Salivary gland disorders — formative SAQs

SAQ 1 — The under-immunised child with bilateral parotitis (10 marks, 15 minutes)

A five-year-old boy whose parents declined vaccinations presents with two days of fever, malaise and progressive bilateral cheek swelling. On examination, the parotid glands are enlarged and tender bilaterally, the ear lobes are pushed outward and forward, the temperature is 38.8 degrees Celsius, and the Stensen duct orifice is inflamed but expresses no frank pus. He has no testicular pain, neck stiffness or abdominal pain. [1]

a) What is the most likely diagnosis, and which two examination features distinguish the parotid swelling from cervical lymphadenopathy? (2 marks) [1]

b) Give the incubation period and the period of infectivity, and state how long the child should be excluded from school. (3 marks) [1]

c) Outline your stepwise management, including the role of antiviral therapy and analgesia. (3 marks) [1]

d) Name four complications of this condition that you would include in your safety-net advice to the parents. (2 marks) [1]

SAQ 2 — The child with recurrent unilateral parotid swelling (10 marks, 15 minutes)

A four-year-old girl has had four episodes of right-sided parotid swelling over the last eighteen months, each lasting five to seven days and resolving without antibiotics. She is well between episodes. On examination during a flare, the right parotid is mildly enlarged and tender, the Stensen duct expresses clear saliva without pus, and the overlying skin is normal. [3]

a) What is the most likely diagnosis, and which two features distinguish it from acute suppurative parotitis? (2 marks) [3] [9]

b) Name the first-line imaging modality and describe two typical findings. (3 marks) [3]

c) Outline the stepwise conservative management you would recommend between flares. (3 marks) [4]

d) Give the indication for sialendoscopy and state the expected long-term prognosis of this condition. (2 marks) [5] [4]