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Step 1 12.2.12
Muscle III/skinI
| Question | Answer |
|---|---|
| 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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