Title: MD / Course 2
Tags: MD::msk MD::dermatology MD::rheumatology MD::anatomy::lower_limb

Q: what type of arthritis is this?
[...]
A: rheumatoid arthritis (affecting MCP, PIP, MTP, and other joints symmetrically)

Q: what type of arthritis is this?
[...]
A: psoriatic arthritis (affecting PIP, DIP, and large joints in asymmetrical fashion)

Q: what type of arthritis is this?
[...]
A: ankylosing spondylitis (affecting axial skeleton + large peripheral joints in asymmetrical fashion)

Q: what type of arthritis is this?
[...]
A: osteoarthritis (affecting DIP, base of thumb, knees, hips, lumbar, cervical spine)

Q: what are sicca sx?
[...]
A: dry eyes and mouth

Q: what is Raynaud's phenomenon?
[...]
A: constriction of small blood vessel leading to change in colour in tip of fingers

Q: describe the pathophys of rheumatoid arthritis
[...]
A: CD4+ cells secrete cytokines → activate macrophages and synovial cells → swollen synovial tissue (pannus formation) → erosion of articular cartilage, bone, synovial membrane

what is the dx criteria for rheumatoid arthritis?
need ≥6 pnts
1. increased rheumatoid factor (IgM abs against Fc IgG) or presentation of anti-CCP abs (1 pnt)
2. increased CRP (ESR not allowed in Alberta) (1 pnt)
3. inflammatory arthritis of ≥3 joints (up to 5 pnts)
4. sx duration > 6 wks (1 pnt)
5. exclusion of diseases w/ similar clinical presentations (e.g., psoriatic arthritis, gout, pseudogout, SLE)

Q: how to ix rheumatoid arthritis?
1. [...]
2. [...]
3. [...]
A: anemia of chronic disease; synovial fluid: turbid fluid, decreased viscosity, increased WBC cnt (3-50 billion/L); X-rays (not necessary to confirm)

Q: what is the tx for rheumatoid arthritis?
best initial therapy: [...]
1st line DMARDs: [...]
2nd line DMARDs: [...]
A: NSAIDs (can be decreased or discontinued following successful tx w/ DMARDs) OR glucocorticoids for acute flares (prednisone); methotrexate, hydroxychloroquine, sulfasalazine; TNF inhibitors, rituximab, leflunomide
Extra: gold standard is MTX (20-25 mg weekly PO or SC) + folic acid
HCQ ± SSZ usually added to MTX

Q: what is the fn of DMARDs (e.g., methotrexate, hydroxychloroquine, sulfasalazine)?
[...]
A: to supress inflammation

Q: why might you see systemic sx, such as skeletal muscle breakdown, rheumatoid nodules on skin, fever, pleural effusion, increased hepcidin, and atheromatous placques, in rheumatoid arthritis?
[...]
A: due to inflammatory cytokines

Q: 40F presents w/ swan neck deformity and Baker (popliteal) cyst alongside fever and anemia of chronic disease. Genetic testing reveal the pt is HLA-DR4+. What is the most likley dx?
[...]
A: rheumatoid arthritis

Q: when to avoid methotrexate use?
[...]
A: in pregnancy/breastfeeding women

Q: how does hydroxychloroquine work?
[...]
A: by creating basic intracellular environment (prevents cell's ability to create MHC-peptide complexes; affects protein processing; antimalarial drug)

Q: describe the pathogenesis of osteoarthritis
[...]
A: mechanical wear and tear destroys articular cartilage → inflammation w/ inadequate repair (proteoglycans--, type I collagen++, elasticity--)

Q: what is the fn of hyaluronic acid?
1. [...]
2. [...]
A: provs viscosity; w/ lubricin, protects joint surface from shear stresses

what are some joint changes in osteoarthritis present on x-ray?
1. joint space narrowing
2. osteophyte formation (new bone growth)
3. subchondral sclerosis
5. subchondral bone cysts

Q: which hand joints are often affected in osteoarthritis?
1. [...]
2. [...]
3. [...]
A: DIP (Heberden's nodes); PIP (Bouchard's nodes); CMC at thumb

Q: what is the tx for osteoarthritis?
best initial tx: [...]
most definitive tx: [...]
A: physical therapy, weight reduction, NSAIDs; surgery: consider joint replacement

Q: what is bursitis?
[...]
A: inflammation of ≥1 sacs of synovial fluid
Extra: common sites: elbow, shoulder, hip, knee, ankle (remember the unhinged mnemonic)

Q: what is the diff btw osteoarthritis and rheumatoid arthritis in terms of pathogenesis?
[...]
A: osteoarthritis is inflamm due to mechanical wear and tear whereas RA is due to AI inflamm

Q: what is the diff btw osteoarthritis and rheumatoid arthritis in terms of predisopsing factors?
osteoarthritis: [...]
RA: [...]
A: age, female, obesity, joint trauma; female, smoking, HLA-DR4, RF, anti-CCP

Q: what is the diff btw osteoarthritis and rheumatoid arthritis in terms of presentation?
osteoarthritis: [...]
RA: [...]
A: affects elderly; pain worsens w/ use; affects young; prolonged morning stiffness that improves w/ use

Q: what is the diff btw osteoarthritis and rheumatoid arthritis in terms of synovial fluid analysis?
[...]
A: osteoarthritis has WBC count < 2 billion/L whereas RA is anti-CCP +ve (and high WBCs)

Q: 70F presents with morning stiffness of the shoulders and hip girdle. He has hypertension, and his medications are lisinopril and rosuvastatin. He says that aside from occasional headaches, he feels well. His temperature is 37.5°C (99.5°F), pulse 75/minute, respirations 14/minute, and blood pressure is 140/80. The only abnormal laboratory blood and urine findings are an ESR of 100 mm/hr and hemoglobin of 11 g/dL. What is the most likely diagnosis?
[...]
A: polymyalgia rheumatica

Q: what is the diff btw fibromyalgia and polymyalgia rheumatica in terms of age?
[...]
A: fibromyalgia is usually in women 30-50 y/o whereas PR is >50 y/o

Q: what is the diff btw fibromyalgia and polymyalgia rheumatica in terms of location?
[...]
A: fibromyalgia is widespread whereas PR is shoulder and pelvic girdle

Q: what is the diff btw fibromyalgia and polymyalgia rheumatica in terms of tx?
fibromyalgia: [...]
PR: [...]
A: antidepressants, NSAIDs, rest; low-dose prednisone (extremely good response)

Q: what is fibromyalgia?
[...]
A: chronic condition of central sensitization (hypersensitivity to pain, sleep disturbances)

Q: what is tx for fibromyalgia?
[...]
A: antidepressants (TCA, SNRIs), gapapentin, pregabalin, muscle relaxants, physical therapy
Extra: avoid narcotics
gabapentin: anticonvulsant medication primarily used to treat partial seizures and neuropathic pain
pregabalin: anticonvulsant, analgesic and anxiolytic medication used to treat epilepsy, neuropathic pain, fibromyalgia, restless leg syndrome, opioid withdrawal and generalized anxiety disorder

Q: how to tell if arthritis is inflammatory or not based on clinical sx?
[...]
A: stiffness >30 min, B sx present, RA/PsA joint pattern

Q: how to tx septic arthritis?
[...]
A: ceftriaxone and vancomycin until culture test results

Q: how to dx septic arthritis?
most accurate test: [...]
other tests: [...]
A: joint aspiration; elevated WBCs, +gram stain, +fluid culture

Q: which joint is most affected in gout?
[...]
A: 1st metatarsal joint of big toe (podagra often presents)

Q: what causes gout?
[...]
A: intra-articular deposition of monosodium urate crystals due to disorders of urate metabolism

Q: how to dx gout?
dx tests: [...]
lab tests and imaging: [...]
A: joint fluid aspirate shows needle-shaped, -vely birefringent crystals; serum uric acid elevated (but can be normal), rat-bite erosions in advanced gout

Q: how to tx gout?
acute attacks: [...]
maintenance: [...]
A: high-dose NSAIDs (e.g., indomethacin) and colchicine 1st line; steroids if NSAIDs ineffective; allopurinol, weight loss, avoid EtOH consumption

Q: what is the diff btw gout and pseudogout in terms of hx?
[...]
A: gout is male, binge drinking, recent surgery whereas pseudogout is hemochromatosis or hyperparathyroidism

Q: what is the diff btw gout and pseudogout in terms of physical findings?
[...]
A: first big toe affected in gout whereas wrists and knees in pseudogout

Q: what is the diff btw gout and pseudogout in terms of crystal shapes in joint fluid aspirate?
[...]
A: gout has needle shaped w/o crystal birefringence whereas pseudogout is rhomboid and has crystal birefringence

Q: how does allopurinol work?
[...]
A: by inhibiting xanthine oxidase, decreasing the production of uric acid
Extra: can use in gout and tumour lysis syndrome

Q: how to tx SLE?
mild joint sx: [...]
acute flares: [...]
progressive/refractory cases: [...]
A: NSAIDs; corticosteroids (be wary of Cushing syndrome and possible avascular necrosis from chronic use); !!hydroxychloroquine!! (isolated skin and joint involvement), cyclophosphamide (severe cases of lupus nephritis), azathioprine

what does DOPAMINE RASH stand for in SLE dx?
1. Discoid rash
2. Oral ulcers
3. Photosensitivity
4. Arthritis (nondeforming)
5. Malar rash
6. Immunologic criteria: dsDNA, Sm proteins, APL
7. Neuro sx (lupus cerebritis, seizures)
8. Elevated ESR
9. Renal disease
10. ANA+
11. Serositis (pleural or pericardial effusion)
12. Hematologic abnormalities

Q: what tests would you use to rule out lupus?
[...]
A: ANA (high sensitivity b/c ANA is +ve in other conditions as well)

Q: which tests would you use to rule in (specific) lupus?
[...]
A: anti-dsDNA, anti-Sm, APL

Q: which organs/things do these biologics do in SLE?
belimumab: [...]
anfrilumab: [...]
rituximab: [...]
A: skin and joint disease (or as adjunct for renal disease); skin and joint disease; severe, refractory lupus

what are common clinical features of gout?
1. hyperuricemia (mostly underexcretion)
2. acute monoarticular arthritis
3. acute polyarticular arthritis
4. tophi and chronic arthritis
5. nephrolithiasis

Q: what is the strongest predictor of incidence of gout?
[...]
A: serum uric lvls (directly correlated w/ incidence of gout)

Q: what is DECT used for?
[...]
A: to detect and classify uric acid stones (useful in gout dx)
Extra: DECT = dual energy CT

Q: what is the most common cause of septic arthritis and what is the tx?
[...]
A: Staph aureus; ceftriaxone and vancomycin (in young ppl, suspect gonococcal infection)

Q: how to tx pseudogout?
acute flares: [...]
management and prevention: [...]
A: NSAIDs, colchicine, glucocorticoids; colchicine

Q: what is the most likely cause of degenerative arthritis in children and teens?
[...]
A: osteochondritis dessicans (often in knee)

Q: what is the classic triad seen in reactive arthritis?
[...]
A: conjunctivitis, urethritis, arthritis
Extra: can use cephalosporins (e.g., ceftriaxone) and fluoroquinolones to tx G- infections often seen in reactive arthritis

Q: which tissues are affected in Reiter syndrome (type of reactive arthritis)?
[...]
A: joint spaces, lining of urethra, conjunctiva
Extra: can use cephalosporins (e.g., ceftriaxone) and fluoroquinolones to tx G- infections often seen in reactive arthritis

what occurs in CREST syndrome (think systemic sclerosis)?
1. Calcinosis
2. Raynaud phenomenon
3. Esophageal dysmotility
4. Sclerodactyly
5. Telangiectasia

Q: how to dx scleroderma?
1. [...]
2. [...]
3. severe disease may cause MAHA; dx depends on constellation of sx
A: RF+ and ANA+; anti-centromere abs for CREST syndrome

how to tx scleroderma?
acute flares: corticosteroids
limited scleroderma: methotrexate
Raynaud phenomenon: Ca2+ channel blockers (e.g., amlodipine)
renal disease: angiotensin-converting enzyme inhibitors

Q: what does active ROM pain and passive ROM pain suggest?
[...]
A: articular arthritis

Q: what does active ROM pain and passive ROM no pain suggest?
[...]
A: non-articular arthritis

Q: what does active ROM no pain and passive ROM pain suggest?
[...]
A: non-MSK related

Q: how does giant cell arteritis present?
[...]
A: new headache caused by subacute granulomatous inflammation of large vessels (aorta, external carotid, vertebral arteries) in females >50 y/o

Q: how to dx giant cell arteritis?
best initial test: [...]
most accurate test: [...]
A: ESR > 50 mm/h (influenced by age); temporal artery biopsy

Q: how to tx giant cell (temporal) arteritis?
[...]
A: high-dose prednisone to prevent occular involvement

Q: what is the most feared complication of giant cell arteritis?
[...]
A: blindness secondary to occlusion of central retinal artery (br of int. carotid artery)

Q: how does Takayasu arteritis present?
[...]
A: large vessel AI vasculitis in Asian women < 40 y/o (aortic claudication, diff bp in both upper extremities)

Q: how to tx Takayasu arteritis?
[...]
A: prednisone 0.5-1 mg/kg/day for 1 month, taper to maintenance dose < 10 mg

Q: how to dx polyarteritis nodosa?
imaging: [...]
viral: [...]
other labs: [...]
A: string of beads in mesenteric angiogram; HBV and HCV serology; Cr, muscle enzymes, urinalysis

Q: how to tx polyarteritis nodosa?
[...]
A: corticosteroids; supplement w/ cyclophosphamide in moderate to severe cases

Q: how to tx Buerger's disease (thromboangiitis obliterans)?
[...]
A: immediate smoking cessation

Q: describe the pathophys of Buerger's disease (thromboangiitis obliterans)
[...]
A: inflammatory occlusive thrombus → distal extremity ischemia, digit ulcers/gangrene → autoamputation

Q: how to dx granulomatosis w/ polyangiitis (GPA; aka Wegener's granulomatosis)?
[...]
A: c-ANCA (PR3-ANCA) and CXR w/ large nodular densities

Q: how to tx granulomatosis w/ polyangiitis (GPA; aka Wegener's granulomatosis)?
[...]
A: glucocorticoids w/ rituximab or cyclophosphamide

Q: how does cyclophosphamide work?
[...]
A: by alkylating DNA

Q: what are side effects of cyclophosphamide?
blood/cancer: [...]
other: [...]
A: aplastic anemia, leukemia, bladder cancer; hair loss, GI disturbances, SIADH

Q: what are the main differences of microscopic polyangiitis from GPA?
1. [...]
2. [...]
3. [...]
A: does not affect nasopharynx; no granulomas; has p-ANCA (MPO-ANCA) instead of c-ANCA

Q: how to tx microscopic polyangiitis?
[...]
A: corticosteroids + cyclophosphamide

Q: what are the 3 main types of ANCA-associated vasculitis (AAV)?
1. [...]
2. [...]
3. [...]
A: GPA (granulomatosis w/ polyangiits; formerly called Wegener's granulomatosis); MPA (microscopic polyangiitis); EGPA (eosinophilic granulomatosis w/ polyangiitis; aka Churg-Strauss syndrome)

Q: Pt presents with palpable purpura with thrombocytopenia, arthritis, renal disease, and abdominal pain. What is the most likely dx and tx?
[...]
A: Henoch-Schonlein purpura; self-resolving disease (give steroids only if severe)

Q: where does giant cell arteritis usually affect?
[...]
A: temporal branch of carotid artery (headache, visual disturbances, jaw pains)

Q: where does Takayasu arteritis usually affect?
[...]
A: arteries from aortic arch (weak pulse, neuro sx)

Q: where does Kawasaki disease usually affect?
[...]
A: coronary arteries (4/5 CRASH sx; prolonged high fever)

Q: where does polyarteritis nodosa usually affect?
[...]
A: commonly the skin but can affect any organ (string of beads appearance on angiogram, end organ ischemic damage)

Q: where does Buerger's disease (thromboangiitis obliterans) usually affect?
[...]
A: blood clots in small arteries of fingers, toes (ulcers, dead tissues in extremities)

Q: where does GPA usually affect?
[...]
A: nasopharynx, lungs, kidneys (chronic pain, saddle nose deformity, breathing difficulties, ulcers w/ blood coughing, decreased urine production, increased bp)

Q: where does microscopic polyangiitis usually affect?
[...]
A: vessels of kidneys and lungs (kidney inflamm, weight loss, skin lesions, fever, nerve damage)

Q: where does Churg-Strauss syndrome (EGPA) usually affect?
[...]
A: vessels of kidneys and lungs (sinusitis, lung damage, kidney damage)

Q: where does Henoch-Shonlen purpura usually affect?
[...]
A: vessels of kidneys and lungs (sx depends on where IgA attacks small blood vessels)

what are the CRASH and burn sx in Kawasaki disease?
1. Conjunctivitis (bilateral, nonexudative)
2. polymorphous Rash (desquamating)
3. cervical lymphAdenopathy
4. Strawberry tongue: cracked red lips, oral mucositis
5. Hand-foot erythema (desquamation, edema)
6. burn (fever)

Q: what occurs in Kawasaki disease?
[...]
A: inflammation of coronary arteries causing aneurysms (most common type of vasculitis in children)

Q: how to tx Kawasaki disease?
[...]
A: IVIG and aspirin

Q: how to dx Kawasaki disease?
1. CXR: [...]
2. echocardiography: [...]
3. labs: [...]
4. 4/5 CRASH sx, high fever lasting 5 days
5. ECG w/ arrhythmias, abnormal Q waves, prolonged PR, QT intervals
A: cardiomegaly; coronary artery aneurysms, pericardial effusions, decreased contractility; increased CRP, ESR, plt

Q: A 38-year-old woman comes to the emergency department because of shortness of breath and cough, productive of blood-tinged sputum for 3 days. She has been unresponsive to antibiotic therapy from her family doctor. Her temperature is 38.0°C (100.4°F), pulse is 92/min, respirations are 18/min, and blood pressure is 110/68 mm Hg. Laboratory studies show an elevated erythrocyte sedimentation rate (ESR) and circulating cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA). Urinalysis shows dysmorphic red cells and red blood cell casts. Which antibody (excluding c-ANCA) is most likely to be found in the patient's serum?
[...]
A: anti-proteinase-3 abs
Extra: Granulomatosis with polyangiitis (GPA), formerly referred to as Wegener granulomatosis (WG), is a systemic disorder that involves both granulomatosis and polyangiitis. It is a form of vasculitis (inflammation of blood vessels) that affects small- and medium-sized vessels in many organs. Damage to the lungs and kidneys can be fatal and it requires long-term immunosuppression.
Classic signs and symptoms are hemoptysis, nasal mucosal ulceration, and saddle-nose deformity along with kidney damage (rapidly progressive glomerulonephritis, hematuria). Lung involvement that does not resolve with antibiotic therapy should raise a suspicious of a non-infectious etiology. Cytoplasmic antineutrophil cytoplasmic antibodies (c-ANCA) are associated with GPA and a specific subtype of these seen commonly in GPA are directed specifically against the anti-proteinase 3.
The condition was originally named for Friedrich Wegener, who described the disease in 1936. As a response to Wegener's association with the German Nazi party, professional bodies and journals have replaced his name with a descriptive name. However, the older name is still often seen.

Q: A 42-year-old man comes to the emergency department because of a 2-day fever and blurred vision which prevented him from working. The patient has not travelled recently and has not been in contact with any sick individuals. However, for the past month, he has had joint pain, tingling and numbness in his hands and feet, and low appetite with weight loss. He is hypertensive and auscultation shows a pericardial friction rub. A livedo reticularis pattern rash on his arms and legs is observed as well as tender lesions on the dorsum of his feet. Laboratory studies show increased CRP, leukocytosis, and the presence of hepatitis B surface antigen. What is the most likely dx?
[...]
A: polyarteritis nodosa
Extra: Polyarteritis nodosa (PAN) is a systemic vasculitis that affects medium-sized muscular arteries and is strongly associated with Hepatitis B (HBV) infection, although most cases are idiopathic. PAN is mediated by the formation of antigen-antibody complexes, and the mechanism of why this leads to medium-sized vessel inflammation is unknown. Inflammation can begin in the tunica intima and progress to include the entire wall, eventually destroying the elastic laminae and causing fibrinoid necrosis. Patients with PAN are typically characterized by systemic symptoms that include fatigue, weight loss, weakness, fever, and arthralgias. In addition, cutaneous features include tender erythematous nodules, purpura, ulcers, bulbous or vesicular eruptions, and livedo reticularis. Other systems that are affected include cardiac, renal, central and peripheral nervous systems, and the gastrointestinal system. PAN appears to spare the lungs, large and small sized vessels, as well as veins, and this is not clearly understood. Once PAN is suspected, diagnosis is confirmed by completing laboratory studies, vessel biopsy, and histological studies. Due to the multisystem effects of PAN, early diagnosis is crucial for treatment. Once diagnosed, PAN is treated with corticosteroids as well as antiviral agents for patients with HVB-related PAN.

Q: how to tx ankylosing spondylitis?
[...]
A: initially w/ NSAIDs then biologics
Extra: AS is a chronic inflammatory disease of the axial skeleton that leads to partial or even complete fusion and rigidity of the spine. Males are disproportionately affected and > 90% of patients are positive for the HLA-B27 genotype, which predisposes to the disease. The most characteristic early finding is pain and stiffness in the neck and lower back, caused by inflammation of the vertebral column and the sacroiliac joints, and improves with exercise.

Q: what does Choosing Wisely Canada have to say about ANA?
[...]
A: don't order it as a screening test w/o specific signs or sx of a rheumatic condition

Q: describe the pathophys of Marfan syndrome
[...]
A: FBN1 gene mutation causes fibrillin 1 structural dysfn causing fibrillin loss (compromises muscle strength and elasticity)

Q: how to tx Marfan syndrome?
meds: [...]
surgery: valve and lens replacement, aortic dissection repair
A: beta blockers (slows aortic dilation) and angiotensin receptor blockers (decrease TGF-beta signalling, slows aortic dilation)

Q: what are 2 key PE findings in Marfan syndrome?
[...]
A: thumb sign and wrist sign

Q: A five-month-old infant is brought by his distressed mother to the pediatrician's office because of easy bruising. She reports that her child bruises easily on his back and arms when he is laid in his crib every night. She also states that his joints feel "loose" and she is afraid of dislocating his shoulders when she picks him up. Physical examination shows ecchymoses, hyperextensible skin, and cigarette-paper like stretch marks on the skin. What diagnosis best describes the defect causing this infant's presentation?
[...]
A: Ehler's-Danlos syndrome (EDS)
Extra: Ehlers-Danlos syndrome is an inherited disease of defective collagen synthesis. Depending on the sub-type of Ehlers-Danlos syndrome, the disease can either be autosomal dominant or recessive. Ehlers-Danlos can be sub-divided into several different types including classic (collagen type V), hypermobility, vascular (collagen type III), kyphoscoliosis, arthrochalasia, and dermatosparaxis Ehlers-Danlos syndrome. This infant in the clinical vignette is exhibiting a classical form of Ehlers-Danlos syndrome. The classical form is an autosomal dominant disorder characterized by a mutation in collagen type V. Symptoms include joint hypermobility, frequent joint dislocations, thoracolumbar scoliosis, hyperextensible skin, easy bruising, and atrophic scars. Cardiac and pulmonary conditions, while rare, can occur and include mitral valve prolapse and spontaneous pneumothorax. Physical examination shows cigarrette-paper like scars (from poor wound healing), hyperextensible skin (stretching of skin greater than 4 centimeters), and hypermobile joints (dorsiflexion of the thumb greater than 90 degrees).

Q: A 22-year-old man comes to his primary care provider's office because of shoulder pain. He states that he always dislocates his shoulder during his company's annual softball game. He also reports easy bruising and stretchy skin. On physical examination, the patient's skin is hyperextensible and smooth velvety with cigarrette-paper like scars. His thumb is passively dorsiflexed to greater than 90 degrees. A clinical diagnosis of Ehlers-Danlos syndrome is made. A defect in which of the following is most associated with his form of Ehlers-Danlos syndrome?
[...]
A: type V collagen (classic)
Extra: Ehlers-Danlos syndrome is a disorder of faulty collagen synthesis most commonly affecting collagen type III and V. Ehlers-Danlos can be sub-divided into several different types including classic (collagen type V), hypermobility, vascular (collagen type III), kyphoscoliosis, arthrochalasia, and dermatosparaxis Ehlers-Danlos syndrome. Symptoms of Ehlers-Danlos syndrome include hyperextensible skin, hypermobile joints, easy bruising, berry aneurysms, organ rupture, joint dislocation, and mitral valve prolapse.

Q: A 29-year-old Caucasian woman comes to her primary care physician for a routine physical. She reports that she has a history of easy bruising and that her uterus ruptured during a pregnancy in her early twenties. She states that her mother also has a history of uterine rupture during pregnancy. Physical examination shows an increased range of motion in her fingers and toes (greater than 90 degrees on passive dorsiflexion of the thumb). Her skin is very thin and fragile. Which type of collagen is most likely defective?
[...]
A: type III collagen (vascular)
Extra: Ehlers-Danlos syndrome is a disorder of faulty collagen synthesis most commonly affecting collagen type III and V. Ehlers-Danlos can be sub-divided into several different types including classic (collagen type V), hypermobility, vascular (collagen type III), kyphoscoliosis, arthrochalasia, and dermatosparaxis Ehlers-Danlos syndrome. Symptoms of Ehlers-Danlos syndrome include hyperextensible skin, hypermobile joints, easy bruising, berry aneurysms, organ rupture, joint dislocation, and mitral valve prolapse.

Q: what are the 2 main clinical presentations associated w/ scleroderma?
[...]
A: Sjogren disease and Raynaud phenomenon
Extra: Most patients with systemic sclerosis (scleroderma) will also have vascular dysfunction, most commonly Raynaud phenomenon. Secondary Sjögren disease is also associated with RA, SLE, and Scleroderma (Systemic sclerosis).There is no increased association of scleroderma with polymyositis, reactive arthritis, or dermatomyositis.

Q: what is the MOA of leflunomide?
[...]
A: inhibition of dihydroorotate dehydrogenase to stop uridine synthesis (targets rapidly dividing cells like lymphocytes)
Extra: Aspirin and corticosteroids can control symptoms but don't stop disease progression. Biologics are used if patients don't respond to conventional DMARDs which are the first-line therapy.
DMARDs:
1. Methotrexate (+folic acid)= Gold standard- Inhibits dihydrofolate reductase to inhibit synthesis of purines
2. Hydroxychloroquine = An antimalarial- Increases pH in intracellular compartments (ex. lysosomes, endosomes, golgi complex) so the cells can't create antigens for immune recognition
3. Sulfasalazine= Metabolized into sulfapyridine (antibacterial) and mesalazine (aka. 5-ASA: anti-inflammatory) by bacteria in colon
4. Leflunomide= Inhibits dihyrdrooroate dehydrogenase to stop uridine (i.e. pyrimidine) synthesis- especially tagerts rapidly dividing cells like lymphocytes.

Q: what is the diff btw joint involvement (think size) btw gout and pseudogout?
[...]
A: gout is small & medium whereas pseudogout is larger
Extra: Gout:
- Pain= Intense
- Joints involved= Small and medium
- Hyperuricemia= Typically present
- Radiographic features= Tophi, erosive changes
- Synovial fluid analysis= Monosodium Urate crystals (negative birefringent needle-shaped crystals)
Pseudogout:
- Pain= Moderate
- Joints involved= Larger
- Hyperuricemia= Not associated
- Radiographic features= Chondrocalcinosis
- Synovial fluid analysis= Calcium pyrophosphate crystals (Positive birefringent rhomboid-shaped crystals)

Q: what is the diff btw radiographic features btw gout and pseudogout?
[...]
A: gout has tophi & erosive changes whereas pseudogout has chondrocalcinosis (calcium deposition in cartilage)
Extra: Gout:
- Pain= Intense
- Joints involved= Small and medium
- Hyperuricemia= Typically present
- Radiographic features= Tophi, erosive changes
- Synovial fluid analysis= Monosodium Urate crystals (negative birefringent needle-shaped crystals)
Pseudogout:
- Pain= Moderate
- Joints involved= Larger
- Hyperuricemia= Not associated
- Radiographic features= Chondrocalcinosis
- Synovial fluid analysis= Calcium pyrophosphate crystals (Positive birefringent rhomboid-shaped crystals)

Q: what are common adverse effects of hydroxychloroquine (e.g., in SLE)?
[...]
A: retinopathy (ocular toxicity), general GI (nausea w/ cramps, anorexia, vomiting), muscle weakness

Q: what does slapped cheek disease refer to?
[...]
A: parvovirus B19 viral infection (common in children)

Q: what is the ddx of migratory pattern of polyarthritis?
[...]
A: rheumatic fever, early gonococcal arthritis, acute childhood leukemia

Q: what is the ddx of additive/progressive pattern of polyarthritis?
[...]
A: RA, SLE, other inflammatory arthritis

Q: what is the ddx of intermittent pattern of polyarthritis?
[...]
A: crystal arthropathy, PsA, ReA, SLE

Q: how do RA and OA differ in terms of joints affected?
[...]
A: RA has elbows, ankles, MTPs + MCPs whereas osteo has spine (note: thumb can't differentiate the two)

Q: how does the potency of synthetic glucocorticoids change as they become longer acting?
[...]
A: more potent w/ longer acting drugs

Q: what are the sx of Cushing syndrome?
[...]
A: obesity, hyperglycemia & diabetes, muscle weakness, htn, osteoporosis, increased risk of bacterial & fungal infections

Q: what are some side effects of synthetic glucocorticoid use?
[...]
A: iatrogenic Cushing syndrome, psychiatric problems, peptic ulcers, buffalo hump, moon facies, truncal obesity

Q: what is ankylosing spondylitis?
[...]
A: chronic inflamm disease of spine and pelvis that leads to fusion of affected joints (strongly assoc w/ HLA-B27)

Q: describe the clinical presentation of ankylosing spondylitis
spine: [...]
systemic: [...]
A: decreased spine flexion, loss of lumbar lordosis, hip pain & stiffness; anterior uveitis, heart block (aortic valve)

Q: how to dx ankylosing spondylitis?
1. X-ray: [...]
2. genetics: [...]
3. serology: [...]
A: fused sacroiliac joints, squaring of lumbar vertebrae, vertical syndesmophytes, bamboo spine; HLA-B27 (85-95% of cases); -ve RF, -ANA, increased ESR / CRP in 85% of cases

Q: how to tx ankylosing spondylitis?
best initial therapy: [...]
refractory cases: [...]
A: NSAIDs (e.g., indomethacin) for pain, exercise to improve posture and breathing; TNF inhibitors or sulfasalazine

Q: what are the main sero-ve spondyloarthropathies?
[...]
A: PAIR: psoriatic arthritis. ankylosing spondylitis, IBD (enteropathic spondylitis), reactive arthritis

Q: how to tx psoriatic arthritis?
[...]
A: methotrexate or anti-TNF biologics (etanercept, infliximab, adalimumab); NSAIDs for pain
Extra: NSAIDs then DMARDs then biologics

Q: how to dx polymyositis and dermatomyositis?
best initial test: [...]
most accurate test: [...]
A: increased serum creatinine kinase and anti-Jo-1 abs; muscle biopsy

Q: how to tx polymyositis and dermatomyositis?
best initial tx: [...]
steroid-resistant/intolerant cases: [...]
A: high-dose corticosteroids w/ taper after 4-6 wks; azathioprine and/or methotrexate

Q: what are common presentations of polymyositis?
[...]
A: symmetric, progressive proximal muscle weakness; pts can also dev myocarditis

Q: 53M presents with Gottron papules, heliotrope rash, shawl and face rash, and mechanic hands. What is the most likely dx?
[...]
A: dermatomyositis (tx w/ high dose corticosteroids; antimalarials and sun avoidance can help prev rashes)

Q: A 47-year-old man comes to the outpatient provider because of a 5-month history of weakness in the shoulders and hip muscles. The patient reports having difficulty getting out of a chair and climbing stairs. The patient has no other medical conditions and previously led an active lifestyle. Temperature is 37.8°C (100.0°F), blood pressure is 122/68 mmHg, pulse is 67/min, and respiratory rate is 12/min. Physical examination is notable for tenderness and weakness in the shoulder and hip muscles. The following is also noted on bilateral ocular examination:
What would a muscle biopsy reveal?
[...]
A: perimysial infiltration by CD4+ T-cells and B-cells (dermatomyositis)

Q: What would be present in a muscle biopsy of a pt w/ polymyositis?
[...]
A: endomysial infiltration by CD8+ T-cells

Q: how does polymyalgia rheumatica present?
[...]
A: pain and stiffness in hip and shoulders unilaterally progressing bilaterally (HLA-DR4, adenovirus, parvovirus B19; temporal arteritis)
Extra: must ask if pt has headache or pain when chewing

Q: what would you expect to see in labs for polymyalgia rheumatica?
[...]
A: increased CRP, ESR; normal muscle enzymes; non-erosive joint disease on X-ray

Q: what are common side effects of MTX?
general: [...]
organ-specific: [...]
A: oral ulcers (manage w/ folic acid), nausea, fatigue (from anemia), reduced appetite; hepatotoxicity, nephrotoxicity, neurotoxicity, pneumonitis

Q: A 62 year old male presents with swelling along right 3rd finger. Describes whole finger swelling like a sausage has been present for 2 months. Also notes nail changes with thickening and pitting. What initial therapy would you recommend?
[...]
A: NSAIDs for psoriatic arthritis (followed by DMARDs)

Q: 62 year old male with psoriatic arthritis is currently on Etanercept once a week biologic therapy. The patient has been stable on this medication for the past 3 years. Today they have no active joints and report not having any recent flares. The patient is due to have a total knee replacement in 2 months. What should the surgeon do regarding the biologic therapy?
[...]
A: discontinue Entanercept 2 wks before surgery and restart 2 wks after

Q: what is enthesitis?
[...]
A: inflamm at fibrocartilage insertions of tendons, fascia, or ligaments into bone

Q: what is risk of developing ankylosing spondylitis w/ FDR?
[...]
A: 8%

describe the clinical presentation of rheumatoid arthritis
1. arthritis w/ morning stiffness that improves w/ activity
2. cytokine effects: fever, malaise, weight loss, myalgias
3. rheumatoid nodules (central zone of necrosis surrounded by epithelioid histiocytes)
4. vasculitis
5. baker cyst (swelling of bursa behind knee)
6. pleural effusions, lymphadenopathy, interstitial lung fibrosis

describe Schober's test
Extra: tests for ankylosing spondylitis
measure 10 cm above PSIS and <15 cm when bending may indicate AS

Q: what is the dx criteria for JIA?
[...]
A: age onset < 16 y/o and arthritic sx ≥ 6 wks

Q: what is the tx for JIA?
best initial tx: [...]
2nd line agents: [...]
A: NSAIDs and strengthening exercises; corticosteroids (for myocarditis) and DMARDs (MTX, anti-TNF)

Q: how does pauciarticular (oligoarthritis) present clinically in children w/ JIA?
[...]
A: ≤4 joints; no systemic sx; uveitis common (slit-lamp exam for dx)

Q: how does polyarthritis present clinically in children w/ JIA?
[...]
A: ≥5 joints symmetric; systemic sx rare

Q: how does systemic onset JIA present clinically in children?
[...]
A: recurrent high fever, hepatosplenomegaly, salmon-coloured macular rash

Q: how does systemic onset JIA present on RF and ANA in children?
[...]
A: RF-, ANA-

Q: how does polyarthritis JIA present on RF and ANA in children?
[...]
A: RF+ rare (indicates severe disease), young children may be ANA+ w/ milder disease

Q: how does pauciarticular (oligoarthritis) JIA present on RF and ANA in children?
[...]
A: RF-, ANA+

Q: Patient presents with Raynaud's syndrome, tight skin, and telangiectasia. Their labs are positive for Scl-70 and anti-centromere. What is the most likely dx?
[...]
A: scleroderma

Q: what does I and VI skin phototypes mean on the Fitzpatrick scale of skin phototypes?
I: [...]
VI: [...]
A: white: always burns, does not tan; black: never burns, tans very easily

Q: what are the 2 flat primary skin lesions?
[...]
A: macule (<1 cm) and patch (>1 cm)

Q: what are the 2 solid, elevated primary skin lesions w/o deep component?
[...]
A: papule (<1 cm), plaque (>1 cm)

Q: what are solid, elevated primary skin lesions w/ deep component called?
[...]
A: nodule

Q: what are fluid filled, elevated, prurulent primary skin lesions called?
[...]
A: pustule

Q: what are the 2 fluid filled, elevated, non-prurulent primary skin lesions called?
[...]
A: vesicle (< 1cm), bulla (>1 cm)

Q: what is this primary skin lesion called?
[...]
A: macule (flat lesion w/ well-circumscribed change in skin colour < 1cm; e.g., freckle, labial macule)

Q: what is this primary skin lesion called?
[...]
A: patch (macule > 1 cm; macules are flat lesion w/ well-circumscribed change in skin colour < 1cm; e.g., large birthmark)

Q: what is this primary skin lesion called?
[...]
A: papule (elevated solid skin lesion <1 cm; e.g., mole, acne)

Q: what is this primary skin lesion called?
[...]
A: plaque (papule >1 cm; elevated solid skin lesion <1 cm; e.g., psoriasis)

Q: what is this primary skin lesion called?
[...]
A: vesicle (small fluid-containing blister < 1 cm; e.g., chickenpox, shingles)

Q: what is this primary skin lesion called?
[...]
A: bulla (small fluid-containing blister > 1 cm; e.g., bullous pemphigoid)

Q: what is this primary skin lesion called?
[...]
A: pustule (vesicle containing pus; e.g., pustular psoriasis)

Q: what is this skin lesion called?
[...]
A: wheal (transient smooth papule or plaque; e.g., hives/urticaria)

Q: what is this secondary primary skin lesion called?
[...]
A: scale (flaking off of stratum corneum; e.g., eczema, psoriasis, SCC)

Q: what is this secondary skin lesion called?
[...]
A: crust (dry exudate; e.g., impetigo)

Q: what is the diff btw primary and secondary skin lesiosn?
[...]
A: primary are de novo whereas secondary develops from trauma, manipulation (rubbing, scratching), complication (infection) of initial lesion

Q: what are the 5 layers of the epidermis?
[...]
A: stratum: corneum, lucidum, granulosum, spinosum, basale (come, let's get sunburned)

Q: what type of skin distribution / pattern is this?
[...]
A: annular

Q: what type of skin distribution / pattern is this?
[...]
A: retiform (net-ike; e.g., vasculopathy)

Q: what type of skin distribution / pattern is this?
[...]
A: serpiginous (snake-like; e.g., cutaneous larva migrans from dog parasite)

Q: what type of skin distribution / pattern is this?
[...]
A: clustered/herpetiform (e.g., HSV)

Q: what type of skin distribution / pattern is this?
[...]
A: reticulated

Q: what type of skin distribution / pattern is this?
[...]
A: linear

Q: what type of skin distribution / pattern is this?
[...]
A: Blaschko's lines

Q: what is the dx?
[...]
A: cherry hemangioma
Extra: - Definition: Extremely common benign vascular cutaneous lesion. Increase in number with age and are often widespread. Often a cosmetic concern to pts. Often found in the trunk.
- Primary morphology: Papule -> bright red to violaceous macules or domed papules.
- Secondary morphology: None
- Etiology: Proliferation of dilated venules.
- Symptoms: Mostly cosmetic
- Treatment: None necessary unless irritated or bleeding 2^o to trauma.

Q: what is the primary morphology of a cherry hemangioma?
[...]
A: bright red or violaceous papules (due to proliferation of dilated venules)
Extra: - Definition: Extremely common benign vascular cutaneous lesion. Increase in number with age and are often widespread. Often a cosmetic concern to pts. Often found in the trunk.
- Primary morphology: Papule -> bright red to violaceous macules or domed papules.
- Secondary morphology: None
- Etiology: Proliferation of dilated venules.
- Symptoms: Mostly cosmetic
- Treatment: None necessary unless irritated or bleeding 2^o to trauma.

Q: what is the dx?
[...]
A: venous lake
Extra: - Definition: Common lesion, usually manifesting as a dark blue or violaceous papule on the lip or ear of an elderly person. 95% men.
- Primary morphology: Papule
- Secondary morphology: None
- Etiology: Dilation of venules thought to be caused by sun damage -> weakening the vascular adventitia and permits dilation of superficial vascular structures.
- Symptoms: Mostly cosmetic
- Treatment: No treatment necessary. Often cosmetic concerns. May resemble malignant lesions.

Q: what is the primary morphology of a venous lake?
[...]
A: papule (due to dilation of venules perhaps by sun damage)
Extra: - Definition: Common lesion, usually manifesting as a dark blue or violaceous papule on the lip or ear of an elderly person. 95% men.
- Primary morphology: Papule
- Secondary morphology: None
- Etiology: Dilation of venules thought to be caused by sun damage -> weakening the vascular adventitia and permits dilation of superficial vascular structures.
- Symptoms: Mostly cosmetic
- Treatment: No treatment necessary. Often cosmetic concerns. May resemble malignant lesions.

Q: what is the dx?
[...]
A: dermatofibroma
Extra: - Definition: Common, benign skin neoplasms comprised of collagen, macrophages (histiocytes), capillaries, and fibroblasts. Firm, skin coloured or slightly pigmented usually measuring 0.5-1 cm in diameter. Often persist for life. Most common in legs of women and often appear in young adulthood. Often solitary. Round with well defined border. Dimple or Fitzpatrick sign often present and help with diagnosis.
- Primary morphology: Papule
- Secondary morphology: None
- Etiology: Unknown; but some may arise from trauma or insect bites.
- Symptoms: May be tender or pruritic.
- Treatment: Not necessary

Q: what is the primary morphology of dermatofibroma?
[...]
A: papule; dimple / Fitzpatrick sign often present (unknown etiology; may arise from trauma or insect bites)
Extra: - Definition: Common, benign skin neoplasms comprised of collagen, macrophages (histiocytes), capillaries, and fibroblasts. Firm, skin coloured or slightly pigmented usually measuring 0.5-1 cm in diameter. Often persist for life. Most common in legs of women and often appear in young adulthood. Often solitary. Round with well defined border. Dimple or Fitzpatrick sign often present and help with diagnosis.
- Primary morphology: Papule
- Secondary morphology: None
- Etiology: Unknown; but some may arise from trauma or insect bites.
- Symptoms: May be tender or pruritic.
- Treatment: Not necessary

Q: what is the dx?
[...]
A: spider angioma
Extra: - Definition: Most prevalent telangiectasia. Central arteriole with various small twisted vessels radiating out. Has classic refuel pattern where if pressed down and released it will refill from the center out.
- Primary morphology: Telangiectasia
- Secondary morphology: None
- Etiology: Spontaneous and is present in 40% of normal children up to age 8. Women can develop during pregnancy. Oral contraceptives can causeàfrom high estrogen levels.
- Treatment: None/discontinue contraceptives

Q: what is the primary morphology of spider angioma?
[...]
A: telangiectasia (can be idiopathic; can arise during pregnancy; can be due to hyperestrogenemia)
Extra: - Definition: Most prevalent telangiectasia. Central arteriole with various small twisted vessels radiating out. Has classic refuel pattern where if pressed down and released it will refill from the center out.
- Primary morphology: Telangiectasia
- Secondary morphology: None
- Etiology: Spontaneous and is present in 40% of normal children up to age 8. Women can develop during pregnancy. Oral contraceptives can cause -> from high estrogen levels.
- Treatment: None/discontinue contraceptives

Q: what is the dx?
[...]
A: seborrheic keratosis
Extra: - Definition: Extremely common, benign neoplasms of epidermis on back and neck. Stuck on appearance. Primary morphology: Keratosis or keratotic papule or plaque. Has well defined borders. Increase in number with age. Scratching can cause scaling. Can occur on any site. Often seen on skin relaxation lines of skin (Langer lines)
- Secondary morphology: Scales or crust
- Etiology: Unknown but has a familial trait for the development of multiple SKs (autosomal dominant). Symptoms: may become painful or pruritic when traumatized -> ±redness and bleeding
- Treatment: None.
- Subtype: Dermatosis Papulosis
- Definition: Papular seborrheic keratosis on the face of darker skinned individuals.

Q: 40M presents with a benign neoplasm of the epidermis on his back. It has well defined borders and some of them present with scaling. These dark papules and plaques are seen on Langer lines (skin relaxation lines). What is the dx?
[...]
A: seborrheic keratosis
Extra: - Definition: Extremely common, benign neoplasms of epidermis on back and neck. Stuck on appearance. Primary morphology: Keratosis or keratotic papule or plaque. Has well defined borders. Increase in number with age. Scratching can cause scaling. Can occur on any site. Often seen on skin relaxation lines of skin (Langer lines)
- Secondary morphology: Scales or crust
- Etiology: Unknown but has a familial trait for the development of multiple SKs (autosomal dominant). Symptoms: may become painful or pruritic when traumatized -> ±redness and bleeding
- Treatment: None.
- Subtype: Dermatosis Papulosis
- Definition: Papular seborrheic keratosis on the face of darker skinned individuals.

Q: what is the dx?
[...]
A: acrochordons (skin tags)
Extra: - Definition: Common, benign, cutaneous growths. Small, flesh-coloured, pedunculated, fleshy papules, most commonly found on eyelids, neck, axillary, and inguinal.
- Primary morphology: Papule
- Secondary morphology: n/a
- Etiology: Associated with age, diabetes, and obesity.
- Symptoms: Usually asymptomatic but can be irritated by jewelry.
- Treatment: Can freeze off or may fall off spontaneously.

Q: what is the primary morphology of acrochordons?
[...]
A: papule (assoc w/ age, diabetes, obesity)
Extra: - Definition: Common, benign, cutaneous growths. Small, flesh-coloured, pedunculated, fleshy papules, most commonly found on eyelids, neck, axillary, and inguinal.
- Primary morphology: Papule
- Secondary morphology: n/a
- Etiology: Associated with age, diabetes, and obesity.
- Symptoms: Usually asymptomatic but can be irritated by jewelry.
- Treatment: Can freeze off or may fall off spontaneously.

Q: what is the dx?
[...]
A: fibrous papule of the nose
Extra: - Definition: Small, benign, flesh-coloured papules one the noes or central face. May be difficult to distinguish from other small papule lesions.
- Primary morphology: Papule
- Secondary morphology: None
- Etiology: Unknown
- Symptoms: Typically, asymptomatic but may bleed with trauma.
- Treatment: None

Q: 50M presents with small, benign, flesh-coloured papules on the nose and central face. What is the most likely dx?
[...]
A: fibrous papules of the nose
Extra: - Definition: Small, benign, flesh-coloured papules one the noes or central face. May be difficult to distinguish from other small papule lesions.
- Primary morphology: Papule
- Secondary morphology: None
- Etiology: Unknown
- Symptoms: Typically, asymptomatic but may bleed with trauma.
- Treatment: None

Q: what is the dx?
[...]
A: pyogenic granuloma
Extra: - Definition: Rapidly growing, benign, vascular growths. Usually present as a solitary red papule or nodule that grows quickly and bleeds easily. Common in children and women.
- Primary morphology: Papule
- Secondary morphology: None
- Etiology: Unknown. Associated with isotretinoin, topical retinoids, indinavir, 5-fluorouracil, capecitabine, mitoxantrone, and anti-epidermal growth factor inhibitors (anti-EGFRs).
- Symptoms: bleeds easily
- Treatment: surgery, curettage, cryotherapy

Q: what is the tx?
[...]
A: surgery, curettage, cryotherapy
Extra: - Definition: Rapidly growing, benign, vascular growths. Usually present as a solitary red papule or nodule that grows quickly and bleeds easily. Common in children and women.
- Primary morphology: Papule
- Secondary morphology: None
- Etiology: Unknown. Associated with isotretinoin, topical retinoids, indinavir, 5-fluorouracil, capecitabine, mitoxantrone, and anti-epidermal growth factor inhibitors (anti-EGFRs).
- Symptoms: bleeds easily
- Treatment: surgery, curettage, cryotherapy

Q: what is the dx?
[...]
A: benign acquired nevi (typically acquired during childhood, adolescence, or very early adulthood)
Extra: - Definition: Nevi are typically acquired during childhood, adolescence, or very early adulthood and senesce in later years. Can darken during pregnancy.
- Compound nevi are more common in those with lighter skin colours. Other forms of nevi are more common in individuals of African and Asian descent.

Q: what is the dx?
[...]
A: junctional nevi
Extra: Definition: Flat and pigmented macule that is more common in young individuals.
Primary morphology: Macule

Q: what is the dx?
[...]
A: compound nevus
Extra: - Definition: Elevated and pigmented papule
- Primary Morphology: Papule

Q: what is the diff btw the primary morphology of junctional nevi vs compound nevi?
junctional nevi: [...]
compound nevi: [...]
A: macule; papule

Q: what is the dx?
[...]
A: intradermal nevi
Extra: - Definition: Flesh coloured papules.
- Primary Morphology: Papule

Q: 2 week old baby presents with the following lesions. What is the dx?
[...]
A: congenital melanocytic nevus
Extra: - Definition: Benign nevus present at birth or within the first few weeks of life. Often flat and tan in colour. Trunk (38%) or Extremities (48%)... less common in head and neck (14%). Most are elevated lesions that have a brown pigmentation.
- Primary Morphology: Papule or Plaque
- Small: final adult size <1.5cm
- Medium: >10-20cm
- Large: >30-40cm
- Giant: >60cm
- *Most are 3-4 cm in size

Q: The lesion blanches when pressure is applied to the central body. Is this a cherry hemangioma or spider nevus?
[...]
A: spider nevus
Extra: How would you differentiate between a spider telangiectasia and a cherry hemangioma?
- Spider Telangiectasia have a central body with telangiectasia radiating out from the central body akin to the legs on a spider
- A cherry hemangioma is a solid red or violaceous papule
- A spider angioma is blanchable when pressure is applied to the central body.
- Cherry hemangioma is not blanchable
- Cherry hemangioma is more common in older adults while spider telangiectasia are more common in children

Q: what is the dx?
[...]
A: infantile hemangioma
Extra: - Definition: common infantile benign endothelial cell neoplasm, characterized by early proliferation (bright red) and then spontaneous involution (grey purple).
- Epi: Usually absent at birth and reach 80% of final size by 3.2mo.
- Risk factors: girls, preemies, low birthweight, older mothers who had villus sampling
- Treatment: most self-resolved (30% by 3, 70% by 7), severe can be managed with propranolol (beta-blocker)
- Complications: periocular haemangiomas -> blindness

Q: what are complications of infantile hemangioma?
[...]
A: periocular hemangioma leading to blindness
Extra: - Definition: common infantile benign endothelial cell neoplasm, characterized by early proliferation (bright red) and then spontaneous involution (grey purple).
- Epi: Usually absent at birth and reach 80% of final size by 3.2mo.
- Risk factors: girls, preemies, low birthweight, older mothers who had villus sampling
- Treatment: most self-resolved (30% by 3, 70% by 7), severe can be managed with propranolol (beta-blocker)
- Complications: periocular haemangiomas -> blindness

Q: what is the dx?
[...]
A: vascular malformation (port wine stain)
Extra: - Definition: wine-red coloured lesion with sharp midline demarcation secondary to vascular malformation. Present at birth and grow proportionately and persist into adulthood.
- Struge-Weber Syndrome: Vascular malformation in trigeminal distribution + seizure disorder.
- Complications: soft tissue hypertrophy

Q: 30F presents with congenital wine-red coloured lesion with sharp midline demarcation secondary to vascular malformation. What is the dx?
[...]
A: vascular malformation (port wine stain)
Extra: - Definition: wine-red coloured lesion with sharp midline demarcation secondary to vascular malformation. Present at birth and grow proportionately and persist into adulthood.
- Struge-Weber Syndrome: Vascular malformation in trigeminal distribution + seizure disorder.
- Complications: soft tissue hypertrophy

Q: what is the dx?
[...]
A: milia
Extra: - Definition: small firm white papules with keratin
- Epi: 40-50% of infants will have milia, usually on the face
- Management: resolves within 1st 4wk of life (infants), resolves spontaneously (children)

Q: what is the dx?
[...]
A: miliaria (heat rash)
Extra: - Definition: small vesicles of retained sweat, trapped under a swollen stratum corneum due occlusion of eccrine sweat duct
- Epi: any age group

Q: what is the dx?
[...]
A: mastocytosis
Extra: - Definition: excessive collection of normal mast cells. In children, limited to skin; in adults, can involve BM, liver, spleen, LN.
- Urticaria pigmentosa: general form of child mastocytosis. ≥1 tan-brown papules/plaques. Large lesions in children -> excessive histamine -> diarrhea/wheezing Darier’s Sign: urtication of mastocytosis lesion

Q: what causes mastocytosis?
[...]
A: XS collection of normal mast cells (XS histamine can cause diarrhea/wheezing [urticaria pigmentosa])
Extra: - Definition: excessive collection of normal mast cells. In children, limited to skin; in adults, can involve BM, liver, spleen, LN.
- Urticaria pigmentosa: general form of child mastocytosis. ≥1 tan-brown papules/plaques. Large lesions in children -> excessive histamine -> diarrhea/wheezing Darier’s Sign: urtication of mastocytosis lesion

Q: what is the dx?
[...]
A: halo nevi
Extra: - Definition: mole surrounded by white ring/halo
- Epi: incidence rate in <20yo is 1%, average age is 15. 20% of pt have vitiligo. More likely to have melanocytic nevi

Q: what is the dx?
[...]
A: dermal melanosis (Mongolian spot)
Extra: - Definition: blue-grey spots present at birth usually on lumbosacral region.
- Management: self-resolve in early childhood

Q: what is the dx?
[...]
A: alopecia areata
Extra: - Definition: non-scarring patterned alopecia, usually presenting with circular areas of alopecia
- Epi: 1.7% lifetime risk, 1-in-5 pt have a FHx
- Etiology: organ-specific autoimmune disease (T-cell mediated)
- Investigation: exclamation point hair which narrows proximally as it exits the hair follicle
- Complications: chronic relapse, alopecia totalis

Q: what pattern is pathognomonic for alopecia arreata?
[...]
A: exclamation point hair (narrows proximally as it exits the hair follicle)
Extra: - Definition: non-scarring patterned alopecia, usually presenting with circular areas of alopecia
- Epi: 1.7% lifetime risk, 1-in-5 pt have a FHx
- Etiology: organ-specific autoimmune disease (T-cell mediated)
- Investigation: exclamation point hair which narrows proximally as it exits the hair follicle
- Complications: chronic relapse, alopecia totalis

Q: what should you suspect in a patient that presents with vascular malformation in trigeminal distribution and seizure disorder?
[...]
A: Struge-Weber syndrome
Extra: vascular malformation (port wine stain)
- Definition: wine-red coloured lesion with sharp midline demarcation secondary to vascular malformation. Present at birth and grow proportionately and persist into adulthood.
- Struge-Weber Syndrome: Vascular malformation in trigeminal distribution + seizure disorder.
- Complications: soft tissue hypertrophy

Q: what is the dx?
[...]
A: malignant melanoma
Extra: Definition: uncontrolled melanocyte division Epi: 30% associated to nevus, remainder de novo
Subtypes:
- Nodular melanoma (top, left): dark brown to bluish-black nodule that grows rapidly. Likely to ulcerate or bleed.
- Superficial spreading melanoma (top, right, SSMM): new onset vertical growth -> nodule.
- Acral Letiginous Melanoma (ALMM, bottom left): palms, soles and nails (Hutchinson’s nail)
- Lentigo Maligna Malignant Melanoma (bottom, right): asymmetric brown-black macule or patch with color variegation and irregular borders. Slow growing SSMM on elderly photosensitive pt
Management: surgery (margins based on depth of invasion of the tumour)

Q: what is the dx?
[...]
A: nodular melanoma (grows rapidly; likely to ulcerate or bleed)
Extra: Definition: uncontrolled melanocyte division Epi: 30% associated to nevus, remainder de novo
Subtypes:
- Nodular melanoma (top, left): dark brown to bluish-black nodule that grows rapidly. Likely to ulcerate or bleed.
- Superficial spreading melanoma (top, right, SSMM): new onset vertical growth -> nodule.
- Acral Letiginous Melanoma (ALMM, bottom left): palms, soles and nails (Hutchinson’s nail)
- Lentigo Maligna Malignant Melanoma (bottom, right): asymmetric brown-black macule or patch with color variegation and irregular borders. Slow growing SSMM on elderly photosensitive pt
Management: surgery (margins based on depth of invasion of the tumour)

Q: what is the dx?
[...]
A: superficial spreading melanoma (new onset vertical growth -> nodule)
Extra: Definition: uncontrolled melanocyte division Epi: 30% associated to nevus, remainder de novo
Subtypes:
- Nodular melanoma (top, left): dark brown to bluish-black nodule that grows rapidly. Likely to ulcerate or bleed.
- Superficial spreading melanoma (top, right, SSMM): new onset vertical growth -> nodule.
- Acral Letiginous Melanoma (ALMM, bottom left): palms, soles and nails (Hutchinson’s nail)
- Lentigo Maligna Malignant Melanoma (bottom, right): asymmetric brown-black macule or patch with color variegation and irregular borders. Slow growing SSMM on elderly photosensitive pt
Management: surgery (margins based on depth of invasion of the tumour)

Q: what is the dx?
[...]
A: acral lentiginous melanoma (ALM; palms, soles, nails; Hutchinson's nail)
Extra: Definition: uncontrolled melanocyte division Epi: 30% associated to nevus, remainder de novo
Subtypes:
- Nodular melanoma (top, left): dark brown to bluish-black nodule that grows rapidly. Likely to ulcerate or bleed.
- Superficial spreading melanoma (top, right, SSMM): new onset vertical growth -> nodule.
- Acral Letiginous Melanoma (ALMM, bottom left): palms, soles and nails (Hutchinson’s nail)
- Lentigo Maligna Malignant Melanoma (bottom, right): asymmetric brown-black macule or patch with color variegation and irregular borders. Slow growing SSMM on elderly photosensitive pt
Management: surgery (margins based on depth of invasion of the tumour)

Q: what is the dx?
[...]
A: Lentigo maligna melanoma (asymm brown-black macule/patch w/ colour variegation and irregular borders; slow growing melanoma on elderly photosensitive pts)
Extra: Definition: uncontrolled melanocyte division Epi: 30% associated to nevus, remainder de novo
Subtypes:
- Nodular melanoma (top, left): dark brown to bluish-black nodule that grows rapidly. Likely to ulcerate or bleed.
- Superficial spreading melanoma (top, right, SSMM): new onset vertical growth -> nodule.
- Acral Letiginous Melanoma (ALMM, bottom left): palms, soles and nails (Hutchinson’s nail)
- Lentigo Maligna Malignant Melanoma (bottom, right): asymmetric brown-black macule or patch with color variegation and irregular borders. Slow growing SSMM on elderly photosensitive pt
Management: surgery (margins based on depth of invasion of the tumour)

Q: what is the dx?
[...]
A: solar elastosis (precancerous)
Extra: - Definition: form of dermatoheliosis (photoageing) where massive deposits of amorphous, yellow, elastin-like material deposit in upper dermis
- Epi: fair-skinned
- Symptoms: yellow, thickened, coarsely wrinkled skin. Can be hyper or hypopigmented. Telangiectasias.

Q: Pt presents with yellow, thickened, coarsely wrinkled skin due to dermatoheliosis. A biopsy shows amorphous, yellow, elastin-like material deposit in the upper dermis. What is the dx?
[...]
A: solar elastosis (premalignant)
Extra: - Definition: form of dermatoheliosis (photoageing) where massive deposits of amorphous, yellow, elastin-like material deposit in upper dermis
- Epi: fair-skinned
- Symptoms: yellow, thickened, coarsely wrinkled skin. Can be hyper or hypopigmented. Telangiectasias.

Q: what is the dx?
[...]
A: cutis rhomboidalis nuchae
Extra: - Definition: harmless cutaneous condition of posterior neck characterized by deep furrowing.
- Epi: elderly, lighter skin
- Etiology: chronic sun damage -> development of disorganized and damaged collagen and elastic tissue
- Symptoms: quadrangular and rhomboidal shaped exaggerated skin folds, leathery
- Management: irreversible

Q: what is the etiology of cutis rhomboidalis nuchae?
[...]
A: chronic skin damage causing damaged collagen and elastic tissue
Extra: - Definition: harmless cutaneous condition of posterior neck characterized by deep furrowing.
- Epi: elderly, lighter skin
- Etiology: chronic sun damage -> development of disorganized and damaged collagen and elastic tissue
- Symptoms: quadrangular and rhomboidal shaped exaggerated skin folds, leathery
- Management: irreversible

Q: what is the dx?
[...]
A: Favre and Racouchot disease (FRD, aka solar/senile comedones)
Extra: - Definition: small cysts and large blackheads form on face and neck
- Etiology: actinic damage, no inflammation
- Epi: smokers, men, fair-skinned

Q: what is the dx?
[...]
A: actinic (solar) keratoses
Extra: - Definition: Precancerous epithelial lesions that are found on sun-exposed areas such as the ace, neck, upper chest, forearms, and dorsal hands. 0.01-5% incidence of malignant transformation to SCC.
- Epi: Fair skinned people; rarely in darker phototypes Morphology: Flat, scaly, rough papules with ill defined boarders; beginning as rough localized skin lesions that are easily felt but not seen. Variable in size. Can coalesce to form plaques.
- “Actinic Cheilitis” – lower lip involvement
- Treatment: Initially may heal without treatment... Aggressive sun avoidance/protection (at least SPF 30). Cryotherapy or superficial curettage and cautery for individual lesions. 5- fluorocil 5% cream applied bid for 3 wk.

Q: how to tx actinic (solar) keratoses?
[...]
A: sun screen & avoid sun; cryotherapy / superficial curettage / cautery for indiv lesions; 5-FU
Extra: - Definition: Precancerous epithelial lesions that are found on sun-exposed areas such as the ace, neck, upper chest, forearms, and dorsal hands. 0.01-5% incidence of malignant transformation to SCC.
- Epi: Fair skinned people; rarely in darker phototypes Morphology: Flat, scaly, rough papules with ill defined boarders; beginning as rough localized skin lesions that are easily felt but not seen. Variable in size. Can coalesce to form plaques.
- “Actinic Cheilitis” – lower lip involvement
- Treatment: Initially may heal without treatment... Aggressive sun avoidance/protection (at least SPF 30). Cryotherapy or superficial curettage and cautery for individual lesions. 5-fluorocil 5% cream applied bid for 3 wk.

Q: what is the dx?
[...]
A: nodular BCC (most common overall)
Extra: Definition: Most common skin cancer of cells in stratum basale. A largely non-metastasizing cancer. Limited to sun-exposed areas.
Subtypes:
- Nodular: most common overall. Pearly papule with rolled boarder that my ulcerate and have superficial telangiectasia.
- Infiltrating: invades dermis
- Pigmented: most common among Africans, Asians,
- and Hispanics. Brown, blue, or black macule, papule, or nodule. Often on DDx with malignant melanoma. Can have telangiectasia. May have rolled edge.
- Superficial: Appear as dry, flat papules or plaques that enlarge slowly and sometimes develop a raised boarder. May be shiny or scaly. Well defined and develop pink to red colour. Mostly found on trunk.
Etiology: dysregulation in the sonic-hedgehog pathway. Inactivation of PTCH1 gene or sporadic activation of SMO genes.
- Treatment: Should be tailored to pt; surgery
- Electrodissectionandcurettage(ED&C), excision
- Cryosurgery
- Radiation; for ppl not good candidates for surgery.
- Mohs Surgery; removal until the border of the surgical field is cancer free. Criteria: recurrent, aggressive subtype, >2cm in size, are on head/neck.
- Topical treatments (for small lesions): imiquimod

Q: what is the dx?
[...]
A: superficial BCC (appears as dry, flat papules or placques that enlarge slowly and sometimes develops a raised border)
Extra: Definition: Most common skin cancer of cells in stratum basale. A largely non-metastasizing cancer. Limited to sun- exposed areas.
Subtypes:
- Nodular: most common overall. Pearly papule with rolled boarder that my ulcerate and have superficial telangiectasia.
- Infiltrating: invades dermis
- Pigmented: most common among Africans, Asians,
- and Hispanics. Brown, blue, or black macule, papule, or nodule. Often on DDx with malignant melanoma. Can have telangiectasia. May have rolled edge.
- Superficial: Appear as dry, flat papules or plaques that enlarge slowly and sometimes develop a raised boarder. May be shiny or scaly. Well defined and develop pink to red colour. Mostly found on trunk.
Etiology: dysregulation in the sonic-hedgehog pathway. Inactivation of PTCH1 gene or sporadic activation of SMO genes.
- Treatment: Should be tailored to pt; surgery
- Electrodissectionandcurettage(ED&C), excision
- Cryosurgery
- Radiation; for ppl not good candidates for surgery.
- Mohs Surgery; removal until the border of the surgical field is cancer free. Criteria: recurrent, aggressive subtype, >2cm in size, are on head/neck.
- Topical treatments (for small lesions): imiquimod

Q: what is the dx?
[...]
A: pigmented BCC
Extra: Definition: Most common skin cancer of cells in stratum basale. A largely non-metastasizing cancer. Limited to sun- exposed areas.
Subtypes:
- Nodular: most common overall. Pearly papule with rolled boarder that my ulcerate and have superficial telangiectasia.
- Infiltrating: invades dermis
- Pigmented: most common among Africans, Asians,
- and Hispanics. Brown, blue, or black macule, papule, or nodule. Often on DDx with malignant melanoma. Can have telangiectasia. May have rolled edge.
- Superficial: Appear as dry, flat papules or plaques that enlarge slowly and sometimes develop a raised boarder. May be shiny or scaly. Well defined and develop pink to red colour. Mostly found on trunk.
Etiology: dysregulation in the sonic-hedgehog pathway. Inactivation of PTCH1 gene or sporadic activation of SMO genes.
- Treatment: Should be tailored to pt; surgery
- Electrodissectionandcurettage(ED&C), excision
- Cryosurgery
- Radiation; for ppl not good candidates for surgery.
- Mohs Surgery; removal until the border of the surgical field is cancer free. Criteria: recurrent, aggressive subtype, >2cm in size, are on head/neck.
- Topical treatments (for small lesions): imiquimod

Q: what is the (genetic) etiology of BCC?
[...]
A: dysregulation of sonic hedgehog pathway
Extra: Definition: Most common skin cancer of cells in stratum basale. A largely non-metastasizing cancer. Limited to sun- exposed areas.
Subtypes:
- Nodular: most common overall. Pearly papule with rolled boarder that my ulcerate and have superficial telangiectasia.
- Infiltrating: invades dermis
- Pigmented: most common among Africans, Asians,
- and Hispanics. Brown, blue, or black macule, papule, or nodule. Often on DDx with malignant melanoma. Can have telangiectasia. May have rolled edge.
- Superficial: Appear as dry, flat papules or plaques that enlarge slowly and sometimes develop a raised boarder. May be shiny or scaly. Well defined and develop pink to red colour. Mostly found on trunk.
Etiology: dysregulation in the sonic-hedgehog pathway. Inactivation of PTCH1 gene or sporadic activation of SMO genes.
- Treatment: Should be tailored to pt; surgery
- Electrodissectionandcurettage(ED&C), excision
- Cryosurgery
- Radiation; for ppl not good candidates for surgery.
- Mohs Surgery; removal until the border of the surgical field is cancer free. Criteria: recurrent, aggressive subtype, >2cm in size, are on head/neck.
- Topical treatments (for small lesions): imiquimod
fun fact: BCC is assoc w/ inactivation of PTCH1 gene or sporadic activation of SMO genes

Q: how to tx BCC in general?
[...]
A: surgery: electrodissection and curettage (ED&C), Mohs, cryosurgery (radiation for non-surgical candidates)
Extra: Definition: Most common skin cancer of cells in stratum basale. A largely non-metastasizing cancer. Limited to sun- exposed areas.
Subtypes:
- Nodular: most common overall. Pearly papule with rolled boarder that my ulcerate and have superficial telangiectasia.
- Infiltrating: invades dermis
- Pigmented: most common among Africans, Asians,
- and Hispanics. Brown, blue, or black macule, papule, or nodule. Often on DDx with malignant melanoma. Can have telangiectasia. May have rolled edge.
- Superficial: Appear as dry, flat papules or plaques that enlarge slowly and sometimes develop a raised boarder. May be shiny or scaly. Well defined and develop pink to red colour. Mostly found on trunk.
Etiology: dysregulation in the sonic-hedgehog pathway. Inactivation of PTCH1 gene or sporadic activation of SMO genes.
- Treatment: Should be tailored to pt; surgery
- Electrodissectionandcurettage(ED&C), excision
- Cryosurgery
- Radiation; for ppl not good candidates for surgery.
- Mohs Surgery; removal until the border of the surgical field is cancer free. Criteria: recurrent, aggressive subtype, >2cm in size, are on head/neck.
- Topical treatments (for small lesions): imiquimod

Q: what is the dx?
[...]
A: squamous cell carcinoma (SCC; often seen w/ ulcers, crusting, erythematous plaque)
Extra: - Definition: Malignancy of cutaneous squamous keratinocytes in the epidermis occurring most frequently on sun-exposed areas.
- Etiology: malignant transformation of actinic keratoses or de novo
- Morphology: Erythematous, hyperkeratotic papule or nodule that may ulcerate. May also be skin coloured and smooth. Over time develops a depressed center and becomes fixed to underlying areas. New masses within scars or chronic ulcerations are highly suspicious for SCC. Immunocompromised pt – can occur anywhere (oral, anal, cervical mucosa, male genetals). Fair skinned transplant pt – usually scaly warts in areas of prior sun damage.
- “Bowen’s Disease” – early stage of SCC, slow growing, superficial SCC
- Treatment: Mohs surgery (only low-risk pts) and standard surgical excisions with 3-4mm margins. High risk pts usually get 6 mm margins. ED&C (time 3) with margins of 3-4 mm may be used for non-surgical pts. Radiation.

Q: Pt presents with erythematous, hyperkeratotic papule or nodule that ulcerates. The lesions have a depressed center and is fixed to the underlying area. What is the dx?
[...]
A: squamous cell carcinoma (SCC)
Extra: - Definition: Malignancy of cutaneous squamous keratinocytes in the epidermis occurring most frequently on sun-exposed areas.
- Etiology: malignant transformation of actinic keratoses or de novo
- Morphology: Erythematous, hyperkeratotic papule or nodule that may ulcerate. May also be skin coloured and smooth. Over time develops a depressed center and becomes fixed to underlying areas. New masses within scars or chronic ulcerations are highly suspicious for SCC. Immunocompromised pt – can occur anywhere (oral, anal, cervical mucosa, male genetals). Fair skinned transplant pt – usually scaly warts in areas of prior sun damage.
- “Bowen’s Disease” – early stage of SCC, slow growing, superficial SCC
- Treatment: Mohs surgery (only low-risk pts) and standard surgical excisions with 3-4mm margins. High risk pts usually get 6 mm margins. ED&C (time 3) with margins of 3-4 mm may be used for non-surgical pts. Radiation.

Q: what's the diff btw keloid scarring and hypertrophic scar?
keloid: [...]
hypertrophic: [...]
A: lesions extend beyond margins of scar; lesions remain w/in expected margins of scar

Q: Patient presents with erythematous crusted and ulcerated papules, plaques, and nodules. What is the most likely dx?
[...]
A: SCC

Q: Patient presents with pearly papules and plaques with a rolled border. What is the most likely dx?
[...]
A: basal cell carcinoma

Q: what are moles?
[...]
A: melanocytic lesions

Q: how to differentiate btw BCC and SCC?
SCC: [...]
BCC: [...]
A: firm, flesh-coloured keratotic papules/plaques & smooth nodules; ulceration & scaling; ulceration, pearly/raised edges, telangiectasias
Extra: - SCC presents as firm, flesh-colored keratotic papules or plaques and smooth nodules. A thick cutaneous horn and ulceration may accompany these lesions.
- Features that suggest BCC are translucency, ulceration, telangiectasias, pigmentation, and a rolled border.
Melanoma can be assessed w/ ABCDE criteria (asymmetry, borders, colours, diameter > 6 mm, evolution)

Q: what is the general ix for blisters?
[...]
A: skin biopsy for histopath, immunofluorescence, direct ab testing

Q: what is the dx?
[...]
A: bullous pemphigoid (BP)

Q: what is the pathophys of bullous pemphigoid?
[...]
A: IgG autoabs bind hemidesmosomal complex in basement membrane of skin -> complement activation & inflamm mediators -> tense bullae

Q: how to tx bullous pemphigoid?
[...]
A: topical corticosteroids for localized, systemic corticosteroids (prednisone) for extensive disease; oral doxycycline after blistering under ctrl

Header: where does pemphigus and pemphigoid affect?
Extra 1: pemphigus = flaccid blister = lose keratinocyte adhesion = autoab targets desmosomes
bullous pemphigoid = tense blister = lose adhesion of epidermis to dermis in basement membrane zone = autoab targets hemidesmosome (hamburger)

Q: where does bullous pemphigoid affect?
[...]
A: hemidesmosome causing loss of adhesion of epidermis to dermis in basement membrane zone

Q: which skin layer does pemphigus vulgaris affect?
[...]
A: desmosomes causing loss of keratinocyte adhesion

Q: what does Nikolsky's sign indicate in blisters?
[...]
A: pemphigus vulgaris (PV)
Extra: “Nikolsky’s Sign” – Lateral pressure on adjacent lesioned skin or rubbing normal-appearing skin will extend bullae or cause erosion.

Q: what occurs in superficial (1st degree) burns?
[...]
A: epidermis burned (red, little swelling, no blisters, painful)

Q: what occurs in superficial partial thickness (2nd degree) burns?
[...]
A: epidemis and papillary dermis burned (pink/red, moist, moderate swelling, blisters, painful)

Q: what occurs in deep partial thickness (2nd degree) burns?
[...]
A: all of epidermis and reticular dermis burned (red-white, blistered, moist, moderate swelling)

Q: what occurs in full thickness (3rd degree) burns?
[...]
A: all of epidermis, dermis, sub-Q tissue (white/black, charred, leathery, does not blanch, not painful)

Q: how long do superficial (1st degree) burns take to heal?
[...]
A: 2-5 days (no scar)

Q: how long do superficial partial thickness (2nd degree) burns take to heal?
[...]
A: 7-10 days (no scar)

Q: how long do deep partial thickness (2nd degree) burns take to heal?
[...]
A: 14 d (may need grafting, has hypertrophic scarring)

Q: how long do full thickness (3rd degree) burns take to heal?
[...]
A: long/never

Q: what occurs in 4th degree burns?
[...]
A: involves muscle or bone (usually electrical)

Q: what % of body is burned if head is affected?
[...]
A: 9% (4.5% front, 4.5% back)

Q: what % of body is burned if trunk is affected?
[...]
A: 36% (18% chest/abdo, 18% back)

Q: what % of body is burned if arms are affected?
[...]
A: 9% per arm (4-5% front, 4-5% back)

Q: what % of body is burned if legs are affected?
[...]
A: 18% each leg (9% front, 9% back for each leg)

Q: what % of body is burned if genitals are affected?
[...]
A: 1%

Q: how to immediately manage severe burns?
[...]
A: fluid resuscitation: Ringer's lactate & 4 cc/kg/%TBSA burn

what are the 4 phases of wound healing?
1. coagulation
2. inflammation
3. proliferation
4. remodelling
Extra: "can I pro remodel?"

Q: what is the main cell type in coagulation phase of wound healing?
[...]
A: platelets (fibrin plug formation, release of GFs, cytokines, hypoxia)
Extra: "can I pro remodel?"

Q: what are the main cell types in inflammation phase of wound healing?
[...]
A: neutrophils, monocytes, macrophages (cell recruitment & chemotaxis, wound debridement)
Extra: "can I pro remodel?"

Q: what are the main cell types in proliferation phase of wound healing?
[...]
A: keratinocytes, fibroblasts, endothelial cells (epidermal resurfacing, fibroplasia, angiogenesis, ECM deposition, contraction)
Extra: "can I pro remodel?"

Q: what is the main cell type in remodelling phase of wound healing?
[...]
A: myofibroblasts (scar formation & revision, ECM degradation, futher contraction and tensile strength)
Extra: "can I pro remodel?"
A myofibroblast is a cell that differentiates from fibroblasts in response to tissue injury. Synthesizes components of the extracellular matrix during wound healing. Can cause pathologic fibrosis.

Q: what is diff btw primary and secondary intention of wound healing?
primary: [...]
secondary: [...]
A: close w/ sutures, quick heal; do not suture, larger scar

Q: how to measure ulcer size of wounds?
[...]
A: length = longest axis, width = next axis perpendicular

Q: how long do fingernails and toenails grow?
fingernails: [...]
toenails: [...]
A: 3 mm/mo (6-12 mo for fingernail to completely grow back); 1 mm/mo (12-18 mo for toenail to completely grow back)

Q: what is onycholysis?
[...]
A: separation of nail plate from its bed (indicative of psoriasis)

Q: what is this sign called?
[...]
A: clubbing (think liver disease)

Q: what do these nails indicate?
[...]
A: chronic renal failure (Lindsay nails)

Q: what does this sign indicate?
[...]
A: nail melanoma (Hutchinson sign)

Q: how to tell if alopecia areata is scarring?
[...]
A: if follicles not present, scarring

Q: 50M presents with hypertrophic, rough papules that are thick and crusted with ill-defined borders. The patient claims that his initial lesions healed, but there remain persistent lesions with an erythematous base. What is the most likely skin lesion?
[...]
A: actinic keratosis

Q: which drugs can induce bullous disease?
[...]
A: diuretics (furosemide, spironolactone), ACE inhibitors (Captopril), D-penicillamine

Header: what is the name of this node?

Q: what do anti-Jo-1 and anti-synthetase +ve abs indicate?
[...]
A: polymyositis

Q: what do anti-MD5, anti-Mi-2, anti-TIF1, anti-NXP-2 +ve abs indicate?
[...]
A: dermatomyositis

Q: what is tx for mild-moderate acne?
[...]
A: topical retinoids and topical benoyl peroxide (kills Propionibacterium acnes; can consider topical clindamycin, erythromycin)

Q: what is the tx for moderate-severe acne?
[...]
A: in addition to topical tx, add oral abx such as doxycycline or minocycline; super severe, give oral retinoids (isotretinoin)

Q: what type of acne is this?
[...]
A: comedonal acne (give topical retinoid ± benzoyl peroxide)

Q: what type of acne is this?
[...]
A: papulopustular acne (give topical benzoyl peroxide)

Q: what is the dx?
[...]
A: cystic acne

Q: Patient presents with erythematous papules and pustules without comedones around the ear and chest. They also present with rhinophyma. The patient presents with no other sx. What is the tx?
[...]
A: avoiding triggers and giving metronidazole (dx: rosacea)

Q: what is the dx?
[...]
A: erythematotelangiectatic rosacea

Q: what is the dx?
[...]
A: papulopustular rosacea

Q: what is the dx?
[...]
A: phymatous rosacea

Q: what are common brand name rx for comedonal acne?
[...]
A: Tretinoin, Tazarotene, Adapalene (all are topical retionids)

Q: what are some common rx for papular and pustular acne?
[...]
A: clindamycin / erythromycin + benzoyl peroxide, dapsone gel, azelaic acid

Q: what is the dx?
[...]
A: perioral/periorificial dermatitis

Q: what is the dx?
[...]
A: varicella zoster (chicken pox)

Q: what is the prodrome of varicella?
[...]
A: malaise, fever, headache, myalgia (24 h before rash)

Q: what is tx for varicella-zoster?
children: [...]
adults: [...]
A: vaccine (otherwise self-limited); acyclovir (pain ctrl w/ gabapentin, tricyclic antidepressants)

Q: what is the dx?
[...]
A: herpes zoster (singles)
Extra: - Definition: reactivation of dormant varicella
- Epi: 20% of people who have had varicella Morphology: herpetiform (clustered vesicles) that follow dermatomes
- Symptoms: pruritus, tingling, tenderness, hyperesthesia, intense pain. Facial involvement can have corneal involvement (!!!)
- Management: early treatment with antivirals

Q: what is the tx for 1st episode of HSV?
[...]
A: acyclovir / famciclovir / valacyclovir, esp for immunocompromised patients
Extra: - Definition: reactivation of dormant varicella
- Epi: 20% of people who have had varicella Morphology: herpetiform (clustered vesicles) that follow dermatomes
- Symptoms: pruritus, tingling, tenderness, hyperesthesia, intense pain. Facial involvement can have corneal involvement (!!!)
- Management: early treatment with antivirals

Q: what is HSV-1?
[...]
A: common cold sore or herpes labialis (recurrent oral herpes)
Extra: - Definition: reactivation of dormant varicella
- Epi: 20% of people who have had varicella Morphology: herpetiform (clustered vesicles) that follow dermatomes
- Symptoms: pruritus, tingling, tenderness, hyperesthesia, intense pain. Facial involvement can have corneal involvement (!!!)
- Management: early treatment with antivirals

Q: what is HSV-2?
[...]
A: recurrent genital herpes (cluster of blisters on erythematous base, but w/ less pain and systemic involvement than primary infection)
Extra: - Definition: reactivation of dormant varicella
- Epi: 20% of people who have had varicella Morphology: herpetiform (clustered vesicles) that follow dermatomes
- Symptoms: pruritus, tingling, tenderness, hyperesthesia, intense pain. Facial involvement can have corneal involvement (!!!)
- Management: early treatment with antivirals

Q: what is the dx?
[...]
A: erythema multiforme (EM; symptomatic tx is all that is necessary)
Extra: - Definition: acute, self-limited skin disease characterized by abrupt onset of symmetric fixed red papules Etiology: infection, often HSV
- Morphology: papules, vesicles, target lesions
- Subtypes: minor (minimal mucosal involvement, no systemic symptoms)

Q: what is the dx?
[...]
A: scabies
Extra: - Definition: pruritic dermatitis caused by infestations with Sarcoptes sabiei (8-legged mite, often 10-15 mites per host)
- Morphology: wavy, thread-like gray-white burrow (tunnel that female mite excavates to lay eggs) Symptoms: itchiness due to allergic rxn
- Management: topical anti-scabietic twice, one week apart. Permethrin for children >2. Children <2 and pregnant pt overnight day 1 and day 5. 5-10% ppt sulfur in white petroleum applied (bid for 5 days). Wash linens, gloves in hot water. Should treat all family members.
- Course: pruritus and lesions can persist for 2-4 weeks, lesions may remain despite eradication for months

Q: what is tx for scabies?
[...]
A: 5% permethrin from neck down (≥2 tx separated by 1 week & close contacts tx); oral ivermectin effective
Extra: - Definition: pruritic dermatitis caused by infestations with Sarcoptes sabiei (8-legged mite, often 10-15 mites per host)
- Morphology: wavy, thread-like gray-white burrow (tunnel that female mite excavates to lay eggs) Symptoms: itchiness due to allergic rxn
- Management: topical anti-scabietic twice, one week apart. Permethrin for children >2. Children <2 and pregnant pt overnight day 1 and day 5. 5-10% ppt sulfur in white petroleum applied (bid for 5 days). Wash linens, gloves in hot water. Should treat all family members.
- Course: pruritus and lesions can persist for 2-4 weeks, lesions may remain despite eradication for months

Q: what is tx for lice?
[...]
A: 5% permethrin, benzyl alcohol, mechanical removal (wash body, clothes, bedding)
Extra: - Definition: infestation of scalp by Pediculus capitis (bloodsucking, wingless 6-legged insect). Spread by head to head contact.
- Diagnosis: 0.8mm eggs (nits) on scalp
- Symptoms: pruritus (may take 2-6wks to become evident, time needed for immunologic response to irritant in lice saliva)
- Management: Pyethrins, permethrin applied twice, 1 week apart to kill nits that have survived, to kill resistant bugs, reduce risk of re-infestation

Q: what is dx?
[...]
A: tinea versicolor
Extra: - Definition: A skin infection secondary to yeast that is not a dermatophyte. Commonly caused by Malassezia furfur.
- 1°: Macules (versicolor means many colours)
- 2°: Branny scale
- Morphology: well demarcated brown scaling patches causing temporary hypopigmentation.
- Management: ketoconazole or selenium sulfide shampoos

Q: what is tx for tinea versicolor?
[...]
A: topical ketoconazole or selenium sulfide
Extra: - Definition: A skin infection secondary to yeast that is not a dermatophyte. Commonly caused by Malassezia furfur.
- 1°: Macules (versicolor means many colours)
- 2°: Branny scale
- Morphology: well demarcated brown scaling patches causing temporary hypopigmentation.
- Management: ketoconazole or selenium sulfide shampoos

Q: what is the tx for thrush?
[...]
A: oral fluconazole tablets, nystatin swish and swallow, clotrimazole troches
Extra: - Definition: Oral yeast infection caused by Candida sp. Common in neonates. In older childrenàsign of immunosuppression.
- 1°: Erosion
- 2°: Macerated White Scale

Q: what is dx?
[...]
A: Candida intertrigo (found in moisture trapped areas)
Extra: Candida intertrigo
- Definition: Infection seen in areas where moisture is trapped.
- 1°: Patch, pustules, papules
- 2°: Erosions, scale
- Morphology: Moisture trapped areas, often satellite lesions on periphery (small inflammatory papules, pustules, or erosions).
- Management: try to keep affected area dry. Use topical anti-yeast treatments (clotrimazole, nystatin, ketoconazole, terbafine cream). Often combined with topical steroid for dermatitis.
Diaper Dermatitis
- Definition: a form of intertrigo, often superinfected. 1°: Patch, pustules
- 2°: Erosions

Q: what is the dx?
[...]
A: tinea corporis (ringworm)
Extra: Definition: Fungal infections caused by three genera of fungus (microsporum, trichophyton, epidermophyton) that can invade and multiply in keratinized tissue (hair, skin, nails)
1°: Annular plaque, patch, vesicle 2°: Scale, fissure
Investigation: KOH
Subtypes: The Tineas
- Tinea Corporis; Classic annular ring configuration (ringworm)
- Tinea Pedis; Most common. Often in 4th web space of foot. Can have moccasin pattern from thickened stratum corneum(keratoderma).
- Tinea Cruis; Jock itch; usually spread from tinea pedis. Cutaneous superficial dermatomyositis -> treat with terbinafine, ketoconazole, or azole fungal agents.
- Tinea Unguis (aka onychomycosis); 1° Nail dystrophy, systemic therapies can be successful (terbinafine, itraconazole, fluconazole)

Q: what is the dx?
[...]
A: tinea pedis
Extra: Definition: Fungal infections caused by three genera of fungus (microsporum, trichophyton, epidermophyton) that can invade and multiply in keratinized tissue (hair, skin, nails)
1°: Annular plaque, patch, vesicle 2°: Scale, fissure
Investigation: KOH
Subtypes: The Tineas
- Tinea Corporis; Classic annular ring configuration (ringworm)
- Tinea Pedis; Most common. Often in 4th web space of foot. Can have moccasin pattern from thickened stratum corneum(keratoderma).
- Tinea Cruis; Jock itch; usually spread from tinea pedis. Cutaneous superficial dermatomyositis -> treat with terbinafine, ketoconazole, or azole fungal agents.
- Tinea Unguis (aka onychomycosis); 1° Nail dystrophy, systemic therapies can be successful (terbinafine, itraconazole, fluconazole)

Q: how to tx dermatophyte infections (tineas)?
tinea cruris: [...]
tinea unguium (onychomycosis): [...]
A: terbinafine, ketoconazole, or azole fungal agents; terbinafine, itraconazole, fluconazole (systemic therapies)
Extra: Definition: Fungal infections caused by three genera of fungus (microsporum, trichophyton, epidermophyton) that can invade and multiply in keratinized tissue (hair, skin, nails)
1°: Annular plaque, patch, vesicle 2°: Scale, fissure
Investigation: KOH
Subtypes: The Tineas
- Tinea corporis; Classic annular ring configuration (ringworm)
- Tinea pedis; Most common. Often in 4th web space of foot. Can have moccasin pattern from thickened stratum corneum(keratoderma).
- Tinea cruis; Jock itch; usually spread from tinea pedis. Cutaneous superficial dermatomyositis -> treat with terbinafine, ketoconazole, or azole fungal agents.
- Tinea unguis (aka onychomycosis); 1° Nail dystrophy, systemic therapies can be successful (terbinafine, itraconazole, fluconazole)

Q: what is the dx?
[...]
A: impetigo due to Staph

Q: how to tx impetigo?
mild localized disease: [...]
severe disease (non-MRSA): [...]
severe disease (MRSA likely): [...]
A: topical abx (mupirocin); oral cephalexin / dicloxacillin / erythromycin; oral TMP-SMX / clindamycin / doxycycline

Q: Patient presents with pustules and honey-coloured crusts on an erythematous base around the mouth, nose, and ears. What is the most likely dx?
[...]
A: impetigo due to Staph or Strep group A (bullous impetigo almost always caused by S. aureus)

Q: what is the dx?
[...]
A: folliculitis due to Staph, Strep, or G- bacteria

Q: how to tx folliculitis?
mild superficial disease: [...]
severe disease (non-MRSA): [...]
severe disease (MRSA likely): [...]
A: topical abx (mupirocin); oral cephalexin or dicloxacillin (similar to impetigo tx); oral clindamycin or doxycycline

Q: how to manage furuncles/carbuncles?
[...]
A: oral cephalosporins (cefazolin, ceftriaxone, etc.)

Q: what is the dx?
[...]
A: Staphylococcal scalded skin syndrome (SSSS)

Q: what is the dx?
[...]
A: erysipelas due to group A Strep

Q: how to tx cellulitis?
[...]
A: 5-10 days of oral abx similar to impetigo tx (non-MRSA: oral cephalexin, dicloxacillin, or erythromycin; MRSA: oral TMP-SMX, clindamycin, or doxycycline)

Q: what is the dx if this were found in an adult?
[...]
A: cellulitis due to group A strep

Q: what is the dx if this were found in a child?
[...]
A: cellulitis due to Staph

Q: which bacteria most likely cause this presentation?
[...]
A: S. aureus, E. coli, C. perfringens, S. pyogenes

Q: how to tx necrotizing fasciitis?
[...]
A: early and aggressive surgical debridement; broad spectrum abx (penicillin G for Strep, clindamycin to decrease exotoxin production, metronidazole or 3rd gen cephalosporin for G-)

Q: what is the dx?
[...]
A: Molluscum contagiosum (poxvirus skin infestation; often self-limited disease)

Q: Patient presents with tiny flesh-coloured dome-shaped waxy papules with central umbilications on the face and trunk. What is the most likely dx?
[...]
A: Molluscum contagiosum

Q: how to tx Molluscum contagiosum?
[...]
A: usually self-limiting; can use local destruction (curetting, freezing, cantharidin [blistering agent])

Q: what is the dx?
[...]
A: warts due to HPV

Q: how to dx verrucae (warts) apart from exam findings and hx?
[...]
A: PCR of the lesion for HPV

Q: what is the dx?
[...]
A: pityriasis rosea (give supportive tx)

Q: what is the dx?
[...]
A: pityriasis (aka tinea) versicolor (caused by yeast called Malassezia)

Q: how to ix this lesion?
fungal scraping: [...]
Wood's light exam: emits a [...] colour
A: KOH exam (look for hyphae), fungal culture; yellow

Q: how to tx this lesion?
[...]
A: topical anti-fungals (shampoo: selenium sulfide or ketoconazole; creams: ketoconazole cream)

Q: what is the dx?
[...]
A: tinea
Extra: Tinea is a group of fungal skin infections often caused by dermatophytes. Can affect a variety of areas of the body, including: feet (tinea pedis), nails (tinea unguium), scalp (tinea capitis), torso (tinea corporis) and groin (tinea cruris). Less commonly-affected areas include the face (tinea faciei), hands (tinea manuum), and beard (tinea barbae).

Q: what should we avoid in tx of superficial fungal infections?
[...]
A: do NOT use steroids

Q: what is the dx?
[...]
A: impetigo

Q: what is ecthyma?
[...]
A: deeper version of impetigo caused by group A strep

Q: how to tx this lesion
[...]
A: antivirals: acyclovir, valacyclovir, famciclovir

Q: what is the dx?
[...]
A: VZV (HHV 3/chicken pox)

Q: what is the dx?
[...]
A: herpes/varicella zoster (shingles)
Extra: unilateral dermatomal dist'n

Q: why do we avoid topical corticosteroids and antifungals w/ tinea corporis and pedis?
[...]
A: b/c it can draw fungus to deeper layers of skin (Majocchi's granuloma)

Q: what is a furuncle?
[...]
A: deep folliculitis beyond the dermis with abscess formation in the subcutaneous tissue

Q: what type of lesion is this?
[...]
A: carbuncle (confluent folliculitis)

Q: why does Choosing Wisely Canada recommend we don't routinely prescribe abx for bilateral lower leg redness and swelling?
[...]
A: b/c bilateral sx is NOT cellulitis

Q: what is the dx?
[...]
A: candidal dermatitis

Q: what is the dx?
[...]
A: scabies (tx w/ 5% permethrin)

Q: what is the dx?
[...]
A: herpes zoster (shingles)

Q: what is the pathognomonic feature of this condition?
[...]
A: comedones (this is acne vulgaris)

Q: what type of acne is this?
[...]
A: pustular

Q: what major sequelae of acne vulgaris is illustrated here?
[...]
A: scarring

Q: what is the dx?
[...]
A: seborrheic dermatitis (classic location by nose; associated w/ Malassezia furfur)

Q: how to tx this lesion?
scalp: [...]
other areas: [...]
A: ketoconazole, selenium sulfide, or zinc pyrithione shampoos; topical antifungals (ketoconazole cream) ± corticosteroids

Q: what is the most likely dx?
[...]
A: psoriasis

Q: how to tx psoriasis?
local disease: [...]
severe disease / presence of psoriatic arthritis: [...]
A: topical steroids, calcipotriene (vit D deriv), retinoids (vit A deriv; tazarotene, acitretin); MTX or anti-TNF biologics (etanercept, infliximab, adalimumab)

Q: what is the most likely dx?
[...]
A: lupus erythematosus

Q: what are the primary knee extensors?
[...]
A: vastii and rectus femoris
Extra: vatii = vatus lateralis, intermedius, medialis

Q: what is the most likely dx?
[...]
A: steroid acne
Extra: The lack of comedomes, symmerty of the lesions, the location and the mono-morphic nature of the eruption suggest Steroid Acne. Lichen planus is a violaceous (purple-blue) colour. These are papules and not plaques so plaque psoriasis is an inappropriate choice. Atopic dermatitis is more likely to be flexural. The location is inappropriate for periorificial dermatitis. Although comedomes are black heads and white heads, the term whitehead is colloquial and can also refer to a pustule.

Q: how to tx rosacea?
[...]
A: topical metronidazole
Extra: Topical retinoid creams are only of use on comedones and rosacea is an inflammatory skin conditon which has no comedones. Although topical and/or systemic corticosteroids will give an initial improvement, in the long run they will actually worsen the problem. Benzoyl peroxide, alone or in combination with not be effective and will certainly worsen the skin irritation common to this condition. Metronidazole is used here as an antiflammatory and not an antimicrobial.

Q: how to tx erythematotelangiectatic rosacea?
[...]
A: brimonidine gel
Extra: antiinflammatories not helpful for erythemotaotelangiectatic rosacea
Brimonidine gel is a selective α2 adrenergic agonist. The ophthalmic formulation decreases the production of aqueous humor and is used to treat open-angle glaucoma and ocular hypertension. The topical formulation is thought to induce vasoconstriction and is used to treat rosacea-associated erythema.

Q: what is the Parkland formula?
[...]
A: give 4 cc/kg/%TBSA burn/24 h of Ringer's lactate; 1/2 first 8 hrs, 1/2 next 16 hrs from time of burn

Q: what urine output do we want for good fluid resuscitation?
[...]
A: 0.5-1 cc/kg/hr via urinary catheter

Q: A 60kg 44 year old male is brought into the emergency department suffering from burns. Family members explain that they were on a camping trip and the patient accidentally tripped and fell into the camp fire 2 hours ago. After your assessment you determine burns on the following areas:
First-degree: Full front side of right arm
Superficial partial-thickness: Half of back torso
Deep partial-thickness: Half of front torso
Third-degree: Full left arm (back and front side)
What is the total body surface area of involvement?
[...]
A: 27%
Extra: Half of back torso= 9%
Half of front torso= 9%
Full left arm= 9%
TOTAL= 27%
All second (superficial and deep thickness burns) and third degree burns are included in the calculation. First-degree burns are not included in the TBSA calculation.

Q: what sign helps distinguish this lesion?
[...]
A: Fitzpatrick's (aka dimple) sign

Q: A patient presents with poorly demarcated erythematous platches or plaques showing excoriations and lichenification. What is the most likely dx?
[...]
A: atopic dermatitis

Q: how to differentiate the 3 clinical patterns of eczema in terms of timing?
acute: [...]
sub-acute: [...]
chronic: [...]
A: vesicle can be seen; wet eczema ("weeping"); dry red patches ± lichenification

Q: what does [1] show?
[...]
A: perivascular lymphocytic inflammation
Extra: Dermatitis
- Definition: inflammation of the skin, broad term that includes atopic dermatitis, allergic contact dermatitis, seborrheic dermatitis, stasis dermatitis, asteaotic dermatitis, eczema, sun burns.
- Biopsy demonstrates spongiosis
Image:
- Perivascular lymphocytic inflammation (small lymphocytes following vascular pattern) [1]
- Intracellular edema [2]
- Vesicles (caused by the intraepidermal edema) [3]

Q: what does [2] show?
[...]
A: intracellular edema
Extra: Dermatitis
- Definition: inflammation of the skin, broad term that includes atopic dermatitis, allergic contact dermatitis, seborrheic dermatitis, stasis dermatitis, asteaotic dermatitis, eczema, sun burns.
- Biopsy demonstrates spongiosis
Image:
- Perivascular lymphocytic inflammation (small lymphocytes following vascular pattern) [1]
- Intracellular edema [2]
- Vesicles (caused by the intraepidermal edema) [3]

Q: what does [3] show?
[...]
A: vesicles (caused by intraepidermal edema)
Extra: Dermatitis
- Definition: inflammation of the skin, broad term that includes atopic dermatitis, allergic contact dermatitis, seborrheic dermatitis, stasis dermatitis, asteaotic dermatitis, eczema, sun burns.
- Biopsy demonstrates spongiosis
Image:
- Perivascular lymphocytic inflammation (small lymphocytes following vascular pattern) [1]
- Intracellular edema [2]
- Vesicles (caused by the intraepidermal edema) [3]

Q: what is the dx?
[...]
A: (allergic) contact dermatitis

Q: 45M presents with pruritus and an eczematous linear rash after exposure to nickel. What is the most likely dx?
[...]
A: contact dermatitis (tx w/ topical corticosteroids and allergen avoidance)

Q: how to ix contact dermatitis?
[...]
A: patch testing w/ epicutaneously applied haptens

Q: what is the dx?
[...]
A: seborrheic dermatitis (tx w/ ketokonazole, selenium sulfide, zinc pyrithione shampoos)

Q: what is the dx?
[...]
A: nummular dermatitis

Q: 56F presents with the following after a long plane ride. What is the tx?
[...]
A: compression wraps for lower leg edema and topical anti-inflammatory for pruritis (stasis dermatitis)

Q: what is the dx?
[...]
A: xerosis (dry skin) / asteatotic dermatitis
Extra: - Definition: desiccation of stratum -> small cracks -> stinging/itching feeling
- Etiology: ageing, dry climate
- 1°: patch
- 2°: scale
- Treatment: Avoiding desiccants and using topical therapy to restore skin as barrier to H2O loss.

Q: what is the dx?
[...]
A: atopic dermatitis

Q: how to tx atopic dermatitis (eczema)?
1st line for flares: [...]
2nd line for flares: [...]
relief from pruritis: [...]
use emmolients, avoid harsh soaps, limit hot showers
A: topical corticosteroids; calcineurin inhibitors (e.g., tacrolimus); H1-blockers (e.g., hydroxyzine at night)

Q: Patient presents with a Herald patch and multiple oval, erythematous, scaly plaques and patches along skin cleavage lines. What is the most likely dx?
[...]
A: pityriasis rosea (no tx needed)

Q: what is the dx?
[...]
A: lichen planus (tx w/ topical corticosteroids for mild cases)

Q: how to tx lichen planus?
mild: [...]
severe: [...]
A: topical corticosteroids; systemic corticosteroids and phototherapy

Q: what is the dx?
[...]
A: pityriasis rubra pilaris
Extra: - Definition: Acute cutaneous eruption that is often accompanied by pruritus or pain. A group of rare, chronic dermatoses characterized by generalized plaques with orange-pink scale, follicular keratosis (i.e., excessive keratin production resulting in small, rough eruptions on the skin), and erythroderma. Typically involves the palms and soles but can affect the entire skin with intermittent sparing.
- Morphology: Follicular papules on a erythematous base coalescing to form large orange-red plaques with characteristic islands of sparing. Typically starts on scalp and rapidly spreads in a craniocaudal direction. Can also present. With palmoplantar keratoderma.

Q: what is the dx?
[...]
A: erythroderma
Extra: Definition: diffuse redness of the skin affecting >90% of the body surface.
Etiology: Most commonly caused by: psoriasis, atopic dermatitis, idiopathic erythroderma, cutaneous T-call lymphoma, and drugs (16-19%; see picture)

Q: what is shown in this photo?
[...]
A: Koebner phenomena (due to psoriasis)

Q: what is the dx?
[...]
A: maculopapular drug eruption (drug rash)

Q: what is a serious complication of maculopapular drug eruptions?
[...]
A: DRESS (drug rxn w/ eosinophilia and systemic sx; peripheral eosinophilia, renal dysnfunction, hepatic dysfunction)

Q: what is the dx?
[...]
A: toxic epidermal necrolysis (TEN) / Steven Johnsons syndrome (SJS)

Q: what should always be on the ddx if there is a +ve Nikolsky sign?
[...]
A: SJS and TEN

Q: what is the dx?
[...]
A: erythema nodosum (tx underlying disease)

what are the common causes of erythema nodosum (think NODOSUM mnemonic)?
1. NO cause (60% idiopathic)
2. Drugs: sulfa, NSAIDs, iodides
3. Oral contraceptives
4. Sarcoidosis
5. Ulcerative colitis / Crohn disease
6. Microbio (TB, leprosy, hisoplasmosis, chronic infection)

Q: what is the dx?
[...]
A: cutaneous vasculitis
Extra: - Definition: cutaneous vasculitis may be a skin-limited disease, a primary cutaneous vasculitis w 2ndary systemic involvement or cutaneous manifestation of systemic vasculitis
- Etiology: most commonly small or medium vessel
- Leukocytoclastic Vasculitis (LCV) – Small Vessel Vasculitis secondary to medication (allopurinol, sulfa- drugs, penicillin, anti-convulsants) – 50% idiopathic, 15- 20% drug related
- Morphology: palpable, pruritic papules on lower legs
- Investigations: Hx, biopsy skin, blood work for internal organ involvement
- Symptoms: may be a symptomatic, painful, or pruritic
- Management: if limited to skin, conservative unless cutaneous necrosis

Q: what occurs in type IV hypersensitivity rxns?
[...]
A: sensitized T cells encounter antigen and then release lymphokines (TB skin tests, transplant rejection, contact dermatitis)

Q: describe the hypersensitivity rxn of of polyarteritis nodosa, SLE, rheumatoid arthritis
[...]
A: ag-ab complex fix complement, which attracts PMNs; PMNs release lysosomal enzymes (type III)

Q: how to tx urticaria?
[...]
A: systemic antihistamines (anaphylaxis requires IM epinephrine, antihistamines, IV fluids, airway support)

Q: what is the dx?
[...]
A: angioedema

Q: what are the most common large vessel vasculitides?
[...]
A: giant cell (temporal) arteritis and Takayasu arteritis

Q: what are the most common medium vessel vasculitides?
[...]
A: Buerger disease (thromboangiitis obliterans), Kawasaki disease, polyarteritis nodosa

Q: what is the preferred topical therapy type for acne?
[...]
A: gels (has drying effect)
Extra: - Creams: less potent than ointments
- Ointments: greasy, best at delivering drug and protecting skin barrier. Least irritating
- Lotions: easy to apply especially areas with terminal hair (arms, legs). More irritating, less potent
- than ointment.
- Gels: easiest for hairy skin. Irritating, have drying effect. Often preferred for acne

Q: which type of topical therapy is best at delivery drugs and protecting the skin barrier (least irritating)?
[...]
A: ointments
Extra: - Creams: less potent than ointments
- Ointments: greasy, best at delivering drug and protecting skin barrier. Least irritating
- Lotions: easy to apply especially areas with terminal hair (arms, legs). More irritating, less potent
- than ointment.
- Gels: easiest for hairy skin. Irritating, have drying effect. Often preferred for acne

Q: of creams, ointments, lotions, and gels, which is the most potent?
[...]
A: ointments (least potent are gels)
Extra: - Creams: less potent than ointments
- Ointments: greasy, best at delivering drug and protecting skin barrier. Least irritating
- Lotions: easy to apply especially areas with terminal hair (arms, legs). More irritating, less potent
- than ointment.
- Gels: easiest for hairy skin. Irritating, have drying effect. Often preferred for acne

what quantity to prescribe for topical corticosteroids for these locations?
head/face/arm: 3 g each
leg: 6 g
trunk: 9-12 g
whole body: 30 g

Q: what potency corticosteroid should we use for the following bodily locations?
face/body folds: [...]
torso/arms/legs: [...]
palms/soles: [...]
A: weak steroids (e.g., hydrocortisone 1%); mid potency (e.g., betamethasone 0.1%); high potency (e.g., clobetasol 0.05%)

Q: Patient presents with epidermal atrophy, fragile skin, and striae. They have perioroficial dermatitis and glaucoma. What is the most likely offending agent?
[...]
A: systemic corticosteroids

Q: what does the red arrow indicate?
[...]
A: Auspitz sign
Extra: The Auspitz sign refers to the appearance of small bleeding points after successive layers of scale have been removed from the surface of psoriatic papules or plaques.

Q: what topical therapy is most appropriate?
[...]
A: 0.1% betamethasone ointment (ointments > creams > lotions in terms of potency; psoriasis)

Q: what topical therapy is most appropriate?
[...]
A: 0.1% betamethasone ointment (atopic dermatitis)

Q: what topical therapy is most appropriate?
[...]
A: hydrocortisone 1% ointment (impetigo)

Q: what topical therapy is most appropriate?
[...]
A: clobetasol 0.05% ointment

Q: what is the dx?
[...]
A: HSV

Q: what is the diff btw SJS and TEN?
[...]
A: SJS has epidermal detachment < 10% BSA whereas TEN > 30% BSA

Q: what is the dx?
[...]
A: hidradenitis suppurativa

Q: An African-American patient presents with folliculophilosebaceous units causing inflamed, painful nodules of the axilla. What is the most likely dx?
[...]
A: Hidradenitis suppurativa

Q: what is the dx?
[...]
A: syphillis

Q: what is the dx?
[...]
A: ichthyosis vulgaris

Q: Patient presents with diffuse, dry dermal scaling that resembles fish scales. Genetic testing reveals an inherited mutation in the filaggrin gene. What is the most appropriate tx?
[...]
A: emmolients, keratolytics, topical retinoids

Q: what is the dx?
[...]
A: acanthosis nigricans (typically not tx; assoc w/ DM, Cushing disease, polycystic ovarian syndrome, obesity)

Q: what causes seborrheic dermatitis?
[...]
A: Malassezia fufur (tx w/ ketokonazole, selenium sulfide, zinc pyrithione shampoos)

Q: what is the dx?
[...]
A: eczema herpeticum

Q: what does morbilliform rash mean?
[...]
A: papules coalescing into plaque (drug rxn or viral)

Q: 45M presents with papular target lesions. Lab tests reveal the patient has HSV. What is the most likely dx?
[...]
A: erythema multiforme
Extra: - Definition: acute, self-limited skin disease characterized by abrupt onset of symmetric fixed red papules Etiology: infection, often HSV
- Morphology: papules, vesicles, target lesions
- Subtypes: minor (minimal mucosal involvement, no systemic symptoms)

Q: what is the diff in synovial fluid btw OA and RA?
[...]
A: OA is clear w/ high viscosity & low PMNs whereas RA is opaque w/ low viscosity & high PMNs

Q: what to prescribe pregnant women w/ RA?
[...]
A: hydroxychloroquine and azathioprine (MTX not safe)

Q: what etiology is reactive arthritis commonly associated w/?
[...]
A: GU (e.g., chlamydia) or GI (e.g., shigella) infection (self-limiting condition; give supportive tx)

Q: What does "She Cherishes Cooking Yummy Salmon" help us remember in common causes for reactive arthritis?
[...]
A: Shigella, Chlamydia, Campylobacter, Yersinia, Salmonella

Q: what is the most common type of JIA in girls btw 2-4 y/o?
[...]
A: oligoarticular JIA
Extra: Oligoarticular JIA, which is the most common type of JIA and typically affects girls between 2–4 years, is defined as arthritis that involves ≤ 4 joints within 6 months of disease onset. Typical manifestations include asymmetric swelling, early morning stiffness, and limited and/or painful movement of large weight-bearing joints (e.g., knees, ankles). Chronic anterior uveitis is seen in approx. 25% of oligoarticular JIA cases and may manifest with recurrent episodes of ocular pain, redness, and photosensitivity. Laboratory studies typically show elevated ESR, positive antinuclear antibodies, and a negative rheumatoid factor.
Patients with mild to moderate disease activity can be treated with a combination of NSAIDs and intraarticular glucocorticoids, while patients with severe disease may require treatment with a disease-modifying antirheumatic drug.

Q: what is the most common JIA in girls btw 7-10 y/o?
[...]
A: sero-ve polyarthritis
Extra: Seronegative polyarticular JIA is characterized by the involvement of ≥ 5 joints within 6 months of disease onset. Typical manifestations include symmetrical arthritis of the interphalangeal joints, cervical spine, and temporomandibular joint as well as chronic anterior uveitis. While seronegative polyarticular JIA may also affect large joints and manifest with laboratory findings similar to those of this patient, predominant asymmetrical involvement of weight-bearing joints without concurrent arthritis of the smaller joints is unlikely.

Q: what is the most common JIA in girls 9-12 y/o?
[...]
A: sero+ve polyarthritis

Q: A 57-year-old man comes to the physician because of sudden-onset fever, malaise, and pain and swelling of his wrists and ankles that began a week ago. One month ago, he was started on hydralazine for adjunctive treatment of hypertension. His temperature is 37.8°C (100°F). Examination shows swelling, tenderness, warmth, and erythema of both wrists and ankles; range of motion is limited. Further evaluation is most likely to show an increased level of which autoantibodies?
[...]
A: anti-histone due to drug-induced LE
Extra: Anti-histone antibodies are present in most cases of drug-induced lupus erythematosus (DILE). Since anti-histone antibodies are a subtype of antinuclear antibodies (ANA), ANA will also be positive. Other common triggers of DILE include procainamide, sulfa drugs, methyldopa, isoniazid, and phenytoin. DILE can have many of the features of idiopathic SLE such as fever, arthritis, malar rash, and serositis. However, unlike idiopathic SLE, DILE does not affect the oral mucosa, brain, or kidneys and is typically self-limiting after discontinuation of the offending drug.

Q: A 78-year-old woman comes to the physician because of a 2-month history of right-sided headache and generalized fatigue. She also has pain, weakness, and stiffness of her shoulders and hips. The stiffness is worse in the morning and usually improves after 60-90 minutes of activity. Three months ago, she fell and hit her head on the kitchen countertop. Her temperature is 38.1°C (100.6°F). Examination shows normal muscle strength in bilateral upper and lower extremities; range of motion of the shoulder and hip is mildly limited by pain. Deep tendon reflexes are 2+ bilaterally. Her erythrocyte sedimentation rate is 68 mm/h and serum creatine kinase is 36 mg/dL. What is the most likely underlying cause of this patient's headache?
[...]
A: giant cell arteritis (often found w/ PMR)
Extra: Giant cell arteritis, a type of large-vessel vasculitis, most commonly presents in the elderly. This patient's constitutional symptoms (fever, weakness, weight loss) with additional symptoms of polymyalgia rheumatica, unilateral headache, and an elevated erythrocyte sedimentation rate are all suggestive of this disease. Polymyalgia rheumatica is frequently associated with giant cell arteritis, as ∼50% of patients with GCA have PMR, and ∼15% of patients with PMR will have GCA. Prompt diagnosis via temporal artery biopsy and treatment is warranted to prevent serious complications such as visual loss (from anterior ischemic optic neuropathy) or cerebral ischemia.

Q: which vasculitis is associated w/ HBV and/or HCV?
[...]
A: polyarteritis nodosa
Extra: Polyarteritis nodosa (PAN) like most vasculitides, usually involves multiple organ systems. The absence of p-ANCA and pulmonary symptoms, as well as the association with Hepatitis B (and C), helps to differentiate PAN from other forms of vasculitis. Muscle biopsy typically shows transmural inflammation of the arterial wall with leukocytic infiltration and fibrinoid necrosis, as seen in this patient. Other typical characteristics of PAN include a high ESR level, proteinuria, and hematuria. PAN should be always considered in young adults presenting with stroke or myocardial infarction.

Q: what lab tests would you use to dx Sjogren syndrome?
[...]
A: anti-Ro/SSA, anti-Lab/SSB, anti-RF

Q: what causes keloids?
[...]
A: hyperproliferation of fibroblasts
Extra: Keloids are formed from the hyperproliferation of fibroblasts, which results in disorganized overproduction of hyalinized collagen types I and III. Keloids are most commonly seen in dark-skinned individuals. Common locations for keloids include the earlobes, face (e.g., cheeks), upper extremities, chest, and neck.

Q: what would histopath exam of seborrheic keratosis show?
[...]
A: immature keratinocytes with small keratin-filled cysts

Q: A previously healthy 3-month-old girl is brought to the physician because of fever, irritability, and rash for 3 days. The rash started around the mouth before spreading to the trunk and extremities. Her temperature is 38.6°C (101.5°F). Examination shows a diffuse erythematous rash with flaccid bullae on the neck, flexural creases, and buttocks. Gentle pressure across the trunk with a gloved finger creates a blister. Oropharyngeal examination shows no abnormalities. What is the most likely underlying mechanism of these skin findings?
[...]
A: toxin-induced cleavage of desmoglein (SSSS)
Extra: Cleavage of desmoglein-1 by exfoliative toxin is the mechanism underlying SSSS, a blistering skin disorder that results from toxemia following focal Staphylococcus aureus infections (usually of the nasopharynx). Desmoglein-1 is a desmosomal protein located in the granular layer of the epidermis and responsible for attaching the keratinocytes to one another. Loss of the cell-to-cell attachments results in intraepidermal fissure formation, which presents as fragile, flaccid blisters. Bullous impetigo is also caused by staphylococcal exfoliative toxins but remains localized, in contrast to SSSS.
Treatment of SSSS consists of IV antibiotics and supportive care. Although most patients respond well to conventional therapy, SSSS is a potentially fatal condition with an increased mortality rate in adults.

Q: which epidermal layer does pemphigus vulgaris affect?
[...]
A: IgG in stratum spinosum against desmosomal adhesion proteins
Extra: Autoantibodies against desmosomal adhesion proteins in the stratum spinosum are a diagnostic finding in pemphigus vulgaris. Damage to these proteins causes intraepidermal bullae formation, a positive Nikolsky sign, and flaccid blisters over the face and trunk. However, affected patients are usually >30 years of age and mucosal involvement is very common (often precedes cutaneous manifestations).

Q: what are the active ingredients that make sunscreen "broad spectrum"?
[...]
A: zinc oxide and titanium dioxide

Q: A 6-year-old boy is brought to the physician for evaluation of bilateral erythematous skin lesions on the flexures of the elbows and knees. He has been scratching the areas frequently. He has had similar lesions intermittently for the last 2 years. A photograph of the lesions on the back of the knees is shown. What is the most likely dx?
[...]
A: atopic dermatitis
Extra: This patient's highly pruritic erythematous papules, confluent scaly macules, and lichenified plaques on the popliteal and antecubital fossae with a relapsing, chronic course are highly suggestive of atopic dermatitis.

Q: what is the dx?
[...]
A: shingles (varicella zoster)
Extra: This boy has a painful rash of grouped vesicles on an erythematous base in a dermatomal distribution (C7–C8), which is characteristic of shingles.
Multinucleated giant cells and Cowdry A inclusions are characteristic histopathologic findings found on a Tzanck test of shingles lesions. Initial infection with varicella zoster virus (VZV) causes chickenpox, which this patient likely developed because he has not received any vaccinations. Immunosuppression (e.g., from cyclosporine taken to prevent chronic transplant rejection) is a risk factor for reactivation of VZV (shingles) after a period of latency in dorsal root ganglia. Other risk factors include older age, HIV infection, and malnutrition.

Q: what is the dx?
[...]
A: acute urticaria
Extra: Q: An 18-year-old woman comes to the physician because of a pruritic rash on her back for the past 2 hours. This morning, she started a course of ceftriaxone for treatment of pyelonephritis. A photograph of the rash is shown. This patient's skin findings are most likely associated with which of the following?
A: Hyperpermeability of the superficial dermal vasculature
Hyperpermeability of the superficial dermal vasculature, caused by mast cell activation in the dermis, is typical of the urticaria seen in this patient. In the immediate phase of type 1 hypersensitivity reactions, mast cells release histamine and other inflammatory and vasodilatory mediators, which induces localized, cutaneous swelling. Common mast cell activators include aspirin, antibiotics, and allergens.

Q: A 23-year-old woman comes to the physician because of a 5-month history of a pruritic rash on the cubital fossae of the upper extremities. She has no history of serious illness and takes no medications. A skin biopsy of the rash shows intraepidermal accumulation of edematous fluid and widening of intercellular spaces between keratinocytes. What is the most likely diagnosis?
[...]
A: eczematous dermatitis
Extra: Eczematous dermatitis is the umbrella term for multiple conditions with overlapping clinical and histopathological features, including atopic dermatitis and allergic contact dermatitis. Each type manifests as a pruritic, erythematous, maculopapular rash with occasional crusting, drainage of serous fluid, and vesicle or bulla formation. This patient's 5-month history of a rash on both arms suggests a diagnosis of atopic dermatitis, a chronic condition that typically develops on flexural surfaces (e.g., the antecubital fossae) in childhood but that can also manifest in adulthood.

Q: A 32-year-old woman with a recurrent vesicular genital rash comes to the physician because of a 3-day history of a painful, pruritic rash that began on the extremities and has spread to her trunk. Her only medication is acyclovir. Her temperature is 38.1°C (100.6°F). Examination of the skin shows several reddish-purple papules and macules, some of which have a dusky center with a lighter ring around them. What is the most likely diagnosis?
[...]
A: erythema multiforme
Extra: This patient with recurrent genital HSV and a painful exanthem with target lesions most likely has erythema multiforme (EM). EM is a type IV hypersensitivity reaction of the skin that can be triggered by certain infections (e.g., HSV, Mycoplasma pneumoniae) and medications (e.g., beta-lactam antibiotics, sulfonamides, phenytoin). EM is characterized by lesions of varying morphology (e.g., macules, papules, vesicles) that typically progress to target lesions and spread proximally from the backs of the hands and feet, as seen here. Nikolsky sign is negative and the disease course is self-limiting in most cases.

Q: what is the precursor lesion to SCC?
[...]
A: actinic keratosis

Q: what is the key histopath feature of cutaneous SCC?
[...]
A: keratin pearls
Extra: Keratin pearls are the key histopathologic feature of cutaneous squamous cell carcinoma (SCC). SCC typically manifests as ulcerative, crusted, and/or scaly lesions on sun-exposed areas. It is locally invasive and can spread to the lymph nodes but rarely metastasizes. In addition to extensive sun exposure, SCC of the skin is associated with immunosuppression, chronically draining sinuses, and arsenic exposure.

Q: what is the diff btw closed and open comedones?
[...]
A: closed are whiteheads whereas open are blackheads

Q: ddx for painful genital erosions/ulcers?
[...]
A: HSV, Behcet, pemphigus, lichen planus

Q: ddx for painless genital erosions/ulcers?
[...]
A: primary syphilis, chlamydia (lymphogranuloma venereum), granuloma inguinale (Klebsiella granulomatis)

Q: what is the purpose of DEXA (dual energy X-ray absorptiometry) scans?
[...]
A: to estimate bone density

Q: how to manage compression fractures?
[...]
A: sx management as fracture heals & fix osteoporosis

Q: how to manage hip fractures?
[...]
A: stabilize bone segments to allow healing & restore mechanics; surgery

Q: what is the diff btw simple and comminuted fractures?
simple: [...]
comminuted: [...]
A: bone broken in 2 places; bone broken in multiple places

Q: what is diff btw cortical and cancellous bone?
[...]
A: cortical bone is stronger & denser whereas cancellous bone is weaker & lighter

Q: what happens to osteoclast and osteoblast activity in age-related osteoporosis?
[...]
A: osteoclasts increase activity whereas osteoblasts decrease activity

Q: what happens to osteoblasts in glucocorticoid induced osteoporosis?
[...]
A: differentiation into fat cells and apoptosis (prolonged lifespan of osteoclasts)

Q: what is the diff btw primary and secondary bone healing?
[...]
A: primary has absolute stability & little callus formation whereas secondary has relative stability and callus formation

what are the 4 stages of secondary fracture healing?
1. inflamm phase
2. soft callus
3. hard callus
4. remodelling

Q: what to do if we have severely malaligned fracture fragments or joint dislocation?
[...]
A: realign / reduce limb & immobilize b4 imaging; elevate limb

Q: what are the major steps for major energy trauma w/ open fractures?
[...]
A: primary trauma survey ABCs -> secondary trauma survey -> tertiary trauma survey 24h after admission

Q: how to calculate the ankle-brachial index?
[...]
A: ABI = P(leg) / P(arm); use systolic pressures; ABI < 0.9 is concerning

Q: how to tx pelvic ring fractures?
[...]
A: pelvic circumferential compressive devices (PCCDs to tamponade vessel injury & reduce potential space)

Q: what are the 6Ps of compartment syndrome?
early signs: [...]
too late signs: [...]
A: pain, poikilothermia, palpable swelling; paresthesias, pulseless, paralysis

Q: what does Wolff's law state?
[...]
A: bone remodelling occurs in response to mechanical stress

Q: what are alpha motor neurons?
[...]
A: nerves that leave spinal cord to innervate skeletal muscle (aka LMNs)

Q: what is the fn of calcium for actin and myosin?
[...]
A: calcium allows actin and myosin to bind, shortening the sarcomere & causing a contraction

Q: how do muscles increase strength of contractions?
[...]
A: increased frequency of depolarization

Q: what are the most common bacteria causing impetigo?
non-bullous: [...]
bullous: [...]
A: S. aureus, S. pyogenes; S. aureus

Q: when should you open a blister from a burn?
[...]
A: ONLY if there is painful joint mvmt, very large/bloody/infected area, or chemical burns
Extra: Cleaning & Dressing
·      Sterile saline for cleaning & Debridement of loose dead tissue
·      Leave small blister intact. Open blister if …painful movement of joint, very large, bloody or infected, chemical burns
·      Topical antibiotic cream (Flamazine) and ointment.. need to change daily
·      Newer silver dressings… change less frequently

Q: how to investigate burn wounds?
1. labs: [...]
2. [...]
3. if inhalation suspected, get [...]
A: CBC, lytes, creatinine, EtOH; swab wound for culture & sensitivity; ABG & caroxyl hemoglobulin lvl
Extra: Assess adequate fluid resuscitation- Monitor patient since formula is a guide only
·      Foley catheter to monitor urine output for 0.5-1.0 ml/kg/hour
·      Assess mental status
·      Capillary refill
·      Extremities temperature
Procedures & Investigations
·      Procedure—NG or feeding tube to reduce ileus in GI tract
·      Check CBC, lytes, creatinine, ETOH level
·      Swab burn wound for culture & sensitivity
·      If inhalation injury suspected get ABG & Carboxyl Hemoglobulin level
Medications
·      IV Morphine for pain
·      PPI or h2 blockers to prevent GI stress ulcers
·      Check Tetanus status
·      Topical antibiotic but NO systemic antibiotic

Q: which nerve is most at risk from a proximal humeral fracture?
[...]
A: axillary n.

Q: which nerve is most at risk from a humeral shaft fracture?
[...]
A: radial n.

Q: what are the 3 nerves in the "M" seen in the brachial plexus from sup. to inf.?
[...]
A: musculocutaneous n., median n., ulnar n.

Q: how to manage a proximal humerus fracture in a young person?
[...]
A: splint and sling, or sling only

Q: how much does an MRI cost?
[...]
A: $600-700

Q: how much does a single CT scan cost?
[...]
A: $300-400

Q: how much does an X-ray cost?
extremity: [...]
spine: [...]
A: $20-30; $60

Q: what is a pathologic fracture?
[...]
A: fracture occurred more easily b/c of unhealthy/weak bone

Q: what is an occult fracture?
[...]
A: fracture not apparent on imaging (may need MRI 1 day later, CT, or bone scan 2-3 days later)

Q: This is the femur. Describe the fracture.
[...]
A: shortened and angulated transverse fracture

Q: describe the fracture of the radius and ulna
[...]
A: shortened with anteriorly displaced distal fragments

Q: what type of angulation is this fracture?
[...]
A: apex volar (shortened, angulated)

Q: what type of fracture is this?
[...]
A: femoral neck fracture

Q: what type of fracture is this?
[...]
A: intertrochanteric hip fracture

Q: what is nonunion?
[...]
A: incomplete healing of fracture

Q: fracture fragments are [...] from one another
A: distracted
Extra: patella fracture

Q: distal fragment is [medially/laterally] displaced
A: laterally

Q: where is the problem if someone says they have lots of pain when they walk on uneven surfaces?
[...]
A: subtalar and talonavicular joints (responsible for inversion and eversion)

Q: what is knock-knee also called?
[...]
A: genu valgum

Q: what is bowleg also called?
[...]
A: genu varum (often due to rickets, skeletal dysplasia, trauma; most resolve w/o tx)

Q: what is the normal standing hindfoot alignment?
[...]
A: valgus

Q: what is the normal tiptoe hindfoot alignment?
[...]
A: varus

Q: what is the most likely dx of "someone kicked me in the back of the leg" in a "male weekend warrior"?
[...]
A: Achilles (calcaneal) tendon rupture
Extra: - best dx using PE: +ve Thompson test
- no need for imaging
- ability to plantarflex is NEVER a good indicator for a torn Achilles b/c lots of other things can plantarflex the ankle (e.g., rupture of any posteromedial tendons)

Q: how to tx Achilles tendon rupture?
[...]
A: put pt in full plantarflexion splint AND educate pt they are at high risk of DVT
Extra: - very minimal difference in re-reupture rates btw surgical and non-surgical tx (maybe 1 mo diff)
- best dx using PE: +ve Thompson test
- no need for imaging
- ability to plantarflex is NEVER a good indicator for a torn Achilles b/c lots of other things can plantarflex the ankle (e.g., rupture of any posteromedial tendons)

Q: what do the Ottawa ankle rules state about ordering X-rays?
[...]
A: when pain in malleolar region and any of: bony tenderness in lat/med malleoli OR inability to bear weight

Q: how to tx ankle sprains?
[...]
A: RICE then early functional rehab (recovery time: MANY months)
Extra: do NOT order an MRI (most will say ATFL & CFL tear)

Q: in general, how long does it take for a bone to heal?
[...]
A: ~6 weeks

Q: how to manage malleolar ankle fractures?
[...]
A: reduce, splint, X-rays

Q: what is the most common risk factor for bunions?
[...]
A: genetics (NOTHING has been shown to slow progression or correct the bunion)

Q: when do we do surgery on bunions?
[...]
A: PAIN, rapid progression, transfer metatarsalgia (pain elsewhere in foot)

Q: what is the dx?
[...]
A: hallux valgus (bunion)

Q: what is hallux rigidus?
[...]
A: arthritis in great toe MTP joint (due to trauma or idiopathic)

Q: what are the 1st line tx of hallux rigidus?
[...]
A: rest, NSAIDs, activity modifications, footwear

Q: what is the dx?
[...]
A: pes planovalgus

Q: which tendons are affected in adult pes planovalgus?
[...]
A: tibialis post. tendon & triple joint complex (subtalar, TN, CC)
Extra: tib post is key stabilizer of medial arch of foot; other impt ones include spring lig. and plantar fascia

Q: how to tx pes planovalgus?
early stages: [...]
advanced flattening: [...]
A: RICE, anti-inflammatories, orthotics; ankle supports, surgery (do NOT inject corisone into tendon sheath)

Q: what is hemarthrosis?
[...]
A: blood in joint capsule (no need to aspirate if swelling present w/in 1-2 hrs of injury except for pain relief)

Q: what causes hemarthrosis?
tears: [...]
other: [...]
A: ligaments, menisci; fracture, extensor mechanism disruption

Q: how to tx meniscal tear?
[...]
A: non-operative except for outer rim, meniscectomy, transplant

Q: which image would likely have hemarthrosis?
[...]
A: the rightmost image (tx: non-weight bearing on crutches and refer for surgical consultation)

Q: what are the only things not in knee capsule?
[...]
A: MCL, LCL, bursa (except suprapatellar and semimembranosus)

Q: which bursa enlarges w/ Baker's cyst?
[...]
A: semi-membranosus bursa

Q: what does lipohemarthrosis indicate?
[...]
A: fracture (intra-articular fracture allows fat to leak from bone marrow)

Q: what causes bruising around the knee apart from direct impact to soft tissue?
[...]
A: fracture, patellar dislocation, MCL/LCL

what are the most common causes of knee hemarthrosis?
1. bleeding disorder
2. intra-articular fracture
3. meniscus tear
4. patellar dislocation/subluxation
5. ACL/PCL tear
Extra: BLIMP + ACL/PCL = bleeding disorder, intra-articular fracture, meniscus tear, patellar stuff

Q: what is the diff btw hemarthrosis and effusion?
[...]
A: timing of swelling: hemarthrosis is w/in minutes due to blood whereas effusion is overnight/days due to inflammation
Extra: BLIMP + ACL/PCL = bleeding disorder, intra-articular fracture, meniscus tear, patellar stuff

Q: why is acute knee dislocation a surgical emergency?
[...]
A: due to popliteal artery entrapment causing acute limb ischemia

Q: what x-ray view is this called?
[...]
A: skyline view

Q: what is the dx?
[...]
A: joint effusion in suprapatellar recess

Q: what is the tx for these 2 types of patellar fracture?
left: [...]
right: [...]
A: conservative management; surgical management

Q: what type of fracture is this?
[...]
A: Segond fracture
Extra: Segond fracture is an avulsion fracture of the knee that involves the lateral aspect of the tibial plateau and is very frequently (~75% of cases) associated with disruption of the anterior cruciate ligament (ACL). On the frontal knee radiograph, it may be referred to as the lateral capsular sign.

Q: what is the dx?
[...]
A: tibial plateau fracture

Q: what are alleviating factors for OA?
[...]
A: rest, warm baths, massage

Q: what is the most likely cause of osteomyelitis?
[...]
A: Staph aureus (80-90%) via hematogenous means

Q: what is the most likely dx?
[...]
A: osteomyelitis

Q: what is this arrow pointing towards?
[...]
A: osteophytes

Q: what is this arrow pointing towards?
[...]
A: subchondral cyst

Q: how does the pelvic ring break?
[...]
A: usually in 2 places (pubic rami fractures often mimic hip fractures)

Q: what type of fracture is this?
[...]
A: subcapital fracture

Q: what is the dx?
[...]
A: posterior dislocation of femur

Q: what causes tetanus?
[...]
A: neurotoxin produced by Clostridium tetani (G+ bacillus)

Q: what is the incubation period of tetanus?
[...]
A: 3-21 days

Q: when is the only time you give tetanus immunoglobulin?
[...]
A: if pt has unknown or <3 doses in vaccine series in unclean wound

Q: when do you give tetanus containing vaccines in clean minor wounds?
1. [...]
2. [...]
A: unknown or <3 doses in vaccine series; >3 doses and >10 years since last booster dose

Q: how to protect fetus from tetanus prior to birth?
[...]
A: immunize pregnant mothers w/ Tdap in pregnancy

Q: what are common tetanus vaccine side effects?
children: [...]
adults: [...]
A: mild systemic rxns (fever, irritability, fussiness), drowsiness; fevers, chills, headache, fatigue

Q: which metatarsal is most commonly fractured in athletes?
[...]
A: 5th metatarsal due to strong ligament attachments

Q: what is the dx?
[...]
A: calcaneal fracture

Q: in classic OA of the hip, which ROM does the patient lose first?
[...]
A: internal rotation

Q: femoral neck fractures are at risk for what complications?
[...]
A: AVN and non-union

Q: what is the dx?
[...]
A: AVN

Q: what are the 2 main etiologies of greater trochanteric pain syndrome?
1. [...]
2. [...]
A: tendinitis of gluteus medius; trochanteric bursitis

Q: Patient presents with pain over the greater trochanter that radiates down the lateral aspect of their thigh. Pain is aggravated with walking, running, and lying on the affected side. Physical exam reveals IT band tenderness but normal lumbar spine active ROM and hip passive ROM. What is the most likely dx?
[...]
A: greater trochanteric pain syndrome

Q: how to tx greater trochanteric pain syndrome?
[...]
A: conservative: PE, rest, NSAIDs, education

Q: Patient presents with spontaneous onset of pain radiating from their thigh to their knee and around their greater trochanter to buttock. Physical exam reveals a positive Trendelenburg sign, painful hip internal rotation, and painful hip contracture. An x-ray was ordered (see image below). What is the most likely dx?
[...]
A: AVN

Q: how to tx AVN?
pharmacological: [...]
procedural: [...]
A: Tylenol, NSAIDs; core bone from femoral head, hip arthroplasty

Q: Patient presents with snapping and locking of the hip joint. Physical exam reveals a loss of hip flexion and internal rotation. As you try to flex the hip, it goes into external rotation. What is the most likely dx?
[...]
A: hip labral tear

Q: what happens in internal extra-articular snapping hip syndrome?
[...] OR [...]
A: iliopsoas tendon flips over lesser trochanter or ASIS; iliofemoral lig. snaps over femoral head

Q: what happens in internal intra-articular snapping hip syndrome?
[...]
A: labral tear (true hip subluxation after total hip arthroplasty)

Q: how to investigate snapping hip syndrome?
[...]
A: u/s, x-ray AP pelvis+lat. hip, MR arthrogram

Q: how to manage snapping hip syndrome?
[...]
A: PT, lifestyle modification, NSAIDs

Q: what is the difference btw acute and chronic MSK injuries?
[...]
A: acute are "traumatic" whereas chronic are "overuse" injuries

Q: Patient has a valgus / ER twist of the right knee when cutting to the left. What What is the most likely dx?
[...]
A: right knee ACL tear

Q: where is the most common location of stress fractures?
[...]
A: lower extremity (tibia & metatarsals)

Q: how to manage stress fractures?
[...]
A: rest from all sx-provoking activity until pain free for ≥2 weeks

Q: Patient presents with gradual onset medial tibia pain over the past 3 years. They report diffuse pain along the length of their medial tibia and is aggravated with running, jumping sports, and dance. An x-ray does not reveal anything normal. A triple phase bone scan shows the following. What is the most likely dx?
[...]
A: periostitis

Q: how to manage periostitis?
1st line: [...]
if persistent: [...]
A: symptomatic management w/ RICE & lifestyle modifications; surgical periosteal stripping

Q: define the following grades of muscle strains/tears
grade 1: [...]
grade 2: [...]
grade 3: [...]
A: microtearing (mild pain, swelling, no/little loss of fn); partial tear (moderate sx w/ some loss of fn); complete tear (severe sx w/ significant fnl loss)

Q: how to manage muscle injuries in general?
[...]
A: symptomatic management w/ RICE; AVOID NSAID/ASA to avoid bleeding

Q: what is the diff btw tendinitis and tendinosis?
[...]
A: tendinitis is acute tendon inflammation whereas tendinosis is intra-tendinous degenerative change

Q: what is enthesopathy?
[...]
A: tendon disease at tendon-bone insertion/interface

Q: how to manage chronic tendon injuries?
[...]
A: RICE, bracing, NSAID, lifestyle management

Q: how to manage tendon tears?
partial tears: [...]
complete tears: [...]
A: immobilization; immobilization ± surgical repair

Q: where is the most common location of "high" ankle sprains?
[...]
A: interosseous membrane (followed by ATFL then CFL)

Q: how to manage ligament injuries?
all grades: [...]
grade 2 & 3: [...]
A: RICE, NSAIDs, physio; protective bracing

Q: what is the diagnostic criteria for compartment syndrome?
[...]
A: opening pressure >30 mmHg and >20 mmHg 5 minutes post-exertion

Q: how to tx bursitis?
[...]
A: reduce friction/impingement, NSAIDs, bursectomy, aspiration, corticosteroid injection

Q: what is the dx for stiff shoulder (aka frozen shoulder, adhesive capsulitis, Goju-kata)?
1. [...]
2. [...]
A: fnl restriction of both active and passive ROM; normal x-rays except for osteopenia or calcific tendonitis

Q: what are the 3 stages of stiff shoulder?
1. [...]
2. [...]
3. [...]
A: painful (2-9 mo); stiff (4-12 mo); recovery (thawing; self-resolving up to 4 years)

Q: A 12-year-old girl comes to the emergency department with her father because of right wrist pain. She states that the pain began 17 days ago and has continued to worsen. She reports being ill with a fever and an upper respiratory illness prior to the onset of the wrist pain. Her temperature is 38.5°C (101.3°F), pulse is 92/min, respirations are 22/min, and blood pressure is 132/76 mm Hg. Physical examination shows the right wrist is erythematous, warm, swollen, and tender to palpation over the distal radius. Radiographs of the wrist show soft tissue edema and a large radiolucency in the distal radius. What is the most definitive treatment for this condition?
[...]
A: IV abx with irrigation and debridement of the lesion
Extra: Hematogenous spread is the most common cause of osteomyelitis in pediatric populations. In the acute phase of osteomyelitis, treatment with intravenous (IV) antibiotics is the first step in management. Determination of the microorganism can occur if blood cultures are positive (blood must be taken before administering antibiotics), through biopsy, or sampling at the time of surgery. The choice of antibiotics depends on the organism, though vancomycin and piperacillin/tazobactam are commonly used empirically. If the initial IV antibiotic course fails to treat the osteomyelitis or if it is a severe or chronic case of osteomyelitis, then surgical irrigation and debridement is necessary, followed by a course of IV antibiotics for 4-6 weeks.
Chronic osteomyelitis is defined as infection that has been present for more than 2 weeks and signs of devitalized bone. It is treated with surgical irrigation and debridement and intravenous antibiotics for 4-6 weeks.

Q: how to investigate osteomyelitis?
labs: [...]
imaging: [...]
most accurate test: [...]
A: WBC, ESR, CRP, blood cultures; x-rays, MRI; bone aspiration w/ Gram stain & culture

Q: how to tx osteomyelitis?
[...]
A: surgical debridement of affected bone followed by IV abx for 4-6 weeks (empiric abx)

Q: what is the most common cause of osteomyelitis?
[...]
A: Staph. aureus

Q: what is the most common cause of osteomyelitis in patients with sickle cell disease?
[...]
A: Salmonella and Staph. aureus

Q: what is the dx?
[...]
A: pityriasis rosea (follows skin lines)

Q: what is the dx?
[...]
A: hives/wheal (linear elevated plaque on erythematous base)

Q: what is the dx?
[...]
A: seborrheic keratosis

Q: A 3-year-old-girl presents with 5 weeks of joint pain and swelling. She has a swollen knee which is in a flexion contracture. Her right 4th finger is swollen from distal to the proximal interphalangeal joint through to the metacarpal joint. The 4th finger is also erythematous for the last 4 weeks. She has no rash or fever. She has been diagnosed with asymptomatic uveitis. Her mother has a scaly rash with an erythematous base on her arm that has never been treated as it improves each summer with sun exposure. What is her most likely diagnosis?
[...]
A: psoriatic juvenile idiopathic arthritis

Q: when to image suspected scaphoid fractures?
[...]
A: CT or MRI in 7-14 days post-fracture

Q: which tendons are affected by de Quervain tenosynovitis?
[...]
A: extensor pollicis brevis and abductor pollicis longus

Q: A 70-year-old woman presents to the emergency department to evaluate left wrist pain. The patient was cleaning the bathroom when she slipped, fell, and landed on an outstretched left arm. She was subsequently unable to move her left wrist due to pain. Past medical history is notable for hypertension, and she takes amlodipine daily. She does not smoke or consume alcohol. Vital signs are within normal limits. Physical examination demonstrates swelling and deformity of the left wrist. Plain films of the left wrist are shown below. Which of the following is the most likely diagnosis?
[...]
A: Colles fracture
Extra: This older patient presents after a fall on an outstretched hand (“FOOSH” injury). Imaging of the wrist demonstrates a distal radius fracture with dorsal angulation, which is consistent with a Colles fracture.
Colles fractures are the most common wrist fracture and typically occur after sports-related injuries in younger patients or low-energy trauma in older patients with osteoporosis. A fracture will appear on plain films of the distal radius, with varying degrees of impaction, displacement, and associated intra-articular fractures. The most common mechanism of injury involves a fall on an outstretched hand, such that the direction of force displaces the radial fragment dorsally.
Smith fractures are distal radius fractures with volar angulation. The most common mechanism of injury for this fracture pattern is falling onto flexed wrists. This contrasts to Colles fractures, wherein the wrist is held in extension during the fall. Smith fractures can be diagnosed via plain films.
Clinically, both fracture patterns will demonstrate swelling and deformity of the wrist with limited passive and active range of motion due to pain. Assessment of neurovascular status should take place before and after closed reduction.

Q: what happens in external snapping hip syndrome?
[...] OR [...]
A: post. IT band snaps over greater trochanter; ant. fibres of gluteus maximus slide over greater trochanter

Q: Dinah is 25 years old and sustained a right tibia fracture. A similar x-ray is shown. 1 year later, she has crepitus with active or passive right knee range of motion. What is the most likely reason for this crepitus?
[...]
A: fracture involves extension to articular cartilage

Q: what is the most common mechanism of injury leading to a rupture of the anterior cruciate ligament?
[...]
A: non-contact, pivoting injury

Q: A 35 year woman is seen for a 2 month history of hip symptoms. They work as a scuba diving instructor. They have diabetes, and are otherwise healthy. Daily when they walk or swim, they feel their right hip keeps "popping out of joint", causing them to "catch my breath" for a moment. This happens more than 50 times each day. During the physical examination, you ask her to walk. You walk beside her, with your hand on her lateral hip. You hear and feel a "pop" at the LATERAL HIP approximately every 10 steps. What anatomic structure is most likely causing this patient's symptoms?
[...]
A: IT band

Q: compared with normal synovial fluid, knee joint fluid aspirate for bacterial septic arthritis is likely to show [high/low] glucose
A: low

Q: genu varum is associated with bow leg and [medial/lateral] compartment arthritis
A: medial

Q: A 32-year-old male basketball coach is brought to the emergency department with severe pain in the left arm, which is getting progressively worse. He has noticed redness spreading up his arm from a small abrasion he got on the court 2 days ago. He has been feeling unwell. His vital signs show pulse = 100, blood pressure = 95/50, temperature 38.7 degrees Celsius. The bacterial that has the highest acute risk to his limb is [...]
A: group A streptococcus

Q: why is it difficult to eradicate infection of a total joint replacement?
[...]
A: b/c bacteria adheres to the implant with a glycocalyx

Q: bone gets most of its blood supply from the [endosteal/periosteal] blood supply
A: endosteal

Q: An otherwise healthy 70 year old patient has a right displaced intertrochanteric hip fracture due to a fall. What would reduce the risk of perioperative complications?
[...]
A: early mobilization after surgery

Q: A patient has severe plantar aspect heel pain while walking. This pain is worst during their first few steps each morning, and persists all day. This has been going on for 6 months. What is the most likely diagnosis?
[...]
A: plantar fasciitis

Q: A 30 year old fully immunized patient with tetanus immunization 2 years ago sustains a fracture. Appropriate initial therapy for an open fracture of the tibia with gross contamination from dirt and gravel most appropriately includes:
[...]
A: abx and irrigation with saline

Q: what does this right knee x-ray show?
[...]
A: varus with medial OA

Q: how to dx osteosarcoma?
best initial test: [...]
most accurate test: [...]
imaging: [...] for staging and surgical planning
A: plain x-rays (Codman triangle or sunburst pattern); biopsy; CT

Q: how to tx osteosarcoma?
1. [...]
2. [...]
A: surgery and pre- & postperative chemotherapy (e.g., MTX, doxorubicin, cisplatin); amputation

Q: what is the dx?
[...]
A: giant cell tumour of the bone

Q: Patient presents with local pain and swelling of the skin over their femur. Their labs show increased ALP and an x-ray shows a sunburst lytic bone lesion. What is the dx?
[...]
A: osteosarcoma (tx w/ local excision & chemo)

Q: 15M presents with local pain and swelling over their femur with systemic sx. Their labs present with leukocytosis and increased ESR. Their x-ray shows lytic bone lesions with onion skin periosteal reaction. What is the dx?
[...]
A: Ewing sarcoma (tx w/ local excision, chemo, radiation)

Q: what is the dx?
[...]
A: osteosarcoma

Q: what is the dx?
[...]
A: Ewing sarcoma

Q: what is the ddx in a worrisome bone lesion in someone >40 y/o?
[...]
A: metastatic carcinoma or myeloma

Q: what is the ddx in a worrisome bone lesion in someone <40 y/o?
[...]
A: sarcoma

Q: what is sarcoma?
[...]
A: malignant tumours of connective tissues of mesenchymal origin (NOT epithelial, glandular, or hematopoeitic)

what are red flags that point you towards malignant bone lesions?
1. night/rest pain
2. bone pain & soft tissue mass
3. low E bone fracture (regardless of age)
4. constitutional sx

Q: 25F presents with hip pain with rest and activity. The x-ray presents with a well-defined sclerotic border with no obvious periosteal reaction. What is the dx?
[...]
A: simple bone cyst

Q: 10M presents with constant shoulder pain and swelling around the deltoid. An x-ray reveals an ill-defined proximal humerus lesion with new bone formation and soft tissue mass. The MRI is shown below. What is the most likely dx?
[...]
A: osteosarcoma
Extra: MRI shows large destructive lesion and large soft tissue mass

Q: what is the most important predictor of survival in bone sarcomas?
[...]
A: presence of metastatic disease

Q: what type of surgical management is necessary for osteosarcoma?
[...]
A: wide margin (en bloc) resection

Q: what are the big 3 primary bone sarcomas?
1. [...]
2. [...]
3. [...]
A: osteosarcoma (think Terry Fox); chondrosarcoma; Ewing sarcoma

Q: what is the dx?
[...]
A: chondrosarcoma
Extra: Chondrosarcoma is a heterogeneous group of malignant tumors that arise from cartilaginous tissue and typically occur in patients > 50 years old. Usually occur in the pelvis, ribs, and metaphyses of long bones.

Q: what tumour grade are most osteosarcomas?
[...]
A: high grade (mainly affecting 10-25 y/o)

Q: how to tx chondrosarcoma?
[...]
A: ONLY surgery (not chemosensitive, not radiation sensitive)

Q: who is mostly affected in chondrosarcoma?
[...]
A: ppl 40-70 y/o (58% male, 42% female)

Q: how to tx this lesion?
[...]
A: SURGERY (dx: chondrosarcoma)

Q: how to dx chondrosarcoma?
local imaging: [...]
systemic imaging: [...]
A: MRI; bone scan, chest CT

Q: who does Ewing sarcoma most affect?
[...]
A: children and young adults 10-20 yrs

Q: 15M presents with bone pain, a painful bone mass, and systemic symptoms. You suspect Ewing sarcoma. What do you do?
1. [...]
2. local imaging: [...]
3. systemic imaging: [...]
4. urgent referral to oncology center
A: protected weightbearing; MRI; bone scan, chest CT, bone marrow aspirate

Q: how to tx Ewing sarcoma?
[...] or [...]
A: multimodal chemo; rad therapy + negative margin resection

Q: what is epiphysiodesis?
[...]
A: surgery that is performed on the physis, or growth plate, of the longer leg

Q: how to investigate benign bone lesions?
bare min: [...]
concern for malignant lesion: [...]
A: PE + x-rays; MRI

Q: what is the most common benign bone tumour (not including enchondromas)?
[...]
A: osteochondroma (lat. bony projections of growth plate)

Q: what is the dx?
[...]
A: osteochondroma
Extra: Osteochondroma is the most common primary benign bone tumor. It appears on an x-ray as a bony protrusion with a cartilaginous cap and either a broad base (sessile) or narrow base (pedunculated). The tumor arises from the growth plate during periods of rapid bone growth (late childhood and adolescence) but is left behind on the metaphysis as the bone grows in length. Usually asymptomatic but may occasionally cause pain due to pressure on soft tissue structures.

Q: what is the dx?
[...]
A: enchondroma
Extra: A benign intramedullary cartilaginous neoplasm that typically occurs in patients 10-40 years of age. Most commonly seen in the phalanges. Appears on x-ray as a well-defined osteolytic lesion. A calcified chondroid matrix may be present, but a periosteal reaction is usually absent.

Q: should we biopsy this lesion?
[...]
A: NO, b/c it's an enchondroma

Q: Which benign bone tumour presents in young adults as a painful, dull "tooth ache" in the bone that is relieved with NSAIDs?
[...]
A: osteoid osteoma

Q: what is the dx?
[...]
A: osteoid osteoma

Q: how to tx osteoid osteoma?
[...]
A: RF ablation (heat probe; dx w/ x-ray or CT scan)

Q: how to tx giant cell tumour of bone?
[...]
A: extended intra-lesional curettage (aggresive removal of tumour with expanded margins)

Q: what is the 2-year survival of metastatic bone disease?
[...]
A: 15-20%

Q: A 35 year old patient presents with one day history of low back pain. They have new numbness of the bilateral legs, feet, and perineal area. They have fever and chills. Of the following, which is the most likely cause of their back pain?
A. Osteomyelitis of the feet
B. Multiple myeloma
C. Cauda equina syndrome
D. Infection in the epidural space
[...]
A: D

Q: A 20 year old soccer player presents with a 1 month history of severe acute onset low back pain, worse with movement. The back is normal to palpation. History and physical exam are otherwise normal. She has the following x-ray. How much is the top vertebrae (L5) slipped anteriorly, compared to the bottom vertebrae (S1)?
[...]
A: 5-25%

Q: Fiadh is a 45 year old woman who presents with bilateral lower extremity lesions on x-ray, suspicious for metastatic bone disease. Which diagnostic test is most appropriate to identify the source of the neoplasm?
[...]
A: CT scan of the chest, abdomen, and pelvis to look for primary malignancies

Q: A 63 year old woman has localized pain for 3 years with extension of her low back. She has no radicular symptoms, no claudication symptoms and no neurological red flags. On exam, she has focal back pain only with extension based loading maneuvers around the L5/S1 region. Which of the following cortisone injections could you consider for this patient for pain control after an x-ray is obtained?
[...]
A: facet injections at L5/S1 bilaterally
Extra: medial branch block of the dorsal root

Q: A 40 year old woman has a two year history of stable low back pain. When asked where the pain is, she points at the right buttock. With ambulation, the right buttock pain radiates down her leg. There is no numbness, weakness, bowel or bladder involvement. Pain is eradicated when she wears compression shorts. Her mechanical low back pain generator is most likely the:
[...]
A: right SI joint

Q: of osteosarcoma, chondrosarcoma, and Ewing sarcoma, which is chemo sensitive but not radiation therapy sensitive?
[...]
A: osteosarcoma

Q: of osteosarcoma, chondrosarcoma, and Ewing sarcoma, which is chemo sensitive and radiation therapy sensitive?
[...]
A: Ewing sarcoma

Q: An athlete is doing high intensity interval training exercise. They are keeping the arm fixed against the body, flexing the elbow to pick a sand-filled weighted ball up off the ground. What type of biceps contraction is occurring?
[...]
A: concentric contraction
Extra: A concentric contraction is a type of muscle activation that causes tension on your muscle as it shortens. As your muscle shortens, it generates enough force to move an object. This is the most popular type of muscle contraction.

Q: What type of contraction is occuring in the biceps when lowering in a biceps curl?
[...]
A: eccentric contraction
Extra: Eccentric contraction occurs when the total length of the muscle increases as tension is produced. For example, the lowering phase of a biceps curl constitutes an eccentric contraction.

Q: holding the dumbbell in a constant/static position rather than actively raising or lowering it is an example of [...] contraction
A: isometric
Extra: Isometric contraction occurs when muscle length remains relatively constant as tension is produced. For example, during a biceps curl, holding the dumbbell in a constant/static position rather than actively raising or lowering it is an example of isometric contraction.

Q: A 33 year old bus driver has a 2 month history of sudden onset pain, tingling, and weakness in their left lower extremity. The tingling is on the left anterior thigh and knee, and the weakness is in knee extension. He has diagnostic imaging which shows nerve root compression. What is the most likely level of compression?
[...]
A: left L3 nerve root

Q: what is a Bennett fractture?
[...]
A: fracture of base of thumb resulting from forced abduction of 1st metacarpal

Q: what is a Lisfranc injury?
[...]
A: fracture-dislocation involving foot btw tarsals and metatarsal bases

Q: what is a Colles fracture?
[...]
A: comminuted, impacted, displaced distal radial fracture ("FOOSH" injury resulting in a "dinner fork" deformity)

Q: A 57-year-old man presents to the emergency department after being found down outside a bar. Emergency medical services were called to the scene after several bystanders saw the person lying in the street. The patient is poorly responsive and unable to provide a history. Temperature is 37.0°C (98.6°F), pulse is 110/min, respirations are 24/min, blood pressure is 130/80 mmHg, and O2 saturation is 93% on room air. The patient’s speech is slurred, and he responds only to pain. Physical examination reveals scattered abrasions over the arms and legs and a 1 cm laceration over the right occiput. The patient is further noted to have swelling of the right hand. A radiograph of the right hand is obtained and shown below. Which of the following best describes the mechanism of injury associated with this injury?
[...]
A: force applied to a clenched fist (boxer's fracture)
Extra: This patient presents after being found down with right-hand swelling, scattered abrasions, and a head laceration. Given these findings, he was likely involved in a physical altercation. Imaging demonstrates a fracture of the distal end of the fifth metacarpal, which is consistent with a boxer fracture. The most common mechanism of action leading to this injury pattern is a direct force applied to a clenched fist.
Boxer fractures are common and represent approximately 10% of all hand fractures. It is most commonly seen amongst boxers (hence the name), individuals involved in physical altercations, and athletes participating in contact sports (e.g., football, rugby). The most common mechanism of injury for this fracture involves axial pressure applied to the metacarpal bone when the fist is in a clenched position.
Clinically, patients with boxer fractures will often experience dorsal hand pain, swelling, and possible deformity over the fifth knuckle. Treatment is generally conservative and involves analgesia with closed reduction and placement in an ulnar gutter splint. Surgical referral is indicated for severe deformity or a high degree of displacement and angulation.

what does FITT stand for in physical activity?
F: frequency
I: intensity
T: time (minutes of MVPA)
T: type

Q: what do the Canadian Physical Activity guidelines recommend for every adult age 18-64?
1. [...] minutes of MVPA
2. [...] ≥2X/week
A: ≥150; muscle & bone strengthening activities using major muscle groups

A 28-year-old female presents to the family medicine clinic for her routine prenatal visits and would like to discuss exercise throughout her pregnancy. Prior to getting pregnant, she engaged in moderate aerobic activity 4-5 days per week, with 2-3 aerobic exercise sessions at a moderate intensity lasting 45-60 minutes, and 1-2 days of resistance exercise. She has mostly continued with this level of activity, but does report more fatigue in the first 12-weeks of her pregnancy so has decreased her activity to 3-4 days per week. She would like to know what is recommended regarding activity during pregnancy. What is the most appropriate exercise prescription?
1. 150 minutes of moderate intensity aerobic exercise as tolerated
2. ≥2 days of resistance exercise and flexibility training most days of week
3. Kegel exercises encouraged

Q: worldwide, [...] women and [...] men do not do enough physical activity to stay healthy
A: 1 in 3; 1 in 4

Q: what is the risk of a CV event per 100,000 hours of vigorous exercise in individuals at risk of CVD?
[...]
A: 1 event per 100,000

Q: what is the NNT for exercise prescription (Vuori et al., 2013)?
[...]
A: 12 (to get 1 person >150 MVPA)

Q: how many hours of "tummy time" per day for infants <1 y/o?
[...]
A: ≥30 minutes

Q: when does screen time become ok for infants?
[...]
A: ~3-4 years (<1 hr screen time)

Q: how much physical activity should infants 1-4 y/o have per day?
[...]
A: ≥180 minutes/day of a variety of physical activities at any intensity

Q: what heart rate level should people target in MVPA?
[...]
A: 55-90% max hr (max hr = 220-age)
Extra: FITT = frequency, intensity, time, type

what are the cancer AEROBIC exercise guidelines using the FITT principle (Campbell et al., 2019)?
F: ≥3 times per week
I: MVPA
T: ≥90 minutes/week
T: prolonged, rhythmic activities using large muscle groups

Q: what exercises to avoid in pregnancy?
[...]
A: contact sports, sports w/ high risk of fall, hot yoga, scuba diving, sky diving

Q: what type of physical activity to prescribe sedentary populations?
[...]
A: start w/ low intensity activity in shorter bouts and gradually increase (focus on mastery and improved self-efficacy)

Q: how often should ppl w/ SCI exercise?
[...] of MVPA 2X/week
A: ≥20 minutes

Q: what counts as hypertension?
SBP: [...] OR
DBP: [...]
A: ≥140 mmHg; ≥90 mmHg

Q: what exercises to avoid in ppl w/ hypertension?
[...]
A: avoid heavy lifting, esp w/ breath holding

Q: what types of exercises to prescribe ppl w/ knee OA?
[...]
A: non-weight bearing aerobic exercise

Q: what are the 2 main types of extensor mechanism injury?
1. [...]
2. [...]
A: patella baja (quadss tendon rupture); patella alta (patellar tendon rupture)

Q: Patient has injured their quads with eccentric contraction when they missed a step on the staircase. They heard a pop and now present with difficulty weightbearing with buckling of the knee. PE reveals weakness in knee extension. The patient is unable to actively fully extend the knee but is able to passively extend the knee. There is no bruising. What are the 2 most likely ddx?
[...]
A: patella baja and patella alta

Q: how to treat extensor mechanism injury (quads tendon/patellar lig.)?
incomplete tear w/ intact extensor mechanism: [...]
complete tear: [...]
A: immobilize in full extension x2 weeks w/ incremental increase in ROM; surgical repair w/ post-op brace (x2 weeks)

Q: Patient presents with a non-contact twisting injury with the knee extended and foot in external rotation. The patient reports extreme pain and felt a pop during the time of injury. There is a large effusion and the knee feels tender medially. Apprehension test reveals discomfort with passive lateral patellar translation. What is the most likely dx?
[...]
A: patellar dislocation (likely lateral dislocation due to medial tenderness)

Q: how to treat patellar dislocation?
1st time: [...]
recurrent: depends on cause
A: physiotherapy ± bracing

Q: Patient presents with a Segond fracture and a Lachman test reveals increased ant. tibial translation. What is the most likely dx?
[...]
A: ACL tear

Q: how to treat ACL tears?
do: [...]
AVOID: [...]
A: crutches, WBAT, RICE; Zimmer splint

Q: Patient is involved in an MVA with a "dashboard injury." There is a posterior sag sign and positive posterior drawer test but normal x-ray. What is the most likely dx?
[...]
A: PCL tear (may also have torn other ligaments, menisci, etc.)

Q: how to treat PCL tears?
non-surgical: [...]
consider surgery if: [...]
A: RICE, crutches and bracing; significant instability, avulsion of ligamentous insertion on tibia

Q: how to treat MCL tears?
1. [...]
2. [...]
A: hinged knee brace ± crutches 4-6 weeks; physio/rehab

Q: how to treat meniscus tears?
conservative: [...]
consider surgery if: [...]
A: RICE, NSAIDs, physio, crutches PRN; significant mechanical sx, recurrent effusion, ACL injury

Q: what is the main diff btw the physis of children and adults?
[...]
A: children have growth plate in the metaphysis whereas adults don't

Q: what is the lateral bony projection called in osteochondroma?
[...]
A: exostosis (arises from mutations in exostosin 1 & 2)

Q: where is osteochondroma most often found?
[...]
A: metaphysis of long bones (e.g., femur, tibia)

Q: where are giant cell tumours most often found?
[...]
A: epiphysis of long bones (etiology: fracture, radiation exposure)

Q: what are giant cell tumours made of?
[...]
A: osteoclast-like cells and neoplastic mononuclear cells

Q: how to differentiate osteoblastoma from osteoid osteoma based on NSAID response?
[...]
A: osteoblastoma does not respond whereas osteoid osteomas do

Q: why do osteoid osteomas respond to NSAIDs?
[...]
A: b/c the sclerotic bone tissue around the nidus produced prostaglandins, which can be modified w/ NSAIDs

Q: how to differentiate osteoblastoma and osteoid osteomas based on bone erosion?
[...]
A: osteoblastoma has bone erosion of vertebrae whereas osteoid osteomas don't erode surrounding bone (usually cortex of long bones)

Q: where are osteomas usually found?
[...]
A: surface of facial bones (assoc w/ Gardner syndrome (polyps in colon)

Q: where are chondromas usually found?
[...]
A: medullary cavity of small bones (e.g., hands and feet)

Q: what type of growth pattern is exhibited in chondromas?
[...]
A: lobular growth pattern (of chondrocytes)

Q: from which cells do osteosarcomas arise?
[...]
A: osteoblasts (often in metaphysis of long bones)

Q: which mutation causes Ewing's sarcoma?
[...]
A: t(11;22) giving rise to EWSR1/FLI1 fusion (Ewing sarcoma protein)

Q: where is Ewing's sarcoma usually found?
[...] and [...]
A: diaphysis of long bones; pelvic flat bones

what are common sx of osteosarcomas OTHER than B sx?
1. bone pain
2. swelling
3. decreased ROM
4. pathologic fractures

Q: what are key sx of osteoid osteomas?
[...]
A: worse at night and improves w/ NSAIDs

Q: what are the 2 pathognomonic x-ray features of osteosarcoma?
[...]
A: sunburst appearance and Codman's triangle

Q: in addition to imaging, suspicion for bone malignancy should also be monitored with:
1. kidneys: [...]
2. liver: [...]
3. serology: [...]
A: urinalysis, creatinine; LFTs; ESR, blood urea nitrogen

Q: what causes Rouleaux formation in multiple myeloma?
[...]
A: nonfunctional IgG abs

Q: what do cytokines do to osteoclast and osteoblast activity?
[...]
A: increased osteoclast and decreased osteoblast activity (leads to bone destruction and hypercalcemia)

Q: other than SPEP and UPEP, how should we check for multiple myeloma?
1. serology: [...]
2. kidneys: [...]
A: serum Ca2+, blood urea nitrogen; creatinine, uric acid

Q: what does UPEP check for in multiple myeloma?
[...]
A: Bence-Jones protein (light chains rapidly filtered from blood)

Q: which mutations are associated with osteosarcoma?
[...]
A: RB1 and TP53 gene mutations

Q: A 20-year-old female comes to the office for a follow-up appointment. Two weeks ago, the patient fell during a college basketball game on an overstretched arm. Since then, she has experienced tenderness around the snuffbox of the right hand. An x-ray obtained following the injury failed to demonstrate a scaphoid fracture. However, imaging did show a circular lucent lesion with central irregular calcifications at the metaphysis of the base of the 5th proximal phalanx. The cortex appears intact. Vital signs are within normal limits. Family history and medical history are unremarkable. What is the most likely diagnosis?
[...]
A: chondroma
Extra: Chondromas are benign cartilage-producing tumors that typically occur in the metaphysis of long bones in individuals 20 to 50 years of age. They are mostly asymptomatic but may produce pain or pathologic fracture. On imaging, chondromas appear as a well circumscribed lucent lesion with central irregular calcifications, a sclerotic rim, and an intact cortex.
This patient has chondroma , a benign tumor of hyaline cartilage that typically develops in the medullary cavity (enchondroma) or on the cortical surface (juxtacortical chondroma). It occurs typically in individuals 20 to 50 years of age. It appears as a metaphyseal lesion of the tubular bones in the hands and feet. While it is usually a solitary lesion, multiple enchondromas are associated with Ollier disease and Maffucci syndrome.
Most enchondromas are asymptomatic and are detected incidentally, as in the case of this patient. Occasionally, they may cause pain or pathologic fracture. On imaging, chondromas are characterized by a well circumscribed lucent lesion with central irregular calcifications, a sclerotic rim, and an intact cortex. Macroscopically, they are usually < 3 cm, gray-blue in color, and translucent. Histologically, they are composed of benign cartilage with central calcifications and peripheral ossification. Solitary lesions rarely undergo sarcomatous transformation, but with enchondromatosis syndromes, the risk is higher. Treatment may include observation or curettage, depending on the clinical course.

Q: A 10-year-old boy is brought to the clinic by his parents due to buttock pain, low-grade fever, and fatigue. His parents report that the pain began a few months ago after a fall during a soccer game, but they did not seek care as they thought it would spontaneously resolve. Since then, the pain has increased and often awakens the patient at night. In the office, the patient's temperature is 37.8°C (100.0°F), pulse is 77/min, and blood pressure is 110/63 mmHg. On physical examination, there is swelling around the right iliac crest with some pain upon palpation. The neurological exam reveals a mild limp when the child is asked to walk but is otherwise normal. An x-ray reveals an osteolytic lesion surrounded by multiple layers of new bone. Biopsy of the lesion shows round small blue cells. What is the most likely dx?
[...]
A: Ewing sarcoma
Extra: Ewing sarcoma is a malignant tumor seen in children and young adults. Patients usually present with pain and constitutional symptoms. On x-ray, it usually appears as an “onion skin ” lytic lesion. Biopsy shows sheets of small blue cells. The majority of cases are associated with a balanced (11;22) translocation, leading to fusion of EWS-FLI1 genes.
This young boy is presenting with progressive bone pain, low-grade fever, and fatigue. The x-ray shows a characteristic “onion skin ” lesion. Finally, the biopsy reveals sheets of small blue cells, confirming the diagnosis of Ewing sarcoma.
Ewing sarcoma is a highly malignant tumor that accounts for approximately 10% of primary malignant bone tumors. It commonly affects children 5 to 15 years of age. The tumor usually arises in the diaphysis of long bones and the bones of the pelvis . Symptoms include bony pain, tissue swelling, fever, fatigue, weight loss, anemia, and pathologic fractures. On x-ray, it manifests as a large lytic lesion with significant periosteal reaction deposited in an “onion-skin ” or "moth-eaten" fashion. Laboratory tests often show elevated erythrocyte sedimentation rate (ESR).
The majority (85%) of Ewing sarcomas are found positive for a balanced (11;22) translocation that generates an in-frame fusion of the EWSR1 gene on chromosome 22 to the FLI1 gene on chromosome 11. How this fusion leads to the development of Ewing sarcomas remains unclear. Similarly, the origin of the cells has not yet been determined, but is presumed to be mesenchymal stem cells or primitive neuroectodermal cells.

Q: how to tx non-specific back pain (strained muscles or ligaments)?
[...]
A: activity and NSAIDs

Q: what does sciatica likely indicate?
[...]
A: disc herniation or spinal stenosis

Q: how to tx disc herniation?
non-surgical: [...] and [...]
surgical removal if pain lasts [...]
A: rest + NSAIDs; corticosteroids; ≥6 weeks

Q: what is PE maneuver to check for disc herniation?
[...]
A: straight leg raise test (+ve if painful)

Q: Patient presents with weakness in knee extension and a decreased patellar reflex. What radiculopathy is this most likely?
[...]
A: L4 radiculopathy

Q: Patient presents with weakened hip abduction and ankle dorsiflexion. They also have trouble heel walking. What radiculopathy is this most likely?
[...]
A: L5 radiculopathy

Q: Patient presents with weakened ankle plantarflexion and decreased Achilles tendon reflex. They also have trouble toe walking. What radiculopathy is this most likely?
[...]
A: S1 radiculopathy

Q: Patient presents with back pain, radiculopathy, loss of bladder & sphincter control, and sexual dysfunction. Upon PE, they present with saddle anesthesia. What is the most likely dx?
[...]
A: cauda equina syndrome

Q: what is the tx for cauda equina syndrome?
[...] and [...]
A: immediate surgical decompression via laminectomy; high dose of steroids

Q: Why is pain alleviated in patients with spinal stenosis when bending forward?
[...]
A: b/c it widens the vertebral foramen (pain exacerbated by walking or standing -> "shopping cart sign")

Q: how to tx spinal stenosis?
non-surgical: [...]
surgical: decompression surgery
A: PT, NSAIDs, epidural steroid injections

Q: older post-menopausal women with vertebral fractures often present with [lordosis/kyphosis] of the spine
A: kyphosis

Q: how to tx vertebral fractures?
non-surgical: [...]
surgical if pain lasts [...] or patient has [...]
A: bracing, pain management, managing osteoporosis; ≥6 weeks; neurologic deficits

which cancers often metastasize to the bone from most common to least?
1. prostate and breast
2. kidney
3. thyroid
4. lung

Q: Patient presents with asymmetric joint inflammation, dactylitis, and pencil-in-cup deformity. What is the most likely dx?
[...]
A: psoriatic arthritis

Q: what percentage of people will have disc degeneration by age (HULT study, 1954)?
40-44: [...]
50: [...]
50-59%: 95%+
A: 56%; 87%

Q: what does Choosing Wisely Canada say about imaging for low back pain (regardless of duraion of sx)?
only image if there are [...] or [...]
A: red flags; need for planning of therapeutic intervention

Q: what questionnaire can you use to assess for yellow flags w/ low back pain?
[...]
A: STarT back screening tool

Q: what does a Keele STarT back screening tool score of <3 mean?
[...]
A: low risk

Q: what does a Keele STarT back screening tool score of >4 but Q5-9 ≤3 mean?
[...]
A: medium risk

Q: what does a Keele STarT back screening tool score of >4 but Q5-9 ≥3 mean?
[...]
A: high risk

Q: what is the most common cause of lower back pain?
[...]
A: musculoligamentous strain/sprain

Q: Patient presents with exquisite spot tenderness in the lower back in a taut band with firm pressure applied for ~5 seconds. There is restricted ROM but not complete loss. There are no neurological deficits on PE. What is the most likely dx?
[...]
A: major myofascial pain

Q: how to alleviate myofascial pain?
[...] or [...]
A: stretching muscle; inject trigger point

Q: Patient presents with difficulty standing up after being seated. Which gluteal muscle is affected in this myofascial pain syndrome?
[...]
A: gluteus minimus

Q: Patient presents with difficulty standing on 1 leg unsupported. Which gluteal muscle is affected in this myofascial pain syndrome?
[...]
A: gluteus medius

Q: Patient presents with pain upon sitting and walking uphill. Which gluteal muscle is affected in this myofascial pain syndrome?
[...]
A: gluteus maximus

Q: which muscle is being palpated in this photo?
[...]
A: quadratus lumborum

Q: which muscle is being affected here?
[...]
A: iliopsoas

Q: what does Fortin's finger test assess for?
[...]
A: SI joint pain

Q: how to tx SI joint pain?
biomechanics: [...]
active exercise: [...]
injections: [...]
A: compression shorts, weight loss, PT; core stability, strengthening global mobilizers, endurance; joint blocks

Q: when are SI joint blocks indicated?
diagnostic: [...]
therapeutic: [...]
A: to rule in/out SIJ as cause for LBP; when combined w/ corticosteroid for pain management

Q: what are indications for facet blocks?
1. [...] months of {c1::persistent nonradicular axial pain}}
2. not responding to conservative mgmt/physio
3. fnl disability
A: ≥3

Q: what is the diff btw an exiting and transversing nerve root?
[...]
A: exiting is root going out of foramen whereas transversing goes across a disc to exit in the lvl below

Q: how to manage lumbar radiculopathies?
[...]
A: education, analgesia, follow-up, imaging if sx persist

Q: what are the 3 most common causes of lumbar spinal stenosis?
[...]
A: ligamentum flavum hypertrophy, facet hypertrophy, disc herniation

Q: Patient presents with loss of hand function, numbness, balance difficulty, and bladder disturbance. What is the most likely mechanical dx?
[...]
A: myeloapthy due to cervical stenosis

Q: what is main diff btw radiculopathy & claudication vs myelopathy?
[...]
A: radic + claud is painful in PNS (hyporeflexia) whereas myelopathy is not painful in CNS (hyperreflexia)

Q: what type of fracture is this?
[...]
A: Bennett fracture (results from forced abduction of thumb; tx: cast for 3-4 weeks in stable, non-displaced fractures)

Q: what is the dx?
[...]
A: Hill-Sachs fracture
Extra: Hill-Sachs defects are a posterolateral humeral head depression fracture, resulting from the impaction with the anterior glenoid rim, and indicative of an anterior glenohumeral dislocation. It is often associated with a Bankart lesion of the glenoid.

Q: what is the dx?
[...]
A: Monteggia fracture
Extra: fracture of proximal/middle ulna with dislocation of radial head

Q: what is the dx?
[...]
A: ant. glenohumeral dislocation

Q: what is the dx?
[...]
A: AC joint separation (Grade 3)

Q: what is the dx?
[...]
A: post. glenohumeral dislocation

Q: what is the dx?
[...]
A: RA

Q: what is the dx?
[...]
A: psoriatic arthritis

Q: what is the dx?
[...] and [...]
A: comminuted radial head fracture; elbow joint effusion
Extra: sail sign and posterior fat pad sign

Q: what is the dx?
[...]
A: comminuted left clavicle fracture

Q: what is the dx?
[...]
A: Greenstick fracture (incomplete ulnar fracture)

Q: what is the dx?
[...]
A: supracondylar fracture of the right humerus

Q: what is the dx?
[...]
A: scaphoid waist fracture

Q: what is the dx?
[...]
A: buckle (torus) fracture of the distal radius

Q: what is the dx?
[...]
A: trimalleolar fracture of the right ankle