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Goljan Muscles/Skin
| Question | Answer |
|---|---|
| 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
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