Skin/MS Pathology Flashcards
1
Q
Trendelenberg sign
A
dropping of the lifted legs hip
Due to paralysis of the abductors of gluteus medius and gluteus minimus-> Superior gluteal invervation
2
Q
Foot drop
A
Peroneal nerve damaged
dorsiflexes and everts the foot
PED
3
Q
Can’t stand on tip toes
A
Tibial nerve damage
inverts and plantaflexes the foot
TIP
4
Q
Thigh adduction innervated
- anterior hip dislocation
(4 muscles)
A
Obturator
adductor longu, adductor, brevis, anterior portion of adductus magnus, gracilis
5
Q
Thigh flexion and leg extension nerve
A
Femoral
worry in pelvic fracture
6
Q
Knee trauma worry about this nerve
Can
A
tibial
7
Q
posterior hip dislocation and can’t jump
nerve and muscle
A
inferior gluteal enervating the gluteus maximus
8
Q
pathology due to activating mutation in fibroblast growth factor receptor 3 (FGFR3)
A
Achrondroplasia - dwarfism
9
Q
Achodroplasia
A
imparied cartilage proliferation in the growth plate
Dwarfism
10
Q
Endochondrial bone formation
A
formation of bone via cartilage matrix which is replaced -> implicated in achondroplasia
11
Q
Intramembranous bone fomration
A
formation of long bone w/out preexisting cartilage matrix - > flat bone formation (Skull and rib cage) thus why normal head in dwarfism
12
Q
3 signs of osteogenesis imperfecta
A
multiple fractures (thinking child abuse)
Blue sclera
hearing loss
13
Q
Thinning scleral collagen revealing choroidal veins
Defect in?
A
Blue sclera - in osteogenesis imperfecta
thing Autosomal defect in collagen type 1
14
Q
Osteopetrosis is what and due to what?
A
inhereted defect in bone resorption -> abnormally thick and heavy bone
due to poor osteoclast activity - like carbonic anhydrase II mutations
15
Q
Carbonic anydrase II mutatio nleads to
A
Osteopetrosis
can’t make acidic environment to resorb bone - osteoclasts do not work as well
16
Q
Renal tubular acidosis w/ bone fractures is connected how?
A
lack of carbonicanhydrase II activity - osteopetrosis
- Normal enzyme activity leads to pumping of H in the lumen of tubules as NH4 and bicarb in the serum, lack of enzyme -> acidosis
17
Q
myelopththisic process due to?
What causes?
Bone fractures
vision and hearing impairment
hydrocephalus
A
bone thickens out the marrow region leading o anemia, thrombocytopenia and leukopenia, as sen in osteoporosis
hearing and vision loss w/ nerve impingement
hydrocephalus w/ foramen magnum oclusion
18
Q
Rx for psteopetrosis works how?
A
give bone marrow transplant so you have new source for monocyte derived osteoclasts
19
Q
Defective mineralization of osteoid is called ?
Due to ?
A
rickets/ osteomalacia
due to VIt D deficiency, osteoblasts make osteoid but not mineralized
20
Q
Active Vit D does what?
3 things
A
raises serum Ca and phosphate levels by acting on
intestine - increase absorb of Ca and phos
kidney - increase resorb of Ca and phos
bone - increase resorb of Ca and phos
21
Q
1 alpha hydroxilation occur where after what>
A
in the proximal tubule of the kidney after 25 hydroxylation of Vit D
22
Q
Frontal bossing, pigeon breast deformity, archaic rosary and what other symptom cause ?
What age group
A
Rickets in kids less than one
Usually also see bowed legs
Frontal bossing - large forehead
pigeon breast - inward bending of the ribs w/ anterior protrusion
rachitic rosary - ostoid deposition at chostochondral angle
23
Q
low serum Ca and phos w/ increased PTH and alk phos seen in ?
A
Osteomalacia
24
Q
Most common forms of osteoporosis (2)
A
senile - old age leads to loss of bone mass naturally w/out exercise or diet
postmenopause - lose of estrogen
25
Labs in osteoperosis
Serum Ca, phosphate, PTH and alk phos are NORMAL
26
Mosaic pattern on lamellar done is called?
Due to
Paget disease of the bone
Due to imbalance of osteoclast and osteoblast function in later 60s
27
Clinical features of pagets disease? (4)
Labs
bone pain - improper bone formation
hearing loss -impinged CN8
lion like facies
increasing hat size
- isolated alk phis levels due to isolated osteoblast activity post osteoclast activation (maybe viral)
28
Bisphosphates work in osteoporosis and Pagets due to
inhibition apoptosis of osteoclasts
Can also give calcitonin in pagets
29
2 complications in pagets
osteosarcoma - mutated cancerous osteoblasts
| high output cardiac failure - AV shunts in bone -> high pressure
30
2 locations of osteomylitis in adults and kids
causes?
metaphysis in kids due to transient bacterium
epiphysis in adults due to open wounds
31
6 organisms implicated in osteomylitis
```
staph aureus - most common
N gonorrhea - sexually active
Salmonella - sickle cell
pseudomonas - Diabetics and IV use
pasteurella - Cat and dog bites
mycopbaterium tuberculosis
```
32
Potts disease
TB and bone vertebrae implicated osteomyolitis
33
Cat and dog bites or scratches and you have osteomylitis caused by
pasteurella
34
Diabetics and IV drug use predispose this infectious organism for osteomyolitis
pseudomonas
35
Lytic focus of necrosis surrounded by sclerosis on x ray
clinical features?
osteomyolitis
Bone pain w/ fever and leukocytosis
36
Ischemic necrosis of the bone or marrow ->
Causes? (4)
avascular aseptic necrosis
Trauma
steroids
sickle cell anemia (dactelitis)
caisson disease - (gas emboli)
37
Gardner Syndrome (3)
Familial adenomys polyposis
fibromitosis in retroperitoneum
osteomas of the facial bone
38
bening tumor on the surface of facial bones
osteoma
39
young adult (<25) comes in w/ a tumor on the cortex of his long bone (the diaphysis)
x ray will reveal
osteoid osteoma
bony mass w/ radiolucent core - (osteiod)
40
Osteoblastoma differs from osteoid osteoma 3 ways
larger than 2cm
arises from the vertebrae - vs cortex of long bones
does not respond to ASA
41
Give ASA for bone pain w/ what tumor
osteoid osteoma
benign tumor of osteoblast
42
most common benign tumor of the bone grows where
Osteochdroma browns as a lateral projection of the growth plate - metaphysics
43
Osteochondroma concerns
transforms to chondosarcoma w/ overlying cartilage cap
44
Sunburst appearance and lifting of the periosteum -> cowman triage seen where?
Peak incidence?
in osteosarcoma
in teens and elderly
45
Osteosarcoma arises where?
Similar to
metaphysis of long bones - usually distal femur and proximal tibia
giant cell tumor except epiphysis
46
Risk factors for osteocarcoma (3)
familial retinoblastoma - teen
paget disease - elderly
radiation exposure - elderly
47
pleomorphic cells that produce osteoid seen on histology
osteosarcoma - malignant
48
Unique feature of giant cell tumor
only bone tumor arising in the epiphysis of long bone
- tumor comprised of multinucleated giant cells and stromal cells
49
Soap bubble appearance on x ray w/ a young adult
giant cell tumor
| - locally aggressive and may recur
50
onion skin on x ray in a map child less than 15
ewing sarcoma
periosteum laying down new bone that is circumferentially compressed
malignant proliferation of poorly differentiated cells from neuroectoderm
51
Ewing sarcoma cells derived from
neuroectoderm
May present METS but highly treatable
52
small round blue cells that resemble lymphocyte differential in diaphysis of long bone (3)
Can have fever
Ewing sarcoma - 11:22 translocation
osteomylitis
lymphoma
53
11:22 translocation
Ewing sarcoma
54
Cartilage tumors usually arise from?
medulla of the of bone
55
small bones of the hand present w/ tumor
chondroma
56
tumor of medulla of the pelvis or central skeleton
chondrosarcoma
57
Most common bone tumor
See?
METS
See osteolytic punched out lesions
- EXCEPT prostate and breast cancer -> sclerosis and osteoblastic lesions (breast is also lytic)
58
Articular surface lining the synovial joint is made of what
What is secreted by synovium
hyaline cartilage type II
fluid rich in hyaluronic acid
59
Progressive degeneration of articular cartilage is what?
Affects which joints?
Osteoarthritis
DIP*, PIP, hips, lower lumbar spine, knees
60
Joint stillness in the morning that gradually gets worse throughout the day
Pathologically see (3)
Osteoarthritis
- joint mice- cartilage breaks into the synovium
- ebunartion or polishing of sub chondral bone
- osteophyte formation in the DIP
61
heberden nodes
DIP osteophite formation
62
Bouchard node
PIP osteophite formation
63
HLA DR4
Seen in rheumatoid arthritis
64
Synovitis leading to the formation of a pannus
Rhuematoid arthritis
inflammation -> grannulation tissue w/ associated fibroblasts, blood vessels and myfibroblasts (deviation and ankylosis)
See joint narrowing, loss of cartilage and osteropenia on X Ray
65
ankylosis
fusion - seen in rheumatoid arthritis
66
morning stiffness that improves w. activity
Rheumatoid arthritis
Break gown granulation tissue that build up over night throughout the day
67
Which joints are spared in RA
DIP
Symmetrical involvement otherwise
68
Clinical features of RA? (6)
```
Arthritis
fever, malaise, weight loss
Rheumatoid nodules
Vasculitis
bakers cyst
Pleural effusions, LAD, intersitial lung fibrosis
```
69
Lab findings of RA
found in fluid
IgM autoantibody agianst Fc portion of IgG
Rheumatoid factor
See PMNs and high protein
70
Complications of RH(2)
Anemia due to chronic disease
| secondary amyloidsosis, acute phase reactants SAA-> AA deposited
71
HLA B27
Seronegative spndyloarthritis
72
Seronegative Spondyloarthritis (3)
Meaning?
Ankylosing spondyloarthritis
Reiter syndrome
Psoriatic arthritis
Means lack of RA factor, HLA B27 and Axial skeleton involvement
73
Bamboo spine
```
Presentation and target group
Extra articular (2)
```
ankylosing spondyloarthritis
young adults usually males w/ low back pain -> fusion of vertebra
Uveitis(red eye/blind)
aoritis (potential aneurism and regurgitation)
74
Reitor syndome qualified by (3)
Seen when
Urethritis, conjunctivitis, arthritis
-Cant see, can't pee, can't climb a tree
Post GI or chylamidia trachomatis infection
75
Sausage fingers/toes
Seen in sporadic arthritis - 10% of psoriasis
Axial and peripheral joints and DIP commonly
76
Infectious arthritis presentation and causal agents (2)
N gonorrhoeae - young adults
S aureus - older children and adults (2nd most common)
Single joint usually the knee
- warm joint w/ limited range of motion fever, leukocytosis and elevated ESR
77
Gout is due to generally -
hyperuricemia
Hyper purine metabolism or decreased excretion by the kidney
78
2 types of Gout (2; 1 and 3)
Primary - unknown cause due to hyper urea production and deposition of monosodium in tissues
Secondary
- Leukopenia and myeloproliferative disorders
- Lesch nyhan syndrome
- renal insufficiency
79
Deficiency in what enzyme leads to symptoms of mental retardation and self mutilation
Lesch Nyhan syndrome
- missing hypoxanthine guanine phosphoribosyltransferase
-> rescues hypoxthanthine and guanine before they are converted by xanthine oxidase xanthine and ultimately uric acid
80
Acute inflammatory reaction that is precipitated by consumption of alcohol or meats
Acute gout - commonly affects the big toe (podagra)
alcohol- slows excretion
meats - throws more purine into the system
81
tophi is made of what?
Associated w/
white chalky aggregates of uric acid crystals and fibrosis and giant cell reaction
- Chronic gout
82
Chronic gout leads to
renal failure w/ deposition of crystals in the kidney tubules
83
negative birefringence under polarized light
yellow, needle shaped, associated w/ hyperuicemia gout
84
rhomboid-shaped crystals w/ positive birefringence under polarized light
pseudogout
due to calcium pyrophosphate dihydrate deposition
85
malar rash w/ ANA and bilateral proximal muscle weakness
Dermatomysitis
| NOT SLE
86
Clinical features of dermatomyositis (1 +3)
bilateral proximal muscle weakness-> distal weakness (can't comb hair can't climb stairs)
Rash on
- upper eyelid (heliotrope, purple)
- malar rash
- red papules on elbows, knuckles and knees
87
Anti jo 1 antibody
See also in lab (2)
dermatomyosisits
Also have ANA and increase creatine kinase
88
Perimysial inflammation (CD4 T cells) w/ perivascular atrophy
Dermatomyositis
- periphery of fascicle - closer to skin...(rashes)
differs from polymyositis w/ inflammation of endomysial inflammation w/ CD8
89
Polymyositis
-pathophys?
bilateral proximal muscle weakness w/out skin rash
- endomysial inflammation w/ necortic muscle fibers on biopsy
90
What needs to be ruled out with dermatomyositis?
underlying carcinoma especially gastric carcinoma
91
X linked muscular dystrophy(2) is due to what?
Duchenne -deletion of dystropin gene
Becker - mutation of dystropin gene
92
Dystophin is implicated in what and important for what?
in x linked muscular dystrophy
important in anchoring muscle cytoskeleton and EC matrix
93
Kid presents w/ calf that feels fatty around 1 yrs old
muscular dystrophy - X linked
Calf pseudohypertrophy
aslod find elevated serum creatine
distal muscles overworked when learning to walk and eventually replaced w/ fat (dystrophy)
94
cause of death in duchenne dystophy
due to replacement of myocardium or diaphragm w/ fat and have cardiac or respiratory failure
95
mutated dystophin leads to
beckers muscular dystophy, still have some protein made -> milder disease
96
presentation of muscle weakness that gets worse w/ use especially the eye (ptosis and diplopia)
pathophys?
Myasthenia gravis
Autoantobodies to the postsynaptic ACh receptor at the neuromuscular junction, less ACH w/ repeated use -> less ability to overcome the Ab blockade
97
Rx strategy in myasthenia gravis
acyetycholinesterase inhibitors -> more ACh around
Does not work in Lambert Eaton Syndrome due to lack of ini alt ACh w/ AB against the Ca channel
98
Association w/ myasthenia gravis and action?
thymic hyperplasia or thyoma
removal -> improvement in symptoms
99
Proximal muslce weakness that gets better w/ use and eyes are NOT affected
Patho-phys
Lambert Eaton Syndrome
Autoantibodies against the Ca channel presynaptically preventing depolarization and ACh release
Symptoms improve w/use due to increased Ca gradient -> eventual overwhelming of Ab
100
Lambert Eaton Syndrome etiology
due to paraneoplastice syndrome - often small cell carcinoma; resolves w/ removal
101
Lipoblast are characteristic of?
liposarcoma - most common malignant soft tissue tumor;
102
most common soft tissue tumor in adults benign
lipoma
103
Cardiac rhabdomyoma is associated w/ what syndrome
tuberous sclerosis
Rhabsomyoma - benign tumor of skeletal muscle
104
malignant skeletal muscle tumor?
Patient population and common site?
rhabdomyosarcoma
most common in kids
-vagina in girls; head and neck
105
rhabdomyoblast characteristic of ?
what is the name of the intermediate filament associated w/?
rhabdomyosarcoma
desmin
106
Layers of the skin top to bottom (4)
Stratum corneum
Stratum ganuosu,
Strum Spinosum
Stratum basalis
107
atopic dermatitis (eczema) location and description
flexor regions,
| puritic erythematous oozing rash w/ vesicles and edema
108
Eczema is often associated w/
asthma and allergic rhinitis
Type 1 hypersensitivity
109
Contact dermatitis location and description
differs from eczema?
Where contact w/ allergen - poison ivy, nickel, drugs, irritants
puritic erythematous oozing rash w/ vesicles and edema
differs in type IV hypersensitivity
110
Comedome vs pustule vs nodule
comedome - white head/ black head blockage w/ excessive sebum and keratin production
Pustule/pimple is inflammation
nodule is scarred pustule
111
infectious agent in acne
MOA
proptionibacterium acnes
produces lipases that break down sebum releasing pro inflammatory FA
112
Rx for acne
benzoyl peroxide - antimicrobial
| Vit A Isotretinoin - maintains specialized epithelial cells
113
Psorisis location and descripition
well circumscribed salmon colored plaque w/ silver scales
Extensor surface and scalp
may see pitting nails
114
HLA -C and areas of trauma
associated w/ triggering of psoriasis
115
Acanthosis
epidermal hyperplasia - psoriasis
116
parakeratosis
hyperkeratosis and retention of keratinocyte nuclei
| -psoriasis
117
munro microabcesses
collection of PMNs in the stratum corneum
118
elongated dermal papillae the has thinned epidermis and picks when bleeds
auspitz sign
| - psoriasis
119
5 Ps in Lichen Plansus
```
Puritic
Planar
Polygonal
Purple
Papule
```
120
Lichen Plansus normally attacks the (3)
wrists
elbos
oral mucosa - Wickham striae - reticular white lines)
121
Wickham striae -
reticular white lines of the oral mucosa in lichen planus
122
sawtooth appearance at the dermal epidermal junction
Associated w/ what infection
lichen planus
Chronic Hep C
123
autoimmune destruction of demosomes called?
occurs where?
pemphigus vulgaris
IgG attacks desmoglein (type II hypersensitivity) - separation of stratum spinosum
Skin AND oral mucosa
124
autoimmune destruction of hemidemosomses called?
Occurs where?
bullous pemphigoid
IgG attacks the hemidesmosome component of BM (BP180)
Only in the skin
125
Acantholysis
Separation of stratum spinsosum keratinocytes -> subrabasal blisters
pemphigus vulgaris
126
Nikolsky's sign
Immunofloresence
thin walled bullae that easily rupture - does not include the BM w/ desmosome IgG attack
-> shallow erosions w/ dried crust
Seen in pemphigus vulgaris
Fish net w/ IgG attacking the desmosome,
127
Tense bullae that do not rupture, autoimmune disease of the skin
Immunoflorescene?
Bullous pemphigoid
Linear IgG Attacking the BM
128
Deposition of IgA at the tips of the dermal papillae?
Often due to ?
Dermatitis herpetiformis
- vesiculal lesions
Celiac
129
dematitis herpetiformis presentation (2)
puritic vesicles and bollae grouped - herpetiform
130
Targetoid rash and bullae that may be seen after a drug (penicillin) given is called?
erythema multiform
targetoid w/ central epidermal necrosis
131
Common cause of erythema multiform (5)
```
HSV - most comon
Mycoplasma
drugs (penicillin and sulfonamides)
Autoimmune - SLE,
Malignancy
```
132
Stevens Johns syndrome characterized by
Erythema multiform w/ oral mucosa/lip involvement and fever
133
diffuse sloughing go the skin resembling a large burn, often due to adverse drug reaction
Toxic epidermal necrosis
Progression of erythema multiforme -> steven johnson syndrome
134
Erythema nodosum is ?
acute, nodular, erythematous eruption that usually is limited to the extensor aspects of the lower legs.
- pain in subQ fat
most common form of panniculitis
135
Erythema nodosus cause (6)
```
tuberculosis,
bacterial
deep fungal infection,
sarcoidosis,
inflammatory bowel disease
cancer
```
136
waxy stuck on appearance
See on histology
Seborrheic keratosis, common in elderly = extremities and face
see keratin pseudocyts on histology
137
Sudden onset of multiple seborrheic keratosis is called what? and worried of?
Leser Trelat sign
Worry about underlying carcinoma of GI
138
Acanthosis nigricans characterized by? (2)
Seen where? (2)
epidermal hyperplasia
darkening of the skin
-velvet like
axilla or groin
139
dark velvety skin seen on a patient may indicate 2 things
```
insulin resistance (DMII)
malignancy - gastric carcinoma
```
140
Elevated nodule w/ cental ulcerates crater surrounded by dilated telangictatic vessel
pink pearly papules
Basal cell carcinoma
141
Common location and histology of basal cell carcinoma
upper lip(vs squamous cell)
basal cell nodules w/ peripheral palisading
142
Risk factors for skin carcinoma(3)
UVB induced DNA sunlight
Albinosim
Xeroderma pigmentosum - Auto recessive broken nucleotide excision repair mech
143
hyperkeratotic, scaly plaque on the face back or neck
Actinic kertatosis
| precursor of squamous cell carcinoma
144
Ulcerated nodular mass on the face, maybe the lower lip
character feature
squamous cell carcinoma
keratin pearls
145
Additional risk factors for squamous cell carcinoma (3)
immunosuppressive therapy (most common CA post transplant)
arsenic exposure
chronic inflammation - burn or draining sinus
146
Keratoacnthoma
Presentation
well differentiated squamous cell carcinoma that develops rapidly and regresses spontaneously
Cup shape tumor filled w/ keratin debris
147
Melanocytes are derived from?
How do they pigment skin?
neural crest cell derived
synth melanin in melanosomes(tyrosine precursor) which are transferred to melanocytes
148
Vitilago pathophys
localized loss of skin pigmentation w/ autoimmune destruction of melanocytes
149
Albinism cause
Types(2)
enzyme defect (usually tyrosinase) impairing melanin production
Just ocular
both eyes and skin (oculocutaneous)
150
small tan - brown macule that darkens w. sunlight exposure due to?
freckle (ephelis)
increased # of melanosomes (NOT melanocytes)
151
Mask of hyper pigmentation w/ pregnancy or OCP
melasma
152
Congenital nevi can be differentiated by the presence of what
hair
153
Acquired nevi progression(3)
junctional nevus - nest of melanocytes at epidermal-dermal junction (kids)
compound nevus - extends to dermis
intradermal nevus - junctional component lost (adults)
154
Signs of melanoma
ABCD
Asymmetrical shape
irregular Border
irregular Color
Diameter >6mm
155
Addititional risk factor for melanoma in addition to sun
dysplastic nevus syndrome
| Auto dominant disorder characterized by formation of dysplastic nevi
156
Most important facto in risk of METS in melanoma
depth into the dermis
Breslow thickness
1st radial growth horizontally
157
Lentigo maligna melanoma
lentoginous proliferation (radial) sub variant of melanoma
Similar to superficial spreading, another variant
Both good prognosis
158
Nodular melanoma
early vertical growth variant
| poor prognosis
159
acral lentiginous
occurs where
w/ who?
melanoma arises on palms or soles
arises on dark skinned individuals w/out UV exposure
160
impetigo causes(2)
Presentation (3)
Stauph aureus and Streptococcal pyrogenes
*superficial
```
erythematous macules (flat)-> pustules on the face and eventual rupture
-erosions and dry crusted honey colored lesions
```
161
Difference between impetigo and cellulitis
Bugs are the same
impetigo is superficial
cellulitis is deeper w/ red tender dwollen rash and fever
162
cellulitis risk factors(3)
recent surgery
trauma
insect bite
(indroducing S aureus and Streptococcal pyrogenes)
163
Surgical emergency surrounding cellulitis
associated feature?
necrotizing fasciitis w/ necrosis of sub Q tissue w/ anaerobic bacteria infection
Crepitus w/ production of CO2
164
Sloughing of skin w/ erythematous rash and fever due to ?
NOT just TENs
Also Staphylococcal scalded skin syndrome
-differs histiologically by separation at strum granulosum vs dermal epidermal junction
165
S aureus virulence factors causing dermicological dysfunction
Exfoliative A and B toxins -> epidermolysis of stratum ganulosum
166
Testicular METS gros to
peri-aortic lymph nodes
167
Ehlers Danlos syndrome is due to a defect in ?
Type V and sometimes type I collegen
Type III in vascular
168
Mutation leading to achondroplasia?
FGFR3
169
Achondroplasia is passed on how?
AD after a sporadic mutation in the germ line
-higher incidence w/ advanced paternal age
homozygous gene -> in utero fatality
170
FGFR3 mutation leads to what?
mutation characterized by?
Achrondroplasia
mutation leading to a constitutively active fibroblast growth factor receptor that inhibits chondrocyte proliferation so it won't lay down new cartilage interfering w/ endochondral ossification
171
2 Benign bone primary bone tumors and associated age groups
Osteoclastoma seen in 20-40 yr olds
Osteochondroma seen in <25 yrs; males
172
2 Malignant primary bone tumors and associated age groups
Osteosarcoma seen in males 10-20
Ewing sarcoma seen in males <15
173
Soap supple appearance on x ray at the ditsal femur or proximal tibia
osteoclastoma (also called giant cell tumor)
| -benign proliferation of osteoclasts
174
mature bone w/ cartilaginous cap seen on long metaphysics of bone
Osteochondroma
- benign
May be a type of haramtoma
175
Most common malignant bone tumor in kids
Osteosarcoma
176
2 X ray signs seen in osteosarcoma
Codmans triangle - periosteum is lifted off the bone by the tumor
sunburst sign - opacification
177
Oning skin appearance of the bone seen in what tumor and where
Translocation?
Ewing sarcoma - extremely aggressive
disruption and destruction of the diathesis of long bones, pelvis, scapula and ribs
T11:22
178
Common METS to the bone? (6)
Lytic vs blastic
More common than primary tumors
Permanently Relocated Tumors Like Bone
```
Prostate - Blastic
Renal cell carcinoma
Testes/ Thyroid
Lung - Lytic
Breast - BOTH
```
179
presentation of hypercalcemia and diffuse bone pain ?
think of METS to the bone
may have epidural spinal cord compression and associated sensory and motor deficits along w/ bowel dysfunction
180
Primary defect in osteoporosis?
```
Lab Values?
Ca?
Phos?
ALP?
PTH?
```
Overactive osteoclasts compared to osteoblasts
All normal
181
Primary defect in Pagets Disease of the bone?
```
Lab Values-
Ca?
Phos?
ALP?
PTH?
```
Overactive osteoclast and osteoblasts -> unorganized remedying of the bone (marbled)
Ca - normal
Phos - normal
ALP - increased due to turnover
PTH - normal
182
Primary defect in osteomalacia?
```
Lab Values?
Ca?
Phos?
ALP?
PTH?
```
```
Also known as rickets in kids, Vit D deficiency leading to inability of mineralize osteiod made by osteoblasts
Ca- Low
-> Increased PTH
-> Low Phos
-> increased ALP
```
183
Primary defect in osteopetrosis
```
Lab Values?
Ca?
Phos?
ALP?
PTH?
```
Mutation -> lack of carbonic anhydrase II leading to lack of osteoclast function
Increased ALP w/ thickened dense bone
may have decrease in Ca -> increase in PTH
184
Primary defect in osteitis fibrosa cystica
```
Lab Values?
Ca?
Phos?
ALP?
PTH?
```
Hyperparathyroidism either due to primary cause or due to type 1A psuedohyperparathyroidism (PTH resistance in renal tubules)
HIGH PTH
-> increased Ca
-> decrease in Phos
may or may not have increased ALP
185
Renal insuffiency will have what effect on bone density
Lab Values?
Lack of dihydroxylation of Vit D will lead to decreased Ca
- > increased PTH
- > INCREASED Phos (unable to excrete)
186
Brown tumors found where?
found in osteitis fibrous cystica where excess PTH due to primary hyperparathyroidism or psuedohyperathyroidsm (Renal receptors resistant to PTH)
-> excess osteoclastic activity and cystic lesions filled w/ fibrous stroma and blood found in bone
187
Bone replaced by fibroblasts, collagen and irregular trabecular is called?
Part of what triad?
polyostic fibrous dysplasia
Part of McCune -Albright syndrome
- precocious puberty
- cafe au lait spots
188
First line Rx w/ osteoperosis(3)
what also is considered?
bisphosphates
- alendronate
- risendronate
- etidronate
pulsitile PTH also
-Teriparatide
189
Behavior changes that prevent osteoporosis ((6)
stop
- smoking
- alcohol
- steroids
- H2 and PPIs (need H for Ca absorption)
- heparin (long term)
Weight bearing exercise
190
Concern w/ bisphophates (2)
erosive esophagitis
| osteonecrosis of the jaw
191
Bisphosphates indicated for (3)
osteoporosis
Pagets disease of the bone
humoral hypercalcemia from malignancy
( PTH related peptide - paraneoplastic effect of small cell lung cancer for example)
192
bone pain, with bone enlargement and arthritis
Pagets disease of the bone
193
vertebral compression fractures
osteoperosis
194
Pagets disease of the bone is at an increased risk of what sequlae?
osteosarcoma
- may also have hearing loss w/ auditory foramen narrowing
195
Mutation in carbonic anyhdrase II is called?
Presentation? (3)
Osteopetrosis
Thick brittle bone-> fractures
cranial nerve impingement w/ excess bone
panyctopenia ( thrombocytopenia, infection) due to loss of bone marrow
196
RANK L inhibitor
Denosumab
-inhibits osteoclastic activity
-Remember osetoblast is the initiating factor that activates osteoclasts
197
SERM used for osteoporosis
Raloxifene
Tamoxifen used for Breast CA
198
Positive anterior drawer sign
ACL injury
199
Unhappy triad is due to what?
Composed of what?
lateral force applied to planted foot leading to damaged
ACL
MCL
meniscus (lateral more common than medial)
200
Housemade knee
prepatellar bursitis
201
clergyman knee
infraplatellar bursitis
202
Rotator cuff muscles and function
SItS
Supraspinatus - 1st 15 degrees of abduction
Infraspinatous - lateral rotation
teres minor - lateral rotation
Subscapularis - medial rotation
203
Most common torn rotator cuff muscle and test
Supraspinatous is most common torn rotator cuff muscle
Test with empty can test
204
Dislocated shoulder is
head of the humerus comes out of glenoid cavity
205
separated shoulder is
clavicle separates from the acromion process and coracoid process
206
subacromial buristis
impingement between head of the humorous and corocoaronial arch
207
shoulder impingement?
seen in?
acromion process compresses the supraspinatus tendon
repetitive overhead activities - baseball, tennis
208
Bones of the Wrist
So Long To Pinky Here Comes The Thumb
```
scaphoid - proximal lateral
lunate
triquetrum
Pisiform - Proximal medial
Hamate - distal medial
Capitate
Trapezoid
Trapezium - distal lateral
```
209
pain in the anatomic snuff box break in
worry about?
scaphoid bone injury
necrosis to the proximal bone due to retrograde blood flow
210
Ankle sprain more likely to tear (3)
Lateral
- Anterior talofibular ligament
- Calcaneo fibular ligament
- Posterior talofibular ligament
Medial - rare
-deltoid ligament
211
Most hip locations occur where?
Risk of damaging what?(5)
posterior dislocation
medial circumflex and lateral circumflex of deep femoral artery
femoral vein,
femoral nerve
head of femur
212
Most common knee injury < 45?
Presents as?
Rx? (4)
Patellofemoral syndrome
anterior knee pain exacerbated w/ activity
strengthen quadriceps
stretching exercises - hamstrings, calves, hip, iliotibial band
minimize hard movement (jogging, stop and starts)
maximize walking and low impact
213
Pain beneath the calcaneus that is worse int he first few steps in the morning and after weight bearing?
Plantar fasciitis
214
Structures damaged by anterior shoulder location?
test what nerve by doing what?
axillary nerve
posterior circumflex artery
supraspinatous tendon
anterior glenohumeral ligaments- seperation
posteriolateral glenohumeral ligaments - abrasion
stroke the deltoid for sensation before reduction
215
Painless thickening of flexor tendons of the palms - usually affecting which finger?
Risk factors (4)
Dupuytrens contraction
- 4th
unknown etiology but risks:
- male
- >40
- family
- alcohol/smoking
216
Frozen shoulder is?
adhesive capsulitis due to shoulder adhesions that lock the shoulder after disuse with an injury
especially if > 50 , woman and diabetic
217
Excessive bruising and bulge midhumoral think?
bicep tendon rupture
popye lesion
218
Large bump seen over the elbow that is painless
olecronon bursitis
Rx w/ needle to drain
219
tennis elbow is injury to?
lateral epicondylitis
inflamed lateral epicondyle and wrist extensors
220
golfers elbow?
medial epicondylitis
inflamed medial epicondyle and wrist flexors
221
eburnation
polished ivory like appearance of bone in OA
222
Radiographic changes in Osteoarthritis(3)
sclerotic changes
joint narrowing
ostrophyte formation
223
Presentation of Osteoarthritis
which joints in the hand(2)
Rx:
pain in weight bearing joints that gets worse during the day and with use
affects the DIP and PIP
-NO MCP
improves w/ rest, NSAIDs, acetaminophen (scheduled), hyaluronic acid, glucocorticoid injection, opiods
224
heberdens nodules vs bouchards nodules
osteophyte formation in OA in the DIP vs PIP respectfully
225
Predisposing factors for OA vs RA
age, weight and abnormal joint deformity vs
female and HLA DR4
226
Presentation of RA (4)
joints of the hands affected (2)
morning stiffness lasting >30 min,
gets better with use,
symmetrical joint involvement
w/ systemic features (fever, fatigue, pleuritis, pericarditis)
Affects the MCP and PIP
-NO DIP
227
Bakers cyst commonly seen w?
RA
228
Hypersensitivity type of RA?
Associated antibodies (2)
Type 3
Rheumatoid factor- IgM to IgG antibody (not specific)
Anticitrullinated peptide protein (ACPA) - more specific
229
Advanced RA of the hand pathology (4)
ulnar deviation of fingers
subluxation
Boutonnieres - flexed PIP and extended DIP
Swan neck deformity - extended PIP and flexed DIP
230
Rx for RA (5)
```
NSAIDs
DMARDs
- methotrexate
-sulfasalazine
-TNF alpha inhibitors
-hydroxychloroquine
```
231
TNF alpha inhibitors (5)
```
Etanercept
Infliximab
adalimuxiab
golimumab
certolizumab
```
232
Radiographic findings in RA (3)
pannus formation
bone and cartilage erosion
increased synovial fluid
233
Uses of n acytylcystine?(3)
acetaminophen overdose
mucolytic in CF or intubation
nephropathy prevention w/ contrast
234
Risk of Celexicob use? (3)
thrombosis (not for those w/ CV family risk)
sulfa allergies
gastritis or ulcers (still some effect)
235
Renal problems w/ NSAIDS (2)
Others? (3)
Acute interstitial nephritis
Decreased renal perfusion w/ less prostaglandins keeping open the afferent arteriole
Gastritis/ peptic ulcer w/ COX1 inhib
fluid retention
aplastic anemia
236
how does Acetaminophen differ from NSAIDs?
Biggest toxicity concern?
peripherally inhibited
acts in the CNS as antipyretic and analgesic
NO anti inflammatory
The liver w/ NAPQI metabolites
237
ASA toxicity? (5)
gastric ulceration
tinnitus
acute renal failure
interstitial nephritis
hyperventilation -> respiratory alkalosis
-eventual lactic acidosis -> metabolic alkalosis
238
ASA effect on
bleeding time
PT/INR
PTT
Increases - anti platelet
No effect
No effect
239
Causes of Gout (3)
hyperuricemia -> deposition of monosodium irate crystals may be due to
increased purine food intake
decreased excretion - thiazide/loop diuretic use
Lesch Hyhan syndrome
increased cell turnover w/ Leukemia Rx
240
Podagra
painful swollen, red 1st MTP in gout
241
Gout acute attacks can be due to (2)
large meals
Alcohol use - competes for excretion w/ uric acid
242
Associated Gout findings(2)
Uric acid Tophi - external ear, olecranon bursa, achilles tendon
asymmetrical dystribution
243
Acute Gout attack drugs and MOA
NSAIDS- anti inflammatory
Colchicine - inhibits tublin -> decreased leukocyte chemotaxis
Steroids - anti inflammatory
244
Chronic Gout drugs and MOA (3)
Xanthine oxidase inhibitors
- allopurinol - not to be given acutely due to worsening/prolonging of symptoms
- febuxostat
- probenacid- inhibits uric acid reabsorption from Proximal renal tubule -> increased secretion
245
Chondrocalcinoisis
seen in pseudogout where Ca deposits in the articular cartilage (especially the meniscus of the knee) leading to Calcification seen on x ray
246
How does psuedogout differ from gout
Pseudo gout is rhomboid positive birefringent w/ parallel light
also usually affects large joints
Rx is the same
247
Pathology associated w/ HLA B27
PAIR - seronegative spondyloarthropathies
Psoriatic arthritis
ankylosing spondylitis
inflammatory bowel disease
Reactive arthritis
No Rheumatoid factor, more often males
248
Pencil in cup deformity seen on x ray?
psoriatic arthritis
especially the DIP
249
symptoms of psoriatic arthritis
Joints?
dactylitis
| asymmetric and patchy involvement affecting the fingers (DIP), spine and sacroiliac
250
Uveitis and aortic regurgitation are often associated w?
How can you improve the primary problem
ankylosing spondylitis - bamboo spine
- can also have conduction abnormalities and CV disease
Exercise helps
251
Reactive arthritis is characterized by(3)?
Pathogenisis vs septic arthritis
Can't see, can't pee, can't climb a tree
Conjunctivitis
Urethritis
Arthritis
Differs from septic in that it is a Rxn to the infection after the fact - fluid aspiration shows inflammation ~RA instead of pus and WBCs
252
Infections associated w/ Reactive arthritis (5)
Chlamydia
Post GI
-salmonella, Shigella, Yesernia, campylobacter, clostridium
253
3 forms of Juvenile Idiopathic arthritis
all have onset before 10
```
Polyarticular JIA(severe and symmetrical)
Pauciarticular JIA (few large joints)
systemic onset JIA (LAD, hepatomegaly, Rash, fever, elevated WBC, anemia prior to arthritis)
```
254
Infections causing septic arthritis?(3)
presentation (3)
Nessieria gonorrhea
S aureus
Streptococcus
polyarticular, migratory arthritis w/ asymmetric pattern
255
Associations w/ gonococcal arthritis (3)
Diagnose w?
SAD
synovitis - knee
tenosynovitis - hand
dermatitis - pustules
arthrocentesis
256
Check what before starting infliximab and the like?
PPD because TNF alpha inhibitors may reactivate latent TB
257
TNF alpha agents implicated for what arthritic processes(3)
RA
psoriases
ankylosing spondylitis
258
See elevated CK in this X linked muscle disease
Duchennes and Beckers
259
Difference between Duchene and beckers on molecular level
both X linked
Duchenne is a Deletion in dystophin -> accelerated mucle brakdown
beckers is a mutation
260
Qower's manuever
seen in duchenne doe to pelvic muscles being weak and needing to use hands
261
Sjogren's antibodies(3)
SS-A (rho)
SS-B (La)
occasionally rheumatoid factor or SLE
262
Triad of sjogrens syndrome
associated complications (3)
Xerophthalmia - dry mouth
Xerostomia - dry eyes
arthritis
parotid enlargment
B cell lymphoma risk
dental carries
263
ANA + in (7)
```
SLE
sjogrens
polymyostitis/dermatomystitis
Scleroderma
RA
juvenile Idopathaic arthritis
mixed connective tissue disease
```
264
Libman sacks endocarditis?
sterile vegitations seen in SLE
265
Common cause of death in SLE?
Check what to prevent?
lupes nephritis (wire loopis)
- Diffuse proliferative if nephritis
- membranous glomerulonephritis is nephrotic
Check serum creatinine and UA for proteinuria
266
Serum Antibody and changes associated w/ Lupus (5)
```
ANA
Anti DNA - renal associated
Anti Smith
antiphospholipid (anti cardiolipin) - coag risk
decreased C3 and C4 -infection risk
```
267
Drug induced lupus serum antibody
which drugs?
anti-histone
```
Sulfonamides
Hydralazine
INH
Phenytoin
Procainamide
```
268
What may be a false + in SLE
VDRL
269
Symptoms associated w/ SLE
| -11 total
Skin(4)
- malar rash
- discoid rash
- photosensitivity
- painless oral ulcers
Inflam(3)
- arthritis (>2 joints, nonerrosive)
- serositis (pleuritis, percarditis)
- +ANA
Organ involvement(3)
- renal (proteinuria, casts)
- Neuro (seizure/psychosis)
- Heme ( anemia, low WBCs, platelets)
Immune(1)
- antiphospholipid, Anti DNA, Anti Smith, false VDRL
270
Polymyalgia rheumatica characterized by?
Associated w?
Labs?(2)
Differs from?
proximal joint pain
-shoulders and hips (Rx steriods)
Elevated ESR
Normal CK
Polymyosistis (proximal muscle pain)
271
Polymyalgia rheumatica associated w/ which vasculitis
temporal arteritis
proximal joint pain(shoulder and hip)
272
Anti jo antibodies
Polymyositis/dermatomyositis
273
difference between polymyositis and dermatomyositis(2)
Both have proximal muscle weakness, symmetrical
```
Skin involvement in dermatomyositis
- malar
gottrons papules on knuckles
helitrope rash - eyes
mechanics hands - rough hands and feet
```
CD4 in dermatomyocitis vs CD8
274
Skin involvement in dermatomyositis (4)
malar rash
gottrons papules on knuckles
helitrope rash - eyes
mechanics hands - rough hands and feet
275
Labs in polymyositis and dermatomyositis
CK?
Antibodies? (3)
elevated CK
ANA
Aldolase
anti-jo-1
276
Fibromyalgia is
associated signs?(6)
Rx(4)
Excessive muscle tenderness in 11 out of 18 trigger points
also - generalized pain, fatigue, sleep disturbance, HA, cognitive difficulties, mood changes
pregabalin - anti-convulsent
milnacipran -SNRI
Amytriptyline, fluoxitine
277
Proximal weakness vs distal weakness think
larger muscle disorders like polymyolitis vs distal think nerve disorders
278
anticentromere w?
CREST Scleroderma
279
anti toposiomerase w?
Also called
Scl-70
Diffuse scleroderma
280
Diffuse sceroderma vs CREST prognosis
Rapid widespread skin involvement, potentially fatal while Crest is limited in skin insolvent, often confined to fingers
281
CREST scleroderma stands for?
```
Calcinosis
Raynauds
Esophageal dysmotility
Scleroderma
Telangiectasia
```
282
Shiny skin w/ trouble swallowing ?
Check for in blood?
Scleroderma (CREST)
Anticentromere Ab
283
zona occuden uses what proteins (2)
tight junction - impermeable
claudin and occludin
284
zona adherins uses what proteins (2)
adhering junctions
belt w/ actin filaments
and CADherins - Ca dependent adhesion proteins
285
macula adhering uses what proteins
desmosomes to connect cells
keratin interactions w. cadherins
-pemphigous vulgaris
286
Gap junction connects between cells using what protein
connexons
287
Hemidesmosomes use what proteins
connects to basement membrane w/ keratin
integrins also
bullous pemphigoid
288
melanocytes are found in the
stratum basale
289
Fibroblasts are important in producing(4)
collagen
glycosaminoglycan
reticular and elastic cells
glycoprotein
290
The itch that rashes
Rx: (6)
atopic dermatitis
```
moisturizers w/ emollient
calcineuron inhibitors (tacrolimus, primecromlimus)
UV light - better in the summer
topical steriods
antihistamine
leukotriene inhibitors
```
291
Common location of atopic dermatitis
in the flexors - behind the knee and in the elbow
Maybe all over a baby that is being cleaned too much
292
verrucae
wart
293
ephelis
freckle
excess melanin NOT melanicytes
294
nevi
mole
295
Linear puritic rash
what type of hypersensitivity
contact dermatitis - poison ivy or nickel
Type IV
296
4 causes and associated Rx w/ Acne
hyperkeratosis - retinoids, isotretinion
sebum overproduction - isotretinion, OCPs, spiranolactone
propioni bacterium acne - erythromycin, tetracyclin, doxy, minocyclycline, clindamycin, benzoyl peroxide
inflammation - steriods
297
isotretinion, OCPs, spiranolactone are all used in RX for
acne
298
Skin disorder associated w/ asthma and allergic rhinits
atopic dermatitis
| eczema
299
keratin filled cysts - horn cells
seberrheic keratosis
300
increased stratum spinosum w/ decreased stratum granulosum w/ parakeratotic scaling?
psoriasis
301
Psoriasis is often found where?
on the extensor surface (NOT in folds)
| knees and elbows
302
depigmentation due to decreases melanin production
cause?
ambinoism
decreased tyrosinase activity
303
depigmentation due to decrease in menanocyte #
cause?
vitiligo
??
304
darkening of the dace seen in pregnancy or OCP
melasma
305
flaccid blisters w/ Nikolskys sign?
Involve the mouth?
phemphigus vulgaris - IgG against desmoglein 3 or 1
skin just sloughs off
involves the mouth
306
tense blisters w/out Nikolskys Sign?
Involves the mouth
Bullous pemphigoid - IgG against hemidesmosomes, Eoisinophils w/in the blister
No oral involvement
307
Auspitz sign is
may also seen in this derm path unrelated to the skin?
pinpoint bleeding when the silver plaques are scraped off
pitting of the nails
308
puritic papules, vesicles and bullae in extensor surfaces after eating wheat product
Deposition of what?
dematitis herpatiformis in celiac
IgA in the tips of the dermal papillae
309
Erythema multiform is associated(4)
Can lead to ?
DRUGS
- sulfa,
- beta lactim, penicllin
- Anti-Seizure
- allopurinol
also
- infections (HSV, Mycoplasma pneumoniae)
- cancers
- Auto immune
Leads to Stevens Johnson Syndrome and TENS is >30% of the body
310
Presentation of Erythema multiforme
macules and papules forming a target lesion due to central necrosis
thought to be due to microvascular deposition of immune complexes
311
Stevens johnsons syndrome is different from Toxic epidermal necrolysis
Both have fever, bulla formation,necrosis, sloughing skin and high mortality
TENs has > 30% skin involvement
312
See a darkened skin in a flexor think of 2 things (neck or axilla)
diabetes mellatis
| >40 gastrointestinal adenocarcinoma (Visceral malignancy)
313
Premalignant derm path treat w/ 5 florouricil
Found by?
actinic keratosis, treat due to squamous cell risk
found by feeling - sandpaper, rough
314
Painful lesion of the fat, commonly found on anterior tibia
Associated path (7)
erythema nodosum
```
sarcoidosis
TB
histioplasmosis
coccidiomycosis
Post strept
leprosy
Crohns
```
315
6 Ps of Lichen Planus
associated w/
```
purple
Puriritic
Papules
polygonal shape
Planar
Plaque
```
Hepatitis C
-sawtooth infiltrate
316
see a herald patch on the neck and a couple days later see a christmas tree distribution of a rash called?
Rx
Pityriasis rosea
Self resolving in 6-8 wks
317
Necrotising fascititis caused by? (2)
suspect when? (2)
Clostridium perfenges and Strep pyrogenes
- When tenderness is beyond the erythematous border
- crepitis is felt
318
Honey rusted lesions of the superficial skin cause by (2)
Impetigo
Staph aureus
Strep pyrogenes
319
Erythematous painful lesion of the dermis and subcutaneous tissue caused by?(2)
Cellulitis
Staph aureus
Strep pyrogens
320
Exotoxin A and B from staph Aureus responsible for what derm path
pathophys?
Staph Scalded Skin Syndrome
keratinocyte attachment of stratum granulosum is destroyed -> sloughing skin
321
Pink pearly nodules caused by?
| Keratin pearls caused by?
basal cell carcinoma
| squamous cell carcinoma
322
most common malignant skin pathology
seen histology
basal cell carcinoma,
-Rarely METS locally destructive
palisading nuclei
323
Rolled birders, telanectasias and central necrosis
basal cell carcinoma
324
S 100 tumor marker important in
melanoma
325
Excisional biopsy key in prognosis of what disease
melanoma
- depth is key in risk of METs
Asymetrical
Borders (irregular)
Color (not uniform)
Diameter
326
Thickened scar around face or chest
keloid
327
Calcium deposition seen in a joint that is nonerrosive
acute pain and swelling?
Pseudogout
w. calcium pyrophosphate crystals seen on aspiration
