Musculoskeletal

Question 1

What are the 6p’s of lichen planus?

Answer 1

PRURITIC
PURPLE
POLYGONAL
PLANAR
PAPULES
PLAQUES

Question 2

Lichen planus a blistering skin disorder? Assoc with?

Answer 2

No.

Hep C

Question 3

5 infectious skin disorders?

Answer 3

Impetigo
Cellulitis
Necrotizing fasciitis
SSC
Hairy leukoplakia

Question 4

Define cellulitis

Answer 4

Acute, painful, spreading infection of dermis and subcutaneous tissue. Starts from break in skin from trauma or infection

Question 5

What is impetigo and cellulitis associated with?

Answer 5

S. Aureus, s. Pyogenes

Question 6

3 major skin cancers?

Answer 6

SCC
BASAL CELL CARCINOMA
MELANOMA

Question 7

Cancer assoc with arsenic exposure?

Answer 7

SCC

Question 8

SCC can spread where? Histopath includes what?

Answer 8

Spread to lymph nodes.

Keratin “pearls “

Question 9

What two skin disorders assoc with SCC?

Answer 9

Actinic keratosis- scaly plaque and precursor to SCC

Keratoacanthoma- variant that can grow rapidly and regress spontaneously.

Question 10

Risk of melanoma for metastasis?

What are the ABCDEs?

Answer 10

Highly metastatic, Depth of tumor assoc with risk of metastasis.

Asymmetry, border, color, diameter, evolution over time.

Question 11

What is the tumor marker for melanoma? Associated with what mutation?

Answer 11

S-100 tumor marker

Driven by activating mutation in BRAF kinase.

Question 12

Describe Aspirin mechanism

Answer 12

Inhibits cox1 cox2 via covalent acetylation to decrease TXA2 AND prostaglandins. Increase bleeding time for life cycle of platelet (7 days). No effect on pt, PTT. A type of NSAID.

Question 13

Clinical a dosages for aspirin

Question 14

Toxicities for aspirin?

Answer 14

GI ulceration, bleeding. Tinnitus (cn VIII). Reye’s syndrome for kids tx for viral infection. Stimulates respiratory centers can cause hyperventilating and resp alkalosis.

Question 15

Particular use of indimethacin? What kind of drug is it?

Answer 15

Used to close PDA, is an NSAID

Question 16

Name the 5 blistering skin disorder

Answer 16

Pemphigus vulgaris- autoimmune of igG to desmosin
Bulbous pemphigoid- igG to hemidesmosomes
Dermatitis herpetiformis- igA deposits at dermal papillae, associated with celiacs
Erythema multiforme- assoc with mycoplasma pneumonia with, hsv. Look like targets
Steven-Johnson syndrome- associated with adverse drug rxn. 2 membranes involved.

Question 17

Name 2 benign bone tumors

Answer 17

1. Giant cell tumor (soap bubble at epiphysis) 2. Osteochondroma (metaphysis)

Question 18

Name 3 malignant bone tumors

Answer 18

1. Ewing Sarcoma (diaphysis) 2. Chondrosarcoma (diaphysis) 3. Osteosarcoma “Codman triangle (Metahpysis)

Question 19

Compare contrast osteoarthritis and rheumatoid arthritis

Answer 19

O is mechanical due to age, obesity, trauma, joint deformity. Pain in weight-bearing joints with improvement after use. Tx NSAIDS, glucocorticoids. RA is autoimmune due to inflammation and destruction of synovial joints. Pannus formation, ulnar deviation of fingers. Tx NSAIDS, gluccocorticoids , TNF-alpha inhibitors.

Question 20

Sjogren syndrome. Autoimmune or mechanical? Symptoms.

Answer 20

Autoimmune due to destruction of exocrine glands (lacrimal/salivary). Xeropthalmia (decreased tear production), xerostomia, bilateral parotid enlargement.

Question 21

Describe polymyositis and dermatomyositis

Answer 21

Polymyositis- symmetric proximal muscle weakness due to inflammation of CD8 T cells. Dermatomysositis- similar to polymyositis including malar rash (seen in SLE), shawl and face rash. Tx steroids.

Question 22

Define Myositis ossification

Answer 22

Metaplasia of skeletal muscle to bone following muscular trauma.

Question 23

Define scleroderma

Answer 23

Excessive fibrosis and collagen deposition throughout the body. Leads to puffy and taught skin.

Question 24

Define CREST ( a type of scleroderma)

Answer 24

CREST: Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactlyly, Telangiesctasia.

Question 25

Describe RA

Answer 25

Autosomal disorder with genetic predispositions for HLA-DR4 or switching of arginine to citrulline.

Clinical Presentation: effecting small joints (not DIP), morning stiffness, pannus formation (fibrous granulation tissue in joints), cervical spine involvement
Labs: anti-citrulline antibodies.