Head and Neck Pathology, Pathology, USMLE Step 1 - Full Vignette with Extended Explanations скачать в хорошем качестве

Head and Neck Pathology, Pathology, USMLE Step 1 - Full Vignette with Extended Explanations

A 26-year-old woman presents with a painless right neck lump of two weeks duration, intermittent sore throats, ear pain when swallowing, tobacco use, and no systemic symptoms. Exam reveals a mobile cervical node, cryptic right tonsil, and fair oral hygiene. Imaging and biopsies show cystic nodal changes and tonsil pathology. How should clinicians approach the diagnostic workup and classification of such oropharyngeal lesions based on these findings? VIDEO INFO Category: Head and Neck Pathology, Pathology, USMLE Step 1 Difficulty: Easy - Basic level - Suitable for medical students Question Type: Recent Changes Case Type: Complicated Condition Explore more ways to learn on this and other topics by going to https://endlessmedical.academy/auth?h... QUESTION A 26-year-old woman is seen in clinic for a painless right neck lump first noticed two weeks ago while showering. She reports off-and-on sore throats over the past year, occasional ear pain on the right with swallowing, and no weight loss or fevers. She smokes about half a pack per day and started in late high school; she has not tried to quit yet. She works night shifts stocking shelves and often misses dental checkups.... OPTIONS A. For cancers starting in the tonsil or base of tongue, first use p16 protein testing on the tissue biopsy to decide if the cancer is HPV-related for staging and prognosis; add HPV-specific testing only when p16 is unclear or does not fit the clinical picture. New in 2025, routine HPV testing is al... B. For cancers starting in the tonsil or base of tongue, first use p16 on the tissue biopsy and add HPV tests only when p16 is unclear; there were no 2025 changes, and testing beyond the oropharynx is still not recommended at any site. C. All head and neck cancers, including larynx and oral cavity tumors, should now have routine HPV testing, and 2025 staging uses HPV status for every site regardless of where the tumor starts. D. Any neck-node needle sample must always have E6/E7 mRNA testing together with p16, even when a tonsil tissue biopsy is strongly p16-positive and explains the node, and 2025 recommends the same approach for every site. CORRECT ANSWER A. For cancers starting in the tonsil or base of tongue, first use p16 protein testing on the tissue biopsy to decide if the cancer is HPV-related for staging and prognosis; add HPV-specific testing only when p16 is unclear or does not fit the clinical picture. New in 2025, routine HPV testing is also recommended for squamous cancers that start inside the nose and sinuses, and the update gives practical steps for testing node samples from needle biopsies. Routine HPV testing is still not advised for most other head and neck sites such as the larynx and the oral cavity. EXPLANATION For cancers starting in the tonsil or base of tongue, first use p16 protein testing on the tissue biopsy to decide if the cancer is HPV-related for staging and prognosis; add HPV-specific testing only when p16 is unclear or does not fit the clinical picture. New in 2025, routine HPV testing is also recommended for squamous cancers that start inside the nose and sinuses, and the update gives practical steps for testing node samples from needle biopsies. Routine HPV testing is still not advised for most other head and neck sites such as the larynx and the oral cavity. This reflects current practice updates. p16 on the primary oropharyngeal tissue remains the first step because it is a strong, practical marker for HPV-related disease and drives staging and prognosis in the oropharynx.... --------------------------------------------------- Our cases and questions come from the https://EndlessMedical.Academy quiz engine - multi-model platform. Each question and explanation is forged by consensus between multiple top AI models (GPT, Claude, Grok, etc.), with automated web searches for the latest research and verified references. Calculations (e.g. eGFR, dosages) are checked via code execution to eliminate errors, and all references are reviewed by several AIs to minimize hallucinations. Important note: This material is entirely AI-generated and has not been verified by human experts; despite stringent consensus checks, perfect accuracy cannot be guaranteed. Exercise caution - always corroborate the content with trusted references or qualified professionals, and never apply information from this book to patient care or clinical decisions without independent verification. Clinicians already rely on AI and online tools - myself included - so treat this book as an additional focused aid, not a replacement for proper medical education. Visit https://endlessmedical.academy for more AI-supported resources and cases. This material can not be treated as medical advice. May contain errors. ---------------------------------------------------