Musculoskeletal - Skin - Connective Tissue_2 Flashcards Preview

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Flashcards in Musculoskeletal - Skin - Connective Tissue_2 Deck (218):
1

presentation of dermatomyositis?

similar to polymyositis, but also invovles malar rash, Gottron's papules. heliotrope rash, shawl and face rash, mechanic's hands

2

dermatomyositis carries ↑ risk of what?

occult malignancy

3

pathology in dermatomyositis?

perimysial inflammation and atrophy with CD4+ T cells

4

findings in polymyositis/dermatomyositis?

↑ CK • ANA (+) • anti-Jo-1 Ab (+)

5

treatment for polymyositis/dermatomyositis?

steroids

6

what is the frequency of myasthenia gravis?

most common NMJ disorder

7

frequency of lambert eaton myasthenic syndrome?

uncommon

8

pathophysiology of MG?

autoantibodies to postsynaptic AChR

9

pathophysiology of LEMS?

autoantibodies to presynaptic Ca++ channel →↓ ACh release

10

clinical presentation of MG?

ptosis • diplopia • weakness • worsens with muscle use

11

clinical presentation of LEMS?

proximal muscle weakness • improves with muscle use

12

MG associated with what?

thymoma • thymic hyperplasia

13

LEMS associated with what?

SCLC

14

what happens with AChE inhibitor administration in MG?

reversal of symptoms

15

what happens with AChE inhibitor administration in LEMS?

no effect

16

what is myositis ossificans?

metaplasia of skeletal muscle to bone following muscular trauma

17

myositis ossificans is most often seen where?

in upper or lower extremity

18

myositis ossificans may present how?

as suspicious mass at site of known trauma or as incidental finding on radiography

19

what happens in scleroderma (SS)?

excessive fibrosis and collagen deposition throughout the body

20

common manifestation of SS?

sclerosis of skin, manifesting as puffy and taut skin with absence of wrinkles • also sclerosis of renal, pulm, CV, GI systems

21

most likely cause of death in SS?

sclerosis of pulmonary system

22

epidemiology of SS?

75% female

23

2 major types of SS?

diffuse scleroderma • CREST syndrome

24

clinical features of diffuse scleroderma?

widespread skin involvement, rapid progression, early visceral involvement

25

marker for diffuse scleroderma?

anti-Scl-70 Ab (anti-DNA topoisomerase I Ab)

26

clinical features of CREST syndrome?

Calcinosis • Raynaud's phenomenon • Esophageal dysmotility • Sclerodactyly • Telangiectasia

27

skin involvement in CREST syndrome?

limited skin involvement, often confined to fingers and face

28

clinical course of CREST syndrome relative do diffuse scleroderma?

more benign clinical course

29

marker for CREST syndrome?

anticentromere antibody

30

what is a macule?

flat lesion with well-circumscribed change in skin color <5mm

31

examples of macule?

freckle • labial macule

32

what is a patch?

macule >5mm

33

what is an example of a patch?

large birthmark (congenital nevus)

34

what is a papule?

elevated solid skin lesion <5mm

35

example of papule?

mole (nevus) • acne

36

what is a plaque?

papule >5mm

37

what is an example of derm plaque?

psoriasis

38

what is a derm vesicle?

small fluid containing blister <5mm

39

example of derm vesicle?

chickenpox (varicella) • shingles (zoster)

40

what is a bulla?

large fluid containing blister >5mm

41

example of bulla?

bullous pemphigoid

42

what is a pustule?

vesicle containing pus

43

example of pustule?

pustular psoriasis

44

what is wheal?

transient smooth papule or plaque

45

example of wheal?

hives (urticaria)

46

what is derm scale?

flaking off of stratum corneum

47

example of derm scale?

eczema • psoriasis • SCC

48

what is derm crust?

dry exudate

49

example of derm crust?

impetigo

50

what is hyperkeratosis?

↑ thickness of stratum corneum

51

example of hyperkeratosis?

psoriasis

52

what is parakeratosis?

hyperkeratosis with retention of nuclei in stratum corneum

53

example of parakeratosis?

psoriasis

54

what is acantholysis?

separation of epidermal cells

55

example of acantholysis?

pemphigus vulgaris

56

what is acanthosis?

epidermal hyperplasia [↑spinosum]

57

example of acanthosis?

acanthosis nigricans

58

what is dermatitis?

inflammation of the skin

59

example of dermatitis?

atopic dermatitis

60

pathogenesis of albinism?

normal number of melanocytes with ↓ melanin production due to ↓ tyrosinase activity • can also be caused by failure of neural crest cells to migrate during development

61

what is melasma (chloasma)?

hyperpigmentation associated with pregnancy (mask of pregnancy) or OCP use

62

what is vitiligo?

irregular areas of complete depigmentation

63

vitiligo is caused by what?

↓ in melanocytes

64

what are verrucae?

warts

65

verrucae are caused by what?

HPV

66

what do verrucae look like?

soft, tan colored, cauliflower like papules

67

microscopic features of verrucae?

epidermal hyperplasia • hyperkeratosis • koilocytosis

68

what are verrucae on genitals?

condyloma accuminatum

69

what is melanocytic nevus?

common mole

70

pathogenicity of melanocytic nevus?

benign, but melanoma can arise in congenital or atypical moles

71

intradermal nevi are what?

papular

72

junctional nevi are what?

flat macules

73

what is urticaria?

hives- pruritic wheals that form after mast cell degranulation

74

what is ephelis?

freckle

75

molecular features of ephelis?

normal number of melanocytes, ↑ melanin pigment

76

what is atopic dermatitis (eczema)?

pruritic eruption, commonly on skin flexures

77

atopic dermatitis is often associated with what?

other atopic diseases (asthma, allergic rhinitis)

78

course of atopic dermatitis?

usually starts on the face in infancy and often appears in the antecubital fossa thereafter

79

what is allergic contact dermatitis?

type IV HSR that follows exposure to allergen

80

where do lesions occur in allergic contact dermatitis?

at site of contact • (nickel, poison ivy, neomycin)

81

what is psoriasis?

papules and plaques with silvery scaling, especially on knees and elbows

82

microscopic features of psoriasis?

acanthosis with parakeratotic scaling (nuclei still in stratum corneum)

83

cellular features of psoriasis?

↑ stratum spinosum • ↓ stratum granulosum

84

what is Auspitz sign in psoriasis?

pinpoint bleeding spots from exposure of dermal papillae when scales are scraped off

85

psoriasis can be associated with what?

nail pitting and psoriatic arthritis

86

what is seborrheic keratosis?

flat, greasy, pigmented squamous epithelial proliferation with keratin filled cysts (horn cysts)

87

how does seborrheic keratosis look?

stuck on

88

lesions in seborrheic keratosis occur where?

on head, trunk, and extremities

89

incidence of seborrheic keratosis?

common benign neoplasm of older persons

90

what is the Leser-Trelat sign?

sudden appearance of multiple seborrheic keratoses, indicating an underlying malignancy (GI, lymphoid)

91

what is pemphigus vulgaris?

potentially fatal autoimmune skin disorder with IgG Ab against desmoglein 3 (1 and/or 3), a part of the desmosomes (needed for cell adhesion)

92

IF findings in pemphigus vulgaris?

Ab around epidermal cells in a reticular or net like pattern

93

dermatologic pathology findings in pemphigous vulgaris?

acantholysis- intraepidermal bullae causing flaccid blister involving the skin and oral mucosa

94

positive PE sign in pemphigus vulgaris?

Nikolsky's sign (separation of the epidermis upon manual stroking of the skin)

95

what is bullous pemphigoid?

autoimmune disorder with IgG Ab against hemidesmosomes (epidermal basement membrane)

96

IF findings in bullous pemphigoid?

shows linear immunofluorescence

97

Bx findings in bullous pemphigoid?

eosinophils within tense blisters

98

how does bullous pemphigoid compare to pemphigus vulgaris?

similar to but less severe than PV • affects skin but spares oral mucosa • negative Nikolsky's sign

99

presentation of dermatitis herpetiformis?

pruritic papules, vesicles, and bullae

100

cause of dermatitis herpetiformis?

deposits of IgA at the tips of dermal papillae

101

dermatitis herpetiformis is associated with what?

celiac disease

102

erythema multiforme is associated with what?

infections • drugs • cancers • autoimmune disease

103

infections associated with erythema multiforme?

Mycoplasma pneumoniae • HSV

104

drugs associated with erythema multiforme?

sulfa drugs • β lactams • phenytoin

105

erythema multiforme presents with what?

multiple types of lesions- macules, papules, vesicles, and target lesions

106

Stevens-Johnson syndrome is characterized by what?

fever • bulla formation and necrosis • sloughing of skin • high mortality rate

107

skin lesions involved in Stevens-Johnson syndrome?

typically 2 mucus membranes are involved and skin lesions may appear like targets as seen in erythema multiforme

108

stevens johnson syndrome usually associated with what?

adverse drug reaction

109

what is the more severe form of stevens johnson syndrome?

>30% of body surface area involved→toxic epidermal necrolysis

110

what is acanthosis nigricans?

epidermal hyperplasia causing symmetrical, hyperpigmented, velvety thickening of skin, especially on neck or in axilla

111

acanthosis nigricans is associated with what?

hyperinsulinemia (diabetes, obesity, Cushings) • visceral malignancy

112

what is actinic keratosis?

premalignant lesions caused by sun exposure

113

how does actinic keratosis look?

small, rough, erythematous or brownish papules or plaques

114

how is risk of cancer in actinic keratosis assessed?

risk of SCC is proportional to degree of epithelial dysplasia

115

what is erythema nodosum?

inflammatory lesions of subcutaenous fat, usually on the anterior shins

116

erythema nodosum is associated with what?

sarcoidosis • coccidioidomycosis • histoplasmosis • TB • streptococcal infections • leprosy • crohn's disease

117

what are the 6 P's of lichen planus?

pruritic • purple • polygonal • planar • papules

118

histopathology of lichen planus?

sawtooth infiltrate of lymphocytes at dermal-epidermal junction

119

lichen planus is associated with what?

hepatitis C

120

what is the presentation of pityriasis rosea?

herald patch followed days later by christmas tree distribution

121

what does pityriasis rosea look like?

multiple plaques with collarette scale

122

course of pityriasis rosea?

self resolving in 6-8 weeks

123

what happens in sunburn?

UV radiation causes DNA mutations, inducing apoptosis of keratinocytes

124

which type of light is dominant in tanning and photoaging?

UVA

125

which type of light is dominant in sunburn?

UVB

126

sunburn can lead to what?

impetigo and skin cancers

127

which skin cancers can be caused by sunburn?

basal cell carcinoma • SCC • melanoma

128

what is impetigo?

very superficial skin infection

129

organisms that cause impetigo?

usually S aureus or S pyogenes

130

transmissibility of impetigo?

highly contagious

131

appearance of impetigo?

honey colored crusting

132

features of bullous impetigo?

has bullae and is usually caused by S aureus

133

what is cellulitis?

acute, painful, spreading infection of dermis and subcutaneous tissues

134

organisms that cause cellulitis?

S pyogenes or S aureus

135

cellulitis often starts with what?

a break in skin from trauma or another infection

136

what is necrotizing fasciitis?

deeper tissue injury usually from anaerobic bacteria or S pyogenes

137

necrotizing fasciitis results in what?

crepitus from methane and CO2 production

138

necrotizing fasciitis AKA?

flesh eating bacteria

139

skin appearance in necrotizing fasciitis?

bullae and purple color

140

what happens in staphylococcal scalded skin syndrome (SSSS)?

exotoxin destroys keratinocyte attachments in the stratum granulosum only

141

difference between SSSS and TEN?

SSSS destroys stratum granulosum only, • TEN destroys dermal-epidermal junction

142

SSSS characterized by what?

fever • generalized erythematous rash with sloughing of the upper layers of the epidermis that heals completely

143

SSSS seen in who?

infants and children

144

what is hairy leukoplakia?

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

145

virus that mediates hairy leukoplakia?

EBV

146

hairy leukoplakia occurs in who?

HIV patients

147

what is the most common skin cancer?

basal cell carcinoma

148

basal cell carcinoma found where?

sun exposed areas of body

149

severity of basal cell carcinoma?

locally invasive, but almost never metastasizes

150

appearance of basal cell carcinoma?

pink, pearly nodules, commonly with telangiectasias, rolled borders, and central crusting or ulceration • or • nonhealing ulcers with infiltrating growth • or • scaling plaque

151

histological features of BCCs?

palisading nuclei

152

what is the second most common skin cancer?

SCC

153

SCC of skin is associated with what?

excessive exposure to sunlight, immunosuppression, arsenic exposure

154

SCC of skin commonly appears where?

face, lower lip, ears, hands

155

severity of SCC of skin?

locally invasive, but may spread to lymph nodes • rarely metastasizes

156

appearance of SCC of skin?

ulcerative red lesions with frequent scale • chronic draining sinuses

157

histopathology of SCC of skin?

keratin pearls

158

which scaly plaque is a precursor to SCC of skin?

actinic keratosis

159

which variant of skin SCC grows rapidly for 4-6 weeks and may regress spontaneously over months?

keratoacanthoma

160

which skin cancer is a common tumor with significant risk of metastasis?

melanoma

161

tumor marker associated with melanoma?

S-100

162

predisposing factors for melanoma?

sunlight exposure • fair-skinned persons at ↑ risk

163

risk of mets in melanoma is proportional to what?

depth of tumor

164

what should you look for in melanoma?

ABCDEs: • Asymmetry • Border irregularity • Color variation • Diameter>6mm • Evolution over time

165

4 types of melanoma?

superficial spreading melanoma • nodular melanoma • lentigo maligna melanoma • acrolentiginous melanoma

166

genetics of melanoma?

often driven by activating mutation in BRAF kinase

167

primary treatment for melanoma?

excision with appropriately wide margins

168

metastatic or unresectable melanoma in patients with BRAF V600E mutation may benefit from what?

vemurafenib, a BRAF kinase inhibitor

169

lipoxygenase pathway yields what?

leukotrienes

170

function of LTB4?

neutrophil chemotactic agent

171

LTC4, LTD4, LTE4 function in what?

bronchoconstriction • vasoconstriction • contraction of smooth muscle • ↑ vascular permeability

172

action of PGI2?

inhibits platelet aggregation and promotes vasodilation

173

effect of corticosteroids on arachidonic acid products?

inhibits PLA2 • inhibits protein synthesis →↓ COX

174

effect of NSAIDs, aspirin, acetaminophen, COX-2 inhibitors on arachidonic acid products?

inhibit COX enzymes to ↓ formation of endoperoxides PGG2 and PGH2

175

effect of zileuton on arachidonic acid products?

inhibits lipoxygenase to ↓ formation of hydroperoxides (HPETEs)

176

action of TXA2?

↑platelet aggregation • ↑ vascular tone • ↑ bronchial tone

177

action of PGE2 and PGF2?

↑ uterine tone • ↓ vascular tone • ↓ bronchial tone

178

action of prostacyclin (PGI2)?

↓ platelet aggregation • ↓ vascular tone • ↓ bronchial tone • ↓ uterine tone

179

effect of zafirleukast and monteleukast on arachidonic acid products?

block actions of LTC4 and LTD4 at receptors

180

MOA of aspirin?

irreversibly inhibits COX1 and COX2 by acetylation→↓ synthesis of TXA2 and PGs • NSAID

181

effect of aspirin on blood labs?

↑ bleeding time • no Δ in PT, PTT

182

clinical use of low dose aspirin?

<300mg/d ↓ platelet aggregation

183

clinical use of intermediate dose aspirin?

300-2400mg/d→ antipyretic and analgesic

184

clinical use of high dose aspirin?

2400-4000mg/d→anti-inflammatory

185

toxicity of aspirin?

gastric ulceration • tinnitus • stimulates respiratory centers causing hyperventilation and respiratory alkalosis

186

chronic use of aspirin can lead to what?

acute renal failure • interstitial nephritis • upper GI bleeding

187

risk of what in children with aspirin use?

Reyes syndrome when used to treat viral infection

188

which drugs are NSAIDs?

ibuprofen • naproxen • indomethacin • ketorolac • diclofenac

189

MOA of NSAIDs?

reversibly inhibit COX1 and COX2→ block PG synthesis

190

clinical use of NSAIDs?

antipyretic • analgesic • anti-inflammatory

191

special use of indomethacin?

close a PDA

192

toxicity of NSAIDs?

interstitial nephritis • gastric ulcer • renal ischemia

193

MOA of COX2 inhibitors (celecoxib)?

reversibly inhibit COX2 found in inflammatory cells and vascular endothelium • spares COX1 to protect gastric mucosa and platelet function

194

clinical use of celecoxib?

RA and OA, patients with gastritis or ulcers

195

toxicity of celecoxib?

↑risk of thrombosis • sulfa allergy

196

MOA of acetaminophen?

reversibly inhibits COX mostly in CNS, is inactivated peripherally

197

clinical use of acetaminophen?

antipyretic • analgesic • not anti-inflammatory • used instead of aspirin in children with viral infection to avoid reyes syndrome

198

toxicity of acetaminophen?

OD→hepatic necrosis; acetaminophen metabolite depletes glutathione and forms toxic tissue adducrs in liver

199

antidote for acetaminophen overdose?

N-acetylcysteine- regenerates glutathione

200

which drugs are bisphosphonates?

alendronate, other -dronates

201

MOA of bisphosphonates?

pyrophosphate analogs; bind hydroxyapatite in bone, inhibiting osteoclast activity

202

clinical use of bisphosphonates?

osteoporosis • hypercalcemia • pagets disease of bone

203

toxicity of bisphosphonates?

corrosive esophagitis • osteonecrosis of the jaw

204

MOA of allopurinol?

inhibits xanthine oxidase, ↓ conversion of xanthine to uric acid • used in lymphoma and leukemia to prevent tumor lysis associated urate nephropathy

205

PK considerations for allopurinol?

↑ concentrations of azathiprine and 6-MP

206

CI with allopurinol?

do not give salicylates (↓ urate clearance)

207

MOA of febuxostat?

inhibits xanthine oxidase

208

MOA of probenecid?

inhibits reabsorption of urate in PCT (also inhibits secretion of penicillin)

209

MOA of colchicine?

binds and stabilizes tubulin to inhibit polymerization, impairing leukocyte chemotaxis and degranulation

210

AE of colchicine?

GI side effects, especially is given PO

211

which are the NSAIDs for acute gout?

naproxen, indomethacin

212

ROA for glucocorticoids for acute gout?

oral or intraarticular

213

immune precaution for all TNF-α inhibitors?

all predispose to infection including reactivation of latent TB since TNF blockade prevents activation of macrophages and destruction of phagocytosed microbes

214

which drugs are the TNFα inhibitors?

etanercept • infliximab, adalimumab

215

MOA of etanercept?

fusion protein (receptor for TNF-α + IgG1 Fc), produced by recombinant DNA • decoy receptor

216

clinical use of etanercept?

RA • psoriasis • ankylosing spondylitis

217

MOA of infliximab, adalimumab?

anti TNFα monoclonal Ab

218

clinical use of infliximab and adalimumab?

crohns • RA • ankylosing spondylitis • psoriasis