Sinonasal Malignancies — MCQs
What is the most common oral cancer?
Which among the following parotid tumors spreads through neural sheath
Osteomas are common in which of the following sinuses?
What is the most common malignancy found in the maxillary antrum?
Carcinoma of maxillary sinus stage III {T3 N0 M0}, Treatment of choice is
What is the staging system used for the condition seen in the patient after a history of intubation, as shown in the image?
Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
The following test is done for the evaluation of:
Which of the following is not a cause of oropharyngeal carcinoma?
Trismus in carcinoma of the temporal bone occurs due to involvement of:
Sinonasal Malignancies Indian Medical PG Practice Questions and MCQs
Question 1: What is the most common oral cancer?
- A. Transition cell ca
- B. Mucoepidermoid
- C. Adenocarcinoma
- D. Squamous cell ca (Correct Answer)
Explanation: ***Squamous cell ca*** - **Squamous cell carcinoma (SCC)** accounts for over **90% of all oral cancers**, making it the most prevalent type. - It arises from the **stratified squamous epithelium** lining the oral cavity. *Transition cell ca* - This term is more commonly associated with tumors of the **urinary tract**, such as transitional cell carcinoma of the bladder. - **Transitional cell carcinomas** are not typically found in the oral cavity. *Mucoepidermoid* - **Mucoepidermoid carcinoma** is the most common primary malignant tumor of **salivary glands**, not the oral cavity lining. - While salivary glands are in the oral region, this type of cancer originates specifically from these glands. *Adenocarcinoma* - **Adenocarcinoma** originates from **glandular tissue** and represents a small percentage of oral cancers. - It is much **less common** than squamous cell carcinoma in the oral cavity.
Question 2: Which among the following parotid tumors spreads through neural sheath
- A. Sq cell ca
- B. Mixed parotid tumour
- C. Adenocystic ca (Correct Answer)
- D. Lymphoma
Explanation: ***Adenocystic ca*** - **Adenoid cystic carcinoma** is notoriously known for its propensity for **perineural invasion**, meaning it spreads along nerve sheaths, leading to high recurrence rates and difficulty in complete eradication. - This characteristic spread pattern allows the tumor to infiltrate adjacent tissues beyond its apparent margins, often resulting in **neurological symptoms** like pain or paralysis. *Sq cell ca* - **Squamous cell carcinoma** (SCC) of the parotid gland is typically aggressive and spreads through **lymphatic and hematogenous routes**, as well as direct extension, but perineural invasion is not its primary mode of spread. - While SCC can invade nerves, it is not as defining a feature as it is for adenoid cystic carcinoma, and its aggressiveness is more often related to its rapid growth and tendency for **lymph node metastasis**. *Mixed parotid tumour* - A **mixed parotid tumor**, also known as a **pleomorphic adenoma**, is typically a **benign tumor** that grows slowly and expansively. - While a malignant transformation (carcinoma ex pleomorphic adenoma) can occur, primary mixed tumors do not spread through **neural sheaths**. *Lymphoma* - **Lymphoma** in the parotid gland is a **hematopoietic malignancy** that primarily involves lymphoid tissue. - Its spread typically occurs via the **lymphatic system** to regional lymph nodes and other lymphoid organs, rather than direct perineural invasion.
Question 3: Osteomas are common in which of the following sinuses?
- A. Frontal (Correct Answer)
- B. Ethmoid
- C. Maxillary
- D. Sphenoid
Explanation: ***Frontal*** - **Osteomas** are the most common benign tumors of the paranasal sinuses, with the **frontal sinus** being the most frequently affected site. - They are slow-growing, dense bone tumors and can cause symptoms like headache, facial pain, or visual disturbances if they grow large enough to obstruct sinus drainage or compress vital structures. *Ethmoid* - While osteomas can occur in the ethmoid sinuses, they are **less common** compared to the frontal sinuses. - Ethmoid osteomas may present with symptoms related to orbital involvement due to proximity. *Maxillary* - The maxillary sinuses are **infrequently affected** by osteomas. - When present, maxillary osteomas can cause facial pain, swelling, or obstruct sinus drainage leading to sinusitis. *Sphenoid* - Osteomas in the sphenoid sinus are **rare**. - Due to the critical structures surrounding the sphenoid sinus, even small osteomas in this location can potentially cause significant symptoms, such as visual changes or cranial nerve palsies.
Question 4: What is the most common malignancy found in the maxillary antrum?
- A. Mucoepidermoid Carcinoma
- B. Adenocarcinoma
- C. Squamous cell carcinoma (Correct Answer)
- D. Adenoid Cystic Carcinoma
Explanation: ***Squamous cell Ca*** - **Squamous cell carcinoma** (SCC) accounts for the vast majority (approximately 80%) of all malignancies arising in the **maxillary antrum** (or maxillary sinus). - Its high prevalence is often linked to chronic inflammation, environmental factors, and a higher density of **squamous epithelium** or metaplasia in the region. *Mucoepidermoid Carcinoma* - This is a common salivary gland malignancy but is **rare in the maxillary antrum**, where glandular tissue is less predominant. - While it can occur in sinonasal tracts, it is not the most frequent primary malignancy there. *Adenoid Cystic Carcinoma* - **Adenoid cystic carcinoma** is a common malignancy of the salivary glands and can occur in the sinonasal tract, but it is **much less frequent than SCC** in the maxillary antrum. - It often exhibits a **perineural invasion** pattern and a slow, but aggressive growth. *Adenocarcinoma* - While adenocarcinomas can arise from the **glandular epithelium** of the maxillary antrum, they are considerably **less common than squamous cell carcinoma**. - They are often associated with specific occupational exposures, such as **wood dust** or leather dust.
Question 5: Carcinoma of maxillary sinus stage III {T3 N0 M0}, Treatment of choice is
- A. Chemotherapy
- B. Chemotherapy and Surgery
- C. Radiotherapy
- D. Surgery and Radiotherapy (Correct Answer)
Explanation: ***Surgery and Radiotherapy*** - For **stage III maxillary sinus carcinoma (T3 N0 M0)**, a **multimodal approach** combining surgical resection with postoperative radiation therapy is generally considered the standard of care for optimal local control and survival outcomes. - **Surgery** aims to achieve clear margins, while **radiotherapy** targets microscopic residual disease and reduces the risk of recurrence. *Chemotherapy* - **Chemotherapy** alone is typically used for **systemic disease** or as a palliative measure, not as a primary curative treatment for localized stage III carcinoma. - Its role in **maxillary sinus cancer** is often reserved for induction therapy in advanced unresectable cases or as part of concurrent chemoradiation. *Chemotherapy and Surgery* - While chemotherapy may be used in combination with surgery for some advanced cancers, it is not the primary adjunctive modality alongside surgery for **stage III maxillary sinus carcinoma**; **radiotherapy** is more commonly indicated. - The primary role of chemotherapy in this context is usually in conjunction with radiation or for distant metastasis. *Radiotherapy* - **Radiotherapy alone** would not be sufficient for a T3 tumor, which involves extensive local invasion (e.g., bone of orbit, anterior ethmoid sinus, pterygoid plates, or cheek skin). - While radiation is crucial, **surgical debulking** or resection is necessary to remove the bulk of the disease and allow the radiation to be more effective.
Question 6: What is the staging system used for the condition seen in the patient after a history of intubation, as shown in the image?
- A. Cormack and Lehane (Correct Answer)
- B. AJCC
- C. TNM
- D. Radkowski
Explanation: ***Cormack and Lehane*** - The **Cormack and Lehane classification** system is used to grade the view of the **larynx** during **direct laryngoscopy** for intubation. - Given the history of intubation and the image showing the laryngeal view, this system is the most appropriate for staging the visual difficulty or success of intubation. *AJCC* - The **American Joint Committee on Cancer (AJCC) staging system** is primarily used for **oncological staging**, classifying the extent of cancer. - It is not relevant for assessing the view of the larynx during intubation. *TNM* - **TNM staging** (Tumor, Node, Metastasis) is a widely used system for classifying the **progression of cancer**. - This system is specific to cancer staging and is not applicable to the assessment of airways for intubation. *Radkowski* - The **Radkowski staging system** is used to classify **pediatric subglottic stenosis**, a narrowing of the airway below the vocal cords. - While it deals with airway issues, the question focuses on the view during intubation, not the severity of subglottic stenosis, and the image does not specifically point to this condition.
Question 7: Statement 1 - A 59-year-old patient presents with flaccid bullae. Histopathology shows a suprabasal acantholytic split. Statement 2 - The row of tombstones appearance is diagnostic of Pemphigus vulgaris.
- A. Statements 1 & 2 are correct, 2 is not explaining 1 (Correct Answer)
- B. Statements 1 and 2 are correct and 2 is the correct explanation for 1
- C. Statements 1 and 2 are incorrect
- D. Statement 1 is incorrect
Explanation: ***Correct: Statements 1 & 2 are correct, 2 is not explaining 1*** **Analysis of Statement 1:** - A 59-year-old patient with **flaccid bullae** and **suprabasal acantholytic split** on histopathology is the classic presentation of **Pemphigus vulgaris** - The flaccid (easily ruptured) nature of bullae distinguishes it from tense bullae seen in bullous pemphigoid - The suprabasal location of the split (just above the basal layer) with acantholysis (loss of cell-to-cell adhesion) is pathognomonic - **Statement 1 is CORRECT** ✓ **Analysis of Statement 2:** - The **"row of tombstones" or "tombstone appearance"** is indeed a diagnostic histopathological feature of Pemphigus vulgaris - This appearance results from basal keratinocytes remaining attached to the basement membrane while suprabasal cells separate due to acantholysis - The intact basal cells standing upright resemble a row of tombstones - **Statement 2 is CORRECT** ✓ **Does Statement 2 explain Statement 1?** - Statement 2 describes a **histopathological appearance** (tombstone pattern) that is a **consequence** of the suprabasal split - However, it does NOT explain the **underlying cause** of the flaccid bullae or the suprabasal split - The true explanation involves **IgG autoantibodies against desmoglein 3 (and desmoglein 1)**, which attack intercellular adhesion structures (desmosomes), causing **acantholysis** - Therefore, **Statement 2 does NOT explain Statement 1** ✗ *Incorrect: Statement 2 is the correct explanation for Statement 1* - While both statements describe features of Pemphigus vulgaris, the tombstone appearance is a descriptive finding, not an explanatory mechanism *Incorrect: Statements 1 and 2 are incorrect* - Both statements are medically accurate descriptions of Pemphigus vulgaris features *Incorrect: Statement 1 is incorrect* - Statement 1 correctly describes the cardinal clinical and histopathological features of Pemphigus vulgaris
Question 8: The following test is done for the evaluation of:
- A. Cheek tenderness in maxillary sinusitis (Correct Answer)
- B. Abnormality of nasal valve
- C. Severity of proptosis
- D. Skin pinch for dehydration
Explanation: ***Cheek tenderness in maxillary sinusitis*** - The image shows a person palpating the area over the **maxillary sinus** with their fingers. This examination technique is used to elicit tenderness, a common sign of **maxillary sinusitis**. - **Tenderness on palpation** over the maxillary sinus is a key clinical finding indicating inflammation or infection within the sinus cavity. *Abnormality of nasal valve* - Evaluation of the nasal valve typically involves external observation, internal examination with a speculum, or specialized maneuvers like the **Cottle test**, which involves pulling the cheek laterally to open the valve; it does not involve pressing on the cheek as depicted. - The nasal valve is an internal structure, and its palpation for abnormality would not be performed by pressing on the outer cheekbone as shown. *Severity of proptosis* - Proptosis (exophthalmos) refers to the **abnormal protrusion of the eyeball**. It is typically measured using an **exophthalmometer**. - The action shown in the image, pressing on the cheek, is not a method used to assess or quantify the severity of proptosis. *Skin pinch for dehydration* - The **skin pinch test** (turgor test) for dehydration is usually performed by pinching the skin on the back of the hand, lower arm, or abdomen, not the cheek. - Delayed return of the pinched skin to its normal state, known as **poor skin turgor**, indicates dehydration. The image does not show this technique.
Question 9: Which of the following is not a cause of oropharyngeal carcinoma?
- A. Occupational exposure to hydrochloric acid (Correct Answer)
- B. Smoking
- C. Human Papilloma Virus infection
- D. Occupational exposure to isopropyl oil
Explanation: **Explanation:** The primary risk factors for oropharyngeal carcinoma (OPC) are lifestyle-related and viral, rather than chemical or industrial. **1. Why Option A is the Correct Answer:** Occupational exposure to **hydrochloric acid (HCl)** is primarily associated with dental erosion and irritation of the upper respiratory tract, but it is **not** a recognized carcinogen for the oropharynx. In contrast, exposure to strong inorganic acid mists (like sulfuric acid) is linked specifically to **laryngeal cancer**, not oropharyngeal cancer. **2. Analysis of Other Options:** * **Smoking (Option B):** Tobacco use is a classic risk factor. Carcinogens like nitrosamines and polycyclic aromatic hydrocarbons cause field cancerization, leading to squamous cell carcinoma (SCC) of the entire aerodigestive tract. * **Human Papilloma Virus (Option C):** HPV (specifically **Type 16**) is now the leading cause of oropharyngeal cancer globally, especially involving the palatine tonsils and base of tongue. HPV-positive tumors have a better prognosis than tobacco-related ones. * **Isopropyl Oil (Option D):** Occupational exposure to the manufacture of isopropyl alcohol (specifically the "strong acid process" involving isopropyl oil) is a documented risk factor for cancers of the **paranasal sinuses and the oropharynx**. **Clinical Pearls for NEET-PG:** * **Most Common Site:** The **palatine tonsil** is the most common site for oropharyngeal SCC. * **HPV Marker:** **p16** immunohistochemistry is used as a surrogate marker for HPV-associated oropharyngeal cancer. * **Plummer-Vinson Syndrome:** Associated with post-cricoid (hypopharyngeal) carcinoma, not primarily oropharyngeal. * **Diet:** Deficiencies in Vitamin A and C are also implicated in the development of oral and pharyngeal malignancies.
Question 10: Trismus in carcinoma of the temporal bone occurs due to involvement of:
- A. Dura
- B. Temporomandibular joint (Correct Answer)
- C. Mastoid
- D. Eustachian tube
Explanation: **Explanation:** In the context of temporal bone carcinoma (most commonly Squamous Cell Carcinoma), **Trismus** (inability to open the mouth) is a significant clinical sign indicating **anterior extension** of the tumor. **Why the Temporomandibular Joint (TMJ) is correct:** The anterior wall of the external auditory canal (EAC) is in direct anatomical proximity to the glenoid fossa and the TMJ. When a malignancy breaches the anterior bony or cartilaginous wall of the EAC, it invades the TMJ and the associated pterygoid muscles. This infiltration leads to pain and mechanical restriction of mandibular movement, resulting in trismus. This finding usually signifies an advanced stage (T3 or T4) and a poorer prognosis. **Why other options are incorrect:** * **Dura:** Involvement of the dura (superior extension through the tegmen) leads to neurological complications, CSF otorrhea, or meningitis, but does not mechanically restrict jaw movement. * **Mastoid:** Posterior extension into the mastoid air cells causes retroauricular pain and swelling, but the mastoid process does not interface with the muscles of mastication. * **Eustachian tube:** While the tumor can involve the Eustachian tube leading to middle ear effusion and conductive hearing loss, it does not cause the muscular or joint fixation required for trismus. **High-Yield NEET-PG Pearls:** * **Most common site:** The External Auditory Canal is the most common site for temporal bone malignancy. * **Most common histology:** Squamous Cell Carcinoma. * **Clinical Red Flag:** Chronic otorrhea that becomes **blood-stained** or is associated with **deep-seated ear pain** should always be suspicious of malignancy. * **Staging:** Facial nerve palsy and Trismus are indicators of advanced disease (T4 in the modified Pittsburgh staging system).
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