BAILEY CH.

9
81 - 121
81. The most commonly used particle for radiation therapy is:
A. Photon
B. Proton
C. Electron
D. Neutron

A
8 1 . Answer: A.
Photons are the most commonly used particle. Electrons are widely
available, while protons and neutrons require very special and
expensive equipment. PAGE1683
• 82. Which is the most common type ofbasal cell carcinoma (BCC)?
A. Nodular
B. Morpheaform
C. Pigmented
D. Sclerosing

A
82. Answer:A.
The most common type of BCC is nodular (nodulo ulcerative). This
lesion typically presents as a discrete, raised circular lesion that often
has a central ulceration and rolled borders. The lesion is pink and waxy
with a network of capillaries. Morpheaform (also known as sclerosing)
is the most aggressive form of BCC. Pigmented BCC is characterized by
its brown pigment and differs from nodular BCC by the brown
pigmentation only. PAGE 1724
• 83. The optimal treatment for a small recurrent nasopharyngeal (NP)
carcinoma in the nasopharynx after radiotherapy is:
A. Second course of radiation
B. Chemotherapy and radiation
C. Radical surgical resection
D. Targeted therapy
E. Local excision and postoperative radiotherapy

C
83. Answer: C.
Most patients with persistent or recurrent NP cancer are inoperable.
Those with small tumors may benefit from surgery . One study reports
2 - year disease control over 70%. PAGES 1889-1890
• 84. In the course of a neck dissection, profuse venous bleeding occurs
in the area be low the posterior belly of the digastrics and anterior to
the jugular vein. As multiple clamps are applied to control the
bleeding, which of the following nerves is at highest risk of injury?
A. The spinal accessory
B. The glossopharyngeal
C. The hypoglossal
D. The vagus
E. The superior laryngeal nerve

C
84. Answer: C.
The hypoglossal nerve lies in level II of the neck immediately below and
deep to the posterior belly of the digastric tendon. Attempts to control
bleeding in this area without nerve identification place the nerve at
risk. PAG E 1 824
85. A 48-year-old patient presents with a 1.5-cm biopsy-proven, poorly
differentiated squamous cell carcinoma of the left ear. Which of the
following is the most appropriate stage of the primary tumor (T) ?
A. T1
B. T2
C. T3
D. T4

B
85. Answer: B.
T2: tumor >2 cm or tumor of any size with two or more high-risk
features, which include depth of invasion >2 mm, Clark level IV or
greater, perineural invasion, location on ear or non-hair-bearing lip and
poorly differentiated or undifferentiated.
PAGE 1728
86. Reirradiation as a single treatment modality is a well-defined
treatment for recurrent:
A. Larynx cancer
B. Tongue base cancer
C. Nasopharyngeal cancer
D. Skull base cancer
E. Skin cancer

C
86. Answer: C.
Multiple studies have shown a 5-year local control after reirradiation of
nasopharyngeal cancer to be 50% to 60%. PAGE1712
87. The most common acute toxicity observed after oral radiation
therapy are:
A. Mucositis, osteonecrosis, and xerostomia
B. Mucositis, carotid endarteritis, and xerostomia
C. Mucositis, dysphagia, and xerostomia
D. Mucositis, fibrosis, and xerostomia

C
87. Answer: C.
Painful mucositis leading to dysphagia and dry mouth are the most
common acute toxicities observed. Radio necrosis, fibrosis, and major
vessel inflammation manifest as late toxicities. PAG E 1 689
88. Which artery is at greatest risk of injury during endoscopic
endonasal anterior cranial base resection?
A. Frontopolar artery
B. Frontoorbital artery
C. Anterior cerebral artery
D. Anterior communicating artery
E. Anterior ethmoidal artery

B
88. Answer: B.
The frontoorbital artery, a branch of the anterior cerebral artery, runs
along the inferior surface of the frontal lobe, and so presents an
increased risk of injury.
89. What is characteristic of paratracheal and paraesophageal
lymphatic metastases from a hypopharyngeal carcinoma?
A. Lateral pyriform sinus involvement
B. Retropharyngeal involvement
C. Vocal cord paralysis
D. Postcricoid tumor involvement

D
89. Answer: D.
Invasion of the pyriform apex (20%), postcricoid mucosa (57%), and
subglottis is associated with metastasis in the paratracheal and
paraesophageal nodes. PAGE 1921
90. Which is the most common site involved by lymphoma within
Waldeyer ring?
A. Tonsils
B. Base of tongue
C. Nasopharynx
D. Oral tongue

A
90. Answer: A.
About 50% of all Waldeyer ring non-Hodgkin lymphomas arise in the
palatine tonsil, 20% of which are bilateral. In decreasing order,
lymphomas in this region also arise from the pharyngeal tonsil, base of
tongue, or lingual tonsil, or involve multiple primary sites. Symptoms
correspond with the location of disease and tumors are typically submu
cosal, not ulcerative. PAG E 2037
91. How many base pairs are in the human diploid genome?
A. 6,000,000
B. 60,000,000
C. 600,000,000
D. 6,000,000,000

D
91. Answer: D.
In head and neck cancer, on average, 1 to 15 base pairs are mutated for
each exome. There may be 6,000 to 90,000 mutations for the 6.4 billion
base pairs in the human genome. PAG E 1 647
92. Laryngeal preservation in a patient with a T3N2C hypopharyngeal
cancer is most likely to be successful with which of these
chemotherapy treatments?
A. Concurrent chemoradiation with cisplatin and 5-FU
B. Concurrent chemoradiation with cisplatin and cetuximab
C. Induction chemotherapy using cisplatin and 5-FU followed by radiotherapy
D. Induction chemotherapy with docetaxel,cisplatin,and 5 FU followed by
radiotherapy

D
92. Answer: D.
The GORETEC study compared induction chemotherapy with cisplatin
and 5-FU to docetaxel, cisplatin, and 5-FU. Laryngeal preservation was
higher with the three drug regimen. PAG E 1 697
93. What is the 5-year overall survival of laryngeal cancer?
A. 48%
B. 63%
C. 75%
D. 92%

B
93. Answer: B.
In between 1999 and 2005,the 5-year survival of laryngeal cancer has
statisti cally decreased to 63%. PAGES 1961-1962
94. A patient with a T3NO squamous cell carcinoma of the lateral floor of the
mouth is to undergo surgical treatment. Which of the following is an
appropriate neck dissection in this case?
A. Selective neck dissection of levels I and II (suprahyoid dissection)
B. Selective neck dissection of levels I, II, and III (supraomohyoid dissection)
C. Selective neck dissection of levels II, III, and IV (lateral dissection)
D. Modified radical neck dissection preserving the jugular vein and the spinal
accessory nerve
E. Modified radical preserving the spinal accessory nerve
B
Answer: B.
Selective neck dissection for oral cavity cancer of levels I to III is
appropriate for oral cavity tumors, with the exception of oral tongue
cancer which can spread to level IV and requires dissection of levels I to
IV. PAGES 1821-1822
95. Which of the following statements is correct with regard to
chemotherapy?
A. The addition of chemotherapy to radiation improves survival of
patients with stage IIa nasopharyngeal cancer.
B. Combination chemotherapy significantly improves the survival of
patients with recur rent disease over single agent chemotherapy
alone.
C. Induction chemotherapy followed by radiation therapy is the
standard of care for un resectable disease.
D. Current standards of care are based on phase III data.
D
Answer: D.
Phase III trials compare the response of a new drug to standard
treatment. Phase III clinical trial data provide level I evidence, which is
the best evidence to support the use of chemotherapeutic regimens.
PAG E 1 694
96. Free tissue transfer after ablation for recurrent oropharyngeal
cancer will result in:
A. An improvement of preoperative functional status
B. A lower recurrence rate than if a pedicled flap was used
C. Lower hospital costs
D. Decreased metastatic disease
E. A lower requirement for further surgery

E
Answer: E.
The use of previously unirradiated tissue improves healing and reduces
the need for further surgery. It does not increase cancer control. It may
indirectly reduce hospital costs through better healing. PAG ES 1 7 1 0-1
711
97. A 65-year-old man being treated for T3N2c squamous cell
carcinoma of the larynx with adjuvant chemoradiation has significant
pain during the fifth week of radiation, requiring hospitalization for
fluids and pain control. What should be done with the patient's
treatment during the hospitalization?
A. Discontinue radiation and do not resume
B. Defer radiation until patient is discharged
C. Continue radiation while patient admitted
D. Stop chemotherapy
C
Answer: C.
Every effort should be made to continue treatment while treating
toxicity. Extended treatment time is associated with reduced tumor
control. PAG E 1 684
98. What is the main advantage of the gastric transposition flap over
jejunal flap in reconstruction of the esophagus?
A. Improved voice outcomes
B. Less morbidity
C. Single anastomosis
D. Larger vessels for microvascular anastomosis

C
98. Answer: C.
Gastric transposition has the advantage of a robust blood supply and
creation of a single pharyngeal anastomosis. Morbidity with gastric
pull-up is greater than that associated with jejunal free flaps, and voice
outcomes are typically "hollow," whereas voice with jejunal free flap is
"wet." PAGE 1932
99. After an endoscopic endonasal resection of a craniopharyngioma,
the patient presented with serum sodium of 155 mEq/L, high urine
output, and a urine-specific gravity of 1 .001 . What is the diagnosis and
the best treatment option?
A. Inappropriate secretion of antidiuretic hormone/ 1 -deamino-8-d-
arginine vasopressin (DDAVP)
B. Inappropriate secretion of antidiuretic hormone/fluid restriction
C. Diabetes insipidus/DDAVP
D. Diabetes insipidus/fluid restriction
C
99. Answer: C.
High urine output of low specific gravity (over 250 mL in 2 hours) with
high serum sodium characterizes diabetes insipidus. PAGE 2094
100. The goal of surgery in secondary hyperparathyroidism is:
A. Normal serum calcium
B. Improve renal function
C. Control of parathyroid hormone (PTH)
D. Reduction of cardiovascular events

D
100. Answer: D.
The increased mortality associated with untreated secondary
hyperparathyroidism is primarily related to cardiovascular
complications induced by ectopic calcifications. The goal of surgery is to
reduce PTH secretion when medical management has failed, which is
associated with a lower incidence of major cardiovascular events and
overall lower mortality. PAGE2136
101. The optimal treatment of recurrent cervical lymph node
metastasis in nasopharyngeal carcinoma is:
A. Second course of radiotherapy
B. Modified neck dissection
C. Radical neck dissection
D. Radical neck dissection followed by radiotherapy
E. Chemotherapy and radiotherapy

C
101. Answer: C.
Reirradiation results in only a 20% 5-year survival rate. Radical neck
dissection reportedly achieved tumor control in over 65% of patients.
PAGE 1888
102. Which of these orbital bones contributes to the orbital rims?
A. Sphenoid
B. Zygomatic
C. Palatine
D . Lacrimal

B
102. Answer: B.
The orbital rim is comprised of the nasal bone, maxillary bone,
zygomatic bone, and frontal bone. The sphenoid and lacrimal bones are
part of posterior and medial walls of the orbital vault, while the
palatine bone is not part of the orbital vault. PAGE2065
103. Which of these is the most accurate predictor of disease-related
survival for patients with head and neck squamous cell carcinoma?
A. T stage
B. Current use of alcohol and/or tobacco
C. Presence of cervical lymph node metastasis
D. Presence of significant comorbid cardiopulmonary disease

C
103. Answer: C.
While all of the above variables contribute to survival, cervical
metastases are the primary determinant of disease-specific survival.
Many series report a 50% reduction in survival when nodal metastases
are present. PAG E 1 840
104. Sentinel lymph node biopsy should be offered when a patient has:
A. A 0.75-mm-thick melanoma of the scalp without ulceration and no
clinical evidence of lymph node metastases
B. A 3.5-mm-thick melanoma ofthe scalp without ulceration and no
clinical evidence of lymph node metastases
C. A 3.5-mm-thick melanoma of the scalp without ulceration and with
lymph node metastases in two cervical lymph nodes
D. A 3.5-mm-thick melanoma ofthe scalp without ulceration, with no
clinical evidence of lymph node metastases, and with distant
metastases in the spine
B
104. Answer: B.
A sentinel lymph node biopsy is not offered to patients with lesions
measuring 0.75 mm or smaller and to those with clinical nodal or
distant metastasis. PAGE 1746
105. The most accurate radiologic method to stage the NO neck in oral
cancer is with:
A. CT
B. MRI
C. Positron emission tomography (PET)/CT
D. Palpation

A
105. Answer: A.
High-resolution CT scanning is the imaging modality of choice to stage
the cNO neck in oral cavity cancer and is superior to MRl or PET-CT in
evaluation of the neck. Evidence of clinically suspicious lymph node
metastases includes size > 1 cm, central necrosis, round rather than
ovoid shape, and poorly defined borders suspicious for extra capsular
spread. PAGE 1860
106. Rituximab is which kind of drug used in the treatment of certain
lymphomas?
A. Small-molecule tyrosine kinase inhibitor
B. Monoclonal antibody against CD20
C. Protease inhibitor
D. Proteosome inhibitor

B
106. Answer: B.
Rituximab is an anti-CD20 monoclonal antibody. In symptomatic
patients, combination chemotherapy and immunotherapy is
considered to be standard therapy. The addition of rituximab with the
standard CHOP (cyclophosphamide, doxorubicin, vincristine, and
prednisone) regimen (R-CHOP) has shown significant improvement in
outcomes without additional major toxicity and is well tolerated in
symptomatic elderly patients with relevant comorbidities. PAGE 2036
107. A 72-year-old man presents with a 25-mm mass in the tail of the
parotid on the left. CT show a second 20-mm mass on the right. What
is the most likely diagnosis?
A. Bilateral Warthin tumor
B. Multifocal pleomorphic adenoma
C. Adenopathy
D. Metastases for an unknown primary

A
107. Answer: A.
Warthin tumors can be multifocal in up to 50% ofcases, and bilateral
Warthin tumors are seen in over 1 0% of patients. These are commonly
associated with smoking and have a classic appearance on fine-needle
aspiration biopsy. PAGE1762
108. A 28-year-old undergoes partial parotidectomy with facial nerve
dissection for a 22-mm tumor. Pathology shows a low-grade
mucoepidermoid carcinoma. Margins are negative. The neck is
radiologically negative. What therapy do you recommend?
A. No further therapy, observation
B. Completion of total parotidectomy
C. Total parotidectomy, adjuvant radiation
D. Total parotidectomy, neck dissection
A
108. Answer: A.
Complete surgical excision of low-grade mucoepidermoid cancer is
curative, and with clear margins, adjuvant therapy is not
recommended. These tumors have a low incidence of nodal
involvement, and if the neck is radiologically negative, elective neck
dissection is not recommended for these tumors. PAG E 1 764
109. The primary treatment for intrabony ameloblastoma requires:
A. Dental extraction
B. Enucleation
C. Enucleation and curettage
D. Resection with 1 .0 to 1 .5 cm bony margin

D
109. Answer: D.
When margins are negative, most patients with ameloblastoma can be
cured. Incomplete removal is associated with an unacceptable
recurrencerate. PAGE2104
110. The commonest presenting symptom of nasopharyngeal (NP)
carcinoma is
A. Epistaxis
B. Hearing loss due to serous otitis media
C. Enlarged cervical lymph node
D. Nasal obstruction
E. EAbducent nerve palsy

C
1 10. Answer: C.
The presenting symptoms of NP cancer reflect the size and location of
the primary tumor. The most common symptom is a neck mass. Cranial
nerve involvement reflects intracranial spread. PAGE: 1877
111. A 35-year-old woman presents with a 3-month history of
progressing double vision. On examination you note normal acuity, but
there is a left cranial nerve 6 palsy. What is the next step?
A. Obtain an MRl and CT
B. Electromyography of lateral rectus
C. Serial clinical examination in 2 weeks
D. Begin high-dose steroids

A
• 1 1 1 . Answer: A.
• Cranial nerve deficits should always raise the suspicion of malignancy.
Imaging is the next step to identify whether an orbital, skull base, or
intracranial tumor is responsible for nerve deficits. PAGES2064-2065
112. A 55-year-old man presents with a 3-cm right-sided neck mass.
Flexible laryngoscopy shows a mass originating on the right
aryepiglottic fold extending superiorly onto the epiglottis. Both true
vocal cords are mobile. CT scan shows paraglottic space invasion and
multiple right-sided lymph nodes none larger than 3 cm. What is the
TNM stage?
A. T2N2aMO
B. T2N2bMO
C. T3N2aMO
D. T3N2bMO
D
112. Answer: D. PAGE 1964, TABLE 124.2
113. What is the gold standard/preferred method for a laryngeal
speech?
A. Electrolarynx use
B. Esophageal speech
C. Tracheoesophageal (TE) speech
D. Soft tissue shunting

C
113. Answer: C.
TE speech has been rated the most desirable form of a laryngeal
speech by both speech pathologists and patients, and is the preferred
method of a laryngeal speech by naive listeners. PAGE 1987
114. Indications for elective treatment of the neck include all of the
following except:
A. T3-T4 primary lip SSCa
B. Recurrent lip SSCa
C. Locally advanced basal cell carcinoma (BCC)
D. If free flap reconstruction is necessary
E. Histology showing poorly differentiated SSCa

C
1 14. Answer: C.
BCC rarely metastasizes to cervical lymph nodes. In the absence of
clinical nodal disease, elective neck dissection is not indicated.
PAG E 1 791
115. During a lateral infratemporal approach to the cranial base,
exposure of the petrous carotid artery segment requires:
A. Lateralization of the mandibular nerve and the middle meningeal
artery
B. Sacrifice of the mandibular nerve and the middle meningeal artery
C. Sacrifice of the maxillary nerve and the middle meningeal artery
D. Lateralization of the ophthalmic nerve and sacrifice of the middle
meningeal artery
E. Sacrifice of the vidian nerve and sphenopalatine artery B
1 15. Answer: B.
Exposure of the petrous carotid requires sacrifice of the mandibular
nerve, middle meningeal artery, and the eustachian tube. PAGE 2090
116. Which of the following statements regarding tracheal cancers is true?
A. The duration of symptoms prior to presentation is longer for squamous
cell carcinoma (SCCA) than for adenoid cystic carcinoma.
B. The duration of symptoms prior to presentation is longer for adenoid
cystic carcinoma than for SCCA.
C. SCCA is more likely than adenoid cystic carcinoma to present with
wheezing.
D. Adenoid cystic carcinoma is more likely than SCCA to present with
hemoptysis.
E. Prolonged use of corticosteroids is uncommon in tracheal cancers prior
to diagnosis.
B
1 16. Answer: B.
Tracheal tumors are slow-growing, often causing diagnosis to be
delayed. The mean duration of symptoms for patients with SCCA and
adenoid cystic carcinoma was 12.2 months. The duration of symptoms
was longer in adenoid cystic carcinoma than SCCA (18.3 months vs. 4.5
months) and in tumors that were deemed to be unresectable
(unresectable adenoid cystic carcinoma 23.7 months; unresectable
SCCA 7.58 months).
PAGE 1990
117. Which of the following statements about nerve sheath tumors is not
accurate?
A. The majority ofperipheral nerve sheath tumors arise in the nasal cavity
and paranasal sinuses.
B. Peripheral nerve sheath tumors arising in the paranasal sinuses,
compared to the neck or internal auditory canal, are fast growing, and
symptomatic at an early stage.
C. Peripheral nerve sheath tumors in the nasal cavity and paranasal sinuses
lack encapsulation with neoplastic cells undermining adjacent respiratory
mucosa.
D. Treatment of nerve sheath tumors in the nasal cavity and paranasal
sinuses is radiation followed by surgical excision.
C
1 17. Answer: C.
Ninety percent of nerve sheath tumors are benign, the majority being
schwannoma or neurofibroma. In the sinonasal tract, they present as a
submucosal mass.
PAG E 2048
118. What is the main lower eyelid retractor?
A. Whitnall ligament
B. Capsulopalpebral fascia
C. Inferior oblique muscle
D. Orbicularis oculi

B
1 18. Answer: B.
The capsulopalpebral fascia is the main retractor of the lower lid, while
the levator palpebrae is the main retractor of the upper lid. Whitnall
ligament is part of the upper lid anatomy, while the orbicularis oculi is
responsible for eyelid closure, and the inferior oblique muscle
contributes to globe movement. PAGES 2065-2066
119. The preferred management of adenoid cystic carcinoma limited to
the trachea, with no evidence of distant metastatic disease, and
involving 3 cm of trachea is:
A. Bronchoscopy with neodymium YAG laser resection
B. Tracheal resection with free tissue transfer reconstruction
C. Bronchoscopy with cryoablation
D. Tracheal resection with primary repair

D
119. Answer: D.
Tracheal resection and primary reanastamosis is the preferred treatment for the majority
of both benign and malignant tracheal neoplasms. (PAGES 1992-1993) There are patient
and tumor factors that determine if tracheal resection with end to end anastomosis can be
performed safely. Important patient factors include body mass index, body habitus, and
medical comorbidities such as diabetes mellitus and chronic obstructive pulmonary
disease. Tumor factors include the length of the resection needed to remove the tumor
with margins. A segmental resection greater than 4 cm or six tracheal rings may put
tension on the anastomosis. Tumors with extension into the mediastinum, esophagus, and
bronchial tree may require combined cervicothoracic procedures or non surgical
treatment. Prior radiation therapy and previous tracheotomy with resulting scar tissue (and
potential seeding of the anterior neck with tumor) make resection with primary
anastomosis more challenging. For those patients in whom resection is contraindicated,
tracheotomy, endoscopic tumor ablation, and stent placement are options.
PAG ES 1 992-1 993
120. Which oral site is most commonly afflicted by cancer?
A. Tongue
B. Floor of mouth
C. Alveolus
D. Tongue base

A
120. Answer: A.
The oral tongue is the most common subsite of the oral cavity to
develop cancer, occurring in 32% of cases, followed by the floor of
mouth. Oral cavity cancer is the most common site for head and neck
cancer in the United States. PAG E 1 854
TERIMA KASIH