Skin/MS Pathology Flashcards Preview

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Flashcards in Skin/MS Pathology Deck (327):
1

Trendelenberg sign

dropping of the lifted legs hip

Due to paralysis of the abductors of gluteus medius and gluteus minimus-> Superior gluteal invervation

2

Foot drop

Peroneal nerve damaged

dorsiflexes and everts the foot

PED

3

Can't stand on tip toes

Tibial nerve damage


inverts and plantaflexes the foot

TIP

4

Thigh adduction innervated

- anterior hip dislocation

(4 muscles)

Obturator

adductor longu, adductor, brevis, anterior portion of adductus magnus, gracilis

5

Thigh flexion and leg extension nerve

Femoral

worry in pelvic fracture

6

Knee trauma worry about this nerve

Can

tibial

7

posterior hip dislocation and can't jump

nerve and muscle

inferior gluteal enervating the gluteus maximus

8

pathology due to activating mutation in fibroblast growth factor receptor 3 (FGFR3)

Achrondroplasia - dwarfism

9

Achodroplasia

imparied cartilage proliferation in the growth plate

Dwarfism

10

Endochondrial bone formation

formation of bone via cartilage matrix which is replaced -> implicated in achondroplasia

11

Intramembranous bone fomration

formation of long bone w/out preexisting cartilage matrix - > flat bone formation (Skull and rib cage) thus why normal head in dwarfism

12

3 signs of osteogenesis imperfecta

multiple fractures (thinking child abuse)
Blue sclera
hearing loss

13

Thinning scleral collagen revealing choroidal veins

Defect in?

Blue sclera - in osteogenesis imperfecta

thing Autosomal defect in collagen type 1

14

Osteopetrosis is what and due to what?

inhereted defect in bone resorption -> abnormally thick and heavy bone

due to poor osteoclast activity - like carbonic anhydrase II mutations

15

Carbonic anydrase II mutatio nleads to

Osteopetrosis

can't make acidic environment to resorb bone - osteoclasts do not work as well

16

Renal tubular acidosis w/ bone fractures is connected how?

lack of carbonicanhydrase II activity - osteopetrosis

- Normal enzyme activity leads to pumping of H in the lumen of tubules as NH4 and bicarb in the serum, lack of enzyme -> acidosis

17

myelopththisic process due to?

What causes?
Bone fractures
vision and hearing impairment
hydrocephalus

bone thickens out the marrow region leading o anemia, thrombocytopenia and leukopenia, as sen in osteoporosis

hearing and vision loss w/ nerve impingement

hydrocephalus w/ foramen magnum oclusion

18

Rx for psteopetrosis works how?

give bone marrow transplant so you have new source for monocyte derived osteoclasts

19

Defective mineralization of osteoid is called ?

Due to ?

rickets/ osteomalacia

due to VIt D deficiency, osteoblasts make osteoid but not mineralized

20

Active Vit D does what?

3 things

raises serum Ca and phosphate levels by acting on

intestine - increase absorb of Ca and phos
kidney - increase resorb of Ca and phos
bone - increase resorb of Ca and phos

21

1 alpha hydroxilation occur where after what>

in the proximal tubule of the kidney after 25 hydroxylation of Vit D

22

Frontal bossing, pigeon breast deformity, archaic rosary and what other symptom cause ?

What age group

Rickets in kids less than one

Usually also see bowed legs

Frontal bossing - large forehead
pigeon breast - inward bending of the ribs w/ anterior protrusion
rachitic rosary - ostoid deposition at chostochondral angle

23

low serum Ca and phos w/ increased PTH and alk phos seen in ?

Osteomalacia

24

Most common forms of osteoporosis (2)

senile - old age leads to loss of bone mass naturally w/out exercise or diet
postmenopause - lose of estrogen

25

Labs in osteoperosis

Serum Ca, phosphate, PTH and alk phos are NORMAL

26

Mosaic pattern on lamellar done is called?

Due to

Paget disease of the bone

Due to imbalance of osteoclast and osteoblast function in later 60s

27

Clinical features of pagets disease? (4)

Labs

bone pain - improper bone formation
hearing loss -impinged CN8
lion like facies
increasing hat size

- isolated alk phis levels due to isolated osteoblast activity post osteoclast activation (maybe viral)

28

Bisphosphates work in osteoporosis and Pagets due to

inhibition apoptosis of osteoclasts

Can also give calcitonin in pagets

29

2 complications in pagets

osteosarcoma - mutated cancerous osteoblasts
high output cardiac failure - AV shunts in bone -> high pressure

30

2 locations of osteomylitis in adults and kids

causes?

metaphysis in kids due to transient bacterium

epiphysis in adults due to open wounds

31

6 organisms implicated in osteomylitis

staph aureus - most common
N gonorrhea - sexually active
Salmonella - sickle cell
pseudomonas - Diabetics and IV use
pasteurella - Cat and dog bites
mycopbaterium tuberculosis

32

Potts disease

TB and bone vertebrae implicated osteomyolitis

33

Cat and dog bites or scratches and you have osteomylitis caused by

pasteurella

34

Diabetics and IV drug use predispose this infectious organism for osteomyolitis

pseudomonas

35

Lytic focus of necrosis surrounded by sclerosis on x ray

clinical features?

osteomyolitis

Bone pain w/ fever and leukocytosis

36

Ischemic necrosis of the bone or marrow ->

Causes? (4)

avascular aseptic necrosis

Trauma
steroids
sickle cell anemia (dactelitis)
caisson disease - (gas emboli)

37

Gardner Syndrome (3)

Familial adenomys polyposis
fibromitosis in retroperitoneum
osteomas of the facial bone

38

bening tumor on the surface of facial bones

osteoma

39

young adult (<25) comes in w/ a tumor on the cortex of his long bone (the diaphysis)

x ray will reveal

osteoid osteoma

bony mass w/ radiolucent core - (osteiod)

40

Osteoblastoma differs from osteoid osteoma 3 ways

larger than 2cm
arises from the vertebrae - vs cortex of long bones
does not respond to ASA

41

Give ASA for bone pain w/ what tumor

osteoid osteoma

benign tumor of osteoblast

42

most common benign tumor of the bone grows where

Osteochdroma browns as a lateral projection of the growth plate - metaphysics

43

Osteochondroma concerns

transforms to chondosarcoma w/ overlying cartilage cap

44

Sunburst appearance and lifting of the periosteum -> cowman triage seen where?

Peak incidence?

in osteosarcoma

in teens and elderly

45

Osteosarcoma arises where?

Similar to

metaphysis of long bones - usually distal femur and proximal tibia

giant cell tumor except epiphysis

46

Risk factors for osteocarcoma (3)

familial retinoblastoma - teen
paget disease - elderly
radiation exposure - elderly

47

pleomorphic cells that produce osteoid seen on histology

osteosarcoma - malignant

48

Unique feature of giant cell tumor

only bone tumor arising in the epiphysis of long bone

- tumor comprised of multinucleated giant cells and stromal cells

49

Soap bubble appearance on x ray w/ a young adult

giant cell tumor
- locally aggressive and may recur

50

onion skin on x ray in a map child less than 15

ewing sarcoma

periosteum laying down new bone that is circumferentially compressed

malignant proliferation of poorly differentiated cells from neuroectoderm

51

Ewing sarcoma cells derived from

neuroectoderm

May present METS but highly treatable

52

small round blue cells that resemble lymphocyte differential in diaphysis of long bone (3)

Can have fever

Ewing sarcoma - 11:22 translocation
osteomylitis
lymphoma

53

11:22 translocation

Ewing sarcoma

54

Cartilage tumors usually arise from?

medulla of the of bone

55

small bones of the hand present w/ tumor

chondroma

56

tumor of medulla of the pelvis or central skeleton

chondrosarcoma

57

Most common bone tumor

See?

METS

See osteolytic punched out lesions
- EXCEPT prostate and breast cancer -> sclerosis and osteoblastic lesions (breast is also lytic)

58

Articular surface lining the synovial joint is made of what

What is secreted by synovium

hyaline cartilage type II

fluid rich in hyaluronic acid

59

Progressive degeneration of articular cartilage is what?

Affects which joints?

Osteoarthritis

DIP*, PIP, hips, lower lumbar spine, knees

60

Joint stillness in the morning that gradually gets worse throughout the day

Pathologically see (3)

Osteoarthritis

-joint mice- cartilage breaks into the synovium
- ebunartion or polishing of sub chondral bone
- osteophyte formation in the DIP

61

heberden nodes

DIP osteophite formation

62

Bouchard node

PIP osteophite formation

63

HLA DR4

Seen in rheumatoid arthritis

64

Synovitis leading to the formation of a pannus

Rhuematoid arthritis

inflammation -> grannulation tissue w/ associated fibroblasts, blood vessels and myfibroblasts (deviation and ankylosis)

See joint narrowing, loss of cartilage and osteropenia on X Ray

65

ankylosis

fusion - seen in rheumatoid arthritis

66

morning stiffness that improves w. activity

Rheumatoid arthritis

Break gown granulation tissue that build up over night throughout the day

67

Which joints are spared in RA

DIP

Symmetrical involvement otherwise

68

Clinical features of RA? (6)

Arthritis
fever, malaise, weight loss
Rheumatoid nodules
Vasculitis
bakers cyst
Pleural effusions, LAD, intersitial lung fibrosis

69

Lab findings of RA

found in fluid

IgM autoantibody agianst Fc portion of IgG
Rheumatoid factor

See PMNs and high protein


70

Complications of RH(2)

Anemia due to chronic disease
secondary amyloidsosis, acute phase reactants SAA-> AA deposited

71

HLA B27

Seronegative spndyloarthritis

72

Seronegative Spondyloarthritis (3)

Meaning?

Ankylosing spondyloarthritis
Reiter syndrome
Psoriatic arthritis

Means lack of RA factor, HLA B27 and Axial skeleton involvement

73

Bamboo spine

Presentation and target group
Extra articular (2)

ankylosing spondyloarthritis

young adults usually males w/ low back pain -> fusion of vertebra

Uveitis(red eye/blind)
aoritis (potential aneurism and regurgitation)

74

Reitor syndome qualified by (3)

Seen when

Urethritis, conjunctivitis, arthritis
-Cant see, can't pee, can't climb a tree

Post GI or chylamidia trachomatis infection

75

Sausage fingers/toes

Seen in sporadic arthritis - 10% of psoriasis

Axial and peripheral joints and DIP commonly

76

Infectious arthritis presentation and causal agents (2)

N gonorrhoeae - young adults
S aureus - older children and adults (2nd most common)

Single joint usually the knee
- warm joint w/ limited range of motion fever, leukocytosis and elevated ESR

77

Gout is due to generally -

hyperuricemia

Hyper purine metabolism or decreased excretion by the kidney

78

2 types of Gout (2; 1 and 3)

Primary - unknown cause due to hyper urea production and deposition of monosodium in tissues

Secondary
-Leukopenia and myeloproliferative disorders
-Lesch nyhan syndrome
-renal insufficiency

79

Deficiency in what enzyme leads to symptoms of mental retardation and self mutilation

Lesch Nyhan syndrome
- missing hypoxanthine guanine phosphoribosyltransferase

-> rescues hypoxthanthine and guanine before they are converted by xanthine oxidase xanthine and ultimately uric acid

80

Acute inflammatory reaction that is precipitated by consumption of alcohol or meats

Acute gout - commonly affects the big toe (podagra)

alcohol- slows excretion
meats - throws more purine into the system

81

tophi is made of what?

Associated w/

white chalky aggregates of uric acid crystals and fibrosis and giant cell reaction

- Chronic gout

82

Chronic gout leads to

renal failure w/ deposition of crystals in the kidney tubules

83

negative birefringence under polarized light

yellow, needle shaped, associated w/ hyperuicemia gout

84

rhomboid-shaped crystals w/ positive birefringence under polarized light

pseudogout

due to calcium pyrophosphate dihydrate deposition

85

malar rash w/ ANA and bilateral proximal muscle weakness

Dermatomysitis
NOT SLE

86

Clinical features of dermatomyositis (1 +3)

bilateral proximal muscle weakness-> distal weakness (can't comb hair can't climb stairs)

Rash on
-upper eyelid (heliotrope, purple)
-malar rash
-red papules on elbows, knuckles and knees

87

Anti jo 1 antibody

See also in lab (2)

dermatomyosisits

Also have ANA and increase creatine kinase

88

Perimysial inflammation (CD4 T cells) w/ perivascular atrophy

Dermatomyositis
- periphery of fascicle - closer to skin...(rashes)

differs from polymyositis w/ inflammation of endomysial inflammation w/ CD8

89

Polymyositis

-pathophys?

bilateral proximal muscle weakness w/out skin rash

- endomysial inflammation w/ necortic muscle fibers on biopsy

90

What needs to be ruled out with dermatomyositis?

underlying carcinoma especially gastric carcinoma

91

X linked muscular dystrophy(2) is due to what?

Duchenne -deletion of dystropin gene

Becker - mutation of dystropin gene

92

Dystophin is implicated in what and important for what?

in x linked muscular dystrophy

important in anchoring muscle cytoskeleton and EC matrix

93

Kid presents w/ calf that feels fatty around 1 yrs old

muscular dystrophy - X linked
Calf pseudohypertrophy

aslod find elevated serum creatine

distal muscles overworked when learning to walk and eventually replaced w/ fat (dystrophy)

94

cause of death in duchenne dystophy

due to replacement of myocardium or diaphragm w/ fat and have cardiac or respiratory failure

95

mutated dystophin leads to

beckers muscular dystophy, still have some protein made -> milder disease

96

presentation of muscle weakness that gets worse w/ use especially the eye (ptosis and diplopia)

pathophys?

Myasthenia gravis

Autoantobodies to the postsynaptic ACh receptor at the neuromuscular junction, less ACH w/ repeated use -> less ability to overcome the Ab blockade

97

Rx strategy in myasthenia gravis

acyetycholinesterase inhibitors -> more ACh around

Does not work in Lambert Eaton Syndrome due to lack of ini alt ACh w/ AB against the Ca channel

98

Association w/ myasthenia gravis and action?

thymic hyperplasia or thyoma

removal -> improvement in symptoms

99

Proximal muslce weakness that gets better w/ use and eyes are NOT affected

Patho-phys

Lambert Eaton Syndrome

Autoantibodies against the Ca channel presynaptically preventing depolarization and ACh release

Symptoms improve w/use due to increased Ca gradient -> eventual overwhelming of Ab

100

Lambert Eaton Syndrome etiology

due to paraneoplastice syndrome - often small cell carcinoma; resolves w/ removal

101

Lipoblast are characteristic of?

liposarcoma - most common malignant soft tissue tumor;

102

most common soft tissue tumor in adults benign

lipoma

103

Cardiac rhabdomyoma is associated w/ what syndrome

tuberous sclerosis

Rhabsomyoma - benign tumor of skeletal muscle

104

malignant skeletal muscle tumor?

Patient population and common site?

rhabdomyosarcoma

most common in kids
-vagina in girls; head and neck

105

rhabdomyoblast characteristic of ?

what is the name of the intermediate filament associated w/?

rhabdomyosarcoma

desmin

106

Layers of the skin top to bottom (4)

Stratum corneum
Stratum ganuosu,
Strum Spinosum
Stratum basalis

107

atopic dermatitis (eczema) location and description

flexor regions,
puritic erythematous oozing rash w/ vesicles and edema

108

Eczema is often associated w/

asthma and allergic rhinitis

Type 1 hypersensitivity

109

Contact dermatitis location and description

differs from eczema?

Where contact w/ allergen - poison ivy, nickel, drugs, irritants

puritic erythematous oozing rash w/ vesicles and edema

differs in type IV hypersensitivity

110

Comedome vs pustule vs nodule

comedome - white head/ black head blockage w/ excessive sebum and keratin production

Pustule/pimple is inflammation

nodule is scarred pustule

111

infectious agent in acne

MOA

proptionibacterium acnes

produces lipases that break down sebum releasing pro inflammatory FA

112

Rx for acne

benzoyl peroxide - antimicrobial
Vit A Isotretinoin - maintains specialized epithelial cells

113

Psorisis location and descripition

well circumscribed salmon colored plaque w/ silver scales

Extensor surface and scalp

may see pitting nails

114

HLA -C and areas of trauma

associated w/ triggering of psoriasis

115

Acanthosis

epidermal hyperplasia - psoriasis

116

parakeratosis

hyperkeratosis and retention of keratinocyte nuclei
-psoriasis

117

munro microabcesses

collection of PMNs in the stratum corneum

118

elongated dermal papillae the has thinned epidermis and picks when bleeds

auspitz sign
- psoriasis

119

5 Ps in Lichen Plansus

Puritic
Planar
Polygonal
Purple
Papule

120

Lichen Plansus normally attacks the (3)

wrists
elbos
oral mucosa - Wickham striae - reticular white lines)

121

Wickham striae -

reticular white lines of the oral mucosa in lichen planus

122

sawtooth appearance at the dermal epidermal junction

Associated w/ what infection

lichen planus

Chronic Hep C

123

autoimmune destruction of demosomes called?

occurs where?

pemphigus vulgaris

IgG attacks desmoglein (type II hypersensitivity) - separation of stratum spinosum

Skin AND oral mucosa

124

autoimmune destruction of hemidemosomses called?

Occurs where?

bullous pemphigoid

IgG attacks the hemidesmosome component of BM (BP180)

Only in the skin

125

Acantholysis

Separation of stratum spinsosum keratinocytes -> subrabasal blisters

pemphigus vulgaris

126

Nikolsky's sign

Immunofloresence

thin walled bullae that easily rupture - does not include the BM w/ desmosome IgG attack
-> shallow erosions w/ dried crust

Seen in pemphigus vulgaris

Fish net w/ IgG attacking the desmosome,

127

Tense bullae that do not rupture, autoimmune disease of the skin

Immunoflorescene?

Bullous pemphigoid

Linear IgG Attacking the BM

128

Deposition of IgA at the tips of the dermal papillae?

Often due to ?

Dermatitis herpetiformis
- vesiculal lesions

Celiac

129

dematitis herpetiformis presentation (2)

puritic vesicles and bollae grouped - herpetiform

130

Targetoid rash and bullae that may be seen after a drug (penicillin) given is called?

erythema multiform

targetoid w/ central epidermal necrosis

131

Common cause of erythema multiform (5)

HSV - most comon
Mycoplasma
drugs (penicillin and sulfonamides)
Autoimmune - SLE,
Malignancy

132

Stevens Johns syndrome characterized by

Erythema multiform w/ oral mucosa/lip involvement and fever

133

diffuse sloughing go the skin resembling a large burn, often due to adverse drug reaction

Toxic epidermal necrosis

Progression of erythema multiforme -> steven johnson syndrome

134

Erythema nodosum is ?



acute, nodular, erythematous eruption that usually is limited to the extensor aspects of the lower legs.

- pain in subQ fat
most common form of panniculitis

135

Erythema nodosus cause (6)

tuberculosis,
bacterial
deep fungal infection,
sarcoidosis,
inflammatory bowel disease
cancer

136

waxy stuck on appearance

See on histology

Seborrheic keratosis, common in elderly = extremities and face

see keratin pseudocyts on histology

137

Sudden onset of multiple seborrheic keratosis is called what? and worried of?

Leser Trelat sign

Worry about underlying carcinoma of GI

138

Acanthosis nigricans characterized by? (2)

Seen where? (2)

epidermal hyperplasia

darkening of the skin
-velvet like

axilla or groin

139

dark velvety skin seen on a patient may indicate 2 things

insulin resistance (DMII)
malignancy - gastric carcinoma

140

Elevated nodule w/ cental ulcerates crater surrounded by dilated telangictatic vessel

pink pearly papules

Basal cell carcinoma

141

Common location and histology of basal cell carcinoma

upper lip(vs squamous cell)

basal cell nodules w/ peripheral palisading

142

Risk factors for skin carcinoma(3)

UVB induced DNA sunlight
Albinosim
Xeroderma pigmentosum - Auto recessive broken nucleotide excision repair mech

143

hyperkeratotic, scaly plaque on the face back or neck

Actinic kertatosis
precursor of squamous cell carcinoma

144

Ulcerated nodular mass on the face, maybe the lower lip

character feature

squamous cell carcinoma

keratin pearls

145

Additional risk factors for squamous cell carcinoma (3)

immunosuppressive therapy (most common CA post transplant)
arsenic exposure
chronic inflammation - burn or draining sinus

146

Keratoacnthoma

Presentation

well differentiated squamous cell carcinoma that develops rapidly and regresses spontaneously

Cup shape tumor filled w/ keratin debris

147

Melanocytes are derived from?

How do they pigment skin?

neural crest cell derived

synth melanin in melanosomes(tyrosine precursor) which are transferred to melanocytes

148

Vitilago pathophys

localized loss of skin pigmentation w/ autoimmune destruction of melanocytes

149

Albinism cause

Types(2)

enzyme defect (usually tyrosinase) impairing melanin production

Just ocular
both eyes and skin (oculocutaneous)

150

small tan - brown macule that darkens w. sunlight exposure due to?

freckle (ephelis)

increased # of melanosomes (NOT melanocytes)

151

Mask of hyper pigmentation w/ pregnancy or OCP

melasma

152

Congenital nevi can be differentiated by the presence of what

hair

153

Acquired nevi progression(3)

junctional nevus - nest of melanocytes at epidermal-dermal junction (kids)

compound nevus - extends to dermis

intradermal nevus - junctional component lost (adults)

154

Signs of melanoma

ABCD

Asymmetrical shape
irregular Border
irregular Color
Diameter >6mm

155

Addititional risk factor for melanoma in addition to sun

dysplastic nevus syndrome
Auto dominant disorder characterized by formation of dysplastic nevi

156

Most important facto in risk of METS in melanoma

depth into the dermis
Breslow thickness

1st radial growth horizontally

157

Lentigo maligna melanoma

lentoginous proliferation (radial) sub variant of melanoma

Similar to superficial spreading, another variant

Both good prognosis

158

Nodular melanoma

early vertical growth variant
poor prognosis

159

acral lentiginous
occurs where
w/ who?

melanoma arises on palms or soles

arises on dark skinned individuals w/out UV exposure

160

impetigo causes(2)

Presentation (3)

Stauph aureus and Streptococcal pyrogenes

*superficial

erythematous macules (flat)-> pustules on the face and eventual rupture
-erosions and dry crusted honey colored lesions

161

Difference between impetigo and cellulitis

Bugs are the same

impetigo is superficial
cellulitis is deeper w/ red tender dwollen rash and fever

162

cellulitis risk factors(3)

recent surgery
trauma
insect bite

(indroducing S aureus and Streptococcal pyrogenes)

163

Surgical emergency surrounding cellulitis

associated feature?

necrotizing fasciitis w/ necrosis of sub Q tissue w/ anaerobic bacteria infection

Crepitus w/ production of CO2

164

Sloughing of skin w/ erythematous rash and fever due to ?

NOT just TENs

Also Staphylococcal scalded skin syndrome
-differs histiologically by separation at strum granulosum vs dermal epidermal junction

165

S aureus virulence factors causing dermicological dysfunction

Exfoliative A and B toxins -> epidermolysis of stratum ganulosum

166

Testicular METS gros to

peri-aortic lymph nodes

167

Ehlers Danlos syndrome is due to a defect in ?

Type V and sometimes type I collegen

Type III in vascular

168

Mutation leading to achondroplasia?

FGFR3

169

Achondroplasia is passed on how?

AD after a sporadic mutation in the germ line
-higher incidence w/ advanced paternal age

homozygous gene -> in utero fatality

170

FGFR3 mutation leads to what?

mutation characterized by?

Achrondroplasia

mutation leading to a constitutively active fibroblast growth factor receptor that inhibits chondrocyte proliferation so it won't lay down new cartilage interfering w/ endochondral ossification

171

2 Benign bone primary bone tumors and associated age groups

Osteoclastoma seen in 20-40 yr olds

Osteochondroma seen in <25 yrs; males

172

2 Malignant primary bone tumors and associated age groups

Osteosarcoma seen in males 10-20

Ewing sarcoma seen in males <15

173

Soap supple appearance on x ray at the ditsal femur or proximal tibia

osteoclastoma (also called giant cell tumor)
-benign proliferation of osteoclasts

174

mature bone w/ cartilaginous cap seen on long metaphysics of bone

Osteochondroma
- benign

May be a type of haramtoma

175

Most common malignant bone tumor in kids

Osteosarcoma

176

2 X ray signs seen in osteosarcoma

Codmans triangle - periosteum is lifted off the bone by the tumor

sunburst sign - opacification

177

Oning skin appearance of the bone seen in what tumor and where

Translocation?

Ewing sarcoma - extremely aggressive

disruption and destruction of the diathesis of long bones, pelvis, scapula and ribs

T11:22

178

Common METS to the bone? (6)

Lytic vs blastic

More common than primary tumors
Permanently Relocated Tumors Like Bone

Prostate - Blastic
Renal cell carcinoma
Testes/ Thyroid
Lung - Lytic
Breast - BOTH

179

presentation of hypercalcemia and diffuse bone pain ?

think of METS to the bone

may have epidural spinal cord compression and associated sensory and motor deficits along w/ bowel dysfunction

180

Primary defect in osteoporosis?

Lab Values?
Ca?
Phos?
ALP?
PTH?

Overactive osteoclasts compared to osteoblasts

All normal

181

Primary defect in Pagets Disease of the bone?

Lab Values-
Ca?
Phos?
ALP?
PTH?

Overactive osteoclast and osteoblasts -> unorganized remedying of the bone (marbled)

Ca - normal
Phos - normal
ALP - increased due to turnover
PTH - normal

182

Primary defect in osteomalacia?

Lab Values?
Ca?
Phos?
ALP?
PTH?

Also known as rickets in kids, Vit D deficiency leading to inability of mineralize osteiod made by osteoblasts
Ca- Low
-> Increased PTH
-> Low Phos
-> increased ALP

183

Primary defect in osteopetrosis

Lab Values?
Ca?
Phos?
ALP?
PTH?

Mutation -> lack of carbonic anhydrase II leading to lack of osteoclast function

Increased ALP w/ thickened dense bone
may have decrease in Ca -> increase in PTH

184

Primary defect in osteitis fibrosa cystica

Lab Values?
Ca?
Phos?
ALP?
PTH?

Hyperparathyroidism either due to primary cause or due to type 1A psuedohyperparathyroidism (PTH resistance in renal tubules)

HIGH PTH
-> increased Ca
-> decrease in Phos
may or may not have increased ALP

185

Renal insuffiency will have what effect on bone density

Lab Values?

Lack of dihydroxylation of Vit D will lead to decreased Ca

-> increased PTH
-> INCREASED Phos (unable to excrete)

186

Brown tumors found where?

found in osteitis fibrous cystica where excess PTH due to primary hyperparathyroidism or psuedohyperathyroidsm (Renal receptors resistant to PTH)

-> excess osteoclastic activity and cystic lesions filled w/ fibrous stroma and blood found in bone

187

Bone replaced by fibroblasts, collagen and irregular trabecular is called?

Part of what triad?

polyostic fibrous dysplasia

Part of McCune -Albright syndrome
- precocious puberty
-cafe au lait spots

188

First line Rx w/ osteoperosis(3)

what also is considered?

bisphosphates
- alendronate
-risendronate
-etidronate

pulsitile PTH also
-Teriparatide

189

Behavior changes that prevent osteoporosis ((6)

stop
-smoking
-alcohol
-steroids
-H2 and PPIs (need H for Ca absorption)
-heparin (long term)

Weight bearing exercise

190

Concern w/ bisphophates (2)

erosive esophagitis
osteonecrosis of the jaw

191

Bisphosphates indicated for (3)

osteoporosis
Pagets disease of the bone
humoral hypercalcemia from malignancy
( PTH related peptide - paraneoplastic effect of small cell lung cancer for example)

192

bone pain, with bone enlargement and arthritis

Pagets disease of the bone

193

vertebral compression fractures

osteoperosis

194

Pagets disease of the bone is at an increased risk of what sequlae?

osteosarcoma


- may also have hearing loss w/ auditory foramen narrowing

195

Mutation in carbonic anyhdrase II is called?

Presentation? (3)

Osteopetrosis

Thick brittle bone-> fractures
cranial nerve impingement w/ excess bone
panyctopenia ( thrombocytopenia, infection) due to loss of bone marrow

196

RANK L inhibitor

Denosumab
-inhibits osteoclastic activity

-Remember osetoblast is the initiating factor that activates osteoclasts

197

SERM used for osteoporosis

Raloxifene

Tamoxifen used for Breast CA

198

Positive anterior drawer sign

ACL injury

199

Unhappy triad is due to what?

Composed of what?

lateral force applied to planted foot leading to damaged

ACL
MCL
meniscus (lateral more common than medial)

200

Housemade knee

prepatellar bursitis

201

clergyman knee

infraplatellar bursitis

202

Rotator cuff muscles and function

SItS

Supraspinatus - 1st 15 degrees of abduction
Infraspinatous - lateral rotation
teres minor - lateral rotation
Subscapularis - medial rotation

203

Most common torn rotator cuff muscle and test

Supraspinatous is most common torn rotator cuff muscle

Test with empty can test

204

Dislocated shoulder is

head of the humerus comes out of glenoid cavity

205

separated shoulder is

clavicle separates from the acromion process and coracoid process

206

subacromial buristis

impingement between head of the humorous and corocoaronial arch

207

shoulder impingement?

seen in?

acromion process compresses the supraspinatus tendon

repetitive overhead activities - baseball, tennis

208

Bones of the Wrist

So Long To Pinky Here Comes The Thumb

scaphoid - proximal lateral
lunate
triquetrum
Pisiform - Proximal medial
Hamate - distal medial
Capitate
Trapezoid
Trapezium - distal lateral

209

pain in the anatomic snuff box break in

worry about?

scaphoid bone injury

necrosis to the proximal bone due to retrograde blood flow

210

Ankle sprain more likely to tear (3)

Lateral
-Anterior talofibular ligament
-Calcaneo fibular ligament
-Posterior talofibular ligament

Medial - rare
-deltoid ligament

211

Most hip locations occur where?

Risk of damaging what?(5)

posterior dislocation

medial circumflex and lateral circumflex of deep femoral artery
femoral vein,
femoral nerve
head of femur

212

Most common knee injury < 45?

Presents as?

Rx? (4)

Patellofemoral syndrome

anterior knee pain exacerbated w/ activity

strengthen quadriceps
stretching exercises - hamstrings, calves, hip, iliotibial band
minimize hard movement (jogging, stop and starts)
maximize walking and low impact

213

Pain beneath the calcaneus that is worse int he first few steps in the morning and after weight bearing?

Plantar fasciitis

214

Structures damaged by anterior shoulder location?

test what nerve by doing what?

axillary nerve
posterior circumflex artery
supraspinatous tendon
anterior glenohumeral ligaments- seperation
posteriolateral glenohumeral ligaments - abrasion

stroke the deltoid for sensation before reduction

215

Painless thickening of flexor tendons of the palms - usually affecting which finger?

Risk factors (4)

Dupuytrens contraction
- 4th

unknown etiology but risks:
-male
->40
-family
-alcohol/smoking

216

Frozen shoulder is?

adhesive capsulitis due to shoulder adhesions that lock the shoulder after disuse with an injury

especially if > 50 , woman and diabetic

217

Excessive bruising and bulge midhumoral think?

bicep tendon rupture

popye lesion

218

Large bump seen over the elbow that is painless

olecronon bursitis

Rx w/ needle to drain

219

tennis elbow is injury to?

lateral epicondylitis

inflamed lateral epicondyle and wrist extensors

220

golfers elbow?

medial epicondylitis

inflamed medial epicondyle and wrist flexors

221

eburnation

polished ivory like appearance of bone in OA

222

Radiographic changes in Osteoarthritis(3)

sclerotic changes
joint narrowing
ostrophyte formation

223

Presentation of Osteoarthritis

which joints in the hand(2)

Rx:

pain in weight bearing joints that gets worse during the day and with use

affects the DIP and PIP
-NO MCP

improves w/ rest, NSAIDs, acetaminophen (scheduled), hyaluronic acid, glucocorticoid injection, opiods

224

heberdens nodules vs bouchards nodules

osteophyte formation in OA in the DIP vs PIP respectfully

225

Predisposing factors for OA vs RA

age, weight and abnormal joint deformity vs

female and HLA DR4

226

Presentation of RA (4)

joints of the hands affected (2)

morning stiffness lasting >30 min,
gets better with use,
symmetrical joint involvement
w/ systemic features (fever, fatigue, pleuritis, pericarditis)

Affects the MCP and PIP
-NO DIP

227

Bakers cyst commonly seen w?

RA

228

Hypersensitivity type of RA?

Associated antibodies (2)

Type 3

Rheumatoid factor- IgM to IgG antibody (not specific)
Anticitrullinated peptide protein (ACPA) - more specific

229

Advanced RA of the hand pathology (4)

ulnar deviation of fingers

subluxation

Boutonnieres - flexed PIP and extended DIP

Swan neck deformity - extended PIP and flexed DIP

230

Rx for RA (5)

NSAIDs
DMARDs
- methotrexate
-sulfasalazine
-TNF alpha inhibitors
-hydroxychloroquine

231

TNF alpha inhibitors (5)

Etanercept
Infliximab
adalimuxiab
golimumab
certolizumab

232

Radiographic findings in RA (3)

pannus formation
bone and cartilage erosion
increased synovial fluid

233

Uses of n acytylcystine?(3)

acetaminophen overdose
mucolytic in CF or intubation
nephropathy prevention w/ contrast

234

Risk of Celexicob use? (3)

thrombosis (not for those w/ CV family risk)
sulfa allergies
gastritis or ulcers (still some effect)

235

Renal problems w/ NSAIDS (2)

Others? (3)

Acute interstitial nephritis

Decreased renal perfusion w/ less prostaglandins keeping open the afferent arteriole


Gastritis/ peptic ulcer w/ COX1 inhib
fluid retention
aplastic anemia

236

how does Acetaminophen differ from NSAIDs?

Biggest toxicity concern?

peripherally inhibited
acts in the CNS as antipyretic and analgesic

NO anti inflammatory

The liver w/ NAPQI metabolites

237

ASA toxicity? (5)

gastric ulceration
tinnitus
acute renal failure
interstitial nephritis
hyperventilation -> respiratory alkalosis
-eventual lactic acidosis -> metabolic alkalosis

238

ASA effect on

bleeding time
PT/INR
PTT

Increases - anti platelet

No effect
No effect

239

Causes of Gout (3)

hyperuricemia -> deposition of monosodium irate crystals may be due to

increased purine food intake
decreased excretion - thiazide/loop diuretic use
Lesch Hyhan syndrome
increased cell turnover w/ Leukemia Rx

240

Podagra

painful swollen, red 1st MTP in gout

241

Gout acute attacks can be due to (2)

large meals

Alcohol use - competes for excretion w/ uric acid

242

Associated Gout findings(2)

Uric acid Tophi - external ear, olecranon bursa, achilles tendon

asymmetrical dystribution

243

Acute Gout attack drugs and MOA

NSAIDS- anti inflammatory
Colchicine - inhibits tublin -> decreased leukocyte chemotaxis
Steroids - anti inflammatory

244

Chronic Gout drugs and MOA (3)

Xanthine oxidase inhibitors
-allopurinol - not to be given acutely due to worsening/prolonging of symptoms
- febuxostat

- probenacid- inhibits uric acid reabsorption from Proximal renal tubule -> increased secretion

245

Chondrocalcinoisis

seen in pseudogout where Ca deposits in the articular cartilage (especially the meniscus of the knee) leading to Calcification seen on x ray

246

How does psuedogout differ from gout

Pseudo gout is rhomboid positive birefringent w/ parallel light

also usually affects large joints

Rx is the same

247

Pathology associated w/ HLA B27

PAIR - seronegative spondyloarthropathies

Psoriatic arthritis
ankylosing spondylitis
inflammatory bowel disease
Reactive arthritis

No Rheumatoid factor, more often males

248

Pencil in cup deformity seen on x ray?

psoriatic arthritis

especially the DIP

249

symptoms of psoriatic arthritis

Joints?

dactylitis
asymmetric and patchy involvement affecting the fingers (DIP), spine and sacroiliac

250

Uveitis and aortic regurgitation are often associated w?

How can you improve the primary problem

ankylosing spondylitis - bamboo spine
- can also have conduction abnormalities and CV disease

Exercise helps

251

Reactive arthritis is characterized by(3)?

Pathogenisis vs septic arthritis

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

Conjunctivitis
Urethritis
Arthritis

Differs from septic in that it is a Rxn to the infection after the fact - fluid aspiration shows inflammation ~RA instead of pus and WBCs

252

Infections associated w/ Reactive arthritis (5)

Chlamydia

Post GI
-salmonella, Shigella, Yesernia, campylobacter, clostridium

253

3 forms of Juvenile Idiopathic arthritis

all have onset before 10

Polyarticular JIA(severe and symmetrical)
Pauciarticular JIA (few large joints)
systemic onset JIA (LAD, hepatomegaly, Rash, fever, elevated WBC, anemia prior to arthritis)

254

Infections causing septic arthritis?(3)

presentation (3)

Nessieria gonorrhea
S aureus
Streptococcus

polyarticular, migratory arthritis w/ asymmetric pattern

255

Associations w/ gonococcal arthritis (3)

Diagnose w?

SAD

synovitis - knee
tenosynovitis - hand
dermatitis - pustules

arthrocentesis

256

Check what before starting infliximab and the like?

PPD because TNF alpha inhibitors may reactivate latent TB

257

TNF alpha agents implicated for what arthritic processes(3)

RA
psoriases
ankylosing spondylitis

258

See elevated CK in this X linked muscle disease

Duchennes and Beckers

259

Difference between Duchene and beckers on molecular level

both X linked
Duchenne is a Deletion in dystophin -> accelerated mucle brakdown

beckers is a mutation

260

Qower's manuever

seen in duchenne doe to pelvic muscles being weak and needing to use hands

261

Sjogren's antibodies(3)

SS-A (rho)
SS-B (La)

occasionally rheumatoid factor or SLE

262

Triad of sjogrens syndrome

associated complications (3)

Xerophthalmia - dry mouth
Xerostomia - dry eyes
arthritis

parotid enlargment
B cell lymphoma risk
dental carries

263

ANA + in (7)

SLE
sjogrens
polymyostitis/dermatomystitis
Scleroderma
RA
juvenile Idopathaic arthritis
mixed connective tissue disease

264

Libman sacks endocarditis?

sterile vegitations seen in SLE

265

Common cause of death in SLE?

Check what to prevent?

lupes nephritis (wire loopis)
- Diffuse proliferative if nephritis
-membranous glomerulonephritis is nephrotic

Check serum creatinine and UA for proteinuria

266

Serum Antibody and changes associated w/ Lupus (5)

ANA
Anti DNA - renal associated
Anti Smith
antiphospholipid (anti cardiolipin) - coag risk
decreased C3 and C4 -infection risk

267

Drug induced lupus serum antibody

which drugs?

anti-histone

Sulfonamides
Hydralazine
INH
Phenytoin
Procainamide

268

What may be a false + in SLE

VDRL

269

Symptoms associated w/ SLE
-11 total

Skin(4)
- malar rash
-discoid rash
-photosensitivity
-painless oral ulcers

Inflam(3)
-arthritis (>2 joints, nonerrosive)
-serositis (pleuritis, percarditis)
-+ANA

Organ involvement(3)
- renal (proteinuria, casts)
-Neuro (seizure/psychosis)
-Heme ( anemia, low WBCs, platelets)

Immune(1)
- antiphospholipid, Anti DNA, Anti Smith, false VDRL

270

Polymyalgia rheumatica characterized by?
Associated w?

Labs?(2)

Differs from?

proximal joint pain
-shoulders and hips (Rx steriods)

Elevated ESR
Normal CK

Polymyosistis (proximal muscle pain)

271

Polymyalgia rheumatica associated w/ which vasculitis

temporal arteritis

proximal joint pain(shoulder and hip)

272

Anti jo antibodies

Polymyositis/dermatomyositis

273

difference between polymyositis and dermatomyositis(2)

Both have proximal muscle weakness, symmetrical

Skin involvement in dermatomyositis
- malar
gottrons papules on knuckles
helitrope rash - eyes
mechanics hands - rough hands and feet

CD4 in dermatomyocitis vs CD8

274

Skin involvement in dermatomyositis (4)

malar rash
gottrons papules on knuckles
helitrope rash - eyes
mechanics hands - rough hands and feet

275

Labs in polymyositis and dermatomyositis

CK?
Antibodies? (3)

elevated CK

ANA
Aldolase
anti-jo-1

276

Fibromyalgia is

associated signs?(6)

Rx(4)

Excessive muscle tenderness in 11 out of 18 trigger points

also - generalized pain, fatigue, sleep disturbance, HA, cognitive difficulties, mood changes

pregabalin - anti-convulsent
milnacipran -SNRI

Amytriptyline, fluoxitine

277

Proximal weakness vs distal weakness think

larger muscle disorders like polymyolitis vs distal think nerve disorders

278

anticentromere w?

CREST Scleroderma

279

anti toposiomerase w?

Also called

Scl-70

Diffuse scleroderma

280

Diffuse sceroderma vs CREST prognosis

Rapid widespread skin involvement, potentially fatal while Crest is limited in skin insolvent, often confined to fingers

281

CREST scleroderma stands for?

Calcinosis
Raynauds
Esophageal dysmotility
Scleroderma
Telangiectasia

282

Shiny skin w/ trouble swallowing ?

Check for in blood?

Scleroderma (CREST)

Anticentromere Ab

283

zona occuden uses what proteins (2)

tight junction - impermeable

claudin and occludin

284

zona adherins uses what proteins (2)

adhering junctions

belt w/ actin filaments
and CADherins - Ca dependent adhesion proteins

285

macula adhering uses what proteins

desmosomes to connect cells

keratin interactions w. cadherins
-pemphigous vulgaris

286

Gap junction connects between cells using what protein

connexons

287

Hemidesmosomes use what proteins

connects to basement membrane w/ keratin

integrins also

bullous pemphigoid

288

melanocytes are found in the

stratum basale

289

Fibroblasts are important in producing(4)

collagen
glycosaminoglycan
reticular and elastic cells
glycoprotein

290

The itch that rashes

Rx: (6)

atopic dermatitis

moisturizers w/ emollient
calcineuron inhibitors (tacrolimus, primecromlimus)
UV light - better in the summer
topical steriods
antihistamine
leukotriene inhibitors

291

Common location of atopic dermatitis

in the flexors - behind the knee and in the elbow

Maybe all over a baby that is being cleaned too much

292

verrucae

wart

293

ephelis

freckle

excess melanin NOT melanicytes

294

nevi

mole

295

Linear puritic rash

what type of hypersensitivity

contact dermatitis - poison ivy or nickel

Type IV

296

4 causes and associated Rx w/ Acne

hyperkeratosis - retinoids, isotretinion

sebum overproduction - isotretinion, OCPs, spiranolactone

propioni bacterium acne - erythromycin, tetracyclin, doxy, minocyclycline, clindamycin, benzoyl peroxide

inflammation - steriods

297

isotretinion, OCPs, spiranolactone are all used in RX for

acne

298

Skin disorder associated w/ asthma and allergic rhinits

atopic dermatitis
eczema

299

keratin filled cysts - horn cells

seberrheic keratosis

300

increased stratum spinosum w/ decreased stratum granulosum w/ parakeratotic scaling?

psoriasis

301

Psoriasis is often found where?

on the extensor surface (NOT in folds)
knees and elbows

302

depigmentation due to decreases melanin production

cause?

ambinoism

decreased tyrosinase activity

303

depigmentation due to decrease in menanocyte #

cause?

vitiligo

??

304

darkening of the dace seen in pregnancy or OCP

melasma

305

flaccid blisters w/ Nikolskys sign?

Involve the mouth?

phemphigus vulgaris - IgG against desmoglein 3 or 1

skin just sloughs off

involves the mouth

306

tense blisters w/out Nikolskys Sign?

Involves the mouth

Bullous pemphigoid - IgG against hemidesmosomes, Eoisinophils w/in the blister

No oral involvement

307

Auspitz sign is

may also seen in this derm path unrelated to the skin?

pinpoint bleeding when the silver plaques are scraped off

pitting of the nails

308

puritic papules, vesicles and bullae in extensor surfaces after eating wheat product

Deposition of what?

dematitis herpatiformis in celiac

IgA in the tips of the dermal papillae

309

Erythema multiform is associated(4)

Can lead to ?

DRUGS
- sulfa,
-beta lactim, penicllin
-Anti-Seizure
-allopurinol

also
-infections (HSV, Mycoplasma pneumoniae)
-cancers
- Auto immune

Leads to Stevens Johnson Syndrome and TENS is >30% of the body

310

Presentation of Erythema multiforme

macules and papules forming a target lesion due to central necrosis

thought to be due to microvascular deposition of immune complexes

311

Stevens johnsons syndrome is different from Toxic epidermal necrolysis

Both have fever, bulla formation,necrosis, sloughing skin and high mortality

TENs has > 30% skin involvement

312

See a darkened skin in a flexor think of 2 things (neck or axilla)

diabetes mellatis
>40 gastrointestinal adenocarcinoma (Visceral malignancy)

313

Premalignant derm path treat w/ 5 florouricil

Found by?

actinic keratosis, treat due to squamous cell risk

found by feeling - sandpaper, rough

314

Painful lesion of the fat, commonly found on anterior tibia

Associated path (7)

erythema nodosum

sarcoidosis
TB
histioplasmosis
coccidiomycosis
Post strept
leprosy
Crohns

315

6 Ps of Lichen Planus

associated w/

purple
Puriritic
Papules
polygonal shape
Planar
Plaque

Hepatitis C
-sawtooth infiltrate

316

see a herald patch on the neck and a couple days later see a christmas tree distribution of a rash called?

Rx

Pityriasis rosea

Self resolving in 6-8 wks

317

Necrotising fascititis caused by? (2)

suspect when? (2)

Clostridium perfenges and Strep pyrogenes

-When tenderness is beyond the erythematous border
-crepitis is felt

318

Honey rusted lesions of the superficial skin cause by (2)

Impetigo

Staph aureus
Strep pyrogenes

319

Erythematous painful lesion of the dermis and subcutaneous tissue caused by?(2)

Cellulitis

Staph aureus
Strep pyrogens

320

Exotoxin A and B from staph Aureus responsible for what derm path

pathophys?

Staph Scalded Skin Syndrome

keratinocyte attachment of stratum granulosum is destroyed -> sloughing skin

321

Pink pearly nodules caused by?
Keratin pearls caused by?

basal cell carcinoma
squamous cell carcinoma

322

most common malignant skin pathology

seen histology

basal cell carcinoma,
-Rarely METS locally destructive

palisading nuclei

323

Rolled birders, telanectasias and central necrosis

basal cell carcinoma

324

S 100 tumor marker important in

melanoma

325

Excisional biopsy key in prognosis of what disease

melanoma
- depth is key in risk of METs

Asymetrical
Borders (irregular)
Color (not uniform)
Diameter

326

Thickened scar around face or chest

keloid

327

Calcium deposition seen in a joint that is nonerrosive

acute pain and swelling?

Pseudogout

w. calcium pyrophosphate crystals seen on aspiration