Head and Neck Surgery Practice Questions

Q: Which of the following statements about Zenker's diverticulum is false?

It is the most common esophageal diverticulum. ***It is the most common esophageal diverticulum*** - This statement is **false**. Zenker's diverticulum is the most common type of **pharyngoesophageal diverticulum**, not esophageal diverticulum. - **Midesophageal diverticula** (traction diverticula) and **epiphrenic diverticula** are types of true esophageal diverticula that are more common than Zenker's diverticulum. *Most patients are above 50 years of age* - This statement is **true**. Zenker's diverticulum is typically a disease of **older individuals**, with most patients presenting over the age of 50. - It results from **cricopharyngeal muscle dysfunction** and increased intraluminal pressure over time. *Mucosal outpouching through the Killian's triangle* - This statement is **true**. Zenker's diverticulum is a **false diverticulum**, meaning it involves only the mucosa and submucosa. - It protrudes through **Killian's triangle**, a weak area between the cricopharyngeal muscle and the thyropharyngeal muscle. *Halitosis is commonly associated with Zenker's diverticulum* - This statement is **true**. Food and debris can become trapped within the diverticulum. - The decaying material can lead to **bad breath** (halitosis) and a sour taste.

Q: For lower lip carcinoma of <1 cm in size, the treatment of choice will be:

Excision. ***Excision*** - For **small lesions (<1 cm)** of lower lip carcinoma, **surgical excision** with adequate margins is the standard and most effective treatment. - This approach offers excellent **local control** and allows for **histopathological evaluation** of the tumor and margins. *Radiation* - While radiation therapy can be effective for lip carcinoma, it is generally reserved for **larger tumors**, those with positive margins after excision, or patients who are **poor surgical candidates**. - For small lesions, surgical excision typically provides a better cosmetic and functional outcome with a single treatment. *Chemotherapy* - **Chemotherapy** is rarely used as a primary treatment for early-stage lower lip carcinoma; its role is usually limited to **advanced or metastatic disease**. - It does not offer the same local control as surgery or radiation for small, localized lesions. *Radiation and chemotherapy* - **Combined modality therapy** with radiation and chemotherapy is typically reserved for **locally advanced disease**, tumors with high-risk features, or patients with **nodal involvement**. - For a small lesion (<1 cm), this approach would be **overtreatment** and expose the patient to unnecessary side effects.

Q: Which of the following statements about Laryngeal carcinoma is false?

More common in females. ***More common in females*** - This statement is **false** because laryngeal carcinoma is significantly **more common in males** than in females, with a male-to-female ratio of about 4:1. - The higher incidence in males is primarily attributed to higher rates of **smoking and alcohol consumption**, which are major risk factors. *After laryngectomy, esophageal voice can be used* - This statement is **true**; an **esophageal voice** is one method of voice rehabilitation after a total laryngectomy, where air is swallowed and then expelled to vibrate the pharyngoesophageal segment. - Other options for voice restoration include **tracheoesophageal puncture (TEP) with a voice prosthesis** and **electrolarynx**. *Smoking is the most important risk factor* - This statement is **true**; **smoking** is the single most significant modifiable risk factor for laryngeal carcinoma, increasing the risk by many-fold depending on duration and intensity. - **Alcohol consumption** acts synergistically with smoking to further elevate the risk. *Common in patients over 40 years of age* - This statement is **true**; laryngeal carcinoma predominantly affects individuals in **middle to older age groups**, with peak incidence typically occurring between 50 and 70 years. - The disease is rare in individuals under 40, although incidence in younger patients may be increasing due to rising **HPV-related oropharyngeal cancers**.

Q: Which of the following sinuses is most commonly predisposed to malignancy?

Maxillary. ***Maxillary*** - The **maxillary sinus** is the most common site for **paranasal sinus malignancies**, accounting for approximately 80% of these cancers. - This predisposition is thought to be due to its large surface area and exposure to carcinogenic substances inhaled through the nasal cavity. *Ethmoid* - While the ethmoid sinus can be involved in malignancy, it ranks second to the **maxillary sinus** in terms of frequency. - Tumors originating here often present with ophthalmic symptoms due to its proximity to the orbit. *Frontal* - Malignancies of the **frontal sinus** are relatively rare compared to those in the maxillary and ethmoid sinuses. - Due to its location, symptoms might include forehead pain or swelling. *Sphenoid* - The **sphenoid sinus** is the least common site for paranasal sinus malignancies. - Tumors in this sinus are often difficult to diagnose early due to its deep and central location, with symptoms potentially involving cranial nerve palsies.

Q: Which of the following sites of Ca larynx has the best prognosis?

Glottic. ***Glottic*** - **Glottic carcinomas** tend to have the best prognosis among laryngeal cancers because they present early with symptoms like **hoarseness of voice**, leading to earlier detection. - The **vocal cords** lack extensive lymphatic drainage, which delays metastatic spread compared to other laryngeal subsites. *Supraglottis* - **Supraglottic carcinomas** often present at an advanced stage because early symptoms are vague or absent. - This region has a **rich lymphatic network**, leading to a higher incidence of regional lymph node metastases and a poorer prognosis compared to glottic tumors. *Subglottis* - **Subglottic carcinomas** are very rare and often present at an advanced stage due to the late onset of symptoms. - They also have a **higher likelihood of early distant metastasis** and regional lymph node involvement, contributing to a worse prognosis. *All have poor prognosis* - This statement is incorrect because there is a significant difference in prognosis among the various laryngeal subsites. - While laryngeal cancer can be serious, the **glottic region** generally has a much better prognosis due to early detection and limited lymphatic spread relative to supraglottic and subglottic cancers.

Q: Membrane incised during hemilaryngectomy is

Thyrohyoid membrane. ***Thyrohyoid membrane*** - During a **hemilaryngectomy**, the **thyrohyoid membrane** is typically incised to allow access to the laryngeal structures for tumor resection. - This membrane connects the **thyroid cartilage** to the hyoid bone, and its incision facilitates surgical manipulation of the larynx. *Cricothyroid membrane* - The **cricothyroid membrane** is located between the **cricoid** and **thyroid cartilages** and is primarily used for emergency airway access (cricothyrotomy), not for routine hemilaryngectomy. - Incising this membrane would provide inadequate surgical access for a hemilaryngectomy and is not the primary target for this procedure. *Aryepiglottic fold* - The **aryepiglottic fold** forms the lateral boundary of the laryngeal inlet and contains the **aryepiglottic muscle**. - While it is a key structure in the larynx, it is part of the laryngeal framework and is not a membrane that is typically incised to gain surgical access during a hemilaryngectomy. *Infralaryngeal space* - The **infralaryngeal space** refers to the region below the larynx, primarily the trachea. - This is not a membrane; instead, it is an anatomical region, and incising it would not provide direct access to the laryngeal structures for tumor removal in a hemilaryngectomy.

Q: Hemorrhage after thyroidectomy is most commonly due to which artery?

Inferior thyroid artery. ***Inferior thyroid artery*** - The **inferior thyroid artery** is the **most common source** of hemorrhage after thyroidectomy due to its **variable anatomy** with multiple small branches that are challenging to secure. - It arises from the **thyrocervical trunk** (branch of subclavian artery) and supplies the lower poles and posterior aspects of the thyroid gland. - The **intimate relationship with the recurrent laryngeal nerve** makes dissection more delicate, and the numerous small branches are prone to slipped ligatures postoperatively. - Hemorrhage from the inferior thyroid artery branches is the leading cause of postoperative bleeding requiring re-exploration. *Superior thyroid artery* - While the **superior thyroid artery** can be a source of bleeding, it is typically the **first vessel ligated** during thyroidectomy at the upper pole, making it well-secured early in the procedure. - It arises from the **external carotid artery** and has a more consistent anatomy with fewer branches compared to the inferior thyroid artery. - When properly ligated at the beginning of surgery, bleeding from this vessel is less common in the postoperative period. *External carotid artery* - The **external carotid artery** itself does not directly supply the thyroid gland and is a larger, more deeply situated vessel. - Direct injury to the external carotid artery during routine thyroidectomy is extremely rare and would represent a major surgical complication. *Internal carotid artery* - The **internal carotid artery** does not supply the thyroid gland and runs posterolateral to the surgical field. - Injury to this vessel during thyroidectomy would be a catastrophic and extremely rare complication, not a source of routine postoperative hemorrhage.

Q: Sialolithiasis is most commonly seen in which gland?

Submandibular. ***Submandibular*** - The **submandibular gland** is the most common site for **sialolithiasis** due to several factors. - Its **Wharton's duct** is long, tortuous, and travels against gravity, and the saliva from the submandibular gland is more alkaline and contains a higher concentration of mucin and calcium, all contributing to stone formation. *Parotid* - While sialolithiasis can occur in the **parotid gland**, it is much less common than in the submandibular gland. - The saliva from the parotid gland is more serous, making stone formation less likely. *Sublingual* - **Sialolithiasis** in the **sublingual gland** is exceedingly rare. - The numerous small ducts and serous nature of its secretions make stone formation highly unlikely. *Minor salivary gland* - **Minor salivary glands** are rarely affected by **sialolithiasis**. - While they can develop other pathologies like mucoceles, stone formation is not a common presentation.

Question 1

In the context of oropharyngeal cancer, for which nodal status is Level III lymph node dissection indicated?

Accepted Answer

N2

Answer

N3

Answer

N0

Answer

N1

Question 2

Which of the following statements about Zenker's diverticulum is false?

Accepted Answer

It is the most common esophageal diverticulum

Answer

Most patients are above 50 years of age

Answer

Mucosal outpouching through the Killian's triangle

Answer

Halitosis is commonly associated with Zenker's diverticulum

Question 3

For lower lip carcinoma of <1 cm in size, the treatment of choice will be:

Accepted Answer

Excision

Answer

Radiation

Answer

Chemotherapy

Answer

Radiation and chemotherapy

Question 4

A patient presents with cancer of the larynx involving the left false cord, left arytenoid, and left aryepiglottic fold, with bilateral mobile true cords. What is the treatment of choice in this patient?

Accepted Answer

Supraglottic laryngectomy (Horizontal partial laryngectomy)

Answer

Total laryngectomy

Answer

Radiotherapy followed by chemotherapy

Answer

Vertical hemilaryngectomy

Question 5

Which of the following statements about Laryngeal carcinoma is false?

Accepted Answer

More common in females

Answer

After laryngectomy, esophageal voice can be used

Answer

Smoking is the most important risk factor

Answer

Common in patients over 40 years of age

Question 6

Which of the following sinuses is most commonly predisposed to malignancy?

Accepted Answer

Maxillary

Answer

Ethmoid

Answer

Frontal

Answer

Sphenoid

Question 7

Which of the following sites of Ca larynx has the best prognosis?

Accepted Answer

Glottic

Answer

Supraglottis

Answer

All have poor prognosis

Answer

Subglottis

Question 8

Membrane incised during hemilaryngectomy is

Accepted Answer

Thyrohyoid membrane

Answer

Aryepiglottic fold

Answer

Cricothyroid membrane

Answer

Infralaryngeal space

Question 9

Hemorrhage after thyroidectomy is most commonly due to which artery?

Accepted Answer

Inferior thyroid artery

Answer

External carotid artery

Answer

Superior thyroid artery

Answer

Internal carotid artery

Question 10

Sialolithiasis is most commonly seen in which gland?

Accepted Answer

Submandibular

Answer

Parotid

Answer

Sublingual

Answer

Minor salivary gland

Head and Neck Surgery — MCQs

Head and Neck Surgery — MCQs

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