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Flashcards in Musculoskeletal Deck (198):
1

What cell type are responsible for the inflammatory response in gout? And what drug targets this inflammatory response?

Neutrophils
Colchicine - interferes with microtubule formation necessary for neutrophil chemotaxis.

2

What are the 5 layers of the epidermis (from surface to base)?

"Californians Like Girls in String Bikinis"
-stratum Corneum
-stratum Lucidum
-stratum Granulosum
-stratum Spinosum
-stratus Basalis

3

Where in skin are blood vessels located?

in the dermis (below the epidermis)

4

Which layers of the epidermis are affected in psoriasis?

-stratum granulosum is decreased
-stratum spinosum is increased (get plaque formation in spinosum)

5

Eccrine glands

secrete sweat

6

Sebaceous glands

associated with hair follicles; holocrine secretions of sebum (holocrine secretions = plasma membrane ruptures, destroying cell, thereby secretion product into lumen)

7

Zona occudens

=tight junction
-->between cells
-->composed of claudins and occludins

8

Zona adherens

=intermediate junction
-->between cells
-->composed of Cadherins (Calcium-dependent Adhesion molecules) that connect to Actin

9

Macula adherens

=Desmosome
-->between cells
-->autoantibodies to desmosomes = pemphigus vulgaris

10

Gap junctions

between adjacent cells
-->cardiac cells, osteocytes, neurons (electrical coupling)

11

Integrin

connects basolateral surface of cell to basement membrane

12

Hemidesmosome

connects cell to underlying extracellular matrix (to basement membrane)
-->autoantibodies to hemidesmosomes = bullous pemphigoid

13

"Unhappy Triad" Knee injury:

*Force from Lateral side, causing damage to:
-MCL = Medial Collateral Ligament
-ACL = Anterior Cruciate Ligament
-Lateral (or Medial) Meniscus

14

Abnormal passive abduction of the knee?

indicates torn MCL (medial collateral ligament)

15

ACL and PCL attach to what bone?

Tibia

16

Level to do a lumbar puncture?

Level of Iliac crest (about L4)

17

Pudendal nerve block is done where?

Ischial spince

18

4 Rotator Cuff muscles:

SItS
-Supraspinatus
-Infraspinatus
-teres minor
-Subscapularis

19

Muscle that initiates abduction of the arm (first 10-15 degrees), before deltoid kicks in?

Supraspinatus
-->injury to supraspinatus is the most common rotator cuff injury

20

Common cause of long thoracic nerve injury (and thus winged scapula)?

-->Mastectomy (or any trauma/injury to axillary region)

21

Bones of the wrist (from thumb to pinky)

"Some Lovers Try Positions That They Can't Handle"
-Scaphoid
-Lunate
-Triquetrum
-Pisiform
-Trapezium
-Trapezoid
-Capitate
-Hamate

22

Which nerve innervates the thumb + 2.5 fingers of the palm of the hand?

Median nerve

23

Which nerve innervates the thumb + half of the hand on the dorsum of the hand?

Radial nerve

24

Which nerve innervates the pinky + 1/2 ring finger on both the palm and dorsum of hand?

Ulnar nerve

25

What nerve is lesioned by a fracture of the surgical neck of the humerus or by dislocation of the humerus?

Axillary nerve

26

Nerve injured in a lesion to the shaft of humerus?

Radial nerve --> get "wrist drop"

27

Which nerve may be compressed by the use of crutches in the axilla or by "Saturday Night Palsy"?

Radial nerve compression --> get "wrist drop"

28

Lesioned nerve if fracture hook of hamate?

Ulnar nerve

29

Lesioned nerve if fracture medial epicondyle of humerus?

Ulnar nerve

30

Compressed nerve if fracture supracondylar area of humerus?

Median nerve

31

Part of brachial plexus that is compressed by a Pancoast tumor of the ung?

Lower trunk of brachial plexus --> get Kumpke's palsy (total claw hand - loss of function of all lumbricals, get clawing of all the digits)

32

Which side of hand is the carpal tunnel?

-->flexor retinaculum, on palmar side of wrist

33

What muscle protects the brachial plexus from injury in a clavicle fracture?

Subclavius muscle

34

How to test for an axillary nerve injury?

Test sensation over deltoid

35

5 nerves that come off the brachial plexus? Which are extensors? Flexors?

"MARMU"
-Musculocutaneous
-Axilary
-Radial
-Median
-Ulnar

*Extensors = Axillary and Radial
*Flexors = Musculocutaneous, Median, Ulnar

36

Lesion to upper trunk of brachial plexus (C5, C6):
-what's this called?
-symptoms?
-what may cause this?

Erb's palsy = "waiter's tip"
--> can't abduct arm; arm is medially rotated; and hand is out behind back, like waiting for a tip

-->may be caused by trauma to shoulder (like in a car accident) or trauma during child delivery

37

Injury to Long Thoracic Nerve?

-->Winged Scapula

38

Injury to Lower trunk of Brachial Plexus (C8,T1):
-what's this called?
-symptoms?
-what may cause this?

-->"Klumpke's palsy" = "Claw Hand" of ALL digits
-->symptoms = all fingers form a claw (vs ulnar nerve injury claw hand-->only 4th and 5th digits can't extend, form claw)

-->may occur d/t an embryologic or childbirth defect

39

Injury to Posterior Cord of Brachial Plexus?

Can't extend hand, so get "wrist drop" (can't extend, so hand just hangs flaccidly)
*makes sense, b/c posterior cord gives rise to the axillary and radial nerves, which are the extensors

40

Injury to axillary nerve:
-causes?
-symptoms?

*caused by fracture to surgical neck of humerus or dislocation of humerus
*symptoms:
-paralysis of deltoid, so can't abduct arm at the shoulder (can still do initial abduction)
-decreased sensation over deltoid

41

Injury to Radial nerve:
-causes?
-symtpoms?

*causes:
-crutches compressing radial nerve at axilla or compression from saturday night palsy
-fracture of midshaft of humerus

*symptoms:
-wrist drop; can't extend with brachioradialis, extensors of wrist and fingers, supinators, triceps... all extensors :(
-also: loss of sensation over posterior arm, dorsal hand (the part supplied by radial) and dorsal thumb

42

Injury to Musculocutaneous nerve:
-symptoms?

-decreased flexion of arm at the elbow (b/c musclocutaneous innervates the flexors: biceps, brachialis, coracobrachialis)
-decreased sensation at lateral forearm

43

Distal lesion to Median Nerve:
-cause?
-symptoms?

*Causes:
-carpal tunnel syndrome
-dislocated lunate

*Signs:
-"Pope's blessing" --> can't extend 2nd and 3rd digits, so they are both clawed

44

Proximal lesion to Median Nerve:
-cause?
-symptoms?

*Cause = fracture of supracondylar humerus
*symptoms:
-"Ape Hand" --> can't oppose/abduct thumb d/t atrophy of thenar muscles (so thumb is basically glued to other fingers, laterally)

45

Distal lesion to Ulnar nerve:
-cause?
-symptoms?

*Cause = fractured hook of hamate (like if fall onto outstretched hand)
*Symptoms:
-Clumsiness of hands
-Ulnar "claw hand" --> can't extend 4th and 5th digits, so they are both in a claw (pinky and ring finger)

46

Sensory defect over Lateral Forearm?

Injury to Musculocutaneous nerve

47

Sensory defect over Posterior arm?

Injury to Radial nerve

48

Proximal lesion to ulnar nerve:
-cause?
-symptoms?

-fracture at medial epicondyle (funny bone)
-problems with flexion; decreased sensation over the hypothenar eminence, medial 1.5 fingers.

49

Waiter's tip position of hand: injury to?

Upper Trunk of brachial plexus (C5, C6)

50

Claw hand, involving all digits: injury to?

Inferior Trunk of Brachial Plexus (C8, T1)

51

Function of Lumbricals?

-Flex MCP joints
-Extend DIP and PIP joints

*so make an "L" with fingers/hand

52

Claw Hand, but of only the pinky and ring finger (4th and 5th digits): injury to?

Distal Ulnar Nerve injury: loss of medial lumbrical function

53

"Pope's Blessing" - can't extend the 2nd and 3rd digits: injury to?

median nerve injury--> loss of lateral lumbrical function

54

"Ape Hand" - can't abduct the thumb: injury to?

Proximal median nerve injury (like if fracture the supracondylar humerus)

55

2 Complications of Mastectomy?

1) Winged Scapula (injury to Long thoracic nerve, and thus Serratus Anterior)
2) Lymphedema (which may lead to Lymphangiosarcoma)

56

Long Thoracic Nerve innervates what muscle?

Serratus Anterior

57

Muscles of the Thenar Eminence? Innervation?

Meat lOAF:
*Median Nerve
-Opponens pollicis
-Abductor pollicis brevis
-Flexor pollicis brevis

58

Muscles of the Hypothenar Eminence?
Innervation?

*Ulnar nerve
-Opponens digiti minimi
-Abductor digiti minimi
-Flexor digiti minimi

59

Functions of the Dorsal vs Palmar Interosseous Muscles:

"DAB PAD"
-Dorsal--> ABduction of fingers
-Palmar--> ADduction of fingers

60

Where should intramuscular injections into butt be done? Why?

-->Inject into supero-lateral quadrant of but
-->to avoid "gluteus medius gait"
-if inject into superomedial quadrant-->may injure gluteal nerves
-if inject into inferomedial quadrant--> may injure sciatic nerve
-if inject into inferolateral quadrant--> lots of muscles have tendinous insertions here

61

Positive Trendeleburg sign

-->when standing on one leg, shift weight to opposite side of body than the standing leg
-->d/t injury to the the superior gluteal nerve; so injury to gluteus medius and minimus muscles

62

Can't evert or dorsiflex foot?

-->injury to common peroneal nerve; get "foot drop"

"PED" - "Peroneal Everts and Dorsiflexes; if injured, the foot is dropPED"

63

"Foot drop"

-d/t injury of common peroneal nerve
-can't dorsiflex foot

64

Can't invert or plantarflex foot?

Injury to Tibial Nerve

"TIP" - "Tibial nerve Inverts and Plantarflexes; if injured, can't stand on TIP toes"

65

Sciatic Nerve

on posterior thigh; splits into common peroneal and tibial nerves

66

Deep Peroneal Nerve:
-innervates?

-innervates Anterior compartment of leg

67

Superficial Peroneal Nerve:
innervates?

innervates Lateral compartment of leg

68

Tibial Nerve:
-innervates?
-if injured?

Posterior compartment of leg

*if injured:
-can't invert of plantarflex foot (inversion = moving sole foot towards medial plane; plantarflexion = standing on tiptoes; so, can't do either of these things)
-decreased sensation at sole of foot

69

In skeletal muscle contraction, which parts of the sarcomere change length?

I-band and H-band both shorten in muscle contraction
*I-band = Thin filaments ONLY
*H-band = Thick filaments ONLY
*Z-lines will move closer together (b/c entire sarcomere contracts, gets shorter)
***note: A-band is the entire length of the thick thilament, regardless of overlap by thin filament; so, it's length does not change during contraction

70

Drugs that act at the Dihydropyridine receptor? What's the effect?

Dihydropyridine Calcium-Channel Blockers (ie Nifedipine and Amlodipine
-by binding to the dihydropiridine receptor, can't get conformational change, so don't get Calcium release from sarcomplasmic reticulum (so, it blocks muscle contraction)

71

Dantrolene mechanism and use?

Dantrolene binds the Ryanodine receptor on the sarcoplasmic reticulum; so, prevents conformational change and release of Calcium from Sarcomplasmic Reticulum (so, blocks skeletal muscle contraction)

*Uses for dantrolene:
-Malignant hyperthermia (from inhalation anesthetics and succinylcholine)
-Neuroleptic malignant syndrome (toxicity of anti-psychotic drugs)

72

Dihydropyridine and Ryanodine receptors:

Dihydropyridine = voltage-dependent Calcium channels in T-tubules
Ryanoide = Calcium release channels in sarcoplasmic reticulum

***in close proximity to each other...

73

Type 1 vs Type 2 muscles:

*Type 1:
-Red fibers (b/c lots of mitochondria and myoglobin; so increased oxidative phosphorylation)
-slow twitch
-for sustained conraction

*Type 2:
-white fibers (b/c fewer mitochondria and myogobin; more in anaerobic glycolysis)
-fast twitch
-get hypertrophy of fast-twitch, type 2 fibers in weight training

74

Which type of muscle fibers are hypertrophied in weight trainers?

Type 2 muscle fibers --> white, fast-twitch fibers; involved in anaerobic gycolysis

75

Effect of Nitric Oxide on Smooth Muscle Contraction (mechanism):

Nitric Oxide --> Guanylate Cyclase --> increased cGMP --> inhibits MLCK --> Smooth muscle Relaxation

76

MLCK (Myosin Light Chain Kinase) and MLCP (Myosin Light Chain Phosphatase)

*both are involved in mechanism of smooth muscle contraction/relaxation:

*MLCK--> phosphorylates myosin to myosin-P --> get smooth muscle contraction
-MLCK is activated by Calcium binding to Calmodulin

*MLCP --> dephosphorylates myosin-P to myosin --> get smooth muscle Relaxation (stimulated by Nitric Oxide, Sildenafil, etc... increased cGMP)

77

Calmodulin

Calcium-binding messenger protein
*in smooth muscle contraction: Calcium binds calmodulin --> activates MLCK --> phosphorylates myosin --> smooth muscle contraction

78

Endochondral ossification: what kind of bone growth?

-->Longitudinal bone growth
-first have a cartaliginous bone model made by chondrocytes
-defect in endochondral ossification in achondroplasia; so short limbs

79

Membranous ossification: what kind of bones grow this way?

-->flat bone growth (skull, face, axial skeleton)
-functional in achondroplasia; so, have large head...

80

Continuous activation of FGFR3 (Fibroblast growth factor receptor)?

-->inhibits chondrocyte proliferation; leads to Achondroplasia

81

Genetic inheritance of Achondroplasia:

-associated with increased paternal age
-Autosomal dominant inheritance
-if homozygous dominant --> lethal in utero

82

What type of bone loss in osteoporosis?

Trabecular/spongy bone loses mass

83

Type 1 vs Type 2 osteoporosis:

Type 1 = postmenopausal women
Type 2 = senile; affects men and women >70 yo

84

Treatment of choice (and other trtmnts) for osteoporosis?

*Bisphosphonates = treatment of choice
*other options:
-SERMs
-Calcitonin
-Pulsatile PTH in severe cases

85

Colles' fracture

fracture of distal radius; see in osteoporosis

86

Erlenmeyer flask on x-ray

=bones flare out on x-ray
-->see in osteopetrosis

87

Osteopetrosis:
-cause?
-presentation?
-lab values of serum Ca, P, ALP, PTH?

-abnormal function of osteoclasts d/t a genetic deficiency of carbonic anhydrase II --> have failure of bone resorption, so get really thick, dense bones that are prone to fracture;

*NORMAL levels of Ca, P, ALP, and PTH

*have decreased marrow space, b/c bone fills it up; so, have pancytopenia (anemia, thrombocytopenia), and have extramedullary hematopoiesis

*can also cause cranial nerve impingement and palsies, because of narrowed foramina

88

Cause of osteomalacia?
Lab values of Ca, P, ALP, PTH?

=Rickets in kids
-->d/t vitamin D deficiency
-decreased Ca, elevated PTH, decreased P, normal ALP

89

Paget's disease of bone:
-cause?
-Presentation?
-Lab values of Ca, P, ALP, PTH?

*Cause: Increase in both osteoclasts and osteoblasts; FIRST get increase in Osteoclast activation; followed by increase in osteoblasts

*Get mosaic bone pattern
-increased hat size
-hearing loss d/t auditory foramen narrowing
-may lead to osteogenic sarcoma
-may be viral in origin (paramyxovirus)
-may get high output heart failure

*Labs:
-elevated ALP (really elevated), but normal Ca, P, PTH

90

"brown tumors" of bone:

see with osteitis fibrosa cystica (primary hyper-parathyroidism)

91

Polyostotic fibrous dysplasia:

bone's replaced by fibroblasts, collage, irregular bony trabeculae
-->get this with McCune-Albright syndrome (+endocrine probs/precocious puberty + cafe-au-lait spots)

92

bone replaced by fibroblasts and collagen + precocious puberty/endocrine abnormalities + cafe au lait spots

McCune Albright Syndrome
--> a form of polyostotic fibrous dysplasia (where bone is replaced by fibroblasts, collagen, etc...)

93

colon polyps + lipomas + osteomas?

Gardner's syndrome

94

Which bone tumor is associated with Retinoblastoma?

Osteosarcoma (Rb)

95

Most common benign tumor of bone?

Ostochondroma
*see in men <25 years of age
-rare for it to become malignant

96

onion skin appearance in bone

Ewing's sarcoma
-->anaplastic small blue cell malignant tumor; seen in boys <15 yo

97

11;22 translocation, associated with what bone tumor?

Ewing's sarcoma
-->anaplastic small blue cell malignant tumor; seen in boys <15 yo

98

Malignnat bone tumor in men b/w 30-60 years old?

Chondrosarcoma (all other bone tumors, benign and malignant, seem to affect younger pts)

99

Codman's triangle (elevation of periosteum) on x-ray?

Osteosarcoma (associated with Paget's disease, familial retinoblastoma...)

100

"soap bubble" or "double bubble" on bone x-ray?

Giant cell tumor = Osteoclastoma; a benign bone tumore (osteoma)

101

noninflammatory pain in joints at the end of the day?

Osteoarthritis
-->affects DIP and PIP

102

Heberden's nodes

DIP --> affected in Osteoarthritis

103

Bouchard's nodes

PIP --> affected in osteoarthritis

104

joint space narrowing from destruction of articular cartilage, and sclerosis on x-ray of joint?

-->Osteoarthritis
-also have subchondral cysts, osteophytes, eburnation

105

Eburnation

polished, ivory-like appearance of bone; see in osteoarthritis

106

What type of hypersensitivity reaction is Rheumatoid Arthritis?

Type III hypersensitivity

107

pannus formation in joints?

Rheumatoid arthritis

108

Baker's cyst

behind the knee; see in Rheumatoid arthritis

109

Rheumatoid Factor:

IgM antibody that is anti-IgG
-->secreted by B-cells

***Cartilage components act as autoantigens --> activate CD4 T-cells --> B cells secrete RF, which is specific for the Fc component of IgG

110

morning stiffness that lasts >30 mins, improves with use + symmetric joint involvement + systemic symtpoms?

Rheumatoid arthritis

111

Treatment options for Rheumatoid Arthritis:

-NSAIDs
-COX-2 inhibitors
-Glucocorticoids
-Methotrexate, Sulfasalazine, Hydroxychloroquine (all are disease-modifying drugs)

112

"can't see, can't spit, can't climb up shit"

--> Sjogren's:
-xerophthalmia (dry eyes, conjunctivitis)
-xerostomia (dry mouth, dysphagia)
-arthritis

113

Strong association with HLA-D4?

Rheumatoid Arthritis
(note: DM I is also associated with HLA-D4)

114

anti-SS-A (anti-Ro) and anti-SS-B (anti-La)

Sjogren's syndrome

115

negatively-birefringent needle-shaped yellow crystals + PRPP excess + hyperuricemia?

Gout

116

Podagra

=painful MTP joint (big toe)
--> Gout

117

Tophus formation on ear, olecranon bursa, Achilles tendon

Gout

118

Why gout exacerbations after alcohol consumption?

b/c alcohol metabolites compete for same excretion sites in kidney as uric acid; so, get decreased uric acid secretion --> hyperuricemia --> goutttttt

119

Acute and Chronic treatments for Gout:

*Acute:
-NSAIDs (ie indomethacin, naproxen) = drug of choice for acute gout
-Colchicine

*Chronic:
-Allopurinol
-Febuxostat (inhibits xanthine oxidase)
-Probenecid (inhibits reabsorption of uric acid in PCT)

120

Calcium Pyrophosphate, rhomboid crystals, weakly positive-birefringent

Pseudogout

121

swollen, red, painful joints; monoarticular , migratory arthritis with asymmetrical pattern; unprotected sex...

Gonococcal arthritis (septic infectious arthritis)

122

Causes of septic arthritis:

-Gonorrhea
-S. aureus
-Streptococcus

123

Causes of chronic infectious arthritis?

-TB (after mycobacterial dissemination)
-Lyme disease

124

Seronegative Spondyloarthropathies:
-Why "seronegative"?
-HLA associated with them?
-List them

-Seronegative b/c no RF
-HLA-B27
-PAIR:
-->Psoriatic arthritis
-->Ankylosing spondylitis
-->IBD
-->Reactive Arthritis (Reiter's syndrome)

125

seronegative spondyloarthropathy that involves sacroiliac joints?

Ankylosing spondylitis

126

Seronegative spondylarthropathy with "pencil-in-cup" deformity on x-ray + dactylitis?

Psoriatic arthritis

127

"bamboo spine"

ankylosing spondylitis

128

"can't see, can't pee, can't climb a tree"

-->Reactive Arthritis (follows chlamydia or GI/Shigella infections)
-conjunctivitis + anterior uveitis
-urethritis
-arthritis

129

Reactive arthritis usually follows what kinds of infections?

-Shigella (GI)
-Chlamydia

130

anti-phospholipid antibodies

SLE
-->may cross-react with cardiolipin on syphilis tests, giving a false (+) RPR/VDRL

131

anti-dsDNA antibodies

SLE
-->associated with renal disease (so, specific and poor prognosis)

132

Anti-histone antibodies

Drug-induced Lupus
*SHIPP
-Sulfonamides
-Hydralazine
-Isoniazid
-Procainamide
-Phenytoin

***have increased risk of drug-induced lupus in pts who are slow acetylators of drugs in the liver...

133

anti-Smith antibodies

SLE
-->specific, but not prognostic

134

Signs/Symptoms of SLE:

-Malar rash (worse in sun)
-Discoid rash
-antibodies (anti-nuclear = ANA, anti-dsDNA, anti-Smith, anti-Histones (drug-induced), anti-phospholipid (cross-react with Syphilis tests))
-Mucositis (oropharyngeal ulcers)
-Neurologic symptoms
-Libman-Sacks endocarditis
-Hilar lymphadenopathy
-Wire-loop lesions in kidneys with immune complex deposition
-Serositis--> Pericarditis, Pleuritis
-Arthritis

135

Non-caseating granulomas, hilar lymphadenopathy, hypercalcemia, interstitial fibrosis (restrictive lung disease), erethyma nodosum, Bell's palsy, black women...

Sarcoidosis

136

Why hypercalcemia in Sarcoidosis?

-->have elevated vitamin D activation in epithelioid macrophages --> elevated vitamin D

137

Treatment for sarcoidosis?

Steroids

138

What type of lymphocyte is elevated in broncho-alveolar lavage fluid in Sarcoidosis?

CD4 T-cells

139

Joint pain and stiffness, but no muscle weakness; elevated ESR; normal CK (b/c no muscle weakness); associated with Temporal/Giant Cell Arteritis:

Polymyalgia Rheumatica

140

Treatment for Polymyalgia Rheumatica?

Prednisone (also treat Temporal/Giant Cell Arteritis with high-dose steroids...)

141

Treatment for Fibromyalgia?

TCAs/Anti-depressants

142

Progressive muscle weakness caused by CD8 T-cell-induced injury to myofibers; usually in shoulders; positive ANA, anti-Jo-1, and elevated CK, elevated aldolase?

Polymyositis
-->associated with increased risk of malignancy
***note: if rash + polymyositis --> Dermatomyositis

143

progressive symmetric muscle weakness caused by CD8 T-cell-induced injury to myofibers + Rash (malar rash, heliotrope rash, shawl-and-face rash, etc), + positive ANA, anti-Jo-1, elevated CK, elevated aldolase?

Dermatomyositis
-->associated with increased risk of malignancy

144

Myasthenia Gravis:
-autoantibodies to?
-how does muscle use affect symptoms?

-autoantibodies to post-synaptic ACh receptors
-symptoms worsen with muscle use
-reverse symptoms with AChE inhibitors (Edrophonium test...)

145

Lambert-Eaton syndrome:
-autoantibodies to?
-how does muscle use affect symptoms?

-autoantibodies to presynaptic Calcium channels, so get decreased ACh release --> proximal muscle weakness)
-symptoms improve with muscle use

146

What paraneoplastic disease is associated with Lambert-Eaton syndrome?

Small cell lung cancer

147

Affect of AChE-inibitors on Myasthenia Gravis? Lambert Eaton?

-->reverses Myasthenia Gravis (b/c problem is with the ACh receptors)
-does not reverse Lambert-Eaton (b/c problem with ACh release)

148

Which neuromuscular jxn disease is associated with a thymoma?

Myasthenia Gravis

149

Proximal vs Distal weakness?

Proximal = muscle problem (like with Lambert-Eaton)
Distal = neuro problem (has longer path to get there; more room for errors!)

150

What is scleroderma?

-->excessive fibrosis and collagen deposition throughout the body

151

anti-DNA topoisomerase I antibody (=anti-Scl-70 antibody)

Diffuse scleroderma

152

anti-Centromere antibody

CREST scleroderma

153

which has worse clinical course: diffuse or CREST scleroderma?

-->Diffuse = faster progression, early visceral involvement
-->CREST - more benign clinical course

154

CREST scleroderma:

-Calcinosis (subepithelial calcium deposits)
-Raynaud's
-Esophageal dysmotility
-Sclerodactyly
-Telangiectasia

155

What is hyperkeratosis?

increased thickness of stratum corneum (see with psoriasis)

156

What is urticaria?

Hives; get pruritic wheals after mast cell degranulation

157

Atopic Dermatitis:

=Eczema
-->pruritis; often associated with other atopic diseases (asthma, allergic rhinitis)
-->also seen in Wiskott-Aldrich syndrome (deletion of B and T-cells; elevated IgE and IgA, but decreased IgM; also have: thrombocytopenic purpura and infections)

158

What type of hypersensitivity rxn is allergic contact dermatitis (ie from nickel, poison ivy...)?

=type IV hypersensitivity

159

salmon-colored plaques with silvery scaling; plaques bleed if scales are scraped off:

=Psoriasis
"Auspitz sign" = bleeding when scales scraped off

160

Changes in epidermis layers in Psoriasis:

-increased stratum spinosum; decreased stratum granulosum
-also: hyperkeratosis = increased thickness of stratum corneum; and parakeratosis = retention of nuclei in stratum corneum

161

Seborrheic keratosis:

-->squamous epithelial proliferations, look like they are pasted on and can easily be peeled off
-->commonly seen in older people
-->benign, but should have melanoma as part of dd

162

Vitiligo?

Have areas of skin with decreased pigmentation; d/t decrease melanocytes

163

Melasma/Chloasma

Hyperpigmentation of skin associated with pregnancy or OCP use

164

Contagious, honey-colored crusting of skin

Impetigo
-->S. aureus or S. pyogenes (GAS)

165

White, painless plaques on tongue that CANNOT be scraped off; often in HIV pts?

-->Hairy Cell Leukoplakia
*EBV-mediated
(not to be confused with hairy cell leukemia; a B-cell neoplasm with TRAP as a tumor marker)

166

autoimmune skin disorder with IgG antibodies; blisters on skin and oral mucosa; epidermis separates when stroke skin

--> Pemphigus Vulgaris
anti-ephithelial cell antibody = IgG anti-Desmosome antibody

***potenitally fatal

167

Autoimmune skin disorder with IgG antibodies; blisters on skin, but not on oral mucosa; skin does not separate when stroked

--> Bullous pemphigoid = anti-hemidesmosome antibodies = antibodies against the epidermal basement membrane

-->less severe than pemphigus vulgaris

168

Pruritis + GI/malabsorption?

Celiac:
-pruritis/rash = Dermatitis Herpetiformis
-->have deposits of IgA at the tips of dermal papillae

169

Fever + Bulla formation and necrosis + sloughing of skin; often associated with adverse drug reaction; high mortality rate

Stevens-Johnson syndrome
(associated with seizure drugs, etc)

170

Toxic epidermal necrolysis

=more severe form of Stevens-Johnson syndrome

171

Pruritic, Purple, Polygonal Papules?

-->Lichen planus
-associated with Hepatitis C!

172

Skin disorder associated with Hepatitis C?

-->Lichen Planus (pruritic, purple, polygonal papules)

173

Actinic Keratosis

premalignant lesions associated with sun exposure; risk of progression to squamous cell carcinoma

174

Lichen Planus

Pruritic, Purple, Polygonal Papules
-->associated with Hepatitis C

175

Acanthosis nigricans:
-what part of skin is effected?
-associated with?

-hyperplasia of stratum spinosum
-see with hyperglycemia (ie Cushing's, Niacin use, Diabetes) and visceral malignancies (like gastric adenocarcinoma)

176

S-100 tumor marker

Melanoma

177

Keratin pearls on histopathology

Squamous cell carcinoma

178

actinic keratosis is a precursor to what type of skin cancer?

precursor to squamous cell carcinoma

179

What skin cancer is associated with arsenic exposure?

Squamous cell carcinoma
(also, of course, associated with excessive sunlight exposure)

180

Atypical skin mole is a precursor to what type of skin cancer?

Melanoma

181

Effect of Aspirin on BT, PT, PTT?

-Increased Bleeding Time
-No effect on PT, PTT

182

Naproxen

NSAID (alleve!)

183

Ketorolac

an NSAID, given by IV

184

Benefit of COX-2 inhibitors over other types of NSAIDs?

-->less corrosive effects of NSAIDs on the gastric mucosa (still have some though, just less!)

185

How does Acetaminophen differ from NSAIDs?

-->also reversibly inhibits COX-1 and COX-2 (like NSAIDs), BUT, mostly acts in the CNS. It's inactivated peripherally, so is not used as an anti-inflammatory analgesic drug

186

Antidote of Acetaminophen? What's it's mechanism?

antidote = N-acetylcysteine --> regenerates glutathione (which is depleted in acetaminophen overdose)

187

Consequences of Acetaminophen overdose?

-->Hepatic necrosis; acetaminophen metabolite depletes glutathione, so forms toxic tissue adducts in liver
-->treat by giving N-acetylcysteine, which regenerates glutathione

188

Bisphosphonates:
-mechanism?
-all end in what suffix?
-cinical uses?
-toxicities?

-all end in "-dronate" (Etidronate, Pamidronate, Alendronate, Risedronate, Zoledronate)
-Mechanism = inhibit osteoclast activity (analog of pyrophosphate, which is a component of hydroxyapatite, so reduces both formation and resorption of hydroxyapatite

*clinical uses:
-paget's disease
-menopausal osteoporosis
-malignancy-associated hypercalcemia

*toxicities:
-errosive esophagitis (NOT Zoledronate though); so should take drug upright, not before bed
-osteonecrosis of jaw!
-nausea, diarrhea, blah blah

189

Probenicid

used to treat chronic gout
-inhibits reabsorption of uric acid in the PCT
-->ALSO: inhibits secretion of penicillin! (so, makes penicillin last longer!)

190

Allopurinol:
-use?
-mechanism?
-what 2 drugs have increased concentrations when taken with allopurinol? and why?

-treatment for chronic gout
-inhibits xanthine oxidase (so decreased conversion of xanthine to uric acid)
-can also in lymphoma and leukemia

*Allopurinol increases concentrations of:
-Azathioprine (anti-metabolite precursor of 6-MP; used for kidney transplants and autoimmune disorders)
-6-Mercaptopurine (anti-metabolite; inhibits purine synthesis)
-->b/c these both are normally metabolized by xanthine oxidase!

191

Febuxostat

chronic treatment of gout
-->inhibits xanthine oxidase

192

Colchine mechanism? side effects?

-->used for acute treatment of gout
-binds and stabilizes tubulin, inhibiting polymerization; this impairs leukocyte chemotaxis and degranulation!

*Side effects:
-->GI: Diarrhea

193

Drug of choice in treatment of acute gout?

#1 choice = NSAIDs (Naproxen, Indomethacin...)

*can also use colchicine or steroids to treat acute gout

194

List the 3 TNF-alpha inhibitors:

-Etanercept
-Infliximab
-Adalimumab

195

Etanercept mechanism?

-->Recombinant form of the TNF receptor, so binds TNF

-->uses: RA, psoriasis, ankylosing spondylitis

196

Infliximab mechanism?

anti-TNF antibody

-->uses: Crohn's, RA, ankylosing spondylitis

197

Adalimumab mechanism?

anti-TNF antibody

-->uses: RA, psoriasis, ankylosing spondylitis

198

Main thing that must be checked before initiating therapy with TNF-alpha-inhibitors?

-->Do PPD to check for latent TB; because if inhibit TNF-alpha --> can get activation of macrophages and reactivation of latent TB infection.