Theme 11: Skin and Musculoskeletal Pathology

Question 1

What lesions are caused by vocal abuse?

Answer 1

Vocal cord nodules (bilateral)

Vocal cord polyps (unilateral)

Question 2

Where do vocal cord polyps normally occur?

Answer 2

Reinke’s space/ventricular space, anterior half

Question 3

Which group is more at risk of developing vocal cord polyps?

Answer 3

Young women, though can occur at any age

Question 4

Professional singers are most at risk of developing this type of lesion.

Answer 4

Vocal cord nodules and polyps

Question 5

How does the common aetiology of vocal cord nodules and polyps cause the changes in the stroma?

Answer 5

Trauma damages the tissues or triggers inflammatory response, leading to vascular permeability and oedema and eventually fibrosis.

Question 6

“Polypoid lesions formed by expansion of the lamina propria by fluids, protein and fibrosis. Rhinorrhoea and chronic headaches are common clinical features”

Answer 6

Sinonasal polyps

Question 7

Why do sinonasal polyps cause chronic headaches?

Answer 7

They can lead to obstruction of the outflowing sinuses, leading to increased pressure in the sinuses.

Question 8

What are the causes of sinonasal polyps?

Answer 8

Allergy, infection, diabetes, aspirin sensitivity, asthma, cystic fibrosis

Question 9

Do sinonasal polyps have potential for malignant transformation?

Answer 9

No

Question 10

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

Answer 10

Nasal polyps

Question 11

What causes allergic fungal sinusitis?

Answer 11

Hypersensitivity to fungal antigens

Question 12

Is allergic fungal sinusitis more common in cooler or warmer climates?

Answer 12

Warmer

Question 13

What are the clinical features of allergic fungal sinusitis?

Answer 13

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)

Question 14

What is the cause of oral lichen planus?

Answer 14

Aetiology is unknown

Question 15

Which gender is more at risk of developing lichen planus?

Answer 15

Female > males

Question 16

What feature is characteristic of reticular lichen planus?

Answer 16

Wickham Striae (fine, white, lace-like striae)

Question 17

What feature is characteristic of erosive lichen planus?

Answer 17

Atrophic oedematous mucosa with ulcerations

Question 18

Is lichen planus associated with increased malignant potential?

Answer 18

Yes

Question 19

What is the most common malignancy of the oral cavity?

Answer 19

Squamous cell carcinoma

Question 20

What are leukoplakia and erythroplakia often associated with?

Answer 20

Squamous cell carcinoma

SCC of the oral cavity is often preceded by white (leukoplakia) or red (erythroplakia) mucosal patches.

Question 21

True or false: Squamous cell carcinoma of the oropharynx is associated with sexually transmitted infection

Answer 21

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

Question 22

What are the most common sites for developing SCC of the oropharynx?

Answer 22

Tonsils and base of the tongue

Question 23

What is the most common salivary gland neoplasm?

Answer 23

Pleomorphic adenoma

Benign neoplasm composed of ductal epithelial cells and myoepithelial cells within a mesenchymal stroma

Question 24

Where are pleomorphic adenomas most commonly found?

Answer 24

Parotid gland

Question 25

Do pleomorphic adenomas have a significant malignant potential?

Answer 25

Yes, there is a ~1% risk of malignant transformation per year to form 'carcinoma ex-pleomorphic adenoma'.

Question 26

What are the clinical symptoms associated with pleomorphic adenoma.

Answer 26

Asymptomatic, slow-growing mass

Question 27

"A basaloid malignancy of the salivary glands consisting of epithelial and myoepithelial cells. Most commonly arise in minor salivary glands."

Answer 27

Adenoid cystic carcinoma

Question 28

True or false: Adenoid cystic carcinomas are incurable.

Answer 28

True All patients will die with the tumour, and many will die because of it. 60% will metastasize to lung, bone, brain, liver

Question 29

Adenoid cystic carcinomas account for what % of salivary gland neoplasms?

Answer 29

10%

Question 30

What % of adenoid cystic carcinomas arise in minor salivary glands?

Answer 30

75%

Question 31

"Carcinoma arising in association with pleomorphic adenoma"

Answer 31

Carcinoma ex-pleomorphic adenoma

Question 32

What prognosis is associated with a carcinoma ex-pleomorphic adenoma that has invaded 1mm beyond it's capsule?

Answer 32

Good. Generally, if a carcinoma ex-pleomorphic adenoma has invaded <1.5mm beyond the capsule, the prognosis is good.

Question 33

What prognosis is associated with a carcinoma ex-pleomorphic adenoma that has invaded 2mm beyond the capsule?

Answer 33

Bad. Generally, if a carcinoma ex-pleomorphic adenoma had invaded >1.5mm beyond the capsule, the prognosis is bad (<50% 5y survival)

Question 34

What is the most common benign neoplasm of the larynx?

Answer 34

Juvenile laryngeal papillomatosis

Question 35

What is the most common malignant neoplasm of the sinonasal tract?

Answer 35

Squamous cell carcinoma of the nose and paranasal sinuses

Question 36

What is the most common tumour encountered in the oral cavity?

Answer 36

Fibroepithelial polyp

Question 37

What is the most common malignancy of the oral cavity?

Answer 37

Squamous cell carcinoma

Question 38

What is the most common non-neoplastic lesion of the salivary glands?

Answer 38

Salivary gland mucocele

Question 39

What is the most common salivary gland neoplasm

Answer 39

Pleomorphic adenoma

Question 40

Warthin's tumour is most common in which salivary gland?

Answer 40

Parotid It is the 2nd most common parotid gland tumour

Question 41

What is the most common bilateral tumour?

Answer 41

Warthin's tumour

Question 42

Joint disorder associated with hyperuricaemia

Answer 42

Gout

Question 43

Which skin condition commonly results in "butterfly rash" on the face?

Answer 43

Lupus erthematosus

Question 44

Condition with itchy plaques known as Wickham's striae

Answer 44

Lichen planus

Question 45

A premalignant condition common in sun-exposed sites

Answer 45

Actinic keratosis

Question 46

Malignant tumour of bones

Answer 46

Osteosarcoma

Question 47

A condition with a 'heliotropic rash'

Answer 47

Dermatomyositis

Question 48

Most common cancer of the oral cavity

Answer 48

Squamous cell carcinoma

Question 49

Inflammatory skin condition with well-defined plaques on the extensor surfaces

Answer 49

Psoriasis

Question 50

Most common malignancy of the skin

Answer 50

Basal cell carcinoma

Question 51

Treatment of choice for uncomplicated shingles

Answer 51

Aciclovir

Question 52

Fungal infection of the scalp

Answer 52

Tinea capitis

Question 53

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

Answer 53

Nasal polyps

Question 54

__?__ thickness is used as a prognostic parameter in melanoma

Answer 54

Breslow's

Question 55

Atopic eczema is a type __?__ hypersensitivity reaction

Answer 55

1

Question 56

Contact dermatitis is a type __?__ hypersensitivity reaction

Answer 56

4 (delayed)

Question 57

What types of dermatitis are included under 'dermatitis of unknown aetiology'?

Answer 57

Seborrhoeic dermatitis - affect areas rich in sebaceous glands: scalp, forehead, upper chest Nummular dermatitis - oval- or coin-shaped lesions

Question 58

What is Auspitz sign?

Answer 58

Sign associated with psoriasis, in which removal of a scale causes small bleeding points