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Step 1 > First Aid Respiratory/ MSK > Flashcards

First Aid Respiratory/ MSK Flashcards

1
Q

Emphysema

(a) Pathology
(b) Physical exam finding
(c) CXR finding

A

Emphysema = obstructive pulmonary disease (causes air trapping)

(a) Air space enlargement, reduced recoil and diffusion capacity, increased compliance
Increased elastase activity => loss of elastase fibers => increased compliance
(b) Pursed lip breathing = self PEEP
Exhaling thru pursed lips increases airway pressure
(c) CXR: barrel chest (increased AP diameter 2/2 air trapping)

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2
Q

Name the term that describes max volume that can be expired after a max inspiration

A

Vital capacity

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3
Q

2 things diphenhydramine is indicated for besides allergy

A

Motion sickness, sleep aid

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4
Q

2 histologic features of thyroid papillary carcinoma

A
  1. Orphan annie cells = empty-appearing nuclei
  2. psamomma bodies
    - also seen in meningiomas and ovarian cystadenoma
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5
Q

Which lung cancer is associated w/

(a) Small dark blue cells
(b) Keratin pears
(c) Nests of neuroendocrine cells
(d) Glandular pattern on histology

A

Lung cancers: small cell and non-small cell (adenocarcinoma, squamous cell, large cell, bronchial carcinoid)

(a) Small dark blue cells = small cell (neoplasm of neuroendocrine cells)
(b) Keratin pearls seen in squamous cell carcinoma (central, RF: smoking)
(c) Nests of neuroendocrine cells = bronchial carcinoid tumor
(d) Glandular pattern = adenocarcinoma

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6
Q

What is pulmonary compliance?

(a) Example of disease that reduces pulm compliance

A

Pulmonary compliance = amount of volume change per unit of pressure
-so high compliance means it takes a lot of volume w/ a little pressure

(a) Decrease in pulmonary compliance w/ pulmonary fibrosis or pulmonary edema (decreases efficacy of diffusion surface)

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7
Q

Pathology of bronchiectasis (2 mechanisms)

(a) Associated conditions/RFs
(b) Clinical symptoms

A

Bronchiectasis = chronic inflammation and inability to clear mucoid secretions

(a) CF, primary ciliary immotility (Kartageners), smoking
(b) Productive cough, recurrent infections, hemoptysis

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8
Q

Differentiate Bohr and Haldane effect of H+ on Hb

A

Bohr effect in tissues where high H+ promotes O2 unloading

Haldane effect in the lungs where high O2 promotes H+ dissociation and CO2 formation

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9
Q

Tumor marker for medullary thyroid cancer

A

Calcitonin

-medullary thyroid cancer = of parafollicular (C-cells)

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10
Q

Compare the prognosis of lung cancers:

  • large cell
  • bronchial carcinoid
A

Bronchial carcinoid has excellent prognosis, while large cell carcinoma has a poor prognosis (less responsive to chemotherapy)

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11
Q

Obstructive vs. restrictive pulmonary disease

(a) Lung volumes
(b) FEV1/FVC ratio

A

Obstructive

(a) Air trapping => increased volumes
(b) Pathognomonic reduces ratio (under 80%) b/c both are reduced by FEV1 is more significantly reduced

Restrictive

(a) Decreased volumes, expansion is restricted
(b) Ratio is normal, at or over 80%

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12
Q

MC cause of fat emboli

A

Long bone fracture

Typical presentation: pt fractures femur then becomes suddenly SOB w/ CP

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13
Q

Two places pain from the diphragm radiates

A

Pain from diaphragmatic irritation (ex: air or blood in peritoneal cavity) can be referred to the shoulder (C5) and trapezius (C3,C4) b/c C3,4, and 5 keep you breathing and alive (phrenic nerve)

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14
Q

Give example of causes of hypoxemia with

(a) Normal A-a gradient
(b) Elevated A-a gradient

A

Normal Alveolar-arterial gradient = 10-15mmHg

(a) Hypoxemia w/ normal gradient: high altitude, hypoventilation (ex: opioid overdose causing respiratory depression)
(b) Hypoxia w/ elevated A-a gradient from V/Q mismatch or a limitation in diffusion (ex: fibrosis), or right to left shunt

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15
Q

ARDS

(a) CXR
(b) CT
(c) Histology findings
(d) How is severity graded?

A

ARDS

(a) B/l alveolar infiltrates
(b) CT: found glass opacities, dependent consolidations
(c) Histo: diffuse alveolar damage w/ exudate (protein-rich leakage) forming intra-alveolar hyaline membrane
(d) Severity graded on PaO2 / FiO2 ratio or by required PEEP

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16
Q

Tx of ARDS- 2 parts

A

ARDS Tx

  1. Tx underlying cause: pneumonia, sespis, acute pancreatitis, uremia
  2. Vent w/ high PEEP and low tidal volumes
    - high PEEP to prevent airway collapse at end-expiration and to recruit collapsed alveoli
    - LOOWWW tidal volumes
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17
Q

Give a brief overview of basic asthma tx

A

Acute rescue inhaler = beta-agonist (to cause bronchodilation) Albuterol

For persistent asthma- start w/ daily meds

  1. Low dose ICS (inhaled corticosteroid fluticasone, budesonide) or can use monteleukast (antileukotriene)
  2. add LABA (Salmeterol) or monteleukast
  3. oral steroids if acutely in need
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18
Q

MC cause of primary spontaneous pneumotohorax

A

Rupture of apical blebs or cysts, MC found in tall young thin males

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19
Q

Chronic bronchitis

(a) Clinical definition
(b) Pathology
(c) Physical exam findings

A

Chronic bronchitis = obstructive pulmonary disease

(a) Productive cough for 3+ mo of the year for 2 or more years (not necessarily consecutive)
(b) Hyperplasia of mucus secreting secreting glands in the bronchi
(c) Wheezing, crackles, cyanosis, CO2 retention (hypercapnia) => secondary polycythemia

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20
Q

Malignancy associated w/ asbestosis exposure

A

Mesothelioma

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21
Q

Complications of neonatal respiratory distress syndrome

(a) Heart
(b) Lungs
(c) If give supplemental O2

A

Complications

(a) Patent ductus arteriosus b/c not a big enough increase of O2 tension that usually occurs at birth to close the shunt
(b) Bronchopulmonary dysplasia
(c) Giving 100% O2 can cause free radical damage of eyes and lungs => blindness, pulmonary dysplasia

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22
Q

Sleep apnea

(a) Differentiate central vs. obstructive
(b) Presenting symptoms
(c) Lab abnormality

A

Sleep apnea = repeated breathing arrest for at least 10 seconds during sleep

(a) Central due to lack of respiratory effort from reduced CNS drive. Obstructive from physical obstruction of the airway
(b) Daytime sleepiness
(c) Polycythemia- chronic hypoxia stimulating EPO release

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23
Q

What are club/Clara cells?

A

Club/clara cells = bronchiolar exocrine cells

  • secrete detoxifying substance
  • act as stem cells to regenerate bronchiolar epithelium
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24
Q

Mechanism of pseudoephedrine and phenylephrine

(a) Indication
(b) Toxicity

A

Pseudoephedrine and phenylephrine are both alpha agonists (Sudafed)

(a) Used as nasal decongestants- wrk by reducing edema, nasal congestion
(b) Toxicity- HTN, anxiety for pseudoephedrine 2/2 CNS stimulation

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25
Q

2 complications of pancoast tumor

A

Pancoast tumor = carcinoma in the lung apex

  1. invasion of cervical sympathetic chain => Horner’s (ipsilateral ptosis, miosis, anihidrosis)
  2. SVC syndrome- medical emergency of blocked SVC drainage
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26
Q

Predictive factor for neonatal respiratory distress syndrome

A

L:S ratio in amniotic fluid under 1.5
-indicating not enough surfactant => fetal lungs have high surface tension causing alveolar collapse

(lecithin:spingomyelin ratio)

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27
Q

Which drug is especially good for aspirin-induced asthma

A

Monteleukast (antileukotriene)

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28
Q

Which cancers have Psammoma bodies

A

Psammoma: concentric, laminated, calcified spheres

High yield: PSaMMoma
Papillary thyroid carcinoma
Serous cystadenocarcinoma of the ovary
Meningioma
Mesothelioma (lung)
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29
Q

Which lung cancers are central

A

‘Sentral’: small cell, squamous cell

Squamous cell: hilar mass arising from the bronchus

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30
Q

What is Homan’s sign?

A

Physical exam finding of DVT

-calf pain upon dorsiflexion of the foot

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31
Q

Differentiate guaifenesin and dextromethorphan

A

Guaifenesin (Mucinex, Robittusin) is an expectorant- doesn’t suppress the cough reflex, just thins respiratory secretions

Dextromethorphan (Robittusin) is an antitussive (antagonist of NMDA glutamate receptors)
-abusive potential, mild opioid effect when used in excess

-Robittusin actually has both expectorant and antitussive

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32
Q

Describe the cell type lining the upper vs. lower respiratory tract

A

Pseudostratified ciliated columnar cells to the terminal bronchioles, then cuboidal cells in bronchioles

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33
Q

Next line of tx for allergic asthma resistant to inhaled steroids and LABA

A

Omalizumab = monoclonal anti-IgE antibody

-binds to unbound serum IgE

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34
Q

Ferrous vs. ferric

(a) Hgb form

A

Just the “2 of us” => ferrous = Fe2+

Ferric = Fe3+

(a) Hgb w/ Fe2+ has high affinity for O2, while methemoglobin is oxidized (Hb-Fe3+) and has lower affinity for O2

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35
Q

3 criteria of Light’s criteria for exudative pleural effusion

A
  1. Fluid:serum protein over 0.5
  2. Fluid:serum LDH over 0.6
  3. Fluid LDH over 2/3(ULN)
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36
Q

46 yo F admitted for severe pancreatis, w/in 24 hrs develops severe hypoxemia requiring vent support w/ high FiO2

  • rhonci and crackles of exam
  • ABG on 60% FiO2: pH 7.43, pCO2 35, PO2 108

Dx

A

Dx = ARDS (acute respiratory distress syndrome)

  • acute inflammatory lung injury w/ increased vascular permeability of the lungs
  • PaO2 / FiO2 ratio grades severity
  • leakage of protein-rich (exudative) fluid causes noncardiogenic pulmonary edema
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37
Q

Differentiate diphenhydramine from loratadine

(a) Side effect
(b) Indication

A

Diphenhydramine (benadryl) is a first generation H1 histamine receptor blocker, toxicity includes sedation
-so is dimenhydrinate (dramamine)

Loratadine (Claritin) is a second generation w/ much less CNS entry (b/c lipophobic) => far less sedating
-so is fexofenadine (Allegra) and cetrizine (Zyrtec)

-allergy indicated for both, diphenhydramine also indicated for motion sickness and sleep aid

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38
Q

B/l hilar lymphadenopathy w/ noncaseating granulomas

A

Sarcoidosis = restrictive pulmonary lung disease

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39
Q

Utility of the alveolar gas equation

A

Use the alveolar gas equation to calculate partial pressure of oxygen in the alveoli, then can use this to calculate the A-a (Alveolar-arterial) gradient

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40
Q

Exposures to the following affect the upper or lower lobes?

(a) Asbestosis
(b) Coal
(c) Silica

A

(a) Asbestosis affects lower lobes

(b,c) Coal and silica

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41
Q

3 parts of Virchow’s triad

A

SHE

Stasis
Hypercoagulability
Endothelial damage (exposed collagen triggers the clotting cascade)

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42
Q

Thyroid cancer

(a) MC
(b) Not from follicular cells
(c) Worst prognosis
(d) Associated w/ Hashimoto’s
(e) MC benign thyroid neoplasm

A

Thyroid cancer

(a) 90% are papillary thyroid cancer, excellent prognosis => thyroidectomy
(b) Medullary thyroid cancer is from parafollicular (calcitonin, not PTH, secreting) cells
(c) Anaplastic/undifferentiated (only 1-2% of thyroid cancers) progress rapidly and have poor prognosis
(d) B-cell lymphoma associated w/ Hashimoto’s
(e) MC benign thyroid neoplasm = follicular adenoma

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43
Q

Which lung cancer cells may produce

(a) Carcinoid syndrome
(b) Cushings
(c) SIADH
(d) Hypercalcemia
(e) beta-hCG
(f) Lambert-Eaton

A

Lung cancer paraneoplastic syndromes

(a) Carcinoid syndrome (flushing, diarrhea, wheezing 2/2 5-HT secretion) by bronchial carcinoid tumor
(b) Cushings (2/2 ACTH secretion) by small cell
(c) SIADH by small cell
(d) Hypercalcemia 2/2 PTHrP secretion by squamous cell carcinoma
(e) beta-hCG can be secreted by large cell carcinoma
(f) Lambert-Eaton 2/2 antibodies against pre-synaptic Ca2+ channels 2/2 small cell carcinoma

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44
Q

Which 4 structures (and at what vertebral level) perforate the diaphragm?

A

“I ate 10 eggs at 12”
IVC T8, T10 esophagus, aorta T12

T8- vena cava (IVC)
T10- esophagus and vagus (CN X at T10)
T12- aorta

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45
Q

Why is SVC syndrome a medical emergency?

A

B/c it can raise intracranial pressure enough to cause aneurysm/rupture of intracranial arteries

46
Q

Differentiate follicular adenoma and follicular carcinoma

A

Both follicular are from follicular cells (produce TSH), both are cold nodules

  • adenoma has complete capsular confinement on histology
  • while carcinoma has some invasion of the blood vessels or thyroid capsule on histology
47
Q

Tx for DVT

(a) Acutely
(b) Chronic prevention

A

DVT mgmt

(a) Acutely- heparin or LMWH (enoxaparin)
(b) Chronically prevent w/ an oral anticoagulant: warfarin or Noac (Rivaroxaban)

48
Q

What pH abnormality would you expect in response to high altitude?

A

At high altitude there’s lower PIO2 (partial pressure of inspired O2), so you increase ventilation to compensate which causes you to blow off more CO2 (decreased PCO2)

Decreased PCO2 = respiratory alkalosis

49
Q

Physical exam finding besides for hypoxemia that can help distinguish fat embolism from pulmonary embolism

A

Fat embolism associated w/ petechial rash (and typically after long bone fracture)

50
Q

Asthma

(a) Inspiratory to expiratory ratio
(b) Clinical test
(c) Pathology

A

Asthma: bronchial hyperresponsiveness causing reversible bronchoconstriction and smooth muscle hypertrophy

(a) Reduced insp/exp ratio (takes longer to expire)
(b) Methacholine (muscarinic receptor agonist) challenge
(c) Mucus plugs in sputum

51
Q

Physiology of neonatal respiratory distress syndrome

(a) 2 causes besides prematurity
(b) CXR appearance

A

Neonatal respiratory distress syndrome = hyaline membrane disease- type II pneumocytes aren’t developed yet => surfactant deficiency => high alveolar surface tension/low compliance => alveolar collapse

(a) Prematurity MC, also maternal diabetes (high fetal insulin decreases surfactant production) and C-section (reduced fetal corticosteroid release)
(b) Ground glass opacities on CXR

52
Q

Differentiate taut and relaxed form of Hgb

(a) Which is favored by H+

A

Taut form has lower affinity for O2 (form in tissues to facilitate O2 unloading) vs. relaxed form has higher affinity (300x) for O2 (as in lungs to facilitate O2 uptake)

(a) H+/acidosis favors O2 unloading, so favors taut form
Ex: exercising tissue produces lactic acid, Hb acts as buffer for H+ therefore unloading O2 into tissues

53
Q

Differentiate minute ventilation and alveolar ventilation

A

Minute ventilation = amount of gas that enters lungs per minute

Alveolar ventilation = amount of gas that enters the alveoli per unit time

54
Q

What drug is first line therapy for chronic asthma

(a) Mechanism

A

Inhaled corticosteroids = fluticasone, budesonide

a) Inhibits cytokine syntesis, inactivated NF-kappaB (TF that induces TNF-alpha

55
Q

3 drugs for pulmonary hypertension- describe the classes

(a) Bosentan
(b) Sildenafil
(c) Iloprost

A

(a) Bosentan = endothelin receptor antagonist to decreased pulmonary vascular resistance
(b) Sildenafil = PDE-5 inhibitor to prolong vasodilatory effect of NO
(c) Iloprost = prostacyclin analogs w/ direct vasodilatory effects

56
Q

Name a drug in addition to guaifenesin that acts as an expectorant

(a) Use in CF pts

A

N-acetylcysteine (yes the NAC that’s used in acetaminophen overdose) can be used as mucolytic
-cleaves disulfide bridges btwn mucus glycoproteins

(a) Loosens mucus plugs in CF pts

57
Q

MC lung cancer in nonsmokers

A

Still adenocarcinoma (MC overall)

58
Q

Obstructive vs. restrictive pulmonary disease

(a) Chronic bronchitis
(b) Idiopathic pulmonary fibrosis
(c) ARDS
(d) Myasthenia gravis
(e) Asthma
(f) Bronchiectasis
(g) Emphysema
(h) Sarcoidosis

A

Obstructive (obstructed flow) vs. restrictive (restricted expansion)

(a) Chronic bronchitis (hypertrophy of mucus secreting cells) is obstructive
(b) IPF is restrictive
(c) ARDS is restrictive
(d) MG is restrictive w/ normal Aa gradient (reduced muscle effort)
(e) Asthma is obstructive (airway hyperresponsiveness and mucus plugs)
(f) Bronchiectasis is obstructive
(g) Emphysema obstructive
(h) Sarcoidosis restrictive

59
Q

Define physiologic dead space

(a) 2 components

A

Physiologic dead space = amount of air inhaled that does not participate in gas exchange

(a) Air in the upper airway (like throat and stuff) + alveolar dead space (due to V/Q mismatch) j

60
Q

Transudative vs. exudative pleural effusion

(a) Protein content
(b) Mechanism
(c) Etiologies

A

Transudative

(a) low protein
(b) Due to increased hydrostatic or decreased oncotic pressure
(c) HF, nephrotic syndrome, hepatic cirrhosis

Exudative

(a) high protein
(b) state of increased vascular permeability
(c) Malignancy, pneumonia

61
Q

Describe how exercise changes the V/Q matching throughout the lungs

A

Exercise causes the V/Q ratio from the apex to base to become more uniform

-w/ increased cardiac output there is vasodilation of the apical capillaries => V/Q ratio approaches 1

62
Q

Cutoff for pulmonary hypertension

(a) Normal pulmonary artery pressure
(b) Mutation implicated in idiopathic/familial PAH
(b) Name 2 secondary etiologies

A

Pulm HTN defined as pulmonary artery pressure over 25 mmHg at rest (or over 30 during exercise)

(a) Normal: 10-14 mmHg
(b) BMPR2 gene mutation predisposing to abnormal vasculature b/c normally protein acts to inhibit smooth muscle growth => hyperplasia of smooth muscle
(c) Secondary causes of PAH: hypoxia 2/2 damage to lung parenchyma (ex: COPD), increased backflow pressure from left heart (left HF, severe MS)
- hypoxia => pulmonary vasoconstriction => PAH

63
Q

What is methemoglobinemia?

(a) How does it classically present clinically?
(b) Tx

A

Methemoglobinemia = oxidized Hgb (Hb-Fe3+ instead of normal Hb-Fe2+) which has a lower affinity for O2, higher affinity for CN-

(a) Presents w/ cyanosis and ‘chocolate covered’ (deoxygenated) blood
(b) Tx w/ supplemental O2 and methylene blue
- methylene blue acts as electron acceptor to help recycle NADPH so NADP+ is more available to reduce Hb-Fe3+

64
Q

At what part of the breath is the peripheral vascular resistance the lowest?

A

At functional reserve capacity (volume left after normal expiration) PVR is at a minimum, airway and alveolar pressure are 0

65
Q

Differentiate ACL and PCL

A

Anterior and posterior here refer to their sites of tibial attachment

So PCL attaches the femur to posterior tibia

66
Q

Which muscle abducts the arm

A

Arm abduction is initiated by supraspinatus (rotator cuff muscle) then taken over by deltoid

67
Q

Muscle injured by pitching injury

A

Infraspinatous (I in SItS of rotator cuff muscles)

68
Q

Nerve injured by

(a) Fracture of surgical neck of the humerus
(b) Midshaft fracture of the humerus
(c) Supracondylar fracture of the humerus
(d) Superficial laceration of the palm

A

Nerve injury

(a) Fracture of surgical neck of the humerus = axillary nerve (C5-C6)
(b) Midshaft fracture damages the radial nerve (C5-T1) in the radial groove
(c) Supracondylar fracture of the humerus => median nerve (C5-T1) injury
(d) Superficial laceration of the palm can damage the recurrent branch of the median nerve (C5-T1)

69
Q

Waiter’s tip deformity vs. Claw hand

A

2/2 damage to upper trunk of brachial plexus (C5-C6 roots) => waiter’s tip deformity

Damage to lower trunk of brachial plexus (C8-T1) => clamp hand

70
Q

Nerve injured by

(a) pelvic fracture
(b) fibular neck fracture
(c) Baker cyst
(d) Posterior hip dislocation

A

Nerve injury

(a) Pelvic fracture- femoral nerve (L2-L4) injury
(b) Fibular neck fracture can damage common peroneal nerve (L4-S2)
(c) Baker’s cyst in popliteal fossa can damage tibial nerve (L4-S3)
(d) Posterior hip dislocation can injury the inferior gluteal nerve (L5-S2)

71
Q

What nerve innervates

(a) Gluteus maximus
(b) Gluteus medius
(c) Posterior thigh
(d) Perineum

A

Innervation of

(a) Gluteus maximus = inferior gluteal nerve (L5-S2)
(b) Gluteus medius and minimus by superior gluteal nerve (L4-S1)
(c) Posterior thigh by sciatic nerve (L4-S3) before it splits into common peroneal and tibial
(d) Perineum innervated by the pudendal nerve (S2-S4)

72
Q

Landmark for nerve block during child birth

A

Can block the pudendal nerve (S2-S4), which innervates the perineum, using the ischial spine as a lnadmark

73
Q

Distinguish nerves in charge of dorsi and plantar flexing the foot

A

PED TIP

Peroneal nerve Everts and Dorsiflexies (if injured, foot dropPED)

Tibial nerve Inverts and and Plantarflexes (if injured, can’t stand on TIPtoes)

74
Q

In which direction to interveretebral discs most likely herniate?

A

Discs herniate posterolaterally b/c the posterior longitudinal ligament is much thinner than the anterior longitudinal ligament the lies along the midline of the vertebral bodies

75
Q

Name the nerve and artery pairing that runs through the

(a) axilla
(b) surgical neck of the humerus
(c) Midshaft of the humerus

A

(a) Axilla: long thoracic nerve, lateral thoracic artery
(b) Surgical neck of the humerus: Axillary nerve, posterior circumflex artery
(c) Midshaft of the humerus: radial nerve (in the radial groove), deep brachial artery

76
Q

Name the nerve and artery pairing that runs through the

(a) Cubital fossa
(b) Popliteal fossa
(c) Posterior to medial malleolus

A

(a) Cubital fossa: median nerve and brachial artery
(b) Popliteal fossa: tibial nerve and popliteal artery
(c) Posterior to the medial malleolus: tibial nerve and posterior tibial artery

77
Q

Which type of muscle fibers are hypertrophied by weight training

A

Weight training causes hypertrophy of the fast-twitch, white (b/c less mitochondria and less myoglobin) muscle fibers

-fast-twitch fibers for fast but un-sustained contraction

78
Q

Differentiate type 1 and type 2 muscle fibers

A

Type 1 = red fibers = slow twitch

  • red b/c more mitochondria and more myoblin
  • slower onset but sustained contraction

Type 2 = white fibers = fast twitch

  • white b/c less mitochondria and less myoflobin
  • faster reaction, but un-sustained
79
Q

Mechanism by which osteoclasts dissolve bone

A

Osteoclasts secrete acid (via carbonic anhydrase II rxn which is deficient in osteopetrosis) and collagenases

80
Q

Precursor cells of osteoblasts vs. osteoclasts

A

Osteoblasts (build bone) are from mesenchymal stem cells in the periosteum
-secrete collagen and catalyzing mineralization

Osteoclasts (break down bone) come from monocytes/macrophages, are multinucleated

81
Q

Impact of estrogen on bones

A

Estrogen inhibits apoptosis of osteoblasts, and inhibits apoptosis in osteoclasts => helps maintain healthy strong bone

Explains why post-menopausal F (less estrogen) have higher risk of osteoporosis

82
Q

Differentiate the mechanism by which bones of the skull/face and skeleton are formed

A

Endochondrial ossification of skeleton = first cartilage laid down, then replaced w/ woven bone and later remodeled into lamellar bone

Membranous ossification of skull and facial bones = woven bone formed w/o cartilage then later remodeled into lamellar bone

Explains why face/head is normal size in achondroplasia (defect in cartilage synthesis)

83
Q

MC location of osteonecrosis

A

Osteonecrosis = avascular necrosis, MC site is the femoral head due to insufficiency of the medial circumflex femoral artery

84
Q

What is osteitis fibrosa cystica?

A

Osteitis fibrosa cystica = ‘brown tumors’ of bone due to fibrous replacement of the bone

2/2 hyperparathyroidism

85
Q

Infections associated w/ Reactive arthritis

A

Reactive arthritis (Reiter syndrome- ‘can’t see, can’t pee, can’t climb a tree’- uveitis, urethritis, arthritis

Post-GI (Shigella, Salmonella, Yersinia, Campylobacter) and chlamydia

86
Q

MC lupus pt

A

Female of reproductive age and African descent

87
Q

2 falsely abnormal lab values seen in antiphospholipid syndrome

A

Anticardiolipin antibodies and lupus anticoagulant can cause

  1. false positive VDRL
  2. prolonged PTT
88
Q

Self-IgG in lupus that is

(a) Sensitive but not specific
(b) Specific but not sensitive
(c) Sensitive for drug induced lupus
(d) Prognostic indicator for renal disease involvement

A

Antibodies in SLE

(a) ANA
(b) Anti-dsDNA
(c) Antihistone
(d) Anti-dsDNA: poor prognostic indicator, MC seen w/ renal involvement

89
Q

Describe lupus nephritis

(a) Nephritic
(b) Nephrotic

A

Lupus nephritis = type III hypersensitivity rxn (explains why C3 is low b/c immune complex deposition)

(a) Nephritic syndrome: diffuse proliferative glomerulonephritis
(b) Nephrotic: membranous glomerulonephritis

90
Q

Elevated serum ACE levels, expect what histologic finding?

A

Elevated serum ACE is associated w/ sarcoidosis, in which case you’d see widespread noncaseating granulomas

91
Q

Clinical findings of

(a) Polymyalgia rheumatica
(b) Fibromyalgia

A

Clinically

(a) Polymyalgia rheumatica- pain/stiffness in shoulders and hips (‘girdles’), can be w/ fever malaise and wt loss. No muscular weakness. F over 50
(b) Fibromyalgia- widespread MSK pain w/ stiffness paresthesias poor sleep and fatigue. F 20-50 yo

92
Q

Tx

(a) Polymyalgia rheumatica
(b) Fibromyalgia

A

Tx

a) Polymyalgia rheumatica = low-dose corticosteroids
(b) Fibromyalgia = regular exercise, antidepressants (TCAs, SNRI

93
Q

Pain/stiffness in pt w/ temporal arteritis

A

Polymyalgia rheumaticaaaaaa

-huge overlap in the two syndromes

94
Q

Polymyositis vs. Dermatomyositis

(a) T cell involved
(b) Location of inflammation

A

Polymyositis (lacks cutaneous findings)

(a) CD8
(b) Endomysial inflammation (inner nerve sheath farther from skin)

Dermatomyositis (Gottron papules, heliotrope rash)

(a) CD4
(b) Perimysial inflammation (outer sheath, closer to skin)

95
Q

What is myositis ossificans?

A

Metaplastic change of skeletal muscle into bone following muscular trauma

So get a ‘mass’ at the site of trauma, or found incidentally on radiography

96
Q

Ab seen in

(a) diffuse scleroderma
(b) CREST syndrome

A

(a) Anti-Scl70 antibody = anti-DNA topoisomerase I Ab

(b) Anti-centromere Ab

97
Q

Differentiate scale and crust

A

Scale (ex: eczema, psoriasis) is a flaking off of the stratum corneum

While crust is a dry exudate (ex: impetigo)

98
Q

What is melasma?

A

Melasma = ‘pregnancy glow!’

Hyperpigmentation associated w/ pregnancy or OCP use

99
Q

Etiology of vitiligo

A

Vitiligo = irregular areas of complete depigmentation 2/2 autoimmune destruction of melanocytes

100
Q

Etiology of albinism

A

Albinism: normal amount of melanocytes, just reduced melanin production b/c of reduced tyrosinase activity or defective tyrosine transport

  • also can be from failure of neural crest cell migration (b/c melanocytes are derived from neural crest cells)
  • increased risk of skin cancer
101
Q

Differentiate organisms implicated in cellulitis vs. abscess

A

Cellulitis = infxn is of the deeper dermis and subcutaneous tissue, from either S. pyogenes (GAS) or Staph aureus

While abscess is a walled-off collection of pus w/in deeper layers of skin that is almost always caused by S. aureus (often MRSA)

102
Q

Differentiate mechanism of staph scalded skin syndrome and toxic epidermal necrolysis

A

SSSS: exotoxin destroys keratinocyte attachments in stratum granulosum only

vs. destruction of dermal-epidermal jxn seen in TEN

103
Q

Molluscum contagiosum

(a) Clinical presentation
(b) Cause

A

Molluscum contagiosum

a) Small umbilicated papules (raised under 1cm
(b) Poxvirus
- seen in children or sexually transmitted in adults

104
Q

Cause of necrotizing fasciitis

A

Bacterial infxns: anaerobes or S. pyogenes (GAS)

Results in crepitus from methane and CO2 production

105
Q

Pemphigus vulgaris vs. bullous pemphigoid

(a) More severe
(b) Involves oral mucosa
(c) Consistency of bullae

A

Pemphigus vulgaris = IgG against desmogelin (component of desmosomes)

(a) Much more severe, potentially fatal
(b) Involves oral mucosa
(c) Flaccid bullae

Bullous pemphigoid (‘Abs bullo the epidermis’) = IgG against hemidesmosomes at BM

(a) Less severe
(b) Spares oral mucosa
(c) Tense bullae

106
Q

Condition associated w/ Lichen planus

A

Lichen planus (pruritis, polygonal, purple) associated w/ HepC

107
Q

Buzzwords for bone tumors

(a) Codman triangle
(b) Onion skin periosteal reaction
(c) Soap bubble appearance
(d) Sunburst pattern on Xray

A

(a) Codman triangle = osteosarcoma (of osteoblasts) from elevation of periosteum
(b) Onion skin periosteal rxn = Ewing sarcoma
(c) Soap bubble appearance = giant cell tumor (‘osteoclastoma’)
(d) Sunburst pattern = osteosarcoma (another description of Codman’s triangle)

108
Q

Ewing sarcoma

(a) Demographic
(b) MC location
(c) Histology
(d) Xray
(e) Translocation

A

Ewing Sarcoma

(a) Boys under 15 yoa
(b) Diaphysis (shaft) of long bones
(c) Anaplastic small blue cells
(d) Onion skin periosteal rxn on Xray
(e) T(11;22) forming fusion protein

109
Q

Skin cancer most likely to metastasize

(a) Tumor marker

A

Melanoma

(a) S-100 tumor marker

110
Q

Describe Vemurafenib utility in metastatic or unresectable melanoma

A

Melanoma often driven by BRAF kinase, primary tx is excision w/ appropriately wide margins, but can also use Vemurafenib = BRAF kinase inhibitor

Especially useful in pts w/ BRAF V600E mutation

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