Part 3 board review (Pt.4)

Mongolian spot

blackish blue

port wine

red and flat

Hemangioma

red and raised (usually reduce with age)

vitiligo

patchy absence of melanin

Chloasma

patchy deposition of melanin (pregnancy)

tinea versicolor

white patches (subdermal fungus)

albino

generalized lack of pigmentation including eyes and skin

Basal cell carcinoma

waxy, indurated or hard, least likely to metastasize (interferon)

squamous cell carcinoma

irregular, flaky, bleeding

melanoma

pigmented, multicolor, invasive skin cancer

Psoriasis

silver scales, brown patches, discolored areas on extensors, pitted nails (UV treatment)

tinea capitis

ring worm

Lyme disease

spirochete carried by ticks, erythema migrans, central clearing, bulls eye rash

acne vulgaris

hair follicle inflammation, forehead, cheek, nose and chin

acne rosacea

deep inflammation of nose, redness of face

kaposi sarcoma

herald patch

SLE

butterfly rash (malar) (heliotrope)

NO UV

Dermatomyositis

rash on eyelids and knuckles (heliotrope)

NO UV

seborrheic dermatitis

scaly skin in hairy regions

seborrheic keratosis

benign, brown, raised scaly lesions or flat brown discolorations

actinic keratosis

hard, precancerous

cellulitis

staph or strep infection (Dangerous → ER)

red-spread- dead

Clubbing nails

COPD, Arthritis, cancer, hypertrophic pulmonary osteoarthropathy (HPO), CHF and RA

Transverse groove and lines on nails

systemic disease

Vertical lines on nails

aka splinter hemorrhages (SBE)

Pitted nails

psoriasis

Spoon nails (koilonychia)

iron deficiency and fungus

Tests when clubbing nails are present

spirometry, CBC, arthritis panel and x-ray

Tests for beau’s /transverse lines on nails

metabolic panel

tests for splinter hemorrhage

culture and echo

tests for pitted nails

arthritis panel, x-ray

Old eyes

presbyopia (farsighted)

old ears

presbycusis (Sensorineural deficit)

Otosclerosis (conduction deficit) → cerumen most common

Most common fracture in elderly

Hip

most common traumatic fracture in elderly

wrist

compression fracture in elderly

T4-T8

Visual loss =

cataracts

Senility

over 60 years old, caused by multiple infarcts

Alzheimer’s (presenility)

amnesia (short term first), aphasia, apraxia, agnosia

CVA’s

episodes: seconds to days

recovery: months to years

TIAs

complete recovery within 24 hours

Temporal arteritis

localized headache (giant cell arteritis) associated with polymyalgia rheumatica (generalized achiness), hypertension, fever, increased ESR, arteriogram, aspiration biopsy

Primary cancer

female and male: lung

Female → genital (breast), male → genital (prostate)

dx biopsy

Secondary cancer (mets)

breast (lytic)

prostate (blastic)

lytic (75%)

EKG for

pain and muscle death

CHF

echo for fatigue and weak muscles

CHF

insidious onset, swollen, fatigue, nocturnal dyspnea

MI

sudden onset, painful

Arteriosclerosis

insidious onset, claudication, fatigue, pale

Anemia

insidious onset, fatigue, pale

pneumonia

crackles, common complication to bedridden (Fracture, etc)

COPD

prolonged expiration, barrel chest

Neuro/muscular

vibration is most commonly lost first

CVA

hemiplegia, difficult speech, dementia

Parkinson

shuffling gait, resting tremor, cog wheel rigidity, bradykinesia

post-polio

foot flop

OA

asymmetrical typically

Symmetrical only in the knee

RA

usually symmetrical

asymmetrical in SI

HLA-B27

negative ANA

negative RA latex

Increased ESR and syndesmophytes

MOCE

multiple myeloma

osteosarcoma

chondrosarcoma

Ewings sarcoma

Ulnar deviation

reducible = SLE

permanent joint deformity = RA

distal tuft destruction seen with

scleroderma, psoriatic arthritis, HPT

KVP controls

contrast (latitude), change 15%, speed of electron

Low kVp =

high contrast = few shades, short scale

High kVp =

low contrast = lots of shades, long scale

more of me - more kVp

the developers main job is to

reduce the exposed silver bromide crystals

the fixers main job is to

remove the unexposed silver bromide crystals

GB stones

often made of cholesterol, less than 10% are visible on x-ray

Porcelain gallbladder is calcified

kidney stones

greater than 99% are made of calcium (staghorn calculi in the calyx)

vessels

aorta calcification is less than 3.5cm

(>3.5cm is an aneurysm)

(>6cm is a medical emergency)

Soft tissue

no air in small intestines normally

silhouette sign (bacterial pneumonia)

paralytic ili (stiar step gas)

perirenal fat outlines the kidney

abdominal calcifications (kidney, GB)

vessel calcification (HTN, HPT, PSS)

Avulsion fracture

clay shoveler’s

transverse fx

pathological disease (banana fx)

fatigue fx

repetitive physical stress (march)

comminuted

more than 2 piecews

impacted fracture

one part driven into another

Greenstick fx

children

Compound fx

part protruding through skin

growth plate

salter harris (children)

Os odontoideum

normal variant → line through the base (looks like fx)

Os terminale

normal variant → line through TIP (cap)

Vertical cleft through vertebral body =

butterfly

normal variant

Wasp waist

block vertebra, non-segmentation

normal variant

undescended scapula

Sprengel’s (omovertebral bone)

normal variant

multiple block vertebra

klippel-feil, cervical spine

normal variant

horizontal lines in the body

hahn’s fissure (vascular)

normal variant

Vertical lines in the body

hemangioma (benign)

normal variant

most common congenital anomaly of spine

spina bifida

Spina bifida vera

huge neural arch defect

multiple levels and is very very bad

radiculopathy usually present

multiple levels of vertical lines in the vertebral body

osteoporosis

LAO = RPO cervical

cervical left IVF

RAO = LPO cervical

cervicals right IVF

Tube tilt for oblique x-rays

anterior = caudad 15 degrees

posterior = cephalad 15 degrees

LAO=RPO lumbar

right pars, left SI Joint

RAO = LPO lumbars

left pars, right SI joint

Dysplastic spondy

congenital defect in pars

Isthmic spondy

broken early in life

degenerative spondy

L4

Traumatic spondy

severe trauma

Pathological spondy

disease causes pars defect