Head and neck pathology

Question 1

Pathogenesis of oral cancer if HPV is injurious agent

Answer 1

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

Question 2

Best test for Wegeners granulomatosis? And why?

Answer 2

c-ANCA positivity in the serum >95% pts

Question 3

Common pathogens causing infection in the nasopharynx

Answer 3

Rhinovirus- key

Parainfluenza, influenza

Question 4

Common pathogens causing infection in the oropharynx

Answer 4

Group A Strep (pyogenes)
Corynebacterium diphtheriae
EVC

Question 5

Common pathogens causing infection in the epiglottis

Answer 5

haemophilus influenzae

Question 6

Common pathogens causing infection in the larynx/trachea

Answer 6

Parainfluenza, S aureus

Question 7

Common pathogens causing infection in the bronchi

- Separate into virus + bacterial

Answer 7

Viral: influenza
Bacterial: Strep pneumoniae + h influenza

Question 8

TCP for diphtheria

Answer 8

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)

Question 9

TCP influenza

Answer 9

Seasonal high fever, chills, dry cough, SOB.

Might have myalgia, arthralgia, headache.

Question 10

Menieres features

Answer 10

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

Question 11

Acoustic neuroma

Answer 11

• 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

Question 12

Presbycusis

Answer 12

• 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

Question 13

Noise-induced hearing loss

Answer 13

• 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

Question 14

Cholesteatoma features

Answer 14

• Painless otorrhea

- Progressive hearing loss

Question 15

Otosclerosis features

Answer 15

• 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.

Question 16

Pathogens implicated in otitis externa

Answer 16

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

Question 17

TCP RRV

Answer 17

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

Question 18

TCP classic dengue fever

How to remember?

Answer 18

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

Question 19

In which patients does dengue haemorrhagic fever occur?

Answer 19

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

Question 20

What are the main two clinical forms of dengue fever?

Answer 20

1. Febrile flu-like form

2. Classic dengue fever “breakbone”

Question 21

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

Answer 21

Kunjin, West Nile Virus, Murray Valley Encephalitis.

Kunjin encephalitis is a strain of West Nile Virus.

Question 22

Kunjin presentation

Answer 22

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

Question 23

Which two viruses does Chikungunya cross-react with?

Answer 23

Chikungunya, Sindbis + RRV.

Question 24

TCP of Chikungunya

Answer 24

Myalgia + arthralgia
Maculopapular rash
Fever
Headache

Question 25

Which 4 viruses have prominent myalgia + arthralgia

Answer 25

RRV - chronic polyarthralgia Dengue "breakback" fever Chikungunya Barmah forest

Question 26

Most common 2 arboviral infections in tropical NQ?

Answer 26

Ross river virus | Barmah forest virus

Question 27

Gold standard diagnosis of malaria?

Answer 27

Microscopy

Question 28

Treatment malaria?

Answer 28

Artemisinin

Question 29

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

Answer 29

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

Question 30

TCP lepto

Answer 30

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

Question 31

TCP melioidosis subacute

Answer 31

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.

Question 32

Chronic melio triad of symptoms

Answer 32

haemoptysis, night sweats + weight loss = chronic TB

Question 33

P vivax malaria TCP

Answer 33

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

Question 34

P falciparum clinical features

Answer 34

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

Question 35

Q fever rx

Answer 35

Acute; doxycycline for 3 weeks | Chronic: doxycycline + quinolones (3 years!)

Question 36

Clinical features Zika virus

Answer 36

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

Question 37

TCP Japanese encephalitis | What to note about this case

Answer 37

``` 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