MSK, Derm, Connective Flashcards by amar Mirza

Classic sle presentation

endocarditis (wart like sterile on both sides of valve),
hilar adenopathy,
raynauds.
Fever, fatigue, weight loss

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Nephritis of sle

Diffuse proliferative glomerulonephritis = nephritic

Membranous glomerulonephritis = nephrotic

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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

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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

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Classic person to get SLE

14-15 year old black girls

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What is sarcoidosis and who does it affect?

Immune mediated widespread noncaseating granulomas and elevated ACE levels. Black women.

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Sarcoidosis presentation

Often asymptomatic except enlarged lymph node, cxr shows bilateral hilar adenopathy, reticular opacities.

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sarcoidosis associations

restrictive lung disease, erythema nodosum, bells palsy, epithelial granulomas, uveitis, hypercalcemia

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sarcoidosis treatment

steroids

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what is polymyositis

progressive symmetric proximal (shoulder) weakness due to CD8 cells. positive ANA and anti Jo-1

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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

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treatment for polymyositis/dermatomyositis

steroids

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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.

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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

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Myasthenia gravis association

Thymoma, thymic hyperplasia

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Lambert Eaton association

small cell lung cancer

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myositis ossificans

benign outgrowing of bone near site of trauma (surgery)

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Scleroderma

excessive fibrosis/collagen. skin is puffy and tight, sclerosis of renal, cardio, gi and lungs (most likely to kill)

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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