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HY Musc/Derm extras

Day 8

QuestionAnswer
What drug can be used in place of long term aspirin therapy in patients who have an asthmatic reaction to aspirin? Clopidogrel
Name the 4 main NSAIDs. Ibuprofen, naproxen, indomethacin, and ketorolac.
Which anti-inflammatory drugs should not be used in a patient with sulfa allergies? COX-2 inhibitors (e.g., celecoxib)
What is the difference between the mechanism of action of aspirin and that of acetaminophen? Aspirin irreversibly inhibits cyclooxygenase while acetaminophen reversibly inhibits it.
Which of the following properties does acetaminophen lack: antipyretic, analgesic, anti-inflammatory? Anti-inflammatory
What antidote can also be used to prevent contrast-induced nephropathy and as a mucolytic (breaks down mucus plugs) when inhaled? N-acetylcysteine (used in acetaminophen toxicity)
Which class of drugs inhibits osteoclastic activity and reduces both the formation and reabsorption of hydroxyapatite? Bisphosphonates (all end in -dronate: etidronate, pamidronate, alendronate, risedronate, zoledronate)
Why do bisphosphonates require the patient to remain in an upright position for several hours after taking the drug? Which bisphosphonate is an exception to this rule? B/c they can cause corrosive esophagitis. Zoledronate does not cause this side effect.
Which class of drugs should never be given to gout patients? Salicylates; only very high doses will clear uric acid, and only minimally; low to medium doses will actually decrease uric acid clearance
What test should be given before starting a patient on a TNF-alpha inhibitor (etanercept, infliximab, adalimumab)? TB test (e.g., PPD skin test); drugs like infliximab predispose to reactivation of latent TB due to decreased macrophage function
What is the difference between the composition of etanercept and infliximab and adalimumab? EtanerCEPT is a reCEPTor that binds TNF. InfliximAB and adalimumAB are anti-TNF AntiBodies (AB)
What are the layers of the epidermis from base to surface? stratum Basalis, stratum Spinosum, stratum Granulosum, stratum Lucidum, stratum Corneum (Betty Sue's Grandma Loves Cupcakes)
How are the epidermal layers altered in psoriasis? Stratum Granulosum is decreased and Stratum Spinosum is increased
How does the epidermis receive nutrients? Via diffusion (no blood vessels in the epidermis)
"Tight junction" that prevents diffusion across paracellular space Zona occludens
Name 2 proteins that compose the zona occludens (tight junction). Claudins and occludins (occludins occlude stuff from moving across the paracellular space)
"Intermediate junction" that surrounds the perimeter just below the zona occludens (tight junction) Zona adherens
What two proteins make up the zona adherens (intermediate junction)? Cadherins connecting to actin (CADherins are Calcium dependent ADhesion molecules)
"Desmosome" that acts as a small, discrete site of attachment Macula adherens
What two proteins are involved in the macula adherens (desmosome)? Cadherins attaching to intermediate filaments (keratin, desmoplakin)
Antibodies against the macula adherens are seen in which disease? Pemphigus vulgaris (macula adherens=desmosomes)
Allows adjacent cells to communicate for electric and metabolic functions (e.g., cardiac cells) Gap junctions
What proteins are involved in gap junctions? Connexons (with central channel)
What protein maintains the integrity of the basement membrane? What does it bind to? Integrin; binds to laminin in the BM
Connects cells to underlying EC matrix Hemidesmosome
Which disease involves antibodies against hemidesmosomes? Bullous pemphigoid
What sign indicates tearing of the ACL? Positive drawer sign
What sign indicates a torn MCL (medial collateral ligament)? Abnormal passive abduction
What is the unhappy triad of the knee? 1. Medial collateral ligament (MCL) 2. Anterior cruciate ligament (ACL) 3. Lateral (or medial) meniscus
Which landmark is used for a pudendal n block? Ischial spine (pudendal n block aka saddle n block is used to relieve pain in childbirth)
Which landmark is used to do a lumbar puncture? Iliac crest (for spinal tap, cord ends at L1/L2, so keep needle between L3-L5)
Which rotator cuff m is most commonly injured? Supraspinatus
Which rotator cuff m is injured in a pitching injury? Infraspinatus (laterally rotates the arm)
At what site does rotator cuff impingement typically occur? During what type of actions is it injured? What test is used to diagnose? Occurs at the acromion with repetitive overhead actions (swimming, tennis serves), and is dx with empty can test (+ if patient finds it painful to abduct arm 15 degrees with thumb turned down)
What is the other name for a lateral epicondylitis? Tennis elbow (laTEral=TEnnis)
What is the other name for a medial epicondylitis? Golf elbow
Lack of which structure in the m fiber may lead to uncoordinated contraction of individual fibers? T tubules (depolarization travels along m cell and down the T tubule)
Which m cell receptors mediate calcium-induced calcium release? Ryanodine receptors (mutated in malignant hyperthermia)
How do osteocytes communicate? Via gap junctions
Garnder on knees all the time. What type of injury will he have? Pre-patellar bursa
During m contraction, which band always remains the same length? A band (A is Always the same, while H and I bands shrink)
At which m receptor do CCBs like nifedipine act? Dihydropyridine receptors (first step in calcium-induced calcium release prior to ryanodine receptors)
At which m receptor does dantrolene have an inhibitor effect? Ryanodine receptors (used to treat malignant hyperthermia)
Slow twitch, red fibers, increased mitochondria and myoglobin concentration (increased oxidative phosphorylation)--> sustained contraction Type 1 muscle (1 slow, red ox)
Fast twitch; white fibers due to decreased mitochondria and myoglobin concentration (increased anaerobic glycolysis) Type 2 muscle
Which muscle type is predominantly seen in postural skeletal m (mm of spine and soleus m of the calf)? Type 1
Which muscle type becomes hypertrophied during weight training (eg., lats, biceps, deltoids)? Type 2
What causes the myosin head to detach from the actin filament? ATP binding
Lack of ATP for the skeletal and cardiac m contraction cycle leads to what finding? Rigor mortis
What causes the conformational change that moves tropomysoin out of the way so actin/myosin cycling can occur? Ca binding to troponin
Release of what two substances generates the power stroke? Release of ADP and inorganic phosphate (Pi)
Name 4 drugs/classes that inhibit myosin light chain kinase (MLCK) to prevent contraction of sm m. 1. NO 2. Dihydropyridine CCB (nifedipine) 3. Epinephrine (@ B2 receptors) 4. Prostaglandin E2
Name 3 drugs/classes/substances that stimualte myosin lgiht chain phosphatase to promote sm m relaxation. 1. Sildenafil 2. NO 3. LPS of gram neg organisms
Which myosin light chain leads to sm m relaxation? Myosin light chain phosphatase (myosin + actin)
Which myosin light chain leads to sm m contraction? Myosin light chain kinase (MLCK) (myosin P + actin-->cross-bridge formation)
Where do osteoblasts come from (hint: it's not, "when a man and a woman really love each other...")? Msenechymal stem cells in the periosteum KNOW THIS FOR SURE!
Woven bone formed directly without cartilage; later remodeled to lamellar bone Membranous ossification (flat bone growth in the skill, facial bones, and axial skeleton)
What is the most reliable indicator of osteoblast activity? Bone-specific alkaline phosphatase (osteoblasts release it)
Give 3 reliable indicators of osteoclast activity. 1. TRAP 2. Urinary hydroxyproline 3. Urinary deoxypyridinoline (most reliable of the 3)
What are the chances of one normal parent and one parent with achondroplasia having a child with the disease? AD: 50% chance of disease, 50% chance of normal
What are the chances that two parents with achondroplasia will have the disease? AD: 50% chance of disease, 25% chance of carrier, 25% chance of spontaneous abortion (homozygous for mutation)
What gene is responsible for limb lengthening? FGF gene
What is the genetic abnormality underlying achondroplasia? Constitutive activation of fibroblast growth factor receptor 3 (FGFR3) which inhibits chondrocyte proliferation
Do patients with achondroplasia have problems with infertility? Generally no problems with fertility; do need to deliver via C-section b/c of narrow pelvic outlet
What diuretics are useful in women with osteoporosis? Thiazides (decrease urinary calcium excretion and may improve bone density)
Which diuretics are contraindicated in women with porous bones? Furosemide (loops lose calcium!)
What are the risk factors for osteoporosis? Older age, smoking, corticosteroids, white, thin, no weight bearing exercise (step up, you!), poor calcium and vit D, hypogonadism, heparin
How are mild cases of osteoporosis treated? Estrogen (SERMS) adn/or calcitonin (builds bone)
Why are severe cases of osteoporosis treated with pulsatile rather than continuous PTH? Continuous PTH will pull calcium out of your bones!
How is osteoporosis diagnosed? Dexa bone density scan of lumbar spine or femur
What is the mechanism of action of the drug of choice in severe osteoporosis cases? Bisphosphonates (-dronates): inhibit osteoclast activity; reduce both formation and resorption of hydroxyapatite (bone mineral complex)
What type of factor is responsible for 75% of the peak bone mass differences among individuals? Genetic factors
What are the two most important factors for osteoclast differentiation? What produces them? RANK-L and M-CSF; osteoblasts make these factors
What is the triad of osteopetrosis? 1. Anemia 2. Thrombocytopenia 3. Infection Basically pancytopenia
What X-ray finding is seen in osteopetrosis? Erlenmeyer flask bones that flare out (may cause cranial n impingement due to narrowed foramina)
What digestive disorder can lead to osteomalacia/rickets? Cholestasis, or anything that causes malabsorption of fat soluble vitamins (ADEK).
How does PTH affect phosphate, alkaline phosphatase, and calcium levels in the serum? Increases calcium and alk phos (generally), and decreases phosphate (PTH is the Phosphate Trasher Hormone)
What virus is suspected to be involved in Paget's disease of the bone? Paramyxovirus
Increased hat size and hearing loss due to narrowed auditory foramen Paget's disease of bone (most patients are asymptomatic though)
Mosaic bone pattern with long bone chalk stick fractures Paget's disease of bone
Paget's disease can lead to what cardiac and oncogenic complications? Increase blood flow from increased arteriovenous shunts may cause high-output heart failure; can lead to osteosarcoma
What is the treatment for Paget's? Bisphosphonates (-dronates) to inhibit osteoclasts (the primary problem in Paget's is overactive osteoclasts)
Besides Paget's, what other disease may lead to hearing loss due to narrowing of the auditory foramen? Osteopetrosis
Cafe-au-lait/Coast of Maine spots, unilateral bone lesions, and precocious puberty McCune Albright syndrome
How are calcium, phosphate, and PTH serum levels affected in renal insufficiency? Serum calcium is decreased (primary problem), phosphate is increased (diseased kidney is unable to excrete it), and PTH is increased (compensatory mech for loss of calcium)
Colon polyps (can cause colorectal cancer), lipomas, and osteoma (benign bone tumors) Gardner's syndrome (FAP): Gardner's grow lumps and bumps everywhere
Familial retinoblastoma predisposes to which malignant bone tumor? Osteosarcoma (also Paget's, bone infarcts, and radiation)
Anaplastic small blue cell malignant tumor of bone that is extremely aggressive, but responsive to chemo. May have Homer-Wright rosettes. Ewing's sarcoma (11;22)
Expansile, glistening mass within the medullary cavity of older individuals; malignant Chondrosarcoma
What are the predisposing factors for osteoarthritis? Age, obesity, joint deformity
Which arthritis is non-inflammatory and has no systemic symptoms? Osteoarthritis
What is the treatment for osteoarthritis? Acetaminophen, NSAIDs and COX-2i, inject joint w/steroids, inject hyaluronic acid into joints, opioids, joint replacement
What type hypersensitivity is rheumatoid arthritis? Type 3
Baker's cysts (behind the knee) Rheumatoid arthritis
What is rheumatoid factor? IgM antibodies against IgG
Which antibody is less sensitive than rheumatoid factor but more specific? anti-CCP antibody
What is the treatment for rheumatoid arthritis? NSAIDs and anti-TNF agents (entercept, infliximab, and adalimumab)
Which syndrome associated with an increased risk of dental carries is associated with rheumatoid arthritis? Sjogren's syndrome
Which virus can present with symmetric arthritis that mimics RA in adults, but resolves spontaneously? Parvovirus (causes slapped cheek/Fifth's disease in children)
Groin pain exacerbated by weight bearing; assoc'd with sickle cell disease, SLE, high dose steroid therapy, and alcoholism. Avascular necrosis of the femoral head
Type 1 collagen defect that causes problems with bone matrix formation Osteogenesis Imperfecta (I=1)
Dactylitis in young child Sickle cell disease (painful swelling of hands and feet during a vaso-occlusive crisis)
Beading on chest felt by palpation, bowed legs Vit D deficiency (rickets in children; problem with osteoid matrix accumulation around trabecula)
Lesch-Nyhan syndrome is associated with which joint disease? Gout
Which diuretics may precipitate gout? Thizaide and loop diuretics (decrease excretion of uric acid)
Which biochemical disease affecting the liver may lead to gout? von Gierke's disease
Yellow crystals under parallel light Gout
What is the MC location for tophus formation in gout? The external ear (also olecranon bursa or Achilles tendon)
Why does alcohol consumption precipitate gouty attacks? B/c alcohol metabolites compete for the same excretion sites in kidney as uric acid, causing decreased uric acid secretion and subsequent buildup in blood
Hot, swollen knee in a young, sexually active person (monoarticular, migratory arthritis with asymmetrical pattern) Neisseria gonorrhea; dx with joint aspirate
What are the MCC of chronic infectious arthritis? TB (from mycobacterial dissemination) and Lyme disease
Dactylitis (sausage fingers), pencil in cup deformity on x-ray Psoriatic arthritis
Patient who gets up early in morning and runs 5 miles to allow for functioning throughout the day (suffers from fusion of joints in the spine) Ankylosing spondylitis
Ankylosing spondylitis predisposes patients for what cardiac and pulmonary abnormalities? Aortic regurg and pulmonary fibrosis or restrictive lung disease; may also limit chest expansion
Arthritis after a diarrheal illness Inflammatory bowel disease assoc'd seronegative spondyloarthropathy (HLA-B27)
What is Reiter's triad? 1. Conjuctivities and anterior uveitis 2. Urethritis 3. Arthritis Seen post-GI or chlamydia infections
What organism can cause arthritis seen in Reiter's triad? Shigella flexneri
What is the treatment for seronegative spnodyloarthropathies? NSAIDs, steroids, and anti-TNF agents (main tx)
What is the treatment for SLE (4)? 1. Glucocorticoids 2. NSAIDs 3. Hydroxychloroquine 4. Cyclophosphamide
What lab test is specific for the renal disease of lupus? Anti-dsDNA antibodies
What is causes CD8 T cell injury to myofibers in polymyositis? Overexpression of MHC Class I proteins on the sarcolemma
Malar rash, heliotrope (eyelid) rash, "shawl and face" rash, Gottron's papules (on knuckles), and mechanic's hands. Increased risk of malignancy. Dermatomyositis
MC NMJ disorder Myasthenia Gravis
Myasthenia gravis is associated with which tumor? Thymoma
How can an edrophonium test be used to distinguish between under and over dosing of AChE inhibitors in myasthenia gravis treatment? No response w/administration= cholinergic crisis-over treatement; discontinue use of AChE inhibitor. Improvement w/administration= myasthenia crisis= undertreatment; increase does of AChE inhibitors
Which NMJ disease presents with weakness that improves with use? Lambert-Eaton syndrome
Which NMJ disease is assoc'd with paraneoplastic diseases (small cell lung cancer)? Lambert-Eaton syndrome
What test is used to diagnose Lambert-Eaton? Isometric contraction test (examiner exerts force on limb to see if strength improves)
Which NMJ disease presents with dry mouth, impotence, hyporeflexia, and weakness that improves throughout the day? Lambert-Eaton syndrome
Which bulking disease presents with puffy, taut skin with absence of wrinkles? Scleroderma (progressive systemic sclerosis); 2 types: diffuse scleroderma (anti-Scl-70 Ab/anti-topoisomerase I Ab) and CREST (anti-centromere Ab)
Which scleroderma (PSS) type has a more benign course with less visceral involvement and a slower progression? CREST
Which epidermal layer is increased in hyperkeratosis? Stratum corneum (seen in psoriasis)
Which epidermal layer shows hyperplasia in acanthosis? Sratum spinosum (seen with acanthosis nigricans)
Which dermatologic finding presents as hyperkeratosis with rention of nuclei in stratum corneum? Parakeratosis
Which dermatologic finding presents as separation of epidermal cells (seen in pemphigus vulgaris)? Acantholysis
How are lipomas treated? with excision (benign)
What is the MCC soft tissue tumor of childhood? From where does it arise? Rhabdomyosarcoma; arises from skeletal m in head and neck region
Epidermal hyperplasia, hyperkeratosis, and koilocytosis Warts; verruca vulgaris on hands and condyloma acuminatum on genitals (caused by HPV)
1 year old infant with h/o mild asthma who is bathed daily presents with puritic eruption on skin flexures. Atopic dermatiis (excema)
What type of hypersensitivity is allergic contact dermatitis? Type 4
Silver, parakeratotic scaling, Auspitz sign (bleeding when scale is scratched off) Psoriasis
What is the sign of Leser-Trelat? Sudden appearance of multiple seborrheic keratoses indicating an underlying malignancy (e.g., GI, lymphoid); not a pre-malignancy though
Young people get moles, old people get _________. Seborrheic keratoses (SKs)
Normal melanocyte # with decreased melanin production due to decreased activity of tyrosinase; may be caused by failure of neural crest cell migration during development Albinism
Irregular areas of complete depigmentation caused by a decrease in the number of melanocytes Vitiligo
Crepitus from methane and CO2 production Necrotizing fasciitis
Keratinocytes in which skin layer are destroyed by the exotoxin in Staphylococcal scaled skin syndrome? Stratum granulosum only
Positive Nikolsky's sign (separation of epidermis upon manual stroking of skin) Pemphigus vulgaris (don't confuse with Auspitz's sign of psoriasis where the silverly scale bleeds when scraped off); Bullous pemphigoid has a negative Nikolsky's sign
Immunoflourescence reveals net-like or reticular pattern Pemphigus vulgaris (Vulgar=common; COMMONers wear hair NETS and work in DESperate conditions= vulgaris has NET like pattern and antibodies against DESmosomes)
Deposits of IgA at the tips of dermal papillae Dermatitis herpetiformis; assoc'd with Celiac disease
>30% of body surface area sloughing off and detaching; may be caused by seizure meds, sulfa drugs, -cillins, and allopurinol TEN
Derm disorder assoc'd with hepatitis C Lichen planus (purple, pruritic, polygonal papules)
Cutaneous horn. Tx? Actinic keratosis; tx= 5-Fu
Hyperplasia of the stratum spinosum assoc'd with hyperinsulinemia (e.g., from Cushing's disease, diabetes) and visceral malignancy (>40yo) Acanthosis nigricans
Herald patch followed days later by a "Christmas tree" distribution Pityriasis rosea
Skin cancer that is locally invasive, rarely mets, has keratin pearls, and has an "eaten away" appearance SCC
Locally invasive but never metastasizes; rolled, pearly borders with central ulceration commonly with telangiectasias BCC
S100 + skin cancer with significant risk of metastasis. Dysplastic nevus is precursor lesion. Melanoma
ABCDs of melanoma Asymmetry Border irregularity Color Diameter
What feature of a melanoma correlates with its risk of metastasis? Depth (Breslow's depth); do NOT shave off otherwise you won't know the true depth; do punch biopsy instead
Variant of SCC that grows rapidly (4-6 weeks) and regresses spontaneously (4-8 weeks) Keratoacanthoma
What is the precursor lesion for SCC? Actinic keratosis
Created by: sarah3148