Diseases of the Pharynx Practice Questions

Q: Trismus in tonsillar abscess is due to spasm of which muscle?

Pterygoid muscle. **Explanation:** **Trismus** (lockjaw) in the context of a peritonsillar abscess (Quinsy) is a classic clinical sign indicating that the inflammatory process has spread beyond the confines of the pharyngeal wall. 1. **Why Pterygoid Muscle is Correct:** The tonsillar fossa is separated from the **parapharyngeal space** by the superior constrictor muscle and the pharyngobasilar fascia. When a tonsillar abscess develops, the inflammation or infection can penetrate this boundary, irritating the **medial pterygoid muscle**, which lies in the lateral boundary of the parapharyngeal space. This irritation leads to protective muscle spasm (reflex tonic contraction), resulting in the inability to open the mouth (trismus). 2. **Why Other Options are Incorrect:** * **Prevertebral muscles:** These are located posterior to the prevertebral fascia. While they may be involved in Retropharyngeal abscesses (causing neck stiffness), they do not control mandibular movement. * **Superior constrictor:** This muscle forms the floor of the tonsillar fossa. While it is inflamed during tonsillitis (causing odynophagia), its contraction does not cause jaw closure. * **Inferior constrictor:** This muscle is located much lower in the laryngopharynx and is involved in swallowing, not mastication. **Clinical Pearls for NEET-PG:** * **Quinsy Triad:** Severe odynophagia, "hot potato" voice, and trismus. * **Anatomy:** The medial pterygoid and the masseter are the primary "jaw closers." In Quinsy, it is specifically the **medial pterygoid** due to its proximity to the parapharyngeal space. * **Complication:** If trismus is present, it often suggests the infection has reached the **masticator space** or the anterior compartment of the **parapharyngeal space**.

Q: All of the following can give rise to a membrane on the pharynx except?

Staphylococcus aureus. ### Explanation The formation of a **pseudomembrane** on the pharynx is a classic clinical sign of specific infections characterized by tissue necrosis and fibrinous exudate. **1. Why Staphylococcus aureus is the correct answer:** While *Staphylococcus aureus* is a common cause of acute follicular tonsillitis, it typically presents with **purulent exudate** (pus) localized to the tonsillar crypts rather than a cohesive, spreading membrane. It does not typically produce the fibrinous, necrotic layer required to form a true or false membrane on the pharyngeal wall. **2. Analysis of Incorrect Options (Membrane-forming conditions):** * **Corynebacterium diphtheriae:** The hallmark of Diphtheria is a thick, **greyish-white, leathery membrane** that is highly adherent. Attempting to remove it results in bleeding because it involves the underlying epithelium. * **Candida albicans:** Fungal pharyngitis (Oral Thrush) presents as **creamy white, curd-like patches**. These can coalesce into a membrane that, unlike diphtheria, is easily scraped off, leaving an erythematous base. * **Vincent’s Angina:** Caused by a symbiotic infection of *Borrelia vincentii* and *Fusobacterium*, it produces a **dirty grey membrane** over a sloughing ulcer on the tonsil, often accompanied by a characteristic malodor (halitosis). **3. Clinical Pearls for NEET-PG:** * **Differential Diagnosis of Pharyngeal Membrane:** Diphtheria, Vincent’s Angina, Infectious Mononucleosis (EBV), Candidiasis, Agranulocytosis, and Aphthous ulcers. * **Infectious Mononucleosis:** Often presents with a widespread white membrane on the tonsils, associated with posterior cervical lymphadenopathy and splenomegaly. * **High-Yield Distinction:** If the membrane **bleeds on touch**, think Diphtheria; if it is **painless and scrapable**, think Candidiasis.

Q: Rose's position is extension at which joint?

Atlanto-occipital joint. ### Explanation **Rose’s position** is a classic surgical posture used in ENT and pediatric surgery. It involves placing the patient supine with a bolster or sandbag under the shoulders, allowing the head to hang off the edge of the table. **1. Why the Correct Answer is Right:** The primary objective of Rose’s position is to achieve **maximal extension of the head**. This extension occurs specifically at the **Atlanto-occipital joint** (the articulation between the atlas/C1 and the occipital bone). By extending this joint, the surgeon gains a direct, vertical line of sight into the oropharynx and nasopharynx, while also preventing the aspiration of blood into the larynx by allowing it to pool in the nasopharynx (which acts as a dependent sump). **2. Why the Incorrect Options are Wrong:** * **Option B (C1 and C2 joint):** The Atlanto-axial joint is primarily responsible for **rotation** (the "no" movement), not the primary extension required for this surgical exposure. * **Options C & D (C3-C4 and C5-C6):** These represent the lower cervical spine. While some degree of cervical flexion/extension occurs here, Rose’s position specifically targets the craniovertebral junction to align the oral and pharyngeal axes. **3. Clinical Pearls for NEET-PG:** * **Indications:** Most commonly used for **Tonsillectomy**, Adenoidectomy, and repair of Cleft Palate. * **The "Barking Dog" Position:** Do not confuse Rose's position with the **Boyce-Jackson position** (Sniffing position), which involves *flexion* of the lower cervical spine and *extension* at the atlanto-occipital joint, used for direct laryngoscopy and intubation. * **Complication:** Excessive extension in patients with Down Syndrome or Rheumatoid Arthritis can lead to atlanto-axial subluxation.

Q: Which of the following is an indication for tonsillectomy?

Recurrent upper respiratory infection. ### Explanation Tonsillectomy is one of the most common surgical procedures in ENT, and its indications are strictly categorized into absolute and relative indications. **1. Why "Recurrent upper respiratory infection" is correct:** According to the **Paradise Criteria**, recurrent infections are a primary indication for tonsillectomy. Specifically, surgery is indicated if a patient suffers from: * 7 episodes in 1 year, OR * 5 episodes per year for 2 consecutive years, OR * 3 episodes per year for 3 consecutive years. Each episode must be documented with clinical features like fever (>38.3°C), cervical lymphadenopathy, or tonsillar exudate. **2. Why other options are incorrect:** * **Rheumatic Fever and Glomerulonephritis:** Historically, these were considered indications to prevent further streptococcal sequelae. However, current evidence and guidelines (including the American Academy of Otolaryngology) state that tonsillectomy **does not** alter the natural course of these diseases or prevent their recurrence. Therefore, they are no longer considered standard indications for the procedure. **3. High-Yield Clinical Pearls for NEET-PG:** * **Absolute Indications:** 1. Sleep Apnea/Obstructive Sleep Apnea (OSA) due to tonsillar hypertrophy (most common indication in children). 2. Suspicion of malignancy (unilateral tonsillar enlargement). 3. Recurrent peritonsillar abscess (Quinsy). * **Most Common Complication:** Post-operative hemorrhage. * *Primary:* Within 24 hours (usually due to inadequate ligation). * *Secondary:* Between 5–10 days (usually due to infection/sloughing of the clot). * **Eagle’s Syndrome:** Elongated styloid process causing throat pain; tonsillectomy is often the surgical approach for styloidectomy.

Q: Excessive hemorrhage from tonsillectomy is due to injury of which structure?

Paratonsillar vein. **Explanation:** The **paratonsillar vein** (also known as the external palatine vein) is the most common cause of excessive or troublesome primary hemorrhage during tonsillectomy. 1. **Why Paratonsillar Vein is Correct:** This vein descends from the soft palate, crosses the lateral surface of the tonsillar capsule, and enters the pharyngeal venous plexus. During the dissection of the tonsil from its bed, this vein is frequently injured. Because it is a venous structure located in the loose areolar tissue of the tonsillar bed, it can bleed profusely, making it the primary culprit for immediate intraoperative or early postoperative bleeding. 2. **Why Other Options are Incorrect:** * **Tonsillar Artery:** While this is the *main* arterial supply (a branch of the facial artery), it is usually ligated or cauterized during the procedure. It causes significant bleeding if missed, but statistically, the paratonsillar vein is the more frequent source of "excessive" oozing. * **Ascending Palatine Artery & Lingual Artery:** These are nearby vascular structures (branches of the facial and external carotid arteries, respectively) that provide collateral supply. While they contribute to the vascularity of the region, they are not the most common source of surgical hemorrhage. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Hemorrhage:** Occurs during the surgery or within 24 hours. Most common cause: **Paratonsillar vein**. * **Reactionary Hemorrhage:** Occurs within 24 hours (usually due to slipping of a ligature or rise in BP). * **Secondary Hemorrhage:** Occurs 5–10 days post-op. Most common cause: **Infection**. * **Main Arterial Supply:** Tonsillar branch of the **Facial Artery**. * **Safety Landmark:** The **Internal Carotid Artery** lies approximately 2.5 cm posterolateral to the tonsil.

Q: A 79-year-old retired opera singer presents with dysphagia, which has become progressively worse during the last 5 years. He states that he is sometimes aware of a lump on the left side of his neck and that he hears gurgling sounds during swallowing. He sometimes regurgitates food during eating. What is the likely diagnosis?

Zenker's (pharyngoesophageal) diverticulum. **Explanation:** The clinical presentation is classic for **Zenker’s Diverticulum (ZD)**, a pulsion diverticulum occurring through **Killian’s dehiscence** (a weak area between the thyropharyngeal and cricopharyngeal parts of the inferior constrictor muscle). **Why Option D is Correct:** * **Demographics:** Typically affects elderly males (79-year-old). * **Gurgling sounds (Boyce’s sign):** Caused by air and fluid mixing within the diverticulum during swallowing. * **Regurgitation:** Undigested food trapped in the sac is regurgitated, often leading to halitosis (bad breath) or aspiration. * **Neck Lump:** A "lump" that may appear or change size during meals (usually on the left side due to the esophagus's slight leftward inclination). **Why Incorrect Options are Wrong:** * **A. Carcinoma of the esophagus:** While it causes progressive dysphagia in the elderly, it typically presents with significant weight loss and would not explain the gurgling sounds or the regurgitation of *undigested* food from a neck pouch. * **B. Foreign body:** This presents acutely with sudden onset dysphagia and odynophagia, not a 5-year progressive history. * **C. Plummer-Vinson Syndrome:** Characterized by the triad of iron-deficiency anemia, glossitis, and esophageal webs. It primarily affects middle-aged women and does not present with a neck lump or gurgling sounds. **High-Yield Clinical Pearls for NEET-PG:** * **Investigation of Choice:** Barium Swallow (shows a pouch behind the esophagus). * **Contraindication:** Rigid esophagoscopy (high risk of accidental perforation of the thin-walled sac). * **Treatment:** Endoscopic Dohlman’s procedure (stapling the party wall) or open diverticulectomy with cricopharyngeal myotomy. * **Killian-Jamieson Diverticulum:** A similar pouch but located *below* the cricopharyngeus, lateral to the recurrent laryngeal nerve.

Question 1

Trismus in tonsillar abscess is due to spasm of which muscle?

Accepted Answer

Pterygoid muscle

Answer

Prevertebral muscles

Answer

Superior constrictor

Answer

Inferior constrictor

Question 2

Which of the following is most accurate in describing coblation intracapsular tonsillectomy?

Accepted Answer

It can only cut, and not coagulate

Answer

Electric energy is transferred to vibration energy

Answer

It creates significant thermal injury to tissues

Answer

It utilizes a thin layer of ionized sodium to ablate tissues

Question 3

A 20-year-old patient presents with difficulty in breathing and impaired hearing. Examination reveals enlargement of upper deep cervical lymph nodes. What is the most likely diagnosis?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Angiofibroma

Answer

Hodgkin's Lymphoma

Answer

Carcinoma tongue

Question 4

A 58-year-old male patient presents with halitosis, mild dysphagia, and regurgitation of undigested food. Radiological examination reveals a specific anatomical abnormality. What is the most likely location of this presentation?

Accepted Answer

Posterior segment of the esophagus, inferior to the inferior pharyngeal constrictor muscle

Answer

Anterior segment of the esophagus, superior to the inferior pharyngeal constrictor muscle

Answer

Posterior segment of the esophagus, superior to the inferior pharyngeal constrictor muscle

Answer

Anterior segment of the esophagus, inferior to the inferior pharyngeal constrictor muscle

Question 5

All of the following can give rise to a membrane on the pharynx except?

Accepted Answer

Staphylococcus aureus

Answer

Corynebacterium

Answer

Candida

Answer

Vincent's angina

Question 6

All of the following statements about Lymphoepithelioma are true, except?

Accepted Answer

Parotid gland is the most common site of Lymphoepithelioma in the Head & Neck region.

Answer

It is associated with EBV infection.

Answer

It is highly radiosensitive.

Answer

It is a type of squamous cell carcinoma.

Question 7

Rose's position is extension at which joint?

Accepted Answer

Atlanto-occipital joint

Answer

C1 and C2 joint

Answer

C3 and C4

Answer

C5 and C6

Question 8

Which of the following is an indication for tonsillectomy?

Accepted Answer

Recurrent upper respiratory infection

Answer

Rheumatic fever

Answer

Glomerulonephritis

Answer

All

Question 9

Excessive hemorrhage from tonsillectomy is due to injury of which structure?

Accepted Answer

Paratonsillar vein

Answer

Ascending palatine artery

Answer

Tonsillar artery

Answer

Lingual artery

Question 10

A 79-year-old retired opera singer presents with dysphagia, which has become progressively worse during the last 5 years. He states that he is sometimes aware of a lump on the left side of his neck and that he hears gurgling sounds during swallowing. He sometimes regurgitates food during eating. What is the likely diagnosis?

Accepted Answer

Zenker's (pharyngoesophageal) diverticulum

Answer

Carcinoma of the esophagus

Answer

Foreign body in the esophagus

Answer

Plummer-Vinson (Kelly-Patteson) syndrome

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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