Musculo - Pathology Part 2 Flashcards
1
Q
Hypercalcemia associated with sarcoidosis occurs because of the increased conversion of what substance into its active form in epithelioid macrophages?
A
Vitamin D
2
Q
What type of arthritis is associated with sarcoidosis?
A
Rheumatoid arthritis (remember: GRAIN (Gammaglobulinemia, Rheumatoid arthritis, ACE increase, Interstitial fibrosis, Noncaseating granulomas)
3
Q
What is the treatment for sarcoidosis?
A
Steroids
4
Q
Polymyositis involves progressive _____ (proximal/distal) muscle weakness.
A
Proximal
5
Q
Which part of the immune system causes damage in polymyositis?
A
CD8+ T-cell-induced injury to myofibers
6
Q
Polymyositis most often involves what body part?
A
Shoulders
7
Q
Dermatomyositis is similar to polymyositis but also involves what skin symptom?
A
Rash (heliotrope, malar and shawl and face)
8
Q
Which lab results are abnormal in polymyositis/dermatomyositis?
A
Elevated creatine kinase, elevated aldolase, positive antinuclear antibody, and anti-Jo-1
9
Q
What is the diagnostic procedure for dermatomyositis and polymyositis?
A
Muscle biopsy
10
Q
What is the treatment for polymyositis and dermatomyositis?
A
Steroids are used to treat both disorders
11
Q
Gottrons papules are symptoms of what disease?
A
Dermatomyositis
12
Q
While the symptoms of myasthenia gravis _____ (improve/worsen) with muscle use, symptoms of Lambert-Eaton syndrome _____ (improve/worsen) with muscle use.
A
Worsen; improve
13
Q
Myasthenia gravis is caused by autoantibodies to which receptor?
A
Acetylcholine receptors
14
Q
Name two ophthalmic manifestations of myasthenia gravis.
A
Ptosis and diplopia
15
Q
Myasthenia gravis is associated with which type of tumor?
A
Thymoma
16
Q
Individuals with myasthenia gravis complain of generalized weakness that is worse in the _____ (morning/evening).
A
In myasthenia gravis, weakness tends to be worse toward the end of the day
17
Q
Lambert-Eaton syndrome is caused by autoantibodies to which types of ionic channels, leading to a decrease in acetylcholine release?
A
Calcium channels
18
Q
Lambert-Eaton syndrome leads to _____ (proximal/distal) muscle weakness.
A
Proximal
19
Q
Which malignancy is most closely associated with Lambert-Eaton syndrome?
A
Small-cell lung cancer
20
Q
True or False? Both myasthenia gravis and Lambert-Eaton syndrome improve with acetylcholinesterase inhibitor use.
A
False; although myasthenia gravis symptoms reverse with the use of acetylcholinesterase inhibitors, there is no reversal in Lambert-Eaton syndrome with acetylcholinesterase inhibitors alone such as edrophonium
21
Q
While myasthenia gravis involves autoantibodies against the _____ (presynaptic/postsynaptic) acetylcholine receptors, Lambert-Eaton syndrome involves autoantibodies against the _____ (presynaptic/postsynaptic) calcium channels.
A
Postsynaptic; presynaptic
22
Q
In contrast to myasthenia gravis, Lambert-Eaton syndrome spares what muscle group?
A
Extraocular muscles
23
Q
What five characteristics are associated with mixed connective tissues diseases?
A
Raynauds phenomenon, Fatigue, Arthralgias, Myalgias, and Esophageal hypomotility (remember: Raynauds FAME)
24
Q
Patients with mixed connective tissue disease are positive for _____ autoantibodies.
A
U1 ribonucleoprotein
25
What is the treatment for mixed connective tissue disease?
Steroids
26
What condition involves excessive fibrosis and collagen deposition throughout the body but most commonly under the skin?
Scleroderma
27
Does scleroderma affect more men or women?
Women
28
Although scleroderma most commonly affects the skin, what four other organ systems can it affect?
Cardiovascular, pulmonary, gastrointestinal, and renal
29
Describe the progression of diffuse scleroderma.
Widespread skin involvement, rapid progression, and early visceral involvement
30
What are the two types of scleroderma?
Diffuse scleroderma and CREST syndrome
31
Diffuse scleroderma is associated with which antibody?
Anti-Scl-70 antibody (anti-DNA topoisomerase I antibody)
32
What does CREST stand for?
Calcinosis, Raynauds phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia
33
A patient presents for examination. Although middle-aged, she has no wrinkles (denies plastic surgery) and her skin is puffy and taut. She also complains of difficulty swallowing. From what disease is she suffering?
Scleroderma
34
Skin involvement in CREST syndrome is often confined to which two areas of the body?
Fingers and face
35
Which has a more benign course: diffuse scleroderma or CREST syndrome?
CREST syndrome
36
Which antibody is associated with CREST syndrome?
Anticentromere antibody (remember: C for CREST)
37
What is a lipoma?
A soft, well-encapsulated tumor derived from fat
38
True or False? Lipoma recurrences are common even after excision.
False; simple excision of lipomas is usually curative
39
While lipomas are _____ (benign/malignant) in nature, liposarcomas are _____ (benign/malignant).
Benign; malignant
40
Rhabdomyoma is a benign tumor derived from what kind of muscle?
Striated (skeletal or cardiac) muscle
41
Rhabdomyoma of the heart is associated with which genetic disease?
Tuberous sclerosis
42
What is the most common malignant soft tissue tumor of childhood?
Rhabdomyosarcoma
43
Rhabdomyosarcomas often arise from skeletal muscle from what two locations in the body?
Head and neck
44
_____ (Macules/Patches) are flat discolorations of the skin <1 cm in size, while _____ (macules/patches) represent a similar lesion except they are > 1 cm in size.
Macules; patches
45
_____ (Papules/Plaques) are elevated skin lesions < 1 cm in size, while _____ (papules/plaques) represent a similar lesion but are > 1 cm in size.
Papules; plaques
46
_____ (Bullae/Vesicles) are small fluid-containing blisters, while _____ (bullae/vesicles) are large fluid-containing blisters.
Vesicles; bullae
47
Which dermatologic term describes a transient vesicle?
Wheal
48
What irregular, raised lesion results from scar tissue hypertrophy following trauma to skin, especially in African-Americans?
Keloid
49
What is the medical term for a blister containing pus?
Pustule
50
Dried exudate from a vesicle, bulla, or pustule is called a _____.
Crust
51
An increased thickness of the stratum corneum is known as _____.
Hyperkeratosis
52
Which phenomenon describes hyperkeratosis with retention of nuclei in stratum corneum, as seen in psoriasis?
Parakeratosis
53
While acantholysis is the _____ (hyperplasia/separation) of epidermal cells, acanthosis represents epidermal _____ (hyperplasia/separation).
Separation; hyperplasia
54
Tinea versicolor is an example of what type of dermatologic lesion?
Macule
55
Acne vulgaris is an example of what type of dermatologic lesion?
Papule
56
Psoriasis causes what gross and microscopic dermatologic lesions?
Plaques, parakeratosis and hyperkeratosis
57
Chickenpox is an example of what type of dermatologic lesion?
Vesicle
58
Hives are an example of what type of dermatologic lesion?
Wheal
59
Pemphigus vulgaris causes which pathologic change of the epidermis?
Acantholysis
60
Another name for warts, _____ are soft, tan-colored, cauliflower-like lesions of the skin.
Verrucae
61
Name three histopathologic findings in verrucae.
Epidermal hyperplasia, hyperkeratosis, and koilocytosis
62
Warts found on the hands are referred to as _____ _____, while warts found on the genitals are called _____ _____.
Verruca vulgaris; condyloma acuminatum
63
Condyloma acuminatum, or genital warts, are caused by what virus?
Human papillomavirus
64
What is the lay term for a nevocellular nevus, a benign lesion?
Mole
65
Hives, also known as _____, are pruritic wheals that form secondary to degranulation of what type of cell?
Urticaria; mast cells
66
A freckle, a lesion that results from increased melanin pigment, is also known as _____.
Ephelis
67
In the case of atopic dermatitis (eczema), pruritic eruption takes place on which surfaces of the body?
Flexor surfaces
68
Atopic dermatitis is often associated with which two other atopic diseases?
Asthma and allergic rhinitis
69
Allergic contact dermatitis is a type _____ hypersensitivity reaction that follows exposure to an allergen.
IV
70
Acanthosis with parakeratotic scaling that is particularly found on knees and elbows is called what?
Psoriasis
71
An increased stratum spinosum and a decreased stratum granulosum is seen with which skin disorder?
Psoriasis
72
A woman develops plaques and papules with silvery scaling on her elbows and knees. Pinpoint bleeding occurs when a scale is removed. What is the name of the sign describing the latter phenomenon? What is the most likely diagnosis?
Auspitz sign; psoriasis
73
Which skin disorder is described as flat, pigmented, squamous epithelial proliferation with keratin-filled cysts?
Seborrheic keratosis
74
What is the Sign of Leser-Trélat?
The sudden appearance of multiple seborrheic keratoses indicating underlying malignancy
75
In albinism, melanocyte number is _____ (increased/decreased/unchanged), while in vitiligo melanocyte number is _____ (increased/decreased/unchanged).
Unchanged (ie normal); decreased
76
In albinism, decreased melanin production is due to what?
Decreased activity of tyrosinase
77
What developmental failure can result in albinism?
Failure of neural crest cell migration during development
78
How does vitiligo appear clinically?
As irregular areas of complete skin depigmentation
79
Melasma, or skin hyperpigmentation, is associated with what two situations?
Pregnancy and oral contraceptive use
80
Name two organisms that commonly cause impetigo.
Staphylococcus aureus and Streptococcus pyogenes
81
Which infectious superficial skin infection is commonly characterized by honey-colored crusting?
Impetigo
82
Cellulitis, an acute painful spreading infection of the dermis and subcutaneous tissues, is most commonly caused by which two organisms?
Staphylococcus aureus and Streptococcus pyogenes
83
Name the deep tissue infection caused by flesh-eating bacteria that results in crepitus due to bacterial production of carbon dioxide and methane.
Necrotizing fasciitis
84
Which bacteria cause necrotizing fasciitis?
Anaerobic bacteria and Streptococcus pyogenes
85
Staphylococcal scalded skin syndrome is caused by a bacterial product called an _____ that destroys the keratinocyte attachments in the stratum _____ only.
Exotoxin; granulosum
86
A parents calls the pediatrician because her newborn has a fever and rash. Every time she picks the baby up, it seems like her skin peels off. From what is the baby suffering?
Staphylococcal scalded skin syndrome
87
Which virus causes hairy leukoplakia?
Epstein-Barr virus
88
Hairy leukoplakia is associated with which underlying medical condition?
HIV infection
89
True or False? Hairy leukoplakia is described as white painless plaques on the tongue that can be easily scraped off.
False; hairy leukoplakia is characterized by white plaques on the tongue that cannot be scraped off
90
Which autoimmune blistering skin disorder affects the skin but not the oral mucosa?
Bullous pemphigoid
91
Which blistering autoimmune skin disorder is most severe?
Pemphigus vulgaris
92
A patient presents with bullae sparing the oral mucosa. From what disease is she suffering?
Bullous pemphigoid
93
While in bullous pemphigoid immunoglobulin G antibody is directed against the _____, in pemphigus vulgaris immunoglobulin G antibody is directed against the _____.
Hemidesmosomes (epidermal basement membrane); desmosomes
94
What is the difference in the appearance of bullous pemphigoid and pemphigus vulgaris on immunofluorescence?
Bullous pemphigoid demonstrates linear immunofluorescence whereas pemphigus vulgaris reveals antibodies around cells of the epidermis in a reticular or netlike pattern
95
A patient presents with large bullae. On exam, there is epidermal separation on stroking of the lesion. What is this sign called and from what disorder is this patient suffering?
Positive Nikolskys sign; the patient has pemphigus vulgaris
96
True or False? A positive Nikolskys sign is common in both pemphigus vulgaris and bullous pemphigoid.
False; patients with bullous pemphigoid have a negative Nikolskys sign
97
Patients with bullous pemphigoid have what cell type within blisters?
Eosinophils
98
What skin condition is associated with celiac disease?
Dermatitis herpetiformis
99
Dermatitis herpetiformis is associated with pruritic papules and vesicles and deposits of what at the tips of dermal papillae?
Immunoglobulin A
100
Which skin disorder presents with multiple types of lesions, including macules, papules, vesicles, and target lesions?
Erythema multiforme
101
List four causes of erythema multiforme.
Infection (Mycoplasma pneumoniae, HSV), drugs, cancers, and autoimmune disease
102
Which syndrome is characterized by high fever, bulla formation, necrosis, ulceration of the skin, and a high mortality rate?
Stevens-Johnson syndrome
103
Stevens-Johnson syndrome usually has what etiology?
Drug reaction
104
A more severe form of Steven-Johnson syndrome is known as what?
Toxic epidermal necrolysis
105
Which skin disorder involves pruritic, purple, and polygonal papules?
Lichen planus
106
What infectious disease is associated with lichen planus?
Hepatitis C
107
Which skin disorder is described as small, rough, erythematous, or brownish papules?
Actinic keratosis
108
What kind of lesion is actinic keratosis: malignant, benign, or premalignant?
Premalignant
109
Name two clinical conditions that are associated with acanthosis nigricans.
Hyperlipidemia (ie., from Cushings disease, diabetes) and hyperinsulinemia
110
Erythema nodosum is characterized by inflammatory lesions of subcutaneous fat located on which part of the body?
Anterior shins
111
With what disease processes is erythema nodosum associated?
Coccidioidomycosis, histoplasmosis, tuberculosis, leprosy, streptococcal infections, sarcoidosis
112
What skin disorder is characterized by a herald patch followed by a Christmas tree distribution of lesions?
Pityriasis rosea
113
Describe the appearance and course of pityriasis rosea.
Multiple papular eruptions with spontaneous remissions
114
In what stage of life is strawberry hemangioma seen?
During the first few weeks of life
115
At what age does strawberry hemangioma typically regress?
5 to 8 years of age
116
At what age do cherry hemangiomas appear?
30 to 49 years of age
117
Cherry hemangiomas _____ (do/do not) regress spontaneously.
Do not
118
Squamous cell carcinoma is associated with what environmental exposures?
Sunlight and arsenic
119
Where does squamous cell carcinoma most commonly occur?
Hands and face
120
Does squamous cell carcinoma metastasize rarely or commonly?
Rarely
121
What is the histopathologic finding in squamous cell carcinoma?
Keratin pearls
122
What is a common precursor lesion to squamous cell carcinoma?
Actinic keratosis
123
What is the gross appearance of squamous cell carcinoma?
Ulcerative red lesion
124
Squamous cell carcinoma is associated with what chronic condition?
Associated with chronic draining sinuses in the skin
125
Keratoacanthoma is a variant of squamous cell carcinoma with what growth pattern?
Rapid growth (4-6 weeks) and spontaneous regression (4-8 weeks)
126
Where are basal cell carcinomas most commonly found?
On sun-exposed areas of the body
127
Basal cell tumors have _____ nuclei seen on histology.
Palisading
128
Basal cell carcinomas are locally invasive but almost never _____.
Metastasize
129
What is the gross appearance of basal cell carcinomas?
Pearly papules
130
A bald male patient presents with a lesion on the crown of his head. It has rolled edges with central ulceration. What type of cancer does he have?
Basal cell tumor
131
What aspect of a melanoma correlates best with the risk of metastases?
Depth of invasion
132
What lesion is a precursor of melanoma?
Dysplastic nevus (atypical mole)
133
What tumor marker is associated with melanoma?
S-100
134
Describe the physical appearance of melanoma on exam.
Dark with irregular borders
