pp skin, mm, bone, Rheu Flashcards
What are 1st degree burns?
Red (epidermis)
What are 2nd degree burns?
Blisters (hypodermis)
What are 3rd degree burns?
Painless neuropathy (dermis)
What diseases have palm and sole rashes?
“TRiCKSSS”
Toxic Shock Syndrome
Rocky Mountain spotted fever Coxsackie A:
Hand-Foot-Mouth disease Kawasaki
Scarlet fever
Staph Scaled Skin
Syphilis
What is Erythema Multiforme?
Target lesions (viral, drugs)
What is Stevens Johnson syndrome?
Erythema Multiforme Major (mouth, eye, vagina)
What is Toxic Epidermal Necrolysis?
Stevens Johnson w/ skin sloughing
What is Pemphigus vulgaris?
Ab against desmosomes => circular immunofluorescence, in epidermis, oral lesions, + Nikolsky sign
What is Bullous Pemphigoid?
Ab against hemidesmosomes => linear immunofluoresence, subepidermal, “floating” keratinocytes, eosinophils
What is Eczema?
Dry flaky dermatitis in flexor creases “itch that rashes”
What is Nummular dermatitis?
Circular eczema
What is Spongiotic eczema?
Weeping eczema: scratching causes oozing “like a sponge”
What is Lichenification?
Scratching => thick leathery skin
What is Pityriasis Rosea?
Herald patch that follows skin lines (Tx: sunlight) “C-mas tree pattern”
What is Lichen Planus?
Polygonal pruritic purple papules
Very itchy
What is Scabies?
Linear excoriation “burrows” in webs of fingers, toes, belt line (Sarcoptes scabies)
What does UV-A cause?
Aging
What does UV-B cause?
Burns and cancer
What are the ABCD’s that indicate worse prognosis of skin cancer?
- Asymmetric
- Irregular Borders
- Color differences
- > 4mm Diameter
What does the Clark level tell you?
Invasion of melanoma
What does Breslow’s classification tell you?
Depth of melanoma
Where are Malignant
Melanomas usually found?
Males: back Females: leg
What is the precursor of a Malignant Melanoma?
Hutchison’s freckle
What are the types of Malignant Melanomas?
Superficial spreading: most common, flat brown
Nodular: worst prognosis, black, dome- shape
Lentigo maligna melanoma: elderly pts, fair-skin
Acral lentigous: AIDS pts, dark skin
Where are Squamous Cell carcinomas usually found?
Flat flaky stuff on lower face, keratin pearls
What is the precursor of Squamous Cell carcinoma?
Actinic keratosis (red scaly plaque)
What are the types of Squamous Cell carcinoma?
Bowen’s disease: SCC in situ on uncircumcised penis dorsum
Verrucous carcinoma: wart on foot
Where are Basal Cell carcinomas usually found?
Pearly papules on upper face, palisading nuclei, good prognosis
What are the types of Basal Cell carcinomas?
Nodular: waxy nodule w/ central necrosis
Superficial: red scaly plaques, like eczema
Pigmented: looks like melanoma
Sclerosing: yellow waxy plaques
What is Acne Rosacea?
Blush all the time, worse w/ stress/alcohol
What is a Brown Recluse Spider Bite?
Painful black necrotic lesion
What is Cellulitis?
Warm red skin
What is Cutaneous Anthrax?
Painless black necrotic lesion
What is a Decubitus Ulcer?
Bedsore
What is a DVT?
Blood clot in veins, associated w/ hypercoagulable state
What is Erysipelas?
Shiny red, raised, does not blanch, usually on face, assoc w/ Strep pyogenes
What is Icthyosis?
Gradual lizard skin
What is Miliaria?
“Heat rash”: burning, itching papules on trunk
What is Molluscum Contagiosum?
Fleshy papules w/ central dimple, pox virus (can be STI)
What is Psoriasis?
Silver scales on extensors, nail pitting, differentiated too fast, worse w/ stress
* Auspitz sign: remove scale =>
pinpoint bleeding
* Koebner’s phenomenon: lesions at
sites of skin trauma
What is a Pyogenic Granuloma?
Vascular nodule at site of previous injury
What is Seborrheic Dermatitis?
Dandruff in eyebrows, nose, behind ears
What is Seborrheic Keratosis?
Rubbery warts with aging, greasy
What is Thrombophlebitis?
Vein inflammation w/ thrombus
What is Vitiligo?
White patches, anti-melanocyte Ab
What is Xeroderma Pigmentosa?
Bad DNA repair
What is Erythema Chronicum
Lyme disease (solitary lesion that spreads)
What is Erythema Infectiosum?
Fifth disease “slapped cheeks” due
to Parvovirus B19
What is Erythema Marginatum?
Rheumatic fever (red margins)
What is Erythema Multiforme?
Target lesions due to HSV,
Phenytoin, Barbs, Sulfas
What is Erythema Multiforme Major?
Stevens Johnson syndrome (> 1 mucosal surface)
What is Erythema Nodosum?
Fat inflammation (painful red nodules on legs), sarcoidosis
Where is CK-MB found?
Heart
Where is CK-MM found?
Muscle
Where is CK-BB found?
Brain
Why should you wait 30min after a meal before swimming?
All blood in gut and skeletal mm. have ran out of ATP
How does a neurogenic muscle disease present?
Distal weakness + fasiculations
How does a myopathic muscle disease present?
Proximal weakness + pain
What is a light chain composed of?
Actin
What is a heavy chain composed of?
Myosin
What band of the sarcomere does not change length?
A band
Where are the T-tubules located?
Cardiac muscle: Z line
Skeletal muscle: A-I
junction
What is Duchenne’s MD?
Dystrophin frameshift, Gower sign, calf pseudohypertrophy
What is Becker’s MD?
Dystrophin missense, sx >5 y/o
What is Myotonic Dystrophy?
Bird’s beak face, can’t let go when shake hands
What is Myasthenic syndrome = Lambert-Eaton?
Gets stronger as day goes by, stronger w/ EMG, not small cell CA associated
What is Myasthenia gravis?
Gets weaker as day goes, stronger w/ Edrophonium, weaker w/ EMG, rule out thymoma
What is Multiple sclerosis?
Anti-myelin Ab, young woman w/ vision problems, sx come &go
What is Metachromatic Leukodystrophy?
Arylsulfatase deficiency, kid with MS presentation
What is Ataxia Telangectasia?
Spider veins, IgA deficiency
What is Freidrich’s ataxia?
Retinitis pigmentosa, scoliosis
What is Adrenal Leukodystrophy?
Carnitine shuttle problem, adrenal failure
What is Guillane-Barre?
Ascending paralysis, 2 wk after URI
What is ALS?
Middle age male w/ fasiculations, descending paralysis, no sensory problems
What is Werdnig-Hoffman?
Fasciculations in a newborn, no anterior horns
What is Polio?
Asymmetric fasiculations in child, 2 wk after gastroenteritis
What is Choreoathetosis?
Dance-like movements, wringing of hands, quivering voice
What is Atonic cerebral palsy?
No muscle tone, floppy
What is Slipped Capital femoral Epiphysis?
Obese boys w/ dull achy pain in the hip and a limp
What is Legg-Calves-Perthes?
Limp (femur head avascular necrosis)
What is Osgood-Schlatter?
Knee pain (tibial tubercle
avascular necrosis)
What is Septic arthritis?
Joint pain (Staph aureus) with fever
What is Ankylosing Spondylitis?
Ligament ossification => vertebral body fusion, ↓lumbar curve, stiffer in morning, kyphosis, uveitis, HLAB-27
What is Cauda Equina Syndrome?
“Saddle anesthesia”: can’t feel butt, thighs, perineum
Where does bone cancer metastasis occur from?
Breast, prostate, lung, kidney
What is Costochondritis?
Painful swelling of chest joint- bone attachments, worse w/ deep breath
What is Disk Herniation?
Straight leg raise => shooting pain
What is Lumbar Stenosis?
MRI “hourglass”, low back pain
What is Ochronosis = Alkaptonuria?
Kids w/ OA, black urine, homogentisic acid oxidase deficiency
What is Osteitis Fibrosis cystica?
Inflammation of bone w/ holes due to high PTN
What is Osteogenesis Imperfecta?
Blue sclera, multiple broken bones
What is Osteomalacia = Rickets?
Soft bones (waddling gait)
Craniotabes (soft skull)
Rachitic rosary (costochondral thickening)
Harrison’s groove
Pigeon breast (sternum protrusion)
What is Osteomyelitis?
Infected bones
What is Osteonecrosis = Legg- Calve- Perthes?
Wedge-shaped necrosis of femur head
What is Osteopenia?
Lost bone mass
What is Osteopetrosis?
↓Osteoclast activity => marble
bones (obliterate own bone
marrow)
What is Osteoporosis?
Loss of bone matrix (not calcification) => compression fractures
What is Osteosclerosis?
Thick bones from scarring
What is Paget’s Disease?
“My hat doesn’t fit”, paramyxovirus, ↑osteoclasts/blasts, fluffy bone, osteosarcoma, ↑CO heart failure, deafness, ↑alkaline phosphatase alone
what is Rheumatoid Factor?
An IgM against IgG Fc
What are Tophi?
Gout crystals + giant cells
What is Podagra?
Big toe inflammation from gout
What is CREST syndrome?
Calcinoss
Raynaud’s
Esophageal dysmotility
Sclerodactyly
Telangiectasia
What Ab is associated with CREST?
Anti-centromere Ab
What diseases have Raynaud’s syndrome?
- Scleroderma
- Takayasu’s
- RA
- SLE
What platelet count do most types of vasculitis have?
Low platelets
Which vasculitis has a high platelet count?
Kawasaki disease
Which vasculitis has a normal platelet count?
Henoch-Schönlein purpura
What is Osteoarthritis?
Pain worse w/ activity, PIP/DIP joints
What is Rheumatoid Arthritis?
Pain worse in morning, MCP/PIP joints
What is Stills’ Disease?
Juvenile RA
What is Pseudogout?
Pyrophosphate crystals in knees/wrists
What is Gout?
Urate crystals in big toe, (-) birefringence
What is Myositis?
1 muscle hurts
What is Polymyositis?
> 1 muscle hurts
What is Dermatomyositis?
Myositis + rash
What is Fibromyalgia
Hurt all the time, 11 trigger points
What is Polymyalgia Rheumatica?
Weak shoulders, temporal arteritis
What is SLE = Lupus?
Meet 4 criteria: “DOPAMIN RASH”
Discoid rash
Oral ulcers
Photosensitivity
Arthritis
Malar rash
Immunologic disorder: Anti-ds DNA, antiSmith,
Cardiolipin Ab
Neurologic disorder: seizure or psychosis
Renal failure: die of this
ANA
Serositis: pleuritis/pericarditis (Libman-
Hemolytic anemia
Sacks endocarditis)
What is Scleroderma?
Tight skin, fibrosis
CREST
Esophageal dysmotility due to dilation
What is Takayasu’s Arteritis?
Asian women with weak pulse, aorta inflammation
What is Polyarteritis Nodosa?
p-ANCA Ab, attacks gut/kidney, Hep B
What is Wegener’s Granulomatosis?
c-ANCA Ab, attacks ENT, lungs, kidney
What is Goodpasture’s?
Anti-GBM Ab, attacks lung/kidney, RPGN
What is Reiter’s syndrome?
Males that can’t see, pee, or climb a tree
What is Sjögren’s syndrome?
Females that have dry eyes/mouth, RA
What is Behçet’s syndrome?
Oral and genital ulcers, uveitis
What is Churg-Strauss?
Asthma, eosinophils, multi-organ involved
Any permanent neurological damage suffered PRIOR to the age of 21 years
Cerebral Palsy
- No muscle tone
- Frontal cortex is involved
- Involves corticospinal tract (CST)
Atonic
Dance-like movements. Basal ganglia is
involved.
Choreoathetosis
Kernicterus is most common in a
newborn
buildup of bilirubin
choreoathetosis
2 bugs that manifest spastic Hemiplegia
Toxo–parietal lobe
Herpes- temporal lobe
midline cortical problem
Legs are worse than arms
Spastic Diplegia
condition Involving the cortical white matter early Adrenal gland failure (electrolyte
imbalances i.e., aldosterone)
adrenoleukodystrophy
Increased incidence of Retinitis
Pigmentosa, Scoliosis, and Hypertrophic Cardiomyopathy
Friedreich’s Ataxia
cerebellar, DNA breakage, cancer, malabsorption, spider veins
Ataxia-Telangiectasia
Enterovirus that hides in the dorsal root ganglion (DRG)
polio
Two weeks following a gastroenteritis asymmetrical paralysis
polio
Fasciculations in a newborn Floppy baby
Congenital anterior horn degeneration
Werdnig Hoffman’s Disease
Fasciculations in a middle-aged man
Descending paralysis
Amyotrophic Lateral Sclerosis (ALS)
Upper and Lower Motor Neuron Disease
NO sensory neuron involvement
ALS
when is plasmapheresis used in autoimmune neuropathies
respiratory compromise
when is IV gamma globulins used in autoimmune neuropathies
significant weakness
RX for autoimmune neuropathies early in dx
steroids
middle-aged female with visual disturbance
CN 5 is commonly involved
MS
attack MLF, internuclear ophthalmoplegia, optic neuritis
MS/metachromatic leukodystrophy
arylsufatase enzyme def. in 5-10 yo
demyelination of neurons
Metachromatic leukodystrophy
atropine and pralidoxime indication
organophosphate poisoning
anticholinergic: Atropine use for
heart blocks and dry up secretion b4 surgery
glycopyrrolate indication (Anticholinergic)
dry up lungs secretions b4 surgery
anticholinergic: benztropine indication
parkinson and dystonia
use for COPD bc they do not dry up secretions
ipratropium
Tiotropium
mc mucolytic
Guaifenesin
N-acetylcysteine
Reversible ACH inhibitor
Edrophonium(DX of MG)
Neostigmine (RX of myasthenia Gravis)
paraneoplastic syndrome that is a presynaptic Ca2+ channel blocker
Lambert Eaton
Edinger-westphal nucleus damaged by syphillis
eye accommodate but slow to react
glove and stocking distribution of neuropathy is due to
sorbitol accumulation
ascending paralysis with anemia post gastroenteritis
GB dt campylobacter jejuni
Birds beak facial appearance and hand spasm and slow to release shaked hands
myotonic dystrophy
Nonsense and frameshift mutations disease occurrence
early in life
missense mutation disease occurrence
late onset
Becker’s and duchenne’s inheritance patterns
x-linked recessive
Chronic pain treatment
Amitriptyline (best for fibromyalgia)
Gabapentin
Carbamazepine
what modulates pain signal
serotonin
pain inhibition
GABA
mcc causes of myositis and polymyositis
hypothyroidism/Cushing’s syndrome and drugs
autoimmune cause of myositis and polymyositis
JO-1
infectious cause of myositis and polymyositis
Trichinella spiralis
Taenia Solium
Drugs that block ADH and correct
Conivaptan or Tolvaptan
does not decrease mortality
Aldo blockers (decrease mortality)
Eplerenone
spironolactone(block 5-a-reductase–gynecomastia)
decrease mortality in pt only if BP can tolerate (high BP)
Beta blocker: metoprolol, Bisoprolol and carvedilol
decrease TPR, increase Bradykinin, Angioedema
ACE-I/ARBs
inhibit neprilysin to increase ANP
Sacubitril
Digitalis Toxicity RX
Digibind and Digifab
MOA of Digitalis
block the K on the Na/K pump
slurring QRS dt k leaking out
2 mean causes of Digit toxicity
more likely to depolarize
hypercalcemia and hypokalemia