Sialadenitis — MCQs
Uveoparotid fever is seen in:
Post operative parotitis is caused by -
"Xerostomia" is seen in all of the following EXCEPT in
A 20-year-old woman complains of a headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen's duct on intraoral examination; her temperature is 38.3°C, and the pulse rate is 80/min. Laboratory data show a hemoglobin level of 14 g/dL, a hematocrit of 40%, a white blood cell count of 11,000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which diagnostic test will help confirm the diagnosis of epidemic parotitis?
A 25-year-old woman presents with severe throat pain, difficulty swallowing, and trismus. CT neck shows a peritonsillar fluid collection and inflammation. What is the next best step?
Oophoritis, Orchitis, Chipmunk cheeks seen in:
Ciliary staphyloma occurs due to all of the following except:
What investigation uses dye to find out stones in the salivary gland?
Which of the following is not a primary symptom of Sjögren's syndrome?
Microscopically, epimyoepithelial islands are typically seen in:
Sialadenitis Indian Medical PG Practice Questions and MCQs
Question 1: Uveoparotid fever is seen in:
- A. Rheumatoid Arthritis
- B. Sjogren's syndrome
- C. SLE
- D. Sarcoidosis (Correct Answer)
Explanation: ***Sarcoidosis*** - **Uveoparotid fever** (also known as Heerfordt's syndrome) is a rare manifestation of **sarcoidosis**, characterized by bilateral **uveitis**, **parotid gland enlargement**, facial nerve palsy, and fever [1]. - Sarcoidosis is a systemic granulomatous disease, and **uveoparotid fever** represents a specific, classic constellation of symptoms within this condition [1]. *Rheumatoid Arthritis* - While **rheumatoid arthritis** can cause **ocular inflammation** (e.g., scleritis, episcleritis), it does not typically present as **uveitis** or **parotid gland enlargement** [2]. - Its primary targets are synovial joints, leading to inflammatory **polyarthritis**. *Sjogren's syndrome* - **Sjogren's syndrome** is well-known for affecting exocrine glands, causing **sicca symptoms** (dry eyes and mouth) due to lymphocytic infiltration of the lacrimal and salivary glands [2]. - However, while **parotid gland enlargement** can occur, it's not typically associated with **uveitis** in the specific combination described as **uveoparotid fever**. *SLE* - **Systemic Lupus Erythematosus (SLE)** is a multi-system autoimmune disease that can affect nearly any organ, including the eyes (e.g., retinal vasculitis, episcleritis) and occasionally salivary glands [3]. - However, **uveoparotid fever** is not a characteristic or specific manifestation of **SLE**.
Question 2: Post operative parotitis is caused by -
- A. E.coli
- B. Streptococcus
- C. Pneumococcus
- D. Staph aureus (Correct Answer)
Explanation: ***Staph aureus*** - **Staphylococcus aureus** is the most common cause of **acute suppurative (post-operative) parotitis** - Post-surgical conditions including **dehydration**, **poor oral hygiene**, **reduced salivary flow**, and **immunosuppression** facilitate **bacterial ascension** through Stensen's duct from the oral cavity - The bacterium proliferates in stagnant saliva, causing acute infection of the parotid gland *E.coli* - **Escherichia coli** is primarily associated with **gastrointestinal and urinary tract infections** - Rarely implicated in salivary gland infections and not a typical cause of post-operative parotitis *Streptococcus* - While **Streptococcal species** can cause various infections, they are less commonly associated with **acute bacterial parotitis** compared to **Staphylococcus aureus** - May occasionally cause parotitis but not the predominant organism in post-operative settings *Pneumococcus* - **Streptococcus pneumoniae** commonly causes **pneumonia, meningitis, and otitis media** - Rarely causes **acute suppurative parotitis** and is not typically associated with post-operative parotitis - When sialadenitis occurs, it usually affects different patient populations
Question 3: "Xerostomia" is seen in all of the following EXCEPT in
- A. Anticholinergic drugs
- B. Oral sepsis (Correct Answer)
- C. Sjogren's syndrome
- D. Dehydration
Explanation: ***Oral sepsis*** - **Oral sepsis** typically involves infection and inflammation of the oral cavity and can lead to symptoms like pain, swelling, and pus formation, but it does not directly cause a decrease in saliva production, which is characteristic of xerostomia. - While oral sepsis can occur alongside or exacerbate other oral health issues, it is not a primary cause of **dry mouth** itself. *Anticholinergic drugs* - **Anticholinergic drugs** block the action of acetylcholine, which is a neurotransmitter involved in stimulating salivary glands. - This blockage leads to reduced saliva production, a common and well-known side effect that causes **xerostomia**. *Sjogren's syndrome* - **Sjögren's syndrome** is an autoimmune disease characterized by the immune system attacking moisture-producing glands, primarily the salivary and lacrimal (tear) glands. - This autoimmune destruction directly leads to chronic **xerostomia** (dry mouth) and dry eyes. *Dehydration* - **Dehydration** occurs when the body lacks sufficient fluid, which affects overall fluid balance, including saliva production. - Reduced fluid intake or excessive fluid loss directly decreases the volume of saliva produced, resulting in **dry mouth** or xerostomia.
Question 4: A 20-year-old woman complains of a headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen's duct on intraoral examination; her temperature is 38.3°C, and the pulse rate is 80/min. Laboratory data show a hemoglobin level of 14 g/dL, a hematocrit of 40%, a white blood cell count of 11,000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which diagnostic test will help confirm the diagnosis of epidemic parotitis?
- A. Blood test for immunoglobulin G (IgG) antibodies
- B. complete blood count
- C. viral throat swab
- D. single blood test for specific immunoglobulin M (IgM) (Correct Answer)
Explanation: ***Single blood test for specific immunoglobulin M (IgM)*** - A **single IgM** measurement is highly indicative of **acute or recent infection** with the mumps virus, which causes epidemic parotitis. - Detecting mumps-specific IgM antibodies confirms the presence of an **active immune response** to the virus. *Blood test for immunoglobulin G (IgG) antibodies* - **IgG antibodies** indicate **past infection or vaccination** and do not confirm an active mumps infection. - A **four-fold rise** in IgG over time (paired acute and convalescent sera) can suggest recent infection but is not as definitive for acute cases as IgM. *Complete blood count* - While the patient's WBC count shows **lymphocytosis**, which can be seen in viral infections like mumps, it is **non-specific** and does not confirm the diagnosis. - The CBC provides general information about immune response but cannot identify the specific viral agent. *Viral throat swab* - A viral throat swab can be used for **PCR testing** or viral culture to detect the mumps virus, but it may have a **lower sensitivity** compared to serological tests, especially later in the illness. - Collecting a proper throat swab can be uncomfortable for the patient and requires specific handling for viral detection.
Question 5: A 25-year-old woman presents with severe throat pain, difficulty swallowing, and trismus. CT neck shows a peritonsillar fluid collection and inflammation. What is the next best step?
- A. Immediate tonsillectomy
- B. Needle aspiration and antibiotics (Correct Answer)
- C. Oral corticosteroids
- D. Empirical antibiotics alone
Explanation: ***Needle aspiration and antibiotics*** - The presence of a **peritonsillar fluid collection** on CT neck, along with severe throat pain, **dysphagia**, and **trismus**, is indicative of a **peritonsillar abscess (PTA)**. - **Needle aspiration** provides immediate relief by draining the pus and allows for culture-guided antibiotic therapy, while broad-spectrum **antibiotics** address the bacterial infection. *Immediate tonsillectomy* - **Tonsillectomy** is generally reserved for recurrent peritonsillar abscesses or chronic tonsillitis, not as the primary immediate treatment for an acute PTA. - Doing so acutely carries a higher risk of complications due to the **inflammation** and potential compromise of the airway. *Oral corticosteroids* - While corticosteroids can reduce inflammation and pain, they do not resolve the underlying bacterial infection or drain the **pus collection**. - Using **corticosteroids alone** risks worsening the infection by masking symptoms without treating the cause. *Empirical antibiotics alone* - Although antibiotics are crucial for treating the bacterial infection, they may not be sufficient on their own to resolve a **frank abscess**, especially one causing significant symptoms. - **Drainage** is often necessary to achieve clinical improvement and prevent complications such as airway obstruction or spread of infection.
Question 6: Oophoritis, Orchitis, Chipmunk cheeks seen in:
- A. Sialadenosis.
- B. Mumps. (Correct Answer)
- C. Mucocele.
- D. Sialadenitis.
Explanation: ***Mumps*** - **Mumps** is a viral infection that commonly presents with **bilateral parotid gland swelling**, leading to the characteristic "chipmunk cheeks" appearance. - It can also cause complications such as **oophoritis** (inflammation of the ovaries) in females and **orchitis** (inflammation of the testes) in males, which are key features seen in this clinical description. *Sialadenosis* - **Sialadenosis** refers to a non-inflammatory, non-neoplastic enlargement of the salivary glands, often the parotid glands. - While it can cause swollen glands, it is typically associated with systemic conditions like **diabetes** or **alcoholism** and does not cause oophoritis or orchitis. *Mucocele* - A **mucocele** is a common lesion of the oral mucosa that results from either rupture of a salivary gland duct and spillage of mucin into the surrounding soft tissues (extravasation type) or obstruction of a salivary gland duct (retention type). - It usually presents as a benign, fluid-filled swelling, most commonly on the **lower lip**, and is not associated with systemic inflammation or widespread glandular involvement. *Sialadenitis* - **Sialadenitis** is an inflammation of a salivary gland, often due to bacterial infection or duct obstruction (e.g., by salivary stones). - While it can cause painful swelling of the salivary glands, it typically affects only one gland and does not lead to complications like oophoritis or orchitis.
Question 7: Ciliary staphyloma occurs due to all of the following except:
- A. Scleritis
- B. Absolute glaucoma
- C. Episcleritis (Correct Answer)
- D. Perforating injury
Explanation: ***Episcleritis*** - **Episcleritis** is a benign, self-limiting inflammation of the episclera, which is a superficial layer of connective tissue, and does not lead to **scleral thinning** or ectasia. - Therefore, it does not cause **ciliary staphyloma**, which is a bulging of the sclera in the ciliary body region. *Scleritis* - **Scleritis** is a severe, chronic inflammatory disease affecting the sclera, often leading to **scleral thinning** and weakening. - This thinning can predispose to the formation of a **ciliary staphyloma**, especially if the inflammation is localized in the ciliary region. *Absolute glaucoma* - **Absolute glaucoma** is a severe form of glaucoma characterized by persistently high **intraocular pressure (IOP)**, leading to total vision loss and often significant **scleral thinning** due to chronic pressure. - The elevated IOP can cause stretching and thinning of the sclera, particularly in weakened areas like the **ciliary body**, resulting in a **ciliary staphyloma**. *Perforating injury* - A **perforating injury** to the globe can directly weaken the **scleral wall**, especially if it occurs near the **ciliary body**. - Subsequent healing with scar tissue, often under intraocular pressure, can lead to ectasia and the formation of a **ciliary staphyloma**.
Question 8: What investigation uses dye to find out stones in the salivary gland?
- A. MR angiography
- B. USG
- C. Breast imaging
- D. Sialography (Correct Answer)
Explanation: ***Sialography*** - **Sialography** is an imaging technique that involves injecting a **radiopaque dye** into the salivary ducts to visualize the internal structure and identify obstructions like stones (**sialoliths**). - This method allows for detailed imaging of the ductal system, revealing the exact location and size of stones or strictures. *Breast imaging* - **Breast imaging**, such as mammography or ultrasound of the breast, is used to detect abnormalities within the **breast tissue**. - It is completely unrelated to the diagnosis of salivary gland stones. *MR angiography* - **MR angiography (MRA)** is a type of MRI that specifically visualizes **blood vessels** and blood flow throughout the body. - It is used to detect vascular diseases, not obstructions in salivary glands. *USG* - **Ultrasound (USG)** can visualize salivary gland stones, but it does not typically involve the use of an injected dye for this purpose. - While useful for initial screening, **sialography** provides a more detailed view of the ductal system, especially smaller or more complex stones.
Question 9: Which of the following is not a primary symptom of Sjögren's syndrome?
- A. Parotid gland enlargement
- B. Dry eyes
- C. Dry mouth
- D. Systemic manifestations (Correct Answer)
Explanation: ***Systemic manifestations*** - While Sjögren's syndrome can have **systemic manifestations**, they are secondary complications or features, not among the **primary, defining symptoms** that establish the diagnosis. - The primary symptoms directly relate to **exocrine gland dysfunction**, specifically lacrimal and salivary glands. *Dry eyes* - This is a cardinal symptom, resulting from damage to the **lacrimal glands** leading to decreased tear production. - Patients typically report a **gritty or burning sensation** in their eyes. *Dry mouth* - Another core symptom, resulting from dysfunction of the **salivary glands** and reduced saliva flow. - This can lead to difficulties in **speaking, swallowing**, increased dental carries, and oral discomfort. *Parotid gland enlargement* - This is a common and often **visible clinical sign** of Sjögren's syndrome, indicating inflammation of the **major salivary glands**. - It results from lymphocytic infiltration and is typically recurrent or persistent.
Question 10: Microscopically, epimyoepithelial islands are typically seen in:
- A. Epithelial-myoepithelial carcinoma
- B. Myoepithelioma
- C. Mucoepidermoid carcinoma
- D. Sjögren's syndrome (Correct Answer)
Explanation: ***Sjögren's syndrome*** - **Epimyoepithelial islands** are a characteristic histopathological feature of **Sjögren's syndrome**, particularly in affected salivary glands. [1] - These islands represent **benign lymphoepithelial lesions** where ducts are surrounded by lymphocytes, eventually forming true islands. *Epithelial-myoepithelial carcinoma* - This is a **malignant salivary gland tumor** with dual differentiation, but it typically presents as distinct inner epithelial and outer myoepithelial layers around ducts or cords, not as true "islands." - While it involves both epithelial and myoepithelial cells, its arrangement and neoplastic nature differ from the benign epimyoepithelial islands of Sjögren's. *Myoepithelioma* - This is a **benign tumor composed predominantly of myoepithelial cells**, often appearing in various morphological patterns (spindle, plasmacytoid, epithelioid, clear cell). - It does not typically form the well-defined **lymphoepithelial islands** seen in Sjögren's, as its characteristic is the proliferation of myoepithelial cells in a different architectural pattern. *Mucoepidermoid carcinoma* - This is a common **malignant salivary gland tumor** characterized by a mixture of mucin-producing cells, epidermoid cells, and intermediate cells. - Its histological features are distinct and do not include the formation of **epimyoepithelial islands**, which are diagnostically specific to Sjögren's syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 235-236.
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