Skin and Musculoskeletal Pathology Flashcards
1
Q
Epidemiology of carcinoma of oral cavity
A
most common malignant tumour of oral cavity
oral squamous cell carcinoma 6th most common cancer
incidence and mortality increasing
2
Q
Aetiology of oral carcinoma
A
alcohol and tobacco oral smokeless tobacco HPV - 16 and 18 diet - fruit and veg protective, meat and red chili powder risk factors genetic
3
Q
Pathenogenesis of oral carcinoma
A
normal > hyperplasia > mild/moderate dysplasia > severe dysplasia/CIS > SCC
4
Q
What is the mechanism of spread of oral carcinoma?
A
tumour embolism
cervical lymph nodes
lung liver bone
5
Q
Which is the most common cancer of the larynx?
A
squamous cell carcinoma
6
Q
Aetiology of carcinoma of the larynx?
A
tobacco and alcohol HPV 6 and 11 metal/ plastic workers exposure to paint exposure to radiation reflux genetics
7
Q
Pathenogenesis
A
hyperplasia > dysplasia > CIS > invasive carcinoma
8
Q
definition of lichen planus
A
muco-cutaneous condition
cutaneous lesions = itchy, purple papules forming plaques
small risk of malignant transformation
9
Q
who are vocal cord nodules most commonly seen in?
A
heavy smokers or people who put strain on their voice
adults and men
10
Q
What are the associated symptoms of nodules?
A
voice change
11
Q
where are nodules located?
A
true vocal cords
12
Q
what are nasal polyps?
A
recurrent rhinitis = focal protrusions of mucosa
13
Q
what happens when they are large?
A
encroach airway and impede sinus drainage
14
Q
aetiology of nasal polyps?
A
allergic
15
Q
what is acute sinusitis usually preceeded by?
A
acute or chronic rhinitis
16
Q
which sinuses are most commonly affected by obstruction?
A
frontal and anterior ethmoid sinuses
17
Q
what are the causative agents of sinusitis?
A
mixed microbial flora - inhabitants of oral cavity
18
Q
what is pleomorphic adenoma?
A
salivary gland tumour
19
Q
where are pleomorphic adenoma most commonly found?
A
parotid gland
20
Q
What are pleomorphic adenoma made up of?
A
mixed epithelial and myoepithelial in chondromyxoid stroma
21
Q
Inflammatory skin conditions and tumours
A
Lecture 2
22
Q
definition of dermatitis
A
reactive pattern
chronic inflammation - superficial dermis
23
Q
epidemiology of dermatitis
A
common - 5% children
24
Q
what are the 3 clinical stages of dermatitis
A
acute dermatitis - weeping serous exudate
subacute dermatitis - crusting
chronic - scratching
25
what is atopic eczema?
childhood
associated with asthma and hayfever
type 1 hypersensitivity reaction
26
what is contact irritant dermatitis?
direct injury to skin by irritant
27
what is contact allergic dermatitis?
nickel, dyes, rubber act as haptens which combine with epidermal protein to become immunogenic
28
What is psoriasis?
red oval plaques
fine silvery scale
small bleeding points
29
what is the pathogenesis of psoriasis?
massive cell turnover
30
what is the aetiology of psoriasis
genetic - major histocompatibility complex on chromosome 6p2
environmental triggers e.g. stress
31
associated diseases of psoriasis
increased risk of non-melanoma skin cancer
| CVD
32
Types of lupus?
discoid DLE = skin only
| systemic = visceral disease
33
clinical manifestation of lupus?
red scaly patches
scarring
scalp involvement = alopecia
SLE = butterfly rash
34
what is lupus?
auto-immune affecting connective tissues
| kidneys important
35
What is dermatomyositis?
peri-ocular oedema and erythema - heliotropic rash
myositis - muscle weakness
25% associated with underlying cancer
36
What are bullous diseases?
fluid filled blisters
37
what is bullous pemphigoid?
subepidermal blisters which do not rupture easily
38
what is the pathenogenesis of bullous pemphigoid?
autoantibodies to glycoprotein in basement membrane
39
what is dermatitis herpetiformis?
small itchy blisters
| extensor surfaces
40
who often gets dermatitis herpetiformis?
young
| associated with coeliac
41
what causes dermatitis herpetiformis
IgA in dermal papillae
42
what is the most common malignant tumour?
basal cell carcinoma
43
what is the aetiology of basal cell carcinoma?
sun exposure
| occasionally radiotherapy
44
what does BCC look like clinically
early: nodule
late: ulcer
45
what causes squamous cell carcinoma?
```
UV irradiation
sun exposure
radiotherapy
hydrocarbon exposure
BRAF inhibitors for melanoma
```
46
what does SCC look like clinically?
nodule with ulcerated crusted surface?
47
what is actinic keratinosis?
pre-malignant disease
| dysplasia to squamous epithelium
48
what does actinic keratinosis look like?
scaly lesion with erythmatous base
49
what are naevi
moles
50
what is atypical mole syndrome?
families with increased incidence of melanoma
| multiple clinical atypical moles
51
how do you determine a naevus from a melanoma?
Asymmetrical
Borders uneven
Colour
Diameter >6mm
52
causes of melanoma
sun exposure
race
family history
giant congenital naevi
53
What mutation is seen in melanoma?
BRAF
54
what prognostic features are used in melanoma?
```
Breslow thickness
granular layer of epidermis > base of tumour
>4.00mm 45-60% 5 year survival
site - BANS - poor
ulceration
sentinel node
```
55
treatment of melanoma?
surgery
| BRAF inhibitors
56
what is dermatophytosis?
infections of the skin, nails and hair
| e.g. Tinea corporis, tinea pedis
57
what causes dermatophytosis?
Trichophyton
| Microsporum
58
what is the pathenogenesis of dermatophytosis?
dermatophytes use keratin as nutritional substrate
59
how to diagnose dermatophytosis?
skin scrapings
60
how to treat dermatophytosis?
topical or systemic antifungals e.g. Clotrimazole, terbafine
| systemic - griseofulvin
61
what are viral warts?
asymptomatic growths of skin
62
what causes viral warts?
HPV
63
how does HPV cause warts?
proliferation of stratum corneum, granulosum and spinosum
64
how to treat viral warts?
salicylic acid
silver nitrate
cryosurgery
65
how to prevent warts
gardasil - 16 and 18, 6 and 11
| barrier protection
66
what is impetigo?
crusting around nares or corners of mouth
67
what is the causative organism of impetigo?
staph aureus
68
what is the treatment of impetigo?
topical antiseptics
| oral antibiotics
69
what is erysipelas?
rash over face, raised, demarcated
70
what is the causative organism of erysipelas?
strep pyogenes
71
what is the treatment of erysipelas?
antibiotics
72
what is cellulitis?
infection of inner layers of skin
73
what are the causative agents of cellulitis?
S. aureus, Group A strep, other B-haemolytic strep
74
what is the pathenogenesis of cellulitis?
break in skin
| bug enters
75
clinical presentation of cellulitis
red, hot, swollen, painful
loss of skin creases
fever, pus
76
what is the treatment of cellulitis?
elevation, rest, antibiotics, source control
77
what is necrotising fasciitis
flesh eating bug
| tracks along fascia and cuts of blood supply
78
what are the main types of necrotising fasciitis
Type 1: poly-microbial risk factors: diabetes, obesity, alcohol, older
Type 2: group A strep
younger, associated cut or injury
79
pathenogenesis of necrotising fasciitis
type 1: ischaemia
| type 2: infection, toxin release
80
clinical presentation of necrotising fasciitis?
```
swelling
erythema
pain
crepitus
sepsis
necrosis
```
81
treatment of necrotising fasciitis
surgical emergency
| antibiotics
82
what is gangrene?
necrosis caused by inadequate blood supply
83
risk factors of gangrene
athersclerosis
smoking
diabetes
autoimmune
84
what is wet gangrene
infection
85
what are the causative agents of wet gangrene
skin - staphs, streps, enteric - anaerobes, clostridium
86
what is the treatment of gangrene?
source control
revascularisation
antibiotics
87
what is diabetic foot infection?
superficial to deep infection in diabetes patients
88
what is the pathenogenesis of diabetes foot infection?
Damage to blood vessels - ischaemia, impaired immunity, poor wound healing
damage to nerves
high blood sugars - prone to infections
89
what are the causative agents of diabetic foot infection?
superficial - skin flora
| deeper - skin and enteric flora
90
what is the treatment for diabetic foot infection?
surgical debridement
revascularisation
antibiotics
diabetic control
91
what is osteomyelitis
infection of bone
92
what mechanisms are used in osteomyelitis?
contiguous
haematogenous
penetration
93
what is the treatment of osteomyelitis?
antibiotics 4-6 weeks
| surgical debridement
94
what is septic arthritis?
infection of joints
95
what are the causative agents of septic arthritis?
s. aureus, streps, haemophilius, N. gonorrhoaeae, E.coli
96
what is the clinical presentation of septic arthritis?
pain, swelling, erythema, reduced ROM, sepsis
97
what is the treatment of septic arthritis?
antibiotics - 4-6 weeks
| surgical source control - wash out
98
what is a prosthetic joint infection?
infection of tissue and bone around prosthetic joint
99
what is the pathenogenesis of prosthetic joint infection
bugs establish biofilm
100
clinical presentation of prosthetic joint infection
pain, instability, swelling/ erythema, sinus formation - pus
101
treatment of prosthetic joint infection
antibiotics alone
antibiotics with debridement
single-stage revision
two-stage revision
102
what is syphilis
sexually transmitted infection
103
what causes syphilis
treponema pallidum
104
how do we treat syphilis?
penicillin
105
what is the commonest type of joint disease?
osteoarthritis
106
what is osteoarthritis?
degenerative joint disease
| progressive erosion of articular cartilage
107
clinical features of OA
bony spurs
| cysts at joint margins
108
causes of OA
```
aging
secondary - sports
diabetes and obesity
knees and hands in women
hip in men
```
109
pathenogenesis of OA
```
loss of cartilage in between bones
bony spurs
fluid filled cysts in marrow
pain and limitation of movement
chondrocytes = IL-1
matrix break down
```
110
clinical primary OA
abnormal stresses in weight baring joints
fingers, knees and cervical and lumbar spines
heberden's and bouchard's nodes
111
what is RA
chronic systemic disorder
non-supprative proliferative synovitis - destruction of articular cartilage and ankylosis of joints
women 3x more than men
112
pathogenesis of RA
filling of joint space with pannus producing ankylosis of joint space
113
RA clinical features
malaise, fatigue and generalised musculoskeletal pain to start off with
joints warm, painful and stiff in morning
fluctuates over 4-5 years
small joints of hands and feet
114
aetiology RA
```
genetic susceptibility - HLA- DR4, DR1
primary exogenous arthritogen - EBV
autoimmune reaction - CD4
cytokines
IL-6 and TNF alpha and beta
```
115
RA criteria for diagnosis
1. morning stiffness
2. arthritis in 3 or more joints
3. hand joints
4. symmetric arthritis
5. Rheumatoid nodules
6. serum rheumatoid factor
typical radiographic changes - narrow joint space, loss of cartilage
4 of above criteria
116
Gout definition
end point of hyperuricaemia
| uric acid end product of purine metabolism
117
clinical features of gout
```
acute arthritis
chronic arthritis
tophi
gouty neuropathy
transient attack of acute arthritis - crystallization of urates within and about joints - chronic gouty arthritis
deposition of urates in joints
```
118
how do sarcomas spread?
blood
| lung liver
119
benign bone tumours
osteomas
| osteoblastomas
120
what is an osteosarcoma?
malignancy of bone
young age group
around knee most common
