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Pathology > Bone and Skin > Flashcards

Bone and Skin Flashcards

1
Q

2 types of formed bones?

A

Lamellar (organised well, strong)

Woven (haphazardly organised, weak)

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2
Q

What is aseptic necrosis?

A

Death of bone due to interference with its blood supply

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3
Q

What is Perthe’s disease?

A

aseptic necrosis of femoral epiphysis and head

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4
Q

How does Perthe’s disease present?

A

In children, boys > girls
5-11yrs
pain and limp!!!

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5
Q

What is osteomyelitis?

A

inflammation of the bone due to bacterial infection

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6
Q

Who and where is osteomyelitis most common?

A

In children

in the metaphysis of long bones

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7
Q

Causes of osteomyelitis?

A

Blood-borne
Compound fracture
direct spread from adjacent infection

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8
Q

Causative organisms of osteomyelitis?

A

Coagulase and staph

salmonella (in sickle cell disease)

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9
Q

Acute osteomyelitis symptoms?

A

high fever, severe pain, tenderness, WCC

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10
Q

Treatment of acute osteomyelitis?

A

Prompt antibiotic treatment

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11
Q

Complications of acute osteomyelitis?

A

sepsis, septic arthritis, chronic osteomyelitis, sinus tract formation, amyloidosis, SCC in sinus tract, abscess

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12
Q

Septic arthritis causes?

A

Haematogenous spread
Direct spread
Following penetrating injury

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13
Q

Septic arthritis causative organisms?

A

staph

strep

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14
Q

Clinical presentation of septic arthritis?

A

red, hot, swollen joint

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15
Q

Rheumatoid Arthritis associated HLA?

A

HLA-DR4

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16
Q

What do 85% of RA patients have in their serum?

A

Rheumatoid factor

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17
Q

Where does RA usually affect?

A

symmetrical proximal interphalangeal joints

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18
Q

Extra-articular manifestations of RA?

A 
Rheumatoid nodules
Vasculitis
Cardiac disease
Pulmonary disease
Amyloidosis
Anaemia
Uveitis, Scleritis
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19
Q

What is sero-negative arthritis?

A

a group of diseases in which tests for rheumatoid factor are negative

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20
Q

What joints are typically involved in sero-negative arthritis?

A

sacroiliac joints and spine

as well as typical peripheral joints

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21
Q

What HLA is associated with with seronegative arthritis?

A

HLA-B27

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22
Q

What is ankylosing spondylitis?

A

a polyarthritis which may eventually result in ‘Bamboo’ rigidity
inflammation -> fusion -> rigidity

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23
Q

What HLA is associated with ankylosing spondylitis?

A

HLA B27 (90%)

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24
Q

When does ankylosing spondylitis begin and how does it present?

A

Early 20s

pain and limitation of movements at sacroiliac joints

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25
Q

Extra-articular manifestations of ankylosing spondylitis?

A

aortic valve incompetence, uveitis, IBD, peripheral arthropathy

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26
Q

Where are changes seen in osteoarthritis?

A

in the articular cartilage and bone

minimal change in synovium

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27
Q

Treatment of osteoarthritis?

A

Replace with artificial joint

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28
Q

Crystal arthropathies include?

A

gout (urate crystals)
pseudogout (calcium pyrophosphate crystals)
oxalate (in pts on dialysis)

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29
Q

Causes of gout?

A

idiopathic decrease in uric acid excretion
secondary to thiazide diuretics
secondary to chronic renal failure
inc. production due to inc. cell turnover
inc. purine synthesis
high dietary purine

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30
Q

Acute gout symptoms?

A

red, hot, tender, painful
big toe
ppt by alcohol, drugs, surgery
uric acid crystals in synovium and fluid

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31
Q

Chronic gout symptoms?

A

cartilage of ear & joints
crystalline deposits of urate in fibrous tissues and cartilage
deposits- tophi
foreign body type giant cell reaction

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32
Q

Factors that affect fracture healing?

A 
movement
interposed soft tissue
gross misalignment
infection
pre-existing bone disease
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33
Q

Most common tumour in bone?

A

Secondary tumour- mets

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34
Q

Primary tumour of bone categories?

A

Benign
Borderline (locally aggressive/recurrent but doesn’t mets)
Malignant

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35
Q

What is the commonest true primary bone tumour?

A

Osteosarcoma

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36
Q

What age do osteosarcomas occur in?

A

75% in 10-25yrs

in patients >40yrs, 50% associated with Paget’s disease

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37
Q

Most common sites for osteosarcoma?

A

lower femur, upper tibia/humerus

pelvis in Paget’s

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38
Q

Features of osteosarcoma?

A

medullary cavity
sunray spicules
+/- soft tissue extensions

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39
Q

Prognosis for osteosarcoma?

A

5yr survival = 50-60%

mets via blood to lungs occurs early on

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40
Q

What is Ewing’s tumour?

A

cavity of long bones, ribs and pelvis that begins in medullary cavity

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41
Q

Who does Ewing’s tumour occur in?

A

Age 5-20yrs

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42
Q

What translocation is Ewing’s tumour associated with?

A

t (11:22) (q24;q12)

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43
Q

Prognosis of Ewing’s tumour?

A

5yr survival of >50%

mets common but generally sensitive to chemo

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44
Q

What is multiple myeloma?

A

monoclonal gammopathy
bone marrow biopsy shows inc. plasma cells
multiple lesions on x-ray

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45
Q

Most common sites that mets to bone?

A

breast, bronchus, thyroid, kidney, prostate

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46
Q

Pathophysiology of mets to bone?

A

Usually promotes lytic activity causing bone destruction

mets from prostate causes osteosclerotic action

47
Q

Who do chondrosarcomas occur in?

A

middle aged and elderly (30-60)
90% arise de novo
10% from pre-existing chondroma

48
Q

Where do chondrosarcomas occur?

A

Axial skeleton especially pelvis and ribs

49
Q

What is Kaposi’s Sarcoma associated with?

A

AIDs

Human HPV 8

50
Q

What is osteoporosis?

A

reduction in the actual amount of normally mineralised bone matrix
diagnosed by bone density scan

51
Q

Who is osteoporosis common in?

A

Elderly, especially females (due to dec. in oestrogen post-menopause)
Steroid use
Cushing’s syndrome

52
Q

Blood chemistry in osteoporosis?

A

Usually normal

53
Q

What causes Rickets and Osetomalacia?

A

deficiency of active metabolites of Vit D

54
Q

Causes of osteomalacia?

A 
elderly/housebound/institutionalised
dietary deficiency
malabsorption
anticonvulsants
chronic renal failure
55
Q

Biochemistry of osteomalacia?

A

Calcium- normal or slightly low
Phosphate- often low
Alk Phos- often raised

56
Q

Most common cause of primary hyperparathyroidism?

A 
Parathyroid adenoma (80%)
Parathyroid hyperplasia
Parathyroid carcinoma (rare)
57
Q

Effects of hyperparathyroidism?

A 
hypercalcaemia
renal stone formation
metastatic calcification
peptic ulceration
pancreatitis
58
Q

What bone disease does primary hyperparathyroidism cause?

A

Osteitis fibrosa cystica

+/- brown tumour formation (hemosiderin)

59
Q

Features of renal osteodystrophy?

A

secondary hyperparathyroidism
osteomalacia
osteosclerosis
soft tissue calcification

60
Q

What frequently occurs in patients on dialysis?

A

deposition of aluminium in bone
severely inhibits mineralisation of bone
osteomalacia

61
Q

What is Paget’s disease of bone?

A

localised increase in bone turnover with disorderly bone remodelling
affected bones are thickened, soft and vascular

62
Q

Features of Paget’s disease of bone?

A

bone pain, deformities, deafness, fractures, nerve of spinal cord compression, osteosarcoma, high output cardiac failure

63
Q

Blood chemistry of Paget’s disease?

A

Calcium usually normal

Alk Phos is markedly elevated

64
Q

Where does Paget’s disease usually affect?

A

lumbar vertebrae, sacrum, pelvis and skull

65
Q

Benign skin neoplasms?

A

Squamous cell papillomas (wart)
Basal cell papilloma/ seborrheic keratosis
Melanocytic naevi

66
Q

Types of melanocytic naevi?

A 
junctional
compound
intradermal
blue
spitz
67
Q

Genotype and phenotype of skin neoplasms?

A 
White>Black
familial
Japan- feet, mucous membranes
Australia > Ireland
light skin, blue eyes, light or red hair, freckles, sunburn easily, tan with difficulty
68
Q

What happens in solar elastosis?

A

inc. numbers of elastic fibres, fibres thicken and clump, disruption in collagen
directly associated with sun exposure

69
Q

What is solar/actinic keratosis?

A

epidermal dysplasia in response to long-term UVB exposure

can progress to SCC in situ or invasive SCC

70
Q

Features of SCC in situ?

A

slightly raised, scaly, erythematous patch
severe epidermal dysplasia
no invasion through BM

71
Q

Prevalence of skin neoplasms?

A

SCC (45%)
BCC (45%)
Adnexal tumours
MM (10%)

72
Q

Features of SCC?

A 
any part of body, esp. sun-exposed areas
may start as solar/ actinic keratosis
inc. with age
ulcer with raised edges
may mets (usually to LNs first)
73
Q

BCC features?

A

recurrence (rodent ulcer)
hair-bearing skin, sun-exposed areas
inc. with age
pearly lesion, central ulceration, raised edges
islands of dark-staining basal-like cells
mitoses ++
locally invasive, never mets

74
Q

When can BCCs be problematic?

A

locally invasive- can go to the eye and cause blindness

75
Q

What does ABCDE stand for?

A 
Asymmetry
Borders uneven
Colour multiple
Diameter >5mm
Evolving
76
Q

Types of malignant melanoma?

A

lentigo melanoma
superficial spreading melanoma
nodular malignant melanoma
acral lentiginous malignant melanoma

77
Q

Features of Lentigo Malignant Melanoma?

A 
elderly, long-term sun exposure
skin atrophic, solar elastosis
pleomorphic melanocytes
in situ = confined to epidermis, invasive = dermis involvement
prognosis good (usually thin)
78
Q

Features of superficial spreading melanoma?

A

any age
? short term sun exposure
pre-existing naevus
prognosis variable (depends on thickness)

79
Q

Features of nodular malignant melanoma?

A

similar epidemiology to SSM
nodule
invasive -> dermis, no epidermal component
prognosis usually poor (depends on thickness)

80
Q

Grading of Malignant Melanomas?

A

Breslow thickness

Clark level

81
Q

Clark level staging?

A 
Level 1- epidermis
Level 2- papillary dermis
Level 3- filling papillary dermis
Level 4- reticular dermis
Level 5- subcutaneous fat
82
Q

Prognostic factors in melanoma?

A

Breslow thickness
ulceration
mitotic rate
clark level

83
Q

Mutations in melanoma?

A

BRAF (40-60%)
NRAS (10-15%)
KIT

84
Q

Common skin infections?

A

Folliculitis
Furuncle (boil)
Carbuncle

85
Q

What is folliculitis?

A

Infection of hair follicles

common sites- axillae, buttocks, hips

86
Q

Causes of folliculitis?

A 
Staph aureus (most common)
Pseudomonas aeruginosa (hot tubs)
Candida (diabetes)
87
Q

Treatment for folliculitis?

A

often unnecessary

topical agents

88
Q

What can folliculitis lead on to?

A

Furuncle or carbuncle formation

89
Q

Causative agent for furuncles (boil) and carbuncles?

A

Staph aureus

90
Q

Predisposing features for furuncles/carbuncles?

A

Diabetes
Steroid treatments
Immunosuppression

91
Q

Treatment for furuncles/carbuncles?

A

flucloxacillin
erythromycin
good skin care
dressing of draining wounds

92
Q

Causes of impetigo?

A

Strep pyogenes, Staph aureus

93
Q

Who is impetigo most common in?

A

Children age 2-5yrs

94
Q

Treatment for impetigo?

A

Topical mupirocin or retapamulin

Oral flucloxacillin

95
Q

What can follow impetigo?

A

Rarely can cause post-strep glomerulonephritis

96
Q

What is erysipelas?

A

acute infection of upper dermis and superficial lymphatics (face and legs)

97
Q

Features of erysipelas?

A

orange peel skin
sharply demarcated
painful
associated with lymphatic damage, diabetes

98
Q

Treatment for erysipelas?

A

Benzyl penicillin

99
Q

Treatment for scabies?

A

topical permethrin

if severe oral ivermectin

100
Q

Clinical manifestations of scabies infection?

A

itchy papules on fingers
erythematous papules on chest/abdomen
Norwegian crusts in immunocompromised

101
Q

Main causes of cellulitis?

A

Staph aureus

Group A streptococci

102
Q

Diagnosis of cellulitis?

A

swabs of lesions

blood cultures

103
Q

Treatment of cellulititis?

A

Flucloxallin and Amoxycillin

104
Q

Prevention of surgical wound infection?

A 
aseptic technique
prophylaxis antibiotics (in exposure-prone surgery)
105
Q

Two types of necrotising fasciitis?

A

Streptococcal (Group A)

Mixed (anaerobes and coliforms)

106
Q

Mortality of necrotising fasciitis?

A

20-50%

107
Q

Causes of gas gangrene?

A

clostridia (most commonly clostridium perfringens)

108
Q

Treatment of gas gangrene?

A

surgical emergency
surgical debridement (amputation)
benzyl penicillin and metronidazole

109
Q

Treatment for tetanus?

A

antiserum and muscle paralysis

ventilation

110
Q

Cause of anthrax?

A

Bacillus anthracis

111
Q

Treatment for anthrax?

A

ciprofloxacin

112
Q

Causes of osteomyelitis?

A

Staph aureus
Pseudomonas aeruginosa (following penetrating injury to foot/heel)
Venous spread to vertebrae from bladder in elderly
Salmonella in Sickle Cell Disease
Haemophilus influenzae following bacteraemia
M. tuberculosis following extra-pulmonary spread

113
Q

What tumour is associated with small round blue cells?

A

Ewing’s sarcoma

114
Q

What tests are useful in the diagnosis of RA?

A

Rheumatoid Factor

Anti-citrullinated Peptide Antibody (ACPA)

Pathology (13 decks)

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