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ABSITE WEEK 3

Total questions: 37

Worksheet time: 19mins

Name
Class
Date
1.

What is the most common cause of a neck mass in males >60 years of age?

a)

Bacterial lymphadenitis

b)

Brachial cleft cyst

c)

Metastatic carcinoma

d)

Laryngocele

2.

60 yo male patient with neck mass comes for a second opinion after outside surgeon recommended open biopsy. This option:

a)

Is acceptable

b)

Has no effect on survival if the mass is cancer

c)

Is inappropriate w/o head and neck exam to search for primary

d)

Is always necessary prior to definitive therapy

3.

42 yo male patient presents with a central lower lip lesion that is 2cm in diameter, most appropriate treatment is:

a)

Wedge resection with primary closure

b)

Abbe-Estlander flap

c)

Karapandzic flap

d)

Total lower lip resection with free flap

4.

A 48 yo patient with ulceration located in the anterior floor of the mouth, positive for squamous cell carcinoma. In addition to surgical excision of he primary tumor, bilateral neck dissection would be indicated if the following were found...

a)

Bilateral 2cm lymph nodes in neck

b)

2.5cm lesion diameter

c)

Single cervical 2.5cm lymph node

d)

All of the above

5.

Head and neck exam reveals a palpable right base of tongue mass and FNA of the ipsilateral neck mass reveals squamous cell carcinoma. The most appropriate next step is:

a)

Primary radiotherapy

b)

Open biopsy of neck mass followed by neck dissection

c)

Neck dissection since FNA is reliable for diagnosis

d)

Panendoscopy with biopsy of tongue mass

6.

A palpable base of tongue mass is biopsied and confirmed to be SCC. It is 2.5cm in diameter, what is the staging of this lesion?

a)

T1

b)

T2

c)

T3

d)

T4

7.

Patient undergoes a right selective neck dissection; this would become a modified radical dissection if this included removal of:

a)

Central compartment nodes

b)

External jugular vein

c)

Vagus nerve

d)

Accessory nerve

8.

The main dysfunction that is a direct sequelae of a radical neck dissection is:

a)

Hoarseness

b)

Facial drop

c)

Hearing loss

d)

Shoulder dysfunction

9.

22 yo college student complains of 3 feels history of enlarging neck mass over mid portion of the SCM. You palpate a 4cm soft, cystic and does not appear inflamed. What is the most likely diagnosis?

a)

Thyroglossal duct cyst

b)

Branchial cleft cyst

c)

Cystic hygroma

d)

Metastatic cancer from a skin primary

10.

70 yo female presents with a large asymptomatic right neck mass which is mobile horizontally but not vertically. Auscultation reveals a bruit. The next most appropriate step is:

a)

FNA of mass

b)

Open biopsy with frozen section

c)

Antibiotics with mass excision in the future

d)

Radiographic evaluation

11.

35 yo Asian male with right posterior triangle neck mass complains of right-sided hearing loss should have:

a)

Empiric course of anti-TB antibiotics

b)

Nasopharyngoscopy to r/o a mass

c)

CT scan of the brain

d)

Open biopsy of the neck mass

12.

35 yo female presents with asx slowly growing mass at the angle of her jaw on the right; the mass is 2cm, mobile and contender. FNA of the mass will most likely reveal:

a)

Pleomorphic adenoma

b)

Mucoepidermoid cancer

c)

Adenoid cystic carcinoma

d)

Metastatic disease

13.

55 yo male presents with gradually enlarging mass in right parotid which is painless but hard to palpation. There is obvious facial weakness on the side of the mass. Most likely diagnosis is:

a)

Pleomorphic adenoma

b)

Parotid duct obstruction secondary to stone

c)

Malignant tumor of parotid

d)

Lymphoma

14.

55 yo with painless mass but facial weakness on the side of mass. FNA reveals mucoepidermoid carcinoma and CT shows 3cm intraparotid mass. What is the treatment of choice?

a)

Enucleation of mass

b)

Superficial Parotidectomy

c)

Parotidectomy with facial nerve sacrifice

d)

Parotidectomy with facial nerve reconstruction and postop RT

15.

What of the following are associated with an increased risk of malignant melanoma?

a)

More than 3 blistering sunburns as a child

b)

Blonde or red hair with fair skin

c)

History of multiple dysplastic nevi

d)

All of the above

16.

Which of the following is NOT included in the staging of malignant melanoma?

a)

Breslow level

b)

Presence of ulceration

c)

Presence of regression

d)

Lymph node metastasis

17.

33 yo woman 3 years out from wide excision and SLNB for 2.3mm nodular melanoma of the post-auricular area presents with a mass adjacent to the parotid. FNA diagnostic for metastatic melanoma and there is an involved lymph node. There is no evidence of distant metastatic disease, what is the next step?

a)

Radiation to neck

b)

Radical neck dissection and superficial parotidectomy

c)

Radical neck dissection and superficial parotidectomy with postop interferon

d)

Superficial parotidectomy only

18.

Which of the following is NOT true regarding non-melanoma skin cancers?

a)

SCC can occur in burn scars and chronic wounds

b)

BCC and SCC are a/w UV exposure

c)

Both SCC and BCC are resistant to radiation therapy

d)

Mohs surgery would be appropriate for BCC of the face

19.

Which one of the following sarcomas is noted to spread to regional LN?

a)

Leiomyosarcoma

b)

Malignant fibrous histiocytoma

c)

Synovial sarcoma

d)

Rhabdomyosarcoma

20.

38 yo woman undergoes total thyroidectomy and postop is not able to elevate her pitch of phonation in choir. What nerve may have been injured during her procedure?

a)

Glossopharyngeal nerve

b)

Internal branch of superior laryngeal nerve

c)

External branch of superior laryngeal nerve

d)

Recurrent laryngeal nerve

21.

45 yo complaining of difficulty breathing and neck discomfort 2 hours after a total thyroidectomy is found to be using accessory muscles to breath and has obvious ecchymotic mass overlying incision. What is the most appropriate next step:

a)

Open wound at bedside

b)

Return to OR for neck exploration

c)

Intubate patient

d)

Apply pressure dressing

22.

During a total parathyroidectomy, the surgeon cannot identify the right inferior gland. Where should the surgeon look first?

a)

Tracheoesophageal groove

b)

Periesophageal

c)

Intrathyroidal

d)

Thymus

23.

40 yo woman presents to clinic with 1 year history of large midline neck mass with dysphagia and dyspnea. She has a firm rubbery goiter on exam. What is correct regarding the diagnosis of thyroiditis?

a)

Serum thyroglobulin levels are low in subacute thyroiditis

b)

RAI uptake is increased in acute thyroiditis

c)

FNA can differentiate Reidel thyroiditis and cancer

d)

Thyroid autoantibidies are elevated in Hashimoto

24.

50 yo woman presents with asymptomatic 1.2cm thyroid nodule, normal TSH, and FNA returns follicular neoplasm. What is the next step:

a)

Reassurance and repeat US in 6 months

b)

Thyroid lobectomy

c)

Total thyroidectomy

d)

Total thyroidectomy with level VI LN dissection

25.

In addition to PTU or methimazole, what is the best treatment for thyroid storm:

a)

Dexamethasone

b)

Phenoxybenzamine

c)

Aspirin

d)

Postoperative Lugols solution

26.

62 yo with thyroid mass and palpable cervical LN undergoes FNA which returns as Hurtle cells. What is the best treatment?

a)

Radioactive Iodine

b)

Thyroid lobectomy with MRND

c)

Total thyroidectomy

d)

Total thyroidectomy with MRND

27.

Otherwise healthy 8 year old boy is found to have 1cm mass on left lateral neck near SCM. It is non painful. He has no recent illness or current complaints. What is the best management of this mass?

a)

FNA

b)

Complete excision of mass and any fistulous tract

c)

Watchful waiting and close monitoring

d)

Short course antibiotics

28.

45 yo woman presents with 5 day history of anterior neck pain radiating up the jaw. She states she had a cold a week ago. Exam shows diffusely enlarged thyroid that is tender to palpation. What is the best first treatment?

a)

Prednisone

b)

Non-steroidal anti-inflammatory drugs

c)

Propranolol

d)

Levothyroxine

29.

31 yo asymptomatic woman was referred for incidental finding of thyroid nodule on CT of the neck for trauma. US shows 1.2cm right nodule with microcalfications and 8mm indeterminate lesion on left lob. What is next step:

a)

US Surveillance in 6 months

b)

US guided aspiration of both nodules

c)

US guided aspiration of right sided nodule

d)

Thyroid lobectomy

30.

What nerve is mostly likely to be injured during thyroidectomy?

a)

Recurrent laryngeal nerve

b)

Vagus nerve

c)

External branch of superior laryngeal nerve

d)

Accessory nerve

31.

65 yo man presents with ulcerated and exophytic lesion on right posterolateral tongue. He has a history of smokeless tobacco products since he was a teen. What of the following is the most likely diagnosis?

a)

adenocarcinoma

b)

lichen sclerosus

c)

squamous cell carcinoma

d)

pleomorphic adenoma

32.

35 yo woman presents with thyroid nodule identified by her PCP. She has no clinical lymphadenopathy, and pathology of FNA demonstrates Hurthle cells. What is the next step in management?

a)

Continued monitoring

b)

RAI

c)

Lobectomy

d)

Total thyroidectomy

33.

33 yo woman postop total thyroidectomy for 2.3cm papillary thyroid carcinoma with positive LN. Which of the following is the next step?

a)

Return to OR for completion MRND

b)

Adjuvant neck radiation

c)

Adjuvant chemotherapy

d)

Radioactive iodine ablation

34.

69 yo post-renal transplant has fatigue, bone pain, weakness.

Lab studies: Ca 11, PTH 9800, elevated phosphate

Which of the following is most likely cause of presentation:

a)

Parathyroid carcinoma

b)

Parathyroid adenoma

c)

Defect in renal calcium sensor

d)

Parathyroid hyperplasia

35.

16 yo presents with swelling on left neck which is fluctuant, at anteromedial border of SCM confirmed on MRI to be 6cm with mild peripheral enhancement. What is next step:

a)

Order confirmatory study with US or CT

b)

Recommend elective surgery for complete excision

c)

Recommend emergency surgery due to risk of infection

d)

Refer to genetic counseling prior to surgery

36.

Parathyroid hormone regulates calcium-phosphate metabolism by:

a)

Decreasing CA absorption in intestines

b)

Inhibiting osteoclasts

c)

Increasing reabsorption of calcium in the kidney

d)

Increasing reabsorption of phosphate in the kidney

37.

64 yo woman developed chronic renal failure 2/2 HTN and is awaiting transplant. Despite maximal medical therapy, Ca and PTH remain high. What is the next best step in management:

a)

IV fluids and diuretics

b)

cessation of calcimimetics

c)

bisphosphonate therapy

d)

subtotal parathyroidectomy