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Flashcards in DIT Rheum and Derm Deck (98):
1

Endochondral ossification?

Chondrocytes make cartilage first (name makes sense). Osteoclasts and blasts then make WOVEN then LAMELLAR bone (after fractures or PAGETs you see woven)

Happens on long bones

2

Membranous ossification?

Osteoclasts and osteoblasts build without cartilage frame (skull and face)

3

What causes achondroplasia? Genetics?

FGFR3 (fibroblast growth factor receptor receptor) which inhibits chondrocytes (so no endochondrial ossification)

Mutations occur sporadically and associated with advanced paternal age. MUTATIONS then passed on autosomally dominant (makes sense b/c gene shuts down the gene)

4

Benign growth of bone growth in normal location is a what?

What does it look like on X ray?

Hamartoma. Osteochondroma.

CHunk of Bone osteoCHondroma

5

What is osteoclastoma? What do you see on X ray?

OsteoCLastoma is Clean so soap bubble

Soap bubble on X ray, osteoclasts broke down the matrix.

Giant cell tumor

6

What is the most common malignant bone tumor (not counting MM)?

Osteosarcoma and ages 10-20

7

What is location and X ray finding of osteosarcoma?

Knee or tibia

(X ray: osteoSarComa)
Sunburst tumor (looks pretty, but will kill you)
Codman triangle (elevation of periosteum)

8

Who gets Ewing Sarcoma?

Young boy

9

Where does Ewing sarcoma grow? What do you see on X ray?

Shaft of long bone.

Onion skin (can see layers of it)
Can see bone being blasted away. (Patrick ewing smells like onion)

10

What is genetics of Ewing sarcoma?

t11:22 (easy to remember b/c Patrick Ewing's number)

11

What metastasizes to bone?

PB KTL (lead kettle)

Prostate Breast Kidney, Testes/Thyroid, Lung

12

What is osteoclast from?

Monocyte/macrophage (they are multinucleate, will help with osteoclastoma recognition, multiple cells)

13

What is suffix of bisphosphanates? What do they do?

-dronate

Inhibit osteoclasts. Allows osteoblasts to catch up

Osteoparosis
Paget Disease of one
Humoral hypercalcemia of malignancy
Long term steroids

14

Side effects of -dronates?

Jaw osteoclastic activity (weird b/c normally stops it)

Erosive esophagitis

15

Parathyroid horomne agonist?

Teriparatide (mumble it and it sounds like teriparathyroid)

Teri ache won't have issue

16

What is going on in osteopetrosis? How do you treat it (it makes sense!)?

Petrosis like petrified (greek for rock)

Carbonic anhydrase II deficiency (can't make acid to break down bone) so bone keeps getting bigger.

Invades area for myeloid growth: pancytopenia.

Closes foramen so cranial nerve issues.

Marble bone and thickening. bone is easy to fracture

TX is marrow transplant b/c monocytes is where osteoclasts are from!!!

17

Labs of Pagets disease? Tx?

High alkaline phosphate b/c bone turnover

Tx is bisphophanates (-dronates) and that inhibits osteoclast!

18

Labs of osteomalacia?

low serum calcium
High parathyroid (to build up calcium b/c its Vit D deficient)
Low serum phosphate b/c PTH is PHOSPHATE THRASHING HORMONE

High alkaline phosphatase from bone turnover

19

pg 192 for more notes

ok

20

What are chondrocytes?

they maintain cartilage

21

What is unhappy triad?

Lateral collision with planted foot.

MCL
ACL
Lateral meniscus or medial (lateral more common, makes sense since that is what is compressed)

22

Hip dislocation can injure what?

Circumflex artery
Femoral vein
Femoral nerve

23

What tears first in ankle sprain?

ATFL Anterior talofibular ligament

ATFL (always tears first ligament)

24

What tears second, and third in ankle sprain?

Calcaneofibular Ligament
Posterior talofibular ligament

25

Rotator cuff muscles and function? Innervation?

SItS C5-6
Supraspinatus abduction
Infraspinatus: lateral rotation
Teres minor lateral rotation and adduct
subscapularus medially rotate and deduction

26

Structures injured in anterior shoulder dislocation (3+STARS)

Axillary nerve and POSTERIOR circumflex artery (ask if sensation to shoulder so you know when injury happens if it hurts after reduction)

Supraspinatus tendon

Anterior glenohumeral ligament and labrum

Posteriolateral humeral head defect from abrasion against anterior rim of glenoid

27

Punch with closed fist and tenderness in snuffbox?

Scaphoid fracture regardless of x ray!

Can result in painful arthritis if not fixed b/c distal to proximal blood flow

28

What finger joints are involved in osteoarthritis?

PIP (bouchard nodes)
DIP (heberden nodes)

NO MCP!!!

29

3 uses for N-acetylcysteine?

NAC (nephropathy, acetominophen OD, Cystic fibrosis)

Acetaminophen OD (regen glutathione)

Mucolytic (CF)

Nephropathic use of contrast

30

What joints are involved in rheum?

MCP and PIP. Ulner drift

there is no DIP

31

What type of hypersensitivity is RA?

Type III (some type IV according to first aid)

32

Serum test for rheumatoid arthritis? Which is specific?

Rheumatoid factor (IgM anti IgG)

Anti-cyclic citrullinated peptide is specific

33

Disease modifying agents for Rheum Arthritis?

Methroterxate, sulfasalazine, TNF alpha inhibitors (etanercept, infliximab, adalimumab, golimumab, certolizumab)

34

Gout crystals are what? What do they look like? Why do people have gout?

negative Berfringent. so Not Blue when parallel, instead Parallel to light are yellow (l's in yellow are parallel)

They are uric acid

More eating of purine foods
Less excretion of uric acid (diuretics)
Lesh-Nyhan
Treated for leukemia/lymphoma

35

What are 2 things that can precede a gout attack?

Large meal

Alcohol consumption (b/c alcohol fights for uric acid for sites of excretion in kidney)

36

Acute gout tx? Mechanism for each?

NSAIDs (indomethacin is tx of choice): COX inhib

Steroids (a few days worth): inhibit NFkappa B

Colchicine (rarely used): Low therapeutic index and diarrhea is common. Prevents microtubule polymerization

37

Chronic gout tx? And mechanism?

Allopurinol inhibits xanthine oxidase (so does febuxostat)

Probenecid: inhibits reabsorption of uric acid in proximal convoluted tubules (also blocks penicillin uptake, so fun fact is they used it during shortages during WWII)

38

What are psuedogout crystals? What do they look like? how do you tell from gout? How do you treat?

They are calcium pyrophosphate.

They are positive Berfringent so Blue when parallel to light (gout was yellow, so its different)

Bigger joints. older people

Tx is same with NSAIDs and if bad, steroids/colchicine

39

Calcification of cartilage in knee suggests what?

pseudogout (+ berfringent of light would be Blue to parallel crystals)

40

What are the HLA B27 associated Disease?

PAIR.

Psoriatic arthritis
Ankylosing spondylitis
Inflammatory bowel disease
Reactive arthritis (Reiter syndrome)

41

What disease has pencil in cup on Xray?

PIP is malformed in PSORIATIC arthritis.

Also see sausage fingers.

42

Sacroiliac joints are fusing? What is the disease?

If you see that, think ANKYLOSING spondylitis

Improves with exercise. Reduced spine mobility

43

What risks come with ankylosing spondylitis?

fusion of vertebrae
sacroiliac joint ankylosis
uveitis
AORTIC REGURGE

44

What is reactive arthritis?

HLA B27 associated and after a Chlamydia infection

GI infection: shigella, salmonella, yersinia, campylobacter, clostridium

Traid:
Cant see
Cant pee
Can't climb a tree

45

What is etanercept?

TNF alpha decoy reCEPTor (etanerCEPT)

46

What is osteitis fibrosis cystica?

Excess PTH causes bone break down (hyperparathoiridism or pseudohypoparathyroidism (b/c renals don't recognize PTH))

47

What is benztropine used for?

antimuscarinic used in PARKINSONS

PARK my BENZ

48

What are anti-histone antibodies?

Drug induced lupus (SHIPP)

Sulfonamides
Hydralazine
Isoniazid
Phenytoin
Procainamide

49

Antiphospholipid antibodies mean what?

Associated with lupus, cause hyper coagulation (false positive from syphilis)

50

Diffuse scleroderma vs limited scleroderma? What is serology?

Diffuse: Anti-Scl-70 (anti-DNA topo1). Widespread involvement and progression to viscera

Lmited: antiCentromere (C for CREST) (more benign)
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly
Telangiectasia

51

Sjogrens triad?

Dry eyes
Dry mouth
Arthritis

Cana't see
Cant spit
Cant climb up shit

52

Pseudohypertrophy of calf cause?

Duchenne. Frameshift of dystrophin gene (X recessive)

Also Gower's maneuver

Also Beckers is just a mutation in gene and not as severeL

53

Little old lady with fever and stiffness in shoulder and hip with weight loss. No muscular weakness?

What are labs? What are tx?

Polymyalgia rheumatica

Higher ESR, normal CK (b/c no muscle breakdown)

Tx is steroids

54

Pain and weakness (mostly weakness) of proximal muscles suggests what?

What is causing it?

How do you Dx?

(b/c proximal, think myositis b/c bigger muscles and more chance for pathology (if it were distal think nerve b/c longer nerves more chance for pathology)

CD8 T cell induced injury to muscles often in shoulder or hip

Muscle biopsy, elevated CK (muscle breakdown), ANA, anti Jo-1

55

FDA approved for fibromyalgia?

Pregabalin (nerve pain decreased)

Minlacipran (similar to SSRI)

56

AntiSmith?

SnRP in lupus

57

Anti-centromere antibodies?

CREST scleroderma

58

Anti0topo antibodies?

Diffuse scleroderma (Scl70(

59

Anti-Jo-1 antibodies?

Polymyositis/Polydermositis

60

Anti-Ro

sjogren

61

Fascial rash, raynaud in a young woman?

lupus

62

Arthritis, dry mouth, dry eyes?

Sjogren

Cant see
can't spit
can't climb shit

63

epiderm layers? Mnemonic alert

Californians Like Girls in String Bikinis

stratum Corneum
Stratum lucidum
stratum granulosusm
stratum spinosum
stratum basale

dermis

64

Zona occludes is what?

tight junction

65

What is zonula adherens? what does it do?

It is below tight junction

Actin connected to adjacent cells with CADherens (Ca++ dependent Adhesion proteins)

Losing E cadherin promotes metastasis

66

What is the macula adherens?

Desmosomes (Macula adherents is Desmosome: MAD (MAD is PVD pretty violent dog from sms mnemonic i made). Support by keratin interaction. Pemphigus vulgaris hits it

67

What makes up gap junction?

connexon

68

What does bullous pemphigoid hit?

Hemidesmosomes. Bullous pemphigoid is below

69

How do you treat atopic dermatitis?

Eczema

moisturize
Calcineurin inhibitors (tacrolimus or pimercrolimus RMEMBER)
topical steroids
antihistamines
leukotrinee inhibitors
UV
If severe: systemic steroids

70

What is a freckle?

higher concentration of melanin (NOT higher concentration of melanocytes!)

71

4 parts of pathophys of acne? Tx for each?

Hyperkeratosis: Retinoids

Sebum overproduction (grease): Isotretinoin, SPIRONOLACTONE (anti androgen) OCPs

Propionibacterium acnes prolif: Clindamycin, Benzoyl peroxide, erethryomycin

Inflammation: steroids if big event (short term works, but long term makes worse)

72

Parakeratotic scaling?

Nuclie in stratum corneum. PSORIASIS

Also see more spinosum (pSoriasis)
Also see less granulosum

73

Psoriasis extra findings?

Auspitz sign
nail pitting
psoriatic arthritis (pen in cup)

74

Causes of albinism?

Decreased melanin production b/c less tyrosinase

75

Vitiligo is caused by what?

Autoimmune destruction of melancytes

76

What is melasma caused by?

in preggers (mask of pregnancy) or OCP

77

What causes impetigo?

S. auereus and s pyogenes

78

Whatis cellulitis and what causes it?

Acute painful infection of dermis and subQ tissue. S progenies and S aureus

79

What cause necrotizing fasciitis?

S pyogenes or anaerobic bacteria.

Crepitus is methane and CO2 production

80

Staphylococcal scalded skin syndrome is caused by what?

What do you see?

Who has it?

Exotoxin A and B will destroy stratum granulosum keratinocyte attachments.

Fever
Erythematous rash
SLOUGHING of skin!!

Children

81

What is hairy leukoplakia caused by? Symptoms?

White and painless plaques on tongue that can't be scraped off.

EBV in HIV positive patients

82

Pemphigus vulgaris is attacking what?

Symptoms

MAD.

Macula Adhereins (Desmosomes)

Flaccid blisters
Oral lesions
PAINFUL Blisters
Nikolsky sign is separation of skin by stroking skin!!!

83

Menmonic for pemphigus vulgaris?

DAMN is a Vulgar word

Desmosomes (macula adherins)
Acantholysis
Mouth
Nikolsky's sign

84

How to tell bullous pemphigoid apart from pemphigus vulgarism?

Hemidesmosomes on stain instead as it is BULLOW the dermis

Tense blisters instead of flaccid
No nikolski sign (not as severe)
Mouth sparing (not as severe)

85

Symptom of dermatitis herpetiformis? Caused by what?

IgA in dermal papillae. Associated with celiac.

Pruritic papules, vesicles and bullae (arie!)

86

What is erythema multiform?

Associated with infections, drugs, cancer or autoimmune.

They are target lesions from deposition of immune complexes depositing in ORAL or superficial skin vessels!

can become steven-johnson

87

What causes Steven Johnsons?

Seizure meds
Sulfa meds
Penicillins
Allopurinol (outlier)

88

What is Toxic Epidermal Necrolysis?

TEN is 30% or more of body are involved

89

What is mnemonic for lichen plans? What is the his to?

6 P's

Pruritic
Purple
Polygonal
planar apules
Plaques
Planus

Sawtooth infiltrate of lymphocytes at dermal-epi junction. (hepatitis C)

90

What is actinic keratosis?

Premalignant from sun exposure you can feel better than see. 5 FU is treatment

91

Acanthosis nigricans is what?

Epidermal hyperplasia making hyper pigmented area on neck or axilla.

Hyperinsulinemia )diabetes, obesity, cushing) canc asue it

Rarely malignancy, probs diabetes

92

Erethema nodosum?

Inflam of subcu fat. Painful.

Can see with Crohn's disease and infections or SARCOID

(stre, leprosy, TB, histo, coccidio)

93

What has a herald patch before christmas tree?

Pityriasis rosea

94

Most common skin cancers in order? What is order of metastasis?

Basal, Squamous, Melanoma for frequency.

Malignancy is reversed

95

Keratin pearls on histopathology?

Squamous cell carcinoma.

Rarely metastasizes but can be locally invasive and make lesions!

96

What skin issue can have pearly nodules with telangiectasia and rolled borders and potential ulceration (bumpy but well defined)

Basal cell carcinoma

97

What has palisading nuclei on histopathology?

Basal cell carcinoma (basal cells are palisading up!)

98

What does S-100 mean?

neural crest derivative (so in melenoma)