Anatomy
2 questionsLymphatic drainage of oropharynx is mainly through?
Inlet of larynx is formed by:
NEET-PG 2013 - Anatomy NEET-PG Practice Questions and MCQs
Question 991: Lymphatic drainage of oropharynx is mainly through?
- A. Superficial cervical lymph nodes
- B. Submandibular nodes
- C. Jugulodigastric node (Correct Answer)
- D. Jugulo-omohyoid nodes
Explanation: ***Jugulodigastric node*** - The **jugulodigastric node** (also known as the principal node of Küttner) is the primary drainage site for infections and malignancies of the posterior third of the tongue and tonsils, which are key components of the oropharynx. - It is a prominent node within the **deep cervical lymph node** chain, specifically located in the superior deep cervical group. *Superficial cervical lymph nodes* - These nodes primarily drain the superficial structures of the neck, scalp, and ear, and are **not the main drainage pathway** for the oropharynx. - They form a chain along the external jugular vein. *Submandibular nodes* - The **submandibular nodes** mainly drain the anterior two-thirds of the tongue, gums, floor of the mouth, and anterior face. - While part of the oral cavity, they are **not the primary drainage** for the oropharynx itself. *Jugulo-omohyoid nodes* - The **jugulo-omohyoid node** is located lower in the deep cervical chain, near the intermediate tendon of the omohyoid muscle. - It is a key drainage node for the **anterior tongue**, but not the primary or main drainage for the entire oropharynx.
Question 992: Inlet of larynx is formed by:
- A. Aryepiglottic fold (Correct Answer)
- B. Vocal cord
- C. False vocal cord
- D. Folds from the base of the tongue to the epiglottis
Explanation: ***Aryepiglottic fold*** - The **inlet of the larynx** is the opening into the laryngeal cavity from the pharynx. - It is bordered anteriorly by the **epiglottis**, laterally by the **aryepiglottic folds**, and posteriorly by the **arytenoid cartilages** and **interarytenoid notch**. *False vocal cord* - The **false vocal cords** (ventricular folds) are located within the laryngeal cavity, inferior to the inlet. - They play a protective role but do not form the boundaries of the laryngeal inlet itself. *Folds from the base of the tongue to the epiglottis* - These folds, including the **glossoepiglottic folds**, connect the tongue to the epiglottis. - They are superior to the laryngeal inlet and are part of the oropharynx, not direct borders of the inlet. *Vocal cord* - The **true vocal cords** are responsible for voice production and are located deeper within the larynx, inferior to the false vocal cords. - They do not form any part of the laryngeal inlet.
Dental
1 questionsWhat is the most common cause of an oroantral fistula?
NEET-PG 2013 - Dental NEET-PG Practice Questions and MCQs
Question 991: What is the most common cause of an oroantral fistula?
- A. TB
- B. Penetrating injury
- C. Tooth extraction (Correct Answer)
- D. Maxillary sinusitis
Explanation: ***Tooth extraction*** - Extrinsic trauma, particularly during the **extraction of maxillary posterior teeth**, is the most frequent cause of an oroantral fistula. - The close anatomical relationship between the **roots of maxillary molars and premolars** and the floor of the maxillary sinus makes this a common complication. *TB* - While tuberculosis can cause various oral and maxillofacial lesions, it is an **extremely rare cause** of oroantral fistulas. - TB lesions typically present as **ulcerations or granulomas**, rather than direct fistulous tracts to the sinus. *Penetrating injury* - Penetrating injuries can certainly cause communication between the oral cavity and the maxillary sinus, but they are **less common than tooth extractions** in their overall incidence. - Such injuries are usually associated with **trauma or foreign bodies**, which are not the primary mechanism for most oroantral fistulas. *Maxillary sinusitis* - Maxillary sinusitis can occasionally lead to bone erosion and communication with the oral cavity, but it is **not the most common etiology** for an oroantral fistula. - Sinusitis more often causes **symptoms such as facial pain, pressure, and discharge**, rather than a direct fistula as a primary presentation.
ENT
4 questionsWhich of the following statements about acute retropharyngeal abscess is true?
Which part of the larynx is most commonly involved in tuberculosis (TB)?
Laryngitis sicca is associated with ?
Hot potato voice is characteristic of ?
NEET-PG 2013 - ENT NEET-PG Practice Questions and MCQs
Question 991: Which of the following statements about acute retropharyngeal abscess is true?
- A. Treatment often involves incision and drainage.
- B. Acute retropharyngeal abscess is common in adults.
- C. Swelling typically occurs unilaterally.
- D. Acute retropharyngeal abscess is often due to lymphadenitis. (Correct Answer)
Explanation: ***Acute retropharyngeal abscess is often due to lymphadenitis.*** - The **retropharyngeal lymph nodes** (nodes of Rouviere) are prominent in children and drain the nasopharynx, oropharynx, and paranasal sinuses. Infection in these areas can lead to **suppurative lymphadenitis**, which can then progress to an abscess. - **Lymphadenitis** following an upper respiratory tract infection is the **most common etiology** in children, who represent the majority of cases. This is a characteristic pathophysiological mechanism specific to retropharyngeal abscesses. - While other causes exist (trauma, foreign bodies, odontogenic infections in adults), this statement best captures the typical presentation and etiology. *Acute retropharyngeal abscess is common in adults.* - **Retropharyngeal abscesses** are far more common in **children**, especially those under 6 years of age, due to the presence of prominent retropharyngeal lymph nodes that typically atrophy by age 5-6. - In adults, retropharyngeal abscesses are rarer and usually result from trauma, foreign bodies, or odontogenic infections rather than lymphadenitis. *Swelling typically occurs unilaterally.* - The **retropharyngeal space** is a **midline structure**, and infection typically causes **bilateral** or central swelling. - **Edema and inflammation** affect the entire space, leading to generalized posterior pharyngeal wall bulging rather than true unilateral presentation. - While some asymmetry may be visible, describing the swelling as "typically unilateral" is inaccurate. *Treatment often involves incision and drainage.* - While this statement is technically true for **mature abscesses**, it is **incomplete** as a characterizing statement about retropharyngeal abscesses. - Treatment depends on stage: **early phlegmon or cellulitis** may respond to **intravenous antibiotics alone**, while a **mature abscess** requires both **I&D and antibiotics**. - The statement lacks the important context that **antibiotics are the cornerstone** of treatment, with surgical drainage reserved for established abscesses. - This is a treatment modality rather than a defining characteristic of the condition, making it a less complete answer than the etiology-based statement.
Question 992: Which part of the larynx is most commonly involved in tuberculosis (TB)?
- A. Anterior
- B. Posterior (Correct Answer)
- C. Middle
- D. Anywhere
Explanation: ***Posterior*** - The **posterior larynx**, specifically the **arytenoids** and **interarytenoid area**, is the most common site for tuberculosis involvement. - This region is susceptible due to its rich **lymphatic supply** and direct exposure to infected secretions from the lungs. *Anterior* - While TB can affect any part of the larynx, the **anterior laryngeal structures** are less frequently the primary site of involvement. - The vocal cords, which are in the anterior-middle aspect, are less commonly affected initially compared to the posterior structures. *Middle* - The middle part of the larynx, including the **vocal cords**, is not the predominant site for initial tuberculous lesions. - Involvement here often occurs as the disease progresses from more commonly affected areas. *Anywhere* - Although TB can theoretically affect any part of the larynx, it demonstrates a strong predilection for the **posterior laryngeal region**. - Stating "anywhere" does not accurately reflect the statistically significant preference for specific anatomical sites.
Question 993: Laryngitis sicca is associated with ?
- A. Rhinosporidium
- B. M. leprae
- C. Klebsiella ozaenae
- D. Klebsiella rhinoscleromatosis (Correct Answer)
Explanation: ***Klebsiella rhinoscleromatis*** - **Laryngitis sicca** is characterized by extreme dryness and crusting of the laryngeal mucosa, which is a known manifestation of complications due to **Rhinoscleroma**. - **Rhinoscleroma** is a chronic granulomatous disease caused by *Klebsiella rhinoscleromatis* (formerly *K. rhinoscleromatosis*), primarily affecting the upper respiratory tract including the larynx. *Rhinosporidium* - **Rhinosporidium seeberi** is an aquatic protistan parasite that causes **rhinosporidiosis**, characterized by friable, polypoidal lesions, often in the nose, but typically not laryngitis sicca. - The lesions caused by Rhinosporidium are usually vascular and bleeding, rather than dry and crusting. *M. leprae* - **Mycobacterium leprae** is the causative agent of **leprosy**, a chronic infectious disease primarily affecting the skin, peripheral nerves, upper respiratory tract mucosa, eyes, and testes. - While *M. leprae* can affect the larynx, it typically causes **granulomatous infiltration** and nodule formation leading to hoarseness and stridor, not specifically laryngitis sicca. *Klebsiella ozaenae* - *Klebsiella ozaenae* is associated with **ozena**, a form of chronic atrophic rhinitis characterized by a foul odor, crusting, and atrophy of nasal mucosa. - While it causes dryness and crusting, its primary manifestation is in the **nasal cavity**, and it is not directly linked to laryngitis sicca in the context tested here.
Question 994: Hot potato voice is characteristic of ?
- A. Nasopharyngeal carcinoma
- B. Glottic carcinoma
- C. Subglottic carcinoma
- D. Supraglottic carcinoma (Correct Answer)
Explanation: ***Supraglottic carcinoma*** - Among the given options, **supraglottic carcinoma** is the best answer, as it can produce a **"hot potato" voice** (also known as a "muffled" or "potato-in-the-mouth" voice) due to tumor bulk in the supraglottic region. - The tumor interferes with normal resonance and articulation of speech by reducing the pharyngeal space and impairing the mobility of the **epiglottis** and aryepiglottic folds. - **Clinical note:** Hot potato voice is **classically** associated with **acute supraglottic inflammatory conditions** such as **peritonsillar abscess (quinsy)**, **acute epiglottitis**, and **retropharyngeal abscess** rather than malignancies. However, any mass lesion in the supraglottic region that causes pharyngeal space reduction can theoretically produce this voice quality. *Nasopharyngeal carcinoma* - **Nasopharyngeal carcinoma** is located in the **nasopharynx** (above the soft palate) and typically presents with **nasal obstruction**, epistaxis, **conductive hearing loss** (Eustachian tube involvement), and cranial nerve palsies. - It does not affect the supraglottic larynx or oropharynx in a way that would produce the characteristic "hot potato" voice. *Glottic carcinoma* - **Glottic carcinoma** primarily affects the **true vocal cords**, leading to early symptoms of **progressive hoarseness** or dysphonia due to impaired vocal cord vibration. - While it affects voice quality significantly, it produces a **hoarse or breathy voice**, not the muffled "hot potato" quality associated with supraglottic space-occupying lesions. *Subglottic carcinoma* - **Subglottic carcinoma** is located **below the true vocal cords** and is the rarest laryngeal malignancy, often presenting late with **stridor** and **dyspnea** due to airway narrowing. - Voice changes occur late and are related to **airway obstruction** or superior extension to the vocal cords, not the characteristic muffled sound of a "hot potato" voice.
Internal Medicine
1 questionsMost common cause of retropharyngeal abscess in adults?
NEET-PG 2013 - Internal Medicine NEET-PG Practice Questions and MCQs
Question 991: Most common cause of retropharyngeal abscess in adults?
- A. Tonsillitis
- B. Lymphadenitis (Correct Answer)
- C. Tooth extraction
- D. TB
Explanation: ***Lymphadenitis*** - **Lymphadenitis** in the retropharyngeal space, often secondary to an upper respiratory tract infection, is the most common cause of retropharyngeal abscesses in adults. - The infection spreads from inflamed lymph nodes to form a **purulent collection** in the potential space behind the pharynx. *TB* - **Tuberculosis (TB)** can cause retropharyngeal abscesses, particularly in immunocompromised individuals or endemic areas, but it is less common than pyogenic infections [1]. - TB abscesses tend to be more **chronic** and may be associated with vertebral involvement (Pott's disease) [1]. *Tooth extraction* - While dental infections, including complications from **tooth extraction**, can lead to deep neck space infections, they are not the most common cause of retropharyngeal abscess specifically. - Infections from teeth more often spread to the **submandibular** or **parapharyngeal spaces**. *Tonsillitis* - **Tonsillitis** is a common cause of pharyngeal inflammation and can lead to peritonsillar abscesses, which are distinct from retropharyngeal abscesses. - While severe tonsillitis can occasionally spread to the retropharyngeal space, it is primarily local and less common than direct lymphatic seeding.
Microbiology
1 questionsWhat is the most common cause of a peritonsillar abscess?
NEET-PG 2013 - Microbiology NEET-PG Practice Questions and MCQs
Question 991: What is the most common cause of a peritonsillar abscess?
- A. Streptococcus pneumoniae
- B. Staphylococcus aureus
- C. H. influenzae
- D. Group A beta-hemolytic streptococcus (Correct Answer)
Explanation: ***Group A beta-hemolytic streptococcus*** - This bacterium, also known as **_Streptococcus pyogenes_**, is the most common cause of **streptococcal pharyngitis**, which is the precursor to most peritonsillar abscesses. - Peritonsillar abscesses are typically a complication of untreated or inadequately treated **tonsillitis**. *Streptococcus pneumoniae* - While **_Streptococcus pneumoniae_** can cause upper respiratory infections like sinusitis and otitis media, it is not the primary cause of peritonsillar abscesses. - Its infections are more commonly associated with **pneumonia** and **meningitis**. *Staphylococcus aureus* - **_Staphylococcus aureus_** is a common cause of skin and soft tissue infections, but it is less frequently isolated as the primary pathogen in peritonsillar abscesses. - It can be involved in **polymicrobial infections** or as a secondary invader. *H. influenzae* - **_Haemophilus influenzae_** can cause various infections, particularly in children, such as otitis media and epiglottitis. - However, it is not considered the most common cause of **peritonsillar abscesses**.
Surgery
1 questionsWhich of the following conditions is least likely to cause bilateral recurrent laryngeal nerve palsy?
NEET-PG 2013 - Surgery NEET-PG Practice Questions and MCQs
Question 991: Which of the following conditions is least likely to cause bilateral recurrent laryngeal nerve palsy?
- A. Thyroid carcinoma
- B. Lymphadenopathy
- C. Thyroid surgery
- D. Aortic aneurysm (Correct Answer)
Explanation: ***Aortic aneurysm*** - An aortic aneurysm, especially of the ascending aorta, is **less likely to cause bilateral recurrent laryngeal nerve palsy** because the left recurrent laryngeal nerve typically hooks under the aortic arch, while the right nerve hooks under the subclavian artery. - For **bilateral involvement**, two separate and simultaneous lesions affecting both nerves would be required at different anatomical locations with this etiology, making it a rare cause. *Thyroid carcinoma* - An aggressive **thyroid carcinoma** can directly invade or compress the recurrent laryngeal nerves (RLNs) due to their proximity to the thyroid gland. - If the carcinoma is extensive or multifocal, it can lead to **bilateral involvement** by affecting both nerves. *Lymphadenopathy* - Significant **cervical or mediastinal lymphadenopathy** (e.g., due to metastatic disease or lymphoma) can compress or encase both recurrent laryngeal nerves. - This proximity allows for potential **bilateral compression or damage** to the nerves as they ascend in the tracheoesophageal grooves. *Thyroid surgery* - **Thyroidectomy** is a common cause of recurrent laryngeal nerve injury due to the nerves' close anatomical relationship with the thyroid gland. - **Bilateral recurrent laryngeal nerve palsy** can occur if both nerves are damaged during dissection, often due to surgical misidentification, thermal injury, or traction.