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Goljan Muscles/Skin

Monosodium urate crystals (MSU) yellow when parallel to slow ray of compensator
Calcium pyrophosphate crystals (pseudogout) blue when parallel to slow ray of compensator
Osteoarthritis degeneration articular cartilage; subchondral cysts; eburnation; osteophytes at margins
Joints weight bearing (femoral head); DIP joint (Heberden’s nodes), PIP joints (Bouchard nodes)
Neuropathic joint 2° to neurologic disease; DM, syringomyelia, tabes dorsalis
Rheumatoid arthritis (RA) female dominant; HLA Dr4
RF IgM antibody against Fc portion IgG; causes inflammation of synovial tissue
Pannus inflamed hyperplastic synovial tissue destroys articular cartilage; joint fusion
Joints MCP and PIP joints
S/S morning stiffness; ulnar deviation of hands; carpal tunnel (entrapped median nerve)
Rx methotrexate often used as initial therapy, aspirin
Sjogren’s syndrome destruction lacrimal and minor salivary glands; RA; anti-SS-Ro/SS-La (SSa and SSb)
S/S dry eyes and dry mouth
Caplan syndrome pneumoconiosis + rheumatoid nodules in lungs
Felty’s syndrome RA + splenomegaly with hypersplenism
Gouty arthritis underexcretion uric acid; big toe first affected; tophus in soft tissue sign chronic gout
Gout associations alcohol, Pb poisoning
Tophus MSU crystals produce foreign body giant cell reaction next to joint
Uricosuric agents probenecid and sulfinpyrazone
Allopurinol ↓ synthesis uric acid; xanthine oxidase inhibitor
Pseudogout involves knee; linear calcification in articular cartilage
Ankylosing spondylitis HLA-B27 seronegative (RF negative) spondyloarthropathy; male dominant
S/S sacroiliitis; bamboo spine causing kyphosis; aortitis; uveitis
Associations C. trachomatis MC, psoriasis, ulcerative colitis, Shigella, Campylobacter, Yersinia
Reiter’s syndrome HLA-B27; Chlamydia urethritis; arthritis; conjunctivitis; Achilles tendon periostitis
Osteomyelitis children hematogenous spread of Staphylococcus aureus to metaphysis
Osteomyelitis in HbSS Salmonella paratyphi
Pseudomonas aeruginosa osteomyelitis puncture of foot when wearing rubber foot wear
Tuberculous osteomyelitis usually involves vertebra (Pott’s disease)
Disseminated gonococcemia female dominant; C6-C9 deficiency
Disseminated gonococcemia septic arthritis (knee); tendinitis/synovitis and skin pustules in feet/wrists
Lyme disease bite Ixodes tick; Borrelia burgdorjeri; reservoirs white footed mouse, white tailed deer
Early S/S erythematous concentric rash (erythema chronicum migrans), Rx doxycycline
Late S/S arthritis, Bell’s palsy (often bilateral), myocarditis, Rx doxycycline
Babesiosis carried by Ixodes tick; Babesia are intraerythrocytic parasites; hemolytic anemia
Cat bite potential for Pasteurella multocida septic arthritis
Osgood Schlatter’s inflammation proximal tibial apophysis at patellar tendon insertion; knobby knee
Osteogenesis imperfecta AD; ↓ synthesis type I collagen; pathologic fractures; blue sclera
Blue sclera reflection choroidal veins
Achondroplasia AD; impaired enchondral calcification and premature closure of epiphyses
S/S normal head/vertebral column, short extremities
Osteopetrosis AD/AR; osteoclast defect; too much bone; pathologic fractures
Osteoporosis ↓ bone mass and density; pathologic fractures
Postmenopausal osteoporosis estrogen deficiency - ↑ osteoclastic activity, ↓ osteoblastic activity
S/S vertebral compression fractures, Colles fracture
Colles fracture fractured distal radius with dinner fork appearance
Prevention estrogen (under investigation), calcium, vitamin D, stress exercises (walking, weight lifting)
Aseptic necrosis femoral head femoral head fracture, corticosteroids, sickle cell disease; MRI best test
Scaphoid bone fracture aseptic necrosis in wrist bone
Volkmann’s ischemic contracture fracture of distal radius; damage to brachial artery and median nerve
Legg-Perthe’s disease aseptic necrosis of ossification center (femoral head) in children
Paget’s disease elderly males; lytic/blastic bone lesions produce thick, weak bone
S/S pathologic fractures; ↑ serum AP; ↑ risk for osteogenic sarcoma
Osteoid osteoma radiolucent lesion in cortex proximal femur; nocturnal pain relieved by aspirin
Osteogenic sarcoma adolescent male; RB suppressor gene association; distal femur; ↑ AP
Radiograph “sunburst” appearance, Codman’s triangle
Ewing’s sarcoma primitive neuroectodermal tumor; round cell tumor
Radiograph “onion skinning”
Osteochondroma MC benign bone tumor; exophytic growth off metaphysis of distal femur
Chondrosarcoma MC malignant cartilaginous tumor; pelvic bones, proximal femur
Giant cell tumor epiphysis distal femur/proximal tibia; giant cells + neoplastic mononuclear cells
Muscle weakness primary muscle disease, neurosynapse disease, neurogenic disease
Duchenne’s muscular dystrophy XR; deficiency dystrophin; ↑ serum CK at birth; waddling gait
Dystrophin attaches portions of cell membrane to sarcomere; important in contraction
Becker’s dystrophy XR, defective dystrophin
Myotonic dystrophy AD; trinucleotide repeat disorder; cannot release grip
Myasthenia gravis autoantibody against acetylcholine receptors (type II); thymic hyperplasia B cells
S/S diplopia at end of day first sign; dysphagia solids/liquids upper esophagus; thymoma
Dupuytren’s contracture fibromatosis palmar fascia
Lipoma MC soft tissue tumor
Liposarcoma MC adult sarcoma
Embryonal rhabdomyosarcoma MC childhood sarcoma
Autoimmune disease loss of self-tolerance
Serum ANA greatest sensitivity for detecting SLE
SLE type III reaction; confirm with anti-dsDNA, anti-Sm
S/S malar rash, photophobia, joint pain, fibrinous pericarditis, nephritic GN
Drug-induced lupus procainamide, hydralazine; anti-histone antibodies
Antiphospholipid antibodies lupus anticoagulant, anti-cardiolipin antibodies; vessel thrombosis
PSS excess collagen; anti-topoisomerase antibodies
S/S dysphagia solids/liquids, Raynaud’s, intersitial lung disease, renal failure
CREST centromere antibody/calcinosis; Raynaud; esophageal dysmotility; sclerodactyly; telangiectasia
Dermatomyositis/polymyositis ↑ serum CK; risk of malignancy
Mixed connective tissue disease anti-ribonucleoprotein antibody
Antibody against acetylcholine receptor myasthenia gravis
Antibody against basement membrane Goodpasture’s syndrome
Antibody against endomysium and gliadin celiac disease
Antibody against insulin and islet cell type I diabetes
Antibody against intrinsic factor and parietal cell pernicious anemia
Antibody against microsome and thyroglobulin Hashimoto’s thyroiditis
Antibody against mitochondria primary biliary cirrhosis
Antibody against proteinase 3 of neutrophil (cANCA) Wegener’s granulomatosis
Antibody against myeloperoxidase of neutrophil(pANCA) microscopic polyangiitis
Antibody against TSH receptor Graves disease
Ichthyosis vulgaris ↑ thickness of stratum corneum; absent granular layer
Solar lentigo “liver spot” in elderly; increased melanocytes
Senile purpura trauma to fragile vessels on dorsum of hands; normal finding in elderly
Acute eczema weeping rash with vesicles
Chronic eczema dry, thickened, pruritic skin
Atopic dermatitis dry skin, eczema (type I reaction); children - face, intertriginous areas
Allergic contact dermatitis type IV hypersensitivity; poison ivy, nickel rash
Contact photodermatitis tetracycline; rash in sun exposed areas
Superficial dermatophytoses KOH preparation shows fungi located in stratum corneum
Tinea capitis Trichophyton tonsurans MCC (negative Wood’s lamp)
Tinea capitis child with dog Microsporum canis (positive Wood’s lamp)
Tinea versicolor hypopigmentation; Malassezia furfur; “spaghetti” (hyphae)/”meatball” KOH
Seborrheic dermatitis dandruff; Malassezia furfur
Molluscum contagiosum poxvirus; bowl-shaped with central depression filled with keratin
Rubeola Koplik’s spots; Warthin-Finkeldey giant cells
Rubella teratogenic; rash; postauricular adenopathy; arthritis in adults
Parvovirus “slapped face”; RBC aplasia, aplastic anemia (HbSS), spontaneous abortions, arthritis
Roseola HSV-6; high fever and then rash
Toxic shock syndrome toxin-producing S. aureus; tampon wearing; hypotension, desquamating rash
Scarlet fever group A streptococcus with erythrogenic toxin; strawberry tongue
Actinic (solar) keratosis precursor for squamous cell carcinoma; recur when scrapped off
Psoriasis elevated salmon-colored plaques covered by silver-colored scales; nail pitting
Pityriasis rosea herald patch followed by rash in lines of cleavage
Varicella chickenpox; rash at different stages; Reye syndrome association
Herpes zoster vesicular rash following a sensory dermatome
HSV and Varicella-zoster virus remain latent in sensory ganglia
Impetigo group A streptococcus; honey crusted lesions on face
Pemphigus vulgaris autoimmune disease; IgG antibodies against intercellular attachment sites
Pemphigus vulgaris intraepidermal bullae; acantholytic cells; row of tombstones
Bullous pemphigoid autoimmune disease; IgG antibodies against basement membrane
Bullous pemphigoid subepidermal bullae
Pemphigus vulgaris/bullous pemphigoid type II hypersensitivity
Dermatitis herpetiformis autoimmune disease; IgA ICs; subepidermal bullae with neutrophils
Dermatitis herpetiformis association with celiac disease
Erythema multiforme vesicles and bullae; bullseye appearance
Risk factors drugs, M. pneumoniae infection
Stevens Johnson syndrome erythema multiforrne involving mouth
Acne vulgaris androgen dependent (receptor on sebaceous glands)
Acne vulgaris Propionibacterium acnes lipases produce fatty acids causing inflammation
Acne rosacea pustular, erythematous lesion on face resembling malar rash
Urticaria type I and III reactions; type I due to mast cell release of histamine (drugs, fire ant bites)
Angioedema subcutaneous swelling
Causes ACE inhibitor (bradykinin); C1 esterase inhibitor deficiency (C2 and C4 decreased)
Sporotrichosis traumatic implantation of Sporothrix fungus into subcutaneous tissue
Causes rose gardener, lobster fisherman (sphagnum moss)
S/S chain of subcutaneous nodules
Tuberculoid leprosy intact cellular immunity (positive lepromin skin test); granulomas; no organisms
S/S autoamputation of digits; skin depigmentation and anesthesia
Lepromatous leprosy defective cellular immunity (negative lepromin skin test); no granulomas
S/S leonine face, erythema nodosum during treatment
Histology Grenz zone (zone free organisms) foamy macrophages with organisms
Rx dapsone
Erythema nodosum painful nodule on shins; subcutaneous fat inflammation
Associations coccidioidomycosis, TB, leprosy
Keratoacanthoma benign neoplasm; mimics squamous cancer; spontaneously resolves
UVB light cancers basal cell carcinoma, squamous cell carcinoma, malignant melanoma
Vitiligo autoimmune destruction melanocytes producing skin depigmentation
Seborrheic keratosis pigmented, wart-like lesion; “stuck on” appearance
Leser-Trelat sign multiple outcroppings seborrheic keratosis; consider stomach cancer
Acanthosis nigricans verrucoid pigmented lesion usually in axilla; associated with gastric cancer
Chloasma pregnancy mask due to increased melanocytes
Nevocellular nevus benign pigmented tumor modified melanocytes
Histology nevus cells proliferate along basal cell area, dermis, or both
Dysplastic nevus precursor for malignant melanoma
Malignant melanoma malignant tumor of melanocytes; most rapidly increasing cancer worldwide
ABCD for melanoma A, asymmetry; B, irregular border; C, color change; D, increased diameter
Risk factors severe sunburn at early age (MC), dysplastic nevi
Radial growth phase spreads laterally in epidermis/superficial dermis but does not result in metastasis
Vertical growth malignant cells penetrate into dermis; potential for metastasis
Lentigo malignant melanoma face of elderly
Superficial spreading melanoma lower extremities, back
Nodular melanoma aggressive tumor with no radial growth phase
Acral lentiginous melanoma palms, soles, under nails; may occur in blacks
Prognosis depends most on depth of invasion
Prevention sunscreen >15
Porphyria cutanea tarda photosensitive bullous disease; deficiency uroporphyrinogen decarboxylase
S/S hypertrichosis, fragile skin, port wine colored urine (uroporphyrins)
Black widow (Latrodectus) envenomation neurotoxin; abdominal muscle cramps
Brown recluse (Loxosceles) envenomation necrotoxin; skin ulcer
Created by: megankirch