64 Diseases of head + neck

Question 1

What is the most common malignant tumour of the oral cavity and larynx?

Answer 1

Squamous cell carcinoma.

Question 2

What is the long term survival for squamous cell carcinoma in the oral cavity?

Answer 2

50%

Question 3

Where do squamous cell carcinomas of the mouth commonly arise? (6)

Answer 3

Floor.
Ventrolateral tongue.
Retromolar region.
Lower lip.
Soft palate.
Gingiva.

Question 4

How does squamous cell carcinoma of the oral cavity commonly present? (4)

Answer 4

Pain.
Difficulty swallowing/speaking.
Numbness/tingling of the tongue.
White/dark patches.

Question 5

What is the aetiology of carcinoma of the oral cavity? (6)

Answer 5

Tobacco + alcohol (synergistic).
Smokeless tobacco containing areca nut + calcium hydroxide.
HPV.
Meat + red chilli powder.

Question 6

What are the important genetic changes that occur in carcinoma of the oral cavity? (3)

Answer 6

Inactivation of p16 + p53.

Over activation of cyclin-D (increased cell motility).

Question 7

Which conditions/lesions are precancerous to oral carcinoma? (6)

Answer 7

Submucous fibrosis.
Actinic keratosis.
Lichen planus.
Leukoplakia and erythroplakia.
Chronic hyperplastic candidosis.

Question 8

What is the aetiology of carcinoma of the larynx? (9)

Answer 8

Tobacco.
Alcohol.
HPV 6 + 11.
Dietary: Salt, preserved meats, dietary fats.
Metal/plastic workers.
Work: exposure to paint, diesel and gasoline fumes, asbestos.
Exposure to radiation.
Laryngopharyngeal reflux.
Genetic.

Question 9

Where do most carcinomas of the larynx arise?

Answer 9

On the true vocal cords.

Question 10

What are the symptoms of carcinoma of the larynx? (4)

Answer 10

Hoarseness.
Pain.
Haemoptysis.
Dysphagia.

Question 11

Lesions in Lichen planus? (3,2)
Pathogenesis?
Who?

Answer 11

Cutaneous: itchy, purple papules + Wickham’s striae.
Oral: reticular striations, ulcerative lesions.
T cell autoimmune.
Middle aged females.

Question 12

What are vocal cord nodules/polyps?
Who are they seen in? (3)
Symptoms?

Answer 12

Benign reactive lesions.
Heavy smokers/singers. Adult men.
Hoarseness and increasing effort.

Question 13

What is the aetiology of nasal polyps?
Effects?
Histology? (3)

Answer 13

Recurrent rhinitis leading to mucosal folds.
Large/multiple may stop sinus drainage - sinusitis.
Oedematous mucosa, hyperplastic mucous glands, eosinophil infiltrate.

Question 14

What is the aetiology of sinusitis? (2)

Which are most affected? (2)

Answer 14

Acute/ chronic rhinitis or extension of upper tooth infection through antrum.
Frontal, anterior ethmoid.

Question 15

Which bacteria are found in sinusitis?

Answer 15

Mixed oral.

Fungal if severe: mucomycosis in diabetics.

Question 16

What is a cholesteatoma?

Associated with?

Answer 16

Cystic lesions filled with cholesterol. May precipitate foreign body giant cell reaction.
Chronic otitis media.

Question 17

What is otosclerosis?
Pathogenesis?
Results in?

Answer 17

Bilateral abnormal bone deposition in middle ear. Familial.
Fibrous ankylosis - bony overgrowth - anchorage of middle ear bones to oval window.
Marked hearing loss.

Question 18

What is labyrinthitis?
Symptoms?
Causes? (4)

Answer 18

Inflammatory disorder of the inner ear.
Disturbed balance + hearing.
Bacterial, viral, Wegner’s granulomatosis, poyarteritis nodosa.

Question 19

What is Ramsay Hunt syndrome?

Answer 19

VZV in sensory ear nerves causing labrynthitis and facial paralysis.

Question 20

Which cancers affect the external ear?
Associated with?
Who?

Answer 20

Basal cell and squamous cell carcinomas.
Actinic radiation (sun).
Elderly men.

Question 21

In the ear canal, which cancer is most commonly seen?

In who?

Answer 21

Squamous cell carcinoma.

Women.

Question 22

What is a paraganglioma?
Symptoms? (5)
Who?
Behaviour?

Answer 22

Middle ear tumour.
Pulsatile tinnitus, hearing loss, aural pressure, pain, bloody otorrhea (discharge).
Middle aged women.
Very locally aggressive.

Question 23

What are the causative organisms in acute otitis media? (3)

Answer 23

Streptococcus pneumoniae
H. influenzae
Moraxella catarrhalis

Question 24

What is serous otitis media?

Answer 24

Eustachian tube obstruction results in serous fluid build up in middle ear.

Question 25

When does chronic otitis media occur?

Organisms? (3)

Answer 25

Persistent acute infection.

Pseudomonas aeruginosa, Staphylococcus aureus, fungal.

Question 26

What are the complications of chronic otitis media? (4)

Answer 26

Tympanic perforation + discharge
Aural polyps
Cholesteatoma
Disarticulation of ossicles - hearing loss.