64 - Diseases of the head and neck

Question 1

Most common malignant tumour of oral cavity?

Answer 1

SCC

Question 2

most likely spot to get tumour in oral cavity?

Answer 2

floor of mouth

Question 3

Carcinoma of oral cavity - aetiology

Answer 3

Tobacco and alcohol note synergistic relationship between two
Meat and red chilli powder
genetics

Question 4

HPV types

Answer 4

HPV16 and 18

Question 5

Protective factors for oral cavity carcinomas

Answer 5

anti oxidants in fruit and veg (vit A and C)

Question 6

Pre-cancerous lesions and conditions

Answer 6

submucous fibrosis
actinic keratosis
lichen planus
leukoplakia and erythroplakia
chronic hyperplastic candidosis

Question 7

most common cancer in larynx

Answer 7

SCC

Question 8

HPV numbers for laryngeal cancer

Answer 8

6 and 11

Question 9

Risk factors for laryngeal cancer

Answer 9

Tobacco and -OH
Diet with low green leafy veg and rich in salt preserved meats and dietary fats
Metal/plastic workers
Exposure to paint, diesel and gas fumes, asbestos.
Radiation
Laryngopharyngeal reflux
Genetics

Question 10

Lichen planus -

Answer 10

muco-cutaneous condition

Question 11

Lichen planus - pathogenesis

Answer 11

unknown however suggested t-cell mediated immune response

Question 12

Lichen planus - clinical presentation

Answer 12

itchy, purple papules forming plaques with Wickham’s striae

Oral lesions = reticular striations, plaque-like, erosive, ulcerative lesions, desquamative gingivitis

Small risk of malignant transformation

Question 13

Vocal cord nodules and polyps

Answer 13

Reactive lesions
Heavy smokers or singers
Adults and men affected

Question 14

Vocal cord nodules and polyps - clinical presentation

Answer 14

hoarseness
change in vocal quality
increased effort producing voice
usually located on the true vocal cords

Question 15

Nasal polyps

Answer 15

Recurrent attacks of rhinitis
4cm
allergic aetiology

Question 16

Nasal polyps - histology

Answer 16

oedematous mucosa with loose stroma containing hyperplastic/cystic mucous glands infiltrated with mixed inflammatory infiltrate rich in eosinophils

Question 17

Acute and chronic otitis media -

Answer 17

infants and children

viral w/ general URTI

Question 18

Acute and chronic otitis media - causative organisms

Answer 18

strep. pneumoniae
h.influenzae
moraxella catarrhalis

Question 19

Acute and chronic otitis media - causative organisms chronically

Answer 19

pseudomonas aeruginosa, staph. aureus

Question 20

Acute and chronic otitis media - complications

Answer 20

perforation of ear drum
aural polyps, cholesteatoma
mastoiditis, temporal cerebritis or abscess
destructive necrotising otitis

Question 21

Destructive necrotising ostitis is a consequence of otitis media

Answer 21

in a diabetic person esp. when P. aeruginosa is the causative organism

Question 22

Cholesteatoma -

Answer 22

Associated w/ chronic otitis media

Question 23

Cholesteatoma - pathogenesis

Answer 23

chronic inflammation and perforation of the eardrum due to ingrowth of squamous epithelium or metaplasia of secretory epithelial lining of middle ear

Question 24

Cholesteatoma - microscopically

Answer 24

cystic lesions lined by keratinising squamous epithelium and filled with debris and cholesterol clefts

Question 25

Cholesteatoma - complications

Answer 25

precipitates surrounding inflam rxn enhance by rupture and may result in foreign body giant cell rxn erosion of ossicles, the labyrinth and adjacent bone hearing loss v. rare. CNS complications: brain abscess and meningitis

Question 26

Otosclerosis

Answer 26

abnormal bone deposition in the middle ear usually bilateral. begins early in life and familial

Question 27

Otosclerosis - pathogenesis

Answer 27

uncoupling of normal bone resorption and formation fibrous ankylosis -> bony overgrowth -> anchorage of middle ear bones to oval window

Question 28

Otosclerosis - clinical features

Answer 28

Degree of immobilisation governs the severity of hearing loss Slowly progressive leading to hearing loss

Question 29

Labyrinthitis -

Answer 29

inflammatory disorder of inner ear

Question 30

Labyrinthitis - clinical presentation

Answer 30

disturbances of balance and hearing

Question 31

Labyrinthitis - autoimmune processes

Answer 31

Wegener granulomatosis or polyarteritis nodosa

Question 32

Carcinomas - ear

Answer 32

External (pinna) - BCC and SCC. elderly men Ear canal - SCC, middle-aged to elderly women not associated w/ sun exposure

Question 33

Paragangliomas -

Answer 33

most common tumour of the middle ear, originating in the paraganglia

Question 34

Paragangliomas - presenting symptoms

Answer 34

pulsatile tinnitus, hearing loss, aural pressure/fullness, dizziness, otalgia and bloody otorrhea