Carotid Body Tumors — MCQs
Treatment of choice for carcinoma larynx T1N0M0 stage -
Carney triad consists of:
Which of the following is the best in-vivo screening choice for carotid artery stenosis?
Which of the following statements about parotid tumors are correct? a) Pleomorphic adenoma is the most common variety b) Malignant disease is the most common variety c) Facial nerve involvement indicates malignancy d) Superficial parotidectomy is the treatment of choice
A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
An asymptomatic old patient presents with bruit in the carotid artery. Which of the following is the investigation of choice?
True about carotid body tumor is all except:
Which of the following is the best management for radiation induced occlusive disease of carotid artery?
Which of the following is true regarding carcinoid tumor?
Treatment of resectable T4N0M0 stage of head and neck carcinoma is?
Carotid Body Tumors Indian Medical PG Practice Questions and MCQs
Question 1: Treatment of choice for carcinoma larynx T1N0M0 stage -
- A. External beam radiotherapy (Correct Answer)
- B. Surgery
- C. Radioactive implants
- D. Surgery & radiotherapy
Explanation: ***External beam radiotherapy*** - For **early-stage laryngeal cancer (T1N0M0)**, both **radiotherapy and surgery are considered equally effective first-line treatments** with excellent local control rates (>90%). - EBRT offers the advantage of being **completely non-invasive** while preserving vocal function and avoiding surgical risks. - Treatment duration is typically **6-7 weeks**, requiring patient compliance with daily fractions. - Preferred when patient prefers non-invasive approach or has comorbidities making surgery high-risk. *Surgery* - **Transoral laser microsurgery (TLS)** or endoscopic **cordectomy** are equally effective surgical options for T1 glottic cancer with cure rates comparable to radiotherapy. - Modern laser techniques provide excellent **voice preservation** with minimal morbidity. - Advantages include **shorter treatment time** (single procedure), obtaining tissue for histopathology, and preserving radiotherapy as salvage option. - Both **surgery and radiotherapy are Category 1 recommendations** for T1N0M0 disease; choice depends on institutional expertise, patient preference, and individual factors. *Radioactive implants* - **Brachytherapy (radioactive implants)** can be used for early-stage glottic cancer at specialized centers. - However, **external beam radiotherapy** is more commonly employed due to greater accessibility and extensive outcome data. *Surgery & radiotherapy* - **Combined modality treatment** is indicated for **locally advanced disease** (T3-T4) or **node-positive disease** (N+). - For **T1N0M0 disease**, single modality (either surgery OR radiotherapy) is sufficient and preferred to minimize treatment-related morbidity.
Question 2: Carney triad consists of:
- A. Gastric leiomyoma, pulmonary hamartoma, adrenal adenoma
- B. Gastric adenocarcinoma, bronchial carcinoid, pheochromocytoma
- C. Gastric GIST, pulmonary chondroma, extra-adrenal paraganglioma (Correct Answer)
- D. Gastric lymphoma, pulmonary fibrosis, adrenal cortical carcinoma
Explanation: ***Gastric GIST, pulmonary chondroma, extra-adrenal paraganglioma*** - Carney triad is a rare syndrome characterized by the simultaneous occurrence of three distinct tumors: **gastric gastrointestinal stromal tumor (GIST)**, **pulmonary chondroma**, and **extra-adrenal paraganglioma**. - This specific combination of tumors defines the triad, making this option the correct identification. *Gastric leiomyoma, pulmonary hamartoma, adrenal adenoma* - While gastric leiomyoma is a benign tumor of smooth muscle, it is generally considered a precursor of GIST, but **GIST** is the specific component of the triad. - **Pulmonary hamartoma** and **adrenal adenoma** are not the specific components of Carney triad. *Gastric adenocarcinoma, bronchial carcinoid, pheochromocytoma* - **Gastric adenocarcinoma** is a malignant epithelial tumor, not a mesenchymal tumor like GIST. - A **bronchial carcinoid** is a neuroendocrine tumor, and while **pheochromocytoma** is an adrenal form of paraganglioma, the triad specifically refers to **extra-adrenal paraganglioma** and **pulmonary chondroma**. *Gastric lymphoma, pulmonary fibrosis, adrenal cortical carcinoma* - **Gastric lymphoma** is a lymphoid malignancy, distinct from GIST [1]. - **Pulmonary fibrosis** is a lung disease characterized by scarring and not a tumor. **Adrenal cortical carcinoma** is a malignant tumor of the adrenal cortex, not a feature of Carney triad.
Question 3: Which of the following is the best in-vivo screening choice for carotid artery stenosis?
- A. Digital Subtraction Angiography (DSA)
- B. CT
- C. MRI
- D. USG (Correct Answer)
Explanation: ***USG*** - **Ultrasound** (USG), specifically **carotid duplex ultrasonography**, is the **safest**, most cost-effective, and readily available initial screening tool for carotid artery stenosis due to its non-invasive nature and ability to visualize blood flow and vessel morphology. - It combines **B-mode imaging** with **Doppler flow analysis** to provide real-time images and flow velocity measurements, allowing for assessment of the degree of **stenosis** and plaque characteristics without radiation or contrast agents. - Sensitivity and specificity exceed 85-90% for detecting significant stenosis, making it the preferred first-line screening modality. *Digital Subtraction Angiography (DSA)* - **DSA** is the **gold standard** for anatomical detail and remains the most accurate method for quantifying carotid stenosis, but it is **invasive** and requires arterial catheterization. - It involves **ionizing radiation** and **iodinated contrast agents**, carrying risks of stroke (0.5-1%), arterial dissection, nephrotoxicity, and contrast allergic reactions. - Due to its invasive nature and associated risks, DSA is reserved for **pre-surgical planning** or when non-invasive imaging is inconclusive, not for initial screening. *CT* - **Computed tomography angiography (CTA)** involves **ionizing radiation** and typically requires an **iodinated contrast agent**, which carries risks of allergy and nephrotoxicity. - Though CTA provides excellent anatomical detail and can visualize vessel wall calcification, it is generally reserved for confirmation or surgical planning rather than initial screening due to its higher cost, radiation exposure, and contrast-related risks. *MRI* - **Magnetic resonance angiography (MRA)** can visualize carotid arteries well but is more expensive, less accessible than ultrasound, and may require a **gadolinium-based contrast agent**, which can have adverse effects (nephrogenic systemic fibrosis in renal impairment). - It is often used when ultrasound findings are equivocal or in cases where CTA is contraindicated, but it's not the preferred initial screening method due to its complexity, cost, longer examination time, and contraindications (pacemakers, metallic implants).
Question 4: Which of the following statements about parotid tumors are correct? a) Pleomorphic adenoma is the most common variety b) Malignant disease is the most common variety c) Facial nerve involvement indicates malignancy d) Superficial parotidectomy is the treatment of choice
- A. Only statements a and c are correct
- B. Only statements a, c, and d are correct (Correct Answer)
- C. All statements are correct
- D. Only statements b and d are correct
Explanation: ***Only statements a, c, and d are correct*** - **Pleomorphic adenoma** is indeed the most common parotid tumor (60-70% of all parotid tumors) - **Facial nerve involvement** is a strong clinical indicator of malignancy, as benign tumors typically displace rather than invade the nerve - **Superficial parotidectomy** with facial nerve preservation is the standard surgical treatment for most parotid tumors - Statement b is false: approximately **80% of parotid tumors are benign**, with malignant tumors representing only ~20% *Only statements a and c are correct* - While this correctly identifies that pleomorphic adenoma is most common and facial nerve involvement suggests malignancy, it incorrectly excludes statement d - Superficial parotidectomy is indeed the standard treatment for most parotid tumors *All statements are correct* - This is incorrect because statement b is false - Malignant disease is NOT the most common variety; benign tumors (especially pleomorphic adenomas) predominate *Only statements b and d are correct* - This is incorrect because statement b is false - Malignant disease represents only ~20% of parotid tumors, not the most common variety
Question 5: A 26-year-old male presents to the outpatient department with a discrete thyroid swelling. On neck ultrasound, an isolated cystic swelling of the gland is seen. What is the risk of malignancy associated with this finding?
- A. 48%
- B. 12%
- C. 24%
- D. 3% (Correct Answer)
Explanation: ***3%*** - **Purely cystic thyroid nodules** (as described in this case with "isolated cystic swelling") have a **very low risk of malignancy**, typically **2-3%** or less. - According to **ATA guidelines** and **TIRADS classification**, purely cystic nodules are considered **low suspicion** lesions. - The cystic nature suggests a **benign process** such as a degenerated adenoma, colloid cyst, or simple cyst. - **Fine needle aspiration (FNA)** may still be considered if the nodule is >2 cm or has any suspicious solid components, but is often not required for purely cystic lesions. *48%* - This percentage is **significantly higher** than the actual malignancy risk for a purely cystic thyroid swelling. - Such a **high risk** would typically be associated with **solid nodules** exhibiting highly suspicious ultrasound features such as: - Microcalcifications - Irregular or spiculated margins - Taller-than-wide shape - Marked hypoechogenicity - Extrathyroidal extension *24%* - This percentage represents a **moderate to high risk** of malignancy, which is **not characteristic** of an isolated purely cystic thyroid swelling. - A risk in this range might be seen with: - **Mixed solid-cystic nodules** with predominantly solid components - Solid nodules with **intermediate suspicious features** on ultrasound *12%* - While lower than 24% or 48%, 12% is still **considerably higher** than the generally accepted malignancy risk for purely cystic thyroid nodules. - This risk level could be plausible for: - **Predominantly cystic nodules** with some eccentric solid components - Solid nodules with **mildly suspicious** features on ultrasound
Question 6: An asymptomatic old patient presents with bruit in the carotid artery. Which of the following is the investigation of choice?
- A. Doppler ultrasonography (Correct Answer)
- B. Internal carotid angiography
- C. Aortic arch angiography
- D. Spiral CT angiography
Explanation: ***Doppler ultrasonography*** - **Doppler ultrasonography** is a non-invasive, quick, and accurate method for assessing the degree of stenosis in the carotid arteries. - It provides information on **blood flow velocity** and plaque morphology, which is crucial for determining the need for intervention in **asymptomatic carotid bruits**. *Internal carotid angiography* - **Internal carotid angiography** is an invasive procedure with a risk of complications such as stroke. - It is typically reserved for cases where non-invasive imaging is inconclusive or as a preliminary step to endovascular intervention, not as a primary diagnostic tool for an **asymptomatic patient**. *Aortic arch angiography* - **Aortic arch angiography** is also an invasive procedure primarily used to visualize the great vessels originating from the aortic arch. - While it can show the proximal carotid arteries, it is not the initial investigation of choice for focusing specifically on **carotid stenosis**. *Spiral CT angiography* - **Spiral CT angiography** involves radiation exposure and intravenous contrast material, making it less suitable as a first-line screening tool. - While it provides detailed anatomical information, **Doppler ultrasonography** is preferred as the initial investigation due to its safety, lack of radiation, and effectiveness for **asymptomatic carotid disease**.
Question 7: True about carotid body tumor is all except:
- A. Lyre sign on angiography
- B. Hereditary predisposition
- C. Benign
- D. First-bite syndrome is a known complication (Correct Answer)
Explanation: ***Correct Answer: First-bite syndrome is NOT a known complication*** - **First-bite syndrome** is classically associated with **parotid gland surgery**, not carotid body tumor surgery - It occurs due to **sympathetic denervation** following parotid surgery, causing severe pain with the first bite of each meal - Carotid body tumor surgery has different complications: **cranial nerve injuries** (vagus, hypoglossal, glossopharyngeal), **vascular injury**, and **stroke** - This is the EXCEPTION - it is NOT true about carotid body tumors *Hereditary predisposition - TRUE* - **10-35% of carotid body tumors** have a familial/hereditary pattern - Associated with mutations in **succinate dehydrogenase (SDH) genes** (SDH-B, SDH-C, SDH-D) - Hereditary cases tend to be **bilateral** and present at a younger age - While most are sporadic, hereditary predisposition is a well-recognized feature *Lyre sign on angiography - TRUE* - The **"lyre sign"** is a classic angiographic finding - Represents **splaying of the carotid bifurcation** as the tumor grows between the internal and external carotid arteries - This widening of the carotid angle resembles the shape of a lyre (ancient musical instrument) - Highly characteristic of carotid body tumors *Benign - TRUE* - Carotid body tumors are typically **benign paragangliomas** - Slow-growing and usually do not metastasize - Only **5-10% are malignant** with metastatic potential - However, they can be locally aggressive and cause complications due to their location
Question 8: Which of the following is the best management for radiation induced occlusive disease of carotid artery?
- A. Carotid endarterectomy
- B. Low dose aspirin
- C. Carotid bypass procedure
- D. Carotid angioplasty and stenting (Correct Answer)
Explanation: ***Carotid angioplasty and stenting*** - **Radiation-induced carotid artery disease** often involves the distal part of the carotid artery, making it less amenable to surgical endarterectomy. - **Angioplasty and stenting** offer a less invasive approach with good technical success in these challenging cases, especially given the increased fragility and fibrosis of radiated tissues. *Carotid endarterectomy* - **Carotid endarterectomy** in previously radiated fields is associated with a significantly higher risk of complications, including **cranial nerve injury**, **wound infection**, and **carotid artery rupture**, due to tissue fibrosis and scarring. - The disease often extends beyond the easily accessible segment for endarterectomy in radiation-induced cases. *Low dose aspirin* - **Low-dose aspirin** is an important component of medical therapy for **atherosclerotic disease** and **stroke prevention**, but it is insufficient as a sole treatment for symptomatic or high-grade occlusive disease of the carotid artery. - It helps manage the underlying **atherosclerotic process** but does not directly address the severe stenosis or occlusion. *Carotid bypass procedure* - **Carotid bypass procedures** are complex surgical interventions usually reserved for cases of **carotid artery occlusion** or **recurrent stenosis** after previous interventions where endarterectomy or stenting is not feasible. - While an option, it is more invasive and technically demanding than angioplasty and stenting, particularly in already radiated tissues with compromised vascular integrity.
Question 9: Which of the following is true regarding carcinoid tumor?
- A. Associated with serotonin production
- B. Potentially malignant tumor
- C. Neuroendocrine tumor (Correct Answer)
- D. Most common site is lung
Explanation: ### Most common site is lung - Carcinoid tumors are more commonly found in the **gastrointestinal tract**, specifically the appendix and ileum, rather than the lungs [1]. - This statement is false as they can occur in the lungs but are not the most common site overall. ### Potentially malignant tumor - Carcinoid tumors can be classified as **malignant,** especially if they show aggressive behavior or metastasis. - Many carcinoid tumors, particularly those in the gastrointestinal tract, can be **non-functional** and less aggressive [1]. ### Neuroendocrine tumor - Carcinoid tumors are indeed a type of **neuroendocrine tumor**, arising from **neuroendocrine cells**. - This classification emphasizes their origin and potential for secretion of hormones like **serotonin**. ### Associated with serotonin production - Many carcinoid tumors produce **serotonin**, leading to symptoms like **carcinoid syndrome** when they metastasize, particularly to the liver [1]. - This statement is true, indicating their involvement in neuroendocrine secretions.
Question 10: Treatment of resectable T4N0M0 stage of head and neck carcinoma is?
- A. Radiotherapy alone
- B. Surgery and Radiotherapy (Correct Answer)
- C. Chemoradiation
- D. Surgery alone
Explanation: ***Surgery and Radiotherapy*** - For **resectable T4N0M0 head and neck carcinoma**, the standard treatment is **surgical resection** of the primary tumor followed by **adjuvant radiotherapy**. - This approach achieves optimal **local control** for advanced primary tumors without nodal involvement. - **Adjuvant radiotherapy** is essential for T4 tumors due to high risk of microscopic residual disease and local recurrence. - Surgery allows for complete tumor removal with negative margins, while radiotherapy addresses subclinical disease. *Radiotherapy alone* - Radiotherapy alone is **insufficient as monotherapy** for T4 tumors due to the large tumor burden and extensive local invasion. - Single modality radiation cannot reliably achieve adequate tumor control for advanced primary lesions. - Generally reserved for early-stage disease or patients unfit for surgery. *Chemoradiation* - **Definitive chemoradiation** is an alternative for **unresectable T4 tumors** or when organ preservation is desired (e.g., laryngeal cancer). - For **resectable** T4N0M0 disease, surgery with adjuvant RT is preferred as it provides better local control and allows pathological staging. - Chemoradiation may be used postoperatively if high-risk features are found (positive margins, perineural invasion, extranodal extension). - In this **N0 case with resectable tumor**, upfront surgery is the preferred initial approach. *Surgery alone* - While surgical resection is crucial for T4 tumors, **surgery alone is inadequate** due to high risk of locoregional recurrence. - T4 classification indicates extensive local invasion, necessitating **adjuvant radiotherapy** to eradicate microscopic disease. - Combined modality treatment (surgery + RT) significantly improves local control and survival compared to surgery alone.
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