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MSK Flashcards

1
Q

Rotator Cuff Muscles

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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2
Q

Supraspinatus M

A

Suprascapular N
abduct arm 0-15 degrees
Assess with empty can test

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3
Q

Infraspinatus M

A

Suprascapular N
external rotation
Pitching injury

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4
Q

Teres Minor M

A

axillary N

adduct and externally rotate arm

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5
Q

Subscapularis M

A

upper and lower subscapular N

Internal roation and adduct arm

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6
Q

Deltoid M

A

axillary N

15-100 degrees abduction

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7
Q

Tapezius M

A

Accessory N

>90 degree abduction

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8
Q

Serratus Anterior M

A

Long Thoracic N

>100 degrees abduction

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9
Q

Axillary N

A

C5-C6
injury via fractured neck of humerus or anterior dislocation of humerus
Presents as flat deltoid, loss of abduction, loss of sensation over deltoid and lateral arm

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10
Q

Musculocutaneous N

A

C5-C7
injury via upper trunk compression
presents as decreased bicep reflex, weakness in forearm flexion and supination, loss of sensation over lateral forearm

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11
Q

Radial N

A

C5-T1
injury via compression of axilla, midshaft fracture of humerus, repetitive pronation of forearm
Presents as wrist drop, decreased grip strength, loss of sensation over posterior arm and dorsal hand

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12
Q

Median N

A

C5-T1
Injury via supracondylar fracture of humerus or carpal tunnel
Presents as ape hand or Pope hand, loss of wrist flexion, thumb opposition, lumbrical of index and middle fingers, loss of sensation over thenar eminence and dorsal and palmar aspects of lateral 3.5 fingers

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13
Q

Ulnar N

A

C8-T1
Injury via fracture of medial epicondyle of humerus or fracture hook of hamate from FOOSH
presents as ulnar claw, radial deviation of wrist, loss of wrist flexion, flexion of medial fingers, loss of sensation over medial 1.5 fingers

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14
Q

Recurrent branch of Median N

A

C5-T1
injury via superficial laceration of palm
presents as ape hand, loss of thenar muscle group (opposition, abduction, flexion of thumb)

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15
Q

Erb Palsy

A

Injury- traction tear of upper trunk (C5-6) via trauma
Deltoid, supraspinatus- abduction
infraspinatus- lateral rotation
Biceps- flexion, supination

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16
Q

Klumpke palsy

A

Injury via traction or tear of lower trunk (C8-T1) via grab branch of tree
Intrinsic hand muscles (lumbricals, interossei, thenar, hypothenar)- total claw hand

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17
Q

Thoracic outlet syndrome

A

Compression of lower trunk and subclavian vessels via cervical rib
Atrophy of intrinsic muscles, ischemia, pain and edema

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18
Q

Winged Scapula

A

Lesion of long thoracic N C5-C7 via axillar node dissection after mastectomy, stab wounds
Serratus Anterior- inability to anchor scapula to thoracic cage

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19
Q

Wrist bones

A

Scaphoid, lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid, Trapezium

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20
Q

Scaphoid

A

Most fractured via FOOSH

avascular necrosis and nonunion due to retrograde blood supply from branch of radial A

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21
Q

Hand Muscles

A

Thenar- opponenes pollicis, Abductor pollicis brevis, flexor pollicis brevis, superficial head
Hypothenar- opponens digits minimi, abductor digiti minimi, flexor digiti minimi brevis
Dorsal interossei- abduct fingers
Palmar interossei- adduct fingers
Lumbrincals- flex MCP, extend PIP and DIP

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22
Q

Ulnar claw

A

When extending fingers, 1st and 2nd cannot extend

lesion at distal ulnar N

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23
Q

Pope’s blessing

A

When making. a fist, 3-5th fingers cannot flex

lesion at proximal median N

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24
Q

Median Claw

A

when extending fingers, 3-5th fingers do not extend

lesion at distal median N

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25
Q

OK gesture

A

When making. a fist, 1-2 fingers cannot flex

lesion at proximal ulnar N

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26
Q

Hip abductors

A

gluteus medius and minimus

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27
Q

Hip adductors

A

adductor magnus, adductor longus, adductor brevis

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28
Q

hip extensors

A

gluteus maximus, semiteninosus, semiembranosus

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29
Q

Hip flexors

A

iliopsoas, recus femoris, tensor fascia lata, pectineus, sartorius

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30
Q

Hip internal rotation

A

gluteus medius, gluteus minimus, tensor fascia lata

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31
Q

Hip external rotation

A

Iliopsoas, gluteus maximus, piriformis, obruator

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32
Q

Iliohypogastric N

A

T12-L1
Sensory- suprapubic
motor- transversus abdominus and internal oblique
injury via ab surgery, present with burning or tingling pain in surgical incision site radiating to inguinal and suprapubic region

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33
Q

Genitofemoral N

A

L1-L2
sensory- scrotum/labia majora, medial thigh
Motor- cremaster
injury via laproscopic surgery
decreased upper medial thigh and anterior thigh sensation beneath the inguinal L, absent cremasteric reflex

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34
Q

Lateral femoral cutaneous

A

L2-L3
sensory- anterior and lateral thigh
Injury via tight clothing. obesity, pregnancy, pelvic procedures
decreased thigh sensation

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35
Q

Obturator N

A 
L2-L4
sensory- medial thigh
motor- obturator externa, adductor longus, adductor brevis, gracilis, pectineus, adductor magnus
injury via pelvic surgery
decreased thigh sensation and adduction
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36
Q

Femoral N

A 
L2-L4
sensory- anterior thigh, medial leg
Motor- quads, iliacus, pectineus, sartorius
injury via pelvic fracture
decreased leg extension
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37
Q

Sciatic N

A

L4-S3
Motor- semitendinosus, semimembranosus, biceps, adductor magnus
Injury via herniated disc, posterior hip dislocation

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38
Q

Common peroneal

A

L4-S2
superficial peroneal N= sensory to dorsum of foot and motor to peroneus longus and brevis
Deep peroneal N= sensory to web space between hallux and 2nd digit and motor to tibialis anterior
Injury via trauma or compression of lateral leg, fibular neck fracture
Foot drop (inverted and plantarflexed), loss of sensation on dorsum of foot

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39
Q

Tibial B

A

L4-S3
sensory- sole of foot
Motor- bicep femoris, tricep surae, plantaris, popliteus, flexors of foot
Injury via knee trauma, bakers cyst, tarsal tunnel syndrome
Can’t tiptoe, can’t curl toes and loss of sensation on sole

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40
Q

Superior Gluteal N

A

L4-S1
motor- gluteus medius, gluteus minimus, tensor fascia lata
Iagtrogenic injury via IM injection to superomedial gluteal
Trendelenburg sign- lesion contra to side of hip that drops

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41
Q

Inferior gluteal N

A

L5-S2
motor to gluteus maximus
injury via posterior hip dislocation
difficulty climbing stairs, rising from seated position

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42
Q

Pudendal N

A

S2-S4
sensory- perineum
motor- external urethral and anal sphincters
injury via stretch during child birth, prolonged cycling, horseback riding
decreased sensation in perineum and genital area, fecal/urinary incontinence

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43
Q

Knee exam

A

Lateral femoral condyle- ACL

Medial femoral condyle - PCL

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44
Q

Anterior Drawer test

A

Increased anterior gliding of tibia due to ACL injury

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45
Q

Posterior drawer test

A

increased posterior gliding of tibia due to PCL injury

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46
Q

Abnormal passive abduction

A

knee either extended or at 30 degrees, lateral force –> medial space widening of tibia –> MCL injury

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47
Q

Abnormal passive adduction

A

knee either extended or at 30 degrees, medial force –> lateral space widening of tibia–> LCL injury

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48
Q

McMurray Test

A

flexion and extension of knee with rotation of tibia/foot
pain, popping on internal rotation and varus –> lateral meniscal tear
pain, popping on external rotation and valgus force –> medial meniscal tear

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49
Q

Ankle sprain

A

Anterior Talofibular L most common low ankle sprain
via overinversion/supination of foot
Anterior inferior tibiofibular L most common high anle sprain

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50
Q

Lumbosacral Radiculopathy

A

Paresthesia and weakness related to specific lumbosacral spinal nerves. Intervertebral disc herniates posterolaterally through annulus fibrosus into central canal due to thin posterior longitudinal L and thicker anterior longitudinal L

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51
Q

L4 radiculopathy

A

weakness of knee extension and decreased patellar reflex

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52
Q

L5 radiculopathy

A

weakness of dorsiflexion, difficulty in heel walking

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53
Q

S1 radiculopathy

A

weakness of plantar flexion
difficulty in toe walking
decreased Achilles Reflex

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54
Q

Muscle Contraction

A
  1. AP opens VGCC –> ACh release
  2. postsynaptic ACh bind –> muscle cell depolarize
  3. Travel into muscle via T-tubules
  4. conformational change of DHPR and ryanodine receptor –> calcium release from SR
  5. Tropomyosin released via bind troponin to Ca2+ –> exposed myosin binding site
  6. Myosin head binds to actin, Pi released –> powerstroke
  7. muscle shortening
  8. Bind new ATP –> detach myosin head
    ATP hydrolysis into ADP and Pi –> cocked position, myosin can bind to a new site
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55
Q

Type 1 muscle fibers

A 
slow
red
oxidative phosphorylation --> sustained contraction
high mitochondria
endurance training
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56
Q

Type 2 muscle fibers

A 
Fast
White
Anaerobic glycolysis
low mitochondria
weight, resistance training, sprinting
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57
Q

Muscle spindle

A

increase length and speed of stretch –> via DRG –> activated inhibitory interneuron and a MN –> inhibition of antagonist muscle
Type 1a and 2 sensory axons
increase muscle stretch activates

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58
Q

Golgi tendon organ

A

increase tension –> DRG –> activate inhibitory interneuron –> inhibit agonist muscle
Tendon Type 1b sensory axon
increase muscle force activates

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59
Q

Endochondral ossification

A

Axial skeletal bones, appendicular skeleton, base of skull
1. cartilaginous model via chondrocytes
2. osteoclasts and osteoblasts later replace with woven bone and remodel to lamellar bone
Defective in achondroplasia

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60
Q

Membranous ossification

A

calvarium, facial bones, clavicle

woven bone formed directly without cartilage. Later remodeled to lamellar bone.

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61
Q

Osteoblast

A

build bone by secreting collagen and catalyzing mineralization in alkaline environment via ALP
Mesenchymal stem cell in periosteum

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62
Q

Osteoclast

A

dissolves bone by secreting H+ and collagenases
monocyte/macrophage lineage
RANK receptors stimulated by RANKL.
OPG bing RANKL to prevent interaction –> decrease osteoclast

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63
Q

PTH

A

low –> anabolic

high PTH –> catabolic

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64
Q

Estrogen

A

inhibit apoptosis in bone forming osteoblasts and induce apoptosis in osteoclasts.
Cause closure of epiphyseal plate during puberty

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65
Q

Medial Epicondylitis

A

golfers

repetitive flexion –> main near medial epicondyle

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66
Q

Lateral epicondylitis

A

tennis

repetitive extension –> pain near lateral epicondyle

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67
Q

Metacarpal neck fracture

A

Boxer’s
direct blow with a closed fist
4th/5th metacarpal

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68
Q

Carpal Tunnel

A

Entrapment of Median N –> nerve compression –> paresthesia, pain, numb
Thenar eminence atrophy
Tinel + and Phalen +
Associated with pregnancy, RA, hypothyroidism, DM, acromegaly, dialysis

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69
Q

Guyon Canal syndrome

A

Compression of Ulnar N

cyclists

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70
Q

Clavicle Fractures

A

Children, birth trauma
FOOSH or direct trauma
Weakest at middle and lateral thirds
shoulder drop, shortened clavicle, medially rotated arm

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71
Q

Lateral Force applied to planted foot

A

Damage to ACL, MCL and medial meniscus

acute pain, joint instability

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72
Q

Prepatellar bursitis

A

inflammation of the prepatellar bursa in front of knee cap

via repeated trauma or pressure from excessive kneeling

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73
Q

Baker cyst

A

popliteal fluid collection in gastrocnemium-semimembranosus bursa
communicated with synovial space and related to joint disease

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74
Q

DeQuervain Tenosynovitis

A

Noninflammatory thickening of abductor pollicis longus and extensor pollicis brevis tendons –> pain and tenderness at radial styloid
+Finkelstein
increased risk in new mothers, golfers, racquet sport, thumb texters

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75
Q

Ganglion cyst

A

fluid filled swelling overlying joints or tendon sheath
Dorsal wrist
herniation of dense connective tissue

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76
Q

iliotibial band syndrome

A

overuse injury of lateral knee that occurs in runners

Pain secondary to friction of iliotibial band against lateral femoral epicondyle

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77
Q

Limb compartment syndrome

A

increased pressure within fascial compartment of limb –> venous outflow obstructed and arteriole collapse –> anoxia and necrosis
caused by long bone fractures, reperfusion, animal venom
severe pain and tense, swollen compartments with passive stretch of muscles

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78
Q

Medial tibial stress syndrome

A

shin splints
shin pain and diffuse tenderness in runners and military recruits
caused by bone resorption that outpaces bone formation

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79
Q

Plantar fasciitis

A

inflammation of plantar aponeurosis

heel pain worse in morning and tenderness

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80
Q

Developmental dysplasia of the hip

A 
abnormal acetabulum development in newborns
risks= breech
hip instability, dislocation
Ortolani and Barlow --> clunk
confirm with US
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81
Q

Legg Calve Perthes Disease

A

Idiopathic avascular necrosis of femoral head
presents 5-7 years with hip pain and limp
Males
Xray normal

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82
Q

Osgood Schlatter disease

A 
Traction apophysitis
overuse injury by repetitive strain and chronic avulsion of the secondary ossification center of proximal tibial tubercle.
Adolescents after growth spurt
running and jumping athletes
anterior knee pain
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83
Q

Patellofemoral syndrome

A

overuse injury
young female athletes
anterior knee pain exacerbated with sitting or weight bearing on flexed knee
T(x): NSAIDs, thigh muscle strengthening

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84
Q

Radial Head subluxation

A

Nursemaids elbow
<5 years
sudden pull on arm –> immature annular L slips over head of radius
Arm held in extended and pronated

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85
Q

Slipped capital femoral epiphysis

A

obese young adolescents with hip/knee pain and altered gait
increased axial force on femoral head –> epiphysis displaces relative to femoral neck
D(x): X ray

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86
Q

Green stick fracture

A

incomplete fracture after bending stress

bone fails on tension side, compression side intact

87
Q

Torus fracture

A

axial force applied to immature bone –> cortex buckles on compression side and fractures
Tension side remains intact

88
Q

Achondroplasia

A

failure of longitudinal bone growth –> short limbs
membranous ossification not affected –> large head
Active FGFR3 –> inhibit chondrocyte proliferation
AD
associated with high paternal age

89
Q

Osteoporosis

A

Trabecular and cortical cone lose mass
via low estrogen
Lead to vertebral compression fractures –> acute back pain, loss of height
D(x): DEXA scan
prophylaxis- weight bearing exercise and Ca2+ and vitamin D intake
T(x): bisphophonates, teriparatide, SERMs, denosumab

90
Q

Osteopetrosis

A

Failure of normal bone resorption due to defective osteoclasts –> thick, dense bones that are prone to fracture
Mutation in carbonic anhydrase II
Pancytopenia, extramedulary hematopoiesis
CN impingement and palsies

91
Q

Osetomalacia/ Rickets

A

Defect mineralization of osteoid or cartilaginous growth
Vitamin D deficiency –> low Ca2+ –> high PTH –> low PO4
high ALP
Bowed legs, rachitic rosary, soft skull

92
Q

Paget Disease

A

increased osteoclast activity then increased osteoblast activity
normal calcium, phosphorus and PTH, increased ALP
mosaic lamellar bone, chalk stick fractures, hearing loss
high output heart failure
increased risk of osteosarcoma
T(x): bisphosphonates

93
Q

Avascular necrosis of bone

A

infarction of bone and marrow
painful
most common- femoral head (medial circumflex A)
causes are corticosteroids, alcohol, SCD, trauma, SLE

94
Q

Osteitis fibrosa cystica

Primary hyperPTH

A

high calcium, ALP, PTH
low PO4
brown tumors due to fibrous replacement of bone

95
Q

Osteitis fibrosa cystica

Secondary hyperPTH

A

low calcium
high PO4, ALP, PTH
compensation for CKD

96
Q

Hyper vitamin D

A

high calcium, PO4

low PTH

97
Q

Osetochondroma

A

Benign
male <25
metaphysis of long bones
lateral bony projection of growth plate covered by cartilaginous cap

98
Q

Osteoma

A

middle age
surface of facial bones
associated with Gardner Syndrome

99
Q

Osteiod Osteoma

A 
Adults <25 yrs
Males
cortex of long bones
bone pain worse at night and relieved with NSAID
<2cm
100
Q

osteoblastoma

A

Males
Vertebrae
>2cm, pain unresponsive to NSAIDs

101
Q

Chondroma

A

medulla of small bones of hands and feet

benign tumor of cartilage

102
Q

Giant Cell Tumor

A

20-40 years
Epiphysis of long bones
neoplastic mononuclear cells that express RANKL
soap bubble on X ray

103
Q

Osteosarcoma

A 
males <20 
Metaphysis of long bones
malignant osteoblasts
painful, enlarging mass
Codman triangle (elevation of periosteum)
Aggressive
104
Q

Chondrosarcoma

A

medulla of pelvis, proximal femur and humerus

tumor of malignant chondrocytes

105
Q

Ewing Sarcoma

A 
White boys <15
Diaphysis of long bones
Anaplastic small blue cells of neuroectoderm 
t(11;22)
onion skin periosteal reaction
Aggressive
106
Q

Osteoarthritis

A

Mechanical wear and tear of articular cartilage
Age, female, obesity, joint trauma= increase risk
pain in weight bearing joints after use, improve with rest, asymmetric
osteophytes, joint space narrow, noninflammatory, Heberden nodes and Bouchard nodes
T(x): NSAID, glucocorticoids

107
Q

RA

A

autoimmune inflammation –> pannus
Female, HLA-DR4, +RF, anti CCP +
pain swelling and morning stiffness >1 hour in morning, symmetric
erosions, subchondral cysts, ulnar finger deviation, swan neck, boutonniere
T(x): NSAID, glucocorticoids

108
Q

Gout

A

Acute inflammatory monoarthritis via monosodium urate crystals in joints
risk= male, HTN, obesity, DM, dyslipidemia, alcohol
Uricemia
needle shaped crystals (-) bifringence, yellow under parallel light, blue under perpendicular light
Joint is red, swollen, painful, tophus, after large meal
T(x): NSAIDS, xanthine oxidase inhibitors

109
Q

Calcium Pyrophosphate deposition disease

A

calcium pyrophosphate within joint space
>50
associated with hemochromatosis, hyperPTH
pain and swelling with acute inflammation
Rhomboid and + bifringent, blue parallel light
T(x): NSAIDS, colchicine, glucocorticoids

110
Q

Systemic juvenile idiopathic arthritis

A

systemic arthritis <16
daily fevers, salmon pink macular rash, arthritis
associated with anterior uveitis
leukocytosis, thrombocytosis, anemia, high ESR, CRP
T(x): NSAIDs, steroids, MTX, TNF inhibitors

111
Q

Sjogren Syndrome

A

Autoimmune destruction of exocrine glands
women 40-60
inflammatory joint pain, keratoconjunctivitis, xerostomia, anti ANA, RF, SSa or SSb, parotid enlargement
complications: dental caries, MALT lymphoma

112
Q

Septic arthritis

A

S. aureus, strep, N. gonorrheae –> red and painful with WBC > 50,000

113
Q

gonococcal arthritis

A

STI that presents as purulent arthiris or polyarthralgia, tenosynovitis and dermatitis

114
Q

Psoriatic arthritis

A

HLA B27
Associated with skin psoriasis and nail lesions
asymmetric and patchy involvement
pencil in cup deformity

115
Q

Ankylosing spondylitis

A

HLA B27
symmetric involvmeent of spine and SI joint –> ankylosis, uveitis, aortic regurgitation
bamboo spine
males

116
Q

Inflammatory bowel disease

A

HLA B27

Associated with spondyloarthritis

117
Q

reactive arthritis

A

conjunctivitis, urethritis, arthritis
Shigella, chlamydia, campylobacter, salmonella
HLA B27

118
Q

SLE

A

autoimmune
Type 3 hypersensitivity
Associated with early deficiency of complement proteins
Libman Sacks Endocarditis, lupus nephritis arthritis, mallar rash, photosensitivity
anti SSA +
death via renal disease, infections, CV disease

119
Q

Mixed connective Tissue disorder

A

features of SLE, systemic sclerosis and polymyositis

anti UI RNP

120
Q

Antiphospholipid syndrome

A

Associated with SLE
D(x): Hx of thrombosis or spontaneous abortion with lupus anticoagulant, anticardiolipin, anti B2 glycoprotein 1 Ab
T(x) systemic anticoagulation

121
Q

Polymyalgia rheumatica

A 
pain and stiffness in proximal muscles with fever, malaise, weight loss
NO MUSCULAR WEAKNESS
Women >50
associated with giant cell arteritis
high ESR, CRP, normal CK
T(x) glucocorticoids
122
Q

Fibromyalgia

A

20-50 women
chronic, widespread MSK pain with tender points, stiffness, paresthesia, poor sleep, fatigue, cognitive disturbance
T(x) regular exercise, antidepressants, neuro pain agents

123
Q

Polymyositis

A

ANA +, high CK, anti Jo1, anti SRP, anti Mi-2
progressive symmetric proximal muscle weakness
endomysial inflammation with CD8+ T cells

124
Q

Dermatomyositis

A

ANA +, high CK, anti Jo1, anti SRP, anti Mi-2
Gottron papules, photodistributed facial erythema, shawl and face rash, dark and thick fingertips
increase risk of occult malignancy
perimysial inflammation and atrophy of CD4 T cells

125
Q

Myasthenia Gravis

A

Autoantibodies to postsynaptic AChR
fatigue muscle wekness, prosis, diplopia, proximal muscle weakness, respiratory muscle involvement, dyspnea, dysphagia, difficulty chewing
associated with thymoma, hyperplasia
AChE inhibitor –> reverse symptoms

126
Q

Lambert Eaton myasthenic syndrome

A

autoantibodies to presynaptic VGCC
proximal muscle weakness, autonomic symptoms, hyporeflexia, improve with muscle use
associated with small cell lung cancer
AChE inhibitor –> minimal effect

127
Q

Raynaud Phenomenon

A

low blood flow to skin due to arteriolar vasospasm in response to cold or stress
color change from white to blue to red
fingers and toes
Secondary if with SLE, CREST, mixed connective tissue disease –> treat with calcium channel blockers

128
Q

Scleroderma

A

Systemic sclerosis
autoimmunity, noninflammatory vasculopathy and collagen deposition with fibrosis\puffy, taut skin without wrinkles, fingertip pitting

129
Q

Diffuse scleroderma

A

widespread skin involvement
rapid progression
earlyvisceral development
Associated with anti Scl-70 Ab and anti RNA pol III Ab

130
Q

Limited Scleroderma

A

skin involvement to finger and face
CREST syndrome- calcinosis cutis, anti Centromere Ab, raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia
Benign

131
Q

Skin layer

A 
Stratum corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basalis
Dermis
132
Q

Epithelial cell junctions

A

Tight junctions- prevent paracelluar movement of solutes (claudins and occludins)
Adherens junctions- belt connecting actin cytoskeletons of adjacent cells with cadherins
Desmosome- structural support via intermediate filament interactions.
Gap junctions- connexons permit electrical and chemical communication between cells
Hemidesmosomes- connect keratin in basal cells to underlying BM
Integrins- membrane proteins that maintain integrity of basolateral membrane by binding collagen, laminin and fibronectin in BM

133
Q

Macule

A

flat lesion with well circumscribed change in skin color <1 cm
Freckle

134
Q

Patch

A

Macule >1 cm

birthmark

135
Q

Papule

A

elevated solid skin lesion <1cm

mole, acne

136
Q

Plaque

A

papule >1cm

Psoriasis

137
Q

Vesicle

A

small fluid containing blister <1cm

chickenpox

138
Q

Bulla

A

Large fluid filled blister >1 cm

139
Q

Pustule

A

vesicle containing pus

140
Q

Wheal

A

transient smooth plaque or papule

Hives

141
Q

Scale

A

flaking off of strum cornuem

eczema

142
Q

Crust

A

Dry exudate

impetigo

143
Q

Hyperkeratosis

A

increased thickness of stratum corneum

psoriasis, calluses

144
Q

Parakeratosis

A

retention of nuclei in stratum corneum

actinic keratosis

145
Q

Hypergranulosis

A

increased thickness of stratum granulosum

lichens planus

146
Q

Spongiosus

A

epidermal accumulation of edematous fluid in intercellular spaces

147
Q

Acantholysis

A

separation of epidermal cells

148
Q

Acanthosis

A

Epidermal hyperplasia

149
Q

Albinism

A

Normal melanocyte number with low melanin production
low tyrosine activity or defective tyrosine transport
increased risk of skin cancer

150
Q

Melasma

A

acquired hyperpigmentation associated with pregnancy or OCP use

151
Q

Vitiligo

A

irregular patches of complete depigmentation
destruction of melanocytes
Associated with autoimmune disorders

152
Q

Seborrheic dermatitis

A

erythematous, well demarcated plaques with greasy yellow scales in areas rich in sebaceous glands
Associated with parkinsons
Malassezia
T(x) topical antifungal and corticosteroids

153
Q

Acne

A

Mutifactorial
increased sebum/ androgen production, abnormal keratinocyte desquamation, Cutibacterum acnes and inflammation
T(x): retinoids, benzoyl peroxide, Abx

154
Q

Atopic dermatitis

A 
Type 1 hypersensitivity reaction
pruritic eruption
Associated with other atopic diseases
increase serum IgE
mutations in filaggrin gene
face in infants, antecubital fossa in children and adults
155
Q

Allergic contact dermatitis

A

Type 4 hypersensitivity secondary to contact allergen

156
Q

Melanocytic nevus

A

Mole
benign
intradermal nevi are papular, junctional Nevi are macules

157
Q

Pseudofolliculitis Barbe

A

Foreign body inflammatory facial skin disorder
firm, hyperpigmented papules and pustules that are painful and pruritic
cheeks, jawline, neck
after shaving

158
Q

Psoriasis

A 
papules and plaques with silvery scaling
knees and elbows
increased stratum spinosum, decreased stratum granulosum
Auspitz sign- pinpoint bleeding
nail pitting and arthritis
159
Q

Rosacea

A

inflammatory facial skin disorder
erythematous papules and pustules
Associated with facial flushing

160
Q

Seborrheic Keratosis

A

flat, greasy pigmented squamous epithelial proliferations of immature keratinocytes with keratin filled cysts
head trunk and extremities

161
Q

Verrucae

A

warts
low risk HPV
soft tan cauliflower papules
epidermal hyperplasia, hyperkeratosis, koilocytosis

162
Q

Urticaria

A

Hives
pruritic wheals that form after mast cell degranulation
superficial dermal edema and lymphatic channel dilations

163
Q

Angiosarcoma

A 
blood vessel malignancy 
head, neck, breast
elderly on sun exposed skin
Associated with radiation therapy, postmastectomy lymphedema
Aggressive
164
Q

Bacillary angiomatosis

A

Benign capillary skin papules in AIDS
Bartonella
neutrophilic infilrate

165
Q

Cherry hemangiona

A

Benign capillary hemangioma in middle aged adults

increase with age

166
Q

Glomus Tumor

A

Benign, painful, red blue tumor
under fingernails
modified smooth muscle cells of the thermoregulatory glomus body

167
Q

Kaposi Sarcoma

A

endothelial malignancy
skin, mouth, GI tract, respiratory tract
AIDS
HHV8 and HIV

168
Q

Pyogenic granuloma

A

polypoid lobulated capillary hemangioma that can ulcerate and bleed
Trauma and pregnancy

169
Q

Strawberry Hemangioma

A

benign capillary hemangioma of infancy
first few weeks of life
grow rapidly and regress

170
Q

Impetigo

A

superficial skin infection
S. aureus, S. pyogenes
contagious
honey colored crusting

171
Q

Erysipelas

A

infection involving upper dermis and superficial lymphatics
S. pyogenes
well defined raised demarcation between infected and normal skin

172
Q

Cellulitis

A

acute painful spreading infection of deeper dermis and subQ tissues
S. pyogenes, S. aureus
start with break in skin from truama

173
Q

Abscess

A

collection of pus from walled off infection within deeper layers of sin
S. aureus

174
Q

Necrotizing fascitis

A 
Deeper tissue injury
S. pyogenes, anaerobic bacteria
pain out of proportion
crepitus from methane and CO2 production
Flesh eating bacteria
Bullae and skin necrosis, SURGICAL EMERGENCY
175
Q

Staph scalded skin syndrome

A

Exotoxin destroys keratinocyte attachment in stratum granulosum
fever, generalized erythematous rash
+ Nikolsky sign

176
Q

Herpes

A

HSV1 and HSV2 of skin occurs anywhere from mucosal surfaces to normal skin

177
Q

Molluscum contagiosum

A

umbilicated papules caused by pox virus

children

178
Q

Varicella

A

multiple crops of lesions in various stages from vesicles to crusts
dermatomal distribution

179
Q

Hairy Leukoplakia

A

irregular white painless plaques on lateral tongue
cannot be scraped off
EBV and HIV

180
Q

Pemphigus vulgaris

A

Potentially fatal. older adults
Type 2 hypersensitivity
IgG Ab against desmoglein 1 or desmoglein 3
flaccid intraepidermal bullae caused by acantholysis
Oral mucosa involved
+ Nikolsky sign
Reticular pattern around epidermal cells

181
Q

Bullous pemphigus

A 
older adults
Type 2 hypersensitivity
IgG Ab against hemidesmosomes
Tense blisters containing eosinophils
oral mucosa spared
(-) Nikolsky sign
linear patter and epidermal-dermal junction
182
Q

Dermatidis herpetiformis

A 
Pruritic papules vesicles and bullae
elbo knees butt
deposits IgA at tips of dermal papillae
Associated with celiac
T(x) dapsone, gluten free diet
183
Q

Erythema multiforme

A

Associated with infections, frugs

macules, papules, vesicles, target lesions

184
Q

Steven Johnson Syndrome

A

fever, bullae formation and necrosis, sloughing of skin at dermal–epidermal junction, high mortality rate
mucous membranes
targetoid lesions
Adverse drug reaction

185
Q

Toxic Epidermal Necrolysis

A

more severe form of SJS involving >30% of body

186
Q

Acanthosis nigricans

A

epidermal hyperplasia
symmetric, hyperpigmented thickening of skin
axilla, neck
Associated with DM, obesity, visceral malignancy

187
Q

Actinic keratosis

A

premalignant lesions caused by sun exposure
small, rough erythematous papules or plaques
risk of SCC

188
Q

Erythema nodosum

A

painful, raised inflammatory lesions of SubQ fat
anterior shins
associated with sarcoidosis, coccidioidomycosis, histoplasmosis, TB, strep, leprosy, IBD

189
Q

Lichen Planus

A

pruritic, purple, polygonal, planar, papules and plaques
mucosal involvement –> Wickham striae and hypergranulosis
Sawtooth infiltrate of lymphocytes at dermal-epidermal junction
associated with hep C

190
Q

Pityriasis rosea

A

Herald path followed by scaly erythematous plaques
trunk
multiple pink plaques with collarette scale
self resolve

191
Q

Sunburn

A

Acute cutaneous inflammatory reaction due to excessive UV irradiation
cause DNA mutations
UVB

192
Q

Superficial burn

A

Epidermis only
similar to sunburn, localized painful dry blanching redness with no blisters
painful

193
Q

Superficial partial thickness

A

all epidermis and some dermis
blisters, blanches with pressure, swollen, warm
painful to temperature and air

194
Q

seep partial thickness burn

A

all of epidermis and some dermis
blisters, does not blanch with pressure
painless, perception of pressure only

195
Q

Full thickness burn

A

all skin
white waxy dry inelastic leathery, does not blanch
painless, perception of deep pressure

196
Q

deeper injury burn

A

all skin and partial involvement of muscle/fascia
white dry inelastic, does not blanch with pressure
painless, some perception of deep pressure

197
Q

BCC skin

A 
upper lip
most common
sun exposed areas
rare metastasis
waxy pink pearly nodules, rolled borders, central crusting 
pallisading nuclei
198
Q

Keratoacanthoma

A

middle aged elderly
rapid growth, resemble SCC
dome shaped nodule with keratin filled center
may spontaneously regress

199
Q

Melanoma

A 
METASTASIS, s-100 marker
Associated with dysplastic nevi
increased risk in fair skin
Breslow thickness
ABCDE
mutation in BRAF kinase
T(x) excision
200
Q

SCC skin

A 
lower lip, face, ears, hands
associated with immunosuppression, chronic nonhealing wounds and arsenic exposure
spread to LN
ulcerative red lesions
histo- keratin pearls
201
Q

Acetaminophen

A

reversible COX inhibitor- CNS mostly
use in antipyretic, analgesia
Adverse: overdose –> hepatic necrosis

202
Q

Aspirin

A

NSAID irreversible inhibit COX
used in low does for decrease platelet aggregation, intermediate dose antipyretic and analgesic, high dose for anti inflammatory
Adverse: GI ulcers, tinnitus, allergies, AKI, interstitial nephritis, GI bleed
Reye syndrome in children
OD T(x): NaHCO3

203
Q

Celecoxib

A

Reversible selective inhibitor of COX2
used for RA and osteoarthritis
Adverse: increase risk of thrombosis and sulfa

204
Q

Nonsteroidal anti inflammatory drugs

A

ibuprofen, naproxen, indomethacin
reversible inhibit COX1/2
used in antipyretic, analgesia, anti inflammatory
Adverse: interstitial nephritis, GI ulder, renal ischemia, aplastic anemia

205
Q

Leflunomide

A

reversible inhibit dihydroorotate dehydrongenase –> block pyrimidine synthesis
used in RA and psoriatic arthritis
Adverse: diarrhea, HTN, heptaotox, teratogen

206
Q

Bisphosphonates

A

Alendronate, ibandronate, risedronate, zoledronate
pyrophosphate analog, inhibit osteoclase
used in osteoporosis, hypercalcemia, Paget disease, osteogenesis imperfecta
Adverse: esophagitis, osteonecrosis of jaw, atypical femoral stress fractures

207
Q

Teriparatide

A

PTH analog, increase osteoblast when pulsatile
used in osteoporosis
Adverse: increased risk of osteosarcoma

208
Q

Probenecid

A

inhibit reabsorption of uric acid in PCT –> precipitate uric acid caliculi
use in gout chronic

209
Q

Allopurinol

A

competitive xanthine oxidase inhibitor

used in chronic gout and lymphoma and leukemia treatment

210
Q

Pegloticase

A

uricase –> water soluble

used for chronic gout

211
Q

Febuxostat

A

inhibit xanthine oxidase

used for chronic gout

212
Q

Used for acute gout

A

NSAID, glucocorticoids, colchicine

213
Q

Etanercept

A

TNFa inhibitor
fusion protein produced by recombinant DNA
used for RA, psoriasis, ankylosing spondylitis
Adverse: infection, drug induced lupus

214
Q

Infliximab, adalimumab, certolizumab, golimumab

A

TNFa inhibitor (Ab)
used for IBD, RA, ankylosing spondylitis and psoriasis
Adverse: infection, drug induced lupus

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