Recurrence of a thyroglossal cyst a year after it was simply excised from a girl's neck leads to a second operation. Which procedure should be done now?

Sistrunk operation with central hyoid

Total thyroidectomy with the cyst

Repeat simple excision of the cyst

Incision and drainage with antibiotics

Rapid growth over 3 months of a hard, fixed lump in the left parotid, with weakness of the lower half of the face on that side and a firm 2 cm level II node, brings a man to the head and neck clinic. Ultrasound-guided core biopsy shows high-grade mucoepidermoid carcinoma. MRI shows the tumour in both lobes of the gland, surrounding the main trunk of the facial nerve, and CT of the chest is clear. He is fit for surgery and has been counselled about the face. Which plan is most appropriate?

Radical parotidectomy, neck dissection, radiotherapy

Radiotherapy alone to the parotid and neck

Superficial parotidectomy with nerve preservation

Total parotidectomy alone, keeping the nerve

MRI and PET-CT stage a non-keratinising nasopharyngeal carcinoma as T2 N2 M0 in a fisherman with good kidney function and performance status. What is the standard primary treatment?

Concurrent cisplatin chemoradiotherapy

Chemotherapy with no radiotherapy

Resection by a maxillary swing approach

Radical neck dissection, then observation

Head and neck oncology, salivary glands and neck masses

43 NEET-PG practice questions on Head and neck oncology, salivary glands and neck masses, part of ENT. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A midline neck swelling at the level of the hyoid in a child moves upward when the tongue is put out. What is the most likely diagnosis?
1. AThyroid nodule
2. BSubhyoid bursitis
3. CDermoid cyst
4. DThyroglossal cyst
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Answer: D · Thyroglossal cyst
A thyroglossal cyst forms along the track of the thyroid's descent from the foramen caecum, and is attached to the hyoid and to the tongue base through the duct remnant. It therefore rises both on swallowing and on protruding the tongue. A thyroid nodule rises on swallowing but not on tongue protrusion.
- A: A thyroid nodule moves with swallowing only.
- B: A subhyoid bursa does not have a tract to the tongue base.
- C: A midline dermoid does not move with tongue protrusion.
Remember this
A midline cyst that moves up on tongue protrusion is a thyroglossal cyst.
Question 2 · Medium
A painful, slow-growing swelling of the hard palate in a woman, with numbness of the upper teeth on the same side, is biopsied. Histology shows small basaloid cells in a cribriform 'Swiss cheese' pattern, with tumour cells wrapped around nerves. What is the most likely diagnosis?
1. APleomorphic adenoma
2. BMucoepidermoid carcinoma
3. CAcinic cell carcinoma
4. DAdenoid cystic carcinoma
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Answer: D · Adenoid cystic carcinoma
Adenoid cystic carcinoma is the commonest malignant tumour of the minor salivary glands and the submandibular gland. Its cribriform pattern and marked perineural invasion explain pain, numbness and skip spread along nerves, and it often recurs late and spreads to the lungs. Treatment is wide excision with nerve margins and postoperative radiotherapy.
- A: Pleomorphic adenoma is painless and has chondromyxoid stroma.
- B: Mucoepidermoid carcinoma has mucous, intermediate and epidermoid cells, not a cribriform basaloid pattern.
- C: Acinic cell carcinoma has serous acinar cells and occurs mainly in the parotid.
Remember this
Cribriform tumour with perineural invasion causing pain or numbness: adenoid cystic carcinoma.
Question 3 · Medium
Recurrence of a thyroglossal cyst a year after it was simply excised from a girl's neck leads to a second operation. Which procedure should be done now?
1. ATotal thyroidectomy with the cyst
2. BSistrunk operation with central hyoid
3. CRepeat simple excision of the cyst
4. DIncision and drainage with antibiotics
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Answer: B · Sistrunk operation with central hyoid
The thyroglossal tract runs close to, and often through, the body of the hyoid up to the foramen caecum, so simple excision leaves epithelium behind and recurrence is common. The Sistrunk operation removes the cyst, the central part of the hyoid body and a core of tongue tissue up to the foramen caecum, cutting recurrence to a few per cent.
- A: The thyroid is normal and does not need removal.
- C: Repeating a simple excision leaves the tract and recurs again.
- D: Drainage is only for an acute abscess and leads to a fistula.
Remember this
Thyroglossal cyst: Sistrunk operation (cyst, central hyoid and tract to the foramen caecum).
Question 4 · Hard
Rapid growth over 3 months of a hard, fixed lump in the left parotid, with weakness of the lower half of the face on that side and a firm 2 cm level II node, brings a man to the head and neck clinic. Ultrasound-guided core biopsy shows high-grade mucoepidermoid carcinoma. MRI shows the tumour in both lobes of the gland, surrounding the main trunk of the facial nerve, and CT of the chest is clear. He is fit for surgery and has been counselled about the face. Which plan is most appropriate?
1. ARadiotherapy alone to the parotid and neck
2. BRadical parotidectomy, neck dissection, radiotherapy
3. CSuperficial parotidectomy with nerve preservation
4. DTotal parotidectomy alone, keeping the nerve
Show answerHide answer
Answer: B · Radical parotidectomy, neck dissection, radiotherapy
A high-grade malignancy that already causes facial palsy and encases the nerve needs total (radical) parotidectomy with sacrifice of the involved nerve, ideally with immediate cable grafting. Clinically positive nodes need a therapeutic neck dissection, and high grade, nerve involvement and nodes all call for postoperative radiotherapy. A nerve that is already paralysed by tumour is not preserved.
- A: Primary radiotherapy is inferior to surgery for salivary cancers.
- C: Superficial parotidectomy leaves deep lobe disease and tumour on the nerve.
- D: Keeping an encased, paralysed nerve leaves tumour behind, and the node-positive neck is untreated.
Remember this
Parotid cancer invading the facial nerve: radical parotidectomy with nerve sacrifice, neck dissection and adjuvant radiotherapy.
Question 5 · Medium
MRI and PET-CT stage a non-keratinising nasopharyngeal carcinoma as T2 N2 M0 in a fisherman with good kidney function and performance status. What is the standard primary treatment?
1. AConcurrent cisplatin chemoradiotherapy
2. BChemotherapy with no radiotherapy
3. CResection by a maxillary swing approach
4. DRadical neck dissection, then observation
Show answerHide answer
Answer: A · Concurrent cisplatin chemoradiotherapy
Nasopharyngeal carcinoma is radiosensitive and lies in a surgically awkward site next to the skull base, so radiotherapy (IMRT) is the mainstay. Stage I is treated with radiotherapy alone; stage II to IVA disease gets concurrent cisplatin chemoradiotherapy, often after induction gemcitabine-cisplatin. Surgery is kept for residual or recurrent neck nodes or small local recurrence.
- B: Chemotherapy alone cannot control the primary or the neck.
- C: Maxillary swing nasopharyngectomy is for selected recurrences, not primary treatment.
- D: Neck dissection alone leaves the primary untreated.
Remember this
Locoregionally advanced nasopharyngeal carcinoma: concurrent cisplatin chemoradiotherapy, not primary surgery.
Question 6 · Medium
Aspirate from a fluctuant lateral neck swelling: thick, turbid, creamy fluid with cholesterol crystals and keratin debris on microscopy. The swelling lies deep to the upper third of the anterior border of the right sternocleidomastoid in a student aged 22. Which lining would histology of the excised cyst most likely show?
1. ASquamous epithelium with lymphoid tissue
2. BEndothelium-lined lymphatic spaces
3. CColumnar epithelium with thyroid follicles
4. DKeratinised epithelium with hair follicles
Answer and explanation in LearnFree account
Question 7 · Hard
Dysphagia and a muffled 'hot potato' voice for a year bring a schoolgirl to the ENT clinic. A smooth, reddish, firm midline mass sits on the back of the tongue behind the circumvallate papillae, and it does not bleed on touch. Her TSH is 9.8 mIU/L (normal 0.5-4.5) with a low-normal free T4. A technetium scan shows uptake only at the tongue base and none in the neck. She has no stridor or bleeding and is eating normally, though slowly, and her weight is steady. What is the most appropriate first treatment?
1. ATransoral excision of the mass
2. BBiopsy of the mass under anaesthesia
3. CRadioiodine ablation of the mass
4. DLevothyroxine to suppress TSH and shrink it
Answer and explanation in LearnFree account
Question 8 · Hard
Follow-up clinic, 8 months after concurrent chemoradiotherapy for stage III non-keratinising nasopharyngeal carcinoma: a man from Mizoram has no symptoms, and nasopharyngeal endoscopy shows only post-radiation mucosal change. Before treatment his plasma EBV DNA was 12,000 copies/mL; it fell to undetectable by the end of treatment, and it is now 2,400 copies/mL on two samples taken a month apart. The neck is clinically normal, he has no bone pain or cough, and his liver enzymes are normal. A trainee suggests the rise reflects only reactivation of latent infection. What is the best next step?
1. AReassurance, as endoscopy is normal
2. BRepeat the EBV DNA in 6 months
3. COral acyclovir for EBV reactivation
4. DPET-CT and MRI to look for recurrence
Answer and explanation in LearnFree account
Question 9 · Easy
Among these oral potentially malignant lesions, which carries the highest risk of malignant change?
1. AReticular lichen planus
2. BHomogeneous leukoplakia
3. CErythroplakia
4. DFrictional keratosis
Answer and explanation in LearnFree account
Question 10 · Easy
Which neck node level contains the jugulodigastric node?
1. ALevel I
2. BLevel IV
3. CLevel III
4. DLevel II
Answer and explanation in LearnFree account
Question 11 · Easy
A cook from Nagaland has a painless, hard lump just below the right mastoid tip, behind the angle of the mandible, for 3 months. The mouth and oropharynx look normal, and FNAC shows metastatic undifferentiated carcinoma. Which examination is most likely to find the primary?
1. AThyroid ultrasound
2. BNasopharyngeal endoscopy
3. CUpper GI endoscopy
4. DIndirect laryngoscopy
Answer and explanation in LearnFree account
Question 12 · Hard
Biopsy and MRI in a construction worker who chews tobacco: squamous cell carcinoma of the lateral border of the tongue, 2.5 cm across, with a depth of invasion of 6 mm. No nodes are palpable and none are enlarged on imaging (cT2 N0). He is fit, lives 300 km from the cancer centre and may not return reliably for follow-up, and is planned for wide local excision of the tongue with a 1 cm margin. His surgeon must now decide how to manage the clinically negative neck. Which approach is supported by the Tata Memorial randomised trial and current guidelines?
1. AWatchful waiting with neck ultrasound
2. BElective radiotherapy to both necks
3. CRadical neck dissection of levels I-V
4. DElective neck dissection of levels I-III
Answer and explanation in LearnFree account
Question 13 · Medium
CT and orthopantomogram of a tobacco chewer show a gingivobuccal carcinoma abutting the lower alveolus near the second molar, without erosion of the bony cortex. Which bone procedure is most appropriate with the wide excision?
1. ACurettage of the alveolus
2. BHemimandibulectomy
3. CMarginal mandibulectomy
4. DSegmental mandibulectomy
Answer and explanation in LearnFree account
Question 14 · Easy
Overall, which tumour is the commonest neoplasm of the salivary glands, and is found most often in the parotid?
1. AWarthin tumour
2. BMucoepidermoid carcinoma
3. CBasal cell adenoma
4. DPleomorphic adenoma
Answer and explanation in LearnFree account
Question 15 · Medium
A small ulcer at the tip of the tongue in a bidi smoker is biopsied and shows squamous cell carcinoma. Which lymph nodes are first at risk from this site?
1. ASubmental nodes of both sides
2. BSupraclavicular nodes
3. CRetropharyngeal nodes
4. DIpsilateral submandibular nodes only
Answer and explanation in LearnFree account
Question 16 · Medium
Which triad, described by Trotter, points to nasopharyngeal carcinoma spreading into the lateral pharyngeal wall and parapharyngeal space?
1. ADeafness, palatal palsy, facial neuralgia
2. BEpistaxis, nasal block, cheek swelling
3. CDiplopia, ptosis, numb forehead and cheek
4. DHoarseness, dysphagia, referred otalgia
Answer and explanation in LearnFree account
Question 17 · Medium
Left supraclavicular lymph node, hard and 2 cm across, found on examination of a man with weight loss, early satiety and epigastric fullness. In which neck level does this node lie, and which primary does it classically signal?
1. ALevel VI; carcinoma of the thyroid
2. BLevel IB; carcinoma of the tongue
3. CLevel IV; carcinoma of the stomach
4. DLevel II; carcinoma of the tonsil
Answer and explanation in LearnFree account
Question 18 · Medium
Diplopia on looking to the left is the new complaint of a man being treated for a left nasopharyngeal carcinoma, whose CT shows erosion of the skull base near the foramen lacerum. Which cranial nerve is most likely involved?
1. AAbducens nerve
2. BHypoglossal nerve
3. CTrochlear nerve
4. DOculomotor nerve
Answer and explanation in LearnFree account
Question 19 · Medium
Statements about the classical radical neck dissection (Crile): 1. It removes nodal levels I to V. 2. It removes the spinal accessory nerve. 3. It removes the vagus nerve. 4. It removes the internal jugular vein and sternocleidomastoid. Which statements are true?
1. A1 and 3 only
2. B2, 3 and 4 only
3. C1, 2, 3 and 4
4. D1, 2 and 4 only
Answer and explanation in LearnFree account
Question 20 · Hard
Fine-needle aspiration of a 3 cm right level II node in a software engineer who has never smoked shows p16-positive squamous cell carcinoma. Flexible endoscopy of the nose, pharynx and larynx and a careful oral examination show no primary tumour, and contrast CT of the neck shows only the node, with no necrosis or extranodal spread. He is anxious and asks the surgeon simply to remove the lump so that it can be examined whole. What is the most appropriate next step to find the primary?
1. AEmpirical radiotherapy to the whole pharynx
2. BRepeat CT of the neck in 3 months
3. CPET-CT, then examination under anaesthesia with biopsies
4. DExcision biopsy of the neck node
Answer and explanation in LearnFree account
Question 21 · Medium
Before a planned Sistrunk operation for a midline cystic swelling that rises on tongue protrusion in a boy of 6, what is the most important investigation?
1. ASerum calcitonin
2. BFNAC of the cyst
3. CBarium swallow for a pharyngeal pouch
4. DUltrasound to confirm a normal thyroid
Answer and explanation in LearnFree account
Question 22 · Easy
In India, which oral subsite is most often affected by squamous cell carcinoma, because tobacco quid is kept in the mouth?
1. AFloor of the mouth
2. BGingivobuccal complex
3. CHard palate
4. DDorsum of the tongue
Answer and explanation in LearnFree account
Question 23 · Hard
A cystic, painless 4 cm swelling at the anterior border of the right sternocleidomastoid, at the level of the angle of the jaw, has appeared over 3 months in a hotel manager aged 52 who does not smoke. Ultrasound shows a thin-walled cyst with clear fluid, and the referral letter reads 'branchial cyst, for excision'. FNAC yields watery fluid with a few atypical squamous cells, and p16 staining is awaited. The mouth looks normal on a quick look in a busy clinic, and the tonsils were not palpated. Which step should come before any neck surgery?
1. AAspiration and injection of a sclerosant
2. BExcision of the cyst as a day case
3. CRepeat ultrasound in 3 months
4. DExamination and biopsy of tonsils and tongue base
Answer and explanation in LearnFree account
Question 24 · Hard
Histopathology after wide excision of a carcinoma of the floor of the mouth with bilateral neck dissection: tumour 3.5 cm, depth of invasion 11 mm, all margins clear by at least 6 mm, no perineural invasion; 3 of 41 nodes are positive, the largest 2.2 cm, and one of them shows extranodal extension. The patient, a shopkeeper aged 50, has healed well by day 12 and is fit, with normal creatinine. His hearing is normal on audiometry. The tumour board must start adjuvant treatment within 6 weeks of surgery. Which adjuvant treatment is indicated?
1. ARadiotherapy with concurrent cisplatin
2. BSix cycles of chemotherapy alone
3. CRadiotherapy alone to the primary and neck
4. DObservation with three-monthly review
Answer and explanation in LearnFree account
Question 25 · Medium
Type I modified radical neck dissection differs from the classical radical neck dissection by keeping one structure that the radical operation removes. Which one?
1. ASternocleidomastoid muscle
2. BSubmandibular gland
3. CSpinal accessory nerve
4. DInternal jugular vein
Answer and explanation in LearnFree account

18 more Head and neck oncology, salivary glands and neck masses questions

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Head and neck oncology, salivary glands and neck masses

A midline neck swelling at the level of the hyoid in a child moves upward when the tongue is put out. What is the most likely diagnosis?

A painful, slow-growing swelling of the hard palate in a woman, with numbness of the upper teeth on the same side, is biopsied. Histology shows small basaloid cells in a cribriform 'Swiss cheese' pattern, with tumour cells wrapped around nerves. What is the most likely diagnosis?

Recurrence of a thyroglossal cyst a year after it was simply excised from a girl's neck leads to a second operation. Which procedure should be done now?

MRI and PET-CT stage a non-keratinising nasopharyngeal carcinoma as T2 N2 M0 in a fisherman with good kidney function and performance status. What is the standard primary treatment?

Among these oral potentially malignant lesions, which carries the highest risk of malignant change?

Which neck node level contains the jugulodigastric node?

A cook from Nagaland has a painless, hard lump just below the right mastoid tip, behind the angle of the mandible, for 3 months. The mouth and oropharynx look normal, and FNAC shows metastatic undifferentiated carcinoma. Which examination is most likely to find the primary?

CT and orthopantomogram of a tobacco chewer show a gingivobuccal carcinoma abutting the lower alveolus near the second molar, without erosion of the bony cortex. Which bone procedure is most appropriate with the wide excision?

Overall, which tumour is the commonest neoplasm of the salivary glands, and is found most often in the parotid?

A small ulcer at the tip of the tongue in a bidi smoker is biopsied and shows squamous cell carcinoma. Which lymph nodes are first at risk from this site?

Which triad, described by Trotter, points to nasopharyngeal carcinoma spreading into the lateral pharyngeal wall and parapharyngeal space?

Left supraclavicular lymph node, hard and 2 cm across, found on examination of a man with weight loss, early satiety and epigastric fullness. In which neck level does this node lie, and which primary does it classically signal?

Diplopia on looking to the left is the new complaint of a man being treated for a left nasopharyngeal carcinoma, whose CT shows erosion of the skull base near the foramen lacerum. Which cranial nerve is most likely involved?

Statements about the classical radical neck dissection (Crile): 1. It removes nodal levels I to V. 2. It removes the spinal accessory nerve. 3. It removes the vagus nerve. 4. It removes the internal jugular vein and sternocleidomastoid. Which statements are true?

Before a planned Sistrunk operation for a midline cystic swelling that rises on tongue protrusion in a boy of 6, what is the most important investigation?

In India, which oral subsite is most often affected by squamous cell carcinoma, because tobacco quid is kept in the mouth?

Type I modified radical neck dissection differs from the classical radical neck dissection by keeping one structure that the radical operation removes. Which one?