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Clinical Pathology > Skin and Musculoskeletal Pathology > Flashcards

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

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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
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3
Q

Pathenogenesis of oral carcinoma

A

normal > hyperplasia > mild/moderate dysplasia > severe dysplasia/CIS > SCC

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4
Q

What is the mechanism of spread of oral carcinoma?

A

tumour embolism
cervical lymph nodes
lung liver bone

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5
Q

Which is the most common cancer of the larynx?

A

squamous cell carcinoma

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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
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7
Q

Pathenogenesis

A

hyperplasia > dysplasia > CIS > invasive carcinoma

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8
Q

definition of lichen planus

A

muco-cutaneous condition
cutaneous lesions = itchy, purple papules forming plaques
small risk of malignant transformation

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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

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10
Q

What are the associated symptoms of nodules?

A

voice change

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11
Q

where are nodules located?

A

true vocal cords

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12
Q

what are nasal polyps?

A

recurrent rhinitis = focal protrusions of mucosa

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13
Q

what happens when they are large?

A

encroach airway and impede sinus drainage

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14
Q

aetiology of nasal polyps?

A

allergic

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15
Q

what is acute sinusitis usually preceeded by?

A

acute or chronic rhinitis

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16
Q

which sinuses are most commonly affected by obstruction?

A

frontal and anterior ethmoid sinuses

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17
Q

what are the causative agents of sinusitis?

A

mixed microbial flora - inhabitants of oral cavity

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18
Q

what is pleomorphic adenoma?

A

salivary gland tumour

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19
Q

where are pleomorphic adenoma most commonly found?

A

parotid gland

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20
Q

What are pleomorphic adenoma made up of?

A

mixed epithelial and myoepithelial in chondromyxoid stroma

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21
Q

Inflammatory skin conditions and tumours

A

Lecture 2

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22
Q

definition of dermatitis

A

reactive pattern

chronic inflammation - superficial dermis

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23
Q

epidemiology of dermatitis

A

common - 5% children

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24
Q

what are the 3 clinical stages of dermatitis

A

acute dermatitis - weeping serous exudate
subacute dermatitis - crusting
chronic - scratching

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25
Q

what is atopic eczema?

A

childhood
associated with asthma and hayfever
type 1 hypersensitivity reaction

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26
Q

what is contact irritant dermatitis?

A

direct injury to skin by irritant

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27
Q

what is contact allergic dermatitis?

A

nickel, dyes, rubber act as haptens which combine with epidermal protein to become immunogenic

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28
Q

What is psoriasis?

A

red oval plaques
fine silvery scale
small bleeding points

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29
Q

what is the pathogenesis of psoriasis?

A

massive cell turnover

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30
Q

what is the aetiology of psoriasis

A

genetic - major histocompatibility complex on chromosome 6p2
environmental triggers e.g. stress

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31
Q

associated diseases of psoriasis

A

increased risk of non-melanoma skin cancer

CVD

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32
Q

Types of lupus?

A

discoid DLE = skin only

systemic = visceral disease

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33
Q

clinical manifestation of lupus?

A

red scaly patches
scarring
scalp involvement = alopecia
SLE = butterfly rash

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34
Q

what is lupus?

A

auto-immune affecting connective tissues

kidneys important

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35
Q

What is dermatomyositis?

A

peri-ocular oedema and erythema - heliotropic rash
myositis - muscle weakness
25% associated with underlying cancer

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36
Q

What are bullous diseases?

A

fluid filled blisters

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37
Q

what is bullous pemphigoid?

A

subepidermal blisters which do not rupture easily

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38
Q

what is the pathenogenesis of bullous pemphigoid?

A

autoantibodies to glycoprotein in basement membrane

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39
Q

what is dermatitis herpetiformis?

A

small itchy blisters

extensor surfaces

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40
Q

who often gets dermatitis herpetiformis?

A

young

associated with coeliac

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41
Q

what causes dermatitis herpetiformis

A

IgA in dermal papillae

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42
Q

what is the most common malignant tumour?

A

basal cell carcinoma

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43
Q

what is the aetiology of basal cell carcinoma?

A

sun exposure

occasionally radiotherapy

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44
Q

what does BCC look like clinically

A

early: nodule
late: ulcer

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45
Q

what causes squamous cell carcinoma?

A 
UV irradiation 
sun exposure 
radiotherapy 
hydrocarbon exposure 
BRAF inhibitors for melanoma
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46
Q

what does SCC look like clinically?

A

nodule with ulcerated crusted surface?

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47
Q

what is actinic keratinosis?

A

pre-malignant disease

dysplasia to squamous epithelium

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48
Q

what does actinic keratinosis look like?

A

scaly lesion with erythmatous base

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49
Q

what are naevi

A

moles

50
Q

what is atypical mole syndrome?

A

families with increased incidence of melanoma

multiple clinical atypical moles

51
Q

how do you determine a naevus from a melanoma?

A

Asymmetrical
Borders uneven
Colour
Diameter >6mm

52
Q

causes of melanoma

A

sun exposure
race
family history
giant congenital naevi

53
Q

What mutation is seen in melanoma?

A

BRAF

54
Q

what prognostic features are used in melanoma?

A 
Breslow thickness
granular layer of epidermis > base of tumour 
>4.00mm 45-60% 5 year survival 
site - BANS - poor 
ulceration 
sentinel node
55
Q

treatment of melanoma?

A

surgery

BRAF inhibitors

56
Q

what is dermatophytosis?

A

infections of the skin, nails and hair

e.g. Tinea corporis, tinea pedis

57
Q

what causes dermatophytosis?

A

Trichophyton

Microsporum

58
Q

what is the pathenogenesis of dermatophytosis?

A

dermatophytes use keratin as nutritional substrate

59
Q

how to diagnose dermatophytosis?

A

skin scrapings

60
Q

how to treat dermatophytosis?

A

topical or systemic antifungals e.g. Clotrimazole, terbafine

systemic - griseofulvin

61
Q

what are viral warts?

A

asymptomatic growths of skin

62
Q

what causes viral warts?

A

HPV

63
Q

how does HPV cause warts?

A

proliferation of stratum corneum, granulosum and spinosum

64
Q

how to treat viral warts?

A

salicylic acid
silver nitrate
cryosurgery

65
Q

how to prevent warts

A

gardasil - 16 and 18, 6 and 11

barrier protection

66
Q

what is impetigo?

A

crusting around nares or corners of mouth

67
Q

what is the causative organism of impetigo?

A

staph aureus

68
Q

what is the treatment of impetigo?

A

topical antiseptics

oral antibiotics

69
Q

what is erysipelas?

A

rash over face, raised, demarcated

70
Q

what is the causative organism of erysipelas?

A

strep pyogenes

71
Q

what is the treatment of erysipelas?

A

antibiotics

72
Q

what is cellulitis?

A

infection of inner layers of skin

73
Q

what are the causative agents of cellulitis?

A

S. aureus, Group A strep, other B-haemolytic strep

74
Q

what is the pathenogenesis of cellulitis?

A

break in skin

bug enters

75
Q

clinical presentation of cellulitis

A

red, hot, swollen, painful
loss of skin creases
fever, pus

76
Q

what is the treatment of cellulitis?

A

elevation, rest, antibiotics, source control

77
Q

what is necrotising fasciitis

A

flesh eating bug

tracks along fascia and cuts of blood supply

78
Q

what are the main types of necrotising fasciitis

A

Type 1: poly-microbial risk factors: diabetes, obesity, alcohol, older
Type 2: group A strep
younger, associated cut or injury

79
Q

pathenogenesis of necrotising fasciitis

A

type 1: ischaemia

type 2: infection, toxin release

80
Q

clinical presentation of necrotising fasciitis?

A 
swelling 
erythema 
pain 
crepitus 
sepsis 
necrosis
81
Q

treatment of necrotising fasciitis

A

surgical emergency

antibiotics

82
Q

what is gangrene?

A

necrosis caused by inadequate blood supply

83
Q

risk factors of gangrene

A

athersclerosis
smoking
diabetes
autoimmune

84
Q

what is wet gangrene

A

infection

85
Q

what are the causative agents of wet gangrene

A

skin - staphs, streps, enteric - anaerobes, clostridium

86
Q

what is the treatment of gangrene?

A

source control
revascularisation
antibiotics

87
Q

what is diabetic foot infection?

A

superficial to deep infection in diabetes patients

88
Q

what is the pathenogenesis of diabetes foot infection?

A

Damage to blood vessels - ischaemia, impaired immunity, poor wound healing
damage to nerves
high blood sugars - prone to infections

89
Q

what are the causative agents of diabetic foot infection?

A

superficial - skin flora

deeper - skin and enteric flora

90
Q

what is the treatment for diabetic foot infection?

A

surgical debridement
revascularisation
antibiotics
diabetic control

91
Q

what is osteomyelitis

A

infection of bone

92
Q

what mechanisms are used in osteomyelitis?

A

contiguous
haematogenous
penetration

93
Q

what is the treatment of osteomyelitis?

A

antibiotics 4-6 weeks

surgical debridement

94
Q

what is septic arthritis?

A

infection of joints

95
Q

what are the causative agents of septic arthritis?

A

s. aureus, streps, haemophilius, N. gonorrhoaeae, E.coli

96
Q

what is the clinical presentation of septic arthritis?

A

pain, swelling, erythema, reduced ROM, sepsis

97
Q

what is the treatment of septic arthritis?

A

antibiotics - 4-6 weeks

surgical source control - wash out

98
Q

what is a prosthetic joint infection?

A

infection of tissue and bone around prosthetic joint

99
Q

what is the pathenogenesis of prosthetic joint infection

A

bugs establish biofilm

100
Q

clinical presentation of prosthetic joint infection

A

pain, instability, swelling/ erythema, sinus formation - pus

101
Q

treatment of prosthetic joint infection

A

antibiotics alone
antibiotics with debridement
single-stage revision
two-stage revision

102
Q

what is syphilis

A

sexually transmitted infection

103
Q

what causes syphilis

A

treponema pallidum

104
Q

how do we treat syphilis?

A

penicillin

105
Q

what is the commonest type of joint disease?

A

osteoarthritis

106
Q

what is osteoarthritis?

A

degenerative joint disease

progressive erosion of articular cartilage

107
Q

clinical features of OA

A

bony spurs

cysts at joint margins

108
Q

causes of OA

A 
aging 
secondary - sports 
diabetes and obesity 
knees and hands in women 
hip in men
109
Q

pathenogenesis of OA

A 
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
Q

clinical primary OA

A

abnormal stresses in weight baring joints
fingers, knees and cervical and lumbar spines
heberden’s and bouchard’s nodes

111
Q

what is RA

A

chronic systemic disorder
non-supprative proliferative synovitis - destruction of articular cartilage and ankylosis of joints
women 3x more than men

112
Q

pathogenesis of RA

A

filling of joint space with pannus producing ankylosis of joint space

113
Q

RA clinical features

A

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
Q

aetiology RA

A 
genetic susceptibility - HLA- DR4, DR1 
primary exogenous arthritogen - EBV 
autoimmune reaction - CD4 
cytokines 
IL-6 and TNF alpha and beta
115
Q

RA criteria for diagnosis

A
  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
Q

Gout definition

A

end point of hyperuricaemia

uric acid end product of purine metabolism

117
Q

clinical features of gout

A 
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
Q

how do sarcomas spread?

A

blood

lung liver

119
Q

benign bone tumours

A

osteomas

osteoblastomas

120
Q

what is an osteosarcoma?

A

malignancy of bone
young age group
around knee most common

Clinical Pathology (8 decks)

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