Head and neck tumours: biochemical screening in paraganglioma: 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 tumours: biochemical screening in paraganglioma

Sample item

A 38-year-old has a painless pulsatile mass at the carotid bifurcation, with episodic headaches, palpitations and sweating. What should be done before any biopsy or surgery?

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

The answer and the reasoning

A. Plasma or urinary metanephrines, with alpha-blockade if raised

A minority of head and neck paragangliomas secrete catecholamines. Symptoms of paroxysmal hypertension, palpitations and sweating call for biochemical screening with metanephrines before manipulation, and alpha-blockade first if secretion is confirmed, to avoid a hypertensive crisis. Needle biopsy is avoided.

Option by option

  • A. Plasma or urinary metanephrines, with alpha-blockade if raised (correct)

    Correct. Metanephrine screening and alpha-blockade prevent a catecholamine crisis during manipulation.

  • B. Fine-needle aspiration cytology of the mass

    Needle aspiration risks bleeding and a hypertensive surge in a secreting tumour.

  • C. Thyroid function tests with radioiodine uptake

    Thyroid tests do not address a catecholamine-secreting tumour.

  • D. Serum calcitonin and carcinoembryonic antigen

    Calcitonin and CEA are markers of medullary thyroid carcinoma.

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.

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Plasma or urinary metanephrines, with alpha-blockade if raised. A minority of head and neck paragangliomas secrete catecholamines.

Why is "Fine-needle aspiration cytology of the mass" not the answer?

Needle aspiration risks bleeding and a hypertensive surge in a secreting tumour.

Why is "Thyroid function tests with radioiodine uptake" not the answer?

Thyroid tests do not address a catecholamine-secreting tumour.

Why is "Serum calcitonin and carcinoembryonic antigen" not the answer?

Calcitonin and CEA are markers of medullary thyroid carcinoma.

What concept does this question test?

It tests Head and neck tumours: biochemical screening in paraganglioma in ENT. Symptoms of paroxysmal hypertension, palpitations and sweating call for biochemical screening with metanephrines before manipulation, and alpha-blockade first if secretion is confirmed, to avoid a hypertensive crisis. Needle biopsy is avoided.

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 tumours: biochemical screening in paraganglioma?

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.