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Step 1 Exam > Musculoskeletal, Skin, and CT - First Aid > Flashcards

Musculoskeletal, Skin, and CT - First Aid Flashcards

1
Q

Tight junction (aka zonula occludens)

A

prevents paracellular movement of solutes; composed of claudins and occludins

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2
Q

Adherens junction (aka zonula adherens)

A

below tight junction; forms belt connecting actin cytoskeletons of adjacent cells with cadherins

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3
Q

Cadherins are…

A

Ca2+ dependent adhesion proteins.

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4
Q

Loss of E-cadherin promotes…

A

metastasis.

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5
Q

Desmosome (macula adherens)

A

structural support via keratin interactions

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6
Q

Autoantibodies to the desmosome cause…

A

pemphigus vulgaris.

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7
Q

Gap junction

A

channel proteins called connexons permit electrical and chemical communication between cells

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8
Q

Integrins

A

membrane proteins that maintain the integrity of basolateral membrane by binding to collagen and laminin in the basement membrane

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9
Q

Hemidesmosome

A

connects keratin in basal cells to the underlying BM

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10
Q

Autoantibodies to the hemidesmosome leads to…

A

bullous pemphigoid (hemidesmosomes are down “bullo”)

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11
Q

Anterior drawer sign tests for…

A

ACL injury.

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12
Q

Posterior drawer sign tests for…

A

PCL injury.

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13
Q

Valgus stress (abduction) tests for….

A

MCL injury.

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14
Q

Varus stress tests for (adduction)….

A

LCL injury.

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15
Q

McMurray test

A

pain on external rotation = medial meniscus pain on internal rotation = lateral meniscus

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16
Q

Unhappy Triad

A

injury due to lateral force applied to planted leg; consists of damage to ACL, MCL and medial meniscus (or lateral meniscus)

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17
Q

Pudendal nerve block is given….

A

to relieve the pain of delivery into the ischial spine.

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18
Q

Rotator Cuff Muscles

A

Supraspinatus Infraspinatus Teres minor Subscapularis

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19
Q

Supraspinatus

A

-suprascapular nerve -abducts arm initially -most common rotator cuff injury

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20
Q

Infraspinatus

A

-suprascapular nerve -laterally rotates arm -pitching injury

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21
Q

Teres minor

A

-axillary nerve -adducts and laterally rotates arm

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22
Q

Subscapularis

A

-subscapular nerve -medially rotates and adducts arm

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23
Q

The most commonly fractured carpal bone is…

A

the scaphoid bone and it is prone to avascular necrosis due to retrograde blood supply. It can be palpated in the anatomical snuff box.

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24
Q

Dislocation of the lunate may cause…

A

acute carpal tunnel.

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25
Q

A fall on an outstretched hand that damages the hook of hamate can cause…

A

ulnar nerve injury.

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26
Q

Carpal Tunnel Syndrome

A

entrapment of median nerve leading to parestesia, pain and numbness

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27
Q

Guyon Canal Syndrome

A

compression of the ulnar nerve classically seen in cyclists

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28
Q

Erb Palsy is an injury of the…

A

upper trunk caused by lateral traction on infant’s neck during delivery or trauma in adults.

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29
Q

Erb Palsy Muscle/Functional Deficits

A

Deltoid/Supraspinatus - abduction (arm hangs by side) Infraspinatus - lateral rotation (arm is medially rotated) Biceps brachii - flexion, supination (arm extended and pronated)

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30
Q

Klumpke Palsy is an injury of the….

A

lower trunk due to upward force on infant arm during delivery or adult trauma.

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31
Q

Klumpke Palsy Muscle/Functional Deficits

A

total claw hand due to intrinsic hand muscle deficits

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32
Q

Thoracic Outlet Syndrome is a….

A

compression of lower trunk and subclavian vessels due to a cervical rib injury or a Pancoast tumor.

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33
Q

Thoracic Outlet Syndrome has the same deficits as…

A

Klumpke’s palsy.

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34
Q

Winged Scapula is an injury of…

A

the long thoracic nerve due either axillary node dissection after masectomy or stab wounds.

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35
Q

Winged Scapula Muscle/Functional Deficits

A

Serratus Anterior = cannot abduct arm above a horizontal position

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36
Q

Causes of injury to the axillary nerve (C5-C6)

A

fractured surgical neck of humerus; anterior dislocation of the humerus

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37
Q

Presentation of axillary nerve injury

A

-flattened deltoid -loss of arm abduction past 15 degrees -loss of sensation over delt and lateral arm

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38
Q

Cause of injury to musculocutaneous nerve (C5-C7)

A

upper trunk compression

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39
Q

Musculocutaneous Injury Presentation

A

-loss of forearm flexion/supination -loss of sensation over lateral forearm

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40
Q

Cause of injury to Radial nerve (C5-T1)

A

-midshaft fracture of humerus -compression of axilla due to crutches or sleeping with arm over chair

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41
Q

Presentation of radial nerve injury

A

-wrist drop -decreased grip strength -loss of sensation over posterior arm/forearm and dorsal hand

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42
Q

Cause of injury to Median nerve (C5-T1)

A

-supracondylar fracture of humerus -carpal tunnel syndrome or wrist laceration

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43
Q

Presentation of Median nerve injury

A

-ape hand and pope’s blessing -Tinel sign (tingling on percussion) -loss of sensation over thenar eminence and dorsal/palmar aspects of lateral 3.5 fingers

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44
Q

Cause of injury to the Ulnar nerve (C8-T1)

A

fracture of the medial epicondyle of the humerous or fractured hook of hamate

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45
Q

Ulnar nerve injury presentation

A

-ulnar claw -loss of sensation over medial 1.5 fingers including hypothenar eminence

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46
Q

Injury to the recurrent branch of the median nerve

A

superficial palm laceration

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47
Q

Presentation of recurrent median nerve injury

A

ape hand -loss of thenar musclegroup -no loss of sensation

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48
Q

Interosseous Muscles DAB PAD

A

Dorsals ABduct Palmars ADduct

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49
Q

Lumbrical muscles act to…

A

flex and the MCP and extend at the PIP and DIP.

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50
Q

Obturator (L2-L4) injury is due to…

A

pelvic surgery and leads to decreased thigh sensation and decreased adduction.

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51
Q

Femoral (L2-L4) injury is due to…

A

pelvic fracture and leads to decreased thigh flexion and leg extension.

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52
Q

Common peroneal (L4-S2) injury is due to…

A

trauma or compression of the lateral aspect of the leg or fibular neck fracture.

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53
Q

Common peroneal injury presents with…

A

foot drop and loss of sensation on dorsum of foot

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54
Q

Tibial injury (L4-S3) can be due to…

A

knee trauma, baker cyst or tarsal tunnel syndrome.

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55
Q

Tibial injury presents with…

A

inability to curl toes and loss of sensation on the sole of the foot; if lesion is proximal, foot loses inversion and plantar flexion

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56
Q

Superior gluteal nerve (L4-S3) injury is due to…

A

posterior hip dislocation or polio.

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57
Q

Superior gluteal injury presents with..

A

Tendelenburg gait.

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58
Q

Trendelenburg gait is when…

A

the pelvis tilts because the weight-bearing leg cannont maintain alignment of the pelvis through hip abduction

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59
Q

In Trendelenburg gait, the lesion is…

A

contralateral to the side of the hip that drops.

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60
Q

Inferior gluteal nerve injury is due to…

A

posterior hip dislocation.

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61
Q

Inferior gluteal nerve presentation

A

difficulty climbing stairs, rising from seated position; loss of hip extension

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62
Q

The sciatic nerve splits into…

A

the common peroneal and tibial.

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63
Q

Axilla/Lateral Thorax nerve and artery

A

long thoracic n. and lateral thoracic a.

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64
Q

Surgical neck of humerus nerve and artery

A

axillary n and posterior circumflex a.

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65
Q

Midshaft of humerus nerve and artery

A

radial n and deep brachial a.

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66
Q

distal humerus/cubital fossa nerve and artery

A

median n and brachial a.

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67
Q

Popliteal fossa nerve and artery

A

tibial n and popliteal a.

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68
Q

medial malleolus nerve and artery

A

tibial n and posterior tibial a.

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69
Q

Type 1 Muscle Features

A

-slow twitch -red fibers (from incresaed mitochondria/myoglobin) -increased oxidative phosphorylation –> sustained contraction

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70
Q

Type 2 Muscle Featured

A

-fast twitch -decreased mitochondria/myoglobin (white fibers) -increased anaerobic glycolysis

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71
Q

Weight training results in…

A

hypertrophy of fast-twitch muscle fibers.

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72
Q

Endochondral ossification

A

cartilaginous model of bone is first made by chondrocytes; osteoclasts and osteoblasts later replace with woven bone and then remodel to lamellar bone

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73
Q

Endochondral ossification occurs in…

A

bones of the axial and appendicular skeleton and at the base of the skull

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74
Q

Membranous ossification

A

woven bone is formed directly without cartilage; later remodeled to lamellar bone

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75
Q

Membranous ossification occurs at…

A

bones of calvarium and facial bones

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76
Q

Osteoblasts act to…

A

build bone by secreting collagen and catalyzing mineralization.

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77
Q

Osteoblasts differentiate from…

A

mesenchymal stem cells in the periosteum.

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78
Q

Osteoclasts are…

A

multinucleated cells that dissolve bone by secreting acid and collagenases.

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79
Q

Osteoclasts differentiate from…

A

monocytes/macrophages.

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80
Q

Estrogen inhibits…

A

apoptosis of osteoblasts and promotes apoptosis of osteoclasts.

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81
Q

Under estrogen deficiency, bone experiences…

A

excess remodeling cycles and resorption leading to osteoporosis.

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82
Q

Achondroplasia is…

A

failure of longitudinal bone growth leading to short limbs.

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83
Q

In achondroplasia, membranous ossification is…

A

not affective leading to rather large head compared to limbs.

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84
Q

Achondroplasia occurs because…

A

constitutive activation of FGF3 inhibits chondrocyte proliferation.

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85
Q

Osteoporosis is…

A

loss of trabecular bone mass despite normal bone mineralization and lab values (Ca2+ and PO43-)

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86
Q

Diagnosis of osteoporosis is with…

A

a bone mineral density test (DEXA) with a T-score of

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87
Q

Type I Osteoporosis Features

A

-postmenopausal -increased bone resoprtion due to decreased estrogen levels -femoral neck fracture, distal radius fracture

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88
Q

Type II Osteoporosis Features

A

-senile osteoporosis -men and women >70

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89
Q

Treatment for Type II Osteoporosis

A

-Bisphosphonates -pulsatile PTH -SERMs -Denosumab

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90
Q

Osteopetrosis is..

A

failure of normal bone resorption due to defective osteoclasts resulting in thickened bones prone to fracutre.

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91
Q

In osteopetrosis, bone fills the…

A

marrow space leading to pancytopenia and extramedullary hematopoeisis.

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92
Q

In osteopetrosis, osteoclasts have mutations that…

A

impair the ability of osteoclast to generate an acidic envirnoment necessary for bone resoprtion.

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93
Q

Osteopetrosis x-rays show…

A

bone in bone appearance.

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94
Q

Osteopetrosis can result in…

A

cranial nerve impingement and palsies as a result of narrowed foramina.

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95
Q

Osteomalacia/Rickets is due to…

A

Vitamin D deficiency. Defective mineralization/calcification of osteoid leads to soft bones that bow out.

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96
Q

Decreased vitamin D decreases….

A

serum calcium, which increases PTH which decresaes serum phosphate.

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97
Q

In osteomalacia/rickets, there is hyperactivity of osteoblasts leading to…

A

increased ALP.

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98
Q

Paget’s diseases of bone is due to…

A

increase in both osteoblastic and osteoclastic activity.

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99
Q

Lab levels in Paget’s

A

-calcium, phosphorus, PTH normal -increased ALP

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100
Q

Paget’s demonstrates…

A

a mosaic pattern of woven and lamellar bone. See long bone chalk-stick fractures.

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101
Q

Paget’s increases the risk of…

A

high-output heart failure and osteogenic sarcoma.

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102
Q

Signs of Pagets’

A

-increased hat size -hearing loss

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103
Q

Stages of Paget

A
  1. Lytic (osteoclasts) 2. Mixed (osteoclasts and blasts) 3. Sclerotic (blasts) 4. Quiescent
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104
Q

Osteonecrosis can be caused by…

A

trauma, high dose corticosteroids, alcoholism and sickle cell.

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105
Q

The most common site for osteonecrosis is…

A

the femoral head due to insufficiency of medial circumflex femoral artery.

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106
Q

Giant Cell Tumor Features

A

-20-40 yrs old -located at epiphyseal end of long bones (often the knee) -benign -“soap bubble” appearance on xray -multinucleated giant cells

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107
Q

Osteochondroma features

A

-benign -males < 25 -mature bone w/ cartilagimous cap

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108
Q

Osteosarcoma Features

A

-bimodal distribution (10-20 yrs; > 65 yrs) -metaphysis of long bones (usually knee)

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109
Q

Predisposing factors for Osteosarcoma

A

-Paget disease of bone -bone infarcts -radiation -familial retinoblastoma -Li-Fraumeni

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110
Q

On x-ray, osteosarcoma shows…

A

Codman triangle or sunburst pattern.

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111
Q

Treatment of osteosarcoma

A

surgical en bloc resection and chemo

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112
Q

Ewing Sarcoma Features

A

-boys < 15 -commonly appears in diaphysis of long bones, pelvis, scapula and ribs -anaplastic small blue cell malignant tumor -early mets but responds to chemo -onion skin appearance -11;22 translocation

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113
Q

Chondrosarcoma Features

A

-malignant, cartilaginous -men 30-60 yrs -usually in pelvis, spine, scapula, humerus, tibia or femur -can result from osteochondroma (rare)

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114
Q

Chondrosarcoma appears as…

A

an expansile glistening mass within the medullary cavity

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115
Q

Osteoarthritis Etiology

A

mechanical - joint wear and tear destroys articular cartilage

116
Q

Osteoarthritis Joint findings (6)

A

-subchondral cysts -sclerosis -osteophytes -eburnation -Heberden nodes (DIP) -Bouchard nodes (PIP)

117
Q

Predisposing factors for osteoarthritis

A

-age -obesity -joint deformity -trauma

118
Q

Classic Presentation of Osteoarthritis

A

Pain in weight-bearing joints after use; improves with rest. Knee cartilage loss begins medially (bowlegged). Noninflammatory

119
Q

Treatment for Osteoarthritis

A

-NSAIDs -Intra-articular Glucocorticoids

120
Q

Rheumatoid Arthritis Etiology

A

-autoimmune (inflammatory destruction of synovial joionts) -mediated by cytokines and type III and type IV HSR

121
Q

Joint findings in RA (5)

A

-pannus formation (MCP, PIP) -rheumatoid nodules (fibrinoid necrosis) -ulnar deviation of fingers -subluxation -Baker cyst (popliteal foss)

122
Q

Predisposing Factors for RA

A

-females -rheumatoid factor (anti-IgG antibody) -anti-cyclic citrullinated peptide -HLA-DR4

123
Q

Classic Presentation of RA

A

-morning stiffness > 30 minutes -improves with use -symmetric -systemic symptoms (fever, fatigue, pleuritis, pericarditis)

124
Q

Treatment for RA

A

-NSAIDs -glucocorticoids -disease-modifying agents (methotrexate, sulfasalazine, TNF-alpha inhibitors)

125
Q

Sjogren syndrome is an…

A

autoimmune disorder characterized by destruction of exocrine glands (esp. lacrimal and salivary).

126
Q

Sjogren syndrome predominantly affects…

A

females 40-60 yrs old.

127
Q

Findings of Sjogren syndrome

A

-xerophthalmia -xerostomia -presence of anti-nuclear antibodies (SS-A and SS-B) -bilateral parotid enlargement

128
Q

Xerophthalmia is…

A

decreased tear production and corneal damage

129
Q

Xerostomia is…

A

decreased saliva production

130
Q

Complications of Sjogren Syndrome

A

-dental caries -MALT lymphoma

131
Q

Gout is…

A

acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals in the joints.

132
Q

Gout is associated with…

A

hyperuricemia which can be caused by underexcretion of uric acid (90%) or overproduction.

133
Q

Overproduction of uric acid is seen in…

A

Lesch-Nyhan syndrome, increased PRPP, increased cell turnover and von Gierke disease.

134
Q

Underexcretion of uric acid can be caused by…

A

thiazide diuretics.

135
Q

In gout, the crystals are…

A

needle shaped and negatively birefringent (yellow under parallel light and blue under perpendicular light).

136
Q

symptoms of gout

A

-asymmetric -swollen, red, painful joint -tophus formation

137
Q

Classic manifestation of gout is…

A

painful MTP joint of the big toe (podagra).

138
Q

Acute attacks of gout tend to occur after…

A

a large meal or alcohol consumption (alcohol competes for the same excretion sites as uric acid in the kidney).

139
Q

Treatment of acute gout

A

-NSAIDs -Glucocorticoids -Colchicine

140
Q

Treatment of chronic gout

A

-xanthine oxidase inhibitors (allopurinol or febuxostat)

141
Q

Pseudogout presents with…

A

pain and effusion in a joint caused by deposition of calcium pyrophosphate crystals in the joint space.

142
Q

On x-ray, pseudogout shows…

A

chondrocalcinosis.

143
Q

Pseudogout forms…

A

basophilic, rhomboid crystals athat are weakly positively birefringent.

144
Q

Features of Pseudogout

A

-large joints (knee) - >50 yrs

145
Q

Diseases associated with pseudogout include…

A

hemochromatosis, hyperparathyroidism, and hypoparathyroidism.

146
Q

Treatment for Pseudogout

A

-NSAIDs -Colchicine

147
Q

Common causes of infectious arthritis are…

A

S. aureus, Streptococcus and N. gonorrhaeae.

148
Q

Gonococcal arthritis is an…

A

STD that presents as a migratory arthritis with an asymmetric pattern. S = synovitis (knee) T = tenosynovitis (hand) D = dermatitis (pustules)

149
Q

Seronegative Spondyloarthropaties are…

A

arthritis wihtout rheumatoid factor and a strong association with HLA-B27.

150
Q

Types of Seronegative Spondyloarthropathies (PAIR)

A

P = Psoriatic arthritis A = Ankylosing spondylitis I = Inflammatory bowel disease R = Reactive Arthritis

151
Q

Psoriatic Arthritis Features

A

-joint pain/stiffness with psoriasis -asymmetric -dactylitis (sausage fingers) -“pencil in cup” on xray

152
Q

Ankylosing spondylitis Features

A

-chronic inflammatory disease of the spine and sacroiliac joints -ankylosis (fusion of joints), uveitis and aortic regurgitation -bamboo spine on xray

153
Q

Inflammatory Bowel Disease

A

-Crohn’s and UC are often accompanied by ankylosing spondylitis or peripheral arthritis

154
Q

Reactive Arthritis Class triad

A

-conjunctivits (and anterior uveitis) -Urethritis -arthritis (can’t see, can’t pee, can’t bend my knee)

155
Q

Reactive arthritis is usually due to…

A

post-GI (shigella, salmonella, yersinia or campylobacter) or chlamydia infxns.

156
Q

Classic Presentation of Systemic Lupus Erythematous (SLE)

A

-rash -joint pain -fever -female of reproductive age -African descent

157
Q

SLE is associated with…

A

Libman-Sacks endocarditis and Lupus Nephritis.

158
Q

Libman-Sacks is…

A

a wart-like vegetation on both sides of a valve.

159
Q

Lupus nephritis is…

A

Type III HSR -nephritic: diffuse proliferative glomeurlonephritis -nephrotic: membranous glomeulonephritis

160
Q

Common causes of death in SLE

A

-CV disease -Infxns -Renal disease

161
Q

Lupus Findings

A
  1. ANA (sensitive, not specific) 2. anti-dsDNA Abs (specific) 3. Anti-Smith antibodies (specific) 4. Antihistone Abs (sensitive for drug-induced lupus) 5. Anticardiolipin Abs 6. decresed C3, C4 and CH50 due to immune complex formation
162
Q

Treatment of SLE

A

-NSAIDs -Steroids -Immunosuppressants -Hydroxychloroquine

163
Q

Sarcoidosis is characterized by…

A

immune-mediated, non-caseating granulomas and elevated ACE levels.

164
Q

Sarcoidosis is common in…

A

balck females.

165
Q

Sarcoidosis is often asymptomatic except for…

A

enlarged LNs.

166
Q

Findings of Sarcoidosis on CXR are…

A

bilateral hilar adenopathy and reticular opacities.

167
Q

Sarcoidosis is associated with…

A

restrictive lung disease (interstitial fibrosis), erythema nodosum, lupus pernio, Bell palsy, epithelioid granulomas (w/ Schaumann and asteroid bodies), uveitis and hypercalcemia.

168
Q

Hypercalcemia in sarcoidosis is due to…

A

increased 1alpha-hydroxylase mediated Vit. D activation in macrophages.

169
Q

Treatment for Sarcoidosis is….

A

steroids.

170
Q

Polymyalgia rhematica symptoms are…

A

pain/stiffness in shoulders/hips often with fever, malaise and weight loss.

171
Q

Polymyalgia rheumatica does not cause…

A

muscular weakness.

172
Q

Polymyalgia rheumatica is common in…

A

women older than 50.

173
Q

Polymyalgia rheumatica is associated with…

A

temporal (giant cell) arteritis.

174
Q

Findings of Polymyalgia rheumatica

A

-increased ESR -increased CRP -normal CK

175
Q

Treatment of Polymyalgia rheumatica

A

low-dose corticosteroids

176
Q

Fibromyalgia is most commonly seen in…

A

females 20-50 yrs old. It is chronic musculoskeletal pain associated with stiffness, paresthesias, poor sleep and fatigue.

177
Q

Fibromyalgia treatment

A

-regular exercise -antidepressants -anticonvulsants

178
Q

Polymyositis is…

A

progressive, symmetrical proximal muscle weakness characterized by endomysial inflammation with CD8 T cells. Most often involves the shoulders.

179
Q

Dermatomyositis is…

A

similar to polymositis but also has a rash, Gottron papules, heliotrope rash. (shawl and face rash and mechanic’s hands)

180
Q

Dermatomyositis has increased risk of…

A

occult malignancy.

181
Q

Dermatomyositis pathology

A

-perimysial inflammation and atrophy with CD4 T cells

182
Q

Findings of Polymyositis and Dermatomyositis

A

-increased CK -positive ANA -positive anti-Jo-1 -positive anti-SRP -positive anti-Mi-2 Abs

183
Q

Treatment of Dermatomyositis and Polymyositis

A

steroids.

184
Q

Pathophysiology of Myasthenia gravis

A

autoantibodies to postsynaptic ACh receptor

185
Q

Clinical findings of myastenia gravis

A

ptosis, diplopia, weakness *worsens with muscle use

186
Q

Myasthenia gravis is associated with…

A

thymoma and thymic hyperplasia

187
Q

In myasthenia gravis, AChE inhibitor will…

A

reverse symptoms.

188
Q

Pathophysiology of Lambert-Eaton Myasthenic Syndrome

A

autoantibodies to presynaptic Ca2+ channels leading to decreased ACh release

189
Q

Lambert-Eaton Clinical Findings

A

-proximal muscle weakness -autonomic symptoms (dry mouth, impotence) *improves with muscle use

190
Q

Lambert-Eaton is associated with…

A

small cell lung cancer.

191
Q

Myositis Ossificans is…

A

metaplasia of skeletal muscle to bone following muscular trauma.

192
Q

Scleroderma is…

A

excessive fibrosis and collagen deoposition throughout the body. commonly sclerosis of the skin, mainfesting as puffy and taut skin. 75% female.

193
Q

Most common cause of death in scleroderm is…

A

pulmonary sclerosis.

194
Q

Diffuse Scleroderma

A

-widespread skin involvement -rapid progression -early visceral involvement -associated with anti-Scl-70 Ab (anti-DNA topoisomerase I Ab)

195
Q

Limited Scleroderma

A

-skin involvement limited to fingers and face -CREST involvement -anit-Centromere Ab

196
Q

CREST

A

C = Calcinosis R = Raynoaud E = Esophageal dysmotility S = Sclerodactyly T = Telangiectasia

197
Q

A macule is a…

A

flat lesion with well-circumscribed chin in skin color < 1 cm Ex. freckle, labial macule

198
Q

A patch is…

A

a macule > 1 cm. Ex. large birthmark (congenital nevus)

199
Q

A papule is…

A

an elevated, solid skin lesion < 1 cm. Ex. mole (nevus), acne

200
Q

A plaque is…

A

a papule > 1 cm. Ex. Psoriasis

201
Q

Vesicle

A

small fluid-containing blister < 1 cm Ex. chickenpox, shingles

202
Q

Bulla

A

large fluid containing blister > 1 cm Ex. bullous pemphigoid

203
Q

Pustule

A

vesicle containing pus ex. pustular psoriasis

204
Q

Wheal

A

transient smooth papule or plaque Ex. hives (urticaria)

205
Q

Scale

A

flaking off of stratum corneum Ex. eczema, psoriasis, SCC

206
Q

Crust

A

dry exudate Ex. impetigo

207
Q

Hyperkeratosis

A

increased thickness of the stratum corneum Ex. psoriasis, calluses

208
Q

Parakeratosis

A

hyperkeratosis with retention of nuclei in stratum corneum Ex. psoriasis

209
Q

Spongiosis

A

epidermal accumulation of edematous fluid in the intercellular spaces Ex. eczematous dermatitis

210
Q

Acantholysis

A

separation of epidermal cells Ex. pemphigus vulgaris

211
Q

Acanthosis

A

Epidermal hyperplasia (increased spinosum) Ex. Acanthosis nigricans

212
Q

Albinism is…

A

normal melanocyte number with decreased melanin production due to decreased tyrosinase activity or defective tyrosine transport (or by failure of neural crest cell migration)

213
Q

Albinism has an increased risk of…

A

skin cancer.

214
Q

Melasma (cholasma) is…

A

hyperpigmentation associated with pregnancy or OCP use

215
Q

Vitiligo

A

irregular areas of complete depigmentation caused by autoimmune destruction of melanocytes

216
Q

Verrucae

A

warts caused by HPV; soft, tan cauliflower-like papules

217
Q

Histological changes of verrucae

A

epidermal hyperplasia, hyperkeratosis, koilocytosis

218
Q

Melanocytic nevus

A

common mole; melanoma can arise in congenital or atypical moles *intradermal nevi are papular **junctional nevi are flat molecules

219
Q

Urticaria

A

hives; pruritic wheals that form after mast cell degranulation

220
Q

Urticaria is characterized by…

A

superficial dermal edema and lymphatic channel dilation.

221
Q

Ephelis

A

freckle; normal number of melanocytes but increased melanin pigment

222
Q

Atopic dermatitis (eczema)

A

pruritic eruption commonly on skin flexures; often associated with other atopic diseases (asthma, allergic rhinits)

223
Q

Atopic dermatitis usually starts on…

A

the face in infancy and often appears in the antecubital foassae after.

224
Q

Allergic Contact Dermatitis

A

Type IV HSR that follows exposure to teh allergen; lesions occur at the site of contact (ex. nickel, poison ivy, neomycin)

225
Q

Psoriasis

A

papules and plaques with silvery scaling (knees and elbows); acanthosis with parakeratotic scaling increased spinosum, decreased granulosm Auspitz sign

226
Q

Psoriasis can be associated with…

A

nail pitting and psoriatic arthritis.

227
Q

Seborrheic keratosis is…

A

flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts (horn cysts); look “stuck on” *common benign neoplasm of older people

228
Q

Seborrheic keratosis lesions occur on…

A

the head, trunk and extremities.

229
Q

Lese-Trelat sign is…

A

a sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (GI, lymphoid).

230
Q

Impetigo

A

superficial skin infection from S. aureus or S. pyogenes very infectious ***honey-colored crusting

231
Q

Bullous impetigo has…

A

bullae and is usually due to S. aureus.

232
Q

Cellulitis is…

A

acute, painful spreading infxn of the dermis and subcutaneous tissue.

233
Q

Cellulitis is usually due to…

A

S. pyogenes or S. aureus.

234
Q

Cellulitis often starts with…

A

a break in thes kin from trauma or another infxn.

235
Q

Necrotizing fasciitis is…

A

a deeper tissue injury usually from anaerobic bacteria or S. pyogenes.

236
Q

Necrotizing fasciitis results in….

A

crepitus from methane and CO2 production. “flesh-eating bacteria”

237
Q

Necrotizing fasciitis causes…

A

bullae and a purple color to the skin.

238
Q

Staphylococcal scalded skin syndrome is due to….

A

an exotoxin that destroys keratinocyte attachments in the stratum granulosum only.

239
Q

Staph scalded skin syndrome is characterized by…

A

fever and erythematous rash with sloughing of the upper layers of the epidermis that heals completely.

240
Q

Hairy leukoplakia is…

A

a white, painless plaque on the tongue that cannot be scraped off.

241
Q

Hairy leukoplakia is mediated by…

A

EBV and it occurs in HIV + patients.

242
Q

Pemphigus vulgaris is a…

A

potentially fatal skin disorder with IgG antibody against desmoglein component of desmosomes. There is flaccid intraepidermal bullae caused by acantholysis; oral mucosa also involved.

243
Q

Immunofluorescence of Pemphigus vulgaris reveals…

A

Abs around epidermal cells in a reticular pattern. (net-like)

244
Q

Pemphigus vulgaris has a positive…

A

Nikolsky sign (separation of epidermis upon manual stroking of skin).

245
Q

Bullous Pemphigoid is less severe….

A

than Pemphigus vulgaris. It involves IgG antibody against hemidesmosomes.

246
Q

Bullous Pemphigoid shows….

A

tense blisters containing eosinophils that affect the skin but spare the oral mucosa.

247
Q

Immunofluorescence of bullous pemphigoid reveals…

A

a linear pattern at the epidermal-dermal junction.

248
Q

Bullous pemphigoid has a negative…

A

Nikolsky sign.

249
Q

Dermatitis herpetiformis

A

pruritic papules, vesicles and bullae. Deposits of IgA at the tips of dermal papillae

250
Q

Dermatitis herpetiformis is associated with…

A

celiac disease.

251
Q

Erythema multiforme is associated with….

A

infections (mycoplasma pneumoniae, HSV) drugs (sulfa drugs, beta-lactams, phenytoin) cancers autoimmune disease

252
Q

Erythema multiforme presents with…

A

multiple lesions - macules, papules, veiscles and target lesions.

253
Q

Stevens-Johnson Syndrome is characterized by…

A

fever, bulla formation and necrosis, sloughing of skin, and a high mortality rate.

254
Q

SJS typically involves…

A

2 mucous membranes (lips and mouth, etc.). Skin lesions appear like targets. Associated with drug rxn.

255
Q

A more severe form of SJS is…

A

toxic epidermal necrolysis with more than 30% of the body involved.

256
Q

Acanthosis nigricans is…

A

epidermal hyperplasia causing symmetrical, hyperpigmented, velvety thickening of skin, especially on neck or axilla.

257
Q

Acanthosis nigricans is associated with…

A

hyperinsulinemia (diabetes, obesity, Cushing’s) and visceral malignancy (gastric adenocarcinoma).

258
Q

Actinic keratosis is….

A

premalignant lesions caused by sun exposure.

259
Q

Actinic keratosis presents as…

A

small, rough, erythematous/brownish papules or plaques.

260
Q

Risk of SCC with actinic keratosis is proportional to…

A

the degree of epithelial dysplasia.

261
Q

Erythema nodosum is…

A

a painful, inflammatory lesion of subcutaneous fat, usually on anterior shins.

262
Q

Erythema nodosum is often idiopathic but can be associated with…

A

sarcoidosis, coccidioidomycosis, histoplasmosis, TB, strep, leprosy and Crohn’s.

263
Q

6 Ps of Lichen Planus

A

pruritic purple polygonal planar papules plaques

264
Q

Mucosal involvement with Lichen Planus manifests as…

A

Wickham striae (reticular white lines). Also sawtooth infiltrate of lymphocytes at the dermal-epidermal junction.

265
Q

Lichen Planus is associated with…

A

Hep C.

266
Q

Pityriasis rosea presents as…

A

a herald patch followed days later by christmas tree distribution of multiple plaques with collarette scale.

267
Q

Course of Pityriasis rosea

A

self-resolving in 6-8 wks.

268
Q

Sunburn causes…

A

DNA mutations, inducing apoptosis of keratinocytes.

269
Q

UVA is dominant in…

A

tanning and photoagin.

270
Q

UVB is dominant in…

A

sunburn.

271
Q

Sunburn can lead to…

A

impetigo and skin cancer.

272
Q

The most common skin cancer is…

A

basal cell carcinoma. It is found in sun-exposed areas of the body and is locally invasive but rarely metastasizes.

273
Q

BCC presents with…

A

pink, pearly nodules, commonly with telangiectasias, rolled borders and central crusting/ulceration.

274
Q

BCC can also appear as…

A

nonhealing ulcers with infiltrating growth or as a scaling plaque.

275
Q

Histology of BCC shows…

A

palisading nuclei.

276
Q

Squamous Cell Carcinoma is associated with…

A

excessive exposure to sunlight, immunosuppression, and arsenic.

277
Q

SCC commonly appears on…

A

the face, lower lip, ears and hands. It is locally invasive, can spread to LNs but rarely metastasizes.

278
Q

SCC appears as…

A

ulcerative red lesions with frequent scale. And chronic draining sinuses.

279
Q

Histology of SCC shows…

A

keratin “pearls”.

280
Q

Melanoma has a significant risk of…

A

metastasis. Risk correlates with depth of tumor.

281
Q

Tumor marker of melanoma

A

S-100

282
Q

Melanoma is associated with…

A

sunlight exposure, fair-skinned persons are at increased risk.

283
Q

ABCDEs of Melanoma

A

A = asymmetry B = border irregularity C = color variation D = diameter > 6 mm E = evolution over time

284
Q

Melanoma is often driven by …

A

an activating mutation of BRAF kinase.

285
Q

Primary treatment of melanoma is…

A

excision with appropriately wide margins.

286
Q

Metastatic or unresectable melanoma in pts with BRAF V600E mutation may benefit from…

A

vemurafenib, a BRAF kinase inhibitor.

Step 1 Exam (32 decks)

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