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Pathology · patient case with 2 questions

Child with lymphadenopathy and petechiae

Patient: Child

Chief complaint: Sore throat, fatigue and swollen glands.

Background: Several weeks of malaise.

Current findings: Generalised lymphadenopathy and palatal petechiae.

Question 1

What is the most likely diagnosis and causative organism?

  1. Acute leukaemia
  2. Infectious mononucleosis caused by Epstein–Barr virus
  3. Herpangina caused by coxsackievirus A
  4. Primary herpetic gingivostomatitis caused by HSV-1
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Correct answer: B. Infectious mononucleosis caused by Epstein–Barr virus

  • A. Leukaemia is an important differential given the petechiae and lymphadenopathy, and must be excluded, but the overall picture here fits mononucleosis.
  • B. CORRECT. The combination of fatigue, generalised lymphadenopathy and PALATAL PETECHIAE is classic INFECTIOUS MONONUCLEOSIS, caused by EPSTEIN–BARR VIRUS. Splenomegaly and atypical lymphocytes on the blood film complete the picture, and the monospot test confirms it.
  • C. Herpangina produces vesicles and ulcers confined to the SOFT palate and oropharynx, without generalised lymphadenopathy.
  • D. Primary herpetic gingivostomatitis presents with acutely inflamed marginal gingiva and vesicles that ulcerate, mainly in toddlers.

Note: Clinical caution: avoid contact sport in acute mononucleosis because of the risk of splenic rupture. Ampicillin or amoxicillin given in mononucleosis produces a characteristic rash.

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Question 2

Which HPV type is most responsible for squamous cell carcinoma of the tonsil?

  1. HPV 16
  2. HPV 32
  3. HPV 11
  4. HPV 6
Show answer and explanation

Correct answer: A. HPV 16

  • A. CORRECT. HPV 16 is the dominant high-risk type in OROPHARYNGEAL squamous cell carcinoma, particularly of the tonsil and base of tongue. HPV-positive oropharyngeal carcinoma is a distinct entity, occurring in younger non-smokers and carrying a considerably better prognosis than HPV-negative disease.
  • B. HPV 32 is associated with focal epithelial hyperplasia (Heck disease), which is benign.
  • C. HPV 11 is likewise low-risk, causing genital warts and respiratory papillomatosis.
  • D. HPV 6 is a low-risk type causing condyloma acuminatum.

Note: Note the distinction the exam tests: HPV drives OROPHARYNGEAL cancer (tonsil, base of tongue). Cancer of the ORAL CAVITY proper remains predominantly tobacco and alcohol related.

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