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MSK/Derm > Pathology > Flashcards

Pathology Flashcards

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Dermatology Board Prep flashcards
1
Q

Achondroplasia

A

AD FGFR3 mutation (chromosome 4)- large head, short limbs

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2
Q

Osteoporosis

A

Trabecular bone loses mass (trabecular thinning) but normal bone mineralization and labs, DEXA

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3
Q

Type I osteoporosis

A

Post-menopausal - increased resorption due to decreased estrogen (overexpression of RANK receptor)

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4
Q

Type II osteoporosis

A

Old age - prophylax with weight bearing exercise, Ca, Vitamin D - treatw ith bisphosphonates, PTH analogs, SERMs

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5
Q

Osteopetrosis

A

Defective osteoclasts due to carbonic anhydrase 2 mutation (can’t make acidic environment) - dense bones prone to fracture, bone in bone on x-ray, can cause CN impingement and palsies

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6
Q

Osteomalacia/rickets

A

Vit D deficiency - defective mineralization of osteoid - bowed legs, bony prominence at costochondral junction, indentations in lower ribs, soft skull, increased ALP and PTh

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7
Q

Paget disease of bone

A

Increased osteoblastic and osteoclastic (very large and can have up to 100 nuclei - RANKL and M-CSF) activity - increased ALP, mosaic pattern of bone, increased risk of osteosarcoma and heart failure

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8
Q

Stages of Paget’s disease

A

Lytic, Mixed, Sclerotic, Quiescent

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9
Q

Osteonecrosis

A

MC in femoral head (insufficient medial circumflex femoral artery) - ASEPTIC causes (Alcoholism, Sickle cell, Storage, Exogenous corticosteroids, Pancreatitis, Trauma, Idiopathic, Caisson)

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10
Q

Osteoporosis lab values

A

ALL NORMAL - decreased bone mass

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11
Q

Osteopetrosis lab values

A

Normal or decreased Ca - all others normal

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12
Q

Paget disease lab values

A

Increased ALP

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13
Q

Osteomalacia/rickets lab values

A

Decreased Ca/P and Increased ALP/PTH

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14
Q

Hypervitaminosis D lab values

A

Increased Ca/P and Decreased PTH

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15
Q

Osteitis fibrosa cystica

A

Brown tumors due to fibrous replacement of bone

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16
Q

Primary hyperparathyroidism lab values

A

Decreased P - Increased Ca, ALP, PTH

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17
Q

Secondary hyperparathyroidism lab values

A

Decreased Ca - Increased P, ALP, PTH — often a compensation for end stage renal disease

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18
Q

Giant cell tumor

A

Epiphyseal end of long bones - benign tumor (often in knee) - SOAP BUBBLE on xray - multinucleated giant cells

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19
Q

Osteochondroma

A

MC benign tumor (males less than 25) – mature bone with cartilaginous cap, rarely becomes chondrosarcoma

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20
Q

Osteosarcoma

A

10-20 years old and > 65 (Pagets) - risks are infarction, radiation, familial Rb, and Li-Fraumeni syndrome - found in metaphyses of long bones (knee) - CODMAN TRIANGLE - SUNBURST on xray - VERY AGGRESSIVE

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21
Q

Ewing sarcoma

A

Boys less than 15 – common in diaphysis of long bones, pelvis, scapula, and ribs – anaplastic small blue cell malignant tumor – very aggressive but responds to chemo – onion skin periosteal reaction in bone — t(11;22) translocation fusing EWS-FLI 1

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22
Q

Osteoarthritis joint findings

A 
Subchondral cysts, sclerosis, osteophytes, eburnation, synovitis
Heberden nodes (DIP) and Bouchard nodes (PIP)
23
Q

Osteoarthritis clinical

A

Pain in weight bearing joints AFTER USE, improve with rest, bowlegged, no inflammation - risks are age/obesity/trauma

24
Q

Osteoarthritis treatment

A

Acetaminophen, NSAIDs, intra-articular glucocorticoids

25
Q

Rheumatoid arthritis joint findings

A

Pannus formation in joints (MCP, PIP), subcutaneous nodules, ulnar deviation of fingers, subluxation

26
Q

Rheumatoid arthritis clinical

A

TYPE III and IV HYPERSENSITIVITY - Females, positive rheumatoid factor (IgM against Fc of IgG) - ANTI-CCP IS MORE SPECIFIC - Associated with HLA-DR4 - Morning stiffness that improves with use, symmetric joints, systemic symptoms

27
Q

Rheumatoid arthritis treatment

A

NSAIDs, glucocorticoids, methotrexate, sulfasalazine, TNF-a inhibitors

28
Q

Sjogren syndrome

A

Exocrine gland destruction - FEMALES - inflammatory joint pain, xerophthalmia, xerostomia, SS-A and/or SS-B positive, bilateral parotid enlargement —- can have dental caries or MALT lymphoma

29
Q

Gout findings

A

MONOarthritis - monosodium urate crystals - males - hyperuricemia from underexcretion (thiazides) or overpdocution (Lesch-Nyhan, PRPP excess, tumor lysis, von Gierke) —- needle shaped and negative birefringent crystals

30
Q

Gout symptoms

A

Asymmetric joints - swollen, red, painful joints (big toe) - tophus formation — worse with large meals or alcohol (AVOID RED MEATS) - neutrophils are responsible for inflammation

31
Q

Gout treatment

A

Acute - NSAIDs (indomethacin), glucocorticoids, colchicine

Chronic - XO inhibitors (allopurinol, febuxostat), probenecid, rasburicase

32
Q

Pseudogout

A

Calcium pyrophosphate crystals (basophilic, rhomboid crystals, weakly birefringent) - KNEE - can be in hemochromatosis, hyperPTH, osteoarthritis
Treatment - NSAIDs, glucocorticoids, colchicine

33
Q

Infectious arthritis

A

S. aureus, Strep, N. gonorrhoeae

Gonococcal arthritis is STD (Synovitis, Tenosynovitis, Dermatitis)

34
Q

Sponyloarthropathies

A

PAIR - Psoriatic arthritis, Ankylosing spondylitis, IBD, Reactivie arthritis
HLA-B27 positive

35
Q

Psoriatic arthritis

A

Sausage fingers, pencil in a cup on xray

36
Q

Ankylosing spondylitis

A

Spine and sacroiliac joints (Bamboo spine on xray) - respiratory (decreased chest wall expansion), CV (ascending aortitis), eye (uveitis)

37
Q

Reactive arthritis (Reiter syndrome)

A

Males in 20s-30s - “Can’t see, can’t pee, can’t bend my knee” - Conjunctivitis, Urethritis, Arthritis (sterile joint aspirates) - Post GI or chlamydial infections

38
Q

Lupus symptoms

A

RASH OR PAIN - Rash (malar or discoid), Arthritis (2 or more joints), Soft tissues/serositis (pericarditis, pleuritis), Hematologic disorders (pancytopenia - type II HS), Oral ulcers, Renal disease/Raynaud phenomenon, Photosensitivity/Positive VDRL/RPR, Antinuclear antibodies, Immunosuppressants, Neurologic disorders

39
Q

Lupus clinical

A

FEMALES, Libman Sacks endocarditis (nonbacterial vegetations on BOTH SIDES of valve), Nephritis is type III HS (diffuse proliferative glomerulonephritis or membranous glomerulonephritis) - causes of death are CV disease, infection, renal disease

40
Q

Lupus labs

A

ANA (sensitive), Anti-dsDNA (specific), Anti-smith (most specific), Antihistone (drug induced lupus - SHIPPE - Sulfa, Hydralazine, Isoniazid, Phenytoin, Procainamide, Ethambutol)

41
Q

Lupus treatment

A

NSAIDs, steroids, immunosuppressant, hydroxychloroquine, cyclophosphamide

42
Q

Antiphospholipid syndrome

A

In SLE patients - multiple miscarriages and thrombosis - lab findings: lupus anticoagulant, anticardiolipin (VDRL/RPR false positive), anti-B2 glycoprotein antibodies

43
Q

Sarcoidosis

A

40 YEAR OLD AFRICAN AMERICAN FEMALE WITH BILATERAL HILAR LYMPHADENOPATHY - noncaseating granulomas, elevated serum ACE and CD4/CD8 ratio - Schaumann and asteroid bodies, uveitis, hypercalcemia - Tx is steroids

44
Q

Polymyalgia rheumatica

A

Pain/stiff shoulders and hips, women > 50, associated w/ temporal arteritis - NORMAL CK - rapid response to low dose corticosteroids

45
Q

Fibromyalgia

A

PAIN EVERYWHERE (abnormal central processing of pain) - NORMAL LABS - Females 20-50 - can have depression/anxiety - Tx with antidepressants (TCAs, SSRIs) and anticonvulsants

46
Q

Polymyositis

A

Proximal muscle weakness (endomysial inflammation with CD8 T Cells and increased MHC I) —- ANA, anti-Jo-1, anti-SRP, anti-Mi2 antibodies —- tx steroids and immunosuppression

47
Q

Dermatomyositis

A

Malar rash with proximal muscle weakness (perimysial inflammation with CD4 T cells) - Gottron papules (dorsal MCP), heliotrope rash (periorbital), shawl and face rash, mechanics hands —- ANA, anti-Jo-1, anti-SRP, anti-Mi2 antibodies —- tx steroids and immunosuppression

48
Q

Myasthenia gravis

A

Antibodies to postsynaptic Ach receptor (decrease end plate potential) - ptosis, diplopia, weakness (EOM affected first), WORSE WITH USE!! — associated with thymoma, thymic hyperplasia – AChE inhibitor reverses symtpoms – Tx with Cholinesterase inhibitors (physostygmine, neostigmine, pyridostigmine)

49
Q

Lambert-Eaton

A

Antibodies to presynaptic Ca channel (decreased ACh release) - proximal muscle weakness (trouble climibing stairs/standing out of a chair), dry mouth, impotence — SPARES EYES AND IMPROVES WITH USE – associated with small cell lung cancer

50
Q

Myositis ossificans

A

Metaplasia of skeletal muscle into bone following trauma

51
Q

Scleroderma

A

Autoimmunity (accumulation of CD4 lymphocytes leads to fibroblast stimulation), noninflammatory vasculopathy, and collagen deposition with fibrosis — puffy, taut skin with fingertip pitting — renal, pulmonary, CV, GI sclerosis – DIFFUSE (anti-Scl 70 antibody) – LIMITED (CREST involvement, anti-centromere antibody) – CREST: Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactyly, Telangiectasia – pulmonary HTN/vessel damage can also be part of CREST

52
Q

Causes of myopathy

A

CK normal - glucocorticoid induced and polymyalgia rheumatica —- CK elevated - inflammation, statin induced, hypothyoroidism

53
Q

Lipoma/liposarcoma

A

Lipomas are mobile and have mature fat cells without pleomorphism — liposarcomas are malignant and have lipoblasts (cells that produce non-membrane-bound cytoplasmic lipid), cause nuclear indentations and scalloping of nuclear membranes, present as slow growing painless masses in deep connective tissue

MSK/Derm (4 decks)

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