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US > Musculoskeletal and Connective Tissue > Flashcards

Musculoskeletal and Connective Tissue Flashcards

1
Q

Where does the ACL extend?

A

Lateral femoral condyle to the anterior tibia

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2
Q

where does the PCL extend?

A

From the medial femoral condyl to the posterior Tibia

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3
Q

What is the anterior drawer sign?

A

Bend knee at 90 degree angel

Anterior gliding due to ACL injury

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4
Q

What is the posterior drawer sign?

A

Bend at 90 degree angle (posterior gliding due to PCL injury)

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5
Q

Abnormal passive abduction?

A 
Bend at 30 degrees 
Lateral valgus (external roatation) has MCL injury
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6
Q

Abnormal passive adduction

A

Knee extended at 30 degree angle (medial force means LCL injury

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7
Q

What is the McMurray text

A

Flexion and extension of the knee with rotation of the tibia and foot (the sounds will have external popping sound: medial meniscal tear

Pain: popping on internal rotation (lateral meniscal tear)

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8
Q

what is the unhappy triad of contact sports?

A

Lateral force applied to planted leg
Damage to : ACL, MCL and medial meniscus

(Can also have the lateral meniscus injury)

Will present with acute knee pain, and joint instability

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9
Q

what is prepatellar bursitis?

A

Inflammation of the knee’s largest sac of synovial fluid

Can be caused by repeated trauma of from excessive kneeling

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10
Q

What is a Baker’s cyst?

A

Popliteal fluid collection in the gatrocneimius -semi-membraneous bursa commonly communicating with the synovial space.

related to chronic joint disease

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11
Q

what are the muscles of the rotator cuff?

A

Supraspinatus (abducts arm initially) before the action of the deltoid

(most common rotator cuff injury)

Infraspinatus: laterally rotates the arm (pitching injury)

Teres minor: adducsts and laterally rotates the arm

Subscapularis: upper and lower subscapular nerves (medially rotates and abducts the arm)

innervated by C5 and C6

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12
Q

what is golfer’s elbow? (medial epicondylitis)?

A 
Repetitive flexion (forehand shots) or idopathic
Pain is near the medial epicondyle
Lateral epicondylitis: tennis elbow 
Repetitive extension (backhand shots) pain near the lateral epicondyle
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13
Q

What are the wrist bones?

A 
Trapezium
Trapazoid
Capitate
Hameta
Triquetrium
Pisiform
Lunale 
Sacphoid
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14
Q

What is the most commonly fractured carpal bone?

A

The scaphoid
Usually due to fall on outstretched hand
Is prone to avascular necrosis due to retrograde blood supply

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15
Q

what is the carpal tunnel syndrome?

A

entrapement of the median nerve in carpal tunnel
leads to paresthesi, pain and numbness
Thenar eminence is atrophoed

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16
Q

What are diseases associated with the carpal tunnel syndrome?

A 
Pregnancy
RA
Hypothyroidism 
Diabetes
Dialysis related amyloidosis
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17
Q

What is the Guyon Canal syndrome?

A

Compression of the ulnar nerve at wrist or hand

Clasically seen in cyclists due to pressure from the handlebars

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18
Q

How is the axillar C5-C6 affected?

A

Fractured neck of the humerus, with anterior dislocation of the humerus

Will present with flattened deltoid
Loss of arm abduction at shoulder (15 degrees)
Loss of sensation over deltoid muscle and lateral arm

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19
Q

Injury to musculocutaneous C5-C7

A

Other forearm
Usually due to trunk compression
Loss of foreamr flexion and supination
Loss of sensation over the lateral portion of the forearm

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20
Q

Injury to the radial (C5-T1) ?

A

Midshaft fracture of the humerus
Compression of the axilla due to crutches or sleeping with the arm over chair

Wrist drop (loss of elbow)
Wrist and finger extension
Decreased in grip strength
Loss of sensation over the posterior arm and forearm of the dorsal hand

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21
Q

Injury to median nerve C5-T1?

A

Supracondylar fracture of the humerus (proximal lesion)
Carpal tunnel syndrome (wrist laceration)

Presents with the ape hand or the Pope’s blessing

Loss of wrist flexion, flexion of the lateral fingers, thumb opposition

Loss of sensation over the thenar eminence and dorsal palmer aspects of lateral 3/1/2 fingers

Tinel syndome: tingling on percussion in carpal tunnel syndrome

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22
Q

Injury to the Ulner C8-T1?

A

Fracture of the medial epicondyle of the humerus (funny bone…if proximal leision)

Fractured hook of hamate (distal lesion)

will have the ulnar claw on digit extension

Radial deviation of the wrist upon flexion (proximal lesion)

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23
Q

Injury to the recurrent branch of the median nerve 9C5-T1)?

A

Leads to Ape Hand
Loss of thenar muscle group (opposition) abduction, and flexion of the thumb

No loss of sensation

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24
Q

What is Erb’s palsy?

A

Injury of C5 -C6

Caused: lateral traction of the neck during delivery
Adults: Trauma
What is the muscle deficit and functional deficit:

Deltoid: abduction (arm hangs by the side)
Infraspinatus: lateral rotation (arm is medially rotated)
Biceps brachii: Flexion, supination (arm is extended and pronated)

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25
Q

Klumke palsy?

A

Traction or tear of the lower trunk (C8-T1)

Infants: upward force on the arm during delivery
Adults: trauma (grabbing a tree branch to break the fall)

Muscle deficit: 
Lumbricals
Interossei 
Thenar 
Hypothenar

Leads to total hand clow

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26
Q

Thoracic outlet syndrome?

A

Compression of lower trunk and the subclavian vessels

Due to cervical rib, or the pancoast tumor

Causes atrophy of the intinsic hand muscles (ischemia, pain, and edema due to vascular compression)

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27
Q

What is the winged scapula?

A

Lesion of the long thoracic nerve
Due to axillary node dissection after the mastectomy
Stab wounds

Have inability to anchor the scapula to the thoracic cage (cannot abduct the arm above a horizontal position)

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28
Q

Describe the ulnar claw?

A

Pinkie and finger beside are pulled down

Due to distal ulner nerve injury

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29
Q

What is the Pope’s blessing?

A

Pinkie and finger beside are pulled down

Atrophy of the remaining fingers

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30
Q

What is the median claw?

A

Middle finger, to thumb are curled down

Distal median nerve compression

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31
Q

Ok gesture?

A

Pinkie and finger beside

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32
Q

What are the muscles of the Thenar median?

A

Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Superficial head

(perform the functions: oppose, abduct, and flex)

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33
Q

What are muscles, and function of the hypothenar (ulnar)?

A

Opponens digiti minimi
Abductor digitit minimi
Flexor digiti minimi brevis

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34
Q

What do the dorsal interossei do?

A

Abduct the finger

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35
Q

What do the palmer interossei do?

A

Adduct the fingers

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36
Q

what do the lumbricals do?

A

Flex at the MCP joint, extend the PIP and DIP joins

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37
Q

Injury to obturator (L2-L4)?

A

Caused by pelvic surgery

Decrease thigh sensation (medial, and decrease adduction)

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38
Q

Injury to femoral L2-L4?

A

Pelvic fracture

Decrease thigh flexion and leg extension

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39
Q

Common peroneal L4-S2?

A

Trauma or compression of the lateral aspect of the leg (fibular neck fracture)

Results in foot drop (inervated and plantar flexed at rest)

Loss of sensation in the dorsum of the foot

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40
Q

Injury to the Tibial L4-S3 region?

A

Knee trauma, Baker cyst
Inability to curl toes, and loss of sensation on sole of foot

Proximal lesion: foot everted at rest with loss of inversion and plantar flexion

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41
Q

Injury to superior gluteal L4-S1?

A

Usually inatrogenci due to intramuscular injection
Trendenlenberg sign or gait

Pelvis tils because weight bearing leg cannot maintain alignement of the pelvis through hip abduction

Lesion is contralateral to the side of the hip drop (ipsilateral to the extremity on which the patient stands)

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42
Q

Inferior gluteal L5-S2 region?

A

Caused by posterior hip dislocation
Leads to difficulty climbing stairs, raising from seated position
Loss of hip extention

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43
Q

what does the sciatic nerve innervate?

A

Posterior thigh (before splitting to common peroneal and tibial nerves)

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44
Q

What does the pudendal nerve (S2 and S4) innervate?

A

The perineum (is blocked during childbrith) with ischial space as a landmark

Choose the superolateral gluteal quadrant as intramuscular injection sire to avoid nerve injury.

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45
Q

What are signs of lumbrosacral radiculopathy?

A

Parethesis and weakness in the specific regions
Often associated with disc herniation

Usually the disk protrude posterior

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46
Q

What is deficit if have L3-L4?

A

weakness of the knee extention and decfreased pateller reflex

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47
Q

What is deficit if have L4-L5?

A

Weakness of dorsiflexion, difficulty in heel walking

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48
Q

L5-S1 herniated disc?

A

Weakness of plantar flexion (difficulty in toe walking) decreased in achilles reflex

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49
Q

Artery associated with the long thoracic?

A

Lateral thoracic

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50
Q

Artery associated with surgical neck of humerus (axilla)

A

Posterior circumflex

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51
Q

Artery associaed with midshaft of humerous?

A

Nerve: Radial
Artery: Deep brachial

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52
Q

Artery/Nerve associated with the distal humerus and cubital fossa?

A

Median nerve

Brachial artery

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53
Q

Nerve/Artery associated with the popliteal fossa?

A

Tibial nerve

Popliteal artery

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54
Q

Nerve/artery associated with medial malleolus?

A

Tibial nerve

Posterior tibial artery

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55
Q

How does muscle contraction occur?

A

action potential opens up calciym gated channels (neurotransmiter release)
ligand binds to muscle cell and causes depolarization ( at muscle end plate)
Depolarization travels along the muscle cell and down the T-tubule
Ca is released from sarcoplasma
Ca binds to troponin and causes conformational change in tropomyosin (out of the myosin binding groove)
Myosin releases bound ADP and PI
Shortening of the H and I band between the Z lines
Binding of the new ATP causes the myosin head to detach

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56
Q

what are the differences between the type 1 and type 2 muscles?

A

Type 1: slow twitch (red fibers) sustained contraction
Increase after endurance training

Type 2: fast twitch (white) increase after weight and resistance training.

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57
Q

What is the difference between endochrondral ossification and membraneous ossification?

A

Endochrondial: cartilogenous model osteoblasts and osteoclasts replace with woven bone

(axial, appendicular skeleton, base of skull)

Membraneous ossification: Bones of calvarium and face (formed without cartilege)

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58
Q

What is function of osteoblasts?

A

Builds bone by secreting collagen and mineralization in akaline environment

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59
Q

What are osteoblasts?

A

Dissolves bone by secreting H+ collegen

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60
Q

What does parathyroid hormone do?

A

High levels of TH levels will cause the catabolic effects (osteitis, fibrosa cystica)

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61
Q

What does estrogen do?

A

encourgages apoptosis of the osteoclasts

Inhibits the apoptosis of osteoblasts

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62
Q

What is achondroplasia?

A

Failure of longitudinal bone growth (short limbs and large head)

Autosomal dominent with full pentrance (homozygous is lethal)

Most common cause of dwarfism

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63
Q

Describe the process of osteoporosis?

A

Cortical bone loss (even if the lab serum Ca is normal)

Can lead to vertebral compression fractures

Kyphosis, back pain, and loss of height

Can also present with fractures of the femoral neck (distal radius)

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64
Q

What is the cause of osteoporosis?

A

Increase bone absorption (due to decrease estrogen level)

Secondary to drugs (steroids and ETOH), anticonvulsants, anticoagulants, hyperparathyroidism, multiple myeloma etc

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65
Q

How is osteoporosis diagnoses?

A

Bone density with a T score < 2.5

OR with fragility fracture of the hip or vertebrae

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66
Q

How to treat osteoporosis?

A 
Calcium
Vitamin D during adulthood
Bisphophonates
Teriparatide 
SERMS
Calcitonin  
weight bearing exercise
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67
Q

What is osteopetosis?

A

Failure of normal bone absorption due to defective osteoclasts
Thickened dense bone that is prone to fracture
X-ray will show a stone appeared
Can have cranial nerve impingement and palsies due to narrowed foramina

Bone marrow transplant may be curative because osteoclasts are derived from monocytes

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68
Q

What happens in osteomalacia and rickets?

A

Has defective mineralization of osteoid (adults)

Defective cartilaginous growth plates in children

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69
Q

What do x-rays show?

A

Looser zones (pseudo fractures) in osteomalasia
Will have epiphyseal widening
Metaphyseal cupping and fraying in rickets

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70
Q

What do children with rickets have?

A

Have bow legs with bead like costochondral junctions

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71
Q

What are the lab values for osteomalacia and rickets?

A 
Decreased vitamin D
Decreased serum Ca
Increased PTH secretion
Decreased PO4
Has hyperactivity of osteoblasts which cause increase in ALP
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72
Q

What is Paget disease of bone? (osteiti deformans)?

A

Local bone disorder
Have increased osteoclastic activity followed by increased osteoblastic activity.
This forms poor quality bone

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73
Q

What do the lab features of Paget’s disease show?

A

Serum Ca increased
Phosphorous and PTH level are normal
Increased ALP

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74
Q

Why is there heart failure in Paget’s disease?

A

Have increased blood flow from AV shunts
Can cause high output heart failure
Have an increase risk of osteogenic sarcoma

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75
Q

What are some clinical features of Paget’s disease?

A

Hat sizing may be difficult due to skull thickening

Can have hearing loss due to auditory foramen narrowing

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76
Q

What are the different stages of Paget’s disease ?

A

Lytic: osteoclasts
Mixed: Osteoclasts and osteoblasts
Sclerotic: osteoblasts
Quiescent: minimal osteoclasts/osteoblast activity

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77
Q

What is osteonecrosis?

A

Infarction of the bone marrow (usually very painful)

Caused by insufficiency of the femoral artery

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78
Q

What are the causes of osteonecrosis?

A 
Corticosteroids
ETOH
Sickle Cell 
Trauma
Bends
Legg-Calve Perthes disease (idiopathic) 
Gaucher disease
Slipped capital femoral epiphysis
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79
Q

What are the two types of benign bone tumors?

A

Osteochondroma: Most common bengin tumor
Bony exostosis
Usually males less then 25 years old

Giant Cell tumor:20-40 years old
Epiphyseal end of the long bones (usually the knee)
Locally aggressive benign tumor (soap bubble appearance on x-ray)

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80
Q

What are the types of malignant tumors?

A

Osteosarcoma: second most common after multiple myeloma

Bimodal distribution : 10-20 years, and then older then 65

Usually at metaphysis of the long bones, around the knee

2) Ewing Sarcoma: Boys less then 15 years old (usually at diaphysis of the long bones, the pelvis, scapula, ribs

Anaplastic small cell malignant tumor

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81
Q

What are predisposing factors for sarcoma?

A

Li-Farumani

Retinoblastoma

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82
Q

What are predisposing factors for Ewing sarcoma?

A

11+ 22 translocation

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83
Q

Pathogenesis of osteoarthritis vs RA?

A

OA: wear and tear, chrondocytes mediate degradation and inadequate repair

RA: autoimmune inflammatory cytokines and cells induce pannus

84
Q

OA vs RA for predisposing factors?

A

OA: age, female, obseity, joint trauma

RA: Female, HLA-DR4, silica, + RA factor, anti-IgG

85
Q

What is the presentation of OA vs RA?

A

Pain in weight bearing joints after use
Assymetric joint involvement

RA: pain, swelling, morning stiffness
Symmetric joint involvement
Systemic symptoms: fever, fatigue, weight loss

86
Q

OA vs RA joint findings?

A

osteophytes (bone spurs)
Synovial fluid with WBC
Involves tje MCP, PIP, wrist, DIP

87
Q

Treatment of OA vs RA?

A

OA: tylenol, NSAIDS, intra-articular glucocorticoids

RA: NSAIDS, glucocorticoids, disease modifiying agents (methrotrexate) sulfasalazine

88
Q

What are extra-articular manifestations of RA?

A 
Fibrinoid necrosis 
Interstitial lung disease
Pleuritis
Pericarditis
Anemia of chronic 
AA amyloidosis 
Sjogren's 
Scleritis 
Carpal Tunnel syndrome
89
Q

What are the findings associated with gout?

A

Inflammatory monoarthritis: precipitation of monosodium urate crystals in joints

More common in males

Caused by undersecretion of uric acid (90%) usually exacerbated by medication (thiazides)

Overproduction of uric acid (10% of patients) Lesch-Ny

90
Q

How do the crystals look like?

A

Needle shaped, and birefringent under polarized light.

91
Q

What are the symptoms of Gout?

A

Assymetric joint distribution
Joint is swollen and red and painful
Classic is painful MTP joint of the big toe

92
Q

How to treat the gout?

A

NSAIDS
Glucocorticoids
Colchicine
Chronic: xanthine oxidase inhibitors

93
Q

What is calcium pyrophosphate deposition disease?

A

Deposit of calcium pyrophosphate crystals within the space

Occurs in patients > 50 years old

Both in men and women

Have pain, swelling with acute inflammation (pseudogout) and chronic degeneration

94
Q

How are the crystals for the calcium pyrophospate disease vs the gout?

A

Crytasls for gout are bifringent (yellow under parallel light)

Calcium pyrophosphate: rhomboid shaped, weakly bifringent (blue)

95
Q

What is Sjogren’s syndrome?

A

Autoimmune, destruction of exocrine glands (lacrimal and salivery) by lymphocyte infiltrates

96
Q

What are the findings of Sjogren’s syndrome?

A 
Inflammatory joint pain
Keratoconjunctivitis sicca *dry eyes) 
Zerostomia: dry salivery glands 
Preseance of anti-nuclear antibodies: SS-A, anti-Ro, or SS-B 
Bilateral parotid enlargement
97
Q

What are possible complications of Sjogren syndrome?

A

Usually associated with RA, SLE, systemic sclerosis

Complications: dental cavities, MALT (mucosa associated lymphoid tissue, parotid enlargement

98
Q

What are the main bugs that cause spetic arthritis?

A

Staph aureus, Streptoccus, N. Gonorrhea

99
Q

What are the clinical features of septic arthritis ?

A

Red
Painful
WBC > 50,000

100
Q

What are the signs of Septic Arthritis?

A

STI that presents with purulent arthritis (knee)

Triad of : polyarthalgia, tenosynovitis, dermatitis, pustules

101
Q

What is seronegative spondyloarthritis?

A

Arthritis wihout the Rheumatoid factor (no anti-IgG antibody)
Strong association with inflammatory back pain, periperheal arthritis, stiffness, enthesitis, dactylitis

102
Q

Characteristics of psoriatic arthritis?

A

Skin and nail leisions
Have assymetirc and patchy involvement
Dactylitis and pencil in cup deformity on x-ray

103
Q

What are the characteristics of inflammatory bowel disease?

A

Crohn’s disease and ulcerative colitis are often associated with spondyloarthritis

104
Q

What is the classic triad associated with Reiter’s syndrome?

A

Conjunctivitis
Urethritis
Arthritis

105
Q

What is classic presentation of SLE?

A

Rash
Joint pain
Fever

106
Q

What is Libman-Sacks endocarditis?

A

Non bacterial verrucous thrombi (on mitral or aortic valve)

107
Q

What is Lupus mephritis?

A

Glomular deposition of anti-DNA immune complexes

108
Q

What are common causes of death in SLE?

A

Cardiovascular disease
Infections
Renal disease

109
Q

What are other symptoms with SLE?

A 
Rash
Arthritis
Serositis
Hematologica disorder
Oral and nasal ulcers
Renal disease
Photosensitivty 
Anti-nuclear antibodies 
anti-dsDNA, anti-sun
Neurological disorders
110
Q

What are the lab findings of SLE?

A

ANA
Anti-dsDNA (poor prognosis, usually renal disease)
Anti-Smith
Antihistone antibodies (sensitive for drug induced lupus)
C3, C4, CH50

111
Q

How to treat SLE?

A

NSAIDS, steroids, immunosuppressants

Hydroxychloroquinine

112
Q

what are characteristics of antiphospholipid syndrome?

A

Most common autoimmune after SLE
Diagnosis is usually due to history of thrombosis (arterial or venous)
Can have spontaneous abortion
Treat with systemic anticoagulation

113
Q

What to note about anticardioiin antibodies and the lupus anticoagulant?

A

Can cause false positive of the VDRL/RPR and prolonged PTT

114
Q

What is a mixed connective tissue disease?

A

Has features of SLE, systemic scelrosis, polymyositis

Associated with anti UI

115
Q

What are the characteristics of sarcoidosis?

A

Widespread granulomas
Have elevated serum ACE levels
Assymptomatic except for enlarged lymph nodes
Associated with the intersitial lung fibrosis, erthema nodosum, lupus pernio (skin lesions on face) uveitis, hypercalcemia

Treatment: steroids

116
Q

What are characteristics of polymyalgia rheumatica?

A

Pain and stiffness in shoulders and hips
Associated with fever, malaise, and weight loss
NO MUSCULAR weakness
Most common in women > 50 years old
Associated with giant cell temporal arteritis
Have increased ESR and CRP, and CK

Has a rapid response to steroids.

117
Q

What is fibromylagia?

A

Females 20-50 years old

Widespread musculoskeletal pain with paresthesia, fatigue, congnitive disturbance

118
Q

How is fibromyalgia treated?

A

Exercise
Antidepressents
Anticonvulsants

119
Q

What are lab values of ploymyositis and dermatomypositis?

A

CK, ANA+, anti-Jo +, anti-SRP, anti-Mi

120
Q

Characteristics of polymyositis?

A

Progressive muscle weakness with endomysial inflammation with CD8 T cells (often involves the shoulders)

121
Q

Characteristics of dermatomyositis?

A

Similar to polymyositis except has a malar rash
Grotton papules (nodules on the hand)
Heliotrope rash
Perimysial inflammation and atrophy with CD4+ T cells

122
Q

What are the 2 neuromuscular junction diseases?

A

Mysanthia gravis

Lambert-Eaton myasthenic syndrome

123
Q

What are characteristics of the Mysanthia gravis?

A

Patho: autoantiboidies to the Ach receptor
Clinical: ptosis, diplopia, weakness. Will worsen with muscle use
Associated with thymic hyperplasia or thymoma
Treatment: AchE inhibitor (will

124
Q

Characteristics of Lambert-Eaton myasthenic syndrome?

A

Uncommon
Autoantibodies to presynaptic Ca channel (so decrease in AcH release

Clincial proximal muscle weakness, autonomic symptoms, improves with muscle use

Small cell carcinoma

Not well treated

125
Q

Characteristics of myositis ossificans?

A

Hypertrophic ossification of the skeletal muscle following muscular trauma

Usually in the upper or the lower extremity

Usually incidental finding on the x-ray

126
Q

What is the traid of scleroderma?

A

Autoimmune
Non inflammatory vasculopathy
Collagen deposition with fibrosis

Most common manifestation: puffy, taut skin without wrinkles and pitting fingertupes

127
Q

What are the causes of death of scleroderma?

A

Renal
Pulmonart
Cardiovascular
Gi complications

128
Q

Two types of scleroderma and complications?

A

Diffuse: widespread skin involvement, rapid progression, and associated with anti-scl 70 antibody

Limited: CREST syndrome Calcinosis, Raynad, Esophageal dismotility, Sclerodactyl, Telangiectasia
Associated with the anti-centromere antibody

129
Q

Characteristics of Raynaud’s phenomenon?

A

Decreased blood flow due to vasospasm of small vessels due to cold or stress

Colour is blue or white, and changes to the red

What is raynaud’s syndome? When associated with SLE, or CREST

130
Q

What is digital ulceration of Raynaud?

Treatment?

A

When you have critical ischemia of the tips of the fingers

Treatment with Ca blockers

131
Q

what are the 3 skin layers?

A

epidermis
Dermis
Subcutaenous

132
Q

What are the layers of the epidermis?

A 
Stratum Corneum 
Stratum Luciderm
Strantum Granulosum 
Stratum Spinosum
Stratum Basale
133
Q

What are the types of junction for epithelial cells?

A

Tight junctions: prevents paracellular movement of soluts

Adherens: connects cytoskeletons of adjacent cells

Desmosomes: structural support via filaments

Gap junctions: channel proteins that allows electrical and chemical communication between the cells.

134
Q

Hemidesmosome?

A

Connects keratin to the basal membrane

135
Q

Integrins?

A

Membrane proteins that maintain the integrity of basolateral membrane by binding to collagen and laminin

136
Q

Macule?

A

Flat lesion, well circumscribed change in skin color less then 1 cm

137
Q

Patch?

A

Macule more then 1cm (large birthmark)

138
Q

Papule?

A

elevated skin lesion < 1 cm

Moleor acne

139
Q

Plaque?

A

Papule > 1 cm (psoraiasis)

140
Q

Vesicle?

A

Fluid containing < 1 cm

Chicken pox

141
Q

Bulla?

A

Large fluid containing blister > 1 cm

Bullous pemphigoid

142
Q

Pustule?

A

Vesicle with pus

Pustular psoarisis

143
Q

Wheal?

A

transient smooth papule or plaque

hives

144
Q

Scale?

A

Flaking of the stratum corneum (Eczema, psoriasis, SCC)

145
Q

Crust?

A

Dry exudate (impetigo)

146
Q

Hyperkeratosis?

A

Increase thickenss of stratum corneum (psoriasis, calluses)

147
Q

Parakeratosis?

A

Hyperkeratosis with retention of the nuclei in stratum corneum (psiasis)

148
Q

Hypergranulosis?

A

Increase thickness of stratum granulosum (lichen planus)

149
Q

Spongiosis?

A

epidermal accumulation of edematous fluid within intracellular space (eczematous dermatitis)

150
Q

Acantholysis vs acanthosis?

A

Seperation of epidermal cells (pemphigus vulgaris)

Acanthosis: acanthosis nigricans

151
Q

Albinism?

A

Normal melanocytes, with decrease in melanin production
Due to decrease tyrosinase activity
Increase risk of skin cancer

152
Q

Melasma?

A

Hyperpigmentation assocaited with pregnancy

153
Q

Vitligo?

A

Irregular areas of pigmentation, caused by autoimmune destruction of melancytes.

154
Q

Acne?

A

Pilosebaceous follicle with increase sebum and jeratin
Propionibacterium acne: onstuction and inflammation

Treat with retinoids, benzoyl peroxide and antibiotics

155
Q

Atopic dermatitis? (eczema)

A

Pruritic eruption (at skin flexures)
Assocaited with atopic disease like asthma, allergie
Increase in serum IgE
In the face during infancy

156
Q

Allergic contact dermatitis?

A

Type IV hypersensitivity reaction after exposure to an allergen

157
Q

Melanocytic nevus?

A

Common mole (benign) but the melanoma can come fromth atypical mole

158
Q

Psoriasis?

A

Papules and plaques with silvery scaling on kneesand elbows
Acanthosis with parakeratotic scaling (corneum layer)

Auspitz sign: pinpoint bleeding spot from exposure of the dermal papillae where scale is removed

159
Q

Rosacea?

A

Inflammatory disorder with erythematous papules and pustules but no comedones

Phymatous rosacea can cause rhinophyma(bulbous deformation of the nose)

160
Q

Seborrheic keratosis?

A

Greasy squamous epithelial proliferation with keratin filled cysts

161
Q

Verrucae?

A

Warts, caused by HPV, soft and looks like cauliflower

162
Q

Urticaria?

A

Hives.

Pruritic wheals that form from mast cell degranulation

163
Q

Angiosarcoma?

A

Blood vessel malignancy
Usually head, neck, breast areas
Elderly, sun exposed
Associated with radiation therapy and post mastectomy
Hepatic angiosarcome associated with vinyly chloride and arsenic
Very aggressive (usually delayed diagnosis)

164
Q

Bacillary angiomatosis?

A

Benign capillary skin papules in AIDS patinet

Caused by Bartonella Hensleae infection

165
Q

Cherry hemangioma

A

Benign capillary hemangioma
Does not regress
Increase with the elderly

166
Q

Cystic hygroma ?

A

Cavernous lypmhangioma of the neck, associated with Turner syndrome

167
Q

Glomous tumor?

A

Benign
Painful
Redblue
Under the fingernails

168
Q

Kaposi Sarcoma?

A

Endothelial malignancy of the the skin
Can also be found in the mouth, GI tract, and respiratory
Associated with HHV and HIV

169
Q

Pyrogenic granuloma?

A

Polyploid (lobulated capillary hemangioma) can ulcerate and bleed
Associated with trauma and pregnany

170
Q

Strawberry hemangioma?

A

Benign hamngioma

Occurs in 1/200 births, grows rapidly, and then regresses spontaneously

171
Q

Impetigo?

A

Superficla skin infection
S aureus and S pyrogens
Very contageous
Bullos impetigo is caused bu S aureus

172
Q

Eryspelas?

A

Infection of the dermis and lymphatics of the dermis

Sharp demcarcation between normal and abnormal skin

173
Q

Cellulitis?

A

Acute, painful infection of the dermis and subcutaenous
Caused by the S-aureus and S pyrogens
Usually have break in the skin

174
Q

Abcess?

A

Collection of pus from walled off infection within deeper layers of the skin

Offending organism is always S. Aureus

175
Q

Necrotizing fascitiis?

A

Deeper tissue injury from anaerobic bacteria (S.pyrogens)

Will have crepitus from methane
Causes bullae and purple color of the skin
Flesh eating bacteria

176
Q

Staphylococcal scalded skin syndrome?

A

Exotoxin destroys keratinocyte attachements to the stratum granulosum only

Fever and generalized erythematous rash that has sloughing off of the upper layers of the dermis that heals comletely

177
Q

What are the Herpes infection?

A

HSV1 and HSV 2 can occur anywhere there is mucosal surface.

Herpes labialis , genitals, and the finger

178
Q

Molluscum Contagiosum?

A

Umbilicated papules caused by poxvirus

Frequently seen

179
Q

Varicella Zoster virus?

A

Causes chicken pox, and singles

Will have multiple crops with different ages.

180
Q

Hairy leukoplakia?

A

Irregular, white, plaques on lateral portion of the tongue

181
Q

Pemphigus vulgaris?

A

Can be fatal autoimmune skin disorder with IgG antibody desmoglein

Flaccid intraepidermal bullae caused by acantholysis

Immunofluorecece around will have netlike pattern

182
Q

Bullous pemphigod?

A 
Less severe then pemphigus vulgaris 
Involved IgG antibodies against hemidesmosoms
Forms tense blisters 
Immunofluorescence shows linear pattern 
Nikoslsky sign is negative
183
Q

Dermatitis herpetiformis?

A

Pruritic papules, vesicles, and bullae around the elbows
Deposits of IgA at tips of the dermal papillae
Associaed with celiac disease
Treatment with Dapsone (gluten free diet)

184
Q

What is erythema multiforme?

A

Associated with with infections, drugs, sulfa drugs

185
Q

What is Steven Johnson Syndrome?

A

Fever, bullae formation with necrosis and sloughing off of he skin

High mortaity rate

Usually adverse drug reaction

A more toxic form called toxic dermal necrolysis has 30% of the body surface with lesions.

186
Q

Acnathosis nigricans?

A

Epidermal hyperplasia
Hyperpigmentation of the skin in axilla or the neck region
Associated with insulin resistance and visceral malignancy (gastric adenocarcinoma)

187
Q

Actinic keratosis?

A

Small rough, erythomatous or brownish plauqe
Premalignany
Risk of cancer depends on the degree of epithelial dysplasia

188
Q

Erythema nodosum>

A

Painful
Inflammatory leisions of subcutaneous fat (usually anterior of the shins)
often idiopathic but can be associated to sarcoidosis, coccidoidomycosis, histoplasmosis, TB, leprosy

189
Q

lichen planus?

A 
Prurituc
Purple
Polygonal 
Papules
Plaques
assocaited with hep C
190
Q

Pityriasis rosea?

A

Herald patch, followed by scaly erythematous plaues

Christmas tree distribution on the trunk

191
Q

Sunburn?

A

Acute, inflammatory reaction to UV radiation

Causes DNA mutation and apoptosis of keratinocytes

192
Q

Basal cell carcinoma?

A

Most common
Sun exposed areas of the body and face
Locally invasive, rare to metastasizw
Can also appear as ulcer or non healing scaling

193
Q

Squamous cell carcinoma?

A

Second most common cancer
Exposure to sunlight
Locally invasive
No mets
looks like keratin pearls
Actinic keratosis: scaly plauqe (precursor)
Keratoacanthoma: varient that grows fast, 4-6weeks, and mat regress after

194
Q

Melanoma?

A 
Risk increased in fair person with sun exposure 
Assymeetry
Border irregular 
Color variation
Diameter more then 6
Evolution over time

Types of melanoma:

Superficial spreading
Nodular
lentigo maligna
acral lentiginous

195
Q

Acetominophen mechanism?

A

Inhibits cyclooxygenase in CNS
Anti fever, and analgesia (NO anti-inflammatory)
Overdose causes hepatic necrosis
N-Acetylcysteine is the antidote.

196
Q

ASA mechanism?

A

Irreversibly inhibits cyclooxygenase (COX-1 and COx2) by covalent acetylation

Decrease of synthesis of TXA2

Low dose < 300 mg/day will decrease platelet function
300-2400 anti-pyretic and analgesia
HIgh dose 2400-4000 anti-inflammatory

Adverse effects: gastric ulcer, tinnitus, renal failure, interstitial nephritis,

Risk of Reye syndrome in children treated with ASA for viral infection

197
Q

Mechanism of Celecoxib?

A

Reversibly inhibits COX 2 isofrom 2 (inflammatory and vascular endothelium)

Mediates inflammation and pain

Use in RA and osteoarthritis

Increase risk of thrombosis

198
Q

Mechanism of NSAIDS?

A

Include Ibuprofen, naproxen, indomethacine, ketorolac, diclofenac

Mechanism: reversibly inhibit COX 1 and COX 2

Blocks prostaglandin syntheis

Anti-pyretic, analgesic, anti-inflammatory

Indomethacin is used to close the PDA

199
Q

Mechanism of Leflunamide?

A

Reversibly inhibits dihyroorotate dehydrogenase preventing pyrimidine synthesis

200
Q

Mechanism of Bisphosphonates?

A

(examples include Alendrotnate, ibandronate, resdronate, zoledronate)

Binds to hydroxyapatite and inhibits osteoclast activity

Clinical use: Osteoporosis, hypercalcemia, Paget’s disease of the bone, metastatic bone disease, osteogeneis imperfecta

201
Q

Mechanism of Teriparatide?

A

PTH analog given subcutaneously
Increase in osteoblastic activity
Used for osteoporosis (increase in bone growth)
Can cause transient hypercalcemia

202
Q

What are the gout drugs?

A

Allopurinol

Hibitis xanthine oxidase

Also used in lymphoma and leukemia to prevent tumor lysis

Febuoxstat
Inhibits xanthine oxidase

Pegloticase

Recombinant uricase that catalyses metabolism of uric acid

Probenecid inhibts resorption of uric acid in proximal convoluted tubule

203
Q

What are drugs that are used for acute gout?

A

NSAIDS (naproxen, indomethacom_

Do not give salicylates (all but highest dose will depress uric acid clearence

Glucocoticoids: oral, intra-articular or prenteral

Colchicine: Binds and stabilizes tubulin to inhibit mircrotubule polymerization

204
Q

TNF-Alpha inhibitors?

A

All TNF-Alpha inhibitors predispose to infection including reactivation of latent TB since TNF is important to granuloma formation and stabilization

205
Q

What about the drug etanercept?

A 
Fusion protein (receptor TNF-alpha
Used for EA, psoriasis, ankolosing spodylitis
206
Q

Infliximab, adalimumab

A

Anti-TNF alpha monoclonal antibody

Used for inflammatory bowel disease, ankolysing spondylitits, psorasis

207
Q

Rasburicase?

A

Recombinent uricase that catalyzes metabolism of uric acid to allantoin

Clinical use: pervention and treatment of tumor lysis syndrome

US (17 decks)

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