Rheum/Ortho+Derm Flashcards
(34 cards)
1
Q
(NON-modifiable) RF for osteoporotic fractures {2/2}
A
- advancing age
- female
- white, hispanic, asian (NOT BLACK)
- personal or family hx of fractures
2
Q
(potentially modifiable) <six> RF for osteoporotic fractures {1/2}</six>
A
- DEC physical activity
- low body weight
- poor calcium and Vit D intake
- excessive alcohol or tobacco use
- premature menopause
- glucocorticoid use
3
Q
3 phases of wound healing <in-pro-ma></in-pro-ma>
A
- inflammatory phase
- proliferative phase
- maturation phase
4
Q
acanthosis nigrans
A
- HYPERpigmented, velvety plaques
- axilla or neck
- assoc w/:
- DM, obesity
- visceral malignancy,
- endocrinopathy
5
Q
ACL
A
- anterior cruciate ligament can be damaged by sudden decelerations and pivots on an extended knee during sports activity
- PE: excessive motion of the tibia with respect to the femur (eg Lachman test, anterior drawer test)
- originates on lateral femoral condyle, inserts on ant intercondylar area of tibia
6
Q
acute allergic contact dermatitis (ACD)
A
- form of eczema caused by a type 4 (delayed) hypersensitivity rxn to an Ag on the skin surface
- Ag taken up by Ag-presenting Langerhan cells and presented to CD4+ T-cells in regional lymph nodes
- T-cells are ativated and migrate to skin
- at skin, incite an inflamm resp within 24 hrs of Ag re-exposure
7
Q
acute allergic contact dermatitis (ACD) Histo
A
- spongiosis
- edema fluid in intercellular space of the epidermis
- intercellular bridges become more distinctive
- edema leads to intraepidermal vesicles
- perivascular infiltrate of lymphocytes and eosinophils
- iwth persistent Ag exposure:
- lesions become less edematous and weepy
8
Q
Body’s muscles
A
- 2 main fiber types:
- Type 1 (slow twitch): perform actions requiring low-level sustained force (postural maintenance)
- aerobic metab, have high myoglboin (oxygen storage) and mitochondrial (aerobic respiration) concentrations
- paraspinal muscles mostly Type 1
- Type 2 (fast twitch)-rapid forceful pulses of movement
- 2b: derive ATP energy through anaerobic glycogenolysis and subsequent glycolysis
- 2a=intermed between Type 1 and 2b-they generate ATP via aerobic metab
9
Q
Bone mass
A
- in adulthood, bone mass is determined by peak bone mass and the rate of bone loss
- variation in peak bone mass is determined by genetic and environmental factors (nutritional status, physical activity
- AA women: higher bone density and lower risk of fractures that women of other ethnicities
10
Q
capillary hemangiomas
A
- small and superficial
11
Q
CaSR-Calcium sensing receptors
A
- transmembrane G-protein-coupled (metabotropic) receptors
- help regulate the secretio of PTH in response to changes in circulating calcium levels
12
Q
Difference between reABsorption and re_sorption
A
- re-AB-sorption:
- absorbing again
- re_sorption:
- lysis and assimilation of a substance (as of bone)
- pathological or physiological loss of a substance
13
Q
Disuse atrophy
A
- skeletal muscle fibers decrease in size
- tissue loss due to cellular death or reduced cell size
- may be physiologic (atrophy of wolffian ducts in the female fetus, atrophy of maternal uterus following childbirth) or pathologic
- pathologic atrophy: due to lack of use, loss of hormonal or neurologic stimulation (denervation atrophy), impaired circulation, mechanical compression, aging, or nutritional insufficiency
- localized or generalized
- due to: decreased physical workload
- also seen in adrenal cortex during prolonged glucocorticoid use due to suppression of ACTH release
- can lead to acute adrenal insufficiency if exogenous gluc therapy is abruptly discontinued
- cellular level: decreased protein synthesis and loss of myofibrils
14
Q
Duchenne muscular dystrophy
A
- X-linked recessive myopathy
- PP: deletion of dystrophin gene on X chromosome p21, get frameshift mutation
- dystrophin=protein that allows interaction between extracellular connective tissue and the intracellular contraction apparatus
- Epid: 2-5 yo boys
- CP: proximal muscle weakness, enlargement of the distal muscles (calf hypertrophy)
- Gower sign-use hands to rise from a squat or form a chair to compensate for prox mu weakness
15
Q
ecchymosis
A
- cutaneous OR sub-cutaneous
- collection of EXTRAVASATED blood..at least 1cm diameter
- indicate deep hemorrhage (hematoma) d/t:
- bony fracture
- ligamentous rupture
- muscular injury
- do NOT blanch under pressure b/c RBC are NOT contained within the vasculature
- evolution of color change (blue/red–>brown–>green—>ylw)
- used for estimation of age of injury
16
Q
FOOSH
A
- fall onto an outstretched dorsiflexed hand
- common cause of upper extremity injury
- distal complications are most common-include scaphoid fracture, lunate dislocation, and distal radius fracture
17
Q
Lentigines
A
small tan or brown macules most often sen on the sun-exposed skin of a middle-aged or elderly person
18
Q
Psoriasis histo
A
- HYPER-para-keratosis
- acanthosis
- elongation of rete ridges
- mitotic activity aboe the epidermal basal cel layer
- reduced/absent stratum GRANULOSUM (grab)
- neutrophils may form spongiotic clusters in superficial dermia and parakeratotic s. corneum
- **Munro microabscesses
- Auspitz sign-pinpoint bleeding when scale removed form the plaque
19
Q
PTH and bone
A
- stimulates Ca release from bone mineral compartment
- via: INC production of M-CSF and RANK-L
- RANK-L binds RANK on onsteoclasts, stimulates them=INC Ca [enhanced bone matrix degradation]
20
Q
PTH and kidney
A
- stimulate reabsorption of calcium in distal convoluted tubule
- inhibits phosphate reabsorption in proximal convoluted tubule (PCT)
- stimulates production of 1,25-(OH)2D3 (CALCITRIOL) via stimulation of 1alpha-hydroxylase in proximal convoluted tubuled (PCT)
- feedback inhibition of PTH synthesis
- INC intestinal calcium absorption
- INC serum Ca
21
Q
PV and BP
A
PV-desmosome
BP-HEMI-desmosomes
22
Q
Quadriceps muscle group
A
- connected to the patella which is attached to the tibial tubercle by the patellar ligament
- repetitive quad contraction can lead to Osgood-Schlatter dz
- charac: focal pain and swelling at tibial tuberosity
23
Q
RF for Osteoporotic Fractures
A
- NON-modifiable:
- advancing age
- female sex
- white, hispanic, asian
- personal or fhx of fractures
- Modifiable
- DEC physical activity
- low body weight
- poor ca and vit D intake
- xs slcohol or tobacco use
- premature menopause
- glucocor
24
Q
seborrheic keratosis
A
- benign
- tan-brown epidermal tumor
- middle aged/elderly
- anywhere on body
- variable appearance
- nearly flat macules
- raised, wart-like lesions
- few mm to several cm
- “STUCK-ON”
25
strawberries and cherries
* strawberry (capillary) hemangioma
* benign
* vascular tumors
* childhood
* regress by 5-8 yo
* composed of capillaries separated by connective tissue
* cherry hemangiomas
* mc benign vascular proliferation in ADULTS
* small, bright red
* cutaneous papules
* consist of:
* dilated capillaries
* post capillry venules in papillary dermis
* do NOT regress spontaneously
26
Supracondylar humeral fractures
* common pediatric elbow fractures
* occur after hyperflexion or hyperextension injuries
* significant risk of neurovascular compromise
* brachial artery, median nerve, radial nerve all run anterior to elbow.
* supracondylar fractures result in anterolateral displacement of the proximal fracture fragment typically cause radial nerve injury
* causes wrist drop (due to denervation of hand/finger extensor muscles) and sensory loss over the posterior forearm/dorsolateral hand
27
telangiectasias
* small, permanent dilations of superficial capillaries or venules
* blanch under pressure
* commonly seen in aging, chronic solar damage, long-term glucocorticoid use, rosacea, and a variety of systemic d/o
28
TGFbeta and wound healing
* tgfbeta is critical for fibroblast migration, proliferation, and connective tissue synthesis
* INC TGFbeta is responsible for the hypertrophic/keloid scarring and fibrosis of the lung, liver, and kidney that ccur with chronic inflammation
29
Vertebral oseomyelitis
* suspected in pts with new or worsening back pain, fever, and recent endocarditis or bactermia (espec S. aureus)
* suspected if there are new neuro findings and fever with/without back pain
* MRI of spine for diagnosis
30
What jacks up PTH (phosphate trasihng hormone)
* DEC serum Ca
* INC serum PO4
* DEC serum Mg
31
Paget disease of bone
* accelerated bone remodeling with eventual bony overgrowth
* three main phases:
* 1. Osteolytic phase-{CLAST dominant}
* 2. Mixed phase-{CLAST + BLAST}
* rapid INC in BLAST formation
* 3. Osteo-SCLEROTIC phase-{BLAST dominant}
* dense, hypovascular, MOSAIC PATTERN of lamellar bone with irregular haphazard oriented sections separated by PROMINENT CEMENT LINES
32
A f/m THICK--\>thin
* H band: just thick myosin
* I band: just thin myosin
* A band: thick and thin
33
ACS (acute compartment syndrome)
* PP: INC pressure within fascial compartments of the limbs
* leads to impaired perfusion
* can cause:
* severe pain
* myonecrosis
* nerve injury
* mc site: anterior compartment of the leg which contains:
* **anterior tibial artery**
* **deep peroneal (fibular) nerve**
* foot extensor muscles
34
Discharge checklist
* details medication changes and followup appts
* can significantly facilitate a pt's transition from the hospital
* imrpoves adherence to out pt tx
* indivs with smooth transition from in to out pt setting are at lower risk for early rehospitalization
