Head and neck pathology Flashcards
Pathogenesis of oral cancer if HPV is injurious agent
HPV 16 –> loss of tumour suppressor genes E1, E2
Best test for Wegeners granulomatosis? And why?
c-ANCA positivity in the serum >95% pts
Common pathogens causing infection in the nasopharynx
Rhinovirus- key
Parainfluenza, influenza
Common pathogens causing infection in the oropharynx
Group A Strep (pyogenes)
Corynebacterium diphtheriae
EVC
Common pathogens causing infection in the epiglottis
haemophilus influenzae
Common pathogens causing infection in the larynx/trachea
Parainfluenza, S aureus
Common pathogens causing infection in the bronchi
- Separate into virus + bacterial
Viral: influenza
Bacterial: Strep pneumoniae + h influenza
TCP for diphtheria
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)
TCP influenza
Seasonal high fever, chills, dry cough, SOB.
Might have myalgia, arthralgia, headache.
Menieres features
Vertigo lasting for minutes-hours, hearing loss and tinnitus.
Low-frequency hearing loss with horizontal nystagmus
Acoustic neuroma
- 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
Presbycusis
- 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
Noise-induced hearing loss
- 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
Cholesteatoma features
- Painless otorrhea
- Progressive hearing loss
Otosclerosis features
- 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.
Pathogens implicated in otitis externa
Bacterial most common= pseudomonas (40%), s aureus, E coli
Fungal infections = aspergillus (90%), candida
Viral rare
TCP RRV
Returned traveler from Asia/NQ resident presents with chronic polyarthralgia, red maculopapular rash, fever, malaise, headache.
TCP classic dengue fever
How to remember?
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
In which patients does dengue haemorrhagic fever occur?
In those with pre-existing antibodies to a different dengue serotype.
What are the main two clinical forms of dengue fever?
- Febrile flu-like form
2. Classic dengue fever “breakbone”
Which three arboviruses have cross-reacting antibodies? Which one is a strain of the other?
Kunjin, West Nile Virus, Murray Valley Encephalitis.
Kunjin encephalitis is a strain of West Nile Virus.
Kunjin presentation
Just milder febrile illness than Murray Valley Encephalitis. Can sometimes cause encephalitis.
Which two viruses does Chikungunya cross-react with?
Chikungunya, Sindbis + RRV.
TCP of Chikungunya
Myalgia + arthralgia
Maculopapular rash
Fever
Headache
Which 4 viruses have prominent myalgia + arthralgia
RRV - chronic polyarthralgia
Dengue “breakback” fever
Chikungunya
Barmah forest
Most common 2 arboviral infections in tropical NQ?
Ross river virus
Barmah forest virus
Gold standard diagnosis of malaria?
Microscopy
Treatment malaria?
Artemisinin
Which antigen does the RDT test for in malaria? What happens when you clear the parasite
PfHRP2 antigen – antibody-based detection, pan malaria* positive even after clearing parasitaemia with Artemisinin.
TCP lepto
NQ farmer presents with biphasic illness
- First flu phase = fever, chills, myalgia, headache
- Second Weils disease = jaundice, fever, haemorrhage, renal liver = CNS involvement
TCP melioidosis subacute
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.
Chronic melio triad of symptoms
haemoptysis, night sweats + weight loss = chronic TB
P vivax malaria TCP
Returned traveler from endemic area presents with fever, chills, rigors, fatigue, mild jaundice + splenomegaly and anaemia.
P falciparum clinical features
Acute renal failure + “blackwater fever” - malarial haemoglobinuria, coma, acidosis, adhesion proteins clog deep veins (DVT)
Q fever rx
Acute; doxycycline for 3 weeks
Chronic: doxycycline + quinolones (3 years!)
Clinical features Zika virus
Most people asymptomatic
Fever, maculopapular rash, arthralgia or conjunctivitis
Infection during pregnancy –> microcephaly
TCP Japanese encephalitis
What to note about this case
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
