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USLME Kiss my ass and pray > Skin/MS Pathology > Flashcards

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

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2
Q

Foot drop

A

Peroneal nerve damaged

dorsiflexes and everts the foot

PED

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3
Q

Can’t stand on tip toes

A

Tibial nerve damage

inverts and plantaflexes the foot

TIP

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4
Q

Thigh adduction innervated

  • anterior hip dislocation

(4 muscles)

A

Obturator

adductor longu, adductor, brevis, anterior portion of adductus magnus, gracilis

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5
Q

Thigh flexion and leg extension nerve

A

Femoral

worry in pelvic fracture

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6
Q

Knee trauma worry about this nerve

Can

A

tibial

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7
Q

posterior hip dislocation and can’t jump

nerve and muscle

A

inferior gluteal enervating the gluteus maximus

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8
Q

pathology due to activating mutation in fibroblast growth factor receptor 3 (FGFR3)

A

Achrondroplasia - dwarfism

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9
Q

Achodroplasia

A

imparied cartilage proliferation in the growth plate

Dwarfism

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10
Q

Endochondrial bone formation

A

formation of bone via cartilage matrix which is replaced -> implicated in achondroplasia

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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

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12
Q

3 signs of osteogenesis imperfecta

A

multiple fractures (thinking child abuse)
Blue sclera
hearing loss

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13
Q

Thinning scleral collagen revealing choroidal veins

Defect in?

A

Blue sclera - in osteogenesis imperfecta

thing Autosomal defect in collagen type 1

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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

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15
Q

Carbonic anydrase II mutatio nleads to

A

Osteopetrosis

can’t make acidic environment to resorb bone - osteoclasts do not work as well

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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
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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

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18
Q

Rx for psteopetrosis works how?

A

give bone marrow transplant so you have new source for monocyte derived osteoclasts

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19
Q

Defective mineralization of osteoid is called ?

Due to ?

A

rickets/ osteomalacia

due to VIt D deficiency, osteoblasts make osteoid but not mineralized

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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

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21
Q

1 alpha hydroxilation occur where after what>

A

in the proximal tubule of the kidney after 25 hydroxylation of Vit D

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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

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23
Q

low serum Ca and phos w/ increased PTH and alk phos seen in ?

A

Osteomalacia

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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

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25
Q

Labs in osteoperosis

A

Serum Ca, phosphate, PTH and alk phos are NORMAL

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26
Q

Mosaic pattern on lamellar done is called?

Due to

A

Paget disease of the bone

Due to imbalance of osteoclast and osteoblast function in later 60s

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27
Q

Clinical features of pagets disease? (4)

Labs

A

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)
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28
Q

Bisphosphates work in osteoporosis and Pagets due to

A

inhibition apoptosis of osteoclasts

Can also give calcitonin in pagets

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29
Q

2 complications in pagets

A

osteosarcoma - mutated cancerous osteoblasts

high output cardiac failure - AV shunts in bone -> high pressure

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30
Q

2 locations of osteomylitis in adults and kids

causes?

A

metaphysis in kids due to transient bacterium

epiphysis in adults due to open wounds

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31
Q

6 organisms implicated in osteomylitis

A 
staph aureus - most common
N gonorrhea - sexually active
Salmonella - sickle cell
pseudomonas - Diabetics and IV use
pasteurella - Cat and dog bites
mycopbaterium tuberculosis
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32
Q

Potts disease

A

TB and bone vertebrae implicated osteomyolitis

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33
Q

Cat and dog bites or scratches and you have osteomylitis caused by

A

pasteurella

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34
Q

Diabetics and IV drug use predispose this infectious organism for osteomyolitis

A

pseudomonas

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35
Q

Lytic focus of necrosis surrounded by sclerosis on x ray

clinical features?

A

osteomyolitis

Bone pain w/ fever and leukocytosis

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36
Q

Ischemic necrosis of the bone or marrow ->

Causes? (4)

A

avascular aseptic necrosis

Trauma
steroids
sickle cell anemia (dactelitis)
caisson disease - (gas emboli)

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37
Q

Gardner Syndrome (3)

A

Familial adenomys polyposis
fibromitosis in retroperitoneum
osteomas of the facial bone

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38
Q

bening tumor on the surface of facial bones

A

osteoma

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39
Q

young adult (<25) comes in w/ a tumor on the cortex of his long bone (the diaphysis)

x ray will reveal

A

osteoid osteoma

bony mass w/ radiolucent core - (osteiod)

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40
Q

Osteoblastoma differs from osteoid osteoma 3 ways

A

larger than 2cm
arises from the vertebrae - vs cortex of long bones
does not respond to ASA

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41
Q

Give ASA for bone pain w/ what tumor

A

osteoid osteoma

benign tumor of osteoblast

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42
Q

most common benign tumor of the bone grows where

A

Osteochdroma browns as a lateral projection of the growth plate - metaphysics

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43
Q

Osteochondroma concerns

A

transforms to chondosarcoma w/ overlying cartilage cap

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44
Q

Sunburst appearance and lifting of the periosteum -> cowman triage seen where?

Peak incidence?

A

in osteosarcoma

in teens and elderly

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45
Q

Osteosarcoma arises where?

Similar to

A

metaphysis of long bones - usually distal femur and proximal tibia

giant cell tumor except epiphysis

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46
Q

Risk factors for osteocarcoma (3)

A

familial retinoblastoma - teen
paget disease - elderly
radiation exposure - elderly

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47
Q

pleomorphic cells that produce osteoid seen on histology

A

osteosarcoma - malignant

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48
Q

Unique feature of giant cell tumor

A

only bone tumor arising in the epiphysis of long bone

  • tumor comprised of multinucleated giant cells and stromal cells
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49
Q

Soap bubble appearance on x ray w/ a young adult

A

giant cell tumor

- locally aggressive and may recur

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50
Q

onion skin on x ray in a map child less than 15

A

ewing sarcoma

periosteum laying down new bone that is circumferentially compressed

malignant proliferation of poorly differentiated cells from neuroectoderm

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51
Q

Ewing sarcoma cells derived from

A

neuroectoderm

May present METS but highly treatable

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52
Q

small round blue cells that resemble lymphocyte differential in diaphysis of long bone (3)

Can have fever

A

Ewing sarcoma - 11:22 translocation
osteomylitis
lymphoma

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53
Q

11:22 translocation

A

Ewing sarcoma

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54
Q

Cartilage tumors usually arise from?

A

medulla of the of bone

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55
Q

small bones of the hand present w/ tumor

A

chondroma

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56
Q

tumor of medulla of the pelvis or central skeleton

A

chondrosarcoma

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57
Q

Most common bone tumor

See?

A

METS

See osteolytic punched out lesions
- EXCEPT prostate and breast cancer -> sclerosis and osteoblastic lesions (breast is also lytic)

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58
Q

Articular surface lining the synovial joint is made of what

What is secreted by synovium

A

hyaline cartilage type II

fluid rich in hyaluronic acid

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59
Q

Progressive degeneration of articular cartilage is what?

Affects which joints?

A

Osteoarthritis

DIP*, PIP, hips, lower lumbar spine, knees

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60
Q

Joint stillness in the morning that gradually gets worse throughout the day

Pathologically see (3)

A

Osteoarthritis

  • joint mice- cartilage breaks into the synovium
  • ebunartion or polishing of sub chondral bone
  • osteophyte formation in the DIP
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61
Q

heberden nodes

A

DIP osteophite formation

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62
Q

Bouchard node

A

PIP osteophite formation

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63
Q

HLA DR4

A

Seen in rheumatoid arthritis

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64
Q

Synovitis leading to the formation of a pannus

A

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

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65
Q

ankylosis

A

fusion - seen in rheumatoid arthritis

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66
Q

morning stiffness that improves w. activity

A

Rheumatoid arthritis

Break gown granulation tissue that build up over night throughout the day

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67
Q

Which joints are spared in RA

A

DIP

Symmetrical involvement otherwise

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68
Q

Clinical features of RA? (6)

A 
Arthritis
fever, malaise, weight loss
Rheumatoid nodules
Vasculitis
bakers cyst
Pleural effusions, LAD, intersitial lung fibrosis
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69
Q

Lab findings of RA

found in fluid

A

IgM autoantibody agianst Fc portion of IgG
Rheumatoid factor

See PMNs and high protein

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70
Q

Complications of RH(2)

A

Anemia due to chronic disease

secondary amyloidsosis, acute phase reactants SAA-> AA deposited

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71
Q

HLA B27

A

Seronegative spndyloarthritis

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72
Q

Seronegative Spondyloarthritis (3)

Meaning?

A

Ankylosing spondyloarthritis
Reiter syndrome
Psoriatic arthritis

Means lack of RA factor, HLA B27 and Axial skeleton involvement

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73
Q

Bamboo spine

Presentation and target group
Extra articular (2)
A

ankylosing spondyloarthritis

young adults usually males w/ low back pain -> fusion of vertebra

Uveitis(red eye/blind)
aoritis (potential aneurism and regurgitation)

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74
Q

Reitor syndome qualified by (3)

Seen when

A

Urethritis, conjunctivitis, arthritis
-Cant see, can’t pee, can’t climb a tree

Post GI or chylamidia trachomatis infection

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75
Q

Sausage fingers/toes

A

Seen in sporadic arthritis - 10% of psoriasis

Axial and peripheral joints and DIP commonly

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76
Q

Infectious arthritis presentation and causal agents (2)

A

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

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77
Q

Gout is due to generally -

A

hyperuricemia

Hyper purine metabolism or decreased excretion by the kidney

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78
Q

2 types of Gout (2; 1 and 3)

A

Primary - unknown cause due to hyper urea production and deposition of monosodium in tissues

Secondary

  • Leukopenia and myeloproliferative disorders
  • Lesch nyhan syndrome
  • renal insufficiency
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79
Q

Deficiency in what enzyme leads to symptoms of mental retardation and self mutilation

A

Lesch Nyhan syndrome
- missing hypoxanthine guanine phosphoribosyltransferase

-> rescues hypoxthanthine and guanine before they are converted by xanthine oxidase xanthine and ultimately uric acid

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80
Q

Acute inflammatory reaction that is precipitated by consumption of alcohol or meats

A

Acute gout - commonly affects the big toe (podagra)

alcohol- slows excretion
meats - throws more purine into the system

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81
Q

tophi is made of what?

Associated w/

A

white chalky aggregates of uric acid crystals and fibrosis and giant cell reaction

  • Chronic gout
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82
Q

Chronic gout leads to

A

renal failure w/ deposition of crystals in the kidney tubules

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83
Q

negative birefringence under polarized light

A

yellow, needle shaped, associated w/ hyperuicemia gout

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84
Q

rhomboid-shaped crystals w/ positive birefringence under polarized light

A

pseudogout

due to calcium pyrophosphate dihydrate deposition

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85
Q

malar rash w/ ANA and bilateral proximal muscle weakness

A

Dermatomysitis

NOT SLE

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86
Q

Clinical features of dermatomyositis (1 +3)

A

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
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87
Q

Anti jo 1 antibody

See also in lab (2)

A

dermatomyosisits

Also have ANA and increase creatine kinase

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88
Q

Perimysial inflammation (CD4 T cells) w/ perivascular atrophy

A

Dermatomyositis
- periphery of fascicle - closer to skin…(rashes)

differs from polymyositis w/ inflammation of endomysial inflammation w/ CD8

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89
Q

Polymyositis

-pathophys?

A

bilateral proximal muscle weakness w/out skin rash

  • endomysial inflammation w/ necortic muscle fibers on biopsy
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90
Q

What needs to be ruled out with dermatomyositis?

A

underlying carcinoma especially gastric carcinoma

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91
Q

X linked muscular dystrophy(2) is due to what?

A

Duchenne -deletion of dystropin gene

Becker - mutation of dystropin gene

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92
Q

Dystophin is implicated in what and important for what?

A

in x linked muscular dystrophy

important in anchoring muscle cytoskeleton and EC matrix

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93
Q

Kid presents w/ calf that feels fatty around 1 yrs old

A

muscular dystrophy - X linked
Calf pseudohypertrophy

aslod find elevated serum creatine

distal muscles overworked when learning to walk and eventually replaced w/ fat (dystrophy)

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94
Q

cause of death in duchenne dystophy

A

due to replacement of myocardium or diaphragm w/ fat and have cardiac or respiratory failure

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95
Q

mutated dystophin leads to

A

beckers muscular dystophy, still have some protein made -> milder disease

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96
Q

presentation of muscle weakness that gets worse w/ use especially the eye (ptosis and diplopia)

pathophys?

A

Myasthenia gravis

Autoantobodies to the postsynaptic ACh receptor at the neuromuscular junction, less ACH w/ repeated use -> less ability to overcome the Ab blockade

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97
Q

Rx strategy in myasthenia gravis

A

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

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98
Q

Association w/ myasthenia gravis and action?

A

thymic hyperplasia or thyoma

removal -> improvement in symptoms

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99
Q

Proximal muslce weakness that gets better w/ use and eyes are NOT affected

Patho-phys

A

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

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100
Q

Lambert Eaton Syndrome etiology

A

due to paraneoplastice syndrome - often small cell carcinoma; resolves w/ removal

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101
Q

Lipoblast are characteristic of?

A

liposarcoma - most common malignant soft tissue tumor;

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102
Q

most common soft tissue tumor in adults benign

A

lipoma

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103
Q

Cardiac rhabdomyoma is associated w/ what syndrome

A

tuberous sclerosis

Rhabsomyoma - benign tumor of skeletal muscle

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104
Q

malignant skeletal muscle tumor?

Patient population and common site?

A

rhabdomyosarcoma

most common in kids
-vagina in girls; head and neck

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105
Q

rhabdomyoblast characteristic of ?

what is the name of the intermediate filament associated w/?

A

rhabdomyosarcoma

desmin

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106
Q

Layers of the skin top to bottom (4)

A

Stratum corneum
Stratum ganuosu,
Strum Spinosum
Stratum basalis

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107
Q

atopic dermatitis (eczema) location and description

A

flexor regions,

puritic erythematous oozing rash w/ vesicles and edema

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108
Q

Eczema is often associated w/

A

asthma and allergic rhinitis

Type 1 hypersensitivity

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109
Q

Contact dermatitis location and description

differs from eczema?

A

Where contact w/ allergen - poison ivy, nickel, drugs, irritants

puritic erythematous oozing rash w/ vesicles and edema

differs in type IV hypersensitivity

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110
Q

Comedome vs pustule vs nodule

A

comedome - white head/ black head blockage w/ excessive sebum and keratin production

Pustule/pimple is inflammation

nodule is scarred pustule

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111
Q

infectious agent in acne

MOA

A

proptionibacterium acnes

produces lipases that break down sebum releasing pro inflammatory FA

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112
Q

Rx for acne

A

benzoyl peroxide - antimicrobial

Vit A Isotretinoin - maintains specialized epithelial cells

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113
Q

Psorisis location and descripition

A

well circumscribed salmon colored plaque w/ silver scales

Extensor surface and scalp

may see pitting nails

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114
Q

HLA -C and areas of trauma

A

associated w/ triggering of psoriasis

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115
Q

Acanthosis

A

epidermal hyperplasia - psoriasis

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116
Q

parakeratosis

A

hyperkeratosis and retention of keratinocyte nuclei

-psoriasis

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117
Q

munro microabcesses

A

collection of PMNs in the stratum corneum

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118
Q

elongated dermal papillae the has thinned epidermis and picks when bleeds

A

auspitz sign

- psoriasis

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119
Q

5 Ps in Lichen Plansus

A 
Puritic
Planar
Polygonal
Purple
Papule
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120
Q

Lichen Plansus normally attacks the (3)

A

wrists
elbos
oral mucosa - Wickham striae - reticular white lines)

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121
Q

Wickham striae -

A

reticular white lines of the oral mucosa in lichen planus

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122
Q

sawtooth appearance at the dermal epidermal junction

Associated w/ what infection

A

lichen planus

Chronic Hep C

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123
Q

autoimmune destruction of demosomes called?

occurs where?

A

pemphigus vulgaris

IgG attacks desmoglein (type II hypersensitivity) - separation of stratum spinosum

Skin AND oral mucosa

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124
Q

autoimmune destruction of hemidemosomses called?

Occurs where?

A

bullous pemphigoid

IgG attacks the hemidesmosome component of BM (BP180)

Only in the skin

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125
Q

Acantholysis

A

Separation of stratum spinsosum keratinocytes -> subrabasal blisters

pemphigus vulgaris

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126
Q

Nikolsky’s sign

Immunofloresence

A

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,

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127
Q

Tense bullae that do not rupture, autoimmune disease of the skin

Immunoflorescene?

A

Bullous pemphigoid

Linear IgG Attacking the BM

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128
Q

Deposition of IgA at the tips of the dermal papillae?

Often due to ?

A

Dermatitis herpetiformis
- vesiculal lesions

Celiac

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129
Q

dematitis herpetiformis presentation (2)

A

puritic vesicles and bollae grouped - herpetiform

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130
Q

Targetoid rash and bullae that may be seen after a drug (penicillin) given is called?

A

erythema multiform

targetoid w/ central epidermal necrosis

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131
Q

Common cause of erythema multiform (5)

A 
HSV - most comon
Mycoplasma
drugs (penicillin and sulfonamides)
Autoimmune - SLE,
Malignancy
132
Q

Stevens Johns syndrome characterized by

A

Erythema multiform w/ oral mucosa/lip involvement and fever

133
Q

diffuse sloughing go the skin resembling a large burn, often due to adverse drug reaction

A

Toxic epidermal necrosis

Progression of erythema multiforme -> steven johnson syndrome

134
Q

Erythema nodosum is ?

A

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
Q

Erythema nodosus cause (6)

A 
tuberculosis, 
bacterial 
deep fungal infection,
 sarcoidosis,
 inflammatory bowel disease
 cancer
136
Q

waxy stuck on appearance

See on histology

A

Seborrheic keratosis, common in elderly = extremities and face

see keratin pseudocyts on histology

137
Q

Sudden onset of multiple seborrheic keratosis is called what? and worried of?

A

Leser Trelat sign

Worry about underlying carcinoma of GI

138
Q

Acanthosis nigricans characterized by? (2)

Seen where? (2)

A

epidermal hyperplasia

darkening of the skin
-velvet like

axilla or groin

139
Q

dark velvety skin seen on a patient may indicate 2 things

A 
insulin resistance (DMII)
malignancy - gastric carcinoma
140
Q

Elevated nodule w/ cental ulcerates crater surrounded by dilated telangictatic vessel

A

pink pearly papules

Basal cell carcinoma

141
Q

Common location and histology of basal cell carcinoma

A

upper lip(vs squamous cell)

basal cell nodules w/ peripheral palisading

142
Q

Risk factors for skin carcinoma(3)

A

UVB induced DNA sunlight
Albinosim
Xeroderma pigmentosum - Auto recessive broken nucleotide excision repair mech

143
Q

hyperkeratotic, scaly plaque on the face back or neck

A

Actinic kertatosis

precursor of squamous cell carcinoma

144
Q

Ulcerated nodular mass on the face, maybe the lower lip

character feature

A

squamous cell carcinoma

keratin pearls

145
Q

Additional risk factors for squamous cell carcinoma (3)

A

immunosuppressive therapy (most common CA post transplant)
arsenic exposure
chronic inflammation - burn or draining sinus

146
Q

Keratoacnthoma

Presentation

A

well differentiated squamous cell carcinoma that develops rapidly and regresses spontaneously

Cup shape tumor filled w/ keratin debris

147
Q

Melanocytes are derived from?

How do they pigment skin?

A

neural crest cell derived

synth melanin in melanosomes(tyrosine precursor) which are transferred to melanocytes

148
Q

Vitilago pathophys

A

localized loss of skin pigmentation w/ autoimmune destruction of melanocytes

149
Q

Albinism cause

Types(2)

A

enzyme defect (usually tyrosinase) impairing melanin production

Just ocular
both eyes and skin (oculocutaneous)

150
Q

small tan - brown macule that darkens w. sunlight exposure due to?

A

freckle (ephelis)

increased # of melanosomes (NOT melanocytes)

151
Q

Mask of hyper pigmentation w/ pregnancy or OCP

152
Q

Congenital nevi can be differentiated by the presence of what

153
Q

Acquired nevi progression(3)

A

junctional nevus - nest of melanocytes at epidermal-dermal junction (kids)

compound nevus - extends to dermis

intradermal nevus - junctional component lost (adults)

154
Q

Signs of melanoma

A

ABCD

Asymmetrical shape
irregular Border
irregular Color
Diameter >6mm

155
Q

Addititional risk factor for melanoma in addition to sun

A

dysplastic nevus syndrome

Auto dominant disorder characterized by formation of dysplastic nevi

156
Q

Most important facto in risk of METS in melanoma

A

depth into the dermis
Breslow thickness

1st radial growth horizontally

157
Q

Lentigo maligna melanoma

A

lentoginous proliferation (radial) sub variant of melanoma

Similar to superficial spreading, another variant

Both good prognosis

158
Q

Nodular melanoma

A

early vertical growth variant

poor prognosis

159
Q

acral lentiginous
occurs where
w/ who?

A

melanoma arises on palms or soles

arises on dark skinned individuals w/out UV exposure

160
Q

impetigo causes(2)

Presentation (3)

A

Stauph aureus and Streptococcal pyrogenes

*superficial

erythematous macules (flat)-> pustules on the face and eventual rupture
-erosions and dry crusted honey colored lesions
161
Q

Difference between impetigo and cellulitis

A

Bugs are the same

impetigo is superficial
cellulitis is deeper w/ red tender dwollen rash and fever

162
Q

cellulitis risk factors(3)

A

recent surgery
trauma
insect bite

(indroducing S aureus and Streptococcal pyrogenes)

163
Q

Surgical emergency surrounding cellulitis

associated feature?

A

necrotizing fasciitis w/ necrosis of sub Q tissue w/ anaerobic bacteria infection

Crepitus w/ production of CO2

164
Q

Sloughing of skin w/ erythematous rash and fever due to ?

A

NOT just TENs

Also Staphylococcal scalded skin syndrome
-differs histiologically by separation at strum granulosum vs dermal epidermal junction

165
Q

S aureus virulence factors causing dermicological dysfunction

A

Exfoliative A and B toxins -> epidermolysis of stratum ganulosum

166
Q

Testicular METS gros to

A

peri-aortic lymph nodes

167
Q

Ehlers Danlos syndrome is due to a defect in ?

A

Type V and sometimes type I collegen

Type III in vascular

168
Q

Mutation leading to achondroplasia?

169
Q

Achondroplasia is passed on how?

A

AD after a sporadic mutation in the germ line
-higher incidence w/ advanced paternal age

homozygous gene -> in utero fatality

170
Q

FGFR3 mutation leads to what?

mutation characterized by?

A

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
Q

2 Benign bone primary bone tumors and associated age groups

A

Osteoclastoma seen in 20-40 yr olds

Osteochondroma seen in <25 yrs; males

172
Q

2 Malignant primary bone tumors and associated age groups

A

Osteosarcoma seen in males 10-20

Ewing sarcoma seen in males <15

173
Q

Soap supple appearance on x ray at the ditsal femur or proximal tibia

A

osteoclastoma (also called giant cell tumor)

-benign proliferation of osteoclasts

174
Q

mature bone w/ cartilaginous cap seen on long metaphysics of bone

A

Osteochondroma
- benign

May be a type of haramtoma

175
Q

Most common malignant bone tumor in kids

A

Osteosarcoma

176
Q

2 X ray signs seen in osteosarcoma

A

Codmans triangle - periosteum is lifted off the bone by the tumor

sunburst sign - opacification

177
Q

Oning skin appearance of the bone seen in what tumor and where

Translocation?

A

Ewing sarcoma - extremely aggressive

disruption and destruction of the diathesis of long bones, pelvis, scapula and ribs

T11:22

178
Q

Common METS to the bone? (6)

Lytic vs blastic

A

More common than primary tumors
Permanently Relocated Tumors Like Bone

Prostate - Blastic
Renal cell carcinoma
Testes/ Thyroid
Lung - Lytic
Breast - BOTH
179
Q

presentation of hypercalcemia and diffuse bone pain ?

A

think of METS to the bone

may have epidural spinal cord compression and associated sensory and motor deficits along w/ bowel dysfunction

180
Q

Primary defect in osteoporosis?

Lab Values?
Ca?
Phos?
ALP?
PTH?
A

Overactive osteoclasts compared to osteoblasts

All normal

181
Q

Primary defect in Pagets Disease of the bone?

Lab Values-
Ca?
Phos?
ALP?
PTH?
A

Overactive osteoclast and osteoblasts -> unorganized remedying of the bone (marbled)

Ca - normal
Phos - normal
ALP - increased due to turnover
PTH - normal

182
Q

Primary defect in osteomalacia?

Lab Values?
Ca?
Phos?
ALP?
PTH?
A 
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
Q

Primary defect in osteopetrosis

Lab Values?
Ca?
Phos?
ALP?
PTH?
A

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
Q

Primary defect in osteitis fibrosa cystica

Lab Values?
Ca?
Phos?
ALP?
PTH?
A

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
Q

Renal insuffiency will have what effect on bone density

Lab Values?

A

Lack of dihydroxylation of Vit D will lead to decreased Ca

  • > increased PTH
  • > INCREASED Phos (unable to excrete)
186
Q

Brown tumors found where?

A

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
Q

Bone replaced by fibroblasts, collagen and irregular trabecular is called?

Part of what triad?

A

polyostic fibrous dysplasia

Part of McCune -Albright syndrome

  • precocious puberty
  • cafe au lait spots
188
Q

First line Rx w/ osteoperosis(3)

what also is considered?

A

bisphosphates

  • alendronate
  • risendronate
  • etidronate

pulsitile PTH also
-Teriparatide

189
Q

Behavior changes that prevent osteoporosis ((6)

A

stop

  • smoking
  • alcohol
  • steroids
  • H2 and PPIs (need H for Ca absorption)
  • heparin (long term)

Weight bearing exercise

190
Q

Concern w/ bisphophates (2)

A

erosive esophagitis

osteonecrosis of the jaw

191
Q

Bisphosphates indicated for (3)

A

osteoporosis
Pagets disease of the bone
humoral hypercalcemia from malignancy
( PTH related peptide - paraneoplastic effect of small cell lung cancer for example)

192
Q

bone pain, with bone enlargement and arthritis

A

Pagets disease of the bone

193
Q

vertebral compression fractures

A

osteoperosis

194
Q

Pagets disease of the bone is at an increased risk of what sequlae?

A

osteosarcoma

  • may also have hearing loss w/ auditory foramen narrowing
195
Q

Mutation in carbonic anyhdrase II is called?

Presentation? (3)

A

Osteopetrosis

Thick brittle bone-> fractures
cranial nerve impingement w/ excess bone
panyctopenia ( thrombocytopenia, infection) due to loss of bone marrow

196
Q

RANK L inhibitor

A

Denosumab
-inhibits osteoclastic activity

-Remember osetoblast is the initiating factor that activates osteoclasts

197
Q

SERM used for osteoporosis

A

Raloxifene

Tamoxifen used for Breast CA

198
Q

Positive anterior drawer sign

A

ACL injury

199
Q

Unhappy triad is due to what?

Composed of what?

A

lateral force applied to planted foot leading to damaged

ACL
MCL
meniscus (lateral more common than medial)

200
Q

Housemade knee

A

prepatellar bursitis

201
Q

clergyman knee

A

infraplatellar bursitis

202
Q

Rotator cuff muscles and function

A

SItS

Supraspinatus - 1st 15 degrees of abduction
Infraspinatous - lateral rotation
teres minor - lateral rotation
Subscapularis - medial rotation

203
Q

Most common torn rotator cuff muscle and test

A

Supraspinatous is most common torn rotator cuff muscle

Test with empty can test

204
Q

Dislocated shoulder is

A

head of the humerus comes out of glenoid cavity

205
Q

separated shoulder is

A

clavicle separates from the acromion process and coracoid process

206
Q

subacromial buristis

A

impingement between head of the humorous and corocoaronial arch

207
Q

shoulder impingement?

seen in?

A

acromion process compresses the supraspinatus tendon

repetitive overhead activities - baseball, tennis

208
Q

Bones of the Wrist

A

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
Q

pain in the anatomic snuff box break in

worry about?

A

scaphoid bone injury

necrosis to the proximal bone due to retrograde blood flow

210
Q

Ankle sprain more likely to tear (3)

A

Lateral

  • Anterior talofibular ligament
  • Calcaneo fibular ligament
  • Posterior talofibular ligament

Medial - rare
-deltoid ligament

211
Q

Most hip locations occur where?

Risk of damaging what?(5)

A

posterior dislocation

medial circumflex and lateral circumflex of deep femoral artery
femoral vein,
femoral nerve
head of femur

212
Q

Most common knee injury < 45?

Presents as?

Rx? (4)

A

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
Q

Pain beneath the calcaneus that is worse int he first few steps in the morning and after weight bearing?

A

Plantar fasciitis

214
Q

Structures damaged by anterior shoulder location?

test what nerve by doing what?

A

axillary nerve
posterior circumflex artery
supraspinatous tendon
anterior glenohumeral ligaments- seperation
posteriolateral glenohumeral ligaments - abrasion

stroke the deltoid for sensation before reduction

215
Q

Painless thickening of flexor tendons of the palms - usually affecting which finger?

Risk factors (4)

A

Dupuytrens contraction
- 4th

unknown etiology but risks:

  • male
  • > 40
  • family
  • alcohol/smoking
216
Q

Frozen shoulder is?

A

adhesive capsulitis due to shoulder adhesions that lock the shoulder after disuse with an injury

especially if > 50 , woman and diabetic

217
Q

Excessive bruising and bulge midhumoral think?

A

bicep tendon rupture

popye lesion

218
Q

Large bump seen over the elbow that is painless

A

olecronon bursitis

Rx w/ needle to drain

219
Q

tennis elbow is injury to?

A

lateral epicondylitis

inflamed lateral epicondyle and wrist extensors

220
Q

golfers elbow?

A

medial epicondylitis

inflamed medial epicondyle and wrist flexors

221
Q

eburnation

A

polished ivory like appearance of bone in OA

222
Q

Radiographic changes in Osteoarthritis(3)

A

sclerotic changes
joint narrowing
ostrophyte formation

223
Q

Presentation of Osteoarthritis

which joints in the hand(2)

Rx:

A

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
Q

heberdens nodules vs bouchards nodules

A

osteophyte formation in OA in the DIP vs PIP respectfully

225
Q

Predisposing factors for OA vs RA

A

age, weight and abnormal joint deformity vs

female and HLA DR4

226
Q

Presentation of RA (4)

joints of the hands affected (2)

A

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
Q

Bakers cyst commonly seen w?

228
Q

Hypersensitivity type of RA?

Associated antibodies (2)

A

Type 3

Rheumatoid factor- IgM to IgG antibody (not specific)
Anticitrullinated peptide protein (ACPA) - more specific

229
Q

Advanced RA of the hand pathology (4)

A

ulnar deviation of fingers

subluxation

Boutonnieres - flexed PIP and extended DIP

Swan neck deformity - extended PIP and flexed DIP

230
Q

Rx for RA (5)

A 
NSAIDs
DMARDs
- methotrexate
-sulfasalazine
-TNF alpha inhibitors
-hydroxychloroquine
231
Q

TNF alpha inhibitors (5)

A 
Etanercept
Infliximab
adalimuxiab
golimumab
certolizumab
232
Q

Radiographic findings in RA (3)

A

pannus formation
bone and cartilage erosion
increased synovial fluid

233
Q

Uses of n acytylcystine?(3)

A

acetaminophen overdose
mucolytic in CF or intubation
nephropathy prevention w/ contrast

234
Q

Risk of Celexicob use? (3)

A

thrombosis (not for those w/ CV family risk)
sulfa allergies
gastritis or ulcers (still some effect)

235
Q

Renal problems w/ NSAIDS (2)

Others? (3)

A

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
Q

how does Acetaminophen differ from NSAIDs?

Biggest toxicity concern?

A

peripherally inhibited
acts in the CNS as antipyretic and analgesic

NO anti inflammatory

The liver w/ NAPQI metabolites

237
Q

ASA toxicity? (5)

A

gastric ulceration
tinnitus
acute renal failure
interstitial nephritis
hyperventilation -> respiratory alkalosis
-eventual lactic acidosis -> metabolic alkalosis

238
Q

ASA effect on

bleeding time
PT/INR
PTT

A

Increases - anti platelet

No effect
No effect

239
Q

Causes of Gout (3)

A

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
Q

Podagra

A

painful swollen, red 1st MTP in gout

241
Q

Gout acute attacks can be due to (2)

A

large meals

Alcohol use - competes for excretion w/ uric acid

242
Q

Associated Gout findings(2)

A

Uric acid Tophi - external ear, olecranon bursa, achilles tendon

asymmetrical dystribution

243
Q

Acute Gout attack drugs and MOA

A

NSAIDS- anti inflammatory
Colchicine - inhibits tublin -> decreased leukocyte chemotaxis
Steroids - anti inflammatory

244
Q

Chronic Gout drugs and MOA (3)

A

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
Q

Chondrocalcinoisis

A

seen in pseudogout where Ca deposits in the articular cartilage (especially the meniscus of the knee) leading to Calcification seen on x ray

246
Q

How does psuedogout differ from gout

A

Pseudo gout is rhomboid positive birefringent w/ parallel light

also usually affects large joints

Rx is the same

247
Q

Pathology associated w/ HLA B27

A

PAIR - seronegative spondyloarthropathies

Psoriatic arthritis
ankylosing spondylitis
inflammatory bowel disease
Reactive arthritis

No Rheumatoid factor, more often males

248
Q

Pencil in cup deformity seen on x ray?

A

psoriatic arthritis

especially the DIP

249
Q

symptoms of psoriatic arthritis

Joints?

A

dactylitis

asymmetric and patchy involvement affecting the fingers (DIP), spine and sacroiliac

250
Q

Uveitis and aortic regurgitation are often associated w?

How can you improve the primary problem

A

ankylosing spondylitis - bamboo spine
- can also have conduction abnormalities and CV disease

Exercise helps

251
Q

Reactive arthritis is characterized by(3)?

Pathogenisis vs septic arthritis

A

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
Q

Infections associated w/ Reactive arthritis (5)

A

Chlamydia

Post GI
-salmonella, Shigella, Yesernia, campylobacter, clostridium

253
Q

3 forms of Juvenile Idiopathic arthritis

A

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
Q

Infections causing septic arthritis?(3)

presentation (3)

A

Nessieria gonorrhea
S aureus
Streptococcus

polyarticular, migratory arthritis w/ asymmetric pattern

255
Q

Associations w/ gonococcal arthritis (3)

Diagnose w?

A

SAD

synovitis - knee
tenosynovitis - hand
dermatitis - pustules

arthrocentesis

256
Q

Check what before starting infliximab and the like?

A

PPD because TNF alpha inhibitors may reactivate latent TB

257
Q

TNF alpha agents implicated for what arthritic processes(3)

A

RA
psoriases
ankylosing spondylitis

258
Q

See elevated CK in this X linked muscle disease

A

Duchennes and Beckers

259
Q

Difference between Duchene and beckers on molecular level

A

both X linked
Duchenne is a Deletion in dystophin -> accelerated mucle brakdown

beckers is a mutation

260
Q

Qower’s manuever

A

seen in duchenne doe to pelvic muscles being weak and needing to use hands

261
Q

Sjogren’s antibodies(3)

A

SS-A (rho)
SS-B (La)

occasionally rheumatoid factor or SLE

262
Q

Triad of sjogrens syndrome

associated complications (3)

A

Xerophthalmia - dry mouth
Xerostomia - dry eyes
arthritis

parotid enlargment
B cell lymphoma risk
dental carries

263
Q

ANA + in (7)

A 
SLE
sjogrens
polymyostitis/dermatomystitis
Scleroderma
RA
juvenile Idopathaic arthritis
mixed connective tissue disease
264
Q

Libman sacks endocarditis?

A

sterile vegitations seen in SLE

265
Q

Common cause of death in SLE?

Check what to prevent?

A

lupes nephritis (wire loopis)

  • Diffuse proliferative if nephritis
  • membranous glomerulonephritis is nephrotic

Check serum creatinine and UA for proteinuria

266
Q

Serum Antibody and changes associated w/ Lupus (5)

A 
ANA
Anti DNA - renal associated
Anti Smith
antiphospholipid (anti cardiolipin) - coag risk
decreased C3 and C4 -infection risk
267
Q

Drug induced lupus serum antibody

which drugs?

A

anti-histone

Sulfonamides
Hydralazine
INH
Phenytoin
Procainamide
268
Q

What may be a false + in SLE

269
Q

Symptoms associated w/ SLE

-11 total

A

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
Q

Polymyalgia rheumatica characterized by?
Associated w?

Labs?(2)

Differs from?

A

proximal joint pain
-shoulders and hips (Rx steriods)

Elevated ESR
Normal CK

Polymyosistis (proximal muscle pain)

271
Q

Polymyalgia rheumatica associated w/ which vasculitis

A

temporal arteritis

proximal joint pain(shoulder and hip)

272
Q

Anti jo antibodies

A

Polymyositis/dermatomyositis

273
Q

difference between polymyositis and dermatomyositis(2)

A

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
Q

Skin involvement in dermatomyositis (4)

A

malar rash
gottrons papules on knuckles
helitrope rash - eyes
mechanics hands - rough hands and feet

275
Q

Labs in polymyositis and dermatomyositis

CK?
Antibodies? (3)

A

elevated CK

ANA
Aldolase
anti-jo-1

276
Q

Fibromyalgia is

associated signs?(6)

Rx(4)

A

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
Q

Proximal weakness vs distal weakness think

A

larger muscle disorders like polymyolitis vs distal think nerve disorders

278
Q

anticentromere w?

A

CREST Scleroderma

279
Q

anti toposiomerase w?

Also called

A

Scl-70

Diffuse scleroderma

280
Q

Diffuse sceroderma vs CREST prognosis

A

Rapid widespread skin involvement, potentially fatal while Crest is limited in skin insolvent, often confined to fingers

281
Q

CREST scleroderma stands for?

A 
Calcinosis
Raynauds
Esophageal dysmotility
Scleroderma
Telangiectasia
282
Q

Shiny skin w/ trouble swallowing ?

Check for in blood?

A

Scleroderma (CREST)

Anticentromere Ab

283
Q

zona occuden uses what proteins (2)

A

tight junction - impermeable

claudin and occludin

284
Q

zona adherins uses what proteins (2)

A

adhering junctions

belt w/ actin filaments
and CADherins - Ca dependent adhesion proteins

285
Q

macula adhering uses what proteins

A

desmosomes to connect cells

keratin interactions w. cadherins
-pemphigous vulgaris

286
Q

Gap junction connects between cells using what protein

287
Q

Hemidesmosomes use what proteins

A

connects to basement membrane w/ keratin

integrins also

bullous pemphigoid

288
Q

melanocytes are found in the

A

stratum basale

289
Q

Fibroblasts are important in producing(4)

A

collagen
glycosaminoglycan
reticular and elastic cells
glycoprotein

290
Q

The itch that rashes

Rx: (6)

A

atopic dermatitis

moisturizers w/ emollient
calcineuron inhibitors (tacrolimus, primecromlimus)
UV light - better in the summer
topical steriods
antihistamine
leukotriene inhibitors
291
Q

Common location of atopic dermatitis

A

in the flexors - behind the knee and in the elbow

Maybe all over a baby that is being cleaned too much

292
Q

verrucae

293
Q

ephelis

A

freckle

excess melanin NOT melanicytes

294
Q

nevi

295
Q

Linear puritic rash

what type of hypersensitivity

A

contact dermatitis - poison ivy or nickel

Type IV

296
Q

4 causes and associated Rx w/ Acne

A

hyperkeratosis - retinoids, isotretinion

sebum overproduction - isotretinion, OCPs, spiranolactone

propioni bacterium acne - erythromycin, tetracyclin, doxy, minocyclycline, clindamycin, benzoyl peroxide

inflammation - steriods

297
Q

isotretinion, OCPs, spiranolactone are all used in RX for

298
Q

Skin disorder associated w/ asthma and allergic rhinits

A

atopic dermatitis

eczema

299
Q

keratin filled cysts - horn cells

A

seberrheic keratosis

300
Q

increased stratum spinosum w/ decreased stratum granulosum w/ parakeratotic scaling?

301
Q

Psoriasis is often found where?

A

on the extensor surface (NOT in folds)

knees and elbows

302
Q

depigmentation due to decreases melanin production

cause?

A

ambinoism

decreased tyrosinase activity

303
Q

depigmentation due to decrease in menanocyte #

cause?

A

vitiligo

??

304
Q

darkening of the dace seen in pregnancy or OCP

305
Q

flaccid blisters w/ Nikolskys sign?

Involve the mouth?

A

phemphigus vulgaris - IgG against desmoglein 3 or 1

skin just sloughs off

involves the mouth

306
Q

tense blisters w/out Nikolskys Sign?

Involves the mouth

A

Bullous pemphigoid - IgG against hemidesmosomes, Eoisinophils w/in the blister

No oral involvement

307
Q

Auspitz sign is

may also seen in this derm path unrelated to the skin?

A

pinpoint bleeding when the silver plaques are scraped off

pitting of the nails

308
Q

puritic papules, vesicles and bullae in extensor surfaces after eating wheat product

Deposition of what?

A

dematitis herpatiformis in celiac

IgA in the tips of the dermal papillae

309
Q

Erythema multiform is associated(4)

Can lead to ?

A

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
Q

Presentation of Erythema multiforme

A

macules and papules forming a target lesion due to central necrosis

thought to be due to microvascular deposition of immune complexes

311
Q

Stevens johnsons syndrome is different from Toxic epidermal necrolysis

A

Both have fever, bulla formation,necrosis, sloughing skin and high mortality

TENs has > 30% skin involvement

312
Q

See a darkened skin in a flexor think of 2 things (neck or axilla)

A

diabetes mellatis

>40 gastrointestinal adenocarcinoma (Visceral malignancy)

313
Q

Premalignant derm path treat w/ 5 florouricil

Found by?

A

actinic keratosis, treat due to squamous cell risk

found by feeling - sandpaper, rough

314
Q

Painful lesion of the fat, commonly found on anterior tibia

Associated path (7)

A

erythema nodosum

sarcoidosis
TB
histioplasmosis
coccidiomycosis
Post strept
leprosy
Crohns
315
Q

6 Ps of Lichen Planus

associated w/

A 
purple 
Puriritic
Papules
polygonal shape
Planar 
Plaque

Hepatitis C
-sawtooth infiltrate

316
Q

see a herald patch on the neck and a couple days later see a christmas tree distribution of a rash called?

Rx

A

Pityriasis rosea

Self resolving in 6-8 wks

317
Q

Necrotising fascititis caused by? (2)

suspect when? (2)

A

Clostridium perfenges and Strep pyrogenes

  • When tenderness is beyond the erythematous border
  • crepitis is felt
318
Q

Honey rusted lesions of the superficial skin cause by (2)

A

Impetigo

Staph aureus
Strep pyrogenes

319
Q

Erythematous painful lesion of the dermis and subcutaneous tissue caused by?(2)

A

Cellulitis

Staph aureus
Strep pyrogens

320
Q

Exotoxin A and B from staph Aureus responsible for what derm path

pathophys?

A

Staph Scalded Skin Syndrome

keratinocyte attachment of stratum granulosum is destroyed -> sloughing skin

321
Q

Pink pearly nodules caused by?

Keratin pearls caused by?

A

basal cell carcinoma

squamous cell carcinoma

322
Q

most common malignant skin pathology

seen histology

A

basal cell carcinoma,
-Rarely METS locally destructive

palisading nuclei

323
Q

Rolled birders, telanectasias and central necrosis

A

basal cell carcinoma

324
Q

S 100 tumor marker important in

325
Q

Excisional biopsy key in prognosis of what disease

A

melanoma
- depth is key in risk of METs

Asymetrical
Borders (irregular)
Color (not uniform)
Diameter

326
Q

Thickened scar around face or chest

327
Q

Calcium deposition seen in a joint that is nonerrosive

acute pain and swelling?

A

Pseudogout

w. calcium pyrophosphate crystals seen on aspiration

USLME Kiss my ass and pray (33 decks)

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