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► Med Notes > Musculoskeletal - Skin - Connective Tissue_2 > Flashcards

Musculoskeletal - Skin - Connective Tissue_2 Flashcards

1
Q

presentation of dermatomyositis?

A

similar to polymyositis, but also invovles malar rash, Gottron’s papules. heliotrope rash, shawl and face rash, mechanic’s hands

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2
Q

dermatomyositis carries ↑ risk of what?

A

occult malignancy

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3
Q

pathology in dermatomyositis?

A

perimysial inflammation and atrophy with CD4+ T cells

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4
Q

findings in polymyositis/dermatomyositis?

A

↑ CK • ANA (+) • anti-Jo-1 Ab (+)

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5
Q

treatment for polymyositis/dermatomyositis?

A

steroids

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6
Q

what is the frequency of myasthenia gravis?

A

most common NMJ disorder

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7
Q

frequency of lambert eaton myasthenic syndrome?

A

uncommon

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8
Q

pathophysiology of MG?

A

autoantibodies to postsynaptic AChR

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9
Q

pathophysiology of LEMS?

A

autoantibodies to presynaptic Ca++ channel →↓ ACh release

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10
Q

clinical presentation of MG?

A

ptosis • diplopia • weakness • worsens with muscle use

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11
Q

clinical presentation of LEMS?

A

proximal muscle weakness • improves with muscle use

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12
Q

MG associated with what?

A

thymoma • thymic hyperplasia

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13
Q

LEMS associated with what?

A

SCLC

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14
Q

what happens with AChE inhibitor administration in MG?

A

reversal of symptoms

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15
Q

what happens with AChE inhibitor administration in LEMS?

A

no effect

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16
Q

what is myositis ossificans?

A

metaplasia of skeletal muscle to bone following muscular trauma

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17
Q

myositis ossificans is most often seen where?

A

in upper or lower extremity

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18
Q

myositis ossificans may present how?

A

as suspicious mass at site of known trauma or as incidental finding on radiography

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19
Q

what happens in scleroderma (SS)?

A

excessive fibrosis and collagen deposition throughout the body

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20
Q

common manifestation of SS?

A

sclerosis of skin, manifesting as puffy and taut skin with absence of wrinkles • also sclerosis of renal, pulm, CV, GI systems

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21
Q

most likely cause of death in SS?

A

sclerosis of pulmonary system

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22
Q

epidemiology of SS?

A

75% female

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23
Q

2 major types of SS?

A

diffuse scleroderma • CREST syndrome

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24
Q

clinical features of diffuse scleroderma?

A

widespread skin involvement, rapid progression, early visceral involvement

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25
Q

marker for diffuse scleroderma?

A

anti-Scl-70 Ab (anti-DNA topoisomerase I Ab)

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26
Q

clinical features of CREST syndrome?

A

Calcinosis • Raynaud’s phenomenon • Esophageal dysmotility • Sclerodactyly • Telangiectasia

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27
Q

skin involvement in CREST syndrome?

A

limited skin involvement, often confined to fingers and face

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28
Q

clinical course of CREST syndrome relative do diffuse scleroderma?

A

more benign clinical course

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29
Q

marker for CREST syndrome?

A

anticentromere antibody

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30
Q

what is a macule?

A

flat lesion with well-circumscribed change in skin color <5mm

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31
Q

examples of macule?

A

freckle • labial macule

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32
Q

what is a patch?

A

macule >5mm

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33
Q

what is an example of a patch?

A

large birthmark (congenital nevus)

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34
Q

what is a papule?

A

elevated solid skin lesion <5mm

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35
Q

example of papule?

A

mole (nevus) • acne

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36
Q

what is a plaque?

A

papule >5mm

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37
Q

what is an example of derm plaque?

A

psoriasis

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38
Q

what is a derm vesicle?

A

small fluid containing blister <5mm

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39
Q

example of derm vesicle?

A

chickenpox (varicella) • shingles (zoster)

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40
Q

what is a bulla?

A

large fluid containing blister >5mm

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41
Q

example of bulla?

A

bullous pemphigoid

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42
Q

what is a pustule?

A

vesicle containing pus

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43
Q

example of pustule?

A

pustular psoriasis

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44
Q

what is wheal?

A

transient smooth papule or plaque

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45
Q

example of wheal?

A

hives (urticaria)

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46
Q

what is derm scale?

A

flaking off of stratum corneum

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47
Q

example of derm scale?

A

eczema • psoriasis • SCC

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48
Q

what is derm crust?

A

dry exudate

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49
Q

example of derm crust?

A

impetigo

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50
Q

what is hyperkeratosis?

A

↑ thickness of stratum corneum

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51
Q

example of hyperkeratosis?

A

psoriasis

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52
Q

what is parakeratosis?

A

hyperkeratosis with retention of nuclei in stratum corneum

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53
Q

example of parakeratosis?

A

psoriasis

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54
Q

what is acantholysis?

A

separation of epidermal cells

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55
Q

example of acantholysis?

A

pemphigus vulgaris

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56
Q

what is acanthosis?

A

epidermal hyperplasia [↑spinosum]

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57
Q

example of acanthosis?

A

acanthosis nigricans

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58
Q

what is dermatitis?

A

inflammation of the skin

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59
Q

example of dermatitis?

A

atopic dermatitis

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60
Q

pathogenesis of albinism?

A

normal number of melanocytes with ↓ melanin production due to ↓ tyrosinase activity • can also be caused by failure of neural crest cells to migrate during development

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61
Q

what is melasma (chloasma)?

A

hyperpigmentation associated with pregnancy (mask of pregnancy) or OCP use

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62
Q

what is vitiligo?

A

irregular areas of complete depigmentation

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63
Q

vitiligo is caused by what?

A

↓ in melanocytes

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64
Q

what are verrucae?

A

warts

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65
Q

verrucae are caused by what?

A

HPV

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66
Q

what do verrucae look like?

A

soft, tan colored, cauliflower like papules

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67
Q

microscopic features of verrucae?

A

epidermal hyperplasia • hyperkeratosis • koilocytosis

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68
Q

what are verrucae on genitals?

A

condyloma accuminatum

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69
Q

what is melanocytic nevus?

A

common mole

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70
Q

pathogenicity of melanocytic nevus?

A

benign, but melanoma can arise in congenital or atypical moles

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71
Q

intradermal nevi are what?

A

papular

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72
Q

junctional nevi are what?

A

flat macules

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73
Q

what is urticaria?

A

hives- pruritic wheals that form after mast cell degranulation

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74
Q

what is ephelis?

A

freckle

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75
Q

molecular features of ephelis?

A

normal number of melanocytes, ↑ melanin pigment

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76
Q

what is atopic dermatitis (eczema)?

A

pruritic eruption, commonly on skin flexures

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77
Q

atopic dermatitis is often associated with what?

A

other atopic diseases (asthma, allergic rhinitis)

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78
Q

course of atopic dermatitis?

A

usually starts on the face in infancy and often appears in the antecubital fossa thereafter

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79
Q

what is allergic contact dermatitis?

A

type IV HSR that follows exposure to allergen

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80
Q

where do lesions occur in allergic contact dermatitis?

A

at site of contact • (nickel, poison ivy, neomycin)

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81
Q

what is psoriasis?

A

papules and plaques with silvery scaling, especially on knees and elbows

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82
Q

microscopic features of psoriasis?

A

acanthosis with parakeratotic scaling (nuclei still in stratum corneum)

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83
Q

cellular features of psoriasis?

A

↑ stratum spinosum • ↓ stratum granulosum

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84
Q

what is Auspitz sign in psoriasis?

A

pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off

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85
Q

psoriasis can be associated with what?

A

nail pitting and psoriatic arthritis

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86
Q

what is seborrheic keratosis?

A

flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts (horn cysts)

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87
Q

how does seborrheic keratosis look?

A

stuck on

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88
Q

lesions in seborrheic keratosis occur where?

A

on head, trunk, and extremities

89
Q

incidence of seborrheic keratosis?

A

common benign neoplasm of older persons

90
Q

what is the Leser-Trelat sign?

A

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

91
Q

what is pemphigus vulgaris?

A

potentially fatal autoimmune skin disorder with IgG Ab against desmoglein 3 (1 and/or 3), a part of the desmosomes (needed for cell adhesion)

92
Q

IF findings in pemphigus vulgaris?

A

Ab around epidermal cells in a reticular or net like pattern

93
Q

dermatologic pathology findings in pemphigous vulgaris?

A

acantholysis- intraepidermal bullae causing flaccid blister involving the skin and oral mucosa

94
Q

positive PE sign in pemphigus vulgaris?

A

Nikolsky’s sign (separation of the epidermis upon manual stroking of the skin)

95
Q

what is bullous pemphigoid?

A

autoimmune disorder with IgG Ab against hemidesmosomes (epidermal basement membrane)

96
Q

IF findings in bullous pemphigoid?

A

shows linear immunofluorescence

97
Q

Bx findings in bullous pemphigoid?

A

eosinophils within tense blisters

98
Q

how does bullous pemphigoid compare to pemphigus vulgaris?

A

similar to but less severe than PV • affects skin but spares oral mucosa • negative Nikolsky’s sign

99
Q

presentation of dermatitis herpetiformis?

A

pruritic papules, vesicles, and bullae

100
Q

cause of dermatitis herpetiformis?

A

deposits of IgA at the tips of dermal papillae

101
Q

dermatitis herpetiformis is associated with what?

A

celiac disease

102
Q

erythema multiforme is associated with what?

A

infections • drugs • cancers • autoimmune disease

103
Q

infections associated with erythema multiforme?

A

Mycoplasma pneumoniae • HSV

104
Q

drugs associated with erythema multiforme?

A

sulfa drugs • β lactams • phenytoin

105
Q

erythema multiforme presents with what?

A

multiple types of lesions- macules, papules, vesicles, and target lesions

106
Q

Stevens-Johnson syndrome is characterized by what?

A

fever • bulla formation and necrosis • sloughing of skin • high mortality rate

107
Q

skin lesions involved in Stevens-Johnson syndrome?

A

typically 2 mucus membranes are involved and skin lesions may appear like targets as seen in erythema multiforme

108
Q

stevens johnson syndrome usually associated with what?

A

adverse drug reaction

109
Q

what is the more severe form of stevens johnson syndrome?

A

> 30% of body surface area involved→toxic epidermal necrolysis

110
Q

what is acanthosis nigricans?

A

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

111
Q

acanthosis nigricans is associated with what?

A

hyperinsulinemia (diabetes, obesity, Cushings) • visceral malignancy

112
Q

what is actinic keratosis?

A

premalignant lesions caused by sun exposure

113
Q

how does actinic keratosis look?

A

small, rough, erythematous or brownish papules or plaques

114
Q

how is risk of cancer in actinic keratosis assessed?

A

risk of SCC is proportional to degree of epithelial dysplasia

115
Q

what is erythema nodosum?

A

inflammatory lesions of subcutaenous fat, usually on the anterior shins

116
Q

erythema nodosum is associated with what?

A

sarcoidosis • coccidioidomycosis • histoplasmosis • TB • streptococcal infections • leprosy • crohn’s disease

117
Q

what are the 6 P’s of lichen planus?

A

pruritic • purple • polygonal • planar • papules

118
Q

histopathology of lichen planus?

A

sawtooth infiltrate of lymphocytes at dermal-epidermal junction

119
Q

lichen planus is associated with what?

A

hepatitis C

120
Q

what is the presentation of pityriasis rosea?

A

herald patch followed days later by christmas tree distribution

121
Q

what does pityriasis rosea look like?

A

multiple plaques with collarette scale

122
Q

course of pityriasis rosea?

A

self resolving in 6-8 weeks

123
Q

what happens in sunburn?

A

UV radiation causes DNA mutations, inducing apoptosis of keratinocytes

124
Q

which type of light is dominant in tanning and photoaging?

A

UVA

125
Q

which type of light is dominant in sunburn?

A

UVB

126
Q

sunburn can lead to what?

A

impetigo and skin cancers

127
Q

which skin cancers can be caused by sunburn?

A

basal cell carcinoma • SCC • melanoma

128
Q

what is impetigo?

A

very superficial skin infection

129
Q

organisms that cause impetigo?

A

usually S aureus or S pyogenes

130
Q

transmissibility of impetigo?

A

highly contagious

131
Q

appearance of impetigo?

A

honey colored crusting

132
Q

features of bullous impetigo?

A

has bullae and is usually caused by S aureus

133
Q

what is cellulitis?

A

acute, painful, spreading infection of dermis and subcutaneous tissues

134
Q

organisms that cause cellulitis?

A

S pyogenes or S aureus

135
Q

cellulitis often starts with what?

A

a break in skin from trauma or another infection

136
Q

what is necrotizing fasciitis?

A

deeper tissue injury usually from anaerobic bacteria or S pyogenes

137
Q

necrotizing fasciitis results in what?

A

crepitus from methane and CO2 production

138
Q

necrotizing fasciitis AKA?

A

flesh eating bacteria

139
Q

skin appearance in necrotizing fasciitis?

A

bullae and purple color

140
Q

what happens in staphylococcal scalded skin syndrome (SSSS)?

A

exotoxin destroys keratinocyte attachments in the stratum granulosum only

141
Q

difference between SSSS and TEN?

A

SSSS destroys stratum granulosum only, • TEN destroys dermal-epidermal junction

142
Q

SSSS characterized by what?

A

fever • generalized erythematous rash with sloughing of the upper layers of the epidermis that heals completely

143
Q

SSSS seen in who?

A

infants and children

144
Q

what is hairy leukoplakia?

A

white, painless plaques on the tongue that cannot be scraped off

145
Q

virus that mediates hairy leukoplakia?

A

EBV

146
Q

hairy leukoplakia occurs in who?

A

HIV patients

147
Q

what is the most common skin cancer?

A

basal cell carcinoma

148
Q

basal cell carcinoma found where?

A

sun exposed areas of body

149
Q

severity of basal cell carcinoma?

A

locally invasive, but almost never metastasizes

150
Q

appearance of basal cell carcinoma?

A

pink, pearly nodules, commonly with telangiectasias, rolled borders, and central crusting or ulceration • or • nonhealing ulcers with infiltrating growth • or • scaling plaque

151
Q

histological features of BCCs?

A

palisading nuclei

152
Q

what is the second most common skin cancer?

A

SCC

153
Q

SCC of skin is associated with what?

A

excessive exposure to sunlight, immunosuppression, arsenic exposure

154
Q

SCC of skin commonly appears where?

A

face, lower lip, ears, hands

155
Q

severity of SCC of skin?

A

locally invasive, but may spread to lymph nodes • rarely metastasizes

156
Q

appearance of SCC of skin?

A

ulcerative red lesions with frequent scale • chronic draining sinuses

157
Q

histopathology of SCC of skin?

A

keratin pearls

158
Q

which scaly plaque is a precursor to SCC of skin?

A

actinic keratosis

159
Q

which variant of skin SCC grows rapidly for 4-6 weeks and may regress spontaneously over months?

A

keratoacanthoma

160
Q

which skin cancer is a common tumor with significant risk of metastasis?

A

melanoma

161
Q

tumor marker associated with melanoma?

A

S-100

162
Q

predisposing factors for melanoma?

A

sunlight exposure • fair-skinned persons at ↑ risk

163
Q

risk of mets in melanoma is proportional to what?

A

depth of tumor

164
Q

what should you look for in melanoma?

A

ABCDEs: • Asymmetry • Border irregularity • Color variation • Diameter>6mm • Evolution over time

165
Q

4 types of melanoma?

A

superficial spreading melanoma • nodular melanoma • lentigo maligna melanoma • acrolentiginous melanoma

166
Q

genetics of melanoma?

A

often driven by activating mutation in BRAF kinase

167
Q

primary treatment for melanoma?

A

excision with appropriately wide margins

168
Q

metastatic or unresectable melanoma in patients with BRAF V600E mutation may benefit from what?

A

vemurafenib, a BRAF kinase inhibitor

169
Q

lipoxygenase pathway yields what?

A

leukotrienes

170
Q

function of LTB4?

A

neutrophil chemotactic agent

171
Q

LTC4, LTD4, LTE4 function in what?

A

bronchoconstriction • vasoconstriction • contraction of smooth muscle • ↑ vascular permeability

172
Q

action of PGI2?

A

inhibits platelet aggregation and promotes vasodilation

173
Q

effect of corticosteroids on arachidonic acid products?

A

inhibits PLA2 • inhibits protein synthesis →↓ COX

174
Q

effect of NSAIDs, aspirin, acetaminophen, COX-2 inhibitors on arachidonic acid products?

A

inhibit COX enzymes to ↓ formation of endoperoxides PGG2 and PGH2

175
Q

effect of zileuton on arachidonic acid products?

A

inhibits lipoxygenase to ↓ formation of hydroperoxides (HPETEs)

176
Q

action of TXA2?

A

↑platelet aggregation • ↑ vascular tone • ↑ bronchial tone

177
Q

action of PGE2 and PGF2?

A

↑ uterine tone • ↓ vascular tone • ↓ bronchial tone

178
Q

action of prostacyclin (PGI2)?

A

↓ platelet aggregation • ↓ vascular tone • ↓ bronchial tone • ↓ uterine tone

179
Q

effect of zafirleukast and monteleukast on arachidonic acid products?

A

block actions of LTC4 and LTD4 at receptors

180
Q

MOA of aspirin?

A

irreversibly inhibits COX1 and COX2 by acetylation→↓ synthesis of TXA2 and PGs • NSAID

181
Q

effect of aspirin on blood labs?

A

↑ bleeding time • no Δ in PT, PTT

182
Q

clinical use of low dose aspirin?

A

<300mg/d ↓ platelet aggregation

183
Q

clinical use of intermediate dose aspirin?

A

300-2400mg/d→ antipyretic and analgesic

184
Q

clinical use of high dose aspirin?

A

2400-4000mg/d→anti-inflammatory

185
Q

toxicity of aspirin?

A

gastric ulceration • tinnitus • stimulates respiratory centers causing hyperventilation and respiratory alkalosis

186
Q

chronic use of aspirin can lead to what?

A

acute renal failure • interstitial nephritis • upper GI bleeding

187
Q

risk of what in children with aspirin use?

A

Reyes syndrome when used to treat viral infection

188
Q

which drugs are NSAIDs?

A

ibuprofen • naproxen • indomethacin • ketorolac • diclofenac

189
Q

MOA of NSAIDs?

A

reversibly inhibit COX1 and COX2→ block PG synthesis

190
Q

clinical use of NSAIDs?

A

antipyretic • analgesic • anti-inflammatory

191
Q

special use of indomethacin?

A

close a PDA

192
Q

toxicity of NSAIDs?

A

interstitial nephritis • gastric ulcer • renal ischemia

193
Q

MOA of COX2 inhibitors (celecoxib)?

A

reversibly inhibit COX2 found in inflammatory cells and vascular endothelium • spares COX1 to protect gastric mucosa and platelet function

194
Q

clinical use of celecoxib?

A

RA and OA, patients with gastritis or ulcers

195
Q

toxicity of celecoxib?

A

↑risk of thrombosis • sulfa allergy

196
Q

MOA of acetaminophen?

A

reversibly inhibits COX mostly in CNS, is inactivated peripherally

197
Q

clinical use of acetaminophen?

A

antipyretic • analgesic • not anti-inflammatory • used instead of aspirin in children with viral infection to avoid reyes syndrome

198
Q

toxicity of acetaminophen?

A

OD→hepatic necrosis; acetaminophen metabolite depletes glutathione and forms toxic tissue adducrs in liver

199
Q

antidote for acetaminophen overdose?

A

N-acetylcysteine- regenerates glutathione

200
Q

which drugs are bisphosphonates?

A

alendronate, other -dronates

201
Q

MOA of bisphosphonates?

A

pyrophosphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity

202
Q

clinical use of bisphosphonates?

A

osteoporosis • hypercalcemia • pagets disease of bone

203
Q

toxicity of bisphosphonates?

A

corrosive esophagitis • osteonecrosis of the jaw

204
Q

MOA of allopurinol?

A

inhibits xanthine oxidase, ↓ conversion of xanthine to uric acid • used in lymphoma and leukemia to prevent tumor lysis associated urate nephropathy

205
Q

PK considerations for allopurinol?

A

↑ concentrations of azathiprine and 6-MP

206
Q

CI with allopurinol?

A

do not give salicylates (↓ urate clearance)

207
Q

MOA of febuxostat?

A

inhibits xanthine oxidase

208
Q

MOA of probenecid?

A

inhibits reabsorption of urate in PCT (also inhibits secretion of penicillin)

209
Q

MOA of colchicine?

A

binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation

210
Q

AE of colchicine?

A

GI side effects, especially is given PO

211
Q

which are the NSAIDs for acute gout?

A

naproxen, indomethacin

212
Q

ROA for glucocorticoids for acute gout?

A

oral or intraarticular

213
Q

immune precaution for all TNF-α inhibitors?

A

all predispose to infection including reactivation of latent TB since TNF blockade prevents activation of macrophages and destruction of phagocytosed microbes

214
Q

which drugs are the TNFα inhibitors?

A

etanercept • infliximab, adalimumab

215
Q

MOA of etanercept?

A

fusion protein (receptor for TNF-α + IgG1 Fc), produced by recombinant DNA • decoy receptor

216
Q

clinical use of etanercept?

A

RA • psoriasis • ankylosing spondylitis

217
Q

MOA of infliximab, adalimumab?

A

anti TNFα monoclonal Ab

218
Q

clinical use of infliximab and adalimumab?

A

crohns • RA • ankylosing spondylitis • psoriasis

► Med Notes (62 decks)

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