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Clinical Pathology Year 2 > Skin & Musculoskeletal Pathology > Flashcards

Skin & Musculoskeletal Pathology Flashcards

(65 cards)

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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
Aetiology of carcinoma of the oral cavity?
- Tobacco & alcohol use (75%) - Betel quids containign areca nut (oral tobacco) - HPV (16 and 18) - Dietary factors (meat & chilli) - Genetic factors
26
What are some pre-cancerous lesions and conditions?
- Submucous fibrosis - Actinic keratosis - Lichen planus - Leukoplakia & erythroplakia
27
What are some causes of carcinoma of the larynx?
- Tobacco and alcohol - HPV (6 and 11) - Diet - Metal/plastic/paint/aspestos workers - Laryngopharyngeal reflux
28
What is Lichen planus?
=Muco-cutaneous condition | Cutaneous lesions- itchy, purple forming plaques with Wickham's striae
29
What are Nasal polyps caused by?
Recurrent attacks of rhinitis (hyperplastic mucous glands, rich in eosinophils)
30
What is acute/chronic Otitis Media?
(mostly infants/ children) Strep pneumoniae, H influenzae, Moraxella catarrhalis Chronic otitis media associated with Cholesteatoma
31
Carcinomas of the external ear (pinna)?
BCC and SCC | Usually in older men and associated with actinic radiation
32
Carcinomas of the ear canal?
SCC | Middle aged-elderly women. Not associated with sun exposure
33
What is a paraganglioma?
Most common tumour of the middle ear. | pulsatile tinnitusm hearing loss, aural pressure/fullness, dizziness
34
What are the 3 clinical stages of dermatitis (eczema)?
1) Acute dermatitis: skin red, weeping serous exudate 2) Subacute dermatitis: less exudate, itching & crusting 3) Chronic: skin thick and leathery
35
Histology of eczema?
Spongiosis (intracellular oedema within epidermis)
36
2 types of pathogenesis of Contact Irritant Dermatitis?
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
Features of Psoriasis?
Well defined, red oval plaques on extensor surfaces (knees, elbows). Fine silvery scale. Auspitz sign.
38
Histology of psoriasis?
'Psoriasiform hyperplasia': - Regular elongated club shaped rete ridges - thinning of epidermis over dermal papillae - parakeratotic scale - neutrophils in scale (Munro microabscesses)
39
Key feature of Systemic Lupus Erythematosus?
Butterfly rash on cheeks and nose | also, microscopically: LE band= IgG deposited in basement membrane
40
What is Dermatomyositis?
- 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
Can Pemphigus and Bullous Pemphigoid be detected by immunofluorescence? (IMF)
Yes
42
What is Dermatitis Herpetiformis?
Small itchy blisters, on extensor surfaces (often young patients), associated with Coeliac disease IgA deposition in dermal papillae on IMF Neutrophil microabscesses
43
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) Visceral cancer b) Coeliac disease c) Internal malignancy d) Diabetes Mellitus
44
Features and aetiology of Basal cell carcinoma?
Commonest malignant tumour (metastases very rare) Nodule, develops into rodent ulcer - Sun exposure, pale skin - Gorlin's syndrome (rare)
45
Features and aetiology of Squamous cell carcinoma?
- UV radiation - Radiotherapy - Hydrocarbon exposure - Chronic scars/ulcers - Drugs (eg BRAF inhibitors for melanoma)
46
Does Squamous cell carcinoma metastasise?
Metastases in 5% (lip, ear, perineum)
47
What is a pre-malignant disease in Squamous Cell carcinoma?
Actinic Keratosis Dysplasia to squamous epithelium Common in chronic sun exposed sites Rarely progresses to invasive disease
48
Melanoma?
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
What is Lentigo Maligna?
Face, elderly people. Slow growing, flat, pigmented patch. | proliferation of atypical melanocytes along basal layer of epidermis. Can invade dermis, lentigo maligna melanoma
50
What is used as a prognostic factor in Melanoma?
``` 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
What is the pathogenesis behind osteoarthritis?
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
What is Robbins-Pathologic basis of Rheumatoid Arthritis?
- 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
Genetic susceptibility in RA?
65-80%^ | HLA- DR4 and DR1
54
What is the autoimmune reaction that occurs within the synovial membranes?
CD4 positive T cells | mediators of joint damage = cytokines
55
Criteria for diagnosis of RA?
- Morning stiffness - Arthritis in 3 or more joints - Symmetrical arthritis - Serum Rheumatoid factor
56
What is sero-negative arthritides?
Lack RF 1. Ankylosing spondylitis 2. Reiter's syndrome 3. Psoriatic arthritis 4. Enteropathic arthritis
57
Why can Gout cause acute arthritis?
Crystallization of urates within & about the joints--> leads to chronic gouty arthritis & deposition of masses of urates in joints and other sites (tophi)
58
What may cause Infective arthritis?
- Fever, leucocytosis, elevated ESR | - Bacterial: Staph, strep, gonococcus, mycobacteria
59
Osteoclast dysfunction is also known as what? What is it caused by? Histological landmark?
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
What can Paget's disease result in?
``` Tumours- benign (Giant cell tumour) and malignant (osteosarcoma, chondrasarcoma) ```
61
What is osteomalacia?
Defects in matrix mineralisation Related to lack of Vit D Decreased bone density
62
What can Hyperparathyroidism lead to?
Increases bone resorption & calcium mobilization from the skeleton Increases renal tubular reabsorption & retention of calcium Net effect- Hypercalcaemia
63
What are the syndromes associated with the following soft tissue tumours: a) neurofibroma b) fibromatosis c) myxoma, melanotic schwannoma d) cystic hygroma
a) Neurofibromatosis Type 1 b) Gardner syndrome c) Carney syndrome d) Turner syndrome
64
What is a malignant bone tumour?
Osteosarcoma Young age group Commonest site- around the knee
65
What is Rhabdomyolysis? | can be a result of trauma, drugs, extreme temperature, severe exertion, lengthy surgery
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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