Head and neck: unknown primary: 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: unknown primary

Sample item

FNAC of a level II neck node shows metastatic squamous carcinoma, but no primary is found on examination and CT. Which approach is most appropriate?

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

The answer and the reasoning

C. PET-CT, panendoscopy with directed biopsies and tonsillectomy or tongue base mucosectomy

Unknown primary squamous carcinoma in a neck node is investigated with PET-CT and examination under anaesthesia with biopsies of likely sites such as the nasopharynx, tonsils and tongue base. Occult primaries are often in the tonsil or tongue base.

Option by option

  • A. Thyroidectomy

    The thyroid is an unlikely site for squamous carcinoma.

  • B. Observation

    Observation delays treatment.

  • C. PET-CT, panendoscopy with directed biopsies and tonsillectomy or tongue base mucosectomy (correct)

    Correct. A structured search detects most primaries.

  • D. Chemotherapy without further work-up

    Treatment without locating the primary is not optimal.

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

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Questions about this ENT question

What is the answer to this ENT question?

The best answer is C, PET-CT, panendoscopy with directed biopsies and tonsillectomy or tongue base mucosectomy. Unknown primary squamous carcinoma in a neck node is investigated with PET-CT and examination under anaesthesia with biopsies of likely sites such as the nasopharynx, tonsils and tongue base.

Why is "Thyroidectomy" not the answer?

The thyroid is an unlikely site for squamous carcinoma.

Why is "Observation" not the answer?

Observation delays treatment.

Why is "Chemotherapy without further work-up" not the answer?

Treatment without locating the primary is not optimal.

What concept does this question test?

It tests Head and neck: unknown primary in ENT. Occult primaries are often in the tonsil or tongue base.

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: unknown primary?

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.