Salivary Gland and Neck Swelling Disorders (ENT Perspective) MCQs

ENT · 43 free questions with answers & explanations.

1. A 50-year-old male presents with a painless, slow-growing mass in the parotid gland for 10 years. On CT, the mass is well-defined with areas of T2 hyperintensity on MRI suggesting cartilaginous or myxoid material. The most likely diagnosis is:
2. A 35-year-old male presents with a painless, fluctuant swelling at the angle of the mandible. On aspiration, the fluid is watery and contains cholesterol crystals. What is the most likely diagnosis?
3. Frey's syndrome is a recognized complication following parotidectomy. What is the mechanism and most effective treatment?
4. A 45-year-old woman presents with bilateral parotid swelling, dry eyes, and dry mouth. On serology, she is anti-Ro/SSA positive. Salivary gland ultrasound shows parenchymal inhomogeneity with multiple hypoechoic foci. Salivary gland biopsy shows periductal lymphocytic infiltration with focus score of 3. The diagnosis is:
5. A thyroglossal duct cyst is found at the hyoid bone level in a 10-year-old. The Sistrunk procedure for its excision includes removal of which structure along with the cyst tract?
6. A 40-year-old male with a lateral neck mass undergoes fine needle aspiration cytology showing squamous cells in cystic fluid. Which investigation is most critical to perform next before assuming a diagnosis of branchial cyst?
7. Frey's syndrome (auriculotemporal nerve syndrome) is a recognized complication after parotid surgery. The underlying pathophysiology is:
8. A 55-year-old male presents with a painful enlarging submandibular swelling that increases at mealtimes. Ultrasound shows a hyperechoic shadow with posterior acoustic shadowing in the submandibular duct. The most common composition of submandibular salivary calculi is:
9. A 35-year-old woman presents with a non-tender, smooth, fluctuant swelling in the anterior triangle of the neck that transilluminates brilliantly. The swelling has been present since childhood and increases in size during upper respiratory tract infections. The most likely diagnosis is:
10. Adenoid cystic carcinoma of the parotid gland is known for perineural invasion. Which of the following best describes its behaviour and the clinical consequence of perineural invasion?
11. A 40-year-old patient on long-term antihypertensive therapy presents with bilateral painless parotid gland enlargement. Which drug class is the most common culprit?
12. A 50-year-old man with a level III neck node biopsy showing metastatic squamous cell carcinoma; primary work-up includes CT-PET, panendoscopy, and random mucosal biopsies. The neck primary occult SCC workup should include HPV testing because:
13. A 50-year-old male presents with a painless, slow-growing parotid swelling. FNAC reveals 'basaloid cells in a cylindromatous pattern with mucoid stromal deposits.' CT shows the mass involves deep lobe with perineural spread along the facial nerve. The most likely diagnosis is:
14. A 25-year-old male presents with a painless neck swelling at the anterior border of the sternocleidomastoid muscle at the junction of the upper and middle thirds. The swelling transilluminates and has no pulsations. It has been present since childhood. The most likely embryological remnant is:
15. A 60-year-old female with known Sjogren's syndrome presents with bilateral parotid enlargement, dry mouth, dry eyes, and an elevated serum anti-Ro (SS-A) antibody. Histopathology of a labial salivary gland biopsy shows focal lymphocytic sialadenitis with a focus score of ≥1. Which malignancy is she at significantly higher risk of developing compared to the general population?
16. A 40-year-old woman presents with recurrent bilateral parotid swelling, xerophthalmia, and xerostomia. ANA and anti-SSA/SSB antibodies are positive. Minor salivary gland biopsy shows focal lymphocytic sialadenitis with a focus score ≥1. The most common malignancy that may develop in this condition is:
17. A 35-year-old presents with a soft, compressible, translucent midline neck swelling that moves upward with tongue protrusion and swallowing. It is located between the hyoid bone and the tongue base. The MOST appropriate definitive management is:
18. A Warthin tumor (papillary cystadenoma lymphomatosum) has a strong association with which risk factor, and what percentage of cases are bilateral?
19. Carotid body tumors (paragangliomas) at the carotid bifurcation are characterized by which angiographic finding?
20. A 50-year-old man presents with bilateral parotid enlargement, dry eyes, and dry mouth. Salivary gland biopsy shows periductal lymphocytic infiltrate with glandular destruction. Serological tests are positive for anti-Ro (SS-A) antibodies. The most appropriate management is:
21. A 35-year-old woman has a non-tender, firm neck swelling anterior to the sternocleidomastoid at the junction of upper and middle thirds. Ultrasound shows a cystic lesion with internal septations. FNAC reveals thin squamous cells and cholesterol crystals. The most likely diagnosis is:
22. Frey's syndrome (auriculotemporal nerve syndrome) occurs after parotidectomy due to aberrant reinnervation. The symptom triad consists of:
23. A 30-year-old male presents with a painless, soft, fluctuant neck swelling at the anterior border of the sternocleidomastoid at its junction with the upper third. The swelling transilluminates and has been present since childhood. The most likely diagnosis is:
24. The Frey syndrome (gustatory sweating) following parotid surgery is caused by:
25. A patient presents with recurrent painful swelling of the submandibular gland on eating, especially during gustatory stimulation. Ultrasound shows an echogenic shadow with posterior acoustic shadowing in Wharton's duct. The most likely diagnosis and its commonest stone composition are:
26. A 25-year-old female with history of recurrent oral ulcers and bilateral painless enlargement of parotid glands is found to have hypercalcaemia. The most likely diagnosis is:
27. A 30-year-old presents with a painless fluctuant swelling at the anterior border of the sternocleidomastoid muscle at the junction of its upper and middle thirds. The swelling transilluminates. The most likely diagnosis is:
28. A 25-year-old presents with recurrent painful swelling of the submandibular gland during meals. Plain X-ray shows a radiopaque shadow at the floor of the mouth. The best initial treatment step is:
29. Neck dissection nomenclature: Level IV nodes are located:
30. Fine needle aspiration cytology of a neck node shows epithelial-lined cyst with lymphoid stroma and squamous lining in a 50-year-old smoker. This appearance is most consistent with:
31. A 30-year-old female presents with a fluctuant swelling in the floor of the mouth extending into the neck below the mylohyoid muscle. Ultrasound shows a plunging lesion. The most likely diagnosis is:
32. A branchial cyst presenting as a fluctuant mass at the anterior border of the sternocleidomastoid muscle at the junction of its upper and middle thirds represents a cyst arising from which pharyngeal cleft remnant?
33. Sialolithiasis most commonly affects which salivary gland, and what property of its saliva accounts for this predisposition?
34. A 35-year-old with known HIV presents with bilateral painless parotid gland enlargement. The most likely diagnosis is:
35. A 35-year-old woman presents with a painless, slowly enlarging neck swelling at the anterior border of the sternocleidomastoid at the junction of the upper and middle thirds. It has been present since childhood. Aspiration yields milky-white fluid. The most likely diagnosis is:
36. A 50-year-old presents with recurrent painful right submandibular swelling that worsens at mealtimes and subsides afterwards. USG reveals a calculus in Wharton's duct. The most appropriate definitive treatment for an anterior duct calculus is:
37. A 14-year-old girl has a midline neck swelling that elevates on protrusion of the tongue and moves with swallowing. It has developed a sinus tract after repeated infections. The embryological basis of this lesion is persistence of:
38. Frey's syndrome (gustatory sweating) after parotidectomy is caused by aberrant regeneration of which type of nerve fibres?
39. A 30-year-old woman presents with a cystic, fluctuant swelling in the anterior triangle of the neck at the junction of the upper and middle third, anterior to the sternocleidomastoid. It transilluminates brightly and moves on swallowing and tongue protrusion. The most likely diagnosis is:
40. A patient presents with a painless, stony hard, mobile submandibular gland swelling that enlarges during meals. Plain X-ray (mandible occlusal view) shows a radio-opaque shadow in the floor of mouth. The most appropriate treatment is:
41. Frey's syndrome (auriculotemporal syndrome) is a well-known complication following which procedure?
42. Fine needle aspiration cytology (FNAC) of a lateral neck mass shows 'blue bodies' (mucoid material) surrounded by squamous cells and lymphocytes. The most likely diagnosis is:
43. Parapharyngeal space abscess characteristically displaces which structure medially on examination and imaging?