MSK, Derm, Connective Flashcards
Classic sle presentation
endocarditis (wart like sterile on both sides of valve),
hilar adenopathy,
raynauds.
Fever, fatigue, weight loss
Nephritis of sle
Diffuse proliferative glomerulonephritis = nephritic
Membranous glomerulonephritis = nephrotic
Antibody tests for lupus
Antiphospholipid - false positive syphilis test cause cross reactivity with cardiolipin Antinuclear - sensitive, primary screen Anti dsDNA - very specific Anti smith Anti histone- drug induced lupus
Lupus pneumonic
IM DAMN SHARP Ig Malar rash Discord rash Antinuclear Mucositis (oropharynegal ulcers) Neurological disorders Serositis(pleuritis and pericarditis) Hematological disorders Arthritis Renal disorders Photosensitive
Classic person to get SLE
14-15 year old black girls
What is sarcoidosis and who does it affect?
Immune mediated widespread noncaseating granulomas and elevated ACE levels. Black women.
Sarcoidosis presentation
Often asymptomatic except enlarged lymph node, cxr shows bilateral hilar adenopathy, reticular opacities.
sarcoidosis associations
restrictive lung disease, erythema nodosum, bells palsy, epithelial granulomas, uveitis, hypercalcemia
sarcoidosis treatment
steroids
what is polymyositis
progressive symmetric proximal (shoulder) weakness due to CD8 cells. positive ANA and anti Jo-1
what is dermatomyositis
similar to polymyositis with proximal weakness, but also malar rash, papules, heliotrope rash (under eyes), shawl and face rash, and mechanics hands. Due to CD4
treatment for polymyositis/dermatomyositis
steroids
Myasthenia gravis. Mech. Signs. Rxn to AChE inhib?
1 NMJ disorder, antibodies against ACh recptor, weakness with muscle use, ptosis, diplopia, weakness. reversed with AChEsterase inhib fixes.
Lambert-Eaton Myasthenic syndrome. Mech. Signs. Rxn to AChE inhib?
Antibodies to Ca channel presynaptic so no ACh release. proximal weakness improves with use, and insisitive to AChE inhib
Myasthenia gravis association
Thymoma, thymic hyperplasia
Lambert Eaton association
small cell lung cancer
myositis ossificans
benign outgrowing of bone near site of trauma (surgery)
Scleroderma
excessive fibrosis/collagen. skin is puffy and tight, sclerosis of renal, cardio, gi and lungs (most likely to kill)
diffuse scleroderma. signs and antibody
widespread scleroderma which is rapid. anti Scl-70 antibody (topoisomerase)
CREST syndrome. signs and antibody
Calcinosis, Raynaud’s, Esophageal Dysmotility, Sclerodactyly, Telangiectasia. Limited skin involvement (just fingers and hands. Not as bad as diffuse sclero. Anti-centromere antibody
Albinism
normal melanocytes, but no tyrosinase activity = hitlers dream. (or abnormal neural crest migration)
Melasma
normal hyperpigmentation due to pregnancy
vitiligo
decreased melanocytes
verrucae
HPV wart. soft, tan color, cauliflower-like.
Urticaria
hives. aka post mast cell degranulation
Ephelis
freckle
Atopic dermatitis
Eczema. puritic eruption on flexor surfaces
allergic contact dermatitis
Type IV hypersensitivity. poison ivy, neomycin
psoriasis
papules and plaques with silvery scaling on knees and elbows. basically incomplete apical differentiation (like p53 and p63 knockout mouse)
seborrheic keratosis
flat, greasy, pigmented with kerytin cysts. basically lauren’s face. it is benign but if multiple appear can signal malignancy
Pemphigus vulgaris
IgG against desmoglein. Reticulate staining
Bullous pemphigoid
IgG against hemidesmasome on epidermal basement. Eosinophils inside. Not oral
Dermatitis herpetiformis
Celiac disease blisters. Puritic papules, vesicles, and bullae. IgA
Erythema multiforme
Blistering skin with rings of red surrounding dusky dry center. Caused by
- infxn(mycoplasma pneumo, hsv)
- drugs (sulfa, b lactams, phenytoin)
- Cancer
- Autoimmune
Steven Johnson Syndrome
Fever, bulla formation and necrosis with high mortality. type two mucus membranes (eyes and lips) plus skin lesions which look like erythema multiforme. Caused by drugs (antibiotics, NSAIDs, allopurinol, sulfa drugs).
Worse version is toxic epidermal necrolysis
Acanthosis nigricans
hyperplasia and darkening of skin flexor surfaces due to hyperinsulinemia, and visceral malignancy
actinic keratosis
premalignant SCC. small rough red
erythema nodosum
inflammaotry subcut fat (normally on shins). caused by : sarcoidosis, coccidiodomycosis, histoplasmosis, TB, strep, leprosy, crohns
Lichen Planus
6Ps. pruriic, purple, polygonal, planar, papules, plaques. hepatitis C association.
Impetigo
superficial skin infection caused by S. aureus or S. pyogenes. contagious and “honey colored”. bullous = S aureus
Cellulitis
baiscally deeper impetigo. acute, painful, spreading infxn of dermis and subcut. from S. pyogenes and s. aureus. starts with break in skin.
necrotizing fasciitis
“flesh eating bacteria”. S pyogenes or anaerobe. crepitus from methane and CO2. bulla and purple skin
Scalded Skin Syndrome
Staphylococcal. Exotoxin mediated which destroys attachments and stratum granulosum. skin sloughs off but will heal completely.
difference between SSSS and Toxic Epidermal Necrolysis?
SSSS only stratus granulosum while TEN (more severe SJS) destroys Epidermal - Dermal Junction and wont heal.
BCC
pink pearly nodules with telegiectasis rolled boarders, and central crusting or ulcers. histo has palisading nuclei
SCC
sun, immunosuppresion, arsenic. ulcerative red lesions with scaling. chronic sinus drainage. histo: keratin pearls.
Melanoma
S-100 marker, deeper = met, BRAF V600E, vemurafenib
