Transcript PPT - UCLA Head and Neck Surgery

1. Advantages of ultrasound imaging include:
 A. Imaging modality of choice for thyroid
 B. Doppler sonography can be used for assessment of
blood flow
 C. Scanning in the sagittal plane offers optimal
visualization
 D. A and B
 E. All of the above
2. Features suggestive of malignancy in a
thyroid nodule include all of the following
EXCEPT:
 A. Hyperechoic
 B. Microcalcifications
 C. Increased blood flow on Doppler
 D. Tail shape
 E. Irregular border
3. Parathyroid imaging on ultrasound:
 A Is less accurate than sestamibi scans in localizing a
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solitary adenomas
B. Normal parathyroid glands can be visualized with
high resolution ultrasonography
C. Parathyroid adenomas are hyperechoic relative to
the thyroid gland
D. Superior parathyroid glands are on a deeper plane
than the inferior glands
E. Ectopic parathyroid gland may be visualized on
ultrasound in the posterior mediastinum
4. Ultrasound imaging of salivary glands:
 A. Is useful for differentiating sialadenitis from
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neoplasms and lymphadenopathy
B. Is useful for imaging deep lobe parotid tumors
C. Shows similar echogenicity to the thyroid
D. A and C
E. All of the above
5. Ultrasound characteristics of salivary
malignancies include:
 A. Calcifications
 B. Smooth shape
 C. Increased vascularity on Doppler imaging
 D. Ovoid lesion with short axis less than 5 mm
 E. Homogeneous echostructure
6. Ultrasound imaging for head and neck cancer:
 A. Can detect metastatic lymph nodes not detected by
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CT or MRI
B. Round shape of lymph node suggests malignancy
C. Intranodal cystic degeneration suggests malignancy
D. Can be used to avoid elective neck dissection in NO
necks
E. All of the above
7. Ultrasound-guided fine needle aspiration:
 A. Is done using a 27 gauge needle
 B. Aspiration is performed first
 C. Bevel of the needle is pointed away from the
transducer
 D. Needle should be irrigated with fixative prior to
insertion
 E. The needle should be used to shave cells along the
needle path
Punctate echogenicities in thyroid nodules.
Frates M C et al. Radiology 2005;237:794-800
©2005 by Radiological Society of North America
8. Normal paraganglia contain all of the
following EXCEPT:
 A. Sustentacular cells
 B. Cells which stain positively with S-100
 C. Schwann cells
 D. Chief cells
 E. Catecholamine-containing cells
9. The following is true about paragangliomas:
 A. The most common type is the
pheochromocytoma
 B. 10% occur in the head and neck
 C. Secretion of epinephrine from head and neck
paragangliomas may occur
 D. Vagal paragangliomas are more common than
jugulotympanic paragangliomas.
 E. Familial paragangliomas occur in MEN 1,
Carney’s triad, and von Hippel-Lindau disease
10. Carotid body tumors
 A. A positive Fontaine’s sign indicates movement of a
lateral neck mass laterally but not vertically
 B. Increased mitotic rate and capsular invasion
indicate malignancy
 C. Malignancy is determined by histology
 D. Diagnosis can be made radiographically by
posterior displacement of the internal and external
carotid arteries
 E. Classification of tumors is based on size
11. Recommended treatment of carotid body
tumors:
 A. Requires preoperative embolization before surgical
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removal
B. Results in permanent cranial nerve deficit(s) in 50%
of cases
C. Observation is an option for some patients with
carotid body tumors.
D. Radiation therapy can reduce the size of the tumor.
E. Surgical resection is preferred over radiation therapy
for multicentric tumors
12. Vagal paragangliomas:
 A. Arise from the inferior vagal ganglion
 B. Arise from the nodose ganglion
 C. Arise from the jugular ganglion
 D. A and B
 E. All of the above
13. Peripheral nerve neoplasms:
 A. Neurofibromas are encapsulated and may occur
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singly or multiply
B. Schwannomas most commonly occur in the head
and neck region
C. Antoni type A areas contain loosely arranged
hypocellular zones
D. Malignant transformation is more common in
multiple neurofibromas than in solitary
E. Cranial neuropathies are rare following resection of
schwannomas
14. Metastatic disease to the neck:
 A. Location of the metastatic node in level 5 are
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most commonly associated with a hypopharyngeal
primary
B. Fine needle aspiration biopsy diagnosis of
adenocarcinoma indicates a primary in a salivary
gland
C. The most common distant site to metastasize to
the neck is from a lung primary
D. B and C
E. All of the above
15. Sarcomas of the neck:
 A. 80% of head and neck sarcomas are derived from soft
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tissues of the neck
B. Occur most commonly in children
C. Staging for bone sarcomas is based on size
D. Staging for soft tissue sarcomas is based on site of
origin
E. The most common sarcoma in the head and neck is
the malignant fibrous histiocytoma
16. Rhabdomyosarcoma
 A. Accounts for 50% of sarcomas in all age groups
 B. Most common site in the head and neck is in the
neck
 C. Metastatic disease is present in 80% of cases at
presentation
 D. Primary treatment is surgical resection
 E. Highest incidence occurs in first decade of life
17. Rare sarcomas of the neck:
 A. Osteosarcoma of the mandible frequently
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metastasizes to the neck
B The most common site of fibrosarcoma in the head
and neck is in the neck
C. Alveolar soft part sarcoma is associated with the
fusion gene ASPL-TFE3
D. Epithelioid hemangioendothelioma exhibits
extremely aggressive behavior
E. Liposarcoma is the most common soft tissue
sarcoma in the head and neck in adults
18. Rarer sarcomas of the neck:
 A. Malignant hemangiopericytoma (MPC) arise from
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the cells of Zimmerman, around capillaries and
postcapillary venules
B. Majority of HPCs occur in the paranasal sinuses
C. Malignant peripheral nerve sheath tumor (MPNST)
can occur either spontaneously or with NF-1
D. MPNST has recurrence rates of more than 40%
despite aggressive treatment
E. All of the above
19. Review these before the in-service
 A. Synovial sarcoma
 Typically arises in the hypopharyngeal and retropharyngeal
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region
Malignant giant cell tumor
Radiation induced after treatment for a benign giant cell
tumor, sinonasal region and mandible most common sites
Ewing’s sarcoma
Derived from primitive neuro-ectoderm, 2nd most common
bone tumor in children, mandible, maxilla, skull
Solitary Fibrous Tumor
Desmoid fibromatosis frequent in head and neck, in children,
high local recurrence rate but low mortality