OTORRINO - SEMINAR 10 — NOSE AND PARANASAL SINUS TUMORS

[RECONSTRUCTED] — Most common benign epithelial sinonasal tumor Which is the most common benign epithelial tumor of the nasal cavity according to the presentation? A. Squamous cell carcinoma B. Inverted papilloma C. Adenoid cystic carcinoma D. Malignant melanoma.

[PRACTICE] — Most common malignant histology Which is the most common malignant histological type of sinonasal carcinoma? A. Squamous cell carcinoma B. Osteoma C. Fibroma D. Schwannoma.

[PRACTICE] — Anatomical distribution of sinonasal tumors Which anatomical location accounts for approximately 60% of sinonasal tumors in the historical lecture distribution? A. Frontal sinus B. Sphenoid sinus C. Nasal cavity D. Ethmoid sinus.

[PRACTICE] — General epidemiology and geographic distribution Which statement correctly describes sinonasal malignant tumors according to the seminar? A. They occur predominantly in women younger than 20 years and represent most head and neck cancers. B. They are rare overall, occur more frequently in men, and their incidence varies geographically. C. All sinonasal tumors are malignant and originate from the frontal sinus. D. They occur with identical frequency in every age group and geographic region.

[PRACTICE] — Hardwood dust and adenocarcinoma Which occupational exposure is particularly associated with intestinal-type sinonasal adenocarcinoma? A. Repeated vocal strain B. Hardwood dust C. Cold-water swimming D. Excessive headphone use.

[PRACTICE] — Nickel and squamous cell carcinoma Occupational exposure to nickel is particularly associated with an increased risk of: A. Otosclerosis B. Benign laryngomalacia C. Sinonasal squamous cell carcinoma D. Pleomorphic adenoma.

[PRACTICE] — Viral and environmental risk factors Which virus is associated with some sinonasal epithelial neoplasms? A. Human papillomavirus (HPV) B. Hepatitis A virus exclusively C. Rotavirus D. Respiratory syncytial virus.

[PRACTICE] — Warning symptoms of sinonasal malignancy Which symptom pattern is most suspicious for a sinonasal malignancy? A. Brief bilateral nasal itching during pollen exposure B. Persistent unilateral nasal obstruction with recurrent epistaxis C. Transient sneezing during a viral cold D. Short-lived bilateral watery rhinorrhoea.

[PRACTICE] — Nasal, oral, ocular, facial and auditory manifestations Which combination correctly describes possible clinical manifestations of sinonasal tumors? A. Nasal obstruction, palatal swelling, diplopia, infraorbital paraesthesia and secondary middle-ear effusion B. Isolated vestibular vertigo without any possible nasal symptoms C. Bilateral otosclerosis, cataracts and benign vocal-fold nodules D. Exclusive involvement of the lower respiratory tract without local symptoms.

[PRACTICE] — Classic clinical triad According to the seminar, which combination constitutes the classic clinical triad associated with advanced sinonasal tumors? A. Facial asymmetry, tumor bulging into the oral cavity and a nasal mass B. Vertigo, tinnitus and fluctuating sensorineural hearing loss C. Fever, neck stiffness and altered consciousness D. Dysphagia, iron-deficiency anaemia and oesophageal webs.

[PRACTICE] — CT, MRI, biopsy and angiography A patient has a suspicious unilateral nasal mass associated with diplopia and infraorbital numbness. Which statement correctly describes its diagnostic workup? A. Tympanometry alone establishes tumor histology and orbital extension. B. Nasal endoscopy and biopsy establish tissue diagnosis, CT evaluates bony structures, and MRI is important for orbital and skull-base assessment. C. Audiometry can reliably distinguish every benign from malignant sinonasal tumor. D. CT and MRI are contraindicated in all suspected sinonasal malignancies.

[RECONSTRUCTED] — Inverted papilloma: biological behavior Which statement about inverted papilloma of the nasal cavity is correct? A. It is always bilateral and never recurs. B. It is a malignant lymphoma. C. It is a benign epithelial tumor that may recur and can be associated with squamous cell carcinoma. D. It originates exclusively from the frontal sinus.

[PRACTICE] — Clinical presentation of inverted papilloma Which symptom is characteristic of an inverted nasal papilloma? A. Persistent unilateral nasal obstruction B. Sudden profound bilateral deafness C. Acute peripheral facial paralysis D. Recurrent pain during salivation.

[PRACTICE] — Treatment of inverted papilloma What is the main treatment principle for inverted papilloma? A. Antibiotics alone B. Complete surgical excision, including the attachment site C. Routine chemotherapy for all benign lesions D. Observation without evaluation in every patient.

[PRACTICE] — Comparing Schneiderian papilloma subtypes Which statement correctly compares the three principal Schneiderian papilloma subtypes? A. Exophytic papilloma is most common and has the highest malignant risk. B. Inverted papilloma usually arises on the lateral nasal wall; exophytic papilloma typically arises on the septum; oncocytic papilloma is rare and may be associated with malignancy. C. All three subtypes originate exclusively from the frontal sinus. D. Oncocytic papilloma occurs only in children and cannot undergo malignant transformation.

[PRACTICE] — Krouse staging system Which statement about the Krouse staging system for sinonasal inverted papilloma is correct? A. It classifies only cervical lymph node metastases in malignant melanoma. B. It divides inverted papillomas into stages I–IV according to anatomical extent and malignant association, helping guide surgical planning. C. It is used exclusively for acute bacterial sinusitis. D. It describes the degree of hearing loss caused by otosclerosis.

[RECONSTRUCTED] — Classification of benign sinonasal tumors Which group contains benign tumors of the nose and paranasal sinuses? A. Osteoma, haemangioma and papilloma B. Squamous cell carcinoma, melanoma and lymphoma C. Sinonasal undifferentiated carcinoma and adenocarcinoma D. Rhabdomyosarcoma and chondrosarcoma.

[PRACTICE] — Osteoma Which statement about sinonasal osteoma is CORRECT according to the seminar? A. Osteomas are malignant tumors most commonly arising in the sphenoid sinus. B. Osteomas are slow-growing benign bone tumors, most frequently involving the frontal sinus, and most are asymptomatic. C. Osteomas are primarily associated with EBV infection and always require chemotherapy. D. All patients with osteoma develop immediate orbital invasion.

[PRACTICE] — Fibrous dysplasia A 17-year-old patient develops progressive expansion of a craniofacial bone. Imaging and histology suggest replacement of normal bone by fibro-osseous tissue. Which statement is correct? A. The most likely diagnosis is fibrous dysplasia, and radiotherapy is contraindicated according to the seminar. B. Fibrous dysplasia is a malignant epithelial tumor that exclusively affects the nasal septum. C. Fibrous dysplasia is caused by acute bacterial rhinosinusitis. D. Radiation therapy is the definitive first-line treatment for every case.

[PRACTICE] — Neurogenic benign tumors Which statement correctly distinguishes sinonasal schwannoma from neurofibroma according to the seminar? A. Schwannomas arise from nerve sheath structures and are described as having no malignant degeneration, whereas neurofibromas involve nerve fibers and may be associated with von Recklinghausen disease. B. Schwannomas are always malignant, whereas neurofibromas are epithelial papillomas. C. Neurofibromas occur only in the frontal sinus and are never associated with genetic disease. D. Both tumors are treated exclusively with radiotherapy.

[PRACTICE] — Ohngren's plane Which statement about Ohngren's plane is correct? A. It is a plane used to classify conductive versus sensorineural hearing loss. B. It is an imaginary anatomical plane used to distinguish the posterosuperior suprastructure from the anteroinferior infrastructure of the sinonasal region. C. It divides the larynx into the supraglottis and glottis. D. It is the boundary between the dura and arachnoid mater.

[PRACTICE] — Squamous cell carcinoma: location and metastases Which statement correctly describes sinonasal squamous cell carcinoma according to the lecture? A. It most frequently originates in the frontal sinus and never invades adjacent structures. B. It is the most common sinonasal malignancy and frequently involves the maxillary sinus, with local invasion common at diagnosis. C. It is exclusively a pediatric tumor. D. It never metastasizes to cervical lymph nodes.

[PRACTICE] — Occupational adenocarcinoma A furniture worker with long-term hardwood dust exposure develops persistent unilateral nasal obstruction. Which tumor has a recognized occupational association? A. Sinonasal intestinal-type adenocarcinoma B. Vocal-fold papilloma C. Warthin tumor D. Vestibular schwannoma.

[PRACTICE] — Adenoid cystic carcinoma Which feature is particularly characteristic of sinonasal adenoid cystic carcinoma? A. Rapid resolution without treatment and no recurrence risk B. Slow growth with extensive perineural spread, repeated local recurrence and possible distant metastases C. Exclusive occurrence in the mastoid air cells D. Complete absence of malignant potential.

[PRACTICE] — Mucoepidermoid carcinoma Which statement concerning sinonasal mucoepidermoid carcinoma is CORRECT according to the seminar? A. It is the most common benign tumor of the nasal septum. B. It is extremely rare, and extensive local invasion may make surgical resection difficult. C. It always arises from the olfactory neuroepithelium. D. It is exclusively treated with antifungal medication.

[PRACTICE] — Olfactory neuroblastoma: anatomical origin Olfactory neuroblastoma (esthesioneuroblastoma) most characteristically arises near the: A. Submandibular gland B. Cricoid cartilage C. Olfactory region of the superior nasal cavity D. Mastoid tip.

[PRACTICE] — Rhabdomyosarcoma in children Which malignant sinonasal tumor is particularly important in children according to the presentation? A. Warthin tumor B. Rhabdomyosarcoma C. Pleomorphic adenoma D. Reinke oedema.

[PRACTICE] — Hemangiopericytoma and bone/cartilage malignancies Which statement correctly describes uncommon non-epithelial sinonasal tumors discussed in the lecture? A. Sinonasal hemangiopericytoma may resemble a nasal polyp, while osteogenic sarcoma and chondrosarcoma are rare malignant tumors involving bone or cartilage. B. Hemangiopericytoma is the most common form of laryngeal papilloma. C. Chondrosarcoma exclusively affects the nasal mucosal epithelium. D. Osteogenic sarcoma is a benign viral tumor that never affects bone.

[PRACTICE] — Sinonasal malignant melanoma Which statement about primary sinonasal mucosal melanoma is correct? A. It is always benign. B. It is the most frequent nasal cavity neoplasm. C. It is a rare aggressive malignancy with an unfavorable prognosis. D. It cannot involve the nasal septum.

[PRACTICE] — Metastatic tumors and bleeding risk A highly vascular sinonasal mass is suspected to represent a metastasis. Which primary tumor requires consideration because of its tendency to cause marked bleeding? A. Renal cell carcinoma B. Otosclerosis C. Benign vocal-fold nodules D. Laryngomalacia.

[PRACTICE] — Surgical approaches Which surgical approaches are described for sinonasal malignancy in the lecture? A. Endoscopic resection B. Maxillectomy C. Craniofacial resection D. All of the above.

[PRACTICE] — Contraindications to conventional surgery Which finding may make a sinonasal malignancy unsuitable for conventional curative surgical resection? A. A small localized lesion B. Tumor invasion of critical intracranial structures or the cavernous sinus C. A benign osteoma confined to the frontal sinus D. A superficial nasal lesion without invasion.

[PRACTICE] — Cervical lymph node management Which factor is important when determining whether a patient with sinonasal carcinoma requires cervical neck treatment? A. Regional lymph node involvement B. Eye colour C. Hair colour D. Hand dominance.

[PRACTICE] — Radiotherapy and combined treatment According to the lecture's historical treatment results, which statement regarding radiotherapy and combined therapy for sinonasal carcinoma is CORRECT? A. Radiotherapy is never indicated for sinonasal malignancy. B. The lecture reports an improvement in five-year survival from approximately 23% with surgery alone to 44% with surgery plus chemoradiotherapy in the cited series. C. All sinonasal tumors are cured by antibiotics alone. D. Postoperative treatment has no possible role after maxillectomy.

[PRACTICE] — Survival and prognostic differences between histological types Which statement correctly reflects the historical five-year disease-free survival figures presented in the seminar? A. Malignant melanoma has the most favorable prognosis, with 95% disease-free survival. B. All sinonasal tumors have identical prognosis regardless of histology. C. The lecture reports approximately 30% overall five-year DFS, with particularly unfavorable results for squamous cell carcinoma and malignant melanoma. D. Regional extension and histological type have no prognostic importance.