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MBBS4 > Head and neck pathology > Flashcards

Head and neck pathology Flashcards

1
Q

Pathogenesis of oral cancer if HPV is injurious agent

A

HPV 16 –> loss of tumour suppressor genes E1, E2

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2
Q

Best test for Wegeners granulomatosis? And why?

A

c-ANCA positivity in the serum >95% pts

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3
Q

Common pathogens causing infection in the nasopharynx

A

Rhinovirus- key

Parainfluenza, influenza

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4
Q

Common pathogens causing infection in the oropharynx

A

Group A Strep (pyogenes)
Corynebacterium diphtheriae
EVC

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5
Q

Common pathogens causing infection in the epiglottis

A

haemophilus influenzae

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6
Q

Common pathogens causing infection in the larynx/trachea

A

Parainfluenza, S aureus

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7
Q

Common pathogens causing infection in the bronchi

- Separate into virus + bacterial

A

Viral: influenza
Bacterial: Strep pneumoniae + h influenza

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8
Q

TCP for diphtheria

A

Child, high fever, extremely unwell severe “barking” cough, breathless

O/E

  • marked lymphadenopathy of the neck and soft tissue oedema “bull neck”
  • thick grey pus over tonsils (pseudomembrane)
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9
Q

TCP influenza

A

Seasonal high fever, chills, dry cough, SOB.

Might have myalgia, arthralgia, headache.

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10
Q

Menieres features

A

Vertigo lasting for minutes-hours, hearing loss and tinnitus.
Low-frequency hearing loss with horizontal nystagmus

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11
Q

Acoustic neuroma

A
  • Early symptoms with insidious onset – caused by pressure on CN VIII as a result of tumour expansion in internal acoustic canal
  • Unilateral sensorineural hearing loss
  • Dizziness + unsteady gait
  • Tinnitus
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12
Q

Presbycusis

A
  • Progressive bilateral hearing loss particularly of higher frequencies (use a low-pitched and clear voice to speak with older patients)
  • First noticed in the sixth decade of life
  • Difficulty hearing in noisy, crowded environments
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13
Q

Noise-induced hearing loss

A
  • Hx of loud noise exposure or occupational hazard
  • Slowly progressive hearing loss with loss of high-frequency hearing first
  • Difficulty hearing in noisy, crowded environments
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14
Q

Cholesteatoma features

A
  • Painless otorrhea

- Progressive hearing loss

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15
Q

Otosclerosis features

A
  • Slowly progressive conductive hearing loss, starting unilaterally and progressing bilaterally (2nd ear is affected in 70% of patients with progression)
  • Patients hear better in noisy rather than quiet surroundings = phenomenon called paracusis willisii
  • Quiet speech – they hear their own voices loudly as a result of bone conduction.
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16
Q

Pathogens implicated in otitis externa

A

Bacterial most common= pseudomonas (40%), s aureus, E coli
Fungal infections = aspergillus (90%), candida
Viral rare

17
Q

TCP RRV

A

Returned traveler from Asia/NQ resident presents with chronic polyarthralgia, red maculopapular rash, fever, malaise, headache.

18
Q

TCP classic dengue fever

How to remember?

A

Non-immune, non-indigenous adult/child presents with 5-7 days of “saddleback” fever, marked myalgia + arthralgia, headache, retroorbital pain, ascites, abdominal pain and measles rash.
Dengue breakbone saddleback fever

19
Q

In which patients does dengue haemorrhagic fever occur?

A

In those with pre-existing antibodies to a different dengue serotype.

20
Q

What are the main two clinical forms of dengue fever?

A
  1. Febrile flu-like form

2. Classic dengue fever “breakbone”

21
Q

Which three arboviruses have cross-reacting antibodies? Which one is a strain of the other?

A

Kunjin, West Nile Virus, Murray Valley Encephalitis.

Kunjin encephalitis is a strain of West Nile Virus.

22
Q

Kunjin presentation

A

Just milder febrile illness than Murray Valley Encephalitis. Can sometimes cause encephalitis.

23
Q

Which two viruses does Chikungunya cross-react with?

A

Chikungunya, Sindbis + RRV.

24
Q

TCP of Chikungunya

A

Myalgia + arthralgia
Maculopapular rash
Fever
Headache

25
Q

Which 4 viruses have prominent myalgia + arthralgia

A

RRV - chronic polyarthralgia
Dengue “breakback” fever
Chikungunya
Barmah forest

26
Q

Most common 2 arboviral infections in tropical NQ?

A

Ross river virus

Barmah forest virus

27
Q

Gold standard diagnosis of malaria?

A

Microscopy

28
Q

Treatment malaria?

A

Artemisinin

29
Q

Which antigen does the RDT test for in malaria? What happens when you clear the parasite

A

PfHRP2 antigen – antibody-based detection, pan malaria* positive even after clearing parasitaemia with Artemisinin.

30
Q

TCP lepto

A

NQ farmer presents with biphasic illness

  1. First flu phase = fever, chills, myalgia, headache
  2. Second Weils disease = jaundice, fever, haemorrhage, renal liver = CNS involvement
31
Q

TCP melioidosis subacute

A

Diabetic with chronic renal disease, with hx of excessive alcohol intake, presents with cough + sputum, pleuritic pain, an abscess over a previous cut, some bone and joint pain, as well as fever, chills + rigors.
in the peak of the wet season after going swimming in a local waterhole.

32
Q

Chronic melio triad of symptoms

A

haemoptysis, night sweats + weight loss = chronic TB

33
Q

P vivax malaria TCP

A

Returned traveler from endemic area presents with fever, chills, rigors, fatigue, mild jaundice + splenomegaly and anaemia.

34
Q

P falciparum clinical features

A

Acute renal failure + “blackwater fever” - malarial haemoglobinuria, coma, acidosis, adhesion proteins clog deep veins (DVT)

35
Q

Q fever rx

A

Acute; doxycycline for 3 weeks

Chronic: doxycycline + quinolones (3 years!)

36
Q

Clinical features Zika virus

A

 Most people asymptomatic
 Fever, maculopapular rash, arthralgia or conjunctivitis
 Infection during pregnancy –> microcephaly

37
Q

TCP Japanese encephalitis

What to note about this case

A 
Rice farmer living in tropical climate presents with 
	Fever, headache, vomiting 
	Decreased GCS
	weakness and movement disorders 
	Seizures common

NB Less than 1% of those infected develop clinical illness

MBBS4 (15 decks)

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