1. Advantages of ultrasound imaging include:  A. Imaging modality of choice for thyroid  B. Doppler sonography can be used for assessment of blood flow  C. Scanning in the sagittal plane offers optimal visualization  D. A and B  E. All of the above

2. Features suggestive of malignancy in a thyroid nodule include all of the following EXCEPT:  A. Hyperechoic  B. Microcalcifications  C. Increased blood flow on Doppler  D. Tail shape  E. Irregular border

3. Parathyroid imaging on ultrasound:

 A Is less accurate than sestamibi scans in localizing a solitary adenomas  B. Normal parathyroid glands can be visualized with high resolution ultrasonography  C. Parathyroid adenomas are hyperechoic relative to the thyroid gland  D. Superior parathyroid glands are on a deeper plane than the inferior glands  E. Ectopic parathyroid gland may be visualized on ultrasound in the posterior mediastinum

4. Ultrasound imaging of salivary glands:

 A. Is useful for differentiating sialadenitis from neoplasms and lymphadenopathy  B. Is useful for imaging deep lobe parotid tumors  C. Shows similar echogenicity to the thyroid  D. A and C  E. All of the above

5. Ultrasound characteristics of salivary malignancies include:  A. Calcifications  B. Smooth shape  C. Increased vascularity on Doppler imaging  D. Ovoid lesion with short axis less than 5 mm  E. Homogeneous echostructure

6. Ultrasound imaging for head and neck cancer:  A. Can detect metastatic lymph nodes not detected by CT or MRI  B. Round shape of lymph node suggests malignancy  C. Intranodal cystic degeneration suggests malignancy  D. Can be used to avoid elective neck dissection in NO necks  E. All of the above

7. Ultrasound-guided fine needle aspiration:  A. Is done using a 27 gauge needle  B. Aspiration is performed first  C. Bevel of the needle is pointed away from the transducer  D. Needle should be irrigated with fixative prior to insertion  E. The needle should be used to shave cells along the needle path

Punctate echogenicities in thyroid nodules. Frates M C et al. Radiology 2005;237:794-800

©2005 by Radiological Society of North America

8. Normal paraganglia contain all of the following EXCEPT:  A. Sustentacular cells  B. Cells which stain positively with S-100  C. Schwann cells  D. Chief cells  E. Catecholamine-containing cells

9. The following is true about paragangliomas:  A. The most common type is the pheochromocytoma  B. 10% occur in the head and neck  C. Secretion of epinephrine from head and neck paragangliomas may occur  D. Vagal paragangliomas are more common than jugulotympanic paragangliomas.

 E. Familial paragangliomas occur in MEN 1, Carney’s triad, and von Hippel-Lindau disease

10. Carotid body tumors

 A. A positive Fontaine’s sign indicates movement of a lateral neck mass laterally but not vertically  B. Increased mitotic rate and capsular invasion indicate malignancy  C. Malignancy is determined by histology  D. Diagnosis can be made radiographically by posterior displacement of the internal and external carotid arteries  E. Classification of tumors is based on size

11. Recommended treatment of carotid body tumors:  A. Requires preoperative embolization before surgical removal  B. Results in permanent cranial nerve deficit(s) in 50% of cases  C. Observation is an option for some patients with carotid body tumors.

 D. Radiation therapy can reduce the size of the tumor.

 E. Surgical resection is preferred over radiation therapy for multicentric tumors

12. Vagal paragangliomas:

 A. Arise from the inferior vagal ganglion  B. Arise from the nodose ganglion  C. Arise from the jugular ganglion  D. A and B  E. All of the above

13. Peripheral nerve neoplasms:

 A. Neurofibromas are encapsulated and may occur singly or multiply  B. Schwannomas most commonly occur in the head and neck region  C. Antoni type A areas contain loosely arranged hypocellular zones  D. Malignant transformation is more common in multiple neurofibromas than in solitary  E. Cranial neuropathies are rare following resection of schwannomas

14. Metastatic disease to the neck:

 A. Location of the metastatic node in level 5 are most commonly associated with a hypopharyngeal primary  B. Fine needle aspiration biopsy diagnosis of adenocarcinoma indicates a primary in a salivary gland  C. The most common distant site to metastasize to the neck is from a lung primary  D. B and C  E. All of the above

15. Sarcomas of the neck:

 A. 80% of head and neck sarcomas are derived from soft tissues of the neck  B. Occur most commonly in children  C. Staging for bone sarcomas is based on size  D. Staging for soft tissue sarcomas is based on site of origin  E. The most common sarcoma in the head and neck is the malignant fibrous histiocytoma

16. Rhabdomyosarcoma

 A. Accounts for 50% of sarcomas in all age groups  B. Most common site in the head and neck is in the neck  C. Metastatic disease is present in 80% of cases at presentation  D. Primary treatment is surgical resection  E. Highest incidence occurs in first decade of life

17. Rare sarcomas of the neck:  A. Osteosarcoma of the mandible frequently metastasizes to the neck  B The most common site of fibrosarcoma in the head and neck is in the neck  C. Alveolar soft part sarcoma is associated with the fusion gene ASPL-TFE3  D. Epithelioid hemangioendothelioma exhibits extremely aggressive behavior  E. Liposarcoma is the most common soft tissue sarcoma in the head and neck in adults

18. Rarer sarcomas of the neck:

 A. Malignant hemangiopericytoma (MPC) arise from the cells of Zimmerman, around capillaries and postcapillary venules  B. Majority of HPCs occur in the paranasal sinuses  C. Malignant peripheral nerve sheath tumor (MPNST) can occur either spontaneously or with NF-1  D. MPNST has recurrence rates of more than 40% despite aggressive treatment  E. All of the above

19. Review these before the in-service

    A. Synovial sarcoma  Typically arises in the hypopharyngeal and retropharyngeal region B. Malignant giant cell tumor  Radiation induced after treatment for a benign giant cell tumor, sinonasal region and mandible most common sites C. Ewing’s sarcoma  Derived from primitive neuro-ectoderm, 2 nd most common bone tumor in children, mandible, maxilla, skull D. Solitary Fibrous Tumor  Desmoid fibromatosis frequent in head and neck, in children, high local recurrence rate but low mortality