Category: Quiz

Tibial nerve

TIBIAL NERVE

Q. 1

Nerve supply of adductor magnus is through:

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Q. 1

Nerve supply of adductor magnus is through:

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Ans. C

Explanation:

Innervation of adductor magnus

  • Posterior division of obturator nerve innervates most of the adductor magnus
  • Vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Q. 2

Nerve Supply of the Muscle marked as Muscle A in the diagram is 

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Q. 2

Nerve Supply of the Muscle marked as Muscle A in the diagram is 

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Ans. C

Explanation:

Innervation of adductor magnus

  • Posterior division of obturator nerve innervates most of the adductor magnus
  • Vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Q. 3

True about popliteus are all except‑

 A

Flexor of knee

 B

Intracapsular origin

 C

Supplied by tibial nerve

 D

Causes locking of knee

Q. 3

True about popliteus are all except‑

 A

Flexor of knee

 B

Intracapsular origin

 C

Supplied by tibial nerve

 D

Causes locking of knee

Ans. D

Explanation:

Popliteus

Popliteus is a deep muscle of posterior compartment of leg.

Features of popletius are –

Origin

  • Lateral surface of lateral condyle of femur, origin is intracapsular.
  • Outer margin of lateral meniscus of knee.

Insertion

  • Posterior surface of shaft of tibia above soleal line.

Nerve supply

  • Tibial nerve

Action

  • Ulocks knee joint by lateral rotation of femur on tibia prior flexion.
  • Accessory flexor of knee.


Common perioneal nerve / fibular nerve

COMMON PERIONEAL NERVE / FIBULAR NERVE

Q. 1 Muscles of the anterior compartment of the  leg are innervated primarily by
 A Deep peroneal nerve
 B Superficial peroneal nerve
 C Sural nerve
 D Saphenous
Q. 1 Muscles of the anterior compartment of the  leg are innervated primarily by
 A Deep peroneal nerve
 B Superficial peroneal nerve
 C Sural nerve
 D Saphenous
Ans. A

Explanation:

In the leg, the deep peroneal nerve supplies muscular branches to the Tibialis anterior, Extensor digitorum longus, Fibularis (Peroneus) tertius, and Extensor hallucis longus, and an articular branch to the ankle-joint.


Q. 2

Common peroneal nerve is related to which of the following structures?

 A

Shaft of tibia

 B

Neck of fibula

 C

Lower tibio-fibular joint

 D

Shaft of fibula

Q. 2

Common peroneal nerve is related to which of the following structures?

 A

Shaft of tibia

 B

Neck of fibula

 C

Lower tibio-fibular joint

 D

Shaft of fibula

Ans. B

Explanation:

The common fibular nerve arises from the posterior division of the sacral plexus (L4–S2) and descends in an inferolateral direction, across the popliteal fossa to the fibular head. Just distal to the fibular head, the common fibular nerve bifurcates into the deep fibular and superficial fibular nerves.It is easily palpated against ihe neck of fibula because of its subcutaneous position.It is commonly injured in fractues of neck of the fibula.It gets thickened in leprosy which may also cause foot drop.


Q. 3

Deep peroneal nerve provides sensory innervation to the following?

 A

Anterolateral dorsum of foot

 B

Lateral part of leg

 C

1st web space

 D

5th web space

Q. 3

Deep peroneal nerve provides sensory innervation to the following?

 A

Anterolateral dorsum of foot

 B

Lateral part of leg

 C

1st web space

 D

5th web space

Ans. C

Explanation:

Cutaneous branch of deep peroneal nerve provides sensory innervation to the web space between the first and second toe and a small area just proximal to the first and second toe on the plantar aspect of the foot.

Muscular branch supplies the tibialis anterior, extensor digitorum longus, peroneus tertius, and extensor hallucis longus.
 
Articular branch supplies the ankle and tarsal joints.

Q. 4

Common peroneal nerve is related to which of the  following structures

 A

Shaft of tibia

 B

Neck of fibula

 C

Lower tibio-fibular joint

 D

Shaft of fibula

Q. 4

Common peroneal nerve is related to which of the  following structures

 A

Shaft of tibia

 B

Neck of fibula

 C

Lower tibio-fibular joint

 D

Shaft of fibula

Ans. B

Explanation:

B i.e., Neck of fibula

Common peroneal nerve winds around neck of fibula to enter peroneus longus muscle. Because of its subcutaneous position it can be easily palpated here & is very prone to injury. So fracture neck of fibula may cause foot drop.


Q. 5

False about tibia-fibula is ‑

 A

Nutrient artery of tibia is from posterior tibial artery

 B

Nutrient artery of fibula is from peroneal artery

 C

Proximal end of tibia is related to common peroneal nerve

 D

Tibia is the most common site of osteomyelitis

Q. 5

False about tibia-fibula is ‑

 A

Nutrient artery of tibia is from posterior tibial artery

 B

Nutrient artery of fibula is from peroneal artery

 C

Proximal end of tibia is related to common peroneal nerve

 D

Tibia is the most common site of osteomyelitis

Ans. C

Explanation:

  • Common peroneal nerve is related to neck of fibula (not tibia).
  • Nutrient artery of tibia is a branch of posterior tibial artery.
  • Nutrient artery of fibula is a branch of peroneal artery.
  • Tibia is the commonest site of osteomyelitis.

Q. 6

Nerve that winds around neck of fibula ‑

 A

Tibial nerve

 B

Deep peroneal nerve

 C

Superficial peroneal nerve

 D

Common peroneal nerve

Q. 6

Nerve that winds around neck of fibula ‑

 A

Tibial nerve

 B

Deep peroneal nerve

 C

Superficial peroneal nerve

 D

Common peroneal nerve

Ans. D

Explanation:

Common peroneal nerve winds around neck offibula to enter peroneus longus muscle. Because of its subcutaneous position it can be easily palpated here and is very prone to injury. So fracture neck of fibula may cause foot drop.



Nasopharyngeal Carcinoma

Nasopharyngeal Carcinoma

Q. 1

Treatment of choice of Nasopharyngeal Carcinoma is? 

 A

Surgery

 B

Chemotherapy

 C

Radiotherapy

 D

Chemoradiation

Q. 1

Treatment of choice of Nasopharyngeal Carcinoma is? 

 A

Surgery

 B

Chemotherapy

 C

Radiotherapy

 D

Chemoradiation

Ans. C

Explanation:

Q. 2

Radiotherapy is treatment of choice for:

 A

Nasopharyngeal Ca T3 N1

 B

Supraglottic Ca T3NO

 C

Glottic CaT3N 1

 D

Subglottic Ca T3NO

Q. 2

Radiotherapy is treatment of choice for:

 A

Nasopharyngeal Ca T3 N1

 B

Supraglottic Ca T3NO

 C

Glottic CaT3N 1

 D

Subglottic Ca T3NO

Ans. A

Explanation:

Q. 3 Radiotherapy is the “Treatment” of Choice for:
 A Nasopharyngeal carcinoma T3N I
 B Supraglottic CA T3NO
 C Glottic CA T3NI
 D Subglottic CA T3NO
Q. 3 Radiotherapy is the “Treatment” of Choice for:
 A Nasopharyngeal carcinoma T3N I
 B Supraglottic CA T3NO
 C Glottic CA T3NI
 D Subglottic CA T3NO
Ans. A

Explanation:

Nasopharyngeal carcinoma T3N I


Q. 4

Nasopharyngeal carcinoma is mostly:

 A

Basal cell carcinoma

 B

Squamous cell carcinoma

 C

Adenocarcinoma

 D

Epidermoid carcinoma

Q. 4

Nasopharyngeal carcinoma is mostly:

 A

Basal cell carcinoma

 B

Squamous cell carcinoma

 C

Adenocarcinoma

 D

Epidermoid carcinoma

Ans. B

Explanation:

Q. 5

Trootter’s triad is seen in:

 A

Nassopharyngeal fibroma

 B

Maxillary sinusitis

 C

Nasopharyngeal carcinoma

 D

Maxillary carcinoma

Q. 5

Trootter’s triad is seen in:

 A

Nassopharyngeal fibroma

 B

Maxillary sinusitis

 C

Nasopharyngeal carcinoma

 D

Maxillary carcinoma

Ans. C

Explanation:

Q. 6

Commonest site of Nasopharyngeal carcinoma is:

 A

Roof

 B

Posterior

 C

Lateral wall

 D

Anterior wall

Q. 6

Commonest site of Nasopharyngeal carcinoma is:

 A

Roof

 B

Posterior

 C

Lateral wall

 D

Anterior wall

Ans. C

Explanation:

Q. 7

The following diseases are associated with Epstein-Barr virus infection, EXCEPT:

 A

Infectious mononucleosis

 B

Epidermodysplasia

 C

Nasopharyngeal carcinoma

 D

Oral hairy leukoplakia

Q. 7

The following diseases are associated with Epstein-Barr virus infection, EXCEPT:

 A

Infectious mononucleosis

 B

Epidermodysplasia

 C

Nasopharyngeal carcinoma

 D

Oral hairy leukoplakia

Ans. B

Explanation:

Epstein Barr Virus may lead to the following:

  • Infectious mononucleosis
  •  EBV associated tumors

Ref: Harrison’s Principles of Internal Medicine, 16th Edition, Pages 1046, 47


Q. 8

The Epstein Barr virus is implicated in all of the following conditions, EXCEPT :

 A

Nasopharyngeal Ca

 B

Burkitt’s lymphoma

 C

Infectious mononucleosis

 D

Leukemia

Q. 8

The Epstein Barr virus is implicated in all of the following conditions, EXCEPT :

 A

Nasopharyngeal Ca

 B

Burkitt’s lymphoma

 C

Infectious mononucleosis

 D

Leukemia

Ans. D

Explanation:

EBV is known to cause infectious mononucleosis, lymphoproliferative syndrome(fever, lymphadenopathy and hepatosplenomegaly), burkitt lymphoma, nasopharyngeal carcinoma, and in AIDS patients its known to cause hairy leukoplakia of tongue, interstitial lymphocytic pneumonia and lymphoma. 
 
In Sub saharan africa Burkitt lymphoma is the most common malignancy in young children. It  is thought to result from an early EBV infection that produces a large pool of infected B lymphocytes. It can be diagnosed by presence of increased  IgA antibody levels to both VCA and early EBV antigens.
 
Nasopharyngeal carcinoma is endemic in Southern China, where it is responsible for 25% of mortality from cancer. 
 
Ref: Ray C.G., Ryan K.J. (2010). Chapter 14. Herpesviruses. In C.G. Ray, K.J. Ryan (Eds), Sherris Medical Microbiology, 5e.

Q. 9

Smoking increase the risk of all of the following cancer’s, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

Ca Esophagus

Q. 9

Smoking increase the risk of all of the following cancer’s, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

Ca Esophagus

Ans. B

Explanation:

Role of smoking and development of nasopharyngeal carcinoma is still not clear.

 
Ref: Diet, Nutrition and Cancer: Proceedings of The 16th International Symposium on Mycotoxins By Takamatsu No Miya, Page 51; Carcinomas of The Head and Neck: Evaluation and Management By Charlotte Jacobs, Page 275; Cancer Prevention: The Causes and Prevention of Cancer By Graham A. Colditz, David John Hunter, Page 327

Q. 10

Concomitant chemoradiotherapy is indicated in all of the following malignancies except:

 A

Stage III B Ca Cervix

 B

T2 N0 M0 Anal Cancer

 C

T2 N0 M0 Glottic Cancer

 D

T1 N2 M0 Nasopharyngeal Cancer

Q. 10

Concomitant chemoradiotherapy is indicated in all of the following malignancies except:

 A

Stage III B Ca Cervix

 B

T2 N0 M0 Anal Cancer

 C

T2 N0 M0 Glottic Cancer

 D

T1 N2 M0 Nasopharyngeal Cancer

Ans. C

Explanation:

T2 N0 M0 Glottic Cancer is an early stage glottis tumor extending to supraglottis and /or subglottis and /or with impaired vocal cord mobility, with no lymph node involvement or distant metastasis.

Radiotherapy alone is the standard treatment for early glottis cancer.

Concurrent chemoradiotherapy is indicated in locally advanced disease.

 
Ref: Cervical Cancer: Current and Emerging Trends in Detection and Treatment By Heather Hasan, Page 39; Oxford Desk Reference Oncology By Thankamma, Page321; Gastrointestinal and Liver Tumors By Wolfgang Scheppach, Page 173

Q. 11

A 55 year old man presented with epistaxis. On investigation, nasopharyngeal cancer was diagnosed. Regarding nasopharyngeal carcinoma,

Assertion: This patient may have ulcerative form of nasopharyngeal cancer

Reason: Because epistaxis is the common symptom of ulcerative type
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 11

A 55 year old man presented with epistaxis. On investigation, nasopharyngeal cancer was diagnosed. Regarding nasopharyngeal carcinoma,

Assertion: This patient may have ulcerative form of nasopharyngeal cancer

Reason: Because epistaxis is the common symptom of ulcerative type
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. A

Explanation:

In ulcerative form of nasopharyngeal carcinoma, epistaxis is the common symptom. Proliferative type causes obstructive nasal symptoms. Growth infiltrates submucosally in infiltrative type of carcinoma.

Ref: Diseases of Ear, Nose and Throat By PL Dhingra, 4th Edition, Page 232, 233.


Q. 12

A male patient was diagnosed of having nasopharyngeal carcinoma. He had cranial nerve involvements and conductive deafness at the time of presentation. Consider the following:

Assertion: He may have Trotter’s triad which is associated with nasopharyngeal carcinoma

Reason: He could be presenting with conductive deafness, contralateral temporoparietal neuralgia, and palatal paralysis to acquire the diagnosis.
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 12

A male patient was diagnosed of having nasopharyngeal carcinoma. He had cranial nerve involvements and conductive deafness at the time of presentation. Consider the following:

Assertion: He may have Trotter’s triad which is associated with nasopharyngeal carcinoma

Reason: He could be presenting with conductive deafness, contralateral temporoparietal neuralgia, and palatal paralysis to acquire the diagnosis.
 

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. C

Explanation:

Nasopharyngeal cancer can cause conductive deafness (Eustachian tube blockage), ipsilateral (not contralateral) temporoparietal neuralgia (involvement of cranial nerve V) and palatal paralysis (CN X)- collectively called Trotter’s triad.

 

 


Q. 13

Commonest site of nasopharyngeal carcinoma is:

 A

Roof

 B

Posterior

 C

Lateral wall

 D

Anterior wall

Q. 13

Commonest site of nasopharyngeal carcinoma is:

 A

Roof

 B

Posterior

 C

Lateral wall

 D

Anterior wall

Ans. C

Explanation:

The lateral walls include the eustachian tube, the torus tubarius, and the fossa of Rosenmüller. The most common site of origin for nasopharyngeal carcinoma is the fossa of Rosenmüller.

Q. 14

Which among the following carcinoma is treated by radiotherapy?

 A

Supraglottic Ca T3 N0

 B

Nasopharyngeal Ca T3 N1

 C

Glottic CaT3 N1

 D

Subglottic Ca T3 N0

Q. 14

Which among the following carcinoma is treated by radiotherapy?

 A

Supraglottic Ca T3 N0

 B

Nasopharyngeal Ca T3 N1

 C

Glottic CaT3 N1

 D

Subglottic Ca T3 N0

Ans. B

Explanation:

Over 95% of endemic nasopharyngeal carcinomas (NPC) are classified as WHO type 3 and associated with EBV.

NPC tends to occur in younger persons and is not associated with tobacco usage.

NPC is an aggressive neoplasm with cervical lymph node metastases present in 60 to 90% of patients at diagnosis.

Because of unique anatomic, biological, and clinical characteristics, therapy for NPC is distinctive.

Radiotherapy is the mainstay of local therapy. NPCs are highly chemoradiosensitive.

Intensity-modulated radiation therapy (IMRT) allows for greater conformality of the high-dose regions with relative sparing of adjacent normal tissues compared to traditional radiation techniques.


Q. 15

All of the following are true about Nasopharyngeal carcinoma, EXCEPT:

 A

Bimodal age distribution

 B

Nasopharyngectomy with Radical Neck dissection is the treatment of choice

 C

IgA antibody to EBV is observed

 D

Squammous cell carcinoma is the most common histological subtype

Q. 15

All of the following are true about Nasopharyngeal carcinoma, EXCEPT:

 A

Bimodal age distribution

 B

Nasopharyngectomy with Radical Neck dissection is the treatment of choice

 C

IgA antibody to EBV is observed

 D

Squammous cell carcinoma is the most common histological subtype

Ans. B

Explanation:

Radiotherapy is the treatment of choice for nasopharyngeal carcinoma and not Nasopharyngectomy.
Nasopharyngeal carcinoma has a bimodal age distribution with peak distribution in the second and sixth decades in life.
 

Q. 16

In which country is Nasopharyngeal carcinoma most commonly found?

 A

India

 B

China

 C

Pakistan

 D

Japan

Q. 16

In which country is Nasopharyngeal carcinoma most commonly found?

 A

India

 B

China

 C

Pakistan

 D

Japan

Ans. B

Explanation:

Nasopharyngeal carcinoma is most common in China particularly in southern states and Taiwan.

Factors operative in China are burning of incense or wood(polycyclic hydrocarbon), use of preserved salted fish (nitrosamines) along with vitamin C deficient diet. Infection with Epstein Barr Virus also act as predisposing factor. 
 

Q. 17

All are associated with EBV except ‑

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Oral hairy leukoplakia

 D

Epidermodysplasia

Q. 17

All are associated with EBV except ‑

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Oral hairy leukoplakia

 D

Epidermodysplasia

Ans. D

Explanation:

Ans. is ‘d’ i.e., Epidermodysplasia 

Epstein – Barr Virus (EBV)

.    Belongs to Herpes viruses family.

.   Infection is most common in early childhood, with a second peak during late adolescence.

.   Infectious mononucleosis (IM) is usually a disease of young adults.

.   EBV is transmitted by saliva (oral secretions) of infected person.

.   Intimate oral contact, as in kissing is the predominant mode of transmission         causes kissing disease.

.   The virus enter the pharyngeal epithelial cells and B cells through (CR 2 / or CD21) receptors.

.     Memory B Cells are the reservoir of EBV:

Clinical Manifestations  :Most primary infections are asymptomatic

.     Causes an acute self limited illness          —>          Infectious mononucleosis (Glandular fever)

.     Incubation period                                                         4-8 weeks

.    Age groups                                                                     young adults

.    Most common symptom of IMN is sore throat

.   Most common sign is lymphadenopathy

.   Most common complication —> meningitis/encephalitis



Q. 18

E. B. virus causes all except –

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Burkitt’s Lymphoma

 D

Carcinoma cervix

Q. 18

E. B. virus causes all except –

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Burkitt’s Lymphoma

 D

Carcinoma cervix

Ans. D

Explanation:

Ans. is ‘d’ i.e., Carcinoma Cervix


Q. 19

Estein Barr (EB) virus has been implicated in the following malignancies except –

 A

Hodgkin’s disease

 B

Non Hodgkin’s lymphoma

 C

Nasopharyngeal carcinoma

 D

Multiple myeloma

Q. 19

Estein Barr (EB) virus has been implicated in the following malignancies except –

 A

Hodgkin’s disease

 B

Non Hodgkin’s lymphoma

 C

Nasopharyngeal carcinoma

 D

Multiple myeloma

Ans. D

Explanation:

Ans. is ‘d’ i.e., Multiple myeloma


Q. 20

Ebstein Barr virus is associated with-

 A

Carcinoma larynx

 B

Carcinoma bladder

 C

Carcinoma nasopharynx

 D

Carcinoma maxilla

Q. 20

Ebstein Barr virus is associated with-

 A

Carcinoma larynx

 B

Carcinoma bladder

 C

Carcinoma nasopharynx

 D

Carcinoma maxilla

Ans. C

Explanation:

Ans. is ‘c’ i.e., Carcinoma nasopharynx


Q. 21

The following are true about EBV except – 

 A

A member of herpes virus family

 B

Infects epithelial cells of oropharynx

 C

The main target of virus is the T- cell lymphocytes

 D

It is implicated in nasopharyngeal carcinoma

Q. 21

The following are true about EBV except – 

 A

A member of herpes virus family

 B

Infects epithelial cells of oropharynx

 C

The main target of virus is the T- cell lymphocytes

 D

It is implicated in nasopharyngeal carcinoma

Ans. B

Explanation:

Ans is ‘b’ i.e., Infects epithelial cells of oropharynx 

.   Main target for EBV is B- cell.


Q. 22

Radiotherapy is Rx of choice for:

 A

Nasopharyngeal Carcinoma T3N1

 B

Supraglottic Carcinoma T3NO

 C

Glottic Carcinoma T3N1

 D

Subglottic Carcinoma T3NO

Q. 22

Radiotherapy is Rx of choice for:

 A

Nasopharyngeal Carcinoma T3N1

 B

Supraglottic Carcinoma T3NO

 C

Glottic Carcinoma T3N1

 D

Subglottic Carcinoma T3NO

Ans. A

Explanation:

A i.e. Nasopharyngeal Carcinoma T3N1

Radiotherapy is the standard treatment of nasopharyngeal carcinomaQ, as surgery is not fesibleQ. Patient with advanced disease also receive concurrent chemotherapy.

Radical Radiotherapy is preferred treatment for early supraglottic carcinomas (i.e. small (< 6m1) tumor mass and absence of cartilage invasion). In unfavourable conditions voice preserving supraglottic laryngectomy (surgery) is preferred. Tumors involving the true vocal cords or cartilage are treated with supracricoid laryngectomy & for advanced tumors total laryngectomy is required. Cord fixation is an indirect evidence of cricoarytenoid joint involvement. It upstages the tumor to T3 and precludes voice preserving surgery in all laryngeal cancers. Radiotherapy is preferred modality for definitive treatment of early glottic carcinoma (T2 NO) as it allows voice preservation. Hemilaryngectomy is the usual surgical procedure in early glottic cancers and supracricoid laryngectomy is performed if there is imaging evidence of invasion of anterior or posterior commissure, contra lateral true vocal cord, false vocal cord or parglottic fat invasion.


Q. 23

Secondaries in the neck with no obvious primary malignancy is most often due to –

 A

Ca. Stomach

 B

Ca. Larynx

 C

Ca. Nasopharynx

 D

Ca. Thyroid

Q. 23

Secondaries in the neck with no obvious primary malignancy is most often due to –

 A

Ca. Stomach

 B

Ca. Larynx

 C

Ca. Nasopharynx

 D

Ca. Thyroid

Ans. C

Explanation:

Ans. is ‘c’ i.e., Ca. Nasopharynx 


Q. 24

Trotters triad is seen in –

 A

Angiofibroma

 B

Nasopharyngeal carcinoma

 C

Laryngeal carcinoma

 D

Growth in fossa of Rosenmuller

Q. 24

Trotters triad is seen in –

 A

Angiofibroma

 B

Nasopharyngeal carcinoma

 C

Laryngeal carcinoma

 D

Growth in fossa of Rosenmuller

Ans. B

Explanation:

Ans. is ‘b’ i.e., Nasopharyngeal carcinoma 


Q. 25

Most common tumor to produce metastasis to cervical lymph nodes –

 A

Glottic Ca

 B

Nasopharyngeal carcinoma

 C

Ca Base of tongue

 D

Ca lip

Q. 25

Most common tumor to produce metastasis to cervical lymph nodes –

 A

Glottic Ca

 B

Nasopharyngeal carcinoma

 C

Ca Base of tongue

 D

Ca lip

Ans. B

Explanation:

Ans is “b” i.e. Nasopharyngeal carcinoma 

Note: Glottic carcinoma never metastasizes to lymph nodes and carcinoma lip metastasizes rarely and very late


Q. 26

Concomitant chemoradiotherapy is indicated in all of the following except

 A

Stage III B Ca Cervix

 B

T2 No Mo Glottic Cancer

 C

T1 N2 Mo Nasopharyngeal Cancer

 D

a and b

Q. 26

Concomitant chemoradiotherapy is indicated in all of the following except

 A

Stage III B Ca Cervix

 B

T2 No Mo Glottic Cancer

 C

T1 N2 Mo Nasopharyngeal Cancer

 D

a and b

Ans. B

Explanation:

Ans is B i.e. T2 NO MO Glottic Cancer 

Concomitant chemoradiation means- chemotherapy and radiation therapy are given simultaneously rather than vii sequentially.

“Principles of Combining Anticancer Agents with Radiation Therapy‑

Combining chemotherapy with radiation therapy has produced important improvements in treatment outcome. Randomized clinical trials clinical trials show improved local control and survival through the use of concurrent chemotherapy and radiation therapy for patients with high-grade gliomas and locally advanced cancers of the head and neck, lung, esophagus, stomach, rectum, and anus. There are least two proposed reasons why chemoradiotherapy might be successful. The first is radiosensitization. The underlying concept is that the observed effect of using chemotherapy and radiation concurrently is greater than simply adding the two together. A second proposed reason to combine radiation and chemotherapy is to realize the benefit of improved local control radiation along with the systemic effect of chemotherapy; a concept called spatial additivity.” [Devita, Hellman & Rosenberg’s Cancer: Principles & Practice of Oncology, 8th EditionChapter 211

Now coming to the given options:

  • Anal cancer: Concomitant chemoradiotherapy is the treatment of choice. Chemoradiotherapy achieves survival rates similar to those of radical surgical excision without loss of continence.
  • Cervical cancer: Treatment of cervical cancer is based on stage of disease. In general, early stage disease (I—IIa) can be treated with either radical surgery or radiation therapy. Advanced stage disease (III —IV)is best treated with chemoradiation. [Novaks gynaecology 14/e p1403]
  • Head and Neck Cancer: [Harrison I7/e p550]
  • Patients with head and neck cancer can be categorized into three clinical groups: those with localized disease, those with locally or regionally advanced disease, and those with recurrent and/or metastatic disease.
  • Localized Disease- that is, TI or T2 (stage I or stage II) lesions without detectable lymph node involvement or distant metastases. These lesions are treated with curative intent by surgery or radiation therapy. The choice of modality differs according to anatomic location and institutional expertise. Radiation therapy is often preferred for laryngeal cancer to preserve voice function, and surgery is preferred for small lesions in the oral cavity to avoid the long-term complications of radiation, such as xerostomia and dental decay. Overall 5-year survival is 60-90%.
  • Locally or Regionally Advanced Disease- i.e.disease with a large primary tumor and/or lymph node metastases. Such patients can also be treated with curative intent, but not with surgery or radiation therapy alone. Combined modality therapy including surgery, radiation therapy, and chemotherapy is most successful. Concomitant chemotherapy and radiation therapy appears to be the most effective approach. It can be administered either as a primary treatment for patients with unresectable disease, to pursue an organ preserving approach, or in the postoperative setting for intermediate-stage resectable tumors.
  • Recurrent and/or Metastatic Disease- Patients with recurrent and/or metastatic disease are, with few exceptions, treated with palliative intent. Some patients may require local or regional radiation therapy for pain control, but most are given chemotherapy.
  • Option D – T1 N2 MO Nasopharyngeal cancer is stage III ds. (Locoregional advanced ds.) and hence would need concurrent chemoradiation.
  • Option C – T2 NO MO Glottic cancer is stage II ds. (Localized ds.) and therefore would not need chemoradiation. 

Q. 27

Smoking may be associated with all of the following cancers, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

None

Q. 27

Smoking may be associated with all of the following cancers, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

None

Ans. D

Explanation:

Ans is None > Ca Nasopharynx

All the given options are mentioned by Harrison:

  • Harrison 17/e p2737 writes- “Tobacco smoking causes cancer of the lung, oral cavity, naso-, oro-, and hypopharynx, nasal cavity and paranasal sinuses, larynx, esophagus, stomach, pancreas, liver, kidney (body and pelvis), ureter, urinary bladder, and uterine cervix and also causes myeloid leukemia. There is evidence suggesting that cigarette smoking may play a role in increasing the risk of colorectal and possibly premenopausal breast cancer, but there is no association with postmenopausal breast cancer. There does not appear to be a causal link between cigarette smoking and cancer of the endometrium, and there is a lower risk of uterine cancer among postmenopausal women who smoke.”
  • Thus the answer should be none, however Nasopharyngeal carcinoma is found to be least associated with smoking. Head & Neck Cancers by Enslow Jacobs 2003e p492 writes-“Association between smoking and nasopharyngeal carcinoma has been shown only by a few studies. If the association of tobacco and NPC is real, the possible mechanism of tumor induction would be the nitrosamines and its precursors in tobacco.”

Q. 28

Which one of the following is the most common tumor to produce metastasis to cervical lymph nodes?

 A

Glottic carcinoma

 B

Nasopharyngeal carcinoma

 C

Carcinoma base of tongue

 D

Carcinoma lip

Q. 28

Which one of the following is the most common tumor to produce metastasis to cervical lymph nodes?

 A

Glottic carcinoma

 B

Nasopharyngeal carcinoma

 C

Carcinoma base of tongue

 D

Carcinoma lip

Ans. B

Explanation:

Ans. is ‘b’ i.e. Nasopharyngeal carcinoma 


Q. 29

Cause of U/L secretory otitis media in an adult is:

 A

CSOM

 B

Nasopharyngeal carcinoma

 C

Mastoiditis

 D

Foreign body of external ear

Q. 29

Cause of U/L secretory otitis media in an adult is:

 A

CSOM

 B

Nasopharyngeal carcinoma

 C

Mastoiditis

 D

Foreign body of external ear

Ans. B

Explanation:

 


 


Q. 30

Most common site for nasopharyngeal carcinoma: 

 A

Nasal septum

 B

Fossa of rosenmuller

 C

Vault of nasopharynx

 D

Anterosuperior wall

Q. 30

Most common site for nasopharyngeal carcinoma: 

 A

Nasal septum

 B

Fossa of rosenmuller

 C

Vault of nasopharynx

 D

Anterosuperior wall

Ans. B

Explanation:

Nasopharyngeal carcinoma most commonly arises from fossa of rosenmuller in lateral wall of nasopharynx.


Q. 31

Nasopharyngeal Ca involve:

 A

Nasal cavity

 B

Orophaynx

 C

Oral cavity

 D

All

Q. 31

Nasopharyngeal Ca involve:

 A

Nasal cavity

 B

Orophaynx

 C

Oral cavity

 D

All

Ans. A

Explanation:

 

Nasopharyngeal cancer arises from fossa of Rosenmuller in the lateral wall of nasopharynx and can spread to various sites.


Q. 32

Nasopharyngeal Ca is caused by:

 A

EBV

 B

Papilloma virus

 C

Parvo virus

 D

Adeno virus

Q. 32

Nasopharyngeal Ca is caused by:

 A

EBV

 B

Papilloma virus

 C

Parvo virus

 D

Adeno virus

Ans. A

Explanation:

Etiology of Nasopharyngeal Carcinoma

  • Genetic: It is most common in China.
  • Viral: Epstein-Barr virus is closely associated with nasopharyngeal cancer. Epstein-Barr virus has identified in tumor epithelial cells (not lymphocytes) of most undifferentiated and nonkeratinizing squamous cell carcinoma.
  • Environmental: Burning of incense or wood (polycyclic hydrocarbon); smoking of tobacco and opium; air pollution; nitrosamines from dry salted fish along with vitamin C deficient diet have been linked to the etiology of nasopharyngeal cancer.



Q. 33

Most common presentation in nasopharyngeal carcinoma is with:

 A

Epistaxis

 B

Hoarseness of voice

 C

Nasal stuffiness

 D

Cervical lymphadenopathy

Q. 33

Most common presentation in nasopharyngeal carcinoma is with:

 A

Epistaxis

 B

Hoarseness of voice

 C

Nasal stuffiness

 D

Cervical lymphadenopathy

Ans. D

Explanation:

 

The most common complain at presentation is the presence of an upper neck swelling. Unilateral neck swelling is much more common although bilateral metastasis also occur.


Q. 34

A 70-year-old male presents with Neck nodes. Examination reveals a Dull Tympanic Membrance, deaf­ness and tinnitus and on evaluation Audiometry gives Curve B. The most probable diagnosis is:

 A

Nasopharyngeal carcinoma

 B

Fluid in middle ear

 C

Tumor in interior ear

 D

Sensorineuronal hearing loss

Q. 34

A 70-year-old male presents with Neck nodes. Examination reveals a Dull Tympanic Membrance, deaf­ness and tinnitus and on evaluation Audiometry gives Curve B. The most probable diagnosis is:

 A

Nasopharyngeal carcinoma

 B

Fluid in middle ear

 C

Tumor in interior ear

 D

Sensorineuronal hearing loss

Ans. A

Explanation:

 

 

 



Q. 35

Nasopharyngeal Ca causes deafness by:

 A

Temporal bone metastasis

 B

Middle ear infiltration

 C

Serous effusion

 D

Radiation therapy

Q. 35

Nasopharyngeal Ca causes deafness by:

 A

Temporal bone metastasis

 B

Middle ear infiltration

 C

Serous effusion

 D

Radiation therapy

Ans. C

Explanation:

 

Nasopharyngeal carcinoma spreads to Eustachian tube, blocks it and causes Serous Otitis Media which in turn causes Conductive hearing loss.


Q. 36

Horner’s syndrome is caused by:

 A

Nasopharyngeal carcinoma metastasis

 B

Facial bone injury

 C

Maxillary sinusitis

 D

Ethmoidal polyp

Q. 36

Horner’s syndrome is caused by:

 A

Nasopharyngeal carcinoma metastasis

 B

Facial bone injury

 C

Maxillary sinusitis

 D

Ethmoidal polyp

Ans. A

Explanation:

 

 Nasopharyngeal carcinoma can cause Horner’s syndrome due to involvement of cervical sympathetic chain. –Mohan Bonsai


Q. 37

Trotter’s triad is seen in carcinoma of:

 A

Maxilla

 B

Larynx

 C

Nasopharynx

 D

Ethmoid sinus

Q. 37

Trotter’s triad is seen in carcinoma of:

 A

Maxilla

 B

Larynx

 C

Nasopharynx

 D

Ethmoid sinus

Ans. C

Explanation:

Q. 38

Nasopharyngeal Ca:

 A

M/c nerve involved is vagus

 B

Unilateral serous otitis media is seen

 C

Treatment of choice – radiotherapy

 D

b and c

Q. 38

Nasopharyngeal Ca:

 A

M/c nerve involved is vagus

 B

Unilateral serous otitis media is seen

 C

Treatment of choice – radiotherapy

 D

b and c

Ans. D

Explanation:

Q. 39

Which of thefollowing is NOT true about nasopharyngeal carcinoma?

 A

Bimodal age distribution

 B

EBV is implicated as etiological agent

 C

Squamous cell carcinoma is common

 D

Nasopharyngectomy and lymph node dissection is main­stay of treatment

Q. 39

Which of thefollowing is NOT true about nasopharyngeal carcinoma?

 A

Bimodal age distribution

 B

EBV is implicated as etiological agent

 C

Squamous cell carcinoma is common

 D

Nasopharyngectomy and lymph node dissection is main­stay of treatment

Ans. D

Explanation:

 

In nasopharyngeal carcinoma, radiotherapy is the mainstay of treatment.

Radical neck dissection is required for persistent nodes when primary has been controlled.



Q. 40

Treatment of choice in nasopharyngeal carcinoma:

 A

Radiotherapy

 B

Chemotherapy

 C

Surgery

 D

Surgery and radiotherapy

Q. 40

Treatment of choice in nasopharyngeal carcinoma:

 A

Radiotherapy

 B

Chemotherapy

 C

Surgery

 D

Surgery and radiotherapy

Ans. A

Explanation:

 

TOC for persistent nasopharyngeal fibroma – Radiation + Surgery

TOC for advanced carcinoma – Chemotherapy + Radiation



Q. 41

Most common presentation in nasopharyngeal carcinoma:

 A

Epistaxis

 B

Hoarseness of voice

 C

Nasal stuffiness

 D

Cervical lymphadenopathy

Q. 41

Most common presentation in nasopharyngeal carcinoma:

 A

Epistaxis

 B

Hoarseness of voice

 C

Nasal stuffiness

 D

Cervical lymphadenopathy

Ans. D

Explanation:

 

Cervical lymphadenopathy is the M/C presentation of nasopharyngeal carcinoma. It may be the only manifestation in some cases.


Q. 42

70-years-old man presents with cervical lymphadenopathy. What can be the cause?

 A

Nasopharyngeal carcinoma

 B

Angiofibroma

 C

Acoustic neuroma

 D

Otosclerosis

Q. 42

70-years-old man presents with cervical lymphadenopathy. What can be the cause?

 A

Nasopharyngeal carcinoma

 B

Angiofibroma

 C

Acoustic neuroma

 D

Otosclerosis

Ans. A

Explanation:

Q. 43

Nasopharyngeal cancer occurs most commonly in:

 A

India

 B

Bangladesh

 C

Pakistan

 D

China

Q. 43

Nasopharyngeal cancer occurs most commonly in:

 A

India

 B

Bangladesh

 C

Pakistan

 D

China

Ans. D

Explanation:

Q. 44

All are associated with Epstein Barr virus EXCEPT:

March 2013

 A

Burkitts lymphoma

 B

Nasopharyngeal carcinoma

 C

Infectious mononucleosis

 D

Kaposi sarcoma

Q. 44

All are associated with Epstein Barr virus EXCEPT:

March 2013

 A

Burkitts lymphoma

 B

Nasopharyngeal carcinoma

 C

Infectious mononucleosis

 D

Kaposi sarcoma

Ans. D

Explanation:

Ans. D i.e. Kaposi sarcoma

Human Herpes Virus type 8 is associated with 3 conditions, i.e. Kaposi’s disease, B-cell lymphoma and Castleman’s disease


Q. 45

EBV causes:      

March 2013

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Glandular fever

 D

All of the above

Q. 45

EBV causes:      

March 2013

 A

Infectious mononucleosis

 B

Nasopharyngeal carcinoma

 C

Glandular fever

 D

All of the above

Ans. D

Explanation:

Ans. D i.e. All of the above

Epstein-Barr virus (EBV)/ Human herpesvirus 4 (HHV-4)

  • It is a virus of the herpes family, and is one of the most common viruses in humans.
  • It is best known as the cause of infectious mononucleosis (glandular fever).
  • It is also associated with particular forms of cancer, such as Hodgkin’s lymphoma, Burkitt’s lymphoma, nasopharyngeal carcinoma, and conditions associated with human immunodeficiency virus (HIV) such as hairy leukoplakia and central nervous system lymphomas.
  • There is evidence that infection with the virus is associated with a higher risk of certain autoimmune diseases, especially dermatomyositis, systemic lupus erythematosus, rheumatoid arthritis, Sjogren’s syndrome, and multiple sclerosis.
  • Infection with EBV occurs by the oral transfer of saliva and genital secretions.

Q. 46

EBV (epstein barr virus) causes all except:

September 2005 & March 2013

 A

Glandular fever

 B

Burkitt’s lymphoma

 C

Pancreatic carcinoma

 D

Nasopharyngeal carcinoma

Q. 46

EBV (epstein barr virus) causes all except:

September 2005 & March 2013

 A

Glandular fever

 B

Burkitt’s lymphoma

 C

Pancreatic carcinoma

 D

Nasopharyngeal carcinoma

Ans. C

Explanation:

Ans. C: Pancreatic carcinoma

Epstein-Barr virus (EBV) causes infectious mononucleosis as a primary disease.

The virus infects more than 90% of the average population and persists lifelong in peripheral B-lymphocytes. The virus is produced in the parotid gland and spread via the oral route.

Serology suggests that the Epstein-Barr virus might be involved in the causation of two neoplastic diseases of humans: African Burkitt’s lymphoma and nasopharyngeal carcinoma. Whereas the development of the lymphoma has an even better linkage with chromosomal rearrangements, nasopharyngeal carcinoma shows a unique association with Epstein-Barr virus

It is also associated with causation of glandular fever and lymphoma


Q. 47

All of the following statements about Nasopharyngeal carcinoma are true EXCEPT:         

 A

Bimodal age distribution

 B

Nasopharyngectomy with radical neck dissection is the treatment of choice

 C

IgA antibody to EBV is observed

 D

Squamous cell carcinoma is the most common histological subtype

Q. 47

All of the following statements about Nasopharyngeal carcinoma are true EXCEPT:         

 A

Bimodal age distribution

 B

Nasopharyngectomy with radical neck dissection is the treatment of choice

 C

IgA antibody to EBV is observed

 D

Squamous cell carcinoma is the most common histological subtype

Ans. B

Explanation:

 

Irradiation is the treatment of choice for nasopharyngeal carcinoma


Q. 48

Treatment of choice for nasopharyngeal carcinoma:

 A

Chemotherapy

 B

Radiotherapy

 C

Surgical

 D

Wait & watch

Q. 48

Treatment of choice for nasopharyngeal carcinoma:

 A

Chemotherapy

 B

Radiotherapy

 C

Surgical

 D

Wait & watch

Ans. B

Explanation:

 

Treatment of nasopharyngeal carcinoma

  • Radiation therapy is the mainstay of treatment, with chemotherapy used in advanced cases.
  • Concurrent cisplatin, 5-fluorouracil, and radiotherapy have been shown to improve survival.
  • Sequential chemoradiotherapy with gemcitabine and cisplatin has been shown to improve survival in locoregionally advanced nasopharyngeal carcinoma.
  • Many pediatric studies have used neoadjuvant chemotherapy followed by radiation therapy with improvement in local control or progression-free survival rates over radiotherapy alone.

Q. 49

Horner’s syndrome is caused by:           

March 2009

 A

Facial injury

 B

Nasopharyngeal carcinoma with metastasis

 C

Meniere’s disease

 D

All of the above

Q. 49

Horner’s syndrome is caused by:           

March 2009

 A

Facial injury

 B

Nasopharyngeal carcinoma with metastasis

 C

Meniere’s disease

 D

All of the above

Ans. B

Explanation:

Ans. B: Nasopharyngeal carcinoma with metastasis

Causes of Homer’s syndrome:

First-order neuron lesions

– Arnold-Chiari malformation

– Basal meningitis (e.g., syphilis)

– Basal skull tumors

– Cerebral vascular accident (CVA)/ Wallenberg syndrome (lateral medullary syndrome) disease (e.g., multiple sclerosis)

– Intrapontine hemorrhage

Neck trauma (e.g., traumatic dislocation of cervical vertebrae, traumatic dissection of the vertebral artery)

– Pituitary tumor

– Syringomyelia

Second-order neuron lesions

– Pancoast tumor (tumor in the apex of the lung – most commonly squamous cell carcinoma)

– Birth trauma with injury to lower brachial plexus

– Cervical rib Aneurysm/dissection of aorta

– Nasopharyngeal carcinoma (involvement of cervical sympathetic chain)

– Central venous catheterization

Trauma/surgical injury (e.g., radical neck dissection, thyroidectomy, carotid angiography, coronary artery bypass graft)

– Lymphadenopathy (e.g., Hodgkin disease, leukemia, tuberculosis, mediastinal tumors)

– Neuroblastoma

Third-order neuron lesions

– Internal carotid artery dissection (associated with sudden ipsilateral face and/or neck pain)

– Raeder syndrome (paratrigeminal syndrome) – Oculosympathetic paresis and ipsilateral facial pain with variable involvement of the trigeminal and oculomotor nerves

– Carotid cavernous fistula

Cluster/ migraine headaches

– Herpes zoster

  • Drugs (may cause symptoms similar to Horner syndrome and may affect any region)

– Acetophenazine

– Bupivacaine

– Chloroprocaine

– Chlorpromazine


Q. 50

Nasopharyngeal carcinoma caused by ‑

 A

EBV

 B

HPV

 C

HSV

 D

VZV

Q. 50

Nasopharyngeal carcinoma caused by ‑

 A

EBV

 B

HPV

 C

HSV

 D

VZV

Ans. A

Explanation:

Ans. is ‘a’ i.e., EBV

Nasopharyngeal Carcinoma

  • Nasopharyngeal carcinoma is a rare tumor arising from epithelium of the nasopharynx. Nasopharyngeal cancer is uncommon in India except in North East region where people are predominantly of Mongoloid origin. People in Southern china, Taiwan and Indonesia are more prone to this cancer. The maximum age incidence is in the fifth decade and the male : female ratio is 2 : 1. Squamous cell carcinoma in various grades of its differentiation or its variants as transitional cell carcinoma and lymphoepithelioma, is the most common (85%).

Etiology

Nasopharyngeal carcinoma is multifactorial in origin, the three risk factors are :‑

  1. Genetic : Chinese have a higher genetic susceptibility to nasopharyngeal cancer. Even after migration to other countries they continue to have higher incidence.
  2. Viral : Epstein- Bar virus is closely associated with nasopharyngeal cancer. Specific viral markers are being developed to screen people in high incidence areas.
  3. Environmental: Air pollution, smoking of tobacco and opium, nitrosamines from dry salted fish, smoke from burning of incense and wood have all been incriminated.

Origin and spread

The commonest site of origin of nasopharyngeal carcinoma is fossa of Rosenmuller in the lateral wall of nasopharynx.


Q. 51

Patient with nasopharyngeal carcinoma can present with the following except ‑

 A

Homer’s syndrome

 B

Epistaxis and proptosis

 C

Trismus

 D

Sensineuronal hearing loss

Q. 51

Patient with nasopharyngeal carcinoma can present with the following except ‑

 A

Homer’s syndrome

 B

Epistaxis and proptosis

 C

Trismus

 D

Sensineuronal hearing loss

Ans. D

Explanation:

Ans. is ‘d’ i.e., Sensineuronal hearing loss


Q. 52

Which of the following is a wrong association ‑

 A

HPV – CaCx

 B

EBV – Burkitt’s lymphoma

 C

HHV 8 – Kaposi sarcoma

 D

CMV – Nasopharyngeal carcinoma

Q. 52

Which of the following is a wrong association ‑

 A

HPV – CaCx

 B

EBV – Burkitt’s lymphoma

 C

HHV 8 – Kaposi sarcoma

 D

CMV – Nasopharyngeal carcinoma

Ans. D

Explanation:

Ans. is ‘d’ i.e., CMV-Nasopharyngeal carcinoma


Q. 53

Keratinizing squamous cell carcinoma of nasopharynx is ‑

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Q. 53

Keratinizing squamous cell carcinoma of nasopharynx is ‑

 A

Type I

 B

Type II

 C

Type III

 D

Type IV

Ans. A

Explanation:

Ans. is ‘a’ i.e., Type I



Maxillary Carcinoma

Maxillary Carcinoma

Q. 1

Ohngren’s line is related to:

 A

Maxillary sinusitis

 B

Maxillary cancer

 C

Ethmoidal polyp

 D

Nasal septum

Q. 1

Ohngren’s line is related to:

 A

Maxillary sinusitis

 B

Maxillary cancer

 C

Ethmoidal polyp

 D

Nasal septum

Ans. B

Explanation:

Q. 2

Ohngren’s line that divides maxillary sinus into superolateral and inferomedial zone is related to?

 A

Maxillary sinusitis

 B

Maxillary carcinoma

 C

Maxillary osteoma

 D

Infratemporal carcinoma

Q. 2

Ohngren’s line that divides maxillary sinus into superolateral and inferomedial zone is related to?

 A

Maxillary sinusitis

 B

Maxillary carcinoma

 C

Maxillary osteoma

 D

Infratemporal carcinoma

Ans. B

Explanation:

Ohngren’s line is a line joining the medial canthus of the eye with the angle of the mandible.

It divides the maxillary sinus into two components: suprastructure (superolateral) and infrastructure (inferomedial).

The location as well as extent of tumor (maxillary carcinoma) has prognostic significance.

Tumors involving the suprastructure of the maxillary antrum have a worse prognosis than those involving the infrastructure.


Q. 3

Early maxillary carcinoma presents as:

 A

Bleeding per nose

 B

Supraclavicular lymph node

 C

Proptosis

 D

All

Q. 3

Early maxillary carcinoma presents as:

 A

Bleeding per nose

 B

Supraclavicular lymph node

 C

Proptosis

 D

All

Ans. A

Explanation:

Q. 4

Ohngren’s line that divides maxillary sinus into supero­lateral and inferomedial zone is related to:

 A

Maxillary sinusitis

 B

Maxillary carcinoma

 C

Maxillary osteoma

 D

Infratemporal carcinoma

Q. 4

Ohngren’s line that divides maxillary sinus into supero­lateral and inferomedial zone is related to:

 A

Maxillary sinusitis

 B

Maxillary carcinoma

 C

Maxillary osteoma

 D

Infratemporal carcinoma

Ans. B

Explanation:

Q. 5

First lymph node involved in maxillary carcinoma:

 A

Submental

 B

Submandibular

 C

Clavicular

 D

Lower jugular

Q. 5

First lymph node involved in maxillary carcinoma:

 A

Submental

 B

Submandibular

 C

Clavicular

 D

Lower jugular

Ans. B

Explanation:

 

In paranasal sinus tumors

  • Lymphatic spread: Nodal metastases are uncommon and occur only in the late stages of disease. Submandibular and upper jugular nodes are enlarged. Maxillary and ethmoid sinuses drain primarily into retropharyngeal nodes, but these nodes are inaccessible to palpation.
  • Systemic metastases are rare. May be seen in the lungs (most commonly) and occasionally in bone.
  • Intracranial spread can occur through ethmoids, cribriform plate or foramen lacerum.

Q. 6

Early maxillary carcinoma presents as:

 A

Bleeding per nose

 B

Supraclavicular lymph node enlargement

 C

Tooth pain

 D

All of the above

Q. 6

Early maxillary carcinoma presents as:

 A

Bleeding per nose

 B

Supraclavicular lymph node enlargement

 C

Tooth pain

 D

All of the above

Ans. A

Explanation:

Q. 7

Ohngren’s classification is used for ‑

 A

Maxillary carcinoma

 B

Mandibular carcinoma

 C

Buccal carcinoma

 D

Tongue carcinoma

Q. 7

Ohngren’s classification is used for ‑

 A

Maxillary carcinoma

 B

Mandibular carcinoma

 C

Buccal carcinoma

 D

Tongue carcinoma

Ans. A

Explanation:

Ans. is ‘a’ i.e., Maxillary carcinoma


Q. 8

In Maxillary carcinoma of a 60 year old patient involving anterolateral part of maxilla, the preferred treatment is

 A

Radiotherapy only

 B

Total/extended Maxillectomy followed by radiotherapy

 C

Radiotherapy followed by total/extended maxillectomy

 D

Total/extended maxillectomy alone

Q. 8

In Maxillary carcinoma of a 60 year old patient involving anterolateral part of maxilla, the preferred treatment is

 A

Radiotherapy only

 B

Total/extended Maxillectomy followed by radiotherapy

 C

Radiotherapy followed by total/extended maxillectomy

 D

Total/extended maxillectomy alone

Ans. C

Explanation:

 

Paranasal sinus cancer is uncommon and represents only 0.2 to 0.8% of all malignancies.

  • Cancer of paranasal sinus constitutes 3% of all carcinomas of the aerodigestive tract.
  • The majority of paranasal sinus malignancies (50-80%) originate within the maxillary sinus antrum. Malignancies rarely occur within the other sinuses and originate in the ethmoid, frontal, and sphenoid sinuses in 10%, 1% and 1% respectively.
  • The cause of parasinus malignancy is unknown. However several risk factors have been associated and therefore it is seen more commonly in people working in hardwood furniture industry, nickel refining, leather work, and manufacturer of mustard gas.
  • More than 80% of the malignant tumours are of squamous cell variety. Rest are adenocarcinoma, adenoid cystic carcinoma, melanoma, and various type of sarcomas.
  • Workers of furniture industry develop adenocarcinoma of the Ethmoids and upper nasal cavity. While those engaged in Nickel refining get squamous cell and Anaplastic carcinoma.

Clinical features for maxillary carcinoma

  • It is seen more commonly in the 7th decade of life.
  • Males are affected more commonly than females.
  • Early features of maxillary sinus malignancy are nasal stuffiness, blood-stained nasal discharge, facial paraesthesias or pain and epiphora. These symptoms may be missed or simply treated as sinusitis. Late features will depend on the direction of spread and extent of growth.
  • Medial spread to nasal cavity gives rise to nasal obstruction, discharge and epistaxis. It may also spread into anterior and posterior ethmoid sinuses and that is why most antral malignancies are antroethmoidal in nature.
  • Anterior spread causes swelling of cheeks.
  • Inferior spread leads to expansion of alveolus with dental pain, loosening of teeth, poor fitting dentures, ulceration of gingiva.
  • Superior spread invades the orbit causing proptosis, diplopia, ocular pain and epiphora.
  • Posterior spread is into pterygomaxillary fossa, pterygoid plate and the pterygoid muscles causing trismus.
  • Lymphatic spread in maxillary carcinoma is rare and occurs only in the late stages.
  • Most commonly involved lymph node is submandibular lymph node followed by jugular nodes.

Treatment of maxillary carcinoma

  • For squamous cell carcinoma, the treatment of choice is a combination of radiotherapy and surgery.
  • Radiotherapy can be given before or after surgery. Very often, a full course of pre-operative telecobalt therapy is given, followed 4 – 6 weeks later by surgical excision of the growth by total or extended maxillectomy.


Carcinoma of Oral Cavity

Carcinoma of Oral Cavity

Q. 1

 Referred otalgia can be due to

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Q. 1

 Referred otalgia can be due to

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Ans. D

Explanation:

 

Causes of referred otalgia

Ear receives nerve supply from Vth (auriculotemporal), 1Xth (tympanic br.) and Xth (auricular br.) cranial nerves; and from C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas

1. Via Vth cranial nerve

  • Dental; Caries tooth, apical abscess, impacted molar, malocclusion.
  • Oral cavity; Benign or malignant ulcerative lesions of oral cavity or tongue.
  • Temporomandibular joint disorders; Bruxism, osteoarthritis, recurrent dislocation,  ill-fitting denture.
  • Sphenopalatine neuralgia.

2. Via IXth cranial nerve

  • Oropharynx; Acute tonsillitis, peritonsillar abscess, tonsillectomy. Benign or malignant ulcers of soft palate, tonsil and its pillars.
  • Base of tongue; Tuberculosis or malignancy.
  • Elongated styloid process.

3.   Via Xth cranial nerve. Malignancy or ulcerative lesion of: vallecula, epiglottis, larynx or laryngopharynx, esophagus.

4.   Via C2 and C3 spinal nerves. Cervical spondylitis, injuries of cervical spine, caries spine.


Q. 2

In which of the following head and neck cancers, is lymph node metastasis least common:

 A

Tongue

 B

Buccal mucosa

 C

Hard palate

 D

Lower alveolus

Q. 2

In which of the following head and neck cancers, is lymph node metastasis least common:

 A

Tongue

 B

Buccal mucosa

 C

Hard palate

 D

Lower alveolus

Ans. C

Explanation:

Hard palate [Ref: Recent advances in Surgery no. 25 p 741

Incidence of cervical metastasis in head and neck cancers (in decreasing order)

  • Tongue (most common)
  • Floor of mouth
  • Lower alveolus
  • Buccal mucosa
  • Upper alveolus
  • Hard palate

Q. 3

Referred otalgia is due to:

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of above

Q. 3

Referred otalgia is due to:

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of above

Ans. D

Explanation:

Q. 4

A 70 year old male who has been chewing tobacco for the past 50 years presents with a six months history of a large, fungating, soft papillary lesions in the oral cavity penetrating into the mandible. Lymph nodes are not palpable. Two biopsies taken from the lesion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. The most likely diagnosis is:

 A

Squamous cell papilloma

 B

Squamous cell carcinoma

 C

Verrucous carcinoma

 D

Malignant mixed tumour

Q. 4

A 70 year old male who has been chewing tobacco for the past 50 years presents with a six months history of a large, fungating, soft papillary lesions in the oral cavity penetrating into the mandible. Lymph nodes are not palpable. Two biopsies taken from the lesion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. The most likely diagnosis is:

 A

Squamous cell papilloma

 B

Squamous cell carcinoma

 C

Verrucous carcinoma

 D

Malignant mixed tumour

Ans. C

Explanation:

Verrucous carcinoma is also referred to as a giant condyloma accuminatum or buschke lowenstein tumor.

It is considered an intermediate lesion between condyloma accuminata and invasive squamous cell carcinoma.

These cancers tend to localize and are cured by wide excision, however they can undergo malignant transformation into an invasive squamous cell carcinoma.

Ref: Robbins Pathology 7th Edition, Page 1037 ; Ackerman’s Surgical Pathology 8th Edition, Page 235


Q. 5

Which of the following is the commonest site of oral cancer among Indian population ?

 A

Tongue

 B

Floor of mouth

 C

Alveobuccal complex

 D

Lip

Q. 5

Which of the following is the commonest site of oral cancer among Indian population ?

 A

Tongue

 B

Floor of mouth

 C

Alveobuccal complex

 D

Lip

Ans. C

Explanation:

The most common type of oral cancer in India is buccal mucosa (38%) followed by anterior tongue secondly (16%) and thirdly lower alveolus (15.7%).

So when the percentages of buccal mucosa and lower alveolus are combined it is alveobuccal complex (53.7%), the most common type of oral cancer in India.

Worldwide the most common type of oral cancer is the carcinoma of the lip and secondly carcinoma of the tongue.

Ref: Textbook of Preventive and Community Dentistry, 2nd Edition By SS Hiremath MDS, FICD (USA) 2nd Edition, Page 159; Global Clinical Trials: Effective Implementation and Management By Richard Chin, Menghis Bairu, Page 122.


Q. 6

Abbey-Estlander flap is used in the reconstruction of:

 A

Buccal mucosa

 B

Lip

 C

Tongue

 D

Palate

Q. 6

Abbey-Estlander flap is used in the reconstruction of:

 A

Buccal mucosa

 B

Lip

 C

Tongue

 D

Palate

Ans. B

Explanation:

Abbey-Estlander flap is used in the reconstruction of lip.

 
Ref: Schwartz Principles of Surgery, 8th Edition, Page 518

Q. 7

Abbe – Estlander Flap is used for:

 A

Lip

 B

Tongue

 C

Eyelid

 D

Ears

Q. 7

Abbe – Estlander Flap is used for:

 A

Lip

 B

Tongue

 C

Eyelid

 D

Ears

Ans. A

Explanation:

The Abbe – Estlander Flap is a transposition flap from the opposite lip.

In this reconstructive surgery the tissue is borrowed from the opposite lip at the oral commisure.

Lip reconstruction may be required after trauma or surgical excision.
 
Ref: CSDT, 12th Edition, Page 1238; Otolaryngology: The Essentials By Allen M. Seiden, Page 154

Q. 8

Which of the following is TRUE differential cause of referred otalgia?

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Q. 8

Which of the following is TRUE differential cause of referred otalgia?

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Ans. D

Explanation:

Otalgia can occur as a symptom of carcinoma on the base of tongue, pharynx or larynx.

 
Ear receives nerve supply from 4 cranial nerves such as trigeminal, facial, glossopharyngeal and vagus; and from two branches of cervical plexus called C2 (lesser occipital) and C2 and C3 (greater auricular), pain maybe referred from these remote areas.
 
Facial nerve refers pain to the external ear canal and post auricular region. Second and third cervical nerves refer pain to the postauricular and mastoid regions. 
 
Trigeminal referred otalgia arise from lesions involving the oral cavity and floor of mouth, teeth, mandible, temporomandibular joint, palate and pre auricular skin.
 
Glossopharyngeal referred otalgia arise from the tonsil, base of the tongue, soft palate, nasopharynx, Eustachian tube and pharynx.
 
Vagal referred otalgia arise from the hypopharynx, larynx and trachea.
 
Differential causes of referred otalgia includes migraine, TMJ syndrome, cervical myalgia, fibromyalgia, dental abscess, head and neck malignancy (neoplasm of nasopharynx, sinus, tonsil, base of tongue, hypopharynx), temporal arteritis, inflammatory sinusitis, carotidynia, trigeminal neuralgia, glossopharyngeal neuralgia and GERD.

Q. 9

A chronic tobacco chewer developed erythroplakia in the oral cavity.

Assertion: It is similar to leukoplakia except for its red colour but less malignant than leukoplakia.

Reason: The red colour is due to decreased keratinization.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 9

A chronic tobacco chewer developed erythroplakia in the oral cavity.

Assertion: It is similar to leukoplakia except for its red colour but less malignant than leukoplakia.

Reason: The red colour is due to decreased keratinization.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. D

Explanation:

Erythroplakia is similar to leukoplakia except for its colour.

Erythroplakia is a red patch or plaque on the mucosal surface. The red colour is due to decreased keratinization, and as a result the red vascular connective tissue of the submucosa shines through.

Malignant potential for erythroplakia is 17 times higher than in leukoplakia. Treatment is excision biopsy and follow up.


Q. 10

The most common pre-malignant condition of oral carcinoma is ‑

 A

Leukoplakia

 B

Erythroplakia

 C

Lichen planus

 D

Fibrosis

Q. 10

The most common pre-malignant condition of oral carcinoma is ‑

 A

Leukoplakia

 B

Erythroplakia

 C

Lichen planus

 D

Fibrosis

Ans. A

Explanation:

Ans. is ‘a’ i.e., Leukoplakia

o There are two premalignant lesions for oral Cancer ‑

i) Leukoplakia

ii) Erythroplakia

o Leukoplakia is the most common premalignant lesions.

o But, the risk of malignant transformation of erythroplakia is much higher than that seen with leukoplakia.

o The most common predisposing factor for both these conditions is smoking.


Q. 11

A 70 year old male who has been chewing tobacco for the past 50 years presents with a six months history of a large, fungating, soft papillary lesions in the oral cavity. The lesion has penetrated into the mandible. Lymph nodes are not palpable. Two biopsies taken from the lesion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. The most likely diagnosis is –

 A

Squamous cell papilloma

 B

Squamous cell carcinoma

 C

Verrucous carcinoma

 D

Malignant mixed tumour

Q. 11

A 70 year old male who has been chewing tobacco for the past 50 years presents with a six months history of a large, fungating, soft papillary lesions in the oral cavity. The lesion has penetrated into the mandible. Lymph nodes are not palpable. Two biopsies taken from the lesion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. The most likely diagnosis is –

 A

Squamous cell papilloma

 B

Squamous cell carcinoma

 C

Verrucous carcinoma

 D

Malignant mixed tumour

Ans. C

Explanation:

Ans. is ‘c’ i.e., Verrucuous carcinoma

Verrucuous carcinomas also referred to as giant condyloma accuminatum or Buschke-Lowenstein tumor are considered an intermediate lesion between candyloma accuminatum and invasive squamous cell carcinoma. It is important to distinguish verrucuous carcinoma from squamous cell carcinomas as these tend to remain localized and are cured by wide excision, however they may undergo malignant transformation in to invasive squammous cell carcinomas.

Features of verrucuous carcinomas

o Prediliction for males > 50 years

o Predisposed in tobacco users, poor oral hygiene

Gross                                                         Microscopic

o Large                                                 o Cytological features of malignancy are absent or minimal and rare

o Soft                                                   o Epithelium is thickened and thrown into papillary folds

o Wart like lesions/                                o The folds project both above and below the level of surrounding mucosa

o Papillomatus                                       and crypt like surface grooves exhibit marked, prekeratin plugging

o Fungation may be present                (hyperkeratosis ?) ‑

o The rete projections are broad, bulbous and relatively smooth bordered and there may be chronic inflammatory infiltrate in the subjacent lamina propria. o The deep border of epithelial projections is ‘pushing’ and not infiltrative.

The patient in question is an elderly male (70 years) with a chronic history of tobacco use.

Gross features of a ‘large’, `soft’,’papillary’ lesion that has undergone fungation’ are all consistent with the diagnoses of verrucuous carcinoma. Benign appearing `papillomatoses’ with ‘hyperkaratosis’ further supports the diagnosis. Contiguous structures may be involved as the tumor grows. Tumor of the buccal mucosa can grow to become fixed to the periostium of mandible and with continued growth may eventually destroy the periostium and directly invade the mandible.


Q. 12

Abbe- Estlander Flap is used for:

 A

Lip

 B

Tongue

 C

Eyelid

 D

Ears

Q. 12

Abbe- Estlander Flap is used for:

 A

Lip

 B

Tongue

 C

Eyelid

 D

Ears

Ans. A

Explanation:

Ans. is ‘a’ i.e. Lip

A flap is a skin graft which has its own blood supply. (Normally a skin graft to survive is revascularized by the recipient bed. A flap has its own blood supply.)

Abbey flap is used for Lip reconstruction. It is based on main artery of the orbicularis oris, the labial artery.


Q. 13

The commonest site of oral cancer among Indian population is –

 A

Tongue

 B

Floor of mouth

 C

Alveobuccal complex

 D

Lip

Q. 13

The commonest site of oral cancer among Indian population is –

 A

Tongue

 B

Floor of mouth

 C

Alveobuccal complex

 D

Lip

Ans. C

Explanation:

Ans. is ‘c’ i.e., Alveobuccal complex

  • According to textbook of surgery by ‘Association of surgeons of India’, various cancers of oral cavity are reported with the following frequency:
  • The alveobuccal complex thus accounts for 53.7 percent of oral cancers and thus constitutes the commonest site in the Indian population.

Also Remember

  • Most common site of oral cancer in the world is— Tongue
  • Tobacco is the most imp. risk factor
  • Next is Alcohol

Q. 14

All predisposes to oral cancer except –

 A

Erythroplakia

 B

Leukoplakia

 C

Submucosal fibrosis

 D

Lichen planus

Q. 14

All predisposes to oral cancer except –

 A

Erythroplakia

 B

Leukoplakia

 C

Submucosal fibrosis

 D

Lichen planus

Ans. D

Explanation:

Answer is ‘d’ i.e. Lichen planus 


Q. 15

The commonest pre-malignant condition of oral cancer is –

 A

Leukoplakia

 B

Aphthous ulcer

 C

Lichen planus

 D

Erythro-leukoplakia

Q. 15

The commonest pre-malignant condition of oral cancer is –

 A

Leukoplakia

 B

Aphthous ulcer

 C

Lichen planus

 D

Erythro-leukoplakia

Ans. A

Explanation:

Ans. is ‘a’ i.e., Leukoplakia 

Leukoplakia is the most common (-85%) of the premalignant lesions of the oral cavity.


Q. 16

True statement (s) about oral cancer is/are ‑

 A

Most common in buccal mucosa 

 B

Metastasis uncommon

 C

Respond to Radiotherapy

 D

b and c

Q. 16

True statement (s) about oral cancer is/are ‑

 A

Most common in buccal mucosa 

 B

Metastasis uncommon

 C

Respond to Radiotherapy

 D

b and c

Ans. D

Explanation:

Ans. is ‘b’ i.e. Metastases uncommon; ‘c’ i.e. Responds to Radiotherapy

  • As already mentioned Syphilitic glossitis & chronic irritation by jagged tooth predispose oral cancer.
  • Metastases to distant sites are uncommon
  • Treatment involves both surgery and/or radiotherapy (& chemotherapy for advanced lesions)
  • Buccal mucosa is the most common site of oral cancer in India.
  • Also Remember

Over 95% of cancers of the oral cavity are squamous cell carcinomas.


Q. 17

Predisposing factors for development of oral carcinoma  is

 A

Smoking

 B

Alcohol 

 C

Syphilis

 D

All of the above

Q. 17

Predisposing factors for development of oral carcinoma  is

 A

Smoking

 B

Alcohol 

 C

Syphilis

 D

All of the above

Ans. D

Explanation:

Ans. is ‘d’ i.e., All of the above 


Q. 18

Commonest cancer of the oral cavity is –

 A

Adenocarcinoma

 B

Melanoma

 C

Sarcoma

 D

Squamous cell carcinoma

Q. 18

Commonest cancer of the oral cavity is –

 A

Adenocarcinoma

 B

Melanoma

 C

Sarcoma

 D

Squamous cell carcinoma

Ans. D

Explanation:

Ans. is ‘d’ i.e., Squamous cell carcinoma 


Q. 19

Most common type of oral carcinoma is –

 A

Lip

 B

Cheek

 C

Tongue

 D

Palate 

Q. 19

Most common type of oral carcinoma is –

 A

Lip

 B

Cheek

 C

Tongue

 D

Palate 

Ans. C

Explanation:

Ans. is ‘c’ i.e. Tongue


Q. 20

Trismus in oral cancer patients is severe in those treated with –

 A

Surgery and Radiotherapy

 B

Chemotherapy alone

 C

Surgery alone

 D

Not related to treatment

Q. 20

Trismus in oral cancer patients is severe in those treated with –

 A

Surgery and Radiotherapy

 B

Chemotherapy alone

 C

Surgery alone

 D

Not related to treatment

Ans. A

Explanation:

Ans. is ‘a’ i.e., Surgery and Radiotherapy


Q. 21

Which Ca. has best prognosis –

 A

Ca. Lip

 B

Ca. Cheek

 C

Ca. Tongue

 D

Ca. Palate

Q. 21

Which Ca. has best prognosis –

 A

Ca. Lip

 B

Ca. Cheek

 C

Ca. Tongue

 D

Ca. Palate

Ans. A

Explanation:

Ans is ‘a’ ie Ca lip 

Carcinoma lip

CliZO         ttmi.;,”:

•     Is a locally malignant tumor.

Metastasized to lymph nodes early.

•     Metastases to lymph nodes is late.

•     5 year survival rate is not more than 25′

•     Distant metastasis is rare and very late.

Carcinoma palate

•     Local recurrence rate is low.

Recognized late as it presents as a painless

•     Easily recognized early due to superficial site.

ulcer.

Carcinoma Cheek

Invade the bone of hard palate, floor of the nasal

•     Is a slow growing tumor.

cavity & maxillary antrum.

•     It metastasizes to lymph nodes but distant

Tit involves removal of the underlying bone.

metastasis is rare

If the lesion is larger, partial maxillectomy is

•     Local recurrence is high after resection.

done

 These descriptions of carcinoma clearly rank Ca lip with best prognosis.


Q. 22

In which of the following head and neck cancers, is lymph node metastasis least common: 

 A

Tongue

 B

Buccal mucosa

 C

Hard palate

 D

Lower alveolus

Q. 22

In which of the following head and neck cancers, is lymph node metastasis least common: 

 A

Tongue

 B

Buccal mucosa

 C

Hard palate

 D

Lower alveolus

Ans. C

Explanation:

Ans. is ‘c’ i.e. Hard palate 

Incidence of cervical metastasis in oral cancers (in decreasing order)

  • Tongue (most common)
  • Floor of mouth
  • Lower alveolus
  • Buccal mucosa
  • Upper alveolus
  • Hard palate

Q. 23

Abbey-Estlander Flap is used in the reconstruction of

 A

Buccal mucosa

 B

Lip

 C

Tongue

 D

Palate

Q. 23

Abbey-Estlander Flap is used in the reconstruction of

 A

Buccal mucosa

 B

Lip

 C

Tongue

 D

Palate

Ans. B

Explanation:

Ans. is ‘b’ i.e. Lip


Q. 24

Second primary tumor of head and neck is most commonly seen in malignancy of:

 A

Oral cavity

 B

Larynx

 C

Hypopharynx

 D

Paranasal sinuses

Q. 24

Second primary tumor of head and neck is most commonly seen in malignancy of:

 A

Oral cavity

 B

Larynx

 C

Hypopharynx

 D

Paranasal sinuses

Ans. A

Explanation:

  • Patients with head and neck squamous cell carcinoma (HNSCC) are at increased risk for the development of second primary malignancies compared with the general population.
  • These second primary malignancies typically develop in the aerodigestive tract (lung, head and neck, esophagus).
  • The most frequent second primary malignancy is lung cancer.
  • The highest relative increase in risk is for a second head and neck cancer.
  • The site of the index cancer influences the most likely site of a second primary malignancy.

–    In patients with an index malignancy of the larynx, the second primary tumor was commonly seen in lung, while

–    In patients with an index malignancy of the oral cavity, the second primary tumor was commonly seen in head and neck or esophagus.


Q. 25

Premalignant leison of oral cavity includes:

 A

Erythroplakia

 B

Fordyce spots

 C

Leukoplakia

 D

a and c

Q. 25

Premalignant leison of oral cavity includes:

 A

Erythroplakia

 B

Fordyce spots

 C

Leukoplakia

 D

a and c

Ans. D

Explanation:

Q. 26

The most common premalignant condition of oral carcinoma is:

 A

Leukoplakia

 B

Erythroplakia

 C

Lichen planus

 D

Fibrosis

Q. 26

The most common premalignant condition of oral carcinoma is:

 A

Leukoplakia

 B

Erythroplakia

 C

Lichen planus

 D

Fibrosis

Ans. A

Explanation:

Q. 27

The most common site of oral cancer among Indian population is:

 A

Tongue

 B

Floor of mouth

 C

Alveobuccal complex

 D

Lip

Q. 27

The most common site of oral cancer among Indian population is:

 A

Tongue

 B

Floor of mouth

 C

Alveobuccal complex

 D

Lip

Ans. C

Explanation:

 

Frequency of various cancer of oral cavity in India are :

  • Buccal mucosa 38%
  • Anterior tongue 16%
  • Lower alveolus, floor of mouth 15%

 

 

 


Q. 28

Not included in oral cavity Ca:

 A

Base of tongue

 B

Gingivobuccal sulcus

 C

Soft palate

 D

a and c

Q. 28

Not included in oral cavity Ca:

 A

Base of tongue

 B

Gingivobuccal sulcus

 C

Soft palate

 D

a and c

Ans. D

Explanation:

Q. 29

A 70-year-old male who has been chewing tobacco for the past 50 years presents with  six months history of large, fungating, soft papillary lesions in the oral cavity. The lesion has penetrated into the mandible. Lymph nodes are not palpable. Two biopsies taken from the le­sion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. The most likely diagnosis is:

 A

Squamous cell papilloma

 B

Squamous cell carcinoma

 C

Verrucous carcinoma

 D

Malignant mixed tumor

Q. 29

A 70-year-old male who has been chewing tobacco for the past 50 years presents with  six months history of large, fungating, soft papillary lesions in the oral cavity. The lesion has penetrated into the mandible. Lymph nodes are not palpable. Two biopsies taken from the le­sion proper show benign appearing papillomatosis with hyperkeratosis and acanthosis infiltrating the subjacent tissues. The most likely diagnosis is:

 A

Squamous cell papilloma

 B

Squamous cell carcinoma

 C

Verrucous carcinoma

 D

Malignant mixed tumor

Ans. C

Explanation:

 

Although M/C variety of buccal cancer is squamous cell cancer, Verrucous carcinoma is a variety of well-differentiated squamous cell carcinoma which is locally aggressive involving the bone but lymph node metastasis is uncommon. Histologically. these tumors show marked hyperkeratosis and acanthosis with dysplasia limited to deeper layers. Repeated biopsies report it as squamous papilloma. .


Q. 30

Which Ca has best prognosis:

 A

Carcinoma lip

 B

Carcinoma cheek

 C

Carcinoma tongue

 D

Carcinoma palate

Q. 30

Which Ca has best prognosis:

 A

Carcinoma lip

 B

Carcinoma cheek

 C

Carcinoma tongue

 D

Carcinoma palate

Ans. A

Explanation:

 

  • Oral malignancy with best prognosis is carcinoma lips.
  • Oral cancer with worst prognosis is floor of mouth carcinoma.

Q. 31

True statement about oral cancer is/are:

 A

Most common in buccal mucosa

 B

Systemic metastasis uncommon

 C

Responds to radiotherapy

 D

b and c

Q. 31

True statement about oral cancer is/are:

 A

Most common in buccal mucosa

 B

Systemic metastasis uncommon

 C

Responds to radiotherapy

 D

b and c

Ans. D

Explanation:

 

 


Q. 32

The most common site of oral cancer among indian population is:

 A

Tongue

 B

Floor of mouth

 C

Alveolobuccal complex

 D

Lip

Q. 32

The most common site of oral cancer among indian population is:

 A

Tongue

 B

Floor of mouth

 C

Alveolobuccal complex

 D

Lip

Ans. C

Explanation:

Q. 33

Commonest malignancy type in oral cavity is:

September 2010

 A

Adenocarcinoma

 B

Transitional cell carcinoma

 C

Squamous cell carcinoma

 D

Basal cell carcinoma

Q. 33

Commonest malignancy type in oral cavity is:

September 2010

 A

Adenocarcinoma

 B

Transitional cell carcinoma

 C

Squamous cell carcinoma

 D

Basal cell carcinoma

Ans. C

Explanation:

Ans. C: Squamous cell carcinoma


Q. 34

3 cm oral cavity tumor with single ipsilateral 5 cm lymph node with no distant metastases; stage of tumor is ‑

 A

T3N3M0

 B

T2N2aM0

 C

T2N3M0

 D

T2N2bM0

Q. 34

3 cm oral cavity tumor with single ipsilateral 5 cm lymph node with no distant metastases; stage of tumor is ‑

 A

T3N3M0

 B

T2N2aM0

 C

T2N3M0

 D

T2N2bM0

Ans. B

Explanation:

Q. 35

Most common cancer in males in India ‑

 A

Ca rectum

 B

Ca oral cavity

 C

Ca testis

 D

Ca bladder

Q. 35

Most common cancer in males in India ‑

 A

Ca rectum

 B

Ca oral cavity

 C

Ca testis

 D

Ca bladder

Ans. B

Explanation:

Ans. is ‘b’ i.e., Ca oral cavity



Carcinoma of Larynx

Carcinoma of Larynx

Q. 1

 Referred otalgia can be due to

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Q. 1

 Referred otalgia can be due to

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Ans. D

Explanation:

 

Causes of referred otalgia

Ear receives nerve supply from Vth (auriculotemporal), 1Xth (tympanic br.) and Xth (auricular br.) cranial nerves; and from C2 (lesser occipital) and C2 and C3 (greater auricular), pain may be referred from these remote areas

1. Via Vth cranial nerve

  • Dental; Caries tooth, apical abscess, impacted molar, malocclusion.
  • Oral cavity; Benign or malignant ulcerative lesions of oral cavity or tongue.
  • Temporomandibular joint disorders; Bruxism, osteoarthritis, recurrent dislocation,  ill-fitting denture.
  • Sphenopalatine neuralgia.

2. Via IXth cranial nerve

  • Oropharynx; Acute tonsillitis, peritonsillar abscess, tonsillectomy. Benign or malignant ulcers of soft palate, tonsil and its pillars.
  • Base of tongue; Tuberculosis or malignancy.
  • Elongated styloid process.

3.   Via Xth cranial nerve. Malignancy or ulcerative lesion of: vallecula, epiglottis, larynx or laryngopharynx, esophagus.

4.   Via C2 and C3 spinal nerves. Cervical spondylitis, injuries of cervical spine, caries spine.


Q. 2

A patient presents with carcinoma of the larynx involving the left false cords, left arytenoid and the left aryepiglottic folds with bilateral mobile true cords. Treatment of choice is:

 A

Vertical hemilaryngectomy

 B

Horizontal partial hemilaryngectomy

 C

Total laryngectomy

 D

Radiotherapy followed by chemotherapy

Q. 2

A patient presents with carcinoma of the larynx involving the left false cords, left arytenoid and the left aryepiglottic folds with bilateral mobile true cords. Treatment of choice is:

 A

Vertical hemilaryngectomy

 B

Horizontal partial hemilaryngectomy

 C

Total laryngectomy

 D

Radiotherapy followed by chemotherapy

Ans. B

Explanation:

Q. 3

Referred otalgia is due to:

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of above

Q. 3

Referred otalgia is due to:

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of above

Ans. D

Explanation:

Q. 4

T3 N1 Mo stage of Carcinoma larynx is treated by:

 A

Radiotherapy

 B

Surgery

 C

Chemotherapy

 D

Surgery and radiotherapy

Q. 4

T3 N1 Mo stage of Carcinoma larynx is treated by:

 A

Radiotherapy

 B

Surgery

 C

Chemotherapy

 D

Surgery and radiotherapy

Ans. D

Explanation:

Q. 5

Smoking increase the risk of all of the following cancer’s, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

Ca Esophagus

Q. 5

Smoking increase the risk of all of the following cancer’s, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

Ca Esophagus

Ans. B

Explanation:

Role of smoking and development of nasopharyngeal carcinoma is still not clear.

 
Ref: Diet, Nutrition and Cancer: Proceedings of The 16th International Symposium on Mycotoxins By Takamatsu No Miya, Page 51; Carcinomas of The Head and Neck: Evaluation and Management By Charlotte Jacobs, Page 275; Cancer Prevention: The Causes and Prevention of Cancer By Graham A. Colditz, David John Hunter, Page 327

Q. 6

Which of the following is TRUE differential cause of referred otalgia?

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Q. 6

Which of the following is TRUE differential cause of referred otalgia?

 A

Carcinoma larynx

 B

Carcinoma oral cavity

 C

Carcinoma tongue

 D

All of the above

Ans. D

Explanation:

Otalgia can occur as a symptom of carcinoma on the base of tongue, pharynx or larynx.

 
Ear receives nerve supply from 4 cranial nerves such as trigeminal, facial, glossopharyngeal and vagus; and from two branches of cervical plexus called C2 (lesser occipital) and C2 and C3 (greater auricular), pain maybe referred from these remote areas.
 
Facial nerve refers pain to the external ear canal and post auricular region. Second and third cervical nerves refer pain to the postauricular and mastoid regions. 
 
Trigeminal referred otalgia arise from lesions involving the oral cavity and floor of mouth, teeth, mandible, temporomandibular joint, palate and pre auricular skin.
 
Glossopharyngeal referred otalgia arise from the tonsil, base of the tongue, soft palate, nasopharynx, Eustachian tube and pharynx.
 
Vagal referred otalgia arise from the hypopharynx, larynx and trachea.
 
Differential causes of referred otalgia includes migraine, TMJ syndrome, cervical myalgia, fibromyalgia, dental abscess, head and neck malignancy (neoplasm of nasopharynx, sinus, tonsil, base of tongue, hypopharynx), temporal arteritis, inflammatory sinusitis, carotidynia, trigeminal neuralgia, glossopharyngeal neuralgia and GERD.

Q. 7

A 50 year old male chronic smoker complaints of hoarseness of voice for the past 4 months. Microlaryngoscopic biopsy shows it to be keratosis of the larynx. All are suggested treatment modalities for this condition, EXCEPT:

 A

Stop smoking

 B

Laser vaporizer

 C

Partial laryngectomy

 D

Stripping of vocal cord

Q. 7

A 50 year old male chronic smoker complaints of hoarseness of voice for the past 4 months. Microlaryngoscopic biopsy shows it to be keratosis of the larynx. All are suggested treatment modalities for this condition, EXCEPT:

 A

Stop smoking

 B

Laser vaporizer

 C

Partial laryngectomy

 D

Stripping of vocal cord

Ans. C

Explanation:

Laryngeal keratosis is a precancerous condition.

Treatment modalities includes avoidance of aetiological factors such as smoking, stripping of vocal cords and examination of tissues for malignancy and use of laser vaporization.

The treatment of Keratosis of the larynx is conservative involving microsurgical excision. Partial laryngectomy may be used in the presence of certain T1 stage malignancy of Larynx.

 

 


Q. 8

A 55 year old female patient presents with carcinoma of  larynx involving the left false cords, left arytenoid and the left aryepiglottic folds with bilateral mobile true cords. What is the treatment of choice?

 A

Total Laryngectomy

 B

Radiotherapy followed by chemotherapy

 C

Horizontal hemilaryngectomy

 D

Vertical hemilaryngectomy

Q. 8

A 55 year old female patient presents with carcinoma of  larynx involving the left false cords, left arytenoid and the left aryepiglottic folds with bilateral mobile true cords. What is the treatment of choice?

 A

Total Laryngectomy

 B

Radiotherapy followed by chemotherapy

 C

Horizontal hemilaryngectomy

 D

Vertical hemilaryngectomy

Ans. C

Explanation:

Q. 9

All of the following statements regarding carcinoma larynx are true, except

 A

It has poor prognosis

 B

Common in people below 40 years

 C

It is commonly seen in males

 D

Esophageal speech is used as method of communication following layngectomy

Q. 9

All of the following statements regarding carcinoma larynx are true, except

 A

It has poor prognosis

 B

Common in people below 40 years

 C

It is commonly seen in males

 D

Esophageal speech is used as method of communication following layngectomy

Ans. B

Explanation:

Q. 10

A 60 year old patient presents with carcinoma of the larynx involving the left false cords, left arytenoid and the left aryepiglottic folds with bilateral mobile true cords. Treatment of choice is:

 A

Vertical hemilaryngectomy

 B

Horizontal partial hemilaryngectomy

 C

Total laryngectomy

 D

Radiotherapy followed by chemotherapy

Q. 10

A 60 year old patient presents with carcinoma of the larynx involving the left false cords, left arytenoid and the left aryepiglottic folds with bilateral mobile true cords. Treatment of choice is:

 A

Vertical hemilaryngectomy

 B

Horizontal partial hemilaryngectomy

 C

Total laryngectomy

 D

Radiotherapy followed by chemotherapy

Ans. B

Explanation:

This patients staging is limited to the supraglottic region (T2 lesion – Tumor involving more than one adjacent subsite of supraglottis, glottis, or region outside the supraglottis (vallecula, tongue base, medial wall of pyriform sinus). A voice conserving surgery would be ideal for him. The supraglottis is excised by partial horizontal laryngectomy.

General indications for vertical partial laryngectomy is T2 glottic cancers with impaired vocal cord mobility.

Current recommendations by the American Society of Clinical Oncology are that all patients with T1 or T2 laryngeal cancer, with rare exceptions, should be treated initially with the intent to preserve the larynx.

The advantages of surgery compared with radiation are a shorter treatment period (compared with 6–7 weeks for radiation) and the option of saving radiation for recurrence.


Q. 11

A case of carcinoma larynx with the involvement of anterior commissure and right vocal cord, developed perichondritis of thyroid cartilage. Which of the following statements is TRUE for the management of this case?

 A

He should be given radical radiotherapy as this can cure early tumours

 B

He should be treated with combination of chemotherapy and radiotherapy

 C

He should first receive radiotherapy and if residual tumour is present then should under go laryngectomy

 D

He should first undergo laryngectomy and then post-operative radiotherapy

Q. 11

A case of carcinoma larynx with the involvement of anterior commissure and right vocal cord, developed perichondritis of thyroid cartilage. Which of the following statements is TRUE for the management of this case?

 A

He should be given radical radiotherapy as this can cure early tumours

 B

He should be treated with combination of chemotherapy and radiotherapy

 C

He should first receive radiotherapy and if residual tumour is present then should under go laryngectomy

 D

He should first undergo laryngectomy and then post-operative radiotherapy

Ans. D

Explanation:

This patient is suffering from stage IV disease. Advanced-stage larynx cancer (Stages III and IV) is treated by dual-modality therapy with surgery and radiation. For most T3 and T4 tumors, where total laryngectomy is required for the complete removal of the tumor with amply clear margins, organ preservation treatment with combined chemotherapy and radiation therapy is preferred. Adjuvant radiation should start within 6 weeks of surgery and, on once-daily protocols, lasts 6–7 weeks.


Q. 12

A middle aged man diagnosed of having T3N1M0 stage of carcinoma of larynx. Which among the following is the best treatment modality for this patient?

 A

Radiotherapy

 B

Surgery

 C

Organ preservation treatment with combined chemotherapy and radiation therapy

 D

Surgery and radiotherapy

Q. 12

A middle aged man diagnosed of having T3N1M0 stage of carcinoma of larynx. Which among the following is the best treatment modality for this patient?

 A

Radiotherapy

 B

Surgery

 C

Organ preservation treatment with combined chemotherapy and radiation therapy

 D

Surgery and radiotherapy

Ans. C

Explanation:

This patient is in stage III carcinoma of larynx. 

T3= Vocal cord fixation
N1= Single ipsilateral lymph node 3 cm
M0= No distant metastases
Advanced-stage larynx cancer (Stages III and IV) was historically treated by dual-modality therapy with surgery and radiation. For most T3 and T4 tumors, where total laryngectomy is required for the complete removal of the tumor with amply clear margins, organ preservation treatment with combined chemotherapy and radiation therapy is preferred because there is no difference in overall survival and a superior quality of life. 

Q. 13

A 54 year old man with a long history of smoking is diagnosed with squamous cell carcinoma of the larynx. During the course of a radical neck dissection to remove the tumor and regional lymph nodes, the spinal accessory nerve is severed. As a result, the man would most likely have the greatest difficulty in?

 A

Abducting the arm

 B

Adducting the arm

 C

Elevating the point of the shoulder (shrugging)

 D

Laterally rotating the arm

Q. 13

A 54 year old man with a long history of smoking is diagnosed with squamous cell carcinoma of the larynx. During the course of a radical neck dissection to remove the tumor and regional lymph nodes, the spinal accessory nerve is severed. As a result, the man would most likely have the greatest difficulty in?

 A

Abducting the arm

 B

Adducting the arm

 C

Elevating the point of the shoulder (shrugging)

 D

Laterally rotating the arm

Ans. C

Explanation:

The spinal accessory nerve (cranial nerve XI) is a motor nerve (special visceral efferent) that innervates the sternocleidomastoid and trapezius muscles. The trapezius, a broad, flat, triangular muscle, has fibers in its superior part that originate from the external occipital protuberance and the superior nuchal line, the ligamentum nuchae, and the spinous processes of vertebrae C-7 through T-4.

These upper fibers pass laterally to insert onto the acromion and the spine of the scapula. Activation of this part of the muscle results in elevation of the point of the shoulder (acromion moves superiorly), as in shrugging.

The muscles that promote movement of the arm away from the midline of the body include the deltoid, subscapularis, supraspinatus, and infraspinatus muscles which are innervated by branches of the brachial plexus, not the spinal accessory nerve (CN XI).

When there is damage to the spinal accessory nerve, they may also have difficulty elevating (abducting) the arm above a horizontal plane because the superior fibers of the trapezius, along with the serratus anterior, externally rotate the scapula about an anteroposterior axis, which is required for elevation of the arm beyond a horizontal plane.

However, this is a question of “magnitude”: loss of trapezius function would have greater effect on scapular elevation than rotation (i.e. serratus anterior is better able to compensate for loss of external rotation than levator scapulae can for elevation).

The trapezius adducts the scapula, whereas the major arm adductors include the pectoralis major, teres major, latissimus dorsi, and coracobrachialis muscles. These muscles are innervated by branches of the brachial plexus.

The muscles that act to laterally rotate the arm include the teres minor, infraspinatus, supraspinatus, and the dorsal portion of the deltoid muscles. These muscles are innervated by branches of the brachial plexus, not the spinal accessory nerve (CN XI).


Q. 14

Radiotherapy is used for which stage-I cancer 

 A

Colon

 B

Larynx

 C

Anterior 2/3 of tongue

 D

b and c 

Q. 14

Radiotherapy is used for which stage-I cancer 

 A

Colon

 B

Larynx

 C

Anterior 2/3 of tongue

 D

b and c 

Ans. D

Explanation:

B i.e. Larynx; C i.e. Ant 2/3 of tongue

  • Radiotherapy is reserved for early larynx CA which has not involved cartilage or cervical lymphnodes & don’t impair cord mobilityQ.
  • Surgery is the treatment of choice for early lesions suitable for simple infra oral excision, for tumors on the tip of tongue but brachy therapy with iridium wires has the advantage of preserving the tongue.
  • Stomach, colon, lung CA in early stage are treated by surgery.

Q. 15

Smoking may be associated with all of the following cancers, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

None

Q. 15

Smoking may be associated with all of the following cancers, except:

 A

Ca Larynx

 B

Ca Nasopharynx

 C

Ca Bladder

 D

None

Ans. D

Explanation:

Ans is None > Ca Nasopharynx

All the given options are mentioned by Harrison:

  • Harrison 17/e p2737 writes- “Tobacco smoking causes cancer of the lung, oral cavity, naso-, oro-, and hypopharynx, nasal cavity and paranasal sinuses, larynx, esophagus, stomach, pancreas, liver, kidney (body and pelvis), ureter, urinary bladder, and uterine cervix and also causes myeloid leukemia. There is evidence suggesting that cigarette smoking may play a role in increasing the risk of colorectal and possibly premenopausal breast cancer, but there is no association with postmenopausal breast cancer. There does not appear to be a causal link between cigarette smoking and cancer of the endometrium, and there is a lower risk of uterine cancer among postmenopausal women who smoke.”
  • Thus the answer should be none, however Nasopharyngeal carcinoma is found to be least associated with smoking. Head & Neck Cancers by Enslow Jacobs 2003e p492 writes-“Association between smoking and nasopharyngeal carcinoma has been shown only by a few studies. If the association of tobacco and NPC is real, the possible mechanism of tumor induction would be the nitrosamines and its precursors in tobacco.”

Q. 16

The most common cause of laryngeal stridor in a 60-year ­old male is:

 A

Nasopharyngeal carcinoma

 B

Thyroid carcinoma

 C

Foreign body aspiration

 D

Carcinoma larynx

Q. 16

The most common cause of laryngeal stridor in a 60-year ­old male is:

 A

Nasopharyngeal carcinoma

 B

Thyroid carcinoma

 C

Foreign body aspiration

 D

Carcinoma larynx

Ans. D

Explanation:

 

Most common cause for stridor in 60 years old male will be carcinoma larynx as carcinoma larynx occurs in males (predominantly) at the age of 40-70 years.

Most common and earliest symptom of subglottic cancer is stridor.

  • Nasopharyngeal cancer does not lead to stridor
  • Thyroid cancer causes stridor rarely.



Q. 17

Reflux laryngitis produces:

 A

Subglottic stenosis

 B

Ca larynx

 C

Cord fixation

 D

a and b

Q. 17

Reflux laryngitis produces:

 A

Subglottic stenosis

 B

Ca larynx

 C

Cord fixation

 D

a and b

Ans. D

Explanation:

 

  • There are lots of controversies regarding the reflux laryngitis secondary to reflux gastrointestinal disease. But now some studies document that there is a clear relation between the two.
  • Reflux laryngitis may have the following sequlae:

Bronchospasm

Chemical pneumonitis

Refractory subglottic stenosis

Refractory contact ulcer

Peptic laryngeal granuloma

Acid laryngitis (Heart burn, burning pharyngeal discomfort, nocturnal chocking due to interarytenoid pachydermia)

Laryngeal Carcinoma .

Laryngopharyngeal Reflux

Here classical GERD symptoms are absent. Patients have more of daytime/upright reflux without the nocturnal/supine reflux of GERD. In laryngopharyngeal reflux esophageal motility and lower esophageal sphincter is normal, while upper esophageal sphincter is abnormal. The traditional diagnostic tests for GERD are not useful in LPR.

Symptom Chronic or Intermittent dysphonia, vocal strain, foreign body sensation, excessive throat mucus, Postnasal discharge and cough. Laryngeal findings: Interarytenoid bunching, Posterior laryngitis and subglottic edema (Pseudosulcus)

Sequelae of Laryngopharyngeal Reflux

  • Subglottic stenosis
  • Carcinoma larynx
  • Contact ulcer/granuloma
  • Cricoarytenoid joint fixity
  • Vocal nodule/polyp
  • Sudden infant deaths
  • Laryngomalacia (Association)

Treatment is in similar lines as GERD, but we need to give proton pump inhibitors at a higher dose and for a longer duration (at least 6-8 months).



Q. 18

Premalignant conditions for carcinoma larynx would include:

 A

Leukoplakia

 B

Lichen planus

 C

Papillomas

 D

a and c

Q. 18

Premalignant conditions for carcinoma larynx would include:

 A

Leukoplakia

 B

Lichen planus

 C

Papillomas

 D

a and c

Ans. D

Explanation:

Q. 19

Which of the following is precancerous lesion?

 A

Pachydermia of larynx 

 B

Laryngitis sicca

 C

Keratosis of larynx

 D

Scleroma larynx

Q. 19

Which of the following is precancerous lesion?

 A

Pachydermia of larynx 

 B

Laryngitis sicca

 C

Keratosis of larynx

 D

Scleroma larynx

Ans. C

Explanation:

   

Keratosis of larynx/leukoplakia:‑

It is epithelial hyperplasia of the upper surface of one or both vocal cords.

  • Appears as a white plaque or warty growth on cord without affecting its mobility
  • Regarded as a precarcerous condition as Ca in situ develops frequently
  • T/t=stripping of cords



Q. 20

True statement about Infraglottic carcinoma of larynx is

 A

Commonly spreads to mediastinal nodes

 B

Second most common carcinoma

 C

Most common carcinoma

 D

Spreads to submental nodes

Q. 20

True statement about Infraglottic carcinoma of larynx is

 A

Commonly spreads to mediastinal nodes

 B

Second most common carcinoma

 C

Most common carcinoma

 D

Spreads to submental nodes

Ans. A

Explanation:

 

  • Subglottic cancer is the rarest of laryngeal cancer.
  • Earliest presentation is a globus or foreign body sensation in throat followed by stridor or laryngeal obstruction.
  • Hoarseness is a late feature and occurs due to involvement of glottis or recurrent laryngeal nerve.
  • Lymphatic spread occurs to prelaryngeal, pretracheal, paratracheal and lower jugular nodes (i.e. mediastinal nodes.)

Q. 21

The treatment of choice for stage I cancer larynx is:

 A

Radical Surgery

 B

Chemotherapy

 C

Radiotherapy

 D

Surgery followed by radiotherapy

Q. 21

The treatment of choice for stage I cancer larynx is:

 A

Radical Surgery

 B

Chemotherapy

 C

Radiotherapy

 D

Surgery followed by radiotherapy

Ans. C

Explanation:

 

According to Dhingra

  • Radiotherapy is the treatment of choice for all stage I cancers of larynx, which neither impair mobility nor invade cartilage or cervical nodes.
  • The greatest advantage of radiotherapy over surgery in Ca larynx glottic cancer is – preservation of voice.

Not effective :

  • If cords are fixed
  • In subglottic extension                  
  • In cartilage invasion
  • If nodal metastasis is present

 

Microlaryngeal Surgery

i.e. endoscopic removal of selected larynx by operating microscope and microlaryngeal dissection instruments is used for treating early stages of cancer larynx.

The advantages of surgery compared to radiation are :

  • A shorter treatment period (compared to 6 – 7 weeks for radiation)
  • Saving the option of radiotherapy for recurrence

Drawback of Surgery – Poor Voice Quality

  • Hence from above discussion it can be concluded that microlaryngoscopic surgery / Radiotherapy is the TOC for stage I of laryngeal cancer.
  • In the option – Surgery and not microlaryngoscopic surgery is given.
  • Hence Radiotherapy is being taken as the correct option.



Q. 22

Treatment of Ca larynx in stage. T1 MONO is:

 A

Radiotherapy

 B

Surgery – Total laryngectomy

 C

Laser therapy

 D

Micro laryngoscopic surgery

Q. 22

Treatment of Ca larynx in stage. T1 MONO is:

 A

Radiotherapy

 B

Surgery – Total laryngectomy

 C

Laser therapy

 D

Micro laryngoscopic surgery

Ans. D

Explanation:

Q. 23

For carcinoma larynx in stage III, Treatment of choice is

 A

Radiotherapy and Surgery

 B

Chemotherapy with cisplatinum

 C

Partial laryngectomy with chemotherapy

 D

Radiotherapy with chemotherapy

Q. 23

For carcinoma larynx in stage III, Treatment of choice is

 A

Radiotherapy and Surgery

 B

Chemotherapy with cisplatinum

 C

Partial laryngectomy with chemotherapy

 D

Radiotherapy with chemotherapy

Ans. A

Explanation:

Q. 24

Treatment of choice in stage III carcinoma larynx is:

 A

Chemotherapy

 B

Surgery + radiation

 C

Surgery + chemotherapy

 D

Only radiotherapy

Q. 24

Treatment of choice in stage III carcinoma larynx is:

 A

Chemotherapy

 B

Surgery + radiation

 C

Surgery + chemotherapy

 D

Only radiotherapy

Ans. B

Explanation:

Q. 25

A patient of carcinoma larynx with stridor presents in casualty, immediate management is:

 A

Planned tracheostomy

 B

Immediate tracheostomy

 C

High dose steroid

 D

Intubate, give bronchodilator and wait for 12 hours, if no response, proceed to tracheostomy

Q. 25

A patient of carcinoma larynx with stridor presents in casualty, immediate management is:

 A

Planned tracheostomy

 B

Immediate tracheostomy

 C

High dose steroid

 D

Intubate, give bronchodilator and wait for 12 hours, if no response, proceed to tracheostomy

Ans. B

Explanation:

 

Carcinoma larynx presenting with stridor means it is subglottic laryngeal carcinoma .Ideally in such cases emergency laryngectomy should be performed.

 

But not done in cases if

  • Intubation can not be done as growth is seen in subglottic area, therefore tube can not be put.
  • Planned tracheostomy can not be done as patient is suffering from stridor, which is an emergency. Therefore we will have to do emergency tracheostomy. With the precaution that the area of cancer should be removed within 72 hours.



Q. 26

A patient presents with carcinoma of the larynx involving the left false cord, left arytenoids and the left aryepiglottic folds with bilateral mobile true cords. Treatment of choice is

 A

Vertical hemilaryngectomy

 B

Horizontal hemilaryngectomy

 C

Radiotherapy followed by chemotherapy

 D

Total laryngectomy

Q. 26

A patient presents with carcinoma of the larynx involving the left false cord, left arytenoids and the left aryepiglottic folds with bilateral mobile true cords. Treatment of choice is

 A

Vertical hemilaryngectomy

 B

Horizontal hemilaryngectomy

 C

Radiotherapy followed by chemotherapy

 D

Total laryngectomy

Ans. B

Explanation:

 

Fully mobile vocal cord means either stage I or II carcinoma.TOC in stage I and II is radiotherapy. Radiotherapy is not a given option, therefore voice conservation surgery is done. However the tumor involve left half of supraglottis. Therefore hemilaryngectomy is done.

Vertical hemilaryngectomy means excission of one half of the larynx on one side, i.e., vertical half is removed which include vertical half of supraglottis, glottis and subglottis.

    • It is indicated for specific T, and T2 glottic cancer

Horizontal hemilaryngectomy is the excision of supraglottis only sparing true vocal cords and arytenoids also known as supraglottic laryngectomy.

    • It is indicated for specific T1 and T2 supraglottic cancers which donot involve true vocal cord.

Hence, in supraglottic cancer horizontal hemilaryngectomy should be done to remove supraglottis.

The most significant problem with partial laryngectomies (horizontal/vertical) is aspiration and subsequent pneumonia. Therefore patients with good pulmonary reserve should only be selected.



Q. 27

A case of carcinoma larynx with the involvement of anterior commissure and right vocal cord, developed perichondritis of thyroid cartilage. Which of the following statements is true for the management of this case?

 A

He should be given radical radiotherapy as this can cure early tumours

 B

He should be trated with combination of chemotherapy and radiotherapy

 C

He should first receive radiotherapy and if residula tumour is present then should under go laryngectomy

 D

He should first undergo laryngectomy and then post-operative radiotherapy

Q. 27

A case of carcinoma larynx with the involvement of anterior commissure and right vocal cord, developed perichondritis of thyroid cartilage. Which of the following statements is true for the management of this case?

 A

He should be given radical radiotherapy as this can cure early tumours

 B

He should be trated with combination of chemotherapy and radiotherapy

 C

He should first receive radiotherapy and if residula tumour is present then should under go laryngectomy

 D

He should first undergo laryngectomy and then post-operative radiotherapy

Ans. D

Explanation:

Perichondritis of thyroid cartilage in a patient of Ca larynx suggests invasion of thyroid cartilage i.e. stage T4.

Stage T4 lesions glottic cancer are managed by total laryngectomy with neck dissection for clinically positive nodes and post opera­tive radiotherapy if nodes are not palpable.

Indication of Total laryngectomy in Ca larynx       – Current Otolaryngology 2/e pg-449; Dhingra 5/e, pg-330, 6/e p 310

  • T3 lesions (i.e. with cord fixed) not amenable to chemoradiation or partial laryngectomy procedures
  • All T4 lesions
  • Invasion of thyroid or cricoid cartilage
  • Bilateral arytenoid cartilage involvement
  • Lesions of posterior commissure
  • Failure after radiotherapy or conservation surgery
  • Transglottic cancers i.e. tumors involving supraglottis and glottis across the ventricle, causing fixation of the vocal cord.

Total laryngectomy is contraindicated in patients with distant metastasis.


Q. 28

Treatment of choice for carcinoma LarynxT1 NOMO stage:

 A

External beam radiotherapy

 B

Radioactive implants

 C

Surgery

 D

Surgery and radiotherapy

Q. 28

Treatment of choice for carcinoma LarynxT1 NOMO stage:

 A

External beam radiotherapy

 B

Radioactive implants

 C

Surgery

 D

Surgery and radiotherapy

Ans. A

Explanation:

 

Treatment for stage I of cancer larynx (glottic cancer) is either microlaryngoscopic surgery or Radiotherapy.

External Bean Radiation or Brachytherapy

External bean radiation is most often used to treat laryngeal and hypopharyngeal cancer.

Brachytherapy is rarely used to treat laryngeal or hypopharyngeal cancer.                                                    

Radiation given as the primary treatment for larynx cancer or as an adjuvant treatment after surgery is most often done using an external beam technique, a dose of 6000-7000 cGy is admistered to the primary site.


Q. 29

Select correct statements about Ca larynx:

 A

Glottic Ca is the most common

 B

Supraglottic ca has best prognosis

 C

Lymphatic spread is the most common in subglottic Ca

 D

All

Q. 29

Select correct statements about Ca larynx:

 A

Glottic Ca is the most common

 B

Supraglottic ca has best prognosis

 C

Lymphatic spread is the most common in subglottic Ca

 D

All

Ans. A

Explanation:

Q. 30

The preferred treatment of verrucous carcinoma of the larynx is:

 A

Pulmonary surgery

 B

Electron beam therapy

 C

Total laryngectomy

 D

Endoscopic removal

Q. 30

The preferred treatment of verrucous carcinoma of the larynx is:

 A

Pulmonary surgery

 B

Electron beam therapy

 C

Total laryngectomy

 D

Endoscopic removal

Ans. D

Explanation:

 

Verrucous Carcinoma

    • Verrcous carcinoma makes up only 1-2% of laryngeal carcinomas.
    • The larynx is the second most common site of occurence in the head and neck after the oral cavity.
    • Most common site of involvement is vocal cord.
    • Grossly, verrucous carcinoma appears as a fungating, papillomatous, grayish white neoplasm.
    • Microscopically, it is well differentiated squamous cell carcinoma with minimal cytological atypis.
    • It has low metastatic potential
    • Hoarseness is the most common presented symptom. Pain and dysphagia may occur but are less common.
    • Treatment of most verrucous tumors is primary surgery. Endoscopic laser surgery is appropriate as the tumor is less aggressive than usual squamous cell carcinoma.



Q. 31

Method of speech communications after laryngectomy include:

 A

Electrolarynx

 B

Oesophageal speech

 C

Tracheo-oesophageal speech

 D

All

Q. 31

Method of speech communications after laryngectomy include:

 A

Electrolarynx

 B

Oesophageal speech

 C

Tracheo-oesophageal speech

 D

All

Ans. D

Explanation:

 

Methods mmunication in laryng zed patient

  • Oesophageal speech
  • Electrolarynx
  • Transoral pneumatic device
  • Tracheo-oesophageal speech – Blom-Singer prosthesis – Panje prosthesis



Q. 32

Maintenance of airway during laryngectomy in a patient with carcinoma of larynx is best done by

 A

Tracheostomy

 B

Laryngeal mask airway

 C

Laryngeal tube

 D

Combi tube

Q. 32

Maintenance of airway during laryngectomy in a patient with carcinoma of larynx is best done by

 A

Tracheostomy

 B

Laryngeal mask airway

 C

Laryngeal tube

 D

Combi tube

Ans. A

Explanation:

Q. 33

Smoking predisposes to all of the following cancers EXCEPT:      

September 2012

 A

Carcinoma larynx

 B

Carcinoma bladder

 C

Carcinoma esophagus

 D

Lymphoma

Q. 33

Smoking predisposes to all of the following cancers EXCEPT:      

September 2012

 A

Carcinoma larynx

 B

Carcinoma bladder

 C

Carcinoma esophagus

 D

Lymphoma

Ans. D

Explanation:

Ans: D i.e. Lymphoma


Q. 34

Treatment of choice for laryngeal carcinoma of glottis extending to supraglottic region with vocal cord fixation with papable solitary ipsilateral lymph node is ‑

 A

Conservative laryngectomy

 B

Total laryngectomy

 C

Total laryngectomy with radical neck dissection

 D

Palliative therapy

Q. 34

Treatment of choice for laryngeal carcinoma of glottis extending to supraglottic region with vocal cord fixation with papable solitary ipsilateral lymph node is ‑

 A

Conservative laryngectomy

 B

Total laryngectomy

 C

Total laryngectomy with radical neck dissection

 D

Palliative therapy

Ans. C

Explanation:

 

  • Patient with with glottis carcinoma extending to the supra glottis region along with vocal cord fixation (bad prognostic sign; involvement of thyroarytenoid muscle) belongs to T3 stage og glottis carcinoma
  • Single ipsilateral lymph node of 2 cm size signifies N1 nodal status
  • And there is no evidence of distal metastases so MO
  • This patient belongs to T3N1 MO.
  • Treatment of choice in such patient is total laryngectomy with radical neck dissection.

STAGING OF LARYNX CANCER

  • Treatment of larynx cancer depends upon the stage of the tumor.
  • Therefore, one should know the TNM staging (TNM classification) of large cancer.


Arterial Supply of Lower Limb

Arterial Supply of Lower Limb

Q. 1

Contents of Adductor canal are all EXCEPT:

 A

Femoral artery

 B

Popliteal artery

 C

Nerve to Vastus medialis

 D

Saphenous nerve

Q. 1

Contents of Adductor canal are all EXCEPT:

 A

Femoral artery

 B

Popliteal artery

 C

Nerve to Vastus medialis

 D

Saphenous nerve

Ans. B

Explanation:

Popliteal artery 

THE ADDUCTOR CANAL (Subsartorial/Hunter’s canal) is an aponeurotic tunnel in the middle third of the thigh, extending from the apex of the femoral triangle to the opening in the Adductor magnus, the Adductor hiatus.

(Femoral artery, femoral vein and saphenous nerve go into this canal through superior foramen. Saphenous nerve and artery exit through anterior foramen. Finally, femoral artery and vein exit via the inferior foramen (usually called hiatus) through gap between adductor magnus)


Q. 2

Main blood supply to the head and neck of femur comes from:

 A

Lateral circumflex femoral Artery

 B

Medial circumflex femoral Artery

 C

Artery of Ligamentum Teres

 D

Popliteal Artery

Q. 2

Main blood supply to the head and neck of femur comes from:

 A

Lateral circumflex femoral Artery

 B

Medial circumflex femoral Artery

 C

Artery of Ligamentum Teres

 D

Popliteal Artery

Ans. B

Explanation:

Most of the blood supply to the head and neck of femur is supplied by the medial circumflex femoral artery, its retinacular and epiphyseal branches included.

Medium circumflex femoral artery is an artery that branches from the deep femoral artery and it supplies the medial part of the thigh and hip joint muscles.

Ref: Merriam Websters medical dictionary, by Merrium Webster, Page 400; Campbell’s Operative Orthopaedics 10th/2908.

 


Q. 3

The superficial external pudendal artery is a branch of which of the following artery?

 A

Aorta

 B

Femoral artery

 C

External iliac artery

 D

Internal iliac artery

Q. 3

The superficial external pudendal artery is a branch of which of the following artery?

 A

Aorta

 B

Femoral artery

 C

External iliac artery

 D

Internal iliac artery

Ans. B

Explanation:

Superficial external pudendal artery is a branch of femoral artery. It runs medially to supply skin of the scrotum (or labium majus).


Q. 4

All of the following are contents of adductor canal, EXCEPT?

 A

Femoral artery

 B

Popliteal artery

 C

Nerve to Vastus medialis

 D

Saphenous nerve

Q. 4

All of the following are contents of adductor canal, EXCEPT?

 A

Femoral artery

 B

Popliteal artery

 C

Nerve to Vastus medialis

 D

Saphenous nerve

Ans. B

Explanation:

Femoral artery and vein, saphenous nerve and, in the upper part, the nerve to vastus medialis.

Adductor canal or subsartorial or Hunter‘s canal is a gutter-shaped tunnel in the middle third of the thigh. It extends from the apex of the femoral triangle to the adductor hiatus in the tendon of adductor magnus. 

Boundaries are given below:

  • Anterior and lateral wall: vastus medialis
  • Posterior wall – superior: adductor longus; inferior: adductor magnus
  • Medial wall: Sartorius, which overlies the groove between the above muscles, forming the roof of the canal.

Q. 5

Superficial circumflex iliac artery is a branch of which of the following arteries?

 A

Femoral artery

 B

Internal iliac artery

 C

External iliac artery

 D

Internal pudendal artery

Q. 5

Superficial circumflex iliac artery is a branch of which of the following arteries?

 A

Femoral artery

 B

Internal iliac artery

 C

External iliac artery

 D

Internal pudendal artery

Ans. A

Explanation:

Superficial circumflex iliac artery is a branch of femoral artery. It is the smallest branch of the femoral artery. It pierces the deep fascia of the thigh lateral to the saphenous opening and courses laterally towards anterior superior iliac spine to supply superficial fascia and skin.

Branches of femoral artery:
  • Superficial epigastric artery
  • Superficial circumflex iliac artery
  • Superficial external pudendal artery
  • Deep external pudendal artery
  • Profunda femoris artery
  • Descending genicular artery
Branches of external iliac artery:
  • Inferior epigastric artery
  • Deep circumflex iliac artery

Q. 6

The superficial external pudendal artery is a branch of

 A

Femoral artery

 B

External iliac artery

 C

Internal iliac artery

 D

Aorta

Q. 6

The superficial external pudendal artery is a branch of

 A

Femoral artery

 B

External iliac artery

 C

Internal iliac artery

 D

Aorta

Ans. A

Explanation:

A i.e. Femoral artery


Q. 7

Blood supply of great toe are:

 A

Dorsalis pedis artery

 B

Dorsalis pedis artery

 C

Matacarpal artery

 D

Posterior tibial artery

Q. 7

Blood supply of great toe are:

 A

Dorsalis pedis artery

 B

Dorsalis pedis artery

 C

Matacarpal artery

 D

Posterior tibial artery

Ans. A

Explanation:

A . i.e. Dorsalis pedis artery


Q. 8

Which structure lies midway between the ASIS & pubic symphysis :

 A

Femoral artery

 B

Deep inguinal ring

 C

Superior epigastric artery

 D

Inguinal ligament

Q. 8

Which structure lies midway between the ASIS & pubic symphysis :

 A

Femoral artery

 B

Deep inguinal ring

 C

Superior epigastric artery

 D

Inguinal ligament

Ans. A

Explanation:

A. i.e. Femoral artery 

  • Femoral artery traverses the femoral triangle from its base (which is formed by inguinal ligament – attached between ASIS and Pubic tubercle) at midinguinal point

Deep inguinal ring lies 1/2 inch above midinguinal pointQ; Superficial inguinal ring lies I/2 inch bellow midinguinal point; and Saphenous opening lies 4 cm below & lateral to the pubic tubercle.


Q. 9

The femoral ring is bounded by the following structures except:

 A

Femoral vein.

 B

Inguinal ligament

 C

Femoral artery.

 D

Lacunar ligament.

Q. 9

The femoral ring is bounded by the following structures except:

 A

Femoral vein.

 B

Inguinal ligament

 C

Femoral artery.

 D

Lacunar ligament.

Ans. C

Explanation:

C i.e. Femoral artery


Q. 10

Structure passing deep to flexor retinaculum is:

 A

Post tibial artery

 B

Long saphenous vein

 C

Tibialis ant. tendon

 D

Peroneus tertius

Q. 10

Structure passing deep to flexor retinaculum is:

 A

Post tibial artery

 B

Long saphenous vein

 C

Tibialis ant. tendon

 D

Peroneus tertius

Ans. A

Explanation:

A. i.e. Posterior tibial artery


Q. 11

Main blood supply to the head and neck of femur comes from

 A

Lateral circumflex femoral Artery

 B

Medial circumflex femoral Artery

 C

Artery of Ligamentum Teres

 D

Popliteal Artery

Q. 11

Main blood supply to the head and neck of femur comes from

 A

Lateral circumflex femoral Artery

 B

Medial circumflex femoral Artery

 C

Artery of Ligamentum Teres

 D

Popliteal Artery

Ans. B

Explanation:

B i.e. Medial circumflex femoral Artery


Q. 12

Popliteal Artery Pulsations are difficult to feel because

 A

It is not superficial

 B

It does not cross prominent bone

 C

It is not superficial and does not cross prominent bone

 D

Its pulsations are weak

Q. 12

Popliteal Artery Pulsations are difficult to feel because

 A

It is not superficial

 B

It does not cross prominent bone

 C

It is not superficial and does not cross prominent bone

 D

Its pulsations are weak

Ans. A

Explanation:

Ans is a i.e. It is not superficial 

“The pulse of the popliteal artery is the most difficult of the peripheral pulses to feel because the artery lies deep in the popliteal fossa. It is best examined with the subject lying supine or prone, with the knee flexed, in order to relax the tense popliteal fascia that roofs the popliteal fossa. The popliteal pulse is then felt by deep pressure over the midline of the fossa against the popliteal surface of the femur.” Gray’s Anatomy 40/e p1344

“Because the popliteal artery is deep in the popliteal fossa, it may be difficult to feel the popliteal pulse.” – Essential

clinical anatomy By Keith L Moore, A. M. R. Agur 3/e p356

Option b and c are not true as the popliteal artery crosses the femur and tibia bones.



Q. 13

Superficial epigastric artery is a branch of‑

 A

Internal pudendal artery

 B

External pudendal artery

 C

Internal iliac artery

 D

Femoral artery

Q. 13

Superficial epigastric artery is a branch of‑

 A

Internal pudendal artery

 B

External pudendal artery

 C

Internal iliac artery

 D

Femoral artery

Ans. D

Explanation:

Ans. is ‘d’ i.e., Femoral artery

Branches of femoral artery

1)     Superficial :- Superficial external pudendal, superficial epigastric, superficial circumflex iliac.

2)     Deep branches :- Profunda femoris, deep external pudendal, muscular branches, descending genicular branch (last branch in the adductor canal).

  • Note: Superior epigastric artery is a branch of internal thoracic artery.

Q. 14

False about tibia-fibula is ‑

 A

Nutrient artery of tibia is from posterior tibial artery

 B

Nutrient artery of fibula is from peroneal artery

 C

Proximal end of tibia is related to common peroneal nerve

 D

Tibia is the most common site of osteomyelitis

Q. 14

False about tibia-fibula is ‑

 A

Nutrient artery of tibia is from posterior tibial artery

 B

Nutrient artery of fibula is from peroneal artery

 C

Proximal end of tibia is related to common peroneal nerve

 D

Tibia is the most common site of osteomyelitis

Ans. C

Explanation:

  • Common peroneal nerve is related to neck of fibula (not tibia).
  • Nutrient artery of tibia is a branch of posterior tibial artery.
  • Nutrient artery of fibula is a branch of peroneal artery.
  • Tibia is the commonest site of osteomyelitis.

Q. 15

Structure which lies outside the femoral sheath 

 A

Femoral artery

 B

Femoral nerve

 C

Femoral vein

 D

Genitofemoral nerve

Q. 15

Structure which lies outside the femoral sheath 

 A

Femoral artery

 B

Femoral nerve

 C

Femoral vein

 D

Genitofemoral nerve

Ans. B

Explanation:

 Femoral nerve

Femoral sheath

Femoral sheath is a funnel shaped fascial prolongation around proximal part of femoral vessels, situated in the femoral triangle, below the inguinal ligament. It is 3-4 cm long. It is formed by fascia iliaca.

Femoral sheath is divided into 3 separate fascial compartements by septa :‑

i) Lateral compartment :- It contains femoral artery and femoral branch of genitofemoral nerve.

ii) Intermediate compartment :- Femoral vein.

iii) Medial compartment (femoral canal) :- It is conical in shape, wider above adn narrow below. The wider upper opening is known as femoral ring, which is potentially a weak point in lower abdomen and is the site for femoral hernia. Femoral ring is bounded : Anteriorly by inguinal ligament, medially by lacunar ligament, posteriorly by pectineus with its covering fascia, and laterally by septum separating it from femoral vein. Femoral canal contains lymph node of cloquet or Rosenmuller and lymphatics.



Femoral nerve

FEMORAL NERVE

Q. 1

The skin overlying the region where a venous “cut-down” is made to access the Great saphenous vein is supplied by?

 A

Femoral nerve

 B

Sural nerve

 C

Tibial nerve

 D

Superficial peroneal nerve

Q. 1

The skin overlying the region where a venous “cut-down” is made to access the Great saphenous vein is supplied by?

 A

Femoral nerve

 B

Sural nerve

 C

Tibial nerve

 D

Superficial peroneal nerve

Ans. A

Explanation:

The skin overlying the region where a cut down is made to grant access to the great saphenous vein is supplied by the saphenous nerve. The saphenous nerve is a branch of the femoral nerve.


Q. 2

Saphenous nerve is a branch of:  

 A

Tibial nerve

 B

Sciatic nerve

 C

Common peroneal nerve

 D

Femoral nerve

Q. 2

Saphenous nerve is a branch of:  

 A

Tibial nerve

 B

Sciatic nerve

 C

Common peroneal nerve

 D

Femoral nerve

Ans. D

Explanation:

Branches of femoral nerve

  • Anterior division: In the thigh the anterior division of the femoral nerve gives off anterior cutaneous and muscular branches.

Anterior cutaneous branches: The anterior cutaneous branches comprise the following nerves:

  • Intermediate femoral cutaneous nerve and
  • Medial femoral cutaneous nerve

Muscular branches (rami musculares):

  • The nerve to the Pectineus arises immediately below the inguinal ligament.
  • The nerve to the Sartorius arises in common with the intermediate cutaneous.
  • Posterior division: The posterior division- muscular branches supply the four parts of the Quadriceps femoris.

– The branch to the Rectus femoris enters the upper part of the deep surface of the muscle, and supplies a filament to the hip-joint.

– The branch to the Vastus lateralis, of large size, accompanies the descending branch of the lateral femoral circumflex artery.

The branch to the Vastus medialis descends lateral to the femoral vessels in company with the saphenous nerve.

– The branches to the Vastus intermedius.

– The articular branch to the hip-joint is derived from the nerve to the Rectus femoris.

  • The articular branches to the knee-joint are three in number.

One, a long slender filament, is derived from the nerve to the Vastus lateralis.

– Another, derived from the nerve to the Vastus medialis

– The third branch is derived from the nerve to the Vastus intermedius.


Q. 3

Femoral nerve supplies all except ‑

 A

Pectineus

 B

Sartorius

 C

Vastus medialis

 D

Obturator externus

Q. 3

Femoral nerve supplies all except ‑

 A

Pectineus

 B

Sartorius

 C

Vastus medialis

 D

Obturator externus

Ans. D

Explanation:

Branches of femoral nerve are :‑

  1. From the main trunk :- Nerve supply to iliacus, nerve supply to pectineus and a few vascular branches.
  2. From anterior division :- Intermediate femoral cutaneous nerve (intermediate cutaneous nerve of thigh), medial femoral cutaneous nerve (medial cutaneous nerve of thigh) and muscular branch to sartorius.
  3. From posteior division :- Saphenous nerve, nerve supply to quadriceps femoris (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius).
  4. Articular supply :- Hip joint is supplied by nerve to rectus femoris; knee joint is supplied by nerve to three vasti.

Q. 4

Anterior division of femoral nerve supplies ‑

 A

Rectus femoris

 B

Sartorius

 C

Iliacus

 D

Pectineus

Q. 4

Anterior division of femoral nerve supplies ‑

 A

Rectus femoris

 B

Sartorius

 C

Iliacus

 D

Pectineus

Ans. B

Explanation:

Branches of femoral nerve are :‑

1) From the main trunk :- Nerve supply to iliacus, nerve supply to pectineus and a few vascular branches.

2) From anterior division :- Intermediate femoral cutaneous nerve (intermediate cutaneous nerve of thigh), medial femoral cutaneous nerve (medial cutaneous nerve of thigh) and muscular branch to sartorius.

3) From posteior division :- Saphenous nerve, nerve supply to quadriceps femoris (rectus femoris, vastus medialis, vastus lateralis, vastus intermedius).

4) Articular supply :- Hip joint is supplied by nerve to rectus femoris; knee joint is supplied by nerve to three vasti.


Q. 5

Not a content of Hunter’s canal ‑

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

Sphenous nerve

Q. 5

Not a content of Hunter’s canal ‑

 A

Femoral artery

 B

Femoral vein

 C

Femoral nerve

 D

Sphenous nerve

Ans. C

Explanation:

Ans. is ‘c’ i.e., Femoral nerve

Contents of adductor canal are femoral artery, femoral vein, Saphenous nerve, nerve to vastus medialis, descending genicular artery, deep lymph vessels, and two terminal divisions of obturator nerve.



Sciatic nerve

SCIATIC NERVE

Q. 1

The thickest nerve of the body is?

 A

Radial

 B

Median

 C

Sciatic

 D

Axillary

Q. 1

The thickest nerve of the body is?

 A

Radial

 B

Median

 C

Sciatic

 D

Axillary

Ans. C

Explanation:

Sciatic nerve (L4–S3) is the largest peripheral nerve in the body.It is the longest and widest single nerve in the human body, going from the top of the leg to the foot on the posterior aspect The sciatic nerve is comprised of the tibial and common peroneal nerve and exits the pelvis inferior to the piriformis muscle, between the ischial tuberosity and the greater trochanter of the femur.


Q. 2

Which of the following nerve does not supply muscles of gluteal region?

 A

Sciatic nerve

 B

Sup gluteal nerve

 C

Inf gluteal nerve

 D

Nerve to obturator internus

Q. 2

Which of the following nerve does not supply muscles of gluteal region?

 A

Sciatic nerve

 B

Sup gluteal nerve

 C

Inf gluteal nerve

 D

Nerve to obturator internus

Ans. A

Explanation:

Sciatic nerve (L4–S3) is the largest peripheral nerve in the body. The sciatic nerve is comprised of the tibial and common peroneal nerve and exits the pelvis inferior to the piriformis muscle, and usually gives no branches in the gluteal region.

Superior gluteal nerve (L4–S1): Supplies to gluteus medius and minimus muscles, also provides motor innervation to the tensor fascia latae muscle.
 
Inferior gluteal nerve (L5–S2): Provides motor innervation to the gluteus maximus muscle.
 
Nerve to obturator internus muscles (L5–S2): Provides motor innervation to the superior gemellus muscle and obturator internus muscle.
 

Q. 3

Nerve supply of adductor magnus is through:

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Q. 3

Nerve supply of adductor magnus is through:

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Ans. C

Explanation:

Innervation of adductor magnus

  • Posterior division of obturator nerve innervates most of the adductor magnus
  • Vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Q. 4

Nerve Supply of the Muscle marked as Muscle A in the diagram is 

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Q. 4

Nerve Supply of the Muscle marked as Muscle A in the diagram is 

 A

Tibial part of sciatic nerve

 B

Obturator nerve

 C

Both

 D

None

Ans. C

Explanation:

Innervation of adductor magnus

  • Posterior division of obturator nerve innervates most of the adductor magnus
  • Vertical or hamstring portion innervated by tibial nerve (L2, L3, L4)

Q. 5

Which leaves the pelvis ‑

 A

Piriformis

 B

Sciatic nerve

 C

Superior gluteal vessel

 D

Inferior gluteal vessel

Q. 5

Which leaves the pelvis ‑

 A

Piriformis

 B

Sciatic nerve

 C

Superior gluteal vessel

 D

Inferior gluteal vessel

Ans. B

Explanation:

  • Sciatic nerve leaves the pelvis and runs posteriorly in the thigh.
  • In the upper angle of popliteal fossa, sciatic nerve divides into tibial nerve and common peroneal nerve

Q. 6

All nerves pass thorugh greater sciatic notch except ‑

 A

Superior gluteal nerve

 B

Inferior gluteal nerve

 C

Sciatic nerve

 D

Obturator nerve

Q. 6

All nerves pass thorugh greater sciatic notch except ‑

 A

Superior gluteal nerve

 B

Inferior gluteal nerve

 C

Sciatic nerve

 D

Obturator nerve

Ans. D

Explanation:

Ans. is ‘d’ i.e., Obturator nerve


Q. 7

Which nerve mostly damaged in post dislocation of hip ‑

 A

Sciatic nerve

 B

Femoral nerve

 C

Obturator nerve

 D

Superior gluteal nerve

Q. 7

Which nerve mostly damaged in post dislocation of hip ‑

 A

Sciatic nerve

 B

Femoral nerve

 C

Obturator nerve

 D

Superior gluteal nerve

Ans. A

Explanation:

Ans. is ‘a’ i.e., Sciatic nerve



Sacral plexus

SACRAL PLEXUS

Q. 1 The branches of anterior division of internal iliac artery include all except
 A lnternal pudendal   
 B Superior gluteal 
 C Uterine
 D Obturator
Q. 1 The branches of anterior division of internal iliac artery include all except
 A lnternal pudendal   
 B Superior gluteal 
 C Uterine
 D Obturator
Ans. B

Explanation:

• Internal iliac artery arises at the bifurcation of the common iliac, artery, Opposite the lumbosacral joint (L5/S1 intervertebral disc)

Division Branch

Posterior Iliac artery

• Superior gluteal artery

• Iliolumbar artery

• Lateral sacral arteries

Anterior Iliac Artery– about 8 branches

• Obturator  artery  (occasionally  from  inferior epigastric artery)

• Inferior gluteal artery

• Umbilical   artery,   which   later   persist   as superior vesical artery (remaining artery becomes medial umbilical ligament).

• Uterine artery (females) or deferential artery (males) Vaginal artery (females, can also arise from uterine artery) or inferior vesical artery (males)

• Middle rectal artery

• Internal pudendal artery

• Artery of the perineum

• Accessory   obturator   artery:   The   obturator artery sometimes arises from the main stem or from the posterior trunk of the internal iliac, or it may spring from the superior gluteal artery; occasionally it arises from the external iliac


Q. 2

All of the following are supplied by superior gluteal nerve except

 A

Gluteus maximus

 B

Gluteus minimus

 C

Gluteus medius

 D

Tensor fascia lata

Q. 2

All of the following are supplied by superior gluteal nerve except

 A

Gluteus maximus

 B

Gluteus minimus

 C

Gluteus medius

 D

Tensor fascia lata

Ans. A

Explanation:

Gluteus maximus 

Superior gluteal nerve supplies:

  • Gluteus medius
  • Gluteus minimus &
  • Tensor fasia lata

Muscles of gluteal region are supplied by branches of the sacral plexus.


Q. 3

Pudendal nerve supplying motor part to external sphincter is derived from?

 A

L5-S1 roots

 B

 51-S2 roots

 C

L2-L3 roots

 D

S2-S3 roots

Q. 3

Pudendal nerve supplying motor part to external sphincter is derived from?

 A

L5-S1 roots

 B

 51-S2 roots

 C

L2-L3 roots

 D

S2-S3 roots

Ans. D

Explanation:

S2-S3 roots.

There are two sphincters of the urethra

a. Internal urethral sphincter (also k/a sphincter vesicae)

– it is involuntary in nature

– made up of smooth muscle

–  supplied by sympathetic nerves, from lower thoracic & upper lumbar segments of spinal cord

b. External urethral sphincter (also k/a sphincter vesicae)

–  it is voluntary in nature

– made up of striated muscle fibres

– supplied by the perineal branch of the pudendal nerve (derived from spinal nerves S2,S3 & S4) it controls the membranous urethra and is responsible for the voluntary holding of urine.


Q. 4

Gluteus medius is supplied by?

 A

Superior Gluteal Nerve

 B

Inferior Gluteal Nerve

 C

Nerve to Obturator Internus

 D

Nerve to Quadratus Femoris

Q. 4

Gluteus medius is supplied by?

 A

Superior Gluteal Nerve

 B

Inferior Gluteal Nerve

 C

Nerve to Obturator Internus

 D

Nerve to Quadratus Femoris

Ans. A

Explanation:

Superior Gluteal Nerve supplies the 3 abductors of the hip joint namely the gluteus medius, gluteus minimus and tensor fascia latae.


Q. 5

All of the following statements are true regarding the pudendal nerve, except ?

 A

It is both sensory and motor

 B

It is derived from S2,3,4

 C

It leaves the pelvis through the lesser sciatic foramen

 D

It leaves through lesser sciatic foramen and enter pudendal canal

Q. 5

All of the following statements are true regarding the pudendal nerve, except ?

 A

It is both sensory and motor

 B

It is derived from S2,3,4

 C

It leaves the pelvis through the lesser sciatic foramen

 D

It leaves through lesser sciatic foramen and enter pudendal canal

Ans. C

Explanation:

Pudendal nerve leaves the pelvis, to enter the gluteal region, by passing through the lower part of the greater sciatic foramen. Pudendal nerve leaves the gluteal region by passing through the lesser sciatic foramen and enters the pudendal canal, and by means of its branches supplies the external anal sphincter and muscles and skin of the perineum.


Q. 6

Superior Gluteal Nerve supplies all of the following muscles, except?

 A

Gluteus Medius

 B

Gluteus Minimus

 C

Gluteus Maximus

 D

Tensor fascia lata

Q. 6

Superior Gluteal Nerve supplies all of the following muscles, except?

 A

Gluteus Medius

 B

Gluteus Minimus

 C

Gluteus Maximus

 D

Tensor fascia lata

Ans. C

Explanation:

Superior gluteal nerve innervates gluteus minimus, gluteus medius and tensor fascia lata. It arises from sacral nerve plexus, which is formed from anterior rami of 4th and 5th lumbar nerves and anterior rami of 1st, 2nd, 3rd and 4th sacral nerves. Gluteus maximus muscle is innervated by the Inferior gluteal nerve (L5,S1,S2 nerve root).


Q. 7

Superior gluteal nerve exits the pelvis superior to the piriformis muscle, through the greater sciatic notch. All of the following muscles are supplied by superior gluteal nerve, EXCEPT:

 A

Gluteus medius

 B

Gluteus maximus

 C

Tensor fascia lata

 D

Gluteus minimus

Q. 7

Superior gluteal nerve exits the pelvis superior to the piriformis muscle, through the greater sciatic notch. All of the following muscles are supplied by superior gluteal nerve, EXCEPT:

 A

Gluteus medius

 B

Gluteus maximus

 C

Tensor fascia lata

 D

Gluteus minimus

Ans. B

Explanation:

Muscles supplied by superior gluteal nerve (L4, L5, S1):

 
1. Gluteus medius muscle
2. Gluteus minimus muscles
3. Tensor fascia lata muscle

Gluteus maximus is supplied by inferior gluteal nerve (L5, S1, S2).

Also know: Of all the nerves that pass through the greater sciatic foramen, the superior gluteal nerve is the only one that passes above the piriform muscle.


Q. 8

Pudendal nerve supplying motor part to external anal sphincter is derived from:

 A

L5-S1 roots

 B

S1-S2 roots

 C

L2-L3 roots

 D

S2-S3 roots

Q. 8

Pudendal nerve supplying motor part to external anal sphincter is derived from:

 A

L5-S1 roots

 B

S1-S2 roots

 C

L2-L3 roots

 D

S2-S3 roots

Ans. D

Explanation:

Pudendal nerve supplying motor part to external anal sphincter is derived from S2-4 roots. It provides motor innervation to perineal muscles, sphincter urethrae and levator ani. It is sensory to genitalia.

  • Tibial nerve (L5, S1-3)– It is motor to most of the posterior thigh, posterior leg and plantar surface of the foot.
  • Lateral femoral cutaneous nerve (L2,3) – It is sensory to the lateral thigh.
  • Femoral nerve (L2-4)– It is motor to iliacus, psoas major, psoas minor, and muscles of the anterior thigh.
  • Common peroneal nerve (L4-5, S1-2) – It is motor to the short head of biceps femoris, muscles of the lateral leg, anterior leg and dorsum of foot via superficial and deep peroneal branches.
  • Superior gluteal nerve (L4,5 S1)– It is motor to the gluteus medius and minimus, and the tensor fascia lata.
  • Inferior gluteal nerve (L5, S1-2)– It is motor to gluteus maximus.
Ref: Coloring Guide to Human Anatomy By T. Alan Twietmeyer, page 104.

Q. 9

All of the following structures passes through the Alcock canal, EXCEPT?

 A

 Internal pudendal vein

 B

Internal pudendal nerve

 C

Internal pudendal artery

 D

Obturator internus muscle

Q. 9

All of the following structures passes through the Alcock canal, EXCEPT?

 A

 Internal pudendal vein

 B

Internal pudendal nerve

 C

Internal pudendal artery

 D

Obturator internus muscle

Ans. D

Explanation:

Alcock canal or pudendal canal starts from the lesser sciatic notch and runs forward on the medial surface of the ischial tuberosity up to the pubic arch where it is continuous with the deep perineal pouch.
 
Contents of the pudendal canal are:
  • Pudendal nerve
  • Pudendal artery and vein
Within the canal pudendal nerve give rise to following branches:
  • Perineal nerve
  • Dorsal nerve of penis or clitoris.

 


Q. 10

All of the following nerves are involved in the process of erection of penis, EXCEPT?

 A

Pudendal nerve

 B

Sacral plexus

 C

Hypogastric plexus

 D

Nervi erigentes (S2,3,4)

Q. 10

All of the following nerves are involved in the process of erection of penis, EXCEPT?

 A

Pudendal nerve

 B

Sacral plexus

 C

Hypogastric plexus

 D

Nervi erigentes (S2,3,4)

Ans. C

Explanation:

Erection is parasympathetic and emission and ejaculation are parasympathetic. The erectile response is mediated by a combination of central (psychogenic) innervation and peripheral (reflexogenic) innervation. Sensory nerves that originate from receptors in the penile skin and glans converge to form the dorsal nerve of the penis, which travels to the S2-S4 dorsal root ganglia via the pudendal nerve. 
 
Parasympathetic nerve fibers to the penis arise from neurons in the intermediolateral columns of the S2-S4 sacral spinal segments. These efferent parasympathetic fibers are in the pelvic splanchnic nerves (nervi erigentes). 
 
Sympathetic innervation originates from the T-11 to the L-2 spinal segments and descends through the hypogastric plexus.

Q. 11

All of the following passes through lesser sciatic foramen, except ?

 A

Pudendal nerve

 B

Internal pudendal vessels

 C

Nerve to obturator internus

 D

Inferior gluteal vessels

Q. 11

All of the following passes through lesser sciatic foramen, except ?

 A

Pudendal nerve

 B

Internal pudendal vessels

 C

Nerve to obturator internus

 D

Inferior gluteal vessels

Ans. D

Explanation:

The lesser sciatic foramen is formed by the lesser sciatic notch of the pelvic bone, the ischial, the sacrospinous ligament and the sacrotuberous ligament.

It transmits the following structures:

  • The tendon of the Obturator internus
  • Internal pudendal vessels
  • Pudendal nerve
  • Nerve to the obturator internus

Q. 12

Not true about the anal canal is:

 A

Completely lined by stratified squamous epithelium

 B

Supplied by pudendal nerve

 C

Drained by veins forming portosystemic anastomosis 

 D

Part below pectinate line is spupplied by inf. Rectal artery

Q. 12

Not true about the anal canal is:

 A

Completely lined by stratified squamous epithelium

 B

Supplied by pudendal nerve

 C

Drained by veins forming portosystemic anastomosis 

 D

Part below pectinate line is spupplied by inf. Rectal artery

Ans. A

Explanation:

A. i.e. Completely lined by stratified squamous epithelium


Q. 13

Gluteus medius is supplied by

 A

Superior Gluteal Nerve

 B

Inferior Gluteal Nerve

 C

Nerve to Obturator Internus

 D

Nerve to Quadratus Femoris

Q. 13

Gluteus medius is supplied by

 A

Superior Gluteal Nerve

 B

Inferior Gluteal Nerve

 C

Nerve to Obturator Internus

 D

Nerve to Quadratus Femoris

Ans. A

Explanation:

A i.e. Superior Gluteal Nerve


Q. 14

All are matched accordingly except

 A

Gluteus maximus – Inferior gluteal nerve

 B

Gluteus minimums – superior gluteal nerve

 C

Gluteus medius – Inferior gluteal nerve

 D

Tensor fasciae latae-superior gluteal nerve

Q. 14

All are matched accordingly except

 A

Gluteus maximus – Inferior gluteal nerve

 B

Gluteus minimums – superior gluteal nerve

 C

Gluteus medius – Inferior gluteal nerve

 D

Tensor fasciae latae-superior gluteal nerve

Ans. C

Explanation:

C i.e. Gluteus medius – Inferior gluteal nerve


Q. 15

Gluteus medius muscle is supplied by

 A

Obturator artery

 B

Ilio-inguinal artery

 C

Superior gluteal artery

 D

Inferior gluteal artery

Q. 15

Gluteus medius muscle is supplied by

 A

Obturator artery

 B

Ilio-inguinal artery

 C

Superior gluteal artery

 D

Inferior gluteal artery

Ans. C

Explanation:

C i.e. Superior gluteal artery 


Q. 16

Superior Gluteal Nerve supplies all of the following muscles, Except:

 A

Gluteus Minimus

 B

Gluteus Maximus

 C

Tensor fascia lata

 D

Gluteus Medius

Q. 16

Superior Gluteal Nerve supplies all of the following muscles, Except:

 A

Gluteus Minimus

 B

Gluteus Maximus

 C

Tensor fascia lata

 D

Gluteus Medius

Ans. B

Explanation:

B i.e. Gluteus Maximus

Superior gluteal nerve (L4 1_,5 Si) supplies gluteus medius, gluteus minimus and tensor fascia lata musclesQ. Mn “Superior are those who supply to tense, middle & minimum men”


Q. 17

All of the following are supplied by superior gluteal nerve except

 A

Gluteus maximum

 B

Gluteus minimus 

 C

Gluteus medius

 D

Tensor fascia lata

Q. 17

All of the following are supplied by superior gluteal nerve except

 A

Gluteus maximum

 B

Gluteus minimus 

 C

Gluteus medius

 D

Tensor fascia lata

Ans. A

Explanation:

A i.e. Gluteus maximum


Q. 18

Pudendal nerve is related to: 

 A

Ischial spine

 B

Sacral promontory

 C

Iliac crest

 D

Ischial tuberosity

Q. 18

Pudendal nerve is related to: 

 A

Ischial spine

 B

Sacral promontory

 C

Iliac crest

 D

Ischial tuberosity

Ans. A

Explanation:

Branches of the sacral plexus, the pudendal nerve, and nerve to the obturator internus leave the pelvis through the lower part of the greater sciatic foramen, below the piriformis.

  • They cross the ischial spine with the internal pudendal artery and immediately re-enter the pelvis through the lesser sciatic foramen; they then lie in the ischiorectal fossa.
  • The pudendal nerve supplies structures in the perineum.
  • The nerve to the obturator internus supplies the obturator internus muscle on its pelvic surface.

Q. 19

Superior gluteal nerve does not supply ‑

 A

Tensor fasciae latae

 B

Gluteus medius

 C

Gluteus minimus

 D

Gluteus maximus

Q. 19

Superior gluteal nerve does not supply ‑

 A

Tensor fasciae latae

 B

Gluteus medius

 C

Gluteus minimus

 D

Gluteus maximus

Ans. D

Explanation:

Ans. is ‘d’ i.e., Gluteus maximus

Nerve supplying muscles of gluteal region are :-

i) Inferior gluteal nerve : Gluteus maximus.

ii) Superior gluteal nerve : Gluteus medius and minimus.

iii) Nerve to piriformis : Piriformis

iv) Nerve to obturator internus : Obturator internus, Gemellus superior.

v) Nerve to quadratus femoris : Quadratus femoris, Gemellus inferior.

Tensor fascia latae is supplied by superior gluteal nerve.


Q. 20

All of the following statements are true regarding the nerve (marked with yellow) in this image except:

 A

It is derived from S2,3,4

 B

It is both sensory and motor

 C

It leaves the pelvis through the lesser sciatic foramen

 D

It leaves through lesser sciatic foramen and enter pudendal canal

Q. 20

All of the following statements are true regarding the nerve (marked with yellow) in this image except:

 A

It is derived from S2,3,4

 B

It is both sensory and motor

 C

It leaves the pelvis through the lesser sciatic foramen

 D

It leaves through lesser sciatic foramen and enter pudendal canal

Ans. C

Explanation:

Ans.C)It leaves the pelvis through the lesser sciatic foramen

yellow color nerve is Pudendal nerve

  • Pudendal nerve leaves the pelvis, to enter the gluteal region, by passing through the lower part of the greater sciatic foramen.
  • Pudendal nerve leaves the gluteal region by passing through the lesser sciatic foramen and enters the pudendal canal, and by means of its branches supplies the external anal sphincter and muscles and skin of the perineum.
  • The pudendal nerve originates from the lumbo-sacral plexus (L4-S4). It consists of both sensory fibers (80%) and motor fibers (20%). 
 


Malcare WordPress Security