Theme 11: Skin and Musculoskeletal Pathology Flashcards
What lesions are caused by vocal abuse?
Vocal cord nodules (bilateral)
Vocal cord polyps (unilateral)
Where do vocal cord polyps normally occur?
Reinke’s space/ventricular space, anterior half
Which group is more at risk of developing vocal cord polyps?
Young women, though can occur at any age
Professional singers are most at risk of developing this type of lesion.
Vocal cord nodules and polyps
How does the common aetiology of vocal cord nodules and polyps cause the changes in the stroma?
Trauma damages the tissues or triggers inflammatory response, leading to vascular permeability and oedema and eventually fibrosis.
“Polypoid lesions formed by expansion of the lamina propria by fluids, protein and fibrosis. Rhinorrhoea and chronic headaches are common clinical features”
Sinonasal polyps
Why do sinonasal polyps cause chronic headaches?
They can lead to obstruction of the outflowing sinuses, leading to increased pressure in the sinuses.
What are the causes of sinonasal polyps?
Allergy, infection, diabetes, aspirin sensitivity, asthma, cystic fibrosis
Do sinonasal polyps have potential for malignant transformation?
No
A condition associated with recurrent attacks of rhinitis, in which eosinophils are prominent
Nasal polyps
What causes allergic fungal sinusitis?
Hypersensitivity to fungal antigens
Is allergic fungal sinusitis more common in cooler or warmer climates?
Warmer
What are the clinical features of allergic fungal sinusitis?
Allergic symptoms, rhinorrhoea, headaches and obstruction
Peripheral eosinophilia, elevated IgG
Inspissated (thick) mucus with fungal hyphae (commonly aspergillus) and Charcot-Leyden crystals (eosinophil protein crystals)
What is the cause of oral lichen planus?
Aetiology is unknown
Which gender is more at risk of developing lichen planus?
Female > males
What feature is characteristic of reticular lichen planus?
Wickham Striae (fine, white, lace-like striae)
What feature is characteristic of erosive lichen planus?
Atrophic oedematous mucosa with ulcerations
Is lichen planus associated with increased malignant potential?
Yes
What is the most common malignancy of the oral cavity?
Squamous cell carcinoma
What are leukoplakia and erythroplakia often associated with?
Squamous cell carcinoma
SCC of the oral cavity is often preceded by white (leukoplakia) or red (erythroplakia) mucosal patches.
True or false: Squamous cell carcinoma of the oropharynx is associated with sexually transmitted infection
True.
SCC of the oropharynx is commonly associated with HPV 16 and 18. The variants associated with HPV have a better prognosis than those associated with smoking and alcohol
What are the most common sites for developing SCC of the oropharynx?
Tonsils and base of the tongue
What is the most common salivary gland neoplasm?
Pleomorphic adenoma
Benign neoplasm composed of ductal epithelial cells and myoepithelial cells within a mesenchymal stroma
Where are pleomorphic adenomas most commonly found?
Parotid gland
Do pleomorphic adenomas have a significant malignant potential?
Yes, there is a ~1% risk of malignant transformation per year to form ‘carcinoma ex-pleomorphic adenoma’.
What are the clinical symptoms associated with pleomorphic adenoma.
Asymptomatic, slow-growing mass
“A basaloid malignancy of the salivary glands consisting of epithelial and myoepithelial cells. Most commonly arise in minor salivary glands.”
Adenoid cystic carcinoma
True or false: Adenoid cystic carcinomas are incurable.
True
All patients will die with the tumour, and many will die because of it.
60% will metastasize to lung, bone, brain, liver
Adenoid cystic carcinomas account for what % of salivary gland neoplasms?
10%
What % of adenoid cystic carcinomas arise in minor salivary glands?
75%
“Carcinoma arising in association with pleomorphic adenoma”
Carcinoma ex-pleomorphic adenoma
What prognosis is associated with a carcinoma ex-pleomorphic adenoma that has invaded 1mm beyond it’s capsule?
Good.
Generally, if a carcinoma ex-pleomorphic adenoma has invaded <1.5mm beyond the capsule, the prognosis is good.
What prognosis is associated with a carcinoma ex-pleomorphic adenoma that has invaded 2mm beyond the capsule?
Bad.
Generally, if a carcinoma ex-pleomorphic adenoma had invaded >1.5mm beyond the capsule, the prognosis is bad (<50% 5y survival)
What is the most common benign neoplasm of the larynx?
Juvenile laryngeal papillomatosis
What is the most common malignant neoplasm of the sinonasal tract?
Squamous cell carcinoma of the nose and paranasal sinuses
What is the most common tumour encountered in the oral cavity?
Fibroepithelial polyp
What is the most common malignancy of the oral cavity?
Squamous cell carcinoma
What is the most common non-neoplastic lesion of the salivary glands?
Salivary gland mucocele
What is the most common salivary gland neoplasm
Pleomorphic adenoma
Warthin’s tumour is most common in which salivary gland?
Parotid
It is the 2nd most common parotid gland tumour
What is the most common bilateral tumour?
Warthin’s tumour
Joint disorder associated with hyperuricaemia
Gout
Which skin condition commonly results in “butterfly rash” on the face?
Lupus erthematosus
Condition with itchy plaques known as Wickham’s striae
Lichen planus
A premalignant condition common in sun-exposed sites
Actinic keratosis
Malignant tumour of bones
Osteosarcoma
A condition with a ‘heliotropic rash’
Dermatomyositis
Most common cancer of the oral cavity
Squamous cell carcinoma
Inflammatory skin condition with well-defined plaques on the extensor surfaces
Psoriasis
Most common malignancy of the skin
Basal cell carcinoma
Treatment of choice for uncomplicated shingles
Aciclovir
Fungal infection of the scalp
Tinea capitis
A condition associated with recurrent attacks of rhinitis, in which eosinophils are prominent
Nasal polyps
__?__ thickness is used as a prognostic parameter in melanoma
Breslow’s
Atopic eczema is a type __?__ hypersensitivity reaction
1
Contact dermatitis is a type __?__ hypersensitivity reaction
4 (delayed)
What types of dermatitis are included under ‘dermatitis of unknown aetiology’?
Seborrhoeic dermatitis
- affect areas rich in sebaceous glands: scalp, forehead, upper chest
Nummular dermatitis
- oval- or coin-shaped lesions
What is Auspitz sign?
Sign associated with psoriasis, in which removal of a scale causes small bleeding points
