ENT Oncology — MCQs

ENT Oncology Indian Medical PG Practice Questions and MCQs

Question 111: Most common presentation in nasopharyngeal carcinoma is with:

A. Cervical lymphadenopathy (Correct Answer)
B. Epistaxis
C. Hoarseness of voice
D. Nasal stuffiness

Explanation: ***Cervical lymphadenopathy*** - **Cervical lymphadenopathy** is the most frequent initial symptom, with over 75% of patients presenting with a palpable neck mass, often a **painless, firm mass** in the upper deep cervical chain. - This is due to the rich lymphatic drainage of the nasopharynx to the cervical lymph nodes, leading to early metastasis. *Epistaxis* - While **epistaxis** (nosebleeds) can occur in nasopharyngeal carcinoma, it is generally not the most common presenting symptom. - It usually presents as recurrent, mild **epistaxis** or bloody discharge rather than severe bleeding. *Hoarseness of voice* - **Hoarseness of voice** is typically associated with laryngeal involvement or recurrent laryngeal nerve palsy, which is a less common and usually later manifestation of nasopharyngeal carcinoma. - Primary nasopharyngeal tumors do not directly cause hoarseness unless they extend significantly or metastasize to structures affecting vocal cord function. *Nasal stuffiness* - **Nasal stuffiness** or obstruction can be a symptom due to tumor growth within the nasopharynx. - However, it is a less specific symptom and often overshadowed by the more prominent presentation of cervical lymphadenopathy.

Question 112: Most common site for nasopharyngeal carcinoma:

A. Nasal septum
B. Fossa of Rosenmuller (Correct Answer)
C. Vault of nasopharynx
D. Lateral wall of nasopharynx

Explanation: ***Fossa of Rosenmuller*** - The **fossa of Rosenmuller** (also known as the pharyngeal recess) is a deep indentation located posterolateral to the opening of the **Eustachian tube** in the nasopharynx. - This area is rich in **lymphoid tissue** and is the most common site for the initial development of nasopharyngeal carcinoma, making it a critical region for examination. *Nasal septum* - The **nasal septum** is the cartilaginous and bony wall dividing the nasal cavity into two halves. - While various pathologies can affect the nasal septum, it is not a common site for the primary development of **nasopharyngeal carcinoma**. *Vault of nasopharynx* - The **vault of the nasopharynx** refers to the superior wall or roof of the nasopharynx. - Although nasopharyngeal carcinoma can spread to or involve the vault, it is not the most frequent site of **origin** compared to the fossa of Rosenmuller. *Lateral wall of nasopharynx* - The **lateral wall of the nasopharynx** contains the Eustachian tube opening and the fossa of Rosenmuller. - While the tumor is located on the lateral wall, the most specific and most common site of origin on the lateral wall is the **fossa of Rosenmuller**, making this option less precise.

Question 113: A 50-year-old man with a history of chronic smoking presents with persistent ear pain and a mass in the neck. What is the most likely cause?

A. Otosclerosis
B. Tonsillitis
C. Nasopharyngeal carcinoma (Correct Answer)
D. Acoustic neuroma

Explanation: ***Nasopharyngeal carcinoma*** - This presentation, especially in a chronic smoker, strongly suggests **nasopharyngeal carcinoma**. - **Persistent ear pain** (often referred otalgia due to cranial nerve involvement) and a **neck mass** (due to metastatic lymphadenopathy) are classic symptoms. *Otosclerosis* - Characterized by **progressive conductive hearing loss** due to abnormal bone growth in the middle ear. - It does not typically present with ear pain or a neck mass, and its etiology is not linked to smoking. *Tonsillitis* - An **inflammation of the tonsils** causing sore throat, dysphagia, and sometimes fever. - It does not cause a persistent, unilateral ear pain or neck mass (unless it's a peritonsillar abscess, which is acute). *Acoustic neuroma* - A **benign tumor** of the vestibulocochlear nerve that causes **unilateral sensorineural hearing loss**, **tinnitus**, and dizziness. - It does not present with ear pain or a neck mass.

Question 114: Which of the following is the MOST significant independent risk factor for head and neck cancers?

A. Chronic sinus infection
B. Alcohol consumption
C. Smoking (Correct Answer)
D. None of the options

Explanation: ***Smoking*** - **Smoking** is the **most significant independent risk factor** for head and neck cancers, including those of the oral cavity, pharynx, and larynx. - The carcinogens in **tobacco smoke** directly damage DNA in epithelial cells, leading to oncogenic mutations and tumor formation. - Confers a **5-25 fold increased risk** depending on duration and intensity of use. *Chronic sinus infection* - While chronic inflammation can be a risk factor for some cancers, **chronic sinus infection** is not a generally recognized or significant risk factor for head and neck squamous cell carcinomas. - Inflammation from chronic sinusitis is typically localized to the paranasal sinuses and does not directly induce carcinogenesis in the broader head and neck region. *Alcohol consumption* - **Alcohol consumption** is also a significant independent risk factor for head and neck cancers (relative risk 2-6x). - However, **smoking remains the strongest single risk factor**, with higher relative risk and more direct carcinogenic effects. - Alcohol acts synergistically with smoking, and their combined use increases risk 50-100 fold. *None of the options* - This option is incorrect because **smoking** is the most well-established and significant risk factor for head and neck cancers.

Question 115: All the following statements about laryngeal carcinoma are true except:

A. Laryngeal carcinoma is more common in males.
B. Laryngeal carcinoma is associated with smoking.
C. Laryngeal carcinoma is more common in individuals over 40 years of age.
D. Laryngeal carcinoma has a poor prognosis. (Correct Answer)

Explanation: ***Laryngeal carcinoma has a poor prognosis.*** - While prognosis depends on stage and treatment, laryngeal carcinoma, especially when detected early, often has a **relatively good prognosis** compared to other head and neck cancers, with overall survival rates exceeding 50-60%. - Many patients, particularly those with early-stage disease, can be cured with **surgery or radiation therapy** while preserving laryngeal function. *Laryngeal carcinoma is more common in males.* - **Laryngeal carcinoma** demonstrates a significant **male predominance**, with incidence rates typically 4 to 5 times higher in men than in women. - This disparity is largely attributable to historically higher rates of **smoking and alcohol consumption** among men. *Laryngeal carcinoma is associated with smoking.* - **Smoking** is the most significant and well-established **risk factor** for laryngeal carcinoma, with the risk directly correlated to the intensity and duration of tobacco use. - Exposure to **carcinogens in tobacco smoke** directly damages laryngeal epithelial cells, leading to dysplasia and eventual malignant transformation. *Laryngeal carcinoma is more common in individuals over 40 years of age.* - The incidence of **laryngeal carcinoma** significantly increases with age, with the majority of cases diagnosed in individuals **over the age of 50 or 60 years**. - This age distribution reflects the cumulative exposure to **environmental carcinogens** like tobacco and alcohol over a longer lifespan.

Question 116: Glomus jugulare commonly arises from which location?

A. Mesotympanum
B. Epitympanum
C. Jugular foramen (Correct Answer)
D. Hypotympanum

Explanation: ***Jugular foramen*** - Glomus jugulare tumors arise from **glomus bodies located in the adventitia of the jugular bulb** at the **jugular foramen**. - These are **paragangliomas** originating from chemoreceptor cells in the dome of the jugular bulb, which then extend superiorly into the middle ear cavity (hypotympanum) and can erode through the jugular foramen inferiorly. - The jugular foramen is the anatomical landmark that defines the **primary site of origin** for glomus jugulare tumors, distinguishing them from glomus tympanicum tumors. *Hypotympanum* - The hypotympanum (floor of the middle ear) is commonly **involved secondarily** when glomus jugulare tumors extend upward from the jugular bulb into the middle ear space. - While glomus jugulare tumors frequently present in this location, it represents **tumor extension** rather than the primary site of origin. - **Glomus tympanicum** tumors can arise within the middle ear from the tympanic plexus on the promontory. *Mesotympanum* - This is the central part of the middle ear cavity, directly medial to the tympanic membrane. - This area contains the **tympanic plexus (Jacobson's nerve)** from which **glomus tympanicum** tumors arise, not glomus jugulare. *Epitympanum* - The epitympanum (attic) is the superior part of the middle ear cavity, above the level of the tympanic membrane. - This is not a typical site for paraganglioma origin in the temporal bone.

Question 117: Which of the following is NOT a component of Trotter's triad associated with nasopharyngeal carcinoma?

A. Palatal paralysis
B. Trigeminal Neuralgia
C. Conduction deafness
D. Sensorineural deafness (Correct Answer)

Explanation: ***Sensorineural deafness*** - **Trotter's triad** specifically refers to unilateral **painless conductive hearing loss**, **trigeminal neuralgia**, and **palatal paralysis** in the context of nasopharyngeal carcinoma. - Sensorineural deafness is not typically part of this classic triad as the tumor's direct pressure tends to affect the Eustachian tube leading to conductive hearing loss. *Palatal paralysis* - This is a key component of **Trotter's triad**, resulting from the tumor's invasion of the **IX (glossopharyngeal)** and **X (vagus)** cranial nerves, which innervate the soft palate. - It leads to **dysphagia** and **dysarthria**, often presenting as an early symptom. *Trigeminal Neuralgia* - This refers to **unilateral facial pain** due to involvement of the **V (trigeminal)** cranial nerve, which is a core symptom of **Trotter's triad**. - The tumor's extension can cause compression or infiltration of the nerve, leading to sharp, shooting pains. *Conduction deafness* - This is a cardinal sign of **Trotter's triad** and is caused by the nasopharyngeal tumor obstructing the **Eustachian tube**. - Obstruction leads to fluid accumulation in the middle ear, resulting in **painless unilateral conductive hearing loss**.

Question 118: What syndrome is commonly associated with nasopharyngeal tumors?

A. Trotter's syndrome (Correct Answer)
B. Frey's syndrome
C. Horner's syndrome
D. Eagle's syndrome

Explanation: ***Trotter's syndrome*** - **Trotter's syndrome** is classically associated with **nasopharyngeal carcinoma**, as the tumor's growth can compress nerves and structures in the region. - Key symptoms include **unilateral conductive hearing loss** (due to Eustachian tube obstruction), **trigeminal neuralgia** (due to V3 involvement), and **palatal paralysis**. *Frey's syndrome* - **Frey's syndrome** is characterized by **gustatory sweating and flushing** in the preauricular or temporal region, usually following parotid gland surgery or trauma to the auriculotemporal nerve. - It involves misdirected regeneration of parasympathetic fibers to sweat glands, not directly linked to nasopharyngeal tumors. *Horner's syndrome* - **Horner's syndrome** is a constellation of symptoms including **ptosis**, **miosis**, and **anhidrosis** on one side of the face, resulting from damage to the sympathetic pathway. - While nasopharyngeal tumors can sometimes cause Horner's syndrome if they invade the superior cervical ganglion, it is not the *most common* or specific syndrome directly associated with them. *Eagle's syndrome* - **Eagle's syndrome** is caused by an **elongated styloid process** or calcified stylohyoid ligament, leading to symptoms like neck, throat, or facial pain, especially during jaw movement. - It is an anatomical variant, not directly related to nasopharyngeal tumors.

Practice by Chapter

Staging of Head and Neck Cancer

Practice Questions

Oral Cavity Cancer

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Oropharyngeal Cancer and HPV

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Laryngeal Cancer

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Hypopharyngeal Cancer

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Sinonasal Malignancies

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Salivary Gland Neoplasms

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Thyroid Cancer

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Paragangliomas

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Principles of Radiation Therapy

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Chemotherapy and Targeted Therapy

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Surveillance and Survivorship

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