Head and Neck Surgery Practice Questions

Q: Which type of carcinoma most commonly arises in a thyroglossal cyst?

Papillary. **Explanation:** A thyroglossal duct cyst (TGDC) is the most common congenital neck swelling, resulting from a failure of the thyroglossal duct to obliterate. While malignancy is rare (occurring in <1% of cases), when it does occur, it is almost always of thyroid follicular cell origin. **1. Why Papillary Carcinoma is Correct:** **Papillary Thyroid Carcinoma (PTC)** accounts for approximately **85–90%** of all malignancies arising in a thyroglossal cyst. The reason is attributed to the presence of ectopic thyroid tissue within the cyst wall. Since PTC is the most common type of thyroid cancer in the general population, it is also the most frequent histological subtype found in these remnants. **2. Why Other Options are Incorrect:** * **Follicular Carcinoma:** While it arises from follicular cells, it is significantly less common than PTC in this location (approx. 5–7%). * **Medullary Carcinoma:** This arises from **Parafollicular C-cells**, which are derived from the **ultimobranchial body** (4th branchial pouch), not the thyroglossal duct. Therefore, Medullary carcinoma is virtually never found in a TGDC. * **Anaplastic Carcinoma:** This is an extremely rare, undifferentiated tumor. While theoretically possible, it is not the "most common." **3. NEET-PG High-Yield Pearls:** * **Sistrunk Operation:** The definitive surgical treatment for TGDC, involving excision of the cyst, the entire duct, and the **central portion of the hyoid bone** to prevent recurrence. * **Diagnosis:** Often an incidental finding on histopathology after a Sistrunk procedure. * **Management of Malignancy:** If a TGDC contains PTC, a Sistrunk procedure is often sufficient if the thyroid gland itself is normal on ultrasound. Total thyroidectomy is considered if there are suspicious nodules in the main thyroid gland or cervical lymphadenopathy.

Q: Which of the following is true of a carotid body tumor?

All of the above.. A **Carotid Body Tumor (CBT)**, also known as a **Chemodectoma**, is a rare neoplasm arising from the chemoreceptor cells located at the bifurcation of the common carotid artery. ### **Detailed Explanation** * **Option A (Non-chromaffin paraganglioma):** Carotid bodies are derived from the neural crest. Unlike the adrenal medulla, these cells do not stain with chromium salts (non-chromaffin) and do not typically secrete catecholamines. They function as chemoreceptors sensitive to changes in arterial pH, $pCO_2$, and $pO_2$. * **Option B (Good Prognosis):** Most CBTs are slow-growing, painless, and benign. With modern surgical techniques and preoperative embolization, the prognosis is excellent, although there is a risk of cranial nerve injury (CN IX, X, XI, XII) during excision. * **Option C (Rarely metastasizes):** Only about 5–10% of carotid body tumors are malignant. Malignancy is defined by **clinically documented metastasis** to regional lymph nodes or distant organs (lungs/bones), rather than histological appearance. Since all three statements are accurate descriptions of the pathology, **Option D** is the correct answer. ### **High-Yield Clinical Pearls for NEET-PG** * **Fontaine’s Sign:** The tumor is vertically fixed but **horizontally mobile** (due to its location within the carotid sheath). * **Lyre’s Sign:** On angiography, there is a characteristic splaying/widening of the carotid bifurcation. * **Shamblin Classification:** Used to grade the tumor based on its involvement/encasement of the carotid vessels. * **Genetics:** Approximately 10–35% are familial (often autosomal dominant); these are more likely to be bilateral and are associated with **SDHD gene** mutations. * **Treatment of Choice:** Surgical excision, often preceded by preoperative embolization to reduce vascularity.

Q: What is true regarding a ranula?

It is a cystic swelling in the floor of the mouth.. A **ranula** is a clinical term for a translucent, bluish, cystic swelling found in the **floor of the mouth**. It typically arises from the **sublingual salivary gland** due to trauma or obstruction of the ducts (Ducts of Rivinus). ### Why Option B is Correct: The term "ranula" is derived from the Latin word *rana* (frog), as the swelling resembles the translucent underbelly of a frog. It is classically located lateral to the midline in the floor of the mouth, superior to the mylohyoid muscle. ### Why Other Options are Incorrect: * **Option A:** An **epulis** is a non-specific clinical term for any tumor-like swelling or lump on the **gingiva** (gums), not the floor of the mouth. * **Option C:** A **thyroglossal cyst** is a midline neck swelling that moves with protrusion of the tongue and deglutition; it is an embryological remnant of the thyroglossal duct. * **Option D:** While some ranulas are retention cysts, the majority (especially large ones) are **extravasation pseudocysts**. They lack an epithelial lining and are formed by mucus leaking into the surrounding submucosal tissues. Therefore, calling it a "mucus retention cyst" is technically inaccurate in most clinical cases. ### High-Yield Clinical Pearls for NEET-PG: * **Plunging Ranula:** Occurs when mucus extravasates through or around the **mylohyoid muscle**, presenting as a swelling in the submandibular region (neck). * **Management:** The treatment of choice is **Marsupialization** for simple ranulas, though the definitive treatment to prevent recurrence is the **excision of the sublingual gland**. * **Appearance:** It is typically painless, fluctuant, and transilluminant.

Question 1

A 55-year-old chronic smoker presents with complaints of hoarseness of voice and a single enlarged painless lymph node in the left supraclavicular region. What is the next step in management?

Accepted Answer

Excision biopsy of the lymph node

Answer

CT scan of the chest

Answer

Sputum examination for AFB

Answer

Laryngoscopy and chest X-ray

Question 2

What is the treatment of choice to manage a symphyseal fracture in an 8-year-old child?

Accepted Answer

Cap splint with circumferential wiring

Answer

Intermaxillary fixation

Answer

Open reduction

Answer

No treatment indicated

Question 3

Which type of carcinoma most commonly arises in a thyroglossal cyst?

Accepted Answer

Papillary

Answer

Follicular

Answer

Medullary

Answer

Anaplastic

Question 4

A 25-year-old male patient presents with a bony expansile swelling of the right body of the mandible and mild paresthesia of the right inferior alveolar nerve. An OPG shows a multilocular radiolucency without root resorption. What is the management of an odontogenic keratocyst?

Accepted Answer

Enucleation with peripheral ostectomy

Answer

Marsupialization

Answer

Enucleation

Answer

Resection and radiation

Question 5

During the surgical removal of a torus palatinus, a portion of the palatal bone was fractured. What would you expect to occur?

Accepted Answer

An opening into the nasal cavity

Answer

An opening into the maxillary antrum

Answer

A vertical fracture of the maxilla

Answer

A horizontal fracture of the maxilla

Question 6

Which of the following is true of a carotid body tumor?

Accepted Answer

All of the above.

Answer

It is a non-chromaffin paraganglioma.

Answer

It has a good prognosis.

Answer

It rarely metastasizes.

Question 7

A 80-year-old edentulous patient presents with a midline tumor of the lower jaw, involving the alveolar margin. What is the treatment of choice?

Accepted Answer

Segmental mandibulectomy

Answer

Hemi-mandibulectomy

Answer

Commando operation

Answer

Marginal mandibulectomy

Question 8

Rubber band extraction is indicated in a haemophiliac patient as it facilitates the extraction by:

Accepted Answer

Necrosis of the periodontal ligament (PDL)

Answer

Traction force on the periodontal ligament (PDL)

Answer

Necrosis of the alveolar bone

Answer

Pulling of the periodontal ligament (PDL)

Question 9

What is the most commonly used flap in head and neck surgery?

Accepted Answer

Pectoralis major flap

Answer

Deltopectoral flap

Answer

Latissimus dorsi flap

Answer

Temporalis flap

Question 10

What is true regarding a ranula?

Accepted Answer

It is a cystic swelling in the floor of the mouth.

Answer

It is also called an epulis.

Answer

It is a type of thyroglossal cyst.

Answer

It is a type of mucus retention cyst.

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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