2015 Comprehensive Head & Neck Oncology Lecture Series: Post Test

1.

1 point

Fine needle aspiration biopsy/cytology for salivary masses:

Is not helpful as patients will have surgery anyway.

Is not very sensitive in determining malignancy vs benign.

Is highly specific as to malignancy type.

Can assist with surgery planning/extent and patient counseling.

2.

1 point

Comparing thyroid nodules in children and adults, what is the approximate, overall rate of thyroid malignancy?

1% in children, 5% in adults

25% in children, 5% in adults

12% in children, 5% in adults

5 % in children, 10% in adults

3.

1 point

The most significant prognostic feature of well-differentiated thyroid malignancy is:

Tumor grade/histologic variant.

Age.

Metastases.

Extrathyroidal extension

Tumor size.

4.

1 point

T2N0M0 SCC right epiglottis. Preferred management:

Radiation to bilateral necks and primary.

Radiation to right neck and primary.

Robotic supraglottic with unilateral neck dissection.

Open supraglottic with unilateral neck dissection.

5.

1 point

HPV has been associated with cancer of all these regions of the head and neck, except:

Tonsil

Tongue base

Thyroid

Nasopharynx

Parotid

6.

1 point

The RET proto-oncogene, located on Chromosome 10, is a:

Potassium ion channel receptor.

Fibroblast growth factor receptor.

G-protein receptor.

Tyrosine kinase receptor.

7.

1 point

The rate of occult regional metastasis in a T2 hypopharyngeal cancer is:

40%

30%

60%

10%

8.

1 point

Next generation massively parallel sequencing can be used to sequence:

RNA

DNA

Protein

All of the above.

A & B only

9.

1 point

A patient is referred for newly diagnosed right hypopharyngeal squamous cell carcinoma and provides an outside neck CT examination for review. Which of the following would be considered suspicious for pathologic lymphadenopathy based on imaging findings?

Ipsilateral right III lymph node measuring 14mm in minimal axial diameter (short axis).

Contralateral left level IV lymph node measuring 7mm in short axis with central necrosis.

Cluster of right level IV lymph nodes measuring 9-10mm is minimal axial diameter.

All of the above.

10.

1 point

Possible surgical options to manage laryngeal carcinoma that involves bilateral vocal cords including anterior commissure could include all of the following except

Total laryngectomy.

Endoscopic transoral microlaryngeal excision.

Extended vertical partial laryngectomy.

Supracricoid laryngectomy with CHEP.

11.

1 point

The two most salient features of dysphagia following chemo-radiation are:

Pain and mucositis.

Hypersensitivity and reduced BOT retraction.

Trismus and loss of appetite.

Reduced BOT retraction and reduced laryngeal elevation.

12.

1 point

Which of the following is true regarding inverted papilloma?

Removal of the tumor and scraping the pedicle off of the bone is the best maneuver to prevent recurrence.

The tumor tends to invade the underlying bone.

The risk of conversion to carcinoma is about 10%.

Both B & C

13.

1 point

The rate of neck metastasis for a T3 pyriform sinus cancer is:

100%

40-45%

65-70%

10-15%

20-25%

14.

1 point

Patients with well-differentiated thyroid malignancy presenting with distant metastases:

Are incurable.

Should not be offered surgery.

Should still be considered for aggressive measures to achieve locoregional control including surgery and radioactive iodine.

Have short life expectancy.

15.

1 point

Choose all answers that apply - Radiation stents is/are used to:

Reduce the effects of backscatter radiation to oral mucosa adjacent to metallic restorations.

Physically move the maxilla or mandible away from the main area of radiotherapy.

Reduce mucositis.

Reduce mucositis in patients with zirconia crowns.

All of the above.

16.

1 point

The most common subsite of head and neck cancer to metastasize to the axial skeleton is:

Hypopharyngeal cancer

Oropharyngeal cancer

Nasopharyngeal cancer

Laryngeal cancer

17.

1 point

Pigmented lesion of the right temple. Best method of diagnosis:

Shave biopsy.

Deep shave biopsy.

Punch biopsy.

Wide local excision.

Narrow margin excision.

C or E

18.

1 point

Most HPV related head and neck cancer have:

Mutant p53

Wild type p53

Spliced p53

No p53

19.

1 point

A 44 year old female presents with a palpable mass in the right parotid gland. Patient is unsure of how long the mass has been present, as it was discovered during a routine examination by her primary care physician. Cross sectional imaging reveals a solitary, 25mm, cystic (bright T2 signal), heterogeneously enhancing right parotid lesion demonstrating well-defined and mildly lobulated margins. Left parotid gland appears normal. What is the most likely diagnosis?

Adenoid cystic carcinoma.

Mucoepidermoid carcinoma.

Squamous cell carcinoma.

Benign mixed tumor (pleomorphic adenoma).

20.

1 point

The standard of care for treatment of Stage iVa hypopharyngeal cancer that invades the cricoid cartilage is

Radiation therapy.

Total laryngopharyngectomy, neck dissections and appropriate reconstruction.

Induction chemotherapy with tpf followed by chemoradiation therapy.

Chemoradiation therapy.

Chips protocol.

21.

1 point

Patients with adenoid cystic carcinoma of the salivary glands with known distant metastatic disease:

Can be effectively palliated with systemic chemotherapy

Should be offered palliative measures only since their disease is incurable

Have uniformly poor long-term survival even if locoregional disease is controlled

Can be considered for aggressive locoregional measures including surgery of the primary site after weighing the morbidity of treatment against the risks and impact upon quality of life

22.

1 point

Which neck levels oropharynx carcinoma usually metastasize?

I and II

II and III

III and IV

V and VI

23.

1 point

Patients with suspected thyroid malignancy presenting with hoarseness:

Should undergo preop laryngoscopy.

Raise concern for extrathyroidal extension.

Should undergo detailed preop cross sectional imaging including contrast enhanced CT neck.

Should be considered for formal intraop endoscopy and planned for possible extended resection measures

All of the above.

24.

1 point

The internal jugular vein is the following in relation to the accessory nerve:

Posterior

25.

1 point

Lateral mandibular defects should always be reconstructed with a bony free flap when the patient is dentate:

True

False

26.

1 point

Oral tongue cancers are primarily treated with surgery. When should a neck be done as part of primary therapy (pick one answer):

When the lesion is greater than 2mm in depth.

When the tongue musculature is invaded.

Both of the above.

Neither of the above.

27.

1 point

Choose all answers that apply - The removal of large torus mandibularis or palatinus:

Should be considered at the time of the cancer ablative surgery.

Improves the outcome for prosthetic rehabilitation of the patient.

Can reduce the incidence of post radiation or chemoradiation osteoradionecrosis.

Will reduce the probability of bisphosphonate induced osteonecrosis of the jaw in patients who receive IV bisphosphonates.

28.

1 point

What is the best biomarker for HPV related head and neck cancer?

p18

p16

p53

p soup

29.

1 point

Presentation of pain in a patient with a parotid mass:

Indicates unresectability.

Is diagnostic of malignancy.

Portends worse prognosis in cases of malignancy.

Does not occur in benign tumors.

30.

1 point

HPV is currently the most common cause of oropharyngeal cancer:

True

False

31.

1 point

Contraindications to open partial (conservation) laryngectomy include all of the following except:

Bilateral true vocal cord involvement.

Poor functional status.

Interarytenoid involvement.

Subglottic extension > 1 cm.

32.

1 point

Management of supraglottic tumors involving the petiole:

Should not be managed endoscopically.

Should not be managed with open resection.

Should be irradiated primarily.

Can be challenging endoscopically due to tangential visualization and instrumentation.

Should be left alone

33.

1 point

Lower lip cancers frequently metastasize to the neck

True

False

34.

1 point

Facial nerve rehabilitative procedures (i.e. cable grafting) are best considered

In delayed fashion depending upon postoperative function.

At the time of primary surgery.

Only if adjunctive measures (i.e. radiation) are not planned as this would delay/inhibit nerve recovery.

Only if a clear proximal extratemporal nerve margin can be obtained.

35.

1 point

PI3K is mutated in?

HPV-negative oropharyngeal SCC.

HPV-positive oropharyngeal SCC.

Oral cavity SCC.

All of the above.

A & B Only

36.

1 point

Contraindication to traditional open supraglottic (horizontal) laryngectomy include:

Anterior commissure involvement.

Involvement of one arytenoid.

Pre-epiglottic space involvement.

Prior radiation therapy.

All of the above.

37.

1 point

32 yo patient with bilateral carotid body tumors one of which is 7 cm in size and growing. The best management for optimal function and reduced risk of morbidity:

Bilateral tumor extirpation in one surgery.

Staged excision of both tumors.

Radiation to one, surgery to the other.

Gamma knife.

Observation.

38.

1 point

What percentage of HPV related malignancies are linked to HPV18:

HPV18 is not linked to head/neck cancer.

92%

1%

8%

39.

1 point

Lateral mandibular defects in edentulous patients should always be reconstructed with a bony free flap:

True

False

40.

1 point

Choose all answers that apply - Which of the following statements is/are true regarding the incidence of osteoradionecrosis (ORN) in head and neck cancer patients:

Since 1986, the incidence of ORN in patients whose teeth are removed prior to radiation is about 3%.

The overall incidence of ORN from pooled studies has declined dramatically since 1986 from 11% to 6%.

Since 1986, the incidence of ORN in patients whose teeth are removed after radiation is about 3%.

Pooled studies since 1986 indicate that the incidence of ORN in post-radiation extraction patients without hyperbaric oxygen (HBO) is about 3%.

41.

1 point

How many percent of oropharyngeal cancers were HPV positive among the patient treated with TORS clinical trial at the James?

20

80

60

40

99

42.

1 point

The super-supra glottis swallow is used to:

Increase posterior pharyngeal wall contraction.

Improve airway protection.

Increase hyolaryngeal elevation.

Improve BOT retraction.

43.

1 point

Melanoma of the cheek with a depth of 0.76 with ulceration. What is the best treatment offered:

WLE 2 cm margins.

WLE 1 cm margins.

WLE with neck dissection.

WLE 1-2 cm with sentinel lymph node bx.

44.

1 point

Vocal cord fixation in patients with laryngeal carcinoma is most commonly due to:

Recurrent laryngeal nerve involvement.

Tumor extension into the paraglottic space.

Desmoid reaction due to adjacent tumor.

Cricoarytenoid joint involvement.

45.

1 point

A 57 year old male with newly diagnosed carcinoma ex pleomorphic adenoma of the left parotid gland is referred for evaluation. On examination, the patient is found to have left facial nerve paralysis. What imaging landmark is used to estimate the location of the facial nerve within the parotid gland?

Facial artery – facial nerve is lateral to the artery

Retromandibular vein – facial nerve is lateral to the vein

Retromandibular vein – facial nerve is medial to the vein

Facial artery – facial nerve is medial to the artery

46.

1 point

The practice of personalized medicine involves the use of disease-specific gene biomarkers as an aid for:

Disease prognosis.

Gene-targeted therapy.

Both.

47.

1 point

Children with mucoepidermoid carcinoma of the salivary gland will often have a history of:

Change in taste sensation.

Prior malignancy.

Painful mass.

Neuropathy.

48.

1 point

Visceral (mucosal) involvement by well-differentiated thyroid malignancy:

Is unresectable.

Does not occur.

Should be managed with full-thickness resection (i.e. Esophagectomy, tracheal resection, laryngectomy) to adequately remove gross tumor.

Can be managed with “shave resection”.

49.

1 point

Which vitamin deficiency is associated with hypopharyngeal cancer:

Vitamin A

Vitamin D

Vitamin E

Vitamin C

Vitamin B12

50.

1 point

52 yo dentate male with a FOM SCC invading the chin skin and lateral tongue. The options for reconstruction following extirpation include:

Pec flap with skin graft.

Fibular flap with external and internal components.

Osteocutaneous forearm flap.

Osteocutaneous scapula.

B and D