Musculoskeletal and Connective Tissue Flashcards
1
Q
Where does the ACL extend?
A
Lateral femoral condyle to the anterior tibia
2
Q
where does the PCL extend?
A
From the medial femoral condyl to the posterior Tibia
3
Q
What is the anterior drawer sign?
A
Bend knee at 90 degree angel
Anterior gliding due to ACL injury
4
Q
What is the posterior drawer sign?
A
Bend at 90 degree angle (posterior gliding due to PCL injury)
5
Q
Abnormal passive abduction?
A
Bend at 30 degrees Lateral valgus (external roatation) has MCL injury
6
Q
Abnormal passive adduction
A
Knee extended at 30 degree angle (medial force means LCL injury
7
Q
What is the McMurray text
A
Flexion and extension of the knee with rotation of the tibia and foot (the sounds will have external popping sound: medial meniscal tear
Pain: popping on internal rotation (lateral meniscal tear)
8
Q
what is the unhappy triad of contact sports?
A
Lateral force applied to planted leg
Damage to : ACL, MCL and medial meniscus
(Can also have the lateral meniscus injury)
Will present with acute knee pain, and joint instability
9
Q
what is prepatellar bursitis?
A
Inflammation of the knee’s largest sac of synovial fluid
Can be caused by repeated trauma of from excessive kneeling
10
Q
What is a Baker’s cyst?
A
Popliteal fluid collection in the gatrocneimius -semi-membraneous bursa commonly communicating with the synovial space.
related to chronic joint disease
11
Q
what are the muscles of the rotator cuff?
A
Supraspinatus (abducts arm initially) before the action of the deltoid
(most common rotator cuff injury)
Infraspinatus: laterally rotates the arm (pitching injury)
Teres minor: adducsts and laterally rotates the arm
Subscapularis: upper and lower subscapular nerves (medially rotates and abducts the arm)
innervated by C5 and C6
12
Q
what is golfer’s elbow? (medial epicondylitis)?
A
Repetitive flexion (forehand shots) or idopathic Pain is near the medial epicondyle
Lateral epicondylitis: tennis elbow Repetitive extension (backhand shots) pain near the lateral epicondyle
13
Q
What are the wrist bones?
A
Trapezium Trapazoid Capitate Hameta Triquetrium Pisiform Lunale Sacphoid
14
Q
What is the most commonly fractured carpal bone?
A
The scaphoid
Usually due to fall on outstretched hand
Is prone to avascular necrosis due to retrograde blood supply
15
Q
what is the carpal tunnel syndrome?
A
entrapement of the median nerve in carpal tunnel
leads to paresthesi, pain and numbness
Thenar eminence is atrophoed
16
Q
What are diseases associated with the carpal tunnel syndrome?
A
Pregnancy RA Hypothyroidism Diabetes Dialysis related amyloidosis
17
Q
What is the Guyon Canal syndrome?
A
Compression of the ulnar nerve at wrist or hand
Clasically seen in cyclists due to pressure from the handlebars
18
Q
How is the axillar C5-C6 affected?
A
Fractured neck of the humerus, with anterior dislocation of the humerus
Will present with flattened deltoid
Loss of arm abduction at shoulder (15 degrees)
Loss of sensation over deltoid muscle and lateral arm
19
Q
Injury to musculocutaneous C5-C7
A
Other forearm
Usually due to trunk compression
Loss of foreamr flexion and supination
Loss of sensation over the lateral portion of the forearm
20
Q
Injury to the radial (C5-T1) ?
A
Midshaft fracture of the humerus
Compression of the axilla due to crutches or sleeping with the arm over chair
Wrist drop (loss of elbow)
Wrist and finger extension
Decreased in grip strength
Loss of sensation over the posterior arm and forearm of the dorsal hand
21
Q
Injury to median nerve C5-T1?
A
Supracondylar fracture of the humerus (proximal lesion)
Carpal tunnel syndrome (wrist laceration)
Presents with the ape hand or the Pope’s blessing
Loss of wrist flexion, flexion of the lateral fingers, thumb opposition
Loss of sensation over the thenar eminence and dorsal palmer aspects of lateral 3/1/2 fingers
Tinel syndome: tingling on percussion in carpal tunnel syndrome
22
Q
Injury to the Ulner C8-T1?
A
Fracture of the medial epicondyle of the humerus (funny bone…if proximal leision)
Fractured hook of hamate (distal lesion)
will have the ulnar claw on digit extension
Radial deviation of the wrist upon flexion (proximal lesion)
23
Q
Injury to the recurrent branch of the median nerve 9C5-T1)?
A
Leads to Ape Hand
Loss of thenar muscle group (opposition) abduction, and flexion of the thumb
No loss of sensation
24
Q
What is Erb’s palsy?
A
Injury of C5 -C6
Caused: lateral traction of the neck during delivery
Adults: Trauma
What is the muscle deficit and functional deficit:
Deltoid: abduction (arm hangs by the side)
Infraspinatus: lateral rotation (arm is medially rotated)
Biceps brachii: Flexion, supination (arm is extended and pronated)
25
Klumke palsy?
Traction or tear of the lower trunk (C8-T1)
Infants: upward force on the arm during delivery
Adults: trauma (grabbing a tree branch to break the fall)
```
Muscle deficit:
Lumbricals
Interossei
Thenar
Hypothenar
```
Leads to total hand clow
26
Thoracic outlet syndrome?
Compression of lower trunk and the subclavian vessels
Due to cervical rib, or the pancoast tumor
Causes atrophy of the intinsic hand muscles (ischemia, pain, and edema due to vascular compression)
27
What is the winged scapula?
Lesion of the long thoracic nerve
Due to axillary node dissection after the mastectomy
Stab wounds
Have inability to anchor the scapula to the thoracic cage (cannot abduct the arm above a horizontal position)
28
Describe the ulnar claw?
Pinkie and finger beside are pulled down
| Due to distal ulner nerve injury
29
What is the Pope's blessing?
Pinkie and finger beside are pulled down
| Atrophy of the remaining fingers
30
What is the median claw?
Middle finger, to thumb are curled down
| Distal median nerve compression
31
Ok gesture?
Pinkie and finger beside
32
What are the muscles of the Thenar median?
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Superficial head
(perform the functions: oppose, abduct, and flex)
33
What are muscles, and function of the hypothenar (ulnar)?
Opponens digiti minimi
Abductor digitit minimi
Flexor digiti minimi brevis
34
What do the dorsal interossei do?
Abduct the finger
35
What do the palmer interossei do?
Adduct the fingers
36
what do the lumbricals do?
Flex at the MCP joint, extend the PIP and DIP joins
37
Injury to obturator (L2-L4)?
Caused by pelvic surgery
| Decrease thigh sensation (medial, and decrease adduction)
38
Injury to femoral L2-L4?
Pelvic fracture
| Decrease thigh flexion and leg extension
39
Common peroneal L4-S2?
Trauma or compression of the lateral aspect of the leg (fibular neck fracture)
Results in foot drop (inervated and plantar flexed at rest)
Loss of sensation in the dorsum of the foot
40
Injury to the Tibial L4-S3 region?
Knee trauma, Baker cyst
Inability to curl toes, and loss of sensation on sole of foot
Proximal lesion: foot everted at rest with loss of inversion and plantar flexion
41
Injury to superior gluteal L4-S1?
Usually inatrogenci due to intramuscular injection
Trendenlenberg sign or gait
Pelvis tils because weight bearing leg cannot maintain alignement of the pelvis through hip abduction
Lesion is contralateral to the side of the hip drop (ipsilateral to the extremity on which the patient stands)
42
Inferior gluteal L5-S2 region?
Caused by posterior hip dislocation
Leads to difficulty climbing stairs, raising from seated position
Loss of hip extention
43
what does the sciatic nerve innervate?
Posterior thigh (before splitting to common peroneal and tibial nerves)
44
What does the pudendal nerve (S2 and S4) innervate?
The perineum (is blocked during childbrith) with ischial space as a landmark
Choose the superolateral gluteal quadrant as intramuscular injection sire to avoid nerve injury.
45
What are signs of lumbrosacral radiculopathy?
Parethesis and weakness in the specific regions
Often associated with disc herniation
Usually the disk protrude posterior
46
What is deficit if have L3-L4?
weakness of the knee extention and decfreased pateller reflex
47
What is deficit if have L4-L5?
Weakness of dorsiflexion, difficulty in heel walking
48
L5-S1 herniated disc?
Weakness of plantar flexion (difficulty in toe walking) decreased in achilles reflex
49
Artery associated with the long thoracic?
Lateral thoracic
50
Artery associated with surgical neck of humerus (axilla)
Posterior circumflex
51
Artery associaed with midshaft of humerous?
Nerve: Radial
Artery: Deep brachial
52
Artery/Nerve associated with the distal humerus and cubital fossa?
Median nerve
| Brachial artery
53
Nerve/Artery associated with the popliteal fossa?
Tibial nerve
| Popliteal artery
54
Nerve/artery associated with medial malleolus?
Tibial nerve
| Posterior tibial artery
55
How does muscle contraction occur?
action potential opens up calciym gated channels (neurotransmiter release)
ligand binds to muscle cell and causes depolarization ( at muscle end plate)
Depolarization travels along the muscle cell and down the T-tubule
Ca is released from sarcoplasma
Ca binds to troponin and causes conformational change in tropomyosin (out of the myosin binding groove)
Myosin releases bound ADP and PI
Shortening of the H and I band between the Z lines
Binding of the new ATP causes the myosin head to detach
56
what are the differences between the type 1 and type 2 muscles?
Type 1: slow twitch (red fibers) sustained contraction
Increase after endurance training
Type 2: fast twitch (white) increase after weight and resistance training.
57
What is the difference between endochrondral ossification and membraneous ossification?
Endochrondial: cartilogenous model osteoblasts and osteoclasts replace with woven bone
(axial, appendicular skeleton, base of skull)
Membraneous ossification: Bones of calvarium and face (formed without cartilege)
58
What is function of osteoblasts?
Builds bone by secreting collagen and mineralization in akaline environment
59
What are osteoblasts?
Dissolves bone by secreting H+ collegen
60
What does parathyroid hormone do?
High levels of TH levels will cause the catabolic effects (osteitis, fibrosa cystica)
61
What does estrogen do?
encourgages apoptosis of the osteoclasts
| Inhibits the apoptosis of osteoblasts
62
What is achondroplasia?
Failure of longitudinal bone growth (short limbs and large head)
Autosomal dominent with full pentrance (homozygous is lethal)
Most common cause of dwarfism
63
Describe the process of osteoporosis?
Cortical bone loss (even if the lab serum Ca is normal)
Can lead to vertebral compression fractures
Kyphosis, back pain, and loss of height
Can also present with fractures of the femoral neck (distal radius)
64
What is the cause of osteoporosis?
Increase bone absorption (due to decrease estrogen level)
Secondary to drugs (steroids and ETOH), anticonvulsants, anticoagulants, hyperparathyroidism, multiple myeloma etc
65
How is osteoporosis diagnoses?
Bone density with a T score < 2.5
| OR with fragility fracture of the hip or vertebrae
66
How to treat osteoporosis?
```
Calcium
Vitamin D during adulthood
Bisphophonates
Teriparatide
SERMS
Calcitonin
weight bearing exercise
```
67
What is osteopetosis?
Failure of normal bone absorption due to defective osteoclasts
Thickened dense bone that is prone to fracture
X-ray will show a stone appeared
Can have cranial nerve impingement and palsies due to narrowed foramina
Bone marrow transplant may be curative because osteoclasts are derived from monocytes
68
What happens in osteomalacia and rickets?
Has defective mineralization of osteoid (adults)
Defective cartilaginous growth plates in children
69
What do x-rays show?
Looser zones (pseudo fractures) in osteomalasia
Will have epiphyseal widening
Metaphyseal cupping and fraying in rickets
70
What do children with rickets have?
Have bow legs with bead like costochondral junctions
71
What are the lab values for osteomalacia and rickets?
```
Decreased vitamin D
Decreased serum Ca
Increased PTH secretion
Decreased PO4
Has hyperactivity of osteoblasts which cause increase in ALP
```
72
What is Paget disease of bone? (osteiti deformans)?
Local bone disorder
Have increased osteoclastic activity followed by increased osteoblastic activity.
This forms poor quality bone
73
What do the lab features of Paget's disease show?
Serum Ca increased
Phosphorous and PTH level are normal
Increased ALP
74
Why is there heart failure in Paget's disease?
Have increased blood flow from AV shunts
Can cause high output heart failure
Have an increase risk of osteogenic sarcoma
75
What are some clinical features of Paget's disease?
Hat sizing may be difficult due to skull thickening
| Can have hearing loss due to auditory foramen narrowing
76
What are the different stages of Paget's disease ?
Lytic: osteoclasts
Mixed: Osteoclasts and osteoblasts
Sclerotic: osteoblasts
Quiescent: minimal osteoclasts/osteoblast activity
77
What is osteonecrosis?
Infarction of the bone marrow (usually very painful)
| Caused by insufficiency of the femoral artery
78
What are the causes of osteonecrosis?
```
Corticosteroids
ETOH
Sickle Cell
Trauma
Bends
Legg-Calve Perthes disease (idiopathic)
Gaucher disease
Slipped capital femoral epiphysis
```
79
What are the two types of benign bone tumors?
Osteochondroma: Most common bengin tumor
Bony exostosis
Usually males less then 25 years old
Giant Cell tumor:20-40 years old
Epiphyseal end of the long bones (usually the knee)
Locally aggressive benign tumor (soap bubble appearance on x-ray)
80
What are the types of malignant tumors?
Osteosarcoma: second most common after multiple myeloma
Bimodal distribution : 10-20 years, and then older then 65
Usually at metaphysis of the long bones, around the knee
2) Ewing Sarcoma: Boys less then 15 years old (usually at diaphysis of the long bones, the pelvis, scapula, ribs
Anaplastic small cell malignant tumor
81
What are predisposing factors for sarcoma?
Li-Farumani
| Retinoblastoma
82
What are predisposing factors for Ewing sarcoma?
11+ 22 translocation
83
Pathogenesis of osteoarthritis vs RA?
OA: wear and tear, chrondocytes mediate degradation and inadequate repair
RA: autoimmune inflammatory cytokines and cells induce pannus
84
OA vs RA for predisposing factors?
OA: age, female, obseity, joint trauma
RA: Female, HLA-DR4, silica, + RA factor, anti-IgG
85
What is the presentation of OA vs RA?
Pain in weight bearing joints after use
Assymetric joint involvement
RA: pain, swelling, morning stiffness
Symmetric joint involvement
Systemic symptoms: fever, fatigue, weight loss
86
OA vs RA joint findings?
osteophytes (bone spurs)
Synovial fluid with WBC
Involves tje MCP, PIP, wrist, DIP
87
Treatment of OA vs RA?
OA: tylenol, NSAIDS, intra-articular glucocorticoids
RA: NSAIDS, glucocorticoids, disease modifiying agents (methrotrexate) sulfasalazine
88
What are extra-articular manifestations of RA?
```
Fibrinoid necrosis
Interstitial lung disease
Pleuritis
Pericarditis
Anemia of chronic
AA amyloidosis
Sjogren's
Scleritis
Carpal Tunnel syndrome
```
89
What are the findings associated with gout?
Inflammatory monoarthritis: precipitation of monosodium urate crystals in joints
More common in males
Caused by undersecretion of uric acid (90%) usually exacerbated by medication (thiazides)
Overproduction of uric acid (10% of patients) Lesch-Ny
90
How do the crystals look like?
Needle shaped, and birefringent under polarized light.
91
What are the symptoms of Gout?
Assymetric joint distribution
Joint is swollen and red and painful
Classic is painful MTP joint of the big toe
92
How to treat the gout?
NSAIDS
Glucocorticoids
Colchicine
Chronic: xanthine oxidase inhibitors
93
What is calcium pyrophosphate deposition disease?
Deposit of calcium pyrophosphate crystals within the space
Occurs in patients > 50 years old
Both in men and women
Have pain, swelling with acute inflammation (pseudogout) and chronic degeneration
94
How are the crystals for the calcium pyrophospate disease vs the gout?
Crytasls for gout are bifringent (yellow under parallel light)
Calcium pyrophosphate: rhomboid shaped, weakly bifringent (blue)
95
What is Sjogren's syndrome?
Autoimmune, destruction of exocrine glands (lacrimal and salivery) by lymphocyte infiltrates
96
What are the findings of Sjogren's syndrome?
```
Inflammatory joint pain
Keratoconjunctivitis sicca *dry eyes)
Zerostomia: dry salivery glands
Preseance of anti-nuclear antibodies: SS-A, anti-Ro, or SS-B
Bilateral parotid enlargement
```
97
What are possible complications of Sjogren syndrome?
Usually associated with RA, SLE, systemic sclerosis
Complications: dental cavities, MALT (mucosa associated lymphoid tissue, parotid enlargement
98
What are the main bugs that cause spetic arthritis?
Staph aureus, Streptoccus, N. Gonorrhea
99
What are the clinical features of septic arthritis ?
Red
Painful
WBC > 50,000
100
What are the signs of Septic Arthritis?
STI that presents with purulent arthritis (knee)
| Triad of : polyarthalgia, tenosynovitis, dermatitis, pustules
101
What is seronegative spondyloarthritis?
Arthritis wihout the Rheumatoid factor (no anti-IgG antibody)
Strong association with inflammatory back pain, periperheal arthritis, stiffness, enthesitis, dactylitis
102
Characteristics of psoriatic arthritis?
Skin and nail leisions
Have assymetirc and patchy involvement
Dactylitis and pencil in cup deformity on x-ray
103
What are the characteristics of inflammatory bowel disease?
Crohn's disease and ulcerative colitis are often associated with spondyloarthritis
104
What is the classic triad associated with Reiter's syndrome?
Conjunctivitis
Urethritis
Arthritis
105
What is classic presentation of SLE?
Rash
Joint pain
Fever
106
What is Libman-Sacks endocarditis?
Non bacterial verrucous thrombi (on mitral or aortic valve)
107
What is Lupus mephritis?
Glomular deposition of anti-DNA immune complexes
108
What are common causes of death in SLE?
Cardiovascular disease
Infections
Renal disease
109
What are other symptoms with SLE?
```
Rash
Arthritis
Serositis
Hematologica disorder
Oral and nasal ulcers
Renal disease
Photosensitivty
Anti-nuclear antibodies
anti-dsDNA, anti-sun
Neurological disorders
```
110
What are the lab findings of SLE?
ANA
Anti-dsDNA (poor prognosis, usually renal disease)
Anti-Smith
Antihistone antibodies (sensitive for drug induced lupus)
C3, C4, CH50
111
How to treat SLE?
NSAIDS, steroids, immunosuppressants
| Hydroxychloroquinine
112
what are characteristics of antiphospholipid syndrome?
Most common autoimmune after SLE
Diagnosis is usually due to history of thrombosis (arterial or venous)
Can have spontaneous abortion
Treat with systemic anticoagulation
113
What to note about anticardioiin antibodies and the lupus anticoagulant?
Can cause false positive of the VDRL/RPR and prolonged PTT
114
What is a mixed connective tissue disease?
Has features of SLE, systemic scelrosis, polymyositis
| Associated with anti UI
115
What are the characteristics of sarcoidosis?
Widespread granulomas
Have elevated serum ACE levels
Assymptomatic except for enlarged lymph nodes
Associated with the intersitial lung fibrosis, erthema nodosum, lupus pernio (skin lesions on face) uveitis, hypercalcemia
Treatment: steroids
116
What are characteristics of polymyalgia rheumatica?
Pain and stiffness in shoulders and hips
Associated with fever, malaise, and weight loss
NO MUSCULAR weakness
Most common in women > 50 years old
Associated with giant cell temporal arteritis
Have increased ESR and CRP, and CK
Has a rapid response to steroids.
117
What is fibromylagia?
Females 20-50 years old
| Widespread musculoskeletal pain with paresthesia, fatigue, congnitive disturbance
118
How is fibromyalgia treated?
Exercise
Antidepressents
Anticonvulsants
119
What are lab values of ploymyositis and dermatomypositis?
CK, ANA+, anti-Jo +, anti-SRP, anti-Mi
120
Characteristics of polymyositis?
Progressive muscle weakness with endomysial inflammation with CD8 T cells (often involves the shoulders)
121
Characteristics of dermatomyositis?
Similar to polymyositis except has a malar rash
Grotton papules (nodules on the hand)
Heliotrope rash
Perimysial inflammation and atrophy with CD4+ T cells
122
What are the 2 neuromuscular junction diseases?
Mysanthia gravis
| Lambert-Eaton myasthenic syndrome
123
What are characteristics of the Mysanthia gravis?
Patho: autoantiboidies to the Ach receptor
Clinical: ptosis, diplopia, weakness. Will worsen with muscle use
Associated with thymic hyperplasia or thymoma
Treatment: AchE inhibitor (will
124
Characteristics of Lambert-Eaton myasthenic syndrome?
Uncommon
Autoantibodies to presynaptic Ca channel (so decrease in AcH release
Clincial proximal muscle weakness, autonomic symptoms, improves with muscle use
Small cell carcinoma
Not well treated
125
Characteristics of myositis ossificans?
Hypertrophic ossification of the skeletal muscle following muscular trauma
Usually in the upper or the lower extremity
Usually incidental finding on the x-ray
126
What is the traid of scleroderma?
Autoimmune
Non inflammatory vasculopathy
Collagen deposition with fibrosis
Most common manifestation: puffy, taut skin without wrinkles and pitting fingertupes
127
What are the causes of death of scleroderma?
Renal
Pulmonart
Cardiovascular
Gi complications
128
Two types of scleroderma and complications?
Diffuse: widespread skin involvement, rapid progression, and associated with anti-scl 70 antibody
Limited: CREST syndrome Calcinosis, Raynad, Esophageal dismotility, Sclerodactyl, Telangiectasia
Associated with the anti-centromere antibody
129
Characteristics of Raynaud's phenomenon?
Decreased blood flow due to vasospasm of small vessels due to cold or stress
Colour is blue or white, and changes to the red
What is raynaud's syndome? When associated with SLE, or CREST
130
What is digital ulceration of Raynaud?
| Treatment?
When you have critical ischemia of the tips of the fingers
| Treatment with Ca blockers
131
what are the 3 skin layers?
epidermis
Dermis
Subcutaenous
132
What are the layers of the epidermis?
```
Stratum Corneum
Stratum Luciderm
Strantum Granulosum
Stratum Spinosum
Stratum Basale
```
133
What are the types of junction for epithelial cells?
Tight junctions: prevents paracellular movement of soluts
Adherens: connects cytoskeletons of adjacent cells
Desmosomes: structural support via filaments
Gap junctions: channel proteins that allows electrical and chemical communication between the cells.
134
Hemidesmosome?
Connects keratin to the basal membrane
135
Integrins?
Membrane proteins that maintain the integrity of basolateral membrane by binding to collagen and laminin
136
Macule?
Flat lesion, well circumscribed change in skin color less then 1 cm
137
Patch?
Macule more then 1cm (large birthmark)
138
Papule?
elevated skin lesion < 1 cm
| Moleor acne
139
Plaque?
Papule > 1 cm (psoraiasis)
140
Vesicle?
Fluid containing < 1 cm
| Chicken pox
141
Bulla?
Large fluid containing blister > 1 cm
| Bullous pemphigoid
142
Pustule?
Vesicle with pus
| Pustular psoarisis
143
Wheal?
transient smooth papule or plaque
| hives
144
Scale?
Flaking of the stratum corneum (Eczema, psoriasis, SCC)
145
Crust?
Dry exudate (impetigo)
146
Hyperkeratosis?
Increase thickenss of stratum corneum (psoriasis, calluses)
147
Parakeratosis?
Hyperkeratosis with retention of the nuclei in stratum corneum (psiasis)
148
Hypergranulosis?
Increase thickness of stratum granulosum (lichen planus)
149
Spongiosis?
epidermal accumulation of edematous fluid within intracellular space (eczematous dermatitis)
150
Acantholysis vs acanthosis?
Seperation of epidermal cells (pemphigus vulgaris)
| Acanthosis: acanthosis nigricans
151
Albinism?
Normal melanocytes, with decrease in melanin production
Due to decrease tyrosinase activity
Increase risk of skin cancer
152
Melasma?
Hyperpigmentation assocaited with pregnancy
153
Vitligo?
Irregular areas of pigmentation, caused by autoimmune destruction of melancytes.
154
Acne?
Pilosebaceous follicle with increase sebum and jeratin
Propionibacterium acne: onstuction and inflammation
Treat with retinoids, benzoyl peroxide and antibiotics
155
Atopic dermatitis? (eczema)
Pruritic eruption (at skin flexures)
Assocaited with atopic disease like asthma, allergie
Increase in serum IgE
In the face during infancy
156
Allergic contact dermatitis?
Type IV hypersensitivity reaction after exposure to an allergen
157
Melanocytic nevus?
Common mole (benign) but the melanoma can come fromth atypical mole
158
Psoriasis?
Papules and plaques with silvery scaling on kneesand elbows
Acanthosis with parakeratotic scaling (corneum layer)
Auspitz sign: pinpoint bleeding spot from exposure of the dermal papillae where scale is removed
159
Rosacea?
Inflammatory disorder with erythematous papules and pustules but no comedones
Phymatous rosacea can cause rhinophyma(bulbous deformation of the nose)
160
Seborrheic keratosis?
Greasy squamous epithelial proliferation with keratin filled cysts
161
Verrucae?
Warts, caused by HPV, soft and looks like cauliflower
162
Urticaria?
Hives.
| Pruritic wheals that form from mast cell degranulation
163
Angiosarcoma?
Blood vessel malignancy
Usually head, neck, breast areas
Elderly, sun exposed
Associated with radiation therapy and post mastectomy
Hepatic angiosarcome associated with vinyly chloride and arsenic
Very aggressive (usually delayed diagnosis)
164
Bacillary angiomatosis?
Benign capillary skin papules in AIDS patinet
| Caused by Bartonella Hensleae infection
165
Cherry hemangioma
Benign capillary hemangioma
Does not regress
Increase with the elderly
166
Cystic hygroma ?
Cavernous lypmhangioma of the neck, associated with Turner syndrome
167
Glomous tumor?
Benign
Painful
Redblue
Under the fingernails
168
Kaposi Sarcoma?
Endothelial malignancy of the the skin
Can also be found in the mouth, GI tract, and respiratory
Associated with HHV and HIV
169
Pyrogenic granuloma?
Polyploid (lobulated capillary hemangioma) can ulcerate and bleed
Associated with trauma and pregnany
170
Strawberry hemangioma?
Benign hamngioma
| Occurs in 1/200 births, grows rapidly, and then regresses spontaneously
171
Impetigo?
Superficla skin infection
S aureus and S pyrogens
Very contageous
Bullos impetigo is caused bu S aureus
172
Eryspelas?
Infection of the dermis and lymphatics of the dermis
| Sharp demcarcation between normal and abnormal skin
173
Cellulitis?
Acute, painful infection of the dermis and subcutaenous
Caused by the S-aureus and S pyrogens
Usually have break in the skin
174
Abcess?
Collection of pus from walled off infection within deeper layers of the skin
Offending organism is always S. Aureus
175
Necrotizing fascitiis?
Deeper tissue injury from anaerobic bacteria (S.pyrogens)
Will have crepitus from methane
Causes bullae and purple color of the skin
Flesh eating bacteria
176
Staphylococcal scalded skin syndrome?
Exotoxin destroys keratinocyte attachements to the stratum granulosum only
Fever and generalized erythematous rash that has sloughing off of the upper layers of the dermis that heals comletely
177
What are the Herpes infection?
HSV1 and HSV 2 can occur anywhere there is mucosal surface.
Herpes labialis , genitals, and the finger
178
Molluscum Contagiosum?
Umbilicated papules caused by poxvirus
| Frequently seen
179
Varicella Zoster virus?
Causes chicken pox, and singles
| Will have multiple crops with different ages.
180
Hairy leukoplakia?
Irregular, white, plaques on lateral portion of the tongue
181
Pemphigus vulgaris?
Can be fatal autoimmune skin disorder with IgG antibody desmoglein
Flaccid intraepidermal bullae caused by acantholysis
Immunofluorecece around will have netlike pattern
182
Bullous pemphigod?
```
Less severe then pemphigus vulgaris
Involved IgG antibodies against hemidesmosoms
Forms tense blisters
Immunofluorescence shows linear pattern
Nikoslsky sign is negative
```
183
Dermatitis herpetiformis?
Pruritic papules, vesicles, and bullae around the elbows
Deposits of IgA at tips of the dermal papillae
Associaed with celiac disease
Treatment with Dapsone (gluten free diet)
184
What is erythema multiforme?
Associated with with infections, drugs, sulfa drugs
185
What is Steven Johnson Syndrome?
Fever, bullae formation with necrosis and sloughing off of he skin
High mortaity rate
Usually adverse drug reaction
A more toxic form called toxic dermal necrolysis has 30% of the body surface with lesions.
186
Acnathosis nigricans?
Epidermal hyperplasia
Hyperpigmentation of the skin in axilla or the neck region
Associated with insulin resistance and visceral malignancy (gastric adenocarcinoma)
187
Actinic keratosis?
Small rough, erythomatous or brownish plauqe
Premalignany
Risk of cancer depends on the degree of epithelial dysplasia
188
Erythema nodosum>
Painful
Inflammatory leisions of subcutaneous fat (usually anterior of the shins)
often idiopathic but can be associated to sarcoidosis, coccidoidomycosis, histoplasmosis, TB, leprosy
189
lichen planus?
```
Prurituc
Purple
Polygonal
Papules
Plaques
assocaited with hep C
```
190
Pityriasis rosea?
Herald patch, followed by scaly erythematous plaues
| Christmas tree distribution on the trunk
191
Sunburn?
Acute, inflammatory reaction to UV radiation
| Causes DNA mutation and apoptosis of keratinocytes
192
Basal cell carcinoma?
Most common
Sun exposed areas of the body and face
Locally invasive, rare to metastasizw
Can also appear as ulcer or non healing scaling
193
Squamous cell carcinoma?
Second most common cancer
Exposure to sunlight
Locally invasive
No mets
looks like keratin pearls
Actinic keratosis: scaly plauqe (precursor)
Keratoacanthoma: varient that grows fast, 4-6weeks, and mat regress after
194
Melanoma?
```
Risk increased in fair person with sun exposure
Assymeetry
Border irregular
Color variation
Diameter more then 6
Evolution over time
```
Types of melanoma:
Superficial spreading
Nodular
lentigo maligna
acral lentiginous
195
Acetominophen mechanism?
Inhibits cyclooxygenase in CNS
Anti fever, and analgesia (NO anti-inflammatory)
Overdose causes hepatic necrosis
N-Acetylcysteine is the antidote.
196
ASA mechanism?
Irreversibly inhibits cyclooxygenase (COX-1 and COx2) by covalent acetylation
Decrease of synthesis of TXA2
Low dose < 300 mg/day will decrease platelet function
300-2400 anti-pyretic and analgesia
HIgh dose 2400-4000 anti-inflammatory
Adverse effects: gastric ulcer, tinnitus, renal failure, interstitial nephritis,
Risk of Reye syndrome in children treated with ASA for viral infection
197
Mechanism of Celecoxib?
Reversibly inhibits COX 2 isofrom 2 (inflammatory and vascular endothelium)
Mediates inflammation and pain
Use in RA and osteoarthritis
Increase risk of thrombosis
198
Mechanism of NSAIDS?
Include Ibuprofen, naproxen, indomethacine, ketorolac, diclofenac
Mechanism: reversibly inhibit COX 1 and COX 2
Blocks prostaglandin syntheis
Anti-pyretic, analgesic, anti-inflammatory
Indomethacin is used to close the PDA
199
Mechanism of Leflunamide?
Reversibly inhibits dihyroorotate dehydrogenase preventing pyrimidine synthesis
200
Mechanism of Bisphosphonates?
(examples include Alendrotnate, ibandronate, resdronate, zoledronate)
Binds to hydroxyapatite and inhibits osteoclast activity
Clinical use: Osteoporosis, hypercalcemia, Paget's disease of the bone, metastatic bone disease, osteogeneis imperfecta
201
Mechanism of Teriparatide?
PTH analog given subcutaneously
Increase in osteoblastic activity
Used for osteoporosis (increase in bone growth)
Can cause transient hypercalcemia
202
What are the gout drugs?
Allopurinol
Hibitis xanthine oxidase
Also used in lymphoma and leukemia to prevent tumor lysis
Febuoxstat
Inhibits xanthine oxidase
Pegloticase
Recombinant uricase that catalyses metabolism of uric acid
Probenecid inhibts resorption of uric acid in proximal convoluted tubule
203
What are drugs that are used for acute gout?
NSAIDS (naproxen, indomethacom_
Do not give salicylates (all but highest dose will depress uric acid clearence
Glucocoticoids: oral, intra-articular or prenteral
Colchicine: Binds and stabilizes tubulin to inhibit mircrotubule polymerization
204
TNF-Alpha inhibitors?
All TNF-Alpha inhibitors predispose to infection including reactivation of latent TB since TNF is important to granuloma formation and stabilization
205
What about the drug etanercept?
```
Fusion protein (receptor TNF-alpha
Used for EA, psoriasis, ankolosing spodylitis
```
206
Infliximab, adalimumab
Anti-TNF alpha monoclonal antibody
| Used for inflammatory bowel disease, ankolysing spondylitits, psorasis
207
Rasburicase?
Recombinent uricase that catalyzes metabolism of uric acid to allantoin
Clinical use: pervention and treatment of tumor lysis syndrome
