Week 4 ENT

A 68-year-old man with a history of smoking presents with a painless neck mass. Flexible nasoendoscopy shows a suspicious lesion at the base of the tongue. Most appropriate next step?

• Empirical antibiotics

• Monitor for 2 weeks

• Fine needle aspiration under ultrasound guidance

• Open excision biopsy of the neck mass

• PET scan

A 22-year-old man presents with a painless lump in the upper anterior triangle of the neck, just below the angle of the mandible. It moves on swallowing but not with tongue protrusion. Most likely diagnosis?

• Thyroglossal cyst

• Branchial cleft cyst

• Reactive lymphadenopathy

• Lipoma

• Parotid tumour

A 60-year-old woman presents with hoarseness and is found to have left vocal cord paralysis on flexible nasoendoscopy. She has no history of recent viral illness or trauma. Most appropriate next step?

• Neck ultrasound

• Barium swallow

• Chest x ray

• CT head

• MRI cervical spine

A 34-year-old woman presents with a diffusely enlarged, non-tender thyroid gland that moves on swallowing but not tongue protrusion. Blood tests reveal an elevated TSH, low free T4, and positive anti-thyroid peroxidase (anti-TPO) antibodies. Most likely diagnosis?

• Subacute (de Quervain’s) thyroiditis

• Hashimoto's thyroiditis

• Graves disease

• Multinodular goitre

• Papillary thyroid cancer

A 45-year-old woman is found to have a solitary thyroid nodule that is firm and has been slowly increasing in size. She also reports new-onset hoarseness. According to NICE guidelines, how should this patient be managed?

• Urgent 2-week wait referral to ENT

• Routine GP follow-up in 3 months

• Start levothyroxine to shrink the nodule

• Order thyroid function tests and await results

• Refer for non-urgent ultrasound

A 50-year-old woman undergoes a left hemithyroidectomy for a benign thyroid nodule. Post-operatively, she has a hoarse voice. Flexible nasoendoscopy shows immobility of the left vocal cord in the paramedian position. Which nerve has been injured?

• Hypoglossal nerve

• Superior laryngeal nerve

• Recurrent laryngeal nerve

• Vagus nerve

• Glossopharyngeal nerve

What term describes a “distorted, altered perception of a smell/odour”?

• Anosmia

• Parosmia

• Phantosmia

• Ageusia

• Dysgeusia

What is the most common cause of anosmia overall?

• Malignancy

• COVID-19

• Rhinosinusitis

• Head trauma

• Aging

What is the most common malignant cancer of the larynx by cell type?

• Squamous cell carcinoma

• Adenocarcinoma

• Adenoid cystic carcinoma

• Lymphoma

• Sarcoma

Which infective agent is most associated with squamous cell carcinoma of the larynx?

• Ebstein-Barr Virus (EBV)

• Human Immunodeficiency Virus (HIV)

• Human Papilloma Virus (HPV)

• Hepatitis B Virus (HBV)

• Mycobacterium tuberculosis