skin + musculoskeletal Flashcards
what type of cancers are the majority oral cavity cancers
squamous cell carcinomas
oral squamous cell carcinoma risk factors:
- main two?
- others? 4
main risk:
- smoking (incl chewing tobacco)
- alcohol
nb these are strongly synergistic (if have together, more than double risk)
other risks:
- male
- FH
- HPV virus
- diet low in fruit + veg + high in red meat
which strains of HPV increase risk of oral squamous cell carcinomas?
16 + 18
‘high risk’ ones
ie same that cause cervical cancer
what are the 4 histological changes/stages which lead to invasive carcinomas?
hyperplasia -> dysplasia -> carcinoma in situ -> invasive carcinoma
name 5 pre-cancerous lesions of the oral cavity
- submucous fibrosis
- actinic keratosis
- lichen planus
- leukoplakia + erythroplakia
- chronic hyperplastic candidosis
cancer of the larynx:
- most common type?
squamous cell carcinoma
risk factors for cancer of the larynx? 9
main 2:
- tobacco
- alcohol
- HPV virus
- diets low in fruit + veg + high in meat
- metal/plastic workers
- exposure to paint, diesel + gas fumes, asbestos
- exposure to radiation
- laryngopharyngeal reflux
- genetic susceptibility/FH
infection with which strains of HPV increase your risk of laryngeal cancer?
6 + 11
ie the OPPOSITE to ones which cause cancer of oral cavity + cervical cancer
lichen planus:
- what is it? inc cause
- clinical presentation?
- who is most likely to get it?
muco-cutaneous condition (ie affects mucous membranes + skin)
pathogenesis unknown but thought to be autoimmune mediated
cutaneous lesions:
- itchy
- purple
- lumpy
oral lesions:
- red + white patches on inner cheak + tongue
- burning + discomfort when eating/drinking
nb can also affect genitals
- middle/old-aged people
- affects men + women equally
small change of malignant transformation
nb histoligaclly you see a lot of lymphocytic infiltrate
vocal cord nodules:
- what are they?
- causes? 2
- where located?
- symptoms?
- age/gender affected?
reactive lesions to damage
- heavy smokers
- people who use their voice a lot (eg singers)
usually located on TRUE vocal cords
most commonly associated with a voice change:
- hoarseness
- change in voice quality
- increased effort in producing voice
- adults
- predominantly men
nasal polyps:
- cause?
- appearance histologically?
- possible sequalae?
features point to an allergic aetiology, but most patients with nasal polyps are not atopic
- however can follow recurrent attacks of rhinitis (eg in hayfever)
oedematous glands with lots of inflammatory infiltrate, especially eosinophils
when large +/or multiple can encroach on the airway, impeding on sinus drainage -> sinusitis
acute sinusitis:
- causes? 3
- when does it normally progress to chronic?
- causative organisms?
- possible rare complications? 3
- acute rhinitis
- chronic rhinitis
- tooth/gum infection (-> maxillary sinusitis)
normally becomes chronic is there is an impairment of sinus drainage
normally mixed microbial flora
- the normal inhabitants of the oral cavity
- cranial osteomyelitis
- meningitis
- cerebral abscess
rare but very serious
sialadenitis:
- what is it?
- common causes? 2
inflammation of salivary glands
duct obstruction
- stones (bacterial infection)
- tumours (malignant or benign)
“think of muesli on the stray bus”
what is the most common type of tumour of the salivary glands?
- risk factors/causes? 3
- malignant or benign?
- cell of origin?
- most common gland affected
pleomorphic adenoma (2/3rds)
- heavy smoking
- blockage of salivary ducts
- radiation
almost always benign but can become malignant
mixed origin, lots of different cell lines (hence pleomorphic)
80% are in the parotid gland
what are the signs/symptoms of acute arthritis of a joint? 5
- pain
- heat
- redness
- swelling
- loss of function
osteoarthritis:
- aka?
- pathogenesis?
degenerative joint disease
deterioration or loss of cartilage that acts as a protective cushion in between bones
as the cartilage is worn away, bone forms spurs
fluid filled cysts in the marrow (subchondral cysts)
-> pain + limitation of movement
what main things can predispose a person to getting OA?
- obesity
- genes
- injury
- overuse/repetitive motion
what types of conditions can lead to secondary OA?
- repetitive strain/injury (eg knee in basketball players)
- meningeal tears
- congenital skeletal abnormalities
- obesity
- diabetes
- gout
- RA
what is the cell that is most involved in the pathogenesis of OA?
how?
chondrocytes
produce interleukin-1 (this initiates matrix breakdown)
prostaglandin derivatives induce the release of lytic enzymes - prevents matrix synthesis
what two types of nodes are present in the fingers of someone with OA?
which joints do they affect?
bouchard’s nodes
- proximal IP joint
- “nearer the Base of the finger”
herberden’s nodes
- distal IP joint
- “the HEBRides islands are very remote and far out”
which joints are more commonly affected in OA of:
- women? 2
- men?
women
- hands
- knees
men
- hips
what is ‘swan neck deformity’ a reference to?
abnormality seen in people with severe RA’s hands
RA:
- change induced in joints?
change induced in joints:
- non-suppurative proliferative synovitis
- destruction of articular cartilage + ankylosis of joints
what does ankylosis mean?
abnormal stiffening and immobility of a joint due to fusion of the bones
symptoms of RA:
- joints?
- systemic?
joints: - swollen - warm - painful - stiff in morning + after inactivity
systemic:
- malaise
- fatigue
- generalised MSK pain
- weight loss
- fever
- poor appetite
which joints does RA tend to affect first?
small joints of hands and feet
nb normally affected symmetrically (unlike OA, which is often asymmetric distribution)
what things can lead to the initiation of the inflammation that occurs in RA?
which is the most common one?
- genetic susceptibility (HLA, DR1 + DR4 type)
- – most commonly!
- primary exogenous arthritogen (eg EBV, other viruses, borrelia)
- autoimmune reaction within the synovial membranes (CD4 positive T cells)
- over production of mediators of joint damage (cytokines, IL-1-6 + TNF alpha + beta)
what are the two typical radiographic changes seen in people with RA?
- narrowing of joint space
- loss of articular cartilage
what two blood tests can be used to support the diagnosis of RA?
- which is better?
what other fluid can be analysed? for what?
- anti-CCP (anti-cyclic citrulinated peptide) - BETTER
- rheumatoid factor (RF)
synovial fluid
- presence of a lot of neutrophils -> inflammatory picture
other organs taht can be affected in RA, apart from joints?
what happens to them?
skin (about 50%)
- rhematoid nodules
lungs
- fibrosis of lungs (can also be caused by drugs given to treat RA)
- also methotrexate can caue lung damage (methotrexate lung)
heart + blood vessels
- a lot more prone to atherosclerosis + subsequent MIs/strokes
bones
- osteomalacia can develop due to the RA, but also due to steroids to treat it
eyes
- sjogrens syndrome can occur
- can get scleritis (inflammation of the sclera)
nb can also get liver and kidney problems as side effects of drugs for RA
nb can rarely attack other systems as well
- most common symptoms are in the joints and treating them means less likely to affect other systems but still likely to have some affect on other organs, even if this is sub-clinical
where do rheumatoid nodules occur?
areas of pressure
eg on fingers or elbow etc
gout:
- what is it?
- caused by end product of what nucleic acid metabolism?
end point of a group of disorders producing hyperuricemia
uric acid is the end product of PURINE metabolism
“if your diet is not PURE then you will get gout”
what are tophi?
a deposit of uric acid crystals in people with longstanding hyperuricemia (pathognomic for gout)
Tophi form in the joints, cartilage, bones, and other places throughout the body. Sometimes, tophi break through the skin and appear as white or yellowish-white, chalky nodules
The development of gouty tophi can also limit joint function and cause bone destruction, leading to noticeable disabilities, especially when gout cannot successfully be treated
what are the 4 main clinical features of gout?
- acute arthritis
- chronic arthritis
- tophi in various sites
- gouty nephropathy
get transient attacks of acute arthritis - crystallisation of urates within and about joints, leading to chronic gouty arthritis + deposition of masses of urates in joints and other sites = tophi
definition of a soft tissue tumour?
embryological tissue type origin?
soft tissue-nonepithelial extraskeletal structures exclusive of supportive tissue of organs and lyphoid/haematopoietic tissue
eg:
- fibrous tissue
- adipose tissue
- skeletal muscle
- blood
- lymphatic vasculature
- PNS
mesodermal in origin
name benign soft tissue tumours arising from these tissues:
- fat tissue
- fibrous tissue
- smooth muscle
- striated muscle
- blood vessels
- lymphatic vessels
- peripheral nerves
fat = lipoma
fibrous tissue = fibroma
smooth muscle = leimyoma
striated muscle = rhabdomyoma
blood vessel = haemangioma
lymphatic vessel = lymphangioma
peripheral nerves = neuroma
which type of cancer typically spreads via blood and which typically via lymph:
- sarcomas?
- carcinomas?
sarcomas
- mainly by blood
carcinomas
- mainly by lymph
“people are always worrying about lymph node involvement of most tumours and most common tumours that you see are carcinomas”
name 4 syndrome which are associated with soft-tissue tumours
which tumours are they associated with?
neurofibromatosis type 1
- neurofibroma
gardener syndrome
- fibromatosis
carney syndrome
- myoxoma
- melanotic schwannoma
turner syndrome
- cystic hygroma (a type of lymphangioma)
what is gardeners syndrome?
a subtype of FAP (familial adenomatous polyposis) in which you also commonly get fibromas as well as the typical presentation of FAP
what is the proper names for:
- benign cartilage tumours?
- mixed bone + cartilage bone tumours?
chondromas
osteochondromas
ossteosarcoma:
- age group most affected?
- site of body most commonly affected?
young age group (kids + teenagers)
- “that’swhen your bones are growing the most normally”
around the knee (60%)
chondrosarcoma
- age group affected?
- treatment?
any age group
huge variation in grade and speed of progression
surgical resection +/or amputation
nb very chemo and radio resistant
ewings sarcoma:
- what is it?
- age group most commonly affected?
malignant small, round, blue cell tumour
a rare disease in which cancer cells are found in both bone and soft tissue
- can have characteristics of both mesodermal and ectodermal origin
teenagers/young adults
which tumours most commonly metastasise to bone?
which type of bone lesions do they cause?
prostate
- sclerotic (build new bone)
breast
- mixed
kidney
- lytic (breaks down bone -> high blood Ca)
thyroid
- lytic
lung
- lytic
“lead KeTtLe”
- Pb is the chemical symbol for lead
“cancers only found in men or women are either sclerotic or mixed, ones in both genders are lytic”
what are the 5 layers of the epidermis in thick skin?
from deep to superficial:
- stratum basale (basal cell layer)
- stratum spinosum (prickle cell layer)
- stratum granulosum (granule cell layer)
- stratum lucidum (not in thin skin!)
- stratum corneum (fully keratinised)
what are the 3 clinical stages of dermatitis?
incl features of each stage?
acute dermatitis:
- skin red
- weeping serious exudate
+/- small vesicles
subacute dermatitis:
- skin is red
- less exudate
- very itchy
- crusting
chronic dermatitis:
- skin thick + leathery secondary to scratching
what does dermatitis look like microscopically/histologically?
‘spongiosis’
- intracellular oedema within epidermis
chronic inflammation
- predominantly superficial dermis
epidermal hyperplasia + hyperkeratosis
- mild in acute dermatitis, marked in chronic dermatitis
