Term
|
Definition
| marker for maturity in keratinocytes |
|
|
Term
| Nikolsky sign positive in ____, negative in ____ |
|
Definition
pemphigus; pemphigoid
(is a physical diagnostic sign for acantholysis) |
|
|
Term
| desmogleins, desmoplakins, tonofilaments |
|
Definition
| remember that tonofilaments (i.e. cytokeratin) are attached transversely in desmosomes & on-end in hemidesmosomes |
|
|
Term
| things melanocytes are stimulated by |
|
Definition
| ACTH (MSH), T3, E2, progesterone |
|
|
Term
| apocrine sweat glands are actually... |
|
Definition
| merocrine excretion (eccrine sweat glands use ion channels) |
|
|
Term
| what binds hemidesmosome in BM? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| dDx when you see clubbing |
|
Definition
| lung disease/lung cancer, CHF, A-V malformation, celiac, IBD |
|
|
Term
|
Definition
|
|
Term
|
Definition
(indentations in nail bed, move with growth)
marker for acute illness (can estimate when by growth rate (~1mm/week) |
|
|
Term
|
Definition
White lines that move with growth
(arsenic or thallium poisoning) |
|
|
Term
|
Definition
(white lines that don't move w/ growth)
- marker for hypoalbuminemia |
|
|
Term
|
Definition
| paraphenylenediamine --> allergic dermatitis |
|
|
Term
|
Definition
| lysyl hydroxylase (smooth ER) |
|
|
Term
| What inhibits Th1 differentiation? Th2? |
|
Definition
|
|
Term
| antibodies induced to be secreated by IL-4 (& 13) |
|
Definition
| short term: IgG1; long term: IgE |
|
|
Term
| need this for class switching |
|
Definition
| CD40L (CD40 is on T-cells) |
|
|
Term
| This is needed for T-cell activation |
|
Definition
CD28 (T-cells) & B7 (APCs)
(aside: CTLA-4, i.e. CD152, binds B7 and is responsible for anergy) |
|
|
Term
| how do immune complexes get removed? |
|
Definition
| complement disrupte antigen-antibody bonds --> solubilized the product --> C3b binds RBCs --> transported to spleen for destruction |
|
|
Term
| what infectious diseases can cause T3 hypersensativity? |
|
Definition
strep (post-strep glomerulonephritis), meningitis, hep, mono, malaria, trypanosomes
(aside: serum sickness is a type 3) |
|
|
Term
| what causes kidney damage in SLE? |
|
Definition
|
|
Term
| what form of trypanosome lives in sandfly? human? |
|
Definition
| promastigote (flagellated), amastigote (non-flagellated, intracellular) |
|
|
Term
|
Definition
| stibogluconate (antimony compound) |
|
|
Term
important thing that protects leishmania?
Where does it develop? |
|
Definition
- lipophosphoglycan (LPG)
- it develops in the sandfly gut; it protects the amastigote in a number of ways:
1) binds CR3 via C3bi --> enhances phagocytosis w/out immune system activation
2) resist complement mediated lysis
3) resists acid in lysosome (later infection) |
|
|
Term
| What is messed up when people get chronic cutaneous leishmaniasis (non-healing ulcer for at ~3 months) |
|
Definition
|
|
Term
| what is a possible late complication of localized, cutaneous leishmaniasis? |
|
Definition
| mucocutaneous leishmaniasis |
|
|
Term
| what type of cells do you see in mucocutaneous leismaniasis? |
|
Definition
| mononuclear infiltrate w/ lots of granulomas & few, if any, organisms |
|
|
Term
| what mediates tissue damage in mucocutaneous leishmaniasis (& most things) |
|
Definition
|
|
Term
| how does Th17 produce tissue damage? |
|
Definition
it's a pro-inflammatory T-cell:
- increases TNF & IFN-g production by other T-cells
- increases neutrophils --> increase necrosis, MMPs
- IL-1,6,17,23 |
|
|
Term
| How does IL-10 inhibit Mø? |
|
Definition
| IL-10 induces macrophage arginase --> decreases NO production |
|
|
Term
name precursors for:
BCC
SCC
melanoma |
|
Definition
- none
- actinic keartosis/cheilitis, SCCIS (Bowen's)
- dysplastic nevus |
|
|
Term
wavelengths for:
Blue light
UVA
UVB
UVC |
|
Definition
-460 nm (DNA damage via ROS)
- 320-400 nm (Black light; same as blue light)
- 290-320 nm (sunburns; pyrimidine dimers; pilots, skiers)
- 100-290 nm (welder's arc) |
|
|
Term
| possible, bad complications of sunburn? |
|
Definition
- high output cardiac failure
- infection |
|
|
Term
|
Definition
- chemical (has aromatic ring) --> absorbs UV light (resonance delocalization) (e.g. benzophenones, cinnamates, salicylates)
- Inorganic (e.g. ZnO4): absorb & reflect UVA & UVB |
|
|
Term
| 2 types of pyrimidine dimers, which is most common? |
|
Definition
1) cyclobutane (most common)
2) 6-4 dimers (more mutagenic) |
|
|
Term
| what does Pi do to 1-alpha hydroxylase activity? |
|
Definition
| high Pi inhibits 1 alpha hydroxylase (AKA CYP27B1) |
|
|
Term
| Ca, 25-OH vitD, & 1,25-OH vitD in Vitamine D toxicity? |
|
Definition
|
|
Term
| why is azathioprine a riskfactor for SCC? |
|
Definition
| metabolite (6-thioguinine) is inserted into DNA & converted to ROS produce by UVA light |
|
|
Term
how does inflammation cause SCC?
examples? |
|
Definition
D6 saturation (sequesters chemokines) --> increased inflammation --> Ras-activated proliferation of keratinocytes (SCC)
- epidermolysis bullosa, marjolin's ulcer, scar, burn, lichen sclerosis, lichen planus, discoid lupus |
|
|
Term
|
Definition
non-healing ulcer; may have underlying osteomyelitis
risk of SCC (chronic inflammation) |
|
|
Term
| HPV types that predispose to SCC |
|
Definition
3,5,8
("epidermodysplasia verruciformis" is an AR condition where people get lots of HPV infections & have an increased risk fo SCC b.c. of that) |
|
|
Term
| radiation & heat predispose to what type of skin cancer |
|
Definition
|
|
Term
|
Definition
| SCCIS (well water, meds, insecticides) |
|
|
Term
| where are the atypical cells in actinic keratosis? |
|
Definition
| stratum spinosum (SCCIS is full thickness) |
|
|
Term
| sign of very poor prognosis in SCC? |
|
Definition
|
|
Term
describe features of each type of BCC:
- Nodular
- Morpheaform
- Superficial |
|
Definition
- big nests of cells w/ retractions (most common type)
- looks like a scar; smaller clumps of cells
- scaly & on trunk; cells attached to hair follicles |
|
|
Term
|
Definition
("basal cell nevus syndrome")
PTCH (patched) --> overactivation of smoothened |
|
|
Term
| BCC, palmar pits, jaw cysts, frontal bossing, short 4th metacarpal |
|
Definition
|
|
Term
| markers for aggressiveness in BCC |
|
Definition
- bcl-2 (antiapoptotic)
- anti-SMA (local migration)
- Strombolysin 3 (invasion) |
|
|
Term
| most common type of melanoma |
|
Definition
| superficial spreading (70%) --> located on upper back |
|
|
Term
| melanoma on feet & hands (non-sun exposed areas) |
|
Definition
|
|
Term
| melanoma on face that isn't raise and stays in-situ for a long time |
|
Definition
|
|
Term
| Melanoma that has no "in situ" form |
|
Definition
| nodular (this form has the most mortality) |
|
|
Term
| abridged clark levels (melanoma) |
|
Definition
I:in situe
II: shallow dermal spread
III: fills papilla
IV: fills whole dermis
V: in subcutis |
|
|
Term
| stain for Merkel cell carcinoma |
|
Definition
|
|
Term
| virus associated w/ merkel cell |
|
Definition
|
|
Term
| what embryonic layer does synovium derive from? |
|
Definition
| mesoderm (explains why there is no basement membrane |
|
|
Term
|
Definition
intima (2-3 cells thick: Mø & fibroblasts that secrete HA)
subintima (has lymphatics, capillaries, nerves) |
|
|
Term
|
Definition
|
|
Term
| which form of collagen is secreted but not terminally cleaved? |
|
Definition
| procollagen (tropocollagen is cleaved product) |
|
|
Term
| second messanger in RANK-L signaling? |
|
Definition
|
|
Term
|
Definition
| osteoclast resorption pit |
|
|
Term
|
Definition
|
|
Term
|
Definition
| where osteocyte processes live (lamellae is compact bond where the osteocytes live) |
|
|
Term
| many ____ are contained in one muscle cell/fiber |
|
Definition
|
|
Term
| describe SR & T-tubule triad |
|
Definition
- T-tuble in center, 2 SR membranes on each side
- located at A-I junction |
|
|
Term
Name stages of bone repair:
1 week
2 weeks
1 month
3 months |
|
Definition
- inflammation
- granulation tissue, early mineralization
- woven bone ("bony callus")
- lamellar bone ("remodeling stage") |
|
|
Term
| things that can cause pathologic muscle hypertrophy |
|
Definition
hypothyroid
acromegaly
dystrophies
chronic denervation |
|
|
Term
|
Definition
| infant motor neuron disease (most severe spinal musclar atrophy): SMA1 mutation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| other X-linked musclar dystrophy? |
|
Definition
| emery-dreifuss (gene is "emerin" on Xq28) |
|
|
Term
| triplet repeat muscular dystrophy |
|
Definition
| myotonic dystrophy (CTG repeat of DMPK) |
|
|
Term
|
Definition
| Nemaline myopathy (Z-band (alpha-actinin) inclusions, i.e. "nemaline rods") |
|
|
Term
| Central core disease (myopathy) gene mutation |
|
Definition
|
|
Term
|
Definition
| centronuclear myopathy (see lots of central nuclei like the muscle is trying to repair itself) |
|
|
Term
|
Definition
| mitochondrial myopathies ("ragged red fibers"); opthalmoplegia & encephalopathy are common sequela |
|
|
Term
| inflammatory myositis w/ inflammation not around atrophic muscle |
|
Definition
| dermatomyositis (inflammation is around capillaries) |
|
|
Term
HLA-DR2 associated with?
DR3? |
|
Definition
- narcolepsy & MS
- SLE & Myasthenia |
|
|
Term
| Which HLA has a small beta subunit? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| how many AA on MHCI & MHCII |
|
Definition
|
|
Term
| name the 2 stimuli for T-cell activation |
|
Definition
| MHC I (CD8) or II (CD4) and B7 (attaches to CD28 on T-cells) |
|
|
Term
| acute rejection is mediated primarily by CD4 or CD8? chronic? |
|
Definition
CD8 mediates acute (activated against graft antigens on graft MHC-I
over time, graft dendritic cells decline and no longer travel to lymph nodes --> host APCs present graft antigens to immune system --> CD4 response --> chronic rejection |
|
|
Term
|
Definition
| mix leukocytes w/ antibodies to different types of HLA and complement --> look for complement activation by dye uptake |
|
|
Term
| concentration that urate crystals precipitate @ |
|
Definition
|
|
Term
|
Definition
| red meat, shellfish, beer |
|
|
Term
drugs that can contribute to gout
Drugs that reduce the risk? |
|
Definition
Diuretics (HCTZ & furosemide)
Niacin (metabolized to UA)
Cyclosporin (decrease renal function)
Reduce risk: fibrates, Losartan |
|
|
Term
| skin condition that can cause gout |
|
Definition
| psoriasis (also remember that myeloproliferative disorders are classically associated with gout) |
|
|
Term
| 2 transporters involved in UA transport in kidney and their positions? |
|
Definition
URAT1 (apical)
Glut9 (basolateral) |
|
|
Term
|
Definition
| important in gout: activates caspase1 to cleave IL-1 to it's active product --> inflammation |
|
|
Term
| UA level in trophaceous gout |
|
Definition
|
|
Term
| treatment of gout-induced nephrolithiasis |
|
Definition
|
|
Term
| long standing gout effect in kidney |
|
Definition
| urate nephropathy (uric acid crystals in interstitium) |
|
|
Term
|
Definition
| agranulocytosis; neuropathy |
|
|
Term
|
Definition
| basic pyrophosphate crystalline arthritis (periarthritis, e.g. "frozen shoulder") |
|
|
Term
| other things RF is seen in? |
|
Definition
| HepC, SLE, Sjogrens, Cryoglobulinemia, chronic infections, 10% of elderly |
|
|
Term
thing on APCs/B-cells that activate T-cells
thing on T-cells that activate APCs/B-cells |
|
Definition
B7
CD40L (esp needed for class switching, def = hyper IgM) |
|
|
Term
|
Definition
| HLA-DR4 (explains why it is a CD4+ mediated pathogenesis) |
|
|
Term
|
Definition
| Th1, Th17 (IL-1,6,17 & IFN-g & TNF) |
|
|
Term
| can psoriatic arthritis be on DIPS? |
|
Definition
| yes! usually the first joint affected (usually assymetric: dactylitis, i.e. sausage-finger) |
|
|
Term
| Gene involved in citruilination |
|
Definition
| PADI4 (gene that is associated w/ RA), another gene is PTPN22 (regulates B & T cell function) |
|
|
Term
| why do you get boney erosions w/ RA? |
|
Definition
increased RANK-L expression on synovium
get subcondral trabecular thinnign b.c. of influx of inflammatory cells |
|
|
Term
|
Definition
| neutropenia, splenomegally, rheumatoid arthritis |
|
|
Term
| increased to get this cancer with RA |
|
Definition
|
|
Term
|
Definition
| increased risk of coronary artery disease |
|
|
Term
| markers of systemic inflammation? |
|
Definition
CRP & ESR (fibrinogen) --> both are acute phase reactants
(Check for in RA) |
|
|
Term
|
Definition
acute phase proteins
RF, anti-ccp, ANA |
|
|
Term
|
Definition
| immunosupressive agent: sulfapyradine componenet inhibits B-cell function (RA) |
|
|
Term
|
Definition
| RA: nebulous MOA; hemolysis in G6PD def (so does sulfasalazine!) |
|
|
Term
|
Definition
| Etanercept, Infliximab (RA) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what disease do you get subchondral cysts in? |
|
Definition
|
|
Term
| 2 joint diseases associated w/ hemochromatosis |
|
Definition
Pseudogout & osteoarthritis
Other things for PG: hyperparathyroidism, osteoarthritis
Other thigns w/ osteoarthritis: wilsons, ochronosis, gout, pseudogout, other inflammatory joint diseases |
|
|
Term
| stickler syndrome & blount disease? |
|
Definition
both associated w/ OA:
- defect in collage (many different types)
- congenital tibia varus |
|
|
Term
| dietary deficiencies associated w/ OA? |
|
Definition
|
|
Term
| what is an absolute indication for CCS injections in OA? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| symptom progression w/ gonococcal septic arthritis |
|
Definition
| prodrome (fever, chills) --> migratory arthritis --> settles into a large joint (usually knee) |
|
|
Term
| how can you differentiate gonococcal setptic from non-gonococcal bacterial septic arthritis from physical exam alone? |
|
Definition
| gonococcal is frequently accompanied w/ tenosynovitis (rare in non-gonococcal) |
|
|
Term
| Tx for gonococcal septic arthritis |
|
Definition
- 1 week of IV ceftriaxone (may substitute spectinomycin)
- 1+ weeks of oral amoxicillin/clavulanic acid
always add doxycycline for chlamydia |
|
|
Term
| what is first step in management of septic joint. What do you do with this data? |
|
Definition
aspirate & gram stain
if G+cocci, assume staph or strep --> start on vanco (if MRSA), nafcillin, or cefazolin & do sensitivity testing
if G(-) start on ceftriaxone/ofloxacin
if pseudomonas suspected (IVD), start on antipseudomonals: ceftazidime/piperacillin/gentamicin |
|
|
Term
| most common cause of G(-) septic arthritis |
|
Definition
|
|
Term
| which viral arthritis looks like RA |
|
Definition
|
|
Term
|
Definition
| B-lactams, fluoroquinolones, rifampin |
|
|
Term
give answers to each situation for septic arthritis:
- young, healthy adult:
- RA:
- EtOH:
- IC:
- Myeloproliferative disease:
- IVD:
- Neonates:
- Children:
- Patient w/ UTI:
- Cat bite or scratch:
- Rat Bite: |
|
Definition
- young, healthy adult: gonococcal
- RA: S.aureus
- EtOH: S.pneumo
- IC: G(-)
- Myeloproliferative disease: G(-)
- IVD: Pseudomonas & serratia
- Neonates: G(-), S.aureus, Candida
- Children: Salmonella, S.aureus
- Patient w/ UTI: Proteus, E.coli
- Cat bite or scratch: Pastuerella multocida
- Rat Bite: Streptobacillus moniliformis |
|
|
