PLAB 2 NewCase_7: Nasopharyngeal Carcinoma

1. Which of the following are common presenting symptoms of nasopharyngeal carcinoma? (Select all that apply.)

• A) Unilateral nasal obstruction
• B) Persistent nasal bleeding (epistaxis)
• C) Hearing loss or ear fullness
• D) Weight loss

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Answers:

A) Unilateral nasal obstruction

B) Persistent nasal bleeding (epistaxis)

C) Hearing loss or ear fullnessD) Weight loss

E) Neck lymphadenopathy

Explanation:

Nasopharyngeal carcinoma often presents with unilateral nasal obstruction due to the tumor blocking the nasal passage. Persistent nasal bleeding or blood-streaked nasal discharge is common. The tumor can obstruct the Eustachian tube, leading to hearing loss or a feeling of fullness in the ear. Unexplained weight loss is a systemic symptom of cancer. Enlarged cervical lymph nodes (neck lymphadenopathy) occur due to regional metastasis.

2. How might a nasopharyngeal tumor impact a patient's daily life? (Select all that apply.)

• A) Difficulty breathing through the nose
• B) Impaired hearing affecting communication
• C) Facial numbness or pain
• D) Difficulty swallowing

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Answers:

A) Difficulty breathing through the nose

B) Impaired hearing affecting communication

C) Facial numbness or pain

E) Disrupted sleep due to nasal blockage

Explanation:

The tumor can cause nasal obstruction, making breathing through the nose difficult and disrupting sleep. Hearing impairment affects daily communication and social interactions. If the tumor invades cranial nerves, it may cause facial numbness or pain. Difficulty swallowing is less common unless the tumor extends significantly.

3. What are the possible differential diagnoses for a patient presenting with nasal obstruction and blood-streaked nasal discharge? (Select all that apply.)

• A) Nasal polyps
• B) Chronic sinusitis
• C) Juvenile nasopharyngeal angiofibroma
• D) Wegener's granulomatosis (Granulomatosis w/ polyangiitis)

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Answers:

A) Nasal polyps

B) Chronic sinusitis

C) Juvenile nasopharyngeal angiofibroma

D) Wegener's granulomatosis (Granulomatosis w/ polyangiitis)

Explanation:

Differential diagnoses include:

• Nasal polyps: Cause nasal obstruction but rarely bleeding.

• Chronic sinusitis: Leads to nasal blockage and discharge but bleeding is uncommon.

• Juvenile nasopharyngeal angiofibroma: A benign tumor in adolescent males causing nasal obstruction and bleeding.

• Wegener's granulomatosis: An autoimmune condition causing nasal symptoms and bleeding.

• Nasal foreign body is less likely in adults without a relevant history.

4. Which investigations are useful in diagnosing a nasopharyngeal tumor? (Select all that apply.)

• A) Nasopharyngoscopy
• B) MRI scan of the head and neck
• C) Biopsy of the nasopharyngeal mass
• D) Complete blood count (CBC)

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Answers:

A) Nasopharyngoscopy

B) MRI scan of the head and neck

C) Biopsy of the nasopharyngeal mass

D) Complete blood count (CBC)

Explanation:

• Nasopharyngoscopy: Direct visualization of the nasopharynx to detect tumors.

• MRI scan: Detailed imaging to assess tumor size and spread.

• Biopsy: Histological confirmation of malignancy.

• CBC: May reveal anemia due to chronic blood loss.

Skin prick allergy testing is not relevant for tumor diagnosis.

5. During physical examination, which signs are indicative of a nasopharyngeal tumor? (Select all that apply.)

• A) Enlarged cervical lymph nodes
• B) Cranial nerve palsies (e.g., facial numbness)
• C) Deviated nasal septum
• D) Otitis media with effusion

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Answers:

A) Enlarged cervical lymph nodes

B) Cranial nerve palsies (e.g., facial numbness)

D) Otitis media with effusion

Explanation:

• Enlarged cervical lymph nodes: Common due to lymphatic spread.

• Cranial nerve palsies: Tumor invasion can affect cranial nerves, causing symptoms like facial numbness.

• Otitis media with effusion: Due to Eustachian tube obstruction by the tumor.

Deviated nasal septum and oral ulcers are not typical signs.

6. How would you explain a nasopharyngeal tumor to a patient in layman's terms? (Select all that apply.)

• A) "A growth at the back of your nose is causing symptoms."
• B) "A sinus infection is causing nasal bleeding."
• C) "A possible cancerous mass affects your nasal passage."
• D) "Your nasal bones are misaligned causing blockage."

See All Options

Answers:

A) "A growth at the back of your nose is causing symptoms."

C) "A possible cancerous mass affects your nasal passage."

E) "Swelling needs further tests to determine its nature."

Explanation:

These statements accurately and sensitively explain the condition in simple terms. Mentioning the possibility of cancer prepares the patient for further investigations. Attributing symptoms to infection or misaligned bones is misleading.

7. What lifestyle modifications can help manage symptoms of a nasopharyngeal tumor? (Select all that apply.)

• A) Avoiding smoking and alcohol
• B) Using over-the-counter nasal decongestants regularly
• C) Eating a balanced diet to prevent weight loss
• D) Sleeping with the head elevated

See All Options

Answers:

A) Avoiding smoking and alcohol

C) Eating a balanced diet to prevent weight loss

D) Sleeping with the head elevated

E) Practicing good oral hygiene

Explanation:

• Avoiding smoking and alcohol: Reduces irritation and potential tumor progression.

• Balanced diet: Helps maintain weight and strength.

• Head elevation: Eases breathing during sleep.

• Good oral hygiene: Prevents secondary infections.

• Regular use of nasal decongestants is not advised without medical supervision.

8. Which treatments might be considered for nasopharyngeal carcinoma? (Select all that apply.)

• A) Radiotherapy
• B) Chemotherapy
• C) Surgical removal of the tumor
• D) Antibiotics

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Answers:

A) Radiotherapy

B) Chemotherapy

C) Surgical removal of the tumor

Explanation:

• Radiotherapy: Mainstay treatment due to tumor's radiosensitivity.

• Chemotherapy: Often combined with radiotherapy for advanced cases.

• Surgery: May be considered, though anatomical location often limits this option.

Antibiotics and steroid nasal sprays are not effective treatments for cancer.

9. In addition to medical treatment, what supportive care may be necessary for a patient with a nasopharyngeal tumor? (Select all that apply.)

• A) Nutritional support
• B) Speech and swallowing therapy
• C) Psychological counseling
• D) Physical therapy for muscle weakness

See All Options

Answers:

A) Nutritional support

B) Speech and swallowing therapy

C) Psychological counseling

Explanation:

• Nutritional support: To address weight loss and maintain strength.

• Speech and swallowing therapy: Helps if swallowing or speech is affected.

• Psychological counseling: Supports mental health during treatment.

Physical therapy and home oxygen therapy are less commonly needed unless specific complications arise.

10. What safety netting advice should be given to a patient with a nasopharyngeal tumor? (Select all that apply.)

• A) "Return if symptoms worsen, like increased bleeding."
• B) "Get help for severe headaches or vision changes."
• C) "No need to follow up unless you have new health issues."
• D) "Promptly report any treatment side effects."

See All Options

Answers:

A) "Return if symptoms worsen, like increased bleeding."

B) "Get help for severe headaches or vision changes."

D) "Promptly report any treatment side effects."

Explanation:

• A) Advises the patient to report symptom worsening, indicating possible progression.

• B) Severe headaches or vision changes could indicate tumor extension affecting the brain or optic nerves.

• D) Early reporting of side effects allows for timely management.

• C) Regular follow-up is essential;

• E) Ignoring new symptoms is unsafe.

11. Should a referral be made for a patient with suspected nasopharyngeal carcinoma, and to which specialist? (Select all that apply.)

• A) Yes; refer to an ear, nose, and throat (ENT) specialist
• B) Yes; refer to an oncologist
• C) Yes; refer to a neurologist
• D) No; manage entirely in primary care

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Answers:

A) Yes; refer to an ear, nose, and throat (ENT) specialist

B) Yes; refer to an oncologist

Explanation:

• ENT specialist: For diagnosis and management planning.

• Oncologist: For cancer treatment coordination.

• Neurologist may be involved if there are neurological symptoms, but initial referrals are to ENT and oncology.

• Radiologists perform imaging but are not primary referral recipients.

Primary care alone is insufficient for management.

12. Which examination techniques are useful in assessing a patient with suspected nasopharyngeal carcinoma? (Select all that apply.)

• A) Nasopharyngoscopy with flexible endoscope
• B) Palpation of cervical lymph nodes
• C) Otoscopy
• D) Assessment of cranial nerve function

See All Options

Answers:

A) Nasopharyngoscopy with flexible endoscope

B) Palpation of cervical lymph nodes

C) Otoscopy

D) Assessment of cranial nerve function

Explanation:

• Nasopharyngoscopy: Visualizes the tumor.

• Lymph node palpation: Detects metastasis.

• Otoscopy: Identifies middle ear effusion due to Eustachian tube blockage.

• Cranial nerve assessment: Detects nerve involvement.

• Lung auscultation is less directly relevant.

13. What are common patient complaints during daily activities with a nasopharyngeal tumor? (Select all that apply.)

• A) Difficulty hearing during conversations
• B) Changes in voice or nasal speech
• C) Recurrent nosebleeds disrupting activities
• D) Facial muscle weakness affecting expressions

See All Options

Answers:

A) Difficulty hearing during conversations

B) Changes in voice or nasal speech

C) Recurrent nosebleeds disrupting activities

Explanation:

• Hearing difficulties: Affect communication.

• Voice changes: Due to nasal obstruction.

• Nosebleeds: Can be frequent and disruptive.

Facial muscle weakness may occur but is less common; chewing difficulties are not typical unless advanced.

14. Which factors can increase the risk of developing nasopharyngeal carcinoma? (Select all that apply.)

• A) Epstein-Barr virus (EBV) infection
• B) Diet high in salted fish and preserved foods
• C) Genetic susceptibility
• D) Smoking heavily

See All Options

Answers:

A) Epstein-Barr virus (EBV) infection

B) Diet high in salted fish and preserved foods

C) Genetic susceptibility

E) Occupational exposure to wood dust

Explanation:

• EBV infection: Strongly linked to nasopharyngeal carcinoma.

• Diet: Nitrosamines in preserved foods increase risk.

• Genetics: Certain populations have higher susceptibility.

• Wood dust exposure: Occupational hazard.

Smoking is less directly associated compared to other head and neck cancers.

15. What is the primary goal in managing nasopharyngeal carcinoma? (Select all that apply.)

• A) Eradicate the tumor
• B) Prevent metastasis
• C) Alleviate symptoms and improve quality of life
• D) Reduce nasal congestion with decongestants

See All Options

Answers:

A) Eradicate the tumor

B) Prevent metastasis

C) Alleviate symptoms and improve quality of life

Explanation:

• Primary goals: Effective treatment to eliminate cancer, prevent spread, and manage symptoms.

• Decongestants may offer temporary relief but are not a primary management goal.

Delaying treatment is inappropriate for cancer management.