Mnemonics

OMM
Hypertonic
o Upper PLUSSS
o Lower - QuIPHLRT
Inhibition
o Upper - LoLoRDS
o Lower GRET FiV
DERM
Munro abscess (psoriasis) monroes parakeet eats corn
parakeratosis of the stratum corneum
Hereditary angioneurotic edema C1
Watching ass (2) and balls (6) on the CW from 6-2 is a sight for
sore eyes psoriasis caused by HLA-CW0602
Bully pimp ties his hoes up with ribbon candy
Lichen planus the wicked lich king has sawtooth teeth
sawtooth rete ridges, wickham striae
CDKN2A/CD4 predisposed to malignant melanoma
Verrucae
o Plantar warts - HPV type 1 (1 looks like a tree = plantar)
o Verrucae vulgaris anywhere, MC on surface of hand 2
hands, 4 extremities
o Venereal (condyloma acuminatum) 6 (balls) 11 (penis)
Condyloma acuminatum with carcinoma 16 and 18
age of when people have sex and spread STDs,
cancers

DRUGS
Anakinra - Anna Kendrick is number 1 Anakinra IL-1 inhibitor
Tocilizumab , Actemra liz is tossled that she is number 6, but
ACTS like she likes anna kendrick
A beta pledge (abatacept) all about boobs (CD80) and balls
(CD86) on the bitches (B cells) but theyre afraid of cops (COPD)
binds CD80 and CD86 on B cells to prevent T cell activation
EATIN-ercept eats up the TNF with its 2 lips. The G looks like a
mouth = 2 TNF receptors bound to IgG
Colts player in a limousine running over the tubes

BABY SCIENCE

PE/AF

SCC has keratin pearls indurated, ulcerated nodule

Pruritic, vesicular rash = varicella, chicken pox
Vitiligo sometimes assoc w autoimmune disorders graves,
addisons, etc.
Seborrheic keratosis scaly, pigmented plaques, easily rubbed
off, stuck on. Broad, anastomosing cords of mature stratified sq
ep w small cysts of keratin (horn cysts).
o Assoc w internal malignancies leser trelat sign (esp
gastric carcinoma)
Actinic keratosis assoc w SCC
o Cytologic atypia
o Dyskeratosis limited to basal layers of stratum spongiosum
o Hyperkeratosis and parakeratosis
o Erythematous brown papules
o No invasion into dermis (invasion = SCC)
Ichthyosis vulgaris mild hyperkeratosis and reduced or absent
heratohyaline granules in the epidermis
o Scaly dt inc cohesiveness of the stratum corneum
Acral lentiginous melanoma MC form of melanoma in darkskinned people
o Limited to plams, soles, subungal area
Psoriasis neutrophils localized in epidermal spinous layer or in
small munro microabscesses of stratum corneum
o Downward elongation of rete ridges (be careful
dermatofibroma also has this)
Epidermolysis bullosa
o No antibody in IF microscopy
o Separation of basal layer of epidermis from basement
membrane, no inflammatory cells
Pemphigus vulgaris rupture easily, leave large crusted areas
o Separation of stratum spinosum from basal layer
o IgG targets desmoglein-3
Erythema nodosum self-limited, nonsuppurative, tender
nodules over extensor surfaces of lower extremities
o Triggered by exposure to variety agents drugs,
microorganisms, benign and malignant dz

o Focal hemorrhage, neutrophilic infiltrates in subq fibrous

tissue septa, giant cells at interface b/w septa and adipose
fat tissue
Bullous pemphigoid like pemphigus vulgaris but no
acantholysis.
o IgG against BPAG1 and BPAG2 (basement membrane
proteins)
o IF stain linear deposition of C3 and IgG along epidermal
basement membrane zone
Dermatitis herpetiformis gluten sensitivity
o Urticaria-like plaques and vesicles over extensor surfaces
of the body
o IgG Ab to components of gluten in the intestines => gain
access to circulation => deposit in skin
SLE:
o Pt acts strangely, malaise, joint pain, weight loss, sporadic
fever, agitation, malar rash, erythematous pink plaques
with telangiectatic vessels, oral ulcers, nonblanching
purpuric papules on legs.
o Elevated BUN, creatinine
o ANA positive
o Morph : granular distribution of immune complexes in
basement membrane
Lichen planus multiple flat-topped, violaceous , polygonal
papules
o Injury at dermal-epidermal junction infiltrate of
lymphocytes surrounding apoptotic keratinocytes
Mycosis fungoides (CTCL variant) lymphocytes in the epidermis
o Sezary syndrome systemic dissemination
o Doesnt respond to topical steroid
o Atypical mononuclear cells
o PAS positive
o Epidermis and papillary dermis expanded by extensive
infiltrate of atypical lymphocytes that express CD4 cell
surface markers
Cutaneous necrotizing vasculitis (hypersensitivity angiitis)
palpable purpura
o Circulating immune complexes deposited in vascular walls
o Elaborated C5a complement components attract
neutrophils degranulate and release lysosomal enzymes
=> endothelial damage, fibrin deposits
Assoc w infectious agent (50% of time)
Allergic contact dermatitis spongiotic dermatitis

o Initial 24 hours numerous lymphocytes and macrophages

accumul about superficial venular bed and extend into the
epidermis
o Epidermal keratinocytes separated by edema fluid =>
crete sponge-like appearance (spongiosis)
o Sensitization phase LMW haptens combine w carrier
proteins at cell membrane of Langerhans cells
Inflammatory cells carry Ag through lymphatics to
regional lymph nodes
Present to CD4+ T-lymphoytes
Sensitized T cells migrate back into epidermis
Scleroderma fibrosis, hardening of the skin
o Dysphagia dt involvement of the esophagus
o Also, lung, heart, sm intestine invovlemtn
o Raynaud phenomenon
o Nonpitting edema of hands or fingers
Verruca vulgaris hyperkeratosis (hyperplasia of stratum
corneum), parakeratosis (retention of nuclei in stratum corneum),
hypergranulosis (inc granular cell layer)
Epidermoid cyst (epithelial inclusion cyst) keratin-filled cyst
lined by squamous epithelium having a granular cell layer.
o Other types of cysts include pilar cysts, which are keratinfilled cysts (lined by squamous epithelium not having a
granular cell layer) found typically on the scalp, and
dermoid cysts, which are similar to epidermal inclusion
cysts with the addition of multiple adnexal structures, such
as sebaceous glands or hair follicles. A cystic hygroma is
actually a type of lymphangioma that is found in the neck.
Malignant melanoma positive HMB45 stain
Dermatofibroma firm brown lesion on upper right thigh
o Hyperplasia of basal layer
o Dirty fingers pattern
o Downward elongation of hyperpigmented rete ridges
Stevens Johnson syndrome o After oral sulfonamide
o Necrolytic skin rash
o Lesions on mucous membrane
o Target lesion with 3 zones of color central dusky area
surrounded by edematous pale zone surrounded by
erythematous area.
Pemphigus vulgaris
o Chicken wire appearance on IF stain
o Positive nikolsky sign
o Suprabasal Acantholytic vesicles

Verrucae
o Plantar warts - HPV type 1 (1 looks like a tree = plantar)
o Verrucae vulgaris anywhere, MC on surface of hand 2
hands, 4 extremities
o 16 and 18 cancerous condyloma acuminatum leading to
carcinoma (age of sex when cancers and STD spreads)
o 6 and 11 condyloma acuminatum
tinea versicolor wood lamp reveals yellow fluorescence
mallasezia furfur
PTCH gene predisposition to basal cell (play PiTCH in BASebALl)
CDNK2A dysplastic nevus (malignant melanoma)
SCC in sun-exposed area in child likely xeroderma
pigmentosum
Dermatofibrosarcoma protuberans is the malignant counterpart
of dermatofibroma. The PDGFB gene is juxtaposed with the
promoter region of COL1A1, leading to up-regulation of a growthpromoting factor. Imatinib mesylate can be employed to inhibit
the PDGF receptor tyrosine kinase to control lesions that are
recurrent or metastatic. FGFR3 mutations are more characteristic
for seborrheic keratoses. KIT mutations are found in mast cell
proliferations. Basal cell carcinomas have PTCH1 mutations.
TSC1 mutations are found in tuberous sclerosis, with skin
manifestations, including ash-leaf patches, shagreen patches,
subungual fibromas, and angiofibromas.
Bullous pemphigoid
o Subepidermal bullae, heals without scarring
o Subsequent oral lesions
o MC elderly
o Linear IgG deposition at basal cell-basemet membrane
attachment plaques (hemidesmosomes) containing bullous
pemphigoid antigen (BPAG)
Discoid lupus erythematosus type III hypersensitivity
o IgG deposition among dermal-epidermal junction
o Vacuolization of basal layer
o Perivascular lymphocytic infiltrate
o Lesions on sun-exposed skin

JOINTS
Osteoarthritis dt defects in articular chondrocyte function
o Chondrocytes proliferate in early disease
o Eventually dysfxn
Spondyloarthropathies (ankylosing spondylitis, reiters, psoriatic
arthritis, enteropathic arthritis) can have anterior uveitis and
aortitis

Salmonella osteomyelitis very common in patients with sickle cell

anemia
Klebsiella osteomyelitis common in adults with UTI
Hemochromatosis skin pigmentation, HF, DM, cirrhosis, CPPD
CRYSTALS! Secondary Chondrocalcinosis
Ganglion cyst
o Dorsum of wrist
o Firm subq nodule over extensor tendon of left wrist
o Painful on palpation and movement
o Mucoid fluid aspiratd from nodule
o Arise after trauma from focal myxoid degeneration of CT of
a joint capsule or tendon sheath
o Can be excised
Pigmented villonodular synovitis/tenosynovial giant cell tumor
MC soft tissue tumor of hand, but can occur on knee.
o DT acquired translocation of coding sequence form M-CSF
adjacent to COL6A3
Colored village (pigmented villo-) eats peoples CSF
for sustenance.

BABY SCIENCE (WTH IS IT CALLED????)

Flexors develop from anterior condensation of myotomic
mesoderm
Extensors of upper limb from posterior condensation
Median artery one of the first branches to form from axis artery
All bones of upper limb form from lateral plate mesoderm that
condenses along central axis of upper limb bud
Bones of lower limb form from lateral plate mesoderm that
condenses along central axis of lower limb bud
Weeks 6-8 upper limb rotates laterally 90 degree so elbows
point posteriorly
o Lower limb bud rotates medially 90 degrees
UPLAT/LOME
Umbilical artery gives rise to axis artery of lower limb
DRUGS
Ocular toxicity, corneal deposits, retinal pigmentation =>
blindness, GI distress, ringing in ears, itchy skin
hydroxychlorquinone and chloroquine
Chronic gout probenecid decreases plasma uric acid, inc urine
uric acid blocks tubular reabsorption of UA
Aspirin overdose hyperthermia, metabolic acidosis, dehydration
Ketorolac can be given parenterally

High dose colchicine = significant diarrhea, GI toxicity

NSAIDS hx of MI = avoid COX-2 inhibitor - celecoxib