Musculoskeletal Flashcards
1
Q
What cell type are responsible for the inflammatory response in gout? And what drug targets this inflammatory response?
A
Neutrophils
Colchicine - interferes with microtubule formation necessary for neutrophil chemotaxis.
2
Q
What are the 5 layers of the epidermis (from surface to base)?
A
“Californians Like Girls in String Bikinis”
- stratum Corneum
- stratum Lucidum
- stratum Granulosum
- stratum Spinosum
- stratus Basalis
3
Q
Where in skin are blood vessels located?
A
in the dermis (below the epidermis)
4
Q
Which layers of the epidermis are affected in psoriasis?
A
- stratum granulosum is decreased
- stratum spinosum is increased (get plaque formation in spinosum)
5
Q
Eccrine glands
A
secrete sweat
6
Q
Sebaceous glands
A
associated with hair follicles; holocrine secretions of sebum (holocrine secretions = plasma membrane ruptures, destroying cell, thereby secretion product into lumen)
7
Q
Zona occudens
A
=tight junction
- ->between cells
- ->composed of claudins and occludins
8
Q
Zona adherens
A
=intermediate junction
- ->between cells
- ->composed of Cadherins (Calcium-dependent Adhesion molecules) that connect to Actin
9
Q
Macula adherens
A
=Desmosome
- ->between cells
- ->autoantibodies to desmosomes = pemphigus vulgaris
10
Q
Gap junctions
A
between adjacent cells
–>cardiac cells, osteocytes, neurons (electrical coupling)
11
Q
Integrin
A
connects basolateral surface of cell to basement membrane
12
Q
Hemidesmosome
A
connects cell to underlying extracellular matrix (to basement membrane)
–>autoantibodies to hemidesmosomes = bullous pemphigoid
13
Q
“Unhappy Triad” Knee injury:
A
- Force from Lateral side, causing damage to:
- MCL = Medial Collateral Ligament
- ACL = Anterior Cruciate Ligament
- Lateral (or Medial) Meniscus
14
Q
Abnormal passive abduction of the knee?
A
indicates torn MCL (medial collateral ligament)
15
Q
ACL and PCL attach to what bone?
A
Tibia
16
Q
Level to do a lumbar puncture?
A
Level of Iliac crest (about L4)
17
Q
Pudendal nerve block is done where?
A
Ischial spince
18
Q
4 Rotator Cuff muscles:
A
SItS
- Supraspinatus
- Infraspinatus
- teres minor
- Subscapularis
19
Q
Muscle that initiates abduction of the arm (first 10-15 degrees), before deltoid kicks in?
A
Supraspinatus
–>injury to supraspinatus is the most common rotator cuff injury
20
Q
Common cause of long thoracic nerve injury (and thus winged scapula)?
A
–>Mastectomy (or any trauma/injury to axillary region)
21
Q
Bones of the wrist (from thumb to pinky)
A
“Some Lovers Try Positions That They Can’t Handle”
- Scaphoid
- Lunate
- Triquetrum
- Pisiform
- Trapezium
- Trapezoid
- Capitate
- Hamate
22
Q
Which nerve innervates the thumb + 2.5 fingers of the palm of the hand?
A
Median nerve
23
Q
Which nerve innervates the thumb + half of the hand on the dorsum of the hand?
A
Radial nerve
24
Q
Which nerve innervates the pinky + 1/2 ring finger on both the palm and dorsum of hand?
A
Ulnar nerve
25
What nerve is lesioned by a fracture of the surgical neck of the humerus or by dislocation of the humerus?
Axillary nerve
26
Nerve injured in a lesion to the shaft of humerus?
Radial nerve --> get "wrist drop"
27
Which nerve may be compressed by the use of crutches in the axilla or by "Saturday Night Palsy"?
Radial nerve compression --> get "wrist drop"
28
Lesioned nerve if fracture hook of hamate?
Ulnar nerve
29
Lesioned nerve if fracture medial epicondyle of humerus?
Ulnar nerve
30
Compressed nerve if fracture supracondylar area of humerus?
Median nerve
31
Part of brachial plexus that is compressed by a Pancoast tumor of the ung?
Lower trunk of brachial plexus --> get Kumpke's palsy (total claw hand - loss of function of all lumbricals, get clawing of all the digits)
32
Which side of hand is the carpal tunnel?
-->flexor retinaculum, on palmar side of wrist
33
What muscle protects the brachial plexus from injury in a clavicle fracture?
Subclavius muscle
34
How to test for an axillary nerve injury?
Test sensation over deltoid
35
5 nerves that come off the brachial plexus? Which are extensors? Flexors?
"MARMU"
- Musculocutaneous
- Axilary
- Radial
- Median
- Ulnar
* Extensors = Axillary and Radial
* Flexors = Musculocutaneous, Median, Ulnar
36
Lesion to upper trunk of brachial plexus (C5, C6):
- what's this called?
- symptoms?
- what may cause this?
Erb's palsy = "waiter's tip"
--> can't abduct arm; arm is medially rotated; and hand is out behind back, like waiting for a tip
-->may be caused by trauma to shoulder (like in a car accident) or trauma during child delivery
37
Injury to Long Thoracic Nerve?
-->Winged Scapula
38
Injury to Lower trunk of Brachial Plexus (C8,T1):
- what's this called?
- symptoms?
- what may cause this?
- ->"Klumpke's palsy" = "Claw Hand" of ALL digits
- ->symptoms = all fingers form a claw (vs ulnar nerve injury claw hand-->only 4th and 5th digits can't extend, form claw)
-->may occur d/t an embryologic or childbirth defect
39
Injury to Posterior Cord of Brachial Plexus?
Can't extend hand, so get "wrist drop" (can't extend, so hand just hangs flaccidly)
*makes sense, b/c posterior cord gives rise to the axillary and radial nerves, which are the extensors
40
Injury to axillary nerve:
- causes?
- symptoms?
* caused by fracture to surgical neck of humerus or dislocation of humerus
* symptoms:
- paralysis of deltoid, so can't abduct arm at the shoulder (can still do initial abduction)
- decreased sensation over deltoid
41
Injury to Radial nerve:
- causes?
- symtpoms?
* causes:
- crutches compressing radial nerve at axilla or compression from saturday night palsy
- fracture of midshaft of humerus
* symptoms:
- wrist drop; can't extend with brachioradialis, extensors of wrist and fingers, supinators, triceps... all extensors :(
- also: loss of sensation over posterior arm, dorsal hand (the part supplied by radial) and dorsal thumb
42
Injury to Musculocutaneous nerve:
| -symptoms?
- decreased flexion of arm at the elbow (b/c musclocutaneous innervates the flexors: biceps, brachialis, coracobrachialis)
- decreased sensation at lateral forearm
43
Distal lesion to Median Nerve:
- cause?
- symptoms?
* Causes:
- carpal tunnel syndrome
- dislocated lunate
* Signs:
- "Pope's blessing" --> can't extend 2nd and 3rd digits, so they are both clawed
44
Proximal lesion to Median Nerve:
- cause?
- symptoms?
* Cause = fracture of supracondylar humerus
* symptoms:
- "Ape Hand" --> can't oppose/abduct thumb d/t atrophy of thenar muscles (so thumb is basically glued to other fingers, laterally)
45
Distal lesion to Ulnar nerve:
- cause?
- symptoms?
* Cause = fractured hook of hamate (like if fall onto outstretched hand)
* Symptoms:
- Clumsiness of hands
- Ulnar "claw hand" --> can't extend 4th and 5th digits, so they are both in a claw (pinky and ring finger)
46
Sensory defect over Lateral Forearm?
Injury to Musculocutaneous nerve
47
Sensory defect over Posterior arm?
Injury to Radial nerve
48
Proximal lesion to ulnar nerve:
- cause?
- symptoms?
- fracture at medial epicondyle (funny bone)
| - problems with flexion; decreased sensation over the hypothenar eminence, medial 1.5 fingers.
49
Waiter's tip position of hand: injury to?
Upper Trunk of brachial plexus (C5, C6)
50
Claw hand, involving all digits: injury to?
Inferior Trunk of Brachial Plexus (C8, T1)
51
Function of Lumbricals?
- Flex MCP joints
- Extend DIP and PIP joints
*so make an "L" with fingers/hand
52
Claw Hand, but of only the pinky and ring finger (4th and 5th digits): injury to?
Distal Ulnar Nerve injury: loss of medial lumbrical function
53
"Pope's Blessing" - can't extend the 2nd and 3rd digits: injury to?
median nerve injury--> loss of lateral lumbrical function
54
"Ape Hand" - can't abduct the thumb: injury to?
Proximal median nerve injury (like if fracture the supracondylar humerus)
55
2 Complications of Mastectomy?
1) Winged Scapula (injury to Long thoracic nerve, and thus Serratus Anterior)
2) Lymphedema (which may lead to Lymphangiosarcoma)
56
Long Thoracic Nerve innervates what muscle?
Serratus Anterior
57
Muscles of the Thenar Eminence? Innervation?
Meat lOAF:
* Median Nerve
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis
58
Muscles of the Hypothenar Eminence?
| Innervation?
* Ulnar nerve
- Opponens digiti minimi
- Abductor digiti minimi
- Flexor digiti minimi
59
Functions of the Dorsal vs Palmar Interosseous Muscles:
"DAB PAD"
- Dorsal--> ABduction of fingers
- Palmar--> ADduction of fingers
60
Where should intramuscular injections into butt be done? Why?
- ->Inject into supero-lateral quadrant of but
- ->to avoid "gluteus medius gait"
- if inject into superomedial quadrant-->may injure gluteal nerves
- if inject into inferomedial quadrant--> may injure sciatic nerve
- if inject into inferolateral quadrant--> lots of muscles have tendinous insertions here
61
Positive Trendeleburg sign
- ->when standing on one leg, shift weight to opposite side of body than the standing leg
- ->d/t injury to the the superior gluteal nerve; so injury to gluteus medius and minimus muscles
62
Can't evert or dorsiflex foot?
-->injury to common peroneal nerve; get "foot drop"
"PED" - "Peroneal Everts and Dorsiflexes; if injured, the foot is dropPED"
63
"Foot drop"
- d/t injury of common peroneal nerve
| - can't dorsiflex foot
64
Can't invert or plantarflex foot?
Injury to Tibial Nerve
"TIP" - "Tibial nerve Inverts and Plantarflexes; if injured, can't stand on TIP toes"
65
Sciatic Nerve
on posterior thigh; splits into common peroneal and tibial nerves
66
Deep Peroneal Nerve:
| -innervates?
-innervates Anterior compartment of leg
67
Superficial Peroneal Nerve:
| innervates?
innervates Lateral compartment of leg
68
Tibial Nerve:
- innervates?
- if injured?
Posterior compartment of leg
* if injured:
- can't invert of plantarflex foot (inversion = moving sole foot towards medial plane; plantarflexion = standing on tiptoes; so, can't do either of these things)
- decreased sensation at sole of foot
69
In skeletal muscle contraction, which parts of the sarcomere change length?
I-band and H-band both shorten in muscle contraction
* I-band = Thin filaments ONLY
* H-band = Thick filaments ONLY
* Z-lines will move closer together (b/c entire sarcomere contracts, gets shorter)
* **note: A-band is the entire length of the thick thilament, regardless of overlap by thin filament; so, it's length does not change during contraction
70
Drugs that act at the Dihydropyridine receptor? What's the effect?
Dihydropyridine Calcium-Channel Blockers (ie Nifedipine and Amlodipine
-by binding to the dihydropiridine receptor, can't get conformational change, so don't get Calcium release from sarcomplasmic reticulum (so, it blocks muscle contraction)
71
Dantrolene mechanism and use?
Dantrolene binds the Ryanodine receptor on the sarcoplasmic reticulum; so, prevents conformational change and release of Calcium from Sarcomplasmic Reticulum (so, blocks skeletal muscle contraction)
* Uses for dantrolene:
- Malignant hyperthermia (from inhalation anesthetics and succinylcholine)
- Neuroleptic malignant syndrome (toxicity of anti-psychotic drugs)
72
Dihydropyridine and Ryanodine receptors:
```
Dihydropyridine = voltage-dependent Calcium channels in T-tubules
Ryanoide = Calcium release channels in sarcoplasmic reticulum
```
***in close proximity to each other...
73
Type 1 vs Type 2 muscles:
* Type 1:
- Red fibers (b/c lots of mitochondria and myoglobin; so increased oxidative phosphorylation)
- slow twitch
- for sustained conraction
* Type 2:
- white fibers (b/c fewer mitochondria and myogobin; more in anaerobic glycolysis)
- fast twitch
- get hypertrophy of fast-twitch, type 2 fibers in weight training
74
Which type of muscle fibers are hypertrophied in weight trainers?
Type 2 muscle fibers --> white, fast-twitch fibers; involved in anaerobic gycolysis
75
Effect of Nitric Oxide on Smooth Muscle Contraction (mechanism):
Nitric Oxide --> Guanylate Cyclase --> increased cGMP --> inhibits MLCK --> Smooth muscle Relaxation
76
MLCK (Myosin Light Chain Kinase) and MLCP (Myosin Light Chain Phosphatase)
*both are involved in mechanism of smooth muscle contraction/relaxation:
* MLCK--> phosphorylates myosin to myosin-P --> get smooth muscle contraction
- MLCK is activated by Calcium binding to Calmodulin
*MLCP --> dephosphorylates myosin-P to myosin --> get smooth muscle Relaxation (stimulated by Nitric Oxide, Sildenafil, etc... increased cGMP)
77
Calmodulin
Calcium-binding messenger protein
*in smooth muscle contraction: Calcium binds calmodulin --> activates MLCK --> phosphorylates myosin --> smooth muscle contraction
78
Endochondral ossification: what kind of bone growth?
- ->Longitudinal bone growth
- first have a cartaliginous bone model made by chondrocytes
- defect in endochondral ossification in achondroplasia; so short limbs
79
Membranous ossification: what kind of bones grow this way?
- ->flat bone growth (skull, face, axial skeleton)
| - functional in achondroplasia; so, have large head...
80
Continuous activation of FGFR3 (Fibroblast growth factor receptor)?
-->inhibits chondrocyte proliferation; leads to Achondroplasia
81
Genetic inheritance of Achondroplasia:
- associated with increased paternal age
- Autosomal dominant inheritance
- if homozygous dominant --> lethal in utero
82
What type of bone loss in osteoporosis?
Trabecular/spongy bone loses mass
83
Type 1 vs Type 2 osteoporosis:
Type 1 = postmenopausal women
| Type 2 = senile; affects men and women >70 yo
84
Treatment of choice (and other trtmnts) for osteoporosis?
* Bisphosphonates = treatment of choice
* other options:
- SERMs
- Calcitonin
- Pulsatile PTH in severe cases
85
Colles' fracture
fracture of distal radius; see in osteoporosis
86
Erlenmeyer flask on x-ray
=bones flare out on x-ray
| -->see in osteopetrosis
87
Osteopetrosis:
- cause?
- presentation?
- lab values of serum Ca, P, ALP, PTH?
- abnormal function of osteoclasts d/t a genetic deficiency of carbonic anhydrase II --> have failure of bone resorption, so get really thick, dense bones that are prone to fracture;
* NORMAL levels of Ca, P, ALP, and PTH
* have decreased marrow space, b/c bone fills it up; so, have pancytopenia (anemia, thrombocytopenia), and have extramedullary hematopoiesis
* can also cause cranial nerve impingement and palsies, because of narrowed foramina
88
Cause of osteomalacia?
| Lab values of Ca, P, ALP, PTH?
=Rickets in kids
- ->d/t vitamin D deficiency
- decreased Ca, elevated PTH, decreased P, normal ALP
89
Paget's disease of bone:
- cause?
- Presentation?
- Lab values of Ca, P, ALP, PTH?
*Cause: Increase in both osteoclasts and osteoblasts; FIRST get increase in Osteoclast activation; followed by increase in osteoblasts
* Get mosaic bone pattern
- increased hat size
- hearing loss d/t auditory foramen narrowing
- may lead to osteogenic sarcoma
- may be viral in origin (paramyxovirus)
- may get high output heart failure
* Labs:
- elevated ALP (really elevated), but normal Ca, P, PTH
90
"brown tumors" of bone:
see with osteitis fibrosa cystica (primary hyper-parathyroidism)
91
Polyostotic fibrous dysplasia:
bone's replaced by fibroblasts, collage, irregular bony trabeculae
-->get this with McCune-Albright syndrome (+endocrine probs/precocious puberty + cafe-au-lait spots)
92
bone replaced by fibroblasts and collagen + precocious puberty/endocrine abnormalities + cafe au lait spots
McCune Albright Syndrome
| --> a form of polyostotic fibrous dysplasia (where bone is replaced by fibroblasts, collagen, etc...)
93
colon polyps + lipomas + osteomas?
Gardner's syndrome
94
Which bone tumor is associated with Retinoblastoma?
Osteosarcoma (Rb)
95
Most common benign tumor of bone?
Ostochondroma
* see in men <25 years of age
- rare for it to become malignant
96
onion skin appearance in bone
Ewing's sarcoma
| -->anaplastic small blue cell malignant tumor; seen in boys <15 yo
97
11;22 translocation, associated with what bone tumor?
Ewing's sarcoma
| -->anaplastic small blue cell malignant tumor; seen in boys <15 yo
98
Malignnat bone tumor in men b/w 30-60 years old?
Chondrosarcoma (all other bone tumors, benign and malignant, seem to affect younger pts)
99
Codman's triangle (elevation of periosteum) on x-ray?
Osteosarcoma (associated with Paget's disease, familial retinoblastoma...)
100
"soap bubble" or "double bubble" on bone x-ray?
Giant cell tumor = Osteoclastoma; a benign bone tumore (osteoma)
101
noninflammatory pain in joints at the end of the day?
Osteoarthritis
| -->affects DIP and PIP
102
Heberden's nodes
DIP --> affected in Osteoarthritis
103
Bouchard's nodes
PIP --> affected in osteoarthritis
104
joint space narrowing from destruction of articular cartilage, and sclerosis on x-ray of joint?
- ->Osteoarthritis
| - also have subchondral cysts, osteophytes, eburnation
105
Eburnation
polished, ivory-like appearance of bone; see in osteoarthritis
106
What type of hypersensitivity reaction is Rheumatoid Arthritis?
Type III hypersensitivity
107
pannus formation in joints?
Rheumatoid arthritis
108
Baker's cyst
behind the knee; see in Rheumatoid arthritis
109
Rheumatoid Factor:
IgM antibody that is anti-IgG
-->secreted by B-cells
***Cartilage components act as autoantigens --> activate CD4 T-cells --> B cells secrete RF, which is specific for the Fc component of IgG
110
morning stiffness that lasts >30 mins, improves with use + symmetric joint involvement + systemic symtpoms?
Rheumatoid arthritis
111
Treatment options for Rheumatoid Arthritis:
- NSAIDs
- COX-2 inhibitors
- Glucocorticoids
- Methotrexate, Sulfasalazine, Hydroxychloroquine (all are disease-modifying drugs)
112
"can't see, can't spit, can't climb up shit"
- -> Sjogren's:
- xerophthalmia (dry eyes, conjunctivitis)
- xerostomia (dry mouth, dysphagia)
- arthritis
113
Strong association with HLA-D4?
Rheumatoid Arthritis
| note: DM I is also associated with HLA-D4
114
anti-SS-A (anti-Ro) and anti-SS-B (anti-La)
Sjogren's syndrome
115
negatively-birefringent needle-shaped yellow crystals + PRPP excess + hyperuricemia?
Gout
116
Podagra
=painful MTP joint (big toe)
| --> Gout
117
Tophus formation on ear, olecranon bursa, Achilles tendon
Gout
118
Why gout exacerbations after alcohol consumption?
b/c alcohol metabolites compete for same excretion sites in kidney as uric acid; so, get decreased uric acid secretion --> hyperuricemia --> goutttttt
119
Acute and Chronic treatments for Gout:
* Acute:
- NSAIDs (ie indomethacin, naproxen) = drug of choice for acute gout
- Colchicine
* Chronic:
- Allopurinol
- Febuxostat (inhibits xanthine oxidase)
- Probenecid (inhibits reabsorption of uric acid in PCT)
120
Calcium Pyrophosphate, rhomboid crystals, weakly positive-birefringent
Pseudogout
121
swollen, red, painful joints; monoarticular , migratory arthritis with asymmetrical pattern; unprotected sex...
Gonococcal arthritis (septic infectious arthritis)
122
Causes of septic arthritis:
- Gonorrhea
- S. aureus
- Streptococcus
123
Causes of chronic infectious arthritis?
- TB (after mycobacterial dissemination)
| - Lyme disease
124
Seronegative Spondyloarthropathies:
- Why "seronegative"?
- HLA associated with them?
- List them
- Seronegative b/c no RF
- HLA-B27
- PAIR:
- ->Psoriatic arthritis
- ->Ankylosing spondylitis
- ->IBD
- ->Reactive Arthritis (Reiter's syndrome)
125
seronegative spondyloarthropathy that involves sacroiliac joints?
Ankylosing spondylitis
126
Seronegative spondylarthropathy with "pencil-in-cup" deformity on x-ray + dactylitis?
Psoriatic arthritis
127
"bamboo spine"
ankylosing spondylitis
128
"can't see, can't pee, can't climb a tree"
- ->Reactive Arthritis (follows chlamydia or GI/Shigella infections)
- conjunctivitis + anterior uveitis
- urethritis
- arthritis
129
Reactive arthritis usually follows what kinds of infections?
- Shigella (GI)
| - Chlamydia
130
anti-phospholipid antibodies
SLE
| -->may cross-react with cardiolipin on syphilis tests, giving a false (+) RPR/VDRL
131
anti-dsDNA antibodies
SLE
| -->associated with renal disease (so, specific and poor prognosis)
132
Anti-histone antibodies
Drug-induced Lupus
* SHIPP
- Sulfonamides
- Hydralazine
- Isoniazid
- Procainamide
- Phenytoin
***have increased risk of drug-induced lupus in pts who are slow acetylators of drugs in the liver...
133
anti-Smith antibodies
SLE
| -->specific, but not prognostic
134
Signs/Symptoms of SLE:
- Malar rash (worse in sun)
- Discoid rash
- antibodies (anti-nuclear = ANA, anti-dsDNA, anti-Smith, anti-Histones (drug-induced), anti-phospholipid (cross-react with Syphilis tests))
- Mucositis (oropharyngeal ulcers)
- Neurologic symptoms
- Libman-Sacks endocarditis
- Hilar lymphadenopathy
- Wire-loop lesions in kidneys with immune complex deposition
- Serositis--> Pericarditis, Pleuritis
- Arthritis
135
Non-caseating granulomas, hilar lymphadenopathy, hypercalcemia, interstitial fibrosis (restrictive lung disease), erethyma nodosum, Bell's palsy, black women...
Sarcoidosis
136
Why hypercalcemia in Sarcoidosis?
-->have elevated vitamin D activation in epithelioid macrophages --> elevated vitamin D
137
Treatment for sarcoidosis?
Steroids
138
What type of lymphocyte is elevated in broncho-alveolar lavage fluid in Sarcoidosis?
CD4 T-cells
139
Joint pain and stiffness, but no muscle weakness; elevated ESR; normal CK (b/c no muscle weakness); associated with Temporal/Giant Cell Arteritis:
Polymyalgia Rheumatica
140
Treatment for Polymyalgia Rheumatica?
Prednisone (also treat Temporal/Giant Cell Arteritis with high-dose steroids...)
141
Treatment for Fibromyalgia?
TCAs/Anti-depressants
142
Progressive muscle weakness caused by CD8 T-cell-induced injury to myofibers; usually in shoulders; positive ANA, anti-Jo-1, and elevated CK, elevated aldolase?
Polymyositis
- ->associated with increased risk of malignancy
* **note: if rash + polymyositis --> Dermatomyositis
143
progressive symmetric muscle weakness caused by CD8 T-cell-induced injury to myofibers + Rash (malar rash, heliotrope rash, shawl-and-face rash, etc), + positive ANA, anti-Jo-1, elevated CK, elevated aldolase?
Dermatomyositis
| -->associated with increased risk of malignancy
144
Myasthenia Gravis:
- autoantibodies to?
- how does muscle use affect symptoms?
- autoantibodies to post-synaptic ACh receptors
- symptoms worsen with muscle use
- reverse symptoms with AChE inhibitors (Edrophonium test...)
145
Lambert-Eaton syndrome:
- autoantibodies to?
- how does muscle use affect symptoms?
- autoantibodies to presynaptic Calcium channels, so get decreased ACh release --> proximal muscle weakness)
- symptoms improve with muscle use
146
What paraneoplastic disease is associated with Lambert-Eaton syndrome?
Small cell lung cancer
147
Affect of AChE-inibitors on Myasthenia Gravis? Lambert Eaton?
- ->reverses Myasthenia Gravis (b/c problem is with the ACh receptors)
- does not reverse Lambert-Eaton (b/c problem with ACh release)
148
Which neuromuscular jxn disease is associated with a thymoma?
Myasthenia Gravis
149
Proximal vs Distal weakness?
```
Proximal = muscle problem (like with Lambert-Eaton)
Distal = neuro problem (has longer path to get there; more room for errors!)
```
150
What is scleroderma?
-->excessive fibrosis and collagen deposition throughout the body
151
anti-DNA topoisomerase I antibody (=anti-Scl-70 antibody)
Diffuse scleroderma
152
anti-Centromere antibody
CREST scleroderma
153
which has worse clinical course: diffuse or CREST scleroderma?
- ->Diffuse = faster progression, early visceral involvement
| - ->CREST - more benign clinical course
154
CREST scleroderma:
- Calcinosis (subepithelial calcium deposits)
- Raynaud's
- Esophageal dysmotility
- Sclerodactyly
- Telangiectasia
155
What is hyperkeratosis?
increased thickness of stratum corneum (see with psoriasis)
156
What is urticaria?
Hives; get pruritic wheals after mast cell degranulation
157
Atopic Dermatitis:
=Eczema
- ->pruritis; often associated with other atopic diseases (asthma, allergic rhinitis)
- ->also seen in Wiskott-Aldrich syndrome (deletion of B and T-cells; elevated IgE and IgA, but decreased IgM; also have: thrombocytopenic purpura and infections)
158
What type of hypersensitivity rxn is allergic contact dermatitis (ie from nickel, poison ivy...)?
=type IV hypersensitivity
159
salmon-colored plaques with silvery scaling; plaques bleed if scales are scraped off:
=Psoriasis
| "Auspitz sign" = bleeding when scales scraped off
160
Changes in epidermis layers in Psoriasis:
- increased stratum spinosum; decreased stratum granulosum
- also: hyperkeratosis = increased thickness of stratum corneum; and parakeratosis = retention of nuclei in stratum corneum
161
Seborrheic keratosis:
- ->squamous epithelial proliferations, look like they are pasted on and can easily be peeled off
- ->commonly seen in older people
- ->benign, but should have melanoma as part of dd
162
Vitiligo?
Have areas of skin with decreased pigmentation; d/t decrease melanocytes
163
Melasma/Chloasma
Hyperpigmentation of skin associated with pregnancy or OCP use
164
Contagious, honey-colored crusting of skin
Impetigo
| -->S. aureus or S. pyogenes (GAS)
165
White, painless plaques on tongue that CANNOT be scraped off; often in HIV pts?
-->Hairy Cell Leukoplakia
*EBV-mediated
(not to be confused with hairy cell leukemia; a B-cell neoplasm with TRAP as a tumor marker)
166
autoimmune skin disorder with IgG antibodies; blisters on skin and oral mucosa; epidermis separates when stroke skin
--> Pemphigus Vulgaris
anti-ephithelial cell antibody = IgG anti-Desmosome antibody
***potenitally fatal
167
Autoimmune skin disorder with IgG antibodies; blisters on skin, but not on oral mucosa; skin does not separate when stroked
--> Bullous pemphigoid = anti-hemidesmosome antibodies = antibodies against the epidermal basement membrane
-->less severe than pemphigus vulgaris
168
Pruritis + GI/malabsorption?
Celiac:
- pruritis/rash = Dermatitis Herpetiformis
- ->have deposits of IgA at the tips of dermal papillae
169
Fever + Bulla formation and necrosis + sloughing of skin; often associated with adverse drug reaction; high mortality rate
Stevens-Johnson syndrome
| associated with seizure drugs, etc
170
Toxic epidermal necrolysis
=more severe form of Stevens-Johnson syndrome
171
Pruritic, Purple, Polygonal Papules?
- ->Lichen planus
| - associated with Hepatitis C!
172
Skin disorder associated with Hepatitis C?
-->Lichen Planus (pruritic, purple, polygonal papules)
173
Actinic Keratosis
premalignant lesions associated with sun exposure; risk of progression to squamous cell carcinoma
174
Lichen Planus
Pruritic, Purple, Polygonal Papules
| -->associated with Hepatitis C
175
Acanthosis nigricans:
- what part of skin is effected?
- associated with?
- hyperplasia of stratum spinosum
| - see with hyperglycemia (ie Cushing's, Niacin use, Diabetes) and visceral malignancies (like gastric adenocarcinoma)
176
S-100 tumor marker
Melanoma
177
Keratin pearls on histopathology
Squamous cell carcinoma
178
actinic keratosis is a precursor to what type of skin cancer?
precursor to squamous cell carcinoma
179
What skin cancer is associated with arsenic exposure?
Squamous cell carcinoma
| also, of course, associated with excessive sunlight exposure
180
Atypical skin mole is a precursor to what type of skin cancer?
Melanoma
181
Effect of Aspirin on BT, PT, PTT?
- Increased Bleeding Time
| - No effect on PT, PTT
182
Naproxen
NSAID (alleve!)
183
Ketorolac
an NSAID, given by IV
184
Benefit of COX-2 inhibitors over other types of NSAIDs?
-->less corrosive effects of NSAIDs on the gastric mucosa (still have some though, just less!)
185
How does Acetaminophen differ from NSAIDs?
-->also reversibly inhibits COX-1 and COX-2 (like NSAIDs), BUT, mostly acts in the CNS. It's inactivated peripherally, so is not used as an anti-inflammatory analgesic drug
186
Antidote of Acetaminophen? What's it's mechanism?
antidote = N-acetylcysteine --> regenerates glutathione (which is depleted in acetaminophen overdose)
187
Consequences of Acetaminophen overdose?
- ->Hepatic necrosis; acetaminophen metabolite depletes glutathione, so forms toxic tissue adducts in liver
- ->treat by giving N-acetylcysteine, which regenerates glutathione
188
Bisphosphonates:
- mechanism?
- all end in what suffix?
- cinical uses?
- toxicities?
- all end in "-dronate" (Etidronate, Pamidronate, Alendronate, Risedronate, Zoledronate)
- Mechanism = inhibit osteoclast activity (analog of pyrophosphate, which is a component of hydroxyapatite, so reduces both formation and resorption of hydroxyapatite
* clinical uses:
- paget's disease
- menopausal osteoporosis
- malignancy-associated hypercalcemia
* toxicities:
- errosive esophagitis (NOT Zoledronate though); so should take drug upright, not before bed
- osteonecrosis of jaw!
- nausea, diarrhea, blah blah
189
Probenicid
used to treat chronic gout
- inhibits reabsorption of uric acid in the PCT
- ->ALSO: inhibits secretion of penicillin! (so, makes penicillin last longer!)
190
Allopurinol:
- use?
- mechanism?
- what 2 drugs have increased concentrations when taken with allopurinol? and why?
- treatment for chronic gout
- inhibits xanthine oxidase (so decreased conversion of xanthine to uric acid)
- can also in lymphoma and leukemia
* Allopurinol increases concentrations of:
- Azathioprine (anti-metabolite precursor of 6-MP; used for kidney transplants and autoimmune disorders)
- 6-Mercaptopurine (anti-metabolite; inhibits purine synthesis)
- ->b/c these both are normally metabolized by xanthine oxidase!
191
Febuxostat
chronic treatment of gout
| -->inhibits xanthine oxidase
192
Colchine mechanism? side effects?
- ->used for acute treatment of gout
- binds and stabilizes tubulin, inhibiting polymerization; this impairs leukocyte chemotaxis and degranulation!
* Side effects:
- ->GI: Diarrhea
193
Drug of choice in treatment of acute gout?
#1 choice = NSAIDs (Naproxen, Indomethacin...)
*can also use colchicine or steroids to treat acute gout
194
List the 3 TNF-alpha inhibitors:
- Etanercept
- Infliximab
- Adalimumab
195
Etanercept mechanism?
-->Recombinant form of the TNF receptor, so binds TNF
-->uses: RA, psoriasis, ankylosing spondylitis
196
Infliximab mechanism?
anti-TNF antibody
-->uses: Crohn's, RA, ankylosing spondylitis
197
Adalimumab mechanism?
anti-TNF antibody
-->uses: RA, psoriasis, ankylosing spondylitis
198
Main thing that must be checked before initiating therapy with TNF-alpha-inhibitors?
-->Do PPD to check for latent TB; because if inhibit TNF-alpha --> can get activation of macrophages and reactivation of latent TB infection.
