Head & Neck Oncology · NEET PG Preparation ENT
A 60-year-old man presents with a painless, hard, non-tender swelling in the upper neck at the anterior border of the sternocleidomastoid muscle, at…
Practice question from Head & Neck Oncology (NEET PG Preparation ENT), with the correct answer and a step-by-step solution.
hard · MCQ · Q-437E13
A 60-year-old man presents with a painless, hard, non-tender swelling in the upper neck at the anterior border of the sternocleidomastoid muscle, at the level of the carotid bifurcation. Biopsy reveals a well-differentiated squamous cell carcinoma metastatic to a lymph node, but the primary site is not immediately identifiable on physical examination. What is the most appropriate next step in localization of the primary tumor?
- A.Blind tonsillectomy and random mucosal biopsies of the nasopharynx and hypopharynx
- B.PET-CT scan followed by examination under anesthesia (EUA) with targeted biopsies and HPV/p16 testingCorrect answer
- C.Immediate radical neck dissection followed by observation
- D.Palliative radiotherapy to the entire head and neck axis
Solution
For a CUP (carcinoma of unknown primary) syndrome presenting as an upper neck nodal metastasis, modern evaluation begins with cross-sectional imaging and PET-CT, followed by examination under anesthesia (EUA) and directed biopsies, particularly checking for HPV-associated oropharyngeal (tonsillar/lingual) primary tumors.
More from Head & Neck Oncology
- A 55-year-old chronic smoker and heavy drinker presents with a 4-month history of progressive hoarseness. Laryngoscopy reveals a 1 cm exoph…
- Which of the following spaces of the neck is bounded superiorly by the skull base and inferiorly by the clavicle/mediastinum, and contains…
- A 45-year-old male with a history of betel nut chewing presents with restricted mouth opening (trismus) and a firm, white, non-scrapable mu…
- During a modified radical neck dissection, a surgeon preserves the spinal accessory nerve, the internal jugular vein, and which of the foll…
Practise more ENT
Sign up free for adaptive practice on this chapter, with instant feedback and hints on every question.
Start practising freeFree to start · No credit card needed