Head and neck tumours: base of tongue carcinoma: practice question

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

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ENT · Head and neck tumours: base of tongue carcinoma

Sample item

A 60-year-old has a carcinoma of the base of the tongue and bilateral nodes at presentation. Why is bilateral nodal disease common in this site?

ARich bilateral lymphatics of a midline structure with late presentationBVenous drainage into both internal jugular veinsCAbsence of lymphatic channels in the posterior tongueDDirect invasion across the midline raphe in all cases

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

The answer and the reasoning

A. Rich bilateral lymphatics of a midline structure with late presentation

The base of the tongue has a rich lymphatic network that crosses the midline, and the silent site allows tumours to grow large before symptoms. Nodal metastases to levels II to IV are common, often bilateral, at presentation.

Option by option

A. Rich bilateral lymphatics of a midline structure with late presentation (correct)
Correct. Abundant crossing lymphatics and late diagnosis explain bilateral nodes.
B. Venous drainage into both internal jugular veins
Venous drainage does not determine nodal spread.
C. Absence of lymphatic channels in the posterior tongue
The posterior tongue has abundant lymphatics, not an absence.
D. Direct invasion across the midline raphe in all cases
Not all tumours cross the midline directly; the spread is lymphatic.

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

Questions about this ENT question

What is the answer to this ENT question?

The best answer is A, Rich bilateral lymphatics of a midline structure with late presentation. The base of the tongue has a rich lymphatic network that crosses the midline, and the silent site allows tumours to grow large before symptoms.

Why is "Venous drainage into both internal jugular veins" not the answer?

Venous drainage does not determine nodal spread.

Why is "Absence of lymphatic channels in the posterior tongue" not the answer?

The posterior tongue has abundant lymphatics, not an absence.

Why is "Direct invasion across the midline raphe in all cases" not the answer?

Not all tumours cross the midline directly; the spread is lymphatic.

What concept does this question test?

It tests Head and neck tumours: base of tongue carcinoma in ENT. Nodal metastases to levels II to IV are common, often bilateral, at presentation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Head and neck tumours: base of tongue carcinoma?

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

Is this a real NEET PG question?

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