WorksheetsABSITE WEEK 3
Total questions: 37
Worksheet time: 19mins
What is the most common cause of a neck mass in males >60 years of age?
Bacterial lymphadenitis
Brachial cleft cyst
Metastatic carcinoma
Laryngocele
60 yo male patient with neck mass comes for a second opinion after outside surgeon recommended open biopsy. This option:
Is acceptable
Has no effect on survival if the mass is cancer
Is inappropriate w/o head and neck exam to search for primary
Is always necessary prior to definitive therapy
42 yo male patient presents with a central lower lip lesion that is 2cm in diameter, most appropriate treatment is:
Wedge resection with primary closure
Abbe-Estlander flap
Karapandzic flap
Total lower lip resection with free flap
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...
Bilateral 2cm lymph nodes in neck
2.5cm lesion diameter
Single cervical 2.5cm lymph node
All of the above
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:
Primary radiotherapy
Open biopsy of neck mass followed by neck dissection
Neck dissection since FNA is reliable for diagnosis
Panendoscopy with biopsy of tongue mass
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?
T1
T2
T3
T4
Patient undergoes a right selective neck dissection; this would become a modified radical dissection if this included removal of:
Central compartment nodes
External jugular vein
Vagus nerve
Accessory nerve
The main dysfunction that is a direct sequelae of a radical neck dissection is:
Hoarseness
Facial drop
Hearing loss
Shoulder dysfunction
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?
Thyroglossal duct cyst
Branchial cleft cyst
Cystic hygroma
Metastatic cancer from a skin primary
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:
FNA of mass
Open biopsy with frozen section
Antibiotics with mass excision in the future
Radiographic evaluation
35 yo Asian male with right posterior triangle neck mass complains of right-sided hearing loss should have:
Empiric course of anti-TB antibiotics
Nasopharyngoscopy to r/o a mass
CT scan of the brain
Open biopsy of the neck mass
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:
Pleomorphic adenoma
Mucoepidermoid cancer
Adenoid cystic carcinoma
Metastatic disease
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:
Pleomorphic adenoma
Parotid duct obstruction secondary to stone
Malignant tumor of parotid
Lymphoma
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?
Enucleation of mass
Superficial Parotidectomy
Parotidectomy with facial nerve sacrifice
Parotidectomy with facial nerve reconstruction and postop RT
What of the following are associated with an increased risk of malignant melanoma?
More than 3 blistering sunburns as a child
Blonde or red hair with fair skin
History of multiple dysplastic nevi
All of the above
Which of the following is NOT included in the staging of malignant melanoma?
Breslow level
Presence of ulceration
Presence of regression
Lymph node metastasis
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?
Radiation to neck
Radical neck dissection and superficial parotidectomy
Radical neck dissection and superficial parotidectomy with postop interferon
Superficial parotidectomy only
Which of the following is NOT true regarding non-melanoma skin cancers?
SCC can occur in burn scars and chronic wounds
BCC and SCC are a/w UV exposure
Both SCC and BCC are resistant to radiation therapy
Mohs surgery would be appropriate for BCC of the face
Which one of the following sarcomas is noted to spread to regional LN?
Leiomyosarcoma
Malignant fibrous histiocytoma
Synovial sarcoma
Rhabdomyosarcoma
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?
Glossopharyngeal nerve
Internal branch of superior laryngeal nerve
External branch of superior laryngeal nerve
Recurrent laryngeal nerve
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:
Open wound at bedside
Return to OR for neck exploration
Intubate patient
Apply pressure dressing
During a total parathyroidectomy, the surgeon cannot identify the right inferior gland. Where should the surgeon look first?
Tracheoesophageal groove
Periesophageal
Intrathyroidal
Thymus
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?
Serum thyroglobulin levels are low in subacute thyroiditis
RAI uptake is increased in acute thyroiditis
FNA can differentiate Reidel thyroiditis and cancer
Thyroid autoantibidies are elevated in Hashimoto
50 yo woman presents with asymptomatic 1.2cm thyroid nodule, normal TSH, and FNA returns follicular neoplasm. What is the next step:
Reassurance and repeat US in 6 months
Thyroid lobectomy
Total thyroidectomy
Total thyroidectomy with level VI LN dissection
In addition to PTU or methimazole, what is the best treatment for thyroid storm:
Dexamethasone
Phenoxybenzamine
Aspirin
Postoperative Lugols solution
62 yo with thyroid mass and palpable cervical LN undergoes FNA which returns as Hurtle cells. What is the best treatment?
Radioactive Iodine
Thyroid lobectomy with MRND
Total thyroidectomy
Total thyroidectomy with MRND
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?
FNA
Complete excision of mass and any fistulous tract
Watchful waiting and close monitoring
Short course antibiotics
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?
Prednisone
Non-steroidal anti-inflammatory drugs
Propranolol
Levothyroxine
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:
US Surveillance in 6 months
US guided aspiration of both nodules
US guided aspiration of right sided nodule
Thyroid lobectomy
What nerve is mostly likely to be injured during thyroidectomy?
Recurrent laryngeal nerve
Vagus nerve
External branch of superior laryngeal nerve
Accessory nerve
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?
adenocarcinoma
lichen sclerosus
squamous cell carcinoma
pleomorphic adenoma
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?
Continued monitoring
RAI
Lobectomy
Total thyroidectomy
33 yo woman postop total thyroidectomy for 2.3cm papillary thyroid carcinoma with positive LN. Which of the following is the next step?
Return to OR for completion MRND
Adjuvant neck radiation
Adjuvant chemotherapy
Radioactive iodine ablation
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:
Parathyroid carcinoma
Parathyroid adenoma
Defect in renal calcium sensor
Parathyroid hyperplasia
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:
Order confirmatory study with US or CT
Recommend elective surgery for complete excision
Recommend emergency surgery due to risk of infection
Refer to genetic counseling prior to surgery
Parathyroid hormone regulates calcium-phosphate metabolism by:
Decreasing CA absorption in intestines
Inhibiting osteoclasts
Increasing reabsorption of calcium in the kidney
Increasing reabsorption of phosphate in the kidney
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:
IV fluids and diuretics
cessation of calcimimetics
bisphosphonate therapy
subtotal parathyroidectomy
