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Clinical Pathology Year 2 > Skin & Musculoskeletal Pathology > Flashcards

Skin & Musculoskeletal Pathology Flashcards

1
Q

A condition with a ‘heliotropic’ rash?

A

Dermatomyositis

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2
Q

Infection associated with head and neck carcinoma?

A

human papillomavirus

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3
Q

Most common cancer of the oral cavity?

A

Squamous cell carcinoma

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4
Q

A common antiviral treatment?

A

Aciclovir

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5
Q

Bullous disorder with intra-epidermal bullae?

And with sub-epidermal bullae?

A

Pemphigus

Bullous Pemphigoid

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6
Q

A condition associated with recurrent attacks of rhinitis, in which eosinophils are prominent?

A

Nasal polyps

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7
Q

Major risk factor for laryngeal carcinoma?

A

Cigarette smoking

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8
Q

A pre-malignant disease common in sun exposed sites?

A

Actinic keratosis

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9
Q

A cause of necrotising fasciitis?

A

Streptococcus pyogenes

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10
Q

Condition with itchy plaques known as ‘Wickham’s striae’?

A

Lichen planus

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11
Q

Histological feature of dermatitis?

A

Spongiosis

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12
Q

What are 2 causative organisms involved in fungal infections of the Skin (Dermatophytosis)?

A

Tricophyton spp
Microsporum spp

(dermatophyte fungi ^ use keratin as nutritional substrate)

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13
Q

What is Pityriasis versicolor?

A

(fungal infection of the skin)
Causes hypo- or hyper- pigmentation of the skin
The organisms feed on skin oils, and azelaic acid bleach.

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14
Q

What layers of the skin are affected in viral warts?

A

(proliferation and thickening of): stratum corneum, granulosum and spinosum.

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15
Q

What are some treatments and prevention of viral warts?

A 
Treatment= Salicyclic acid, silver nitrate (topical)
Prevention= Gardasil (types 16 and 18 cause 70% cancer)
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16
Q

What is Erysipelas?

A

Rash over face, raised and demarcated (upper dermis)

Causative organism= strep pyogenes

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17
Q

What is Cellulitis?

A

Infection affecting the inner layers of the skin (dermis and subcutaneous fat, into lymphatics)

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18
Q

What is Ecythema granulosum?

A

Skin infection caused by Pseudomonas aeruginosa.

Small patches of erthema –> necrosis –> ulceration –> scar

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19
Q

What are the 3 types of Necrotising Fasciitis?

A

Type 1: Synergistic/ poly-microbial. Gram negatives. (risk factors= DM, obesity, immunosuppression, older age group)
Type 2: Group A Strep mediated (younger age group, associated with cut/injury)
Type 3: Vibrio vulnifucus (sea water)

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20
Q

What is the pathogenesis behind Type 1 and 2 Necrotising Fasciitis?

A

Type 1- ischaemic tissue

Type 2- infection, toxin release leading to disruption in blood supply - necrosis

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21
Q

What is osteomyelitis and what are some mechaniism involved?

A

Infection of bone.

  • Contiguous (eg Diabetic foot infection)
  • Haematogenous
  • Penetrating (peri-prosthetic, traumatic)
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22
Q

What are some organisms involved in a)early and b)late Prosthetic Joint Infection

A

a) Staph aureus, staph epidermis

b) (above and) E coli, B Haem Streps, Viridans Streps

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23
Q

What organism is Syphilis caused by?

A

Treponema pallidum (a spirochete)

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24
Q

Primary, Secondary and Tertiary Syphilis?

A 
Primary= chancre (3-6 weeks)
Secondary= rash  (everywhere, maculo-papular or pustular) (4-10 weeks after chancre)
Tertiary= 3-15 years after
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25
Q

Aetiology of carcinoma of the oral cavity?

A
  • Tobacco & alcohol use (75%)
  • Betel quids containign areca nut (oral tobacco)
  • HPV (16 and 18)
  • Dietary factors (meat & chilli)
  • Genetic factors
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26
Q

What are some pre-cancerous lesions and conditions?

A
  • Submucous fibrosis
  • Actinic keratosis
  • Lichen planus
  • Leukoplakia & erythroplakia
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27
Q

What are some causes of carcinoma of the larynx?

A
  • Tobacco and alcohol
  • HPV (6 and 11)
  • Diet
  • Metal/plastic/paint/aspestos workers
  • Laryngopharyngeal reflux
28
Q

What is Lichen planus?

A

=Muco-cutaneous condition

Cutaneous lesions- itchy, purple forming plaques with Wickham’s striae

29
Q

What are Nasal polyps caused by?

A

Recurrent attacks of rhinitis (hyperplastic mucous glands, rich in eosinophils)

30
Q

What is acute/chronic Otitis Media?

A

(mostly infants/ children)
Strep pneumoniae, H influenzae, Moraxella catarrhalis
Chronic otitis media associated with Cholesteatoma

31
Q

Carcinomas of the external ear (pinna)?

A

BCC and SCC

Usually in older men and associated with actinic radiation

32
Q

Carcinomas of the ear canal?

A

SCC

Middle aged-elderly women. Not associated with sun exposure

33
Q

What is a paraganglioma?

A

Most common tumour of the middle ear.

pulsatile tinnitusm hearing loss, aural pressure/fullness, dizziness

34
Q

What are the 3 clinical stages of dermatitis (eczema)?

A

1) Acute dermatitis: skin red, weeping serous exudate
2) Subacute dermatitis: less exudate, itching & crusting
3) Chronic: skin thick and leathery

35
Q

Histology of eczema?

A

Spongiosis (intracellular oedema within epidermis)

36
Q

2 types of pathogenesis of Contact Irritant Dermatitis?

A

1- direct injury to skin by irritant (acid, alkali etc)

2- nickel, dyes, rubber. Act as haptens which combine with epidermal protein to become immunogenic

37
Q

Features of Psoriasis?

A

Well defined, red oval plaques on extensor surfaces (knees, elbows).
Fine silvery scale.
Auspitz sign.

38
Q

Histology of psoriasis?

A

‘Psoriasiform hyperplasia’:

  • Regular elongated club shaped rete ridges
  • thinning of epidermis over dermal papillae
  • parakeratotic scale
  • neutrophils in scale (Munro microabscesses)
39
Q

Key feature of Systemic Lupus Erythematosus?

A

Butterfly rash on cheeks and nose

also, microscopically: LE band= IgG deposited in basement membrane

40
Q

What is Dermatomyositis?

A
  • Peri-ocular oedema and erythema (Heliotropic rash)
  • Erythema in photosensitive distribution
  • Myositis (proximal muscle weakness, can check for creatinine kinase)
  • 25% associated with underlying visceral cancer
  • Negative IMF
41
Q

Can Pemphigus and Bullous Pemphigoid be detected by immunofluorescence? (IMF)

A

Yes

42
Q

What is Dermatitis Herpetiformis?

A

Small itchy blisters, on extensor surfaces
(often young patients), associated with Coeliac disease
IgA deposition in dermal papillae on IMF
Neutrophil microabscesses

43
Q

What systemic diseases are the following a sign of?

a) Dermatomyositis?
b) Dermatitis herpetiformis
c) Acanthosis Nigricans (dark warty lesions in armpits)
d) Necrobiosis Liboidica (red & yellow plaques on legs)

A

a) Visceral cancer
b) Coeliac disease
c) Internal malignancy
d) Diabetes Mellitus

44
Q

Features and aetiology of Basal cell carcinoma?

A

Commonest malignant tumour (metastases very rare)
Nodule, develops into rodent ulcer

  • Sun exposure, pale skin
  • Gorlin’s syndrome (rare)
45
Q

Features and aetiology of Squamous cell carcinoma?

A
  • UV radiation
  • Radiotherapy
  • Hydrocarbon exposure
  • Chronic scars/ulcers
  • Drugs (eg BRAF inhibitors for melanoma)
46
Q

Does Squamous cell carcinoma metastasise?

A

Metastases in 5% (lip, ear, perineum)

47
Q

What is a pre-malignant disease in Squamous Cell carcinoma?

A

Actinic Keratosis
Dysplasia to squamous epithelium
Common in chronic sun exposed sites
Rarely progresses to invasive disease

48
Q

Melanoma?

A

Much rarer than BCC and SCC.
Very dangerous malignancy that can metastasize widely
60% melanomas have mutation in BRAF gene (can use BRAF inhibitors in treatment)

49
Q

What is Lentigo Maligna?

A

Face, elderly people. Slow growing, flat, pigmented patch.

proliferation of atypical melanocytes along basal layer of epidermis. Can invade dermis, lentigo maligna melanoma

50
Q

What is used as a prognostic factor in Melanoma?

A 
Breslow thickness (measure on microscope from granular layer of epidermis to base of tumour)
Also look at sentinal node (lymph node which drains from melanoma first)
51
Q

What is the pathogenesis behind osteoarthritis?

A

Deterioration/ loss of cartilage that acts as a protective cushion in between bones
Forms spurs as it is worn away
Fluid-filled cysts in the marrow (subchondral cysts)
(chondrocytes are the cellular basis- they produce interleukin 1 which initiates matrix breakdown)

52
Q

What is Robbins-Pathologic basis of Rheumatoid Arthritis?

A
  • Fibrovascular thickening of synovium, producing a pannus that is eroding into articular cartilage
  • Penetration of pannus into subchondral bone & cyst formation
  • Filling of joint space with pannus producing ankylosis of joint space
53
Q

Genetic susceptibility in RA?

A

65-80%^

HLA- DR4 and DR1

54
Q

What is the autoimmune reaction that occurs within the synovial membranes?

A

CD4 positive T cells

mediators of joint damage = cytokines

55
Q

Criteria for diagnosis of RA?

A
  • Morning stiffness
  • Arthritis in 3 or more joints
  • Symmetrical arthritis
  • Serum Rheumatoid factor
56
Q

What is sero-negative arthritides?

A

Lack RF

  1. Ankylosing spondylitis
  2. Reiter’s syndrome
  3. Psoriatic arthritis
  4. Enteropathic arthritis
57
Q

Why can Gout cause acute arthritis?

A

Crystallization of urates within & about the joints–> leads to chronic gouty arthritis & deposition of masses of urates in joints and other sites (tophi)

58
Q

What may cause Infective arthritis?

A
  • Fever, leucocytosis, elevated ESR

- Bacterial: Staph, strep, gonococcus, mycobacteria

59
Q

Osteoclast dysfunction is also known as what?
What is it caused by?
Histological landmark?

A

Paget’s disease
Caused by paramyxovirus infection
Histological hallmark- mosaic pattern

Initial osteolytic stage, predominant osteoblastic activity. Burnt out osteosclerotic stage (net effect- gain in bone mass)

60
Q

What can Paget’s disease result in?

A 
Tumours- benign (Giant cell tumour)
and malignant (osteosarcoma, chondrasarcoma)
61
Q

What is osteomalacia?

A

Defects in matrix mineralisation
Related to lack of Vit D
Decreased bone density

62
Q

What can Hyperparathyroidism lead to?

A

Increases bone resorption & calcium mobilization from the skeleton
Increases renal tubular reabsorption & retention of calcium
Net effect- Hypercalcaemia

63
Q

What are the syndromes associated with the following soft tissue tumours:

a) neurofibroma
b) fibromatosis
c) myxoma, melanotic schwannoma
d) cystic hygroma

A

a) Neurofibromatosis Type 1
b) Gardner syndrome
c) Carney syndrome
d) Turner syndrome

64
Q

What is a malignant bone tumour?

A

Osteosarcoma
Young age group
Commonest site- around the knee

65
Q

What is Rhabdomyolysis?

can be a result of trauma, drugs, extreme temperature, severe exertion, lengthy surgery

A

Destruction of skeletal muscle
Release of muscle fibre content into the blood (including MYOGLOBIN)
Filtered through the kidneys and enters urine (myoglobinuria- brown urine)

Clinical Pathology Year 2 (11 decks)

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