A 50-year-old man has noted a slowly enlarging lump on the left side of his face for 5 years. On physical examination, there is a firm, subcutaneous, mobile mass anterior to the left ear and above the angle of the mandible. 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. Which of the following is the most likely diagnosis?
A Warthin tumor
B Pleomorphic adenoma
C Adenoid cystic carcinoma
D Teratoma
E Mucoepidermoid carcinoma
F Malignant mixed salivary gland tumor
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A 21-year-old man gives a history of hay fever all his life. He has noted increasing difficulty breathing through his nose for the past several years. This is due to nasal obstruction with a feeling of nasal stuffiness but no bleeding or pain. On physical examination, there are bilateral soft, pale, glistening, rounded masses filling the nasal cavities. Which of the following is the most likely diagnosis?
A Wegener granulomatosis
B Sarcoidosis
C Squamous papillomatosis
D Angiofibromas
E Benign nasal polyps
A 55-year-old man with a 100 pack year smoking history has had a chronic cough for 5 years. However, he has noticed increasing hoarseness for the past 3 months. Yesterday, his sputum was been blood-streaked after coughing. Which of the following is the most likely diagnosis?
A Singer's nodules
B Herpes simplex virus infection
C Laryngeal carcinoma
D Sjogren syndrome
E Laryngeal papillomatosis
A 71-year-old man has noted a small bump on the left lower side of his mouth which he has been able feel with his tongue for the past year. On physical examination, this small firm submucosal mass is 0.7 cm in diameter with no overlying erythema or ulceration. The lesion is excised and on microscopic examination appears to have been produced by obstruction of a minor salivary gland duct. Which of the following is the most likely diagnosis?
A Calculus
B Mucocele
C Mucoepidermoid carcinoma
D Squamous papilloma
E Hematoma
A 25-year-old man has been "snorting" cocaine (self-administering the drug intranasally) for 3 years on a regular basis. Which of the following conditions is he most likely to develop?
A Nasal polyps
B Angiofibroma
C Inverting squamous papilloma
D Wegener granulomatosis
E Septal perforation
A 44-year-old basketball coach has been screaming at players, assistant coaches, referees, and the media for years. The quality of his voice has changed in the last 5 months. Which of the following lesions has he most likely developed?
A Chronic sinusitis
B Laryngeal papilloma
C Mucocele
D Laryngeal nodule
E Laryngeal granuloma
A 40-year-old woman has been bothered by dry eyes and a dry mouth for the past 4 years. On physical examination there are no abnormal findings. 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 which of the following neoplasms?
A Adenoid cystic carcinoma
B Mucoepidermoid carcinoma
C Non-Hodgkin lymphoma
D Pleomorphic adenoma
E Warthin tumor
A 15-year-old boy has had problems with hoarseness for the past 8 years, and during that time has experienced rare episodes of hemoptysis. On physical examination he has had multiple small nodular masses on the vocal folds, and these have been excised on multiple occasions because of recurrence. Microscopic examination of the resected lesions has shown finger-like projections of fibrovascular cores covered by squamous epithelium. Which of the following statements regarding this boy's disease is most appropriate?
A Respond to radiation therapy
B Stem from human papillomavirus infection
C Single gene mutation
D Become malignant
E Spontaneously regress
A 56-year-old man has noted a swelling increasing in size on the right side of his face for the past year. For 3 months he has experienced pain in this area. On physical examination there is a 4 cm firm and tender mass involving the right parotid region. Surgical excision is performed and on microscopic examination is invading surrounding structures, including the facial nerve. Which of the following neoplasms is this man most likely to have?
B Squamous cell carcinoma
C Warthin tumor
E Metastatic laryngeal carcinoma
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 of the parotid gland, but no distinct mass is felt. The parotid gland is biopsied and on microscopic examination shows chronic inflammation with extensive fibrosis. These findings are most likely to be a consequence of which of the following conditions?
A Sjogren syndrome
B Tuberculosis
C Pleomorphic adenoma
D Mumps
E Duct lithiasis
A 49-year-old man has used chewing tobacco for the past 25 years. He goes to his dentist for a routine examination. On physical examination there are several 0.5 cm white plaques on the oral mucous membrane just lateral to the left lower teeth. These plaques cannot be removed by scraping. This man is at greatest risk for developing which of the following conditions?
A Squamous cell carcinoma of the mouth
B Salivary gland duct lithiasis
C Sjogren syndrome
E Mucocele
A 33-year-old woman, a non smoker, has been bothered by a painful area of swelling in her mouth for the past 3 months. On physical examination there is a protruding nodular 1.2 cm tender mass on the gingival margin of her lower right lateral gum. A radiograph reveals that this lesion is eroding adjacent mandible. The lesion is excised and on microscopic examination is covered by non keratinizing squamous epithelium. Most of the lesion is composed of fibroblasts, capillaries, and inflammatory cells including lymphocytes, macrophages, mutlinucleated cells, and neutrophils. This lesion recurs within the next 2 months. Which of the following is the most likely diagnosis?
A Giant cell reparative granuloma
C Lichen planus
D Malignant fibrous histiocytoma
E Oral hairy leukoplakia
A 21-year-old woman has a history of type I diabetes mellitus. She has noted pain on the right side of her face that persisted for the past 2 days. When seen in the emergency room, she is noted to have pain and swelling in the region lateral to her nose extending to her right ear. A head CT scan shows enlargement with bony erosion of the right maxillary sinus and surrounding soft tissue swelling. Laboratory findings include serum sodium of 132 mmol/L, potassium 5.0 mmol/L, chloride 95 mmol/L, CO2 8 mmol/L, glucose 485 mg/dL, and creatinine 0.9 mg/dL. Urinalysis shows 4+ ketones, 4+ glucose, no blood, and no protein. Which of the following conditions is most likely to be producing her findings?
A Allergic rhinitis
B Mucormycosis
C Angiofibroma
E Acute rheumatic fever
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 which of the following infectious agents?
A Epstein-Barr virus
B Mucor
C Group A Streptococcus
D Cytomegalovirus
E Mycoplasma
A 35-year-old man with HIV infection has noted pale patches on his tongue for the past month. He also has experienced a bad taste in his mouth since these lesions appeared. On physical examination he has confluent adherent white to tan plaques on the upper surface of his tongue. No bleeding is noted when the plague is scraped off easily, but the underlying epithelium is erythematous. Laboratory studies show his CD4 lymphocyte count is 300/microliter. Which of the following microscopic findings is most likely to be present in these plaques?
A Budding cells with pseudohyphae
B Caseating granulomata
C Spherules with endospores
D Multinucleated cells
E Marked acanthosis and koilocytosis
A 4-year-old boy has developed a fever with sore throat for the past 3 days. He has had increasing dificulty breathing for the past 8 hours. On physical examination there is a dirty-gray membrane covering eroded mucosal surfaces of the pharyngeal region. A portion of the membrane is examined microscopically and consists of a fibrinopurulent exudate. A gram stain reveals club-shaped gram-positive rods. Which of the following organisms is most likely to produce these findings?
A Group A beta-hemolytic streptococcus
B Hemophilus influenzae
C Staphylococcus aureus
D Bordetella pertussis
E Corynebacterium diptheriae
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. Which of the following is the most likely pathologic abnormality in this woman?
A Ankylosis of bony ossicles
B Inflammation of semicircular canals
C Cystic growth of squamous epithelium
D Neoplastic proliferation of Schwann cells
E Invasion of non-septate hyphae
A 22-year-old man has a small red swollen area on his upper lip that, over the course of the past 5 days, has become a tender vesicle that has now ruptured to leave a painful ulcer. On physical examination there is a solitary, erythematous, 0.8 cm ulcerated lesion. This lesion resolves in the next week without therapy. Which of the following conditions is this man most likely to have?
A Herpes simplex virus infection
B Rhinoscleroma
C Thrush
D Hairy leukoplakia
E Aphthous ulcer
A 48-year-old woman has the abrupt onset of vertigo associated with tinnitus and diminished hearing on the left. On physical examination she has poor balance. She is put on bed rest and given meclizine. She recovers in 4 days. Which of the following anatomic sites is most likely to be involved by her disease?
A Carotid body
B Inner ear
B Anterior neck
D Facial nerve canal
E Mastoid
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. Which of the following is the most likely diagnosis?
A Thyroglossal duct cyst
B Ameloblastoma
C Cholesteatoma
D Mucocele
E Pyogenic granuloma
A 14-year-old boy notes a "bump" on his neck that has been slowly enlarging for the past 2 years. On physical examination, there is a 2 cm diameter discrete, movable, non-tender mass in the anterior midline of the neck above the thyroid cartilage. On head CT scan, this mass is cystic with a thin wall and smooth outlines. Which of the following entities does this lesion most likely represent?
A A malignant neoplasm
B An embryologic remnant
C A granuloma
D A benign neoplasm
E An abscess
A 15-year-old boy notes a pinpoint white lesion just to the left of the tip of his tongue. Over the course of 3 days, this lesion forms a shallow but very painful 0.3 cm ulceration. The lesion disappears in a week. Which of the following is the most likely diagnosis?
A Leukoplakia
B Pemphigus
A 42-year-old truck driver has noted drooping of the left side of his face for the past day. On physical examination he has some pain on palpation behind his left ear, and sounds seem louder on that side as well. His sensation of taste is not the same on the left as on the right. These symptoms abate in 2 weeks without therapy. Which of the following anatomic structures is most likely to be involved with the condition that he has?
C Anterior neck
A 71-year-old man has had a chronic cough for the past 10 years. He has a 50 pack year history of smoking cigarettes. He has noted a change in the quality of his voice over the past 6 months. He has had increasing hoarseness during the past month. Yesterday he noted some blood-streaked sputum. On physical examination there is a palpable 1 cm non-tender right cervical lymph node. Endoscopy reveals a firm, pearly 0.4 x 1 cm plaque with focal ulceration on his right vocal fold. Which of the following is the most likely diagnosis?
A Hemophilus influenzae infection
B Laryngeal papillomatosis
C Parainfluenza virus infection
D Reactive nodule
E Squamous cell carcinoma
A 29-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 consists of squamous epithelium and amorphous debris. Which of the following conditions most likely predisposed this woman to development of her mass lesion?
A Head trauma
B Meniere's disease
C Otosclerosis
D Pachymeningitis
E Recurrent otitis media
A 20-year-old woman has been feeling a lump in her neck for the past 5 years, which she says is not painful, but is now worrying her since she is studying about cancer in school. On physical examination there is a firm but movable mass just above and lateral to the thyroid cartilage on the left. A head CT scan shows a 3 cm cystic circumscribed mass. The mass is excised and on sectioning is filled with watery fluid. Microscopic examination shows a squamous epithelial lining and abundant lymphoid tissue with follicles having variably-sized germinal centers. Which of the following is the most likely diagnosis?
A Branchial cleft cyst
B Ectopic thymic tissue
C Metastatic squamous cell carcinoma
D Paraganglioma
E Thyroglossal duct cyst
F Non-Hodgkin lymphoma
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