This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'Trotters triad is seen in - \nSelect and explain. \nA. Angiofibroma, B. Nasopharyngeal carcinoma, C. Laryngeal carcinoma, D. Growth in fossa of Rosenmuller', 'role': 'user'}, {'content': 'Answer: B \nExplanation: • Nasopharyngeal cancer is most common in China particularly in southern states and Taiwan.\n• People in Southern China, Taiwan and Indonesia are more prone to this cancer.\n• MC tumor to produce cervical LN metastasis\n• MC tumor responsible for secondaries in the neck with no obvious primary malignancy\n• Burning of incense or wood (Polycyclic hydrocarbon), use of preserved salted fish (Nitosamines) along with vitamin C deficient diet (vitamin C blocks nitrosification of amines and is thus protective) may be other factors operative in China.\nEtiology\n• Exact etiology is not known. The factors responsible are:\n−− Genetic: Chinese\n−− Viral: Epstein-Barr virus\n−− Environmental: Air pollution, smoking of tobacco and opium, nitrosamines from dry salted fish, smoke from burning of incense and wood\nPathology\n• Squamous cell carcinoma\xa0in various grades of its differentiation or its variants as transitional cell carcinoma and lymphoepithelioma, is the most common.\n• MC site of origin: Fossa of Rosenmuller in the lateral wall of Nasopharynx.\n• LN involvement is common because of rich lymphatic network in the nasopharynx.\nClinical features\n• Age: It is mostly seen in fifth to seventh decades but may involve younger age groups.\n• Sex: Males are three times more prone than females.\n• Cervical lymphadenopathy is MC presenting symptom (60-90%).\n• Nasal: Nasal obstruction, nasal discharge, denasal speech (rhinolalia clausa) and epistaxis.\n• Otologic: Due to obstruction of Eustachian tube , there is conductive hearing loss, serous or suppurative otitis media.\n• Presence of unilateral serous otitis media in an adult should raise suspicion of nasopharyngeal growth.\n• Involvement of IX , X and XI cranial nerves may occur, constituting jugular foramen syndrome.\n• Can cause conductive deafness (Eustachian tube blockage), ipsilateral temporoparietal neuralgia (involvement of CN V) and palatal paralysis (CN X)-collectively called Trotter’s triad.\n• Cervical nodal metastases may be the only manifestation of nasopharyngeal cancer.\n• Nodal metastases are seen in 75% of the patients, when first seen, about half of them with bilateral nodes.\n• Distant metastases involve bone, lung, liver and other sites.\n• Jaccods’s triad: Ipsilateral ophthalmoplegia + Amaurosis + Ipsilateral neuralgia\nDiagnosis\n• CT scan: Demonstrate erosion of bone at the base of skull and the extent of tumor.\n• Biopsy is essential to show the exact histology of the malignancy.\n• In absence of nasopharyngeal lesion but with strong suspicion of malignancy, nasopharynx is exposed by transpalatal approach and a strip of mucosa and submucosa from the region of fossa of Rosenmuller should be taken and subjected to histology.\nTreatment\n• Irradiation\xa0is treatment of choice.\n• Chemo therapy for stage III and IV cancers', 'role': 'assistant'}]