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Step 1 12.2.12

Muscle III/skinI

What is the mech of scleroderma ( progressive systemic sclerosis? excessive fibrosis and collage ndeposition throughout the body.
What does scleroderma ( progressive systemic sclerosis present like? puffy, taut skin with absence of wrinkles. sclerosis of renal, pulmonary CV, GI
Who gets scleroderma ( progressive systemic sclerosis? 75% female
What is diffuse scleroderma? widespread skin invovlement, rapid progression, early viceral invovlement
What Ab is associated with diffuse scleroderma? anti-Scl-70 Ab (anto DNA topoisomerase I Ab)
What is CREST syndrome of scleroderma (progressive systemic sclerosis)? calcinosis, Raynaud's phenomenona, Esophageal dysmotility, sclerodacytyly, telangiectasia
What ab is CREST syndrome of scleroderma associated with? anti centromere Ab
What is a macule? What could give you one? flat discoloration < 1 cm. see with tinea nersicolor
What is a patch? macule > 1 cm
What is a papule and what can give you one? elevated skin lesion <1 cm. seen in acne vulgaris
What is a plaque, and what can give you one? papule > 1 cm. seen in posriasis
What is a vesicle, what can give you one? small fluid containing blister. seen in chicken pox
What is a wheal? what can give you one? transient vesicle seem in hives
What is a bulla, what can give you one? large fluid containing blister. seen in bullous pamphigoid
What is a keloid ? What can give you one? irregular, raised lesion resulting from scar tissue hypertrophy (follows trauma to skin es in AA). Seen with T. pertenue (yaws)
What is a pustule? blister containing pus
What is a crust? dried exudates from a vescile, bulla, pustule
What is hyperkeratosis? When is it seen? incr thickness of stratum corneum. seen in psoriasis
What is parakeratosis? When is it seen? hyperkeratosis with retention of nuclei in stratum corneum, seen in psoriasis
What is acantholysis? When is it seen? separation of epidermal cells. seen in pemphigus vulgaris
What is acanthosis? epidermal hyperplasia with incr spinosum
What is dermatitis? inflammation of the skin
What is seen in verrucae? warts. soft tan colower cauliflower like lesions. epidermal hyperplasia, hyperkeratosis, koilocytosis
What is seen on hands vs genitals and what causes verrucae? see verruca vulgaris on hands, see condyloma acuminatum on genitals ( caused by HPV)
What is a nevocellular nevus? commonl mole, benign.
What is uticaria? hives. intensely prutitic wheals that form after mast cell degeneration
What is an ephelis? freckle. normal number of melanocytes, incr melanin pigment
What is atopic dermatitis (eczema)? pruritic erruption, common on skin flexures. often associated with other atopic diseases (astma, allergic rhinitis)
What is allergic contact dermatitis? Type IV hypersenstivity that follows sllergen exposure. seen in poison ivy, nickel
What is the presentation of psoriasis? papules and plaques with silvery scaling especially on knees and elbows.
What is seen histiologically in psoriasis? acanthosis with perakeratotic scaling (nuclei still in stratum corneum), incr stratum spinosum, dec stratum granulosom
What is Auspitz Sign? bleeding spots when psoriasis sclaes are scraped off. can be associated with nail pitting and psoriatic arthtritis
What is seen in seborrheic keratosis? flat, greasy, pigmented squamos epithelium proliferation with keratin filled cysts (horn cysts. looks pasted on
Where are the lesions in seborrheic keratosis, what is it associated with in older people? lesions on head, trunk, extremitites. common benign neoplasm of older persons
what is the sign of Leser-Trelat? What does it indicate? sudden appearance of multiple seborrheic keratoses indicating an undelying GI or lymphoid malignancy
What is albinism? normal melanocyte number with decr melanin production due to decr activity of tyrosinase
What developmentally can cause albinism? can be caused by failure of neural crest cells migration during development
What it vitiligo? irregular areas of complete depigmentation. caused by decr in melanocytes
What is seen in melasma (cholasma)? hyperpigmentation associated with pregnancy ( "mask of pregnancy"). or OCP use
What is impetigo? What causes it? What does it look like? superficial skin infection, highly contageou with honey colored crusting. Seen from S. aureus, S. pyogenes
What is cellulitis and what causes it? acute, painful spreading infection of dermis and subcutaneous tissues. usually from S. pyogenes or S. aureus
What is necrotizing fascitis? What causes it? What is commonly seen in PE? seep tissue injury from anaerobic bacteria and S. pyogenes. results in crepitus from methan and CO2 production. "flesh eating bacteria)
What is staphylococcal scalded skin syndrome (SSS)? Who is it commonly seen in? exotoxin of staphyloccus destroys keratinocyte attatchment in stratum granulosum. See fever and generalized erythematous rash with sloughing of upper layers of epidermis. see with newborns and children
What is hairy leukoplakia? What causes it and who gets it? white, painless plaques on tongue that cannot be scraped off. EBV mediated. occurs in HIV patients
What is the mech of pemphigus vulgaris? potentially fatal AID with IgG antibody against desmosomes (anti epithelail cells)
What is seen in immunoflorescence in pemphigus vulgaris? antibodies around cells of epidermis in reticular or netlike pattern
What is seen in pemphigus vulgaris and where? acatholyisis= intraepidermal bullae invovling the skin and oral mucosa
What is Nikolsky's sign? What disease is it positive in? separation of epidermis upon manual stroking of the skin seen in pemphigus vulgaris
What is the mech of bullous pemphigoid? AID with IgG antibody against hemidesmosomes (epidermal BM)
What is seen on immunoflorescence in bullous pemphigoid? linear immunoflorescens with eosinophils in tense blisters
What are 2 distinguishing features of bullous pemphigoid vs pemphigus vulgaris? bullous will spare oral mucosal and has a negative Niokolsky sign
What is the mech of dermatitis herpetiformis and what is it associated with? pruritic papules and vesciles. deposits of IgA at tips of dermal papillae. associated with celiac disease
What is erythema multiforme associated with? infection (Myco pneumonidae, HSV), drug (sulfa, beta lactams, phenytoin), cancers, and AID.
What does erythema multiform present like? multiple types of lesions = macules, papules, vesicles, target lesions
What is Steven's Johnson syndrome? fever, bulla formation and necrosis, sloughing of skin assoicted with drug reactions
What is seen in lichen planus? Pruritic, purple, polygona papules.
What is the mech of lichen planus? What is it associated with? sawtooth infiltrate of lymphocytes at dermal epidermal junction. associated with hepatitis C
What is actinic keratosis? How do you stratify its risk? premalignant lesions caused by sun exposure. carcinoma risk= amount of epithelil dysplasia. see small rough, erythematous or brownish papules
What is acanthosis nigricans? What is it associated with? hyperplasia of stratum spinosum. associated with hyperinsulinemia (Cushings, diabetes) and visceral malignancy
What is erythema nodosum, what is it associated with? inflammatory lesions of subcutaneous fat, usually on anteriror shins. associted with coccidioides, histo, TB, leprosy, streptoccal infections, sarcoid
What is pityriasis rosea? heral patch follwed days later by christmas tree distrodbtuion. multiple papular eruptions, remits spontaneously
Where does squamous cell carcinoma of the skin tend to occur? hands and face in response to sun and arsenic
What is the appearance of squamous cell carcinoma of the skin ? Does it metastasize? ulcerative red lesion associted with chronically draining sinuses
What is the histopathology of squamos cell carcinoma of the skin? keratin pearls
what is the precursor to squamous cell carcinoma? actinic keratosis
What is keratoacanthoma? variant of squamous cell carcinoma that grows rapidly and regrsses spontaneously
Where is basal cell carcinoma of the skin most seen, is it aggressive? most common on sun exposed areas of skin. locally invasive but almost never metastasizes
What is the appearance of basal cell carcinoma of the skin? pearly papules commonly with telanfgiectasias
What is seen in histology of a basal cell carcinoma of the skin? pallisading nuclei
What is the metastasis risk of melanoma? What is the key tumor marker? significant risk of metastasis. S-100 is the tumor marker. associated with sun expsuere
How do you stratify the risk of metastasis in melanoma? What is the precursor? DEPTH of tumor correlates to risk of metastasis. dysplastic nevus is the precursor
What is the mnemonic for the evaluation of a dysplastic nevus? Asymmetry, Border irregularity, Color variation, Diameter > 6mm and history of change (ABCD)
What is the product of the lipoxygenase pathway? leukotrienes
What is LTB4? neutrophil chemotactic agent
What is the function of LTC4, D4, E4? function in bronchoconstriction, vasoconstriction, contraction of SMM and incr in vascular permeability
What is the role of PGI2? inhibts platelt aggregation and promotes vasodialtion. decr vascular tone, bronchial tone, uterine tone
What ate the end products of the COX pathway? prostacylcin, prostaglandins, Thromboxanes
What is the action of PGE2 and PGF2 alpha? incr uterine tone, decr vascular tone, decr bronchial tone
What is the action of TXA2? incr platelet aggregation, incr vascular tone, incr bronchial tone
What is the mech of aspirin? irreversibly inhbits COX-1 and COX-2 by acetylation, which decr synthesis of TXA2 and prostaglandins.
What is the effect on lab values by aspirin? incr BT, no effect on PT, PTT
What is the clinical use of aspirin? low dose: decr platelet aggregation. intermediate dose: antipyretic and analgesic. high dose: anti inflammatory
What are the major SE of aspirin? gastric ulceration, hyperventilation, tinnutus (CNVIII). chronic use can lead to renal failure, interstital nephritis, GI bleed.
What could aspirin cause in a child with a viral infection? Reye's syndrome
What is the class of ibuprofen, naproxen, indomethacin, ketorolae? NSAIDs
What is the mech of ibuprofen, naproxen, indomethacin, ketorolae? reversibly inhibts COX 1 and COX 2. blocks prostaglandin synthesis
What is the clinical use of ibuprofen, naproxen, indomethacin, ketorolae? antipyretic, analgesic, anti-inflmmatory. indomethacin also used to close patent PDA
What are the major SE of ibuprofen, naproxen, indomethacin, ketorolae? renal damage, fluid retention, aplastic anemia, GI distress, ulcers
What is the class/mech of celecoxib? reversiblt inhibts COX2 only. which is found in inflammatory cells. Since it spares COX1 it has fewer effects on GI lining
What is the clinical use of celecoxib? rheumatoid and osteoarthritis, patients with gastritis or ulcers
What is the major SE of celecoxib? incr risk of thrombosis. sulfa allergy. ;less tox to GI mucosa
What is the mech of acetaminophen? reversibly inhibits COX, mostly in CNS. inactivated peripherally
What is the clinical use of acetaminophen? antipyretic, analgesic but not antiinflammatory. used in kids with viral infection to avpoid Reye's syndrome
What are the major SE of acetaminophen? OD= hepatic necrosis. acetaminophen metabolite depletes glutathione and form s toxic adducts in liver.
What is the antidote for acetaminophen? How does it work? N-acetylcysteine is the antidote. works by regenerating glutathione
What is the class of etidronate, pamidronate, alendronate, risendronate, zoledronate (IV)? bisphosphonates
What is the mech of etidronate, pamidronate, alendronate, risendronate, zoledronate (IV)? inhibits osteoclastic activity; reduce both formation and resorbtion of hydroxypatite
What is the clinical use of etidronate, pamidronate, alendronate, risendronate, zoledronate (IV)? malignancy associated hhypercalcemia, Paget's disease, postmenopausal osteoporisis
What are the major SE of etidronate, pamidronate, alendronate, risendronate, zoledronate (IV)? corrosine esophagitis (except zoledronate), nausea, diarrhea, osteonecrosis of the jaw
What is the mech of probenecid? inhibits resorbtion of uric acid in PCT (also inhibits secretion of penicilin)
What is the mech of allopurinol? inhibits xanthine oxidase, decr conversion of xanthine to uric acid. also used in lymphoma and leukemia to prevent tumor lysis associated urate nephropathy
What other drugs can allopurinol incr the concentration of? azathiprine, 6-MP
What should NOT be given with allopurinol? WHy? salicylates because they will depress uric acid clearance
What is the mech of colchicine? binds and stabilizes tubulin to inhibit polymerization impairing leukocyte chemotaxis and degranulation.
What are the major SE of colchicine? GI SE, especially if orally given (indomethacin is less toxic)
What is the NSAID that can be used in acute gout? naproxen
What is class of etanercept, infliximab, adalimumab? TNF-alpha inhibitors
What is the mech of etanercept? recombinat form of human TNF receptor that binds TNF
What is the clinical use of etanercept? RA, psoriasis, ankylosing spondylitis
What is the mech of infliximab? anti-TNF ab
What is the clinical use of infliximab? Crohn's diseaxse, RA, ankylosing spondylitis
What is the mech of adalimumab? anti TNF ab
What is the clinical use of adalimumab? RA, psoriasis, ankylosing spondylysis
What are the major SE of etarnercept, infliximab, adalimumab? predispose to infection including reactivation of latent TB since TNF blockade prevents activation of macrophages
Created by: tjs2123



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