Head & Neck (Q1-23)

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Question 1







A 50 year old man notes a slowly enlarging lump on the left side of his face for several years. On physical examination, there is a firm, mobile mass anterior to the left ear and above the angle of the mandible. The mass is removed and is grossly 3 cm in diameter with discreet borders and a grey-white cut surface. Microscopically it is composed of epithelial elements dispersed throughout a matrix of mucoid, myxoid, and chondroid tissue. Around the mass are serous glands. This lesion is most likely to be a(an):
A Warthin's tumor
B Pleomorphic adenoma
C Adenoid cystic carcinoma
D Teratoma
E Mucoepidermoid carcinoma
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Question 2 A 21-year-old male gives a history of hay fever all his life. He has noted increasing difficulty breathing through his nose for the past several years. This is due to nasal obstruction with a feeling of nasal stuffiness but no bleeding or pain. On physical examination, you find bilateral soft, pale, glistening, rounded masses filling the nasal cavities. The most likely diagnosis is:
A Wegener's granulomatosis
B Sarcoidosis
C Squamous papillomatosis
D Angiofibromas
E Benign nasal polyps
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Question 3 A 55-year-old male with a 100 pack year smoking history has had a chronic cough for years. However, he has noticed increasing hoarseness for several months. Recently, his sputum has been blood-streaked after coughing. You most strongly suspect that he has:
A Singer's nodules
B Herpes simplex virus infection
C Laryngeal carcinoma
D Sjogren's syndrome
E Laryngeal papillomatosis
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Question 4 A 71 year old male has noted a small bump on the left lower side of his mouth which he can feel with his tongue. On physical examination, this small firm mass is 0.7 cm in diameter with no overlying erythema or ulceration. The lesion is excised and appears microscopically to have been produced by obstruction of a minor salivary gland duct. This lesion is most likely to be a:
A Calculus
B Mucocele
C Mucoepidermoid carcinoma
D Squamous papilloma
E Hematoma
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Question 5 A 25 year old male has been "snorting" cocaine (self-administering the drug intranasally) for several years on a regular basis. Which of the following conditions is he most likely to develop:
A Nasal polyps
B Angiofibroma
C Inverting squamous papilloma
D Wegener's granulomatosis
E Septal perforation
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Question 6 A 44-year-old basketball coach has been screaming at players, assistant coaches, referees, and the media for years. He is at most risk for development of:
A Chronic sinusitis
B Laryngeal papilloma
C Mucocele
D Laryngeal nodule
E Laryngeal granuloma
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Question 7 A 40 year old female has seropositivity for both SS-A and SS-B autoantibodies. Her antinuclear antibody test is negative. Of the following features, the one that is NOT characteristic of her underlying condition is:
A Keratoconjunctivitis sicca
B Xerostomia
C Mucormycosis
D Lymphocytic infiltrates of salivary gland
E Risk for B-cell lymphoma
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Question 8 A 15 year old male has had problems with hoarseness for the past 8 years and rare episodes of hemoptysis. He has had multiple resections of small nodular masses on the vocal folds. Microscopically, these masses are composed of finger-like projections of fibrovascular cores covered by squamous epithelium. These lesions are most likely to:
A Respond to radiation therapy
B Stem from human papillomavirus infection
C Be solitary lesions
D Become malignant
E Spontaneously regress
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Question 9 A 56-year-old male has a slow-growing mass involving the right parotid region that he has noticed for the past year. For several months he has experienced pain in this area. Surgical excision is undertaken and the mass is 4 cm in diameter and found to be invading surrounding structures, including the facial nerve. This neoplasm is probably a(an):
A Adenoid cystic carcinoma
B Squamous cell carcinoma
C Warthin's tumor
D Pleomorphic adenoma
E Metastatic laryngeal carcinoma
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Question 10 A 70 year old woman has a sensation of dull pain on the left side of her face. Physical examination reveals that there is firmness in the region of the parotid gland, but no distinct mass is felt. There is only slight tenderness. Microscopically, the excised gland demonstrates chronic inflammation with extensive fibrosis. These findings are most often a consequence of:
A Sjogren's syndrome
B Tuberculosis
C Pleomorphic adenoma
D Mumps
E Duct lithiasis
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Question 11 A 49-year-old male has a long history of use of chewing tobacco. His dentist notes the presence of several 0.5 cm white plaques on the oral mucous membrane just lateral to the left lower teeth. These plaques cannot be removed by scraping. His dentist advises him that he is at risk for development of:
A Squamous cell carcinoma of the mouth
B Salivary gland duct lithiasis
C Sjogren's syndrome
D Pleomorphic adenoma
E Mucocele
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Question 12 Giant cell reparative granulomas of the gingival margin are LEAST likely to:
A Recur after excision
B Erode adjacent bone
C Mimic a pyogenic granuloma
D Contain granulation tissue
E Become malignant
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Question 13 A 21 year old female has a history of type I diabetes mellitus. She recently noted the onset of pain on the right side of her face that persisted for a couple of days. When seen in the emergency room, she is noted to have pain and swelling in the region lateral to her nose extending to her right ear. A head CT scan shows enlargement with bony erosion of the right maxillary sinus and surrounding soft tissue swelling. Laboratory findings include serum sodium of 132 mmol/L, potassium 5.0 mmol/L, chloride 95 mmol/L, CO2 8 mmol/L, glucose 485 mg/dL, and creatinine 0.9 mg/dL. Urinalysis shows 4+ ketones, 4+ glucose, no blood, and no protein. Which of the following conditions is most likely to be producing these findings:
A Allergic rhinitis
B Mucormycosis
C Angiofibroma
D Pleomorphic adenoma
E Acute rheumatic fever
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Question 14 A 50 year old Asian male has pain and discomfort on the left side of his face and has difficulty breathing through is left nostril. Examination with head CT reveals a mass involving the nasopharyngeal region and eroding adjacent bone. The mass is biopsied and is composed of poorly differentiated squamous cells. The origin of this lesion is most likely to be associated with which of the following infectious agents:
A Epstein-Barr virus
B Mucor
C Group A Streptococcus
D Cytomegalovirus
E Mycoplasma
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Question 15 A 35-year-old male with human immunodeficiency virus infection and a CD4 lymphocyte count of 300/microliter is noted to have confluent adherent white to tan plaques on the upper surface of his tongue. No bleeding is noted. Histologically, these plaques are most likely to show:
A Budding cells with pseudohyphae
B Caseating granulomata
C Spherules with endospores
D Multinucleated cells
E Marked acanthosis and koilocytosis
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Question 16 An infectious agent that produces an acute illness, typically in childhood, with upper airway mucosal necrosis with formation of a fibrinopurulent membranous exudate is:
A Group A beta-hemolytic streptococcus
B Hemophilus influenzae
C Mycobacterium tuberculosis
D Influenza A virus
E Corynebacterium diptheriae
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Question 17 A 49 year old female has difficulty hearing on the left. She has no other significant medical problems. This hearing loss has been gradually progressive for years. She has no tinnitus or dizziness or headache. Examination reveals a unilateral bone conductive hearing loss on the left. Her tympanic membranes and external auditory canals appear normal. A head CT scan shows no mass or bony erosion. Which of the following conditions is she most likely to have:
A Ankylosis of bony ossicles
B Inflammation of semicircular canals
C Cystic growth of squamous epithelium
D Neoplastic proliferation of Schwann cells
E Invasion of non-septate hyphae
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Questions 18 and 19: Click on the checkbox first, then the lettered item: (18) A 22-year-old male has a small red swollen area on his upper lip that, over the course of a couple of days, becomes a tender vesicle that ruptures and leaves a painful erythematous 0.8 cm lesion which resolves in about a week.
(19) A 15 year old male notes a pinpoint white lesion just to the left of the tip of his tongue. Over the course of a few days, this lesion forms a shallow but very painful 0.3 cm ulceration. The lesion disappears in a week.
A Herpes simplex virus
B Rhinoscleroma
C Thrush
D Hairy leukoplakia
E Aphthous ulcer
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Questions 20 and 21: Click on the checkbox first, then the lettered item: (20) A 48 year old female has the abrupt onset of vertigo associated with tinnitus and diminished hearing on the left. She is put on bed rest and given meclizine. She recovers in a few days.
(21) A 42 year old truck driver has noted facial drooping on the left for the past day. He has some pain behind his left ear, and sounds seem louder on that side as well. His sensation of taste is not the same on the left as on the right. These symptoms abate in a couple of weeks.
A Carotid body
B Inner ear
B Anterior neck
D Facial nerve canal
E Mastoid
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Question 22 Examination of the oral cavity of a 42 year old male reveals a reddish-blue, circumscribed, papular lesion with superficial ulceration that is located on the left anterior gingival ridge above the mandible. This lesion is most likely to be a(an):
A Thyroglossal duct cyst
B Ameloblastoma
C Cholesteatoma
D Mucocele
E Pyogenic granuloma
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Question 23 A 14 year old male notes a "bump" on his neck that has been slowly enlarging for the past two years. On physical examination, there is a 2 cm diameter discreet mass in the anterior midline of the neck above the thyroid cartilage. On head CT scan, this mass is cystic with a thin wall and smooth border. Which of the following entities does this lesion most likely represent:
A A malignant neoplasm
B An embryologic remnant
C A granuloma
D A benign neoplasm
E An abscess
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