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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
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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
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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
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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

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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
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6
Q

axillary N dysfunction

  • nerve roots
  • presentation
A
  • C5-6

- flattened deltoid w/ loss of sensation -> cant abduct arm greater then 15 degrees

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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)

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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

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9
Q

median N dysfunction

  • nerve roots
  • presentation
A
  • C5-T1

- loss of flexion of fingers and wrist, loss of sensation over thenar eminence

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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
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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
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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
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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
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14
Q

ulnar claw

  • presentation
  • location of lesion
A
  • pinky and ring finger flexed at rest

- proximal median nerve damage

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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
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16
Q

median claw

  • presentation
  • location of lesion
A
  • thumb, index and middle finger flexed at rest

- distal median N damage

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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
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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
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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
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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
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21
Q

Lateral femoral cutaneous

  • nerve roots
  • innervation
  • presentation
A
  • L2-3
  • s: anterior/lateral thigh
  • decreased sensation
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22
Q

Obturator

  • nerve roots
  • innervation
A
  • L2-4

- sensory to medial thigh; m: adductor muscles

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23
Q

Femoral

  • nerve roots
  • innervation
A
  • L2-4

- S: ant/medial thigh, M: extensors

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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

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25
Q

Common peroneal

  • nerve roots
  • innervation
A
  • L4-S2

- sensory to dorsum of foot and motor for eversion and dorsiflexion of foot

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26
Q

Tibial

  • nerve roots
  • innervation
A
  • L4-S3

- S: sole of foot, M: inverting and plantar flexing foot

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27
Q

Sup gluteal

  • nerve roots
  • innervation
  • presentation
A
  • 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
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28
Q

Inf gluteal

  • nerve roots
  • innervation
  • presentation
A
  • L5-S2
  • m: glut max
  • unable to climb stair and loss of hip extension
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29
Q

Pudendal

  • nerve roots
  • innervation
A
  • S2-4

- s: perineum, m: urethral and anal sphincters -> incontinence

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30
Q

Ankle sprains

  • Ant. Talofibular lig; incidence, classification, caused by
  • Ant inf tibiofib lig: incidence
A
  • most common, low ankle sprain, overinversion of foot

- most common high ankle sprain

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31
Q

Radiculopathy

  • what is it
  • L3-4 (root affected, dermatome affected, clinical findings)
  • L4-5
  • L5-S1
A
  • 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
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32
Q

Motor neuron potential and muscle contraction pathway

- steps

A
  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
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33
Q

Types Muscle fibers

  • I (category, color, mito and myoglobin [ ], increases w/ )
  • II (category, color, mito and myoglobin [ ], increases w/ )
A
  • slow, red, high mito and myoglobin concentration, increases with endurance training
  • fast, white, low mito and myoglobin, increase with weight training and sprinting
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34
Q

Vascular SM contraction

- steps

A
  • AP -> L-type Ca channel open -> increase Ca intracellulary -> Ca binds calmodulin -> + myosin light chain kinase -> phosphorylate myosin -> myosin can bind actin -> contraction
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35
Q

Vascular SM relaxation

- steps

A
  • 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
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36
Q

Muscle proprioceptors

  • muscle spindle -> function, location
  • golgi apparatus -> function, location
A
  • 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
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37
Q

Bone Formation

  • endochonral ossification: what is it, steps for processing, which bones
  • membranous ossification: what is it, steps for processing, which bones
A
  • 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
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38
Q

Cells of bone

  • osteoblast: function and differentiation
  • osetoclast: function and differentiation
A
  • build bone with collagen/Ca/Phos in alk environment; from mesenchymal stem cell in periosteum
  • dissolves bone by secreting H+; differentiate from macrophage lineage
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39
Q

Hormones of bone: impact on bone cells

  • PTH
  • Vit D
  • estrogen: + epiphyseal plate
A
  • 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
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40
Q

Elbow injuries

  • medial
  • lateral
A
  • golfers elbow; repetitive flexion w/ pain near medial epicondyle
  • tennis elbow; repetitive extension (backhand) w/ pain near lateral epicondyle
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41
Q

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
A
  • 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
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42
Q

Carpal tunnel

  • what is it
  • causes
A
  • entrapment of median nerve in carpal tunnel -> pain, paresthesia, numbness
  • repetitive use and pregnancy
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43
Q

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
A
  • 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
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44
Q

DeQuervian tenosynovitis

  • pathogenesis
  • sxs
A
  • noninflammatory thickening of ABductor pollicis longus and extensor pollicis brevis
  • pain/tenderness at radial styloid w/ active/passive stretch of thumb tendon
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45
Q

Ganglion Cyst

- what is it

A
  • cyst on dorsal aspect of wrist
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46
Q

Iliotibial band syndrome

  • what is it
  • seen in
A
  • overuse injury of lateral knee from friction of IT band on lateral femoral epicondyle
  • runners
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47
Q

Limb compartment syndrome

  • what is it
  • sequlae
  • causes
  • sxs
A
  • 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
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48
Q

Medial tibial stress syndrome

  • other name
  • pathogenesis
A
  • shin splints

- bone resorption outpace bone formation in tibial cortex

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49
Q

Plantar Fascitis

  • what is it
  • sxs
  • worsening of sxs
A
  • inflammation of plant aponeurosis
  • heel pain and tenderness
  • pain is worse in morning or after being inactive
50
Q

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
A
  • 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
Q

Common Peds Fx

  • green stick
  • buckle
A
  • incomplete fx extending partway through bone, bending stress
  • axial force applied to immature bone, slightly cruches in on itself
52
Q

Achondroplasia

  • what is it
  • sxs
  • why
A
  • 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
Q

Osteoporosis

  • what is it
  • why?
  • dx
  • prophylaxis
  • tx
A
  • 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
Q

Osteopetrosis

  • what is it
  • pathogenesis
  • labs
  • imaging
  • tx
A
  • 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
Q

Osteomalacia/rickets

  • what is it
  • why does it happen
  • x-ray adults
  • x-ray in children
  • sxs in children
A
  • 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
Q

Osteitis deformans

  • also called
  • what is it
  • why
  • histo
  • labs
  • increased risk of
  • sxs
  • stages
  • tx
A
  • 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
Q

Avascular necrosis of bone

  • what is it
  • common location
  • causes (CASTS Legg)
A
  • infarction of bone and marrow
  • femoral head
  • Corticosteroids, EtOH, Sickle cell dx, Trauma, SLE, Legg-Calve-Perthes dx
58
Q

Osteochondroma

  • epi
  • location
  • characteristics
A
  • benign bone tumor under 25 yrs old, males
  • metaphysis
  • lateral to growth plate
59
Q

Osteoma

  • epi
  • location
  • characteristics
A
  • middle age
  • facial bones
  • Gardner syndrome –> will also have polyps in the colon
60
Q

Osteoid osteoma

  • epi
  • location
  • characteristics
  • size
A
  • 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
Q

Osteoblastoma

  • epi
  • location
  • characteristics
A
  • males
  • vertebrae
  • similar to osteoid osteoma but larger than 2 cm
62
Q

Chondroma

  • location
  • characteristics
A
  • medulla of small bones of hands and feet

- benign tumor of cartilage

63
Q

Giant cell tumor

  • epi
  • location
  • characteristics
  • type of cell
  • x ray
A
  • 20-40
  • epiphysis of longbone
  • aggressive benign tumore
  • neoplastic mononuc cells w/ RANKL (osteoclast like)
  • soap bubble appearance
64
Q

Osteosarcoma

  • epi
  • location
  • cell type
  • presentation
  • characteristics
  • xray
  • prognosis
A
  • 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
Q

Chondrosarcoma

  • location
  • characteristics
A
  • medulla of pelvis, prox femur, humerus

- tumor of malignant chondrocytes

66
Q

Ewing sarcoma

  • epi
  • location
  • cells
  • xray
  • prognosis/tx
A
  • 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
Q

OA

  • pathogenesis
  • predisposing fx
  • presentation
  • joint findings
  • tx
A
  • 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
Q

RA

  • pathogenesis
  • predisposing fx
  • presentation
  • joint findings
  • tx
A
  • 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
Q

Gout

  • what is it
  • cause
  • how?
  • micro
  • sxs
  • when
  • tx
A
  • 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
Q

Ca pyrophosphate deposition dx (pseudo gout)

  • what is it
  • cause
  • sxs
  • joint affected
  • micro
  • tx
A
  • 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
Q

Systemic juvenile idiopathic arthritis

  • what is it
  • sxs
  • labs
  • tx
A
  • 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
Q

Sjogren syndrome

  • what is it
  • epi
  • sxs
  • sequlae
  • dx
A
  • 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
Q

Septic arthritis

  • what is it
  • common causes
A
  • arthritis caused by infection

- S. aureus, strep, n gonorrheae (can also have rash and hand tenosynovitis)

74
Q

Seronegative spondyloarthritis

  • what is it
  • subtypes
  • usually includes
A
  • arthritis w/o + rheumatoid factor
  • psoriatic, ankylosing, reactive
  • IBD (Crohns or ulcerative colitis)
75
Q

Psoriatic arthritis

  • sxs
  • xray
A
  • associated with psoriasis and nail lesions

- pencil in cup of DIP deformity on xray

76
Q

Ankylosing spodylitis

  • what is it
  • other sxs
  • epi
  • xray
  • sequlae
A
  • 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
Q

Reactive arthritis

  • sxs
  • seen with
A
  • conjunctivitis, urethritis, arthritis

- Chlamydia

78
Q

SLE

  • what is it
  • caused by
  • sxs
  • heart sequlae
  • kidney sequlae
  • pregnancy
A
  • 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
Q

Polymyalgia Rheumatica

  • sxs
  • labs
  • tx
A
  • 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
Q

Fibromyalgia

  • cause
  • epi
  • sxs
  • tx
A
  • women 20-50
  • chronic widespread pain with TP, stiffness, paresthesia, poor sleep, fatigue
  • exercise, anti-depressant, gabapentin (neuropathic pain)
81
Q

Polymyositis

  • what is it
  • cause
A
  • progressive symmetric proximal muscle weakness w/ endomysial inflammation
  • CB8+ Tcells
82
Q

Dermatomyositis

  • what is it
  • increase risk
  • cause
A
  • polymysitis + Gottron papules, shawl and face rash, or photodistributed facial erythema
  • occult malignancy
  • perimysial inflammation and strophy bc of CD4+ T cells
83
Q

Myasthenia

  • what is it
  • sxs
  • associated with
  • Ach E inhibitor administration
A
  • antibodies to post-synaptic Ach receptor
  • ptosis, diplopia, weakness of muscles that worsens with use
  • thymoma/thymis hyperplasia
  • reverse sxs
84
Q

Lambert-Eaton

  • what is it
  • sxs
  • associated with
  • Ach E inhibitor administration
A
  • antibodies to presynaptic Ca channel -> decrease Ach release
  • proximal muscle weakness, improves with muscle use
  • small cell lung CA
  • minimal effect
85
Q

Raynauds

  • what is it
  • presentation
  • called
  • tx
A
  • 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
Q

Scleroderma

  • what is it
  • common sxs
  • other organs affected
  • diffuse
  • limited
A
  • 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
Q

Skin layers

  • 3 layers
  • epidermal layers
A
  • Epidermis, dermis, subcutaneous fat

- corneum, lucidum, granulosum, spinosum, basale

88
Q

Epi cell junctions

  • tight -> function
  • adherens
  • desmosome
  • gap junction
  • hemidesmosome
A
  • 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
Q

Derm macro terms

  • macule
  • patch
  • papule
  • plaque
  • veiscle
  • bulla
  • pustule
  • wheal
  • scale
  • crust
A
  • 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
Q

Derm micro terms

  • hyperkeratosis
  • parakeratosis
  • hypergranulosis
  • spongiosis
  • acantholysis
  • acanthosis
A
  • 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
Q

Albinism

  • what is it
  • caused by
  • increased risk of
A
  • normal melanocyte number but with decreased production of melanin
  • decrease TK activity or defective tyrosine transport
  • skin cancer
92
Q

Melasma

- what is it

A
  • acquired hyperpigmentation with pregnancy
93
Q

Vitiligo

  • what is it
  • caused by
A
  • areas of hypopigmentation

- AI attack of melanocytes

94
Q

Seborrheic dermatitis

  • what is it
  • area
  • tx
A

erythematous well demarcated plaques, with greasy yellow scales

  • areas rich in sebaceous glands
  • antifungal and steroid
95
Q

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
A
  • 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
Q

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
A
  • 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
Q

Bacterial Skin Infections

  • impetigo
  • erysipelas
  • cellulitis
  • abscess
  • necrotizing fasciitis
  • staph scalded skin syndrome
A
  • 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
Q

Acne

  • etiology
  • cutebacterium acnes
  • tx
A
  • increase in sebum and androgen production
  • colonization of pilosebaceous unit
  • retinoid (vit A), benzoyl peroxide, antibiotic
99
Q

Eczema (atopic dermatitis)

  • what is it
  • where
  • occur with
  • dx
  • predisposition
A
  • 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
Q

Psoriasis

  • what is it
  • where does it occur
  • skin findings
A
  • papules and plaques with silver scaling
  • knees and elbows
  • increase in stratum spinosum and decrease in stratum granulosum
101
Q

Rosacea

  • what is it
  • causes
  • phymatous rosacea
A
  • inflammatory facial skin disorder
  • erythematous papules and pustules w/o commodones
  • can cause bulbous deformation of the nose
102
Q

Verrucae

  • what is it
  • caused by
  • histo
  • on anus or genitals
A
  • warts
  • HPV
  • epidermal hyperplasia, hyperkeratosis
  • condyloma acuminatum
103
Q

Urticaria

  • other name
  • caused by
  • histo
A
  • hives
  • pruritic wheals that form after mast cell degranulation
  • superficial dermal edema and lymph channel dilation
104
Q

Pemphigus vulgaris

  • what is it
  • significance
  • look like and why
  • H and E stain
  • mucosa
  • IF
A
  • 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
Q

Bullous pemphigoid

  • what is it
  • histo
  • mucosa
  • IF
A
  • IgG antibodies against hemidesmosomes
  • blisters containing eosinophils
  • oral mucosa spared
  • linear pattern
106
Q

Steven Johnson syndrome

  • sxs
  • mortality
  • mucus membranes
  • looks like
  • toxic epidermal necolysis
A
  • 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
Q

Acanthosis nigricans

  • what is it
  • location
  • associated with
A
  • epidermal hyperplasia causing, symmertric hyperpigmented thickening of skin
  • axila or neck
  • insulin resistance (DMII, PCOS)
108
Q

Actinic keratosis

- what is it

A
  • pre-malignant lesion caused by sun exposure

- small, rough, erythematous/brwon papules or plaques

109
Q

Burns

  • First degree
  • Second
  • Third
A
  • 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
Q

COX 1 produces

  • thrombaxane
  • prostaglandins GI
  • prostaglandins renal
A
  • 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
Q

COX 2 produces

  • prostacyclin
  • inflammatory prostaglandins
A
  • causes vasodilation and inhibits platelet aggregation

- vascular permeability, increase pain sensation, fever

112
Q

non selective NSAID

  • function
  • examples
  • side effects
A
  • 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
Q

aspirin

  • MOA
  • low doses vs high
  • reyes syndrome
  • sxs for tox and tx
  • contraindications
A
  • 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
Q

selective COX2 inhibitors

  • example
  • benefits
  • downfalls
  • allergies
A
  • 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
Q

acetaminophen

  • MOA
  • tox
  • tox treatment
A
  • 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
Q

acute gout tx

  • NSAID
  • glucocorticoids
  • colcichine: MOA, side effects
A
  • 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
Q

chronic gout tx

  • allopurinol: MOA, other uses, side effect
  • fubuxostat: MOA
  • probenecid: MOA, risks, allergies
  • ASA
  • pegloticase: (MOA, risks, administation)
A
  • 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
Q

Glucocorticoids

  • suffix
  • MOA
  • labs
  • side effects
  • importance of taper
  • chronic side effects
A
  • 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
Q

Osteoporosis Tx

  • bisphosphonates: suffix. MOA, other uses, side effects
  • estrogen therapy, risks
  • SERMS; MOA
  • Denosumab; MOA
  • Calcitonin: MOA, other uses
A
  • 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
Q

Meds to increase Ca

  • Teriparatide
  • Vit D; activated form, MOA
  • Cinacalcet
  • Sevelamer
A
  • 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

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