Diseases of the Pharynx Practice Questions

Q: Name the instrument shown below:

La Force Adenotome. ***La Force Adenotome*** - The image displays a **La Force Adenotome**, an instrument specifically designed for the removal of adenoid tissue. - It features a long shaft with a handle and an angled cutting blade at the tip, enclosed by a protective cage, allowing for precise and controlled adenoidectomy. *St. Clair Thomson Adenoid curette* - A St. Clair Thomson adenoid curette is typically a **smaller, scoop-shaped instrument** with a cutting edge, used for scraping adenoid tissue. - It does not have the elaborate hinged cage mechanism seen in the La Force adenotome. *Beckman adenoid curette* - The Beckman adenoid curette is another type of curette, similar in principle to the St. Clair Thomson, featuring a **sharp, often serrated, loop-shaped end** for adenoid removal. - It lacks the distinct design of a La Force adenotome, which is characterized by its guillotine-like action. *Sluder-Ballenger Tonsillectome* - A Sluder-Ballenger tonsillectome is used for **tonsillectomy**, not adenoidectomy, and has a different design altogether. - It typically consists of a loop or ring that encircles the tonsil, which is then removed by a cutting or crushing mechanism, making it distinct from an adenotome.

Q: A 3-year-old child presents with fever, unilateral throat pain and trismus. Throat examination shows:

Peritonsillar abscess. ***Peritonsillar abscess*** - The image shows a **unilateral bulge** of the soft palate and displacement of the **uvula**, consistent with a peritonsillar abscess. - Clinical features of **fever, unilateral throat pain, and trismus** are classic symptoms of a peritonsillar abscess. *Ludwig's angina* - This is a **bilateral cellulitis of the submandibular and sublingual spaces**, typically presenting with **swelling of the floor of the mouth** and elevation of the tongue. - It does not primarily present with unilateral throat bulging or uvula deviation as depicted. *Retropharyngeal abscess* - An abscess in the **retropharyngeal space** would cause a bulge in the posterior pharyngeal wall, which is not shown in the image. - While it can cause fever and difficulty swallowing, **trismus** and a visible pharyngeal bulge as shown are less typical. *Parapharyngeal abscess* - A parapharyngeal abscess is located laterally to the pharynx and typically presents with **external neck swelling**, fever, and possibly trismus. - It would not cause the **uvula deviation** and **bulging of the soft palate** seen in the image within the oral cavity.

Q: All are indications for the procedure shown except:

Cardiac valvulitis. ***Cardiac valvulitis*** - **Cardiac valvulitis** is a complication of **rheumatic fever**, which can occur after streptococcal pharyngitis. It is not an indication for tonsillectomy, but rather a potentially severe outcome that tonsillectomy might prevent in cases of recurrent strep throat. - While recurrent **streptococcal pharyngitis** (which can lead to rheumatic fever) is an *indication* for tonsillectomy, the valvulitis itself is a disease state and not a reason to perform the surgery. *More than 5 episodes per year for 2 years* - **Recurrent tonsillitis**, defined by frequent episodes (e.g., more than 5-7 episodes per year for several years), is a common indication for **tonsillectomy**. - This criterion is used to justify surgical intervention due to the significant impact on quality of life and potential for complications from chronic or recurrent infections. *Tonsillolithiasis* - **Tonsilloliths** (tonsil stones) can cause bad breath, throat irritation, and foreign body sensation. - If they are **symptomatic** and persistent despite conservative management, tonsillectomy can be performed to remove the source of the problem. *OSA due to hypertrophied tonsils* - **Obstructive sleep apnea (OSA)** in children (and sometimes adults) can be caused by enlarged tonsils and adenoids obstructing the airway during sleep. - When hypertrophied tonsils are a primary cause of **OSA**, tonsillectomy (often with adenoidectomy) is a common and effective treatment.

Q: The instrument set shown below is used for performing which surgery?

Adenotonsillectomy. ***Adenotonsillectomy*** - The image displays a **tonsil snare** (part of an adenotonsillectomy set) and a **Boyle-Davis mouth gag**, which are exclusively used for tonsil and adenoid removal. - Other instruments visible, such as varying sizes of **adenoid curettes** and **suction tubes**, are also characteristic of this procedure. *Septal surgery* - Septal surgery instruments typically include a **nasal speculum**, **septal scalpel**, **Freer elevator**, and **septal forceps**, which are not prominently featured as a complete set here. - While some general surgical tools might overlap, the distinctive instruments for adenotonsillectomy confirm it's not a septal surgery set. *Drainage of Quinsy* - Drainage of a peritonsillar abscess (Quinsy) primarily involves a **scalpel**, a **guarded blade**, and sometimes a **small bore suction catheter**. - The specialized cutting and grasping instruments shown in the image are not typical for a simple incision and drainage procedure. *Tracheostomy* - A tracheostomy set includes specific instruments like **tracheal retractors**, **tracheal hooks**, **dilators**, and various sizes of **tracheostomy tubes**. - None of these specialized instruments for incising and maintaining an airway are present in the provided image.

Q: The facial features shown in the image are characteristic of:

Adenoid facies. ***Adenoid facies*** - The image displays characteristic features of adenoid facies, including a **long, open-mouthed face**, a **pinched nose**, and possibly a **high-arched palate** due to chronic mouth breathing from enlarged adenoids. - This chronic condition often leads to a dull expression, sometimes with **strabismus** (crossed eyes) as seen in the image, and a forward head posture. *Frog face deformity* - This deformity is characterized by **ocular hypertelorism** (widely spaced eyes), a **flat nasal bridge**, and a **short nose**, often associated with conditions like Apert syndrome. - While there is some facial dysmorphology, the specific combination of features does not align with a typical frog face. *Ashen grey facies* - This refers to a **pale, grayish complexion**, often indicative of severe cardiovascular compromise like **circulatory collapse** or **shock**. - The child in the image has a normal skin tone for their ethnicity and does not show signs of acute circulatory distress. *Thyrotoxicosis* - **Thyrotoxicosis** (hyperthyroidism) in children can cause symptoms like **exophthalmos** (bulging eyes), **tachycardia**, weight loss, and an enlarged thyroid gland. - While the child's eyes appear wide-set and sometimes strabismic, these are more consistent with the long-term effects of chronic mouth breathing on facial development rather than acute thyroid dysfunction.

Q: Which is correct regarding the image provided?

Associated with koilonychia. ***Associated with koilonychia*** - The image shows a **post-cricoid web**, a mucosal fold in the upper esophagus, which is a classic feature of **Plummer-Vinson syndrome**. - **Plummer-Vinson syndrome** is characterized by the triad of **iron deficiency anemia**, **dysphagia** (due to esophageal webs), and **koilonychia** (spoon-shaped nails). *Increased tone of lower esophageal sphincter* - This image depicts an **esophageal web** in the **upper esophagus**, not an issue with the lower esophageal sphincter (LES) tone. - Increased tone of the LES is characteristic of **achalasia**, which presents with impaired relaxation and aperistalsis, appearing as a "bird's beak" on barium swallow. *Not a premalignant condition* - **Plummer-Vinson syndrome**, which includes **esophageal webs**, is considered a **premalignant condition** with an increased risk of developing **squamous cell carcinoma** of the esophagus or pharynx. - Surveillance and iron supplementation are crucial due to this elevated cancer risk. *Episodic aphagia* - The dysphagia associated with an esophageal web is typically progressive and chronic, presenting as **difficulty swallowing solids**, rather than episodic complete inability to swallow (aphagia). - Aphagia is a more severe symptom of complete obstruction, while webs cause partial obstruction.

Q: A 35-year-old woman presents with progressive dysphagia to solids. A barium swallow study is performed. Which of the following is true regarding the condition shown in the image?

Associated with iron deficiency anemia. ***Associated with iron deficiency anemia*** - The image shows an **esophageal web** in the upper esophagus, characteristic of **Plummer-Vinson syndrome** (also known as **Paterson-Brown-Kelly syndrome**). - This syndrome consists of the classic triad: **iron deficiency anemia**, **dysphagia**, and **esophageal webs**. - The webs are thin membranes of tissue in the upper esophagus that cause intermittent dysphagia to solids. - Treatment involves **iron supplementation** and mechanical dilation of the web if symptomatic. - This is a **premalignant condition** with increased risk of **post-cricoid and upper esophageal squamous cell carcinoma**. *Increased tone of lower esophageal sphincter* - Increased tone of the **lower esophageal sphincter** is characteristic of **achalasia**, which presents with a **"bird's beak" appearance** on barium swallow. - Achalasia is a primary **motility disorder** caused by degeneration of the myenteric plexus, not a structural web. - The image shows a **web in the upper esophagus**, not LES pathology. *Not a premalignant condition* - Esophageal webs, particularly in **Plummer-Vinson syndrome**, are considered a **premalignant condition**. - There is increased risk of developing **squamous cell carcinoma** of the post-cricoid region and upper esophagus. - Regular **endoscopic surveillance** is recommended due to this malignant potential. *It is a normal phenomenon* - The presence of an **esophageal web** is an **abnormal anatomical structure** and pathological finding. - Esophageal webs cause **dysphagia** and are associated with underlying conditions like **iron deficiency anemia**. - Normal esophageal mucosa should be smooth without web-like strictures.

Q: Carcinoma of pyriform fossa usually presents with :

Dysphagia. ***Dysphagia*** - Carcinoma of the **pyriform fossa** is a type of hypopharyngeal cancer, and given its anatomical location, it commonly interferes with swallowing [1]. - The pyriform fossa lies immediately lateral to the laryngeal inlet, and involvement here directly impacts the ability to form a **food bolus** and propel it into the esophagus. *Lump in the neck* - A neck lump can occur, especially if there is **lymph node metastasis**, but it's often a later symptom [1]. - **Dysphagia** usually precedes the development of a palpable neck mass as the primary tumor expands within the pyriform fossa [1]. *Cough* - While aspiration might lead to coughing, it's not the primary presenting symptom. - Cough is more commonly associated with laryngeal involvement or **tracheal invasion**, which can occur with advanced disease. *Hoarseness* - **Hoarseness** is a prominent symptom if the **vocal cords** or recurrent laryngeal nerve are directly involved [2]. - The pyriform fossa is adjacent but distinct from the vocal cords, so hoarseness is not typically the initial or most common symptom unless the tumor extends medially.

Q: A 60-year-old male presents with painless cervical lymphadenopathy. On examination, the right ear reveals conductive hearing loss with a dull tympanic membrane. Moreover, decreased mobility of the soft palate was also noted. What is the probable diagnosis?

Nasopharyngeal carcinoma. ***Nasopharyngeal carcinoma*** - This presentation with **painless cervical lymphadenopathy**, **conductive hearing loss** due to Eustachian tube obstruction, and **cranial nerve involvement** (affecting the soft palate mobility) is highly suggestive of nasopharyngeal carcinoma, which often metastasizes early. - The conductive hearing loss, specifically a **dull tympanic membrane**, points to **otitis media with effusion** secondary to Eustachian tube dysfunction, a common presentation of nasopharyngeal masses obstructing the tube. *Adenoid cystic cancer* - While adenoid cystic carcinoma can cause cranial nerve palsies due to **perineural invasion**, it more commonly arises in the salivary glands and not typically presents with nasopharyngeal masses causing Eustachian tube obstruction. - It usually presents with a **palpable mass** or **pain**, which is not the primary presentation here. *Juvenile nasopharyngeal angiofibroma* - This is a **benign vascular tumor** typically presenting in **adolescent males** with episodes of **severe epistaxis** and **nasal obstruction**. - It does not commonly present with cervical lymphadenopathy or cranial nerve involvement and is rare in a 60-year-old. *Quinsy* - Quinsy, or **peritonsillar abscess**, presents acutely with **severe sore throat**, **fever**, **trismus**, and sometimes **uvular deviation**. - It is an **infectious condition** and does not typically cause painless cervical lymphadenopathy or conductive hearing loss as described.

Question 1

Name the instrument shown below:

Accepted Answer

La Force Adenotome

Answer

St. Clair Thomson Adenoid curette

Answer

Beckman adenoid curette

Answer

Sluder-Ballenger Tonsillectome

Question 2

A 3-year-old child presents with fever, unilateral throat pain and trismus. Throat examination shows:

Accepted Answer

Peritonsillar abscess

Answer

Ludwig's angina

Answer

Retropharyngeal abscess

Answer

Parapharyngeal abscess

Question 3

All are indications for the procedure shown except:

Accepted Answer

Cardiac valvulitis

Answer

More than 5 episodes per year for 2 years

Answer

Tonsillolithiasis

Answer

OSA due to hypertrophied tonsils

Question 4

The instrument set shown below is used for performing which surgery?

Accepted Answer

Adenotonsillectomy

Answer

Septal surgery

Answer

Drainage of Quinsy

Answer

Tracheostomy

Question 5

The facial features shown in the image are characteristic of:

Accepted Answer

Adenoid facies

Answer

Frog face deformity

Answer

Ashen grey facies

Answer

Thyrotoxicosis

Question 6

Which is correct regarding the image provided?

Accepted Answer

Associated with koilonychia

Answer

Increased tone of lower esophageal sphincter

Answer

Not a premalignant condition

Answer

Episodic aphagia

Question 7

A 35-year-old woman presents with progressive dysphagia to solids. A barium swallow study is performed. Which of the following is true regarding the condition shown in the image?

Accepted Answer

Associated with iron deficiency anemia

Answer

Increased tone of lower esophageal sphincter

Answer

Not a premalignant condition

Answer

It is a normal phenomenon

Question 8

Carcinoma of pyriform fossa usually presents with :

Accepted Answer

Dysphagia

Answer

Lump in the neck

Answer

Cough

Answer

Hoarseness

Question 9

Regarding "Quinsy" all of the following are correct EXCEPT:

Accepted Answer

Pus may be seen pointing underneath the thin mucosa in all cases and is diagnostic

Answer

It is an abscess in the peritonsillar region

Answer

In early stage, intravenous broad spectrum antibiotics may resolve it

Answer

Severe trismus is caused by spasm induced by pterygoid muscles

Question 10

A 60-year-old male presents with painless cervical lymphadenopathy. On examination, the right ear reveals conductive hearing loss with a dull tympanic membrane. Moreover, decreased mobility of the soft palate was also noted. What is the probable diagnosis?

Accepted Answer

Nasopharyngeal carcinoma

Answer

Adenoid cystic cancer

Answer

Juvenile nasopharyngeal angiofibroma

Answer

Quinsy

Diseases of the Pharynx — MCQs

Diseases of the Pharynx — MCQs

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