MSK Flashcards
(214 cards)
1
Q
Rotator Cuff Muscles
A
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
2
Q
Supraspinatus M
A
Suprascapular N
abduct arm 0-15 degrees
Assess with empty can test
3
Q
Infraspinatus M
A
Suprascapular N
external rotation
Pitching injury
4
Q
Teres Minor M
A
axillary N
adduct and externally rotate arm
5
Q
Subscapularis M
A
upper and lower subscapular N
Internal roation and adduct arm
6
Q
Deltoid M
A
axillary N
15-100 degrees abduction
7
Q
Tapezius M
A
Accessory N
>90 degree abduction
8
Q
Serratus Anterior M
A
Long Thoracic N
>100 degrees abduction
9
Q
Axillary N
A
C5-C6
injury via fractured neck of humerus or anterior dislocation of humerus
Presents as flat deltoid, loss of abduction, loss of sensation over deltoid and lateral arm
10
Q
Musculocutaneous N
A
C5-C7
injury via upper trunk compression
presents as decreased bicep reflex, weakness in forearm flexion and supination, loss of sensation over lateral forearm
11
Q
Radial N
A
C5-T1
injury via compression of axilla, midshaft fracture of humerus, repetitive pronation of forearm
Presents as wrist drop, decreased grip strength, loss of sensation over posterior arm and dorsal hand
12
Q
Median N
A
C5-T1
Injury via supracondylar fracture of humerus or carpal tunnel
Presents as ape hand or Pope hand, loss of wrist flexion, thumb opposition, lumbrical of index and middle fingers, loss of sensation over thenar eminence and dorsal and palmar aspects of lateral 3.5 fingers
13
Q
Ulnar N
A
C8-T1
Injury via fracture of medial epicondyle of humerus or fracture hook of hamate from FOOSH
presents as ulnar claw, radial deviation of wrist, loss of wrist flexion, flexion of medial fingers, loss of sensation over medial 1.5 fingers
14
Q
Recurrent branch of Median N
A
C5-T1
injury via superficial laceration of palm
presents as ape hand, loss of thenar muscle group (opposition, abduction, flexion of thumb)
15
Q
Erb Palsy
A
Injury- traction tear of upper trunk (C5-6) via trauma
Deltoid, supraspinatus- abduction
infraspinatus- lateral rotation
Biceps- flexion, supination
16
Q
Klumpke palsy
A
Injury via traction or tear of lower trunk (C8-T1) via grab branch of tree
Intrinsic hand muscles (lumbricals, interossei, thenar, hypothenar)- total claw hand
17
Q
Thoracic outlet syndrome
A
Compression of lower trunk and subclavian vessels via cervical rib
Atrophy of intrinsic muscles, ischemia, pain and edema
18
Q
Winged Scapula
A
Lesion of long thoracic N C5-C7 via axillar node dissection after mastectomy, stab wounds
Serratus Anterior- inability to anchor scapula to thoracic cage
19
Q
Wrist bones
A
Scaphoid, lunate, Triquetrum, Pisiform, Hamate, Capitate, Trapezoid, Trapezium
20
Q
Scaphoid
A
Most fractured via FOOSH
avascular necrosis and nonunion due to retrograde blood supply from branch of radial A
21
Q
Hand Muscles
A
Thenar- opponenes pollicis, Abductor pollicis brevis, flexor pollicis brevis, superficial head
Hypothenar- opponens digits minimi, abductor digiti minimi, flexor digiti minimi brevis
Dorsal interossei- abduct fingers
Palmar interossei- adduct fingers
Lumbrincals- flex MCP, extend PIP and DIP
22
Q
Ulnar claw
A
When extending fingers, 1st and 2nd cannot extend
lesion at distal ulnar N
23
Q
Pope’s blessing
A
When making. a fist, 3-5th fingers cannot flex
lesion at proximal median N
24
Q
Median Claw
A
when extending fingers, 3-5th fingers do not extend
lesion at distal median N
25
OK gesture
When making. a fist, 1-2 fingers cannot flex
| lesion at proximal ulnar N
26
Hip abductors
gluteus medius and minimus
27
Hip adductors
adductor magnus, adductor longus, adductor brevis
28
hip extensors
gluteus maximus, semiteninosus, semiembranosus
29
Hip flexors
iliopsoas, recus femoris, tensor fascia lata, pectineus, sartorius
30
Hip internal rotation
gluteus medius, gluteus minimus, tensor fascia lata
31
Hip external rotation
Iliopsoas, gluteus maximus, piriformis, obruator
32
Iliohypogastric N
T12-L1
Sensory- suprapubic
motor- transversus abdominus and internal oblique
injury via ab surgery, present with burning or tingling pain in surgical incision site radiating to inguinal and suprapubic region
33
Genitofemoral N
L1-L2
sensory- scrotum/labia majora, medial thigh
Motor- cremaster
injury via laproscopic surgery
decreased upper medial thigh and anterior thigh sensation beneath the inguinal L, absent cremasteric reflex
34
Lateral femoral cutaneous
L2-L3
sensory- anterior and lateral thigh
Injury via tight clothing. obesity, pregnancy, pelvic procedures
decreased thigh sensation
35
Obturator N
```
L2-L4
sensory- medial thigh
motor- obturator externa, adductor longus, adductor brevis, gracilis, pectineus, adductor magnus
injury via pelvic surgery
decreased thigh sensation and adduction
```
36
Femoral N
```
L2-L4
sensory- anterior thigh, medial leg
Motor- quads, iliacus, pectineus, sartorius
injury via pelvic fracture
decreased leg extension
```
37
Sciatic N
L4-S3
Motor- semitendinosus, semimembranosus, biceps, adductor magnus
Injury via herniated disc, posterior hip dislocation
38
Common peroneal
L4-S2
superficial peroneal N= sensory to dorsum of foot and motor to peroneus longus and brevis
Deep peroneal N= sensory to web space between hallux and 2nd digit and motor to tibialis anterior
Injury via trauma or compression of lateral leg, fibular neck fracture
Foot drop (inverted and plantarflexed), loss of sensation on dorsum of foot
39
Tibial B
L4-S3
sensory- sole of foot
Motor- bicep femoris, tricep surae, plantaris, popliteus, flexors of foot
Injury via knee trauma, bakers cyst, tarsal tunnel syndrome
Can't tiptoe, can't curl toes and loss of sensation on sole
40
Superior Gluteal N
L4-S1
motor- gluteus medius, gluteus minimus, tensor fascia lata
Iagtrogenic injury via IM injection to superomedial gluteal
Trendelenburg sign- lesion contra to side of hip that drops
41
Inferior gluteal N
L5-S2
motor to gluteus maximus
injury via posterior hip dislocation
difficulty climbing stairs, rising from seated position
42
Pudendal N
S2-S4
sensory- perineum
motor- external urethral and anal sphincters
injury via stretch during child birth, prolonged cycling, horseback riding
decreased sensation in perineum and genital area, fecal/urinary incontinence
43
Knee exam
Lateral femoral condyle- ACL
| Medial femoral condyle - PCL
44
Anterior Drawer test
Increased anterior gliding of tibia due to ACL injury
45
Posterior drawer test
increased posterior gliding of tibia due to PCL injury
46
Abnormal passive abduction
knee either extended or at 30 degrees, lateral force --> medial space widening of tibia --> MCL injury
47
Abnormal passive adduction
knee either extended or at 30 degrees, medial force --> lateral space widening of tibia--> LCL injury
48
McMurray Test
flexion and extension of knee with rotation of tibia/foot
pain, popping on internal rotation and varus --> lateral meniscal tear
pain, popping on external rotation and valgus force --> medial meniscal tear
49
Ankle sprain
Anterior Talofibular L most common low ankle sprain
via overinversion/supination of foot
Anterior inferior tibiofibular L most common high anle sprain
50
Lumbosacral Radiculopathy
Paresthesia and weakness related to specific lumbosacral spinal nerves. Intervertebral disc herniates posterolaterally through annulus fibrosus into central canal due to thin posterior longitudinal L and thicker anterior longitudinal L
51
L4 radiculopathy
weakness of knee extension and decreased patellar reflex
52
L5 radiculopathy
weakness of dorsiflexion, difficulty in heel walking
53
S1 radiculopathy
weakness of plantar flexion
difficulty in toe walking
decreased Achilles Reflex
54
Muscle Contraction
1. AP opens VGCC --> ACh release
2. postsynaptic ACh bind --> muscle cell depolarize
3. Travel into muscle via T-tubules
4. conformational change of DHPR and ryanodine receptor --> calcium release from SR
5. Tropomyosin released via bind troponin to Ca2+ --> exposed myosin binding site
6. Myosin head binds to actin, Pi released --> powerstroke
7. muscle shortening
8. Bind new ATP --> detach myosin head
ATP hydrolysis into ADP and Pi --> cocked position, myosin can bind to a new site
55
Type 1 muscle fibers
```
slow
red
oxidative phosphorylation --> sustained contraction
high mitochondria
endurance training
```
56
Type 2 muscle fibers
```
Fast
White
Anaerobic glycolysis
low mitochondria
weight, resistance training, sprinting
```
57
Muscle spindle
increase length and speed of stretch --> via DRG --> activated inhibitory interneuron and a MN --> inhibition of antagonist muscle
Type 1a and 2 sensory axons
increase muscle stretch activates
58
Golgi tendon organ
increase tension --> DRG --> activate inhibitory interneuron --> inhibit agonist muscle
Tendon Type 1b sensory axon
increase muscle force activates
59
Endochondral ossification
Axial skeletal bones, appendicular skeleton, base of skull
1. cartilaginous model via chondrocytes
2. osteoclasts and osteoblasts later replace with woven bone and remodel to lamellar bone
Defective in achondroplasia
60
Membranous ossification
calvarium, facial bones, clavicle
| woven bone formed directly without cartilage. Later remodeled to lamellar bone.
61
Osteoblast
build bone by secreting collagen and catalyzing mineralization in alkaline environment via ALP
Mesenchymal stem cell in periosteum
62
Osteoclast
dissolves bone by secreting H+ and collagenases
monocyte/macrophage lineage
RANK receptors stimulated by RANKL.
OPG bing RANKL to prevent interaction --> decrease osteoclast
63
PTH
low --> anabolic
| high PTH --> catabolic
64
Estrogen
inhibit apoptosis in bone forming osteoblasts and induce apoptosis in osteoclasts.
Cause closure of epiphyseal plate during puberty
65
Medial Epicondylitis
golfers
| repetitive flexion --> main near medial epicondyle
66
Lateral epicondylitis
tennis
| repetitive extension --> pain near lateral epicondyle
67
Metacarpal neck fracture
Boxer's
direct blow with a closed fist
4th/5th metacarpal
68
Carpal Tunnel
Entrapment of Median N --> nerve compression --> paresthesia, pain, numb
Thenar eminence atrophy
Tinel + and Phalen +
Associated with pregnancy, RA, hypothyroidism, DM, acromegaly, dialysis
69
Guyon Canal syndrome
Compression of Ulnar N
| cyclists
70
Clavicle Fractures
Children, birth trauma
FOOSH or direct trauma
Weakest at middle and lateral thirds
shoulder drop, shortened clavicle, medially rotated arm
71
Lateral Force applied to planted foot
Damage to ACL, MCL and medial meniscus
| acute pain, joint instability
72
Prepatellar bursitis
inflammation of the prepatellar bursa in front of knee cap
| via repeated trauma or pressure from excessive kneeling
73
Baker cyst
popliteal fluid collection in gastrocnemium-semimembranosus bursa
communicated with synovial space and related to joint disease
74
DeQuervain Tenosynovitis
Noninflammatory thickening of abductor pollicis longus and extensor pollicis brevis tendons --> pain and tenderness at radial styloid
+Finkelstein
increased risk in new mothers, golfers, racquet sport, thumb texters
75
Ganglion cyst
fluid filled swelling overlying joints or tendon sheath
Dorsal wrist
herniation of dense connective tissue
76
iliotibial band syndrome
overuse injury of lateral knee that occurs in runners
| Pain secondary to friction of iliotibial band against lateral femoral epicondyle
77
Limb compartment syndrome
increased pressure within fascial compartment of limb --> venous outflow obstructed and arteriole collapse --> anoxia and necrosis
caused by long bone fractures, reperfusion, animal venom
severe pain and tense, swollen compartments with passive stretch of muscles
78
Medial tibial stress syndrome
shin splints
shin pain and diffuse tenderness in runners and military recruits
caused by bone resorption that outpaces bone formation
79
Plantar fasciitis
inflammation of plantar aponeurosis
| heel pain worse in morning and tenderness
80
Developmental dysplasia of the hip
```
abnormal acetabulum development in newborns
risks= breech
hip instability, dislocation
Ortolani and Barlow --> clunk
confirm with US
```
81
Legg Calve Perthes Disease
Idiopathic avascular necrosis of femoral head
presents 5-7 years with hip pain and limp
Males
Xray normal
82
Osgood Schlatter disease
```
Traction apophysitis
overuse injury by repetitive strain and chronic avulsion of the secondary ossification center of proximal tibial tubercle.
Adolescents after growth spurt
running and jumping athletes
anterior knee pain
```
83
Patellofemoral syndrome
overuse injury
young female athletes
anterior knee pain exacerbated with sitting or weight bearing on flexed knee
T(x): NSAIDs, thigh muscle strengthening
84
Radial Head subluxation
Nursemaids elbow
<5 years
sudden pull on arm --> immature annular L slips over head of radius
Arm held in extended and pronated
85
Slipped capital femoral epiphysis
obese young adolescents with hip/knee pain and altered gait
increased axial force on femoral head --> epiphysis displaces relative to femoral neck
D(x): X ray
86
Green stick fracture
incomplete fracture after bending stress
| bone fails on tension side, compression side intact
87
Torus fracture
axial force applied to immature bone --> cortex buckles on compression side and fractures
Tension side remains intact
88
Achondroplasia
failure of longitudinal bone growth --> short limbs
membranous ossification not affected --> large head
Active FGFR3 --> inhibit chondrocyte proliferation
AD
associated with high paternal age
89
Osteoporosis
Trabecular and cortical cone lose mass
via low estrogen
Lead to vertebral compression fractures --> acute back pain, loss of height
D(x): DEXA scan
prophylaxis- weight bearing exercise and Ca2+ and vitamin D intake
T(x): bisphophonates, teriparatide, SERMs, denosumab
90
Osteopetrosis
Failure of normal bone resorption due to defective osteoclasts --> thick, dense bones that are prone to fracture
Mutation in carbonic anhydrase II
Pancytopenia, extramedulary hematopoiesis
CN impingement and palsies
91
Osetomalacia/ Rickets
Defect mineralization of osteoid or cartilaginous growth
Vitamin D deficiency --> low Ca2+ --> high PTH --> low PO4
high ALP
Bowed legs, rachitic rosary, soft skull
92
Paget Disease
increased osteoclast activity then increased osteoblast activity
normal calcium, phosphorus and PTH, increased ALP
mosaic lamellar bone, chalk stick fractures, hearing loss
high output heart failure
increased risk of osteosarcoma
T(x): bisphosphonates
93
Avascular necrosis of bone
infarction of bone and marrow
painful
most common- femoral head (medial circumflex A)
causes are corticosteroids, alcohol, SCD, trauma, SLE
94
Osteitis fibrosa cystica
| Primary hyperPTH
high calcium, ALP, PTH
low PO4
brown tumors due to fibrous replacement of bone
95
Osteitis fibrosa cystica
| Secondary hyperPTH
low calcium
high PO4, ALP, PTH
compensation for CKD
96
Hyper vitamin D
high calcium, PO4
| low PTH
97
Osetochondroma
Benign
male <25
metaphysis of long bones
lateral bony projection of growth plate covered by cartilaginous cap
98
Osteoma
middle age
surface of facial bones
associated with Gardner Syndrome
99
Osteiod Osteoma
```
Adults <25 yrs
Males
cortex of long bones
bone pain worse at night and relieved with NSAID
<2cm
```
100
osteoblastoma
Males
Vertebrae
>2cm, pain unresponsive to NSAIDs
101
Chondroma
medulla of small bones of hands and feet
| benign tumor of cartilage
102
Giant Cell Tumor
20-40 years
Epiphysis of long bones
neoplastic mononuclear cells that express RANKL
soap bubble on X ray
103
Osteosarcoma
```
males <20
Metaphysis of long bones
malignant osteoblasts
painful, enlarging mass
Codman triangle (elevation of periosteum)
Aggressive
```
104
Chondrosarcoma
medulla of pelvis, proximal femur and humerus
| tumor of malignant chondrocytes
105
Ewing Sarcoma
```
White boys <15
Diaphysis of long bones
Anaplastic small blue cells of neuroectoderm
t(11;22)
onion skin periosteal reaction
Aggressive
```
106
Osteoarthritis
Mechanical wear and tear of articular cartilage
Age, female, obesity, joint trauma= increase risk
pain in weight bearing joints after use, improve with rest, asymmetric
osteophytes, joint space narrow, noninflammatory, Heberden nodes and Bouchard nodes
T(x): NSAID, glucocorticoids
107
RA
autoimmune inflammation --> pannus
Female, HLA-DR4, +RF, anti CCP +
pain swelling and morning stiffness >1 hour in morning, symmetric
erosions, subchondral cysts, ulnar finger deviation, swan neck, boutonniere
T(x): NSAID, glucocorticoids
108
Gout
Acute inflammatory monoarthritis via monosodium urate crystals in joints
risk= male, HTN, obesity, DM, dyslipidemia, alcohol
Uricemia
needle shaped crystals (-) bifringence, yellow under parallel light, blue under perpendicular light
Joint is red, swollen, painful, tophus, after large meal
T(x): NSAIDS, xanthine oxidase inhibitors
109
Calcium Pyrophosphate deposition disease
calcium pyrophosphate within joint space
>50
associated with hemochromatosis, hyperPTH
pain and swelling with acute inflammation
Rhomboid and + bifringent, blue parallel light
T(x): NSAIDS, colchicine, glucocorticoids
110
Systemic juvenile idiopathic arthritis
systemic arthritis <16
daily fevers, salmon pink macular rash, arthritis
associated with anterior uveitis
leukocytosis, thrombocytosis, anemia, high ESR, CRP
T(x): NSAIDs, steroids, MTX, TNF inhibitors
111
Sjogren Syndrome
Autoimmune destruction of exocrine glands
women 40-60
inflammatory joint pain, keratoconjunctivitis, xerostomia, anti ANA, RF, SSa or SSb, parotid enlargement
complications: dental caries, MALT lymphoma
112
Septic arthritis
S. aureus, strep, N. gonorrheae --> red and painful with WBC > 50,000
113
gonococcal arthritis
STI that presents as purulent arthiris or polyarthralgia, tenosynovitis and dermatitis
114
Psoriatic arthritis
HLA B27
Associated with skin psoriasis and nail lesions
asymmetric and patchy involvement
pencil in cup deformity
115
Ankylosing spondylitis
HLA B27
symmetric involvmeent of spine and SI joint --> ankylosis, uveitis, aortic regurgitation
bamboo spine
males
116
Inflammatory bowel disease
HLA B27
| Associated with spondyloarthritis
117
reactive arthritis
conjunctivitis, urethritis, arthritis
Shigella, chlamydia, campylobacter, salmonella
HLA B27
118
SLE
autoimmune
Type 3 hypersensitivity
Associated with early deficiency of complement proteins
Libman Sacks Endocarditis, lupus nephritis arthritis, mallar rash, photosensitivity
anti SSA +
death via renal disease, infections, CV disease
119
Mixed connective Tissue disorder
features of SLE, systemic sclerosis and polymyositis
| anti UI RNP
120
Antiphospholipid syndrome
Associated with SLE
D(x): Hx of thrombosis or spontaneous abortion with lupus anticoagulant, anticardiolipin, anti B2 glycoprotein 1 Ab
T(x) systemic anticoagulation
121
Polymyalgia rheumatica
```
pain and stiffness in proximal muscles with fever, malaise, weight loss
NO MUSCULAR WEAKNESS
Women >50
associated with giant cell arteritis
high ESR, CRP, normal CK
T(x) glucocorticoids
```
122
Fibromyalgia
20-50 women
chronic, widespread MSK pain with tender points, stiffness, paresthesia, poor sleep, fatigue, cognitive disturbance
T(x) regular exercise, antidepressants, neuro pain agents
123
Polymyositis
ANA +, high CK, anti Jo1, anti SRP, anti Mi-2
progressive symmetric proximal muscle weakness
endomysial inflammation with CD8+ T cells
124
Dermatomyositis
ANA +, high CK, anti Jo1, anti SRP, anti Mi-2
Gottron papules, photodistributed facial erythema, shawl and face rash, dark and thick fingertips
increase risk of occult malignancy
perimysial inflammation and atrophy of CD4 T cells
125
Myasthenia Gravis
Autoantibodies to postsynaptic AChR
fatigue muscle wekness, prosis, diplopia, proximal muscle weakness, respiratory muscle involvement, dyspnea, dysphagia, difficulty chewing
associated with thymoma, hyperplasia
AChE inhibitor --> reverse symptoms
126
Lambert Eaton myasthenic syndrome
autoantibodies to presynaptic VGCC
proximal muscle weakness, autonomic symptoms, hyporeflexia, improve with muscle use
associated with small cell lung cancer
AChE inhibitor --> minimal effect
127
Raynaud Phenomenon
low blood flow to skin due to arteriolar vasospasm in response to cold or stress
color change from white to blue to red
fingers and toes
Secondary if with SLE, CREST, mixed connective tissue disease --> treat with calcium channel blockers
128
Scleroderma
Systemic sclerosis
autoimmunity, noninflammatory vasculopathy and collagen deposition with fibrosis\puffy, taut skin without wrinkles, fingertip pitting
129
Diffuse scleroderma
widespread skin involvement
rapid progression
earlyvisceral development
Associated with anti Scl-70 Ab and anti RNA pol III Ab
130
Limited Scleroderma
skin involvement to finger and face
CREST syndrome- calcinosis cutis, anti Centromere Ab, raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, Telangiectasia
Benign
131
Skin layer
```
Stratum corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basalis
Dermis
```
132
Epithelial cell junctions
Tight junctions- prevent paracelluar movement of solutes (claudins and occludins)
Adherens junctions- belt connecting actin cytoskeletons of adjacent cells with cadherins
Desmosome- structural support via intermediate filament interactions.
Gap junctions- connexons permit electrical and chemical communication between cells
Hemidesmosomes- connect keratin in basal cells to underlying BM
Integrins- membrane proteins that maintain integrity of basolateral membrane by binding collagen, laminin and fibronectin in BM
133
Macule
flat lesion with well circumscribed change in skin color <1 cm
Freckle
134
Patch
Macule >1 cm
| birthmark
135
Papule
elevated solid skin lesion <1cm
| mole, acne
136
Plaque
papule >1cm
| Psoriasis
137
Vesicle
small fluid containing blister <1cm
| chickenpox
138
Bulla
Large fluid filled blister >1 cm
139
Pustule
vesicle containing pus
140
Wheal
transient smooth plaque or papule
| Hives
141
Scale
flaking off of strum cornuem
| eczema
142
Crust
Dry exudate
| impetigo
143
Hyperkeratosis
increased thickness of stratum corneum
| psoriasis, calluses
144
Parakeratosis
retention of nuclei in stratum corneum
| actinic keratosis
145
Hypergranulosis
increased thickness of stratum granulosum
| lichens planus
146
Spongiosus
epidermal accumulation of edematous fluid in intercellular spaces
147
Acantholysis
separation of epidermal cells
148
Acanthosis
Epidermal hyperplasia
149
Albinism
Normal melanocyte number with low melanin production
low tyrosine activity or defective tyrosine transport
increased risk of skin cancer
150
Melasma
acquired hyperpigmentation associated with pregnancy or OCP use
151
Vitiligo
irregular patches of complete depigmentation
destruction of melanocytes
Associated with autoimmune disorders
152
Seborrheic dermatitis
erythematous, well demarcated plaques with greasy yellow scales in areas rich in sebaceous glands
Associated with parkinsons
Malassezia
T(x) topical antifungal and corticosteroids
153
Acne
Mutifactorial
increased sebum/ androgen production, abnormal keratinocyte desquamation, Cutibacterum acnes and inflammation
T(x): retinoids, benzoyl peroxide, Abx
154
Atopic dermatitis
```
Type 1 hypersensitivity reaction
pruritic eruption
Associated with other atopic diseases
increase serum IgE
mutations in filaggrin gene
face in infants, antecubital fossa in children and adults
```
155
Allergic contact dermatitis
Type 4 hypersensitivity secondary to contact allergen
156
Melanocytic nevus
Mole
benign
intradermal nevi are papular, junctional Nevi are macules
157
Pseudofolliculitis Barbe
Foreign body inflammatory facial skin disorder
firm, hyperpigmented papules and pustules that are painful and pruritic
cheeks, jawline, neck
after shaving
158
Psoriasis
```
papules and plaques with silvery scaling
knees and elbows
increased stratum spinosum, decreased stratum granulosum
Auspitz sign- pinpoint bleeding
nail pitting and arthritis
```
159
Rosacea
inflammatory facial skin disorder
erythematous papules and pustules
Associated with facial flushing
160
Seborrheic Keratosis
flat, greasy pigmented squamous epithelial proliferations of immature keratinocytes with keratin filled cysts
head trunk and extremities
161
Verrucae
warts
low risk HPV
soft tan cauliflower papules
epidermal hyperplasia, hyperkeratosis, koilocytosis
162
Urticaria
Hives
pruritic wheals that form after mast cell degranulation
superficial dermal edema and lymphatic channel dilations
163
Angiosarcoma
```
blood vessel malignancy
head, neck, breast
elderly on sun exposed skin
Associated with radiation therapy, postmastectomy lymphedema
Aggressive
```
164
Bacillary angiomatosis
Benign capillary skin papules in AIDS
Bartonella
neutrophilic infilrate
165
Cherry hemangiona
Benign capillary hemangioma in middle aged adults
| increase with age
166
Glomus Tumor
Benign, painful, red blue tumor
under fingernails
modified smooth muscle cells of the thermoregulatory glomus body
167
Kaposi Sarcoma
endothelial malignancy
skin, mouth, GI tract, respiratory tract
AIDS
HHV8 and HIV
168
Pyogenic granuloma
polypoid lobulated capillary hemangioma that can ulcerate and bleed
Trauma and pregnancy
169
Strawberry Hemangioma
benign capillary hemangioma of infancy
first few weeks of life
grow rapidly and regress
170
Impetigo
superficial skin infection
S. aureus, S. pyogenes
contagious
honey colored crusting
171
Erysipelas
infection involving upper dermis and superficial lymphatics
S. pyogenes
well defined raised demarcation between infected and normal skin
172
Cellulitis
acute painful spreading infection of deeper dermis and subQ tissues
S. pyogenes, S. aureus
start with break in skin from truama
173
Abscess
collection of pus from walled off infection within deeper layers of sin
S. aureus
174
Necrotizing fascitis
```
Deeper tissue injury
S. pyogenes, anaerobic bacteria
pain out of proportion
crepitus from methane and CO2 production
Flesh eating bacteria
Bullae and skin necrosis, SURGICAL EMERGENCY
```
175
Staph scalded skin syndrome
Exotoxin destroys keratinocyte attachment in stratum granulosum
fever, generalized erythematous rash
+ Nikolsky sign
176
Herpes
HSV1 and HSV2 of skin occurs anywhere from mucosal surfaces to normal skin
177
Molluscum contagiosum
umbilicated papules caused by pox virus
| children
178
Varicella
multiple crops of lesions in various stages from vesicles to crusts
dermatomal distribution
179
Hairy Leukoplakia
irregular white painless plaques on lateral tongue
cannot be scraped off
EBV and HIV
180
Pemphigus vulgaris
Potentially fatal. older adults
Type 2 hypersensitivity
IgG Ab against desmoglein 1 or desmoglein 3
flaccid intraepidermal bullae caused by acantholysis
Oral mucosa involved
+ Nikolsky sign
Reticular pattern around epidermal cells
181
Bullous pemphigus
```
older adults
Type 2 hypersensitivity
IgG Ab against hemidesmosomes
Tense blisters containing eosinophils
oral mucosa spared
(-) Nikolsky sign
linear patter and epidermal-dermal junction
```
182
Dermatidis herpetiformis
```
Pruritic papules vesicles and bullae
elbo knees butt
deposits IgA at tips of dermal papillae
Associated with celiac
T(x) dapsone, gluten free diet
```
183
Erythema multiforme
Associated with infections, frugs
| macules, papules, vesicles, target lesions
184
Steven Johnson Syndrome
fever, bullae formation and necrosis, sloughing of skin at dermal--epidermal junction, high mortality rate
mucous membranes
targetoid lesions
Adverse drug reaction
185
Toxic Epidermal Necrolysis
more severe form of SJS involving >30% of body
186
Acanthosis nigricans
epidermal hyperplasia
symmetric, hyperpigmented thickening of skin
axilla, neck
Associated with DM, obesity, visceral malignancy
187
Actinic keratosis
premalignant lesions caused by sun exposure
small, rough erythematous papules or plaques
risk of SCC
188
Erythema nodosum
painful, raised inflammatory lesions of SubQ fat
anterior shins
associated with sarcoidosis, coccidioidomycosis, histoplasmosis, TB, strep, leprosy, IBD
189
Lichen Planus
pruritic, purple, polygonal, planar, papules and plaques
mucosal involvement --> Wickham striae and hypergranulosis
Sawtooth infiltrate of lymphocytes at dermal-epidermal junction
associated with hep C
190
Pityriasis rosea
Herald path followed by scaly erythematous plaques
trunk
multiple pink plaques with collarette scale
self resolve
191
Sunburn
Acute cutaneous inflammatory reaction due to excessive UV irradiation
cause DNA mutations
UVB
192
Superficial burn
Epidermis only
similar to sunburn, localized painful dry blanching redness with no blisters
painful
193
Superficial partial thickness
all epidermis and some dermis
blisters, blanches with pressure, swollen, warm
painful to temperature and air
194
seep partial thickness burn
all of epidermis and some dermis
blisters, does not blanch with pressure
painless, perception of pressure only
195
Full thickness burn
all skin
white waxy dry inelastic leathery, does not blanch
painless, perception of deep pressure
196
deeper injury burn
all skin and partial involvement of muscle/fascia
white dry inelastic, does not blanch with pressure
painless, some perception of deep pressure
197
BCC skin
```
upper lip
most common
sun exposed areas
rare metastasis
waxy pink pearly nodules, rolled borders, central crusting
pallisading nuclei
```
198
Keratoacanthoma
middle aged elderly
rapid growth, resemble SCC
dome shaped nodule with keratin filled center
may spontaneously regress
199
Melanoma
```
METASTASIS, s-100 marker
Associated with dysplastic nevi
increased risk in fair skin
Breslow thickness
ABCDE
mutation in BRAF kinase
T(x) excision
```
200
SCC skin
```
lower lip, face, ears, hands
associated with immunosuppression, chronic nonhealing wounds and arsenic exposure
spread to LN
ulcerative red lesions
histo- keratin pearls
```
201
Acetaminophen
reversible COX inhibitor- CNS mostly
use in antipyretic, analgesia
Adverse: overdose --> hepatic necrosis
202
Aspirin
NSAID irreversible inhibit COX
used in low does for decrease platelet aggregation, intermediate dose antipyretic and analgesic, high dose for anti inflammatory
Adverse: GI ulcers, tinnitus, allergies, AKI, interstitial nephritis, GI bleed
Reye syndrome in children
OD T(x): NaHCO3
203
Celecoxib
Reversible selective inhibitor of COX2
used for RA and osteoarthritis
Adverse: increase risk of thrombosis and sulfa
204
Nonsteroidal anti inflammatory drugs
ibuprofen, naproxen, indomethacin
reversible inhibit COX1/2
used in antipyretic, analgesia, anti inflammatory
Adverse: interstitial nephritis, GI ulder, renal ischemia, aplastic anemia
205
Leflunomide
reversible inhibit dihydroorotate dehydrongenase --> block pyrimidine synthesis
used in RA and psoriatic arthritis
Adverse: diarrhea, HTN, heptaotox, teratogen
206
Bisphosphonates
Alendronate, ibandronate, risedronate, zoledronate
pyrophosphate analog, inhibit osteoclase
used in osteoporosis, hypercalcemia, Paget disease, osteogenesis imperfecta
Adverse: esophagitis, osteonecrosis of jaw, atypical femoral stress fractures
207
Teriparatide
PTH analog, increase osteoblast when pulsatile
used in osteoporosis
Adverse: increased risk of osteosarcoma
208
Probenecid
inhibit reabsorption of uric acid in PCT --> precipitate uric acid caliculi
use in gout chronic
209
Allopurinol
competitive xanthine oxidase inhibitor
| used in chronic gout and lymphoma and leukemia treatment
210
Pegloticase
uricase --> water soluble
| used for chronic gout
211
Febuxostat
inhibit xanthine oxidase
| used for chronic gout
212
Used for acute gout
NSAID, glucocorticoids, colchicine
213
Etanercept
TNFa inhibitor
fusion protein produced by recombinant DNA
used for RA, psoriasis, ankylosing spondylitis
Adverse: infection, drug induced lupus
214
Infliximab, adalimumab, certolizumab, golimumab
TNFa inhibitor (Ab)
used for IBD, RA, ankylosing spondylitis and psoriasis
Adverse: infection, drug induced lupus
