MSK Flashcards
Rotator Cuff Muscles
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Supraspinatus M
Suprascapular N
abduct arm 0-15 degrees
Assess with empty can test
Infraspinatus M
Suprascapular N
external rotation
Pitching injury
Teres Minor M
axillary N
adduct and externally rotate arm
Subscapularis M
upper and lower subscapular N
Internal roation and adduct arm
Deltoid M
axillary N
15-100 degrees abduction
Tapezius M
Accessory N
>90 degree abduction
Serratus Anterior M
Long Thoracic N
>100 degrees abduction
Axillary N
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
Musculocutaneous N
C5-C7
injury via upper trunk compression
presents as decreased bicep reflex, weakness in forearm flexion and supination, loss of sensation over lateral forearm
Radial N
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
Median N
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
Ulnar N
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
Recurrent branch of Median N
C5-T1
injury via superficial laceration of palm
presents as ape hand, loss of thenar muscle group (opposition, abduction, flexion of thumb)
Erb Palsy
Injury- traction tear of upper trunk (C5-6) via trauma
Deltoid, supraspinatus- abduction
infraspinatus- lateral rotation
Biceps- flexion, supination
Klumpke palsy
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
Thoracic outlet syndrome
Compression of lower trunk and subclavian vessels via cervical rib
Atrophy of intrinsic muscles, ischemia, pain and edema
Winged Scapula
Lesion of long thoracic N C5-C7 via axillar node dissection after mastectomy, stab wounds
Serratus Anterior- inability to anchor scapula to thoracic cage
Wrist bones
Scaphoid, lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid, Trapezium
Scaphoid
Most fractured via FOOSH
avascular necrosis and nonunion due to retrograde blood supply from branch of radial A
Hand Muscles
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
Ulnar claw
When extending fingers, 1st and 2nd cannot extend
lesion at distal ulnar N
Pope’s blessing
When making. a fist, 3-5th fingers cannot flex
lesion at proximal median N
Median Claw
when extending fingers, 3-5th fingers do not extend
lesion at distal median N
OK gesture
When making. a fist, 1-2 fingers cannot flex
lesion at proximal ulnar N
Hip abductors
gluteus medius and minimus
Hip adductors
adductor magnus, adductor longus, adductor brevis
hip extensors
gluteus maximus, semiteninosus, semiembranosus
Hip flexors
iliopsoas, recus femoris, tensor fascia lata, pectineus, sartorius
Hip internal rotation
gluteus medius, gluteus minimus, tensor fascia lata
Hip external rotation
Iliopsoas, gluteus maximus, piriformis, obruator
Iliohypogastric N
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
Genitofemoral N
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
Lateral femoral cutaneous
L2-L3
sensory- anterior and lateral thigh
Injury via tight clothing. obesity, pregnancy, pelvic procedures
decreased thigh sensation
Obturator N
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
Femoral N
L2-L4 sensory- anterior thigh, medial leg Motor- quads, iliacus, pectineus, sartorius injury via pelvic fracture decreased leg extension
Sciatic N
L4-S3
Motor- semitendinosus, semimembranosus, biceps, adductor magnus
Injury via herniated disc, posterior hip dislocation
Common peroneal
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
Tibial B
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
Superior Gluteal N
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
Inferior gluteal N
L5-S2
motor to gluteus maximus
injury via posterior hip dislocation
difficulty climbing stairs, rising from seated position
Pudendal N
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
Knee exam
Lateral femoral condyle- ACL
Medial femoral condyle - PCL
Anterior Drawer test
Increased anterior gliding of tibia due to ACL injury
Posterior drawer test
increased posterior gliding of tibia due to PCL injury
Abnormal passive abduction
knee either extended or at 30 degrees, lateral force –> medial space widening of tibia –> MCL injury
Abnormal passive adduction
knee either extended or at 30 degrees, medial force –> lateral space widening of tibia–> LCL injury
McMurray Test
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
Ankle sprain
Anterior Talofibular L most common low ankle sprain
via overinversion/supination of foot
Anterior inferior tibiofibular L most common high anle sprain
Lumbosacral Radiculopathy
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
L4 radiculopathy
weakness of knee extension and decreased patellar reflex
L5 radiculopathy
weakness of dorsiflexion, difficulty in heel walking
S1 radiculopathy
weakness of plantar flexion
difficulty in toe walking
decreased Achilles Reflex
Muscle Contraction
- AP opens VGCC –> ACh release
- postsynaptic ACh bind –> muscle cell depolarize
- Travel into muscle via T-tubules
- conformational change of DHPR and ryanodine receptor –> calcium release from SR
- Tropomyosin released via bind troponin to Ca2+ –> exposed myosin binding site
- Myosin head binds to actin, Pi released –> powerstroke
- muscle shortening
- Bind new ATP –> detach myosin head
ATP hydrolysis into ADP and Pi –> cocked position, myosin can bind to a new site
Type 1 muscle fibers
slow red oxidative phosphorylation --> sustained contraction high mitochondria endurance training
Type 2 muscle fibers
Fast White Anaerobic glycolysis low mitochondria weight, resistance training, sprinting
Muscle spindle
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
Golgi tendon organ
increase tension –> DRG –> activate inhibitory interneuron –> inhibit agonist muscle
Tendon Type 1b sensory axon
increase muscle force activates
Endochondral ossification
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
Membranous ossification
calvarium, facial bones, clavicle
woven bone formed directly without cartilage. Later remodeled to lamellar bone.
Osteoblast
build bone by secreting collagen and catalyzing mineralization in alkaline environment via ALP
Mesenchymal stem cell in periosteum
Osteoclast
dissolves bone by secreting H+ and collagenases
monocyte/macrophage lineage
RANK receptors stimulated by RANKL.
OPG bing RANKL to prevent interaction –> decrease osteoclast
PTH
low –> anabolic
high PTH –> catabolic
Estrogen
inhibit apoptosis in bone forming osteoblasts and induce apoptosis in osteoclasts.
Cause closure of epiphyseal plate during puberty
Medial Epicondylitis
golfers
repetitive flexion –> main near medial epicondyle
Lateral epicondylitis
tennis
repetitive extension –> pain near lateral epicondyle
Metacarpal neck fracture
Boxer’s
direct blow with a closed fist
4th/5th metacarpal
Carpal Tunnel
Entrapment of Median N –> nerve compression –> paresthesia, pain, numb
Thenar eminence atrophy
Tinel + and Phalen +
Associated with pregnancy, RA, hypothyroidism, DM, acromegaly, dialysis
Guyon Canal syndrome
Compression of Ulnar N
cyclists
Clavicle Fractures
Children, birth trauma
FOOSH or direct trauma
Weakest at middle and lateral thirds
shoulder drop, shortened clavicle, medially rotated arm
Lateral Force applied to planted foot
Damage to ACL, MCL and medial meniscus
acute pain, joint instability
Prepatellar bursitis
inflammation of the prepatellar bursa in front of knee cap
via repeated trauma or pressure from excessive kneeling
Baker cyst
popliteal fluid collection in gastrocnemium-semimembranosus bursa
communicated with synovial space and related to joint disease
DeQuervain Tenosynovitis
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
Ganglion cyst
fluid filled swelling overlying joints or tendon sheath
Dorsal wrist
herniation of dense connective tissue
iliotibial band syndrome
overuse injury of lateral knee that occurs in runners
Pain secondary to friction of iliotibial band against lateral femoral epicondyle
Limb compartment syndrome
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
Medial tibial stress syndrome
shin splints
shin pain and diffuse tenderness in runners and military recruits
caused by bone resorption that outpaces bone formation
Plantar fasciitis
inflammation of plantar aponeurosis
heel pain worse in morning and tenderness
Developmental dysplasia of the hip
abnormal acetabulum development in newborns risks= breech hip instability, dislocation Ortolani and Barlow --> clunk confirm with US
Legg Calve Perthes Disease
Idiopathic avascular necrosis of femoral head
presents 5-7 years with hip pain and limp
Males
Xray normal
Osgood Schlatter disease
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
Patellofemoral syndrome
overuse injury
young female athletes
anterior knee pain exacerbated with sitting or weight bearing on flexed knee
T(x): NSAIDs, thigh muscle strengthening
Radial Head subluxation
Nursemaids elbow
<5 years
sudden pull on arm –> immature annular L slips over head of radius
Arm held in extended and pronated
Slipped capital femoral epiphysis
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
Green stick fracture
incomplete fracture after bending stress
bone fails on tension side, compression side intact
Torus fracture
axial force applied to immature bone –> cortex buckles on compression side and fractures
Tension side remains intact
Achondroplasia
failure of longitudinal bone growth –> short limbs
membranous ossification not affected –> large head
Active FGFR3 –> inhibit chondrocyte proliferation
AD
associated with high paternal age
Osteoporosis
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
Osteopetrosis
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
Osetomalacia/ Rickets
Defect mineralization of osteoid or cartilaginous growth
Vitamin D deficiency –> low Ca2+ –> high PTH –> low PO4
high ALP
Bowed legs, rachitic rosary, soft skull
Paget Disease
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
Avascular necrosis of bone
infarction of bone and marrow
painful
most common- femoral head (medial circumflex A)
causes are corticosteroids, alcohol, SCD, trauma, SLE
Osteitis fibrosa cystica
Primary hyperPTH
high calcium, ALP, PTH
low PO4
brown tumors due to fibrous replacement of bone
Osteitis fibrosa cystica
Secondary hyperPTH
low calcium
high PO4, ALP, PTH
compensation for CKD
Hyper vitamin D
high calcium, PO4
low PTH
Osetochondroma
Benign
male <25
metaphysis of long bones
lateral bony projection of growth plate covered by cartilaginous cap
Osteoma
middle age
surface of facial bones
associated with Gardner Syndrome
Osteiod Osteoma
Adults <25 yrs Males cortex of long bones bone pain worse at night and relieved with NSAID <2cm
osteoblastoma
Males
Vertebrae
>2cm, pain unresponsive to NSAIDs
Chondroma
medulla of small bones of hands and feet
benign tumor of cartilage
Giant Cell Tumor
20-40 years
Epiphysis of long bones
neoplastic mononuclear cells that express RANKL
soap bubble on X ray
Osteosarcoma
males <20 Metaphysis of long bones malignant osteoblasts painful, enlarging mass Codman triangle (elevation of periosteum) Aggressive
Chondrosarcoma
medulla of pelvis, proximal femur and humerus
tumor of malignant chondrocytes
Ewing Sarcoma
White boys <15 Diaphysis of long bones Anaplastic small blue cells of neuroectoderm t(11;22) onion skin periosteal reaction Aggressive
Osteoarthritis
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
RA
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
Gout
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
Calcium Pyrophosphate deposition disease
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
Systemic juvenile idiopathic arthritis
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
Sjogren Syndrome
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
Septic arthritis
S. aureus, strep, N. gonorrheae –> red and painful with WBC > 50,000
gonococcal arthritis
STI that presents as purulent arthiris or polyarthralgia, tenosynovitis and dermatitis
Psoriatic arthritis
HLA B27
Associated with skin psoriasis and nail lesions
asymmetric and patchy involvement
pencil in cup deformity
Ankylosing spondylitis
HLA B27
symmetric involvmeent of spine and SI joint –> ankylosis, uveitis, aortic regurgitation
bamboo spine
males
Inflammatory bowel disease
HLA B27
Associated with spondyloarthritis
reactive arthritis
conjunctivitis, urethritis, arthritis
Shigella, chlamydia, campylobacter, salmonella
HLA B27
SLE
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
Mixed connective Tissue disorder
features of SLE, systemic sclerosis and polymyositis
anti UI RNP
Antiphospholipid syndrome
Associated with SLE
D(x): Hx of thrombosis or spontaneous abortion with lupus anticoagulant, anticardiolipin, anti B2 glycoprotein 1 Ab
T(x) systemic anticoagulation
Polymyalgia rheumatica
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
Fibromyalgia
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
Polymyositis
ANA +, high CK, anti Jo1, anti SRP, anti Mi-2
progressive symmetric proximal muscle weakness
endomysial inflammation with CD8+ T cells
Dermatomyositis
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
Myasthenia Gravis
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
Lambert Eaton myasthenic syndrome
autoantibodies to presynaptic VGCC
proximal muscle weakness, autonomic symptoms, hyporeflexia, improve with muscle use
associated with small cell lung cancer
AChE inhibitor –> minimal effect
Raynaud Phenomenon
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
Scleroderma
Systemic sclerosis
autoimmunity, noninflammatory vasculopathy and collagen deposition with fibrosis\puffy, taut skin without wrinkles, fingertip pitting
Diffuse scleroderma
widespread skin involvement
rapid progression
earlyvisceral development
Associated with anti Scl-70 Ab and anti RNA pol III Ab
Limited Scleroderma
skin involvement to finger and face
CREST syndrome- calcinosis cutis, anti Centromere Ab, raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia
Benign
Skin layer
Stratum corneum Stratum Lucidum Stratum Granulosum Stratum Spinosum Stratum Basalis Dermis
Epithelial cell junctions
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
Macule
flat lesion with well circumscribed change in skin color <1 cm
Freckle
Patch
Macule >1 cm
birthmark
Papule
elevated solid skin lesion <1cm
mole, acne
Plaque
papule >1cm
Psoriasis
Vesicle
small fluid containing blister <1cm
chickenpox
Bulla
Large fluid filled blister >1 cm
Pustule
vesicle containing pus
Wheal
transient smooth plaque or papule
Hives
Scale
flaking off of strum cornuem
eczema
Crust
Dry exudate
impetigo
Hyperkeratosis
increased thickness of stratum corneum
psoriasis, calluses
Parakeratosis
retention of nuclei in stratum corneum
actinic keratosis
Hypergranulosis
increased thickness of stratum granulosum
lichens planus
Spongiosus
epidermal accumulation of edematous fluid in intercellular spaces
Acantholysis
separation of epidermal cells
Acanthosis
Epidermal hyperplasia
Albinism
Normal melanocyte number with low melanin production
low tyrosine activity or defective tyrosine transport
increased risk of skin cancer
Melasma
acquired hyperpigmentation associated with pregnancy or OCP use
Vitiligo
irregular patches of complete depigmentation
destruction of melanocytes
Associated with autoimmune disorders
Seborrheic dermatitis
erythematous, well demarcated plaques with greasy yellow scales in areas rich in sebaceous glands
Associated with parkinsons
Malassezia
T(x) topical antifungal and corticosteroids
Acne
Mutifactorial
increased sebum/ androgen production, abnormal keratinocyte desquamation, Cutibacterum acnes and inflammation
T(x): retinoids, benzoyl peroxide, Abx
Atopic dermatitis
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
Allergic contact dermatitis
Type 4 hypersensitivity secondary to contact allergen
Melanocytic nevus
Mole
benign
intradermal nevi are papular, junctional Nevi are macules
Pseudofolliculitis Barbe
Foreign body inflammatory facial skin disorder
firm, hyperpigmented papules and pustules that are painful and pruritic
cheeks, jawline, neck
after shaving
Psoriasis
papules and plaques with silvery scaling knees and elbows increased stratum spinosum, decreased stratum granulosum Auspitz sign- pinpoint bleeding nail pitting and arthritis
Rosacea
inflammatory facial skin disorder
erythematous papules and pustules
Associated with facial flushing
Seborrheic Keratosis
flat, greasy pigmented squamous epithelial proliferations of immature keratinocytes with keratin filled cysts
head trunk and extremities
Verrucae
warts
low risk HPV
soft tan cauliflower papules
epidermal hyperplasia, hyperkeratosis, koilocytosis
Urticaria
Hives
pruritic wheals that form after mast cell degranulation
superficial dermal edema and lymphatic channel dilations
Angiosarcoma
blood vessel malignancy head, neck, breast elderly on sun exposed skin Associated with radiation therapy, postmastectomy lymphedema Aggressive
Bacillary angiomatosis
Benign capillary skin papules in AIDS
Bartonella
neutrophilic infilrate
Cherry hemangiona
Benign capillary hemangioma in middle aged adults
increase with age
Glomus Tumor
Benign, painful, red blue tumor
under fingernails
modified smooth muscle cells of the thermoregulatory glomus body
Kaposi Sarcoma
endothelial malignancy
skin, mouth, GI tract, respiratory tract
AIDS
HHV8 and HIV
Pyogenic granuloma
polypoid lobulated capillary hemangioma that can ulcerate and bleed
Trauma and pregnancy
Strawberry Hemangioma
benign capillary hemangioma of infancy
first few weeks of life
grow rapidly and regress
Impetigo
superficial skin infection
S. aureus, S. pyogenes
contagious
honey colored crusting
Erysipelas
infection involving upper dermis and superficial lymphatics
S. pyogenes
well defined raised demarcation between infected and normal skin
Cellulitis
acute painful spreading infection of deeper dermis and subQ tissues
S. pyogenes, S. aureus
start with break in skin from truama
Abscess
collection of pus from walled off infection within deeper layers of sin
S. aureus
Necrotizing fascitis
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
Staph scalded skin syndrome
Exotoxin destroys keratinocyte attachment in stratum granulosum
fever, generalized erythematous rash
+ Nikolsky sign
Herpes
HSV1 and HSV2 of skin occurs anywhere from mucosal surfaces to normal skin
Molluscum contagiosum
umbilicated papules caused by pox virus
children
Varicella
multiple crops of lesions in various stages from vesicles to crusts
dermatomal distribution
Hairy Leukoplakia
irregular white painless plaques on lateral tongue
cannot be scraped off
EBV and HIV
Pemphigus vulgaris
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
Bullous pemphigus
older adults Type 2 hypersensitivity IgG Ab against hemidesmosomes Tense blisters containing eosinophils oral mucosa spared (-) Nikolsky sign linear patter and epidermal-dermal junction
Dermatidis herpetiformis
Pruritic papules vesicles and bullae elbo knees butt deposits IgA at tips of dermal papillae Associated with celiac T(x) dapsone, gluten free diet
Erythema multiforme
Associated with infections, frugs
macules, papules, vesicles, target lesions
Steven Johnson Syndrome
fever, bullae formation and necrosis, sloughing of skin at dermal–epidermal junction, high mortality rate
mucous membranes
targetoid lesions
Adverse drug reaction
Toxic Epidermal Necrolysis
more severe form of SJS involving >30% of body
Acanthosis nigricans
epidermal hyperplasia
symmetric, hyperpigmented thickening of skin
axilla, neck
Associated with DM, obesity, visceral malignancy
Actinic keratosis
premalignant lesions caused by sun exposure
small, rough erythematous papules or plaques
risk of SCC
Erythema nodosum
painful, raised inflammatory lesions of SubQ fat
anterior shins
associated with sarcoidosis, coccidioidomycosis, histoplasmosis, TB, strep, leprosy, IBD
Lichen Planus
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
Pityriasis rosea
Herald path followed by scaly erythematous plaques
trunk
multiple pink plaques with collarette scale
self resolve
Sunburn
Acute cutaneous inflammatory reaction due to excessive UV irradiation
cause DNA mutations
UVB
Superficial burn
Epidermis only
similar to sunburn, localized painful dry blanching redness with no blisters
painful
Superficial partial thickness
all epidermis and some dermis
blisters, blanches with pressure, swollen, warm
painful to temperature and air
seep partial thickness burn
all of epidermis and some dermis
blisters, does not blanch with pressure
painless, perception of pressure only
Full thickness burn
all skin
white waxy dry inelastic leathery, does not blanch
painless, perception of deep pressure
deeper injury burn
all skin and partial involvement of muscle/fascia
white dry inelastic, does not blanch with pressure
painless, some perception of deep pressure
BCC skin
upper lip most common sun exposed areas rare metastasis waxy pink pearly nodules, rolled borders, central crusting pallisading nuclei
Keratoacanthoma
middle aged elderly
rapid growth, resemble SCC
dome shaped nodule with keratin filled center
may spontaneously regress
Melanoma
METASTASIS, s-100 marker Associated with dysplastic nevi increased risk in fair skin Breslow thickness ABCDE mutation in BRAF kinase T(x) excision
SCC skin
lower lip, face, ears, hands associated with immunosuppression, chronic nonhealing wounds and arsenic exposure spread to LN ulcerative red lesions histo- keratin pearls
Acetaminophen
reversible COX inhibitor- CNS mostly
use in antipyretic, analgesia
Adverse: overdose –> hepatic necrosis
Aspirin
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
Celecoxib
Reversible selective inhibitor of COX2
used for RA and osteoarthritis
Adverse: increase risk of thrombosis and sulfa
Nonsteroidal anti inflammatory drugs
ibuprofen, naproxen, indomethacin
reversible inhibit COX1/2
used in antipyretic, analgesia, anti inflammatory
Adverse: interstitial nephritis, GI ulder, renal ischemia, aplastic anemia
Leflunomide
reversible inhibit dihydroorotate dehydrongenase –> block pyrimidine synthesis
used in RA and psoriatic arthritis
Adverse: diarrhea, HTN, heptaotox, teratogen
Bisphosphonates
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
Teriparatide
PTH analog, increase osteoblast when pulsatile
used in osteoporosis
Adverse: increased risk of osteosarcoma
Probenecid
inhibit reabsorption of uric acid in PCT –> precipitate uric acid caliculi
use in gout chronic
Allopurinol
competitive xanthine oxidase inhibitor
used in chronic gout and lymphoma and leukemia treatment
Pegloticase
uricase –> water soluble
used for chronic gout
Febuxostat
inhibit xanthine oxidase
used for chronic gout
Used for acute gout
NSAID, glucocorticoids, colchicine
Etanercept
TNFa inhibitor
fusion protein produced by recombinant DNA
used for RA, psoriasis, ankylosing spondylitis
Adverse: infection, drug induced lupus
Infliximab, adalimumab, certolizumab, golimumab
TNFa inhibitor (Ab)
used for IBD, RA, ankylosing spondylitis and psoriasis
Adverse: infection, drug induced lupus
