Head and Neck Oncology — Staging and Management (Oral, Laryngeal, Salivary, Neck Nodes) MCQs

ENT · 65 free questions with answers & explanations.

  1. A 58-year-old male presents with a 3 cm squamous cell carcinoma of the right oral tongue with a clinically negative neck (cN0). Depth of invasion on MRI is 8 mm. What is the most appropriate management of the neck?
  2. According to AJCC 8th edition staging, a T2N0M0 squamous cell carcinoma of the glottic larynx is best characterized by which of the following?
  3. A 45-year-old female undergoes total thyroidectomy and is found to have a 4 cm parotid mass. Fine needle aspiration shows mucoepidermoid carcinoma. Which prognostic grading system is most widely used for this tumor?
  4. A 62-year-old male has a clinically N2b neck (multiple ipsilateral nodes, largest 3.5 cm, no extranodal extension on imaging). Following concurrent chemoradiotherapy, residual lymphadenopathy persists at 10 weeks. What is the appropriate next step?
  5. Nasopharyngeal carcinoma (NPC) is staged using AJCC 8th edition. A tumor that involves the parapharyngeal space and extends to the prevertebral musculature, with a single ipsilateral cervical node of 4 cm and no distant metastasis, is classified as:
  6. A 58-year-old male presents with a 3 cm ulcerative lesion on the lateral tongue. Biopsy confirms squamous cell carcinoma. CT neck shows a single ipsilateral 2.5 cm lymph node with no extranodal extension (ENE). According to AJCC 8th edition TNM staging, what is the N category?
  7. Which neck dissection preserves the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve while removing lymph node levels I–V?
  8. A patient with T3N0 squamous cell carcinoma of the supraglottis is planned for primary radiotherapy. Which statement about elective nodal irradiation is most accurate?
  9. A pleomorphic adenoma of the parotid gland is best managed by which surgical approach to minimize recurrence?
  10. The most common malignant tumor of the parotid gland in adults is:
  11. A 58-year-old male smoker presents with a 3 cm ulceroproliferative lesion on the lateral border of the tongue with ipsilateral 2.5 cm single mobile cervical lymph node. Biopsy confirms squamous cell carcinoma. What is the AJCC 8th edition TNM staging?
  12. A patient undergoes selective neck dissection (SND) levels I–III for an oral tongue SCC with clinically N0 neck. Which nerve is at greatest risk of injury during dissection of level IIb (submuscular recess)?
  13. A 52-year-old woman presents with a slow-growing painless parotid swelling. Fine-needle aspiration cytology shows hypocellular stroma with myxoid background, bland epithelial cells in a chondromyxoid matrix, and dual-cell population. The most likely diagnosis and the surgical procedure of choice are:
  14. In transoral robotic surgery (TORS) for oropharyngeal SCC (p16-positive), what is the clinical significance of p16 immunohistochemistry as a surrogate marker for HPV status?
  15. A 45-year-old man presents with progressive dysphagia and a neck mass. Imaging reveals a hypopharyngeal tumour at the pyriform sinus with bilateral lymphadenopathy. Which elective neck nodal level does pyriform sinus carcinoma characteristically metastasize to first, and what is the highest-risk occult contralateral nodal level?
  16. A 58-year-old male presents with a 2.5 cm carcinoma of the mobile tongue (T2) with a single ipsilateral level II lymph node measuring 2.8 cm (clinically palpable, not fixed). Staging under the AJCC 8th edition would be:
  17. A patient with T1N0M0 glottic laryngeal carcinoma (true vocal cord only, normal mobility) is being offered treatment options. Which of the following correctly describes the expected 5-year local control rate for radiotherapy versus transoral laser microsurgery (TLM) for T1 glottic cancer?
  18. An elective neck dissection specimen from a level I–III selective neck dissection for oral cavity cancer is sent for histopathology. The pathologist identifies a single 1.5 cm lymph node at level II with microscopic tumor deposits and no extranodal extension. According to AJCC 8th edition, what is the pathological N classification?
  19. A 65-year-old woman presents with a slow-growing parotid mass confirmed on FNAC as a Warthin's tumor. She is a heavy smoker. Which of the following statements about Warthin's tumors is CORRECT?
  20. During radical neck dissection, the surgeon identifies the accessory nerve (CN XI) coursing through the posterior triangle. Which fascial compartment must be opened to identify and preserve it, and at which landmark does it enter the sternocleidomastoid muscle?
  21. A 58-year-old male with T2N1M0 squamous cell carcinoma of the glottis (right true vocal cord with subglottic extension, right level II lymph node 2.5 cm) is planned for definitive treatment. Which is the MOST appropriate management?
  22. A 65-year-old woman presents with a painless right parotid swelling that has been slowly enlarging for 8 years. Recent rapid growth and facial nerve weakness suggest malignant transformation. Fine-needle aspiration cytology shows carcinoma ex pleomorphic adenoma. The MOST important prognostic factor determining survival is:
  23. Which of the following is the MOST common site of occult (clinically node-negative) cervical metastasis that mandates elective neck dissection when treating oral tongue squamous cell carcinoma ≥4mm depth of invasion?
  24. A modified radical neck dissection (MRND) Type III differs from a radical neck dissection in that it preserves:
  25. A 45-year-old with HPV-positive (p16+) oropharyngeal squamous cell carcinoma T2N2bM0 undergoes definitive chemoradiation. Compared to HPV-negative oropharyngeal carcinoma at the same stage, which statement is CORRECT?
  26. According to the 8th edition AJCC staging, a patient with a 4.5 cm squamous cell carcinoma of the oral tongue with a depth of invasion of 12 mm and a single ipsilateral lymph node of 2.5 cm without extranodal extension is classified as:
  27. A 55-year-old non-smoker, non-drinker male presents with a cystic neck mass at level II. Fine needle aspiration cytology shows squamous cells. p16 immunohistochemistry is strongly positive. The most appropriate next investigation is:
  28. A 60-year-old man with a T2N0 glottic carcinoma (squamous cell, no subglottic extension) undergoes radiotherapy. He develops recurrence confined to the glottis 18 months later. The surgical option offering the best functional preservation is:
  29. In a modified radical neck dissection (type III), which of the following structures are preserved?
  30. A 48-year-old woman presents with a painless right parotid swelling. MRI shows a well-defined 3 cm tumor with slow growth over 3 years. Cytology from FNAC suggests a pleomorphic adenoma. The surgical treatment of choice is:
  31. A 52-year-old male smoker presents with a T2N1M0 squamous cell carcinoma of the glottis. The ipsilateral level II lymph node measures 2.8 cm and is clinically palpable. The standard treatment of choice is:
  32. Regarding neck node staging in head and neck cancer, an ipsilateral lymph node measuring 5.5 cm in greatest dimension without extranodal extension is classified as:
  33. A 60-year-old male presents with a painless right parotid swelling that is hard and fixed to skin. FNAC shows carcinoma cells. Intraoperative frozen section reveals high-grade mucoepidermoid carcinoma with facial nerve involvement. The appropriate surgical management is:
  34. Which of the following salivary gland malignancies has the best overall 5-year prognosis?
  35. A patient with oral cavity SCC has a T3N0M0 lesion of the floor of mouth. Elective (prophylactic) neck dissection is recommended because the risk of occult cervical nodal metastasis at this T stage is approximately:
  36. A 55-year-old smoker presents with a 2 cm supraglottic carcinoma without cord fixation and a single ipsilateral 2.5 cm lymph node. According to AJCC 8th edition TNM staging, this is classified as:
  37. A 60-year-old patient has a pleomorphic adenoma of the parotid gland (4 cm), involving the superficial lobe with no facial nerve involvement and no nodal disease. The treatment of choice is:
  38. In a modified radical neck dissection (MRND), which of the following structures is routinely PRESERVED compared to a radical neck dissection?
  39. A neck node biopsy in a 45-year-old shows metastatic squamous cell carcinoma. PET-CT and panendoscopy fail to reveal a primary tumor. p16 immunostaining of the node is strongly positive. The most likely occult primary site is:
  40. Warthin's tumor (papillary cystadenoma lymphomatosum) of the parotid gland characteristically:
  41. A 58-year-old male smoker presents with a 3 cm right vocal cord squamous cell carcinoma with normal cord mobility, no subglottic extension, and no regional lymph nodes. According to AJCC 8th edition, this is staged as:
  42. In selective neck dissection for a clinically N0 neck in supraglottic carcinoma, which lymph node levels are routinely dissected?
  43. A 45-year-old male has a 2 cm mass in the parotid gland. Fine needle aspiration cytology shows features of mucoepidermoid carcinoma. Which of the following is the most common malignant tumor of the parotid gland?
  44. A patient with nasopharyngeal carcinoma (NPC) is found to have bilateral cervical lymph nodes measuring 6 cm, bilateral, with no distant metastasis. The T stage is T2. The AJCC 8th edition N stage for bilateral cervical nodes measuring 6 cm is:
  45. Adenoid cystic carcinoma of the parotid is known for a characteristic spread pattern that explains its late recurrences and distant metastases years after treatment. This pattern is:
  46. A 55-year-old male smoker presents with hoarseness for 8 months. Laryngoscopy reveals a right true vocal cord lesion crossing the anterior commissure with normal cord mobility. CT shows no cartilage invasion and no nodes. According to AJCC 8th edition, this is staged as:
  47. A patient with a 4 cm squamous cell carcinoma of the floor of mouth with a single ipsilateral lymph node 2.5 cm in maximum dimension, clinically node positive with no extranodal extension, is staged as:
  48. A pleomorphic adenoma of the superficial lobe of the parotid gland is best managed by:
  49. A 50-year-old presents with a painless firm neck mass at level II for 6 weeks. FNAC shows squamous cell carcinoma. Panendoscopy and CT of neck/chest/abdomen are negative for a primary lesion. HPV p16 immunostaining of the FNAC is strongly positive. The most appropriate next step is:
  50. Which of the following is the most common malignant tumor of the salivary glands overall?
  51. A 60-year-old man undergoes total laryngectomy for T4a glottic carcinoma. Six months post-surgery he develops tracheoesophageal voice using a Blom-Singer prosthesis but notes aspiration. The most likely cause is:
  52. Extranodal extension (ENE) of metastatic squamous cell carcinoma in a cervical lymph node changes the nodal stage to at minimum:
  53. A 55-year-old male smoker presents with a T2N1M0 squamous cell carcinoma of the mobile tongue (oral tongue). According to AJCC 8th edition staging, this is classified as:
  54. Which neck dissection removes levels I–V lymph nodes along with the sternocleidomastoid muscle, internal jugular vein, and spinal accessory nerve?
  55. A patient with T1 glottic carcinoma (confined to vocal cord, mobile) is best treated with:
  56. Pleomorphic adenoma of the parotid is best managed by which surgical approach to minimise recurrence?
  57. The 'Waldeyer's ring' consists of which lymphoid tissues?
  58. A 60-year-old male with a 2 cm firm neck node at level II, no identifiable primary on examination, is found on PET-CT to have no primary. Biopsy shows squamous cell carcinoma, p16 positive. The most appropriate next step is:
  59. Warthin's tumour (papillary cystadenoma lymphomatosum) of the parotid gland is characteristically:
  60. A 28-year-old woman presents with a smooth, fluctuant, non-tender swelling in the anterior triangle of the neck at the level of the carotid bifurcation. It transilluminates brilliantly and moves laterally but not vertically. FNA reveals clear fluid with no cells except occasional lymphocytes. What is the most likely diagnosis?
  61. A 4-year-old child has a midline neck swelling that moves upward on swallowing and also on tongue protrusion. It was found to be a thyroglossal cyst. During surgical excision, which part of which bone must be removed to prevent recurrence?
  62. A 55-year-old man undergoes total thyroidectomy. Two days postoperatively, he develops circumoral tingling, positive Chvostek's sign, carpopedal spasm, and prolonged QT interval on ECG. Serum calcium is 6.8 mg/dL. What is the most likely cause and appropriate immediate treatment?
  63. A 48-year-old man presents with a painless level II neck node. FNAC reveals metastatic squamous cell carcinoma. After thorough clinical examination and panendoscopy, no primary tumour is found. PET-CT is also negative for the primary. Which site is the most common occult primary in this scenario?
  64. During a radical neck dissection, the surgeon must preserve the cervical rootlets contributing to the phrenic nerve to avoid hemidiaphragm paralysis. The phrenic nerve arises predominantly from which cervical root?
  65. A 35-year-old woman is found to have a parotid swelling. FNAC reveals a tumour with a biphasic pattern of epithelial cells in a myxochondroid stroma. This is the most common parotid tumour. Surgical excision reveals the tumour has a thin pseudocapsule with satellite nodules. Which operation should have been performed to minimise recurrence?
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