10. Skin & MSK Flashcards
What is the most common aetiology of vocal cord nodules and polyps?
Abuse of voice
How does vocal abuse cause oedema and later fibrosis in the stroma?
Trauma which damages the tissue can cause blood vessels to leak or trigger an inflammatory response which leads to increased vascular permeability.
(nodule/polyp formation)
What is the significance of a polyp becoming fibrotic?
Fibrosis is permanent (unlike oedema + fibrin deposition which are potentially reversible).
This can only be fixed by surgical removal.
What are the 2 most common predisposing factors for laryngeal dysplasia and what effect do they have on the epithelium?
Alcohol + Tobacco
- They activate oncogenes
- Inactivate tumour suppressor genes, thus inhibiting apoptosis
- This increases the chances of uncontrolled cell division and the accumulation of further mutations.
What is the significance of grade in laryngeal epithelial dysplasia?
The chances of progression to invasive cancer.
Low grade = 5 - 10%
High grade = 30 - 50%
What capabilities have invasive cells developed compared to those of non-invasive dysplastic cells?
- Break down bone marrow, stroma and other structures.
- Break apart and migrate.
- Evade immune response.
- Survive and adhere to vessels in distant sites.
- Produce own blood supply.
This makes up 90% of head and neck cancers.
Laryngeal squamous cell carcinoma
A condition associated with recurrent attacks of rhinitis, in which eosinophils are prominent
Nasal polyps
Allergic response to Inhaled fungal allergens (usually aspergillus), associated with peripheral eosinophilia and elevated antifungal IgG.
Allergic fungal sinusitis
How can polyps lead to chronic headaches?
Obstruct the sinuses, therefore mucus can’t drain out. = headache
Do sinonasal polyps have malignant potential?
No, excellent prognosis.
What is the most common malignant cancer of the oral cavity?
Squamous cell carcinoma of oral cavity
Which chronic self-limiting inflammatory condition is common in the oral cavity?
Oral lichen planus
In what group of patients is the prognosis better in oropharyngeal cancer?
Those WITH HPV infection.
Prognosis is worse in drinkers + smokers.
What is the most common salivary gland neoplasm?
Pleomorphic adenoma
Malignant neoplasm of the salivary gland.
Adenoid cystic carcinoma
In what anatomical location are pleomorphic adenomas most common?
Parotid glands (60%)
rare in minor salivary glands, tumours found here are normally malignant.
What sort of malignancy can arise in a pleomorphic adenoma?
Carcinoma ex pleomorphic adenoma
prognosis depends on have far the tumour has spread beyond the capsule.
Good prognosis = less than 1.5mm
Poor prognosis = more than 1.5mm
What is notable about the clinical progression of adenoid cystic carcinoma?
Incurable, all patients will die.
Joint disorder associated with hyperuricaemia?
Gout
also called tophi
Which skin condition commonly results in a “butterfly rash” on the face?
Lupus Erythematosus
Condition with itchy plaques known as ‘Wickham’s striae’?
Lichen Planus
A pre-malignant disease common in sun exposed sites?
Acitinic keratosis
see these scaly patches on the heads of old bald people
Malignant tumour of bones?
Osteosarcoma
most commonly found around the knee
A condition with a ‘heliotropic’ rash?
Dermatomyositis
Inflammatory skin condition with well-defined plaques on the extensor surfaces?
Psoriasis
What is the most common malignant tumour of the skin?
Basal cell carcinoma
rodent ulcer seen in later stages
What is the treatment of choice for uncomplicated shingles?
Aciclovir
A type of fungal infection on the scalp?
Tinea capitis
In which tumour is Breslow’s thickness commonly used as a prognostic parameter?
Melanoma
Commonest type of joint disease?
Osteoarthritis
secondary osteoarthritis is due to a know cause e.g. constant use of joints, knees in basketball players
Deterioration of cartilage at the joints results in the formation of what?
- Bone spurs
- Subchondral cysts - fluid filled cyts in the marrow underneath cartilage
(= pain and limitation of movement)
Cells found in cartilage, responsible for producing and maintaining it.
Chondrocytes
Bony swellings seen in osteoarthritis in the most distal joint of finger.
Herberden’s nodes
HB pencil, from distal to proximal
Bony swellings seen in osteoarthritis in the proximal interphalangeal joints of finger.
Bouchard’s nodes
HB pencil, from distal to proximal
Chronic systemic disorder more common in women, principally affecting the joints.
Rheumatoid arthritis
What is ankylosis?
Abnormal stiffening and immobility of a joint due to fusion of the bones.
What is the diagnosis?
Morning stiffness, affecting 3 or more joints, neutrophils in synovial fluid, positive anti-CCP antibody test.
Rheumatoid arthritis
Ankylosing spondylitis
Reiter’s syndrome
Psoriatic arthritis
Enteropathic arthritis
What have all of these types of arthritis got in common?
Sero-negative arthritis
They all lack rheumatoid factor in serology.
What is pyogenic osteomyelitis?
Bacterial infection of bone.
Systemic illness: fever, malaise, chills, pain, bone destruction in X-ray
osteomyelitis = infection of bone
DEXA score lower than -2.5 is a diagnosis for what disease?
Osteoporosis - reduction in bone mass
-1.0 - -2.5 = osteopenia, less severe
A disease associated with increased bone mass, with disordered and poor architecture due to osteoclast dysfunction.
Paget’s disease
What is osteomalacia?
Problem with mineralising/hardening of bone.
related to lack of vitamin D
Hyperparathyroidism results in hypocalcemia.
True or False?
FALSE
HYPERcalcemia
Increases bone resorption (calcium released into blood stream) and retention of calcium in kidneys.
What is renal osteodystrophy?
Increased bone resorption and bone problems caused by the kidneys failing to maintain proper levels of calcium and phosphorus in blood.
Benign bone tumour.
Osteoma / Osteoblastoma
Benign cartilage tumour.
Chondroma
Systemic sclerosis is characterised by CREST syndrome. What does this stand for?
C - Calcinosis = calcium deposits in soft tissue
R - Raynaud’s phenomenon = fingers change colours due to changes in blood flow
E - Esophageal dysfunction
S - Sclerodactyly = tightening of skin on fingers and toes (look like a pterodactyl)
T - Telangiectasia = look like spider web blood vessels near surface of skin
What is Polymyalgia Rheumatica?
Stiffness, weakness, pain in muscles of neck, limb girdles and upper limbs.
An inherited disease which results in a rapid increase in body temperature and severe muscle contractions when the affected individual is given general anaesthesia.
Malignant hyperthermia
Brown urine or myoglobinuria is associated with what disease?
Rhabdomyolysis
destruction of skeletal muscle and the release of myoglobin into the blood which is filtered by the kidneys making it brown.
Caused by trauma, drugs, severe exertion (marathon running), acute renal failure.
Spongiosis is seen under the microscope of what skin condition?
Eczema / Dermatitis
spongiosis = oedema in the epidermis, separating out the cells
Type of eczema associated with Type I hypersensitivity reaction to an allergen.
Atopic eczema
What is the difference between:
Contact irritant dermatitis and Contact allergic dermatitis?
Contact irritant dermatitis = direct injury to skin by acid, alkali, detergent etc. (AMIR)
Contact allergic dermatitis = nickel (earrings), dyes, rubber. Type IV hypersensitivity reaction.
Discoid Lupus Erythematosus only affects the skin.
True or False?
TRUE
systemic lupus erythematosus affects whole body.
An inflammatory disorder involving muscle weakness and a heliotropic rash.
Dermatomyositis
heliotropic rash = erythema +- oedema around skin of eyes
Type of Bullous disease with blisters that rupture easily?
Pemphigus
intra-epidermal
Sub-epidermal type of Bullous disease with large tough blisters that don’t rupture easily?
Pemphigoid
Small, intensely itchy blisters on the extensor surfaces.
Dermatitis herpetiformis
Skin cancer which has a 5% chance of metastases from the lip and ear.
Squamous cell carcinoma
Benign clusters of melanocytes.
Naevi (moles)
Malignant melanocytes.
Melanoma
How is a melanoma differentiated form a naevus?
Melanoma is:
- Asymmetrical
- Borders uneven
- Colour variation
- Diameter >6mm
ABCD
naevus is the opposite
Slow growing, flat pigmented patch on the faces of old people.
Is this:
- Lentigo Maligna
- Acral Lentigenous Melanoma
- Lentigo maligna
acral lentigenous melanoma affects palms and soles, usually in afro-carribeans. No sun damage unlike lentigo maligna.
Most common type of melanoma in Britain?
Superficial spreading melanoma
What is Breslow thickness used for?
To give a prognosis for melanoma.
It measures the thickness of the melanoma to see how far it has spread.
What gene mutation is commonly seen in melanomas?
BRAF
BRAF inhibitors are a type of treatment used
An indicators for melanoma prognosis. A positive biopsy of this will call for surgical removal of the area.
Sentinel node.
first lymph node that drains the melanoma, if this is positive for melanoma spread, then the rest of the lymph nodes in the area need to be removed to stop disease progression.
What are viral warts caused by?
HPV (human papilloma virus)
Impetigo is crusting around the nares or corners of mouth.
What is it caused by?
Staph Aureus
Infection affecting the dermis and subcutaneous fat; presenting with loss of skin creases, blistering, pus and fever?
Cellulitis
What causes cellulitis?
Staph Aureus, Group A streptococci
They enter through breaks in the skin e.g. wound, insect bite, pre-existing skin condition.
Infection of soft tissues around/behind eye presenting with erythema, swelling, pain on eye movement.
Orbital cellulitis
Necrotising fasciitis is a rapidly progressive and life threatening disease caused by?
Group A streptococcus
‘flesh eating bug’ - gets into the deep structures of fascia.
What is dry gangrene?
Necrosis due to inadequate blood supply to tissue.
Non-infective, ‘mummified’
What is wet gangrene?
Necrosis due to inadequate blood supply to tissue.
+ infection
(similar to gas gangrene - but there is gas release from the organism in gas gangrene)
Why are diabetics susceptible to foot infections?
Diabetes damages + occludes vessels causing ischaemia.
Diabetics also have worse immunity and wound healing.
This in addition to neuropathy and high blood sugar for bacterial infections makes them very susceptible.
(staph aureus, streps, corynebacterium, anaerobes)
Infection which can cause bone death?
Osteomyelitis
Staph aureus, Streps, anaerobes, Kingella, Haemophilus
Infection of the joints, presenting with pain, swellings and a reduced range of motion.
Septic / Pyogenic arthritis
What is a prosthetic joint infection?
What causes it?
Infection of the tissue and bone surrounding a prosthetic joint.
Staph aureus, Staph epidermidis (occasionally fungal)
Late infections way after surgery:
Above, E.coli, Viridans streps
Gummas are a clinical manifestation of what disease?
Tertiary (late) Syphilis
3-15 years after initial infection.
(primary = chancre ulcer on penis secondary = rash around body)
What is a Pilonidal cyst/abscess?
Cysts/abscesses in the natal cleft (at the start of ass crack).
Caused by ingrown hairs.
(armin morshed)
