[SEM2] Head & Neck / Liver Flashcards
(20 cards)
- Which benign liver lesion is most strongly associated with oral contraceptive use?
A. Focal nodular hyperplasia
B. Hemangioma
C. Hepatic adenoma
D. Cholangiocarcinoma
C. Hepatic adenoma
🧠 Rationale: Hepatic adenomas are estrogen-dependent and commonly occur in women using oral contraceptives.
- Which benign liver lesion has the highest risk of spontaneous bleeding or rupture?
A. Hemangioma
B. Focal nodular hyperplasia
C. Hepatic adenoma
D. Metastatic cancer
C. Hepatic adenoma
🧠 Rationale: 10–25% of hepatic adenomas present with hemorrhage; rupture risk increases with lesion size.
- Which of the following liver lesions may undergo malignant transformation to hepatocellular carcinoma (HCC)?
A. Hepatic adenoma
B. Hemangioma
C. Focal nodular hyperplasia
D. Simple cyst
A. Hepatic adenoma
🧠 Rationale: Hepatic adenomas carry a risk of malignant transformation, especially β-catenin subtype.
- Which liver lesion shows a central scar with centrifugal enhancement on imaging?
A. Hemangioma
B. Hepatic adenoma
C. Focal nodular hyperplasia
D. Cholangiocarcinoma
C. Focal nodular hyperplasia
🧠 Rationale: FNH is characterized by a central scar that enhances in the delayed phase (centrifugal enhancement).
- Which of the following statements about liver hemangiomas is TRUE?
A. They require surgical excision due to rupture risk
B. They are commonly hormone-dependent
C. They show peripheral nodular enhancement with centripetal fill-in
D. They are premalignant lesions
C. They show peripheral nodular enhancement with centripetal fill-in
🧠 Rationale: Hemangiomas are vascular lesions with characteristic CEUS or MRI findings; surgery is not usually required.
- A 5-year-old boy presents with ear pain, fever, and a 2-week history of cough
and colds. On examination, there is ear discharge noted. What is the most likely
diagnosis?
A. Otitis externa
B. Acute otitis media with effusion
C. Acute otitis media
D. Chronic otitis media
C. Acute otitis media
Rationale: Most common in children after a viral upper respiratory tract infection. Ear
discharge indicates tympanic membrane rupture due to pus accumulation. Pain, fever,
and recent URI support the diagnosis.
- A 40-year-old male drill instructor presents with persistent hoarseness.
Laryngoscopy reveals a unilateral, exophytic lesion on the vocal cord. What is the
most likely diagnosis?
A. Vocal cord nodule
B. Vocal cord polyp
C. Laryngeal papilloma
D. Laryngeal carcinoma
B. Vocal cord polyp
Rationale: Polyps are typically unilateral, exophytic lesions caused by vocal abuse
(e.g., shouting). Common in professionals like teachers or drill instructors. Nodules are
usually bilateral and symmetric.
- Which level do the following structures drain into?
Nasopharynx?
Oral cavity?
Parotid gland?
Oropharynx?
Larynx?
Hypopharynx?
Thyroid?
4a. A 50-year-old male smoker presents with a subcentimeter lesion on the lower
lip. Biopsy reveals squamous cell carcinoma. Staging: Stage I (T1N0M0). What is
the best initial surgical management?
A. Wide local excision with mandatory flap reconstruction
B. Mohs micrographic surgery
C. Resection with or without reconstruction
D. Chemoradiation
C. Resection with or without reconstruction
Rationale: Early-stage (T1N0M0) squamous cell carcinoma of the lip is managed with
resection. Reconstruction is only considered if tissue loss affects function or cosmesis.
No need for flap in all Stage I cases.
4b.In the same patient with Stage I squamous cell carcinoma of the lower lip
(T1N0M0), when is neck dissection indicated?
A. Always done regardless of nodal status
B. Only done if lesion is >2 cm
C. Done if clinically evident cervical lymphadenopathy
D. Done if positive margins are present
C. Done if clinically evident cervical lymphadenopathy
Rationale: Neck dissection is not routinely indicated in Stage I lesions unless there is
clinically or radiologically evident nodal disease. Otherwise, the risk of occult
metastasis is low in early-stage lip SCC.
4c. What is the indication for adjuvant radiotherapy in a patient with lip squamous
cell carcinoma post-surgery?
A. All patients with T1 lesions
B. Positive surgical margins, deep invasion (>4–5 mm), oral commissure involvement,
or clinically positive nodes
C. Whenever flap reconstruction is performed
D. If the patient refuses neck dissection
B. Positive surgical margins, deep invasion (>4–5 mm), oral commissure
involvement, or clinically positive nodes
Rationale: Adjuvant radiotherapy is reserved for high-risk features: margins not R0
(positive), perineural invasion, depth >4–5 mm, oral commissure location, or nodal
metastasis. Chemotherapy may be added for very advanced cases.
- A 45-year-old male chronic smoker presents with a 2-month history of anosmia
and nasal obstruction. He recently had serious otitis media. On physical exam, a
mass is palpated in the posterolateral neck. What is the most likely diagnosis?
A. Chronic rhinosinusitis
B. Inverted papilloma
C. Nasopharyngeal carcinoma
D. Olfactory neuroblastoma
C. Nasopharyngeal carcinoma
Rationale: Nasopharyngeal CA commonly presents with nasal obstruction, conductive
hearing loss from Eustachian tube dysfunction (otitis media), and a level II–V neck
mass. Strongly associated with EBV and smoking. Often diagnosed late due to deep,
hidden location.
❓A 50-year-old male presents with a painless neck mass. He has no history of smoking or alcohol use. On further questioning, he reports mild sore throat and difficulty swallowing. Flexible laryngoscopy reveals a tonsillar mass. Biopsy confirms squamous cell carcinoma, and HPV-16 is detected. What is the most likely diagnosis?
A. HPV-negative oropharyngeal squamous cell carcinoma
B. HPV-related oropharyngeal squamous cell carcinoma
C. Nasopharyngeal carcinoma
D. Laryngeal carcinoma
B. HPV-related oropharyngeal squamous cell carcinoma
High-Yield Rationale: HPV-related oropharyngeal carcinoma (especially HPV-16) commonly presents in younger, non-smoking patients with a neck mass and minimal mucosal symptoms. Commonly arises from the tonsil or base of tongue, with better prognosis than HPV-negative cancers. Diagnosis confirmed via p16 immunostaining or HPV DNA.
- A 50-year-old male presents with a 3×3 cm right preauricular mass. Imaging
shows a lesion in the superficial lobe of the parotid gland. There are no signs of
facial nerve involvement. Biopsy confirms malignancy. What is the most likely
diagnosis?
A. Pleomorphic adenoma
B. Warthin tumor
C. Mucoepidermoid carcinoma
D. Acinic cell carcinoma
C. Mucoepidermoid carcinoma
Rationale: Most common malignant salivary gland tumor, especially in the parotid. It
may appear benign on exam (slow-growing, no nerve involvement), but biopsy reveals
malignancy. Pleomorphic adenoma is the most common benign tumor, but the question
states the lesion is malignant.
7a. A 23-year-old male presents with 1-week history of right upper quadrant pain
and recent fever. He had prior episodes of loose watery stools while traveling in
the provinces. On exam, there is RUQ tenderness without jaundice. Ultrasound
shows a round hypoechoic lesion with low-level internal echoes. CT reveals a
lesion with enhancing wall and peripheral edema. What is the most likely
diagnosis?
A. Pyogenic liver abscess
B. Amebic liver abscess
C. Hepatic hemangioma
D. Hydatid cyst
B. Amebic liver abscess
Rationale: History of recent diarrhea and travel to endemic area suggests Entamoeba
histolytica infection. Imaging findings of a round, hypoechoic lesion with low-level
echoes are classic. Pyogenic abscess is more common in diabetics or post-biliary
infections, and often polymicrobial.
7b. What is the most appropriate initial management for this patient with an
amebic liver abscess?
A. IV antibiotics and surgical drainage
B. Albendazole and surgical resection
C. Metronidazole therapy
D. Percutaneous drainage alone
C. Metronidazole therapy
Rationale: First-line treatment is metronidazole (or tinidazole), which eradicates
trophozoites in the liver. Drainage is reserved for very large, ruptured, or
non-responding abscesses. No need for routine aspiration unless in danger of rupture
or diagnosis is unclear.
- A 64-year-old male with chronic Hepatitis B presents with progressive
vomiting, weight loss (6 kg over 3 months), visible peristalsis, and hepatomegaly.
Labs show anemia and hypokalemic hypochloremic alkalosis. Endoscopy reveals
a dilated stomach with old food and inability to pass beyond the first part of the
duodenum. CT shows a large right lobe liver mass (10.5 × 8.4 × 7.2 cm) with
central necrosis and arterial phase early washout compressing the duodenum.
AFP is significantly elevated. What is the most likely diagnosis?
A. Cholangiocarcinoma
B. Gastric carcinoma with liver metastasis
C. Hepatocellular carcinoma (HCC)
D. Ampullary carcinoma
- Which of the following best describes the Milan criteria for liver transplantation
eligibility in a patient with hepatocellular carcinoma (HCC)?
A. Single lesion ≤5 cm or up to 3 lesions each ≤3 cm, no vascular invasion or
metastasis
B. AFP >400 and tumor size <3 cm
C. Single lesion ≤3 cm regardless of vascular invasion
D. Any solitary lesion without ascites and bilirubin <2 mg/dL
A. Single lesion ≤5 cm or up to 3 lesions each ≤3 cm, no vascular
invasion or metastasis
Rationale:
The Milan Criteria define eligibility for orthotopic liver transplantation (OLT) in HCC:
1 lesion ≤5 cm or ≤3 lesions each ≤3 cm, no gross vascular invasion, and no distant
metastases. These criteria predict excellent post-transplant survival.
- A 64-year-old HCC patient has a Child-Pugh score of 5. Which of the following
is the correct classification of liver function?
A. Child-Pugh Class B
B. Child-Pugh Class C
C. Child-Pugh Class A
D. MELD score needed to classify
C. Child-Pugh Class A
Rationale:
A score of 5–6 = Class A, indicating well-preserved liver function. Class B = 7–9,
Class C = 10–15. This classification guides resectability and transplant candidacy
decisions in HCC management.
- Given this patient has a 10.5 cm solitary HCC lesion with preserved liver
function (Child-Pugh A), no ascites or encephalopathy, and no extrahepatic
disease, what is the most appropriate next step in management?
A. Transarterial chemoembolization (TACE)
B. Liver transplantation
C. Surgical resection
D. Sorafenib
C. Surgical resection
Rationale:
* Patient is Child-Pugh A (score 5) - good liver reserve
* Single, large lesion with no portal hypertension, no vascular invasion, no metastasis
* Meets resection criteria: Non-cirrhotic or Child-Pugh A, solitary tumor, no extrahepatic spread
* Gastric outlet obstruction due to compression = mass effect → surgery addresses both diagnosis and symptom relief
* Transplant is for smaller lesions within Milan criteria; Sorafenib is for advanced/metastatic disease
* TACE is palliative, not first-line in resectable cases
