weakness. Often paraneoplastic (60% of cases) Diagnose w/ autoantibodies and elctrophys. tests.
steroids from Cushings or theraputics can cause muscle atrophy - especially type 2 fibers. Chlorquine can lead to myopathy Statins can also cause myopathy. Most common and most emphasized! Can counter w/ CoQ-10 supplement may counter.
Drug-induced myopathy
Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease)
Autosomal dominant disorder widely distributed vascular ectasias over the skin and mucous membranes, respiratory, GI, and urinary tracts.
cold sore, herpetic gingivostomatitis, genital herpes, whitlow (tip of finger)
Casative agent: HSV 1 and 2 virus Symptoms - Stinging erythemetous lesion develops at junction of skin and lip (Also gingiva, tongue, and genital region). Proceeds to crusted sore. Lasts up to 10-12 days. No systemic symptoms. Transmission - direct contact, sexual and birthing contacts, associated with stress incubation - 2 days to 2 weeks, latent and recurrent Management - drying agents, acyclovir ointment locally, acyclovir, famiciclovir, valaciclovir, penciclovir - oral and IV protect newborns from exposure, special drug precautions during pregnancy.
Tennis knee
Strain or rupture of medial head of gastrocnemius.
Rhabdomyolysis is the breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream. Myoglobin is harmful to the kidney and often causes tubular necrosis. (myoglobinuria)
Rhabdomyolysis
Charliehorse
- Contusion & tearing of muscle fibers thigh hematoma (collection of blood); pain and stiffness
Immunologic disease with immunologic injury and damage to small bv and capillaries in the skeletal muscle. Activated B and T cells and antibodies with complement are involved w/ capillary damage. Clincal manifestations are muscle weakness and skin rash. Classic rash is a violaceous discoloration of upper eyelids associated w/ periorbital edema, accompanied by a scaling erythemetous eruption or dusky red patches over knuckles, elbows, and knees (Gottron papules). *Check for malignancies (15-25% have underlying) Patients will have elevated CK. Treat with immunosuppressive agents.
Dermatomyositis
Angiosarcoma
agressive malignant sarcomas showing endothelial differentiation.
Strain or rupture of medial head of gastrocnemius.
Tennis knee
Immune disorder due to autoantibodies directed vs presynaptic calcium channels. In contrast to MG rapid repetitive stimulation of of the affected muscle increases the muscle response. Typical presentation is extreme weakness. Often paraneoplastic (60% of cases) Diagnose w/ autoantibodies and elctrophys. tests.
Lamber-Eaton Syndrome
Causative agent: Cocksackie virus (enterovirus) Symptoms - malaise and mild fever, sore throat, lesions in mouth and extremeties. Enanthem occurs within one or two days after onset of symtoms followed by exanthem. Possible ulcerative rash in posterior phalanx. Hand. Foot. Mouth. Transmission - nasopharyngeal droplet, saliva, fecal. Peaks in summer and early fall. Incubation: 3-6 days Diagnosis: clinical appearance, virus isolation from mucous membranes, and fecal serology Management - Symptomatic medications, protect newborns, good handwashing and personal hygeine.
Hand foot and mouth disease,
benign tumor of smooth muscle. Most commonly of uterus - present in 77% of women “uterine fibroids” Leiomyomas of the GI are usually well circumscribed tumors.
Leiomyoma
- Deep gluteal pain felt over the trochanteric bursa, usually due to repetitive action like climbing stairs or running on a steeply elevated treadmill or hills - Gluteus maximus rubs over the greater trochanter causing friction bursitis.
Trochanteric bursitis
Hip pointer
- Bruise or contusion of the iliac crest, usually in the anterior part - May also refer to contusions/avulsions of the greater trochanter, ASIS, AIIS or an avulsion of the muscles from the crest should be termed avulsion fractures
Duchenne’s Muscular Dystrophy
X-linked gene that encodes for dystrophin protein is mutated. Lack of dystrophin protein adjacent to sarcolemma leads to loss of ability to transfer contractile force to connective tissue. DMD pts have little or no dystrophin. Pts present around age 5 with weakness in pelvic girdle followed by pectoral girdle. Duck like gait and gower’s maneuver (need to use hands on knees to stand up. Also pseudohypertrophy of calves. Life expectancy of 35yrs. Death via respiratory insufficiency or cardiomyopathy. Elevated creatine kinase is marker. Female carriers have high ck and cardiomyopathy
Malignant tumor showing smooth muscle differentiation . Increased nuclear pleomorphism and mitotic activity when compared to leiomyoma.
Leiomyosarcoma
Malignant fibrous histiocytoma (MFH)
Characterized by cytologic pleomorphism, bizarre multinucleated cells, and storiform architecture. Now classified as myxofibrosarcoma or undifferentiated pleomorphic sarcoma.
Lymphangioma
Benign tumor of lymph.Typically occur in the skin and SQ soft tissue. Cystic hygroma (cavernous lymphangioma) of neck in children can be associated w/ Turner’s syndrome.
group of very rare malignant vascular tumors w/ clinical behaviour less aggressive than angiosarcoma
Hemangioendotheliomas
Rare clinical syndrome characterized by a marked hypermetabolic state triggered by certain inhalational anesthetics. Associated with mutations in proteins that control levels of cytosolic calcium.
Malignant hyperpyrexia (malignant hyperthermia)
Gluteal limb. Trendelenburg’s sign
- Paralyzed gluteus medius and minimus muscles as a result of injury to the superior gluteal nerve - Normal steadying effect of these muscles is lost so when the foot is raised on the normal side, the pelvis falls on that side. - Also caused by congenital dislocation of the hip or nonunion of a fracture of the femoral neck - Supporting mechanism fails & pelvis sinks when an attempt is made to stand on the affected limb
Drug-induced myopathy
steroids from Cushings or theraputics can cause muscle atrophy - especially type 2 fibers. Chlorquine can lead to myopathy Statins can also cause myopathy. Most common and most emphasized! Can counter w/ CoQ-10 supplement may counter.
Baker’s cyst
Synovial cyst in popliteal space. Can result from any chronic irritation or inflammation of the knee join that increases fluid in the capsule.
Tenosynovial giant cell tumor
Can be localized or diffuse. Localized - solitary slow growing painless mass of tendon sheaths of fingers and wrists. Most common mesenchymal neoplasm of hand. Diffuse - usually knee. rare
Sciatica
Neuritis of the sciatic nerve characterized by intense pain at the back of the leg and/or thigh Can also be caused by pressure on a root of the nerve, e.g., from a herniated disc
Causative agent: variola poxvirus Transmission: direct contact wit skin lesions and mucous membranes. Incubation: 12 days Management - strict isolation, active immunization, VIG within 24 hrs of contact
Smallpox (Variola)
Roseola, exanthem subitum
Causative agent - herpes virus 6 and 7 Symptoms - infants, high fever (102-105), minimal respiratory symptoms, playful, maculopapular rash on neck and trunk 3 days after fever Transmission - probable nasopharyngeal droplet; year round Incubation - 9 days Communicable during febrile stage Management - antipytetics, ganciclovir, no isolation, observe for febrile convulsions. Note: Often mislabeled as penicillin allergy
Tumors consist of an infiltrativ, poorly marginated proliferation of bland fibroblasts w/ collagen. Three main types:1.) abdominal fibromatosis (women after pregnancy) 2.)Extra-abdominal Fibromatosis (musculature of shoulder, chest wall, back, and thigh 3.) Intra-abdominal Fibromatosis (mysentrery or pelvic side walls. Often w/ familial polyposis aka Gardner’s syndrome)
Deep-Seated Fibromatosis (Desmoid Tumors)
Myositis Ossificans
Usually in athletic youth folling trauma in muscle of proximal extremeties. Lesion is cellular containing plump fibroblasts and myofibroblasts. Overtime develops osteoblasts.
Nevus Flammeus
Birthmark. Port Wine Stain = special type that doesnt’ regress. The distribution of the trigeminal nerve can be associated w/ Sturge-Weber syndrome (venous angiomatous masses of cortical leptomeninges, metnal retardation, seizures)
Intermediate malignancy prone to local recurrences. tumor of skin containing cellular elements that resemble both fibroblasts and histiocytes (tissue macrophages).
Dermatofibrosarcoma protuberans (DFSP)
Usually on upper extremities; solitary rapidly growing, sometimes painful mass. Nodular, yet poorly differentiated, proliferation of immature fibroblasts and myofibroblasts in myxoid stroma. Rare recurrence following excision.
Nodular Fascitis
Benign tumor of skin blood vessels that is most often found in skin.
Hemangioma
Benign tumor of lymph.Typically occur in the skin and SQ soft tissue. Cystic hygroma (cavernous lymphangioma) of neck in children can be associated w/ Turner’s syndrome.
Lymphangioma
Schwannoma
neural crest derived. Associated w/ NF2 (tumor suppressor mutation)
Liposarcoma
One of the most common sarcomas of adulthood; typically arises in the deep soft tissues of the proximal extremities and retro peritoneum. Morhpolgical variants: 1.)well-differentiated (indolent w/ local recurrence - use surgical excision) 2.)Myxoid/round cell liposarcoma (intermediate malignancy) 3.) pleomorphic liposarcoma (aggressive tumor, frequently mets)
Calcaneal tendonitis or rupture.
- Tendinitis of the calcaneal (Achilles’) tendon may occur as a result of repetitive activities, especially in individuals who take up running after inactivity or suddenly increase training - Poorly conditioned people who have had a history of tendinitis often sustain tendon rupture Most severe, acute muscular problem of the leg! It is debilitating. - Calcaneal bursitis caused by excessive friction on the bursa (long distance running) causes pain posterior to the heel.
- Tendinitis of the calcaneal (Achilles’) tendon may occur as a result of repetitive activities, especially in individuals who take up running after inactivity or suddenly increase training - Poorly conditioned people who have had a history of tendinitis often sustain tendon rupture Most severe, acute muscular problem of the leg! It is debilitating. - Calcaneal bursitis caused by excessive friction on the bursa (long distance running) causes pain posterior to the heel.
Calcaneal tendonitis or rupture.
Malignant tumor showing skeletal muscle differentiation. Most common soft tissue sarcoma of childhood and adolescence. Three main types: 1.) Embryonal rhabdomyosarcoma - most common subtype. head, neck, GU. Botryoid subtybe in mucousal lining of hollow organs 2.)Alveolar rhabdomyosarcoma - deep soft tissues of the exremeties. 3.) Pleomorphic rhabdomyosarcoma - rares and usually in deep soft tissue of adults. All are very aggressive and require multimodal therapy.
rhabdomyosarcoma
Benign tumor of skin containing cellular elements that resemble both fibroblasts and histiocytes (tissue macrophages).
Dermatofibroma
Palmar fibromatosis (Dupuytren’s contracture)
Palmar fibrous proliferation can cause skin puckering and progressive flexure contracture. Similar pathogensis possible on plantar and penis (peyroinie disease)
Autosomal dominant disorder w/ variable expression. Type 1 (NF1) - chromosome 17 tumor suppressor neurofibromin –> associated w/ cafe au lait spots, optical glioma, and many other skin tumors Type 2 (NF2) - chromosome 22 coding for merlin –> bilateral acoustic schwaanomas, spinal schwaanomas, meningiomas, juvenile cataracts.
Neurofibromatosis
Pyriformis syndrome
- Athletes and women are more likely to develop - Trauma in buttock is associated w/ hypertrophy & spasm of the piriformis compresses sciatic nerve (50% of cases) - Common fibular division splits & goes through piriformis where it is compressed (12% of cases)
Iliotibial band syndrome
- Irritation of the distal portion of the IT band as it rubs against the lateral femoral condyle - Overuse injury inflammation and irritation of the illiotibial band - Most common in long distance runners, but also in weight lifters who do heavy weight squats - Pain typically felt on the lateral aspect of the knee or lower thigh, and is often more intense when descending stairs, or getting up from a seated position - Treatment: rest and reduce inflammation in the usual ways.
Causative agent: Human papilloma virus Symptoms - small skin growth that gradually enlarges. relatively few symptoms, hyperkeratinization, cauliflower like appearance. Incubation: 3 months to many years Management: liquid nitrogen, various acids, laser, surgical, podophyllum
Common warts, plantar warts, flat (juvenile) warts, genital warts, condylomata
Nodular Fascitis
Usually on upper extremities; solitary rapidly growing, sometimes painful mass. Nodular, yet poorly differentiated, proliferation of immature fibroblasts and myofibroblasts in myxoid stroma. Rare recurrence following excision.
Deep-Seated Fibromatosis (Desmoid Tumors)
Tumors consist of an infiltrativ, poorly marginated proliferation of bland fibroblasts w/ collagen. Three main types:1.) abdominal fibromatosis (women after pregnancy) 2.)Extra-abdominal Fibromatosis (musculature of shoulder, chest wall, back, and thigh 3.) Intra-abdominal Fibromatosis (mysentrery or pelvic side walls. Often w/ familial polyposis aka Gardner’s syndrome)
Erythema infectosum, fifth disease
Causative agent: human parovirus B19 Symptoms: RED SLAPPED CHEEKS, youth, very mild upper respiratory illness precedes, lacy rash on upper extremeties follows (may fade and return). Vague joint pain, Transmission - nasopharyngeal droplet, Peaks in spring Incubation - 4-14 days Management - protect pregnant women from exposure. Note- once rash has developed no need to keep from school
neural crest derived. Associated w/ NF2 (tumor suppressor mutation)
Schwannoma
Spider angiomas
skin spider-like vascular malformations seen in association w/ estrogen excess (pregnancy, cirrhosis)
Onchocerciasis
River Blindness or Robles Disease Vector: Blackfly Causative agent: Onchocera volvulus Symptoms: lives in subcutaneous tissues and often causes subcutaneous nodules. Typically found in skin and lymphatics. Eye and skin disease. Hyperpigmented skin. Severe itching, eye lesions, and skin lesions. Inflammatory response often caused by bacterium Wolbachia pipientis, a symbiont of the worms. Keratitis (inflammation of cornea) that is deep and chronic can lead to permanent blindness, and the opacity of the affected area. In chronic infection destruction of elastic fibers in the skin. Positive diagnosis w/ skin snip method. Treat with Ivermectin. Remember IVERmectin for rIVERblindness. Can add doxy for Wolbachia pipentis. MDA can be effective
Synovial cyst in popliteal space. Can result from any chronic irritation or inflammation of the knee join that increases fluid in the capsule.
Baker’s cyst
Birthmark. Port Wine Stain = special type that doesnt’ regress. The distribution of the trigeminal nerve can be associated w/ Sturge-Weber syndrome (venous angiomatous masses of cortical leptomeninges, metnal retardation, seizures)
Nevus Flammeus
present as discrete localized masses - most commonly as cutaneous neurofibroma or in a peripheral nerve as a solitary neurofibroma. The presence of multiple suggest NF1 (tumor suppressor mutation).
Neurofibroma
Myasthenia gravis
Autoimmune disease caused by immune mediated loss of function of the AChR. Associated w/ thymic abnormalities. Muscle weakness may be generalized or localized to extraocular muscles. Diagnose w/ autoantibodies or electrophys testing. Treatment - antichoinesterases, immunosuppresants, plasmpapheresis in acute cases, thymectomy in those w/ thymic tumors.
Motor neuroma
caused by repeated minor trauma. typically of interdigital plantar nerve between third and fourth toes.
Highly malignant sarcoma that usually arises in association w/ the major nerve trunks. Close to 50% have NF1.
Malignant peripheral nerve sheath tumor (MPNST)
Molluscum contagiosum
Causative agent: Poxvirus Symptoms: Asymptomatic, discrete papular, waxy lesions. Umbilicated appearance. Generally only a few. Incubation - 2-7 weeks but as long as 6 months Communicability - infectivity is low, length of infectiivty is unknown Diagnosis: clinical inspection, smear and stain Management: mechanical removal of central core (which contains the virus), liquid N2, acids. Avoid direct contacts, sharing of towels and washcloths
Usually in athletic youth folling trauma in muscle of proximal extremeties. Lesion is cellular containing plump fibroblasts and myofibroblasts. Overtime develops osteoblasts.
Myositis Ossificans
Rubella
Causative agent: Rubella (toga virus) Symptoms upper respiratory symtoms, malaise, low grade fever, fine maculopapular rash, rapidly clears, Forcheimer spots on the soft palat/uvula. A significant congenital form may develop in fetuses exposed early in pregnancy, post auricular node Incubation - 16-18 days Management - isolation, symptomatic meds, immunizaitons, consider globulin for pregnant and susceptibles
Causative agent - herpes virus 6 and 7 Symptoms - infants, high fever (102-105), minimal respiratory symptoms, playful, maculopapular rash on neck and trunk 3 days after fever Transmission - probable nasopharyngeal droplet; year round Incubation - 9 days Communicable during febrile stage Management - antipytetics, ganciclovir, no isolation, observe for febrile convulsions. Note: Often mislabeled as penicillin allergy
Roseola, exanthem subitum
Chicken Pox (varicella)
Causative agent: herpes varicella-zoster virus Symptoms - begin w/ general malaise, mild fever (101-102) and pruritic rash beginning centrally and expanding. Develops from from macule and papule to vesicle in 24 hrs. Drew drop on rose petal. Latent infx may insue (shingles/ herpes zoster). Reye syndrome w/ Aspirin Transmission - nasopharyngeal, skin lesion contact, easily air spread. Peaks in late winter and spring Incubation - 14-16 days communicability - 1-2 days before rash until 5 days after rash crusts diagnose by visual inspection and symptoms, serology management - strict isolation, avoid aspirin, avoid hospitilizaiton exposure to immunocomprimised. active immunization, VZIG to exposed susceptibles and immunocompromised. Oral acyclovir within 24 hrs.
Synovial sarcoma
A misnomer. Not often of synovial joints. Often calcifications.
Ion Channel Myopathies
Group of inherited diseases caused by mutations affecting the function of ion channel properties. Variant clinical presentations depedning on what channel is defunct.
reactive vascular proliferation resulting from opportunistic infx from Bartonella Bacteria in immunocompromies pts. regress w/ proper antibiotics
Bacillary angiomatosis
Group of inherited diseases caused by mutations affecting the function of ion channel properties. Variant clinical presentations depedning on what channel is defunct.
Ion Channel Myopathies
Hemangioendotheliomas
group of very rare malignant vascular tumors w/ clinical behaviour less aggressive than angiosarcoma
Autosomal dominant disorder widely distributed vascular ectasias over the skin and mucous membranes, respiratory, GI, and urinary tracts.
Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Disease)
Can occur in adults and children. Most common adult MD. Myotonia refers t othe sustained involuntary contraction of a group of muscles. Autosomal dominant. Defect in the dystrophia myotonia protein kinase (DMPK) resulting in mutatnt CLC1 chloride channel. Presents with gait abnormalities progressing to hand and wrist weakness, saggin of face, ptosis, and open mouth. Also possibly cataracts, frontal balding, gonadal atrophy, abnormal glucose tolerance, and cardiomyopathy. Muscle biopys can show selective atrophy of type 1 fiberas as well as ring fibers. Elevated CK as well.
Myotonic Dystrophy
binge drinking can produce and acute toxic syndrome of rhabdomyolysis, with rapid breakdown of skeletal muscle.
Ethanol myopathy
Injury to tibial nerve
- Uncommon because of its deep location in the popliteal fossa and posterior compartment - Causes: deep lacerations and posterior dislocation of the knee joint - Paralysis of the muscles in the posterior compartment of the leg and intrinsic muscles of the sole of the foot will occur.
A misnomer. Not often of synovial joints. Often calcifications.
Synovial sarcoma
Causative agent: Poxvirus Symptoms: Asymptomatic, discrete papular, waxy lesions. Umbilicated appearance. Generally only a few. Incubation - 2-7 weeks but as long as 6 months Communicability - infectivity is low, length of infectiivty is unknown Diagnosis: clinical inspection, smear and stain Management: mechanical removal of central core (which contains the virus), liquid N2, acids. Avoid direct contacts, sharing of towels and washcloths
Molluscum contagiosum
Myotonic Dystrophy
Can occur in adults and children. Most common adult MD. Myotonia refers t othe sustained involuntary contraction of a group of muscles. Autosomal dominant. Defect in the dystrophia myotonia protein kinase (DMPK) resulting in mutatnt CLC1 chloride channel. Presents with gait abnormalities progressing to hand and wrist weakness, saggin of face, ptosis, and open mouth. Also possibly cataracts, frontal balding, gonadal atrophy, abnormal glucose tolerance, and cardiomyopathy. Muscle biopys can show selective atrophy of type 1 fiberas as well as ring fibers. Elevated CK as well.
Thyrotoxic myopathy
Hyperthyroidism can cause muscle degeneration and necrosis w/ regeneration. Look for exopthalmic opthalmoplegia. Pts. also get muscle fiber atrophy w/ hypothyroidism.
Incompetant valves in venous return in legs causing back pooling of blood and large squigly superficial veins. - Causative factors: carrying extra weight, long hours of sitting or standing, smoking Deep venous thrombosis (DVT) can inhibit venous return Pregnant women often develop varicose veins, but they usually resolve on their own within a year. Treatment is via sclerotherapy, vein stripping, ablation, and laser therapy. Spider veins are a similar mild cosmetic problem.
Varicose veins
Bacillary angiomatosis
reactive vascular proliferation resulting from opportunistic infx from Bartonella Bacteria in immunocompromies pts. regress w/ proper antibiotics
African Sleeping Sickness (African Trypanosomiasis)
Causative agent: Trypanosome brucei two subspecies: gambiense in West Africa and rhodesiense in East Africa Vector: Tsetse fly Symptoms: Differentiated from T. cruzi by dividing trypanosomes in blood First stage: possible chancre at site of bite, fever, headache, swollen lymph nodes, muscle and joint aches, possibly rash or itchiness Second Stage CNS involvement, neurological symptoms include SOMNOLENCE (extreme sleepiness, esp. at inappropriate times), altered gait, tremors, cranial neuropathies, urinary incontinence. Time scale: gambiense -CNS involvement after 1-2 years, death usually in 3 if not treated rhodesiense: CNS involvement after a few weeks, death in a few months if not treated. Treatment: Suramin, pentamidine, eflornithine, MELASOPROL (only drug once in CNS and vs gambiense. Painful injection and side effects - 5-10% encepalopathy with one half dying.)
Aneurysm in popliteal artery behind knee. Treat with open surgery. Internal graft is an option for patients w/ weak cardiopulmonary systems.
Poplitieal aneurysm
Causative agent: human parovirus B19 Symptoms: RED SLAPPED CHEEKS, youth, very mild upper respiratory illness precedes, lacy rash on upper extremeties follows (may fade and return). Vague joint pain, Transmission - nasopharyngeal droplet, Peaks in spring Incubation - 4-14 days Management - protect pregnant women from exposure. Note- once rash has developed no need to keep from school
Erythema infectosum, fifth disease
Ecthyma contagiosum (Orf virus)
Casative agent: Orf virus Symptoms - Small pimple on hands with no other symptoms. History of sheep handling. transmission - zoonosis from sheep; especially in spring Management- duration is 30-40 days and resolves spontaneously with only symptomatic care; wearing of gloves.
Causative agent: echovirus (enterovirus) Symptoms - flu-like process with mild fever, malaise, abdominal cramping, diarrhea, and non-specific maculopapular rash of trunk. Transmission: fecal oral Incubation 3-6 days Diagnosis - clinical course, viral isolation from feces, serology Management - symptomatic meds, hygeine, care with diaper changing
Echo virus
Trochanteric bursitis
- Deep gluteal pain felt over the trochanteric bursa, usually due to repetitive action like climbing stairs or running on a steeply elevated treadmill or hills - Gluteus maximus rubs over the greater trochanter causing friction bursitis.
