MS Flashcards
1
Q
Muscles of the rotator cuff
- SITS
- nerve
- motion
- test
A
- supraspinatus -> suprascapular N -> ABducts arm -> empty can test
- infraspinatus -> suprascapular N -> externally rotates -> pitching injury
- teres minor -> axillary N -> adduct and externally rotate
- subscapularis -> subscapular N -> internally rotate and adduct
2
Q
Bones of the wrist
- so long to pinky here comes the thumb
- bone most broken
A
- scaphoid, lunate, triquetrium, pisiform, hamate, capitate, trapezoid, trapezium
- scaphoid
3
Q
Muscles of the hand
- thenar
- hypothenar
- interossi
- lumbricals
A
- flexor pollicis brevis, abdutor pollicis brevis, opponens pollicis
- flexor digiti minimi, abductor digiti minimi, opponens digiti minimi
- dorsal -> adbuct fingers, palmar -> adduct fingers
- flex MCP, extend PIP and DIP
4
Q
Areas of the hand
- hypothenar eminence
- thenar eminence
A
- on palm, from ring finger to pinky
- on palm, from thumb to index finger
5
Q
Innervation of hand
- ant
- posterior
A
- ulnar: pinky and half of ring, median: half of ring all the way to thumb
- ulnar: pink and half of ring; median, half of ring to index, stops at MCP; radial: all of thumb and palmar surface from index to half of ring finger
6
Q
axillary N dysfunction
- nerve roots
- presentation
A
- C5-6
- flattened deltoid w/ loss of sensation -> cant abduct arm greater then 15 degrees
7
Q
musculcutaneous N dysfunction
- nerve roots
- presentation
A
- C5-7
- decreased bicep and tricep reflex -> weakness of arm flexion; loss sensation over lateral forearm (thumb side)
8
Q
raidal N dysfunction
- nerve roots
- presentation
A
- C5-T1
- loss of extension in fingers, wrist and elbow. loss sensation over posterior arm/forearm and dorsal hand
9
Q
median N dysfunction
- nerve roots
- presentation
A
- C5-T1
- loss of flexion of fingers and wrist, loss of sensation over thenar eminence
10
Q
ulnar N dysfunction
- nerve roots
- presentation
A
- C8-T1
- ulnar clar with digit extension, radial deviation of wrist on flexion, loss pf sensation over pinky and half of ring finger
11
Q
Erb palsy (waiters tip)
- injury
- cause in infants
- muscle deficit
- presentation
A
- traction/tear of upper trunk
- lateral traction on neck during delivery
- deltoid, infraspinatus, bicep brachii
- arm hangs by side, medially rotated with flexed/supinated forearm
12
Q
Winged scapula
- injury
- cause
- muscle deficit
- presentation
A
- lesion of long thoracic nerve
- axillary node disectoin w/ mastectomy
- serratus anterior
- unable to anchor scapula to thoracic cage
13
Q
Thoracic outlet syndrome
- injury
- cause
- muscle deficit
- presentation
A
- compression of lower trunk
- cervical rib impingement
- atrophy of intrinsic hand muscles -> claw hand
14
Q
ulnar claw
- presentation
- location of lesion
A
- pinky and ring finger flexed at rest
- proximal median nerve damage
15
Q
popes blessing
- presentation
- location of lesion
A
- when trying to make a fist, thumb, index and middle finger stay extended
- proximal median nerve damage
16
Q
median claw
- presentation
- location of lesion
A
- thumb, index and middle finger flexed at rest
- distal median N damage
17
Q
OK gesture
- presentation
- location of lesion
A
- when trying to make a fist, pinky and ring finger stay extended
- distal median nerve damage
18
Q
Ligament tests on knees
- anterior drawer
- posterior drawer
- abnormal passive abduction
- abnormal passive adduction
- McMurray test
A
- ACL -> knee flexed and stabilized, pull lower leg anterior
- PCL -> knee flexed and stabilized, push lower leg posterior
- MCL -> knee flexed and stabilized, ABduct lower leg
- PCL -> knee flexed and stabilized, ADduct lower leg
- MCL/PCL -> internal and external rotation of tibia while flexing and extending knee
19
Q
Iliohypogastric
- nerve roots
- innervation
- presentation
A
- T12-L1
- s: suprapubic area, m: transversus abdominus and internal oblique
- burning/tingling with radiation to inguinal or suprapubic region
20
Q
Genitofemoral
- nerve roots
- innervation
- presentation
A
- L1-2
- Sensory to crotum/labi majora, internal thigh; m: cremaster
- decreased upper medial and anterior thigh sensation; absent cremasteric reflex
21
Q
Lateral femoral cutaneous
- nerve roots
- innervation
- presentation
A
- L2-3
- s: anterior/lateral thigh
- decreased sensation
22
Q
Obturator
- nerve roots
- innervation
A
- L2-4
- sensory to medial thigh; m: adductor muscles
23
Q
Femoral
- nerve roots
- innervation
A
- L2-4
- S: ant/medial thigh, M: extensors
24
Q
Sciatic
- nerve roots
- innervation
A
- L4-S3
- motor to various thigh muscles but more importantly gives rise to tibial and common peroneal nerves
25
Common peroneal
- nerve roots
- innervation
- L4-S2
| - sensory to dorsum of foot and motor for eversion and dorsiflexion of foot
26
Tibial
- nerve roots
- innervation
- L4-S3
| - S: sole of foot, M: inverting and plantar flexing foot
27
Sup gluteal
- nerve roots
- innervation
- presentation
- L4-S1
- M: glut med and minor
- + trundelenberg, where hip drops to side of leg that was flexed -> opposite side (extended leg) glut med weakness
28
Inf gluteal
- nerve roots
- innervation
- presentation
- L5-S2
- m: glut max
- unable to climb stair and loss of hip extension
29
Pudendal
- nerve roots
- innervation
- S2-4
| - s: perineum, m: urethral and anal sphincters -> incontinence
30
Ankle sprains
- Ant. Talofibular lig; incidence, classification, caused by
- Ant inf tibiofib lig: incidence
- most common, low ankle sprain, overinversion of foot
| - most common high ankle sprain
31
Radiculopathy
- what is it
- L3-4 (root affected, dermatome affected, clinical findings)
- L4-5
- L5-S1
- paresthesia and weakness related to specific lumbosacral nerves
- L4, lateral thigh/lat to medial knee/medial shin), weak knee extension -> decrease patellar reflex
- L5, lateral thigh and shin, weakness in dorsiflexion
- S1, posterior lateral thigh and calf, weakness of plantar flexion -> decrease in achilles reflex
32
Motor neuron potential and muscle contraction pathway
| - steps
1. AP open Ca channels -> Ach released
2. Ach binds to receptor on muscle cell and causes depolarization
3. Depolarization goes down T-tubules
4. dihyrdopuridine receptor and ryandine receptor change shapre -> open SR -> Ca released
5. Ca binds to troponin C -> deactivates tropomyosin -> myosin binding sites exposed on actin
6. myosin binds actin -> ATP to ADP -> causing myosin to to move actin and cause muscle to contract -> ADP is released and myosin unbinds
7. If Ca remains then myosin will bind actin again and wait for another ATP
33
Types Muscle fibers
- I (category, color, mito and myoglobin [ ], increases w/ )
- II (category, color, mito and myoglobin [ ], increases w/ )
- slow, red, high mito and myoglobin concentration, increases with endurance training
- fast, white, low mito and myoglobin, increase with weight training and sprinting
34
Vascular SM contraction
| - steps
- AP -> L-type Ca channel open -> increase Ca intracellulary -> Ca binds calmodulin -> + myosin light chain kinase -> phosphorylate myosin -> myosin can bind actin -> contraction
35
Vascular SM relaxation
| - steps
- Ach binds receptor on smooth muscle endothelial cell -> increase intracellular Ca -> + NO synthase -> Arg to NO -> NO diffuses into muscle cell -> GTP to cGMP -> + myosin light chain phosphatase -> dephosphorylate myosin -> myosin can't bind actin -> relaxation
36
Muscle proprioceptors
- muscle spindle -> function, location
- golgi apparatus -> function, location
- MS: senses length and speed of stretch, causes contraction of agonist and relaxation of antagonist to prevent over stretching; in the body of the muscle
- GA: snses tension -> when too much will caus relaxation so injury does not occur; in the tendons
37
Bone Formation
- endochonral ossification: what is it, steps for processing, which bones
- membranous ossification: what is it, steps for processing, which bones
- cartilage formed first and then turned into bone; catrilage model -> woven bone -> lamellar bone; axial and appendicular bones
- bone formed without cartilage template; woven bone to lamellar; skull, face and clavicle
38
Cells of bone
- osteoblast: function and differentiation
- osetoclast: function and differentiation
- build bone with collagen/Ca/Phos in alk environment; from mesenchymal stem cell in periosteum
- dissolves bone by secreting H+; differentiate from macrophage lineage
39
Hormones of bone: impact on bone cells
- PTH
- Vit D
- estrogen: + epiphyseal plate
- increase osteoclast activity to increase serum Ca
- low levels increase osteoblast formation, and at high levels increase osteoclasts
- stop osteoblast apoptosis and induce osteoclast apoptosis; closure of epiphyseal plate in puberty
40
Elbow injuries
- medial
- lateral
- golfers elbow; repetitive flexion w/ pain near medial epicondyle
- tennis elbow; repetitive extension (backhand) w/ pain near lateral epicondyle
41
Wrist and hand injuries
- metacarpal fracture -> what is it, how does it happen, other name
- guyon canal syndrome -> what is it, how does it happen
- usually on pinky side, called boxers fracture caused by hitting something with closed fist
- compression of ulnar nerve; seen in cyclists bc of pressure on handle bars
42
Carpal tunnel
- what is it
- causes
- entrapment of median nerve in carpal tunnel -> pain, paresthesia, numbness
- repetitive use and pregnancy
43
Hip and knee conditions
- tronchanteric bursitis -> what is it, tx
- unhappy triad -> what is it, how did it happen
- prepatellar bursitis -> what is it, how is it caused
- bakers cyst -> what is it, what does it lead to
- inflammation of the gluteal tendon and burs lat to greater trochanter -> NSAID/heat/stretching
- ACL, MCL and medial meniscus tear, caused by force on lateral part of leg pushing in
- inflammation of the bursa in front of knee cap, excessive kneeling
- popliteal fluid collection in gastroc-semimembranous bursa -> leads to OA and RA
44
DeQuervian tenosynovitis
- pathogenesis
- sxs
- noninflammatory thickening of ABductor pollicis longus and extensor pollicis brevis
- pain/tenderness at radial styloid w/ active/passive stretch of thumb tendon
45
Ganglion Cyst
| - what is it
- cyst on dorsal aspect of wrist
46
Iliotibial band syndrome
- what is it
- seen in
- overuse injury of lateral knee from friction of IT band on lateral femoral epicondyle
- runners
47
Limb compartment syndrome
- what is it
- sequlae
- causes
- sxs
- increase pressure withing fascial comparentment of muscles in a limb
- venous outflow obstruction and blockage of lood from arteries -> necrosis of tissue
- long bone fractures, insect venom
- severe pain and swollen compartments
48
Medial tibial stress syndrome
- other name
- pathogenesis
- shin splints
| - bone resorption outpace bone formation in tibial cortex
49
Plantar Fascitis
- what is it
- sxs
- worsening of sxs
- inflammation of plant aponeurosis
- heel pain and tenderness
- pain is worse in morning or after being inactive
50
Childhood MS conditions
- developmental dysplasia of the hip -> what is it, dx, tx
- legg-calve-perhes dx -> what is it, sxs
- osgood schlatter dx -> what is it, epi, sxs
- patellofemoral syndrome -> what is it, exacerbation, tx
- radial head subluxation -> pathogenesis, presentation, caused by
- slipped capital femoral epiphysis -> what is it, epi, sxs, tx
- DD of hip: abnormal acetabulum development that causes hip dislocation; checked with Barlow manuver (will have clunk of hip) and US; splint
- LCP: Idiopathic avascular necrosis of femoral head; 5-7 yrs old, insidious hip pain that causes limp
- OS: overuse injury, repetitive strain of proximal tibial tubercle; adolescents, sports with running and jumping; progressive ant knee pain
- PFS: overuse injury, that causes anterior knee pain in young female athlete; exacerbated by prolonged siiting/ weight bearing on flexed knee; NSAIDs and thigh muscle strengthening
- radial head: immature annular ligament slips over head of radius; pronated and extended; sudden pull on arm
- slipped femoral epiphysis: head of femur slips off of nneck of femu at epiphysis for unknown reason; obese ~12 yrs old; hip pain and altered gait; surgery
51
Common Peds Fx
- green stick
- buckle
- incomplete fx extending partway through bone, bending stress
- axial force applied to immature bone, slightly cruches in on itself
52
Achondroplasia
- what is it
- sxs
- why
- failure of endochondral ossification because chronic FGFR inhibits chondrocyte proliferation
- membranous ossification is fine so big head relative to short limbs
- can be spontaneous or genetic (Auto dom, but has to be heterozygote, cause homo is not compatible with life)
53
Osteoporosis
- what is it
- why?
- dx
- prophylaxis
- tx
- loss of bone mass regardless of bone mineralization and normal lab values
- increase in bone resorption bc of drop in estrogen with menopause
- low bone density with DEXA on hip and vertebra
- weight bearing exerciseand Ca and Vit D supplementation
- bisphosponate, teriparitide, SERM, denosumab (monoclonal anti against RANKL)
54
Osteopetrosis
- what is it
- pathogenesis
- labs
- imaging
- tx
- thickened, dense bones prone to fracture
- failure of normal bone resorption because of defective osteoclasts
- pancytopenia (over growth of cortical bone fills bone marrow)
- diffuse symmetric sclerosis
- bone marrow transplant (osteoclasts are derived from monocytes)
55
Osteomalacia/rickets
- what is it
- why does it happen
- x-ray adults
- x-ray in children
- sxs in children
- defective mineralization of osteoid or cartilage growth plate
- low vit D
- osteopenia and pseudofractures
- epiphyseal widening and metaphyseal cupping
- bow legs, bead-like costochondral junction and cranial tabes (soft skull)
56
Osteitis deformans
- also called
- what is it
- why
- histo
- labs
- increased risk of
- sxs
- stages
- tx
- Pagets disease
- localized disorder of bone remodeling
- increase of osteoclasts and then osteoblasts that form poor quality bone
- mosaic pattern of woven and lamellar bone
- Ca, PO4 normal
- osteosarcoma
- long bone chalk stick fx, increase in hat size, hearing loss
- Lytic, mixed, sclerotic, quiescent
- bisphosphonates
57
Avascular necrosis of bone
- what is it
- common location
- causes (CASTS Legg)
- infarction of bone and marrow
- femoral head
- Corticosteroids, EtOH, Sickle cell dx, Trauma, SLE, Legg-Calve-Perthes dx
58
Osteochondroma
- epi
- location
- characteristics
- benign bone tumor under 25 yrs old, males
- metaphysis
- lateral to growth plate
59
Osteoma
- epi
- location
- characteristics
- middle age
- facial bones
- Gardner syndrome --> will also have polyps in the colon
60
Osteoid osteoma
- epi
- location
- characteristics
- size
- younger than 25, males
- cortex of long bones
- bone pain that worsens at night and is not better with NSAIDS
- smaller then 2cm and radiolucent
61
Osteoblastoma
- epi
- location
- characteristics
- males
- vertebrae
- similar to osteoid osteoma but larger than 2 cm
62
Chondroma
- location
- characteristics
- medulla of small bones of hands and feet
| - benign tumor of cartilage
63
Giant cell tumor
- epi
- location
- characteristics
- type of cell
- x ray
- 20-40
- epiphysis of longbone
- aggressive benign tumore
- neoplastic mononuc cells w/ RANKL (osteoclast like)
- soap bubble appearance
64
Osteosarcoma
- epi
- location
- cell type
- presentation
- characteristics
- xray
- prognosis
- most common, males under 20
- metaphysis of long bone
- malignant osteoblasts
- painful enlarging mass or patho fx
- sunburst pattern
- aggressive, but good response to tx
65
Chondrosarcoma
- location
- characteristics
- medulla of pelvis, prox femur, humerus
| - tumor of malignant chondrocytes
66
Ewing sarcoma
- epi
- location
- cells
- xray
- prognosis/tx
- males younger than 15
- diaphysis of long bones
- anaplastic small blue cells of neuroectodermal origin
- t11:22)
- onion skin periosteium in x-ray
- aggressive and mets eary, but responds to chemo
67
OA
- pathogenesis
- predisposing fx
- presentation
- joint findings
- tx
- mechanical wear destryos articular cartilage and is not adequately repaired
- age, female, obesity
- pain in joints after use but improves with rest
- osteophytes, joint narrowing, non inflammatory synovial fluid, involves DIP not MCP
- activity modification, NSAID/acetaminophen, intra-articular steroid
68
RA
- pathogenesis
- predisposing fx
- presentation
- joint findings
- tx
- autoimmune -> inflammation erodes articular cartilage and bone
- HLA- DR4, rheumatoid factor, (igM that targets Fc of IgG)
- pain, swelling and morning stiffness, gets better with moving around
- erosion, swan neck, boutionerrie, MCP not DIP, + synovial fluid inflammation
- NSAID, methotrexate, TNF-alpha inhibtors
69
Gout
- what is it
- cause
- how?
- micro
- sxs
- when
- tx
- acute, inflammatory, monoarthritis
- precipitation of monosodium urate cystals in joints
- under-excretion of uric acid (renal dx) or over production of uric acid (lesch-nyhan syndrome
- needle shaped crystals that are bifringent under polarized light (yellow) in synovial fluid
- joint is swollen, red, painful
- after meals rich in purines (red meat and seafood)
- acute: NSAID, glucocorticoid, colcichine; chronic: allopurinol, febuxostat
70
Ca pyrophosphate deposition dx (pseudo gout)
- what is it
- cause
- sxs
- joint affected
- micro
- tx
- deposition of Ca-PP in joint
- idiopathic
- pain/swelling with acute inflammation or chronic degradation (pseudo-OA)
- knee
- crystals are round and blue with parallel polarized light
- acute: NSAID, steroid; chronic: colcichine
71
Systemic juvenile idiopathic arthritis
- what is it
- sxs
- labs
- tx
- systemic arthritis seen in pts younger than 12
- daily fever, salmon-pink macular rash, arthritis in 2 or more joints
- increase ESR, CRP, platelets, WBC, decreased RBC
- NSAID, steroids, methotrexate, TNF inhibitors
72
Sjogren syndrome
- what is it
- epi
- sxs
- sequlae
- dx
- AI dx that attacks exocrine glands (especially lacrimal and salivary)
- women, 40-60
- joint pain, decrease saliva and tear formation, parotid enlargement, + rheumatoid factor
- dental carries, MALT lymphoma (parotid enlagement)
- lyphocytes on labial salivary gland biopsy
73
Septic arthritis
- what is it
- common causes
- arthritis caused by infection
| - S. aureus, strep, n gonorrheae (can also have rash and hand tenosynovitis)
74
Seronegative spondyloarthritis
- what is it
- subtypes
- usually includes
- arthritis w/o + rheumatoid factor
- psoriatic, ankylosing, reactive
- IBD (Crohns or ulcerative colitis)
75
Psoriatic arthritis
- sxs
- xray
- associated with psoriasis and nail lesions
| - pencil in cup of DIP deformity on xray
76
Ankylosing spodylitis
- what is it
- other sxs
- epi
- xray
- sequlae
- arthritis that is symmetric and involves spine and SI joint causing joint fusion
- uveitis, aortic regrurg
- men
- bamboo spine
- restrictive lung dx if costovertebral jpints are involved
77
Reactive arthritis
- sxs
- seen with
- conjunctivitis, urethritis, arthritis
| - Chlamydia
78
SLE
- what is it
- caused by
- sxs
- heart sequlae
- kidney sequlae
- pregnancy
- systemic autoimmune disease that can attack various organs; remits and then relapses
- type III hypersensitivity (antigen-antibody-complement complex that is distributed in membrane) that then causes inflammation and destruction of those cells
- butterfly rash, joint pain, fever (usually in women at reproductive age)
- Libman sacks -> thrombi on mitral or aortic valves
- glomerular edposition of anti-DNA antibody causing nephritic -> diffuse proliferative
- increased risk of baby having neonatal lupus -> congenital heart block, rash, cytopenia at birth
79
Polymyalgia Rheumatica
- sxs
- labs
- tx
- pain and stiffness in proximal muscles, w/ fever, malaise, weight loss, w/o muscle weakness
- increase in ESR and CRP, w/ normal creatine kinase
- low dose steroid
80
Fibromyalgia
- cause
- epi
- sxs
- tx
-
- women 20-50
- chronic widespread pain with TP, stiffness, paresthesia, poor sleep, fatigue
- exercise, anti-depressant, gabapentin (neuropathic pain)
81
Polymyositis
- what is it
- cause
- progressive symmetric proximal muscle weakness w/ endomysial inflammation
- CB8+ Tcells
82
Dermatomyositis
- what is it
- increase risk
- cause
- polymysitis + Gottron papules, shawl and face rash, or photodistributed facial erythema
- occult malignancy
- perimysial inflammation and strophy bc of CD4+ T cells
83
Myasthenia
- what is it
- sxs
- associated with
- Ach E inhibitor administration
- antibodies to post-synaptic Ach receptor
- ptosis, diplopia, weakness of muscles that worsens with use
- thymoma/thymis hyperplasia
- reverse sxs
84
Lambert-Eaton
- what is it
- sxs
- associated with
- Ach E inhibitor administration
- antibodies to presynaptic Ca channel -> decrease Ach release
- proximal muscle weakness, improves with muscle use
- small cell lung CA
- minimal effect
85
Raynauds
- what is it
- presentation
- called
- tx
- dereased blood flow to skin bc of arteriolar vasospasm in response to cold or stress
- fingers and toes usually change from white to blue to red
- disease when primary or syndrome when secondary
- Ca channel blocker
86
Scleroderma
- what is it
- common sxs
- other organs affected
- diffuse
- limited
- auto immune vascular dx that causes collagen depostion and fibrosis
- sclerosis of skin -> puffy, taught skin w/o wrinkles
- kidney, lungs, heart, GI
- widespread skin involvement, rapid progression w/ early visceral involvement
- limited to fingers and face, more benign course
87
Skin layers
- 3 layers
- epidermal layers
- Epidermis, dermis, subcutaneous fat
| - corneum, lucidum, granulosum, spinosum, basale
88
Epi cell junctions
- tight -> function
- adherens
- desmosome
- gap junction
- hemidesmosome
- prevent movement of solutes between cells
- between cells, connects one cell to another by cadherins connecting to actin filaments in the cytoskeleton
- between cells, connects one cell to another with cadherin adhering to intermediate filaments in the cell
- allow for electrical and chemical communication between cells
- between cell and connects keratin in cells in the stratum basilis to the BM so they do not slough off
89
Derm macro terms
- macule
- patch
- papule
- plaque
- veiscle
- bulla
- pustule
- wheal
- scale
- crust
- flat, smaller than 1 cm
- flat, bigger than 1 cm
- elevated, smaller than 1 cm
- elevated, bigger than 1 cm
- contains fluid, smaller than 1 cm
- contains fluid, bigger than 1 cm
- contains pus
- transient plaque or papule
- stratum corneum has follen off and stratum lucidum is exposed
- dry exudate
90
Derm micro terms
- hyperkeratosis
- parakeratosis
- hypergranulosis
- spongiosis
- acantholysis
- acanthosis
- increase thickness of stratum corneum -> psoriasis and callus
- nuclei still present in cells of stratum corneum -> psoriasis
- increase thickness of stratum granulonum -> lichen planus
- accumulation of fluid in epidermis -> eczematous dermatitis
- separation of epidermal cells -> pemphigus vulgaris
- epidermal hyperplasia -> acanthosis nigricans
91
Albinism
- what is it
- caused by
- increased risk of
- normal melanocyte number but with decreased production of melanin
- decrease TK activity or defective tyrosine transport
- skin cancer
92
Melasma
| - what is it
- acquired hyperpigmentation with pregnancy
93
Vitiligo
- what is it
- caused by
- areas of hypopigmentation
| - AI attack of melanocytes
94
Seborrheic dermatitis
- what is it
- area
- tx
erythematous well demarcated plaques, with greasy yellow scales
- areas rich in sebaceous glands
- antifungal and steroid
95
Vascular tumors
- angoisarcoma: where, epi; associated w/ ; prognosis
- bacilliary angiomatosis: what is it; affects; caused by
- cherry hemangioma: what is it; epi; tx
- glomus tumor: prognosis; sxs; caused by
- kaposi sarcoma: what is it; caused by; where
- pyogenic granulmona: what is it; associated with
- strawberry hemagioma: what is it; tx
- occurs on head, neck, breast; elderly on sun exposed area; associated with radiation, arsenic and vinyl exposure, commonly occurs w/ chronic lymphadenopathy after mastecomy, very aggressive and difficult to resect
- benign capillary skin papules; AIDS pts; caused by bartonella infections
- benign capillary hemangioma; middle aged pts and increase frequency w/ age; do not regress
- benign; painful, red, under finger nail; modified SM of thermoregulatory glomus body
- endothelial malignancy; caused by HHV8 in pts with AIDS; infects the skin, mouth, GI tract
- polyploid hemangioma that can ulcerate and bleed; associated with trauma and pregnancy
- benign cap hemangioma of infancy, grows rapidly and regresses spontaneously
96
Skin Cancer
- Basal Cell carcinoma: prevalence, location, prognosis, histo
- keratoacanthoma: epi; prognosis; sxs; tx
- melanoma: prognosis; IHC; associated w/; caused by; unresectable
- squamous cell carcinoma: caused by; location; prognosis; histo
- most common, skin exposed areas of body, locally invasive but rarely mets; have pallisading nuclei
- middle aged and elderly; rapidly growing; resembles squamous cell; dome shaped nodule with keratin in the center; can spontaneous regress
- common w/ significant risk of met, correlated with depth of tumor; s100 marker; associated with sulight exposure and dysplastic nevi; usually caused by mutation to BRAF kinase; pts with BRAFv600 use vemurafenib
- excessive exposure to sunlight; commonly on face and lower lip; locally invasive and can spread to LN but rarely mets; keratin pearls
97
Bacterial Skin Infections
- impetigo
- erysipelas
- cellulitis
- abscess
- necrotizing fasciitis
- staph scalded skin syndrome
- honey colored crusting, very contagious
- involves upper dermis and superficial lymph; well definied demarcation from infection and normal skin
- acute, painful; dermis and subcutaneous tissue; breaks in skin or trauma and then spread of infection
- collection of pus from walled off infection in deeper layer of skin -> s aureus
- deep tissue injury, extremly painful, skin is necrotic, surgical emergency
- exotoxin destroys keratinocyte attachment in stratum granulosum; sloughing off of skin
98
Acne
- etiology
- cutebacterium acnes
- tx
- increase in sebum and androgen production
- colonization of pilosebaceous unit
- retinoid (vit A), benzoyl peroxide, antibiotic
99
Eczema (atopic dermatitis)
- what is it
- where
- occur with
- dx
- predisposition
- pruritic eruption
- on face on infants and the on skin flexures in children and adults
- other atopic dx
- increase serum IgE
- mutations to filaggrin gene predispose
100
Psoriasis
- what is it
- where does it occur
- skin findings
- papules and plaques with silver scaling
- knees and elbows
- increase in stratum spinosum and decrease in stratum granulosum
101
Rosacea
- what is it
- causes
- phymatous rosacea
- inflammatory facial skin disorder
- erythematous papules and pustules w/o commodones
- can cause bulbous deformation of the nose
102
Verrucae
- what is it
- caused by
- histo
- on anus or genitals
- warts
- HPV
- epidermal hyperplasia, hyperkeratosis
- condyloma acuminatum
103
Urticaria
- other name
- caused by
- histo
- hives
- pruritic wheals that form after mast cell degranulation
- superficial dermal edema and lymph channel dilation
104
Pemphigus vulgaris
- what is it
- significance
- look like and why
- H and E stain
- mucosa
- IF
- IgG antobodies against desmoglein 1 or 3 (component of desmosomes)
- attach keratinocytes in the strartum spinosum
- flaccid intra-epidermal bullae bc of separation of keratinocytes
- row of tombstones
- oral mucosa is involved
- reticular (net) pattern around epidermal cells
105
Bullous pemphigoid
- what is it
- histo
- mucosa
- IF
- IgG antibodies against hemidesmosomes
- blisters containing eosinophils
- oral mucosa spared
- linear pattern
106
Steven Johnson syndrome
- sxs
- mortality
- mucus membranes
- looks like
- toxic epidermal necolysis
- fever, bullae w/ necrosis, sloghing off of skin at epidermal-dermal junction
- high
- typically involved
- targetoid lesions
- when more than 30% of body surface is involved
107
Acanthosis nigricans
- what is it
- location
- associated with
- epidermal hyperplasia causing, symmertric hyperpigmented thickening of skin
- axila or neck
- insulin resistance (DMII, PCOS)
108
Actinic keratosis
| - what is it
- pre-malignant lesion caused by sun exposure
| - small, rough, erythematous/brwon papules or plaques
109
Burns
- First degree
- Second
- Third
- superifical, only epidermis -> painful, erythematous, blanching
- patrial thickness through epidermis and dermis -> painful, erythematous, blanching, helas w/o scar
- full thickness, epidermis, dermis and hypodermis -> painless, waxy/leathery, non blanching, will scar
110
COX 1 produces
- thrombaxane
- prostaglandins GI
- prostaglandins renal
- prostaglandin that activates platelets to aggregate and vasoconstricts
- COX 1 important in making prostaglandins in GI sxs to protect cells from acid
- important for afferent dilation to increase blood flow to kidneys
111
COX 2 produces
- prostacyclin
- inflammatory prostaglandins
- causes vasodilation and inhibits platelet aggregation
| - vascular permeability, increase pain sensation, fever
112
non selective NSAID
- function
- examples
- side effects
- inhibit both Cox 1 and Cox 2, reversible
- ibuproufen, ketorolac/ diclofenac, indomethacin, meloxicam, peroxicam, naproxen
- gastic inflammation /erosions/ulcerations, bleeding ( effects thrombaxane), increase blood pressure, acute interstitial nephritis and AKI
113
aspirin
- MOA
- low doses vs high
- reyes syndrome
- sxs for tox and tx
- contraindications
- inhibit both Cox 1 and Cox 2, irreversible by acetylating -> have to wait until new platelets are made
- mainly inhibits COX 1 (anti-thromotic) vs starts to also inhibit COX 2 for anti-inflammatory effects
- encephalopathy and liver dysfunction with using NSAIDs a couple days after viral infection
- tinnitus, activated charcoal
- renal dx, 3rd timester pregnancy (pre-mature close of PDA)
114
selective COX2 inhibitors
- example
- benefits
- downfalls
- allergies
- celecoxib
- decreases GI ulcer risk and bleeding risk
- increase risk for forming clots since prostacyclin is blocked and thromboxane isnt
- similiar to sulfonamides so dont give to pt allergic to sulfonamides
115
acetaminophen
- MOA
- tox
- tox treatment
- selective for COX2, but lack anti-inflammatory propoerties so only helps with pain and fever
- metabolized in liver by CYP450 to NAPQi form which is toxic, normally converted to non-toxic glutathione immediately but when there is too much cannot handle and toxic metabolite builds up and damages hepatocytes
- activated charcoal w/i 4 hours of taking the meds, and administer n-acetylcysteine
116
acute gout tx
- NSAID
- glucocorticoids
- colcichine: MOA, side effects
- commonly indomethacin is used for anti-inflammatory effects preventing as many neutrophils from getting into joint
- glucocorticoids,
- disrupts the cytoskeleton of PMNs and inhibits neutrophil migration, phagocytosis and degranulation; diarrhea, n/v, abdominal pain
117
chronic gout tx
- allopurinol: MOA, other uses, side effect
- fubuxostat: MOA
- probenecid: MOA, risks, allergies
- ASA
- pegloticase: (MOA, risks, administation)
- inhibits xanthine oxidase, tumor lysis syndrome, rash (SJS)
- inhibit xanthine oxidase
- inihbit reabsorption of UA in the PCT for those pts who under excrete, forming uric stones (need to stay hydrated) and preventing renal excretion of penicillen, sulfa drug
- high doses will prevent reabosorption of uric acid but low doses will prevenexcretion of uric acid
- converts UA into water soluble allantoin, anaphylaxis and hemolytic anemia in pts with G6PD definiciency, IV in patient
118
Glucocorticoids
- suffix
- MOA
- labs
- side effects
- importance of taper
- chronic side effects
- sone
- prevents the up regulation of PLA2 -> preventing formation of AA and other inflammatory mediators such as prostaglandins, leukotrienes, and NFkappaB
- increase in PMNs because they arent able to migrate to spot of inflammation; also inhibit T and B cell, eosinophils, and Ig creation and release
- hyperglycemia (cause insulin resistance and stimulate gluconeogenesis), cushing syndrome (muscle weakness, adipose deposition in abdomen, thinning of skin, decrease bone mass)
- glucocorticoids mimic cortisol and will cause negative feedback on ACTH, so need to allow for re-balancing of endogenous hormones
- osteoperosis -> avascular necrosis of hip, psychosis, hypokalemia (can also act like aldosterone -> increase Na reabsorption and K excretion)
119
Osteoporosis Tx
- bisphosphonates: suffix. MOA, other uses, side effects
- estrogen therapy, risks
- SERMS; MOA
- Denosumab; MOA
- Calcitonin: MOA, other uses
- dronate; attach to hydroxyappetite and prevent osteoclasts reabsorbing bone, prevent osteoclast formation and induce osteoclasts apoptosis; pagets dx and hyper Ca; acid reflux -> esophagitis/ulcers (take w/ lots of water and remain upright for 30 min), osteonecrosis of jaw, hypo Ca
- treat and prevent postmenopausal osteoporosis, breast CA -> not recommended
- bind to estrogen receptor on specific tissues that mimic action of estrogen; raloxifen -> agonist, preventing bone resorption
- MAB against RANKL -> prevents activation of osteoclasts
- binds to osteoclasts and inhibits resorption and increases Ca excretion, more useful for hyper Ca and pagets
120
Meds to increase Ca
- Teriparatide
- Vit D; activated form, MOA
- Cinacalcet
- Sevelamer
- recombinant PTH, when given in small doses will increase osteoblast formation and activation
- Vit D comes from skin (sun activates it) or from plants and must be activated in kidney to calcitrion, will then increase Ca and phosphate absorption in GI, reabsorption in kidney (PCT-> PO4 and DCT -> Ca); increase in serum Ca will decrease PTH and stop reabsorption of bone; will increase bone turnover by activating both osteoblasts and clasts
- activates Ca sensing receptor in parathyroid gland to decrease production of PTH
- Decreases absorption of phosphate in GI tract; phosphate binds to Ca in serum and decreases free Ca -> by decreasing phosphate absorption you have more free Ca
