Musculoskeletal, skin and connective tissues Flashcards
20 - 50 female, 对称性、弥漫性肌肉痛 + insomnia + fatigue: Dx? Rx? 和 polymyalgia rheumatic, polymyositis 鉴别诊断
Fibromyalgia 纤维肌痛 病因不明 Rx：regular exercise + antidepressenets (TCAs, SSRIs) + anticonvulsants
> 50 yr, 双侧、对称性pain and stiffness in shoulders and hips, often with constitutional sym (night fever, malaise, weight loss): Dx? disease association? lab? Rx?
Dx: polymyalgia rheumatica 风湿性多肌病 disease association： temporal arteritis (50%颞动脉炎病人合并此病 - 怀疑颞动脉炎要马上给激素，防止blindness） lab: ↑ ESR, ↑ CRP, normal CK Rx: low-dose steroids
2nd MC skin cancer? cause? Cx? 好发部位？microscope? if metastasize? precursor disease (重要考点）？ a variant disease? 其特点？
2nd MC skin cancer: SCC (squamous cell carcinoma) cause: sun, immunosuppression, arsenic exposure Cx: ulcerative lesions with frequent scale 好发部位: face, lower lip, ears, hands microscope: keratin “pearls” if metastasize: rarely, locally invasive, but may spread to lymph nodes precursor disease (重要考点): AK (actinic keratosis) 光化性角化病 a variant disease：keratoacanthoma 角化棘皮瘤 grow rapidly (4-6 wks), but may regress spontaneously over months
Acanthosis nigricans (AN): Cx? Disease association (最重要的考点！！）？
Cx: epidermal hyperplasia, symmetrical hyperpigmented, velvety thickening of skin, 好发部位在neck and axilla 腋窝 associated with: 2大类，分为良性、恶性： 1. benign AN: insulin resistance (DM, obesity, cushing syn) 2. malignant AN: visceral malignancy, especially GI and genitourinary neoplasm 如果是中老年病人，忽然出现黑色棘皮，一定要怀疑恶性肿瘤 最常见的肿瘤：gastric adenocarcinoma
Acetaminophen: 什么类型药？ Mechanism? 可逆否？作用位点？inactivation位点？ 是否解热？是否抗炎？Use？ toxicity and the mechanism? antidote?
扑热息痛，和NSAID类似，都是可逆地抑制COX 作用位点: CNS inactivation位点： peripheral 是否解热？ - yes (anti-pyretic) 是否抗炎？- No Use: use instead of aspirin in children to avoid Reye syn toxicity and the mechanism: hepatic necrosis; acetaminophen metabolite (NAPQI) depletes glutathione - form toxic tissue adducts in liver antidote: N - acetylcysteine (regenerate glutathione)
Albinism病因？黑色素细胞数目有无变化？
normal melanocyte #, with ↓ melanin production 病因： 1. ↓ tyrosinase activity 2. defective tyrosine transport 3. failure of neural crest cell migration during development ↑ risk of skin cancer
actinic keratosis: Cx? why important?
光化性角化病 Cx: small, rough (feel like “sand paper”) erythematous or red/brown papules on sun-exposed area; confined to epidermis premalignent to SCC! need to be monitored
acute gout drugs?
- NSAIDs: naproxen 萘普生; indomethacin 2. glucocorticoids (oral or intraarticular) 3. colchicine (stabilize microtubulin ; inhibit chemotaxis of leukocytes) GI side effects
Adalimumab: 什么类型药？同种药物还有什么？ Mechanism? use? 要注意什么？
anti-TNFa McAb （同种药物还有Infliximab） use: IBD,RA, psoriasis, AS (ankylosing spondylitis) 要注意什么：prediposit for infection (reactive latent TB)
allergic contact dermititis: type ? hypersensitivity reaction major histological changes?
type IV histological changes: spongiosis 棘细胞水肿
Allopurinol抗痛风的机制？同样的药物还有？ 如果用于lymphoma, leukemia机制？要注意什么？
Allopurinol抗痛风机制：inhibit XO (xanthine oxidase) 同样的药物还有Febuxostat。急性发作时是禁忌症（应用NSAIDs) 如果用于lymphoma, leukemia机制: prevent tumor lysis-caused irate nephropathy 要注意如果和azathioprine, 6-MP联用抗肿瘤，会↑ 这两种药物concentration: (both metabolized by XO)， 所以如果联用，一定要降低抗肿瘤药物的剂量！！！！
Ankylosing spondylitis: Cx? XR? HLA (class I or II?) 累及其他的器官表现？
Cx: chronic dull back pain, morning stiffness, can be relieved by over-counter pain killer; 一生中不断缓解和复发 XR: “bamboo spine”- vertebral fusion HLA-B27 (class I; class II are DR, DP, DQ) 除了脊柱之外常累及: 1) respiratory: pain limits chest expansion - hypoventilation: 病人随访中必须监测chest expansion 2) cardiac: ascending aortitis ⇒ dilation of aortic ring, aortic insufficiency - AR (aortic regurgitation) 3） eye: uveitis: pain in the eyes, blurred vision, 结膜充血
Aspirin: Mechanism? 作用可逆否？ Clinical use? Toxicity? 对respiratory center作用？
Mechanism? 作用可逆否: covalently acetylate cyclooxygenases (both COX1 and COX2), ⇒ ↓ TXA2, PGs Clinical use: 1. low dose (< 300 mg/day): anti-platelet aggregation (↑ bleeding time until new platelets are made: ~ 7 d; no change in PT, PPT) 小剂量aspirin用于prevention of transient ischemic attack, MI, stroke [对于PE不如wafarrin有效，对于DVT不如heparin有效】 2. intermediate dose (300 - 2400 mg/d): anti-pyrectic, analgesic 3. high dose (> 2400 mg/day): anti-inflammation Toxicity: 1. in adults: gastric ulcer, tinnitus (CN VIII), chronic use caused GI bleeding, nephritis, acute renal failure 2. to treat kids for viral infection: Reye syn stimulate respiratory center⇒ hyperventilation ⇒ respiratory alkalosis
atopic dermatitis又名？ 诊断hallmark? associated with diseases?
atopic dermatitis又名eczema 湿疹 诊断hallmark： intense pruritis, can’t Dx without it 常在5-6岁（甚至婴儿期起病），start on the face in infancy, and often appears in the antecubital fossae thereafter; 终身反复， often associated with other atopic diseases (asthma, allergic rhinitis - UW 考点）
biphosphonates （Alendronate, other -dranotes) 什么类型药？ Mechanism? clinical use? toxicity? 如何预防？
什么类型药：pyrophosphate analogues Mechanism: inhibit osteoclast activity by binding to hydroxyapatite in bone clinical use: osteoporosis, 恶性高钙血症， Paget disease toxicity - corrosive esophagitis; osteonecrosis of the jaw 如何预防- pts take lot of water and remain upright for 30 min;
Dx: fever + generalized erythematous rash + sloughing of the upper layers of the epidermis that heals completely; seen in newborns and children
Dx: Staphylococcal scalded skin syndrome exotoxin destroys keratinocyte attachments in the stratum granulosum (颗粒层，皮肤从外到里第3层）， ⇒ destroy the epidermal dermal junction
blistering skin disorders有哪两种？ 区别： 1. 严重程度？ 2。Ab against? 3. oral mucosa involvement? 4. 荧光染色location? pattern? 5. Nikolsky sign positive/negative?
PA vs. bullous pemphoid, see “notes for printing”
Dx: multiple types of skin lesions (macules, papules, vesicles, “target lesions”-targets with rings and a dusky center showing epithelial disruption) associated with?
Dx: erythema multiforme associated with: 1. infection - mycoplasma pneumoniae, HSV 2. drugs (sulfa, beta-lactams, phenytoin) 3. cancers 4. autoimmune
Dx: multiple plaques with collarette scale (蜀黍红疹）， “herald patch” followed days later by “X’mas tree” distribution?
Pityriasis rosea 玫瑰糠疹 self-resolving in 6-8 wks
Dx: progressive symmetric proximal muscle weakness (常考的描述是“can’t comb hair, can’t raise from chair, 说明累及shoulders and hips):最可能的诊断？ activation of which immune cells? release cytokines?
Dx: polymyositis endomysial inflammation with CD8+ Th1 cells： activate macrophage to release IL-1, TNFa
Dx: proximal muscle weakness (can’t comb hair, can’t clim up stairs) + autonomic sym (dry month, diplopia, impotence)? associated with which disease? 病因？和什么疾病鉴别？
Dx: Lambert-Eaton myathenic syndrome (LEMS) associated with small lung cancer (i.e.: CXR 可见mass in upper lung) 病因: autoantibodies to presynaptic Ca2+ channel ⇒ ↓ Ach release (improve with muscle use) 和什么疾病鉴别: MG (myasthenia gravis) - ab against Ach postsynpatic receptors, worsen with muscle use, associated with thymoma, sym can be reversed with AchE inhibitors)
