Head &neck Semester 2 — Past Paper OmpathStudy

Head &neck sem 2 — Past Paper Questions & Answers Questions and answers 1. A 40-year-old smoker presents with a white patch on the buccal mucosa that cannot be scraped off. (5marks) Tabulate leukoplakia and erythroplakia under: Clinical appearance Risk of malignancy Histological findings Common age group Association with tobacco Answer: Feature Leukoplakia Erythroplakia :------------------ :----------------------------------------- :------------------------------------------ Clinical appearance White patch, cannot be scraped off Red velvety patch Risk of malignancy Lower (5-20%) Higher (50-90%) Histological findings Hyperkeratosis, acanthosis, dysplasia Epithelial atrophy, severe dysplasia, CIS Common age group Middle-aged to elderly (40-70 years) Middle-aged to elderly (50-80 years) Association with tobacco Strong association (smoking, chewing tobacco) Strong association (smoking, chewing tobacco) 2. Compare and contrast microadenoma and macroadenoma of the pituitary (5marks) Answer: Microadenoma: Size: < 10 mm in diameter. Symptoms: Often present with hormonal excess symptoms (e.g., galactorrhea in prolactinoma, Cushing's disease). Mass effect: Rarely cause mass effect symptoms (e.g., visual field defects, headaches). Treatment: Often managed medically or with transsphenoidal surgery. Macroadenoma: Size: ≥ 10 mm in diameter. Symptoms: Can present with hormonal excess or deficiency (due to compression of normal pituitary tissue). Mass effect: Commonly cause mass effect symptoms (e.g., bitemporal hemianopsia, headaches, cranial nerve palsies). Treatment: Usually requires transsphenoidal surgery, sometimes followed by radiation. 3. List five clinical features of laryngeal carcinoma. (5marks) Answer: Hoarseness (persistent, progressive) Dysphagia (difficulty swallowing) Odynophagia (painful swallowing) Stridor (noisy breathing) Neck mass (palpable lymphadenopathy) Chronic cough Weight loss 4. A child presents with a lateral neck swelling. (5marks) Tabulate branchial cyst and thyroglossal duct cyst under: Embryological origin Typical location Lining epithelium Malignant potential Treatment Answer: Feature Branchial Cyst Thyroglossal Duct Cyst :------------------ :------------------------------------------- :------------------------------------------- Embryological origin Remnants of branchial arches/clefts Remnant of thyroglossal duct (thyroid descent) Typical location Lateral neck, anterior to sternocleidomastoid Midline neck, moves with tongue protrusion Lining epithelium Stratified squamous or ciliated columnar Ciliated columnar or stratified squamous Malignant potential Very rare (branchial cleft carcinoma) Rare (papillary thyroid carcinoma) Treatment Surgical excision Sistrunk procedure (excision including central hyoid bone) 5. Compare and contrast cholesteatoma and otosclerosis. (5marks) Answer: Cholesteatoma: Nature: Destructive, expanding growth of keratinizing squamous epithelium in the middle ear or mastoid. Pathogenesis: Can be congenital or acquired (e.g., due to tympanic membrane retraction, chronic otitis media). Symptoms: Foul-smelling otorrhea, conductive hearing loss, earache, vertigo, facial nerve palsy. Complications: Bone erosion, intracranial complications (meningitis, brain abscess). Treatment: Surgical excision. Otosclerosis: Nature: Abnormal bone remodeling in the otic capsule, leading to fixation of the stapes footplate. Pathogenesis: Genetic predisposition, often autosomal dominant with variable penetrance. Symptoms: Progressive conductive hearing loss (initially low frequency), tinnitus, often bilateral. Complications: Sensorineural hearing loss in advanced stages (cochlear otosclerosis). Treatment: Stapedectomy (surgical replacement of stapes) or hearing aids. 6. List five tumors commonly arising in the salivary glands. (5marks) Answer: Pleomorphic adenoma (benign mixed tumor) Warthin's tumor (papillary cystadenoma lymphomatosum) Mucoepidermoid carcinoma Adenoid cystic carcinoma Acinic cell carcinoma Basal cell adenoma Oncocytoma