Question 1 : Which of the following may lead to oral tongue cancers in individuals younger than 40 years of age:
a) TP53 (Li-Fraumeni syndrome)
b) Fanconi anemia
c) Familial atypical multiple mole melanoma (FAMMM) syndrome
d) All of the above
Answer : all of the above.
Question 2 : HPV-positive oropharyngeal cancers show improved response to therapy when compared to HPV-negative cancers of the same site. HPV-16 is responsible for what fraction of these patients.
a) 90%
b) 80%
c) 70%
d) 60%
Answer : 90%
Question 3 : HPV-positive cancers show improved response to therapy when compared to HPV-negative cancers of which sites:
a) Oral cavity
b) Oropharynx
c) Nasopharynx
d) All of the above
Answer : Oropharynx
Question 4 : Which of the following is true about head and neck lymph node levels:
a) Level I : submental and submandibular areas
b) Levels II to IV : internal jugular vein lymph nodes
c) Level V : posterior triangle
d) All of the above
Answer : All of the above
Question 5 : Which of the following is a variant of squamous cell carcinoma of the head and neck region:
a) Lymphoepithelioma
b) Spindle cell carcinoma
c) Verrucous carcinoma
d) Undifferentiated carcinoma
e) All of the above
Answer : all of the above.
Question 6 : All of the following cancers have the tendency to spread to bilateral neck nodes except :
a) Tongue base
b) Soft palate
c) Nasopharynx
d) Hard palate
Answer : hard palate.
Question 7 : Which of the following head and neck region cancer has the highest risk of lymph node metastasis:
a) Salivary gland tumors
b) Sarcomas
c) Squamous cell carcinoma
d) All have similar risk
Answer : Squamous cell carcinoma.
Question 8 : Which of the following is the most common site of distant metastasis from head and neck cancers:
a) Bone
b) Lung
c) Thyroid
d) Liver
Answer : Lung.
Question 9 : Panendoscopy is recommended for head and neck cancers because the risk of synchronous primary cancers is the upper aerodigestive tract is:
a) <1%
b) 1-10%
c) 10-20%
d) >20%
Answer : 1-10%
Question 10 : In the treatment of head and neck cancers, all of the following are advantages of surgery compared with radiotherapy except:
a) More amount of tissue can be addressed with surgery
b) Surgery takes considerably less time
c) The toxicities inherent to radiation therapy can be circumvented
d) Radiation may salvage tumor recurrences not amenable to surgery
Answer : More amount of tissue can be addressed with surgery
Question 11 : In the treatment of head and neck cancers, all of the following are advantages of radiation therapy compared with surgery except:
a) Post procedural surgical complications may be avoided with radiation therapy
b) Radiation may result in better cosmetic outcomes as no tissue is actually removed
c) Elective radiation of neck is potentially a less morbid procedure than surgery
d) Salvage of a surgical failure with radiation is easier than salvaging a radiation therapy failure with surgery
Answer : Salvage of a surgical failure with radiation is easier than salvaging a radiation therapy failure with surgery
Question 12 : Conventional radiation therapy in head and neck cancer primary site is once-daily fractionation, 66 to 70 Gy per fraction, 5 days a week. There are alternatives schedules available too, which of the alternative schedules leads to survival benefit compared with conventional schedule:
a) Hyperfractionation
b) Concomitant boost schedule
c) Both of the above
d) Neither 1 nor 2
Answer : Hyperfractionation
Question 13 : Intensity-modulated RT (IMRT) provides a more conformal does distribution compared to conventional techniques of RT and it reduces the does to the normal tissues. Which of the following is not a disadvantage of IMRT:
a) It is more time consuming
b) Risk of late complications is increased on “hot spots”
c) The risk of marginal miss may be higher
d) The “beam on” time is decreased
Answer : The “beam on” time is decreased
Question 14 : Radical neck dissection is potentially a very morbid procedure. To avoid the complications associated with it, while maintaining the good ontological outcome, modified radical neck dissections (MRND) are performed. Which of the following is a type of MRND:
a) Type I : cranial nerve (CN) XI is spared
b) Type II : CN XI and internal jugular vein are spared
c) Type III : CN XI, the internal jugular vein, and the sternocleidomastoid muscles are spared
d) All of the above
Answer : All of the above
Question 15 : Which of the following modality is more effective in the management of clinically node negative (N0) neck :
a) Radiation
b) Surgery
c) Both are equally effective
d) Neither radiation nor surgery is recommended in management of clinically N0 neck
Answer : both are equally effective
Question 16 : Which of the following immunotherapy molecules are approved in platinum refractory, recurrent or metastatic head and neck cancer
a) Pembrolizumab
b) Nivolumab
c) Both of the above
d) Neither 1 nor 2
Answer : both of the above
Question 17 : Radiation therapy is combination with surgery is indicated in many head and neck cancer subsites. All of the following clinical situations are indications for pre-operative rather than postoperative RT, except:
a) Mobile-neck nodes
b) Expected delayed initiation of postoperative RT by > 8 weeks
c) Gastric pull-up for reconstruction
d) Open biopsy of a positive neck node
Answer : Mobile-neck nodes
Question 18 : Which of the following are indications of postoperative RT in head and neck cancers:
a) Close (< 5 mm) or positive margins
b) Extracapsular extension (ECE)
c) N2a or greater cervical node classification
d) Invasion of the soft tissues of the neck
e) Lymph-vascular invasion
f) Perineural invasion (PNI)
g) T3 to T4 tumor classification
h) > 5 mm of subglottic invasion
i) all of the above
Answer : all of the above
Question 19 : Chemotherapy in combination with radiation is employed in the management of various head and neck cancer sites. This approach when used without surgery leads to organ preservation and good oncological outcomes. Which of the following are methods of delivering chemotherapy with radiation:
a) Concurrent chemotherapy and radiation
b) Induction chemotherapy followed by radiation therapy
c) Induction chemotherapy followed by concurrent chemoradiation
d) All of the above
Answer : all of the above
Question 20 : Which of the following is the most accepted management protocol advanced nasopharyngeal cancers:
a) Concurrent chemoradiation
b) Induction chemotherapy followed by concurrent chemoradiation
c) Concurrent chemoradiation followed by maintenance chemotherapy
d) Surgery followed by concurrent chemoradiation
Answer : Concurrent chemoradiation followed by maintenance chemotherapy
Question 21 : In larynx cancer management, organ preservation is desired by both patients and physicians. The seminal trials done on this subject like VA trail and EORTC trail have shown feasibility and good oncological outcomes of radiation with or without chemotherapy in the management of larynx cancers. Which of the following is false regarding organ preservation approaches in the management of larynx cancer:
a) Over 60% of patients in the CRT arm avoided total laryngectomy in the VA trail
b) Patients in the combination chemoradiation arm in the VA trail showed better emotional well being and freedom from pain compared with those being treated surgically
c) In a meta analysis of VA, EORTC and GETTEC trials of larynx cancer, there was a non-significant trend towards improved survival in the chemoradiation arm
d) In the RTOG 91 – 11 trial long term mortality, not related to larynx cancer was highest in the concurrent chemoradiation arm compared with induction chemo followed by RT and RT aloe groups
Answer : In a meta analysis of VA, EORTC and GETTEC trials of larynx cancer, there was a non-significant trend towards improved survival in the chemoradiation arm
Question 22 : All of the following are true regarding squamous cell cancers of lips except :
a) Vermillion border of lower lip is the most common site of origin
b) Surgery or radiation can both be used for their management, surgery is preferable for lesions larger than 2 cm in size
c) Upper lip cancers have worse prognosis
d) For small lesions interstitial brachytherapy may provide excellent outcomes
Answer : Surgery or radiation can both be used for their management, surgery is preferable for lesions larger than 2 cm in size
Question 23 : Which of the following is not true regarding cancers of the floor of mouth:
a) Majority of cancers occurs in the anterior part of FOM
b) Mandible invasion is a fairly early feature
c) For T1 and superficial T2 tumors the risk of occult neck node mets is 10-15%
d) If the lesion is invading mucosa is adherent to mandible but not grossly invading it then marginal mandibulectomy is to be done
Answer : Mandible invasion is a fairly early feature
Question 24 : All of the following are true regarding cancers of oral tongue except:
a) Granular cell myoblastoma is a rare by highly malignant tumor involving oral tongue
b) Occult cervical lymph node mets occur in around 30% of patients
c) Elective nodal dissection is indicated in lesions of oral tongue with a depth of invasion ≥ 4 mm
d) The PENTOCLO protocol is used in the management of osteoradionecrosis
Answer : Granular cell myoblastoma is a rare by highly malignant tumor involving oral tongue
Question 25 : Which of the following the therapeutic modality of choice for discrete early lesions of retromolar trigone:
a) Surgery
b) Radiation
c) Surgery followed by radiation
d) Combined chemoradiation
Answer : Surgery
Question 26 : Which of the following is not anatomically a part of oropharynx :
a) Tonsillar pillars and tonsillar fossae
b) Pyriform fossa
c) Base of tongue
d) Soft palate and posterior pharyngeal wall
Answer : Pyriform fossa
Question 27 : For early lesions of oropharynx, which of the following provides the best oncological outcome:
a) RT
b) Open surgery
c) TORS/TLM
d) All of the above
Answer : All of the above
Question 28 : The treatment of choice for BOT squamous cell carcinoma is:
a) RT
b) Surgery
c) TORS
d) TLM
Answer : RT
Question 29 : Which of the following is the treatment of choice for soft palate carcinoma :
a) RT
b) Surgery
c) TORS
d) TLM
Answer : RT
Question 30 : Which of the laryngeal cancer subsite has the highest propensity for cervical lymph node spread :
a) Glottis
b) Subglottis
c) Supraglottis
d) All have almost the same probability
Answer : subglottis
Question 31 : In which of the following situation in larynx cancer, hemilaryngectomy which is potentially a voice preserving surgery, can not be done:
a) Involvement of one cord and up to 5 mm of the opposite cord
b) Partial fixation of one cord
c) Up to 9 mm of subglottic extension anteriorly and 5 mm posteriorly
d) Extension to the supraglottic or interarytenoid area
Answer : Extension to the supraglottic or interarytenoid area
Question 32 : Which of the following cancers of supraglottis are better suited for surgery by partial or total laryngectomy (what should be their volume) :
a) > 6 mL
b) < 6 mL
c) None of the above
Answer : > 6 mL
Question 33 : Which of the following is not anatomically a part of hypopharynx
a) Pharyngeal walls
b) Pyriform sinus
c) Post cricoid pharynx
d) Valleculae
Answer : Valleculae
Question 34 : Retropharyngeal lymph node involvement is frequent in pharyngeal wall tumors, which of the following is the preferred modality of treatment for these tumors:
a) RT
b) Surgery
c) TLM
d) TORS
Answer : RT
Question 35 : Nasopharyngeal carcinoma affects individuals slightly younger age than other head and neck squamous cell carcinoma. Which of the following is not a type of nasopharyngeal carcinoma :
a) Keratinizing
b) Nonkeratinizing
c) Undifferentiated
d) Basaloid
Answer : The answer is that all of the above are types of nasopharyngeal carcinoma
Question 36 : For cancers of the nasal vestibule, which is the preferred treatment :
a) Surgery
b) Radiation
c) Robotic surgery
d) None of the above
Answer : Radiation
Question 37 : For cancers of the nasal cavity, which is the preferred curative modality :
a) Surgery
b) Radiation
c) Robotic surgery
d) None of the above
Answer : Surgery
Question 38 : For cancers of maxillary sinus which is the preferred curative modality :
a) Surgery
b) Radiation
c) Robotic surgery
d) None of the above
Answer : Surgery
Question 39 : Which of the following is not true regarding malignancies of salivary glands :
a) One fourth of parotid tumors and half of submandibular tumors are malignant
b) Warthin Tumor generally occurs in older men who are smokers
c) Perineural invasion and local recurrences are hallmarks of adenoid cystic carcinoma
d) In the management of parotid gland tumors, facial nerve needs to be sacrificed often
Answer : In the management of parotid gland tumors, facial nerve needs to be sacrificed often
Question 40 : c-kit is commonly expressed in :
a) Pleomorphic adenoma
b) Adenoid cystic cancer
c) Lymphoepithelioma
d) Eskimoma
Answer : Adenoid cystic cancer
Question 41 : Minor salivary gland tumors are most commonly found on :
a) Buccal mucosa
b) Hard palate
c) Soft palate
d) Nasopharynx
Answer : hard palate
Question 42 : Which of the following is goal of oral cavity reconstruction :
a) Obliteration of the oral cavity
b) Maintaining premaxillary contact
c) Maintaining the finger function of the tongue
d) Facilitate retention and movement of sections within the oral cavity
e) Optimize sensation of the remaining native tissue and the revascularized free tissue transfer
Answer : all of the above