OTORRINO - SEMINARS 6–7 — LARYNGEAL TUMORS

[PRACTICE] — Benign epithelial tumors Which of the following is a benign epithelial tumor of the larynx? A. Squamous cell carcinoma B. Papilloma C. Chondrosarcoma D. Malignant melanoma.

[PRACTICE] — Malignant non-epithelial tumors Which group contains only non-epithelial malignant laryngeal tumors according to the seminar's classification? A. Papilloma, adenoma and fibroma B. Leukoplakia, papilloma and adenoma C. Sarcoma, lymphoma and malignant melanoma D. Squamous cell carcinoma, adenocarcinoma and papilloma.

[PRACTICE] — Juvenile papillomatosis Which statement about juvenile laryngeal papillomatosis is correct? A. It is frequently associated with HPV and may recur after treatment. B. It is always a solitary lesion without recurrence. C. It is primarily caused by Epstein–Barr virus. D. It occurs exclusively in patients older than 60 years.

[PRACTICE] — Treatment of recurrent juvenile papillomatosis Which treatment is emphasized for recurrent juvenile laryngeal papillomatosis? A. Routine total laryngectomy in every patient B. Antibiotics as definitive treatment C. Parotidectomy D. Endoscopic excision using microlaryngoscopy, including laser techniques.

[PRACTICE] — Juvenile papillomatosis and respiratory complications A child presents with progressive hoarseness, intermittent inspiratory stridor and multiple recurrent papillomatous lesions involving the vocal folds. Which statement best explains the clinical significance of this disease? A. It is invariably malignant at diagnosis. B. Despite being histologically benign, recurrent papillomatosis may produce airway obstruction and extend into the tracheobronchial tree. C. It exclusively affects the cochlea. D. Once treated surgically, recurrence is impossible.

[RECONSTRUCTED] — Frequency of adult papilloma Which statement concerning adult laryngeal papilloma is TRUE? A. It is described as the most frequent benign laryngeal tumor in the lecture. B. It always presents with multiple lesions and frequent recurrence. C. It occurs exclusively in children. D. It must always be treated using intravenous antiviral drugs alone.

[RECONSTRUCTED] — Principal symptom of adult papilloma Which clinical feature is most characteristic of adult laryngeal papilloma? A. Sudden conductive hearing loss B. Persistent hoarseness C. Recurrent unilateral epistaxis D. Painful swelling during meals.

[PRACTICE] — Malignant potential of adult papilloma Which statement about adult papilloma is emphasized in the presentation? A. It cannot undergo malignant transformation. B. It never requires histological examination. C. Surgical excision is indicated, with histological assessment because malignant transformation is possible. D. It originates from the submandibular gland.

[PRACTICE] — Epidemiology and clinical appearance Which statement about primary laryngeal sarcoma is correct? A. It accounts for approximately 95% of laryngeal malignancies. B. It is a rare malignant tumor of mesenchymal origin. C. It is always caused by HPV16. D. It originates exclusively from the thyroid gland.

[PRACTICE] — Anatomical origin Which anatomical structure is frequently involved by laryngeal chondroma or chondrosarcoma? A. Posterior portion of the cricoid cartilage B. Nasal septum C. Mastoid tip D. Sublingual gland.

[PRACTICE] — Endoscopic appearance What is a characteristic endoscopic appearance of laryngeal chondrosarcoma? A. A purulent collection behind the tonsil B. A diffuse middle-ear effusion C. A submucosal laryngeal bulge covered by apparently normal mucosa D. An ulcer confined to the gingiva.

[PRACTICE] — Primary malignant melanoma Which statement about primary malignant melanoma of the larynx is correct? A. It is the most common benign laryngeal tumor. B. It occurs exclusively in newborns. C. It cannot arise in the supraglottis. D. It is extremely rare and may appear as a non-pigmented mass.

[PRACTICE] — Sources of metastatic laryngeal tumors Which malignancy is listed as an important source of metastatic tumors involving the larynx? A. Malignant melanoma B. Pleomorphic adenoma without malignant transformation C. Benign osteoma D. Vocal-fold nodules.

[RECONSTRUCTED] — Most common histological type Which histological type accounts for approximately 95% of malignant laryngeal tumors? A. Adenoid cystic carcinoma B. Squamous cell carcinoma C. Lymphoma D. Chondrosarcoma.

What does G3 indicate in the histological grading of laryngeal squamous cell carcinoma? A. Well-differentiated carcinoma B. Carcinoma in situ C. Poorly differentiated carcinoma D. No evidence of malignancy.

[PRACTICE] — Verrucous carcinoma Which variant of laryngeal SCC is characterized by exophytic, wart-like growth and usually well-differentiated histology? A. Verrucous carcinoma B. Basaloid squamous cell carcinoma C. Lymphoma D. Chondrosarcoma.

[PRACTICE] — Comparing malignant epithelial tumor types Which statement correctly distinguishes the main histological variants and less common malignant epithelial tumors of the larynx? A. Basaloid SCC is a benign epithelial tumor identical to an adenoma. B. Verrucous carcinoma is generally well differentiated, basaloid SCC is considered more aggressive, and adenocarcinoma or adenoid cystic carcinoma are rare. C. Adenoid cystic carcinoma accounts for approximately 95% of all laryngeal malignancies. D. Laryngeal SCC always arises from cartilage rather than mucosal epithelium.

[RECONSTRUCTED] — Principal risk factor Which is the most important established risk factor for laryngeal squamous cell carcinoma? A. Acute otitis media B. Otosclerosis C. Tobacco smoking D. Benign positional vertigo.

[RECONSTRUCTED] — Epidemiology of laryngeal carcinoma Which statement about laryngeal carcinoma is FALSE? A. Squamous cell carcinoma is the predominant malignant histology. B. Tobacco and alcohol are major risk factors. C. The historical lecture describes a marked male predominance. D. It occurs more frequently in women than men in the historical lecture population.

[PRACTICE] — Warning signs and atypical risk factors A 55-year-old heavy smoker presents with progressive hoarseness lasting four weeks. Which statement best reflects the seminar's clinical recommendations? A. Hoarseness should only be investigated when it persists for more than one year. B. Persistent hoarseness exceeding two weeks should prompt ENT evaluation, especially in a patient with major risk factors. C. Laryngeal carcinoma always produces severe dysphagia before any voice change. D. Tobacco history has no relevance to the evaluation of dysphonia.

[RECONSTRUCTED] — Potentially premalignant mucosal lesions Which of the following is a potentially premalignant laryngeal mucosal lesion? A. Erythroplakia B. Laryngomalacia C. Normal arytenoid cartilage D. Cerumen impaction.

[RECONSTRUCTED] — Diagnosis of superficial dysplasia Which examination is LEAST useful for establishing the diagnosis of superficial laryngeal dysplasia? A. Direct laryngoscopy B. CT scan of the larynx alone C. Videolaryngoscopy D. Microlaryngoscopy with biopsy.

[PRACTICE] — Regional lymph node metastases Which clinical characteristic is particularly associated with supraglottic carcinoma? A. Early isolated conductive hearing loss B. Absence of lymphatic drainage C. Early cervical lymph node involvement D. Characteristic otorrhoea.

[PRACTICE] — Symptoms of supraglottic carcinoma Which symptoms may indicate supraglottic carcinoma? A. Persistent sore throat and odynophagia B. Referred otalgia C. Dysphagia or foreign-body sensation D. All of the above.

[PRACTICE] — Why supraglottic tumors metastasize early A patient has a small supraglottic tumor but already presents with metastatic cervical lymphadenopathy. Which mechanism best explains this clinical presentation? A. The supraglottis has no lymphatic drainage, forcing all cancers to metastasize through blood. B. The supraglottis contains a rich lymphatic network that facilitates regional lymph node dissemination. C. Supraglottic tumors are always benign and the lymphadenopathy must be unrelated. D. Supraglottic cancer can only metastasize after complete vocal-fold fixation.

[RECONSTRUCTED] — Earliest symptom of glottic cancer Which symptom is most characteristic of early glottic carcinoma? A. Persistent hoarseness B. Early severe dysphagia in every patient C. Recurrent unilateral epistaxis D. Painful swelling of the submandibular gland.

[PRACTICE] — Prognosis of early glottic carcinoma Why does early glottic carcinoma generally have a comparatively favorable prognosis? A. It cannot invade adjacent tissues. B. It usually produces early hoarseness and has relatively sparse lymphatic drainage. C. It is always a benign neoplasm. D. It never requires treatment.

[PRACTICE] — Clinical presentation Which manifestation is especially characteristic of progressive subglottic carcinoma? A. Intermittent otorrhoea B. Isolated vestibular vertigo C. Progressive dyspnea and airway narrowing D. Recurrent painful salivary swelling during meals.

[RECONSTRUCTED] — Comparing clinical presentations Which statement regarding laryngeal cancer is TRUE? A. All subsites produce identical symptoms. B. Regional metastases are impossible in advanced disease. C. Every patient first develops aphonia. D. Clinical manifestations depend on anatomical localization and tumor progression.

[RECONSTRUCTED] — Anatomical changes after total laryngectomy Which statement about a patient after total laryngectomy is FALSE? A. Normal laryngeal phonation is lost. B. Breathing through the mouth and nose remains possible. C. The respiratory and upper digestive pathways are permanently separated. D. Alternative methods of speech rehabilitation can be used.

[PRACTICE] — Voice rehabilitation Which methods are used for voice rehabilitation after total laryngectomy? A. Oesophageal speech B. Electrolarynx C. Tracheoesophageal voice prosthesis D. All of the above.

[RECONSTRUCTED] — Superior laryngeal nerve innervation Which muscle is innervated by the external branch of the superior laryngeal nerve? A. Posterior cricoarytenoid B. Lateral cricoarytenoid C. Cricothyroid D. Thyroarytenoid.

[RECONSTRUCTED] — Reinke oedema Where does Reinke oedema develop? A. Superficial lamina propria of the true vocal folds B. Mastoid antrum C. Retropharyngeal lymph nodes D. Parotid duct.

[RECONSTRUCTED] — HPV-associated versus reflux-associated laryngeal disease Which laryngeal condition is primarily associated with HPV rather than gastroesophageal reflux disease? A. Contact granuloma B. Laryngeal papillomatosis C. Reflux-associated laryngeal inflammation D. Posterior laryngeal irritation.