Head & Neck Path Q

[MudPhud20XX]

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A 42-year-old man has noted a painful lesion in his mouth for the past 2 weeks. On physical examination there is a reddish-blue, circumscribed, papular lesion with superficial ulceration that is located on the left anterior gingival ridge above the mandible. What is the most likely diagnosis?

 

[MudPhud20XX]

A 70-year-old woman has had a sensation of dull pain on the left side of her face for the past 3 months. Physical examination reveals that there is firmness with tenderness to palpation in the region anterior to the ear, but no distinct mass is felt. The parotid gland is biopsied and on microscopic examination shows the findings in the image. What is the most likely to be a consequence of which of the following conditions?

 

[MudPhud20XX]

A 49-year-old woman has had progressive hearing loss on the left for the past 5 years. She has no other significant medical problems. She has no tinnitus or dizziness or headache. On physical examination she has a unilateral bone conductive hearing loss on the left. Her tympanic membranes and external auditory canals appear normal. A head CT scan shows no mass or bony erosion. What is the most likely pathologic abnormality in this woman?

 

[MudPhud20XX]

A 53-year-old man has had a slowly enlarging lump on the left side of his face for 5 years. On physical examination, there is a firm, subcutaneous, mobile mass in the location shown in the coronal MR image with contrast. The mass is removed and is grossly 3 cm in diameter with discrete borders and a grey-white cut surface. Microscopically it is composed of epithelial elements dispersed throughout a matrix of mucoid, myxoid, and chondroid tissue. Around the mass are serous glands. What is the most likely diagnosis?

 

[MudPhud20XX]

A 50-year-old Asian man has had increasing pain and discomfort on the left side of his face for the past year. He has had difficulty breathing through his left nostril for the past month. On physical examination there is erosion of the mucus membrane of the left nostril, with protrusion of focally hemorrhagic, tan, nodular tissue into the nasal cavity. A head CT scan reveals a 7-cm mass involving the nasopharyngeal region and eroding adjacent bone. The mass is biopsied and on microscopic examination is composed of poorly differentiated squamous cells. The development of this lesion is most likely to be associated with what infectious agents?

 

[MudPhud20XX]

A 43-year-old woman has experienced difficulty swallowing due to a dry mouth for the past 4 years. On physical examination she has corneal abrasions from lack of an adequate tear film. Laboratory studies show seropositivity for both SS-A and SS-B autoantibodies. Her antinuclear antibody test is negative. She is at greatest risk for development of what type of neoplasms?

 

[seminoma]

A 70-year-old woman has had a sensation of dull pain on the left side of her face for the past 3 months. Physical examination reveals that there is firmness with tenderness to palpation in the region anterior to the ear, but no distinct mass is felt. The parotid gland is biopsied and on microscopic examination shows the findings in the image. What is the most likely to be a consequence of which of the following conditions?

Sialolithiasis.

A 49-year-old woman has had progressive hearing loss on the left for the past 5 years. She has no other significant medical problems. She has no tinnitus or dizziness or headache. On physical examination she has a unilateral bone conductive hearing loss on the left. Her tympanic membranes and external auditory canals appear normal. A head CT scan shows no mass or bony erosion. What is the most likely pathologic abnormality in this woman?

Otosclerosis.
Edit: Could also maybe be vestibular neuronitis (but not labyrinthitis because no tinnitus) if "dizziness" is not the same as "vertigo". Our clinical skills teacher always makes a big deal about making the patient describe their "dizziness" or "lightheaded-ness" versus just assuming they mean vertigo. Probably not a big deal for Step 1 though lol.

Edit 2: Actually nevermind, vestibular neuronitis doesn't cause hearing loss (vs labyrinthitis).

A 50-year-old Asian man has had increasing pain and discomfort on the left side of his face for the past year. He has had difficulty breathing through his left nostril for the past month. On physical examination there is erosion of the mucus membrane of the left nostril, with protrusion of focally hemorrhagic, tan, nodular tissue into the nasal cavity. A head CT scan reveals a 7-cm mass involving the nasopharyngeal region and eroding adjacent bone. The mass is biopsied and on microscopic examination is composed of poorly differentiated squamous cells. The development of this lesion is most likely to be associated with what infectious agents?

EBV.

A 43-year-old woman has experienced difficulty swallowing due to a dry mouth for the past 4 years. On physical examination she has corneal abrasions from lack of an adequate tear film. Laboratory studies show seropositivity for both SS-A and SS-B autoantibodies. Her antinuclear antibody test is negative. She is at greatest risk for development of what type of neoplasms?

NHL (Sjogrens --> NHL)

Don't know the others.

 

[MudPhud20XX]

A 14-year-old boy has a pinpoint white lesion on the tip of his tongue. Over the course of 3 days, this lesion forms a shallow but very painful 0.4-cm ulceration. The lesion disappears in a week. What is the most likely diagnosis?

 

[MudPhud20XX]

A 30-year-old woman has noted worsening hearing on the right for the past year. On physical examination there is conductive hearing loss on the right. Her right tympanic membrane shows a perforation, but there is no erythema or exudate. A head CT scan shows a 2-cm cystic mass eroding the middle ear region on the right. The mass is excised and on microscopic examination has the appearance shown in the image. What condition is this patient most likely predisposed to development of her mass lesion?

 

[MudPhud20XX]

Sialolithiasis. yup, Duct lithiasis, here is the solution.
The chronic duct obstruction leads to the chronic inflammation and fibrosis with acinar atrophy shown. The gland may become very hard, and a cancer may be suspected clinically. Older persons are more likely to have inspissated salivary gland duct secretions promoting lithiasis. This may also produce an acute sialadenitis.



Otosclerosis. correct, She has otosclerosis, an idiopathic condition in which the small ossicles fuse, diminishing conduction of sound through the middle ear.



EBV. correct



NHL (Sjogrens --> NHL) correct

Don't know the others.