MSK
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- FGFR3 mutation
- achondroplasia -failure of longitudinal bone growth -unaffected membranous ossification -a/w advanced paternal age -AD
- abnl OCs
- osteopetrosis -serum Ca, phos, ALP NORMAL -genetic deficiency of CAII -Erlenmeyer flask bones
- high ALP
- osteitis fibrosa cystica, Paget's dz
- abnl bone architecture caused by inc in OC and OB activity a/w paramyxovirus mosaic bone pattern chalk-stick fractures may cause high output CHF can lead to osteogenic sarcoma
- Paget's dz
- -polyostotic fibrous dysplasia / unilateral bone lesions -endocrine abnl's (precocious puberty) -unilateral pigmented skin lesions
- McCune-Albright syndrome
- most common benign tumors of bone
- osteochondroma (exostosis), giant cell tumor
- bone tumor that usually appears at the epiphysis
- giant cell tumor
- bone tumors that usually appear at the metaphysis
- osteochondroma, osteosarcoma
- intramedullary bone tumors
- enchondroma, chondrosarcoma
- bone tumors of the diaphysis
- Ewing sarcoma, osteoid osteoma
- bone tumors that usu occur at the KNEE
- osteosarcoma, giant cell tumor
- Sjogren's syndrome
- classic triad: dry eyes, dry mouth, arthritis inc risk of B cell lymphoma parotid enlargement ANA(+) - SS-A, SS-B females 40-60
- DIP (Heberden's nodes) and PIP (Bouchard's nodes) involvement
- OA pain in wt-bearing joints AFTER USE
- PIP and MCP involvement
- RA MORNING STIFFNESS
- HLA-DR4
- RA
- HLA-B27
- seronegative spondyloarthropathies -ankylosing spondylitis -Reiter's syndrome -psoriatic arthritis
- can't see can't pee can't climb a tree
- Reiter's syndrome -conjunctivitis and anterior uveitis -urethritis -arthritis
- dactylitis (sausage fingers), pencil-in-cup deformity
- psoriatic arthritis
- a/w Gardner's syndrome often in skull
- osteoma
- interlacing trabeculae of woven bone surrounded by OBs
- osteoid osteoma men<25
- 20-40yrs locally aggressive soap bubble appearance
- giant cell tumor
- men younger than 25 mature bone with cartilaginous cap
- osteochondroma
- men 10-20 Codman's triange, sunburst pattern
- osteosarcoma predisposing factors: -Paget's dz -bone infarcts -radiation -familial retinoblastoma
- hands and feet
- enchondroma
- boys younger than 15 extremely aggressive with early mets, but sensitive to chemo onion-skin appearance long bones, pelvis, scapula, ribs 11:22
- Ewing sarcoma
- men 30-60 pelvis, spine, spacula, humerus, tibia, femur primary origin or from osteochondroma
- chondrosarcoma
- ANA(+) conditions
- 1. SLE 2. Sjogren's, sicca 3. scleroderma 4. polymyositis 5. dermatomyositis 6. RA 7. JA 8. mixed connective tissue dz
- causes of hyperuricemia
- 1. Lesch-Nyhan syndrome 2. PRPP excess 3. dec excretion (due to thiazides) 4. inc cell turnover 5. von Gierke's dz
- yellow crystals under parallel light
- gout
- basophilic, rhomboid crystals that are weakly positively birefringent
- pseudogout
- causes of chronic infxs arthritis
- TB, Lyme dz
- monoarticular migratory arthritis with asymmetrical pattern
- gonococcal arthritis other causes of septic arthritis: S. aureus, Strep
- noncaseating granulomas elevated serum ACE restrictive lung dz bilateral hilar adenopathy erythema nodosum Bell's palsy epithelial granulomas containing microscopic Schaumann and asteroid bodies uveoparotitis hypercalcemia gammaglobulinemia
- sarcoidosis Gammaglobulinemia Rheumatoid arthritis ACE increase Interstitial fibrosis Noncaseating granulomas
- most common NMJ disorder, a/w thymoma
- MG
- paraneoplastic dz, proximal muscle weakness, sx improve with muscle use
- Lambert-Eaton syndrome
- elevated CK
- polymyositis
- elevated ESR, nl CK
- polymyalgia rheumatica
- anti-Jo-1
- polymyositis
- anti-U1RNP
- mixed connective tissue dz
- pain and stiffness in shoulders and hips, a/w temporal arteritis
- polymyalgia rheumatica
- progressive symmetric muscle weakness caused by CD8 T cell-induced injury to myocytes often involves shoulders malar rash heliotrope rash shawl and face rash Gottron's papules inc risk of malignancy inc CK, inc aldolase, ANA(+)
- dermatomyositis
- anti-Scl-70 (anti-DNA topoisomerase I Ab)
- diffuse scleroderma widespread skin involvement, rapid progression, early visceral involvement (lungs, heart, kidneys, GI)
- antiCentromere Ab
- CREST syndrome Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia limited skin involvement, often confined to fingers and face more benign clinical course (than diffuse scleroderma)
- most common soft tissue tumor of childhood
- rhabdomyosarcoma arises from SKM, mostly in head/neck
- separation of epidermal cells
- acantholysis
- epidermal hyperplasia
- acanthosis
- SUPERFICIAL skin infxn from S. aureus or S. pyogenes; very infxs. honey-colored crusting
- impetigo
- infxn of DERMIS and SQ TISSUES by S. pyogenes or S. aureus. acute, painful
- cellulitis
- deep tissue injury from anaerobes or S. pyogenes --> crepitus from methane and CO2 production
- necrotizing fasciitis
- hairy leukoplakia is mediated by ______
- EBV
- fever generalized erythematous rash sloughing of upper layers of epidermis seen in newborns and children
- staphylococcal scalded skin syndrome exotoxin destroys keratinocyte attachments in stratum granulosum
- nl melanocyte number, dec melanin production
- albinism due to dec tyrosinase activity or failure of neural crest migration during development
- dec in melanocyte number
- vitiligo
- mask of pregnancy
- melasma
- nevocellular nevus
- common mole
- ephelis
- freckles
- hyperkeratosis, koilocytosis
- verrucae
- papules and plaques with silver scale acanthosis parakeratosis knees and elbows, scalp and sacral area
- psoriasis usu nonpruritic Auspitz sign - bleeding spots when scales are scraped off
- allergic contact dermatitis and a type ____ hypersensitivity reaction
- IV
- common benign neoplasm of older ppl head, trunk, extremities flat, greasy, pigmented sq epi proliferation with keratinic cysts
- seborrheic keratosis
- premalignant lesions caused by sun exposure small, rough, erythematous or brownish papules
- actinic keratosis "cutaneous horn"
- anti-desmosome IgG acantholysis intraepidermal bullae involving skin and oral mucosa
- pemphigous vulgaris potentially fatal Nikolsky's sign - separation of epidermis upon manual stroking of skin
- anti-hemidesmosome IgG (linear immunofluorescence) eosinophils in blisters spares oral mucosa
- bullous pemphigoid
- recurrent pruritic blistering disorder extensor surfaces of knees, elbows, scalp, upper back, sacral area IgA deposits at tips of dermal papillae a/w celiac dz dermal microabscesses with PMNs and eosinophils at the tips of dermal papillae, which becom
- dermatitis herpetiformis
- macules, papules, vesicles target lesions a/w infxns, drugs, cancers, autoimmune dz
- erythema multiforme
- fever, bullae formation, necrosis, sloughing of skin a/w adverse drug rxn
- Stevens-Johnson syndrome more severe: toxic epidermal necrolysis
- hyperplasia of stratum spinosum a/w hyperinsulinemia, visceral malignancy
- acanthosis nigricans
- sheets and islands of neoplastic epidermal cells, often with keratin pearls
- squamous cell carcinoma -rarely metastasizes -usu appears in sun-exposed areas - [LOWER] face and back of hands -also a/w arsenic, radiation -often originates from actinic keratosis -scaling, indurated, ulcerated nodule
- most common of all malignant skin tumors
- basal cell carcinoma -usu involves sun-exposed areas - head (UPPER face) and neck -almost never metastasizes -pearly papule with telangietasia -palisading nuclei at periphery of tumor cell clusters (darkly staining basaloid cells)
- arises from melanocytes or nevus cells S-100 tumor marker
- melanoma -excessive exposure to sunlight -DEPTH of tumor correlates with risk of mets
- a/w HepC sawtooth infiltrate of lymphocytes at dermal-epidermal jct
- lichen Planus Purple, Pruritic, Polygonal Papules
- multiple papular eruptions herald patch --> christmas tree distribution remits spontaneously
- pityriasis rosea
- inflammation of SQ fat, usu on shins
- erythema nodosum
- What are some conditions that involve erythema nodosum?
- coccidiodomycosis histoplasmosis TB leprosy strep infxns sarcoidosis
- bisphosphonates
- "dronates" inhibit OC activity reduce formation and resorption of hydroxyapatite uses: hyperCa of malignancy, Paget's dz, postmenopausal osteoporosis
- SE of bisphosphonates
- corrosive esophagitis, nausea, diarrhea
- treat acute gout
- colchicine - stabilizes tubulin and inhibit polymerization; GI SE indomethacin
- treat chronic gout
- probenecid - inhibit reabs of uric acid allopurinol - inhibit xanthine oxidase, can inc asathioprine and 6MP concentrations DO NOT give salicylates. all but the highest doses depress uric acid clearance.
- reversibly inhibit COX2
- celecoxib uses: RA, OA SE: inc risk of thrombosis (relative inc in TXA2), sulfa allergy
- reversibly inhibits COX in CNS; inactivated peripherally
- acetaminophen NO anti-inflammatory activity
- antidote for acetominophen toxicity
- N-acetylcysteine - regenerate glutathione
- COX isoform found in inflammatory cells and vascular endothelium
- COX-2
- LTB4
- PMN chemotactic agent "PMNs arive B4 others"
- irreversibly inhibits COX
- aspirin low dose (less than 300mg): inhibit plt aggretation intermediate dose: antipyretic and analgesic high dose (2400-4000): anti-inflammatory
- aspirin SEs
- gastric upset renal failure, interstitial nephritis upper GI bleeding Reye's syndrome
- SE of NSAIDS
- renal damage aplastic anemia GI distress ulcers
- dec plt aggregation vasoD dec uterine tone
- PGI2
- bronchoC vasoC inc cap permeability
- LTC/D/E4
- prostaglandins
- dec vascular tone inc pain inc temp inc uterine tone
- zileuton
- blocks lipoxygenase
- zafirlukast, montelukast
- block leukotriene formation
- etanercept
- "etanerCEPT is a TNF decoy reCEPTor" uses: RA, AS, psoriasis
- infliximab
- anti TNF ab uses: RA, AS, Crohn's SE: TB reactivation