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Flashcards in Bone, Skin, CT, Muscle Deck (156):
1

Most common benign primary bone tumor

Osteochondroma

2

Most common benign primary bone tumor

Osteochondroma

3

Genetic deficiency of carbonic anhydrase II

Osteopetrosis

4

Failure of bone resorption --> thickened and dense bones

Osteopetrosis

5

Bone enlargement, bone pain, arthritis

Paget disease of bone

6

Vertebral compression fractures

Osteoporosis

7

Blisters, Positive Nikolsky sign, desmosomes

Pemphigus vulgaris

8

Increases risk of tendon rupture in adults

Fluoroquinolones

9

Increases risk of tendon rupture in adults

Fluoroquinolones

10

Premalignant, treat with 5 FU, sandpaper like

Actinic keratosis

11

Premalignant, treat with 5 FU, sandpaper like

Actinic keratosis

12

Sunlight improves rash, herald patch, christmas tree distribution

Pityriasis rosea

13

Sunlight improves rash, herald patch, christmas tree distribution

Pityriasis rosea

14

Blisters, negative Nikolsky sign, hemidesmosomes

Bullous pemphigoid

15

Blisters, negative Nikolsky sign, hemidesmosomes

Bullous pemphigoid

16

Sawtooth infiltrates, associated with Hepatitis C, pruritic purple papules

Lichen planus

17

Sawtooth infiltrates, associated with Hepatitis C, pruritic purple papules

Lichen planus

18

Hallmark features of necrotizing fasciitis

rapidly spreading cellulitis
tenderness beyond red border
Often caused by S. pyogenes

19

Hallmark features of necrotizing fasciitis

rapidly spreading cellulitis
tenderness beyond red border
Often caused by S. pyogenes

20

Painless white patches on tongue that cannot be scraped off

Hairy leukoplakia caused by EBV

21

Painless white patches on tongue that cannot be scraped off

Hairy leukoplakia caused by EBV

22

Parakeratotic scaling

Psoriasis

23

Parakeratotic scaling

Psoriasis

24

Keratin filled cysts

Seborrheic keratosis

25

Keratin filled cysts

Seborrheic keratosis

26

Sand paper, predisposition to squamous cell cancer

Actinic keratosis

27

What is endochrondral ossification?

Cartilagenous model of bone is made by chondrocytes; osteoclasts and osteoblasts later replace with woven bone and then remodel to lamellar bone.
-In adults; woven bone occurs after fractures and in Paget disease

28

Which bones of the skeleton undergo endochondral ossification?

Bones of axial and appendicular skeleton and base of skull

29

Which bones undergo membranous ossification?

Bones of calvarium and facial bones

30

What is membranous ossification?

Woven bone is formed DIRECTLY, without cartilage and then later remodeled to lamellar bone

31

Function of osteoblasts

Build bone by secreting collagen and catalyzing mineralization (differentiate from mesenchymal stem cells in periosteum)

32

Function of osteoclasts

Multinucleated cells that dissolve bone by secreting acid and collagenases; differentiate from macrophages and monocytes

33

Effects of parathyroid hormone on bone

-At low intermittent levels they exert anabolic effect on osteoblasts (build bone) and osteoclasts
-Chronically high PTH levels cause catabolic effects (osteitis fibroma cystica)

34

Effects of estrogen on bone

Inhibits apoptosis in bone forming osteoblasts and induces apoptosis in bone-resorbing osteoclasts
-Estrogen deficiency leads to osteoporosis

35

Which type of bone growth is inhibited in Achondroplasia?

Endochondral; the constitutive activation of fibroblast growth factor 3 (FGF3) inhibits chondrocyte proliferation

36

What is the mutation in Achondroplasia?

Mutation in FGFR3 (Arg for Gly substitution) inhibits chondrocyte proliferation
-85% of mutations are sporadic
-AD; homozygosity is lethal

37

Describe bone in Osteoporosis

Trabecular (spongy) bone loses mass and interconnections despite normal mineralization and normal Ca/PO4

38

Medications that can cause osteoporosis?

PPI, H2 blockers, Anticonvulsants, Aromatase inhibitors, Medroxyprogesterone, GnRH agonists, proton pump inhibitors, glucocorticoids, unfractionated heparin, thiazolidinediones

39

Types of osteoporosis

Type I: post-menopausal; increased bone resorption from decreased estrogen levels
Type II: senile; affects men and women > 70 yrs

40

Cause of osteopetrosis

Failure of normal bone resorption from defective osteoclasts --> bone becomes thick and prone to fracture

41

Cause of osteopetrosis

Mutation in carbonic anhydrase II (osteoclasts can't generate acidic environment needed for bone resorption)

42

Complications of osteoPETROSIS

Pancytopenia
Extramedullary hematopoiesis
(Bone fills marrow space)
Can result in CN impingement and palsies as a result of narrowed foramina

43

What is cure for osteopetrosis? Why?

BM transplant
Osteoclasts are derived from monocytes

44

What are labs in osteopetrosis?

Normal

45

Cause of Osteomalacia/Rickets

Vitamin D deficiency --> osteomalacia in adults; rickets in children; due to defective mineralization/calcification of osteoid --> soft bones bow out

46

Labs in Osteomalacia/Rickets

Decreased Vitamin D
Decreased serum Calcium
Increased PTH secretion
Decreased serum PO4
Increased ALP from hyperactivity of osteoblasts

47

Labs in Paget disease

Normal Ca, phosphorous and PTH
Increased ALP

48

What does bone look like in Pagets?

Mosaic pattern of woven and lamellar bone

49

Complications in Paget's disease

Long bone chalk stick fracture
Increased blood flow from increased arteriovenous shunts may cause high output heart failure
Osteogenic sarcoma
Hearing loss from auditory foramen narrowing

50

Treatment for Paget's

Bisphosphonates (inhibit osteoclast activity)

51

S/E of Bisphosphonates
Uses of Bisphosphonates

S/E: Osteonecrosis of Jaw, corrosive esophagitis
Uses: Osteoporosis, Paget's disease, Hypercalcemia

52

What is Teriparatide?

Recombinant PTH analog given subcutaneously that increases osteoblast activity
-Used for osteoporosis, causes increased bone growth

53

Most common location of osteonecrosis? Why?

Femoral head; insufficiency of medial circumflex femoral artery

54

Causes of osteonecrosis (ASEPTIC)

Alcoholism
Sickle cell disease
Exogenous/endogenous corticosteroids
Pancreatitis
Trauma
Idiopathic
Caisson (the bends)

55

Giant cell tumor
a. Epidemiology and location
b. Characteristics

"Osteoclastoma"
a. 20-40 yrs; epiphyseal end of long bones
b. locally aggressive benign tumor often around knee; lytic lesion with soft tissue extension; SOAP bubble appearance on X-ray; multinucleated giant cells

56

Soap bubble appearance on X-ray

Giant cell tumor

57

Osteochondroma
a. Epidemiology and location
b. Characteristics

a. Males

58

Osteosarcoma
a. Epidemiology/location
b. Characteristics

a. Bimodal distribution; metaphysis of long bones; around knee
b. Codman triangle or sunburst pattern on x-ray; aggressive

59

Predisposing factors of Osteosarcoma

Paget disease of bone
Radiation
Li-fraumeni syndrome (p53 mutation)
Bone infarcts
Familial retinoblastoma

60

Ewing sarcoma
a. Epidemiology/location
b. Characteristics

a. Boys

61

Onion skin periosteal reaction in bone

Ewing sarcoma

62

Nighttime bone pain, central nidus

Osteoid osteoma

63

Joint findings in osteoarthritis

Subchondral cysts
Sclerosis
Osteophytes (bone spurs)
Eburnation (polished, ivory like appearance of bone)
Synovitis
Heberden nodes (DIP)
Bouchard nodes (PIP)

64

Which joints are NOT involved in Osteoarthritis?

MCPs

65

Joint findings in RA

Pannus formation (inflammatory granulation tissue(
Subcutaneous nodules (fibrinoid necrosis)
Ulnar deviation of fingers
Subluxation
Swan neck and boutonniere deformities

66

Which joints are rarely involved in RA?

DIPs

67

Etiology of RA

Autoimmune - mediated by cytokines and type III and IV hypersensitivity reactions

68

Antibodies in RA

Rheumatoid factor (anti IgG antibody)
Anti-cyclic citrullinated peptide (more specific)

69

Pathophysiology of Sjogrens syndrome

Autoimmune destruction of exocrine glands (lacrimal and salivary) by lymphocytic infiltrates
-either primary of secondary; associated with other autoimmune disorders

70

Inflammatory joint pain, Xeropthalmia, Xerostomia

Sjogren syndrome

71

Antibodies found in Sjogren syndrome

Antinuclear Abs
SS-A (anti-Ro)
SS-B (anti-La)

72

Most common cause of gout

Under excretion of uric acid

73

Medications that precipitate gout

Thiazide diuretics
Niacin

74

Why does alcohol consumption often cause acute attack of gout?

Alcohol metabolites compete for the same excretion sites in kidney as uric acid does --> uric acid builds up in blood

75

Diseases associated with pseudogout

Hemochromatosis
Hyperparathyroidism
Osteoarthritis

76

Synovitis, Tenosynovitis (hand), Dermatitis (pustules)

Infectious arthritis

77

Seronegative spondyloarthropathies

Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis

78

What makes a seronegative spondyloarthropathy?

Arthritis WITHOUT rheumatoid factor (no anti-IgG Ab)

79

HLA-B27

Psoriatic arthritis
Ankylosing spondylitis
IBD
Reactive arthritis

80

Characteristics of psoriatic arthritis

Joint pain and stiffness associated with psoriasis
Asymmetric and patchy
Dactylitis (sausage fingers)
Pencil in cup deformity on X-ray

81

Ankylosing spondylitis

Ankylosis
Uveitis
Aortic regurgitation
Conduction abnormalities

82

Infections that cause reactive arthritis

Shigella
Salmonella
Yersinia
Campylobacter
Chlamydia

83

Findings in SLE

Antinuclear Abs - sensitive, not specific
Anti-dsDNA Abs - specific, poor prognosis
Anti-Smith Abs - specific, not prognostic
Anti-histone Abs - drug induced lupus
Decreased C3, C4, CH50 from immune complex formation

84

Causes of drug induced lupus

Sulfonamides
Hydralazine
Isoniazid
Procainamide
Phenytoin

85

Anti-phospholipid syndrome findings

History of thrombosis
Spontaneous abortions
Lupus anticoagulant anticardiolipin
Anti-B2 glycoprotein Abs

86

Why can anti-phospholipid syndrome cause false positive VDRL and prolonged PTT?

Anticardiolipin Abs and lupus anticoagulant cause this
PTT is prolonged but in vivo there is hyper coagulation

87

Symptoms of polymyalgia rheumatica

Pain and stiffness in shoulders and hips
Fever, malaise, weight loss
DOES NOT cause muscular weakness

88

Association of polymyalgia rheumatica

Temporal arteritis (giant cell)

89

Findings in polymyalgia rheumatica

Increased ESR, Increased CRP, normal CK

90

Treatment of polymyalgia rheumatica

Low does steroids

91

Fibromyalgia symptoms

Chronic widespread musculoskeletal pain associated with stiffness, parasthesia, poor sleep, fatigue

92

Difference in age of those affected in polymyalgia rheumatic and fibromyalgia

Polymyalgia rheumatica: > 50 years old
Fibromyalgia: 20-50 years

93

Polymyositis vs. Dermatomyositis inflammation

Polymyositis - endomysial inflammation with CD8+ T cells
Dermatomyositis - perimysial inflammation and atrophy with CD4+ T cells

94

Anti Jo 1 +

Polymyositis/dermatomyositis

95

Anti-SRP +
anti-Mi 2 +

Polymyositis/dermatomyositis

96

Associations of Myasethenia gravis

Thymoma, Thymic hyperplasia, thymic atrophy

97

Associations of Lambert Eatin Myasthenic syndrome

Small cell lung cancer

98

Pathophys of Myasthenia gravis

Autoantibodies to postsynaptic Ach receptor (nicotinic)

99

Pathophys of Lambert Eaton

Autoantibodies to presynaptic Ca channel --> decreased Ach release

100

What is myositis ossificans?

METAPLASIA of skeletal muscle into bone following muscular trauma

101

CREST

Limited scleroderma
Calcinosis
Raynaud phenomenon
Esophageal dysmotiligy
Sclerodactyly
Telangiectasia

102

What is a macule? Example?

Flat lesion with well circumscribed change in skin color ( freckle, labial macule

103

What is a patch? Example?

Macule > 1cm --> large birthmark

104

What is a papule? Example?

Elevated solid skin lesion mole (nevus), acne

105

What is a plaque? Example?

Papule > 1cm --> Psoriasis

106

What is a vesicle? Example?

Small fluid-containing blister chickenpox, shingles

107

What is a bulla? Example?

Vesicle > 1cm --> bullous pemphigoid

108

What is a pustule? Example?

Vesicle containing pus --> pustular psoriasis

109

What is a wheal? Example?

Transient smooth papule or plaque --> Hives (urticaria)

110

What is a scale? Example?

Flaking off of stratum corneum --> Eczema, psoriasis, SCC

111

What is a crust? Example?

Dry exudate --> Impetigo

112

Cause of albinism

Normal melanocyte number with decreased melanin production (from decreased tyrosinase activity or defective tyrosine transport) Also caused by failure of neural crest cell migration during development

113

Cause of Vitiligo

Autoimmune destruction of melanocytes

114

Papules and plaques with silvery scaling; parakeratotic scaling

Psoriasis

115

What is parakeratotic scaling?

Nuclei still in stratum corneum

116

Inflammatory facial skin disorder characterized by erythematous papule and pustules but no comedones

Rosacea

117

What is rhinophyma?

Bulbous deformation of nose
Chronic inflammatory change associated with Rosacea

118

Flat, greasy pigmented squamous epithelial proliferation with keratin filled cysts

Seborrheic keratosis

119

Stuck on appearance

Seborrheic keratosis

120

Leser Trelat sign

sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy

121

Well circumscribed, tan-brown slightly raised .5-1.5 cm lesions

Seborrheic keratosis

122

Cause of bullous impetigo

Staph aureus

123

Skin infection involving upper dermis; presents as well-defined demarcation between infected and normal skin

Erysipelas
Caused by S. pyogenes

124

Pathophys of Staph scalded skin syndrome

Exotoxin destroys keratinocyte attachments in stratum granulosum ONLY

125

Irregular, white, painless plaques on tongue that cannot be scraped off

Hairy leukoplakia
EBV mediated

126

Autoimmune IgG Ab against desmoglein

Pemphigus vulgaris

127

Blistering skin disorder with oral mucosa involvement

Pemphigus vulgaris

128

Nikolsky sign +

Pemphigus vulgaris
Stevens Johnson syndrome

129

Autoimmune IgG Ab against hemidesmosomes

Bullous pemphigoid

130

Tense blisters containing eosinophils; affect skin but SPARE oral mucosa

Bullous pemphigoid

131

Causes of erythema multiforme

Infections (mycoplasma pneumoniae, HSV)
Drugs (sulfa drugs, B lactase, phenytoin)
Cancers
Autoimmune disease

132

Fever, bullae formation, necorsis, sloughing of skin

Stevens Johnson syndrome

133

Causes of Stevens Johnson Syndrome

Epileptic drugs
Allopurinol
Sulfa drugs
Penicillin

134

Associations of acanthosis nigricans

Hyperinsulinemia (diabetes, obesity, Cushing)
Visceral malignancy (Gastric adenocardinoma)

135

Premalignant skin lesions caused by sun exposure

Actinic keratosis

136

Small, rough erythematous or brown papule or plaques

Actinic keratosis

137

Associations of erythema nodosum

Sarcoidosis
Coccidiodomycosis
Histoplasmosis
TB
Streptococcal infections
Leprosy
Crohn disease

138

Wickham striae?

Reticular white lines in mucosa
Lichen Planus

139

Skin disorder associated with Hepatitis C

Lichen Planus

140

Multiple plaques with collarette scale

Pityriasis rosea (Christmas tree distribution); self resolves in 6-8 weeks

141

Keratin pearls on histology

Squamous cell carcinoma

142

Keratoacanthoma

Variant of Squamous cell carcinoma that grows rapidly and may recess spontaneously over months

143

S-100 tumor marker

Melanoma

144

Mutation in melanoma

Activating mutation in BRAF kinase

145

What is Vemurafenib?

BRAF kinase inhibitor that can be used in metastatic of unresectable melanoma

146

Alprostadil

PGE1 analog; decreases vascular tone

147

Dinoprostone

PGE2 analog; increases uterine tone

148

Carboprost

PGF2 analog; increases uterine tone

149

Epoprostenol

PGI2 analog; decreases platelet aggregation and vascular tone

150

COX-2

Inducible enzyme undetectable in most tissues except activated inflammatory cells
-Makes PGI2 --> inhibits platelet aggregation

151

S/E of Celecoxib

Increased risk of thrombosis, sulfa allergy

152

Toxicity of NSAIDs

Interstitial nephritis, gastric ulcer, renal ischemia

153

Which drugs do you avoid in gout?

Salicylates --> all but highest doses depress uric acid clearance

154

S/E of TNF alpha inhibitors

Predispose to infection --> reactivated latent TB (TNF important for granuloma formation and stabilization)

155

Etanercept

TNF alpha decoy receptor
Used for RA, psoriasis, ankylosing spondylitis

156

Infliximab, Adalimumab

Anti-TNF alpha monoclonal Ab
Used for IBD, RA, Ankylosing spondylitis, psoriasis