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MSK/Dermatology Flashcards

1
Q 
Physical exam signs for...
ACL injury
PCL injury
MCL injury
LCL injury
Medial meniscus tear
Lateral meniscus tear
A

Anterior drawer sign
Posterior drawer sign
Abnormal passive abduction (medial space widening)
Abnormal passive adduction (lateral space widening)
Pain, popping on external rotation
Pain, popping on internal rotation

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2
Q

Result of lateral force applied to planted leg - presents with acute knee pain and joint instability

A

UNHAPPY TRIAD

ACL
MCL
Medial meniscus

Note - Lateral meniscus damage is not classical but more common

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3
Q

Caused by excessive kneeling

A

Prepatellar bursitis

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4
Q

Popliteal fluid collection in gastrocnemius-semimembranosus bursa

A

BAKER CYST

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5
Q 
Rotator cuff muscles and nerves...
Initial abduction
External rotation
Adduction and external rotation
Adduction and internal rotation
A

Supraspinatus - Suprascapular nerve
Infraspinatus - Suprascapular nerve
Teres minor - Axillary nerve
Subscapularis - Subscapular nerves

Note - All nerves primarily from C5-C6

Note - Supraspinatus most likely to be injured due to impingement between the humeral head and acromium

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6
Q

Caused by repetitive flexion (forehand)

A

Medial epicondylitis (Golfer’s elbow)

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7
Q

Caused by repetitive extension (backhand)

A

Lateral epicondylitis (Tennis elbow)

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8
Q

Wrist bones (lateral to medial; medial to lateral)

A

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

Note - Hook of hamate causes ulnar nerve injury

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9
Q

Risk factors for carpal tunnel

Note - Lunate fracture can cause acute carpal tunnel

A 
Pregnancy
Rheumatoid arthritis
Hypothyroidism
Diabetes
Dialysis-related amyloidosis

Note - Sensation spared on palmar surface as palmar cutaneous branch is external to tunnel

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10
Q

Paresthesia, pain, and numbness in distribution of ulnar nerve in hand

A

GUYON CANAL SYNDROME

Typically seen in cyclists

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11
Q

Humeral neck fracture or anterior dislocation…

Flattened deltoid
Loss of abduction above 15 degrees
Loss of sensation over lateral arm

A

AXILLARY NERVE

C5-C6

Note - Runs along posterior circumflex artery

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12
Q

Upper trunk compression…

Loss of elbow (forearm) flexion
Loss of sensation over lateral forearm

A

MUSCULOCUTANEOUS NERVE

C5-C7

Note - Lateral cord

Note - Sensation over medial forearm is by medial antebrachial cutaneous nerve (medial cord - C8-T1)

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13
Q

Humeral midshaft fracture
Humeral anterolateral supracondylar fractures
Crutches
Saturday night palsy…

Wrist drop (extension)
Decreased grip strength
Loss of sensation over posterior arm and forearm, and dorsomedial hand
A

RADIAL NERVE

C5-T1 - Posterior cord gives rise to Axillary and Radial nerves

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14
Q

Humeral anteromedial supracondylar fracture…

“Ape hand” and “Pope’s blessing” when making fist
Loss of wrist flexion
Loss of 1st and 2nd lumbricals
Loss of sensation over dorsal and palmar lateral 3.5 fingers

A

PROXIMAL MEDIAN NERVE

C5-T1 - Combination of lateral and medial cords

Note - Distal median nerve lesion (e.g. wrist laceration) results in “median claw” on extension (more severe exaggeration)

Note - Runs with brachial artery in the humerus

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15
Q

Humeral medial epicondyle fracture (“funny bone”)…

“Ok sign” on making a fist
Radial wrist deviation on flexion
Loss of 3rd and 4th lumbricals
Loss of interossei (adduction, abduction)
Loss of sensation over dorsal and palmar medial 1.5 fingers

A

PROXIMAL ULNAR NERVE

C8-T1 - Medial cord

Note - Distal ulnar nerve lesion (e.g. fractured hamate) results in “ulnar claw” on extension (more severe exaggeration)

Note - Ulnar claw looks like “Pope’s blessing,” while median claw looks like “ok sign”

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16
Q

Superficial laceration of palm…

“Ape hand”
Loss of thenar function
No loss of sensation

A

RECURRENT BRANCH OF MEDIAN NERVE

C5-T1

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17
Q

Cause of…
Abduction deficit
Lateral motion deficit
Flexion, supination deficit

A

ERB PALSY

Traction or tear of upper brachial trunk (C5-C6) - pulling on neck

Deltoid, Supraspinatus
Infraspinatus
Biceps

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18
Q

Cause of…
Total claw hand - no flexion of MCP or extension of any
DIP/PIP

A

KLUMPKE PALSY

Traction or tear of lower brachial trunk (C8-T1) - pulling on arm or thoracic outlet syndrome (e.g. pancoast tumor)

Intrinsic hand muscles (lumbricals, interossei, thenar, hypothenar)

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19
Q

Cause of…
Winged scapula
Cannot abduct arm above horizontal

A

WINGED SCAPULA

Lesion of long thoracic nerve (C5-C7) - From branchial roots. Innervates the serratus anterior which rotates the scapula upward allowing complete abduction the arm over the head

Note - Runs along lateral thoracic artery

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20
Q

Functions of dorsal and palmar interossei

A

Dorsal - Abduct

Palmar - Adduct

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21
Q

Pelvic surgery…

Decreased medial thigh sensation
Decreased thigh adduction

A

OBTURATOR

L2-L4

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22
Q

Pelvic fracture…

Decreased thigh flexion
Decreased leg extension

A

FEMORAL

L2-L4

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23
Q

Fibula neck fracture…

Loss of eversion and dorsiflexion - foot drop
Loss of sensation on dorsal foot

A

COMMON PERONEAL

L4-S2

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24
Q

Knee trauma, Baker’s cyst (proximal), or tarsal tunnel syndrome (distal)…

Inability to curl toes
Loss of inversion and plantarflexion (proximal) - can’t stand on tiptoes
Loss of sensation on plantar foot

A

TIBIAL

L4-S3

Note - Runs along popliteal to posterior tibial artery

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25
IM injection to gluteal region... Trendelenburg sign - Contralateral hip drop on standing Gluteus lurch - Ipsilateral lean on walking
SUPERIOR GLUTEAL L4-S1 Note - Choose superolateral gluteal quadrant
26
Posterior hip dislocation... Loss of hip extension - Rising from seated position or climbing stairs
INFERIOR GLUTEAL L5-S2 Note - Innervates gluteus maximus, while medius and minimus is by superior gluteal Note - Gluteus maximus for hip extension, while medius and minimus for hip abduction
27
Weakness of knee extension | Decreased patellar reflex
L3/L4 RADICULOPATHY Note - Disc herniation is usually posterolateral
28
Weakness of dorsiflexion | Difficulty in heel walking
L4/L5 RADICULOPATHY
29
Weakness of plantar flexion Difficulty in toe walking Decreased achilles reflex
L5/S1 RADICULOPATHY
30
Mechanism of skeletal muscle NMJ Note - Skeletal NMJ is 1 T-tubule (plasma membrane) with 2 terminal cisternae (SR) making a triad, while cardiac NMJ is only a dyad
Neurotransmitter leads to motor end plate depolarization Depolarization travels along muscle down T-tubule Voltage-sensitive dihydropyridine receptor on T-tubule mechanically induces conformational change in RYR1 receptor on SR Ca released from SR Ca binds Troponin C Tropomyosin released from actin filaments Myosin binds actin filament Myosin releases bound ADP and Pi - Power stroke Binding of new ATP releases myosin ATP hydrolysis to ADP "cocks" myosin Note - Mechanical coupling induces resistance to CCBs which mostly affect Ca-induced-Ca release (smooth, cardiac)
31
Lengths of H, I, Z, and A bands during contraction
``` H zone (Myosin without Actin, near M line) - Shortens I band (Actin without Myosin, near Z line) - Shortens Z line (Sarcomere boundaries) - Shortens A band (Entire Myosin) - Constant ```
32
``` Difference between type 1 and type 2 muscle fibers... Speed Contents Contraction Increased with ``` ("1 slow, red ox")
``` Type 1: Slow Red (mitochondria, myoglobin) Sustained Endurance training ``` ``` Type 2: Fast White (anaerobic glycolysis, glycogen) Not-sustained Resistance training ```
33
Mechanism of smooth muscle contraction/relaxation
``` L-type voltage gated Ca channels open Ca-calmodulin complex forms Myosin-light-chain kinase activated Myosin + Actin converted to Myosin-P + Actin Contraction ``` Parasympathetic (Ach, Bradykinin) on Guanyl Cyclase Activates cGMP cGMP/PKG activate Ca channels NO synthase converts L-Arginine to NO NO diffuses from endothelial cell into smooth muscle cell NO converts CTP to cGMP Activation of Myosin-light chain phosphatase Myosin-P + Actin converted to Myosin + Actin Relaxation Note - No T-tubules
34
Difference between endochondral (axial, appendicular, skull base) and membranous (calvarium, facial) ossification
Endochondral: Cartilaginous model of bone by Chondrocytes Osteoclasts/Osteoblasts replace with woven bone Woven bone remodeled to lamellar bone Note - Increased woven bone in fractures and Paget (osteitis deformans) Membranous: Woven bone formed directly (no chondrocytes) Woven bone remodeled to lamellar bone
35
Mechanism of osteoblast function Note - At low intermittent levels PTH stimulates, but chronically high levels (hyperparathyroidism) results in catabolism
Mesenchymal origin: Secretes collagen and catalyzes mineralization in alkaline environment via ALP Response to to mechanical stress via signals from osteocytes Note - Apoptosis inhibited by estrogen
36
Mechanism of osteoclast function
Monocyte/Macrophage origin - Secretes H and collagenase to break down bone Note - Apoptosis induced by estrogen
37
Acute back pain Loss of height Kyphosis Normal Ca Normal PO4 Normal PTH Normal ALP
VERTEBRAL COMPRESSION FRACTURE Often secondary to osteoporosis - diagnosed with T-score < -2.5 or fragility fracture of hip/vertebrae
38
``` Fragility fractures Generalized osteosclerosis Pancytopenia/extramedullary hematopoiesis Cranial nerve impingement "Bone in bone" on XR ``` Normal or decreased Ca Normal PO4 Normal PTH Normal ALP
OSTEOPETROSIS Carbonic anhydrase II mutation results in inability of osteoclasts to secrete H - No mature trabeculae (spongiosa filling medullary canals) Treat with bone marrow transplant
39
``` Craniotabes (soft skull) Bow legs Epiphyseal widening Metaphyseal cupping and fraying Rachitic rosary at costochondral junction ``` ``` Decreased vit D Decreased Ca Decreased PO4 Increased PTH Increased ALP ```
RICKETS In adults presents as osteomalacia - XR shows osteopenia and pseudofractures only
40
Long bone chalk-stick fractures Increased hat size Hearing loss ``` Normal Ca Normal PO4 Normal PTH Elevated ALP Osteocytes with lacunae in chaotic juxtaposition - Mosaic pattern of woven and lamellar bone ``` Note - AV shunts may cause high output HF
PAGET (OSTEITIS DEFORMANS) Presents in lytic (osteoclasts), mixed (osteoclasts + osteoblasts), scelrotic (osteoblasts), and quiescant stages Increased risk of osteogenic sarcoma (osteosarcoma) which has: 1) destruction of normal trabecular bone pattern 2) mixed radiodense and radiolucent areas 3) periosteal new bone formation 3) lifting of the cortex 4) codmans triange 5) sunburst pattern
41
Common causes of avascular necrosis of femoral head Note - Medial circumflex femoral insufficiency
``` Corticosteroids --> crescent sign (subchondral collapse) Trauma Alcoholism Legg-Calve-Perthes (insidious) SCFE (acute) SCD Gaucher disease Decompression disease ```
42
``` Mechanism of... Hypercalcemia Hyperphosphatemia Decreased PTH Normal ALP ```
HYPERVITAMINOSIS D Caused by supplements of granulomatous disease (e.g. sarcoidosis)
43
Young male with... | Bony exostosis with cartilaginous cap
OSTEOCHONDROMA
44
Young adult with... Soap-bubble on XR at epiphysis of long bones (knee) Multinucleated giant cells
GIANT CELL TUMOR Locally aggressive benign tumor
45
Teenager or elderly with... Codman triangle - elevation of periosteum Sunburst on XR at metaphysis of long bones (knee) Note - Second most common bone malignancy after Multiple Myeloma
OSTEOSARCOMA Aggressive - limb salvage and chemotherapy ``` Associated with... Paget (osteitis deformans) Ischemia Radiation Retinoblastoma Li-Fraumeni p53 mutation (Sarcoma, Breast, Blood, Adrenal) ```
46
Teenage boy with... Onion skin periosteal reaction Diaphysis of long bones, pelvis, scapula, or ribs Anaplastic small blue cell
EWING SARCOMA t(11:22) translocation resulting in EWS-FL11 fusion protein Extremely aggressive with early metastasis but responsive to chemotherapy
47
``` Joint findings associated with... Weight bearing joints DIP/PIP/CMC Joint pain at the end of the day "catching/locking" sensation Asymmetric involvement Bowleggedness (varus) ``` excess biomechanical stress and increased intraarticular metalloprotease activity results in degradation of type II collagen and proteoglycans within articular cartilage
OSTEOARTHRITIS ``` Osteophytes (bone spurs) Joint space narrowing Subchondral sclerosis and cysts Slight synovial hypertrophy Non-inflammatory synovial fluid (< 2000) ``` ``` Associated with... Elderly Female Obese Prior trauma ```
48
``` Joint and immunologic findings associated with... MCP, PIP, wrist - not DIP or CMC Pain, swelling, and morning stiffness > 1 hr Improvement with use Symmetric involvement Constitutional symptoms Ulnar deviation Subluxation Swan neck ```
RHEUMATOID ARTHRITIS immune complex deposition, neutrophil accumulation, perivascular inflammation, osteoclastic activity Pannus (proliferative granulation tissue) Bone and cartilage erosion Increased synovial fluid Juxtaarticular osteopenia Inflammatory synovial fluid (> 2000) HLA-DR4 Rheumatoid factor (anti-IgG) Anti-cyclic citrullinated peptide (specific) Associated with... Female Smoking Silica
49
Extra-articular manifestations of rheumatoid arthritis
``` Skin nodules (fibrinoid necrosis with palisading histiocytes) Lung nodules (Caplan's syndrome) ILD Pleuritis, Pericarditis Felty syndrome (neutropenia, splenomegaly) AA amyloidosis Sjogren's syndrome Scleritis Carpal tunnel ```
50
``` Needle shaped Monosodium urate crystals Negatively birefringent under polarized light Yellow under parallel light Blue under perpendicular light Numerous neutrophils ```
GOUT Treat with NSAIDs, Glucocorticoids, Colchicine Prevent with Xanthine oxidase inhibitors why inflammation? Normally urate crystals have a protective coating of APO E or B. When uric acid levels fluctuate or microtrauma occurs, bare urate crystals are shed and exposed to IgG antibodies. The subsequent antibody binding leads to neutrophil phagocytosis and release of inflammatory cytokines like IL-1
51
``` Chondrocalcinosis on XR Rhomboid crystals Weakly positively birefringent Blue under parallel light Yellow under perpendicular light ```
CALCIUM PYROPHOSPHATE DEPOSITION (PSEUDOGOUT) Treat with NSAIDs, Glucocorticoids, Colchicine Prevent with Colchicine
52
``` Inflammatory joint pain Bilateral parotid enlargement Keratoconjunctivitis Xerostomia Dental caries Antiribonucleoprotein - SS-A (anti-Ro), SS-B (anti-La) ``` Note - ANA and RF may also be present
SJOGREN SYNDROME Note - MALT may present as parotid enlargement
53
Most common etiologies (3) of septic arthritis
S. aureus Streptococcus N. gonorrhoeae Note - N. gonorrhoeae may present as polyarthralgia, tenosynovitis, and dermatitis instead if disseminated
54
HLA associated with seronegative spondyloarthritis - no Rheumatoid factor (anti-IgG antibody) Present as morning stiffness better with exercise and enthesitis
HLA-B27 ``` Includes... Psoriatic arthritis Ankylosing spondylitis IBD Reactive arthritis ```
55
"Pencil in cup" deformity on XR
Psoriatic arthritis
56
Bamboo spine on XR Uveitis Aortic regurgitation
ANKYLOSING SPONDYLITIS Symmetric involvement of spine and sacroiliac joint results in joint fusion (ankylosis)
57
``` Etiologies associated with... Urethritis Enthesitis Asymmetrical arthritis Conjunctivitis ``` ``` Occurs post... Shigella Salmonella Yersinia Campylobacter Chlamydia ```
REACTIVE ARTHRITIS (REITER SYNDROME) HLA B27 Deposition of immune complexes Note: Not disseminated infection, joint aspirates are sterile
58
Anti-histone antibodies
DRUG INDUCED LUPUS Hydralazine Procainamide
59
False positive VDRL/RPR | Falsely prolonged aPTT
Anticardiolipin antibodies and Lupus anticoagulant Note - APS also increases anti-b2 glycoproteins
60
Speckled ANA | anti-U1 RNP antibodies
MIXED CONNECTIVE TISSUE DISEASE Presents as mixture of... SLE Systemic sclerosis Polymyositis
61
Elevate CD4+/CD8+ ratio in bronchoalveolar lavage Enlarged lymph nodes Extensive hilar and mediastinal adenopathy Elevated ACE
SARCOIDOSIS ``` Associated with... ILD Bell palsy Erythema nodosum Epithelioid granuloma (Schaumann and asteroid bodies) Uveitis Hypercalcemia ```
62
``` Pain and stiffness in shoulders and hips Normal strength Constitutional signs Elevated ESR Elevated CRP Normal CK ```
POLYMYALGIA RHEUMATICA Treat with steroids - always investigate for giant cell (temporal) arteritis
63
``` Elevated CK ANA+ Anti-Jo-1+ (aminoacyl tRNA synthetase) Anti-SRP+ (signal recognition particle) Anti-Mi-2+ (helicase DNA binding protein) ``` Associated with... ILD Myocarditis
POLYMYOSITIS/DERMATOMYOSITIS
64
Histology of... | Progressive symmetric muscle weakness
POLYMYOSITIS Endomysial inflammation CD8+ T cells
65
``` Histology of... Progressive symmetric muscle weakness Gottron papules Heliotrope (periorbital) rash Shawl and face rash ```
DERMATOMYOSITIS Perimysial inflammation CD4+ T cells Note - Increased risk of occult malignancy
66
Proximal muscle weakness Improves with use Autonomic symptoms (dry mouth, impotence)
LAMBERT-EATON SYNDROME Auto-antibodies against presynaptic Ca channel leads to decreased Ach release - AchE inhibitors have minimal effect Treat by removal of possible SCLC
67
Suspicious calcified mass at site of previous trauma
MYOSITIS OSSIFICANS
68
Triad of... Autoimmunity Noninflammatory vasculopathy Collagen deposition with fibrosis
SCLERODERMA (SYSTEMIC SCLEROSIS)
69
``` Antibody associated with... Widespread skin sclerosis Rapid progression Early visceral involvement Mortality from PAH or ILD ```
DIFFUSE SCLERODERMA Anti-Scl-70 (anti-DNA topoisomerase I)
70
``` Antibody associated with... Calcinosis Raynaud Esophageal dysmotility Sclerodactyly Telangiectasias ```
LIMITED SCLERODERMA (CREST) Anti-centromere
71
Color sequence and treatment of Raynaud's disease (primary) or Raynaud's syndrome (secondary) Note - Secondary causes include SLE, CREST, and mixed connective tissue disease
White (ischemia) Blue (hypoxia) Red (reperfusion) Treat with Ca channel blockers Note - Only secondary results in digital ulceration (critical ischemia)
72
Layers of epidermis (surface to base)
``` Stratum Corneum (keratin) Stratum Lucidum Stratum Granulosum Stratum Spinosum (desmosomes) Stratum Basale ```
73
Structure and function of Tight Junctions (zona occludens)
Claudins and Occludins - Prevent paracellular movement of solutes
74
Structure and function of Adherens Junctions (zonula adherens)
Connects adjacent cytoskeletons with E-Cadherins (Ca-dependent adhesion proteins, loss of Ca will cause loss of cell-cell adhesions) Note - Loss results in metastasis
75
Structure and function of Desmosomes (macula adherens)
Connection of adjacent Cadherins (Desmoglein, Desmocollin) allows for structural support Note - Autoantibodies result in pemphigus vulgaris
76
Structure of gap junctions
Connexons - located under desmosomes Note - Allows for myocardial and uterine contractions
77
Structure and function of Hemidesmosomes
Connects Keratin to underlying BM Note - Autoantibodies results in bullous pemphigoid
78
Structure and function of Integrins
Membrane proteins which connect intracellular microfilaments to ECM (Fibronectin, Collagen, Laminin)
79
Mechanism of Albinism
Decreased Tyrosinase activity or defective tyrosine transport results in decreased melanin production - normal number of melanocytes Note - Compare to vitiligo which is autoimmune destruction of melanocytes
80
Hyperpigmentation associated with pregnancy or OCP use
MELASMA (CHLOASMA)
81
Increased stratum corneum (hyperkeratosis) Nuclei in stratum corneum (parakeratosis) Increased stratum spinosum (acanthosis) Decreased stratum granulosum Clubbed Rete ridges Microabscesses Auspitz sign - Pinpoint bleeding from dermal papillae with scraping
PSORIASIS Treat with Calcipotriol - Inhibits proliferation while inducing differentiation Note - Associated with psoriatic arthritis, pitting nails, and uveitis
82
Erythematous papules and pustules on face Facial flushing No comedones
ROSACEA Phymatous Rosacea - bulbous deformation of nose
83
Flat, greasy, pigmented plaque Squamous epithelial proliferation Keratin-filled cysts (horn cysts) Looks "stuck on"
SEBORRHEIC KERATOSIS Benign unless sudden eruption - Leser-Trelat sign
84
Epidermal hyperplasia Hyperkeratosis Koilocytosis (large dark nuclei, peripheral halo)
VERRUCAE (CONDYLOMA ACUMINATUM) Note - Condyloma lata is smooth, not cauliflower
85
Skin cancer associated with radiation and chronic postmastectomy lymphedema
ANGIOSARCOMA
86
AIDS patient with... Benign capillary skin papule Neutrophilic infiltrate
BACILLARY ANGIOMATOSIS Bartonella henselae
87
Hemangioma that does not regress - frequency increases with age
CHERRY HEMANGIOMA
88
Cavernous lymphangioma of the neck - associated with Turner syndrome
CYSTIC HYGROMA
89
Painful, red-blue benign tumor under fingernails
GLOMUS TUMOR Modified smooth muscle cells of thermoregulatory glomus body (shunts blood away in cold temp to prevent heat loss and shunt blood towards fingers when hot to promote heat loss)
90
Aids patient with... Cutaneous or GI tract maculopapular lesion or hemorrhagic polypoid lesion Spindle shaped tumor cells with vessel proliferation
KAPOSI SARCOMA HHV-8 Note - Endothelial malignancy
91
Polyploid lobulated capillary hemangioma | May ulcerate and bleed
PYOGENIC GRANULOMA Associated with trauma and pregnancy
92
Etiology of impetigo
S. aureus (especially bullous) | S. pyogenes
93
Infection of upper dermis and superficial lymphatics - clear demarcation
ERYSIPELAS S. pyogenes Note - Cellulitis is infection of deeper dermis and SQ tissues (S. aureus, S. pyogenes)
94
Purple skin Bullae Crepitus (methane, CO2)
NECROTIZING FASCIITIS S. pyogenes Anaerobes
95
``` Child or adult with renal insufficiency... Fever Generalized erythematous rash Sloughing of upper epidermis Nikolsky sign Heals completely ```
STAPHYLOCOCCAL SCALDED SKIN SYNDROME S. aureus exfoliative exotoxin destroys keratinocyte attachments in Stratum Granulosum only
96
Irregular, white, painless plaques on lateral tongue that cannot be scraped off
HAIRY LEUKOPLAKIA EBV in HIV patients and organ transplant patients Note - Thrush is scrapable, and leukoplakia (precancerous) is on top of tongue
97
Flaccid intraepidermal bullae Involves oral mucosa Nikolsky sign Stratum Spinosum acantholysis (separation of epidermal cells) IF shows antibodies around epidermal cells in reticular pattern
PEMPHIGUS VULGARIS IgG against Desmoglein in Desmosomes - desmosomes hold stratum Spinosum Keratinocytes together
98
Tense blisters containing eosinophils Spares oral mucosa No Nikolsky sign IF shows linear pattern at epidermal-dermal junction
BULLOUS PEMPHIGUS IgG against Hemidesmosomes
99
Pruritic papules, vesicles, bullae at elbows IgA at tip of dermal papillae subepidermal blisters cross reactivity of anti-gliadin IgA antibodies with transglutaminase at the dermal basement membrane
DERMATITIS HERPETIFORMIS Associated with Celiac Treat with... Dapsone Gluten-free diet
100
Fever Bullae and necrosis Sloughing at dermal-epidermal junction Involves 2 mucous membranes
STEVENS-JOHNSON SYNDROME >30% involvement - Toxic Epidermal Necrolysis
101
Small, sandpaper, erythematous papules or plaques Hyperkeratosis Parakeratosis
ACTINIC KERATOSIS Associated with sun exposure - may develop into SCC
102
Pruritic, purple, polygonal planar papules and plaques Increased Stratum Granulosum (hypergranulosis) Sawtooth lymphocytic infiltrate at dermal-epidermal junction
LICHEN PLANUS Associated with HCV
103
Herald patch | Followed by scaly erythematous plaques in christmas tree distribution
PITYRIASIS ROSEA Self-resolving
104
Associations with... UVA UVB
Tanning, photoaging | Sunburn
105
Pink, pearly nodules with rolled borders Telangiectasias Palisading nuclei Nonhealing ulcer with infiltrating growth or scaling plaque
BASAL CELL CARCINOMA
106
Face, lips, ears, hands Ulcerative lesion with frequent scale Chronic draining sinuses Intercellular bridges and Keratin pearls
SQUAMOUS CELL CARCINOMA Keratoacanthoma - Variant that grows rapidly and then regresses spontaneously over months
107
Marker and mutation for Melanoma
S-100 marker (neural crest) V600E BRAF mutation Note - Can treat with IL-2
108
Mechanism of Endoperoxide synthesis
Phospholipase A2 converts membrane phospholipids to Arachidonic acid COX-1/2 convert Arachidonic acid to Cyclic endoperoxides Note - Corticosteroids inhibit Phospholipase A2 and NF-kB which induces COX2
109
Mechanism of Leukotriene synthesis
5-Lipoxygenase converts Arachidonic acid to 5-HPETE 5-HPTE forms Leukotrienes
110
Actions of Endoperoxides (Prostacyclin, Prostaglandins, Thromboxane)
PGI2/Prostacyclin - Decreases platelet aggregation, Vasodilation PGE2/D2 - Increased vascular permeability, Vasodilation TXA2/Thromboxane - Increases platelet aggregation, Vasoconstriction Note PGI2 made by endothelium (COX1/2), TXA2 made by platelets (COX1)
111
Action of Leukotrienes
LTC4, LTD4, LTE4 - Vasoconstriction, Increased vascular permeability, Bronchospasm LTB4/5-HETE - Neutrophil chemotaxis Lipoxin A4/B4 - Decreased leukocyte recruitment
112
Mechanism of glands... Salivary and Sweat Mammary Sebaceous and Meibomian
Merocrine (exocytosis) Apocrine (vesicles) Holocrine (lysis)
113
Photosensitivity Hyperpigmentation Atrophy SCC
XERODERMA PIGMENTOSUM Defect in nucleotide excision repair (endonuclease)
114
Mechanism of photoaging (UVA)
``` Epidermal atrophy Rete ridge flattening Decreased collagen fibril production Increased collagen cross-linking Increased collagen/elastin degradation ```
115
Most common cause of ankle sprain - Inversion
Talofibular ligament injury
116
Arterial injury responsible for avascular necrosis after a fracture of the femoral head
Medial femoral circumflex
117
Most common site of LE compartment syndrome
ANTERIOR COMPARTMENT Contains... Deep peroneal nerve Anterior tibial vessels Note - Deep posterior compartment contains Tibial nerve, Posterior tibial vessels, and Peroneal vessels
118
What is at risk of injury with knee dislocation
popliteal artery tibial nerve common peroneal nerve in post/ant dislocations, the popliteal artery is high risk because deep within popliteal fossa and tightly fixed by the adductor magnus and soleus muscles
119
Sensation to medial leg and foot
saphenous nerve
120
What is at risk of injury via penetrating trauma to the popliteal fossa
Tibial nerve because more superficial than popliteal artery
121
``` cramping pain that gradually worsens in leg worse when walks occasionally present at rest worst at night better in chair ``` history of DM, smoking, HTN, hypercholesterolemia
peripheral arterial disease arterial atherosclerosis
122
composed of lipoblasts | non membrane bound cytoplasmic lipid that shifts periodically causing scalloping of the nuclear membrane
liposarcoma

Step 1 (17 decks)

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