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BOARDS! > Rheum/Ortho+Derm > Flashcards

Rheum/Ortho+Derm Flashcards

1
Q

(NON-modifiable) RF for osteoporotic fractures {2/2}

A
  • advancing age
  • female
  • white, hispanic, asian (NOT BLACK)
  • personal or family hx of fractures
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2
Q

(potentially modifiable) <six> RF for osteoporotic fractures {1/2}</six>

A
  • DEC physical activity
  • low body weight
  • poor calcium and Vit D intake
  • excessive alcohol or tobacco use
  • premature menopause
  • glucocorticoid use
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3
Q

3 phases of wound healing <in-pro-ma></in-pro-ma>

A
  1. inflammatory phase
  2. proliferative phase
  3. maturation phase
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4
Q

acanthosis nigrans

A
  • HYPERpigmented, velvety plaques
  • axilla or neck
  • assoc w/:
    • DM, obesity
    • visceral malignancy,
    • endocrinopathy
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5
Q

ACL

A
  • anterior cruciate ligament can be damaged by sudden decelerations and pivots on an extended knee during sports activity
  • PE: excessive motion of the tibia with respect to the femur (eg Lachman test, anterior drawer test)
  • originates on lateral femoral condyle, inserts on ant intercondylar area of tibia
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6
Q

acute allergic contact dermatitis (ACD)

A
  • form of eczema caused by a type 4 (delayed) hypersensitivity rxn to an Ag on the skin surface
  • Ag taken up by Ag-presenting Langerhan cells and presented to CD4+ T-cells in regional lymph nodes
    • T-cells are ativated and migrate to skin
    • at skin, incite an inflamm resp within 24 hrs of Ag re-exposure
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7
Q

acute allergic contact dermatitis (ACD) Histo

A
  • spongiosis
    • edema fluid in intercellular space of the epidermis
    • intercellular bridges become more distinctive
  • edema leads to intraepidermal vesicles
  • perivascular infiltrate of lymphocytes and eosinophils
  • iwth persistent Ag exposure:
    • lesions become less edematous and weepy
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8
Q

Body’s muscles

A
  • 2 main fiber types:
  • Type 1 (slow twitch): perform actions requiring low-level sustained force (postural maintenance)
    • aerobic metab, have high myoglboin (oxygen storage) and mitochondrial (aerobic respiration) concentrations
    • paraspinal muscles mostly Type 1
  • Type 2 (fast twitch)-rapid forceful pulses of movement
    • 2b: derive ATP energy through anaerobic glycogenolysis and subsequent glycolysis
    • 2a=intermed between Type 1 and 2b-they generate ATP via aerobic metab
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9
Q

Bone mass

A
  • in adulthood, bone mass is determined by peak bone mass and the rate of bone loss
  • variation in peak bone mass is determined by genetic and environmental factors (nutritional status, physical activity
  • AA women: higher bone density and lower risk of fractures that women of other ethnicities
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10
Q

capillary hemangiomas

A
  • small and superficial
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11
Q

CaSR-Calcium sensing receptors

A
  • transmembrane G-protein-coupled (metabotropic) receptors
  • help regulate the secretio of PTH in response to changes in circulating calcium levels
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12
Q

Difference between reABsorption and re_sorption

A
  • re-AB-sorption:
    • absorbing again
  • re_sorption:
    • lysis and assimilation of a substance (as of bone)
    • pathological or physiological loss of a substance
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13
Q

Disuse atrophy

A
  • skeletal muscle fibers decrease in size
  • tissue loss due to cellular death or reduced cell size
  • may be physiologic (atrophy of wolffian ducts in the female fetus, atrophy of maternal uterus following childbirth) or pathologic
  • pathologic atrophy: due to lack of use, loss of hormonal or neurologic stimulation (denervation atrophy), impaired circulation, mechanical compression, aging, or nutritional insufficiency
    • localized or generalized
    • due to: decreased physical workload
    • also seen in adrenal cortex during prolonged glucocorticoid use due to suppression of ACTH release
      • can lead to acute adrenal insufficiency if exogenous gluc therapy is abruptly discontinued
  • cellular level: decreased protein synthesis and loss of myofibrils
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14
Q

Duchenne muscular dystrophy

A
  • X-linked recessive myopathy
  • PP: deletion of dystrophin gene on X chromosome p21, get frameshift mutation
    • dystrophin=protein that allows interaction between extracellular connective tissue and the intracellular contraction apparatus
  • Epid: 2-5 yo boys
  • CP: proximal muscle weakness, enlargement of the distal muscles (calf hypertrophy)
    • Gower sign-use hands to rise from a squat or form a chair to compensate for prox mu weakness
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15
Q

ecchymosis

A
  • cutaneous OR sub-cutaneous
  • collection of EXTRAVASATED blood..at least 1cm diameter
  • indicate deep hemorrhage (hematoma) d/t:
    • bony fracture
    • ligamentous rupture
    • muscular injury
  • do NOT blanch under pressure b/c RBC are NOT contained within the vasculature
  • evolution of color change (blue/red–>brown–>green—>ylw)
    • used for estimation of age of injury
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16
Q

FOOSH

A
  • fall onto an outstretched dorsiflexed hand
  • common cause of upper extremity injury
  • distal complications are most common-include scaphoid fracture, lunate dislocation, and distal radius fracture
17
Q

Lentigines

A

small tan or brown macules most often sen on the sun-exposed skin of a middle-aged or elderly person

18
Q

Psoriasis histo

A
  • HYPER-para-keratosis
  • acanthosis
  • elongation of rete ridges
  • mitotic activity aboe the epidermal basal cel layer
  • reduced/absent stratum GRANULOSUM (grab)
  • neutrophils may form spongiotic clusters in superficial dermia and parakeratotic s. corneum
    • **Munro microabscesses
  • Auspitz sign-pinpoint bleeding when scale removed form the plaque
19
Q

PTH and bone

A
  • stimulates Ca release from bone mineral compartment
    • via: INC production of M-CSF and RANK-L
    • RANK-L binds RANK on onsteoclasts, stimulates them=INC Ca [enhanced bone matrix degradation]
20
Q

PTH and kidney

A
  • stimulate reabsorption of calcium in distal convoluted tubule
  • inhibits phosphate reabsorption in proximal convoluted tubule (PCT)
  • stimulates production of 1,25-(OH)2D3 (CALCITRIOL) via stimulation of 1alpha-hydroxylase in proximal convoluted tubuled (PCT)
    • feedback inhibition of PTH synthesis
    • INC intestinal calcium absorption
    • INC serum Ca
21
Q

PV and BP

A

PV-desmosome

BP-HEMI-desmosomes

22
Q

Quadriceps muscle group

A
  • connected to the patella which is attached to the tibial tubercle by the patellar ligament
  • repetitive quad contraction can lead to Osgood-Schlatter dz
    • charac: focal pain and swelling at tibial tuberosity
23
Q

RF for Osteoporotic Fractures

A
  • NON-modifiable:
    • advancing age
    • female sex
    • white, hispanic, asian
    • personal or fhx of fractures
  • Modifiable
    • DEC physical activity
    • low body weight
    • poor ca and vit D intake
    • xs slcohol or tobacco use
    • premature menopause
    • glucocor
24
Q

seborrheic keratosis

A
  • benign
  • tan-brown epidermal tumor
  • middle aged/elderly
  • anywhere on body
  • variable appearance
    • nearly flat macules
    • raised, wart-like lesions
    • few mm to several cm
    • “STUCK-ON”
25
Q

strawberries and cherries

A
  • strawberry (capillary) hemangioma
    • benign
    • vascular tumors
    • childhood
    • regress by 5-8 yo
    • composed of capillaries separated by connective tissue
  • cherry hemangiomas
    • mc benign vascular proliferation in ADULTS
    • small, bright red
    • cutaneous papules
    • consist of:
      • dilated capillaries
      • post capillry venules in papillary dermis
    • do NOT regress spontaneously
26
Q

Supracondylar humeral fractures

A
  • common pediatric elbow fractures
  • occur after hyperflexion or hyperextension injuries
  • significant risk of neurovascular compromise
  • brachial artery, median nerve, radial nerve all run anterior to elbow.
    • supracondylar fractures result in anterolateral displacement of the proximal fracture fragment typically cause radial nerve injury
    • causes wrist drop (due to denervation of hand/finger extensor muscles) and sensory loss over the posterior forearm/dorsolateral hand
27
Q

telangiectasias

A
  • small, permanent dilations of superficial capillaries or venules
  • blanch under pressure
  • commonly seen in aging, chronic solar damage, long-term glucocorticoid use, rosacea, and a variety of systemic d/o
28
Q

TGFbeta and wound healing

A
  • tgfbeta is critical for fibroblast migration, proliferation, and connective tissue synthesis
  • INC TGFbeta is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver, and kidney that ccur with chronic inflammation
29
Q

Vertebral oseomyelitis

A
  • suspected in pts with new or worsening back pain, fever, and recent endocarditis or bactermia (espec S. aureus)
  • suspected if there are new neuro findings and fever with/without back pain
  • MRI of spine for diagnosis
30
Q

What jacks up PTH (phosphate trasihng hormone)

A
  • DEC serum Ca
  • INC serum PO4
  • DEC serum Mg
31
Q

Paget disease of bone

A
  • accelerated bone remodeling with eventual bony overgrowth
  • three main phases:
      1. Osteolytic phase-{CLAST dominant}
      1. Mixed phase-{CLAST + BLAST}
        * rapid INC in BLAST formation
      1. Osteo-SCLEROTIC phase-{BLAST dominant}
        * dense, hypovascular, MOSAIC PATTERN of lamellar bone with irregular haphazard oriented sections separated by PROMINENT CEMENT LINES
32
Q

A f/m THICK–>thin

A
  • H band: just thick myosin
  • I band: just thin myosin
  • A band: thick and thin
33
Q

ACS (acute compartment syndrome)

A
  • PP: INC pressure within fascial compartments of the limbs
  • leads to impaired perfusion
  • can cause:
    • severe pain
    • myonecrosis
    • nerve injury
  • mc site: anterior compartment of the leg which contains:
    • anterior tibial artery
    • deep peroneal (fibular) nerve
    • foot extensor muscles
34
Q

Discharge checklist

A
  • details medication changes and followup appts
  • can significantly facilitate a pt’s transition from the hospital
  • imrpoves adherence to out pt tx
  • indivs with smooth transition from in to out pt setting are at lower risk for early rehospitalization

BOARDS! (14 decks)

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