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Elliot Step 1 > MSK and Skin random presentations > Flashcards

MSK and Skin random presentations Flashcards

1
Q

Skin cancer associated with palisading nuclei?

A

Basal cell Ca

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2
Q

Presents with central area of necrosis surrounded by telangiectasia?

A

Basal cell Ca

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3
Q

Patient presents with an “ulcer that will not heal”

A

Basal cell Ca

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4
Q

Patient receiving ABVD for lymphoma develops a nont healing skin lesion on his face?

A

Squamous cell (inc incidence in immunocompromised, arsenic and sunlight)

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5
Q

Skin disease associated with chrnoic draining sinuses

A

Squamous cell carcinoma

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6
Q

Cup shaped tumor filled with keratin?

A

Squamous cell Ca (grows rapidly and may regress spontaneously over months)

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7
Q

Melanoma at bottom of foot?

A

acrolentiginous melanoma (often seen in african americans)

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8
Q

Melanoma drive by mutation in ?

A

BRAF kinase

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9
Q

Impetigo involves?

A

Epidermis only– caused by staph aureus or s pyogenes

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10
Q

Acute painful infection of dermis and subQ?

A

Cellulitis– often from trauma or break in skin

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11
Q

Child presents with skin that is peeling off from head to toe and fever. Which part of the epidermis does this effect? Toxin?

A

Scalded skin syndrome effects stratum granulosum

Caused by exfoliative toxin A and B

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12
Q

White painless plaques on tongue associated with?

A

EBV

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13
Q

Patient with Hep C presents with pruritis rash and purple rash. What should we see on histology? What will we see on nails?

A

Lichen planus
Histology will show sawtooth appearance with lymphocytes at the dermal epidermal junction– ASSOC with HEP C
Also will see reticular white lines on mucosa (Wickhams Striae)

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14
Q

Patient presents with purple papulaes and white lines on finger nails and in oral mucosa. What disease is this associated with?

A

Lichen Planus assoc with Hep C

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15
Q

Herald patch followed days later by Christmas tree distribution?

A

Pityriasis rosea– will resolve by itself

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16
Q

Premalignant lesions of squamous cell ca?

A

Actinic keratosis

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17
Q

Patient presents with small rough papules. He is a builder?

A

Actinic keratosis–>squamous cell ca

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18
Q

Inflammatory lesions that generally involve the anterior shins?

A

Erythema nodosum

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19
Q

Patient presents with multiple lesions that have targetoid appearance. Most common cause?

A

Erythema multiforme is commonly caused by HSV

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20
Q

Skin disease. Immunofluorescence reveals net like appearance?

A

Pemphigus vulgaris– antibodies to desmoglein 3. Acantholysis (separation of keratinocytes) present. Involve ORAL MUCOSA

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21
Q

Blisters that spare oral mucosa? What is in the blisters?

A

Bullous pemphigoid– antibodies against the hemidesmosomes– linear immunofluorescence; blisters contain eosinophils

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22
Q

Flesh colored wart with epidermal hyperplasia, hyperkeratosis, and koilocytosis

A

Verrucae– HPV

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23
Q

What is an ephelis?

A

Freckle– normal number of melanocytes and increased number of melanosomes

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24
Q

Child with asthma presents with oozing, edematous rash? usually effects?

A

Atopic dermatitis effects extensors

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25
Q

Patient presents with acanthosis and parakeratotic scaling

A

Psoriasis– increases stratum spinosum. Auspitz sign– bleeding due to exposure of dermal papillae

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26
Q

Sudden onset of multiple greasy, flat, pigmented proliferations on skin?

A

Leser Trelat sign– multiple seborrheic keratosis appearing suddenly indicative of underlying malignancy

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27
Q

Hyperkeratosis?

A

Increases thickening of stratum corneum

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28
Q

Parakeratosis?

A

Increased thickening of stratum corneum WITH retention of NUCLEI

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29
Q

Acantholysis?

A

Separation of keratinocytes– commonly seen in pemphigus vulgaris

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30
Q

Spongiosis?

A

Epidermal accumulation of edematous fluid in intracellular space– seen in eczema

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31
Q

Defect in albinism?

A

Decreased tyrosinase activity (converts Dopa to Melanin)

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32
Q

Melanocytes are derived from?

A

Neural crest cells

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33
Q

Rough skin around fingernails with absence of wrinkles

A

Scleroderma

34
Q

Sclerodactyly

A

thickening of skin around fingers and toes

35
Q

Anti DNA topoisomerase

A

Diffuse scleroderma

36
Q

Most likely cause of death in scleroderma?

A

Pulmonary symptoms

37
Q

Anticentromere antibody?

A

CREST

38
Q

AChE inhibitor use in Lambert Eaton

A

No effect

39
Q

Small lung cell cancer may cause?

A

Lambert Eaton– paraneoplastic syndrome

40
Q

Bilateral muscle weakness in shoulders with endomysial inflammation? Immune response?

A

Polymyositis– proximal muscle weakness with CD8+ t cells

41
Q

Malar Rash with pinkish purple rash under eyelids. Shoulder weakness? Immune response?

A

Dermatomyositis– infects perimysial layer; CD4+ t cell involvement– assoc with gastric carcinoma

42
Q

AntiJO antibodies?

A

Dermatomyositis and Polymyositis

43
Q

Skeletal muscle looks like bone. Recent accident.

A

Myositis ossificans– when recently injured skeletal muscle undergoes metaplasia to bone

44
Q

55yo woman presents with fever, weight loss, malaise, pain and stiffness in shoulders and hips. Patient reports no muscle weakness– what is this disease associated with?

A

Polymyalgia Rheumatica– associated with Temporal arteritis

45
Q

Asteroid Bodies

A

Sarcoidosis (AsterROID has sarCOID)

46
Q

Patient undergoes a routine CXR which finds bilateral hilar adenopathy. What blood level might be increased? (2)

A

1) ACE

2) Hypercalcemia (dt elevated 1alpha hydroxylase mediated vit D activation in epithelioid macrophages)

47
Q

Wart like vegetations on both sides of mitral valve?

A

Libman Sacks endocarditis

48
Q

3 drugs that cause SLE?

A

1) Procainamide
2) Isoniazid
3) HydrAlazine (vAsodilator; dec Afterload)

49
Q

Assymetric arthritis with swollen, erythematous, and painful joints?

A

Infectious arthritis– Staph, strep, Neisseria

50
Q

Conjunctivitis, Urethritis, Arthritis– what usually precedes this disease?

A

GI infection (shigella) or Chlamydia infection

51
Q

Uveitis, Aortic regurg, stiff spine?

A

Ankylosing spondylitis– see bamboo spine on imaging

52
Q

Dactylitis

A

Psoriasis (sausage fingers– involves DIP)

53
Q

58yo man with sudden onset of pain in knee. weakly birefringent. What type of crystals will we see?

A

Pseudogout caused calcium PyroPhosPhate crystals; rhomboid. Crystals are blue when parallel to light

54
Q

58 yo man with sudden onset of knee pain. Negatively birefrigent. What type of crystals?

A

Monosodium urate

55
Q

Common causes of gout?

A

HGPRT (purine salvage pathway) deficit; PRPP excess, Von Gierkes— most due to underexcretion

56
Q

Patient presents with sudden painful MTP join of toe. How should we treat him?

A

NSAIDs, glucocorticoids

57
Q

Patient presents with dry eyes and parotid enlargement? What else might she have? Increased risk for?

A

Sjogrens– arthritis, dry mouth. Type 4 hypersentitivity with fibrosis. Anti Ro and Anti La antibodies (ribonucleoproteins)

Increased risk for B cell lymphoma dt chronic inflammation that predisposes to dysplastic changes

58
Q

Patient presents with bilateral pain in MCP and PIP with fever

A

Rheumatoid– rheumatoid nodules (fibrinoid necrosis); pannus formation

59
Q

Rheumatoid arthritis spares?

A

DIP join

60
Q

Patient presents with subchondral cysts and pain in knees?

A

osteoarthritis

61
Q

Bouchards nodes

A

PIP

62
Q

Osteoarthritis spares?

A

MCP

63
Q

Heberden’s nodes?

A

DIP

64
Q

Fever, pleuritis, Anticitrullinated antibody?

A

Rheumatoid– can cause pleuritis and pericarditis

65
Q

Eburnations, osteophytes?

A

Osteoarthritis

66
Q

59 yo contractor, bowlegged, pain in lower extremity, no fever, obsese– why the boweleggedness?

A

Osteoarthritis– Knee cartilage loss begins medially

67
Q

Strong association with HLA DR4

A

Rheumatoid arthritis

68
Q

40 yo man presents with cartilagenous mass on pelvis. Radiologist describes it as a glistening mass within medullary cavity?

A

Chondrosarcoma

69
Q

12 yo boy presents with cancer of diaphysis. Histology shows blue cells. What appearance might we see in bone? From where is this tumor derived?

A

Ewings sarcoma; 11;22 translocation; onion skinning
Derived from neuroectoderm
Tumor responsive to chemo

70
Q

20 yo man presents with slow progressing outgrowth in the metaphysis of his femur

A

Osteochondroma (exostosis)– mature bone with cartilaginous cap– originates from long metaphysis

71
Q

20 yo man presents with bone pain at distal femur and proximal tibia. Histology shows increased malignant osteoid production. What factors might predispose this man to this condition?

A

Li Fraumani; RB, Pagets

72
Q

27 yo female presents with tumor of epiphysis? Xray?

A

Giant cell tumor– shows double bubble appearance

73
Q

Normal labs; abnromal bone exam

A

Osteoporosis (also osteopetrosis)

74
Q

Dec serum Ca, Dec Phos, Inc ALP, Inc PTH

A

Osteomalacia and Rickets

75
Q

Inc. Ca, dec phosph, inc ALP, inc PTH

A

Osteitis fibrosa cystica– brown tumors– hyperparathyroidism

76
Q

Dec. Ca, Inc Phosphate, inc ALP, Inc PTH

A

Pseudohypoparathyroidism– cannot absorb calcium (eg. Renal osteodystrophy, broken vit D receptor on gut)

77
Q

8yo boy presents with full beard, multiple bone lesions, and discolored spots on skin?

A

McCune Albright Sydrome–Polyostotic fibrous dysplasia– bone is replaced by fibroblasts

78
Q

Failure of endochonral ossification results in?

A

Achondroplasia

79
Q

Trabecular spongy bone loss in 50 yo woman– most common fractures?

A

Femoral head and distal radius (Colles’)

80
Q

MOA of osteopetrosis?

A

Carbonic anyhydrase II deficiency–>fail to generate acidic enviornment needed for resorption

81
Q

Patient presents with leukopenia, thrombocytopenia, facial palsy, and trouble hearing?

A

Osteopetrosis– Carbonic anhydrase II inhibitor–>can lead to renal tubular acidosis because patient cannot generate HCO3 or get rid of acid

82
Q

72yo man presents to physician with complain that his head is getting bigger and he cannot hear– what will we see on histology? 2 things this may result in?

A

Pagets disease
woven bone pattern–MOSAIC
chalk stick fractures; AV malformation
May lead to high output heart failure dt AVM; and osteogenic sarcoma

Elliot Step 1 (32 decks)

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