Theme 10 L4: Diseases of the head and neck

Question 1

What is rhinitis and what are the causes?

Answer 1

inflammation of the nasal cavity caused by:

• viruses (RSV, parainfluenza, coronaviruses etc)
• bacteria (haemophilus influenzae)
• inhaled allergen / hypersensitivity reaction

Question 2

What is sinusitis?

Answer 2

• inflammation of paranasal sinuses
• can be acute or chronic
• blockage of draining orifices can lead to blockage and abscess formation
• in severe cases can cause meningitis, cerebral abscesses

Question 3

What are nasal polyps?

Answer 3

• soft, fleshy, polupod lesions
• due to chronic allergic irritation or infection
• may be unilateral or bilateral
• can cause nasal obstruction, rhinorrhoea (runny nose) and headaches

Question 4

What 3 conditions make up Samter’s triad?

Answer 4

nasal polyps, asthma and aspirin intolerance

Question 5

What is oral lichen planus?

Answer 5

• non infectious inflammatory condition
• immunologically mediated mucocuaneous disorder that often presents as chronic dermatologic disease
• skin itchy, violaceous papules, blisters particularly on palms and soles
• affects oral mucosa mostly
• F>M

Question 6

What is Wickham striae?

Answer 6

• interlacing white striae

- feature of lichen planus

Question 7

How do we treat oral lichen planus?

Answer 7

topical steroids - anti - fungal treatment if superimposed fungal infection e.g candidiasis

Question 8

What is laryngitis?

Answer 8

viral or bacterial

inflammation of the larynx

Question 9

What is allergic laryngitis?

Answer 9

• inhalation of allergens/ irritants

- if severe can lead to gross oedema and obstruction

Question 10

What are some causes of vocal cord polyps/ nodules?

Answer 10

due to voice abuse (phonatory trauma), infection (laryngitis), alcohol, smoking

Question 11

What are the features of vocal cord polyps/ nodules?

Answer 11

• may be single or bilateral
• hoarseness or change in voice
• non-neoplastic stromal reactive process related to inflammation and/or trauma

Question 12

What are the 3 major salivary glands?

Answer 12

parotid, submandibular and sublingual

Question 13

What is sialadeitis?

Answer 13

inflammation of the salivary glands

Question 14

What is another word for viral sialadeitis?

Answer 14

mumps

Question 15

What is salivary gland mucocele?

Answer 15

General term used to describe minor salivary gland lesions resulting from obstruction secondary to a mucous plug or intraluminal sialolith

Question 16

What is ranula?

Answer 16

A form of mucus retention cyst or mucus extravasation phenomenon specifically occurring in the floor of the mouth associated with the ducts of the sublingual gland

Question 17

What is the commonest salivary gland tumour?

Answer 17

pleomorphic salivary adenoma (mixed tumour) –> benign tumour but tend to recur, small proportion can undergo malignant change

Question 18

What is the most common location of a pleomorphic adenoma?

Answer 18

80% occur in parotid

Question 19

Other than a pleomorphic salivary adenoma, what are some other tumours that arise in the salivary gland?

Answer 19

• Warthin tumour (benign)
• Mucoepidermoid carcinoma (malignant)
• Adenoid cystic carcinoma (malignant)

Question 20

What is, by far, the most common malignant neoplasm of the oral cavity?

Answer 20

oral SCC

Question 21

What are the most common sites for oral cavity carcinoma? (in descending order of frequency)

Answer 21

lower lip
tongue
floor of mouth
gingival
palate
tonsil
upper lip
buccal mucosa
uvula

Question 22

What are risk factors of SCC?

Answer 22

• tobacco
• alcohol
• oncogenic viruses: HPV, EBV
• sunlight: lip carcinoma
• plummer vinson syndrome (chronic iron deficiency)
• cirrhosis
• immunocompromised states

Question 23

Which conditions might be linked with the development of oral carcinoma?

Answer 23

-lichen planus
-submucous fibrosis
other factors include trauma, dental irritation, poor oral hygiene

Question 24

What are the clinical features of oral SCC?

Answer 24

• Small lesions may be asymptomatic
• Leukoplakia (white patch), erythroplakia (red patch), or speckled leukoplakia (mixed leukoplakin and erythroplakin)
• Mass lesion
• Ulceration
• Pain (local and referred)
• Difficulty swallowing, speaking, chewing and opening the mouth
• Bleeding
• Weight loss
• Enlarged neck nodes (neck mass)/ metastasis
• Advanced tumours can invade into bone, muscle and skin and may form of orocutanoeus fistulas

Question 25

What are the features of laryngeal cancer?

Answer 25

• associated with cigarette smoking / asbestos workers
• typically unilateral but may be bilateral
• white (leukoplakia), red (erythroplakia) or mixed red and white (speckled leukoplakia)
• M>F

Question 26

What are 3 features of psoriatic arthritis?

Answer 26

• salmon pink/ scaly plaques
• arthritis (dactylitis)
• nail pitting

Question 27

What is the defining feature of a SCC?

Answer 27

Keratin layer

Question 28

Why would a patient with psoriasis be at increased risk of developing cancer?

Answer 28

-due to increased cell turnover, so we have more replication and more opportunities for DNA mutation to occur

Question 29

How does a sinus show up on a CT?

Answer 29

Black as they’re filled with air

Question 30

What type of hypersensitivity is bullous pemphigoid?

Answer 30

type II

Question 31

What complication that can cause death is high for bullous pemphigoid?

Answer 31

sepsis