OTORRINO - SEMINARS 8–9 — TUMORS OF THE PHARYNX

[PRACTICE] — Anatomical divisions of the pharynx Which structure belongs anatomically to the oropharynx? A. Anterior two-thirds of the tongue B. Base of the tongue C. Nasal vestibule D. Maxillary sinus.

[PRACTICE] — Hypopharyngeal anatomy Which anatomical structure belongs to the hypopharynx? A. Palatine tonsil B. Rosenmüller's fossa C. Pyriform sinus D. Inferior nasal concha.

[PRACTICE] — Rosenmüller's fossa Which location is particularly important as a site of origin of nasopharyngeal carcinoma? A. Rosenmüller's fossa B. External auditory canal C. Vocal-fold free edge D. Submandibular duct.

[RECONSTRUCTED] — Nasopharyngeal carcinoma and cervical metastases In which tumor are cervical lymph node metastases particularly common? A. Benign external auditory canal osteoma B. Nasopharyngeal carcinoma C. Benign vocal-fold polyp D. Otosclerosis.

[RECONSTRUCTED] — Middle-ear effusion and nasopharyngeal carcinoma An adult has unilateral middle-ear effusion without acute infection, nasal obstruction and a neck mass. What must be excluded? A. Benign positional vertigo B. Nasopharyngeal carcinoma C. Bilateral otosclerosis D. Vestibular migraine.

[RECONSTRUCTED] — First presentation of NPC Which statement about nasopharyngeal carcinoma is correct? A. It never metastasizes. B. It cannot affect cranial nerves. C. It may first present as a cervical mass. D. It is unrelated to EBV.

[RECONSTRUCTED] — Nasopharyngeal malignancy and initial clinical signs Which statement about nasopharyngeal carcinoma is correct? A. Cervical lymph node metastases are very uncommon. B. It can never involve cranial nerves. C. It is unrelated to EBV. D. Cervical lymphadenopathy may be the first clinical manifestation.

[RECONSTRUCTED] — Persistent unilateral hearing impairment A middle-aged adult has persistent unilateral middle-ear effusion, nasal obstruction and a cervical mass. What must be excluded? A. Benign positional vertigo B. Nasopharyngeal carcinoma C. Otosclerosis D. Acute otitis externa.

[PRACTICE] — Epstein–Barr virus Which virus is strongly associated with non-keratinizing nasopharyngeal carcinoma? A. HPV6 B. Rhinovirus C. Respiratory syncytial virus D. Epstein–Barr virus.

[PRACTICE] — Dietary carcinogens Which dietary exposure has historically been associated with nasopharyngeal carcinoma? A. Fresh vegetables B. Nitrosamines associated with preserved salted foods C. Dietary calcium alone D. High water intake.

[PRACTICE] — Histology of lymphoepithelioma Which histological pattern is characteristic of lymphoepithelioma of the nasopharynx? A. Mature adipocytes without epithelial cells B. Keratinizing cells exclusively with no inflammation C. Undifferentiated malignant epithelial cells admixed with abundant lymphocytes D. Normal respiratory epithelium without atypia.

[PRACTICE] — Benign, malignant and secondary nasopharyngeal tumors Which statement correctly describes the classification of nasopharyngeal tumors in the seminar? A. All nasopharyngeal tumors are benign papillomas. B. Nasopharyngeal malignancies include carcinomas and lymphomas, while benign tumors include juvenile angiofibroma, schwannoma and papilloma. C. Nasopharyngeal carcinoma cannot coexist with secondary tumors. D. Lymphoma never occurs in the nasopharynx.

[PRACTICE] — Endophytic versus exophytic growth Which statement best reflects the growth patterns described for nasopharyngeal carcinomas, lymphomas and sarcomas? A. Carcinomas are usually exophytic, whereas lymphomas always remain microscopic. B. Carcinomas usually exhibit endophytic infiltrative growth, whereas lymphomas and sarcomas more often form exophytic masses in the lecture. C. All tumors grow exclusively within bone. D. Growth patterns alone are sufficient for definitive histological diagnosis.

[PRACTICE] — Skull-base extension and cranial nerve deficits Which symptoms can result from skull-base extension of nasopharyngeal carcinoma? A. Diplopia B. Facial sensory changes C. Cranial nerve palsies D. All of the above.

[PRACTICE] — Regional lymphatic dissemination Which lymph node group is particularly relevant in the regional spread of nasopharyngeal carcinoma? A. Retropharyngeal lymph nodes B. Inguinal lymph nodes exclusively C. Popliteal lymph nodes D. Axillary lymph nodes exclusively.

[PRACTICE] — T2 nasopharyngeal carcinoma In nasopharyngeal carcinoma, which T category includes parapharyngeal extension? A. Tis B. T1 C. T2 D. T0.

[PRACTICE] — N classification landmark Which anatomical landmark is important in the nasopharyngeal carcinoma N classification? A. Superior border of the mandible B. Lower border of the cricoid cartilage C. Thyroid isthmus D. Tip of the mastoid process only.

[PRACTICE] — Histological confirmation Which investigation confirms the histological diagnosis of nasopharyngeal carcinoma? A. Nasopharyngoscopy with biopsy B. Tympanometry alone C. Pure-tone audiometry alone D. Anterior rhinoscopy without tissue sampling.

[PRACTICE] — Treatment of non-keratinizing NPC Which is a major treatment approach for non-keratinizing nasopharyngeal carcinoma? A. Antibiotics alone B. Routine isolated tonsillectomy C. Tympanostomy as definitive oncological treatment D. Radiotherapy, often combined with chemotherapy according to stage.

[PRACTICE] — Nasopharyngeal carcinoma: prognosis and treatment outcomes According to the historical figures presented in the lecture, which statement about nasopharyngeal carcinoma prognosis is CORRECT? A. T3–T4 disease has better disease-free survival than T1–T2 disease. B. The lecture reports initial remission above 80% after chemoradiotherapy, but recurrence and long-term disease control remain important concerns. C. Cervical lymph node metastases are impossible in recurrent NPC. D. All patients have identical five-year survival regardless of tumor stage.

[PRACTICE] — Macroscopic pattern of lymphoma Which macroscopic growth pattern is described as characteristic of oropharyngeal lymphoma in the lecture? A. Exclusively intraosseous growth B. Always a deeply ulcerated lesion C. Exophytic growth, frequently without mucosal ulceration D. Growth confined to the external nose.

[RECONSTRUCTED] — Asymmetry of the oropharyngeal isthmus Which disorders can produce asymmetry of the oropharyngeal isthmus? A. Unilateral palatine tonsil carcinoma B. Tonsillar lymphoma C. Peritonsillar inflammatory swelling D. All of the above.

A patient has persistent unilateral sore throat and referred otalgia despite a normal otoscopic examination. Which condition must be considered? A. Oropharyngeal malignancy B. Otosclerosis exclusively C. Cerumen impaction D. Benign positional vertigo.

[RECONSTRUCTED] — Repeated past-exam: most common site What is the most common site of oropharyngeal cancer? A. Posterior pharyngeal wall B. Palatine tonsil C. Soft palate D. Base of tongue.

[RECONSTRUCTED] — Repeated past-exam: causes of oropharyngeal asymmetry Which conditions may cause asymmetry of the oropharyngeal isthmus? A. Unilateral palatine tonsil tumor B. Unilateral tonsillar lymphoma C. Peritonsillar inflammatory swelling D. All of the above.

[RECONSTRUCTED] — Repeated past-exam: otalgia Which symptom is concerning when persistent unilateral throat discomfort is associated with a normal ear examination? A. Referred otalgia B. Brief positional vertigo C. Bilateral eye itching D. Sneezing.

[PRACTICE] — Repeated HPV question Which carcinoma is particularly associated with HPV16? A. Oropharyngeal squamous cell carcinoma B. Cholesteatoma C. Pleomorphic adenoma D. Otosclerosis.

[PRACTICE] — Repeated growth pattern question Which growth pattern is characteristic of oropharyngeal lymphoma in the lecture? A. Always infiltrative and ulcerated B. Exophytic, often without ulceration C. Exclusively intraosseous D. Confined to the nasal septum.

[PRACTICE] — Cervical lymphadenopathy as first manifestation Which is a possible first manifestation of oropharyngeal SCC? A. Complete blindness in every case B. Cervical lymph node enlargement C. Sudden bilateral vestibular failure D. Bilateral otorrhoea.

[PRACTICE] — HPV-positive and HPV-negative staging Which statement about the AJCC 8th-edition staging of oropharyngeal carcinoma is correct? A. All oropharyngeal cancers use one identical staging system regardless of HPV status. B. HPV status is never relevant to staging. C. HPV-mediated and HPV-negative oropharyngeal carcinomas use different staging frameworks. D. The presence of lymph node metastases always means M1.

[PRACTICE] — Treatment of oropharyngeal SCC Which treatments may be appropriate for oropharyngeal SCC, depending on tumor location and stage? A. Transoral surgery B. Radiotherapy C. Chemoradiotherapy D. All of the above.

[PRACTICE] — Diagnosis and prognosis of oropharyngeal malignancy Which statement correctly describes the diagnostic approach and historical prognosis of oropharyngeal malignancy in the seminar? A. A diagnosis can always be established without biopsy, and tumor stage has no effect on outcomes. B. Diagnosis requires appropriate clinical examination and histopathology, while limited non-metastatic disease has better disease-free survival than locally advanced or metastatic disease. C. Cervical lymph node examination is unnecessary because regional metastases never occur. D. CT and MRI are useful only for evaluating the external auditory canal.

[PRACTICE] — Most common hypopharyngeal cancer site What is the most common hypopharyngeal cancer site? A. Postcricoid area B. Posterior wall C. Pyriform sinus D. Soft palate.

[PRACTICE] — Plummer–Vinson syndrome Which syndrome is associated with postcricoid carcinoma? A. Ménière syndrome B. Plummer–Vinson syndrome C. Gradenigo syndrome D. Lemierre syndrome.

[PRACTICE] — Regional lymph node metastases Which statement about hypopharyngeal carcinoma is correct? A. Nodal metastases are rare. B. It is usually asymptomatic even when advanced. C. Regional lymph node metastases are frequent and often early. D. Squamous cell carcinoma is exceptionally rare.

[PRACTICE] — Surgical treatment of advanced disease Which treatment combination is emphasized for advanced hypopharyngeal carcinoma? A. Tympanostomy and adenoidectomy B. Pharyngectomy/laryngectomy with neck dissection ± postoperative radiotherapy C. Nasal packing D. Antihistamines alone.

[PRACTICE] — Repeated anatomical distribution question Which subsite accounts for approximately 80% of hypopharyngeal tumors in the lecture? A. Postcricoid area B. Posterior pharyngeal wall C. Soft palate D. Pyriform sinus.

[PRACTICE] — Repeated Plummer–Vinson question Which syndrome is classically associated with increased risk of postcricoid squamous carcinoma? A. Gradenigo syndrome B. Plummer–Vinson syndrome C. Ménière disease D. Lemierre syndrome.

[PRACTICE] — Major risk factors Which are major risk factors for hypopharyngeal squamous cell carcinoma? A. Tobacco smoking and heavy alcohol consumption B. Otosclerosis and presbycusis C. Uncomplicated allergic rhinitis and cerumen impaction D. Ménière disease and labyrinthitis.

[PRACTICE] — Predominant histological type Which malignant histological type predominates in the hypopharynx? A. Schwannoma B. Osteoma C. Squamous cell carcinoma D. Pleomorphic adenoma.

[PRACTICE] — Advanced hypopharyngeal carcinoma Which combination most strongly suggests advanced hypopharyngeal carcinoma? A. Brief positional vertigo and tinnitus B. Dysphagia, odynophagia, weight loss and cervical lymphadenopathy C. Isolated nasal itching D. Recurrent cerumen impaction.

[PRACTICE] — Early regional metastases Which statement about regional metastases in hypopharyngeal carcinoma is correct? A. They are impossible before distant metastases. B. They occur exclusively in the inguinal region. C. They are absent in all early-stage tumors. D. They are frequent and may develop early.

[PRACTICE] — Histological diagnosis Which investigation confirms hypopharyngeal malignancy? A. Hypopharyngoscopy with biopsy and histopathology B. Audiometry alone C. Tympanometry alone D. Skin prick testing.

[PRACTICE] — Advanced disease treatment Which treatment combination is described for selected advanced hypopharyngeal carcinomas? A. Tympanostomy and adenoidectomy B. Nasal packing and antihistamines C. Pharyngectomy/laryngectomy with neck dissection and selected postoperative radiotherapy D. Antibiotics alone as definitive cancer treatment.

[PRACTICE] — Prognosis versus early glottic cancer Why is the prognosis of hypopharyngeal carcinoma generally poorer than that of early glottic carcinoma? A. Hypopharyngeal tumors are always benign. B. They frequently present late and develop early cervical lymph node metastases. C. They cannot invade surrounding tissues. D. They never interfere with swallowing.

[PRACTICE] — Integrated pharyngeal carcinoma comparison Which combination correctly matches the three major pharyngeal anatomical regions with their most characteristic tumor associations? A. Nasopharynx — HPV16 is the defining association; oropharynx — EBV; hypopharynx — primarily benign papilloma B. Nasopharynx — EBV-associated non-keratinizing carcinoma and frequent cervical metastases; oropharynx — HPV16-associated SCC, commonly involving the palatine tonsil; hypopharynx — pyriform sinus SCC with frequent early nodal spread C. Nasopharynx — no cervical metastases; oropharynx — tumors exclusively of the hard palate; hypopharynx — most cancers arise from the soft palate D. All three regions have identical tumor sites, viral associations and metastatic behavior.