Head and neck oncology: practice question

A ENT question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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ENT · Head and neck oncology

Sample item

A 55-year-old non-smoker has a painless, cystic level II neck mass. FNAC shows squamous cells with cystic change. There are no other findings on clinical examination of the upper aerodigestive tract. Which is the most likely site of the primary, and what is the best next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Oropharynx (tonsil or base of tongue), with panendoscopy and directed biopsy or tonsillectomy

A cystic squamous cell nodal metastasis at level II in an adult is most often from an HPV-related oropharyngeal primary in the tonsil or base of tongue. The work-up uses imaging with PET-CT or MRI, then examination under anaesthesia with directed biopsies and tonsillectomy.

Option by option

  • A. Thyroid gland, with a total thyroidectomy

    Thyroid cancers metastasising to nodes are usually papillary, not squamous, and are managed differently.

  • B. Parotid gland, with a superficial parotidectomy

    A parotid primary would present with a parotid mass and not with isolated squamous cells in a level II node.

  • C. Oropharynx (tonsil or base of tongue), with panendoscopy and directed biopsy or tonsillectomy (correct)

    Correct. Cystic nodes with squamous cells usually point to the oropharynx.

  • D. Nasal vestibule, with an incisional biopsy

    The nasal vestibule would show an obvious lesion on examination.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More ENT questions

Questions about this ENT question

What is the answer to this ENT question?

The best answer is C, Oropharynx (tonsil or base of tongue), with panendoscopy and directed biopsy or tonsillectomy. A cystic squamous cell nodal metastasis at level II in an adult is most often from an HPV-related oropharyngeal primary in the tonsil or base of tongue.

Why is "Thyroid gland, with a total thyroidectomy" not the answer?

Thyroid cancers metastasising to nodes are usually papillary, not squamous, and are managed differently.

Why is "Parotid gland, with a superficial parotidectomy" not the answer?

A parotid primary would present with a parotid mass and not with isolated squamous cells in a level II node.

Why is "Nasal vestibule, with an incisional biopsy" not the answer?

The nasal vestibule would show an obvious lesion on examination.

What concept does this question test?

It tests Head and neck oncology in ENT. The work-up uses imaging with PET-CT or MRI, then examination under anaesthesia with directed biopsies and tonsillectomy.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Head and neck oncology?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.