Please enable JavaScript.
Coggle requires JavaScript to display documents.
Musculoskeletal, skin and connective tissue pathology, autoimmune disease,…
Musculoskeletal, skin and connective tissue pathology
autoimmune disease
systemic lupus erythematosus; SLE
Liben-Sacks endocarditis, Lupus nephritis
common causes: renal disease, infection, cardiovascular disease
rash, joint pain, fever in a female of reproductive age
!!! rash, arthritis, serositis, ulcer, hamatologic disorder, renal disease, photosensitivity, antinuclear antibody, anti-dsDNA, antiSm, antiphospholipid, neurologic disorders
associated with deficiency of early complement protein(eg.C1q,C4,C2)→↓clearance of immune complex
systemic, remitting, and relapsing autoimmune disease (type3 hypersensitivity reaction and lesser type2)
polymyositis/dermatomyositis
associated with interstitial lung disorder
treatment: steroid followed by long-term immunosuppressant therapy
↑CK, +ANA, +anti-Jo-1, +anti-SRP, +anti-Mi-2 antibodies
polymyositis
progressive symmetric proximal muscle weakness, endomysial inflammation with CD8+ cell
dermatomyositis
malar rash(蝶形紅斑), Gottron papules, heliotrope rash, face rash, perimysial(筋鞘) inflammation and atrophy with CD4+ cells
↑ risk of occult malignancy(潜伏癌)
antiphospholipid syndrome
lupus anticoagulant, anticardiolipin, anti-β₂ glycoprotein antibody
treatment: systemic anticoagulation
thrombosis, spontaneous abortion
1° or 2°, most commonly in SLE
polymyalgia rheumatica (リウマチ性多発筋痛症)
women >50 years old
↑ESR, ↑CRP
pain and stiffness in proximal muscle, fever malaise, weight loss
treatment: corticosteroid
Raynaud phenomenon
color change from white to blue to red
mixed connective tissue disease, SLE, CREST syndrome,,,
↓blood flow due to srteriolar vasospasm in response to cold or stress, most often in fingers and toes
treat with Ca channel blocker
fibromyalgia(線維性筋痛症)
women, 20-50 years old
chronic, widespread musculoskeletal pain, stiffness, paresthesias, poor sleep fatigue, cognitive disturbance
treatment: regular exercise, antideperessants, neuropathic pain agent
scleroedema(強皮症)
types
diffuse
widespread, rapid, early, associated with anti-Scl-70 antibody
limited
limited skin involvement (finger and face)
CREST syndrome: calcinosis cutis(カルシウム沈着), anti-Centromere antibody, Raynaud phenomenon, esophageal dysmotility, sclerodactyly(強指症), telangiectasia(毛細血管拡張症)
puffy, taut skin(膨らんでピンと張った皮) without wrinkles, fingertip pitting
autoimmunity, noninflammatory vasculopathy, collagen deposition with fibrosis
mixed connective tissue disease
anti-U1 RNP antibody
feature of SLE, systemic sclerosis, polymyositis
neuromuscular junction disease
myasthenia gravis(重症筋無力症)
most common
autoantibody to postsynaptic ACh receptor
ptosis(眼瞼下垂), diplopia, weakness, worsens with muscle use, improvement after endrophonium test
Lambert-Eaton myasthenic syndrome
autoantibody to presynaptic Ca channel→↓ACh release
proximal muscle weakness, autonomic symptoms, improve with muscle use
dermatology
common skin disorders
atopic dermatitis(eczema)
pruitic eruption, IgE, mutation in filaggrin gene, often appear on face(children), antecubital fossa(adults)
allergic contract dermatitis
type 4 hypersensitivity reaction that follows exposure to allergen
urticaria(じんましん)
pruitic wheals that form after mast cell degranulation, dermal edema, lymphatic channel dilation
melanocytic nevus(色素性母斑)
common mole, benign
acne
↑sebum,androgen production, abnormal keratinocytic desquamation(落屑), inflamation
treatment: retinoid, benzoyl peroxide, antibiotics
pseudofolliculitis barbae
firm, hyperpigmented papules and pustules that are painful and pruritic
cheeks, jawline, neck
psoriasis
↑stratum spinosum, ↓stratum granulosum
Auspitz sign
papules and plaques with silver scaling(銀鱗), especially on knees and elbows
rosacea(酒さ)
erythematous papules and pustules, facial flushing, cause rhinophyma(酒さ鼻)
seborrheic keratosis(脂漏性角化症)
Leser-Trelat sign
flat, greasy, pigmented squamous epithelial proliferation with keratin-filled cysts
verrucae(いぼ)
caused by low risk HPV, cauliflower-like papules, condyloma acuminatum
vascular tumor of skin
bacillary angiomatosis
benign, AIDS, Bartonella infection
Cherry hemangioma
benign, elderly
pyogenic granuloma
polypoid lobulated capillary hemangioma, ulcerate and bleed
cystic hygroma
cavernous lymphangioma in neck, associated with Turner syndrome
angiosarcoma
rare blood vessel malignancy typically occuring in head, neck, breast, aggressive
elderly, sun exposed area
glomus tumor
benign, painful, red-blue, under fingernails
Kaposi sarcoma
endothelial malignancy, in skin, mouth, GItract, respiratory tract
associated with HHV-8 and HIV
Strawberry hemangioma
benign capillary hemangioma of infancy
regress spontaneously
miscellaneous skin disorder
erythema nodosum
painful, raised inflammatory lesion fo subcutaneous fat, often idiopathic, associated with sarcoidosis, coccidiodomycosis, histplasmosis, TB, streptococcal infection, leprosy, IBD
lichen planus(扁平苔癬)
pruritic, purple, polygonal planar papules and plaques, Wickham striae, hypergranulosis, associated with hepatitis C
actinic keratosis(日光角化症)
premalignant lesion, sun exposure, risk of squamous cell carcinoma
pityriasis rosea(バラ疹)
Herald patch, Christmas distribution on trunk, self resolving in 6-8 days
acanthosis nigricans(黒色表皮腫)
symmetic, hyperpigmented thickening of skin, especially in axilla or neck, associated with insulinresistance , visceral malignancy
sunburn
acute cutaneous inflammatory reaction due to excessive UV irradiation, exposure to UVA and UVB ↑risk of skin cancer, can lead to impetigo
blistering skin disorder
dermatitis herpetiformis(疱疹状皮膚炎)
pruritic papulae, vesicles, bullae, IgA
erythema multiforme
multiple lesion
associated with infection, drugs, cancers, autoimmunedisease
bullous pemphigoid(類天疱瘡)
less sever, type 2 hypersensitivity, IgG against hemidesmosome
tense blisters contain eosinophil affect skin
Stevens-Johnson syndrome
toxic epidermal syndrome
fever, bullae, necrosis, sloughing of skin, high mortality
pemphigus vulgaris(尋常性天疱瘡)
flaccid intraepidermal bullae (by acantholysis), type 2 hypersensitivity reaction, +Nikolsky sign
fatal autoimmune disorder with IgG antibody against desmoglein
pigmented skin disorders
melasma
hyperpigmentation associated with pregnancy or OCP use
vitiligo(白斑)
irregular patches of complete depigmentation, caused by autoimmune destruction of melanocytes
albinism
normal melanocyte number with ↓melanin production due to ↓ thyrosinase activity or defective thyrosine transport, ↑ risk of skin cancer
seborrheic dermatitis(脂漏性皮膚炎)
associated with Parkinson disease, Malassezia spp.
treat with topical antifungal and corticosteroid
erythematous, well-demarcated plaques with greasy yellow scales in areas rich in sebaceous glands (eg. scalp, face, periocular region)
burn classification
second-degree
partial thickness burn through epidermis and dermis, blistered, healed without scarring
third-degree
full-thickness burn through epidermis, dermis, hypodermis, skin scars
first-degree
superficial, through epidermis
skin cancer
squamous cell carcinom
face, lower lip, ear, hand, locally invasive but spread to lymph node
actinic keratosis: precursor to squamous cell carcinoma
associated with excessive sun exposure, immunosuppression, chronically draining sinus, arsenic exposure
keratoacanthoma: grow rapidly and regress spontaneously
melanoma
types: superficial spreading; nodular; lentigo maligna(悪性黒子型); acral lentiginous(末端黒子型)
BRAF
asymmetry, border irregularity, color variation, diameter>6mm, evolution over time
significant metastasis, S-100 tumor marker, associated with sunlight exposure, dysplastic nevi(異形成母斑), ↑ risk in fair-skinned person, depth correlate with metastasis
basal cell carcinoma
waxy, pink, pearly nodule, commonly with telangiectasis, rolled border, central crusting or ulceration
most common skin cancer, sun-exposed area, localy invasive, but rarely metastasize
skin infection
bacterial
cellulitis(蜂窩織炎)
acute, painful, spreading, deeper dermis and subcutaneous tissues, from S.pyogenes or S.aureus
abscess
collection of pus from a walled-off infection within deeper layers of skin, form S.aureus
erysipelas(丹毒)
upper dermis and superficial lymphatics, from S.pyogenes
necrotizing fasciitis
deeper tissue injury, from anaerobic bacteria or S.pyogenes, causes bullae and a purple color to the skin
impetigo(とびひ)
superficial skin, S.aureus or S.pyogenes, Honey-colored crusting
bullous impetigo(水疱性膿痂疹) has bullae and from S.aureus
Staphylococcal scalded skin syndrome
fever, erythematous rash with sloughing(かさぶた) of the upper layers of epidermis
Nikolsky sign
exotoxin destroys keratinocyte attachment in stratum granulosum only
viral
molluscum contagiosum(伝染性軟属腫)
poxvirus, umbilicated papules
varicella zoster virus
varicella and zoster
herpes
HSV1,2, herpes labialis, herpes genitalis, herpetic whitlow
hairy leukopenia
irregular, white, painless plaque on lateral tongue, EBV, HIV
arthritis
rheumatoid arthritis
pain, swelling, morning stiffness, symmetric, systemic symptom
erosion, juxta-articular osteopenia, soft tissue swelling, subchondral cyst, joint space narrowing, swan neck finger, boutonniere finger, synovial fluid inflammatory
female, HLA-DR4, smoking, + rheumatoid factor, anti-cyclic citrullinated peptide antibody (anti-CCP; ACPA)
involve MCP, PIP; not DIP, CMC
autoimmune, pannus(proliferative granulation tissue)
treatment: NSAIDs, glucocorticoid, etc
rheumatoid nodules in subcutaneous tissue and lung, interstitial lung disease, pleuritis(胸膜炎), pericarditis, anemia of chronic disease, neutropenia, splenomegaly, AA amyloidosis, Sjogren syndrome, scleritis, carpal tunnel syndrome
osteoarthritis(骨関節炎)
pain after use, improving with rest, asymmetric, no systemic symptoms
osteophytes(骨棘), joint space narrowing, subchondral sclerosis and cysts, synovial(滑膜) fluid non inflammatory
age, female, obesity, juint trauma
involve DIP, PIP, 1st CMC; not MCP
wear and tear destroys articular cartilage→inflammation with inadequate repair
treatment: acetaminophen, NSAIDs, intra-articular glucocorticoid
calcium pyrophosphate deposition disease
pain and swelling with acute inflammation and chronic inflammation
chondrocalcinosis, crystals are rhomboid(菱形)
.>50 years old, idiopathic, most commonly knee
NSAIDs, colchicine
pseudogout, deposition of calcium pyrophosphate crystal within joint space
seronegative spondyloarthritis(血清反応陰性脊椎関節炎)
ankylosing spondylitis(強直性脊椎炎)
Banboo spine, can cause restrictive lung disease
common in male
symmetric involvement of spine and sacroiliac joints→ankylosis, uveitis, aortic regurgitation
inflammatory bowel disease
Chron disease and ulcerative colitis are often associated with spondyloarthritis
psoriatic arthritis(乾癬性関節炎)
associated with skin psoriasis and neil lesion
reactive arthritis
conjunctivitis, urethritis, arthritis
arthritis without rheumatoid factor, associated with HLA-B27, inflammatory back pain, morning stiffness, peripheral arthritis, enthesitis(腱付着部炎), dactylitis(指炎), uveitis
Gout
treatment
NSAIDs, glucocorticoids, colchicine(acute); xanthine oxidase inhibitors (eg. allopurinol, febuxostat) (chronic)
symptoms
food rich in purine, alcohol consumption
asymmetric, swollen, red, painful joint, MTP joint of big toe, tophus formation
findings
risk: male, hypertension, obesity, diabetes, dyslipidemia, hyperuricemia
hyperuricemia
underexcretion (90%)
overproduction (10%)
acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals in joint
needle shaped crystals
systemic juvenile idiopathic arthritis
daily spiking fever(棘状熱), salmon-pink macular rash, uveitis, arthritis, ↑ESR, ↑CRP
treatments: NSAIDs, steroid, methotrexate, TNF inhibitor
childhood arthritis
Sjogren syndrome
women 40-60 years old
inflammatory join pain, Keratoconjunctivitis sicca(乾性角結膜炎), xerostomia(口内乾燥), antinuclear antibody, rheumatoid factor, antiribonucleoprotein, SS-A and SS-B, bilateral parotid enlargement
autoimmune disorder, destruction of exocrine gland by lymphocytic infiltrate
septic arthritis
swollen, red, painful joint, synovial fluid purulent(化膿)
Gonococcal arthritis: STI plus arthritis, polyarthralgia, tenosynovitis(腱鞘炎), dermatitis
S.aureus, Streptococcus, Neisseria are common cause
bone
Paget disease; osteitis deformans(変形性骨炎)
mosaic pattern of woven and lamellar bone
↑ blood flow from ↑ arteriovenous shunt may cause high-output heart failure, hearing loss due to auditory foramen narrowing
↑ osteoclast activity, ↑osteoblast activity→poor-quality bone
↑ risk of osteogenic sarcoma
common, localized disorder of bone remodeling
treatment: bisphosphonate
osteomalacia(骨軟化症)/rickets
most common due to vitamin D deficiency
osteopenia, pseudofracture (in osteomalacia)/ epiphyseal widening and metaphyseal cupping/fraying, bow legs, bead-like costochondral junction(肋軟骨接合部), craniotabe(頭蓋ろう) (in rickets)
defective mineralization of osteoid(頬骨) or cartilaginous growth plates
↓ vitaminD, ↓Ca²⁺, ↑PTH, ↓PO₄³⁻, ↑ALP
osteoporosis
↑ bone resorption related to ↓ estrogen levels and old age
diagnosis: bone mineral density measurement by DEXA, with T-score<-2.5 or fragility fracture
trabecular and cortical bone lose mass and interconnection despite normal bone mineralization
treatment: bisphosphonate, teriparatide, SERM
achondroplasia(軟骨無形成症)
FGFR3 inhibit chondrocyte proliferation
most common cause of dwarfism
failure of longitudinal bone growth→short limbs, large head relative to limbs
osteonecrosis
causes: corticosteroids, alcoholism, sickle cell, trauma,etc
most common site is femoral head (insufficiency of medial femoral artery
infarction of bone and marrow, usually very painful
osteopetrosis(大理石骨病)
pancytopenia, extramedulla ry hematopoiesis(髄外造血)
failure of normal bone resorption due to defective osteoclasts→thickened and dense bone, prone to fracture
primary bone tumor
benign
osteoid osteoma(類骨骨腫)
bone pain that is relieved by NSAIDs
adults<25 years old, male, cortex of long bone
osteoblastoma(骨芽細胞腫)
large size, pain unresponsive to NSAIDs
vertebrae
osteoma
middle age, surface of facial bone, associated with Gardner syndrome
chondroma(軟骨腫)
medulla of small bones of hand and feet
osteochondroma(骨軟骨腫)
mataphysis of long bone
lateral bony projection of growth plate covered by cartilaginous cap, rarely transform to chondrosarcoma
most common, male<25 years old
giant cell tumor
20-40 years old, epiphysis of long bone
neoplastic mononuclear cells that express RANKL and reactive multinucleated giant cell
soap bubble appearance
malignant
chondrosarcoma
tumor of malignant chondrocyte
medulla of pelvis and central skeleton
Ewing sarcoma
anaplastic small blue cells of neuroectodermal origin, t(11;22), onion skin periosteal(骨膜) reaction in bone
generally boys<15 years old, diaphysis of long bones, pelvic flat bones
osteosarcoma
pleomorphic cell, painful enlarging mass or pathologic fracture
aggressive
20% of 1° bone cancer, in males<20 years, mataphysis of long bones